The Unite and RMT unions led a go-slow of over 1000 black cabs in London on 10th September in protest at a “schizophrenic killer” being granted permission to sit “The Knowledge” exam and qualify for a black cab license.
The 38 year-old man strangled his wife in 2000 and was convicted of manslaughter. He was diagnosed with “paranoid schizophrenia” and served just over two years in a secure psychiatric unit before being released from section in 2005. Since this time he has been working for a minicab firm.
Clearly nobody wants to be killed in the back of a taxi, but what is the correct working-class socialist attitude to this demonstration?
For those patients that escape the secure unit and return to life in the community, the Ministry of Justice section remains along with surveillance and risk assessment. This cab driver moved through the system at incredible speed given the nature of his offence. Nevertheless, he would have been subject to the most intimate and thoroughgoing assessments before he was allowed anywhere near the public.
Given his diagnosis it is quite surprising that he is able to drive at all. Most people on anti-psychotic medication would be unfit to drive, as would people experiencing psychosis. The drugs make you drowsy and psychosis makes you see and hear things. If our paranoid schizophrenic is fit to drive, then it suggests he is neither experiencing symptoms nor taking medication. He could be on a very low dose of medication but it would still be very unusual for him to be granted a licence. It is more likely that he is one of the 20% of schizophrenics who “recover” without further episode.
But the trade union response has been to chime in with the tabloid hysteria and attempt to override TfL’s vetting processes. Bob Crow said “it defies belief that such an individual should be allowed out on the streets of London in a black cab”. Jim Kelly from Unite: “The Public Carriage Office must act now to protect the public and the reputation, quality and integrity of the world’s finest taxi drivers.” George Vice (RMT) threatened “If some action is not taken [by the PCO], I am sure the RMT will take it.”
Rethink, a service-user led charity, rightly commented that this response was in danger of becoming “a Salem witch-hunt”. The most important facts of the case are confidential, so the unions are acting purely out of common prejudices about “psycho axe murderers”. We often attempt to mobilise against the decisions of the bosses’ courts and tribunals and assert working-class justice. This was not one of those times.
Despite confidentiality, there is information that should have informed the politics of the trade union response.
The forensic psychiatric system is perhaps the most repressive and effective instrument of state control against violent offenders. The forced administration of tranquilising drugs, an indefinite period of imprisonment and intrusive surveillance are all part of the “treatment”. Unlike prisoners, the “patients” do not serve sentences. Freedom is achieved only by satisfying the unspoken criteria of the psychiatrist. If you play the game and pass the test, then the psychiatrist will apply to the Ministry of Justice for a change in section. The process is arduous and the bureaucracy and the drugs are designed to break any “non-compliance”.
The unions made a fairly offensive assumption that the man’s killing his wife was in some way connected with his mental disorder. According to government figures you are much more likely to be killed by a member of your own family than by someone with a mental disorder. On average only 4 to 9% of murderers have mental disorders — people known to psychiatric services are actually under-represented in homicide statistics. Of that 4%, the majority killed somebody that they knew. However, 34% of all murdered women were killed by their “sane” partner or ex-partner. Whether this cab driver killed his wife because he was responding to command hallucinations is unknown. But it is unlikely that he poses a risk to strangers. Misogyny and monogamy are much bigger factors in wife-killing than psychosis.
The demonstration shows the degree to which psychiatry has retained its authority despite movements that have challenged its power. Psychiatry is far from being an exact science. The history of psychiatry reveals a bunch of quacks pushing whatever diagnostic tools and clinical interventions best serve the ruling class. Past psychiatric conditions included drapetomania (the condition that caused a black slave to run away from their white slave-master). Similarly, the opening of the asylums in the 60s revealed women who had been detained for decades for giving birth outside of marriage. “Treatment” once involved cutting random chunks out of the brain. In short, barbaric abuses of power without any scientific foundation.
Moderated by the successes of the antipsychiatry and survivor movements, that tradition still continues. Psychiatry is primarily a system of social control, using the blunt instruments of neuroleptic drugs and electroshock therapy to police society’s deviants. Whether or not such policing is desirable, we should be clear that psychiatry is not a science for “restabilising chemical imbalances in the brain”. This is just part of the mythology that secures the profession’s grip on power. This mythology is not even believed by the practitioners themselves who have long given up trying to find a biological cause for schizophrenia. However, the spectre of random chemicals setting off murderous impulses is enough to justify all sorts of authoritarian medical interventions.
As the power of the psychiatry was challenged with care in the community, the forensic psychiatric system began to grow. High and medium-secure forensic units are now home to record numbers, increasing 45% since 1996. Increasingly we are being policed on the basis of being mad, rather than bad. The expansion of psychiatry’s remit has also seen the medicalisation of increasing areas of human experience (ADHD, Personality Disorder etc.) These trends, along with escalating surveillance and the collection of biometric data, pose an enormous threat to the project for human liberty. This creeping authoritarianism is reenforced by the kind of anti-mad witchhunts we see in the right-wing press — it has no place in our unions.
We should expect our unions to challenge the negative stereotyping of madness and to pose a challenge to the terrors and abuses of the psychiatric profession. We should have no illusions in the power of psychiatry to heal extreme mental distress. Rather we should hold it up to scientific scrutiny and see it as part of the broader power structures that oppress us. We should pose alternative human responses to mental disorder that seek to bridge the gap between madness and sanity, rather than reenforce alienation and stigma. We should fight for a world in which gender oppression is challenged at every turn, understanding that femicide and rape are part of a broader picture of social violence against women.
Comments
Television
Drugs don't always work?
Oliver James' book "They F*** You Up" (i.e. your mum and dad) had a review of recent research on schizophrenia (or cluster of symptoms that is commonly described under that label). He seems like a good "bourgeois scientist" with a lot of humanity... i.e. who also thinks, broadly, that capitalism *is* to blame for a lot of mental illness/behavioural problems, that he can prove a proper causal link (i.e. not just a coincidence), and that even if the drugs relieve symptoms, there might be a better way even with an "illness" like schizophrenia.
Interesting snippit here on that subject:
http://www.guardian.co.uk/society/2005/oct/22/health.socialcare
Might it be good for someone with the info, to suggest some background reading, otherwise I don't know where this debate will go.
democratic psychiatry
There is a difference between being "anti-science" and being critical of the scientific technologies that are developed under capitalism. A Marxist ecology recognises that capitalism, with its control over the "general intellect", develops capitalistic technologies. The car, the television, the cluster bomb, the nuclear power station and alot psychiatric medication would all fall into this category. They are technologies that further capitalist hegemony and would not have developed under a democratically controlled economy. Wholesale cheerleading of all things scientific is not the correct Marxist position. Instead we need a third camp position "Not capitalist technology, not caveman technology, but international proletarian science!"
That said, the scientific basis of psychiatry is highly dubious. Psychiatrists no longer believe that they will ever find a biological cause for mental illness. They accept that medication alone cures nothing. There is no physical test that will reveal that someone is schizophrenic or depressed. To get a diagnosis of schizophrenia you have to have suffered from one of three loosely defined symptoms (thought disorder, hallucinations, delusions) for over one month. If the same standards were applied to cardio-vascular problems, we would see half the population puffing on asthma inhalers whilst thousands died needing heart surgery. Psychiatry does not even know what schizophrenia is, let alone has any idea how to cure it.
My criticism of psychiatry is not an attempt to downplay the suffering of people experiencing mental health problems. Also, I am not wholly against the use of medication. To an extent, the majority of us self-medicate using alcohol and street-drugs. Psychiatric drugs are just another factor in our environment that may help us get through the day. The use of drugs tends historically to go in waves and we seem to be reaching a bit of a climax at the moment. Similarly, some commentators speak of the second age of depression where we will see suicide rates increase. Put crudely capitalism is making us sick and we're popping whatever pills we can get our hands on to numb the pain.
Although far from ideal, Tom is right to say medication is not bad per se. However, I do oppose the forced administration of this medication and the hegemonic status it wields over other means of recovery. Tom rightly comments that I shouldn't equate madness and criminality, however, people with mental health problems are treated like criminals. This is why psychiatric abuse is fundamentally different from the abuse that is seen in other parts of the public sector - it is systemic.
The question of recovery cannot be separated from the social context and the doctor-patient power dynamic. Mental illness cannot be found inside the individual, rather it manifests in social relations. As Marxists we don't believe in souls, we don't distinguish where one human being starts and another begins. We see the individual in a myriad web of relationships, dialectically creating and being created by the world. Similarly, people do not simply have a mental illness, rather they relate to an experience of mental illness (usually an experience that they find terrifying and inexplicable). The ways in which mental illness is related cannot be separated from the social context. At the moment that social context is littered with state-sponsored violence, stigma and forced medication. Recovery depends on the individual having a more healthy relationship with the world, and this inevitably involves a better relationship to their illness.
What would a socialist approach look like? I spoke in the last article about "bridging the gap between madness and sanity". There is a common misconception that mental illness is something completely separate from people's everyday experience. The mad person is an alien who needs to be locked up and restrained. A better approach would see mental illness as something that lies at the extremities of human experience. A socialist approach would seek to discover *how* people relate to these experiences and what could change socially to aid recovery. I am not suggesting that these experiences should be 'embraced', rather the experiences should be taken seriously. We should recognise our own ignorance as mental health workers and reject stigmatising ideology. I would advocate listening carefully and solidarising with the user/survivor movement and looking to the example of the Democratic Psychiatry movement in Italy in the 70s. This coalition of patients, nurses, communists and psychiatrists managed to repeal the laws imposing forced treatment and locked wards. Such a struggle would form the basis of a psychiatric system founded on human solidarity rather than coercion.