Communities, Madness and Globalisation

Philip Thomas

[1611 words]

I’m grateful for the opportunity to speak in support and solidarity with Occupy London’s achievements in drawing attention to matters that are fundamentally important for every single one of us. In this brief contribution I want to do three things: briefly outline what critical psychiatry is, then offer a personal view of the resonance between critical psychiatry and Occupy London, and finally contrast what I and others have called a global understanding of madness, based in a Western, technological world view, with local understandings based in a rainbow of communities. The key questions I want to raise are who has the right to determine how we should interpret and make sense of distress and madness, and whose interests are served as a result, our own, or those of powerful groups such as the pharmaceutical industry and professional elites?

What is critical psychiatry? In January 1999 a group of over twenty consultant psychiatrists working in the NHS met in Bradford because of deep concerns about the direction in which psychiatry was heading. These concerns related to the Labour government’s proposals to increase powers of coercion in mental health practice, the growing influence of the pharmaceutical industry on the profession, and the rise of biomedical explanations for and technological responses in madness. Since then the Critical Psychiatry Network has campaigned actively in alliance with radical survivor and service user groups. Members of the group have generated a substantial body of written work covering the following areas:

1. The problems of biomedical diagnosis in psychiatry.

2. The problems of evidence-based medicine in psychiatry, and related to this, the relationship between the pharmaceutical industry and psychiatry.

3. The central role of contexts and meanings in the theory and practice of psychiatry,
   
   and
   
   the role of the contexts in which psychiatrists work.

4. The problems of coercion in psychiatry.

5. The historical and philosophical basis of psychiatric knowledge and the practice of psychiatry.

This should give you a flavour of the work of critical psychiatrists, but I want to move on to the affinities between Occupy London and critical psychiatry. This is of course a personal view, one not necessarily shared by all who identify themselves as critical psychiatrists. I’ll start by setting out the key elements from the Occupy London Initial Statement of the 26

^th

October 2011 that you are no doubt familiar with. This highlights the unjust, undemocratic and unsustainable nature of the present global political and economic system. It demands an end to global tax injustice, and a situation in which the interests of global corporations dominate democracy. In particular, it points to the importance of the independence of regulators from the bodies they regulate. It supports action to defend health, social welfare and education from cuts, and an end to wars and the arms trade.

The demand for authentic global equality is particularly significant, along with a call to prioritise the world’s resources for caring for people and the planet over the wealthy, corporate greed and military. It calls for a sustainable economic system that will benefits present and future generations, and calls for an end to government actions that oppress people globally. I want to quote directly from the second and the eighth points:

We are of all ethnicities, backgrounds, genders, generations, sexualities dis/abilities and faiths.

We stand together with occupations all over the world.

And

The present economic system pollutes land, sea and air, is causing massive loss of natural species and environments

, and is accelerating humanity towards irreversible climate change.

I will argue that these two statements create a powerful metaphor for the importance of diversity and difference in relation to the way we make sense of ourselves as human beings, the myriad ways in which we understand our suffering, distress and madness, in the face of the globalisation of Western concepts of mental illness and diagnoses.

Why? Who stands to gain from such actions? Second only to the arms industry in the USA, Britain and Europe, the transnational pharmaceutical industry is one of the most profitable sectors of this flawed and unjust economic system. Despite the economic uncertainties of the last decade, the pharmaceutical industry maintained its position in the Fortune 500 list of most profitable companies. On average, company profits fell 53% in 2001, but the profits of the top ten US pharmaceutical companies rose by 33%, to $37.2 billion. They were the most profitable sector in the US, reporting a profit of 18.5 cents for every dollar of sales. The financial strength of the industry reflects a 30-year trend. The so-called decade of the brain, declared by George Bush Senior in 1990, saw a 50% increase in drug company median profit as a percentage of revenue (Fortune, 2002a). In 2006, global spending on prescription drugs topped $643 billion, even though growth slowed in Europe and North America. The United States accounts for almost half of the global pharmaceutical market, with $289 billion in annual sales followed by the EU and Japan. Emerging markets such as China, Russia, South Korea and Mexico outpaced that market, growing a huge 81 percent. US pharmaceutical industry profit growth was maintained though other industries saw little growth. The pharmaceutical industry “…is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue.”


¹

It follows that the industry has immense influence on the medical profession, and those of you who are interested should read Joanna Moncrieff’s excellent paper

Is psychiatry for sale?


²



But there others organisations benefit from the globalization of Western concepts of madness. My colleague Suman Fernando points out that international organisations have great influence in shaping non-Western countries interpretations of and responses to their populations’ mental health needs


³


. He draws attention to the ‘Grand Challenges in Global Mental Health’ programme, coordinated by the US National Institute of Mental Health in low and middle-income countries. Service user groups and community organisations have had little if any say in its development. The programme assumes that categories of mental illness like schizophrenia and depression as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-4) are universals, and that they arise from ‘molecular and cellular’ disturbances in the brain. But it pays scant attention to the interests and concerns of the communities for whom such Western concepts are alien. Non-Western cultures envision quite different responses to madness and distress, based in local cultural and spiritual systems of support. Only the pharmaceutical industry benefits from the globalization of biomedical psychiatry, a process that risks irreparable harm to diverse indigenous beliefs and healing systems across the globe. There is a direct parallel here with the effects of corporate greed on the ecology. The McGill University anthropologist Lawrence Kirmayer is quoted as follows in Ethan Watters’ excellent book,

Crazy Like Us

:

People like me got into cultural psychiatry because we were interested in differences between cultures – even treasured those differences in the same way a biologist treasures ecological diversity.


⁴

I now want to contrast global biomedical knowledge, with local or indigenous understandings of mental health. Global knowledge purports to be universal, relevant to all cultures at all times. Its epistemology is tightly defined, and protected by terminology, jargon and notions of expertise. Its interpretive systems include science and biomedicine, psychiatry and cognitive psychology, as well as sociology. It espouses the values and beliefs of global capitalism, and this is sustained by vigorous marketing campaigns. It seeks to exploit human relationships and the environment for its own purposes, serving corporate interests such as those of the pharmaceutical industry, the WHO, governments and professional elites like the WPA. It sees the outcome of madness in terms of cure and risk, leading to stigma and social exclusion. It seeks these outcomes through unsustainable, top-down systems of ‘care’ that are little more than medication delivery systems.

In contrast, the epistemology of local systems is heterogeneous, and communities for their members hold knowledge. Its values are participatory and democratic, based in social justice, diversity, and sustainable human relationships. Its interpretive systems are truly diverse, encompassing religious faith and all forms of spirituality, lay belief systems, as well as the social and political struggles shared by oppressed and excluded groups. It functions economically on the basis of social bartering, black or grey economies based on local trust and inter-connections between households and families. Poverty and the need to subsist mediate people’s day-to-day priorities, and this serve the interests of ordinary people, those who experience madness, their families, activist groupings, and communities. It sees madness simply as part of the human condition, a journey towards enlightenment, or as a Shamanic phenomenon. It too is concerned with crisis, but it negotiates risk within the community. It sees the ultimate outcome of madness in terms of social inclusion and recovery, delivered through sustainable local support systems.

This isn’t a romanticized view. Local systems of knowledge and support are already well-established. There is the work of survivor groups like the Hearing Voices Network


⁵


, Mad Pride


⁶


, and community development projects such as Sharing Voices Bradford


⁷


. In Britain there is a strong, radical tradition of community development originating with the Quakers, Robert Owen and so-called ‘utopian’ socialism, and the cooperative movement. Further afield, its ideals resonate strongly with Ghandi’s Ashram, Julius Nyerere’s work on

Ujamaa

(familyhood) in Tanzania, and Paolo Freire’s critical pedagogy in Brazil


⁸


. Community development and related forms of community action and consciousness-raising can play a central role in drawing together marginalized and oppressed groups and enabling them to challenge and respond to the sources of their oppression.

Thank you for your attention.