When we started Mad in America more than a decade ago, we never envisioned that our webzine would one day bloom into a global network of Mad sites. Mad in Denmark, which is newly launched, is the 11th affiliate in that network, and three others are expected to launch later this year.
Personally, I have been waiting for a Mad in Denmark for a number of years. Olga Runciman is a long-time board member of Mad in America, and so it makes for a particularly happy moment that she and her Danish colleagues have launched this site.
I can no longer remember when I first met Olga, but we have been fellow travelers now for at least a decade, spending time together at conferences held in countries that now have a “Mad” site. I mention this because our friendship is emblematic of the spirit that unites the growing network of global Mad sites—there is a commonality of purpose and a shared joy at pursuing radical change together.
Here is Mad in America’s mission statement:
Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.
Our affiliate sites, while they all have editorial independence, share this mission. The roots of this shared mission go back to 1980, when the American Psychiatric Association (APA) published the third edition of its Diagnostic and Statistical Manual (DSM). That is when the APA adopted a “disease model” for diagnosing and treating psychiatric disorders, and in the ensuing decades, that model of care, with pharmaceutical funding at its back, spread around the globe. People everywhere heard of how major psychiatric disorders were caused by chemical imbalances in the brain, and how the drugs fixed those chemical imbalances and thus were like insulin for diabetes.
However, that was not a story of science. Rather it is better understood as a marketing story, one that served psychiatry’s interests as a medical guild and the financial interests of drug companies. And here it is 43 years later, and the public health outcomes with this model of care are clear: the disease model has produced a public health debacle. The global “burden” of psychiatric disorders has notably increased over the past four decades, and there is a growing body of research that tells of how psychiatric drugs worsen long-term outcomes. The diagnoses in the DSM are understood to be “constructs,” as opposed to validated diseases, and the chemical imbalance story has collapsed.
The failure of that disease model makes it a ripe time for a paradigm shift in psychiatry. Indeed, the rapid rise in the number of sites in the “Mad” network tells of how disenchantment with the disease model has spread far and wide. There is a grass-roots rebellion in the making.
While there exists a shared purpose among the Mad sites, each reports news and publishes voices specific to its culture, and the landscape for promoting such radical change may vary widely from country to country. The network provides a means for all of us to learn from each other.
For the sites in our Latin American countries—Brazil and Mexico (soon to be joined by Argentina)— this struggle within psychiatry is understood to be part of a larger political struggle, one related to the protection of human rights for oppressed populations. That is a lesson to be learned: in the U.S., challenges to a medical specialty are mostly seen as specific to that specialty, as opposed to a struggle that is political in kind.
In the UK, there is a strong critical psychiatry movement and a strong user movement, which for years have advocated for a paradigm shift in psychiatry. Mad in the UK helps provide a public platform for those voices for change. At the same time, the struggle for such change in the UK seems tied, in part, to the delivery of services within the National Health Service. Get the NHS to change, and the public’s understanding of psychiatric disorder will similarly evolve.
There is a strong user movement in Ireland too. There have been pockets of Mad activism in Ireland for some time, which have brought together professionals and psychiatric survivors, and the activism there has served as a seed for activism in other European countries. Leaders of these activist efforts have come together to publish Mad in Ireland, and like in the UK, that activism has given this affiliate a head start in terms of making a mark in the Irish community.
In the United States, we tend to lump Scandinavian countries together, and see them all though rose-colored lenses. However, there are distinct differences in the psychiatric landscapes in Finland, Sweden, Norway, and Denmark.
Tornio, in the north of Finland gave rise to Open Dialogue therapy, an innovative approach to treating people with psychotic disorders that is now being adopted in countries throughout much of Europe and beyond. When I wrote Anatomy of an Epidemic, which was the book that prompted the creation of the Mad in America website, I presented Open Dialogue as the example of an alternative to the disease model that could dramatically improve outcomes for psychotic patients, and it seemed that Finland, as a country, could be a beacon for systemic change. Yet, much of Finnish psychiatry has been hostile to Open Dialogue and its methods. Indeed, it has been Finnish psychiatrists who, in recent years, have published findings designed to restore belief in the long-term merits of antipsychotics. In addition, there isn’t much of a “psychiatric survivor” presence in Finland, which, as history has shown, is a vital catalyst for change. As such, Mad in Finland in many ways is introducing to the public ideas that challenge the existing paradigm of care, as opposed to further fueling a discussion that is already common in the country.
In Sweden, psychotherapy has a strong presence, and that does open up a possible challenge to the disease model of care. At the same time, there isn’t much of a “psychiatric survivor” presence in Sweden, and, unlike in the UK, there doesn’t seem to be much of a “critical psychiatry” movement among professionals in the country. Carina Håkansson was one such voice, and she led the way for the creation of the International Institute for Psychiatric Drug Withdrawal, but that organization is now centered in the UK. As such, Mad in Sweden editors, much like the Mad in Finland editors, are engaged in the earlier stages of a struggle to remake psychiatry, introducing the research, for example, that tells of a need for such change. In much of Sweden, the story of drugs that fix chemical imbalances is still seen as a scientific truth.
Now cross the border to Norway. In that country, there has been a vigorous ongoing effort for radical change for some time. In large part, this is the result of there having been a strong psychiatric survivor movement in Norway dating back to 1968, when the group We Shall Overcome was formed. In 2015, a coalition of user groups successfully lobbied the Norwegian Health Ministry to order its four health districts to provide “medication free” treatment for those who wanted such treatment.
The editorial team at Mad in Norway is composed of both professionals and psychiatric survivors, and its readership, on a per-capita basis, is greater than our readership at Mad in America. Norway, in short, is a country where ideas of a paradigm shift are percolating in the public mind, and one that can serve as an international model for change. Yet even here the battle lines are drawn. Conventional psychiatry in Norway is quite biological, with forced treatment more common than in most European countries.
Denmark has much of the same resources for a successful Mad site as Norway: a strong user movement, the long-time presence of Hearing Voices groups, and ongoing public debates about the merits of psychiatric drugs, a debate fostered in part by Peter Gøtzsche, a co-founder of the Cochrane Collaboration. Olga Runciman is internationally known for her leadership in the Hearing Voices movement, and she served as a consultant on a World Health Organization publication in 2022 that called for a paradigm shift in mental health care. The editorial team also brings together a group that has been active in promoting such change for years, both through the publishing of books and through the delivery of services.
As such, Mad in Denmark can hope to gain a considerable readership quickly, and—if the country pioneers alternatives to conventional care—the site can provide reports that will inspire such change elsewhere.
That is the importance of the network of Mad sites: it provides an international forum for the exchange of information, ideas, and initiatives that can inspire change in multiple countries. As such, the network can have an impact that is far beyond the sum of its individual parts.
In October, we are holding our first in-person meeting of editors from the affiliate sites in Copenhagen. It’s a fitting choice, for Denmark is a country, with its relatively small population and progressive politics, that can serve as a laboratory for change. Ours is, in many ways, a David versus Goliath struggle, and yet, with each new affiliate, the voice for change grows stronger and louder.