April Journal, San Marcos Notes on Anti Psychiatry and Social Movements in Health, Harm Reduction and Psychoanalysis
A few days after we got back from Taiwan on the 36 hour Monday April 13th, I found myself giving a talk at Christine Norton’s social work class at Texas Tech in San Marcos, a town just outside of Austin.
My mind popped, thinking about what to say in my two talks, one on my friendship book, another on community mental health and harm reduction, both in Texas, the scene of the crime, of my life.
I started scribbling notes.
Thank you for having me.
It’s an honor to be here.
Thank you Dr Norton, my old University of Chicago comrade.
It's particularly special to be here in Austin, a stone’s throw from Bastrop, just outside of Austin, where my Great Grandmother grew up and went to college.
A writer, she left the family a memoir of growing up, full of the messy details and dirty laundry, tragic histories of the Shepard family and the Jim Crow south, off to War, into modern times.
The mother of five, she regretted the loss of her first, in childbirth, more than any of the others.
Of her four others, three attended Harvard, the fourth, Uncle Louie, who attended West Point. Three of the four served in the second World War. Winston stayed home in South Georgia. He was beloved.
Grandad served in the Pacific, came home crazy, disabusing his kids from adoring him as a war hero. A Harvard doctor, he was imposing and stern.
Carl died in an s and m accident, Dad used to say, knocked down the stairs by his male lover.
Louie outlived them all, settling back home, onto his farm work after the war.
Existentialism was in the air in South Georgia dad used to say of the 1940’s there.
In those days, my dad was late to reading.
So, Mama brought him copies of Classical Gods and Heroes, capturing his imagination, his curiosity, teasing the words out, teaching Dad to read.
Dad eventually found his footing, learning, going to Harvard and Princeton, Chicago, meeting his best friend, traveling from London to Afghanistan by Land Rover, overland, in a journey of approximately 4,600 miles (roughly 7,400 km). They were the subject of my first friendship book… Each struggling with losses and psychiatric categorizations, military service, conduct unbecoming, the slings and arrows of academic careers, HIV, etc.
And onto Dr Norton’s class.
Thank you for having me, I began.
“Might be good if you brought a framework or some concrete material around decolonizing mental health or an activity to keep them engaged,” Dr Norton asked.
What is the root of misery, I asked to begin.
Pain.
Unhappiness.
Students offered a few ideas.
And so we began our conversation about anti psychiatry and social movements in health, harm reduction and psychoanalysis.
Would we have diagnosed and drugged or Einstein, wonders Bruce Levine:
“Albert Einstein… didn't pay attention to his teachers, failed his college entrance examinations twice, and had difficulty holding jobs. However, Einstein biographer Ronald Clark (Einstein: The Life and Times) asserts that Albert's problems did not stem from attention deficits but rather from his hatred of authoritarian, Prussian discipline in his schools. Einstein said, “The teachers in the elementary school appeared to me like sergeants and in the Gymnasium the teachers were like lieutenants.” At age 13, Einstein read Kant's difficult Critique of Pure Reason—because he was interested in it…. Einstein refused to prepare himself for his college admissions as a rebellion against his father’s “unbearable” path of a “practical profession.” After he entered college, one professor told Einstein, “You have one fault; one can’t tell you anything.”
While, “the very characteristics of Einstein that upset authorities so much were exactly the ones that allowed him to excel,... as a youth,” Einstein “would have likely received an ADHD diagnosis, and maybe an ODD one as well.”
Is anti-authoritarianism a mental health problem?
Diagnosed with dyslexia and hyperactivity as a kid. I had a great public school teacher who suggested I wasn’t just a flunkie, but something else might be going on.
I got a diagnosis.
I didn’t really mind the characterization as dyslexic or hyperactive.
Dyslexia was first identified in 1877 by German neurologist Adolph Kussmaul, who termed the condition "Wortblindheit" or "word-blindness" to describe intelligent patients who could not read.
That seemed accurate enough.
This was the mid 1970’s. Notice the word disorder was not included until later.
ADHD was first added to the DSM in 1968 (DSM-II) as "Hyperkinetic Reaction of Childhood," focusing on excessive motor activity. It was renamed to "Attention Deficit Disorder" (ADD) in 1980 (DSM-III) and finally became "Attention Deficit/Hyperactivity Disorder" (ADHD) in 1987 (DSM-III-R). (PubMed Central (PMC) (.gov)
With a diagnosis, the meds that flew my way were many, ritalin, dexedrine, amphetamines that rang in my head.
Why all the meds?
Are we psychologizing and drugging difference?
Or failing to account for structural problems our clients face?
Just because you are paranoid doesn’t mean they are not out to get you, I learned from my homeless clients years ago.
These snippets are chapters in a much longer history of anti psychiatry, harm reduction movements I’d like to explore.
The anti psychiatry movement has many roots, as well as common goals, beginning with the alleviation of suffering as Eric Fromm observed, dovetailing from Frankfurt School Social Theory to Harm Reduction.
Is the goal of this work to create free, healthy people, free bodies. If so, we could do worse than consider the work of Freud. But is Freud radical or conservative?
Does he take on the radical impulse of Marx or follow a more conservative functionalism of the US? In Talcott Parsons’ functionalism, the doctor and patient relationship is hierarchical; the patient goes along to get along, to fit within the system. For Parsons, illness is a form of "deviant behavior" that disrupts social stability; the patient is obliged to fulfill the "sick role" to manage this dysfunction. Here, the physician holds authority, and the patient is obligated to comply in order to get well and return to productive society.
Or does the patient break the system apart as the AIDS activists taught us?
Considering the questions about repression and freedom, I begin with Robinson's study The Freudian Left, a work which considered the work of Herbert Marcuse One Dimensional Man and Eros and Civilization, as well as Wilhelm Reich and Geza Roheim.
Marci Shore reminded me of this story on her European Intellectual History broadcast.
Herbert Marcuse, looking at play as freedom as a space real beyond work and necessity, sex as freedom, anti fascism
Among the most effective ways to oppress a person is to control their bodies, argued anti colonial theorist Franz Fannon. Break the shackles. Repression has its limits. Marcuse and Reich found it dangerous, seeking to liberate our social imagination from the shackles of misery, the dangers of prohibition.
While the American Psychiatric Association had rendered homosexuality as mental illness, and criminality, the intellectual founder of the field was much more agnostic on the matter, informing a young mother, who’d written to him, that it should neither hurt, nor hinder her child.
Marcuse was part of a part of the Frankfurt school that had started before WWII, hunting out the whiff of fascism in the post war modern world. These theorists borrowed from both Freud and Marx, popular culture and poetry to question the darker chapters of our history, including the horrors of National Socialism and the lingering scene tricking forward. Frankfurt theorists wondered about the Dialectic of Enlightenment, tracing a line from its promises to gas chambers. How do we cope with alienation, loneliness, the scene of estrangedness we feel from our labor and ourselves?
What is the etiology of neuroses, the physical environment or the mind? Should we look at Freud or Marx?
With changes in the way we work or with relief from social repression.
Wilhelm Reich’s Mass Psychology of Fascism is still essential. His work on repression is still informative.
HIs later studies of the release of repressed feelings, with his “Orgone” left him in a prison cell.
His work on bodies and repression has found renewed interest lately, particularly with in Olvia Laing’s (2021) study, Everybody: A Book about Freedom. “The body is a source of pleasure and of pain, at once hopelessly vulnerable and radiant with power,” contends Laing, considering the long struggle for bodily freedom, using the life of the renegade psychoanalyst Wilhelm Reich to explore gay rights and sexual liberation, feminism, and the civil rights movement.
Having written two dissertation papers, Marcuse moved to the United States in June 1934, writing Eros and Civilization, One Dimensional Man and The Aesthetic Dimension. His study of social movements and struggles against fascism inspired notable movement figures including his studies Angela Davis and Abby Hoffman.
There must be more to life than means of necessity, he reminded us, suggesting we are only really free when we play.
His work was fundamentally about finding the liberatory potential of human experience, mining Freud for understandings of sexual freedom.
Of course, Marcuse, Reich, and Geza Roheim only anticipated the anti-psychiatry movement to come, that took fruition in the 1960’s, as a coalition of critics—including psychiatrists, patients, and activists—arguing that mainstream psychiatric treatment could be more harmful than helpful. According to Psychiatry Online, this movement challenged the validity of psychiatric diagnoses, over-reliance on medication, and coercive practices like involuntary commitment. Rooted in the 1960s counterculture, the movement questioned the "medical model" of mental illness that Parsons articulated, arguing that many issues are social, existential, or political rather than biological. Key figures included psychiatrists Thomas Szasz, R.D. Laing, David Cooper, and Franco Basaglia. "Revolt from Above": Many early leaders were psychiatrists aiming for radical reform of asylums and coercive treatments, rather than the abolition of all mental health care. Their Main Objections to Conventional Psychiatry: Diagnosis Reliability: that diagnoses are subjective checklists rather than objective medical tests, aimed at billing for services, rather than helping people feel free or healthy.
Quickly, how do you feel when you read the DSM? I asked everyone.
I feel like I have everything.
Another criticism, Iatrogenic Harm: High concern over the side effects and lack of long-term efficacy of psychiatric medications. These were my experiences with the voices in my head after the ritalin and dexedrine I was prescribed. (See my Sustainable Urbanism for a full account of this experience).
Would we have diagnosed Einstein?
What of others who question authority or bounce around too much.
Medicate and sedate them.
To what end - personal freedom or fitting into the social system.
By the 1960s, new movements took on this thinking.
Anti Psychiatry, Icherous Project, Mindfreedom, roots in anti psychiatry,
With the AIDS Movement, people with AIDS became the experts, challenging authorities, the Dr Patient Relationship, creating a highly engaged, participatory, egalitarian model of engagement.
At meetings, activists carried copies of Michael Warner and Foucault’s books, with their calls to resistance to regimes of the normal, to queer our understandings of sickness and health. AIDS activists formed a buddy System, based on social networks, rather than medical expertise to take care of the sick.
Activists trained other activists and peers. User based strategies of risk reduction grew from there, harm reduction, syringe exchange, fuck safe shoot clean.
Borrowing from this, I walked everyone through a few slides on the history of syringe exchange and harm reduction, passing out Richard Ellovich’s old training materials from the Harm Reduction Coalition, highlighting :
15 Principles of Harm Reduction
1) start where the person is at, relevant place in the person's immediate universe.
2) address person’s need in a hierarchy
3) reduce alcohol- and – drug related harm to self and others
4) reduce related risks to self and others
5) recognize there is a whole person, not just a behavior
6) Ask a person, what is it you want to do?
7) allows practitioners to consider pros, and cons, and areas of ambivalence
8) harm reduction is realistic, allows person to be honest, avoid the lie
9) without judging, increase consciousness of choices
10) recognizes and respects autonomy and self determination
11) emphasizes relationship building
12) develop and build skills and ego functions
13) works from strengths, humor, hustle , etc.
14) increases happiness
15) identify and build healthy aspects of self
San Marcos was part of a big month of movement, my head spinning from our return from Taipei to Brooklyn, just the week before. We arrived on Monday night, near midnight, only a few hours before classes the next day.
A few highlights from between Taiwan, Brooklyn, and Marcos.
April 13th
We read reports from the NY Times:
“Breaking News: The Trump administration agreed to allow the rainbow Pride flag at the Stonewall monument in Manhattan, reversing its earlier decision. https://nyti.ms/4vhPXcq”
Newsweek reports: “Nearly 100 protesters were arrested after urging Schumer and Gillibrand to block bomb sales to Israel during a Manhattan protest.”
April 14th
Back in NYC, back in Brooklyn with the Barbes crew. Emily, MM, M, and then Greg showed up, laughed and left, spring in the air. Gorgeous spring.
April 15th
Back in NY, teaching, spring in the air, a townhouse for sale, Alex pouring pints at Bijans, a demo tomorrow, for free speech, a rally at union square for the climate.
April 22
I found myself in San Marcos, giving a talk at Texas State at my old Chicago buddy's mental health class. Pictures of L B J are everywhere, the US at its best and worst, people out dancing to blue grass music at Tantra, chatting with friends. 'There is no adventure without misadventure' ... There are many stories here on a hot night.
April 23
Woke up and gave my friendship talk, recalling
Benjamin, the Sarajevo cello player, Assata, Walt draft riots, Elizabeth Owens, Doris, Elizabeth Meixell, Stanley, Bertha Jennifer, and Mama from Bastrop, "a historic city southeast of Austin known as the 'Most Historic Small Town in Texas,' on the Colorado River and within the Lost Pines Forest region"... We walked through Texas State, where LBJ went to teachers college. Ran into students with signs. Get ICE off campus say students, makes me scared, worried for them. Free speech violated. Faculty audited. I hope people understand the severity. Two profs fired for speaking out. We need targeted universalism, a new language for engagement, from the Institute of Othering and Belonging, says Allen. Students are not protesting. This is now called expressive activity. Bubbles for free speech, says one student, sharing bubbles. Bong Hits for Jesus. And then stopped at the Whittliff Gallery, looking at the history of Texas Music. and explored an old record store and San Marcos Springs.
April 24th
"When I wake I'm torn between the desire to save the world or to savor it" said Christine. That evening we found our way to
St. Elmo Brewing Company, in Springdale, outside Austin. More music and friends. Buddy David arrived. Barbara, growing up, Christine's mom talked about her cult, the conversation was plenty. Laughing even more.
Texas night, lots of music, Guy Clark, True Love Will Find You in the End, by Daniel Johnston. A little Dylan, you're gonna make me lonesome when you go.
Crooning away into the night with Dolly...
Song by Dolly Parton
It's been a long dark night
And I've been a waitin' for the morning
It's been a long hard fight
But I see a brand new day a dawning
I've been looking for the sunshine
You know I ain't seen it in so long
But everything's gonna work out just fine
And everything's gonna be all right
That's been all wrong
'Cause I can see the light of a clear blue morning
I can see the light of a brand new day
I can see the light of a clear blue morning
Oh, and everything's gonna be all right
It's gonna be okay
It's been a long long time
Since I've known the taste of freedom
And those clinging vines
That had me bound, well I don't need 'em
Oh, I've been like a captured eagle, you know an eagle's born to fly
April 25th
Bus to Dallas, from San Marcos, first stop Deep Ellum, All Good Cafe, past Club Dada, posters around, Rev Horton Heat, joshua ray walker, burlesque shows, A woman comes in passing out flyers for an ICE Out event down the street. Waitress prepping for a show with a Japanese Elvis impersonator. They all treat him like Elvis. So it's my one chance to be a star, she tells me, agreeing a stroll to the Dallas Museum of Art is a good idea. I keep walking down Main, past Good Lattimer, where I used to work. Eric picks me up outside. We find our way to White Rock Lake for the KNON benefit, watching the sun go down on the water. The band played a pretty good 'Eyes of the World' by Grateful Dead, 1973, singing: "Wake up to find out that you are the eyes of the world." And drop by Doug's where we play old 45s and laugh. David C dropped by. And we met Colin and talked about Texas Music, ashes on the football field, kids, Trey, the Avid brothers, Carter Albrecht's departure, Dallas music, David Allan Coe, Kenny Withrow, Robert Earle Keene, and Willie, everyone's favorite. Years and years later, a laugh, a survival story, years and years of stories. What happened to Carter? "Albrecht, a keyboard player for the band Edie Brickell & New Bohemians, was shot to death early Monday while trying to kick in the door of his girlfriend's neighbor..." What happened, we wonder. What happened?
April 26th
Thinking about all my old friends here, there, Mama long gone, Dad, in parts unknown, all us, getting older, those I used to see here, who I used to run into in Deep Ellum, old lives, long ago days... as we walk this place, between there and back.
I play some old records, including "Hill Country Rain" by Jerry Jeff Walker, a 1972 song about an easy, and joyous feeling of the Texas Hill Country, the Central Texas region, a contented feeling.
