Madness Is Civilization: When the Diagnosis Was Social, 1948–1980

Historical accounts of the antipsychiatry movement seem to be as polarizing as the movement itself. In an open forum titled “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism,” published in Psychiatric Services in 2006, Rissmiller and Rissmiller (1) described how over several decades, antipsychiatry ideas and momentum, in temporal association with a decline in the vigor of mid-20th century antiestablishment counterculture, moved from a campus-based intellectual movement to a “radical consumerist movement” in community settings. The article generated 10 published letters to the editor (and probably many more strongly worded unpublished letters) by physicians, patients, consumers, social workers, and others involved in the consumerist movement and in community-based mental health care. People were unhappy with a brief historical account, and they let the authors and readers know of their discontent.

In Madness Is Civilization, Michael E. Staub provides a clear perspective of the scrutiny of psychiatric disorders in the mid-20th century by broadly reviewing the clinical, political, sociological, and community work of the protesting intellectuals who propelled the antipsychiatry and countercultural movements from 1948 to 1980. Staub presents a less polarizing account than Rissmiller and Rissmiller to review the topic in seven book chapters and 45 pages of notes and references, which is ample for exploration of the mid-20th century rise in the popularity of the antipsychiatry movement and responses to the movement by physicians, patients, academics, and society as a whole.

Interestingly, Staub does not develop a disposition for the movement; that is, unlike Rissmiller and Rissmiller, he does not indicate which current groups are centered on antipsychiatry ideas. His work ends with the year 1980, leaving readers to draw their own conclusions about current influences on the movement. However, he gives hints throughout the book of the movement's persistent ideas. He often quotes figures, including patients, from the movement. One former patient is quoted in chapter 4 as saying, “There is no medical definition of sanity!” This statement could be lifted from one of today's antipsychiatry Internet chat rooms aiming to reduce psychiatric clinical reasoning to a coin flip, showing that the suspicion surrounding psychiatric treatment still exists.

While unifying themes are present throughout the book, the fourth chapter, “The Therapeutic State,” could stand alone as a scholarly review of the history of the psychiatrist's role in expert testimony and criminal proceedings. This chapter cohesively describes the comprehensive views and actions that developed in response to an increasing concern that all criminal acts could be explained by the presence of a psychiatric disorder or maladaptive personality trait in the accused individual. In a way, Staub shows that the movement's suspiciousness of psychiatric diagnosis and treatment helped to reform modern forensic psychiatry practice.

Notably, APA and the American Journal of Psychiatry play prominent roles in this book. Past association presidents William Menninger and Edward Strecker are quoted, along with the first director of the National Institute of Mental Health, Robert Felix. Staub also cites articles and letters published in the Journal to demonstrate the mixed opinions in the field regarding specific matters and argues that the field's own indecision was used as fuel by antipsychiatry movement leaders. For example, he reports that the Journal “published an essay in 1968 that defended hippies and suggested that their LSD experimentation represented a useful means to achieve heightened political consciousness” (p. 135). This reasoning is in line with the ideas of the movement's leaders—that psychiatric disorders, substance use, and criminal acts represent an individual's expression of existential problems and not the behavioral manifestations of pathological states. However, by presenting various published views of psychiatrists, Staub shows that scholarly publications are appropriate venues for medical debate. Overall, he uses reports and quotations from publications as well as national meetings to demonstrate the field's management of the antipsychiatry movement, highlighting leading psychiatrists' reactions to the views of R.D. Laing, Thomas Szasz, L. Ron Hubbard, and others who led the counterculture.

In the epilogue, Staub seems somewhat skeptical of current changes in diagnostic classification and ideas about symptom continuums. He reports concern about the substantial amount of grant funding “flowing so overwhelmingly into medical research” (p. 193) and not into researching social and cultural factors. He recognizes the resolution of the larger antiestablishment protest of which the mid-century antipsychiatry movement was a part, but he proposes that some current problems in research and clinical medicine (for example, assessing a child's risk of potentially developing a psychiatric disorder and what to do with the information) mirror problems that occurred in the mid-20th century. Psychiatrists and anyone else struggling to understand how large segments of society can angrily discount one branch of medicine should read this book to better understand the history of antipsychiatry groups and the current manifestations of the antipsychiatry movement. As in clinical medicine, a thorough understanding of a history can often explain the observed phenomena.