Setting Psychiatry Free
On Sasha Warren’s Storming Bedlam
Marie Brown
I’m reading Sasha Warren’s Storming Bedlam: Madness, Utopia, and Revolt when the New York Times announces the death of Flaco, the Eurasian eagle-owl that was liberated from his cage at Central Park Zoo by an unknown person (read: abolitionist) one night in February of 2023. Once released, Flaco then proceeded to live freely in Central Park and the surrounding area, much to the delight of the public, who, transfixed, watched his every move. In a city with escalating rent costs, the horror of Trump Tower, and mass inflation, Flaco became a symbol of escape and freedom. Rather than gather him back into the Zoo, it felt as if the Zoo understood that Flaco had become intimately connected to our own deep longings and thus allowed him to roam free. But even from the beginning people were worried about Flaco. Would he eat a rat laced with poison? Would he be able to find love in an urban landscape? Were the crowds gathering beneath his tree with the intention to admire him in fact harming him in some way instead?
“Flaco’s dead,” my partner said. “Blunt force trauma. Flew into a building.”
I texted a Flaco-loving friend: “Flaco’s dead.”
She responded: “We killed him, didn’t we?”
Such is the impossibility of liberation under capitalism. Despite our desire to see ourselves unfettered and unbound, the competing demand to build more and more office spaces and maximize our landscape for human use led us to build such large mega-structures that we took over the sky, rendering it inhospitable to Flaco. In turn, we transformed Flaco from a symbol of liberation into a cautionary tale about the limits of disjointed activism.
Sasha Warren’s Storming Bedlam is similarly preoccupied with the limits of what is possible under capitalism. The book is an account of the global history of radical experimentation in psychiatry, spanning movements such as post-war France’s Institutional Psychotherapy; Italy’s Democratic Psychiatry; and the anti-Asylum movement in Brazil. He engages closely with the work of François Tosquelles, Félix Guattari, Frantz Fanon, Franco Basaglia, and Nise da Silveira, amongst others existing at the revolutionary vanguard of psychiatry and related deinstitutionalization movements. The book takes a rare approach by bringing together all these movements under one roof and contextualizing them within their socio-political epochs. However, Storming Bedlam rejects the typical semblance of historical accounts of psychiatry and instead boldly reads this history as a type of postmortem analysis, searching for the common threads that brought about these movements, as well as what may have restrained them in their progress. Throughout the book, questions regarding the after-effects and impact of these radical factions hang from the text like Quaker queries.
For example, following a discussion of radical forms of therapeutic and non-hierarchical communication presented by Guattari and da Silveira, Warren questions if the “‘serviceclient’ consumer model” is an outgrowth or co-optation of these more radical attempts at reconfiguring mental healthcare and openly wonders “whether movements such as these are only possible within an institution when attached to a charis matic individual, usually a well-spoken and well-known man.” These lingering questions crystallize into the key arguments offered by Storming Bedlam’s historical analysis, with the most crucial being the supposition that any meaningful revolutionary psychiatric project is only possible if psychiatrists recognize that their own liberation is—to use the phrase often attributed to Aboriginal activists—“bound up” with that of their patients.
Assuredly, as Warren’s reading of history shows, the central figures of these radical psychiatry movements were people who themselves experienced what it was like to be incarcerated or otherwise subjugated (e.g., Basaglia spent six months in a fascist prison; Fanon experienced colonial oppression throughout his short life; Tosquelles lived through multiple wars and related military occupations). These psychiatrists were able to extend their own experiences of persecution and oppression to the situation of the mental patient within a total institution. Although the revolutionary psychiatrists of the past may have had their own “lived experience” of oppression through direct experiences of war, colonization, or imprisonment, Warren’s work seems to suggest that these more direct or immediately violent experiences need not be necessary to engender a sense of unity with the so-called “mad.” Instead, that unity can come from the struggle against a common rival: capitalism.
Warren’s anti-capitalist thesis connects to another central argument of Storming Bedlam, which is that the distinction between “psychiatry” and “anti-psychiatry” is an artificial one. As the history of psychiatry shows, the profession has always been connected to optimism and concerned with progressive utopian ideals. Warren demonstrates evidence for this theory by illustrating how psychiatry leans into progressive images, stories, and scenes from the past as a means of defining itself, casting Phillipe Pinel’s initiatory act of breaking the chains in modern psychiatry as an example par excellence. Indeed, today you can read a 2022 statement on the American Psychiatric Association’s website that declares: “All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff.” For Warren, psychiatry and anti-psychiatry have always been the same thing; the only difference is the degree to which the various factions of the discipline have taken up the emancipatory project. Instead of separate entities, Warren casts psychiatry and anti-psychiatry as having more of an ouroboric quality. Like a snake eating its own tail, progressive reforms in psychiatry continually end up collapsing back into themselves, recursively bringing about alternatives in an endless self-reflexive cycle. As Warren states, “Psychiatric utopias always teetered on the edge of a tyrannical nightmare.”
What makes this argument distinctive in the landscape of other works calling for psychiatric revolution is that rather than falling into the old and endlessly divisive trap of viewing psychiatry as a monolithic, monstrous, and oppressive social force, Warren’s argument essentially takes the depressive position. Psychiatry is seen neither as wholly good nor bad, but instead, sadly rife with contradictions superimposed upon it by the conditions of capitalism. The inability to reconcile these contradictions then stifles the utopian dreams it set out for itself. Of course, some may view this as a generous understanding of your average mental health worker. But I don’t think so. You only need to spend some time working in community mental health to see that the patients aren’t the only ones who are unhappy. The low wages, tyranny of paperwork, and unceasing focus on “risk assessment” takes its toll. Writing about the difficulty of therapeutic work within a capitalist system, Benjamin Goldstein states, “I felt trapped by a community mental health system that was not only failing its clients but seemed designed to fail both client and clinician.”
Thus, the contradiction at the heart of psychiatry that Warren posits is that psychiatry on the one hand has embraced a mission of emancipating people, yet on the other has been given the assignment (by families or by the state) of segregating/warehousing surplus populations brought about by the conditions of capitalism. In listening to New York City’s Mayor Eric Adams’s call to “provide care for individuals suffering from untreated severe mental illness,” you can see this idea writ large: “People with severe and untreated mental illness who live out in the open, on the streets, in our subways, in danger and in need” [emphasis mine]. Psychiatry is continually bombarded with these forms of double-speak. As Warren says, “Only by seeing the psychiatric relation as a contradiction within a contradiction can we grasp that it maintains an all-too-often anachronistic and tense relationship with political and economic power.”
“For Warren, psychiatry and anti-psychiatry have always been the same thing; the only difference is the degree to which the various factions of the discipline have taken up the emancipatory project.”
This thesis of Storming Bedlam resonates with Gregory Bateson’s original concept of the double bind, the situation theorized as responsible for the development and maintenance of schizophrenia. Bateson suggested that the double bind is any situation in which a person is confronted with two diametrically opposed, irreconcilable, and therefore impossible-to-fulfill demands. The situation of the double bind is further formed by a perplexity in being able to directly name these competing demands or even clearly identify who or what is imposing them. The original theory located the double bind within the context of the family, such that the so-called ‘schizophrenic patient’ was the victim of inescapable conflicting demands imposed by his or her parents. Of course, Batesonian theory was clear to address the ways in which the psychiatric setting itself recapitulates the double bind for patients within the therapeutic or hospital milieu:
“Since hospitals exist for the benefit of personnel as well as—as much as—more than—for the patient’s benefit, there will be contradictions at times in sequences where actions are taken “benevolently” for the patient when actually they are intended to keep the staff more comfortable. We would assume that whenever the system is organized for hospital purposes and it is announced to the patient that the actions are for his benefit, then the schizophrenogenic situation is being perpetuated.”
What makes the concept of the double bind interesting in light of Storming Bedlam is the way in which, in true La Borde fashion, Warren turns this type of analysis away from the socalled patients (or perhaps it is better here to say “madness” more broadly) and instead focuses it back onto psychiatry itself.
Psychiatry also needs healing, as Tosquelles would have said. In effect, what Storming Bedlam does is identify and name the double bind placed on psychiatry by capitalism, thereby giving it the means through which it can release the chains preventing it from reaching its own self-actualization. He states:
“At a certain point, those who earnestly attempt to create therapeutic environments or communities realize that this pursuit is necessarily curtailed. Not because of this or that theoretical mistake or ‘good intentions gone bad,’ but because the imperatives of capitalism set discrete limits on the aspirations of the healer.”
Elegantly, this theory does exactly what Warren suggests will set us all free. Rather than setting up an “us vs. them” dichotomy between psychiatry and anti-psychiatry or between the psy-professions and the psychiatrized, Warren offers us a theory with which we can come together. Instead of focusing on the endless debate of whether mental illness is or is not a product of the family, the environment, trauma, social constructionism, biology, genetics, or something else entirely, Storming Bedlam rises above these debates, asking “why we are so singularly interested in where madness comes from or why it exists at the expense of interrogating the form of discourse that demands such an explanation and the administrative machine that puts it into motion.”
Granted, one could argue that Warren’s insistence on not falling into these traps may be what sparks the most resistance from the uninitiated. Nothing is sacred in Storming Bedlam and the book critically interrogates even the lived experience and consumer/survivor/ex-patient movements for recapitulating the same hierarchical dynamics as psychiatry. “We are all contaminated by what we try to distinguish ourselves from.” Warren continues, “If our struggle is against a system, it is a system of which we are the parts.” This may not be easy for some to hear but it’s important to listen—for Storming Bedlam has the potential to do for coercive sanism what Gender Trouble did for patriarchy. Want to end patriarchy? Subvert the gender binary. Want to end coercive sanism? Disrupt the division between the “mad” and the “normal.” And as Butler used drag as the means to expose our collective gender performativity, Warren uses the asylum to reveal the ways in which we are all involuntarily committed within the capitalist system.
To be clear, Storming Bedlam is not an easy read. The text has a somewhat rhizomatic quality—ideas and history are presented weblike, intertwined and patch-worked together like the points of contact of an Eva Hesse sculpture. The wellresearched and detailed book is genre-bending; at times reading like a history of the progressive thread of psychiatry; at other times blending into a passionate rallying call; still at other times presenting as a critical analysis of clinical praxis. The macro history of global de-institutionalization mixes with the micro history of first-person accounts of psychiatric hospitalization. The text is delightfully quirky. For this reason, developing a firm understanding of all the book offers feels like an iterative process and it is only with continued readings and a deep engagement that sites of connection can be made. However (and most importantly), Storming Bedlam is well worth the effort it takes to understand it. But I must warn you: what the book offers psychiatry is nothing less than a therapeutic interpretation, and if you are receptive to the interpretation provided, you will come away a changed person, finding it difficult to continue enacting the same dysfunctional patterns of the past. Truth be told, this book will make you blare “Take This Job and Shove It” while quitting your poorly compensated inpatient psychiatry job. Or, perhaps more productively, it will embolden you to take up the task offered, turn towards your patient, and in solidarity, begin the revolutionary act of reimagining psychiatric care—together.