Janice Haaken is a professor emeritus of psychology at Portland State University, a clinical psychologist, and a documentary filmmaker. In addition to her work as a professor at Portland State University, Haaken has taught as a Fulbright scholar at Durham University (UK) and University College Cork (Ireland) and as a visiting professor at London School of Economics (UK), York University (UK), and University of Michigan Ann Arbor.
Her documentaries, including Guilty Except for Insanity (2009), Mind Zone: Therapists Behind the Front Lines (2014), Milk Men: The Life and Times of Dairy Farmers (2016), and Our Bodies Our Doctors (2019), focus on people and places on the social margins, drawing out their insights on the world around them. Jan has received numerous awards for her filmmaking, most recently the Lena Sharpe Persistence of Vision award at the 2019 Seattle International Film Festival.
Haaken publishes extensively in psychoanalysis and feminism, the history and politics of diagnosis, trauma, culture, and memory, and the dynamics of storytelling. In addition to Pillar of Salt: Gender, Memory and the Perils of Looking Back (2000) and Hard Knocks: Psychology and the Dynamics of Storytelling (2010), her new book is called Psychiatry, Politics, and PTSD: Breaking Down (2021).
In this interview, she discusses her background in anti-psychiatry and other social movements and her experience liaising between theory and praxis in feminist movements, Occupy Wall Street, Black Lives Matter, and #MeToo. Weaving a history of how both radical and normative ideas and diagnoses in mental health play out in social movements, Jan draws upon her books and films to discuss how activists and mental health professionals alike can better reflect upon their practices and the role they play within larger social systems. We close by following her recent work, which unpacks the benefits and drawbacks of the PTSD diagnosis for personal narratives, collective memory-making, the US military, NGOs, and global mental health critics.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Emaline Friedman: Your journey has spanned so many topics in psychology and society. Why don’t you tell us a little bit about your background and how you come to this work?
Jan Haaken: Thank you so much for having me on Mad in America. I am a big fan. My work as a psychologist followed my early career as a psychiatric nurse. I was a nurse and then worked in child psychiatry in the late sixties and early seventies. In the University of Washington child psychiatry, psychoanalysis was very much the leading discipline within psychiatry departments.
Many of my mentors were psychoanalysts whom I respected enormously and were very formative in my thinking about clinical work. At the same time, there was a movement that I became part of, the anti-psychiatry movement, as it was called, which included nurses, doctors, residents, and people working in hospital facilities who were rebelling against the whole medical model and the project of institutionalization, as a civil rights campaign.
Psychoanalytic thought remained very important to me. I am a psychoanalytic clinician and social theorist. At the same time, I was kind of nurtured in this world of critique, this mix of ideas that became very much part of the broader critical psychology project and the social movements of that period: the anti-war movement, the feminist movement of the civil rights, de-institutionalization movements, and the sexual revolution.
It was formative for me in that conflict and struggle were an impetus for change and growth. There was a lot of interest in how our distress, our struggles could propel us forward. That, I think, became part of my critique, a few decades later, of the excessive use of trauma and the trauma paradigm to frame states of distress that seem to move too much toward pathologizing.
After my early career as a nurse, I went to graduate school in an Institute that was very much influenced by the Frankfurt School of critical theory, psychoanalysis, Marxism, and feminist theory. I was trained as a clinical psychologist, came to Portland State, and was hired on the faculty as kind of an odd duck in an experimental, behavioral department.
I had a kind of different career trajectory because I came out of a working-class trade-in nursing and then moved into academia. I was very involved in the women’s health movement during that time and its critique of psychiatric diagnosis.
Some of my earliest papers were also on diagnosis. I became really interested in concepts like co-dependence and love addiction that were taken up and valorized by feminists. I kind of unpacked those diagnoses, whether they were helpful in women’s grievances. I also took on diagnoses, personality disorders, and neurotic anxiety disorders, looking at the DSM project and some of that history. A lot of my work follows the history of diagnoses related to theoretical and applied issues in feminism.
Friedman: It sounds like you are a liaison between the currency of mental health diagnosis and critical and activist movements elsewhere.
Haaken: I think in the larger critical theory field there’s—and this includes a lot of the theory and psychoanalytic, feminist psychoanalytic, and feminist film analysis — this hyper abstract, remote theory, and then you get these very practical projects that you see more in community psychology, where people are on the ground.
There, the theory is thin and pragmatic. The conceptual grounding of projects is limited. I have been really interested in navigating between the high theory and the theory on the streets, the praxis that comes out of social movements and clinical work.
I tried to take some of that methodology into my film work and into social movements. I still feel there’s too little reflection or analysis of problems emerging in social change in particular radical movements. So how do we learn from a demonstration? How do we learn from these coalitions forming now?
I have been involved here in Portland, rather than just calling for things that are important and mourning our defeats, celebrating our victories, asking: “How do we learn deeply from social change work?” For a long time, my heart was in bringing psychoanalytic, feminist theory, and critical theory into the disturbances and pathologies of social change, as well as the health and resilience of social movements.
Friedman: So, in many ways, you bring a critical psychological lens to unpacking social movements with people involved in them.
Haaken: Yes. For example, one of my early films, Guilty Except for Insanity, was set at Oregon state hospital. The site is famous for being where One Flew Over the Cuckoo’s Nest was shot. We were able to get clips from that film for free to use in that documentary.
It came out of my own interest in my students’ work on the deinstitutionalization movement and the issue of over-pathologizing and confining people in conditions that are very much like prisons. We questioned why it is so hard to get into that hospital and why it’s so hard to get out. We looked at the intersections between the criminal justice system, the prison system, and the state hospital system, that particular juncture of institutions and rules that govern madness.
Who is mentally ill, who’s mad, and who’s just bad? There had been a practice in the field of psychopathology to kind of bring out someone with a diagnosis of, for example, schizophrenia and interview them. I wanted to more deeply understand how patients who enter hospitals themselves thought about their diagnosis, whether it was correct, and their analysis of the institution and conditions of their confinement, as well as the staff.
It became an exploration of states of subjectivity conditioned by institutionalization but moved into a place where patients themselves were part of the stage. They later joined me in discussions at community events and film festivals.
That was part of the project of critical psychiatry and the anti-psychiatry movement: listening to madness and that people who have different states of mind and consciousness contributing beyond just trotting them out as a case study.
Friedman: Diagnosis can serve social movements, but as you show, it also comes at a high cost to individuals. What is it about your approach that nullifies the standard retort to mental health critics that deconstructing some of these features disrespects those suffering with mental health issues?
Haaken: That’s been a debate. When you are a practicing clinician, as many of us were and are, I think there are forms of suffering that involve claims for care. And Peter Sedgwick was an important influence on my own work. He was part of the anti-psychiatry movement and was sympathetic to its aims around patients’ rights and challenging the tyranny of diagnosis and over-pathologizing people.
But at the same time, it is important to understand what it’s like from the hard bench of a waiting room for a patient who’s trying to seek care.
I am certainly a critic of the medical model, but it’s better than many of the religious models that preceded it. The AA move to define alcoholism as a disease was an enormous advance over alcoholism as a moral failure or a form of degeneracy.
For a long time, the American Psychiatric Association associated it with personality disorders. Still, there is much of that around addiction that lingers as a kind of character defect. So, I think the medical model was an advance, and to bring in diagnoses that re-frame issues that are so morally loaded as public health problems is an unequivocal advance at the same time.
These are also limited categories that have their own traps. Once diagnoses work their way into the diagnostic and statistical manual and the medical establishment’s whole bureaucracy, you are in a very confined space focused on mixed symptom management. It does not deliver much, and people with serious mental illness today are in very bad shape in our system, even with the successes of de-stigmatization campaigns.
Friedman: Even de-stigmatization does not really eliminate a lot of the institutional knock-on effects, the effects of being tossed around the system.
Haaken: People are traumatized by the institutions that are assigned with their care or confinement. Now we have various alarms being set off about the mental health effects of the pandemic and children’s school closures, and so on. But often, the way this gets framed is in terms of access to professional mental health services. Yet we have learned a lot over the decades about good practices for mental health, like eliminating poverty by providing basic food and shelter for people.
The progressive mental health movement must demand something of the larger public and not just settle for spiriting people away to places or directing them to services. As a broader society, we must have greater respect and not call the police when someone is acting odd.
Friedman: The brand of anti-psychiatry that you are talking about contributed so much to left movements at the time, making claims about materialism, colonialism, and industrial capitalism. But now you have popular movements like the Black Lives Matter movement, which functionally equates mental health professionals to nicer police officers. What do you think has changed about how the critical psychology movement interfaces with popular movements today?
Haaken: That’s a historical trajectory I have taken up in my new book on psychiatry, politics, and PTSD, as well as in other work.
In terms of the place of what some called major mental illness, like schizophrenia and psychosis, there was very much a romanticizing of madness to where the person diagnosed with schizophrenia was seen as a kind of folk hero—a poet speaking to the madness of the social order.
Then by the seventies, the medicalization of madness and the move towards pharmaceutical treatment meant people were only listening to someone with schizophrenia long enough to put them on meds.
There was very little interest in what people who were psychotic or odd in some way were communicating. Now with neoliberalism’s profound gutting of public services and privatizing a great deal of what had been public responsibilities, it falls on individuals to take care of themselves. Dependency got pathologized from the Reagan years to the present. One effect has been that claims around mental health became increasingly framed in a trauma narrative.
My own feeling is that the mental health field has not been a very interesting place for radical ideas, maybe beyond how it surfaced in the occupy movement. There was some interesting activity as these camps in different places of Occupy became places for taking care of people who lived on the streets with mental disorders. There was a glimpse of that, but otherwise, I do not see much that’s interesting in the mental health field as it relates to social movements.
Friedman: I agree and would even say Occupy gave some a glimpse into what sort of social life might be able to obviate psychological care as a separate domain of professional services.
Haaken: Yes. It would be good to revisit Occupy as a case study in community mental health and what it means to rely so heavily on professional mental health services. I do not disparage mental health services per se, but I do think as part of the critical psychology project, we are interested in looking at how our work as practitioners becomes part of a larger ideological edifice for a capitalist society where everything becomes privatized, and suffering becomes managed by professionals.
I think we also saw practices of making time and space for neurodivergent people who are processing reality in different ways. There was shared respect for people who have been traumatized and people who were different through various pathways in life, and an effort was made to make space for them in the group. There was an ethical, shared commitment to creating space for people who are by some criteria different.
I think different periods in the history of social movements bring different insights and ideas and open up possibilities. There was a project in Britain with R.D. Laing and the hospitals that flourished as kind of experimental social settings in Britain in the sixties and seventies. R.D. Laing said that someone with catatonic schizophrenia would speak when they have something to say. Then, a few decades later, a lot of that was considered quite ludicrous and was de-legitimized.
When I was treating autistic children at the University of Washington, if you had to wait two years for a “hello,” you waited two years. There was something to that dance of patiently waiting that was later considered completely romantic and misguided.
I think the Occupy movement was not burdened by those practices. Many people knew that there were people with forms of mental illness that must be recognized on their own terms and have things to contribute to the community, and deserve the same respect as anyone else in a group.
Friedman: It really coincides with the direct democracy efforts of that time. That frame gave people pause about making space for people to live out their democratic ideals.
Haaken: Yeah, and you had also asked about the role of critical psychiatry or community mental health practices in the Movement for Black Lives over the last year. As the profession is run primarily by white people, many struggle with the history of racism and white supremacy in our own professions.
How do we draw on these histories to address difficult questions? How are we called upon to do more than just include a week on multiculturalism in our classes? That is not a bad thing, but of course, it has the obvious problem of serving to rationalize the system in this perverse way that assimilates the claims of marginalized peoples into a basically unchanged set of paradigms.
Friedman: That assimilation is common. As an activist, it is hard to critique since it’s progress, but it crucially doesn’t go far enough.
Haaken: In my own activism, I am part of a coalition here in Portland to defend democracy. We all came out of activist backgrounds and are supporting the Black Lives Matter protests here.
I am also working with a BIPOC community. It is very difficult to come out as a white petty, bourgeoisie professional older woman, coming out of a particular background of privilege, to acknowledge that.
But still, you aim to have authentic relationships and not just be there, considering your guilt and discomfort to be some kind of gift to the movement. I have tried to bring psychoanalytic ideas into that work by pointing out collective transference. We all bring our blind spots and histories, hopes, and desires, but also trauma and suffering to social movements. We reenact those in various ways in our groups.
For me, it has been about the practice of being silent and kind of containing and internally processing the tensions in those group settings that can be very intense. The more hope and possibility, the more prone the group is to disappointment, scapegoating, and demoralization. If you cannot take the heat, you should not be in those kitchens! I am drawn to those kitchens, but it takes a lot of emotional maturity.
This has happened with the #MeToo movement and many social movements that I have been part of throughout my career. And so, where I am trying to contribute most is by not pathologizing movements but rather to draw out how conflict and disturbances can be an impetus for change and distinct demands. However, groups can fall apart over their disturbances.
Friedman: I think the emphasis that you have put on internal processing and emotional maturity is really a strong message in the social media era when we are essentially provoked to air all of our reactions.
Haaken: Social media obviously has been identified as a pathogenic vehicle that we are supposed to find a way to inoculate ourselves against personally—no vaccines coming!
I think that technologies have amplified these effects. Still, I also think that there are ways that groups can address some of these dynamics—like the tendency, when people are upset, to scapegoat a particular person or to fixate on an issue or to lash out.
There is a great benefit in sitting with some tension you feel and trying to say, “well, what’s triggering this now for me,” and not to assume that because you have a trigger that somebody else necessarily needs to do something about it. I think that movements can find ways of weathering distress and resist seeing every discomfort as a sign of trauma.
Friedman: You just published this book on psychiatry, politics, and PTSD. Are PTSD and the discourse of trauma different?
Haaken: I have written about trauma more in the context of the recovered memory movement. My book Pillar of Salt followed that movement and debates about Multiple Personality Disorder and satanic ritual abuse. These were phenomena highly associated with one another in the nineties that kind of dominated the mental health field. Vast numbers of clinicians, including people with PhDs, believed a network of Satan worshipers around the country were secretly sexually abusing children.
Now we know that Satanic ritual abuse and pedophilia is an obsession of the right-wing conspiracy theorists, but in the nineties, this was a widely accepted set of ideas. Conspiratorial paranoid thinking tied to the trauma therapists of that era were scary to challenge.
So, when I would do interviews, I carried out field research on how crisis centers were accepting the satanic ritual abuse conspiracy theory. It was like questioning the Holocaust, being a Holocaust denier. A lot of feminist clinicians said, “how can you question this? Women are speaking of this, and you do not question women speaking to this.”
I would say, as feminists, we have enough to fear in the world. We don’t have to make up new ones. A problem that we’ve had to address as feminists is not being fearful of public life, and now you’re inadvertently reproducing a kind of paranoia that is not helpful. Many women get more ill through a process of recovering more and more disturbing memories—more graphic and dramatic scenes from the childhood of torture at the hands of their parents, neighbors, or pastors in the basements of churches and homes that had not been identified. You might see it as a time of group hysteria or moral panic.
I was interested in why these ideas took hold, not just in the debunking of them (many experimental psychologists did this) and saying, “well, why are these narratives resonating with people?”
One line of analysis that I also pursue in my new book is that as we entered a period where social services were being dismantled, including mental health, and more and more burdens were put on the individual to manage their own lives. The mass movement called second-wave feminism had faded out, and it took a more and more dramatic story to break through the threshold of indifference to suffering.
So everyday misery was not enough to move the media or the power brokers in the clinical field. It’s like how in a family, you can have someone throw a bigger and bigger tantrum to get attention. Stories got more and more dramatic and also were about legitimizing a fight for authority and voice among women clinicians in the profession and the history of silencing women and children—and not in a malevolent way.
Many feminists and women clinicians jumped onto that bandwagon because it was a moral crusade. Very little self-reflection attached to it, but it was as much about the competing authorities, including in the law and the mental health field, as it was about how you let children and women speak and giving them a voice about what’s upsetting them.
That book [Pillar of Salt] showed how it was driven by crises in the mental health field in the context of neoliberal capitalism that had undermined so much of earlier programs of community mental health.
I continue with that same line of analysis in the new book. PTSD is the one diagnosis from the field that has survived the various categorical purges. So PTSD is that scrappy survivor, and it came up all the time when I was doing field research in crisis settings.
In making this film, Mindzone: Therapists Behind the Front Lines, I was able to go to a war zone in Afghanistan, follow therapists, and also go to the state hospital. I was interested in when clinicians invoke and use that diagnosis. It was more about the management of situations where clinicians felt pressure to provide something and the pressure of social movements to care for people in a way that didn’t stigmatize them.
It’s a redemptive diagnosis that lost its progressive potential. It became more and more incorporated into the taxonomy of the DSM and the whole institutional apparatus, including the military and VA systems. It became a kind of management strategy. It’s a very narrow frame as it’s used as a diagnosis as the context of what gives rise to the symptom.
It depends on what’s called an event schema or an index trauma that rules out vast amounts of experience. I try to show how it ultimately silences people, even those who benefit in some material way or through access to service.
Friedman: You’re saying it necessarily reduces the context that individuals would be able to provide in telling their stories?
Haaken: Well, there are two aspects of the diagnosis as it relates to social psychology that I take up in the book. One is that, as it becomes part of the popular lexicon, people use it as a shorthand way of saying something happened to me that has really messed me up and it stays with me, I’m having trouble shaking it off, and it’s not my fault.
It’s a way of making a claim as it emerges in group life. If you’ve given me PTSD, I have a claim to you. In a forensic setting, it’s often used in the courts. It requires the plaintiff to say, “I was fine before this happened to me.” If you’re in a car accident, one actually has to establish that you were fine before. So, the more you bring in history that compromises that claim, the more you lose.
PTSD is that kind of diagnosis as a forensic category that says, “I was fine until this war, this rape, or this assault.” Therefore I have a claim on someone here to do something about it. So in that sense, it’s redemptive. It was very important in the early feminist and anti-war movements. In the former, women faced claims like, well, “good women can’t be raped.”
If you went to court against the man and you had “a past,” as they called it, or are masochistically attached to your abuser, these questions would just dominate the court system. PTSD was a rejection of that, saying that you can be totally normal and start to have symptoms because of this particular event. Same with veterans who had been dismissed from the military and had any kind of mental health history.
Then it became something else as part of the institutional apparatus. As the psy-complex and the administration of the state addresses these grievances and normalizes reactions within a very, very narrow range. For example, in the Oregon state penitentiary where I’ve done interviewing, it doesn’t work very well to talk about your trauma. PTSD is seen as making an excuse for yourself.
Among poor people where poverty, exposure to the police state, chronic trauma, and suffering are endemic, PTSD doesn’t cover those conditions because it would open up the whole establishment to claims that it doesn’t want to admit. It’s a narrow portal into claims on the system for support and care.
Friedman: What a stark example of how, to get legal recognition or redemption, you have to make a cut in your own history. One that makes sure you don’t go too far in your demands and claims.
Haaken: Yeah. In pursuing that line of thought, there’s always a risk of being removed from the pressures of clinicians working in crisis settings, who are trying to do a good job. One chapter of my book is on disability and the pressures on people to use PTSD for a disability claim, and the pressure on evaluators.
It’s very important to have that tone of respect for veterans because there are people who built a whole career on deconstructing diagnoses, including PTSD. They are too removed from “the hard cold bench of the waiting room.”
I try to acknowledge the pressure people are under, but I see it as a systemic issue and not an individual issue. That’s an important aspect of critical psychology related to the medical model, which is about locating disease or illness within an individual as opposed to thinking about problems of pathology more systemically.
Friedman: I suppose maybe there’s an element of patience involved, where if enough individuals recognize the same index trauma, here the cost of militarism, then after a certain amount of time, you can point to that event and publicize the similarities.
Haaken: There are progressive clinicians and anti-war veterans groups that have pursued that strategy of the cumulative effect of normal people suffering symptoms for long periods of time can contribute to a broader, progressive social movement, including anti-war movement.
I don’t think that’s the case. My argument is that the history of the PTSD diagnosis is a case study in how diagnoses basically fail—even the ones that carry the mantle of social movements fail to acknowledge and reduce human suffering.
I pursued that line of analysis, looking at the index traumas throughout history that had been part of trauma diagnoses since World War One. The most redemptive trauma diagnoses of the precursors to PTSD were ones where it was an external threat.
Shell shock was framed as something that comes at you from the outside. And part of what was important about Freud’s work after WWI is that he said a lot of the pathology is not from threats from the enemy. It’s something within the military itself. It’s wanting to live up to the ideals that you’ve internalized.
Complying with the command structure is pushing you into situations to do what you know to be immoral. But if you have paralysis of your arm, you can’t pick up the gun. He talked about shell shock as an internal conflict that was really about military hierarchy.
Most of the psychiatrists and psychologists in shell shock talked about it being an external agent. Similarly, when I was tracing the index traumas that tend to be used in the military and VA, they tend to narrowly focus on something coming at you from the enemy.
There’s very little, in fact, it’s explicitly forbidden when you’re in military service to address conflict within a command structure. A lot of the struggles are still of the type that Freud described within the military. The Abraham and Isaac story and how young men and now women are sent off to war and sacrifice to fight, as Muhammad Ali said, to fight the white man’s struggle.
For the most part, the PTSD stories that find their way into the clinical literature have been incredibly sanitized, and partly for understandable reasons. It’s difficult if you’re a psychologist or psychiatrist working within the military to allow space or grievances against the military structure.
Friedman: It’s so fascinating, especially for those new to critical psychiatry who may be interested in how individual experience speaks to social life, to see PTSD diagnoses functioning to ward off a critique of institutionalized hierarchies.
Haaken: There has been an aim on the part of many wonderful clinicians to use PTSD to de-pathologize reactions to war. But I also try to show how actually the main effect is the opposite. I look at the history of personality disorders as they’re used in the military because much of the early PTSD movement was to re-diagnose people who’d been dishonorably discharged from the military under the personality disorder category.
There have been several successful lawsuits by veterans groups dealing with the use of personality disorders. That was one reason why the psychiatric data looked so good during the Vietnam War: military psychiatrists tended to discharge people diagnosed with personality disorders, making them ineligible for benefits. It’s also very, very stigmatizing.
So I became interested in what it means to swap them out and re-frame these veterans as suffering from PTSD. It’s better, but it also has certain costs. It’s still a disorder for which you pay a price. As early feminists knew, any time you complain through the lens of a disorder, there’s a price to pay.
To me, PTSD is a containment strategy and a more costly one than many progressive clinicians who use it recognize. Interestingly enough, most of the critiques of PTSD as a diagnosis come out of global mental health, where clinicians see how it’s used in other political, cultural contexts.
It’s interesting where the critiques come from, and in this case, it’s not clinicians in the US. PTSD is a big international export of American psychiatry to other conflict or crisis zones, and its value as a containment strategy is being recognized.
Friedman: It’s noticed as a way to ward off a critique of institutional structures?
Haaken: There are several lines of critique. A lot of the aid effort goes towards mental health management or treating problems as clinical issues when they really relate to collective suffering and collective ways of remembering.
PTSD is partly tied up in the history of contested memories—how you remember the sources of your suffering. Many saw how clinicians come in and hyper-individualize suffering. It really dismantles collective forms of storytelling and struggling over how we build an account of what happened.
It also separates people who are symptomatic from those who aren’t. I wouldn’t go too far in saying it’s worthless to identify people who are acutely symptomatic in a conflict zone, but one of the critiques is that so much of the funding now from NGOs is based on bringing dazzling, dramatic trauma stories to big donors. Then instead of material support that can make a difference in how people recover, all of these resources go to these trauma projects that thrive on a very dramatic story. It’s clinical tourism at its worst!
MIA Reports are supported, in part, by a grant from the Open Society Foundations