Open source and social psychiatry – what have these terms to do with each other??? Have I finally gone crazy?
While there is a relatively short answer to the last question, it will need a whole long posting to only try to outline a thought that brings open source and social psychiatry together. Instead of a foreword have a quick look at the above Wikipedia links to get a remembrance on what those both terms are about.
Ready? Okay, then let’s have a short look into history:
The phenomenon of the support groups (German: Selbsthilfegruppen) emerged in the so called western world in the 1960ies. Many people with similar problems managed to find each other, organise meetings and talk openly with each other about their sufferings as it never had been witnessed before. If you got cancer, finally you weren’t alone anymore (with a doctor and your family, that is). If you were an alcoholic who wanted to stop drinking, there was besides the drinking buddies you couldn’t talk to about that (in fact you couldn’t talk to them about much) suddenly another circle of people who were as ashamed as you about your habit and as determined as you to finally stop it.
And, though it became possibly not always quite obvious why, support groups did good to the people. Diseased people who participated in a support group were less afraid of their diseases, felt less depressed, more involved in the treatment, better prepared for special treatment or just better. The effectiveness of a professionally led support group for men with prostate cancer
By the time the Internetwas invented support groups even worked via that medium, also with success for their participants. Evaluation of an Internet Support Group for Women with Primary Breast Cancer
Support groups became in fact that successful and popular that discussions arose to make them part of professional health care. Selbsthilfe und PatientInnenorientierung im Gesundheitswesen – Abschied von der Spaltung zwischen Professionellen und Selbsthilfe?
Not to extra mention here that support groups heal their participants usually without receiving any moneys from health care insurance systems, and thus are extremely cheap from that insurance point of view.
Since support groups were so popular it wouldn`t be logical if there hadn’t been any for people with mental problems wouldn’t it? Of course, so there they were and those support groups were even more special than the usual ones. And though documentation of the existence of single support groups of that pre–Internet age is rare to be found online, it looks as if the first „mental health“ or „users of psychiatry“ support groups of Western-Germany started growing in 1970. Selbsthilfe für Patienten – Wie die Selbsthilfe entstanden ist
So what now is so special about those support groups? Let’s have a look at what they aim at: besides all the conventional good things that can be achieved by a support group (personal well being, health – see above), some mental health support groups started to demand a different treatment. Not only that, but a different point of view towards their unnormality. And not only by psychiatrists, doctors or other qualified personnel but by society in general. Some people who suffered on mental health problems thought that the worst single thing they were suffering on was actually the way other people treated them and that only the way they were treated in hospital was enough to call it a day or at least to avoid anything that made them go there again. Many thousand people who were considered mentally abnormal were killed by doctors during the nazi regime. And even in post war Germany users of psychiatry were kept in cage beds and forced medication was part of the therapy. To put it in a nutshell: psychiatric hospitals were a big mess until the 1980ies. Geschichte der Psychiatrie Some contemporary scientists were bright enough to find out about that, e.g. Goffman who coined the term of the total institution for psychiatric hospitals as well as for prisons.
So, in those support groups people with mental problems finally tried to change the policy that was directed at them and that was behind the bad treatment they experienced. They developed a very critical attitude towards psychiatry, often even an anti-psychiatric one. In fact by forming support groups they themselves developed a policy of how to act and react a) towards their unusual inner experiences and b) towards treatment from doctors, family members (who often felt not much less alienated facing the mental disease than the people actually suffering on it) and society. They demanded a status as experts for psychiatric problems. And: they did not only want to be cured – they wanted to cure anybody else as well.
So while e.g. cancer support groups tried to get a grip on the immediate problems that were linked with the cancer disease, many mental health support groups in Western-Germany tried to fight the treatment and the social stigma that was linked with being a psycho.
Imagine the Alcoholics Anonymous not only trying to get clean but asking the society for a better understanding and a broader social acceptance of their addiction. Imagine them demanding an un-stigmatisation of alcohol and alcoholism. They would try to change laws and maybe they would fight against laws that don’t allow kids to drink alcohol. Their argument could be that such a law makes people afraid of alcohol and of alcoholics from childhood on. Might be that the ones who take it very serious would ask for a „Do drink and drive“ programme. But for sure many would work towards a society that respects their addiction and their dignity as alcoholics.
Sounds strange but that is exactly what the anti-psychiatric support groups for people with mental health problems did and do. And what is true for other support group also applies to them: they succeeded and they do their participants good: The situation in German hospitals has become better since cage beds are illegal and corridors have become broader and cleaner. But the point and main success of these support groups is that besides the hospitals there are finally other possibilities of getting help for those people in need.
There are e.g. the so called Weglaufhäuser (run-away houses) in many German cities. They are used by people who need psychiatric treatment but want to avoid a hospital since their past experiences in there were too bad. There they can receive alternative treatments.
Another great example of how the anti-psychiatric support groups have succeeded in dragging respect and dignity for people with mental disorders out of the society is the existence of the Psychoseseminar. This is a place where people with mental problems and mental problem professionals meet on equal height. The thought behind this is that only people who suffer on mental problems know what this is like and what could possibly help them to get better and by letting them narrate about those experiences and really listening to them a better understanding of what mental problems are can be achieved.
So. What has this to do with open source, now? I`ll explain, just let me add one more stroke of the brush to the picture:
By the time social psychiatry has embraced many of the advances those groups have worked for. In German social psychiatric health care there is a more diverse landscape today than 30 years ago. In fact there was hardly social psychiatry 30 years ago.
For those in need there are indeed different offerings they can choose from: day centres, ambulant psychiatric treatment, assisted living and so on. And there are the small, independent from the professional health care system, user-driven projects like the above mentioned Psychoseseminare or Weglaufäuser.
Now. What is the relation to open source? All right, all right. Let’s have a look again at how open source is defined:
- The source code of the software must be public. This means that the know-how of the project must be published somewhere so that it is easily accessible and understandable.
- The software and the source code may be freely copied, distributed and used.
- The software and the source code may be freely changed and made accessible in it’s changed.
And as Eric Raymond wrote: Every good work of software starts by scratching a developer’s personal itch. Meaning they miss a certain function or tool or thy „suffer“ under a malfunctional software.
And now compare ot to anti-psychiatric initiatives:
- Those groups are open for others who are interested and joining them means that new members receive all the knowledge (the source code) that group has gained so far. From early stages on the psychiatry critic or anti-psychiatric initiatives tried to attract as much attention as possible on what they saw are their problems. This was and is only possible by an active information policy that happened via word of the mouth or flyer’s that were printed and given to interested ones. Nowadays many initiatives have a web page.
- Everybody interested can join a initiative or support group, become personally engaged there and use the support and engagement of the others.
- Thanks to the documentation of how to set up a Psychoseseminar, others can try to establish one in their town as well. So all achieved and documented changes to the system of psychiatry can be used for personal or other public interests.
And in addition there are more similarities between Open Source and Anti-Psychiatry (may I call it Open Psychiatry?):
- flat hierarchies
- if a contributor becomes unhappy about the project she or he co-works in he can just leave it and set up a new project, (which is called „forking“ in software developers terms)
I am not saying that psychiatry or social psychiatry is in a very good shape in today’s Germany. Still it is very hard for people to get the treatment they need and want or a treatment at all. I am not saying that all stigmas and problems of people who are having unusual mental experiences are solved or will be by anti-psychiatric initiatives or support groups who are critic towards psychiatry. I am also not saying that all the small successes that we can see today compared to the situation 20 years ago have been achieved by those groups alone. No, of course also psychiatrists and other scientists have their share. And I am also not saying that there should or will be only anti-psychiatric groups in the future.
But I think as there is the giant Windows and there is the dwarf Linux there is psychiatry and there is anti-psychiatry. And similar to the way Linux is developed in the virtual world a more human view and approach towards mental health has been and will be developed in the real world. Both Windows and Linux are used by different people (though some people even use both for different tasks) and both have their flaws. But without Linux the danger to have only ONE monopolistic and bad operating system is very high. And I think the same would be true for a psychiatry without anti psychiatry.
Of course this theory is only a rough approach to the topic and needs deeper analysis and research, which this posting can only be a basis for.