WhitakerNothing vexes me more than the sniping that goes on between psychiatry and the anti-psychiatry movement. I hesitate to add to it, to pile on or to slag another author off, but the recent flare up over Robert Whitaker and his speech before the National Alliance on Mental Illness cannot be ignored.

A mother reports that her son was so inspired by Whitaker’s stirring words at NAMI’s national conference in San Antonio last summer that he tossed his meds and, just like that, the most horrible voices returned, the ones that told him he was, alternatively, God, Jesus or Lucifer.

In a post on Pete Earley’s blog, the mother raps the crusading author of Mad in America and Anatomy of an Epidemic for whipping the mentally ill up unnecessarily about the baddies in psychiatry. She says both Whitaker and NAMI have “blood on their hands.”

I wouldn’t go that far, but it is concerning that Whitaker has somehow missed the memo on the biological basis of schizophrenia. He conveniently ignores this in his books, I suspect, because it doesn’t serve his narrative. His views on medication miss the proverbial forest for the trees too.

Psychiatrist E. Fuller Torrey deconstructs Whitaker here in the unambiguously headlined piece, How Robert Whitaker Got it Wrong. Dr. Torrey, who is a medical doctor, and has a family member who suffers, is a frequent target of the anti-psychiatry crowd.

He notes that Whitaker has managed to overlook the vast multitudes of homeless mentally ill who’ve fallen off their meds and right through the cracks.

He suggests that if Whitaker were to spend some time hanging out with them, “observing the outcome of this natural experiment, instead of delivering lectures on his vision of the impending antipsychotic apocalypse, he would have written a very different book.”

Hanging Out With Schizophrenics

True that. I for one do hang out with them. I’m fascinated with every last homeless schizophrenic guy I can meet on the streets of Boston.  And if Whitaker doubts the power of his own pen, he should meet my friend who drank the Kool Aid and lost everything he’d gained in his hard-won recovery, just like the angry mother who’d sought help for her boy but got muckracking nonsense instead.

Let’s call my buddy Sam. He’s a middle-aged guy, very bookish, with a master’s degree, and after years on the street he finally had a job as a social worker with the city of Boston locating housing for the homeless he knew so much about. He was able to engage his intellectual skills with his street smarts when he came upon Whitaker’s Mad in America. From there it was all downhill.

When Sam showed me his dog-earred copy of Mad in America, and asked for my opinion, I said the book was best taken with a grain of salt.  In short order, however, my friend had flushed his meds, lost his $45,000 a year job, and wound up homeless again.

When I last saw Sam, he was dirty and disheveled and talking to himself in a downtown doorway. I reached his brother and it became a family matter, one with a familiar old warp: hallucinations, delusions, paranoia, and nattering voices that tell him the meds are evil.

Has Psychiatry Itself Created Whitaker?

Not that the boffins in psychiatry get it all right themselves. The practice of “stacking” medications up on each other has overmedicated many.

And, of course, the assumption that people with psychosis have no insight into their own condition has been a disaster for talk therapy. Some, naturally, have more insight than others, just as we in the non-hearing voices world have various degrees of insight about ourselves.

This needs to change, and is changing, mercifully, in progressive psychiatric circles. Here in Boston the Massachusetts General Hospital has dropped its ban on psychiatrists “colluding with delusions.”

This means they can actually attempt to treat audition, which is the chief symptom of schizophrenia, or at least show some curiosity about it. What a novel idea: engaging the symptoms.

Ignoring voices, as bizarre as they may be, only shames the symptom.

Let’s face it, there’s a lot to be anti about, playing right into the hands of the anti-psychiatrists.

Enter Robert Whitaker.

Why Beat Up on NAMI?

Many NAMI members sided online with the distressed mother who had spent three long years stabilizing her son until he heard Whitaker’s highly touted San Antonio talk. She says Whitaker and NAMI both have “blood on the hands,” dealing the organization a public relations disaster of the first order.

I understand her anger, but her grudge against NAMI is unfortunate. NAMI is the best friend we families could  hope to have. What we all need to do is speak up ourselves instead of letting others speak for us.

In his rebuttal to the mother, which Earley was nice enough to post on his site, Whitaker addresses what he calls, dryly, the “culpability question.”

He even snorts that Earley supports people who would have his son forcibly medicated. Really?  I’ve never met Earley, but I’ve read his book and he seems like the most decent man, a father who’s dedicated his life to helping his son.

Why second guess him?

Our real concern, one that could actually use some good muck-racking, is the Catch 22 that makes it impossible to get help for a family member in the throes of psychosis who doesn’t know he’s “dangerous to himself or others.”

It’s a vital concern.

Getting a family help beyond 72 hours is another worry.

But to hear Whitaker tell it, the drugs and treatment centers are the real problem.

The drugs and the treatment centers may be  imperfect, but their elimination is not the answer.

The real problem is all the mad homeless everywhere on the streets of America–or caged in jail cells. Deinstitutionalization has led to mass incarceration, which has been a wholesale social disaster for all to see. 

If his name has become virtually synonymous with anti-psychiatry, Whitaker’s rap is a recycling of arguments put forth by the late Thomas Szasz, a critic of psychiatry, and before him Michel Foucault, the late-twentieth French philosopher and activist who perpetrated the grand myth of the Great Confinement.

Foucault had an intriguing theory, argued with incendiary language, of the sane being clapped away en masse. The only problem is that it wasn’t true. It never happened.

Some people have been “put away” wrongly, for sure, but the historical evidence for the existence of mass confinement is very thin on the ground.

It’s an anti-meds update of an old story–by no means the full story–but the old story still sells.