Intro to psych abolition
By Stefanie Lyn Kaufman-Mthimkhulu and Thokoza Ndlondlo
Thokoza Ndlondlo: Before coming to the Western world, I had never heard the words “psychiatric abolition” — though my life has been one big practice of it. We don’t need to know all of the right words and theories. We need to understand it in practice. In our bodies. Indigenous people, in my experience, are the original practitioners of what we call abolition. Our ways of life, our practices, have always been rooted in these values— interdependence, understanding, meeting each other’s needs collectively, second chances. When someone is behaving in a way that we don’t understand, we don’t isolate this person. We don’t push them further away. We bring them closer. We know that if something is out of balance, it will impact us all.
Grounding
It may be difficult to imagine a psychiatric institution or a therapist’s office as a place of harm, fear, abandonment, violence, or cultural loss. It may go against our instincts to imagine the mental health system as anything other than a medical discipline full of benevolent healers and helpers. For some of us, our own positive encounters with the mental health system may drown out the voices of many who have turned to – or been forced into – psychiatry only to become sicker. For some, the idea of a wretched, run down asylum staffed with cold and punitive workers is just an old story; a tale stacked away in the archives of history, an unfortunate moment in time.
But for many of us, these are not simply old stories, these are our stories. This has happened to us. Recognising that psychiatry is both a vehicle for and a destination of harm means understanding its role in maintaining social order (1) and enacting harm on marginalized peoples (2). Today’s psychiatric model is borne of its racist past (3), one that includes uplifting pseudoscience, racist science (4), and eugenics (5). It is a network of systems that integrates mental health ‘care’ with various forms of policing, control, and confinement, criminalising, disappearing, and stigmatising those society deems wrong, lesser or abnormal, and delegitimising any political dissent (6).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) adjudicates what deviation from the status quo is deemed worthy of a psychiatric diagnosis, which brings with it suggested ‘treatments’ and justification for carceral responses. We must also recognise that the psychiatric system is highly profitable (7) both directly and indirectly in its role in upholding socio-economic inequality.
Psychiatric abolition is rooted in creating care and networks of support outside of psychiatric systems. It is a position that involves dismantling the coercive state power held within psychiatry, and nourishing community-based means of care for people navigating mental health crises. It prompts us to challenge the colonial roots of psychiatry and to resist pathologization (unfairly or wrongly considering something or someone as a problem). It requires us to shift away from Eurocentric treatment and diagnostic models of psychiatry and towards culturally-rooted practices, ancestral wisdom, and Indigenous healing strategies.
While psychiatry has taken many routes, pathways and journeys during its existence, it has been far removed from the roots and intentions of what it means to heal (ironically, the Latin roots of psychology roughly translate to “study of the soul”).
Thokoza Ndlondlo: Psychiatry looks to stop something. But we need to watch this movie all the way to the end to be able to start another movie – we call these episodes. We can’t skip around. We can’t fast forward. And it doesn’t mean it will happen forever. We need to learn to wait — to give the body time to show you what it wants to do. And to differentiate between the body and soul. The body is the meat that walks on the planet, and the soul is the thing walking inside of the meat. The soul carries the body, and the body carries the soul. It’s 50/50. When something is wrong or out of alignment, we need to ask who is stopping who? If a car starts releasing black smoke, we don’t call it crazy. We might need to change the oil and the oil filter. The body might look fine, but the engine is dead. You need to find a good mechanic. A good healer is like a good mechanic.
In truth, our people continue to endure the same violences within a psychiatry without a soul that we always have. The asylum did not die with efforts of deinstitutionalization – it simply proliferated, it multiplied, and it came to live inside of us. And we cannot ignore that its solutions are not working (8).
Not Alternatives – Other Ways of Sense-Making
Psychiatric abolition, like prison abolition, shares dreams for a world without cages and carceral institutions as our primary response to mental health distress and crises. But its vision expands beyond the borders and bounds of the asylum — it extends into the very fabric of how we think about, understand, and respond to experiences of mental distress.
Psychiatry functions more as a cultural belief system and less as a medical science, dependent and reliant upon the localized beliefs, attitudes, and perceptions of what is and is not typical, expected, rational, sane, or acceptable. In a world dominated by white supremacy, colonialism, imperialism, and capitalism, we cannot ignore who is Sick and who makes the categories of Sickness. We cannot ignore who Becomes Sick under the conditions we have been forced to live under.
Though Madness has and will continue to exist throughout time (for a variety of reasons), we believe much of the distress we are witnessing is induced by humans, by our very systems, by our choices, by our lack of humanity, by our corrupted relationships with the environment, animals, plants, water.
Thokoza Ndlondlo: Psych wards and police were there, but it wasn’t what we ran for first. It wasn’t our first or even fifth line of defense. It was an absolute last resort. And nobody was under the impression that it brought anything close to healing. As a Black person, as an Indigenous African, it was a gift to grow up on my ancestral lands. Though my people have lost our resources, our gold, our land, and our lives — those who survived did not lose our knowledge. We can heal with plants. With water. With our hands. With our songs. With our secrets. They still exist in Africa, and these seeds exist in the hearts and spirits of all people who retain contact with their Indigenous soul. The way forward is one of remembering.
Stefanie: My life has been changed, my spirit re-aligned, by Black and Indigenous healers who have utilized their ancestral wisdom that has remained and persevered in the face of the colonial assault and the white imperialist genocides that have happened almost everywhere on Earth — a deep rooted knowledge of what is at the root of distress and what we need to heal it. And one example is thinking about suicidality as a spirit, as a call for transformation, as a calling that something needs to die or change, or something has died and you need to interact with that thing. I learned this from my teachers Thokoza Khage, Gogo Nolanga, and Babe Dabulamandzi. Eduardo Duran talks about this in his work Healing the Soul Wound. In Western culture, we all want to find the thing, name it as the enemy and bury it. We have a war mentality. We don’t want to talk to it and say, Hello, suicidality, thanks for showing up today. What do you have to say? Why are you here? What are you trying to ring the alarm on? Are you a little canary in the coal mine? And so for me, being able to actually not bury it, but open it up really wide and look at it and say, “You ugly thing. What are all of your borders? How can I talk to you? What is this relationship that we have?” Do I need to get out of the situation I am in? Do I need to think about my legacy? Am I out of alignment? Do I have ancestral wounds to heal? Do I need a living funeral? Do I need to be buried in the ground and see how that feels? To be rooted to the Earth? Do I simply need money, or resources? What are you, really?”
Psychiatric abolition is a movement, but it is also a practice of deep community care. It is a shared meal, letting someone move through grief, space to sleep on a floor, sharing pills, sharing plants. It exists when we prioritize connecting with someone over solving problems, when we organize and strategize for cross-movement solidarity and a liberatory future that includes all of us — every body, mind, and spirit. Psychiatric abolition is made possible when we love strangers as we love our closest kin. When we re-sensitize ourselves to our communal and collective responsibilities. When we approach a situation with curiosity, and not fear.
Stefanie: Psychiatric abolition is born when we recognize the Medicine of Madness. The value of Madness. That we are personally and communally enriched by the depth and range of our emotional, spiritual, and psychological experiences. I am under no illusion that Madness, Disability, altered states is an inherently magical experience. I have suffered deeply, and not every voice is a gift. But our lives have value and meaning, despite and because of who we are and what we endure and how we think and move through this world. It is just as possible that a person who is labeled with psychosis is actually communicating with their ancestors and hearing the voices of spirits that want to guide them — as it’s possible that these voices are from trauma, or a way for the brain to speak to itself; or a response to living in inhumane conditions; or, or, or… It is critical to offer people multiple ways to define and make sense of our experiences, knowing that our frameworks and references for ourselves and our stories are important. They matter. And we can shift and change until we find the one that feels right. We don’t have to subscribe to the dominant models of what we’ve been told about ourselves. The choice should always be ours.
(1) https://psycnet.apa.org/record/2010-02544-000
(2) See: The psychiatric survivor and Mad Liberation movement(s); Decolonizing Therapy (Dr. Jennifer Mullan); Black Skin, White Coats (Frantz Fanon); Healing the Soul Wound (Eduardo Duran); Madness: Race and Insanity in America (Antonia Hylton); Mad World: The Politics of Mental Health (Micha Frazer-Carroll); Decarcerating Disability (Liat Ben-Moshe); Abolition Must Include Psychiatry (Stella Akua Mensah and Stefanie Lyn Kaufman-Mthimkhulu); The Protest Psychosis (Dr. Jonathan Metzl); the work of Dr. Samah Jabr; the definition of ableism by Talila Lewis: https://www.talilalewis.com/blog/working-definition-of-ableism-january-2022-update
(3) https://www.pbs.org/wgbh/aia/part4/4h3106t.html
(4) As Dr. Vanessa Jackson details in In Our Own Voice: “Benjamin Rush, MD (1746–1813), signer of the Declaration of Independence, Dean of the Medical School at the University of Pennsylvania and the “Father of American Psychiatry,” described Negroes as suffering from an affliction called Negritude, which was thought to be a mild form of leprosy. The only cure for the disorder was to become white.” (p. 4)
(5) https://education.blogs.archives.gov/2017/05/02/buck-v-bell/
(6) https://psycnet.apa.org/record/2010-02544-000
(8) Study #1: Jordan, J. T., & McNiel, D. E. Perceived coercion during admission into psychiatric hospitalization increases risk of suicide attempts after discharge. Qin P., Nordentoft, M.Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers; Study #2: “Risk Factors for Suicidal Thoughts and Behaviors: A Meta-Analysis of 50 Years of Research.” by Joseph Franklin, PhD, and Jessica Ribeiro, PhD, Vanderbilt University and Harvard University
