anti-psychiatry anti-psychiatry anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. historically critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive treatment or insulin shock therapy. the term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of who agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions. anti-psychiatry symbol beyond concerns about effectiveness, anti-psychiatry might question the philosophical and ethical underpinnings of psychotherapy and psychoactive medication, seeing them as shaped by social and political concerns rather than the autonomy and integrity of the individual mind. they may believe that "judgements on matters of sanity should be the prerogative of the philosophical mind", and that the mind should not be a medical concern. some activists reject the psychiatric notion of mental illness. anti-psychiatry considers psychiatry a coercive instrument of oppression due to an unequal power relationship between doctor and patient, and a highly subjective diagnostic process. wrongful involuntary commitment is an important issue in the movement. the decentralized movement has been active in various forms for two centuries. in the 1960s, there were many challenges to psychoanalysis and mainstream psychiatry, where the very basis of psychiatric practice was characterized as repressive and controlling. psychiatrists identified with the movement included thomas szasz, timothy leary, giorgio antonucci, r. d. laing, franco basaglia, theodore lidz, silvano arieti, and david cooper. others involved were michel foucault, gilles deleuze, félix guattari, and erving goffman. cooper used the term "anti-psychiatry" in 1967, and wrote the book psychiatry and anti-psychiatry in 1971. the word antipsychiatrie was already used in germany in 1904. thomas szasz introduced the definition of mental illness as a myth in the book the myth of mental illness (1961), giorgio antonucci introduced the definition of psychiatry as a prejudice in the book i pregiudizi e la conoscenza critica alla psichiatria (1986). the movement continues to influence thinking about psychiatry and psychology, both within and outside of those fields, particularly in terms of the relationship between providers of treatment and those receiving it. contemporary issues include freedom versus coercion, nature versus nurture, and the right to be different. critics of antipsychiatry from within psychiatry itself object to the underlying principle that psychiatry is by definition harmful. most psychiatrists accept that issues exist that need addressing, but that the abolition of psychiatry is harmful. medical professionals often consider anti-psychiatry movements to be promoting mental illness denial, and has been compared with conspiracy theories. history precursors vienna's narrenturm—german for "fools' tower"—was one of the earliest buildings specifically designed as a "madhouse". it was built in 1784. the first widespread challenge to the prevailing medical approach in western countries occurred in the late 18th century. part of the progressive age of enlightenment, a "moral treatment" movement challenged the harsh, pessimistic, somatic (body-based) and restraint-based approaches that prevailed in the system of hospitals and "madhouses" for people considered mentally disturbed, who were generally seen as wild animals without reason. alternatives were developed, led in different regions by ex-patient staff, physicians themselves in some cases, and religious and lay philanthropists. this "moral treatment" was seen as pioneering more humane psychological and social approaches, whether or not in medical settings; however, it also involved some use of physical restraints, threats of punishment, and personal and social methods of control. as it became the establishment approach in the 19th century, opposition to its negative aspects also grew. according to michel foucault, there was a shift in the perception of madness, whereby it came to be seen as less about delusion, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behaviour or will. foucault argued that, prior to this, doctors could often prescribe travel, rest, walking, retirement and generally engaging with nature, seen as the visible form of truth, as a means to break with artificialities of the world (and therefore delusions). another form of treatment involved nature's opposite, the theatre, where the patient's madness was acted out for him or her in such a way that the delusion would reveal itself to the patient. thus the most prominent therapeutic technique became to confront patients with a healthy sound will and orthodox passions, ideally embodied by the physician . the "cure" involved a process of opposition, of struggle and domination, of the patient's troubled will by the healthy will of the physician. it was thought the confrontation would lead not only to bring the illness into broad daylight by its resistance, but also to the victory of the sound will and the renunciation of the disturbed will. we must apply a perturbing method, to break the spasm by means of the spasm.... we must subjugate the whole character of some patients, subdue their transports, break their pride, while we must stimulate and encourage the others (esquirol, j.e.d., 1816). foucault also argued that the increasing internment of the "mentally ill" (the development of more and bigger asylums) had become necessary not just for diagnosis and classification but because an enclosed place became a requirement for a treatment that was now understood as primarily the contest of wills, a question of submission and victory. close up of the "horrors of kew asylum" featured in lee's pictorial weekly budget police news in 1876 the techniques and procedures of the asylums at this time included "isolation, private or public interrogations, punishment techniques such as cold showers, moral talks (encouragements or reprimands), strict discipline, compulsory work, rewards, preferential relations between the physician and his patients, relations of vassalage, of possession, of domesticity, even of servitude between patient and physician at times". foucault summarised these as "designed to make the medical personage the 'master of madness'" through the power the physician's will exerts on the patient. the effect of this shift then served to inflate the power of the physician relative to the patient, correlated with the rapid rise of internment (asylums and forced detention). the woodilee hospital was opened in 1875 in scotland. other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism, including the breakdown of traditional family structures. by the end of the 19th century, psychiatrists often had little power in the overcrowded asylum system, acting mainly as administrators who rarely attended to patients in a system where therapeutic ideals had turned into institutional routines. in general, critics point to negative aspects of the shift toward so-called "moral treatments", and the concurrent widespread expansion of asylums, medical power and involuntary hospitalization laws, that played an important part in the development of the anti-psychiatry movement. internee being restrained in a bathtub internee in a restraint chair at the west riding pauper lunatic asylum various 19th-century critiques of the newly emerging field of psychiatry overlap thematically with 20th-century anti-psychiatry, for example in their questioning of the medicalisation of "madness". those critiques occurred at a time when physicians had not yet achieved hegemony through psychiatry, however, so there was no single, unified force to oppose. nevertheless, there was increasing concern at the ease with which people could be confined, with frequent reports of abuse and illegal confinement. for example, daniel defoe, the author of robinson crusoe, had previously argued for more government oversight of "madhouses" and for due process prior to involuntary internment. he later argued that husbands used asylum hospitals to incarcerate their disobedient wives, and in a subsequent pamphlet that wives even did the same to their husbands. it was also proposed that the role of asylum keeper be separated from doctor, to discourage exploitation of patients. there was general concern that physicians were undermining personhood by medicalizing problems, by claiming they alone had the expertise to judge, and by arguing that mental disorder was physical and hereditary. the alleged lunatics' friend society arose in england in the mid-19th century to challenge the system and campaign for rights and reforms. in the united states, elizabeth packard published a series of books and pamphlets describing her experiences in the illinois insane asylum, to which she had been committed at the request of her husband. throughout, the class nature of mental hospitals and their role as agencies of control were well recognized. the new psychiatry was partially challenged by two powerful social institutions – the church and the legal system. these trends have been thematically linked to the later 20th century anti-psychiatry movement. as psychiatry became more professionally established during the nineteenth century (the term itself was coined in 1808 in germany by johann christian reil, as "psychiaterie") and developed allegedly more invasive treatments, opposition increased. in the southern us, black slaves and abolitionists encountered drapetomania, a pseudo-scientific diagnosis that presented the desire of slaves to run away from their masters as a symptom of pathology. there was some organized challenge to psychiatry in the late 1870s from the new speciality of neurology, largely centered around control of state insane asylums in new york. practitioners criticized mental hospitals for failure to conduct scientific research and adopt the modern therapeutic methods such as nonrestraint. together with lay reformers and social workers, neurologists formed the national association for the protection of the insane and the prevention of insanity. however, when the lay members questioned the competence of asylum physicians to even provide proper care at all, the neurologists withdrew their support and the association floundered. early 1900s it has been noted that "the most persistent critics of psychiatry have always been former mental hospital patients", but that very few were able to tell their stories publicly or to confront the psychiatric establishment openly, and those who did so were commonly considered so extreme in their charges that they could seldom gain credibility. in the early 20th century, ex-patient clifford w. beers campaigned to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions, publicizing the issues in his book, a mind that found itself (1908). while beers initially condemned psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by adolf meyer and the psychiatric establishment, and toned down his hostility since he needed their support for reforms. in germany during this time were similar efforts which used the term "antipsychiatrie". beers' reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped found, the national committee for mental hygiene, which eventually became the national mental health association. in the uk, the national society for lunacy law reform was established in 1920 by angry ex-patients who sought justice for abuses committed in psychiatric custody, and were aggrieved that their complaints were patronisingly discounted by the authorities, who were seen to value the availability of medicalized internment as a 'whitewashed' extrajudicial custodial and punitive process. in 1922, ex-patient rachel grant-smith added to calls for reform of the system of neglect and abuse she had suffered by publishing "the experiences of an asylum patient". in the us, we are not alone (wana) was founded by a group of patients at rockland state hospital in new york, and continued to meet as an ex-patient group. french surrealist antonin artaud would also openly critize that no pacient should be labeled as "mentally ill" as an exterior identification, as he notes in his 1925 "l'ombilic des limbes", as well as arguing against narcotic's restriction laws in france. much influenced by the dada and surrealist enthusiasms of the day, he considered dreams, thoughts and visions no less real than the "outside" world. in this era before penicillin was discovered, eugenics was popular. people believed diseases of the mind could be passed on so compulsory sterilization of the mentally ill was enacted in many countries. 1930s in the 1930s several controversial medical practices were introduced and framed as "treatments" for mental disorders, including inducing seizures (by electroshock, insulin or other drugs) or psychosurgery (lobotomy). in the