Anarchist Re-Imaginations of Mental Healthcare

Today, I attended a great talk by Bonnie Burstow on anarchist re-imaginations of mental health care, entitled ‘Toward a World with Commons and without Psychiatry: an Anarchist Vision’. The talk spoke to a lot of my concerns having worked in the mental health field for the past couple years, but also spoke to some of my aspirations for the provision of mental healthcare in a collective manner.

Firstly, Burstow outlined the foundations of the contemporary mental health field and its interventions into the lives of those deemed unwell – parens patriae and the responsibility of the state to protect. Parens patriae (parent of the nation) is the notion that the state – like a ‘patriarch’ – could and should intervene in the lives of people when the state deems it to be in the people’s best interest – as defined by the state. The second foundation is the idea that the state is responsible for protecting the peace or its citizens from the other. These two assumptions underpin our practices as mental health provider and through its application serves as a means of social control of those understood as different, while reinforcing state power. 

To counter this, Burstow suggests that there is a need for what she calls mad literacy. Mental health professions – and society-at-large – are largely mad illiterate. She described this as a lack of understanding or willingness to understand those whose behaviours do not conform to social norms. In one example, she spoke of a woman who would knock on doors at night naked. This, to many, would be an act indicative of irrationality and would demand detainment or removal. However, after discussions with this woman, a different conclusion could be found. Firstly, clothing is often seen as representative of civilization. Thus, a shedding of clothing can be understood as shedding the trappings of civilization. Secondly, this individual was acutely aware of global events, watching news of war spreading around the world and issues of poverty every evening. Turns out, she would go door-to-door out of exasperation and a desire to warn others of the bad news. Her behaviour may not be expected, but at the same time, is it that irrational to consider that extra-ordinary action may be a reasonable response to war and poverty?

So, what would be the response to this from an anarchist perspective? Burstow suggests the idea of befriending, a return to an emphasis on basic human relationship building. In terms of what this would look like in practice, in the case of the woman whom felt compelled to knock on doors at night, the apartment residents could come together to discuss solutions. Perhaps a committee of volunteers could be organized, whereby, on a rotational basis, neighbours could sit and comfort the individual during nights of anxiety. Perhaps, a platform could be provided for this individual to express the causes for her concern. These solutions may appear vague, but the idea is not to prescriptive but to harness the creativity of the community. Burstow called for the “commoning of services”, returning healing back to the commons.

A return of healing to the commons requires the challenging of expert knowledge, the idea that mental health care should remain in the purview of mental health professionals. Burstow critiqued professionalization, suggesting that the idea for the need for professional responses is rooted in mad illiteracy (for further exploration on how professional responses can be problematic, check out my previous post on violence against racialized communities). The use of the term befriending, as well as, the follow-up conversation on countering expert knowledge reminded me of a number of anecdotes both from my social work training and at work. During my therapy internship at a university counselling service, our counselling sessions were recorded and analyzed after by a group of psychologists and social workers. I was told time and time again, “you are being a friend, not a therapist”. I really struggled at this placement, and finally quit with my confidence shot. I had shared this anecdote with Burstow, whom responded, “in other words, you were not acting like a jackass”. I have also heard persistently the critique that many clients just want us to be friends, and that if it got to the point where we were just ‘acting as friends’, clients should be discharged. Others have even suggested that services that only served to have workers befriend  clients should have their funding cut altogether. Burstow believes that these comments come from a subconscious desire to defend the profession. The idea is to discourage organic human connectivity as a response to mental health challenges, since anyone has the capacity to engage in this. Indeed, when I heard these comments at my internship, underlying all my self-conscious thoughts about ineptitude was also a murmur of “but I want to be their friend?" 

This discussion of professionalization also reminded me of David Graeber’s popular article, On the Phenomenon of Bullshit Jobs. A previous comment I made regarding the article seems relevant:

How much of the need for my role as a social worker is simply created by the modern capitalist condition that takes away from people’s capacity to build meaningful connections and maintain relationships with friends and family? After this circumstance is manufactured, whereby people lack the time or capacity to connect, I get sent in to ‘look after’ people feeling completely alone and marginalized. And, this is not to say that as social workers, our jobs are meaningless.I would like to think that many genuine relationships and connections are made through our work. However, the idea of the mending of social relations as a professional specialization is surely a unique product of our time and one that would boggle the minds of anyone from outside. 

It is not to say that there is no role to be played by people whom want to focus on mental healthcare as their line of work. However, Burstow believes that the emphasis should be placed on skill-sharing with other community members, to train others with the goal of building autonomy. This vision differs significantly from what others have written regarding social services from an anarchist perspective. For example, Chris Spannos’s reimagining social services for a participatory society argues that the possibility of having more resources dedicated to social services will be realized in an anarchist society – this I don’t disagree. However, he fails to acknowledge how institutional mental health care is inherently counter to ideas of collectivity and liberation. He even goes on to suggest ACT teams as a positive model and that the DSM should only be adapted to new realities instead of abolition.  

Ultimately, Burstow posits three challenges for professionals in the mental health field whom have a desire to resist the current arrangements:

1. Investigate how we can increase the credibility of everyday people and minimize ourselves; 
2. Investigate how we can transfer our skills to the common; 
3. Investigate how we can help those that come into contact with us build community 

I agree that these are crucial questions we must attempt to answer if we are to respond to emotional struggles in a way consistent with liberatory values.