Prescription Abolition and the Politics of Mad Pride by Emily Sheera Cutler

Emily Sheera Cutler intriguingly suggests the un- derlying politics of Mad Pride is consistent with the demand to abolish prescriptions for psychiatric drugs.

Mad Pride Logo

One of the most common objections to Mad Pride is that it is not  helpful or beneficial  to find pride in one’s pain or suffering. I often hear: “I understand LGBTQ pride    or Black pride because those identities don’t inherently cause suffering apart from societal oppression. But pride in madness? Pride in something like depression? How can I be proud of something whose definition literally includes the experience of suffering?”

While madness does not inherently cause suffering for everyone, madness can be painful, and finding pride in pain is intensely difficult for many people. The idea   of finding pride in pain, or accepting pain (physical or emotional) can be used against people in oppressive ways. Perhaps they have been denied access to pain medications or shamed from using substances to mitigate or “escape from” their suffering. So Mad Pride might seem impossible, if not threatening, to them.

It is for this reason that I wonder if Mad Pride is more about celebrating reactions to pain, not necessarily internal experiences of pain.

I think a great deal of psychiatric treatment revolves around the idea that emotional pain is an inevitable part of life that just needs to be tolerated or gotten through. The vast majority of mental health services do not attempt to change the circumstances or systemic factors in an individual’s life that have driven them to experience pain, but rather, the individual’s response to their pain. The overarching goal of conventional mental health treatment is to control a person’s behavior – to ensure they don’t react to the pain they feel in any sort of way that might be “dangerous” to themselves or others.

Our standard response to suicide,  for  example,  is involuntary commitment. Most people don’t expect locking someone up and depriving them of their bodily autonomy for 72 hours to reduce the amount of emotional pain they experience in any meaningful way. The goal is merely to restrict a person’s body – to ensure that they cannot escape their pain by ending their life.

Another common mental health intervention, Dialectical Behavior Therapy, teaches us to “tolerate distress” and “radically accept” the circumstances that are driving us mad. It’s about learning how to experience emotional pain without reacting. Without lashing out in anger or rage toward the system or individual(s) causing  us  pain, without failing to function in the workplace, without making others uncomfortable or being burdensome to those around us.

What if Mad Pride is about resisting the narrative that we should tolerate pain? What if it is about celebrating our right to take whatever action we choose to cope with, reduce, or react to pain?

That is what Mad Pride has come to mean to me personally. It is about the right to scream and cry out  and lash out in rage and make plans to escape through suicide if it comes down to it. It is about the right to use drugs, alcohol, sex (and rock ‘n’ roll while we’re at it) to cope with an oppressive, pain-inducing society. Because perhaps the satisfaction of having rebelled can at least give us some solace. It is about being (sometimes creatively, sometimes destructively) maladjusted to the world and letting those in power know just how fucking crazy they have driven us.

Maybe it doesn’t sit well with many people (myself included) to be proud of feeling depressed. But could we take pride in the ways we might react to it? Could we take pride in our lack of functioning within an oppressive capitalist framework, or indulging in negative thinking    in a world that shoves positivity down our throat, or our choices to cope through substances or self-harm?

I think Mad Pride can be about resisting and escaping pain just as much as it is about embracing it. In a society that tells us to “grin and bear it,” to “man up,” and that “what doesn’t kill you  makes  you  stronger,”  refusing to just “tolerate pain” is an act of rebellion. And I think Asylum readers will all agree that rebellion is something to take pride in.

For this reason, I see the philosophy and framework of prescription abolitionism as central to Mad Pride activism. Prescription abolitionism is the notion that all substances should be legal for all people (with the exception of antibiotics). Instead of a system in which people have to gain permission from a particular medical professional in order to access drugs they want or need, they would be free to access the substance(s) of their choice. Underlying the paradigm of prescription abolitionism is the idea that people should be the ultimate decision-makers over their own minds and bodies. People could still consult with physicians, pharmacists, biochemists, and other professionals (yes, including psychiatrists) about what options are available to address their particular needs or wants and what the potential risks and benefits of each substance might be. However, it would be the individual, not the professional, who makes the ultimate decision about what substances to consume or not.

If Mad Pride champions the right of each person  to resist or react to pain in whatever way they choose, including the use of substances, then prescription abolitionism is not only complementary to, but a necessary component of, this paradigm. Rather than having to demonstrate that a particular drug is medically needed – a subjective designation dependent upon cultural context and the judgment of each individual clinician – Mad people should be able to act as the experts of their own needs and wants.

In our current paradigm of mental health care, psychiatric drugs are often prescribed in order to help people function better within society. They are not usually prescribed in order to reduce the amount of emotional pain a person is in but rather to increase a person’s tolerance of that pain or decrease a person’s ability to react to  that pain. Many consumers and survivors report that antipsychotics do not eliminate their distressing voices but instead make them care less about those voices. For me personally, antidepressants did nothing to address the depths of depression and despair I felt in response to my life circumstances at the time; instead, they made me almost completely apathetic to my emotional pain. While I still felt intensely lonely and alienated, I did not cry as much, complain about it, or engage in self-harm.

In this sense, psychiatric drugs are often used as behavioral control. They are used to help people appear more “normal” or conform to standards of what “mentally healthy,” functioning members of society look like. Or they are used to reduce feelings of discomfort in the friends, family members, co-workers, and mental health professionals of Mad people. In decreasing Mad people’s external reactions to their pain, psychiatric drugs can aid those around them in not feeling so uncomfortable or having to witness that pain themselves. In our current framework, psychiatric drugs are also sometimes used as chemical restraints in institutions – to violently force inmates into submission and compliance, i.e. not showing any outward signs of how much they are suffering.

On the other hand, access to drugs that are seen as hindering people’s functioning or productivity is restricted. It is incredibly difficult, for example, to access benzodiazepines, as they can lead to a blissful or euphoric state resulting in “laziness.” Drugs that allow people an escape from the everyday drudgery of life under capitalism are vilified and demonized. People are told that they should not become “dependent” or rely on these drugs in order to escape their pain, sadness, or ennui. People who are deemed dependent on or addicted to these drugs are often subjected to violence including criminalization and forced withdrawal. In this sense, lack of access to substances is used as behavioral control and coerced conformity to the societal ideal of pain tolerance. In a prescription abolitionist framework, we could move away from the use and restriction of drugs to increase pain tolerance and conformity and toward the use of drugs as resistance to and rebellion against pain. Rather than a psychiatrist or medical professional looking for drugs to fix their patients, to restore their patients to functioning – to help them “grin and bear” their pain like everyone else

– Mad people would have the chance to seek drugs that fit their particular needs as individuals. Maybe they want to consume a drug like a benzodiazepine or an opioid that might allow them to escape their pain and enter a blissful or euphoric state. Or maybe they want to take a drug like Ritalin or Adderall that might allow them to have some quality time focusing on a creative or academic pursuit despite their pain. Or maybe, antidepressants or antipsychotics fit their needs and improve their quality  of life. But in the prescription abolitionist framework, it is Mad people who get to decide if those drugs suit their own needs, rather than a psychiatrist deciding that is what their patients need to be “normal”.

In my opinion, the act of feeling pain, and not tolerating it or hiding it like everyone says we should, but taking matters into our own hands and choosing to react to, resist, or escape from pain is worthy of celebrating. For so many people, pain and suffering are horrible, dehumanizing experiences. Rebelling against those experiences through yelling, screaming, crying, negative thinking, self-harm, or drug use can be an incredibly satisfying way of taking back some of our power, or at least enjoying a modicum of consolation. It’s time for Mad autonomy and Mad resistance to pain.


Emily Sheera Cutler is a Mad Pride activist and a PhD student at the University of South Florida. She provides training and consultancy on non-coercive suicide prevention, disability justice, and community organizing. To read more of her work, visit emilyscutler.com


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