Vol. 5, No. 4 - Psychiatric Survivor Archives of Toronto

ook, Work and Madness: The Rise of Community Psychiatry,
is refreshing because it introduces a new perspective.
It comes out with new answers; and it does so, partly,
because it asks a comparatively new question. Ralph's
question is: How do we account for the rise of community
psychiatry? Given the trend towards deinstitutionalization
and the rapid growth in community psychiatry, it is clear
that Ralph's question is an important one.
The story of community psychiatry unravels as Ralph
attempts to answer her question. It begins slowly as she
summarizes and responds to the answers given to date.
She makes short shrift of conventional answers like the
government's benign explanation. She sees the antipsychiatry
account as more helpful in that it introduces
the issue of conflict of interest. It is the Marxist account
which she finds most cogent.
The Marxists look beyond both hospitalization (incarceration)
and the internal dynamic of the patient-therapist
relationship to examine the larger economic and political
realities. Marxist theorists, says Ralph, demonstrate that
community psychiatry is ultimately in the interests of the
capitalist. The main thrust of community programs are
programs for workers - programs which serve to co-opt
labour by making alienating work slightly more bearable.
With community psychiatry, moreover, the money spent
on the so-called 'unemployables' is kept to a minimum.
The Marxist analysis is on the right track, Ralph affirms.
Still, it does not really explain how community psychiatry
arose. The problem is that theorists have been looking in
the wrong direction. They assume that it arose out of
clinical psychiatry. It arose, Ralph contends, out of
industrial psychiatry.
Ralph proceeds to tell the story of industrial psychiatry,
showing why and how it gave birth to community psychiatry.
She begins with the industrial unrest at the turn
of the century and the rise of a united labour movement.
She highlights the industrial psychologists' solution ­
Taylorism. Taylorism consisted of job restructuring so
that each person had one small repetitive task. The result
was a division of workers from each other and less individual
power over production, all of which weakened
the power of the workers. Discussing the outcome of
Taylorism - alienation - she moves on to Hawthorne's
introduction of the long nondirective interview and its
help in taking the edge off alienation and keeping the
worker subdued. She touches on the introduction of behaviour
modification. And she ends with the introduction
of drugs.
In a nutshell, the story which Ralph tells is the story of
the stifling of the labour movement. Labour unrest and
labour protest were making themselves felt; the industrialists
restructured the jobs to curb worker power. They
introduced talk therapy. Talk therapy allows the workers
to blow off steam, while at the same time encouraging
them to see work-related problems as personal. They
introduced behaviour mod, which discourages any
behaviour which is threatening to the system. And they
tranquillized workers so that unbearable working conditions
started seeming bearable. The upshot is, labour
unrest was quelled. There is no longer a unified labour
movement. There it is. A terrible story, without a doubt,
and one that dearly needed telling.
Do I have any criticisms of the book? Indeed, I do.
For one thing, there is precious little Canadian content.
Given the question asked, an American focus, of course,
was inevitable, for the Americans are the principal players
in this drama. Still, Canadian variations might have been
highlighted. An exploration into the community psychiatry
sponsored by the CMHA would, I suspect, have been
particularly revealing. One further criticism is the lack of
consumer input. Input from workers who have been subjected
to these programs and have come to the conclusion
that 'they've been had' might have livened up the book as
well as given birth to fresh insights.
Be that as it may, I heartily recommend the book. It
is a must for someone trying to come to terms with the
'mental health' system.
by Patricia Urquhart
Not Crazy Like You Think is a
documentary film which grew out of
filmmaker Jacqueline Levitin's oneand-a-half
year involvement with the
members of the Quebec self-help
group Solidarite Psychiatrie. Scenes
show not only the members' relationship
with one another but also various
dramatic "re-enactments" of parts of
their personal stories, selected by the
individual and dramatized with the
Phoenix Rising 37