Mental Illness does not exist. It was invented for two reasons: to control unruly and bothersome people, and to provide a justification for irresponsible behaviour. As Thomas Szasz argued, we no longer speak of arrogance, conceit, selfishness, boredom and so on, but sociopathy, narcissism, schizophrenia and attention deficit disorder. We do this to justify incarceration of undesirables and to pass the buck of our fears and cravings onto a phantom physical cause.
The fundamental fraudulence of the psychiatry industry does not mean there is no need for therapy and for help with our emotional problems, or that the problems themselves are inventions: they are often terrifyingly real. What it means is that the institutionalisation and medicalisation of our social and moral problems is a racket and those who willingly fall for it are handing their responsibility and autonomy over to a secular priesthood which cannot even perceive what ails us, let alone treat it.
SOME PRELIMINARY CONSIDERATIONS
‘I see you don’t like doctors,’ I said, noticing a peculiarly malevolent tone in his voice whenever he alluded to them.
‘It is not a case of liking or disliking. They have ruined my life as they have ruined and are ruining the lives of thousands and hundreds of thousands of human beings, and I cannot help connecting the effect with the cause… Today one can no longer say: “You are not living rightly, live better.” One can’t say that, either to oneself or to anyone else. If you live a bad life, it is caused by the abnormal functioning of your nerves. So you must go to them, and they will prescribe eight penn’orth of medicine from a chemist, which you must take! You get still worse: then more medicine and the doctor again. An excellent trick!’
The Kreutzer Sonata, Leo Tolstoy
Formerly, people were duped by quacks because they believed in their fake cures; now, they are duped by them because they believe in their fake illnesses… Mental illness is not a disease, whose nature is being elucidated by science; it is rather a myth, fabricated by psychiatrists for reasons of professional advancement and endorsed by society because it sanctions easy solutions for problem people… demythologizing psychiatry would undermine and destroy psychiatry as a medical speciality just as surely as the demythologizing of the Eucharist would undermine and destroy Roman Catholicism as a religion.
A Word to the Wise / The Myth of Mental Illness / Schizophrenia, Thomas Szasz
Gaining acceptance into graduate school or medical school and achieving a PhD or MD and becoming a psychologist or psychiatrist means jumping through many hoops, all of which require much behavioral and attentional compliance with authorities, even those authorities one lacks respect for. The selection and socialization of mental health professionals tends to breed out many anti-authoritarians. Degrees and credentials are primarily badges of compliance. Those with extended schooling have lived for many years in a world where one routinely conforms to the demands of authorities. Thus for many MDs and PhDs, people different from them who reject this attentional and behavioral compliance appear to be from another world—a diagnosable one.
How Anti-Authoritarianism is Deemed a Mental Illness, Bruce Levine
‘The view that many well-established theoretical positions in psychology cannot be as widely generalized as their authors assume was given a boost by a carefully argued paper published in 2010. Joe Henrich and colleagues challenged the very foundations of the discipline in arguing that psychologists fail to account for the influence of culture or nurture on human behavior. From a large-scale survey they determined that the vast majority of research in psychology is carried out with citizens – especially college students – of Western, Educated, Industrialized, Rich, Democracies (WEIRD). They note that, where comparative data are available “people in [WEIRD] societies consistently occupy the extreme end of the … distribution [making them] one of the worst subpopulations one could study for generalizing about Homo sapiens” (Henrich et al. 2010: 63, 65, 79)’.
The Anthropology of Childhood, David F. Lancy
‘It turns out that those who adopted the biomedical and genetic beliefs about mental illness were most often those who wanted less contact with the mentally ill or thought of them as dangerous and unpredictable.’
Crazy Like Us, Ethan Watters
‘The presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual, solutions.’
The World Health Organisation
‘Emotional suffering is very real, and the vast majority of people [in the expanding mental-health professions] sincerely wish to help those suffering. But are they really the experts they claim to be? Is our society justified in granting them special status and paying them from common funds? Are they better therapists than minimally trained people who may share their knowledge of behavioural techniques or empathetic understanding of others? Does possessing a license imply that they are using scientifically sound methods in treating people or providing an ‘expert opinion’? Should their opinions be recognised in our courts as having any more validity than the opinions of anyone else?
There is by now an impressive body of research evidence indicating that the answer to these questions is no.’
House of Cards, Robyn Dawes
THE PSYCHOCRAT: MANUFACTURER OF MENTAL ILLNESS
Not that you need Dawes’ research evidence to recognise the fraudulence and unmerited prestige of mental health professionals, psychologists and psychotherapists — i.e. psychocrats;
I mention questions of sanity, but in fact the psychocrat almost never uses the word. Wilhelm Reich, Arthur Maslow, Erich Fromm and even [the deeply authoritarian] RD Laing1 talked meaningfully of psychological truth, but the general assumption since Freud, largely unspoken, is that sanity, if it can be mentioned at all, equals ‘adjustment’ to the ‘norm’, i.e. to a universal state of alienation and confinement which is defined2 as ‘reality’, ‘society’ or, in Freud’s words, ‘ordinary unhappiness’.
The ‘reality’ that psychocrats refer to actively rewards psychopathic behaviour, schizoid attitudes, ocd obsessions, profound anxiety and malingering on an epic scale. We are trained from birth, through school and work, to systematically ignore ‘metacommunication’ (tone of voice, body-language, etc), devalue the context, suppress consciousness (along with all its creative, generous, unpredictable instincts), deform ourselves to fit in warped institutional structures (aka ‘domestication’) and invent mythical demons to avoid facing up to the actual (as opposed to the virtual) reality of life. Those successfully trained are, ipso facto, mad: but they are only permitted a certain, socially optimum, level of madness — as soon as cruelty, bizarre literalness, compulsive cravings and terror of living reach the point where someone can no longer, or no longer wishes to keep ‘reality’ functioning (which more or less amounts to make money) then he or she is deemed [or claims] to
be possessed by the devil have ‘a mental illness’.
As Thomas S. Szasz argued, from every conceivable angle for over fifty years, there is no such thing as mental illness. This, he pointed out, is not a statement of scientifically verifiable fact any more than ‘there is no such thing as social illness’ is, or even ‘there is no such thing as conceptual disease’. Illness and disease are physical alterations of cells, organs and tissues. A genuine disease can be physically detected — discovered in autopsy for example. It cannot be voted into existence by members of the American Psychiatric Association (APA).
The APA publishes the Diagnostic and Statistical Manual of Mental Disorders, or DSM, upon which all Western definitions of mental illness are based. The DSM is written by a committee of authors [many of] who are paid by the pharmaceutical industry to invent new illnesses, in order to expand the market for therapies and narcotics. This is the primary reason why mental ‘illnesses’ are created, but the myth serves two other critical purposes. The second purpose is that medicalised problems absolve people of the burden of free will and responsibility by blaming their disturbances, manias, unhappiness, fears and annoyances on an imaginary ‘illness’. These troubled malingerers, unwilling to take responsibility themselves for their problems, seek out and find members of a medical profession (aka psychiatric doctors) unwilling to allow others to take responsibility for their problems. Malingerers and doctors then come together in a classic game of what I call sanifection, or the client–therapist game; in which one partner (the ‘client’) habitually lies, fake, drifts, through convenience into ‘mental illness’, etc. and the other player (the ‘therapist’) habitually accepts the lie, in order for both parties to communicate the implicit message; ‘security and mutual dependency are more important to us than the uncertainty of the honesty we both secretly crave’. Psychocratic diagnosis is thus a covert agreement; either, in this case, between the psychocrat and the malingerer, who will not take responsibility for himself, or else between the psychocrat and society, which will not take responsibility for others.
The third reason then, that mental illness exists, is that it provides the state medical and drug industry (pharmacratic authority) with a reason to lock up or profitably medicalise scapegoats (Jews, homosexuals and recalcitrant women in the past, those with drug-addiction, ‘schizophrenia’ and anti-authoritarian attitudes today and the offensive, the unemployed and the non-consumer tomorrow). As Szasz points out; in the Theological State, religious authority claims control over the soul of men and women, and those who wish to assert autonomy are persecuted as heretics, in the Communist State state authority claims control over land, labour, surplus and so on, and those who wish to assert control over their own (or their community’s) resources are persecuted as capitalists, and in the [capitalist] Therapeutic State,3 pharmacratic authority claims control over the drugs, medical care, health and ‘rational attitude’ of the citizen, and those who wish to assert control over their own bodies, minds, drug-use or medical care are persecuted as lawbreakers and patients.
Malingering patients, medical authority and state / corporate power all therefore depend on the illusion of mental illness. Malingerers (which includes those who do mental illness through apathy, capitalist anxiety and so on) who wish to avoid a difficult life, who want to short-cut years of striving and get easy ‘self-esteem’ via hits of attention from troubled parents and institutional care; who need a medical excuse to avoid the challenges of love, the reality of nature or the demands of conscience; or who wish to trade prison for hospitalisation (or have it traded for them4) can, with official ratification of course, discover they have a ‘mental illness’. On the other hand, parents who do not love their children — who thereby create unlovable misfits — elites who are threatened by criticism (or by youth), citizens annoyed by troublesome neighbours and the extensive and massively powerful mental health profession all need patients to exist, which is to say they need a ‘rational and objective’ scientific justification to forcibly tranquilise or imprison troublesome people (for their own good). This justification is ‘illness’.
The myth of mental illness does not, however, mean that people are not deeply troubled, overwhelmed with unhappiness and confusion, plagued with obsessive thoughts, terrified of life and pathologically restless — in a word, insane. We are born into an insane world and by the time we are fifteen years old we all have fears, cravings and emotional obsessions that it takes an entire lifetime to face up to and overcome. Nor does it mean that this insanity might not somehow result in deformation of the structure of the brain, just as constantly sitting down deforms the spine. We would rightly look askance at a video-game addict describing his bad back, fatigue and Carpal tunnel syndrome as ‘illnesses’. Nor does it mean that there isn’t a place in life for genuine therapy, advice or counselling; we all need guidance and love and there are people in the world who are very good at giving it5 . What it does mean — and the difference is crucial — is that there is no physical (or genetic) cause of these problems. Your problems are, first of all, yours and, at one remove, those of the society around you. Blaming ‘illness’ for your moral, emotional or social problems is no different to blaming the devil for them.
There is no need to provide evidence for this, for the claim that ‘mental illness’ does not exist, any more than there is to provide evidence that ‘dream illness’ does not exist. The supposed existence of physiological ‘mental illness’ (the religious belief, for example, that it shows up on a brain scan) has nothing to do with evidence; it is a category error — a massive and fraudulent one. If concrete evidence ever were discovered, beyond the usual chimerical (epigenetic-ignoring) ‘genetic markers’, it would cease to be a ‘mental illness’. It would become a physical illness, like syphilis (which causes mental problems) or Alzheimer’s disease.
Or, to look at the problem from another angle, mental illness is judged from its symptoms. Psychiatrists diagnose Mr Smith with depression because he can’t get out of bed, doesn’t smile, says he feels miserable, etc. And what causes these symptoms? Depression! The corrupt circularity of this rhetorical slight-of-hand is not not lost on a few outsiders, such as Marino Pérez-Álvarez who uncovered the fraudulence of the ADHD diagnosis, or A. Marcia Angell, former director of New England Journal of Medicine;
If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be ‘reliable,’ but not valid. The problem with the DSM is that in all of its editions, it has simply reﬂected the opinions of its writers.
In the 1970s the APA published, by committee, a list of nine ‘symptoms’ that depressed patients exhibited. These included things like low mood, lack of interest in ordinary pleasures and so on. Anyone with all the symptoms had the depression ‘illness’. Doctors soon discovered however that people who were grieving exhibited all these symptoms, so the APA created an exception for grief. Critics then pointed out that if the ‘illness’ of depression was a result of losing a person, then why not losing a home, or your good name, or a reason to live, or something even more subtle and profound? The APA responded by… you guessed it… including grief as a mental illness. Yep; if you’ve lost someone in the US you can be diagnosed as mentally ill.6
The foundational fraudulence of the psychiatric medical profession, their nexus of fantasy diseases and their ingrained hostility to social and personal responsibility for mental problems, is, unsurprisingly, vehemently rejected by members of the psychiatric medical profession — who have the semmelweis reflex built in from college.7 It is also rejected by the entire professional middle class and ruling elite, which intuitively understands a) the importance of defending one’s self and one’s class against all forms of criticism with sophisticated forms of special pleading (‘I’m a woman / black / Asperger’s / dyslexic / a dwarf / bald — therefore you can never understand — or, consequently, criticise me’) b) the notion of ‘fitting in’ and c) the key role that the idea ‘mental illness is an illness like any other’ plays in domesticating, institutionalising and tranquillising troublesome non-conformists. Take a look at professional journalism, for example, and see what the attitude there is to mental illness. Or at the teaching profession. Or at management and politics. There is no place in the ideology of authority for the idea that there is no such thing as ‘bad’ people (selfish, obsessive, exploitative, annoying, lazy and so on) just ‘ill’ people (neurotic, psychotic, disordered, dysfunctional, etc.), or for the idea that insanity flourishes in profoundly unnatural, mediated, iniquitous and inequitable societies, or that ‘therapy’ (like ‘aid’) is a euphemism for tranquillising undesirables, or that the biomedical model of mental illness is inherently stigmatising, or that ‘therapists’ have a vested interest in ignoring malingering, or that those afflicted by personal problems might have the power to sort their lives out themselves, or amongst themselves — through individual moral and collective political (rather than pharmaceutical or institutional) interventions. All such ideas strike at the phantom source of professional or elite legitimacy, and so can never be seriously officially considered.
You don’t need to be insane to grasp this, or to know anyone full-on schizophrenic, neurotic, manic-depressive or what have you. Just look at how ordinary people talk about and handle each other’s phobias. ‘I’ve got a phobia,’ we say. But what does this mean to have a phobia? Where is this thing you have? Nowhere8 — like your love of figs or distrust of management or consciousness itself. If ‘phobias’ can be spoken of as things that we have (and they can) it is as a metaphor. To speak and act, as many people do, as if this phobia is an actual, physical lesion, bacteria or scorpion wrapped around the brain-stem causing palpitations whenever you get locked in a cupboard is like saying ‘I’ve just caught a dose of disgust off the television’ or ‘I can’t make love tonight because I’ve wounded my interest in your tits’ or ‘consciousness is an emergent phenomena of brain activity’ or ‘I have schizophrenia’.
POWER DETERMINES REALITY
Szasz, in Schizophrenia, points out that doctors, like all priests, have their holy symbols (the MD degree), rituals (the diagnosis) and powers (access to drugs and diagnostic machinery) which they will stop at nothing to maintain monopolistic control of. In the case of the psychocrat one of the most powerful symbolic powers is his ability to diagnose and treat schizophrenia. Just as undesirables were cursed with imaginary devils by priests in the past, so they are cursed with imaginary schizophrenia by professionals today.
Schizophrenia was invented by Eugen Blueler in 1907; based on the prior invention, in 1898, of dementia praecox by Emil Kraepelin. These men based their invention on behaviour and on their beliefs about that behaviour, not on changes in tissue caused by disease or any other discernible reality. This is how every ‘mental illness’ which followed has been invented (‘discovered’ is the official term) — from homosexuality to attention deficit hyperactivity disorder to the latest set of eating, non-compliant language and ‘oppositional defiant’ disorders. Without such inventions unpleasant people could not be removed, against their will, from society, people unwilling or unable to take responsibility for their problems could not get a good excuse to do so and, crucially, the entire mental-health professional would be out of a job.
Building on Szasz’s observations, it’s worth taking a second look at the professionals who control psychiatric hospitals, these people with the power to deprive others of their liberty for no good reason; these people who believe in things — mental illnesses — which do not exist; these people who present their beliefs in hyper abstract or elaborately coded language; these people who enjoy massive power and prestige based on a little piece of paper — the power, indeed, to decide what is sanity and even reality; these people who do no useful work whatsoever. It’s worth asking what we are usually told to call people who believe in illusions, talk about them strangely, have delusions of grandeur and do nothing of use. That’s right — we call them mentally ill.
Why, you might ask, is society willing to accept one group of ‘mentally ill’ people (the psychocrat) having control over drugs, over language, over institutions and so on, and another group (the patient or ‘service-user’) being drugged, labelled ‘schizophrenic’ (or ‘manic-depressive’ or what have you), being forced to submit to confinement, being forced to take medication or living a life of zero responsibility? Why, you might then ask, does society also accept that children be confined against their will in uncomfortable rooms, in the company of adults hell bent on compelling them to memorise and recall a narrow string of abstract, contextless facts or a limited stream of symbol-manipulation techniques for fifteen years? And finally, perhaps, you might also ask; why does society accept that every square millimetre of land, all productive resources, and all material power to meaningfully shape the environment be in the hands of a microscopically tiny percentage of the population whose only claim to such power is that their parents had it?
I would suggest that the answers to these three questions are tightly connected, fused, in truth, into a universal, unquestioning acceptance of a collective social myth. This myth comprises (although is not limited to) the following core beliefs:
- Money is real and some people deserve to have more of it than other people.
- Learning is the same as schooled-education.
- Entertainment is a product you consume.
- Meaning, like knowledge, is a thing which you have in your head and which you can insert into other heads like coins into a slot-machine.
- Doctors are necessary for health and health-care, and ‘health’ means managing the bundle of ‘symptoms’ (things) that one walks around with or, on a grander scale, reducing them in the population.
- Humans have or need things called ‘rights’ which you need professional middle-men to assert, prove, acquire or defend.
- You should repay your debts and you have a moral obligation to work.
- We need to be in constant contact with a fantastically complicated communication technology system to be happy, well-informed and ‘connected’.
- Feelings are the same as emotions, art is the same as pornography, empathy is the same as sympathy, pain is the same as suffering, offence is the same as abuse, uncertainty is the same as precarity… (etc, etc. — all things)
- Either there is no such thing as quality, goodness, beauty, gender, love or reality (they are subjective states — of some interest to artists, but with no truth-value) or these things do exist but they are what authority says they are.
- It is impossible to stop thinking.
- Mental illness is a thing. It exists, it is real, it is a physical thing.
What all these beliefs have in common is that they establish, directly or indirectly, that power determines reality, and power means acquiring things. This is the common thread that runs through all pre-modern religions, through all modern institutions, through the official ideologies of postmodernism (‘nothing is true’) and scientism (‘only rational thought and rationally apprehended objects are true’), through capitalism (private control of surplus) and communism (state control of surplus), through left, right, up and down.
That power determines reality, and that reality is a collection of objects, is the reason why the myth of mental illness is widely accepted. First of all it is accepted by the mental health authorities: ‘I, the powerful, determine that you, the powerless have this thing called schizophrenia. You, the powerless, are forced to accept my definition, my medication and my confinement. To rebel is to rebel against reality itself; not my individual reality, you understand, but that of the whole scientific establishment and, thereby, of the living source of truth’ Secondly, it is accepted by the mental health patients. ‘I would like to be normal, sane and happy, be free of fear, anxiety, sadness anger, but you see I have schizophrenia. It’s not my responsibility though, no, the scientific establishment — through their representative here on earth, the psychocrat — has decided I have it. I have proof — I’ve been admitted, I’m a case like many others and, lo, here are the drugs which treat me.’
The power in question then, is not that of the individual, but of the sacred text (in this case the DSM; Szasz’s ‘Sharia of the Therapeutic State’), ideology (scientism), and ritual (diagnosis and treatment). Individual power, also known as responsibility, is abhorrent to authority and to their malingering clients who understand ‘being responsible’ as controlling others — which, of course, it always does ‘for their own benefit’.
Autonomy understands responsibility as mastery of one’s self and care for one’s world. Everything in the modern ideology of personality is designed to suppress this. That we might be responsible, or our parents, or our society, is utterly outrageous to authority, which does everything in its power to demean or suppress such a subversive idea (even while telling us that ‘Poverty / Smartphones / Climate change / Poor diet cause mental illness.’ — the tautology of such headlines doesn’t seem to bother newspaper editors). This is why hormones, genes, drugs and illness are fabricated as causes of behaviour, why the disgraceful ‘plea of insanity’ exists, why we describe any kind of excess as an addiction (another ‘mental illness’) and why things like conceit, sneakiness, failure to cope with life, insubordination and cowardliness are rebranded as narcissism, passive-aggression, depression, schizophrenia and anxiety. It is also why the truly autonomous, and responsible, are greeted everywhere on earth with awe, envy, admiration and hatred.
So if we remove the power of institutions and institutional ideology to determine reality, what are we left with? What is schizophrenia (or, by extension, ocd, adhd, manic-depression, phobia, bulimia, etc, etc)? If it’s not an illness, what is it? Does the word have any use?
The word schizophrenia (and its adjectival forms, schizophrenic and schizoid) are functionally the same as boredom, anger, guilt and desire. The time may come when these too become ‘diagnosable conditions’, but for now we correctly recognise them as emotions, which tend to produce certain kinds of ideas (anger, for example, tends to create ideas of revenge, justification and so on) and behaviours (stormy brow, raised voice, etc), which, further, tend to produce certain kinds of effect (tense atmosphere, cowering dog, etc). When we say that ‘he is angry’ we tend to mean he is behaving in a certain way and when we say ‘I am angry’ we tend to mean that we feel a certain way; meanings which blend into each other. We don’t tend to mean that he or I have some kind of anger virus or that the anger organ is malfunctioning and that this is causing the red face, clenched fist, subterranean threat of violence and compelling feeling that everyone else is to blame.
And so it is with schizophrenia. Once we have jettisoned the idea that it is an illness we are left with emotions and behaviours which, like all emotions and behaviours, are generated by the self (my responsibility) or by the world (our responsibility). If these emotions and behaviours tend to occur together, as they do, and are unpleasant or painful, as they are (to a terrifying degree in this case), then it makes sense to consider them — roughly and metaphorically — as one kind of thing (‘schizophrenia’) and then to investigate what might cause this kind of thing.
The problem is, as we shall see, that two profoundly different kinds of ‘emotion and behaviour’ are ordinarily described as schizophrenic. One of these is extraordinarily unpleasant and causes a great deal of suffering. I suggest that, once we have freed it of its mythical medical cause, there is no reason not to call people who think, feel and behave in the following ways schizophrenic:
- Being unusually unresponsive (alogia, catatonia, ‘affective flattening’).
- Feeling unusually anxious, even terrified.
- Speaking metaphorically (‘my tools aren’t in the garage’), incoherently (disorganised speech) or ironically.
- Paranoia and intense self-consciousness.
- Grandiosity and ludicrous self-importance.
- De-realisation; a sense that nothing is real, a conviction of living in a dream, a film or a shoddy virtual copy of the world.
- Detachment and disengagement, a sense that nothing matters.
- Fragmentation; the sense that everything is shattered, divided up, in bits.
- Staring, an obsessive ‘fixing’ upon thoughts or phenomena, intense scrutiny of details.
- Excessive rationality. The premises are bizarre and so are the conclusions, but the route from the former to the latter is [often] worked out with impeccable logic.
There are three kinds of people exhibit these symptoms.9 The first group, those usually admitted or sectioned as schizophrenic, are young people, usually men, who have grown up in an atmosphere that combines excessive emotion (especially critical, controlling or ‘emotionally overinvolved’ parents) with disabling dishonesty about it10 and who are conceited and lazy — who do not feel special enough (sometimes they have a more successful sibling), or unique or ‘esteemed’ enough (often through being deprived of any opportunities for independence, meaningful apprenticeship, etc) and who live in cities or urban areas. By using the techniques of obsessive mentation and sense-denial that such men have already picked up in the [urban] home and school, they begin to cut themselves completely off from the context and focus obsessively on objects (usually the body) and derealised ideas, which now, because they are without their originating, unifying, unselfish source, become a) fragmented and fixed in a freakishly hyper-real (or hyper-awake) present — which provides the sense of isolated protection schizoids seek from a painful reality — and b) are experienced as having come either from elsewhere (a.k.a. paranoia; ‘my thoughts are beamed into me from Titan’) or solely from me (a.k.a. grandiosity; ‘My thoughts control the moon!’) — both of which provide the sense of specialness lacking in the schizoid’s ordinary life. As with any denial of reality, there are dreadful side-effects from behaving in this way, which help confirm to everyone concerned that ‘he is a danger to himself and others’ and that he ‘requires care / attention / medication.’
The second type that exhibits schizoid thinking, feeling and behaviour is the modern and post-modern artist.11 The desire for attention without having actually done anything, intense focus on irrelevant details, absurdity unconnected to any underlying ‘strange truth’, denial of reality, constant irony, detachment and disengagement (think of Warhol’s tight, wry, knowing and slightly sneering distance from everything), shattering wholes into bits with an over-smattering of rationality and order are all hallmarks of the modern artist.
The modern (postmodern / contemporary) artist is exalted by the academic and media institutions of the world. His or her work is the standard of excellence to which all other art must reach if it is to gain access to prominent galleries, television documentaries, culture-section special-features and so on. Why should this be? Why should such transparently ugly creations, which display no harmony, no reality (by which I mean deep reality, not merely ‘things that happen’), no craft and no sense of refined sensibility whatsoever, why should these be the standard of artistic truth in our world? Could it be that this art is felt or perceived to be, by a large number of prominent people, beautiful, interesting or reassuring in some way? Could it be, to put it another way, that those who make decisions about what is artful or not, enjoy the schizoid view? Could they be, in a word, mad?
Yes, and not just them. Not even just those who celebrate Giorgio de Chirico, Marcel Duchamp, Eva Hesse, Wassily Kandinsky, Andy Warhol, Jean-Michel Basquiat, Jasper Johns, Damian Hirst, and other such high priests of ugly, irreal, meaninglessness. Take another look at the list above. Recognise any of those?
That’s right; the third category of schizophrenic… is you.
Are you not? Do you not have a tendency to stare, get utterly caught up in isolated fragments of experience (thoughts, ideas, things, tits, gun-sights, little high-tech objects…)? Do you ever smile thinly and let out cold, cheerless, sarcastic little witticisms? Do you ever get intensely and paralysingly self-conscious? Do you ever feel like life has no ultra-vivid zest, that strong passions and reckless delight seem like childhood myths, that all is drear? Do you ever feel dogged by a restless anxiety, a needling tension, awkwardness or a simmering sense of dread that no amount of fun, no quantity of money, no achievement or orgasm can ever quite quench? Do you ever have a bizarre sense that it’s all about you? Do you ever feel special, or are you addicted to activities which do nothing but make you feel special (famous, liked)? Do you ever get caught up in massively over-the-top enthusiasms which have a touch of mania about them, which sort of excludes everyone, and which you later feel a bit ashamed about? Are you sometimes rather too rational, does your rational mind sometimes lead you to absurd sometimes even horrific conclusions? Do you get annoyed with ‘irrational’ people, do simplicity, nature, innocence and presence sometimes make you feel a bit angsty, a bit irritable? Do you think that beauty is in the eye of the beholder, that truth doesn’t really exist, that reality is a myth? Do you ever have a sickening sense that nothing is real, that you are living in a shoddy cardboard cut-out of a world?
Every one of us is more or less schizoid. Those of us who end up in the funny farm — the full-blown schizophrenic — are just those of us who have taken this mania further than anyone else (very often not much further). We are all born into a world which puts continual pressure on us to focus on isolated objects and data, to perpetually and excessively think, to be a self, to give our autonomy over to institutions and our responsibility over to scapegoats, to be special, to demand unearned self-esteem, to be anxious and needy and to ignore, ridicule, co-opt or actively destroy the context.12 Those of us who bend to these pressures, who deform themselves to win in a world thus structured, are, at best, only different to the self-obsessed, self-conscious, self-imprisoned lunatic in degree, not in kind.
THE DISSIDENT AND THE MYSTIC
But there’s another kind of person routinely labelled as ‘schizophrenic’, who exhibits a group of symptoms which, at first glance, might seem similar to those above, but in fact, is radically different. An enormous number of people who have been diagnosed as schizophrenic since the days of Blueler and Kraepelin — and forcibly institutionalised because of it — have exhibited one or more of the following symptoms:
- Seeing or hearing things which other people do not see (hallucinations and delusions).
- Bizarre, surreal or flamboyant ideas.
- Intensely critical of the whole of society (rather than mere players within it).
- Intractable; particularly antagonistic towards institutional authority.
- Obsessed with the ineffable, the inexpressible, the ungraspable, the mysterious.
- Language non-literal; metaphorical and paradoxical.
- Unpredictable, outrageous, offensive.
- Intense sensitivity.
- Remarkable creativity.
Such people might include Jesus of Nazareth (‘Lift the stone and there you will find me. Split the wood and I am there.’), Jacob Boehme (‘Not I, the I that I am, know these things: but God knows them in me.’), Leo Tolstoy (‘Governments are not only not necessary but are harmful and most highly immoral institutions’) Sri Ramana Maharshi (‘I am everywhere’), Aldous Huxley (’Eternity — it’s as real as shit’) and Ivan Illich (‘School is the advertising agency which makes you believe that you need the society as it is.’)… in short mystics and dissidents. That these people were not committed is an accident of history. Any one of the quotes above, at the wrong time and wrong place, would be enough to confirm a diagnosis of schizophrenia.
Institutionally entrenched professionals are unable to tell the difference between mysticism / dissidence, and schizophrenia for the simple reason that it serves their purposes to institutionalise the job lot. That one group function normally, are healthy and happy, even brilliant, and the other are incompetent, unhealthy, deeply miserable and dull doesn’t enter into official diagnoses.
One consequence of this is the common idea that ‘geniuses are touched with madness’ — or, as Laing had it, ‘schizophrenics are sane and we’re all mad’. There is now a positive mania to diagnose creative geniuses with mental illnesses. The impulse to bring Homer, Buddha, Shakespeare, Beethoven or whoever down to the level of a diagnosable patient is irresistible to those in power and those who serve it. To say, in effect, ‘ah, well, The Odyssey and the Late Quartets are all very wonderful, but I’m glad I’m not a nutcase like those guys!’ and thereby denigrate the mystic, trivialise craft and dedication, exalt fictitious insanity and, once again, abnegate all personal responsibility to oppose authority and find the creative source of life for oneself… How useful!
Creative geniuses (or, more accurately, creative people sufficiently hollowed out to let genius speak) suffer more conspicuously than ordinary people, not because they are famous but because they work to experience and express life without the civilised internal censor interfering. But this is why they are loved: not because they are mad, but the precise opposite, because they are paragons of sanity. We love Chaucer and Mozart and Akutagawa and Krishnamurti because they show us what it really means to be an ordinary human; not an exceptional genius (much less a white man or a Japanese homosexual or whatever), but a conscious member of our species which, underneath the schizoid self, we know ourselves to be.
And this is why they are persecuted. Mystics and dissidents seek and seek to express responsibility, autonomy, what we have in common; life, the context, the consciousness that precedes the intrinsically schizoid self, the sane source of humanity underneath our millennial brainwashing and the present moment. What there is — direct, without the interfering filter of mentation and emotion. All of which is horrifying to authority.
You may have noticed this in your own life? You may have been overwhelmed by a storm of strange and wonderful ideas, tumbling pell mell into your blasted mind? You may have had a profound feeling of horror at the zone of evil that we live in? You may have realised that ‘we are led by the least among us’ and resisted the glad-handing coercions of authority? You may have felt intoxicated by the indescribable mystery of life, or the intense thisness of what is actually happening — and you may have reached beyond your normal, literal speech to grasp a magical analogy, or song, for it? You may have been blessed with a moment of near terrifying brilliance, courage or dignity? You may even have witnessed visions or heard a still quiet voice speaking long-forgotten truths to you? You may have felt, coming from nowhere, an inexpressible love — not love for anything, but an experience of love that, astonishingly, you just are?
You may have noticed that, underneath your schizophrenia, you too are a dissident and a mystic?
(UPDATE) RESPONSE TO CRITICISM:
Responses to this article have so far included ‘it made me want to scream’, ‘it made me want to vomit’ and ‘it made me want to kill myself’. No coincidence that such reactions are from people who are keen to claim that mental illness can make people do things.
Not surprising either that such an article generated a lot of criticism. Nearly all of it centred around confusing the claim that there is no such thing as mental illness (which is by definition true), with the claim that people’s mental problems do not exist (which would be a vile thing to even suggest), or that mental problems do not have physical effects (when of course they do — it’s the cause that is, in the ordinary medical sense, non-physical). I tried to make these things clear, but, like much of real importance (religion, politics, gender, history, etc.) people who have a vested [systemic / institutional / professional / financial] interest in believing something to be true get angry at the suggestion it might not be and then miss important distinctions (i.e. assume it is the same as superficially similar ideas with no such distinctions).
So by your definition TB was a myth before it was properly understood?
In a sense, yes. Again, this doesn’t mean that TB didn’t exist or that it couldn’t be [to some extent] treated, but that the cause was [to some extent] mythical (which is why attempts at curing diseases in the past were so fanciful). While the causes of a disease are not known the word ‘illness’ is [to some extent] a metaphor. However TB is not, primarily a mental or a behavioural problem. It’s a physical problem; therefore tentatively assuming a physical cause does not abnegate responsibility or compromise autonomy so much (although it certainly can), which is the point of the above.
This also applies to modern syndromes the aetiology of which is not understood, such as migraine and torticollis. To describe these as illnesses is [to some extent] a metaphor; but, again, the effects are all mainly physical. It makes sense to go looking for a physical cause (I myself suffer from migraines, the entirely physical causes of which I have largely identified and cut out from my life). It does not make sense to go looking for a physical (genetic, bacterial, viral, structural) cause for, say, Christianity, homosexuality, boredom, fear of birds, depression, psychosis or schizophrenia. Unless, as I say, you want to pass up your responsibility or imprison or anaesthetise people against their will.
The key point is that when the medical establishment are confronted with a problem which is mainly mental or behavioural — a subjective reaction — they go looking for a physical cause and rule out personal and social solutions, preferring pharmaceutical interventions and self-appeasing therapies. They never actually find a definite physical cause, which is why they have to vote ‘diseases’ into existence and why they diagnose on the base of behaviour (masturbation, anal-sex, hallucinations, weird language, alcoholism, anarchism, unemployment, low grades, socialism…) — but the assumption is that the cause of psychological problems and suffering is literal and physical. Personal and collective causes are ruled out. The possibility that traumatic childhood experiences lead to ‘mental illness’, or that verbal abuse during childhood leads to ‘personality disorders’, or that diet can adversely affect mental health or that society drives us out of our wits are instantly and reflexively dismissed by the medical profession (and their dependent clients) for the simple reason that it would put them out of a job (or out of an excuse).
But we know that schizophrenia is genetic / hereditary.
No, we don’t know this. Correlation is not causation. Even one of the authors of the DSM concedes that they have no idea what causes schizophrenia, and that ‘contextual forces play a large role’ in its aetiology. It means nothing that people labelled ‘schizophrenic’ all have the same gene (which isn’t true anyway; and even if it were, self and society would be the decisive, ‘epigenetic’ factors), and it means nothing that depressed people have lowered serotonin. It makes no more sense to say that schizophrenia is caused by genes or depression is caused by serotonin than to say delight is caused by endorphins, fear is caused by adrenaline or sadness is caused by tears. Delightful experience causes delight, fearful experience causes fear and sorrowful experience causes sadness. Once again, what would we ordinarily call someone who rules out experience? Out of their tree.
I am bipolar and I have all kinds of physical problems because of it.
I question this ‘am’ — but in any case, it does not mean that the cause is a physical illness.
Is autism an illness? Is asperger’s?
No. They were invented in much the same way schizophrenia was. The key figure in the history of Autism and Asperger’s was a psychologist called Lorna Wing. She, in effect, invented the so-called ‘spectrum’, which has gone from embracing something like one in 2,500 children in the 1960s to 1 in 64 today. There has been no change in the ‘illness’, rather the diagnosis has widened to include millions of numbed hyper-moderns who now have a ‘condition’ to blame their anesthetised awareness on.
But physical drugs affect people suffering from schizophrenia, so it must be a physical event.
So revolutionary anger is a physical event because a physical bullet can silence it? Drugs affect people with mental problems, but this — obviously — doesn’t mean that the cause of the problems is physical.
This is all very dualistic of you Darren. I thought you rejected Cartesian dualism?
I don’t reject it (I hold, if you’re interested, to a paradoxical both-and state of monism and dualism, with the former ‘giving rise’ to the latter). Dualism has its place. Dividing experience into mind and body is practically useful and, to some extent, factually true. Similar to Newtonian mechanics — not ultimately true, but relatively and usefully so. In this case, in Szasz’s words, ‘The ‘concept of physical illness’ demarcates a category, the same way that, say, ‘the concept of element’ demarcates a category. Atoms are not molecules. Physical illnesses (paresis) are not mental illnesses (panic reaction). Every concept or idea can be used or abused, help people or harm people.’
Once again, the critical point here is that the psyche-profession, the medical establishment, the media and many irresponsible people have a vested interest in abusing such categories by asserting that mental problems are caused by physical factors. There is no evidence of this and if there were, if a physical cause were found then we would pass such people over to neurologists (not that I have any faith in neurologists to deal with the causes of genuine mental disease either — and find Szasz’s enthusiasm for physical medicine as repellant as Foucault and Illich do — but that’s another matter — I’m quite happy to go for a brain scan and take drugs for my headaches).
While we’re on the subject of what I don’t like about Szasz, I find his ideas about what make a happy love relationship and his support of capitalism, completely revolting.
Mental activity is an algorithmic process, like a computer programme. Now computers can fail due to physical damage but also due to software error. Or as we say, a computer virus. The virus is non-physical and causes real damage… similar could occur in the mind.
Yes, I agree. The mind is like a computer programme, and mental illness is like a virus. As I keep saying — mental illness is a metaphor. This is why you use the word ‘like’. Physical illness is not a metaphor, at least not in the same way.
Who are you to stop me from describing schizophrenia as an illness? The division between mental and physical illnesses is blurry anyway.
I’m not stopping you from describing mental illness in this way. I’m pointing out the harm in taking metaphors literally (disastrous in science and religion) and, in this case, of treating ‘mental illness’ like physical illness.
As for ‘blurry’ over to Szasz again:
Typically, physical illnesses are identified by observing the patient’s body: he has a fever, he vomits blood, he is jaundiced, his white cell count is elevated.
Typically, mental illnesses are identified by observing the patient’s verbal pronouncements: he claims to be Jesus, the FBI sends him messages through his teeth, voices tell him that he ought to sill his wife.
There are objective, physical-chemical markers to ascertain that a person has, or has not, a particular brain disease, say subdural hematoma. There are no such markers to ascertain that he has, or has not, a particular mental disease, say schizophrenia. Hence, there is no way a person can disprove the “diagnosis” that he “suffers” from schizophrenia.
The typical medical patient seeks medical help and is hospitalized and treated with his informed consent. The typical mental patient does not seek psychiatric help and is treated without his consent.
(This last point doesn’t apply so much today of course, but it will again).
Note that (notwithstanding his staunch dualism) he uses ‘typically’ as would I. It’s true, none of this is black or white — exceptions and grey areas can always be found (and always will be found by people who wish to avoid unpleasant truths). Focusing on exceptions and grey areas, however, misses the overall, essential, unblurry point which is that the assumption that Schizophrenia, psychosis, mania, addiction, phobia and so on are illnesses in the same sense as cancer, TB, flu and so on rules out meaningful personal and social responsibility. The established medical profession and countless malingerers around the world, clearly have a vested interest in doing this.
I can’t do the gardening, I have a disease. I can’t love you, I have a disease. I can’t be spontaneous, I have a disease. I can’t be free of my parents, I have a disease. I can’t restrain my murderous sexuality, I have a disease. I can’t stop worrying, I have a disease. I can’t calm down, I have a disease. I can’t live without feeling special, I have a disease… and so on. Very convenient this ‘disease’ — but if you didn’t have it, maybe, just maybe, you — or we as a society — could actually solve your dreadful problems?
There is ample evidence that schizophrenia and bipolar were known throughout recorded human history. It is in literature for millennia. Clearly. It is not a 20th or 19th century invention.
Schizophrenia was rare in hunter-gatherers and is either less common in non-Western societies or is more easily dealt with.13
Warner’s (1985) review of comparable epidemiological studies affirms that schizophrenia is less common in developing countries. Such countries also treat schizophrenia more effectively (as the WHO discovered; Barker, 2009 — see also Murphy and Raman 1971; Waxier 1977; Warner 1985; Jablensky 1987; Hopper 1991; Marcolin 1991).
Among indigenous societies, there are many accounts of a lack of mental illness, a minimum of coercion, and wisdom that coercion creates resentment which fractures relationships. The 1916 book The Institutional Care of the Insane of the United States and Canada reports, “Dr. Lillybridge of Virginia, who was employed by the government to superintend the removal of Cherokee Indians in 1827-8-9, and who saw more than 20,000 Indians and inquired much about their diseases, informs us he never saw or heard of a case of insanity among them.” Psychiatrist E. Fuller Torrey, in his 1980 book Schizophrenia and Civilization, states, “Schizophrenia appears to be a disease of civilization.”
Here’s Allen 1997:
Schizophrenia is apparently less common in traditional than in nontraditional societies, and the course of illness in these cultural settings may also be more benign. Viral, political, economic, social labeling, and other explanations have been offered over the years for these differences. In contrast to those ideas that suggest the presence of a schizophrenogenic stress in urbanized, Westernized populations, the author proposes that traditional societies are actually schizophrenogenic compared with nontraditional societies. Assuming a multifactorial threshold model for the development of schizophrenia, traditional societies may be characterized by a lower threshold for developing schizophrenia in at-risk individuals.
(I don’t agree with the rest of Allen’s thesis by the way, but this summary is accurate).
There’s much more. Schizophrenia, like depression (Hidaka 2011) and many other such problems, is a modern [and largely] urban phenomenon. It started with civilisation, and has been getting worse and worse ever since, exploding, like cancer (David & Zimmerman 2010), with the industrial revolution and the advent of modernity.
Of course there were bipolar and schizophrenic people in the past! And they reproduce and keep their genes in the gene pool because often the onset of their illness is after they are sexually mature.
As I explained, there are two utterly different things which are labelled ‘schizophrenia’, one is healthy, insightful, creative, etc (dissidence and mysticism — which was obviously more common in the pre-historic past) and one is unhealthy, mediocre, uncreative (which was non-existent in the pre-historic past, less common outside the WEIRD — see also note 9 below). Neither have a physical cause in the same way that, say, TB, cancer, flu, etc do.
This essay appears in a more concentrated form, as The Myth of Mental Illness, in my free book, 33 Myths of the System, which also explores The Myth of Psychology in greater depth than here, along with the various myths of the world that actually create this mad state of affairs.
The Apocalypedia links the two forms of ‘schizophrenia’ outlined above with, amongst other things, human history, personal relationships, gender, schooling, home brainwashing and dreams.
I was interviewed by Graham Stannard for his Mental Health Matters podcast for a local radio station on these subjects, here. Note that at one point I say that all authors of the DSM have links to drug companies — not true, of course. Got a bit carried away; many authors are (Cosgrove et al., 2006 / 2012).
- Laing was a troubled and reactionary thinker who never questioned the basic institutional framework of psychology. His aim, says Szasz ‘was not to expose the nature of psychiatric power but to seize it.’
- largely by studying sick, alienated, atomised and (as Lancy and Henrich term them) WEIRD addicts in the unnatural hierarchical anti-reality we call ‘the civilised world’ and assuming that they are thereby investigating the essence of human nature.
- Szasz does not use the word ‘capitalist’ critically because he was a capitalist; he supported the market. This vast blindspot in his critique of professionalism was more incisively filled by Foucault.
- Originally here I had said that criminals use the insanity defence to avoid prison, which is true but the matter is far more complex as a reader wrote to explain to me, offering a very good critique of my, admittedly, off-hand judgement. It’s worth quoting in full:
‘While I’m not denying there’s some people who consent to an ‘insanity defence’ with [the intent to get off the hook], nor that the strategy may even be somewhat successful in Szasz’s USA — in which centuries long sentences aren’t unknown — my experience as a criminal justice and (anti-)psychiatric activist in Australia is that very few accused want to use such a defence at all. They are more often coerced into it by lawyers who can pretend to have ‘won’ a case if the result is ‘not guilty by reason of insanity’ and by family members who consider insanity to be less stigmatising than criminality (to them at least). The judiciary like it too because it absolves them of responsibility for (potentially appealable) sentencing by passing the buck to ‘objective scientific experts’.
What’s more, the effective sentence is generally far more draconian than it would have been had they been found guilty.
Not only are they typically incarcerated for an indeterminate length of time which usually turns out to be longer than it would have been had they been found guilty, they are also subjected to greater surveillance and curtailment of rights than a ‘criminal’ prisoner. Both their bodies are imprisoned — sometimes to a bed for days at a time with restraints — and their minds with (usually chemical) ‘therapies’. Multiple dimensions of their identities are delegitimised and subject to constant assault. When/if they’re released they don’t get a finite parole period but rather a lifelong mental health label that renders them permanent outcasts and makes them significantly more vulnerable to future incarceration and/or coercive treatment.
Sex offenders (as was once the case with homosexuals) are doubly cursed in that they’re often considered both criminal and insane, as well as beyond all sympathy from polite, progressive society. Most people — even many criminologists — think that sex offenders are chronic recidivists despite the fact that they are less likely to be (detected) reoffenders than almost any category of prisoner other than murderers.
I recognise that you may already know all this and you’re only referring to a subset of defendants who naively imagine that being found crazy rather than criminal will make things easier for them. But, as with Szasz, the way you do so tends to promote the widespread myth that the ‘insanity defence’ is some kind of loophole employed by the irresponsible and unscrupulous to evade ‘justice’ (i.e. punishment). I agree it’s invalid, for several reasons (not least the age old unresolved epistemological dialectic of free will vs determinism), and should be abolished. But not that it’s a cop-out. At least not for the defendant.’
- If you have to see someone about your problems, your manias, your fears; choose your therapist or psychologist very, very carefully. You need someone who understands all the above and such people are extremely thin on the ground in the ‘mental-health’ profession. Generally you’d be better off with a so-called paraprofessional. Robyn Dawes, in his House of Cards cites hundreds of studies which show that accreditation and qualification bear no relation to ‘patient outcomes’ (i.e. sanity), that mental health professional’s accuracy of judgement does not increase with experience and that paraprofessionals do just as well as professionals with other people’s problems.
- See Lost Connections, by Johann Hari.
- Wikipedia describes The Semmelweis reflex as ‘a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms’. Funnily enough this is yet to be considered a mental illness.
- Once again, please note; I am not saying the phobia is dreamt up or invented. Fear is real, cravings do overwhelm people… but they are not illnesses.
- Another word that we can rescue from the ideological literalness the psychiatric profession wish to monopolise.
- Here Laing, once we have divested him of his shady glamorising and glorification of such suffering, does offer insight.
- Which comes from — as does the kernel of the insights which follow — the outstanding Madness and Modernism, by Louis Sass.
- If what we call Schizophrenia really does have social and personal causes, we would expect, for example, the ‘developing’ world, in which people have greater access to personal and social care for their psychological problems, to have more success in dealing with schizophrenia than the ‘developed’ world which medicalises and institutionalises psychological problems. And that is what we do find: the ‘WHO reported recovery rates of 63% in ‘developing countries’ (i.e. poor and disadvantaged), whereas in developed nations (i.e. Western) the rate was only 39%.’ (Barker, 2009). We would also expect research to discover that personal and social factors, especially in early life, are related to problems commonly diagnosed as ‘psychosis’. Again, that is what we do find (See Read et al, 2005; also Dean et al, 2005 for a thorough refutation of Bleuler and Kraepelin). It is generally only the professional middle-class or those heavily invested in its hegemony who believe that genetic or neurological factors are more likely to cause psychosis than social events and circumstances (like poverty, trauma and abuse), for obvious reasons.
We would also expect two of the premier researchers in the field of cross-cultural research on Schizophrenia to say something like:
In sum, what we know about culture and schizophrenia at the outset of the twenty-first century is the following: Culture is critical in nearly every aspect of schizophrenic illness experience: the identification, definition and meaning of the illness during the prodromal, acute, and residual phases; the timing and type of onset; symptom formation in terms of content, form, and constellation; clinical diagnosis; gender and ethnic differences; the personal experience of schizophrenic illness; social response, support, and stigma; and, perhaps most important, the course and outcome of disorders with respect to symptomatology, work, and social functioning (Jenkins 1998:357).
See Crazy Like Us by Ethan Watters for an overview of how cultural expectations and psychocratic definitions shape symptoms, create ‘illnesses’ and deflect attention away from personal suffering and responsibility. Contains a jaw-dropping chapter dismantling the fantasy of ‘PTSD’ and exposing the delusional swarms of American and European therapists who prance around the world ‘treating’ it with card games and questionnaires, as well as a very good dismantling of the professionally-curated illusions surrounding schizophrenia and depression.
- See Louis A. Sass, Andrew Halliday, George Deveraux and Meyer Fortes. See also Schizophrenia and Civilisation by E.Fuller Torrey, which demonstrates that Schizophrenia is a modern condition. I thought it weird Torrey writing such a book, as he is biological determinist and a strong advocate of coercive treatment, but Michael (see note 3 above) explained; ‘Torrey was originally one of Szasz’s most fanatical disciples but later renounced him. As with so many apostates, he then swung to… a diametrically opposed position — which also happened to be more financially lucrative. Hence the Stanley Foundation funded Treatment Advocacy Center’.