Lucas Richert


On his book Break On Through: Radical Psychiatry and the American Counterculture

Cover Interview of February 12, 2020

A close-up

As we reflect on the #MeToo era, Weinstein, Epstein, and other deeply unseemly characters, it’s important to note that women’s issues and mental health were embedded in radical mental medicine over 50 years ago. Feminism and sexual politics in the late 1960s and 1970s were a vital part of the way that people reassessed gender-based hierarchies in the mental health establishment. As we look back, I think that’s significant.

Here’s just a few examples. First off, psychoanalysis and psychopharmacological interventions were criticized strongly; both Freud’s focus on sexual fantasies and the use of “mother’s little helpers” (benzodiazepines) came under fire. Critics drew from second-wave feminism to refocus on the role of women in mental health.

Radicals, secondly, criticized psychiatry for reinforcing notions of the dutiful mother and obedient housewife, suggesting psychiatry (and pharmaceuticals, yes) were a means to control women. Those women who did not behave “properly” risked ending up in psychiatric care and chemically sedated.  Works like Betty Friedan’s The Feminine Mystique suggested that mass tranquilizer use during the 1950s had pacified women and had facilitated women assenting to the limits imposed on them.

Dr. Phyllis Chesler, a hugely important figure, was especially persuasive and one of the more interesting characters to write about. In 1969 she established the Association for Women in Psychology, completed her PhD at the New School for Social Research, and became a practicing psychotherapist in New York City.

Chesler pushed the limits of the conventional patient-therapist relationship. And thereby challenged men in the profession. “Are you sure you want to sleep with your psychotherapist?” she asked New York magazine readers in June 1972, a time when none of the major American mental health associations had enacted ethical codes disallowing sexual encounters on the treatment couch. The article was called “The Sensuous Psychiatrist” and it illuminated the often unspoken, exploitative aspects of therapy in the late 1960s and 1970s. It featured a distinguished, silver-haired older man embracing a young, attractive woman as they reclined together on a leather couch. (Kind of creepy.)

The article focused on the potential abuse of authority, gender inequalities, and the need to think more critically about the ways in which patients interacted with mental health service providers. Chesler wrote that “most doctor-patient sex” was a “psychological form of such ‘incest’ as well as being medically unethical and legally questionable.” According to Chelser, numerous psychoanalysts believed a turn-on might actually have therapeutic uses. Sadly, she was right. Many therapists regarded sex with patients—a romp on the couch—as a potentially “productive element of the therapeutic process.”

Due to Chesler, new codes were created. The American Psychiatric Association declared sexual activity with patients unethical in 1973, followed by the American Psychoanalytic Association. The American Association of Sex Educators, Counselors, and Therapists trailed in 1975. The American Psychological Association followed suit in 1977.

As a side note, I think that readers would be intrigued by the focus on psychedelic drugs and cannabis in the book. My discussion about cannabis/LSD/MDMA in American mental health should help us better understand current discussions about these substances.

I devote all of chapter six to the history of “substances” that we would normally associate with the counterculture in the 1960s and 1970s. Like marijuana or psychedelics. These drugs were entangled with mental health practice – and were heavily debated. It’s my trippiest chapter. And I hope that it gets readers to think about how they think about drugs. (I didn’t make a mistake here!)