Psychiatric Imaginary

Madness, Fear, and Carceral Protectionism.

As promised, here is the first of some more disability focused work. This essay examines the concept of sanism through the lens of what Liat Ben-Moshe calls “carceral sanism” and questions how the concept of danger and safety are employed in the cultural imaginary to conjure up ideas about madness. Taking inspiration from Yeats’ 1920 poem, The Second Coming—which was invoked by Joan Didion in the title of her work observing, what one critic described to the Washington Post as “a devastating depiction of the aimless lives of the disaffected and incoherent young,” in the Haight-Ashbury district of San Francisco during the 1960’s—the conceptual popular framing of “madness” is challenged through an interrogation of how carceral sanism is foundational to the cultural authority given to bio-psychiatric expertise. This is not intended as a dismissal of anyone’s experience of madness, illness, mental illness, etc., nor is it a dismissal of psychiatry as a whole. It is rather, a harsh critique directed towards the power relationship at play within the psychiatrization of madness under the systems and incentives of capitalism. There are also, of course, images pulled from the archive, most of which is Margiela—because who better to illustrate an essay about the ways we construct “madness” than a brand built on the commodification of institutional critique :-)

xBeatrice

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[Image Description: Margiela, 1989. Two black and white photographs, portrait orientation side by side. Low angle shot looking up from the edge of a runway. A figure walks down the runway towards the bottom right of the picture plane. She is wearing split toed shoes, a signature Margiela look, with circular white stacked heels. It is difficult to make out exactly what the figure is wearing. It appears as if the figure has two layers of clothing on, one interior layer, a flowy light grey in this image, chiffon-like. The second, exterior layer, is almost like a suit made of a plastic garment bag. As if the figure has been put into some sort of hard shell packaging like a toy to keep the light chiffon underneath safe.]

Psychiatric Imaginary — Madness, Fear, and the Conceptual Justifications of Carceral Protectionism

[…] / Things fall apart; the centre cannot hold; / Mere anarchy is loosed upon the world, / The blood-dimmed tide is loosed, and everywhere / The ceremony of innocence is drowned; / The best lack all conviction, while the worst / Are full of passionate intensity.  

Surely some revelation is at hand; / Surely the Second Coming is at hand. / The Second Coming! Hardly are those words out / When a vast image out of Spiritus Mundi / Troubles my sight: somewhere in sands of the desert / A shape with lion body and the head of a man, / A gaze blank and pitiless as the sun, / Is moving its slow thighs, while all about it / Reel shadows of the indignant desert birds. / The darkness drops again; but now I know / That twenty centuries of stony sleep / Were vexed to nightmare by a rocking cradle, / And what rough beast, its hour come round at last, / Slouches towards Bethlehem to be born?  

– William Butler Yeats, The Second Coming (1920) 

Sanism is based on the fundamentally flawed notion that the mere existence of madness threatens the safety and order of society, as a result, the structures and dominant discourses of “what to do” about madness create restrictive parameters for “solutions” giving preference to coercive and carceral practices at the expense of the individual experiencing distress. The premise of sanism relies heavily on cultural mis/perceptions of danger and disorder, a sort of pre-limiting cultural imaginary characterized by a central political goal of exclusion, justified by pathology, reinforced by expertise. Coupled with the predominance of biomedical approaches to mediate, categorize, and control perceived disordered behavior which functions by rhetorically pitting the individual’s autonomy against the general needs of society, it is no wonder that many who advocate for Mad Rights identify with a narrative of hard-earned survival through systematic-resistance which contradicts the therapeutic veneer applied to modern notions of “mental healthcare” ushered into, what William Butler Yeats calls, Spiritus Mundi, via the professionalization of psychiatry as a respected biomedical discipline. Concomitant to the professional valorization of medical expertise, schemas of carceral protectionism emerged as the preferred strategy for ameliorating the perceived problem of unchecked madness in society, resulting in both the perpetuation of sanist rhetoric and beliefs, as well as the justification of harm, violence, or death at the hands of the state under the guise of social “safety.” 

Spiritus Mundi, “World Spirit” in Latin, is defined by Yeats as a sort of collective unconscious, a constant, hidden social reproductive process of creating a collective historical narrative. A way to explain human history through the metaphor of a universal memory or muse, Spiritus Mundi necessarily reflects a reduction in the nuance of human difference to a mere detour in the broader journey of social history. As early as the 14th century, madness was used to describe a mental state which was lessened or irrational and produced noticeable headstrong behavior. As decades wore on additional sociocultural connotations accumulated which associated madness with foolishness and danger.(1) Madness encompasses a wide range of body/mind states and types; some experts posit that madness is a biomedically mediated neurological disease, some argue that it is a result of social circumstances and influenced by the downward pressure of negative social determinants of health, and yet others argue that it is merely part and parcel to human behavior and difference but has been stigmatized through complex intergenerational processes of social labels of deviance, resulting in systematic exclusion from society.(2) There is no scientific validation which supports any one dominant theory of madness (arguably, nor is any one dominant theory of madness necessary), which is directly reflective of the situational and conditional social realms in which madness ontologically operates. 

Carceral Preferences Generate Violent Protections

Throughout the 19th and much of the 20th century, Mad People/“psychiatric patients,” migrants, poor people, houseless people, orphans, intellectually and developmentally disabled people (I/DD), elders, and many other categorically defined groups were institutionalized in large congregant facilities, a process that was end-to-end dominated by medical authority. Billed as a humane answer to the problem of catch-all alms houses, and in response to growing policy-concerns about the perceived phenomenon of increasing numbers of “chronically and severely mentally ill people” led to the fad-like explosion of institutionalization.(3) As the trend of carceral, medicalized rehabilitation phenomenologically accelerated so did the authority and scope of power wielded by biomedical expertise.(4) Central to the struggle over “what to do” with the people who were being affectively cast out of society and into institutionalized life was the development of the construct of bio-rehabilitation leading to a reversal or cure of madness.  

The project of “modern medicine” has developed with an ill-fitting and misguided commitment to conceptual biological cyclicality which does not reflect the realities of lived experiences of illness, madness, or impairment. “Chronic illness required care and management for periods that could sometimes span decades. But psychiatrists, like their medical brethren, remained preoccupied with acute and episodic rather than persistent and long-term disease, and continued to emphasize the paramount importance of restorative therapies.”(5) Thus, a binary is constructed, and reproduced through the expertise granted by decades of medical and psychiatric education, which differentiated between those who can be returned to a state of perceived normalcy through rehabilitation and biomedical intervention, and those who were considered to be irreparably impaired, different, or otherwise clinically unable to be made normal. This is a key ideological tenant of conceptualizations of sanism, those who can be “cured” through biomedical interventions became the living-well, able to return to work, life, and freedom with pharmaceutical support were considered to be rehabilitated, valuable members of society. Sanism represents a manifestation of a imagined preference for the living-well. The darker side of this dualistic understanding of “mild vs. severe mental illness” was that those who could not meet the expectations of psychiatrists were considered to be irreparably damaged, and thus categorically stripped of their personhood, agency, and autonomy. 

This dualistic framing of cure/permanence has historically dictated the scope of access to care that an individual might be eligible to receive, with many deemed uncurable cast out of acute care hospital settings, delegated by doctor’s orders to perpetual, residential confinement in a congregant institution.(6) The common cause for this systemic preference for confinement, namely a carceral preference, was the perception or certification of “permanent not-normalness," though the ways in which that determination was ultimately made varied according the perceived pathology of the individual and along the complex compounding nexus of racialized hate and prejudice.(7) It is also worth noting that regarding perceived “offenses against society,” as is outlined by many first-hand accounts of Mad People, and as will be also discussed in the accounts of Margaret and Frank later in this essay, these boundaries and norms which are violated are often arbitrary. “For psychiatry to become a legitimate profession, let alone a science, a separation was created between those who can be treated (the ‘mentally ill’) and those labeled as incurable (feebleminded and then intellectually disabled).”(8)  This separation relied on the idea that the “incurably mentally ill” were not only incurable but also dangerous.(9) While the justification for removal from society for those with I/DD was often centered in infantilized notions of “mental incapacity,” dictating and defining a social need to protect the individual, by contrast the fear of madness often came down to issues of perceived safety as a result of the inaccurate correlation of states of madness to violence, deviancy, and social unrest.(10) In truth, the fear of madness is unfounded, it is not madness which causes unrest but the incentives of capitalism and the greed, despair, suffering, alienation, and inequality it produces.   

[Image Description: Margiela Couture 2019. Color photograph. Single figure walks forward with a colorful background. Figure is wearing a deconstructed suit, made from light brown herringbone silk wool. The seems are raw and exposed, tacking seams are still in place and proportions are off. Portions of the blazer are skewed at an angle, but it is still recognizable as an abstracted formal menswear blazer. From a few scarce edges, bright chroma-key green peeks out, revealing that the lining would render fully invisible in front of a green screen. The figure walks forward with the powerful coercion of the runway. Endless, forward progress. Several pops of color and contrasting material peek out from details of the jacket. The figure’s hair is wet, gelled down to look like they have just stepped out of the shower. On the figure’s head is a padded type of crown, the aesthetics appear to be referencing medicalized garments, like head protective devices. The figures lips are a dark glossy red with diffuse edges.]

Those individuals who are unable to find stable housing and employment, either as a result of their symptoms or of other aspects of their subaltern identity, are much more likely to experience harm and pathologization of perfectly reasonable reactions to the full weight of negative social determinants baring down and imposing precarity on a person’s survival. Sanism labels this psychic resistance to the dominant values and behaviors of social life under capitalism and marks it as unreasonable, not founded on ideas based in logic, but in madness. It is not that the individual’s mind-state is “unreasonable,” it is that our society is ill-fit to accommodate the complex needs of many Mad People under the incentive structures and fiscal restraints of capitalism. In fact, society is actively antagonistic against Mad People, using psychiatric frameworks to dictate how Mad People may live, if they may be free, and sometimes, as is often the case in Mad People’s encounters with state violence at the hands of police or doctors, how theymust die.  

It is precisely this control over life and death which demonstrates the severe consequences of letting sanist bias mediate collective imaginaries of safety. Letting sanism define the parameters of achieving a safe society will always redound to a preference for carcerality. “Within a carceral protectionist framework, perpetual in/vulnerability is relationally applied. It is racially constructed, related to pathologization (queerness/disability/madness) and deployed through criminalization. Carceral protectionism is about discourses of protecting “the innocent” from “dangerous” bodyminds and also protecting people from their own danger and for their own good (including medication, psychiatrization and placing in custody).”(11) This social reproductive process then manifests into what Ben-Moshe terms carceral sanism. Mad People who struggle with visible symptoms of madness—as outlined and dictated by the authority of psychiatry—are repeatedly characterized as unreliable, violent, anarchistic, and anti-social throughout culture and media. Madness, through the lens of carceral sanism, is not only often seen as a social deficit in need of correction or cure, but also as a social phenomenon demanding a level-headed solution to “clear and present danger.” 

"A gaze blank and pitiless as the sun,”

Often lost in the professionalized narrative of madness, are the real-world material consequences of psychiatrized pathology on the life, freedom, and death of individuals labeled to be dangerous or “crazy.” On June 7, 1945, Mr. Frank, #27967, a Black man in his mid-thirties, was served a meal on a broken plate at a restaurant in downtown Brooklyn, New York. Records note that as a result, “[Frank] became upset and caused a disruption outside the restaurant, yelling and kicking garbage cans.”(12) The staff and customers at Virginia’s Restaurant deemed Frank’s behavior to be not only unusual but menacing—and called the police. When the police arrived, Frank was not arrested, but instead, he was taken to the psychiatric ward at Kings County Hospital and later admitted to the Willard Psychiatric Center in upstate New York. Frank was reasonably upset that his meal had been served to him on a broken plate, yet the other people, through the lens of sanism, felt that he was acting without reason. Not much is known about him other than what his records state, which detail that he was a military veteran who was relatively new to the area without many supportive socioeconomic ties. It is not difficult to imagine the socially determined circumstances which could have been pressing down upon him, and how else those pressures could have been mitigated other than institutionalization. Yet the sanist preference for protective carcerality produces a political economy in which Frank’s life and freedom became secondary to the safety of society. Carceral sanism is a preference for deprivation in the face of need, of confinement over care, and a violent and dispassionate way to enforce social and biological norms. 

[Image Description: Color photograph. Collectible anime toy in front of a blue background with accessories. Figure and accessory are both inside of hard plastic bubble cases. The figure has blond hair with bangs and pigtails. Its face looks down towards its toes, its eyes are gently closed. It wears a tattered white straight jacket like a dress, its arms are lost in fabric restraints. The bottom hem of the garment is shredded. The figure has bare feet and is wearing chunky black and silver ankle restraints.]

When Willard was finally closed in 1995, workers discovered hundreds of suitcases in the attic of an abandoned building, among the many were Frank’s belongings. He would spend the rest of his life institutionalized, dying 30 years later in 1984 having never been released after being remanded to institutionalized care at such a young age. The account of this man’s life—a life, fully stripped of personhood in the name of social “safety” and reduced to a near-nameless account of social abandonment and death as a direct result of sanism—the story of “Mr. Frank, #27967,” is unfortunately quite far from unique. In fact, much of the history of both mental health pathology and policing is so deeply intertwined with the history of racialized violence and white supremacy in America. As Tanja Aho, Liat Ben-Moshe, and Leon J. Hilton attest in Mad Futures: Affect/Theory/Violence (2017), the police have always been used as a sort of occupying armed force, carving out social norms and borders in real time amongst the population: 

Police forces were established to protect owners at a time when black people were considered unruly property, when indigenous people and other people of color, women, and people with disabilities were construed as “irrational” others against which liberal personhood was constructed. The ongoingness of racialized police violence extends this history and continues to assign to social death and literal death those deemed irrational, unruly, unstable, and unpredictable. (p. 291) 

Even today, many people experiencing distress or publicly displaying symptoms of madness are criminalized for the mere suggestion of discordance with prevailing behavioral tendencies, such as “unreasonable agitation” or otherwise pathologized behavior, which begs the question—what exactly was tangibly gained towards collective safety by removing a man from society for half his life over such a small social disruption? It is difficult to produce a satisfactory answer to that question without the support of carceral sanist logic.  

The dominant political economy dictates a social preference that Mad People be cured, or otherwise corrected, and removed from society under these pathological parameters justified by a biomedical approach to mental difference. The consequence of carceral sanism and the policy preferences it produces has meant that hundreds of thousands of people like Frank were remanded to Willard Psychiatric Center and the thousands of other institutions like it over simple breaches of social norms, unfounded perceptions of violence, or simply the bias and opinion of medical experts. Take also for example, Miss Margaret, #25682, who was previously living independently, albeit with multiple chronic health conditions. Margaret was suddenly sent to Willard after a change in doctor dictated by her employer put a provider in charge of her care who felt that, as opposed to the assessment provided by Margaret’s previous doctor, “her physical complaints were overshadowed by emotional problems.”(13) Margaret, like Frank, also spent the rest of her life institutionalized and described her experience as akin to being a fly trapped in a spider web. In the doctor’s opinion, Margaret’s danger to society was simply in existing differently than others in a way which was deemed irreversible and that alone was justification for her removal.  

[Image Description: Nina Donis, F/W11 - Moscow Fashion Week. Color photograph, runway still. A figure walks down the runway on a concrete floor. The background is in shadow. The figure wears bright white tights with black athletic crew socks pulled high up onto the calf. They wear chunky black sneakers. On their torso is a two piece matching padded suit. It looks like a cross between a fencing suit and a straight jacket. Tied at each edge by white cloth ties which arrange themselves along the silhouette of the body in a disorderly fashion.]

This focus on rationality, which in and of itself is a kind of tool for the social measurement of justification, produces a false sense that the perceived absence of rationality, is something to be existentially feared. However, it is important to note, that this is only a perceived absence of rationality, subject to the biases, prejudices, and misconceptions made real through the constant reinforcement of sanism. It is only a sanist perception of “rationality.” A sanist perception of madness dictates that madness is danger, and an urgent fundamental danger at that. Psychiatry is given preference in setting the boundaries and borders of what is perceived as “mad” and its authority prescribes that the only remedy for madness comes, not from meeting people where they are and attempting to support their needs as a community, but from the correction and cure that comes with the threat of potential violent, extractive removal of their person from society as a whole. The Spiritus Mundi of “managing madness” is part of the broader prison industrial complex in its preference for carceral solutions to nearly all breaches of social-biological norms. 

Expertise Through Power/Power Through Expertise

Madness is a complex set of interwoven phenomena, which does not easily reduce into any one digestible framework despite attempts by the state, big pharma, psychiatry, or private insurance companies to concretize the meaning and scope of madness within the context of capitalism. Nevertheless, the overwhelming majority of solutions or interventions for a person experiencing crisis, distress, or other symptoms of madness are based squarely in a biomedical context.(14) What I mean to say is that madness as a medical/bodily disease has received near-unchallenged priority from a policy, research, and drug development perspective, and this preferential bias results in limiting the options available to support mad individuals, whatever their needs, to those supported by the ambiguous and flawed rhetoric of what Thomas Szasz calls the “pediatric model.” The pediatric model is less about the age of the “patient” and more about the power dynamics which become the prerequisite for care. 

According to Szasz, unlike other physicians, who typically treat individuals who actively seek out their services, psychiatrists and pediatricians are unique and alike in that they explicitly often treat persons who do not seek their services willingly.(15) The superstructural care relationship is wholly mitigated by a sort of consent-by-proxy. Szasz, a psychiatrist himself by training, argues that pediatricians treat children not at child’s individual, autonomous will, but at the will of their parents and guardians, who are seen as the only party capable of making an independent decision about the care needed within the bounds and norms of society. Psychiatrists also often treat adults against their will, and by law, are fully within their scope of practice to treat individuals as if they were “irresponsible children.”  

Thus, this expert discipline of psychiatry—founded on prejudicial and paternalistic notions, rife with ambiguous definitions of human worth and permanence—is to Mad People like Yeats’ pitiless and blank, troubled spirit, which let loose a blood-dimmed tide dooming humanity to be forever vexed with nightmares of rapturous elimination. The default social relation between the psychiatrist and the individual deemed necessary by society of rehabilitation, intervention, or cure, is a relation of absolute power warped and guided by sanism, as is well evidenced in many first-hand accounts from Mad People.(16) As an anonymous Canadian Mad Person notes in their own words: 

One of the worst psychiatrists I’ve encountered in my 40-year battle with depression and anxiety … would go on and on explaining things that were obvious. After I attempted suicide by swallowing a bottle of Ativan, perhaps a cry for help, he was angry with me and told me I was finished playing being sick and that it was over for me, that I would go back to work, that I was a fake …(17) 

Madness is depicted as almost antithetical to the needs of capitalism. Madness is a hindrance to productivity, a burr in the otherwise smooth surface of “forward progress.” Madness draws attention to contradictions, and so often as a result it is rejected as an abhorrent or diseased form of life. If a suicide attempt is readily perceived as being an attempt to evade work by any means necessary, what does that say about the conditions of work itself?  

It is arguable that the conditions of capitalism, the alienation it creates, and the violent extraction required to sustain it are just as responsible for producing madness as variations in brain chemistry, hormones, and other biological functions. Capitalism necessarily must force bodies into circumstances which are not conducive to survival. If a body is put in circumstances which are not conducive to its survival, it will struggle to survive. If simple psychological resistance to the validity of that extractive relationship is considered to be anti-social—logic would dictate that “the social” would only exist relative to a political economy which prioritizes capitalism over personhood. “Logic” would dictate that carceral sanism is the only way, that institutionalization is not only a preference but a level-headed response to clear and present (arbitrary) danger. What proof is there that this must be the case, that these dominant systems of value, fueled by racialized, sanist, and ableist hate need endure? What justification is there for exterminating madness for the sake of capitalism other than the systems, structures, and very fundamental values of capitalism itself? 

Indeed, to some scholars and psychiatrists, Mad People, “were only useful insofar as they assisted the researcher (or clinician, in other circumstances) in understanding the affected person’s psychiatric disorder.”(18) What then, is the significance that psychiatry has had such a large role in historically determining the Spiritus Mundi of madness, as well as our collective social relationship to madness, and the range of appropriate sociopolitical responses to an individual who is mad? Surely some revelation is at hand; that uplifting those most affected by cultural imaginaries of madness—a reimagined preference for the survival of Mad People themselves—is key to undoing the claim that without carceral attempts to contain and correct madness the very fabric of society is ill-omened to fall apart at the seams. Mad People’s History, in our own words, demonstrates that, “...ideas of vulnerability shift when marginalized people move to the forefront of creating the narratives and terms of resistance.”(19) In order to combat carceral sanism, a new cultural imaginary must slouch toward Bethlehem to be born. However difficult the cultural reckoning will be, and however painful it might be to reframe and re/form the Spiritus Mundi of not only madness, but danger and safety itself, doesn’t matter. It is what we owe the many souls who were caught needlessly like a fly in a spider’s web. We must make a promise to Mad People—we must want them to live—we must recognize that the danger in society’s sanist responses to perceived irrationality far outweigh the danger of welcoming madness into society itself. 

[Image Description: Margiela runway still. Color photograph. Two figures. The first figure is in full focus in the center of the picture plane. The second figure is out of focus behind the first figure, floating in a dense, black void. The front figure has bare legs and wears clear peep-toe low heeled shoes. It wears a dress, which it must hold up. The bottom of the dress is sack like, clinging to the figures thighs. The top of the dress is square, held taught by the figures up-stretched hands. The figures face is covered by tan mesh. Its features are barely distinguishable underneath. The dress is a shiny silk printed with an image of another torso, slightly abstracted in grey, black and white, wearing a stiff formal blazer.]

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(1) Beers, C. W. (1910). A mind that found itself: an autobiography (2nd Edition). Longmans, Green, and Co., New York. 

(2) Gomory, T., Cohen, D., & Kirk, S. A. (2013). Madness or Mental Illness? Revisiting Historians of Psychiatry. Current Psychology, 32(2), 119–135. https://doi.org/10.1007/s12144-013-9168-3.

(3) Ben-Moshe, L. (2020). Decarcerating Disability: Deinstitutionalization and Prison Abolition. University of Minnesota Press.

Beers, C. W. (1910). A mind that found itself: an autobiography (2nd Edition). Longmans, Green, and Co., New York.

Grob, G. N. (2011). The Problem of Chronic Mental Illnesses, 1860-1940. In Mad among us: a history of the care of America's mentally ill. essay, Free Press. 

(4) Ben-Moshe, L. (2020). Decarcerating Disability: Deinstitutionalization and Prison Abolition. University of Minnesota Press. 

(5) Grob, G. N. (2011). The Problem of Chronic Mental Illnesses, 1860-1940. In Mad among us: a history of the care of America's mentally ill. essay, Free Press. (p. 116) 

(6) Grob, G. N. (2011). The Problem of Chronic Mental Illnesses, 1860-1940. In Mad among us: a history of the care of America's mentally ill. essay, Free Press. (p. 105) 

(7) Gomory, T., Cohen, D., & Kirk, S. A. (2013). Madness or Mental Illness? Revisiting Historians of Psychiatry. Current Psychology, 32(2), 119–135. https://doi.org/10.1007/s12144-013-9168-3.

Johnston, M. S. (2019). ‘He sees patients as Lesser people’: Exploring mental health service USERS’ critiques and appraisals of psychiatrists in Canada. Disability & Society, 35(2), 258–279. https://doi.org/10.1080/09687599.2019.1634524.

Wolframe, P. A. M. (2012). The Madwoman in the Academy, or, Revealing the Invisible Straightjacket: Theorizing and Teaching Saneism and Sane Privilege. Disability Studies Quarterly, 33(1). https://doi.org/10.18061/dsq.v33i1.3425. 

(8) Ben-Moshe, L. (2020). Decarcerating Disability: Deinstitutionalization and Prison Abolition. University of Minnesota Press. (p. 64) 

(9) Wolframe, P. A. M. (2012). The Madwoman in the Academy, or, Revealing the Invisible Straightjacket: Theorizing and Teaching Saneism and Sane Privilege. Disability Studies Quarterly, 33(1). https://doi.org/10.18061/dsq.v33i1.3425. 

(10) Aho, T., Ben-Moshe, L., & Hilton, L. J. (2017). Mad Futures: Affect/Theory/Violence. American Quarterly, 69(2), 291–302. https://doi.org/10.1353/aq.2017.0023. (p. 294) 

(11) Rodriguez, S. M., Ben-Moshe, L., & Rakes, H. (2020). Carceral protectionism and the perpetually (in)vulnerable. Criminology & Criminal Justice, 20(5), 537–550. https://doi.org/10.1177/1748895820947450. (p. 546) 

(12, 13) The Willard Suitcase Exhibit Online. (n.d.). http://www.suitcaseexhibit.org/. 

(14) Large, M., & Ryan, C. J. (2012). Sanism, stigma and the belief in dangerousness. Australian & New Zealand Journal of Psychiatry, 46(11), 1099–1100. https://doi.org/10.1177/0004867412440193. (p. 1100) 

(15) Szasz, T. (1987). Insanity: The idea and its consequences. New York: Wiley. (p. 91) 

(16) Carr, S. (2019). ‘I am not your nutter’: a personal reflection on commodification and comradeship in service user and survivor research. Disability & Society, 34(7-8), 1140–1153. https://doi.org/10.1080/09687599.2019.1608424. (p. 117) 

(17) Johnston, M. S. (2019). ‘He sees patients as Lesser people’: Exploring mental health service USERS’ critiques and appraisals of psychiatrists in Canada. Disability & Society, 35(2), 258–279. https://doi.org/10.1080/09687599.2019.1634524. (p. 267) 

(18) Reaume, G. (2017). From the perspectives of mad people. The Routledge History of Madness and Mental Health, 277–296. https://doi.org/10.4324/9781315202211-16. (p. 172) 

(19) Rodriguez, S. M., Ben-Moshe, L., & Rakes, H. (2020). Carceral protectionism and the perpetually (in)vulnerable. Criminology & Criminal Justice, 20(5), 537–550. https://doi.org/10.1177/1748895820947450. (p. 593) 

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