Julia asked:

I am very interested in anti-psychiatry and what philosophy has to offer in this field today. I believe it is more and better than psychiatry. I am also very interested in the modern philosophers who have accessed this field through existentialism, phenomenology and ethics. Any comments, suggestions or criticism? Or even guidance.

Answer by Craig Skinner

You ask for suggestion, comment, criticism and guidance.

I have all of them for you.

Suggestion: move on from anti-psychiatry. Its job is done.


  *psychiatry and philosophy are not in competition

  *psychiatry helps (or can help) people with mental illness

  *philosophy helps (or can help) all of us to achieve inner harmony and live well

Criticism: to be against abuse of psychiatry is fine, but claims that mental diseases are a myth, a social construct or a means of oppression of individuals by institutions are seriously misguided.

Guidance: limited (see below).

To enlarge slightly:

Anti-psychiatry got going in the 1960s as a reaction to perceived abuses. These were real. Patients were often treated inhumanely, typically in forbidding asylums, nasty treatments such as insulin shock therapy, lobotomy and ECT were overused, and in some countries, dissidents were labelled mentally ill and institutionalized by a coercive state abetted by doctors. But all this has changed (my experience is of the UK). Asylums have closed, patients are now mainly in the community, treatment is a partnership between patient and professional, insulin coma and lobotomy are history, ECT is used sparingly. So now, anti-psychiatry is as silly as anti-gynaecology or anti-cardiology. Of course we should oppose abuse whether it be by psychiatrists, cardiologists or anybody else.

My view of mental illness is shaped by my 50 years as a doctor (not a psychiatrist, rather a physician) and by family experience of mental illness. Like all families, mine has all kinds of illness from cancer to heart disease to mental illness. In particular I had two sisters with schizophrenia and have two other close relatives with bipolar disorder. My sisters’ lives were ruined by their disease. To tell them, as some of the anti-psychiatry advocates claim, that their illness was a myth or social construct, would be a cruel joke indeed. I saw them live with it for decades. The only thing that helped was medication backed by psychiatric nursing/ social work. Similarly, my bipolar loved ones benefit from medication, and one has had an intractable severe depressive episode ended with outpatient ECT. Severe mental illness is as real as cancer, and one day we will understand how and why exactly the brain wiring/ chemistry is scrambled, and will be able to arrest, reverse or prevent these conditions. Meantime, drugs and cognitive therapies can help.

The idea that philosophy (as discourse plus a way of life striving for wisdom) aims for harmony of the soul is an ancient tradition and still thriving. It is central to Socrates, Plato, Aristotle. Stoics, Epicurians, Pyrrhonists, and many modern thinkers such as Heidegger and Wittgenstein. One can call this philosophy-as-therapy, but let’s not confuse this with treating illness. Philosophy as therapy aims to help us all, well or ill, lead a good life, whether the latter is seen in terms of reason, virtue, tranquility, suspension of belief, acceptance of fate, contemplation of the Form of the Good, dissolving pseudoproblems and seeing things aright, more than one of these, or whatever.

My own views of philosophy as therapy have been formed mostly by the Stoics ancient and modern (Epictetus, Marcus Aurelius’ Meditations with Hadot’s commentary The Inner Citadel as a must-read companion, and writings by the Stoicism Today team of academics/ psychotherapists), and by Heidegger and Wittgenstein (both difficult, especially the former, even with guidebooks). But I am light on other existentialists and know next to nothing about phenomenology, and so cant offer guidance there.