Mad World: The Politics of Mental Health

Outspoken

by Micha Frazer-Carroll

‘A radical antidote to the constraints of our current conceptualisation of mental health’  Dazed ‘Exposes the underlying truth that capitalism is fundamentally incompatible with our wellbeing, and teaches us how to transform the ways we understand madness, illness, and disability to build a better world’  Beatrice Adler-Bolton, co-author of  Health Communism Mental health is a political issue, but we often discuss it as a personal one. How is the current mental health crisis connected to capitalism, racism and other social issues? In a different world, how might we transform the ways that we think about mental health, diagnosis and treatment? These are some of the big questions Micha Frazer-Carroll asks as she reveals mental health to be an urgent political concern that needs deeper understanding beyond today's 'awareness-raising' campaigns. Exploring the history of asylums and psychiatry; the relationship between disability justice, queer liberation and mental health; art and creativity; prisons and abolition; and alternative models of care;  Mad World  is a radical and hopeful antidote to pathologisation, gatekeeping and the policing of imagination. Micha Frazer-Carroll  is a columnist at the  Independent . Micha has written for  Vogue, HuffPost, Huck, gal-dem  and  Dazed.  She was nominated for the Comment Awards’ Fresh New Voice of the Year Award, and the Observer/Anthony Burgess Award for Arts Criticism.

Genres: Nonfiction, Psychology, Mental Health, Politics, Disability, Social Justice, History

192 pages, Paperback

First published July 5, 2023

Reviews

[Sarah Cavar · Rating 5 out of 5]

I admit, despite the all-important Death Panel endorsement, I was skeptical of how much I personally would like this book. I often find "introductions" to disability/Madness to range from hyper-simplified to the point of inaccuracy, to limited and essentializing in scope/attitude, to simply a whole bunch of stuff I've heard before. In short, I'm not the audience for even the best "basic" book, and tend to be suspicious of works trying to give wide-spanning introductions to such a complex topic.

Mad World was published at the blurry triple-boundary of "trade" and "academic" and "activist." This is a huge ask to make of any book, and yet, Mad World somehow succeeds: it is a smart, rigorous, and detailed introduction to historical and contemporary Mad politics. Frazer-Carroll achieves a fantastic balance between uncompromising attention to nuance and detail, while also putting her journalistic skills to work in introducing those new to Mad politics to important debates and approaches. I will be studying the craft/method used here for many years in the future, I'm sure, as an example of highly effective health communication that teaches without a moment of condescension.

There is a lot to love in Mad World, but I'd like to point out one thing directly relevant to my own work. For my dissertation, I'm thinking about self-diagnosis and/as identificatory self-determination. This includes both self-diagnosis with existing "conditions" (as it were) but also identification, for example, with multiplicity and plurality (being one of several consciousnesses occupying one body) outside the purview of diagnostic labels such as "dissociative identity disorder." My work and my interlocutors are most often confined discursively to the "chronically online" sphere, with precious little representation in "real" books, academic, trade, or otherwise. In this book, Frazer-Carroll not only directly addresses the salubrious effects and real material implications of self/community-diagnosis, particularly online, but does the same for multiplicity. She cites conversations with actual comrades and those in-community, acknowledging implicitly and explicitly that this is a step toward epistemic justice for Madpeople, and the best way to gain up-to-date information on non-normative psychosocial experiences, besides.

This isn't merely me praising "representation." This is me reading a text in which Mad interlocutors are treated as professionals, experts in their experiences, with concrete knowledge to share with the author and with readers. And Frazer-Carroll writes with such curiosity, excitement, and humility, that this profound move feels completely natural. Why wouldn't Madpeople be experts?

So. Read this book. It would be a great birthday or holiday gift, recommendation for a nonfiction book club, or book for a high school social science/composition classroom. As someone engaging in Mad Studies at the doctoral level, I also found much to chew on in this short, thorough text. The fact that I could share this book with a high school student, my parents, a PhD colleague, and to my activist communities is a testament to the power and necessity of this text. I can't wait to see what Frazer-Carroll writes next!!

[Kamila Kunda · Rating 5 out of 5]

This is the most important book I read this year that helped me structure many thoughts I have had since I started working as a counsellor and went through my own autism diagnostic process in the Netherlands. In “Mad World. The Politics of Mental Health” Micha Frazer-Carroll unpacks the current system of mental healthcare by exposing its flaws, deliberate biases and prejudices and its benefactors: those who wish to uphold capitalist, racial and social power structures. The aim of much of mental healthcare in capitalist societies, and in the UK in particular, isn’t to create safe, supportive and inclusive communities. It is to make sure all members of society are either productive in the capitalist system or denied autonomy to decide about themselves (hence psychiatric diagnoses and evaluations done by professionals which do not include opinions of people with lived experience).

Through the exploration of the history of asylums and the development of psychiatry, the sickening nature of work, colonial and capitalist notions of what’s healthy and normal (all diagnostic tools based on which mental illnesses are classified were developed in the USA), exploitative prison system, concepts around disability and queer liberation, approach to neurodiversity in capitalist economies, Frazer-Carroll exposes how rotten the world we live in is and how much there is to improve. It was infuriating to nod in agreement when I read about the desire for members of Western societies to be submissive and as least disruptive as possible. The paradox is that Western way of thinking about diversity is very narrow, rigid, exclusive and focused on ‘fixing’ every behaviour and way of perceiving the world which deviate from the norm. Individualistic nature of Western societies also puts pressure on individuals to get help and get better (and blames them if they don’t).

In many Western societies subjective ways of obtaining knowledge are dismissed, which leads to structural epistemic injustice - it is psychiatrists and doctors who have a say when it comes to whether people are healthy and what their ‘illness’ is. Normal human responses to circumstances are so often pathologised. But the author is positive about the power we have to change the system. She discusses anti-psychiatry movement, art as a liberating tool, the social model of disability which is becoming more widely accepted.

I found this book incredibly eye-opening, loved the crystal clear, well supported by data and diversity of perspectives argumentation and the nuanced approach to the complexity of mental healthcare, mental illness and Madness. I adopted for myself the phrase “bodyminds” because it finally correctly acknowledges the inseparable nature of the body and the mind. I applauded the author’s lack of enthusiasm for many Western methods of psychiatric treatment because for many people they do not work. Frazer-Carroll is of Antiguan origin and considers also Indigenous approaches to perceiving a person and spiritual healing, which is what has fascinated me for a long time and which I see sorely lacking in the narrow approach to psychiatry in the West. The way she writes about neurodiversity and especially autism deserves all accolades.

I would urge everyone to read “Mad World”. This is the topic that impacts absolutely everyone and which everyone should care about. There is not a single person in the world who walks through life never experiencing feeling at odds, either with themselves, the others or the world at large, and therefore everyone will find food for thought here. This book may help many of us reevaluate the way we have thought about ourselves and others, and may help us embark onto a healthier way to approaching mental health.

[Chris Osantowski · Rating 5 out of 5]

Reason #489 that I love having a partner who is a professor: she hears about books like this early and suggests I read them.

This book empathically and articulately ties the politicization of mental health to personal experiences of mental health in a helpful and concise way. After reading the introduction it was clear this is a very helpful primer for this important subject.

[Corvus · Rating 5 out of 5]

Mica Frazer-Carroll's Mad World is a decent addition to the field of both radical mental health and academia around mental health and disability justice. The author tells us early on that she has a depersonalization disorder diagnosis, and she sometimes mentions this throughout the rest of the book but does not make the error of constantly using herself as a case study which I appreciate. The author is British so there is a lot of history that I learned about mental health and access in that area that I didn't know about as a US American. Much of it mirrors the history here. There are also bits of disability justice, anti-psychiatry, and radical mental health movement history that I did not know about before- including in the USA- despite having read a lot of different texts on the subject. For example , I didn't know that the anti-psychiatry movement spanned political positions on the left and right, ranging from freedom to be oneself to freedom to not have society pay for the cost of medical care and whatnot.

This book also captures well how awful psychiatry has been and how much abuse and absolute wrongdoing has occurred within it. It does this without absolutely burying you in the horrific details. I believe she gives you enough information to know what she's talking about without completely overwhelming the reader. I am also a person who has dealt with some of these abuses personally and have seen others deal with them. There's a long history of psychiatry being used against everyone from enslaved people to activists. At the same time my personal experience has not led me to a fully anti-psychiatry position, just as abuses in other medical fields have not led me to be anti-modern medicine- which leads me to my next point.

This book has some flaws that I see across lots of radical mental health texts, however I do think that the author approaches it with more nuance than many others do. I like that this book asks more questions than it answers. It asks a lot of, "what if we did things x way," sort of questions. However, like many of these sorts of texts, people with very extreme and unglamorous symptoms of mental illness are not really included as much as they should be. We don't fit The narrative of just being sort of different and needing a sort of different society.

This is very personal for me, so it often colors my ability to read these things in ways that I'm not sure are constructive. I have very extreme OCD that ruins my life. I think about getting actual brain surgery on a daily basis. OCD is not just a different way of viewing the world requiring environmental or systemic change. In fact, relying on that can strengthen OCDs grip. My closest family member suffers from very severe paranoid psychosis and has been on the run for many years- including bouts of homelessness and disappearance- because her brain has led her to believe that almost everyone she sees or interacts with is in on a gang stalking plot. This text talks about hearing voices as some sort of spiritual experience and even discusses entertaining and validating delusions because you can never really know - which I guess may be true with spirituality. The unfortunate fact is that the vast majority of people with psychosis have paranoid psychosis. Are these things caused by stressors and lack of social access to needs? They're absolutely exacerbated by them and isolation definitely can trigger episodes. A social and systemic change model would undoubtedly help these people. I'm not denying that. But, in my experience, when dealing with people with paranoid psychosis or severe OCD or any other number of unglamorous and torturous symptoms, most people disappear. Most people do not want to provide support and create the community-based things that we need- including radical mental health advocates.

This is what is so devastating about this sort of thing. There is just criticism of the neoliberal mental health awareness movement and how it places the onus on individual change as the solution. Part of this awareness is that they want awareness of people who have something like short-term mild depression and are able to get out of it by joining a gym and taking an antidepressant and then becoming a "productive member of society." Radical mental health is unfortunately not immune to that same sort of influence. When you're really in the trenches dealing with people who are living in absolute hell, it's quite difficult to believe that the biomedical model isn't pretty important, however flawed. Furthermore with things like schizophrenia, there is marked brain damage and measurable effects of the disease that this book claims are not present in psychiatry. This is why all of it is frustrating because radical mental health tends to be about whatever diagnoses or getting the most attention at the time. And the people able to advocate and get that attention are usually the people who are the "highest functioning" and widely appealing, as is true in any movement.

Another contradiction is that she acknowledges one of the problems with psychiatry and diagnosis is poor inter-rater reliability. This means that from professional to professional they may not come up with the same diagnosis. This is true across all medical fields, but is especially true of psychiatry. I agree. The issue then is that she goes on to support self-diagnosis by people with no training and experience in the field. If the inter-rater reliability between people who are trained is bad, it's going to be even worse between people who aren't. I'm not saying self dx people don't read or research. But, there is a lot of overlap between things and over the decades I have seen various diagnoses be the one that people are seeking out because it is the one that people are talking about the most. Even professionals are not immune from this. This is worse now with the advent of social media. And if one of the main criticisms of psychiatry is that it pathologizes non-normativity, why is there such a strong movement to change diagnosis to include more non-normativity and to allow anyone to diagnose themselves with anything? Nobody wants to get a diagnosis of OCD even though that may be a more correct diagnosis for them than one of autism. People cannot self diagnose with a disorder that includes psychosis because one of the markers of psychosis is not knowing you are experiencing it.

I may be being unfair here because the author makes it very clear in one chapter that the division between a binary biomedical model and a social model of disability isn't really something that exists. She also acknowledges that we can seek radical mental health while still believing that we want treatment or cures. However much of the book is still devoted to focusing on a more social or systemic change model. She does jump around though. I found myself frustrated with a chapter or two, but then she would move on to the next and I would be back on board.

The best parts were where she did balance these things and discussed innovative ways of dealing with various symptoms. Some of the discussions with indigenous healers and how they dealt with people hearing voices, having hallucinations, or dealing with delusions were interesting. I would like to see things like this taking up massive amounts of space and radical mental health texts and guides. I also like that she talked about people creating maps of how to help them when they are really going through it. The key is to create these things and one is in a more stable position. In the case of something like severe psychosis though, getting to that stable position is near impossible without the biomedical model. It does happen, but the vast majority of people that I have known and spoken to who have dealt with psychosis have said that involuntary treatment, while absolutely harrowing, was the only thing that brought them back to themselves.

Near the end of the book she talks about the importance of not leaving anyone behind and not abandoning people with one form of illness in order for another to advance. This is not talked about enough in radical mental health or any other disability justice circles. I've seen Eli Clare and some others discuss, for instance, the abandonment of people with intellectual disability when people with other disabilities focus on telling everyone how intelligent they are. To be a broken record, in radical mental health, people with more extreme symptoms are often abandoned or spoken about incorrectly while other people pathologize difference in behavior and apply diagnosis to it sometimes even after multiple professionals have told them that the diagnosis does not fit. This then changes what that diagnosis means and leads down the path of seeing the people who actually have more extreme access needs being seen as the bad kind of people with that diagnosis (if they are seen at all.) Many people with an autism diagnosis from a young age for instance do not have this diagnosis because they are "privileged." They have the diagnosis because their access needs were so great that they ended up being diagnosed early on in life. This shit is messy and complicated and I'm glad that this author was able to discuss directly the importance of not leaving behind those who may adhere more toward the biomedical model or who may have needs that are isolating.

Overall, in spite of my ranting criticisms at times, this is a really good book written by someone who clearly cares about the issue and did their best to span the wide variety of viewpoints and experiences that exist across the world of madness and mental illness. This text is a valuable one and both organizes and enriches these discussions.

This was also posted to my blog.

Edit: increased to 5 because the more I think about it, the more I realize how good it was and how docking a star was likely about me more than the author or book.

[xenia · Rating 4 out of 5]

Despite the brevity, Mad World is a nuanced take on mental health, weaving insights from Marxism, poststructuralism, democratic psychiatry, neurodivergence, crip theory, transformative justice, LGBTQ struggles, even art therapy and zines. At first, I was frustrated at how short its chapters were. Having finished Empire of Normality earlier this yr, Mad World felt sparser, concerned with breadth rather than depth. I realise now that's the point. It's a resource book meant to guide the newly suffering to a political awakening—an attempt to help those who've felt crushed, alone, or defective all their lives, but who have had no guidance to the causes of their distress.

I've already talked about labour exploitation and mental health in my review of Empire of Normality, so I'll focus on authority and control here.

When I was younger, I used to hate suicide prevention, to the point where I would say I was "pro suicide" (I was that kid). My reasoning was that suicide prevention imprisoned you to life, no matter your experience of it. At the moment of what many suicidal people consider the ultimate relief from pain, you're pulled back by a stranger, whose tactics are informed by de-escalation, rather than care. Your life matters—even if it's miserable and wretched. I hated these people with all my heart. I hated their condescension, their pity, and their authoritarian imposition of values that worked for themselves, but not for others.

I started collecting sleeping pills a few years ago. Having researched, fastidiously, about suicide when I was younger, the particular pill I picked seemed the safest option for a death without recovery. I didn't want to be resuscitated with permanent organ damage. The cliffs were too far away. An exit bag was too much effort to make. Wrist slitting collapses your chest in a gruesome fashion. This seemed clean. While friends were worried, this action, paradoxically, gave me comfort and security. Knowing I had a way out kept me alive, better than any restraint or threat ever had.

It was control I was after—autonomy. This has been a pattern all my life. When I was self-harming as a teen, I was seeking control over my dysregulated emotions. When I had a schizophrenic break in undergrad and tried to kill myself, I was seeking control over the unrelenting pace of assignment deadlines. While these kinds of actions can be an attempt to "gain attention" through "acting out," they come from a place of entrapment. A person "acts out" if they don't know another way of seeking help. Borderline personality disorder is a consequence of complex PTSD, of never having been cared for in a consistent fashion—hence, the "over the top" reactions to small things; it's a survival mechanism to gain the attention of a neglectful guardian. Depression and social withdrawal are similarly driven by intense shame, derived from a lack of validation. Without the capacity to self-soothe or ask for care, we move into less healthy patterns of addiction, self-harm, isolation, and violence.

The point Frazer-Carroll makes throughout this book is that the predominant response to the mentally ill by state and corporate authorities is further violence and restriction. Incarceration in asylums or prisons. Denial of medical services and employment. Enforcement of rigid work practices and hours that disable the mentally impaired. The use of medical diagnoses to dismiss the experiences of trans, schizophrenic, borderline, and autistic subjects. Deployment of police to suppress sufferers of mental crises through injury and death. In all these examples, control is what is at stake here: control of our bodies, our homes, and our lives; control over what we deem helpful and necessary, and what they deem aberrant and illicit.

One of the worst experiences I've had with medical authorities was when I went to a private clinic to get an ADHD diagnosis. I was on their waiting list for over a year. When I finally had my appointment, the psychiatrist went through a list of questions on a form I'd filled out earlier in the week. I spent fifty minutes repeating myself, while the guy ticked boxes. At the end of the session he diagnosed me with depression, something I'd been diagnosed with a decade ago for $12. The appointment cost me $500.

When I started seriously considering transitioning, I went to someone at Student Health who had all these posters about LGBTQ causes and cultural diversity. When I said I had begun somatic therapy, which lessened my body dysmorphia, they immediately honed in on this and became reticent prescribing me estrogen. They treated my gender dysphoria as a misalignment of my bodymind to be solved with mindfulness, rather than as an additional site to address with gender affirming healthcare.

These are the virtue-signalling fuckers who are in the way of genuine, democratic care. They treat you like a child because they've attained the distinction of a profession based on hierarchical disdain for the masses and their subjectivity. These people will kill you through their epistemic fascism, because their views manifest at the institutional level through medical gatekeeping and the invalidation of your personhood. I have grown sicker from their medical care, and it has only been myself, my friends, and a few medical allies, who have kept me alive and hopeful for change. I should not have to read trauma therapy books myself to heal from my cPTSD. I should not have to trade medication with my friends to stay functional at work.

But I have also experienced compassion, love, and humanity from the few medical allies I've met. My new GP who made a pointed effort to orient my transition around informed consent, making the process as painless as possible. My somatic therapist who never acted as if they knew my experience better than I did. And the psychiatrist I met after my suicide attempt a decade ago, who didn't invalidate my experience as an attitudinal problem, but as genuine suffering. It is their compassion that guides me in all my efforts adapting psychotherapy towards mutualist networks of care.

xx

[Christina Meyer · Rating 4 out of 5]

Nothing too revelatory, but a great introduction to liberators mental health care and anti-psychiatry! An excellent integration of various struggles for liberation and how Madness/Mental illness intersects with them all.

[Adam Wilson · Rating 5 out of 5]

Really good critical introduction to the concept of mental health/illness and its development alongside changing requirements of capitalist work. Offers a radical alternative to current modes of psychiatric diagnosis/treatment, encouraging us to look past binaries of sane/insane and to imagine a world in which we might begin to accommodate the messiness of our collective mental lives.

[miriam · Rating 5 out of 5]

thank god for micha tbh!!!!!!!

[silly_ebadu · Rating 5 out of 5]

man. this was a proper affirming read. so well-researched and detailed but in a way that anyone could pick this up and gain something from it without being overwhelmed with loads of information. mad people dem- rise up!!

[Dee · Rating 3 out of 5]

It was good in the sense that it covered a broad range of topics and gave a good overview of the various aspects relating to mental health. However, I also think this was its downfall, there was a lot of breadth but not enough depth. There were some areas where the author made very generalised and blanket statements which weren’t necessarily wrong, but a bit naive.

I agree that a lot of the critique aimed at psychiatry is wholly warranted, there is a lot of power and abuse, but again the author kept making blanket statements about psychiatrists just using the medical model. I also got the sense that there was not enough awareness of how mental health services work, particularly the mental health act, which meant that some of the discussions and critique came across as simplistic and lacking nuance. For example, there are different types of psychiatric inpatient units, there’s care in the community, supported housing etc. I’ve never come across a psychiatrist who just (if at all) works from a ‘medical model’ approach.

I wondered whether discussions with those who work in mental health services and also those with lived experiences who haven’t had solely negative experiences of services may have been useful. Not as a way to discount the horrific experiences that some have been through, but just so that the author is providing a range of discourses to demonstrate the complexity of the topic at hand.

The inclusions of other types of approaches and models was good, such as the trieste model and the hearing voices network. There could perhaps have been discussions about trauma informed approaches and the power meaning threat framework.

[Genevieve · Rating 4 out of 5]

This is a great primer for anyone who wants to begin their journey in understanding the history of how we deal with mental illness and the harms committed by the state in ‘treating’ mental illness.

I generally agree with the perspective in the book and consider it a good contribution to anticarceral discourse. Yet with a partner who works on a secure psychiatric ward, I spent much of the book wondering what the alternative is for the most extreme cases. I appreciated the chapter towards the end that discussed alternatives - from micro initiatives to Trieste’s banning of psychiatric units. But I think this is always my burning question - without judgment if people have mental illnesses or not, how should we as a community reduce the harm that a small minority of people cause others in society?

Nonetheless a great work packed into under 200 pages!

[riddhi · Rating 3 out of 5]

one of the best and most accessible introductions to the intersection of politics and mental health! would recommend this to anyone beginning to foray in the field. i loved the focus on lived experiences of people with mental health conditions, something that mainstream research tends to ignore for the most part. as the author mentioned, radical acceptance comes with radical autonomy of bodyminds.

that being said, i had my fair share of issues with the book. it covered a lot of topics, but at times the information felt insufficient and lacking depth. i appreciated the historical and theoretical portions in each chapter, but to me it felt like a majority of the book was the author expressing their own concerns and opinions – which is great, just not my cup of tea. it left me with a good deal of questions but no answers.

[Ezgi Çakal · Rating 5 out of 5]

'başka bir dünya mümkün' kitabı

gerçekten pek uzun bi kitap olmamasına rağmen çok kapsamlı ve bizi aklımızla ilgili farklı olasılıkları düşünmeye itiyor.

mental hastalıkların/deliliğin sanayi devriminden sonra kapitalizme katılım gösterebilmek ve toplumun üretken bir üyesi olabilmek etrafında tanımlandığını, normal ve anormalin tarihsel olarak sosyal ve politik düzene uyuma bağlı olarak şekillenmesi zemininde pek çok parametreyi tartışıyor.

neoliberal dünyada ise mental sağlık herkesin bireysel sorumluluğunda ve genel anlayışa göre 'iyileşmek' için yapılması gerekenler (terapi, ilaç, self-help ve hatta egzersiz) herkes için işe yaramamakla beraber bizlere sadece hayatta kalma ve norma uyum sağlamada yardımcı oluyor, bizi delirten düzeni değiştirmek için hiçbir araç sunmuyor. bizim mental sağlığımızı koruyamamız da ahlaki bir başarısızlık olarak görülüyor hatta. yapılması gerekeni yapmayanlar ve kafayı toparlayamayanlar...

tarihlerinin başından beri şekil değişiren ancak 'kontrol ve şiddet' ile deliliği toplumdan elimine etmeye çalışma konusunda sabit kalan tımarhane-akıl hastanesi-psikiyatrik tedaviler ve hapishane sistemilerini yıkıcı ve yeniden yapıcı modellerle, komüniteye dayalı ve güven esaslı yapılarla karşılaştırıyor. topluma katılımın norm beklentisine uyarak gerçekleşmediği, insanın kendisiyle ve evrenle ilişkilerine alternatifler. baskı, izolasyon ve ayrıştırmanın tam aksine.

çoook fazla highlight ettiğim yer oldu ancak benim de daha önce düşündüğüm şeyler olan; mental sağlığın destigmatize edilirken bunun sadece güvenli ve yine toplum normundan çok taşmayan depresyon/anksiyete için yapılması, diğer tanılarınsa hala kafanın gidik imajını vererek stigmalarını korumasını işlediği bölümü çok beğendim.
ayrıca 'psikiyatrik bilgi' insan görüşüne bağlı olması ve süreçte değişebilmesine rağmen neden ayet gibi bir insanın hayatını bu kadar dışarıdan belirleyen bir olgu? kişinin otonomisi dikkate alınmadan yapıştırılan bu tanılar bu kadar gerekli mi? gerekli buluyorsak ya da bulmuyorsak ne yapabiliriz? psikiyatri neyi ne kadar biliyor ya da objektif olarak bilmek zorunda mı? neden bazı davranışlar patolojize ediliyor ve 'düzeltilmesi' gerekiyor sanıyoruz? gibi yeni perspektiflere yelken açıyoruz.

bu kadar kısa sürede ayrıca ırk ve disability konularıyla da kesişiyoruz çünkü kapsayıcılık ve dezavantajlı herkesin birleşmeye muhtaçlığı çünkü ayrıştırılmalarının ortaklığı.

mutlaka okuyun derim, akıllı/deli, sağlıklı/hasta, normal/anormal ikiliklerine çok nüanslı bi bakış. her şey insan için.

[ValTheBookEater]

I am going to recommend this to my psychologist who I know would like this.

"We often discuss diagnosis as an adjective (something we are) or a noun (something we have), when in actuality, diagnosis is a verb – a process by which doctors look at a set of attributes (or ‘symptoms') and choose a lens through which to gaze at us".

[The Reading Lantern · Rating 3 out of 5]

Better for its references than its actual content perhaps

[Andres Felipe Contreras Buitrago · Rating 3 out of 5]

Es un buen libro, me gusta que vaya en esa línea de politizar la salud mental. Aunque está muy centrado en el tema de la discapacidad y enfermedades mentales más complejas, hay capítulos que me costaron mucho entender, pero en general, es un buen libro.

Entre las ideas que podemos destacar, está en la que debemos mirar la relación entre la política, la historia y la economía respecto a la salud mental, o sea hay que mirar los problemas desde la raíz, porque el capitalismo produce el sufrimiento contemporáneo, al fin y al cabo, el capitalismo lo único que produce es desigualdad, pobreza, desempleo y personas sin hogar, entre otras muchas problemáticas. La autora es clara, el sufrimiento debe verse más como una preocupación social y política, más que individual, en relación con ello, debemos mirar los problemas de salud mental desde lo colectivo, puesto que se ha reducido esta variable a lo individual, bastaría con mejorar condiciones de vida y de trabajo para mejorar nuestra salud psicológica.

En el primer capítulo la autora nos habla como el concepto de locura cambia con el tiempo, nos menciona la institucionalización de los hospitales psiquiátricos a lo largo de la historia y cómo estos han hecho tratos inhumanos a las personas supuestamente locas y discapacitadas, todo ello porque no son productivos para el capitalismo, y es que es muy subjetivo el concepto de enfermedades mentales como demencia o melancolía, una de las prácticas más inhumanas de la psiquiatría es la lobotomía o inducir convulsiones. Por ello surgió un movimiento antipsiquiatría, muchos de los hospitales psiquiátricos cerraron por las críticas.

La crisis de salud mental global es un hecho, pero hay que tener cuidado el cómo tratamos a cada persona, ya que cada una es un mundo y una complejidad, y hay que tener cuidado el cómo lo ayudamos, ya que el mismo tratamiento nos sirve para todos los tipos de personas, la autora también nos afirma que se ha simplificado en exceso la depresión, muchas de las campañas de salud mental que vemos, están hechos para personas blancas, de clase media y sanas. Los problemas de salud mental no se curan simplemente con medicamentos, terapias, atención plena o hacer ejercicio, el camino es mucho más complejo, y no a todas las personas les funciona lo mismo, el neoliberalismo ha abogado por un enfoque más individual, pero no muchas personas pueden acceder a tratamientos de salud mental. En relación con esto, hay una privatización del estrés, puesto que muchos problemas son ahora individuales. El mayor ejemplo de estos es el supuesto desequilibrio químico que causa la depresión.

Existe una angustia mental por la crisis económica y ambiental que estamos padeciendo, muchas veces las mujeres, personas trans, negros, o migrantes, no pueden acceder tan fácilmente a mejores tratamientos de salud mental, en la misma psiquiatría había racismo en contra de los movimientos afro, puesto que se decía que las personas negras eran más propensas a enfermedades mentales. A los migrantes se les impide el acceso a muchos tratamientos, al punto de que los médicos se les obliga a preguntar el estado migratorio de sus pacientes. Respecto a las personas trans, sus condiciones son muy duras y precarias. Las personas pobres no pueden acceder a una mejor salud mental, muchas condiciones materiales llevan a la depresión o la ansiedad, y es que el hecho de no tener trabajo nos lleva a estar mal, y esa mala situación nos hace no tener trabajo, en ese contexto, solo las personas ricas pueden acceder a mejores terapias, por ello es importante protestar ante estas igualdades.

Hay muchas enfermedades producto del trabajo, cosa que se originó desde la revolución industrial, y que continúa hasta el día de hoy en las grandes empresas comerciales y tecnológicas, el mayor ejemplo de esto es en Amazon, donde muchas personas tuvieron infecciones urinarias por no poder ir al baño, también existen lesiones en el trabajo. Hay un gran agotamiento producto del trabajo, al punto de que en fábricas hay suicidios, en muchas grandes empresas hay pensamientos suicidas. Los trabajos más precarios y mal remunerados son los que producen más impacto en la salud física y mental de las personas, para evitar estos problemas surgió la entidad de Recursos Humanos, para que la persona esté bien y siga produciendo, pero tantas técnicas de salud mental en los puestos de trabajo como siesta, meditaciones, no salvará a las personas de los despidos o de trabajar horas extras. Todo eso se puede resumir en sonreírle al capitalismo. La autora hace un llamado a organizar a los trabajadores y protestar ante estas crisis.

Poco se nos habla de lo mal visto que la discapacidad, muchas veces las personas con enfermedades mentales son excluidas del trabajo, hay un capítulo interesante sobre cómo se ha abusado de la palabra neurodivergente, cosa que se ve muy a menudo en redes sociales, algo importante en este apartado, y es que pensamos erróneamente que nosotros mismos somos individuales y autosuficientes, pero la verdad, es que somos interdependientes, necesitamos de la otra persona, por ello la importancia de la atención comunitaria y la ayuda mutua.

La autora también hace una crítica sobre el diagnóstico, donde mucho de este, puede derivar en lástima o exclusión, pero el diagnóstico solo sirve para controlarnos. El diagnóstico también se reduce a lo biomédico, dejando de lado lo social, político y económico. Muchas personas se suicidan a la espera de atención, por ello se necesita una revolución y no solo entregar medicamentos. Otra cuestión interesante es sobre la dualidad de qué saludable y qué no, el mayor ejemplo de esto es como la homosexualidad durante un tiempo se consideraba una enfermedad mental, pero en este apartado cuando se habla de personas gordas, hay que tener cuidado porque la obesidad dentro de todo es una enfermedad. Para afrontar muchos de los problemas del mundo actual, la autora aboga por el arte. Mucho de lo que escuchamos, leemos, vemos, nos ayuda a sentirnos menos solos. Lo hermoso del arte es que va más allá de lo productivo y lo práctico.

Mucho del encarcelamiento sea por parte del abuso de las autoridades estatales, solo hay que mirar cómo los policías en Estados Unidos abusan de las personas negras, dentro de las cárceles muchas personas tienen problemas mentales y el encierro lo único que hace es aumentarlas, se moverán a las personas con la fuerza y las drogas, se hace un llamado a más inversión en salud la cuestión es qué tipo de salud queremos para nosotros, la autora mencionó un movimiento que aboga por la abolición de los castigos y las cárceles. Algo a destacar aquí es que no se debe individualizar el dolor, se debe mirar sus causas más amplias y sistemáticas, por ejemplo, mirar la raíz de la autolesión y el suicidio. Muchos de los problemas psiquiátricos están relacionados con abuso, privaciones o falta de vivienda o desempleo. Muchas personas no recibieron los cuidados a tiempo.

Por ello es importante un sistema de atención comunitaria, donde se recibe apoyo antes de la llegada de un punto crítico de la persona, menciona un centro de ayuda para todas las personas gratuita que hay en el norte de Italia, un referente muy interesante, donde va más allá de los hospitales psiquiátricos que nosotros tenemos en mente. La autora es clara al mencionar lo complejo de la salud mental, ya que cada persona es distinta. Se debería abogar por tratamientos en otros lugares como el arte, el habla o la naturaleza. Se necesita más financiación, pero hay que cambiar el enfoque respecto a la salud mental. Sobre el apoyo a este rubro, es que debe ser gratuito y no jerárquico, donde haya libertad para escoger el tratamiento. El conocimiento sobre salud mental debe estar en las calles y en las casas, no estar encerrado en la Academia, y debe ser prioritario el acceso a la comida, servicios y un hogar digno. Todo ello ayudaría a una mejor salud mental de las personas.

[Lucy · Rating 4 out of 5]

Wow. This is such an important book, exploring the ways in which mental health is a political issue, and tracing the connections between the current global "mental health crisis" and capitalism, racism and the connecting these issues to legacies of "Madness" and its management in the past. Frazer-Carroll provides a sensitive, thorough but accessible account of the history of psychiatry, disability studies and disability justice, alternative models of care and a critique of pathologization. It is a book that at the same time stirs up anger at all the forms of harm done by capitalism and offers a kind of virtual hug to the reader, a call to resistance and a call to rest (perhaps at the same time). It makes me want to read more, think more, learn more and engage more with disability activism and to examine critically the ways our current discourses on mental health are interconnected with neoliberal capitalist framings of human life as valuable only insofar as it is (economically) productive.

[anna ✩ · Rating 5 out of 5]

years ago I had a falling out with a friend who was diagnosed with BPD. I was ultimately convinced to cut her off completely by users of r/BPDlovedones, who told me that a healthy relationship with someone with a BPD diagnosis is impossible.

in an effort to reassure me that I did nothing wrong, my own therapist said that there was a joke in the therapist community: “what do you do with a client with BPD? refer them to someone else.”

the idea that there was any diagnosis that meant someone wasn’t worth trying to befriend or help always sounded wrong to me. this book taught me so much about the history of mental illness and how rampant discrimination still is, even among those who should know better.

[Sara · Rating 5 out of 5]

L'he trobat un llibre imprescindible per entendre una perspectiva de la psicologia social actualitzada i com ha anat avançant la concepció del món en relació amb la malaltia mental i la discapacitat en general. L'autora fa una barreja perfecta entre exposar dades estadístiques/històriques acurades i introduir debats i preguntes que porten al lector a la reflexió.

A més, he agraït molt que està escrit de manera que qualsevol pot aprendre'n sense aclaparar-se amb tecnicismes. Posa paraules i arguments a molts dels pensaments que no he sabut descriure abans.

Ha sigut interessantíssim de llegir i n'he après un munt.

[recomanat pel profe de psicologia social, així que animo a tots els meus compis de la carrera a llegir-lo :)]

[Anna · Rating 4 out of 5]

A succinct, visionary dive into what is and what could be for mental and physical care that reaches beyond binaries.

[Tristram · Rating 5 out of 5]

I feel like I have never been able to fully explain my hatred towards the mental health care system, modern attitudes towards mental illness, and the nature of everything we’re expected to believe in and accept as ‘good for us’. I feel like most people just don't get it at all. So of course, in some people’s eyes you’re going to look at least a little unhinged if you say you hate something that is widely understood as designed to help.

Yet, anyone who has had negative experiences with any sort of major authority can see how the mental health system is just another brick in this wall of low-level authoritarianism that people have been groomed into accepting as what is righteous and what is necessary to the motions of society. I’m talking about schools, the law, workplaces, and so on. Systems full of ‘the reason is I told you to’. Systems full of pencil pushers and pointless bureaucracy that send you on trips that could have come straight out of Kafka’s The Trial. It’s so overdone to use the adjective Kafkaesque in these conversations, but that’s just the truth of the matter. Mad World covers these ideas by exploring the history of asylums, and exploring the relation between prison and psychiatric wards in a way that I thought was refreshing to read. I’m not unhinged after all.

So when I think about why I hate how mental health and mental illness is packaged to us today, I believe it’s partly because of how I see it reflected in all the other abusive systems I’ve been put through. Yet this one has propaganda which nobody else can see. Propaganda in the form of Instagram infographics with pastel backgrounds and cheat sheets with that fucking ugly, blocky humanoid graphic art style. Propaganda that tells you to drink water and go on walks. Propaganda that tells you it’s okay to call law enforcement on your loved ones if they start acting a little too weirdly - because, it’s okay not to understand. You just do what you think is best. You may not know what’s best, but that’s okay. Because everything is okay. It’s okay not to be okay. Okay. Okay. Okay. Everything is okay.

This is supposed to reinforce the idea of self-care, awareness, openness. I believe that all it does is instil people with a tentative and submissive nature. It teaches them to be scared of people who aren’t ‘okay’. It teaches them to go along with what’s accepted, even if it is abusive. If you make something look gentle enough, then how could it be harmful?

There’s always been something that’s really irritated me about DSM diagnosis labels. About being told that I, and people like me, am ill. Disordered. That we don’t get to have a sense of individuality and can all fit into the same neatly explained label. Who decides the concept of ‘order’ and ‘disorder’? Who decides the minute difference in criteria for ‘schizoaffective disorder’ and ‘bipolar disorder’? And why were they given the right to decide that? Sometimes I don't mind using certain labels amongst other ‘disordered’ people (in fact, the only label I use is autistic, even then that is only amongst friends), because it’s a way to find out who thinks similarly, and to find a sense of solidarity, although I can often figure it out without the need for psychiatric input. It’s also unfortunately necessary if you want your ever-so-caring institutions to cut you a little slack.

This book sums up everything I’ve ever felt about the bullshit of ‘mental health awareness’, the prejudice of being labelled ‘mentally ill’. At the end of the day, I know I am my strongest advocate, and I can only advocate for other people if I am strong in my own self-belief. There is a section in the book that describes how if you fall under a certain category of ‘mental illness’, everything you say can be held against you as an example of ‘deteriorating illness’, and that you will always be the ‘unreliable narrator’. That really struck a chord with me. It’s what infuriates me the most, out of everything.

I feel hopeless a lot of the time that these attitudes will never change, that we’ll never stop being ostracised. Although I like this book a lot, and it has been so validating in my own opinions towards the topic, it also makes me a little more hopeless. You come to realise how deep all this judgement and discrimination goes, and how society intrinsically relies on it in order to exploit us efficiently. I feel like I’m going to be stuck in the welfare system forever. I'm going to be stuck telling my story over and over. On the other hand, it’s given me a tool in mutual aid. I can now share this to people who may need help themselves in coming to realise how they’re fucking themselves over in this world, and that above all we need to stick together. It encourages me to remember what help really should be - peer support.

Although this is a radical work (which can sometimes be a little ham-handed), I think Frazer-Carroll has real skill in nuance. I can tell she genuinely believes in freedom of choice, in freedom of expression, of freedom of self-description. It would be easy to say that all of this system sucks, let's get rid of the entire thing - which is honestly what I kept expecting to pop up. However, she emphasises the importance of people being able to choose what helps them. If diagnosis labels, therapy, and medication help someone, then they should be free to use those even if they are originally key structures in an abusive environment. When I think about what might help me, I am not really sure, but I don't think it's any of the acceptable solutions that we have today. It is possible that it could be simple things like deep empathy and non-judgement. There is a section in the book that describes a solution to helping somebody who is hearing voices would be to behave as if the voices are universal. I thought this was poignant in its compassion, but at the same time a little utopian. People, men in particular, can become severely changed and affected by psychosis, violent and dangerous. No amount of external understanding can help this. This train of thought leads me to become a little disenchanted with the solutions of the book. All these ideas are for people who would be open to the idea of community and vulnerability, which are concepts that a lot of men are notoriously reluctant to engage with. Men are given less solutions in radical healing, because of how we expect each other to behave in the face of adversity. To fully open up these new ideas around healing, there needs to be more discussion and work on how patriarchy impacts men's attitudes towards their own minds. It’s another structure that needs to be fully dismantled before we can progress anywhere. And that seems again, a little too utopian.

Moving to a more historical angle for a moment, I found all the discussion on Quaker ethos towards mental health in comparison to wider society fairly intriguing. I am pretty interested in The Religious Society of Friends and how actually some things that they have done in British society are way more progressive than things that liberal governments have done. I do have a little gripe with the author’s sourcing, though. So much of it comes from The Guardian newspaper, and I noticed a couple of inaccuracies in places, which would usually make me distrustful of a work. However, I think in respect of this one, it doesn’t really matter so much. Because the factual substance is secondary. In my opinion, it doesn’t need the statistics and heavily researched academia to stand up by itself. I do also wish that Frazer-Carroll expanded her discussions to older adults up to the elderly too, as personally I think that the concept of ‘mental illness’ just vanishes from the public conscience towards a certain age group.

All in all, I found this book affirming. I’ve seen reviews saying it was enlightening, but there’s no way I’d describe it in that manner - it’s not news to me. I’ve felt this way for so long. And I’ve felt lonely in feeling this way for so long. I am very fortunate that there are some people who think similarly to me. At the end of the day that’s all you need. Just little circles of people. And not to give in to THE SYSTEM. Thanks to Sam's book club for this read.

[Alex belitzky · Rating 3 out of 5]

I struggled with what rating to give this book because it covered a large range of topics and I did enjoy it, but I found it lacked a bit of depth. Since so many topics were covered the author didn't get a chance to dive into all of them as much as I would have liked and I kind of wished we got that opportunity. I also enjoy reading these types of books and leaving like I learned something but because of my SW degree, I feel like a lot of the questions/concerns the author raised I've already considered so it didn't feel as meaningful to me. HOWEVER, loved the sections about capitalism & disability, those felt the most fruitful for me. Definitely a really great starting point if you want to read more about intersectionality in the mental healthcare industry!

[Kira · Rating 4 out of 5]

An expansive analysis of Madness/Mental Illness history, politicisation and demonisation. Thoughtful and well researched, this is a great starting point for those foraying into the politics of mental health and how that intersects with race, class, sexuality, gender and more. For instance, who can be vocal about their struggles and at what cost? A white actress is able to speak out about her struggles and is hailed as heroic, whereas, a single mother in poverty risks losing her children should she confide in a GP. This gives a lot to chew on, whether you wholly agree or not with Frazer-Carroll’s provocative stance.

[Theresa · Rating 4 out of 5]

mmmmm when i tell you i think about this every day! read it!! or else!! (fr -- it'll be far more concise than the voice memo monologues that'll be sent to your inbox if you don't check it out)

exceptional content, at-times redundant delivery. 8/10.

[Jake · Rating 5 out of 5]

From the intro: “After all, what is the utility of sanity or rationality in a world in which sanity means the death of oppressed people and the planet and rationality means the logic of the market? In this climate, it is madness that will help us burst beyond the so called rational confines of the asylum, of the prison, of capitalism and individualism. As the world drives us increasingly mad, it is crucial that we take mad knowledge seriously and acknowledge its imaginative potential.”

Shortish, mighty, and clear! This work brilliantly (and succinctly) chisels down the carceral/neoliberal bedrock of mental health systems and connects it to an epistemology and call to action/dreaming that is much more abolitionist, much more mad, and—as a result—much more loving. Would really recommend.

Bonus quotes:
“Focused on aligning our bodyminds with the demands of the market, these techniques serve to simultaneously obscure and legitimize the political and economic forces that lead us to suffer in the first place. Mindfulness is no substitute for a unionized workplace.”

“Therefore, debates that treat diagnosis as a noun—asking “is diagnosis good or bad?”—largely overlook the fact that diagnosis is a powerful and kinetic process, always moving, always serving an end. Within the current system, it can therefore be deployed to sustain life or to produce death. Diagnoses are passports: they are not made equally and they are elements of a state system of gatekeeping that should not exist.”

[Sylvia · Rating 5 out of 5]

I think for what this book is, an introduction to Mad politics and mental health, this is an excellent book.

Short enough and very accessible, this book introduces a lot of key concepts and ideas surrounding Mad/Madness and mental health. From the origins of psychiatry, the rise of anti-psychiatry and disability liberation, including SEK, numerous (Marxist) mental patients unions in the 70s, Basaglia in Venice and up to the modern day with contemporary organising such as the Campaign for Psychiatric Abolition (CPA) and activism around Stop SIM and the re-emergence of Mad Pride.

The book tackles a lot in such a short amount as well, from the history of asylums, the situation in the UK, the roles of race, gender and colonialism in relation to disablement, as well as introducing Crip Theory and how normalcy impacts all of us in how we think about impairment and disability. There's also some interesting ideas on tackling the limitations of the 'social model' of disability when considering neurodivergency and mental health and what it means to be 'diagnosed,' linking work and capitalist productivity in relation to diagnosis. Some passages mention the shifts from capitalist production too, such as d/Deaf workers watching farmers during feudalism to learn the skills and how the role of capitalism and the intensification of labour meant disabled people who would have otherwise been able to work during feudalism and the slower demands made for it, would no longer be able to fit into this new economic system.

I think some criticisms I have is probably some of the emphasis on 'prefigurative politics' at one point, which was a bit weird after reading Bevins' book that tackled the limitations of it in the past decade. That and I wish the citations for websites had the titles and authors instead of just the online link and date accessed. That and there's a part near the start that touches on the rise of asylums and workhouses as some kind of preliminary form of welfare state measures and I would have liked to have seen more on that from the post-war period, including some discussion on William Beveridge and the 1942 Beveridge Report and the ableism in there that is itself linked to welfare capitalism.

Otherwise, this is an excellent introduction which I would recommend for anyone who wants/needs to learn more about Mad politics and disability liberation.

[Anthony Steadman · Rating 4 out of 5]

The first section on asylums was interesting. There were also a few good gems here and there, especially the criticism regarding the awareness campaigns. It is striking how much easier and socially acceptable it is to suffer from depression and anxiety. Take an anti-depressant, do some exercise and get that individual back to being a 'useful' unit of production. But the stigma you get from say something like paranoid psychosis is massive. Where are all the awareness campaigns for this? It definetly says alot about which forms of mental health are considered socially acceptable. Namely, those that are more functional in society.

I appreciated the point about the individualization of mental health, framed as a personal responsibility, rather than being understood in relation to an atomizing society that gradually erodes anyone who doesnt fit the economic model. The greatest delusion in my view is to support the status quo system. A system that is ruining the climate, causing massive inequality and impoverishing people.

The contradictions explored were compelling but some of the latter part of the book felt a bit dry. It may have been more related to my state of mind at the time though.

[Sandeep · Rating 5 out of 5]

A radical approach to how we view mental health and the so-called solutions that exist currently to tackle it. Micha Frazer - Carroll argues that mental health is a political issue, but we often discuss it as a personal one. The role and interconnectedness of capitalism, racism and other social issues is dissected and the status quo challenged.

According to Frazer- Carroll ‘madness’ or ‘mental illness’ is actually just behaviour that does not lend itself well to the capitalist economic system and the accompanying suffering, our diagnosis and our treatment are far from objective or apolitical. 

Exploring the history of asylums and psychiatry; the relationship between disability justice, queer liberation and mental health; art and creativity; prisons and abolition; and alternative models of care; Mad World is a hopeful antidote to what could be.

A fantastic book with ideas which stretch out imagination and current perceptions, it has given me a whole different way to look at mental health in our society.

[Meaghan · Rating 4 out of 5]

WOW, it’s hard for a non-fiction book to evoke tears but Mad World did just that! This book filled me with so much hope (which I will gratefully accept anywhere I can.) A wonderful launching point for anyone interested in Mad Studies & exploring it’s inextricable link to disability justice, anti-capitalism, abolition, queer rights (and and and and….)

“The past and present of mental health has been dictated by capital, alienation, racism, colonialism, gendered oppression, psychiatric abuse, incarceration, gatekeeping and the enforcement of particular ways of knowing. The future must be something else. Although this project of liberation may never be finished, we should keep dreaming and imagining, out of our pain, into something that we can really live for.”

[Ray · Rating 3 out of 5]

The first third of this book is an insightful Marxist analysis of mental health, disability, and psychiatry, with eye-opening historical anecdotes about the development of psychiatry in England.

And then... the author just sort of gushes about decentralized networks of "community care", the idea that mutual aid is definitely not charity, and the healing power of zines. The rest is a stale retreading of basic post-structuralist abolitionist rhetoric that could only interest those readers who were asleep for the entirety of 2020.

For all her emphasis on "material conditions" in the first part of the book, it's disappointing that her conclusions are so half-baked. Sure, "teleportation rooms" would be great for people staying on a psychiatric ward, but last I checked those are not real 👍🏻