sustained them out of intellectual honesty and sense of duty — like Professor Szasz, Dr. Ron Leifer, Prof. Narr, and so on.

Mind Freedom’s Fast for Freedom in Mental Health

In the year 2003, MindFreedom5, an international psychiatric survivors’ organization that fights for human rights of people diagnosed with psychiatric disabilities, initiated the Fast for Freedom in Mental Health; a hunger strike “to Challenge International Domination by Biopsychiatry”. By exerting pressure on the APA, they started a debate that questioned the legitimacy of psychiatry, its theories and its methods.

A conspicuous body of outstanding personalities of the mental health profession — such as Peter Breggin, Fred Baughman, Loren Mosher, David Cohen, and many others — took side with the protesters; examining and refuting the responses provided by APA to defend its scientific claims. The event attracted so much media attention that it jeopardised the APA intention of ignoring the survivors or dismissing them as “crazy fools”. Dr. James H. Scully, Jr., MD, then APA Medical Director, refused confrontation with the strikers, saying that he “only talks to serious people”.

Today many people in the mental health profession quote Prof. Loren Mosher, one of those 14 prominent scientists who unanimously agreed that the APA did not provide any scientific evidence for its claims. The response letter of the scientific panel, in support of MindFreedom’s hunger strike, ended with a serious admonition to the APA:

“The panel members could not help but notice the contrast between the hunger strikers, who ask clear questions about the science of psychiatry and consciously take risks in the name of protecting the well-being of users of psychiatry, and the American Psychiatric Association, which evades revealing what actual scientific evidence justifies its authority. By not giving specific answers to the questions posed by the hunger strikers, you appear to be affirming the very reason for the hunger strike.” -- Fast For Freedom Scientific Panel Reply To The American Psychiatric Association6

I’m proud of having had the honour of translating into Italian Loren Mosher’s Letter of Resignation from the American Psychiatric Association7. I translated it night-time, while I was locked in my cell in the psychiatric prison facility of the OPG Montelupo Fiorentino.

We survivors are quite different from the diagnostic picture portrayed in our clinical charts, which depict us unfit, insane, unpredictable and dangerous. The truth is that we are the eyewitnesses to the crimes against humanity of our age! Therefore, we pose a threat to the ruling elite.

…Thanks to courageous and honest scientists like Mosher that survivors of psychiatry keep alive the hope that things will change in the mental health system through an open and sincere confrontation with its professionals. Meeting each other, is the only way to realize that behind academic

divergences lie strong human factors and sincere convictions. I wish that this point gets through very clear, because the survivors’ movement never denied that even mainstream psychiatrists have sometimes proven to be supportive to some of us. Regardless of how rotten psychiatry is, we must not forget that those wearing the white coat are ordinary men and women whose qualities and shortcomings transcend their clinical roles and specializations. I therefore see no point in demonizing psychiatrists as whole, just as I see no sense in glorifying them either.

But, we do attack the ideological foundations of psychiatry.

I’ve mentioned two major campaigns conducted by the users/survivors against psychiatry, I want to make it clear that there have been many other such campaigns. Just to mention a few more:

The Great Escape Bed Push8 that took place in London (UK), where a psychiatric bed was pushed 60 miles- from Mill View Psychiatric Hospital, in Brighton, to the original site of the “Bedlam” asylum in London, to protest against “the poor level of choice of treatments and the widespread use of force used in the psychiatric hospitals”. The protest organized by the International Association Against Psychiatric Assault9 (IAAPA) at the “Deadly Medicine” Exhibition at the “Hygiene Museum” in Dresden; a protest against the falsification of history because the museum denies the over 20,000 murders by starvation carried out in psychiatric institutes from 1945 to 1949.

(Also) the great work carried out on the issue of legal capacity, by the International Disability

Caucus10 for the UN Convention on the Rights of Persons with Disabilities. I’ll also mention that the World Network of Users and Survivors of Psychiatry11 (WNUSP) together with the Bapu Trust12 of India published this summer a booklet entitled First Person Stories on Forced Interventions And Being Deprived of Legal Capacity, which gathers survivors testimonials from all over the world, included my personal story.
Wherever you turn you’ll find users and survivors of psychiatry engaged in the struggle for the abolition of coercive psychiatry. For this reason I’m rather disappointed that coercion was not a key topic of discussion in this congress.
I want to stress that the issue of psychiatric coercion goes hand in hand with the paternalistic belief that some people are entitled to know what’s best for others, and feel entitled to impose their expertise with force or deception. This idea carries the weight of Plato’s views on the role of medicine, which promoted both paternalism and eugenics. This is the root of psychiatric evil, but is also a general problem in medicine, so I won’t plunge into it any further.

Contradictions Within the Psychosocial Approach

Some of the most relevant discrepancies that underlie the idea of psychosocial interventions:

Crushing Psyche between Philosophy and Medicine

To understand what psychosocial rehabilitation is, we should first understand what the psyche is. Most people claim that psyche

nowadays is equivalent to mind. We can’t fail to realize the relational gap between mind and brain: mind is a concept, like soul; brain is an organ, like the heart. Psychologists should handle mind and neurologists brains. Psychiatrists claim to manage to handle both in the name of one science – the model of bio-psychiatry. No scientific discovery will ever fill the gap between the physical (i.e., bodily) and that which is conceptual (i.e., existential). Anyone who places his profession in this gap is destined to be a social controller.
The gap between the physically measurable world and our dynamic experience of its reality is irreducible, the reductionist model attempts to fill it by shrinking Man’s psyche by denying free will, by reducing individual life to the result of interplay of genetic and biochemical circumstances, thus dehumanizing man and magnifying science to a religious status.

Psychologists have since long given up their art, by accepting a medical model of the mind that denies free will and traces all problems to biological and genetic causes, by accepting the cures of “miraculous pills”, before which we are all the same: both patient and healer. The function of psychology has exhausted itself in this system that focuses on the biological sphere.

Most of them (new trends surfacing in mental health) are nothing less than paradigmatic sleights-of-hand to break the frustrating routines of endless therapeutic failures, and keep the illusion of functional services alive. Others are dangerous revivals of paradigms of the past, like the bio-psycho-social approach to mental

health. During the Nazi period, Jews, homosexuals, and all sort of socially unwanted, were diagnosed by psychiatrists as biologically corrupt, psycho-logically unfit, and socially dangerous. Call it mental hygiene or racial hygiene; it’s the same thing today, because we’re witnessing a fusion of the medical, psychological, and social sciences under the umbrella of mental health’s bio-psychiatry. As Albert Einstein wisely warned: “Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.” How come we are so gullible as to blindly swallow all this scientific nonsense?

The Quest for Moral Justifications

Thomas Szasz marvellously puts it, in his book The Theology of Medicine: “In everyday life, the distinction between explanation and justification is often blurred… It is often difficult to know what one should do, what is a valid justification for engaging in a particular action. One of the best ways of resolving such uncertainty is to justify a particular course of action by claiming to explain it.”

A bare description of mental health interventions does not sound very appealing, (hence) the mental health profession seeks new names and theories to describe the same cruel interventions. It’s not dignified to admit to restraining a young, defenceless woman, and then electrocuting her brain. It is easier to boast of carrying out a medical therapeutic intervention on her sick mind. Yet, crude facts are not altered by the justifications we find for them, especially from the victims’ perspective. (However) from the executioner’s perspective

the linguistic manoeuvre provides a solid moral alibi for justifying what is otherwise plainly a cruel act.

The Catholic Church used to burn people at the stake with the justification of salvation of the soul of people who went astray, heretics. (This) religious blind faith allows a fantastic explanation to blind someone to what the Inquisition was doing to people. Similarly, blind faith in mystical medicine blinds you to what most psychiatric interventions are — cruel measures of physical, chemical and environmental control of today’s heretics - homosexuals, drug consumers, etc.

There is no equivalence between mind and brain, or soul and heart. Those who think that they can pinpoint the mind by medicine are fooling themselves; there is no mind, only the person 13. What you claim to do in the name of medicine to patients’ minds, can’t justify your failure to see what you are doing as individuals to other individuals. Doctors curing patients is just a jargon translation — a manoeuvre — of the fact that you are people depriving liberty of other people who have not committed crimes. End of story!

The first person experience of their actions is not affected by theoretical paradigmatic shifts. Being imprisoned and restrained in a psychiatric institution today has the same flavour as it had in the first mad asylums in the past. We can’t accept any apology claiming that tortures have become less bloody, and asylums more habitable (which is, by the way, false). It’s not a matter of quantity or quality, it’s a matter of principle, just like the Holocaust is not merely a matter of numbers. Being electro-shocked or stunned by drugs in the name of bio-psychiatry, the Sacred Roman Inquisition, or whatever, is after all

 

one and the same experience all along history….

Mental Illness: A Myth Without a Sanity Model

Mental illness does not exist! While psychiatric diagnosis are growing in an exponential fashion, no reference is made to any model of sanity against which mental “diseases” can be measured, other than the whims of task forces who vote on the diagnostic criteria. There are no biological tests to diagnose mental illness, it’s all based on interviews or third party accounts.

What is the model of mental sanity today? Is it still, like in the Nazi period, being heterosexual, white, Aryan, productive, and devoted to the regime? Or has it changed? Sincerely, I’m asking you. At this moment thousands of political dissidents are locked up in psychiatric institutions in China and many others all over the world. Nuremberg trials failed to discontinue the psychiatric practice of labelling dissident thinkers as sick, deporting them into institutions, and forcibly treating them.

Heresy: Choosing For Ourselves

The diagnostic labels might have changed, yet the underlying paradigm remains the same: if you don’t comply with the system you are guilty of heresy.
I think the intimate relations that interweave the underlying concepts of heresy and mental illness can hardly be overstressed —if heresy implies choice, and the inquisition was denial of that choice, then psychiatry stands to mental illness as the inquisition stood to heresy. Psychiatric labels are ipso facto stigmatizing procedures, they are intentionally meaningless

misnomers, not intended to communicate anything, and their only scope is to excommunicate unwanted people.

Our society seems unwilling to take the responsibilities that ensue from freedom. It’s easier to wash our hands of all responsibility and handle embarrassing choices by removing the arena of confrontation and calling into account mysterious diseases that require holy psychiatric interventions. So, whenever in the USA a white American citizen shoots Mr. President, it has to be a madman. It is unacceptable to public opinion that the American society can fail to instil patriotic values into its children. But if an Arab shoots Mr. President, things are quite easier to handle, there is no need of psychiatric jargon to handle the situation: the jargon of the war against ‘religious fanatics’ is well established.

Choice and heresy are intimately connected to present-day mental health system. People like me have made the choice of being heretics and dissidents all the way. I owe to Thomas Szasz the great pleasure of having discovered the true meaning of freedom: through his writings, I discovered inner freedom while I was a psychiatric prisoner. No matter how unpleasant my journey into madness and psychiatry has been, I can proudly say to have discovered the true force of heresy: that unrestrained force of change that challenges the commonplace in the name of Man and freedom.

I want to thank with all my heart Dr. Giorgio Antonucci, one of the greatest heretics of our times: a physician and psychoanalyst who challenged psychiatric slavery at its roots. Giorgio has dismantled several Italian asylums, setting free people who were restrained to beds since 20 years! People who had their front teeth removed

because they refused to eat, in order to die, and were fed forcibly, people on whom psychiatrists applied a muzzle to their mouth so that they won’t spit on their jailers. (He is) also an Honorary Member of OISM and both a frontline activist and intellectual dissident. He’s been persecuted by Italian psychiatry and institutions; they slandered him and even took him to court. But he never gave up. He’s a living example to the Italian survivors, and he never denied us support. His heart is as noble and courageous as that of a lion, and he’s a very sweet man too. I thank him for all the support he gives me and for the patience he bears with me, for I acknowledge that I’ve a rather bad temper.

Many survivors and dissident thinkers unite under the umbrella of heresy. Ours is not an elite club based on accumulation of credits for what you do. It’s about being what one believes one ought to be. I’m not here to get a certificate of attendance. I’m here because I am what I am, and I want to share it with you. We heretics don’t think in terms of social status or academic credentials, we value human qualities most of all. And most of us are economically poor people, and we feel really bad when we’re censored and set aside, because we don’t have equal opportunities, many of us have been rendered destitute by psychiatric interventions and stigma!

I hope this digression helps you grasp the spirit that animates many survivors who attack psychiatry. Understanding others is a great accomplishment, and psychiatric survivors are mainly people who are very rich inside, and they represent the civilizing force of present day heresy.

Let’s go back to the issue of diagnoses being a paternalistic counteroffensive to freedom of choice.

Choice and Pyschorehabilitation

Choice was a central pivot of psychological interventions: the therapist sought means of expanding clients’ choices, to overcome the conditions that caused sufferance, or what the client defined as ‘cause of sufferance.’ Now, psychologists have compromised with the medical model. They accept forcibly hospitalized patients who are denied the basic choice of therapeutic contract: i.e., consent to enter therapy. The general attitude in psycho rehab programs is that if the patient is consentient that is better, if not … well, never mind. Psychiatric drugs are given for granted as part of the therapy. There is no longer enthusiasm in the psychological profession, there is no more life to it.

Coercion is the denial of individual choice. Freedom isn’t really freedom if the individual doesn’t own himself and doesn’t enjoy the right to choose, by himself for himself. Freedom of choice implies that some people might make choices we might disapprove of, like suicide or drugs consumption, and so on. I understand the urge people feel to intervene in such choices, especially when they are carried out by beloved ones, but we need to understand that our duty and responsibility to help others exhausts itself with the simple act of offering and rendering available this help, or else we’ll keep falling in the paternalistic trap of justifying coercion and stigma.

Beware- I’m not saying this out of theoretical conjectures! My mother took the emergency exit of fatal freedom, after a lifetime of psychiatric tortures. Of course I miss her very much, and I wish she was here. But I can’t condemn her choice. This world is going nuts; violence, racism and social indifference are the norm. How can

we blame intelligent people who decide that living is not worth the pain it demands?

The foundation of our arguments is the issue of freedom

Any “scientific” discussion that does not drag into the discussion arena the underlying ideological and operative paradigm, is nothing less than an escape from responsibility.

I’m sure my intervention can be easily dismissed since freedom and politics should not be part of a medical congress agenda, unless it’s a conference on ethics. The point is that when medicine (or psychology) deprive people of freedom and consent to treatment, liberty becomes an issue to be faced.

I can’t think of any genuine way of dealing with it other than taking it as a political issue. If you recognize us as human being, and not patients, then you’ll have to recognize that we should enjoy inalienable human rights. Yet, psychiatric alienation disrupts these rights and calls for a mandate that overlooks them. This is precisely what makes psychiatrists alienists and us aliens.

The global effort to establish special rights for the ‘mentally ill’ is an attempt to officialize deprivation of human rights for a subclass of outcasts. The IAAPA has launched a campaign entitled because human rights are indivisible. There is no medical condition - true or false - that can justify the implementation of different criteria in human rights for any individual.

Conclusion

To conclude, I invite you to consider that the urge, which many people feel, to treat the alleged mentally sick is not really a primary question in this world, as it is claimed. I’m

not saying that helping suffering people is not an issue. Of course it is! What I’m saying is that I firmly believe that ‘hearing inexistent voices’ or ‘seeing inexistent things’ is not as grave as not being able to see what is in front of our eyes, or not being honest enough to listen full length to the voice of those who suffered under psychiatry.

If our intellectuals and scientists fail to see this, we’ll be doomed to witness once more the historical horrors of the holocaust, mass sterilizations, and silent genocides in the name of medicine.

Please take in serious consideration this appeal of mine to stop and rethink over your mission of psychosocial rehabilitation. Don’t value medicine above freedom, don’t value your profession above your humanity.

I’d like to finish my discourse by wholeheartedly thanking Dr. Tibaldi, my psychiatrist, who never ceased supporting me, despite my terrible character and bad temper, and believed in me as a person when even my closest friends abandoned me to my psychiatric destiny.

As a closing statement, I’ll offer you a quotation from Yevgeny Zamyatin:

“The world is kept alive only by heretics … Our symbol of faith is heresy: tomorrow is inevitably heresy to today … Yesterday, there was a tsar, and there were slaves; today there is no tsar, but the slaves remain; tomorrow there will be only tsars. We march in the name of tomorrow’s free man — the royal man. We have lived through the epoch of suppression of the masses; we are living in an epoch of suppression of the individual in the name of the masses; tomorrow will bring the liberation of the individual — in the name of man. … The only weapon worthy of man — of tomorrow’s man — is the word.

1) Self-directed

Client sets the goals

Responsibility to provide full information

Connecting people to their own lives and dreams

2) Person – centered or individualized

Appreciative of self responsibility

Building on hope

Innovation and creativity in program development

3. Empowerment based

Working towards systemic change

Enabling the client to be at the center of her own life and choices

4. Holistic

Addressing the whole person

Addressing real life needs

5. Non-linear

Pacing with the individual through recovery (temporality)

Enabling client to define her own “progress”

6. Strengths based

Based on what the person can do rather than on what she cannot

7. Peer support

Seeing the user as not just needing help, but also able to share experiences and learnings

The value of lived experience in program development and clinical thinking

8. Respect

Users as citizens

Recognition and making pathways to ensure and protect human rights

Individuals as agentive in their own lives and choices

Addressing issues of stigma and discrimination

A recovery program would appreciate the fact that people are responsible for their own lives, decisions and risk taking2. Professionals must take a supportive and facilitatory role in assisting the individual to make choices. The recovery model shifts power relationships, from one of control to one of collaboration. People may need necessary assistance in even learning how to make decisions. “Learned helplessness” is a real and debilitating problem. The response to this disability is to not make those decisions oneself, but rather to have a keen and tight practical definition of “necessary assistance”. Knowing when to step in and when to step out is always a difficult process. There are everyday learnings here for the caring professional from every user. The professional must work on the basis of the belief that tomorrow will be different from today, or the same, for this user, depending on her choice for that day. Users are always highly appreciative of that “someone who believed in me, even when I did not believe in myself”. The peer support model, developed by user / survivors in many parts of the world, is a useful model to demonstrate the validity and usefulness of these recovery principles.

To sum up, “recovery” is more than just a new word or a new paradigm shift. The notion conveys the collective power of the user / survivor movement. The recovery philosophy shows that users are active agents of change, rather than passive recipients of services. Not only their change process is effective internally, but also at the systemic level. Therefore recovery is charged with political content for

the user / survivor movement around the world. The user / survivors are in a position to give to the world, and to healing systems, from their visions, insights and experiences. This view of political action, community, self and the world, does not allow for any coercion whatsoever. She was not against anyone choosing the medical model, but would be concerned about the quality of “choice” involved in many conventional treatments.

Judi Chamberlin finished with the user / survivor slogan of “Nothing about us without us!!”

	By Bhargavi Davar

I want to describe to you a healing experience my research team witnessed during one of our studies in Maharashtra, conducted at a traditional healing center (a dargah).

“On day 1, we heard a girl screaming at the top of her voice. She was sitting outside a hut built on the edge of the hill. She had wild open hair. She seemed to be around 16 years of age. From what we could make out, she looked extremely excitable, violent and uncontrollable, an “unmanageable patient” in modern psychiatric description. This would be considered as a psychiatric emergency.

“On the next day’s visit, we encountered her on our way down from the hill. She was sitting outside the hut, tied to a huge boulder. She was dressed in rags and her hair was loose. She was in a completely manic condition. She was singing and shouting. She asked us to remove her chains and in the same breath turned loose a volley of abuses on us, most of which we thankfully did not understand. She was extremely furious: we thought.

“The next day, she was lying on the floor of shrine, her foot chained to the railing. She was shouting and singing loudly again. As soon as she saw us, she became excited and started screaming out abuses at us all over again.

“The next day, we saw her mother bring her to the shrine holding her chain tightly. She was walking around the shrine touching its outside walls. She looked better. Her hair was combed and tied. She had stopped shouting and singing. However, she was still excited, talking and laughing to herself. In the

afternoon we saw her sitting quietly in a corner eating her food.

“When we went the next time (some 4 or 5 days later), she was unrecog-nizable. She was carrying something in her hands to the main shrine. Her hair was combed neatly, her face was clean, her expression serious, her clothes clean and neatly worn, her feet in slippers. We came face to face with her but there was no recognition in her eyes.”

Had she been “cured” of whatever she was afflicted with? We had no answer, but she did not seem anymore like a “violent, unmana-geable patient”.

I propose that the cultural healing places, such as the one I have just described, are “therapeutic communities”. These places nurture people in their existential quest for emotional and spiritual growth. The Indian law (The Mental Health Act of 1987) allows only mental hospitals to be const-ructed. Recent judgements by the Supreme Court

also order the construction of more mental hospitals. The mental health professionals, policy makers and legal officers are presently debating whether the traditional healing centers, which are non-medical and recovery oriented, should be shut down, and the persons who are suffering from psycho-social disabilities, such as the girl above, should be sent to the mental hospitals.

Why do we want to shut down the traditional healing centers and start more mental hospitals? Is there any benefit of doing this for persons with psychosocial disabilities? Mental hospitals in India, which are seen as “modern”, reduce people to a vegetative state, keeping them over drugged, cutting them off from family and society, and killing all their natural creativity and will for life. “Stigma” of “mentally ill patients” is created by these institutions. People shut away in these institutions are seen as “incapable”, soon becoming deskilled and dropping out of life, all their civil, political and socio-economic rights being taken away from them.

Whereas a rather large class of pre-modern institutions exist, which address the health and well being needs of the people that they are serving. These institutions have their spaces and philosophies organized around experiences of illness, recovery and personal growth, and not “mental illness”. People who come there are not labeled with “mental illness”, though many bring emotional and other difficulties. Inbuilt into the value system of such centers is a respect for each person’s capacity, as a person is fully involved in their own recovery process in many ways, importantly through the performance of ritual.

Most important of all, the centers value voluntarism and choice, unlike what is permissible under the Mental Health Act.

Each center has its own philosophy, but some common themes related to personal recovery are: linkage to life, community, nature, to other human beings, to their own self expression and to the cosmos / some transcendental dimension. In these institutions, health is spirituality, and spirituality, health. Health is mind / spirit / body, altogether. There is no “mental” separately from the bodily and the cosmological.

It was amazing for us to see the number of institutions and the number of people who exist, who are struggling with the personal, and inter-personal, philosophical and existential questions of life and are seeking, if not finding, answers through these centers. They are not seen as “incapable” people. The center acts as a “retreat” for these people to find themselves and move on in their lives.

Compared to the mental hospitals, cultural healing centers are very accessible in all parts of the State to all kinds of people. Further, these are not “paid” services in the sense of the free market. Here, pre-capitalistic economies work, leaving much economic decision on the individuals using the centers. Each center is known for its powers to cure something specific: e.g. distress caused by infertility or alcohol addiction.

The principles of architecture of most of these local healing centers deserve to be copied by the “modern” mental health care system. The mental hospitals, being an involuntary system, typically have barracks, with closed wards. A very small area remains open or accessed by the clients. Family members are not allowed to visit the closed wards or the inner wards, being limited to certain

specified visiting areas. What Michel Foucault had described as the “panoptican” remains in most of the colonial, custodial, penal institutions, including the mental hospitals. This type of architecture is built on a vigilance and policing model of care, whereby the wards, the barracks and the spaces of the institution are organized around a central authority. There would typically be a large building with wards extending from the center outwards, as wings, with security systems to be managed from the center. Peripheral grounds would house the less core facilities, such as the rehabilitation ward or the recreation room. Common areas would be restricted to inmates and the time of lock up would rarely allow for free movement. High walls, gates and other security measures such as steel grids, locks, wires other than measures for personal restraint, such as cage like cells for seclusion / solitary confinement, are commonly found. Restricted flow of air and ventilation would be ensured by the small or highly secure windows, making the rooms dinghy and damp. Spaces are not personalized, as everyone is herded together from one ward to another for pre-defined purposes (e.g. dining). Spaces are defined functionally with respect to what activity or treatment will happen where, rather than around the lives and routines of clients. Due to this, personal lives are not individualized but rather regimented. There are often no redeeming sensory features in these institutions, and clients are routinely exposed to bare walls, iron grills, and a colourless life within the wards. To go and visit the garden, see the sky or experience the sunlight is an “outing” for the clients- a part of the structure of daily or weekly activities, if at all, and not a part of life. The doctor’s / service providers’ areas and the client areas are highly bounded and separated. Spaces are organized in such a way to reflect the hierarchy between doctors and clients.

Spaces are also organized in such a way that the clients will not Escape, Die or commit Suicide, a typical pattern of behaviour that we have called the “EDS syndrome” in our other work.

In complete contrast to this, we have found the local healing centers to be community spaces, open and airy. Of course we did not see high walls, wires, grills, and locks anywhere!! There were no solitary cells anywhere. Shock treatments and solitary confinement are for me still the most barbaric of all possible treatments that I have seen anywhere, and we have studied at least 20 traditional healing centers in great detail. People come and go as they please, and they choose where they want to go. This in itself is the evidence of the voluntary nature of these institutions.

The entry into a mental hospital, unlike a local healing center, is violative of human dignity. The family often commits fraud and brings the client per force. The admission procedure is corrupt, as the officials can be bribed into making wrongful admissions. The risk of “dangerousness” is usually more imputed than real, as there is naiveté and bias regarding risk assessment.

In the mental hospitals, people can be shut away for days, weeks, even months together, in solitary confinement or kept in physical restraint until they are dubbed “beyond recovery”. They become the invisible population, the people that visitors are not allowed to see, people occupying the darkest parts of even the most sparkling mental hospitals in India. These people are branded “violent” and “dangerous” and run the high risk of repeated punishments for their imputed reactiveness by the mental health care system. Other than the label of mental illness, they also have to carry the label of being socio-paths. Staffers shun them, and violate their human rights (e.g. beatings and

withdrawal of benefits). They do not see other people, the sunlight, or the world outside. They have no access to toilets and have to live in their own waste. The staffers very rarely visit these people, and exhibit fear and anxiety, or worse, anger and brutality, in the face of the patient’s violence. The staffers are not relaxed people at all. They are taught to protect themselves from the patient’s real or imputed violence. They are taught simple tricks to protect themselves from the violence: stay near the door way, do not make eye contact, do not touch, keep your back to the wall, keep distance, etc. etc. Such lessons are indicators of the overall anxiety about violence in institutions, and shows up the staffers as powerless and fearful people. Therefore, the healing model slips into the punishment model, as the problem is seen to be within the patients, and somehow it must be controlled by the weaker staffers. This fearful attitude actually diminishes the patient even further, making him or her feel beastly.

In the local healing sites, people who were seen as violent and dangerous, such as the girl described above, were out there in the open, in front of everybody, posing a moral question to the community all the time. They were tied to a tree or a stairway, but they maintained their interactions with the community. The community was left to deal with the shouts and abuses, the tearing of clothes, etc. The community also had the moral obligation of seeing that such lives are maintained and some personal needs are provided for (including a bit of the sky). They were not forgotten people.

People with a universal human rights perspective may say that tying up the girl with chains around a stair way was a violation. Of course it is. We are not romanticizing the girl’s plight at all. I am also aware of the

community dynamics which results in someone being brought to these centers and being tied up.

But if the proposed alternative is that we take her to a mental hospital, that would be a bigger and grosser human rights violation. The local healing centers deal with personal agitation, anger and violence, in gentler and often non-violent ways, finding ways and means of bringing the person back to the community quickly and in a way that does not fully rob the person of dignity, freedom and liberty. Dealing with violence in a ritualized manner, through non-violent and playful means, may be a strategy that mental institutions can learn from these healing centers.

In these centers, violence is dealt with in a ritualized manner, as a part of the Grand Play by the Deity or by Destiny. Ritualised dealing of violence, as happens in these centers, does not objectify the violence as a part of the person. Violence is a part of the overall delusion of existence and attachment to this in a personal way was not necessary. The cosmology of health attributed the people’s violence to external causes (e.g. spirit or demon) and so individual labeling or crimina-lizing did not happen.

The experienced mujawars and the healers had sufficient inner stability, skill and confidence in their practice and in their healing traditions, to tame the angry spirits or the demons, and return the person intact and whole to the community. Healers who believe they are protected by the divine are not afraid of human follies. They do not exhibit anger or anxiety or fear when confronted with the violence of the evil spirit.

An angry and evil spirit spelt trouble and destruction for the whole community, not just for the person.

So the community had a stake in the safe return of their relative. They were only too happy to participate in driving out the angry spirit and have their relative back intact. Also, they have faith in the presence of the divine in the mujawar. This is evident in the way the mujawar reflects off knowledge, confidence and power, instead of fear and anxiety. They remain reassured by the mujawar’s demeanor. In this sense, any imputed or actual violence happening in the context of suffering is understood as such, as an indicator of external evil forces, and as a community issue, and remedies sought within the healing and ritualized framework, rather than the individualistic punishment framework.
The segregation of users of the services and the families, found in modern institutions, is not found anywhere. People visiting have access to all parts of these centers. There are also no division of spaces between the healers and the users, and their families. Community healing spaces exist where everyone participates equally, although under the directorship of the healer.

There is great attention paid to the celebration of the deity or the saint, which reflects in the architecture. Particularly, the sufi shrines are very beautiful structures, full of colour and fine decorative work in vivid and celebratory colours. Visitors are exposed to a variety of sensory inputs in the architecture and in the ritual practices. Spaces are organized in a seemless and negotiable manner, suited to human living, and survival, community negotiations and bonding, and also expression of illness and recovery, rather than being to tied to a curative perspective, that in this room or that ward, such and such treatment will happen. The healers do not interfere or intrude upon the non-ritual parts of people’s community lives.

becomes healing in the forms of the sheep. The highest form of voluntarism for users is found in this sect. The “modern” system restricts the mobility of users, whereas, in this sect, also typical, users’ mobility is expanded tremendously. The users, who seek their own recovery, by joining this group of wanderers, wander and journey with sheep, caring for them. It is believed that the sheep have miraculous healing powers. This, to me, is a most beautiful metaphor for personal journeys. “Wandering” is treated derogatorily within the modern psychiatric discourse, even deserving of a label of psycho-pathology (psychosis). This leads to large scale involuntary commitments and forced institutionalizations. However, in this sect, troubled people live in the freedom and space of nature, as wandering pastors, their lives anchored to and their experiences shaped by the lives of the sheep. There is a special value attached to such wandering in this cult, the value of being free. Wandering minstrels living on alms alone are found singly or in groups in many of these centers, and the large open spaces available within and surrounding the shrine allow for their stay and transit.

We are not romanticizing poverty or homelessness here, but pointing to the fact that from another kind of imagination, literally, wandering has led to a spiritual re-opening for at least some people.

We also observed that in most of the healing shrines, healing is organized in order to cater to community healing, rather than to individualized healing. Small, clinic type of arrangements is not found. There seems to be an underlying philosophy that “I remain well only if my friends, neighbours and relatives, my ancestors, my extended community, nature, and

god, remains well”. Large open spaces were congregations of sufferers and others at the time of the healing sermon or aarti and there was space for the expression of appropriate behaviours at this time: celebrations, dancing, trance, drumming, chanting, possession, mediumship, etc. Particularly in Nandre, the healing séance is an intense form of group therapy, even psychodrama, for which space and time have been apportioned and structured in a requisite manner.

There are bystanders, but most if not all, are there with a personal purpose and can feel an engagement with the healing séance. The identities of who is a sufferer and who a family member or care giver, and who is a by stander, becomes merged. The healing spaces are so organized that they do not isolate any person as the “primary client”, indexing that person as “mentally ill” and leading to the risks of psychiatric labelling. Everybody involved in the ritual healing assumes a part of the responsibility in the healing. It is allowed in the local healing centers that healing is primarily interactional, (involving the interactions of human and non-human systems), and the working spaces where healing actions take place are organized in congruence with this outlook.

Here, it is necessary to reflect on the ethical principles of “privacy” and “confidentiality” which inspires much healing work. Much of the traditional healing happens in public, before everybody. How to relate to this becomes a dilemma. Is it alright for a healer to ask a woman about her being battered in front of everyone? Does she feel shamed to speak out in public? Does an alcohol addict feel shamed to speak out in public and to be confronted or admonished in public, before strangers, by the healer? We are not clear what the

potential through harmony of the mind / body / social environment / spirituality. The values of freedom, liberty and choice are vital for any system of health care to be nourishing. Mental health systems (inclusive of law) should be congruent with these fundamental values. Laws and institutions in India are anti-therapeutic, and are largely based on a penal model of crime and punishment, leading up

and sometimes with sadness over, as he says, “the opportunities I was robbed of by my voices.” This book sharpened my awareness of what it means to be wandering, ill, scared and strong all at once. I was most amazed reading about how Kenneth often alternated between being a wandering ill man who used shelters to being an extremely impressive mental health advocate.

This is the first time I read about user-led advocacy, which - to me - is advocacy from the trenches. Kenneth Steele described firsthand not only his descent into madness but also his journey through this darkness, and then his re-entry into the light. The synopses behind the book says that this story is about ‘…Steele’s hard-won recovery from schizophrenia and how activism and advocacy helped him regain his sanity.’ I think this is the most accurate description of the book. As Kenneth learned to fight the voices within, he empowered himself and others to fight the system that left them behind because of their illness. His fight outside fueled the fight within.

This book describes his parallel journeys as a user and a mental health advocate and keeps you in touch with the deeply personal issues and the political issues that make up the mental health system. Kenneth’s story is of a man who endured the kind of mental health system we advocate against, and simultaneously experienced the kind of system we would like to instate. He describes numerous doctors, therapists, nurses who cheered him on as he found himself. He describes tiny ways that he would run into his selfhood, like the time he voluntarily admitted himself into a hospital and was asked to clean himself up. He describes the routine shower and you, as a reader, suddenly realize how he had exoticised the domestic (to borrow a phrase from Narrative therapy).

“It felt wonderful to soap myself down, wash my hair by myself, dry myself off…my self. Each detail of my grooming – liquid soap, mentholated toothpaste, mint-flavoured mouthwash – was a gift, recognition that I was a human being”.

on, just as it egged on the people who turned to him for advice after reading or hearing his interviews about surviving schizophrenia. Giving interviews was a conscious decision he took in order to provide a face to the work he wanted to do as a mental health advocate.

His political awakening came when he realized that many people were demanding that there needed to be a reduction in the amount of money the government spent on welfare schemes for people with illness. Kenneth felt that the consequences of such cutbacks could include landing many people in jail or on the streets. Then he heard Mario Cuomo, the Senator of New York announce his support for community mental health services and also heard him announce that though this support was the most compassionate thing to do it was not a smart political act because people who supported his act did not vote. When the Senator lost, Kenneth describes his anger at the fact that the group the Senator had supported was not in a position to reward his courage with the votes he deserved. This anger was the genesis for the Mental Health Voter Empowerment Project

Becoming a mental health advocate put him in a position to answer questions of users, carers, service providers and, in some cosmic sense, make up for the answers most people did not have when he was ill. Answering questions was sometimes accompanied by a sense of loss over what he did not get because people did not know what he needed. He mentions this at one point,

“If my parents had stayed by my side from early on, if they’d supported me, who knows what a different course my illness might have taken. I wish someone in authority had given them the advice I now offer to parents of young people with mental illness- parents who are concerned because their sons and daughters are

isolating themselves, behaving erratically, not taking their medication, or are hospitalized. I tell them to continue to offer support, to let their children know they are there for them, but to take care of themselves as well. I also advise them (whenever possible) to share the care, to involve other family members in helping the sick person, so that they don’t burn out”.

As a service provider, I often face dilemmas about the best course of action with clients who ‘resist treatment’, I wonder whether it is ethical to let someone live with hallucinatory voices when I know there is another way of being. Kenneth seemed to speak to me when he responded to a psychiatrist who asked him what to do about patients who denied being ill and refused medication. This is what Kenneth said,

“This is the question I’m asked most often by doctors and it’s the hardest to answer because it deals with relationships and attitudes. Mental health professionals need to view the patient as a part of the treatment process, not the patient as the object of the process. A patient who trusts a doctor, and who is trusted, is more likely to comply with a proposed plan of treatment. But I understand your frustration as a physician. Sometimes the patient has to sink to the bottom before he decides that he does not want to drown and reaches for a lifeline. I hope you’ll be there for him then.”

When I read this passage, I was moved not only by Kenneth’s empathy for the person who posed the question but also by what he was saying on behalf of many users, that we need to be participants in the process and not passive recipients of it.

This book is filled with many such moments. I hope you will read it and you too will find the answers you are looking for.

	Bonnie Chernin

Your lover confides in you how much he respects your stability, unlike his mother, his sister, and his sister-in-law, who have a tendency to overreact to the slightest inconvenience. You wonder if your lover is about to do some overreacting himself. Expect it. You think about what words to use. You imagine the direct approach. “Honey, I have schizophrenia.” You hear the word. It sounds clinical, and you like the matter-of-factness. But then you remember its misconceptions: split personality, dangerous, chronically dysfunctional. You have a connected self, you wouldn’t step on an ant let alone assault someone, and hold down a full-time job, rent your own apartment, and have paid off your car.

You rethink this scene. “Honey, you know, I’ve been psychotic.” You like the truth behind this statement, a state of mind that reflects the confusion you had felt. Like the time you believed the “exit” sign was not a direction showing the way out, but a command for you to leave. Immediately.

You remember the time you said the word “psychotic” to a friend. The friend had looked scared. You decide to find another expression, something less threatening.

“Darling,” you picture yourself saying, “I’ve been sick.” You use the term ‘sick’ when you don’t want anyone to know what you are talking about. Like when people ask why it took you eight years to finish college. A euphemism, something to say when you want to hide. But this is your lover. You want to be open. So you search for something else. “Dear,” you envision again, “I’m mentally ill.” You wonder about that. Because sometimes you are mentally well, like say, for the last six years. Consider qualifying it by

adding, “occasionally I was mentally ill.” You realize that this applies to the entire human race.  

Immediately dismiss the o-words: psycho, schizo, wacko, loco, that automatically discount you or anyone else human.  Wonder about the colloquial idioms: freaked out, over the edge, breaking down. You feel attracted to them because they convey a temporary lapse, something to return from, which is true for you. Come to understand that these are casual blue jean words - washed and worn everyday and applied to anything from a broken fingernail to a drug overdose. Ignore silly slang, bonkers and crackpot, as well as food imagery- crackers, nuts, and bananas.

You consider explaining: “There was a time when I was out of my mind. I sat on the floor of my kitchen for an hour and did not know where I was, did not know who I was, did not feel myself in my body.” Recognize that as much as you wanted to be out of your mind, you were hopelessly within it at all times.

Then, you think, “that sounds abstract” and figure he’ll want something concrete. So get specific. “Sweetheart, I’ve been paranoid, grandiose, and deluded sometimes all at once. I believed my father wanted to kill me with his special chicken recipe, special for its secret poison that could murder me only but not the rest of the family who ate it. I thought Reagan was elected in 1980 because I was in the hospital and could not vote against him, and if only I could have cast my ballot, the whole course of American history would have changed. I thought if I read the obituaries at night I would understand what was in store for the new babies born the next day, new

lives to take up where the old ones departed.”

Feel surprised by how these beliefs once felt like reality bound around your arms like Teflon, and now seem distant, old dreams that have lost their powerful hold? Despair of the English language, encumbered with history, loaded with preconceptions, to express meaning for you. You try other tongues and discover words like meshugana, loca, folle, suma-shedshaya, bezumtsa, wariatka. You like the sound of them, but you know they’re lacking too. Make your own words, biot