Two years ago I wrote a short reply to a sensational newspaper article about a schizophrenic black man who had killed a white girl. In that article I looked briefly at the production of the subject “mental patient” as always simultaneously a “dangerous individual”. The former category contains without ever really displacing the former, being an act of assimilation rather than phagocytic dissolution. In that article I also expressed a long held fear that deinstitutionalization would come to an end. In the previous long post I didn’t really touch on any of the more horrific outcomes of deinstitutionalization for the psychiatrized population.
In most places that deinstitutionalization took place it did so in phases. The idea was that community treatment options would exist to help people who were at the acute and chronic ends of the psychopathological continuum. These community centers often failed to appear. Where they did appear they remained underfunded and understaffed. It remains routine to see people who were or would have been in hospital out on the streets rough sleeping or held in prisons and other containment formations. For the thousands of people the asylum never deterritorialized, it just changed names. Many of the people I work with will smash up a cop car in order to get a jail cell for the night where they will be safe and warm. They will do something serious in order to get arrested and sent to prison where there is at least some help.
Today I work with people who have various addictions and it is not uncommon for them to have psychotic experiences. The vast majority of them are roofless homeless people. Recently the center I work in admitted someone who was clearly in need of retreat from the world and was serious in their statements that they were going to kill themselves when they left the needle exchange. This person was admitted straight away. This isn’t what we are designed for; it certainly isn’t what we usually do. The sad fact is we knew calling the cops would result in nothing. There would be no bed in an acute psychiatric admission ward and there would be no crisis intervention help. All our critiques of psychiatric power evaporate under the demand for help.
So there is no doubt that there is a need for asylum in the authentic sense: the need for sanctuary away from the pressures and insanity of a world gone mad by the engine of thanaticism. There are models out there we could look to. I usually point people towards the Soteria Model or to Gheel, fully aware that such models remain less than ideal and always open to recuperation. Still, what do you say to someone who says “I need help right now”, someone who, despite it all, still wants to live. Okay. We’re clear? If we are against psychiatry this does not mean we must be against care; if we are against the asylum this does not mean that we must be against counter-institutions of psychic and physical withdrawal; if we are immersed in sociopathy, this does not mean we should abandon our last shreds of compassion.
The reason I opened with a reference to a two year old opinion piece written for a libertarian communist website is a fear I expressed then and that remains a fear today. My fear then as it is now was that
[t]he danger of the production of the “mental patient” and its subjectivation as dangerous, murderous, and requiring control isn’t simply that it isn’t true. The danger lies in the fact that at a time of austerity and increasing repression, of total policing and total pathologization, the choice of new freedom or new controls might begin to slide away. My fear is that with these stories that seek to criminalize those experiencing mental distress will lead directly to calls for a return to the Asylum.
This call has been made. Earlier this year a team of psychiatrists echoed those behind the alternative soteria model of psychiatry in calling for a new asylum system. As an article in The Atlantic from January explains
“It’s really not as radical as it sounds,” said Dominic A. Sisti, assistant professor of medical ethics, health policy, and psychiatry. Psychiatrists have been making arguments for expanding long-term inpatient care for some time, he says. In their call to “bring back the asylum,” Sisti and his colleagues speak of the original, 19th-century meaning of the term asylum: a place that is a safe sanctuary, that provides long-term care for the mentally ill. “It is time to build them—again,” they write.
It is time to build again. To build a place of genuine sanctuary and long term care. What problem could I have with this? It’s hardly a return to the old image of the horror movie sanotarium, is it? Today the psychiatrized are themselves calling for new hospitals as they see what little community options given them are closed or conglomerated into giant care homes for the elderly. The danger lies not in the fact that this call for a renewed asylum has been issued; it lies in the fact that it is only being listened to now and in the context of brutal social recomposition driven by austerity and a renewed repressive willingness of governments to discipline and punish. The call for asylum could quickly be transformed into the call for The Asylum. The promise of a reterritorialized site of internment for the mentally ill waits in the wings. This time the disciplinary space of the psychiatric institution would operate smoothly in conjunction with the deterritorialized asylum. The former would operate as a dumping ground for the unproductive bodies that couldn’t be put to work, while the latter would ensure that we keep calm and carry on producing/consuming/paying attention. The Disciplinary Asylum would pump its inmates full of sedatives to enact a physical and chemical constraint, while the Control Asylum would continue to keep us in the managed cycle of chemical and audio-visual excitation-innervation-arousal and chemical-meditative-aesthetic destimulation and drugged sleep. An integrated system would see the swift across the semi-permeable membrane.
Already we have seen the return of sweatshops and workhouses at the heart of capitalism. Alongside this we see the increasing use of the “workfare” enforced labour schemes. We see the fractalization of work time and the shattering of existential time. These practices create and manage so many of the new psychopathologies. Work has always been privileged in the treatment of the mad: Freud said all you need is love and work; the old asylums had the inmates plough field or tend crops and receives tokens in return; the concentration camps said work will make you free. We’re seeing the return of those work-based forms of managing the mentally ill that disappeared with the advent of the asylum that was built to respond to their failure. If those policies and practices are failing again today it shouldn’t surprise us that attention turns once more to the concrete asylum.
The “Modern Asylum” would merely be a response to a cycle that has happened before and is already happening again today. In the new york times one prominent psychiatrist commented that ‘institutionalization is already happening, but it is happening in a far less humane way than it could be’. So in fact the reterritorialization of the asylum is beyond the point moment of articulation but is already occurring. It is as if the history of psychiatry is set to play itself out again in grim parody. Baudrillard would tell us that this is what happens when history has reached an ecstatic phase. There is no history in fact, it has entered “hibernation” and if things keep on happening it can only be through the recycling of the old forms. The psychiatrist, Christine Montross, continues:
Asylums for the severely mentally disabled would provide stability and structure. Vocational skills would be incorporated when possible, and each patient would have responsibilities, even if they were carried out with staff assistance. Staff members would be trained to address the needs of minimally verbal adults. Sensory issues often accompany severe intellectual disability, so rooms with weighted blankets, relaxing sounds and objects to squeeze would help patients calm themselves.
Facilities for chronically psychotic patients would have medication regimens and psychoeducation tailored to the needs of those living with mental illness.
The autistic kids would certainly have the “stability and structure” of an imposed routine and a life enclosed within an institutional rhythm. They could receive “vocational skills” of the kind that would prepare them to work jobs the modern asylum would deny them; or perhaps they would be offered the ability to work and earn while in the asylum itself. This could be the production of a new slave labour force modeled on the black prison population: an interior slave industry. These autistic patients would also be fully integrated into the position of “responsibility”, the hoary old word that today has to be read as the responsibility of the debtor to his creditor: a moral blackmail bullshit word. In fact they would be subjected to an intensification of the process of responsibilisation defined by Pat O’Malley in the SAGE Dictionary of Policing as
a term developed in the governmentality literature to refer to the process whereby subjects are rendered individually responsible for a task which previously would have been the duty of another – usually a state agency – or would not have been recognized as a responsibility at all. The process is strongly associated with neoliberal political discourses, where it takes on the implication that the subject being responsibilized has avoided this duty or the responsibility has been taken away from them in the welfare-state era and managed by an expert or government agency.
The “chronically psychotic” would meanwhile be fully integrated into the acceptance of a biopsychiatric paradigm of neurological imbalances requiring neurochemical correction that has been almost entirely discredited as a fraudulent pseudo-science. They would learn that their severe depression is the result of a serotonin imbalance endogenous to their genetics that can only be corrected by adherence to an ssri/snri, psychotherapy and the interiorisation of the depressive identity.
Of course Montross also talks about the kinds of things that autistic people would genuinely benefit from such as nonverbal communication skills and sensory therapies. She never addresses why these therapies could only be available in the modern asylum. One is left to assume it is a lack of imagination or an advocacy of the desire to extend the therapeutic state. Analysing its emergence Polsky would write that ‘the therapeutic state contained its own expansionist impulses’ (73).
Everyone calling for these new modern asylums has one knock down argument: some people need to be institutionalized for a while. I wouldn’t disagree. In fact no anti-psychiatrist has ever really disagreed. The point has always been what kind of institution is suitable, desirable and will actually help people in acute states of psychosomatic suffering. Yet contained within all this is possibility that we are seeing the frenetic stasis of history in its ecstatic symptomatically repeating the initial expansionist overtures of the therapeutic state.
It may be that we need to issue demands for in-patient units for survival’s sake. It may also be that we should be focused on making demands for better community care. The chances are the first demand has already been recuperated and that the latter has been seen to have failed. In previous times we could (and I have) asked whether it isn’t time to return to the survival programs of the Black Panther Party. This time the programs would be undertaken without the promise of the revolution. The revolution is not on the horizon.
The question remains where the willingness to undertake such programs exists today outside of the crippled Greek solidarity movement. Do we have to wait until it is too late to begin to survive? What is this minimal difference between victims and survivors that we seem to lack? It is as if people can only want to survive with the delusions of hope clouding them. It is as if living- if we must go on living- must necessarily be augmented by a promise of a better tomorrow. That is the promise of liars and unconscious dreamers; we have to become lucid dreamers, learning to manipulate and enjoy the nightmare we are trapped within. We have to face up to the idea presented again and again by Franco Berardi that the only viable politics is that of a radical and creative withdrawal into passivity.
A new monasticism and hyper-conformism lies ahead of us in which we can finally become the implosive mass that remains silent. The history of philosophy is split into affirmation and negation, into the “yes” or the “no”, much like all our recent and impending referendums, that get glossed as “a yes in service of a no” or ” a no in service of a deeper yes”. This is bunk. It’s blackmail and stupidity. The silent mass refuses to participate, refuses to answer. There is no yes or no in the implosive void: there is absolute indifference to what is presented.
The question asked of withdrawal is always “where to?” This is where the survivalism kicks in. Our job is to build the life rafts we will survive on, or else to steal them. And it is here that we return to questions of asylums. One respondent to the recent calls to reactivate the asylum system speaks of “Sane Asylums“:
What I proposed was a place — rural, quiet, unhurried, inexpensive and modest — that did not require a “nervous breakdown” for admission. People could check in and out unashamedly without having to apologize, make excuses, mortgage their home, take an oath, subscribe to some creed or get the approval of their insurance plan.
No Joint Commission on Accreditation standards, no utilization review or tissue committees. People entering would not be called patients, clients or inmates. They would be “participants” who could check in and check out as easily as a hotel. Short stays. No computerized reservation system, no room service and no heated indoor pool.
In this retreat, there would be a variety of possibilities, opportunities and alternatives. Most of all, there would be other people there likewise simply for healthy respite and re-charging. Activities would be available, but optional. Discussion groups, yoga, lectures, exercises, impromptu recitals, art, crafts, work — whatever — to be involved in, or not, depending on the participants’ wishes.
If one wanted to talk over his or her problems with another person, fine. If one wanted to collect oneself rather than explore oneself, though, that would be fine also. Confrontation and encounter, or soliloquy and retreat all would be acceptable.
Costs would be very low, because it would be a modest site without wall-to-wall amusements and distractions. No water park. Rather, it would be a simple site where the greatest helping resource would be the participants themselves, who, with a minimum of structure and only a small staff, would serve as the main source of comfort, help and hope to each other. And the mere act of getting away from the “hustle, bustle and commotion of things” would, in itself, be therapeutic.
These are what I have elsewhere called zones of destimulation, but in reality they are really a shift in the kind of stimulation we are exposed to. It imposes no alien rhythm on our bodies but operates by an auto-rhythmic principle. The author of this recommendation states that these places already exist in health spas and yoga retreats and so on. These are the zones of destimulation that are integrated into the society of stimulation’s excitation-deescalation circuitry. The difference should be that we have no desire to come back from our withdrawal. This would be an Invisible Asylum that refused to participate in the psy-functions demand that bodies be returned to productivity or be warehoused.
Just as Baudrillard commented that Disneyland exists to occlude the fact that all of America is Disneyland, the reterritorialized Modern Asylum would also exist to hide the fact the world itself is a madhouse. If the original liberation movements of the psychiatrized populations involved breaking out of the hospital then are offered a clue. Our own psychosurvivalism must be predicated on the breakout from the global madhouse by retreating to the Epicurean Gardens. Maybe this is the only option left to us. To quote Loren Mosher’s letter of resignation from the American Psychiatric Association: “I want no part of it anymore”.
Ah, and I remember: I gotta fucking eat.