Journal of Theoretical and Philosophical Psychology

2014, Vol. 34, No. 1, 28 40

2014 American Psychological Association

1068-8471/14/$12.00 DOI: 10.1037/a0032841

Madness and Justice

Ian Parker

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University of Leicester
This article makes the case for social justice in relation to the conceptions of
madness that currently operate in mental health practice. The argument proceeds in
eight steps which challenge dominant views of madness in the discipline of psychology. Each of these eight steps is linked to the question of social justice. The first step
concerns the irresolvable differences between models of madness, with a focus here
on four mainstream models: the psychiatric medical model, psychoanalytic conceptions
of psychosis, systemic interventions into family systems, and cognitive behavioral
therapy approaches. The second step concerns the differences internal to each of these
models. In the third step I identify a fifth model which is usually occluded in
psychological debate, the model madness elaborates of itself. The article then turns to
the social conditions that structure different models of madness. Step four of the
argument is to emphasize the way that models of madness are embedded in structures
of power and point five steps back to the historical separation of reason from unreason
as condition of possibility for madness as such to be configured as object of
psychology. Step six is concerned with the madness of contemporary social reality,
and step seven with the way that this socially structured madness informs clinical
practice. The eighth step is to draw attention to already-existing alternative social
practices; social justice in action organized by and for the mental health system user and
survivor movements.
Keywords: madness, psychosis, social justice, Foucault, Marxism

Different approaches to madness sometimes lead to conflicts between academic psychologists, and between professionals involved
in mental health services. The different ways of
understanding it, which are sometimes configured in psychology textbooks as competing
models of madness, also sometimes lead to
conflict between professionals and their clients,
and even between those who are given a variety
of diagnostic labels and accept or refuse to
accept what they have been told about themselves. These conflicts are sometimes despite or
perhaps because we do not really know what
it is.

This article takes the term madness as a

shorthand to cover the variety of ways that
academics, professionals, and users of mental
health services debate how mental health and
distress should be understood, and it explores
consequences of the difference of perspective
for social justice. The term madness is useful
because it spans a number of different approaches and for all of the problems of playing
into stereotypical images of the mad (which I
address in the course of this article), it is precisely because it is a colloquial term that it can
function as a more inclusive and accessible reference point for debates that are connected with
social action. The term psychosis, for example, which is favored as a term by many professionals today around which they can discuss
the value of different treatment modalities already sounds to me, at least, a little more definite, sure of what we are getting at, and I dont
think we can be so sure (Bentall, 2004). The
term madness is disturbing to some practitioners, and to some users of mental health services, but is claimed and even celebrated by
others (Curtis, Dellar, Leslie, & Watson, 2000).

I thank my friends in Asylum: Magazine for Democratic

Psychiatry for their support for this and much more besides
in the past year.
Correspondence concerning this article should be addressed to Ian Parker, Professor of Management, School of
Management, University of Leicester, Ken Edwards Building, University Road, Leicester, LE1 7RH, United Kingdom. E-mail: discourseunit@[Link]
28

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MADNESS AND JUSTICE

My starting point is that a minimal point of

agreement between researchers and practitioners within different models is that there are
huge differences between ways of understanding madness, between different approaches to,
or models of madness. That difference of
approach is one reason why it is good to have
multiple perspectives on it, but I am not so sure
that practitioners of the medical model, cognitive behavioral therapy (CBT), systemic approaches, and psychoanalysis (to name four
main approaches taken today) agree that their
different perspectives are even perspectives on
the same thing. Perhaps all that can be agreed
upon as a first step is that there are big, perhaps
irresolvable, differences between the perspectives.
Those differences are grounded in the distinctive ontology and epistemology of our own particular favorite approach, and differences over
ontology and epistemology have massive consequences for social policy, treatment, and social justice. Ontology is about the nature of
being itself, what we understand the things in
the world to be, and here what we understand
the human being, the human subject to be. Different ontologies carry fundamentally different
notions of what human beings are. Epistemology refers to the nature of knowledge, how we
think we can develop knowledge about those
things that our ontology gives us a model for.
Not only are there differences over the nature of
things concerning madness, but over how we
can come to know what they are, what the
criteria for creating knowledge of them are.
It makes a big difference, for example, if we
think that the nature of the human being as
biological organism is the stuff we should be
targeting, if that is our ontology, for then we
will be developing our knowledge through drug
trials. This particular process of knowledge production is an epistemology, a way of getting
knowledge about what madness is as a chemical
imbalance deficit, excess, perhapsthat is
entirely independent of what someone labeled
mad thinks about it. The knowledge of the mad
about who they are, their own expertise, is completely irrelevant to what academic or professional psychologists think they can know about
the things in the world that matter to us if we are
working in a medical model. A CBT perspective also rests on a particular view of the beings
that matter to it, individual thinking beings al-

29

beit with some perceptual or mental processing

faults that can be corrected. The procedures we
use to understand what works and what does not
work as education or training to help people
manage their behavior are things we will come
to understand through a certain kind of knowledge, knowledge of cognitive modeling and
processes that are usually independent of what
the practitioner thinks about them. The procedures work or they do not work and they can be
evaluated scientifically. It is a perspective
which presupposes the nature of its object and
the nature of knowledge about that object, ontology, and epistemology (Loewenthal &
House, 2010).
Briefly put, a systemic approach usually relies on ontology of structured relationships and
that is what matters to that approach. The
knowledge it develops of those systems and
how to intervene in them is the kind of epistemology in which the observer is part of the
equation, part of the system, part of the knowledge. Finally, and with respect to the fourth of
the approaches that will be considered in this
article, psychoanalysis rests on an ontology of a
human subject divided, torn between what they
desire and what they can get, between the unconscious and what they are directly aware of.
That perspective means that the knowledge we
could have of madness cannot be complete but
is infused with our desire to know, to understand, and also, psychoanalysts would argue,
suffused with our desire not to understand, not
to know.
There are, of course, some links between
these different approaches and attempts to stitch
over the differences between them. Those links
are often what enable academics and practitioners with different perspectives to come together from time to time and try to map out
some common ground. Some psychoanalysts,
for example, are still very much tied to the
medical model, yet some are trying to make
links with CBT. Some systemic practitioners
look to psychoanalysis, to what they call the
intrapsychic as an account of what is going on
inside individual members of social systems,
and others link with cognitive behavioral accounts of systems. But eventually we notice that
there is a deadlock in these meetings of different
approaches, a failure to agree.
The connection between the perspectives was
where this article could have begun and that

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PARKER

would have been a more ostensibly consensual

and constructive place to start (Fozooni, 2010).
The concern of psychologists who wish to bring
a social justice dimension into their work is
quite understandably often geared to what proponents of different approaches have in common as a starting point and with how it might be
possible to build an inclusive general approach
in which we could all work. But social justice
for the mad, for those who are described by
psychologists of different kinds, requires a more
abrasive approach. The difference between perspectives is where we have to start and then we
have to learn to live with that.
A consequence of this starting point is that
social justice is predicated not on a harmonious
shared vision of what problems in the world are
or how distress at the level of the individual
should be understood and treated. Rather, we
attend to conflict between academic and professional perspectives and we work those differences in order to open up a space for those who
are subject to psychology to speak about what is
being done to them (Chamberlin, 1990). A
premise of social justice from the standpoint of
those who are speaking for themselves is that
we do not require them to speak the same language as us as a condition for being heard and
that we acknowledge that there is no common
language for describing madness inside psychology. Psychology as such is internally contradictory, molded to different political
economic conditions, and recognition of this
makes resistance to psychology possible in the
form of critical psychology and by allied approaches that would not choose to adopt that
term because it too is internally contradictory
(Parker, 2007).
Difference Within the Models of Madness
The second point I want to make intensifies
this argument, takes it further, and is that there
are big irreconcilable differences inside each of
the models. This second step in the argument
might seem to make things worse in some ways
and it does make things worse for the academics
and practitioner psychologists. The fact that
there are irreconcilable differences within each
of the models is actually good for the rival
approaches; advocates of one model can then sit
back and watch their colleagues tear themselves
apart without having to do the work themselves.

In the case of psychoanalysis, there are a

multitude of perspectives and very little agreement between adherents of different traditions
attempting to comprehend and treat what is
usually termed psychosis. At a most basic
level, again at the level of assumptions about
ontology and epistemology, there is a huge gulf
between the Kleinian psychoanalysts, for example, who see splitting and projection as
evidence that every human subject is a bit mad,
has something psychotic as part of them
(Young, 1994), and Lacanian psychoanalysts
who argue that there is a specific clinical structure, psychotic structure that makes this kind
of subject quite different from a neurotic
(Lacan, 1981/1993). Within the Lacanian camp
there is a further division, between those who
will argue that psychotics do not have an unconscious as such, and then this means that if
there is no unconscious there is no subject
(Fink, 1997). This position is in stark contrast
with those who will say that this is still a subject
who lives their relation to the unconscious as
one of the faces of the normal structure, as
Lacan (19611962, p. 11) puts it.
Inside the systemic tradition there have been
big debates about what it means that someone in
a family has been made into the identified
patient, the one who is ill, but who is made to
carry the disorder of the family system as if it is
inside them (Selvini, Boscolo, Cecchin, &
Prata, 1980). And out of those debates, the
narrative therapy approach would ask how it is
that certain kinds of families are themselves
treated as problems within wider sets of discourses (White, 1989). Here there is an opening
to a fully social, discursive approach to what
pathology is, how it is created, and who is made
to carry the can for it (Parker, 1999). Then again
you have a countertrend that argues that still
there is this narrative operating at a cognitive
behavioral level, inside the individual. There is
then a connection with CBT, but that connection again itself begs the question about what
CBT really is, and to what extent the practitioner reflexively uses the approach to include the
impact of shared faulty thinking about the nature of illness and health, or whether they do
want to keep the treatment in the tracks of a
journey from disorder to what is now called
recovery (Walsh, Stevenson, Cutcliffe, &
Zinck, 2008).

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MADNESS AND JUSTICE

Inside the medical tradition, what looks to be

quite closed and certain from the outside, is a
field of debate, of dispute. This dispute ranges
from the underlying ground rules about how
pathology should be categorized to disputes
over what is happening inside those who are
given treatment. Most psychiatrists working in
the medical model, for example, use the American Psychiatric Associations DSMDiagnostic and Statistical Manual of Mental Disordersas their bible, but this DSM has not only
undergone revision after revision, changing the
framework in which it operates, but it is based
in one particular psychiatric tradition, that of
German psychiatry.
The committee structure of the DSM teams
that are drawing up edition number five is already evident in the tick-box approach used
now, and this also makes it comfortable for
some (not all) CBT practitioners, those kinds of
psychologist who are now working in those
committees. But even back in its origins, there
was a conception of knowledge in the DSM, an
epistemology, which specified that those involved should build their understanding of the
categories (and who fits into them) by way of
observation and accumulation of specific kinds
of symptom (Spiegel, 2005). That approach
within psychiatry is significantly different from
the French tradition which works with a notion
of structure that is approached in a quite different way. A different notion of ontology, of
the way that structure constitutes different kinds
of being means that these medics bypass the
immediate symptoms to grasp the underlying
nature of the subject they meet in the clinic
(Vanheule, 2012).
When we turn to the question of treatment,
we notice an enormous shift in the conception
of what is happening when someone is given
medication. Up until the 1960s it was commonly understood among doctors, psychiatrists,
that the drugs each had their own effects, that
they changed the physiology of the person. This
is a drug-centered view of what happens
(Healy, 2002). The impact of the pharmaceutical companies since the 1960s has changed the
terms of description of what happens, has
shifted psychiatric discourse so that now the
drugs are supposed to be targeting underlying
disease states, correcting imbalances and so on.
This is now a disease-centered approach to
distress that creates and reinforces an ontology

31

of illness, of the illness as what exists and

what should be dealt with (Healy, 2004).
If we shift the discourse back to talk about
what the altered states are that the drugs produce, then we are also led to make use of the
accounts of those who experience them (Moncrieff, 2009). Otherwise, there is no need to
listen to those accounts, they are beside the
point. So, even within the medical approach,
there is an argument about the democratizing of
the approach, to open it to bring the expertise of
those who are given the medication, to weigh up
what the drugs do. Some adherents of these
different approaches are quite flexible, some are
trained in more than one model, and some manage the relation between the competing models
and the bickering inside them well enough. But
all too often there is a closing of ranks against
outsiders, against those from other perspectives,
which seals over the differences in it. But, to
emphasize, as the second point, those differences are there inside the models, and they are
irresolvable.
There are consequences for those attempting
to promote a social justice agenda for those who
are treated as outsiders to these debates, those
to whom the diagnostic labels are applied as if
there is agreement between the professionals in
mental health teams. Social justice for the mad
does not presuppose that there should be a
choice for one particular treatment modality
over others, but that the diversity of perspectives should be made as transparent as possible
(Cresswell & Spandler, 2009). The internal divisions among academic psychologists and
practitioners should be seen as an opportunity
for those who are usually silent in the debates to
be able to participate openly. Only then do we
have the possibility of making those who are
given the labels partners in a dialogue with
those who design the diagnostic systems. The
critical psychiatry movement that anticipated
critical psychology was a lesson in dispute
among the professionals as a sign of health, of
the possibilities of mental health for everyone
else (Ingleby, 1981).
Differences Between the Models and
Madness Itself
I will bring in another model now, a fifth
model. As I do this, it should be noticed that like
each of the main Models I have been talking

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aboutCBT, systemic, psychoanalytic, medicalthis model is internally contradictory

and different experts in this fifth model will
have different competing views. I am not so
concerned with the nature of this model as such
but with the differences between the mainstream models and it. It, the fifth model, is
madness itself. So, the third point I want to
make is that it is necessary to treat madness as
a model of itself, not only because that brings in
the voice of those who are labeled into the mix
of perspectives I am acknowledging here, but
because it enables us to examine how the expert
models relate to it. It is itself also a form of
expertise. People are experts on their own lives,
though they are not always treated as if they are,
and it makes a difference if someone who is
mad can speak about it or not (Bates, 2006).
The problem is that when they speak about it,
when they speak about their experience, they
are too often heard from within the framework
of a particular model, so everything they say is
interpreted, reformulated, and slotted into the
way the practitioner sees the world, into a
worldview, which is what a framework that
specifies what ontology and epistemology we
should take seriously isa worldview. That is
usually the way that these different perspectives
view madness, when they (the professionals) try
to fix it in place so they can cope with it.
Madness cannot win in the face of these strategies. I am not suggesting that madness should
win, or intending to romanticize madness and to
treat this struggle as if it is a zero-sum game.
That is not the issue here. The issue is how each
perspective on madness does, in practice, try to
win and the destructive effect of this attempt to
win on social justice.
So, on the one hand, madness is characterized
both as too disordered, unreasonable, out of
control, and, at the same time it is characterized
as too certain, excessively rigid, a caricature of
reason. The different perspectives on madness
are often difficult to grasp by practitioners
working in other approaches precisely because
of this mixture of flexibility and certainty. Each
of the perspectives on madness appear to the
other perspectives as quite peculiar, incomprehensible or, even at the same time, fixed in a
rigid unassailable view of what madness is
(Newnes, Holmes, & Dunn, 1999, 2001). One
might say that the psychotic discourse that
psychologists try to pin down is actually oper-

ating as a discourse that structures the debates

among the professionals (Hook & Parker,
2002).
When people who are labeled as mad, diagnosed as psychotic professionals might prefer
to say, speak this mixture of flexibility and
certainty is itself treated as a problem. For example, when a conference on hearing voices
was held in Manchester in 1995, we invited
people to come and give papers on their theory
of what it means to hear voices. We let some
psychiatrists and clinical psychologists and psychotherapists come and talk about their own pet
theories. But most of the papers were from
people talking about their own experience and
their own mad theories about that, making use
of telepathy, computer-models, Shamanism and
so on (Parker, Georgaca, Harper, McLaughlin,
& Stowell-Smith, 1995). The conference ended
with a huge row between supporters of different
spiritualist churches. It was a good argument,
more interesting than what you will hear in most
academic and professional conferences. The
point is that it was an argument which showed
us competing models of madness, models as
coherent and supple as the ones we read in the
textbooks and journals. We learned that madness has its own model of itself and the other
models find that difficult to come to terms with,
but we must come to terms with it.
Social justice is only possible when the expertise of those who are theorized about begin
to have their own voices heard in all their complexity and contradictoriness. The demand that
the mad should speak clearly and unequivocally as a condition for being heard is itself
quite unreasonable. As with the dominant
models of madness, the internal contradictoriness of the mental health system user and
survivor movement is a sign of their incompleteness, of the existence of conceptual and
political debate, even of their humanity (Billig,
1987). Social justice requires that we do not set
conditions for participation in mental health services that are unequal, that suppose that those
who speak about their experience are consistent.
Strands of oppositional discursive psychology that are allied to critical psychology have
helped us to take seriously what users of services have always insisted, that their strength
lies in the diversity of perspectives they bring
including a dialectically worked diversityto

MADNESS AND JUSTICE

each of the different positions they adopt

(McLaughlin, 1996).

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The Different Models of Madness Need

to Be Able to Maintain Themselves
The fourth point is about the role of power.
Each of the models needs sources of power to
legitimate their own worldview. It is not enough
to have a good theory. To make the theory stick,
to make enough people believe in it, especially
when it is riddled with contradictions, especially when there are lots of other competing
theories trying their best to do it down, you need
to be able to maintain it and defend it; the psy
complex here operates as an apparatus to enclose the identity of those concerned with mental health, and to divide these professionals
from their objects of inquiry and treatment
(Ingleby, 1985). This is not merely a question of
polite debate. With respect to differences of
opinion which are about what the world is and
how we should understand it, about the nature
of being and knowledge, the stakes of the debate are very high, including for professionals
attempting to mark out a territory against outsiders and against those who seem to work with
outsiders (House & Totton, 2011).
The debates resonate at the heart of our competing views of social order and what we want
(and what we think other people should want).
One only has to step into debates about psychiatry and so-called antipsychiatry to see that
we are in one of those kind of debates with high
stakes (Brown, 1981). And then you see that
discourse should be thought of not as being like
conversation but as like war (Foucault, 2006).
For those of us inside our own garrisons, things
can seem pretty civilized most of the time, and
it is only when we have to do battle with the
other models that things can turn nasty. Take,
for example, the way the pharmaceutical industry sets the agenda for the development of different categories of mental disorder. Many specific categories are formulated not at all on the
basis of what psychiatrists have observed, but
what new drugs seem to be able to remove.
Once a drug works, the category it comes
to define as if it is targeting an already existing
disorder has to be lobbied for, it has to be
marketed, doctors have to be persuaded to prescribe it, and critics have to be silenced. Millions of dollars are spent by the drug companies

33

as part of this process, and they have succeeded

in blocking appointments in universities of people who have argued against them (Healy,
2007). It is a debate conducted with a ruthless
strategy like a war.
And if the medical model has its big battalions through sheer financial power, the other
models have their own sources of support.
Many CBT practitioners are unhappy at the way
a cognitive behavioral quick-fix approach to
happiness has been pushed by governments
keen to get people off incapacity benefit for
long enough to save money, but even so this
State agenda has succeeded in giving CBT far
more power than it had before (Layard, 2006).
If we turn to psychoanalysis, we know that its
institutions have notoriously been adept at protecting their own privilege, using patronage of
wealthy clients to support it when it has been
under threat. It does not always work, but it has
been crucial to the battle to protect the label
psychoanalyst in many countries, and then to
exert control over what are seen as lesser therapies (Parker & Revelli, 2008). Systemic approaches have also had to maintain and defend
themselves and built a following through networks, journals, and links with social work and
welfare systems. (Of course, I should acknowledge that critical psychology such as it is also
has a little niche now in some academic institutions, and for me to make these arguments I
need some kind of support and protection.)
In many countries where there is no system
survivor or user movement, those who are
labeled by the mainstream models have no
voice, or it is a voice that is neutralized and
absorbed by whatever system has been generous
enough to humor it for its own purposes. In
some places now this movement, through the
hearing voices groups or asylum support
groups, does provide spaces, publications for
the voices to have an impact, to join battle
(Romme & Escher, 1993). There is some power
now to these voices, but still pitifully little and
hard-won and this movement still needs to be
fought for to maintain its right to be heard.
The necessary next step for social justice,
therefore, is for the mental health system user
and survivor movement to develop its own collective forms of organization so that it can defend itself against attack, and so that it can
defend individuals who are incarcerated and
drugged (Fabris, 2011). This organizational di-

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PARKER

mension also then needs to address the way that

forms of power that structure academic and
professional practice can also be replicated, as a
necessary result of the dominance of those
forms of power, inside the user movement itself
(Lakeman, McGowan, & Walsh, 2007). The
political struggle for social justice that responds
to mainstream models of madness also needs
to be a political struggle inside the social justice
movement so that it may reflect on its activity,
allow all voices to be heard and renew itself in
the face of new threats (Parker, in press).
The Notion of Madness Itself had to be
Created and Maintained
I want to move on to open up the question of
institutional support and power that is given to
different perspectives on madness, to my fifth
point, because there is a much wider context to
the disagreement between different specific
models. There are attempts by each approach to
set its own ground rules for the debate, and
often the dispute is about the ground rules themselves. But above and beyond those particular
squabbles there are general ground rules set in
place which frame what we think we know
about madness (Pilgrim & Rogers, 1993). This
frame is reiterated over and over again in the
media so that the term psychotic, for example,
is wrenched out of its specific clinical context
and treated as equivalent to madness. Then
other words and phrases cluster around this
popular representation of the mad so that it is
associated not only with being unreasonable but
with something dangerous. Headlines that tell
us that someone who heard voices was then
violent repeat this connection so the readers are
led to believe that voices automatically lead to
violence, despite the fact that most killings and
atrocities in the world are carried out by people
who are, to all intents and purposes, quite sane
(Blackman & Walkerdine, 2001).
The interconnection between the different
professional institutions tends to backup popular representations rather than challenge them
and that is mainly because they want to make a
claim on State resources or charitable support to
do their work and they have to make the case
that there is a serious problem. And there is a
problem, but broad-brush ways of evoking it for
an audience always plays into those problematic
popular representations. The conditions of pos-

sibilitythat is, the guiding assumptions that

make it possible for us to have debates about
how to understand and respond to psychosis
are themselves discursive and practical, and go
well beyond what we have control over. We
cannot get into the newsrooms and editorial
teams that commission shock magazine features
that misrepresent what we know about madness,
to change those assumptions, those images. Still
less can we get back to the historical conditions
of possibility that set the terms of the relation
between reason and unreason (Foucault, 2009).
We can see that in some other cultures there
are more humane and tolerant approaches to
distress. This is not to pretend that all is well in
these other places and that there is always wonderful liberal recognition of difference. But neither should we fall in line with the colonial
export of psychiatry or the globalization from
the West of other models of madness to pretend
that there is a prevalence of schizophrenia of a
certain percentage there because we have
bought the story that there is such a prevalence
of it here. Prevalence varies according to political economic conditions and the very way that
madness is conceptualized varies as well
(Warner, 1994). What we can see from crosscultural psychiatry at least is that ways of marking the difference between reason and unreason
take different forms in different places. That
then makes our world a very dangerous place
for those who come here and who are distressed
and who then describe what would be considered in their culture to be normal experiences
(such as the hearing of voices) to a Western
psychiatrist (Maher, 2012).
We are still living with the legacy of a system
of what have been described by the historian
and philosopher Michel Foucault (1977) as dividing practices that separate those who can
speak about experience, who are reasoning
about it, from those who are on the other side of
a discursive-practical barrier. And this means
that you dont have to be in a locked ward of a
hospital to have your account treated as evidence of your place on the other side of reason,
outside it, as symptom of disease, as faulty
reasoning, as the voice of an index patient or of
psychotic structure.
This is why it is a necessary aspect of social
justice in relation to madness that the relation
between what is usually specified as mad
positioned as the opposite of sane is itself

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MADNESS AND JUSTICE

addressed. The deconstructionist elements of

critical psychology tended to assume an activist
character precisely because deconstruction operates at the level of underlying conceptual assumptions which structure our place in the
world, our subjectivity, and those conceptual
assumptions necessarily connect with political
questions about who has the right to speak in a
social order and who is kept silent. The attempt
to reconstruct schizophrenia around psychological rather than psychiatric categories, for
example, retained a rationalist and functionalist
conception of madness, and it served to guarantee the position of a particular kind of professional, the psychologist (Bentall, 1990). An attention to the concealed voices of those
subject to psychiatric labels, in contrast, has
assumed a deconstructive character that
discovers in the meanings of madness a texture of experience that is not amenable to reconstruction. Instead, the process of historical
excavation situates the meanings in the context
of psychiatric power and resistance to it (Hornstein, 2012).
The Madness of Contemporary Social
Reality
Dividing practices ensure that only if the
subject speaks in a certain kind of way about
madness will they be assumed to be sane. My
sixth point is that this supposed sanity locks us
into something that is actually itself quite mad.
I have intimated that the models of madness
have something mad about them, just as mad as
what they try to speak about. I should also say
that this quite explicitly sets me against the main
traditions in what is sometimes seen as the antipsychiatry tradition, by which I mean the work of
Thomas Szasz (1961). He is seen as an antipsychiatrist even though he vehemently argues
that he is not, and he argues that antipsychiatry is a mirror-image of psychiatry and is effectively a form of psychiatry (Szasz, 2009).
Actually, he is a nice example of a combination
of flexibility and certainty that drives his critics
up the wall because they cannot quite get a fix
on what his position is. It is a bit clearer what he
is against rather than what he is for. What
Szaszs objection to psychiatric coercion does
seem to rely on is a particular version of U.S.
American psychoanalytic ethics, the assumption
that people should be treated as responsible

35

reasonable subjects who can stand on their own

two feet and demand their rights (Szasz, 1965).
And this means that anyone who tries to do
good for them or make them dependent is betraying that kind of subject. Again there is ontology at work here in this quite particular provincial version of psychoanalysis, an idea about
what the human subject is, and an epistemology,
an idea about what our knowledge about that
subject should look like (Parker, 2012).
But what kind of world is this illusion of
independence, of the individual subject who
must stand up for themselves, buying into?
Well, the madness of the markets that is affecting most of us who are being made to pay for
the economic crisis is the least of it. Even the
idea that we should listen to what the markets
say about the measures that are being taken to
get us out of the crisis, which is surely as mad
as listening to invisible voices, is at the lower
end of the spectrum of what I am concerned
with here.
We live in a form of reality that we must each
assume to be true, as the only way to live, in
order to survive. Each day we exchange tokens
that we treat as having a certain fixed value,
even though we know at some deeper level that
they do not, and this money is one of a number
of commodities that are themselves bought and
sold. Our thoughts and feelings, fantasies and
desires are reified, turned into things that are
marketable, and what we imagine to be deepest
about ourselves we also know can be repackaged and sold back to us (Mandel & Novack,
1970). The enclosure of natural resources at the
beginning of capitalism that forced us to sell our
labor power so that we would then have to buy
back what was once ours, but in distorted reified
form now, extends to the enclosure of emotion
so that what we perform at work in the service
sector becomes a kind of deep acting, emotional labor from which others will extract surplus value (Hochschild, 1983).
When Marx (1844) writes about alienation,
he identifies four aspects, four ways that our
subjectivity is distorted under capitalism. We
are, first, alienated from our own creative labor,
from our own sensuous engagement with material in the world as we make something of it.
We are alienated from that creativity when we
sell our labor power to others and we know that
what we are producing is owned by someone
else, that they determine what we produce and

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36

PARKER

how we produce it. We are, second, alienated

from our relations to others as we compete to
sell ourselves, to make ourselves subject to that
first form of alienation where we lose what we
produce at the very moment we produce it. And
that competition requires suspicion and the
sense that if the other gains then we lose.
We are, third, alienated from our own nature,
from our own bodies, knowing that if we fail to
take ourselves to the market-place and sell ourselves at a price lower than our competitors,
then we will suffer, perhaps we will starve. And
this turns our relation to our body into that of a
subject inside a machine who must keep that
machine working, and who becomes fearful of
it breaking down. Fourth, we are alienated,
Marx says, from nature itself, treating it as
something to be mastered and exploited, as if it
must be treated in much the same way as we
have treated ourselves or sold ourselves for
others to treat us. This again makes us anxious
about nature that cannot be mastered, so we are
divided from what we are actually part of and
divided at a deeper level from ourselves (Kovel,
2007).
This social reality is mad. To refuse it is mad,
but to accept it, which is the condition of being
reasonable today, is itself a form of madness.
This is the political economic matrix of reality
in which we either adapt or break down or, in
some cases, become part of the caring professions to try and rather hopelessly patch things
up. The promotion of happiness tied to CBT
in the U.K. is one example of this attempt to
patch things up and make individuals take responsibility for their alienation (Layard, 2005).
Justice here is for each individual one by one
and it occludes the social dimension (Pilgrim,
2008).
In contrast, those who have been concerned
with social justice have shown that the incidence of distress is correlated with inequality,
and they have been arguing for a shift of focus
from individual happiness to the conditions in
which those who have resources relate to those
who do not (Wilkinson & Pickett, 2010). There
is a vital connection here with the question of
how social pain is constituted at different
moments in political economic conditions that
suppress possibilities of social justice (Willoughby, 2012).

Shared Social Assumptions About

Madness Structure Clinical Practice
Contemporary globalised versions of reality
are suffused with images of psychology (De
Vos, 2012) and the images of the human subject
as vulnerable then structures social work interventions and clinical practice, and even the activities of the social justice movements in the
field of mental health (McLaughlin, 2011). This
is the seventh point that I want to turn to now.
Szaszs image of the subject is one that other
forms of psychoanalysis would be very unhappy with, those forms of psychoanalysis for
whom, as Lacanians say, desire is desire of the
Other (Vanheule, 2011). Szaszs image of the
subject would be diametrically opposed by
many systemic practitioners for whom the web
of relationships is exactly what makes us human, and dependent on each other. It would jar
with a good proportion of those working in the
broad cognitive behavioral tradition who have
adopted that framework precisely because it
values the collaborative reasoning that makes
each individual choice have the weight it does.
And, apart from being stung by his vociferous denunciation of them as modern witchdoctors, even some medical tradition psychiatrists would object that there is a benign side to
their discipline where they offer to the patient a
kind of responsibility for managing their illness
at the same time as they relieve the mad of the
burden of being made absolutely morally responsible for what they do when they are under
its influence.
Different approaches to madness each have
their own very good reasons to be wary of
Szaszs version of antipsychiatry because it
seems to be an approach that throws people
back to the wolves in the market-place, rather
than doing something to help them. The problem is that our own practice is bound up with
these wider macrosocial issues Ive been describing. In fact, those wider cultural and political economic dividing practices and frames for
madness are actually replicated in the microsocial world of the clinic and self-help groups.
CBT that is offered as part of State provision
of mental health does riskas we have seen in
the U.K. through the Increasing Access to Psychological Therapies programturning the reflexive work of puzzling through how choices
are made into an instrumental and quite cynical

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MADNESS AND JUSTICE

agenda for moving people off benefits, forcing

them into work they find difficult to cope with
and exposing them to pressures that will eventually lead them back into the mental health
system again (Ferguson, 2008). The economic
pressures that are already hitting people in the
economy are relayed down to them in a different kind of way by professionals subject to
targets, administrative tick-box procedures
and now cuts in services.
This then means that any sustained engagement with a family structure, let alone support
that people might need in tackling community
organizational pressuresthe kind of things
that a systemic therapist might want to include
in their frame of reference when they work with
relatives and even with an extended systemis
made really difficult. Instead the practitioner
has to justify short-term or brief interventions which they hope will not merely put sticking plaster over the problem but which usually
amount to little more than that.
In the case of psychoanalysis, provision in
the public-sector is subject to the same pressures, including bending to demands to measure
how much happier the client is after every session. For those psychoanalysts working independently (as they like to put it), their independent practice means that the worried well
who can pay for treatment skews the whole of
the practice toward catering to the selfindulgent and shunting off what is seen as the
really serious pathology to the other practitioners or, worse, to the psychiatrists (in which
case all the drug options start to look attractive
to the hard-pressed professional). And for service-users, the alternative to complete recovery,
in which case they may be left with no support
at all, might be to turn themselves into entrepreneurs who become professional users, paid
for telling their story again and again and, thus,
reinforcing an identity tied to the mental health
system (Cresswell, 2005).
Conclusions: What is to be done?
Spaces to speak or work creatively away
from what is now becoming a dominant therapeutic ideology are necessary for new approaches to develop. Those spaces include the
work of the democratic psychiatry movement,
which I think is different from antipsychiatry.
It was inspired by the Italian reforms 30 years or

37

so ago that closed the mental hospital in Trieste

and set up cooperatives to help people get back
into everyday life (Basaglia, 1987). Some activists from France visited and protested,
scrawling on the walls that this approach had
released the patients only to then put them into
the chains of work (Ramon, 1988). Those alternative traditions operated with a different conception of labor (Holland, 2011). Where there is
an approach, there is always a critique.
Now democratic psychiatry is a phrase still
alive in the work of Asylum: Magazine of Democratic Psychiatry, for example, and that ethos
is alive in the Hearing Voices Network, the
Paranoia Network, Intervoice, the Soteria
House groups, Mindfreedom, Mad Pride, and so
on (McLaughlin, 2003). The more the merrier;
this is where the voices in and against madness
itself are flourishing and these alternatives sustain people against the big battalions of medical
psychiatry and the other smaller armies of bad
professionals, including psychologists (Parker,
in press). You could say that one consequence
of the argument that Ive made is that we should
acknowledge these issues and be reflexive in
our work, whatever it is. That seems to be a
little minimal and could leave things just as they
are. Another consequence, a maximum demand,
if you like, could be that you have to get together and collectively act now to overthrow
capitalism, which seems overly ambitious (but
really, to be honest, I think that is quite necessary).
The space between those two options has
been worked by those in the user and survivor
movement (Spandler, 2006). There was a serious attempt to avoid the worst of each of the
two options. By that I mean that reflexive agonizing can be annoying and paralyzing, what
smug professionals can sometimes already do
quite well as an excuse for doing nothing. And
some attempts to overthrow capitalism, and
some of the States that pretended to be postcapitalist, have been quite authoritarian, and
have had a very bad record on treatment of the
mad. There is a danger, for example, that a
Marxist rebuttal of psychiatry simply takes
the opportunity to instate another closed and
fixed notion of reason and unreason that divides
the mad from those who are permitted to speak
(Robinson, 1997).
Social justice entails operating between those
two options, working with those who are on

38

PARKER

different points of the dimension depending on

their own political views, a way of operating so
that the possibility is opened for moving from a
quite minimal respect for the experience of
madness to tackling the conditions that make it
so miserable.

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References
Basaglia, F. (1987). Psychiatry inside out: Selected
writings of Franco Basaglia. New York, NY: Columbia University Press.
Bates, Y. (Ed.). (2006). Shouldnt I be feeling better
by now? Client views of therapy. London, UK:
Palgrave Macmillan.
Bentall, R. P. (Ed.). (1990). Reconstructing schizophrenia. London, UK: Routledge.
Bentall, R. P. (2004). Madness explained: Psychosis
and human nature. Harmondsworth, UK: Penguin.
Billig, M. (1987). Arguing and thinking: A rhetorical
approach to social psychology. Cambridge, UK:
Cambridge University Press.
Blackman, L., & Walkerdine, V. (2001). Mass hysteria: Critical psychology and media studies. London, UK: Palgrave.
Brown, P. (1981). Antipsychiatry and the left. In I.
Parker (Ed.), Critical psychology: Critical concepts in psychology, Vol. 2: Contradictions in psychology and elements of resistance (pp. 226 243).
London, UK: Routledge.
Chamberlin, J. (1990). The ex-patients movement:
Where weve been and where were going. In I.
Parker (Ed.), Critical psychology: Critical concepts in psychology, Vol. 2: Contradictions in psychology and elements of resistance (pp. 244 257).
London, UK: Routledge.
Cresswell, M. (2005). Self-harm survivors and
psychiatry in England, 1988 1996. Social Theory
& Health, 3, 259 285. doi:10.1057/[Link]
.8700060
Cresswell, M., & Spandler, H. (2009). Psychopolitics: Peter Sedgwicks legacy for the politics of
mental health. In I. Parker (Ed.) (2011). Critical
psychology: Critical concepts in psychology, Vol.
2: Contradictions in psychology and elements of
resistance (pp. 131149). London, UK: Routledge.
Curtis, T., Dellar, R., Leslie, E., & Watson, B. (Eds.).
(2000). Mad pride: A celebration of mad culture.
London, UK: Spare Change Books.
De Vos, J. (2012). Psychologisation in times of globalisation. London, UK: Routledge.
Fabris, E. (2011). Tranquil prisons: Chemical incarceration under community treatment orders. Toronto, Canada: University of Toronto Press.
Ferguson, I. (2008). Neoliberalism, happiness and
wellbeing. International Socialism, 117, 123143.

Fink, B. (1997). A clinical introduction to Lacanian

Psychoanalysis: Theory and technique. Cambridge, MA: Harvard University Press.
Foucault, M. (1977). Language, counter-memory,
practice: Selected essays and interviews. Oxford,
UK: Blackwell.
Foucault, M. (2006). Psychiatric power: Lectures at
the Collge de France, 19731974. London, UK:
Palgrave Macmillan.
Foucault, M. (2009). History of madness. London,
UK: Routledge.
Fozooni, B. (2010). Cognitive analytic therapy: A
sympathetic critique. Psychotherapy and Politics
International, 8, 128 145.
Healy, D. (2002). The creation of psychopharmacology. Cambridge, MA: Harvard University Press.
Healy, D. (2004). Let them eat prozac: The unhealthy
relationship between the pharmaceutical industry
and depression. New York, NY: New York University Press.
Healy, D. (2007). The engineers of human souls &
academia. In I. Parker (Ed.), Critical psychology:
Critical concepts in psychology, Vol. 3: Psychologisation and psychological culture (pp. 193204).
London, UK: Routledge.
Hochschild, A. R. (1983). The managed heart: Commercialisation of human feeling. Berkeley, CA:
University of California Press.
Holland, E. (2011). Nomad citizenship: Free-market
communism and the slow-motion general strike.
Minneapolis, MN: University of Minnesota Press.
Hook, D., & Parker, I. (2002). Deconstruction, psychopathology and dialectics. South African Journal of Psychology, 32, 49 54. doi:10.1177/
008124630203200207
Hornstein, G. A. (2012). Agness jacket: A psychologists search for the meanings of madness. Rosson-Wye, UK: PCCS Books.
House, R., & Totton, N. (Eds.). (2011). Implausible
professions: Arguments for pluralism and autonomy in psychotherapy and counseling (2nd ed.).
Ross-on-Wye, UK: PCCS.
Ingleby, D. (1985). Professionals as socializers: The
psy complex. In I. Parker (Ed.), Critical psychology: Critical concepts in psychology, Vol. 1: Dominant models of psychology and their limits (pp.
279 307). London, UK: Routledge.
Ingleby, D. (Ed.). (1981). Critical psychiatry: The
politics of mental health. Harmondsworth, UK:
Penguin.
Kovel, J. (2007). The enemy of nature: The end of
capitalism or the end of the world? (2nd revised
ed.). London, UK: Zed Books.
Lacan, J. (19611962). The seminar of Jacques
Lacan, book IX: Identification (C. Gallagher,
Trans., from unedited French manuscripts).

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

MADNESS AND JUSTICE

Lacan, J. (1981/1993). The psychoses: The seminar

of Jacques Lacan, Book III: 19551956. London,
UK: Routledge.
Lakeman, R., McGowan, P., & Walsh, J. (2007).
Service users, authority, power and protest: A call
for renewed activism. Mental Health Practice, 11,
1216.
Layard, R. (2005). Happiness: Lessons from a new
science. Harmondsworth, UK: Penguin.
Layard, R. (2006). The depression report: A new deal
for depression and anxiety disorders. London, UK:
LSE Centre for Economic Performance. Retrieved
from [Link]
[Link]
Loewenthal, D., & House, R. (Eds.). (2010). Critically engaging CBT in an age of happiness: Modality perspectives. Buckingham, UK: Open University Press.
Maher, M. J. (2012). Racism and cultural diversity:
Cultivating racial harmony through counseling,
group analysis, and psychotherapy. London, UK:
Karnac.
Mandel, E., & Novack, G. (1970). The Marxist theory of alienation. New York, NY: Pathfinder
Press.
Marx, K. (1844). Economic and philosophical manuscripts. In New Left Review (Ed.), Karl Marx:
Early writings (pp. 279 400). Harmondsworth,
UK: Pelican.
McLaughlin, K. (2011). Surviving identity: Vulnerability and the psychology of recognition. London,
UK: Routledge.
McLaughlin, T. (1996). Coping with hearing voices:
An empancipatory discourse analytic approach. In
I. Parker (Ed.), Critical psychology: Critical concepts in psychology, Vol. 4: Alternatives and visions for change (pp. 262269). London, UK:
Routledge.
McLaughlin, T. (2003). From the inside out: The
view from democratic psychiatry. European Journal of Psychotherapy, Counselling and Health, 6,
63 66.
Moncrieff, J. (2009). The myth of the chemical cure:
A critique of psychiatric drug treatment. London,
UK: Palgrave.
Newnes, C., Holmes, G., & Dunn, C. (Eds.). (1999).
This is madness: A critical look at psychiatry and
the future of mental health services. Ross-on-Wye,
UK: PCCS Books.
Newnes, C., Holmes, G., & Dunn, C. (Eds.). (2001).
This is madness too: Critical perspectives on mental health services. Ross-on-Wye, UK: PCCS
Books.
Parker, I. (2014). Psychology politics resistance:
Theoretical practice in Manchester. In B. Burstow,
B. A. LeFrancois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting

39

the (R)evolution (pp. 69 86). Montreal, Quebec:

McGill Queens University Press.
Parker, I. (Ed.). (1999). Deconstructing psychotherapy. London, UK: Sage.
Parker, I. (2007). Revolution in psychology: Alienation to emancipation. London, UK: Pluto Press.
Parker, I. (2012). Lacanian psychoanalysis: Revolutions in subjectivity. London, UK: Routledge.
Parker, I., Georgaca, E., Harper, D., McLaughlin, T.,
& Stowell-Smith, M. (1995). Deconstructing psychopathology. London, UK: Sage.
Parker, I., & Revelli, S. (Eds.). (2008). Psychoanalytic practice and state regulation. London, UK:
Karnac.
Pilgrim, D. (2008). Reading happiness: CBT and
the Layard thesis. European Journal of Psychotherapy, Counselling and Health, 10, 247260.
Pilgrim, D., & Rogers, A. (1993). A sociology of
mental health and illness. Buckingham, UK: Open
University Press.
Ramon, S. (1988). Psychiatry in transition: The British and Italian experiences. London, UK: Pluto
Press.
Robinson, J. (1997). The failure of psychiatry: A
Marxist critique. London, UK: Index Books.
Romme, M., & Escher, S. (1993). Accepting voices.
London, UK: MIND.
Selvini, M. P., Boscolo, L., Cecchin, G., & Prata, G.
(1980). Hypothesizing-circularity-neutrality:
Three guidelines for the conductor of the session.
Family Process, 19, 312. doi:10.1111/j.15455300.1980.00003.x
Spandler, H. (2006). Asylum to action: Paddington
Day Hospital, therapeutic communities and beyond. Philadelphia, PA: Jessica Kingsley.
Spiegel, A. (2005, January 3). The dictionary of
disorder: How one man revolutionized psychiatry. New Yorker. Retrieved from [Link]
.[Link]/fact/content/?050103fa_fact
Szasz, T. (1961). The myth of mental illness. New
York, NY: Harper & Row.
Szasz, T. (1965). The ethics of psychoanalysis: The
theory and method of autonomous psychotherapy.
New York, NY: Basic Books.
Szasz, T. (2009). Antipsychiatry: Quackery squared.
New York, NY: Syracuse University Press.
Vanheule, S. (2011). The subject of psychosis: A
Lacanian perspective. London, UK: Palgrave. doi:
10.1057/9780230355873
Vanheule, S. (2012). Diagnosis in the field of psychotherapy: A plea for an alternative to the DSM5.x. Psychology and Psychotherapy: Theory, Research and Practice, 85, 128 142. doi:10.1111/j
.2044-8341.2012.02069.x
Walsh, J., Stevenson, C., Cutcliffe, J., & Zinck, K.
(2008). Creating a space for recovery-focused psychiatric nursing care. Nursing Inquiry, 15, 251
259. doi:10.1111/j.1440-1800.2008.00422.x

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

40

PARKER

Warner, R. (1994). Recovery from schizophrenia:

Psychiatry and political economy (2nd ed.). London, UK: Routledge.
White, M. (1989). The externalizing of the problem
and the re-authoring of lives and relationships. In I.
Parker (Ed.), Critical psychology: Critical concepts in psychology, Vol. 2: Contradictions in psychology and elements of resistance (pp. 169 201).
London, UK: Routledge.
Wilkinson, R., & Pickett, K. (2010). The spirit level:
Why equality is better for everyone. Harmondsworth, UK: Penguin.

Willoughby, C. J. (2012). Economics, the nurturance

gap and social pain theory. Journal of Critical
Psychology, Counselling and Psychotherapy, 12,
14 25.
Young, R. M. (1994). Mental space. London, UK:
Process Press.

Received August 26, 2012

Revision received February 19, 2013
Accepted April 4, 2013

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