Mad studies is a new field that emerged in 2008 from the work of various researchers who have engaged in critiques of psychiatry and psychotherapy in collaboration with activists and service users (Ingram, 2016). It is a field closely related to disability studies. The word “mad” is a way to reclaim a stigmatizing term that has been used historically, while also highlighting historical parallels in how people categorized as mad have been treated (Ingram, 2016). The field focuses on oppression in the form of sanism/mentalism (discrimination against a mental state, traits one has or is deemed to have) and “psy, violence” against “psychiatrized bodies” and epistemic injustice (Gorman & LeFrancois, 2018).This field posits that texts and actions can be read “madly”, that a “mad reading” can be performed in a manner similar to how queer reading is conducted in queer theoretical research, where queer and queering can be found in unexpected places that are otherwise taken for granted as free from queerness (Ingram, 2016). Mad studies, as a counterpoint to the “clinical gaze,” posits that the “mad gaze” is a tool for exposing, for example, sanism and problematizing various practices within psychiatry and psychiatrization. Mad studies is one of the more radical fields of mental health research due to these tools and theories. Mad studies cites Foucault as a leading figure, particularly through his books History of Madness and Psychiatric Power. The mad gaze also has connections, above all, to ancient cynicism, exemplified by Diogenes of Sipos, whose various practices collectively challenge what is considered civilized and accepted. Mad theory focuses more on sanism as a concept rather than stigma, since, according to its proponents, the concept of stigma does not sufficiently highlight the oppression faced by certain individuals categorized as mad (but under DSM classifications) (Gorman & LeFrancois, 2018). Mad studies is also linked to the field of colonialism and racism and how psychiatry has been a major part of these practices and ideological expressions (Gorman & LeFrancois, 2018). One criticism of the field of mad studies is that it has a one, sided focus on resistance to psychiatry with weak connections to other research. Gorman & LeFrancois are careful to point out that they do not glorify certain conditions that can be harmful to the individual if they do not receive help. To outside observers, however, this valorization appears to exist to some extent in concepts such as the “mad gaze” and “mad theory,” and possibly in how certain voices are highlighted as “authentic” and “truth, tellers” simply because they have personally experienced these conditions. Similar problems exist within feminist theory that relies on standpoint theory, where victimhood risks being reified and becomes an “asset.” Mad studies has strong connections to Nietzsche, according to Ingram, who coined the term (Ingram, 2016). Mills (2014) argues that mad studies should embrace a “sly normality” in order to establish itself as a discipline, in the same way that many have done to avoid being drawn into psychiatry by lying and pretending, as a form of silent resistance, out of fear of what might happen (Mills, 2014).
Mad studies is linked to the user movement known as the “recovery movement,” which advocates a “recovery approach.” The foundation of this movement is that the focus should be more on respect, rights, active users, hope, and democracy; it advocates for and encourages active and politicized citizenship and moves away from the biomedical model, which, although it has destigmatizing effects in some cases, can also reinforce stigmatization and, above all, discrimination (Morrison, 2005). People involved in the movement may identify themselves as survivors and/or ex, patients (Morrison, 2005). They are activists fighting for the abolition or reform of psychiatry (Morrison, 2005). This heterogeneous movement is united in its resistance to the “role of the sick” and the “role of the patient” and works to gain more power in the encounter rather than being objectified as a patient. They resist being viewed and rendered passive in the encounter, and having their identity as active citizens disconnected. Furthermore, it is a resistance to merely internalizing the role of patient, which can trigger a process of “secondary deviance” that reinforces the stigmatized role assigned to them by society (Scheff, 1999). This secondary deviance and role reinforcement can become strong because the person is often in a vulnerable and unstable period of life or a crisis (Scheff, 1999, 88). The person is then rewarded when they confirm the deviant role, which becomes a “deviance, amplifying system” in which shame plays a significant role (Scheff, 1999). What Scheff has termed “residual deviance” is transformed into resistance to a far, reaching trend of the psychiatrization of society (Cohen, 2015, 2019; Morall, 2018). Within this movement, efforts are made to build a shared solidarity in which some take on the role of active consumers who want greater control over their choices and the process of seeking help, while others operate more from the identity of “survivors” (Morrison, 2005). It may also involve reclaiming the “pre, mentally, ill” identity to break free from the “patient identity” (Morrison, 2005). Why some focus on resistance through the creation of the “survivor”, stems from how psychiatry tends to initiate a “patient career” that can place a person in a role due to stigmatization, thereby reinforcing diagnoses and encouraging the person to confirm the role of the mentally ill, which, according to advocates of the movement, is, in the worst cases, life, threatening (Scheff, 1999, Goffman, 1961, Morrison, 2005). Part of this involves low expectations of these individuals, where resistance centers on regaining self, belief and discovering one’s resources and strengths that have not been encouraged (Morrison, 2005). Psychiatric diagnoses are often viewed by the psychiatric field as chronic and difficult or impossible to recover from (Morrison, 2005, 5). Studies indicate that self, management tends to be viewed as resistance and that individuals are categorized as “bad” patients if they self-manage rather than assuming a passive, dependent role, a process that Goffman calls the “betrayal funnel,” in which they are drawn into a Kafkaesque process (Morrisson, 2005, 6). Morrison found that Anspach’s theory of “tertiary deviant identity” applied to resistance against psychiatry and “talking back,” which nuances Scheff’s theory that only internalization is possible and not resistance (Morrison, 2005, 11). Anspach provides a typology of four strategies in the formation of tertiary deviant identity: normalization of one’s condition, retreatism, dissociation, and political activism (Morrison, 2005, 11). Part of this resistance consists of political conferences, while other forms include politicized self, help groups (Morrison, 2005, 15). This becomes a way to highlight “subjagated knowledge” (Foucault) or “hidden transcripts” (Scott, 1990), where local, low, ranking knowledge takes the form of alternative discourses and practices (Morrison, 2005, 19). Scott argues that medicalization and depersonalization (through concepts such as mental health) can be destigmatizing, but at the same time they can succeed in “marginalizing resistance in the name of science” (Scott, 1990, in Morrison, 2005, 21).
This movement has also existed among psychologists and psychiatrists who have sought to reform psychiatry. They often view the therapeutic encounter as valuable, but believe it must be linked to fostering active citizenship, a belief in recovery, a belief that meaningful lives are possible, and a stronger connection to social injustices. Psychiatry has been deinstitutionalized and is supposed to be more “community, based,” but in practice, especially in the United States, this has led to greater marginalization and a greater individualization of the problem (Cohen, 2016; Scull, 2022), as society has withdrawn further. Anti, psychiatry grew into a movement during the 1960s. Laing, Guttari, Szasz, Scheff, and Goffman were leading figures in this movement. According to Morrall, referring to Robert Laing and others as part of the “anti, psychiatry” movement is misleading, since they were more interested in reforming it (Morrall, 2018). Laing experimented with what today might be seen as extreme measures, such as allowing someone to regress, in Freud’s terms, by, for example, defecating all over their bedroom. These are examples of what Scull refers to as “foolish and romantic” views of mental health that many researchers have abandoned (Scull, 2022).
In summary, the field of mad studies appears to be quite insular and makes no references to other similar fields, such as social psychiatry. This is a weakness that can also lead to an unnecessary radicalization of the field, where only political activism and organizing are viewed as important. A “mad” perspective and “mad” interpretations may have certain applications, but encouraging this in people can lead to the reification of a particular condition that is harmful to the individual. In Ingram’s article, he presents himself as “mad,” viewing this as a resource because he embodies it firsthand. Other researchers have emphasized the importance of giving service users a voice (Rose, 2019), but the manner in which this is done will be crucial, as mad studies adopt a highly conflict, oriented approach, particularly the abolitionists within the movement.