Mica Frazer-Carroll's Mad World is a decent addition to the field of both radical mental health and academia around mental health and disability justice. The author tells us early on that she has a depersonalization disorder diagnosis, and she sometimes mentions this throughout the rest of the book but does not make the error of constantly using herself as a case study which I appreciate. The author is British so there is a lot of history that I learned about mental health and access in that area that I didn't know about as a US American. Much of it mirrors the history here. There are also bits of disability justice, anti-psychiatry, and radical mental health movement history that I did not know about before- including in the USA- despite having read a lot of different texts on the subject. For example , I didn't know that the anti-psychiatry movement spanned political positions on the left and right, ranging from freedom to be oneself to freedom to not have society pay for the cost of medical care and whatnot.
This book also captures well how awful psychiatry has been and how much abuse and absolute wrongdoing has occurred within it. It does this without absolutely burying you in the horrific details. I believe she gives you enough information to know what she's talking about without completely overwhelming the reader. I am also a person who has dealt with some of these abuses personally and have seen others deal with them. There's a long history of psychiatry being used against everyone from enslaved people to activists. At the same time my personal experience has not led me to a fully anti-psychiatry position, just as abuses in other medical fields have not led me to be anti-modern medicine- which leads me to my next point.
This book has some flaws that I see across lots of radical mental health texts, however I do think that the author approaches it with more nuance than many others do. I like that this book asks more questions than it answers. It asks a lot of, "what if we did things x way," sort of questions. However, like many of these sorts of texts, people with very extreme and unglamorous symptoms of mental illness are not really included as much as they should be. We don't fit The narrative of just being sort of different and needing a sort of different society.
This is very personal for me, so it often colors my ability to read these things in ways that I'm not sure are constructive. I have very extreme OCD that ruins my life. I think about getting actual brain surgery on a daily basis. OCD is not just a different way of viewing the world requiring environmental or systemic change. In fact, relying on that can strengthen OCDs grip. My closest family member suffers from very severe paranoid psychosis and has been on the run for many years- including bouts of homelessness and disappearance- because her brain has led her to believe that almost everyone she sees or interacts with is in on a gang stalking plot. This text talks about hearing voices as some sort of spiritual experience and even discusses entertaining and validating delusions because you can never really know - which I guess may be true with spirituality. The unfortunate fact is that the vast majority of people with psychosis have paranoid psychosis. Are these things caused by stressors and lack of social access to needs? They're absolutely exacerbated by them and isolation definitely can trigger episodes. A social and systemic change model would undoubtedly help these people. I'm not denying that. But, in my experience, when dealing with people with paranoid psychosis or severe OCD or any other number of unglamorous and torturous symptoms, most people disappear. Most people do not want to provide support and create the community-based things that we need- including radical mental health advocates.
This is what is so devastating about this sort of thing. There is just criticism of the neoliberal mental health awareness movement and how it places the onus on individual change as the solution. Part of this awareness is that they want awareness of people who have something like short-term mild depression and are able to get out of it by joining a gym and taking an antidepressant and then becoming a "productive member of society." Radical mental health is unfortunately not immune to that same sort of influence. When you're really in the trenches dealing with people who are living in absolute hell, it's quite difficult to believe that the biomedical model isn't pretty important, however flawed. Furthermore with things like schizophrenia, there is marked brain damage and measurable effects of the disease that this book claims are not present in psychiatry. This is why all of it is frustrating because radical mental health tends to be about whatever diagnoses or getting the most attention at the time. And the people able to advocate and get that attention are usually the people who are the "highest functioning" and widely appealing, as is true in any movement.
Another contradiction is that she acknowledges one of the problems with psychiatry and diagnosis is poor inter-rater reliability. This means that from professional to professional they may not come up with the same diagnosis. This is true across all medical fields, but is especially true of psychiatry. I agree. The issue then is that she goes on to support self-diagnosis by people with no training and experience in the field. If the inter-rater reliability between people who are trained is bad, it's going to be even worse between people who aren't. I'm not saying self dx people don't read or research. But, there is a lot of overlap between things and over the decades I have seen various diagnoses be the one that people are seeking out because it is the one that people are talking about the most. Even professionals are not immune from this. This is worse now with the advent of social media. And if one of the main criticisms of psychiatry is that it pathologizes non-normativity, why is there such a strong movement to change diagnosis to include more non-normativity and to allow anyone to diagnose themselves with anything? Nobody wants to get a diagnosis of OCD even though that may be a more correct diagnosis for them than one of autism. People cannot self diagnose with a disorder that includes psychosis because one of the markers of psychosis is not knowing you are experiencing it.
I may be being unfair here because the author makes it very clear in one chapter that the division between a binary biomedical model and a social model of disability isn't really something that exists. She also acknowledges that we can seek radical mental health while still believing that we want treatment or cures. However much of the book is still devoted to focusing on a more social or systemic change model. She does jump around though. I found myself frustrated with a chapter or two, but then she would move on to the next and I would be back on board.
The best parts were where she did balance these things and discussed innovative ways of dealing with various symptoms. Some of the discussions with indigenous healers and how they dealt with people hearing voices, having hallucinations, or dealing with delusions were interesting. I would like to see things like this taking up massive amounts of space and radical mental health texts and guides. I also like that she talked about people creating maps of how to help them when they are really going through it. The key is to create these things and one is in a more stable position. In the case of something like severe psychosis though, getting to that stable position is near impossible without the biomedical model. It does happen, but the vast majority of people that I have known and spoken to who have dealt with psychosis have said that involuntary treatment, while absolutely harrowing, was the only thing that brought them back to themselves.
Near the end of the book she talks about the importance of not leaving anyone behind and not abandoning people with one form of illness in order for another to advance. This is not talked about enough in radical mental health or any other disability justice circles. I've seen Eli Clare and some others discuss, for instance, the abandonment of people with intellectual disability when people with other disabilities focus on telling everyone how intelligent they are. To be a broken record, in radical mental health, people with more extreme symptoms are often abandoned or spoken about incorrectly while other people pathologize difference in behavior and apply diagnosis to it sometimes even after multiple professionals have told them that the diagnosis does not fit. This then changes what that diagnosis means and leads down the path of seeing the people who actually have more extreme access needs being seen as the bad kind of people with that diagnosis (if they are seen at all.) Many people with an autism diagnosis from a young age for instance do not have this diagnosis because they are "privileged." They have the diagnosis because their access needs were so great that they ended up being diagnosed early on in life. This shit is messy and complicated and I'm glad that this author was able to discuss directly the importance of not leaving behind those who may adhere more toward the biomedical model or who may have needs that are isolating.
Overall, in spite of my ranting criticisms at times, this is a really good book written by someone who clearly cares about the issue and did their best to span the wide variety of viewpoints and experiences that exist across the world of madness and mental illness. This text is a valuable one and both organizes and enriches these discussions.
This was also posted to my Goodreads.
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