Published: Sep 2015, 348pp
“Through decades of decay, despair and dismay, we suffer”
Includes for the first time the text of Sedgwick’s 1983 address to the Royal College of Psychiatrists, ‘The Fate of Psychiatry in the New Populism’
A classic in the field of mental health, one of the few credible critiques of the anti-psychiatry movement which retains its significance today, Psycho Politics includes scholarly appraisals of the ideas of Goffman, Laing, Szasz and Foucault and proposals for a politics of mental health which neither separates mind and body, nor abdicates responsibility for the alleviation of suffering. Sedgwick argues that mental health movements have overemphasised individual civil liberty at the expense of developing collective responsibility for mental health care. This book has wide ranging implications for political activism, social movements and the future of mental health care. This edition has a new foreword by Helen Spandler, Rob Dellar and Alastair Kemp placing Sedgwick’s work in context today.
Psycho Politics was originally published in 1982 by Pluto Press. The decision to reissue it again now was inspired by a recent resurgence of interest in his work in the light of neo-liberal reforms to mental health policy and practice. We hope it might inform a workable platform of opposition to cuts and privatisation affecting mental health services. Over the years, as leftist activists, survivors and academics, we have returned to this work time and time again. It raises some serious challenges that need tackling, perhaps now more than ever. So we thought it was about time it was available for a new generation. We have written this foreword as a critical appreciation.
Peter Sedgwick was an activist in what has been described as the ‘libertarian’ wing of the International Socialists (IS), out of which grew the Socialist Workers Party (SWP). Sedgwick declined to join the SWP because he thought the party wasn’t what it claimed to be—a workers’ organisation. Sedgwick worked as a psychology-turned-politics lecturer who wrote elegantly and persuasively about both. The culmination of a sustained commitment to mental health politics over many years, Psycho Politics was his lasting legacy.
Unfortunately, he wasn’t able to engage in prolonged discussions about the contentious issues he raised in this book. The year following its publication was a tumultuous one for Sedgwick, ending in his tragic death at the age of a 49 in a canal in the North of England. Most people who knew him believe his death was suicide. It is clear that ‘psycho politics’ was never merely an academic interest or impartial critique; Sedgwick cared deeply about human suffering and was profoundly affected by it. What concerns us here is the written work he left behind.
People can be affected by these states in ways which often lead to isolation, hopelessness, confusion, difficulties looking after ourselves or distinguishing fantasy from reality, and all too often, suicide. These situations are frequently caused, or at least exacerbated, by concrete social factors. Many people affected cannot ‘work’ in the conventional sense dictated by capitalism. Hence issues surrounding ‘madness’ have sometimes confused the organised left. ‘Sufferers’ do not fit into capital relations in the old-fashioned way; they will rarely be shop stewards; and can be impulsive, unreliable and make bad cadre. Largely forming an underclass separate from, or at least complicating, the conventional formulation of the working-class, it has been convenient to overlook them. To Sedgwick’s great credit, he wanted to challenge this situation and make mental health a concern of the left. Sadly, much of the organised left still only takes up issues relating to mental health when services or jobs are threatened, and fails to take seriously more fundamental criticisms of psychiatry and mental health care.
We need to understand this to fully appreciate Sedgwick’s contribution. It was his acute awareness of the reality of mental distress that made him so wary of what came to be known during the 1960s and 1970’s as the ‘anti-psychiatry’ movement. It wasn’t always that he disagreed with people who came to be associated with this movement. He was more concerned with how their arguments could be used and misused, especially by anti-welfare governments (Psycho Politics, of course, was written during the rise of Thatcherism). His central thesis was that their arguments bolstered, partly by accident and partly by design, attempts to dismantle welfare services for those labelled ‘mentally ill’ and for the public in general. At the time Sedgwick was writing, long-stay and then even short-stay psychiatric hospitals were in the process of being closed down and replaced by community services which were inadequately resourced. Thirty odd years later, even these community services are being dismantled because they are seen as institutional distractions from a new ideal of ‘recovery’ which has come to dominate the planning and provision of mental health services in the UK.
This new ideal holds individual sufferers of mental distress ultimately responsible for their own distress and recovery. This version of recovery seems to represent high ideals and noble virtues such as self-care, personal responsibility, and the therapeutic optimism that even those previously written off as permanently ‘mentally ill’ can actually get better. If so, are we foolish to clamour against it? Yet this recovery model is not the same as our ideal of recovery, just as the government’s model of economic recovery is not the same as ours…
Sedgwick called for strategic alliances to resist threats to welfare and ensure services are in place to protect those who, for whatever reason, are the most vulnerable to the terrible suffering that ‘madness’ can cause: services that will inevitably be provisional or transitional. While Sedgwick may have minimised the role of patients in these alliances, some have argued that ‘Sedgwickian’ type alliances can be forged between trade unions and critical survivor groups to inspire a more sophisticated ‘Psychopolitics’.
In characteristically lucid prose, Sedgwick argued that “the prickled barbs of the various anti-psychiatry critiques project and tend in so many opposing directions that any attempt to grasp them for use as a unitary whole will wound the critic to the bone of his or her own logic.” Yet Sedgwick’s own pragmatic model of addressing emotional suffering was tantalisingly undeveloped. At worst he merely inverted Laing’s priorities by foregrounding the concerns of families as carers, alongside professionals, sometimes at the expense of patients themselves. Having said that, Sedgwick highlighted the important role families could play as supporters and allies of users and survivors. This is still neglected by many radical mental health groups, as well as by mainstream services, in part because of real or imagined conflicts of interests. As such, Psycho Politics includes an intriguing, and not entirely unjustified endorsement, of the family placement-type model of care in Geel, Belgium. With this in mind, it is interesting to speculate what both Laing and Sedgwick would have made of approaches like Open Dialogue, which are beginning to be applied in the UK. These are co-ordinated programmes which work with the whole family and wider support systems of a person going through a psychotic crisis, to support psycho-social ways of understanding without necessarily resorting to medication. Such approaches run the risk of becoming co-opted by ideological strategies such as the neoliberal recovery model, thereby leaving them at the mercy of market forces. However, practices such as these still point towards the possibility of synthesising Laing and Sedgwick’s insights.
Sedgwick also drew on the work of the anarchist Peter Kropotkin, whose own libertarian socialist approach was not focused on a top-down paternalist welfare state and included a sophisticated endorsement of practices of mutual aid. Whilst this is a potentially useful resource for radical mental health movements ‘from below’, it requires careful re-articulation in the current context of austerity. The challenge Sedgwick set—for society to integrate welfare-socialist forms of collective responsibility with practical strategies for mutual aid and support—is an increasingly pressing concern.
Sedgwick’s final piece on the subject was a curious article in the Bulletin of The Royal College of Psychiatrists in 1983. We have reprinted this as an Appendix. In this he expressed his opposition to that year’s Mental Health Act replacing the previous Act from 1959, in particular its strengthening of the powers of Mental Health Review Tribunals to overrule individual psychiatrists’ powers to detain individual patients in hospital indefinitely against their will. He appears to affirm his unconditional support for the profession, which he suggests is a bulwark against steadily encroaching threats from both populist and bureaucratic elements of the right-wing. This position is anathema to many mental health radicals. Yet it is worth noting that ironically, in the current context, psychiatrists and other medical professionals are often seen by service users as allies, because they can support claims for on-going mental health support and welfare entitlements.
For good reason, well informed survivor activists will be dubious of attempts to form an oppositional platform to current developments in mental health services with reference to Sedgwick alone — or to Sedgwick and Laing. We don’t think Psycho Politics contains all the answers by any means, and it has some serious flaws which we have drawn attention to. But it remains one of the precious few well formulated works of political philosophy relating to our responses to mental health, and without a doubt, Sedgwick’s ideas should be of central concern to anyone committed to revolutionising mental health care.
Helen Spandler, Robert Dellar, Alastair Kemp