“I don’t use the words ‘mental health’. I absolutely wince when I hear them,” says Dr Bonnie Burstow.
My stomach lurches with discomfort when she says this to me.
Burstow is an associate professor at the University of Toronto, where she recently launched the world’s first ‘anti-psychiatry’ scholarship.
In her work as a psychotherapist, Burstow has helped hundreds of “highly suicidal patients,” she tells me. She’s come to believe that conventional psychiatric treatment isn’t in their best interests.
Dr Burstow is a prominent figure in the field of anti-psychiatry, which she describes as "a movement of both psychiatric survivors and professionals saying that we need to abolish psychiatry".
When I first heard about Dr Burstow and the anti-psychiatry movement, I was dismissive – even angry. At a time when the world is finally starting to pay attention to the crippling severity of some mental health issues, the last thing we need, I thought, is a group of mavericks trying to take us three steps backwards.
When Burstow’s new scholarship was announced, reactions were mixed.
Conventional psychiatry holds that biological abnormalities (such as chemical imbalances), along with various psychological and social factors, can lead to mental illnesses such as bipolar disorder, depression and schizophrenia.
I spoke to Professor Carmine Pariante of the Royal College of Psychiatrists. He told me, “looking at this complex bio-, psycho- and social model, and looking at all these components together” is the best way to address mental health issues.
This is the widely accepted approach to mental health, and one that I recognise from both my own treatment and the many dinnertime conversations I’ve had with my psychiatrist housemate about it.
But the 'anti-psychiatry' movement questions whether mental illnesses are actually illnesses at all.
Does she think the pain I go through on a daily basis is entirely fictional, then?
“No,” says Dr Burstow. “Do I believe people have anxiety? Do I believe that people feel compulsions? Of course. But I believe these feelings are a normal human way of experiencing reality.”
Dr Burstow believes, “We have an absolute pretence of what ‘normal’ is. People compare themselves to what we say is normal, and it’s not vaguely like what most people feel.”
I can relate to some of what Dr Burstow is saying. Before being diagnosed with OCD, the last thing I felt was ‘normal’.
If I’d known earlier that the kinds of intrusive thoughts I suffer from are, in fact, quite common in society at large, perhaps I could have avoided years of turmoil.
Dr Burstow argues, “If 99% of people in the world are not what they consider ‘normal’, that all goes to the benefit of psychiatry, because, boy oh boy, does it give them a huge clientele.”
The anti-psychiatry movement also believes there is rampant over-medicating among psychiatrists. A recent report predicted that the global depression drug market, which was valued at $14.5 billion in 2014, will generate $16.8 billion in revenue by the end of 2020.
"Psychiatry assumes things to be biological that are not. When we say ‘mental health’,” Dr Burstow tells me, “it’s saying that the problems people have are to do with a disease.” In her view, “they’re not”.
There’s disagreement among medical professionals on this.
There’s some evidence that disorders tend to run in families, with twin studies suggesting that bipolar disorder is “among the most heritable of medical disorders”.
Prof Pariante, of the Royal College of Psychiatrists, believes that it is simply a matter of time before mental health conditions are proven to be genetically influenced (at least in part).
The anti-psychiatry movement rejects this.
Paola Leon, a practising psychiatrist of 25 years based in Toronto, says, “Life can be difficult. But we’ve started to diagnose certain reactions and behaviours as ‘mental illness’ when, though painful, they are in fact part of the human condition.”
Dr Burstow is also troubled by what she calls psychiatry’s “frightening power".
"It is given power by the state to incarcerate when they decide someone is mentally ill. It has the power to lock someone up, to treat people against their will.”
When I put this to Prof Pariante, he says, “When there is a real risk of someone injuring themselves or others, how can I leave them un-helped, in a situation where I could help?”
But Dr Burstow insists that there are other ways to treat people.
The anti-psychiatry movement advocates for more talking-based therapies, even for very debilitating conditions such as schizophrenia.
I’m not sure I’m convinced by this. I’ve met many people who have benefited from medication, not to mention others who have refused medication and become a danger to themselves, as a result.
The eight months of cognitive behavioural therapy (CBT) that I went through certainly helped me turn a corner with my own mental health struggles, but I feel like a lot of that was just down to realising that what was happening to me was an 'illness': OCD. It gave me an explanation for my symptoms.
Since then, I’ve questioned the efficacy of the numerous exercises I was put through in my CBT, and, with my mental health still sub-par, I’m now on the waiting list for a different form of talking treatment, psychotherapy.
Perhaps the way I’m going to get better is by addressing my life as a whole, and not just focusing on my OCD.
'Open Dialogue', a new form of treatment pioneered in Finland, is now being piloted by the NHS.
It doesn’t completely reject medication, but it puts greater emphasis on the patient’s wider social network, including their family and friends. Instead of meeting with a mental health practitioner one on one, patients work through their problems in the company of their family and extended network.
This approach is similar to Dr Burstow’s championing of ‘community’ to help people who are struggling.
The majority of psychiatrists remain unconvinced about anti-psychiatry, though. Allan Young, chair of the Psychopharmacology Special Committee of the Royal College of Psychiatrists, tells me the anti-psychiatry movement “waxes and wanes” over time.
He considers anti-psychiatrists outliers, calling them “a mixed bag of diverse groups” encompassing everyone from “'flat earth’ types with odd ideas about health to, at the other end, psychiatrists and other mental health professionals".
I’m still looking for the most effective way of coping with mental illness, and I can’t help feeling now that dismissing the anti-psychiatry movement altogether would be doing a disservice to those of us who suffer from poor mental health.
At the very least, it is prompting discussion about new, diverse forms of treatment.
Everyone’s path to good health is different, and finding the right one for you – whatever it may be - is what really matters.
Originally published 25 May 2017.