• Sasha Durakov Warren

Distress is a Weapon: the SPK's Strategic Struggle for Mental Wellness

Updated: May 24

This is part of a series of presentations on the history of radical mental health projects called Mental Health in Crisis. Find recordings at and the landing page for the series with notes, slideshows (with many more images), and info for how to follow the series at

From its earliest days, the field of German psychiatry was split between competing visions of volition and compulsion, psyche and soma at the heart of mental disorder. Moral theories stemming from Immanuel Kant and John Locke saw in madness’ delusional reveries imminently rational deductions from false sets of premises; not far off, Christian psychiatrists like J.C.A. Heinroth portrayed them as the consequence of sin. It was natural that Heinroth equated the insane with Hegel’s “rabble,” seeing little more in madmen than a distillation of the incoherency and idiocy of the mob (Dörner, 242). For Carl Wilhelm Ideler, the psychogenesis of unreason could be located in man’s drives and passions. In the normal man, the passions balance one-another and are tamed by the knowing hand of reason. Let one of these drives develop too far, and you may find yourself enveloped in the impenetrable husk of a florid madness, which is why Ideler joined the chorus of maddoctors warning society that madmen and revolutionaries were united in an "unconcealed striving to destroy all order and coherence of the situation” (in Ibid, 254). To be mad was to have violated the compacts and shared conventions of reason or God. Despite their differing frameworks and etiologies, their corrective techniques shared a spirited infatuation with torture and violence. Spinning patients around in a machine for hours at a time; pouring freezing cold water over their heads without warning; immobilizing them in jackets or strapping them into straight-backed chairs; surrounding their heads with ice; spraying their genitals with jets of water; beating them with rods; or chaining them to the wall through cold nights were justified on two contradictory counts that the mad person was less susceptible to pain and that to torture them was to reduce them to a kind of tabula rasa, a blank and broken state of stupefaction that looked to the psychiatrist like a hunk of manipulable wax. The word “psychiatry” was coined in Germany by one of these champions of torture, Johann Christian Reil. Psychiatry was a small and insular profession, based in rural asylums ostensibly modeled on paternalistic families, that operated openly as a form of medical police (see Engstrom, 20-23). It was marked by the heavy hand of gratuitous violence and a promise to restrain society's miscreants by any means necessary. Try as it might, German psychiatry never could liberate itself from its violent origins and its tendency to identify the poorest, weakest, or simply most problematic members of society as undesirable and parasitic outsiders.

The “Psychists,” as they are collectively and reductively called, retained hegemony until the 1860s, when a younger group based in new university clinics rallied around the battle cry of their leader, Wilhelm Griesinger: “mental illnesses are brain diseases.” Under this glorious banner, they said: out with groundless moral and religious grandstanding, in with pathological anatomy and clinical observation. No more bad conscience and long nights after applying restraints or torture; the Somaticists looked forward to the tranquil sleep that would come with applying treatments derived solely from the mechanical laws of the natural human body. Griesinger somaticized the soul by framing it as the “the sum of all cerebral states,” which were, in turn, the products of the “immense reflex apparatus,” the brain (Griesinger, 6). Being scarcely more complex than a giant clock, the mad know not what they do. To torture or restrain the insane for impulsive acts is tantamount to striking an animal for bad table manners. The engineers of the somatic turn promised a new era marked by the technical resolution of psychic distress and alienation; by the 1880s, with the rise of the generation after Griesinger, they were just the newest organized perpetrators of both. Over time, neuro-psychiatrists like Emil Flechsig (Daniel Paul Schreber’s psychiatrist) progressively stripped whatever human qualities were still attached to the surface layer of patients in experimental clinics, leaving only an epidermal sheath wrapped around a misfiring machine. Meal times became force-feedings for resistant patients who were watched 24-7 under a strict principle of constant surveillance for the subtlest variations and aberrations; once they were dead, their corpses were eagerly traded to universities eager for a constant supply of fresh cadavers to verify for their anatomical hypotheses (see Warren, “Beware,” 37 and Engstrom, 132).

A robotic looking man rides atop a circular vehicle on which the word "steresalion" (sterilization spelled incorrectly) holding a long needle and a book with a cross on it. He has a horn in his mouth. One nurse stands facing the vehicle and another is riding in a lower chamber beneath the man.
Wilhelm Werner, a German patient who documented his own sterilization. He was killed in the euthanasia program around 1940.

Just ten years later, Adolf Jost published The Right to Die, in which he argued that the right of the private individual to choose a medical mercy killing cedes to the state as guardian, where “the diagnosis of incurability is sufficient in itself to justify killing” (in Cohen, Psychiatric Hegemony, 179). This book came amidst a growing interest in hereditary theories of degeneration rooted in bio-essentialist frameworks like Albert Zeller’s popular somatic theory of the “Einheitspsychose,” or “unitary psychosis” that understood the variegated types of madness to be expressions of temporal positions along a linear progression of a single disease. The melancholic was only partly mad, but on their way to total dementia and idiocy (Warren, “Beware,” 37). A possible blueprint of this theory’s combination with effective statecraft came in 1920 with the publication of Die Freigabe der Vernichtung lebensunwerten Lebens, or Permission for the Extermination of Worthless Life, written by the popular lawyer Karl Bindung and the forensic psychiatrist Alfred Hoche, which, citing Jost, asks “Are there human lives that have lost the quality of legally protected entities to such an extent that their continuation has permanently lost all value for the bearer of that life and for society?” They quickly answer:

If one imagines a battlefield strewn with thousands of dead young men, or a mine in which firedamp explosions have trapped hundreds of industrious workers, and if, at the same time, one juxtaposes that image with our mental asylums, with their care for their living inmates – one is deeply shaken by the shocking discordance between the sacrifice of the finest examples of humanity on the largest scale, on the one hand, and by the greatest care that is devoted to lives that are not only absolutely worthless, but even of negative value, on the other hand.

The notion of “lives unworthy of being lived” can be seen in this light as a rational product of the legal category of guardianship that differentiates between those competent enough to make choices for themselves and those who require a paternal stand-in with the bio-psychiatric theory of hereditary degeneration and idiocy. The euthenasia program of Aktion T4 that jump-started the domestic adult euthenasia program was not an aberration but an outgrowth and intensification of endemic trends in European psychiatry (see Cohen, 181-184). This helps to explain why “wild,” that is, unofficial, euthenasia and sterilization at the physicians’ own volition actually accelorated after the Nazi regime reversed the legal order to kill the disabled and mentally ill en masse (see: Caring Corrupted).

Young people growing up in Germany in the 1960s and 70s were confronted with the reality that many of the parents, grandparents, schoolteachers, nurses, and psychiatrists who willingly participated in euthanasia programs or concentration camps (or blissfully ignored them) and still managed to secure cushy university or hospital positions. This basic reality led to a wider examination of the through lines that connected post-war Germany to the horrors of its past, which, on account of these continuities, one could conclude, was not really past. In the late 60s, facing an economic crisis, the coalition parliament formed an emergency government that nullified the parliament. To the growing German left and student movements, the fear that the West German government could slip into a fascist mode in a crisis was seemingly confirmed when, in response to large protests against a visit by the shah of Iran to Berlin, the state’s security forces implemented far-reaching emergency orders banning demonstrations and shutting down highways and sending in thousands of police. The murder of student Benno Ohnesorg exacerbated the crisis into a fever pitch (Geronimo, 27-8). 1968 represents both the peak boiling point of the collective rage of the student movement and the beginning of its decomposition: soon after, it splintered into numerous Maoist and Marxist-Leninist cadres, autonomists and Spontis, feminists and anti-nuclear activists, squatters and queers, and, of course, the big bads of the media, the urban armed struggle groups (Katsiaficas, 60-3). The rediscovery of Wilhelm Reich’s work and the import of critical and anti-psychiatry texts by David Cooper, R.D. Laing, and Félix Guattari around the same time introduced a whole new revolutionary lexicon of desire and an emphasis on psychopolitics (Pross, 7-8 and Bütrer, 197).

Former concentration camp inmates dressed in their camp pinstripe uniforms carry signs that say "no NS-laws" with swastikas crossed out. Some signs bear their camp inmate numbers.
A protest against the emergency laws in Bonn, Germany, 1968. Former concentration camp inmates carry signs warning of a continuity between the emergency laws and the Nazi regime.

Out of the dynamic intercourse of the generational clashes, new youth movements, and growth of anti-psychiatry emerged what Jean-Paul Sartre called “the only possible radicalization of the anti-psychiatry movement” in the medium-sized city of Heidelberg in South-West Germany, namely, the Socialist Patients Collective (das Sozialistische Patientenkollektiv), or SPK. The continuous hostility of local media and a healthy dose of self-mythologization have led to factual disputes that shroud the question of their origins in a certain level of murkiness. But still, some facts are certain. The group was based out of the Department of Psychiatry at the University of Heidelberg. Heidelberg’s psychiatry department has left us with long-lasting but contradictory legacies in the history of psychiatry: it was the workplace of one of the most important psychiatrists of all time, Emil Kraepelin, who developed new modern classificatory tools; it was and is home to the Prinzhorn collection, one of the earliest and largest collections of patient artwork, which valued and has preserved works by psychiatric patients for over a century; and the very same department helped organize euthanasia killings under the directorship of Carl Schneider during the Nazi regime. In 1955, the university seemingly made steps to move in a new direction by hiring Walter von Baeyer, a Jewish professor with a clear progressive agenda. Influenced by the social psychiatry currents in Britain and the US, he decried the still wretched conditions of Germany’s mental hospitals, advocated for community care and psychotherapy over custodialism and aggressive physical treatments, and talked positively of radical psychiatrists like R.D. Laing and Franco Basaglia. At the same time, the university kept on multiple nurses and psychiatrists who served in the SS and were involved in the Nazi euthanasia program (Pross, 6), a situation which led to a split between a more traditional psychiatric milieu and the social psychiatric one. The SPK first began to take shape around Wolfgang Huber, an intense and prickly resident in the department whose frequent clashes with colleagues resulted in having him moved to the undesirable polyclinic where acute patients were observed, sorted, and likely moved elsewhere after a brief time. Against the common wisdom that little serious work was to be done there in such a short time, he participated in large therapy sessions that more closely resembled political rallies than conventional group therapy meetings, which became unmanageable and thus a target for the administration around 1970, who feared that that this man was so lost in his work he “might prescribe dynamite!” (SPK, 19).

Things came to a head on February 5th of that year, when the university finally tried to evict Huber and about 60 patients (SPK, 15). But the patients refused to leave. Instead, they called a general assembly in the clinic and hunkered down for an occupation. This continued until February 29th, when they struck a compromise with the University, never fulfilled, but which promised the patients the renovation and use of a work room and a lump sum payment for development. Out of frustration, the SPK occupied the office of the Rector in July and increased the scope of their demands: they wanted patient control over all care, over right to residency, over the clinics’ funds, and over a house to use as a crisis or refuge house (Ibid, 21). Though they attained official recognition on July 9th, they were repeatedly attacked in the media and by the University in public statements until they were formally evicted on November 14th, 1970, which was not effectively acted upon until a second order was given in May, 1971. After being evicted, many SPK patients were arrested in late June on suspicion of being involved in a shootout with police (Ibid, 24). Throughout this period, their primary collective activity consisted of what they called “agitations,” as opposed to therapy, the main point of which was to identify individual needs and both denaturalize them–that is, situate them in their proper historical context–and collectivize them. On top of that, they collected a few marks at every meeting to allow members to participate in basic care functions: they offered free childcare for those who needed to work, performed home visits to diffuse tension between partners and roommates or to help solve another crisis, tutored students who were falling behind, secured medications when possible, and helped to work out labor or housing disputes by pressuring bosses and landlords (40-1).

A group of densely packed students occupy the University of Heidelberg with signs. Most face an open window and have their backs turned to the camera. One on the left is wearing a long white coat.
Sign reads: "We protest against the firing of the politically inconvenient Dr. Huber."Students protest against Heidelberg University’s dismissal of Dr Huber, 1970. Photograph: Dagmar Welcker

In terms of their activity and immediate demands, the SPK are impressive but not that different from similar groups around the world who primarily demand patient control and offer alternative support structures like the Mental Patient Union in London or Judi Chamberlain in the US. Their uniqueness lies rather first, in their strategic approach to these same problems; second, in their formation and historicization of psychiatric power and madness; and, third, in their conceptualization of political and personal identity. There is much confusion around what the SPK actually said, due in part to their proclivity for falsifiable hyperbole and crude sloganeering. The notion that mental illness is socially determined is often attributed to them, but this is actually disputed on the very first page of their primary text Turn Illness into a Weapon:

it was clear to us from the outset that it's completely unsatisfactory to look for a single bodily cause according to the model of scientific medicine. It also quickly became clear to us that it’s not enough simply to speak of the social cause of illness, that it's too simple to pin “responsibility” for illness and suffering on “evil capitalism.” And it became clear to us that it’s a completely abstract and ineffective affirmation simply to say that society is ill. (1)

Like most anti-psychiatry projects, they hold that illness is not reducible to the purely biological, but it does not follow, as it’s often said, that it is socially determined; outside of these two dominant narratives, what are we left with? It all boils down to how they think of the term “illness.” Notice that the SPK does not speak here of “mental illness” or “disability.” Instead, they use the generic term “illness.” Why?

Illness, for the SPK, is not a thing nor a state, but it is, nonetheless, very real and a constituent part of contemporary capitalist society. It is the crux of their argument and works on many different levels at once, both abstract and empirical, general and highly specific. If anything is for certain, it is that illness bears an essential relationship with capitalism: “Illness is the essential condition, the presupposition and the result of [the] capitalist process of production” (59), they say. This is not the same as saying capitalism alone causes illness or illness didn’t exist until capitalism, but it is to deny a “natural, objective” illness existing free of material context. In fact, the concept and organization of natural illness is intimately related to the kind of illness they are talking about. Early on in Turn Illness into a Weapon, they make it clear that illness can be understood as alienation, in the terms set out by Marx: it “is the alienation [Entfremdung]” as it’s experienced “subjectively, as the experienced condition of physical and psychological needs of the individual” (2). In the capitalist mode of production, the worker is estranged. In The Economic and Philosophic Manuscripts Marx explains what this means: first, he says, because labor is not freely chosen, but is taken up as a forced necessity for survival, it exists outside of the worker. In making the world, the worker is denied the capacity to freely choose their mental or physical activity; the more they work and produce, the more alienated they are from themselves and from the world they make. The type and intensity of work does not arise from one’s own chosen thought and activity, but from the necessity of survival, which means that working beyond one’s own physical or mental limits or in terrible conditions is inevitable, but also more generally that, the more one works, the less time they have to undertake their own endeavours and develop themself and the more their “own time” is reduced to mere reproduction (eating, sleeping, drinking). Work is experienced as organized mortification and denial, an exhausting expenditure for products that oppose the worker as an inaccessible and alien world of things fulfilling none of their immediate needs (74). In pursuance of the means of survival, they must separate themselves from their own power of production and sell it off to another, often resulting in physical or mental degradation, as Marx makes clear in Capital:

a certain crippling of the body and mind is inseparable from the division of labor in society as a whole. But since the age of manufacturing pushes this separation of kinds of work much further, and in its way of dividing the individual attacks him at the roots of life, it is the first age to supply the material and the start to industrial pathology (quoted in SPK, 59).

Illness can be understood in this multifaceted sense of alienation/estrangement from the product of labor, from one’s own capacity to produce, and presents this alienated world as the natural one. For the SPK, that mortification of the self from the world whereby one “becomes merely a fragment of [one’s] own body” (Ibid, 59) is illness, which becomes particularly apparent in those cases when this mortification is subjectively experienced as pain and destruction, in the form of workplace injury, psychic crisis, or immiseration. Illness describes how capital sets one part of us out against another, or, as the SPK puts it, it is “damaged life, life that contradicts itself” (2).

We may seem quite far from the question of madness or psychiatry at this point. Indeed, part of the SPK’s strategy is to despychiatrize madness and present it as a specific type of the alienation process inherent to capitalism. But there is also a historical precedent for their organization. Psychiatry, in its oldest forms, confronted madness explicitly as “alienation.” In fact, in the 18th and early 19th centuries, it was more likely someone in the profession would call themself an “alienist” rather than a “psychiatrist.” This brings us back prior to the totalizing medicalization of madness, when what we would call “psychotic” types were conceived of in terms of delirium, that is, forms of alienation from reason. The mad person has a privileged position in this schema, in that they confront society either as the alienated who have lost contact with civil society and need a shepherd to guide them back or as aliens who are so far gone as to appear as animals. The SPK reverse the terms: to be ill/alienated is actually to wield the potential of increased consciousness of the estrangement of the world. To be healthy is not at all possible; those who believe they are healthy are unaware of their real estrangement from the world. The healthy ideal only describes readiness for exploitation (6), which is itself a state of illness.

One students hang out from the balcony at the university of Heidelberg during an occupation. Below them is a large banner (whose text is transcribed in the caption).
Feb. 2, 1970. Twenty patients + students occupy the clinic at Heidelberg Photo: Hans Speck Text: “Patients and medical work groups protest against the political firing of the inconvenient doctor Huber with a hunger strike.”

To better explain this, the SPK divides illness into two possible moments: the progressive moment and the reactionary moment. Take the example of paranoid delusion. In the common representation, the paranoid person feels themself beset by unknown forces (voices, visions, or mysterious figures) that assault them as an omnipresent force, as if from the environment itself. This differs only in the specifics from the explication of alienation recounted above, and, indeed, “delusion,” the SPK say, “is the product of the individual’s objectification in capitalist society, it’s the expression of the polarized relationship of life and capital, of organic and living matter with inorganic, dead matter” (79). Paranoia as a totalizing sense of estrangement from the world that antagonizes the individual as an alien force expresses the truth of the world. To get more specific: let’s say the paranoid feels followed or surrounded by murderers and holes up in their apartment to escape the horrors outside. Here too, the truth is barely under the surface: murder is the norm of the capitalist mode of production, both immediately in the form of domestic police executions and clearing the way for imperial accumulation, and over time with avoidable accidents or exposure to viruses and diseases at the workplace. Even so, illness having a basis of reality does not determine its outcome and expression; it is merely the starting point. Normally, the patient’s illness is objectified as schizophrenia or bipolar, freezing it as a manipulable and stigmatized property of the person, or, at times, even supplanting the person as their primary form of identification. In this case, the flash of truth is repressed, turned inward, made into a problem for the individual who experiences increasing magnitudes of guilt and fear as they increasingly become the surveilled and controlled object of doctors offices and jail cells. In its reactionary moment, revolt is repressed, and the illness is experienced as a limitation, an “inner prison” (8).

The only real right we have in a capitalist society is the right to sell our labor power; when one is perceived to be incapable of doing so due to being depleted by or excluded from the market, they are no longer the bearer of rights and face the law nakedly, as a “human wreck” (26) or a waste product. Healthcare is organized so as to either maintain the exploitability of the ill or at least to contain and manage illness in its repressed form by molding them into a patient dependent on the most profitable, and not necessarily the most effective, medical techniques and medications (60). “Hospitals are places of production in the same way that factories are,” one member said in 1970, “the patient must turn in everything he has produced there: stool, blood, urine, bile [...], headaches, hallucinations [...] These products translate to medical bills, lab bills, administrative costs [...] thus the illness flows back into the state treasury” (SPK Komplex). In more extreme crises, when the sick surplus cannot be maintained at low costs or adjusting it forcibly to a norm, they are dispensed with in camps (5-6). Located in the polyclinic, the function of which was to observe, sort, and ship mental patients to their next destination at the same university where they used to send them off to be murdered, the SPK were uniquely well-situated to make this observation (Roll and Garcia, 150).

As damaged life, illness constitutes an absolute limit of capitalist production: if everyone is fucked up, the work stops. The bodies and minds of workers must be sustained at the very least insofar as they can get up and work again the next day. The working day is limited in part by the hours of the day, but it’s also limited by the reproducibility of laborers (60). This is the fulcrum of the revolutionary potential of illness and where the possibility of the “progressive” moment presents itself, when “fear will turn into a weapon” (83). Illness, insofar as it is an expression of the real contradictions that permeate our social world, is also a form of protest, a rejection of one’s conditions and the expression of the need for transformation. At that point, one can manage it, repress its call, or “turn illness into a weapon.” At its base, this is a variation of the Marxist theme of “immiseration:” capitalism, said Marx, “far more than any other mode of production is a waster of people, of living-work, a waster not only of flesh and blood but also of nerves and brain” (in SPK, 102). By necessity, it makes masses of people more miserable (and, in this case, sick), and, by doing so, the revolutionary hopes, it digs its own grave, for these degraded and humiliated masses won’t put up with it forever. Since schizophrenia is abstractly characterized as the experience of a world split up, in which one part confronts the person as an alien violence, it is fair to say that the goal of the SPK was to develop the contradiction of schizophrenia, which is to say alienation subjectively experienced as a break, as the basis for resistance against capital. In other words, it was schizophrenia armed.

Under capitalism, we are all on fire. Every person burns from the social contradictions degrading their physical and mental integrity. How does one appropriate that burning and turn it into a destructive flame against our conditions? That was the sole question of madness for the SPK. Like most incendiaries, it couldn’t burn for too long: the original group broke up in 1971, with some eventually fleeing to Italy to work with Basaglia or France with Guattari, a few others are said to have been involved with the RAF armed struggle, and still others kept going on as a smaller group called Patient’s Front.


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– “Mental Health in Crisis” Of Unsound Mind.

–“Unreason Speaks!” Of Unsound Mind.

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