London, 1976. The filth and the fury as the nation's consciousness was gouged by an abrasive multisensory assault. Punk rock had arrived with all its naughtiness and disobedience! The essence of punk: be yourself, no matter how untidy or gauche, while urging DIY and self-empowerment (‘here's three chords, now form a band’).
Celebrating elements that were previously taboo, punk found in mental illness an ideal substrate that was presented in comic and/or glamourised terms. Perfectly, punk emerged just as deinstitutionalisation gained momentum, providing a youth-friendly optic of mental illness as societal exposure to individuals with mental illness increased. Key figures, such as Joey Ramone, spoke out about their personal experiences of mental ill health. A nation's youth dreamt of being ‘so messed up’ (possibly) from a ‘teenage lobotomy’. The mainstream psychiatry of the ‘psycho-mafia’ (a title of a song by The Fall) was under attack!
Punk gave voice to a previously excluded community – reaching out to those stigmatised by prevailing values while rejecting self-stigma (‘destroy what destroys you’). Negative stereotypes of mental illness were thrust back into society's face, reframed as desirable characteristics, all the while lampooning prejudice and discrimination.
For three frantic years punk rock pulverised the stale convention so that even when it delivered on its self-proclaimed destiny by crashing and burning, mainstream society was left with a changed perspective as the punk ethos endured beyond the music. For psychiatry, this has manifested in the rejection of complacency and a demand for continued change.
The Mad Pride movement of the 1990s drew substantially from the punk philosophy of do it yourself through direct action. Challenging negative attitudes by celebrating the positive aspects of madness (‘we're out of the bin and glad to be mad’), erstwhile terms of abuse were re-appropriated as symbols of positive identity. With one quarter of the stigma burden of mental illness attributed to the delivery of care by service providers, the psychiatric profession provided an attractive target (‘psychiatrists, restrain yourselves’).
And so into the 21st century where the philosophy of recovery has penetrated all things mental health, providing an antidote to the prognostic negativism of the medical model for severe mental illness, offering hope and empowerment. The core tenets of recovery share considerable commonality with the ethos of punk rock – self-direction, respect and responsibility, person-centred, strengths-based, empowerment readily translating to the punk notions of DIY, positive action, self-efficacy, inclusiveness, and challenging misinformed convention via anti-hierarchical beliefs.
Psychiatry will always be the punk rock of medicine. For those who enjoyed their formative years as psychiatrists to the tune of punk, the movement seared our brains with an indelible scar, providing permission to think outside of the box, to challenge convention and to believe that everybody can make a useful contribution. Thus, as funding for mental health continues to diminish across high-income countries, despite increasing youth suicide and the stark reality that the life expectancy of those with enduring mental illness is 17 years less than the general population, more than ever we must challenge the source of these inequalities. Anything less would be, to paraphrase that Rotten genius, ‘an inexpensive vacation in the suffering of others’. Never!