Boss of Your Own Brain
“Antipsychiatry” in the Netherlands, 1965-1985dissertation by
(written in Dutch, with a brief English summary in the back as is customary here)
reviewed by Mira de Vries
Blok rightly puts the word “antipsychiatry” in quotation marks. This term, which originated from Cooper (Psychiatry and Anti-psychiatry, 1967), is misleading. Blok prefers to speak of critical psychiatry, apparently meaning psychiatry that is critical of conventional biopsychiatry. I would have recommended the term “social psychiatry,” psychiatry that regards man as an integral part of his social environment. My term would be additionally appropriate as the proponents of this type of psychiatry tended to be socialists.
Although Blok describes great emotional and social upheavals, she tries to do so in a neutral tone, without being judgmental. Yet the reader knows from page one that Blok considers “talking therapy” nonsense and pills effective.
Her dissertation opens with the story of “the octopus man” who was brought to a psychiatric hospital in 1976 after having been encountered in a psychotic state at a train station. (Words like schizophrenia and psychosis are used throughout the book without any reference to what they might mean or how these alleged conditions might be determined to exist.) After having been unsuccessfully treated with “talking therapy” for several weeks in accordance with new ideas about psychiatry, the frustrated staff finally tried a neuroleptic. The octopus man immediately improved. (“You see!” you hear Blok hiss triumphantly between the lines.) Almost as an afterthought she reveals that the octopus man had “an extensive psychiatric past.” Of course in 1976 nobody had yet heard of withdrawal psychoses, which can be stemmed only by the withdrawn drug or a similar one. Apparently Blok had still not heard of it in 2004. Blok, it must be noted, is a historian, not that physicians have heard of it by now.
A similar story is told about Pete, who on page 74 still had not improved without medication. Finally Pete was prescribed lithium, “a successful medicine” according to Blok. Indeed lithium was a cash cow, but Pete didn’t improve with lithium either, Blok admits.
Jan Foudraine, a famous Dutch psychiatrist whose book advocating talking therapies instead of medication was a runaway best seller in that period, is mentioned throughout the dissertation along with Laing, Cooper, Esterson, Basaglia, Foucault, Goffman, Szasz, and others. Blok meets Foudraine’s claims of having cured his patient Carl through talking therapy with healthy skepticism. Rumors even hinted that Foudraine had fabricated Carl’s recovery, she notes. In addition, years later a befriended journalist ran into Carl on the street (he wasn’t locked up?). Carl was obviously not at all cured. A connection between the electroshocks suffered by Carl in his youth and his alleged brain defect is not made by Blok.
Yet another example is the patient who suffered a kind of epileptic attack during an admission interview. As in those days the interaction between doctor and patient assumed almost magical proportions, Blok notes, the psychiatrist thought he had caused the attack by the way he had looked at the patient. Of course that was not the reason, says Blok. The attack had been caused by “wrong medicine.” Still the penny doesn’t drop for Blok.
Practically all the patients described by Blok were receiving drugs as well as talking therapies. One of the end notes reveals that the drugs were high dose cocktails. Apparently social psychiatry’s motto that meds should be minimized didn’t amount to much in practice. Although Blok tells us in detail how humiliating talking therapies were for the patients and often their families as well, she does not contemplate the (side-)effects of the drugs anywhere in the book. Her proposition that the low therapeutic value ascribed to drugs in those days undermined psychiatrists’ authority rings hollow, for if drugs were believed to be so unimportant, why were they so massively prescribed? I find it more likely that other factors were involved in undermining psychiatrists’ authority, if it was undermined. Blok herself describes some possible factors: philosophical conflicts about treatment, competition among the various professions, and a general aversion to authority in the spirit of the times.
With satisfaction I read on page 184 about the demonstrations against a biopsychiatric convention sponsored by Squibb. Pharmaceutical manufacturers were trying to guard their markets, claimed the demonstrators. Unfortunately, today’s psychiatric conventions don’t attract protestors, even though they are all sponsored by the drug manufacturers, even when they are about opposing drug treatments. Perhaps that’s why Blok forgets those market interests at the end of her book. “Anti-antipsychiatry” [meaning biopsychiatry] emerged victorious” she asserts. Indeed, it did, but that is due to medical protocols, slick advertising, and successful lobbying, rather than the efficacy in which Blok believes. She states that schizophrenia is incurable but thanks to psychiatric drugs these people can lead somewhat normal lives. This contradicts findings by the WHO that in countries where there is little money for drugs, many people actually do recover. Blok is optimistic about modern investigative tools, such as scans, which make observing the brain before death possible, despite that such expensive toys have never led to any advancements in psychiatry. Blok is right that some patients feel comfortable with the medical model and psychiatric drugs. But how many, and does that justify imposing the medical model and drugs on everybody? The possibility of a third model, in addition to the medical and social models, is not contemplated by Blok.
In spite of her clear position on talking therapy vs. pills, Blok attempts to credit the social psychiatry movement with introducing lasting improvements. Our new compulsory commitment laws allow only dangerous people to be committed, she posits. This rather optimistic viewpoint contradicts the actual experiences of committed people and lawyers. Psychiatric hospitals do now have patient advisory boards, not that those boards have any power. Nor do the independent patient advocates have any teeth, although some sometimes do manage to influence the institution in individual cases, particularly in non-medical matters. As to the way staff relates to patients, Blok concedes that the complaints are as bitter as ever…
It’s a shame Blok wrote the main body of her work in Dutch, making it unavailable to a broader audience. Her description of the “antipsychiatry” of those days is probably fair, even though her conclusions are wrong. Historians should stick to reporting events anyway, rather than drawing conclusions from them.
As I was not living in the Netherlands during this tumultuous period, I found reading Blok’s racy history rather amusing. In addition, through my activism I have met several retired psychiatrists who must have been at the height of their careers during this period. Blok’s dissertation fills me in on the gossip I missed in my absence. Her conclusions make me wonder who funded it.