Psychological and psychiatric care around 1900 was punitive and institutionalizing, and extreme critics of psychiatry were often unwillingly labeled as antipsychiatry (Burston, 2018; Chapman, 2016), meaning opposition to the “treatment of mental diseases” (Tuke, 1892a, p. 1013). Labeling critics of unethical psychiatric practices as antipsychiatry conflicts with recent efforts toward decolonizing psychological care: Freeing it from the framework that emphasized control over other peoples, cultures, and land (OHRC, n.d). As of 2021, both the Canadian Psychiatric Association and the Canadian Counselling and Psychotherapy Association have acknowledged the harm caused by racialized, exploitative practices in psychiatric and psychological policy (CCPA, 2021; CPA, 2020; Kanani, 2011; Matheson et al., 2022) and require practitioners to develop awareness and ensure cultural safety (CCPA, 2021; CPA, 2020), particularly when approached by Indigenous clients with intergenerational trauma (Matheson et al., 2022). This paper uses a decolonization perspective to review the origins of the term antipsychiatry and the most valid points made by the opposition to unethical psychiatry practices in the 1900s.

The textbook The History of Modern Psychology claims that antipsychiatry was a movement started by psychiatrists Thomas Szasz and Ronald D. Laing in the 1960s (Pickren & Rutherford, 2010) but the term antipsychiatry originated in 1912 with psychiatrist Bernhard Beyer, who used it to describe more extreme critiques of psychiatry’s institutionalizing nature (Burston, 2018); taken literally, antipsychiatry suggests these critiques opposed “the treatment of mental diseases” (Tuke, 1892a, p. 1013). This label was rejected by patients, families, friends, and professionals at the time, and also in the 1960s with both Szasz and Laing, as most recognized the harmful effects of psychiatric asylums and sought reform, not abolishment, of psychiatry (Burston, 2018; Chapman, 2016). The only person to claim the term in writing was a politically unorthodox, counter-culture-supporting psychiatrist David Cooper in the 1960s (Burston, 2018), who participated in anti-apartheid and anti-capitalism movements (Chapman, 2016). Decolonizing psychiatry requires accurately representing these critiques as efforts to improve, rather than dismantle, the field, ensuring a more just approach to mental health care.

Understand concerns before mislabeling reform movements.

Valid criticisms of psychiatry and the power held by psychiatrists originated before 1900 (Burston, 2018) and will continue beyond the 2020s. Two thematic criticisms from the 1900s will be discussed: The first involves psychiatrists’ ethics and the use of asylums to isolate, restrain, and sedate anyone deemed insane. It was noted that the punishing and institutionalizing nature of psychiatry permitted psychiatrists much freedom with the individuals whom they deemed insane and committed to psychiatric asylums: Patients between the 1900-1960s commonly included political activists, sexual minorities, women who did not conform to their husbands wishes, or any other person who acted against the social power structure (Burston, 2018).

The vague definitions of insanity as “not healthy” (Tuke, 1892a, p. 692) and “unsound” (Tuke, 1892a, p. 694), left room for abuse due to their lack of appropriate diagnostic criteria. From a decolonization perspective, these practices reflect how psychiatry was historically weaponized to reinforce social hierarchies and suppress marginalized groups. By labeling political dissenters and social nonconformists as insane, psychiatry contributed to colonial frameworks that prioritized control of a population rather than compassion for life experiences, and justify the subjugation of political, sexual, and gender minorities. Decolonizing psychiatry involves critically examining these power dynamics, recognizing the cultural and political biases in past diagnoses, and ensuring that modern psychiatric practices are informed by respect for diversity, human rights, and cultural safety (Kanani, 2011).

Recognize and Reform unequal power dynamics.

The second criticism highlights how the biases in society led to inaccurate diagnoses and criteria, and the lack of understanding of human variability. For example, biases in diagnoses are evident in the first psychological dictionary, which used observations from asylums to validate diagnostic criteria, creating self-fulfilling standards. “Those possessing black, dark, or dark brown have a greater tendency to become insane … black hair very often accompanies a melancholic temperament” (Tuke, 1892b, p. 563). The data, drawn from fewer than 800 individuals across three asylums, even analyzed the five red-haired individuals for insanity based on hair darkness (Tuke, 1892b). This dehumanization in psychiatric practice may have influenced Szasz, who argued that mental illness untreatable by methods used for physical illnesses and proposed alternate approaches that viewed these issues as moral and social problems (Szasz, 1991).

The era’s over-reliance on medical diagnoses to align individuals with societal norms is clear, and modern data analysis techniques have shown that conclusions from limited, biased data are inaccurate and perpetuate stereotypes, with methods like those addressing small sample sizes (Gossett writing as Student, 1908) emerging alongside these psychiatric discussions. From a decolonization perspective, it is essential to recognize how historical biases in psychiatric diagnoses often reflect colonial attitudes that pathologized non-Western cultural practices and identities. This emphasizes the need for frameworks that can conceptualize differences within mental health diagnostics and treatments, rather than reinforcing stereotypes through narrow definitions of normality.

Identify and Confront Your biases.

In conclusion, the historical context of psychiatric and psychological care reveals a legacy of punitive practices and biased diagnoses. Labeling critiques as antipsychiatry misrepresents their intentions and hinders decolonization efforts, while acknowledging power dynamics and biases is essential for fostering inclusivity in mental health care. We must continue to advocate for reforms prioritizing cultural safety and respect for diverse experiences. A decolonized perspective challenges historical injustices and paves the way for a more equitable future in psychological care.

References

Brückner, B. (2021). Lunatics’ rights activism in Britain and the German Empire, 1870-1920: A European perspective. In Patient voices in Britain, 1840–1948. Manchester University Press. https://doi.org/10.7765/9781526154897.00013

Burston, D. (2018). Psychiatry and Anti-psychiatry: History, Rhetoric and Reality. Eidos: A journal for philosophy of culture, 2(4), 75-88. https://doi.org/10.26319/4717

Canadian Counselling and Psychotherapy Association (2021). Standard of Practice (6^th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.pdf

Canadian Psychiatric Association (2020). A call to action on racism and social justice in mental health. Position Statement. https://www.cpa-apc.org/wp-content/uploads/2020-CPA-Position-Statement-Racism-EN-web-Final.pdf

Chapman, A. (2016). Re-Coopering anti-psychiatry: David Cooper, revolutionary critic of psychiatry. Critical and radical social work, 4(3), 421-432. https://doi.org/10.1332/204986016X1473688814636

Cooper, David (1967). Psychiatry and anti-psychiatry. Routledge.  https://archive.org/details/psychiatryantips00cooprich/page/n5/mode/2up

Kanani, Nadia (2011). Race and madness: Locating the experiences of racialized people with psychiatric histories in Canada and the United States. Critical Disability Discourses, 3, 1-14. https://cdd.journals.yorku.ca/index.php/cdd/article/view/31564

Matheson, K., Seymour, A., Landry, J., Ventura, K., Arsenault, E., & Anisman, H. (2022). Canada’s colonial genocide of Indigenous peoples: A review of the psychosocial and neurobiological processes linking trauma and intergenerational outcomes. International journal of environmental research and public health, 19(11), 6455. https://doi.org/10.3390/ijerph19116455

Office of the Human Rights Commissioner, OHRC (n.d.). Decolonization. Retrieved Sept. 30, 2024 from https://bchumanrights.ca/key-issues/decolonization/

Pickren, W.E., & Rutherford, A. (2010). The golden age of American psychology. In A history of modern psychology in context (pp. 208-235). Wiley. https://www.researchgate.net/publication/259982011

Student. (1908). The probable error of a mean. Biometrika, 6(1), 1-25. https://doi.org/10.2307/2331554

Szasz, T. S. (1991). Ideology and insanity: Essays on the psychiatric dehumanization of man. https://archive.org/details/ideologyinsanity00szas/mode/2up

Tuke, D. H. (1892a). A dictionary of psychological medicine: Giving the definition, etymology and synonyms of the terms used in medical psychology with the symptoms, treatment, and pathology of insanity and the law of lunacy in Great Britain and Ireland. Volume 2. https://wellcomecollection.org/works/g7ep9cx7/items?manifest=2

Tuke, D. H. (1892b). A dictionary of psychological medicine: Giving the definition, etymology and synonyms of the terms used in medical psychology with the symptoms, treatment, and pathology of insanity and the law of lunacy in Great Britain and Ireland. Volume 1. https://wellcomecollection.org/works/g7ep9cx7/items

Originally Published: 2024 – 10 – 07