Antipsychiatry

I debated whether to call this post "antipsychiatry" or "critical psychiatry". Hardly anyone label themselves "antipsychiatrist", at least not these days. It's mostly a term very conservative psychiatrists and psychologists use to smear everyone who disagrees with them. But "critical psychiatry", which is something people do use about their own work, seems a bit too broad. We can think of "criticism" as existing on a scale from those who see systematic problems in psychiatry and the need for some reforms, over those who see the need for very extensive reforms, to those who basically want to tear the whole system down and can properly be called "anti". I want to look at those who are more towards the "anti" end of the scale in this post.

Psychiatry needs criticizing

1. Bad doctors 

Psychiatry absolutely needs criticizing, and there are absolutely systematic problems in the field that cannot be explained away as isolated incidents. I've met some wonderful doctors both as a patient and as a scholar, but there are also many who treat their patients badly, not just "a few bad apples" here and there. 
There are psychiatrists who think that there's no need to listen to their patients or take seriously what they say since they're crazy anyway. Some may have an okay attitude to some patient groups, while being horribly dismissive to, e.g., BPD patients and people with schizo diagnoses. Many psychiatrists serving in mental health tribunals believe that any patient who disagrees in any way whatsoever with their doctor thereby exhibits "lack of insight" (Susanna Radovic has done research on this). Psychiatrists can be very dismissive of patient complaints about medication side effects, even when these cause terrible suffering. Patients may get more and more diagnoses and more and more meds prescribed until they're basically zombies.

The last problem - loads of diagnoses, loads of meds - need not stem from dismissive attitudes towards patients, but an honest desire to help. A psychiatrist once told me that he suspected something like this often goes on: the psychiatrist tries one treatment after the other for the initial diagnosis, but none helps. Both doctor and patient feel frustrated and desperate. When the doctor tells the patient "hey, I think the problem might be that you actually have X in addition to Y! I'm gonna prescribe you a medication for X too!" both of them feel better and more hopeful. But after a while, when the patient still hasn't improved, they feel frustrated and desperate again ... until the doctor once again goes "hey, I think the problem might be that you actually have Z in addition to X and Y!" and they feel momentarily better. And so the vicious circle continues.
Moreover, present-day diagnostic manuals stress what's most unique about each diagnosis, rather than what's most typical. (Mads Henriksen held an interesting presentation about this at a conference I attended earlier this summer.) It is, for instance, very common and typical for schizophrenia patients to suffer from anxiety. But anxiety is hardly unique for schizophrenia - diagnostic criteria instead stress more unusual symptoms like hallucinations. Therefore, psychiatrists might think that a schizophrenia patient who suffers from anxiety has an additional condition - an anxiety disorder - which requires additional medication. Similarly, it's very common and typical for schizophrenia patients to have difficulties with focus and motivation. But psychiatrists may think this means that the patient also has ADHD, and should get ADHD meds on top of the antipsychotics (that is, a medication designed to increase dopamine flow in the brain in addition to a medication designed to block dopamine flow ...). 

There are also common problems with how psychiatry is depicted in mainstream media and social media. 

2. The modern humor theory

There is legit research on how various psychiatric symptoms may be connected to various brain phenomena and brain events involving various neurotransmitters, but it's all very complicated. However, in popular media and social media, we often encounter a kind of updated humor theory of mental disorders.
In antiquity and the middle ages, people believed that the body has four primary fluids or humors - blood, phlegm, black bile and yellow bile. When these are properly balanced, you're healthy, but imbalances lead to both physical and mental problems. Today, people talk about serotonin, dopamine, perhaps oxytocin and adrenaline too. They must be balanced - if they're imbalanced, mental problems result. The role of the psychiatrist is presumably to prescribe medications that rebalance the different neurotransmitters in the brain. Related to this is the bullshit analogy between diabetes and depression, and insulin and antidepressants.
Many psychiatric patients (perhaps mostly depression patients and people who take meds for ADHD) embrace and spread this modern humor theory because they've been told that they're just lazy and should pull themselves together - saying that they have a chemical imbalance in their brains which is comparable to diabetes is their way of pushing back against the laziness accusations. However, people who believe this theory and believe that psychotropic drugs are like insulin for diabetes will also believe that everyone with a psychiatric diagnosis must be on meds, that it's self-destructive not to. This isn't great either. Especially psychosis patients are often pushed to take meds even if the meds don't work, or even if it makes them all-things-considered worse off, and dismissed as too crazy to understand their own good if they object. I'm not saying that people never quit their meds for stupid and ill-considered reasons - in the past, I have myself quit antipsychotics on a number of occassions because tralalala, I feel so good now, I must be cured! But people also quit them for rational reasons, like I did five years ago, after carefully considering the pros and cons and my whole life situation.

The modern humor theory is compatible with all kinds of explanations of what causes them to go imbalanced in the first place. However, there's a widespread tendency to think that if your brain humors are imbalanced, that's really just a quirk of your brain. Perhaps environmental factors may play some small role, but it's mostly just about what's inside your skull, not about your environment. This is both very problematic and very unscientific - personal trauma, family dysfunction, abuse, poverty, job stress, being PoC in a racist society, etc., are all important causes of psychiatric problems. There's plenty of research on this, but popular media and social media tend to focus on humors and genes. 

3. Just get help

People often say that those who suffer and struggle should just "seek help", with the implicit assumption that everyone can be helped and get better if only they choose to. But even if you find a wonderful psychiatrist, the meds might not work, you might be a so-called "non-responder", you might be unable to recover because of shitty life circumstances that you and your psychiatrist are equally helpless to do anything about, and so on. And there is absolutely no guarantee that you manage to find a wonderful or even descent psychiatrist - a shitty one might be worse than having no professional mental health care at all.
The assumption that people who continue to struggle and struggle basically have themselves to blame for not "seeking help" - like, don't they know that there is help to get - is harmful.

To sum up: There's plenty to criticize. But.

BUT

1. Antipsychiatry and the problematic contrast between psychiatry and somatic medicine

Antipsychiatrists like to argue that psychiatry is radically unlike all somatic medicine. Whereas all somatic medicine is super scientific and objective, with reliable diagnostic methods, obvious borders between "healthy" and "sick", not value-laden at all, psychiatry is unscentific, subjective, unreliable, and all about society's values.
Robert Chapman has published at length about this, but here goes the short version: No. Somatic medicine is not all that antipsychiatry cracks it up to be. Psychiatry needs criticism, but somatic medicine does too!

"Somatic medicine" has many subfields and deals with many different kinds of conditions. Some areas might fit the description antipsychiatrists give better than others - for instance, if someone has a bacterial infection we might be able to determine exactly which bacteria it is and which antibiotics will kill them. We might be able to draw a definite line between those who suffer from this infection and those who don't. But grey areas between healthy and ill are everywhere. When is a hairline fracture in a bone an actual medical problem? When does a little menstrual pain turn into a medical issue? Debilitating back pain is one of the most common physical medical problems, and also one that we can't reliably diagnose except by talking to the patient about their problems. There are some weak correlations between debilitating back pain and stuff you can see on a spinal X-ray, but only weak ones - just like you can see some weak correlations between certain detectable brain events and psychiatric problems.
Generally, anyone who says that there's a clear-cut, objective and non-value-laden difference between what's healthy and what's pathological in somatic medicine thereby shits on the entire field of disability studies. 

2. Anti-psychiatry and dismissing people's lived experience

People have very different experiences with psychiatry, ranging from terrible and in itself traumatizing to positive, helpful, even life-changing. However, just like painting all of psychiatry as great and helpful dismisses many people's negative experiences, painting all of it as shitty dismisses positive experiences. 

I'm not saying that people can't be mistaken about their own experiences, that they can't be caught up in "false consciousness", that they can't fail to see that some system they're deeply caught up in actually oppresses and hurts them. What I am saying is this: The burden of proof should be placed on the person who wants to dismiss people's own narratives as mistaken. 

This goes for medication too. People can be mistaken about the effect a certain medication has on them, that's why we do double-blind randomized trials. But once again, the burden of proof should be on the person who claims the pill-taker is mistaken about the effects of the pill. If I believe in homeopathy and insists that sugar pills have a dramatic effect on my health because of water memory, I think it's fine to dismiss my story based on science in general. But if I take a pill that we know does stuff to the brain, the burden of proof should be on the person who insists that I'm wrong about how it affects me mentally.

I was on antipsychotics for many years. We know that their effects vary a lot from person to person (unfortunately for both doctors and patients, since it's tough to go through lengthy trial-and-error periods looking for a medication that does its job without intolerable side effects). I'm sure there's a sizeable portion of the psychotic population for whom all antipsychotics do is numb them down, but I'm also pretty sure that's not everyone.
When Haldol lost its desired effect on me, I desperately compensated by taking more and more Xanax. Xanax, a benzodiazepine, does numb me down. It extingiushes all my worries, and if I took enough, I wasn't scared of my demons anymore. But Haldol, for quite a lot of years, took the demons away with only a little numbing. Actually, I used to think that it didn't bring me down at all, but after I quit them, I realized that wasn't true. I became more energetic, more creative, more fast-thinking, off Haldol than I was on them. Nevertheless, they were very different from Xanax in their effect on me. I could work full-time on Haldol with no demons - whereas getting rid of the demons, or at least the demon fear, with Xanax, required getting pretty damn drugged.
Now, an antipsychiatrist who claims that I am deeply mistaken - actually, Haldol did nothing but numb me as well, anything in addition must be pure placebo effect - should have the burden of proof on their side. If I and others like me, who do experience a different effect from antipsychotics than benzo, couldn't tell the difference between antipsychotics and benzo in a blinded trial, that would be proof. But in the absence of such studies, we should accept patient testimony. For some, antipsychotics only numb them, for others, it has a more targeted effect.

3. Antipsychiatry and the claim that psychiatry "pathologizes" this or that group

Antipsychiatrists can also move far too quickly from "this demographic receives more psychiatric diagnoses than the population at large" to "this demographic is unduly pathologized". This is a bad move. Yes, sometimes groups are unduly pathologized. The often cited example of "draeptomania" - an alleged mental illness that caused nineteenth century American slaves to run away from the plantations - isn't actually illustrative, because even at the time, most doctors thought this was preposterous. But more recent, actual examples include diagnosing political dissidents with schizophrenia in the Soviet Union and afro-Americans fighting for civili rights with paranoia and psychosis in 1970's USA. However, being oppressed and marginalized can actually make people sick too, physically as well as mentally.
For instance, being black in a predominantly white society increases the risk that one will be diagnosed with paranoid schizophrenia, and being black in a predominantly white neighbourhood increases the risk even further (even though it's unlikely that doctors would have more racist prejudice against black people who live in white neighbourhoods than against those who live in mostly black areas). Psychologist Richard Bentall and others have written about this research, and suggests that people who frequently suffers from real racism might have a higher risk of eventually breaking down and becoming clinically paranoid (Bentall thinks there's also an increased risk if you've been bullied, or just generally persecuted in some manner in real life). I don't think this is surprising - but we miss out on how much marginalization and discrimination hurt people if we dismiss any increased frequency of psychiatric diagnoses as due to "pathologization". 

Comparison: Shift workers have an increased risk of cardiovascular problems. Imagine how problematic it would be if we argued that this is only because medicine has a "day job norm", and therefore considers the softer, more open arteries and rythmical heart beats of day workers "normal", whereas the stiffer, closed-up arteries and irregular hearts of shift workers are "pathologized". 

4. Antipsychiatry and being cool

Finally - antipsychiatrists frequently insist that there's no such thing as "psychosis", there's only "trauma". We shouldn't say, according to these people, that trauma can cause psychosis, because that's already wrong and mystifying. Traumatized people are traumatized, that's all there is. There are no psychotics, only trauma victims. 

Well. If someone thinks they've been misdiagnosied as psychotic, when really they were only traumatized, I say we should listen to them - see above on the importance of taking people's own narratives and stories seriously. But don't push that narrative on me!

I may be tragic in some ways. (Or were tragic in some ways, I'm actually quite well off nowadays!) But I'm also kinda cool, I think. Even my most terrifying psychotic experiences have been much more interesting than just "it's trauma" can convey. (Demons! Alternate realities!) I mean, I have experienced plenty of altered states of consciousness without the aid of drugs. That's kinda cool!
So fuck off to anyone who insists that no, you're not cool, you're only tragic and traumatized.

Oppressing the powerful: Why groups can't be compared to individuals

Over at the specfic writing website Mythcreants , Oren Ashkenazi has written a number of posts about "oppressed mages" in fiction and why that concept doesn't work. He's also gotten tons of hate from people who don't like to see their favourite stories critiqued. I think he's making lots of good points in these articles, though I disagree with some of his comparisons. In any case, I'm not just gonna repeat his arguments in my blogpost, that would be pretty pointless. Instead, I'm gonna discuss crucial differences between oppressing a group which is powerful collectively, and oppressing people who are powerful individually.

Terminology

"Mages", in this context, need not refer to literal wizards in a fantasy setting. It can also be mutants with superpowers, or anyone else who's 

a) individually powerful, and

b) whose power doesn't depend on social conventions and other people going along with them.

For instance, Joe Biden, the president of the United States, and Jeff Bezos, one of the world's richest capitalists, are both powerful individuals. But if, hypothetically, everyone in the US decided that Biden shouldn't count as their president, or everyone working for Bezos decided not to take orders from him anymore or allow him to handle money and assets, they would lose their power. This is in contrast to a fictional character like Superman who is enormously strong, physically invulnerable, capable of flying through space at light-speed and so on regardless of what others think of him.

The term "oppressed mages" refers specifically to scenarios in which regular, non-powered people oppress mages as defined above. Scenarios in which one group of mages oppress another don't count. There are some stories in which non-powered people get the upper hand because they have superior tech, like in older X-men stories where regular people use sentinel robots to hunt superpowered mutants. But why don't mages get tech as well? Tech+powers should beat tech only. For a long time, this went unexplained in the X-men (most line-ups include some very rich members; they've even had Forge on the team sometimes, whose superpower is to build amazing tech), until the "House of X" storyline in which it was revealed that the sentinels aren't human creations but cosmic machine gods. This changes the scenario from "oppressed mages" to a "mages vs mages" conflict. (This has probably changed again since I last read the X-men - I'm too old to keep up with superhero comics anymore.)

Anyway. In this post, I focus only on regular humans who oppress mages without the aid of superior tech that the mages (usually for unexplained reasons) lack access to.

In my previous post, I said that you can enjoy flawed stories - we don't have to choose between saying that something is problematic and therefore must be rejected or enjoying it while insisting that it's perfect. Just because there are aspects of, e.g., the X-men, that don't hold up to scrutiny, doesn't mean it's wrong to enjoy the comics or movies - I read the hell out of those comics for years and years.
But lots of people do think you're only allowed to enjoy perfect things, and if they're fans of oppressed mage stories, they desperately insist that it makes sense for regular, non-powered people to oppress superpowered beings.They say that the real world is riddled with examples of small minorities who oppress much larger groups, despite the latter being more powerful in virtue of group size. Now I'm gonna explain why that isn't comparable.

The Gunman Theory of oppression

Imagine you're riding a train in the wild west. Suddenly, the engineer must stop because the rail has been blocked, and a gunman enters the train car. He waves his single revolver wich contains only a handful of bullets at the car full of passangers, and demands that you all throw over your wallets and jewelry. You do as he says, and he takes off with all your belongings. But how could this happen? After all, the whole collective of passengers could have taken him down. At most, he could have shot one or two of you before he was overwhelmed by sheer numbers. 
There's no mystery here. No one wants to die. Even if he could "only" shoot one or two before being overwhelmed, it's a pretty big deal for those who end up dead (and their friends and family). If no one in the car wants to rush him first and be gunned down, everyone's gonna remain seated and do as he says. 

A large group, collectively powerful enough to take out a smaller group of oppressors, might thus need at least a few members who are willing to die for the cause, or risk other serious consequences, in order to get going. In addition, they likely need to coordinate their efforts, and this may be a huge obstacle in itself. 

Suppose you have a society which depends on slavery, with ten times as many slaves as there are slave-owners. If all or most of the slaves rebel at the same time, the rebellion is virtually guaranteed to succeed, even though those who are first in line are likely to be gunned down. But if only a small group rise up, everyone in that group will be killed straight away (or worse), their attempted rebellion fails, and they died for nothing. And the slaves are scattered, unable to plan a simultaneous uprising. If we imagine that they all have cellphones or similar, their prospects look a little better, but they would have to worry about fake calls and spies, or that too many people will chicken out at the last minute.

The Ideology Theory of oppression

In the philosophical literature on oppression, not everyone sticks to the Gunman Theory. Some stress ideology and indoctrination instead. Oppressed people may abstain from rebellion because they have been indoctrinated into thinking their subordinate position is just. They may think that no better society is possible, so there's no choice but to make do with what they've got. They may be so ashamed of belonging to the oppressed group that they wouldn't dream of striking back at their (perceived) betters, etc. 

The Gunman theory and Ideology theory are compatible. Both factors can be in play. Moreover, oppressed people who, at some level, realize that they're in a "gunman type situation", might be motivated to adopt beliefs according to which things are okay the way they are. If they can't change the situation anyway, they might at least feel a little better if they tell themselves that everything is okay.

Now, I'm not gonna try to solve the question of whether "gunman factors" or "ideology" usually play the biggest part in preserving oppression. But I do think you'd be hard-pressed to come up with a real oppressive society that solely relies on ideology/indoctrination to keep the oppressed masses in check. You'd be hard-pressed to think of a real oppressive society in which the oppressed could communicate perfectly and transparently with each other, and the oppressors were unable to punish any individual rebels - but the oppressed still stayed in line, solely due to indoctrination.

This isn't what real-world oppression looks like. Regardless of how much indoctrination the oppressors have at their disposal, they'll also have brute force to back it up.

Mages, gunmen and ideology

If you replace a large group of people which is only collectively strong with individually powerful mages, Gunman-style oppression becomes impossible. Let's replace the group of passangers in the train, collectively strong enough to take out the gunman but one or two will probably be killed, with someone like Wolverine from the X-men, who's individually strong enough to take out the gunman. The gunman can shoot Wolverine and it'll smart a bit, but he'll heal up in seconds and can punch out the gunman without breaking a sweat. Of course he's not just gonna sit there and do as he's told. If we move over to the slave society, but replace the multitude of slaves with just Superman, he's not gonna obey the plantation owners. Sure, they might try to oppress him with ideology alone. "You must do as we say because we have decided that you're inferior and should be ashamed of yourself because your powers make you a freak! That's what we're gonna do to you if you don't obey us - we're gonna yell freak freak freak until you cry!" But how effective is this gonna be, really? 

I guess we can imagine Superman swayed by the "freak" insult if he's been indoctrinated since he was a baby. Even so. Real-life oppressors can be afraid of rebellion - afraid that their victims manage to communicate even though it's hard, and afraid that they'll be willing to risk their lives and die for a better future for their children. But they know that the threshold for rebellion remains quite high, due to everything I wrote under the "Gunman Theory" heading. In the enslaved Superman scenario, all it takes is Superman's anger getting stronger than his shame for a moment, and it's game over for his oppressors. Their situation would be so much more precarious than anything any real-world oppressor has ever experienced. 

Only people utterly devoid of survival instinct and self-interest would try to oppress Superman via indoctrination rather than play nice with him.

But what about sheer numbers?

I've heard the argument that a large enough number of regular people could realistically oppress a small enough number of mages. Let's use the original X-men as an example, since they're not quite as over-powered as many later line-ups. If a bunch of normies attack the X-men, Professor X can fuck with their minds, Marvel Girl telekinetically throw rocks at them, Iceman freeze them, Beast fight them with superhuman agility, Cyclops blast them with eye-lasers, and Angel stomp at their heads or something. But sure - if hundreds of angry humans rush them simultaneously, they're not gonna keep up. They could realistically be beaten to death in that situation. The idea is that this should make the X-men afraid of normies rather than the other way around. 

But this is just the Gunman-on-the-train scenario all over, except the X-men are now placed in the Gunman role and the normies are the passangers. A whole bunch of regular people will be grievously injured or dead before they manage to take the X-men out. (Maybe few deaths and many injuries if the X-men try super hard not to actually kill anyone, but people are generally reluctant to be injured too.) If the X-men were evil oppressors, people might eventually be motivated to risk life and limb to put an end to this horrible oppression - but it's extremely unlikely that pure bigotry would be enough to motivate people to give up their lives. 

If you look at hate-crimes in the real world, they typically play out like this: A bunch of people attack a smaller number, perhaps just one, minority person, or a big and strong hater attack a much smaller and weaker person. We don't see, say, the tiniest homophobes attack enormous muscular Tom-of-Finland-style gay men. We don't see teeny-weeny homophobes get beaten up, attacking again while yelling even more slurs, get beaten up again, fractured, concussed, but they keep yelling, they keep attacking, because their homophobia is just so much stronger than their sense of self-preservation. 

To sum up: A minority may oppress a collectively strong majority. It doesn't follow that regular people would be capable of oppressing individually strong mages.

Wish-fulfilment fantasies and real life

 The following scenario is widely recognized to be a wish-fulfilment fantasy: The heroine in some YA novel mostly read by girls has two hot dudes competing for her affections, and she must choose between them. It's such a common take now to go "they should just go poly and they could all be together", and sure, it would be cool with a wider array of relationships in fiction, but let's set that aside for now. The people involved don't want to have a poly relationship, and the heroine must choose.

Why is this a wish-fulfilment fantasy? After all, it's not a fun situation in real life. She cares about both boys, and when you care about someone, you don't want to see them sad - but inevitably, the one she turns down will be sad and disappointed. Also, even if they try to be all mature about the situation and stay good friends, this is often difficult in practice.
The reason it's still an escapist fantasy that many like to read about (or watch) is that fiction need not treat the situation very realistically and really dig into these problems. Instead, it focuses on how desirable the heroine is. Girls learn from an early age that it's extremely important to be desirable to boys/men, and if you've got two guys who are hot themselves competing for your affections, that means you're super desirable! 

Once we realize that fictional scenarios need not be any fun in real life to provide wish-fulfilment and escapist fantasies to the audience, we can also see that there's so much more fiction that fills this role than just "YA heroine must choose between two hot guys".

Major clarification before I move on: It's possible to really enjoy some piece of fiction and still recognize that it has problematic elements worth criticizing. We don't need to choose between rejecting something, or embracing it while vehemently insisting that it's perfect. I'm gonna talk about Rick and Morty, and I love that show! I've enjoyed the hell out of it from the start! I can still criticize it! "This is perfect" and "this is problematic and therefore terrible and must be rejected" is a false dichotomy!

Okay, here goes: Rick and Morty is a great show but a substantial chunk of the fanbase are made up by terrible people. This shouldn't come as a surprise, since the titular Rick provides wish-fulfilment for nasty people.
Rick is a huge jerk himself, but he's simultaneously the smartest and bestest person in the world (at least in early seasons - later on, he sometimes looks stupid and pathetic, and he doesn't always come out on top anymore). Even when he completely fucks up, like that time he turned the world into a "Cronenberg nightmare" and had to hop over to a different dimension, it's the kind of grand fuck-up only the smartest and the bestest could make. As terrible as he is to other people, their ability to stand up to him and talk back tends to be limited by how inferior they are.
Now, if you're a terrible jerk-ass yourself, this likely has negative consequences for your social life and life in general. But if you're nasty and hateful, you don't want to fantasize about some shiny happy scenario in which you're popular and nice with tons of friends, because you don't like other people, so you don't want to be nice to them or friends with them. Instead, you'll fantasize about being as shitty to others as you like, but they must put up with it, and you get away with it without negative consequences. 

Now, I've seen people argue that douchebags for whom Rick is a wish-fulfilment fantasy haven't paid sufficient attention to the show, because we actually see that he's also lonely and depressed, and even contemplates suicide at one point.
And sure, being depressed or even suicidal isn't fun in real life (duh!). But it can still serve as wish-fulfilment in fiction that doesn't dig into a realistic portrayal of these terrible feelings, but instead just use them as a kind of jerkass license. When Morty feels that he's had enough of Rick's shit and it's time to stand up for himself, Birdperson explicitly says that he mustn't do that. You see, Rick feels bad, and therefore, everyone should keep swallowing all his shit and never talk back. He must be allowed to vent and shit on everyone else as much as he feels like, because he's depressed.
People can fantasize about being the smartest and the bestest in the world, but it's usually obvious that this is never gonna happen to them. But a situation in which everyone around you goes "oh, now I finally understand how hard things are for you! How grand your suffering! I will never again complain about your behaviour - from now on, I will show you nothing but compassion, understanding, and admiration for how well you bear your grand suffering, regardless of what you do or say to me!" might seem like something that could actually happen. So people can absolutely fantasize about, not suffering in itself, but having their suffering recognized as a valid license to be shitty.

This also goes for tragic backstories like murdered parents or a fridged girlfriend. Of course this would be terrible in real life. But if those dead loved ones only fill the narrative function of making the hero cool, dark and brooding and giving him a license to be shitty to others, such deaths can definitely serve a wish-fulfilment purpose. 

So why does any of this even matter? Well, I'm not gonna claim it's super important to be able to spot wish-fulfilment fantasies when you see them. But off the top of my head, I can think of two reasons:

1. If you're a writer, you might want to know whether you write something that works as wish-fulfilment, and if so, for which demographic. That way, you can make conscious choices instead of being taken by surprise by what kind of fans you attract.

2. Also, if you think wish-fulfilment stories are bad and should be criticized - you shouldn't just criticize stuff like Twilight, but stuff like Rick and Morty as well.