Survivors and Sufferers: Forced Medication in a Class Society
Pavel B. Ivanov
Written: 4 March 1997
Introduction: Psychiatry and "Survivors"
In January-February 1997, there was an agitated discussion on the
Radical Psychology Network concerning the usage of forced
ECT and other forced medication in psychiatry. I will try to
summarize in this paper some the questions brought up and the goals
In general, the current situation in psychiatry looks as follows:
There are psychiatric hospitals where people are treated
according to the practices established, which implies possible
application of strong drugs and electroconvulsive therapy (ECT)
if the case is considered serious enough.
A number of problems emerge in this connection:
Diagnosing people as "mentally sick" may be quite
dubious, depending on economic and political interests rather
than on medical considerations proper. Mental patients may be
placed in a hospital by mistake, neglect or malice, which
is a hard experience for a person, leading to the development of
true psychological misbalance.
The adequate level of treatment is difficult to determine
in psychiatry, especially when higher mental functions are
concerned. There may be no distinct boundary between persisting
malady and convinced non-conformism, and the diagnosis may be
biased due to the very fact of the patient's placement in a
Doctors are never free from the social influence when deciding
on the treatment to choose. Local economy, politics and social
climate may distort medical judgment, so that medication may be
excessive and involve various side effects.
The qualification of the psychiatrist is crucial for the right
diagnosis and treatment; the strong methods of medication may be
highly destructive in unqualified application.
Though many people who received psychiatric treatment were feeling
better and could return to normal life, there has always been a doubt
as to whether such people should be considered sane enough, and whether
the medical treatment didn't make them less "human".
Much of this fear is due to the commonly prejudiced attitude to
the "mentally ill", which is expressed in many abusive
words applied to such people: "lunatic", "cracked",
"crazy", "mad" etc. There is a typical parallel
in the common notion: one who had an arm amputated thus became
an invalid for the rest of one's life—in the same way,
one treated with such destructive procedures as strong drugs or
ECT might become a kind of "mental invalid", requiring
more caution in any communication since nobody can know exactly what
is to be expected from a person "injured" that way.
On the other side, the former mental patients put in an isolation
because of that common prejudice are apt to yield to the social
pressure and blame psychiatrists for the harm they presumably made
to their patients. Since social activism has become popular all over
the world, former mental patients start to call themselves
"survivors" and organize into numerous groups fighting
against psychiatry in general or some of its practices.
Several levels could be distinguished in this opposition.
The most "radical" part of "survivors"
say that psychiatry is mass murder and demand the abolishment
of all the means of medication available to psychiatrists,
and thus psychiatry itself.
Also, there are "specialized" movements of this kind
aiming to banning (or cutting funds on) some particular procedure
Less tough groups of "survivors" are not demanding
the complete abolishment of psychiatry (or some of its methods),
but rather restricting its applications, subduing it to a kind
of public control preventing "forced" medication.
Some psychiatrists sympathize to this movement considering it
quite "democratic" in nature.
A lower grade of tension is associated with the activism
suggesting that "forced" medication may take place
under strictly controlled conditions only, and by specially
trained personal, qualified enough to reduce the possible harm
of the procedure to the least degree achievable. The specialists
usually agree with such statements, though there are often
hidden differences in the attitude.
Some "survivor" groups shift the accent to the social
premises of their relative isolation and speak of a complex
rehabilitation system for mental patients demanding that
the others treat them like ordinary people.
I will briefly discuss the problems arising with each of these
types of "survivor" activism in turn.
The anti-psychiatry movement reflects, though in a somewhat
exaggerated way, a number of objective factors pertaining to
any medication, and psychiatry in particular.
Thus, the positions of the doctor and the patient are
objectively opposite, which may grow into a kind of
antagonism under definite social conditions. The polarity
of the positions explains the common observation that
doctors are often unable to cure themselves and have to
consult other doctors when feeling bad. In the conditions
of all-penetrating division of labor characteristic of
capitalist society, the relations between the doctor and the
patient become formal (or even codified) thus transforming
into a psychological game (as described by E. Berne), with
all its conflicts and goal distortion.
Another point is that any categorization is socially biased,
and any diagnosis will reflect both objective symptoms
and the society's attitude to them. So, what is considered
quite normal in one society may be considered as illness
in another, or as a crime in yet another one. The example of
alcoholism is well-known. Some narcotic drugs are near to be
legalized in many countries, thus changing the very notion of
drug dependence. The situation is much more complex with
mental deviations, and psychiatric diagnosis can always be
questioned, with no universally accepted answer possible.
For example, suicidal ideation may be treated as anti-social
act, so that forced medication shall be prescribed at any
suspicion. In another social environment, suicide may be
a normal way of quitting one's life and be supported with
officially provided procedures (hara-kiri in Japan, bath
ritual in the Ancient Rome, parent smothering at chukchi,
The problem is that social regulation may contradict to the
interests of an individual, suppressing personal inclinations
to preserve the social structure. Thus, in class societies,
suicide is rarely allowed for the representatives of the
lower classes, since the well-being of the ruling class is
based on mass exploitation, while suicide would allow the
exploited escape from working for their master. That is why
the ideas of the higher value of human life and post-mortem
punishment for "bad" behavior are being implanted
in the minds of the people.
In the individual consciousness, the opposition of the person
and the society is reflected as oppression, with some social
layers forcing the individual to the alien ways. No wonder
that such oppressed individuals use to unite in defending
themselves from whom they find guilty in their hard experiences.
However, individual (and group) consciousness is not
necessarily correct in detecting the cause of the trouble,
and attacks people and things that are just superficially
related to the problem. Thus, anti-psychiatry movement
blames psychiatrists where it should be concerned with
the economic and social issues determining their work.
No wonder that psychiatrists try to defend themselves from
the unjust criticizing, and become involved in a team game
against their patients.
Another aspect of it is whether there is such thing as
(mental) disease, or it is just an artifact of the
medical paradigm, based on the rigid opposition of
illness and health. One might argue that health is very
individual, and strong variations in mentality should not
be called a disease. However, the argument becomes
meaningless if restricted to the parameters of the
individual only—the solution is to look at the
individual's functionality within the society. If one
is unable to do what is socially expected under given
economic and social conditions, this is what will be
called a deviation from normality; if such deviation
becomes socially destructive, it is called disease.
For example, one's inability to do one's work (imposed
by the society) is a sign of illness; one may go on
doing what one is obliged to do, despite the bad headache
— then one will be considered as slightly uneasy
but not ill.
Note that there is a difference between "illness" and
"feeling sick". The latter is subjective, and may be
quite uncorrelated with social performance. One may
have to work feeling extremely bad—on the contrary,
one may feel fine while the society would diagnose a dangerous
disease (which is especially characteristic of psychiatry).
If medication is applied to such subjectively healthy
person, it will inevitably be felt as repressive, and the
treatment will appear "forced". Under different
circumstances, subjective attitude to similar methods
may be different, and hence any judgment should keep
within the appropriate cultural limits, so that one would
not project one's own experience onto a quite different
As indicated, there are no absolute criteria of forced
treatment. Classifying a particular case as forced reflects
the discrepancy between the social norm and the subjective
conceptions due to inadequacy of vertical relations in the
hierarchy of subjectivity, from the individual, through groups,
social layers, classes, nations, up to the humanity as a whole.
Forced medication is a manifestation of a more general feature
of the respective level of sociality: when society is broken
into numerous groups with opposite interests, and the dominant
way of aggregating them into the whole is competition and
fight, medicine cannot be other than forcing the attitude of
one social group onto the others. Antagonistic society implies
Since capitalism is based on the universal division of labor,
it makes forced medication as universal. The caste of
professionals won't listen to the opinions of
"non-experts", and the patient would not be allowed
to doubt the regimen prescribed. When knowledge and skill
become the articles of trade, they serve to support the lives
of doctors rather than of their patients, which are treated
as raw material for making the doctor's money. One cannot
expect much compassion and kindness to the patient, and
tolerance to the patient's peculiar views. This means that
any medication tends to be forced under capitalism.
The "survivor" activists fighting against
"forced" medication appeal to personal freedom
as an argument. Conscious people should decide themselves
which way of treatment they would prefer, provided the
agreement about the basic social values is achieved, and
the disease can be distinguished from the normality in
a generally accepted way. Beside the already mentioned
relativity of such a distinction, there are many more
narrow places in this approach.
First, an individual who never studied medicine can hardly
make a conscious choice, and the only criteria left are
economic considerations, common prejudices, or personal
sympathies. Thus, poor people will definitely prefer
a cheaper (though not necessarily adequate) treatment,
while the rich are socially compelled to use more expensive
(though quite inefficient) drugs or procedures. The
general medical ignorance serves for the benefit of
numerous healers, sorcerers, shamans, exorcists, miracle-workers
and God's fools. Serious medicine is less spectacular than
an occult show, and hence less convincing for an ignorant
person. To compete on the market, doctors have to make
show of their work, thus wasting the resources that could
be better spared for the people in need. Thus the health of
the society gets eroded. This is just the other side of bourgeois
democracy, which gives the means control into the hands of
those who look better, despite of utter incompetence
and corruption; virtually, a "good look" is a matter of
One more difficulty is that the ability of judgment is
tightly bound to health. People are not abstract spirits
observing the body from the holy heights. The state of the
body affects feelings and reasoning. For example, one
may perfectly know that a bad tooth is dangerous and requires
medication—but the fear of pain would not let them
go to the dentist, until the toothache overweighs the
pain of treatment. The more so with psychiatry, where
therapy is often more distressing for the individual than
the symptoms of disease.
Yes, medication may cause pain—but it often helps.
So people have to be forced into medical treatment,
and they enjoy health after it. Of course, the appearance of
more efficient and safe methods of medication would lead to
less fears and more consent from the patients. Meanwhile,
numerous means of masking the negative sides of treatment
are being applied, from autosuggestion to narcotic drugs.
Hardly anybody will decline narcotizing on the operation
table just because the drugs are altering the normal
functioning of the organism.
If the patient is unable to understand their actual condition,
their consent to treatment is worthless. Moreover, because of
the dependence of judgment on the state of the organism,
it could be dangerous for the patient if the doctor
asked their opinion before doing anything. Is it fare to
reload the burden of decision to a sick person and thus free
doctors from responsibility? Virtually, doctors are to
heal people—this is their job. The patients must be
brought into treatment first of all, and be relieved of their
sickness before being asked of anything. When a surgeon
has to amputate a leg of an unknown person delivered in
the unconscious state, it is considerations of the person's
survival that are of importance, and never one's consent
to become an invalid. Disasters don't ask people when to occur.
The ability of the patient to give conscious consent may
strongly depend on their social status as well. Thus,
in most societies children have no voice in deciding their
fate, and hence all treatment on children is forced.
Again, the negative sides may be masked—but the
matter is still the same: children are made to accept
medication. In general, this is merely a part of the
acculturation process, when a child is forced to
do a great many of things, like wearing the clothes,
using the toilet, eating with forks and spoons, going
to school etc.
Now, the question becomes: what does it it mean to be
forced or coerced into anything? There are various grades
of coercion in everything people shall do as the members of
the group, social layer, or ethnos. It is the matter of
economic and social organization that local or global
acculturation would lose its forced character and become
a smooth process—though the smoothness can hardly ever
be absolute, due to the dialectical nature of any development.
One of the manifestations of free will may be a deliberate
limitation of free will, allowing for "forced"
treatment when it is socially required.
In an imperfect society, when the individual is subdued to
the social demands and forced to act in accordance with the
regulations brought on them from "above", medicine
cannot avoid forced treatment, which can be easily turned into
abuse. The patient comes (or is made to come) to a doctor
for help, and the position of need makes a person vulnerable,
since all the means of satisfying that need are monopolized
by a group of professionals. The patient has to be somehow
protected from the possible abusive use of what normally is
used for therapeutic purposes.
What kind of a problem is it? Its minor part is the abuse
from ill-minded doctors, seeking for profit, following the
perverted sense of caste honesty, or just indifferent to the
patient's feelings (which is a kind of professional illness
in long-experienced practitioners). The criminal use of various
kinds of medication belongs to this category as well.
Actually, this side of medication abuse is common to the
abusive use of anything else, since anything that is alienated
from the people in the ill society can be used against them.
Psychiatry can also used in a criminal way—though the
notion of "crime" completely depends on the kind
of society. However, forced psychiatric treatment is much
less efficient as a means of control than, say, forced drug
dependence or the threat of death. So, it can hardly be very
frequent in practice—hence it becomes more sensational,
and more fit for manipulating public opinion.
Much more typical (and more dangerous) is unintended abuse,
often related to indirect coercion. Thus, if medication is
to be paid for, those who do not have enough money are forced
to stick to the only source of medical treatment available,
and they have to obey any prescriptions just from the fear of
all treatment and support being withdrawn. Most medication
may seem quite voluntary on the face of it, with a deep
feeling of abuse beneath. This feeling may be inadequate,
reflecting the vulnerability of the patient's position rather
than any actual malpractice: the powerless may easily feel
forced to make decisions they don't understand. Still, it
makes the claims of more control on forced medication more
attractive to the poorer layers of society.
Though many practitioners are honest enough and really willing
to help people, they cannot ignore social pressure and act
as they feel right, discarding the other's opinions. This
pressure may be due to either the tradition of treatment
or the prejudices of the patient. Risk of being blamed for
malpractice for not doing like other specialists do is more
strong for psychiatrists, though it is quite real for any other
medical profession too, since tradition still lies in the
foundation of modern medicine. Also, there are a number of
medical schools strictly controlling the activities of their
members. Doctors have to live and support their families—and
they cannot be expected to sacrifice their well-being for
the interests of a stranger. On the other side, the patients
often have some conceptions about how they should be treated;
these common conceptions are usually induced by the current
medical practice as well as by the advertising by the competing
companies producing drugs, medical equipment etc. If a doctor
does not prescribe what has been expected, he/she may be suspected
in following a wrong line, and all the treatment would seem
forced, without any connection to its actual efficiency.
Yet another source of indirect coercion is the dependence of
hospitals on external funding. Thus, if a hospital is sponsored
by a pharmaceutical company, the medical personal has to preferably
use the medicines produced by this company, being just a part
of its advertising campaign. The same effect can be observed
when there exist restrictions on material provision, staff
Is there any way to establish an efficient control over
forced medication? This idea is most popular in the old
capitalist countries, where centuries of propaganda have
formed public mentality which utterly cannot conceive anything
beyond the bourgeois democracy. The democratic idea of
coercion control is to establish one more system of coercion
that would neutralize the possible malpractice in medicine;
the rule is: "like cures like", and many bad things
are hoped to balance each other so that the result would be
at least tolerable.
Different levels of coercion control system could be considered.
Thus, common people are accustomed to expect that the state
would guarantee their "human rights" and take over
the coercion control. This appears to introduce no new social
force, since the state is an apparatus of coercion already,
and it could just have one more task to perform. Within
certain limits, the state may defend the rights of its citizens
(by the expense of the rights of all the non-citizens, of course).
However, the main purpose of the bourgeois state is quite
different from satisfying the needs of the people, and it
would much more readily used in the interests of the competing
groups practicing forced treatment, rather than for protecting
the interests of the patients. In particular, any legal
regulations and court proceedings are sure to mainly serve
the richer part of the society, and ignore the poorer part.
Since the state is mainly the mechanism of preserving the
already existing social organization, it would rather stay
on the side of professional castes, supporting their
self-determination by the expense of the clients' health.
On the lower level, the activists often suggest the creation
of various control organizations (employing themselves as
"true experts"). Such commissions would consider
every particular case and sanction forced medication when it
is really needed. The application of potentially harmful methods
of medication would thus be restricted, and the negative
interference of the state would be neutralized in a part.
The control organizations are conceived as open for the
wide public and ruled by it, in the interests of all the
However, such institutionalized control would mean just one
more social force, which should be somehow controlled too,
the chain of mutually controlling organizations unfolding
to infinity. Nothing prevents the formation of numerous
commissions each one pretending to be the highest instance
and arguing for that right with the rest of the world.
Small specialized organizations are almost sure to fall
under the influence of more powerful and diversified
social groups, becoming mere mouthpiece of their opinions.
Another side of it is the lack of competent judgment.
Public control in the conditions of the division of labor
would necessarily mean the dominance of incompetent
views of the crowd over the sober professional consideration.
Professionals would hardly be any assistance for the
organizations created in the opposition to them, and the
knowledge and experience they monopolize would not be shared
with the public controls. Of course, there may be talented
amateurs who would study medicine to be competent enough;
still, they will always have a choice between either admitted
to the practice of medication and the experience associated with
it (thus becoming the representatives of the medical caste),
or remaining only partially educated and hence incompetent.
Typically, the public commissions are a field for a wide
employment of the numerous "survivors", bringing in
their subjective feelings and exaggerated apprehensions as the
basis for decision making.
One more level of public control is often discussed, delegating
the right of decision to the individuals. It is often argued
that conscious clients should be partners of the doctor
in medical treatment, declining all the solutions that do not
satisfy them. The advocates of this line admit that the
disease may sometimes lead to the loss of self-control in
the patient, so that one cannot decide for oneself; in this case,
the relatives or other legal guardians of that person should
have the casting vote in forcing a medication on him/her.
This attitude is most attractive to many people, since it
plays on their self-importance, and self-conceit. However,
few people can be considered as conscious enough in making
decisions where they know very little or nothing at all.
Incompetence combined with too much self-esteem often leads
to the self-assertive behavior of the patient tempting the
doctor to force a severer treatment on them. Since the family
relations are tightly linked to economic interests in the capitalist
society, the relatives of the patient can rarely be expected to
follow the patient's interests. Rather, they would try to
arrange their own affairs, and may insist on forced medication
driven by economic considerations or hidden conflicts. Thus,
husbands may have their wives electroshocked for "misbehavior",
the aged parents may be put into asylum by their children
for "senile disorders", and inversely, the parents
may have their children drugged for their "strangeness",
etc. In the world where money is the supreme power the individuals
cannot trust each other enough.
Any medication may be harmful due to the unexpected side effects,
the incompetence or neglect of a specialist, or just the insufficient
development of medicine and the absence of less traumatic methods.
Also, forced treatment is a reality of contemporary world,
and one can never be sure that it has been the last resort indeed.
So, the former patients often cannot enter the "normal"
life smoothly enough, especially, if a destructive therapy has
been used on them. This may be either temporary awkwardness
eliminated by adaptation—or a permanent deficiency, invalidation.
In the capitalist society, where an individual is evaluated
depending on his or her ability to produce values that could
be appropriated by the bourgeoisie, any deficiency is considered
as lowering the "market price" of the individual, so
that the former patients become less valuable for the capitalist
society, which is reflected in the other people's attitude to them.
To restore "normal" relations of temporarily disabled
or invalidated people with their social environment, a special
rehabilitation system is required.
To some extent, such system is present in every society,
being the most developed and diversified in the leading
capitalist countries. Thus, it has been recognized that it
would be wasteful to lose the working power of physically
injured people—and various institutions are trying to
enable the invalids to work and to live an active life. This
task is becoming much easier due to the development of wide
computer networks, as well as automation and computer control
of most technological processes. The situation may be quite
paradoxical sometimes, when the society chooses to exercise
"humanism" and employ the invalids, while many
"normal" people cannot find a job and lose their
health because of the awful conditions they have to live in.
Former mental patients are a special case. Usually, they have
no bodily defects, and their ability to work cannot be doubted.
Still, poor knowledge of the origin and functioning of human
consciousness makes the behavior of such people less predictable
and potentially dangerous for other people and destructive for
industrial processes. Most modern conceptions of consciousness
assume that it is the property of the individual organism, and
particularly the brain; any damage to the brain should then
be treated as a disorganization of conscious activity, so that
thus injured people could only be employed with a great care,
under close observation and with all possible precautions—just
to be on the safe side. Naturally, such an attitude is
offending the people who have already had an unpleasant experience
and are reminded of it every time. This results in additional
stress, which may cause a remission of the disease, thus confirming
the popular prejudices about the mentally ill.
There are different levels the rehabilitation system may be set up
at. Some capitalist states have already adopted the national
programs of support for the physically invalidated people, but
there are still no such programs for the rehabilitation of
the people with deviating psychology. Many "survivor"
activists are trying to attract the public attention to this problem
creating various organizations and launching movements in support
of the former mental patients' right on "normal" life.
However, their efforts may lead to the opposite effect, since
the very their formation into a separate public force enhances
their difference from the "ordinary" people and makes
the others to suspect mercenary motives behind the "survivor"
On a wider scale, the problem is to provide the human conditions
of life and the access to any activity for the people with
behavior deviations. Since nobody can exactly define what is
normality, it may be difficult to decide whether a particular
type of behavior is socially acceptable or it should be treated
as potentially destructive. It is quite easy to classify a
genius or a revolutionary as "mad"—and force
a psychiatric treatment on them. There is a very dim distinction
between "mental illness" and "crime".
A highly developed rehabilitation system could help many people
to preserve their personality and avoid forced medication.
However, no such system can be self-sufficient under capitalism,
since it is concerned with the implications only, but never with
the cause. In the class society, people will inevitably be
divided into opposite social groups, and this fragmentation
will penetrate any side of life and activity. Defending the
rights of one group is only possible by the expense of the rights
(and money) of all the rest of the people, so that the antagonistic
nature of the society is reproduced in every kind of relations, at
The richer capitalist states have more resources for the
development of the rehabilitation system for invalidated people.
However, these resources are not infinite, mainly depending on
the ability of the developed countries to rob less developed
or weaker nations. As soon as there are no more room to
expand, and no more others' wealth to seize, the internal conflicts
in the old capitalist countries are bound to break through,
and the social programs are first to be sacrificed.
Statistics and Ethics
There may be different approaches to the problem of forced
medication and the negative consequences of medical treatment.
Thus, one might point out that the discussion of such issues
cannot be based on reliable evidence. There are no properly
documented data on the particular cases of forced medication,
and the statistics of its usage. There is no way to discover
which part of thus treated people were injured by the treatment,
since the very attribution of the cause of injury is socially
biased. The vast literature produced by the "survivor"
groups cannot be trusted too much, since it advocates a particular
viewpoint and mostly collects the materials supporting it,
discarding the circumstances that seem "irrelevant"
to the authors. So, there can be no "scientific"
talk on the subject, and no way to reconcile the opposite
positions, which can only be stated, but never changed.
This kind of the categorization belongs to the ethic level
Since any statistics is futile where the opposite economic and
social interests encounter, the figures are no argument in the
polemics for/against forced medication, and no quantitative
references may be made. What percent of a person suffers
from a medication-induced injury? Is the pain of one person
less painful than the pain of the millions? Does in alter the
situation if there are just hundreds of injured by ECT rather
than thousands of them? Harm and relief cannot be weighed.
The typical quantitative argument is that most patients get
much better after the treatment, and it is relatively few who
suffer from the side effects or malpractice. Well, this might
be convincing if the problem of the efficiency of the current
medication techniques were considered. However, the problem
of forced treatment is not purely medical, since it concerns
the relations between the individual and the society, and
not the patient's susceptibility to a specific kind of treatment.
Of course, the proportion of side effects should be reduced
as much as possible—but the side effects can never be
completely eliminated, and the decisions are to be socially
motivated anyway. Thus, the efficiency of medication cannot be
measured in numbers: one death of the hundred is in no way less
distressing than ten or forty deaths, and the only valid criterion
is the absence of disease—which is impossible in an
unhealthy societal environment.
Another quantitative approach is to stress the existence
of much more urgent social problems. Thus, forced ECT is
much less frequent than poverty, hunger, oppression etc.
Does it mean that the associated problems should not be
discussed at all? Yes, they should—though there
is a limit of activity above which the ethical evaluations
get inverted: if "ECT survivor" activism
attracts too much public attention (which is quite possible
due to a smell of sensation associated with it), it may mask
other acute problems, thus contributing to the process of
"pain production" inherent to the current level
of economic and social development.
There are two sides in every ethical problem related to
forced medication. First, the medicine should help people
as it can—and this may assume forced treatment
as well. Second, free will of the patients should be
esteemed. Doctors have no moral right to reload responsibility
to the people in need—but they should not exploit
on the patient's vulnerability too much. In ideal,
the patient and the doctor should cooperate, and their
interaction should be marked with tolerance and compassion,
mutual kindness and honesty. Unfortunately, this is not
always (if ever) possible in the capitalist society,
where compassion and kindness have their market price
as anything else. Cooperation with the patient may become
dangerous, when the patient is disoriented by noisy
advertising or sensation-inflating journalism.
Thus, in a class society, there is a contradiction between
the "negative" goal of curing people who do not want
it and the "positive" goal of assisting people to
feel better. This contradiction is present at any level,
from the nation to the individual. The dominant ideology
of bourgeois individualism loads the major responsibility
for the adequacy of the choice to the individuals, which
are virtually never free enough to be responsible for their
deeds. So, a doctor has to decide whether to use force
for the patient's good, and be blamed for that—or
to let the illness grow, and be blamed for that too.
Most patients (the poorer ones) have little choice
with capitalist medicine. Still, they have to decide
whether to fight with those who treat them, or to oppose
the social system that cannot guarantee them a healthy
life, or at least a decent medical assistance.
There is one more ethical aspect of forced treatment:
any coercion is a reduction of humanness in the people.
Forced medication may heal the body, or behavior—but
it will inevitably cripple a part of personality,
poison the consciousness of the former patients.
Heavy experiences cripple the souls—though
forced medication is just one possibility among many
others, since all the relations between the person and the
society are based on explicit or implicit coercion under
capitalism. For a human being, life is not the highest
value, and may be sacrificed for spiritual goals;
hence, the spiritual oppression may be much more
destructive for personality than physical suffering.
Survivors and Sufferers
The common-level psychology under capitalism is marked by two
opposite tendencies. On one side, an individual is urged
to be active and to make one's fate with one's own efforts.
On the other side, people are being distracted from the
fundamental principals of social organization and suggested
to pass such thoughts to somebody else, or simply rely on
the abstract "order" usually embodied in the state.
This internal contradiction makes the people's behavior
rather impulsive, which is propagandized by the media as
behavioral norm. People make many isolated acts reacting on
the alternating everyday situations, but these acts do not
constitute any integrity, and the existence seems devoid of any
sense, which requires external stimulation to perform anything
significant. This is the world of no stable convictions
and no preferable direction of development.
As a manifestation of that, any idea has to be pushed forth
by private initiative, and appeal to private initiative,
competing with many other ideas. However, this forced
competition of ideas and projects tends to substitute the goal
of economic or social improvement with a quite different goal
of winning the prize, whatever it is.
This often occurs to the numerous support groups, which originally
unite people who purport to broadcast truth and protect individuals
from social pressure, but have to do it in such a sensational and
inflated manner, that the original idea gets lost in the flood
of extravagant actions and provocative claims. The activists
are usually rather copious, and their works are filled with
illustrative cases and statistics—both being fiction
rather than the results of a serious research. This fiction
gradually grows into a tradition, and more recent writings
refer to the older products as "authentic documents".
The necessity to attract public attention (that is, to be
a strong enough stimulus for the man in the street) makes
the activist groups use inadequately aggressive language.
Thus, psychiatric "survivors" glow with sacred
hatred against psychiatry, speaking in the language of war
and presenting every clinical error as a sign of the corruption
of the profession in general. Instead of supplying the
psychiatrists with a better understanding of their patients,
they raise a wave of protest in the professionals; instead of
educating the psychiatrists, they try to castrate them.
But since any forced medication is a social rather than
medical problem, there is no use to blame psychiatrists,
without any trouble for those at the power.
Generally, the medicine is blamed for injuring the patients
and forcing harmful methods on them and thus making them
invalidated and inferior in the eyes of the rest of society.
The pity of the ordinary people is a good card to play on.
However, the very activity of the "survivors"
may become an argument against their movement: the people who
feel well enough to lead that active life, to write and publish
numerous articles and books, to participate in various disputes
and construct personal sites on the Internet—such people
do not produce an impression of disability. Few "normal"
people can be that robust. The thought is quite logically
suggested that all that noise around forced psychiatry is
mere disguise, and the actual goals of the "survivor"
activism are far from humanism and charity. Anti-psychiatry
becomes a means of attaining some economic or political goals.
Activism and Class Struggle
A well-developed capitalist society has a rather complex
social organization. There are numerous social groups, layers
and classes, and the relations between ethnic formations
are built according to the same model: class antagonism.
This social hierarchy may unfold itself differently in
different respects, and those who belonged to the same
social group in one hierarchical structure may belong to
opposite (and conflicting) groups in another unfolding.
This complexity is far from the old conceptions of class
society, with just two main classes struggling for economic
and social dominance. Today, class struggle may be hidden
under apparent cooperation, it may affect particular aspects
of interpersonal relations only, or even be represented by
the different sides of the same personality and felt as a
subjective experience. This hierarchical complexity reflects
the hierarchy of modern capitalist economy, which has developed
with the new ways of value production and consumption.
As division of labor is becoming the absolute principle
governing the development of capitalism, any kind of activity
may, under definite conditions, form into a special business,
obeying the laws of capitalist economy. Such transformation
is usual for various kinds of social activism, and the wide
social movements have certain economic interests behind them,
collapsing soon after they have played their role to the end.
Some "survivor" groups are stressing their radical
orientation, their negative attitude to the capitalists system
and desire to improve the society. They may claim themselves
the successors of the old traditions of the working movement,
and even flirt with communist ideas. The "survivor"
movement is said to struggle against psychiatry as an oppression
tool, employed by the ruling class to bring the people to
Well, there may be some parallels between activism and class
struggle. Both are the manifestations of the same antagonistic
structure of capitalist society, and there is no impenetrable
wall between them. Class struggle may assume the form of
social activism, and activism may grow into class struggle.
Still, they are different social phenomena, with their own
functions within the whole. In a sense, they are complementary
— and one can notice that the peak of activism coincides
with the low phase of class struggle. This is not a coincidence.
The ideology of the working movement is to change the world
by a joint effort, so that the particular sides of life would
become more bright due to the global change of social organization.
The workers are to build the new society by themselves, they are
to invent the principles and forms of the future. Quite the
opposite of this attitude is represented by the "survivor"
ideology of social activism. Its basic idea is the struggle of
victims against social evil associated with a limited group of
people, the professional "evil-makers". The task of
activism is to throw down this social evil, without changing the
society itself—the position quite close to bourgeois
liberalism. The activists may admit that the roots of the
problem are in the nature of capitalism itself—but they
cannot imagine how the social system could be changed, and
so they have to conclude that all one has to do is to survive.
Thus, people are encouraged to be victims, rather than conscious
personalities able to change the rules if the rules are against
But where can the "victims" get assistance from?
Capitalist economy is a self-balanced system, and any shift
of the balance in the interests of one social group will result
in the redistribution of the public wealth on a large scale.
Social activism thus appears to be just another side of
economic competition, with every group pulling the blanket
onto themselves and quarreling with the other aspirants.
Yes, an invalid's participation in the Olympics is a great
support for the person's spirit—but the money spent
on that might draw a hundred people out of hunger.
The class roots of the working movement and social activism
are different too, since activism is almost completely based
on the intelligentsia, with its oscillations between angry
radicalism and fearful loyalty. The internal contradictions
of activism reflect this intermediate social position of
the activists. While the working movement may be progressive,
activism is merely progressist. Virtually, it often occurs that
such progressist movements serve the interests of the wealthier
capitalists, being their tool in the economic competition and
political struggle. Thus, numerous "green" movements
have nothing to do with ecology: their function is to support
one group of capitalists against another, to undermine the
business of a competing company or the economy of a weaker
country. One more example is the noise around forcing
psychiatric treatment on political opponents: somehow it
finally happens to fight against the communist ideas only,
quite ignoring the psychological oppression in the capitalist
countries. There is much speculation on the Stalinist regime,
and the fantasy of a bourgeois produces enough fiction
about the most sadist forms of repression which they readily
ascribe to the communists, without a slightest thought of
the evidence (which may well be invented afterwards).
In particular, Stalin is blamed for the wide use of psychiatry
to suppress the political opponents; there is no evidence
on that (except the specially invented), and there cannot be
any—still, much shouting is enough to make the Philistine
There is a significant difference between activism and Marxism
in that the "survivors" mostly talk about malpractice
and potential danger of common procedures, while a Marxist
would first investigate the economic and social conditions
that has lead to the very necessity of treatment. The activists
like talking about human rights—in Marxism, there are no
abstract human rights at all, since the relations between people
depend on their place in the economy. For Marxist, a capitalist
has the right, say, to force medical treatment on a worker who
is not obedient enough—but this right is not something
"natural" or "inherent" to the class of
capitalists, being mere implication of its economical position.
The exploited have no rights, and this is their social position
too. Of course, this scheme is much less apparent in the
developed capitalist societies; however, it can be traced in
every particular case, forced medication included.
The corollary of the Marxist approach is that the major cause of
any disease is the low level of economic development, with the
respectively underdeveloped social organization. Poverty cripples
the souls much more often than a "malignant" psychiatrist,
and injures the bodies long before they become injured by the
"bad" doctors. Ill conditions of life lead to physical
illness, while the absence of any hope results in compensatory
psychological deviations, readily becoming mental disease.
On the other side, the level of medical treatment available
depends on the thickness of the purse under capitalism, so that
those who need help most often cannot have it at all.
The bourgeois may argue that poverty is not a strong stressor
on itself, and poverty does not necessarily lead to mental
malfunction or unhappiness. There are so many poor people who
are much happier than the rich, who have so many responsibilities
and must work hard to preserve their social status. Still,
there is no bourgeois who would give all their money to the poor
and become as deprived of property and civil rights. The destructive
effect of poverty does not depend on whether one had experienced
a better life or not—however, individual experience may
make a person aware of these effects, thus leading to the
conscious frustration and psychological distress.
Such people are more likely to be subjected to forced medication
for their "anti-social" behavior; this would be
a medical procedure, of course, and a kind of healing too—and
it is the ill social system that makes them the means of
social control. There are no direct implications for class
struggle arising from forced medication—rather, the
"survivor" activism should serve the needs of a more
global social change to become something more than the weep
of a hurt puppy.
Seeking for the Future
Social activism (including the "survivor" movements)
purports to improve the society, making it more human and
protective for its members. Indeed, social changes of this kind
could be observed in the developed capitalist countries, and
the activists are apt to think that it was the result of their
"struggle". They say that activism is to replace the
working movement and that it has become the only efficient form
of the struggle for a better social organization.
Well, social progress implies some contribution from social
activism, though its actual role is much more modest. Class
struggle will always remain the major force of development
in the capitalist society, and all the achievements of activism
could not be possible without a strong support from the working
movement (including the international level), which is directly
linked to the economic processes. The observable reorganizations
of society are due to the drastic changes in economy, and the
corresponding adjustment of the basic social relations, in the
However, the role of the working movement should not be
overestimated too. In fact, the working movement and social
activism are the levels of the same hierarchy, and their
relations may be inverted in a definite context.
They are the complementary sides of the reproduction of
the capitalist social organization, and the progress they
cause cannot break the very foundations of capitalism,
leading to a new socioeconomic formation. Capitalism can
be improved, to a certain extent, as long as its internal
contradictions can be resolved within the capitalist system.
Still, the formation change is inevitable, sooner or later,
and the leading force of this change cannot be identified with
none of the basic classes of capitalism, and, of course,
none of the classes pertaining to the earlier historical stages.
Like bourgeoisie was the third force that came to power when
the class struggle between landlords and peasants had reached
its culmination, there is a new social force in the present
society, which will shape the future economic formation to
replace capitalism, and this force is different from both
bourgeoisie and the working class.
It would be premature to make any guesses until the very
economy of capitalism shows the directions where the future
of the humanity is to be sought. However, one can say with
certainty that the efficiency and progressiveness of both
the working movement and social activism depends on whether
they support the birth of the new economic formation
(and the new social system), thus preparing the conditions
for the higher stage of human development to come.