Coercion As Cure: A Critical History Of Psychiatry

Categories

Health

Society

This article is based on a recent message by Vince Boehm who sends out alerts, useful news items, and comment to a group of mental health professionals, decision makers and activists.

Vince sends out two essays on the nature of psychiatry as practiced today. The first is by eminent psychiatrist, Thomas Szasz, Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York.   It is titled, COERCION AS CURE: A CRITICAL HISTORY OF PSYCHIATRY, the title of his upcoming book.

Image: "Psychiatry destroys the mind - electroshock: pain and betrayal as therapy" (in German)

The second is by Leonard Roy Frank, commenting on the Szasz essay. Frank is the editor of Random House Webster's Quotationary (20,000 quotes arranged in 1,000 alphabetized categories. His Webster's Wit & Humor Quotationary and his Freedom: Quotes and Passages from the World’s Greatest Freethinkers and 5 gift books titled Inspiration, Love, Money, Wisdom, and Wit, were published by Random House as well.

Leonard is a shock survivor and activist. His Electroshock Quotationary, an illustrated, 154-page collection of chronologically arranged quotations, excerpts, and short essays about the history and nature of the controversial psychiatric procedure known as electroshock (electroconvulsive treatment, ECT) may be downloaded free of charge at http://endofshock.com/102C_ECT.PDF

- - -

Thomas Szasz, the anti-psychiatry psychiatrist, has written an exceptional piece. Among other things, he makes a very important point about psychiatric treatment: Great confusion results from our failure to distinguish between voluntary treatment and society-mandated coercive intervention. While there is nothing wrong with a person deciding to get any treatment they believe will help them, there is great harm in forcibly subjecting a person to drugs, shock or other treatment against their consent.

Mental disease is fictitious disease. Psychiatric diagnosis is disguised disdain. Psychiatric treatment is coercion concealed as care, typically carried out in prisons called “hospitals.” Formerly, the social function of psychiatry was more apparent than it is now. The asylum inmate was incarcerated against his will. Insanity was synonymous with unfitness for liberty. Toward the end of the nineteenth century, a new type of psychiatric relationship entered the medical scene: persons experiencing so-called “nervous symptoms” began to seek medical help, typically from the family physician or a specialist in “nervous disorders.” This led psychiatrists to distinguish between two kinds of mental diseases, neuroses and psychoses: Persons who complained of their own behavior were classified as neurotic, whereas persons about whose behavior others complained were classified as psychotic. The legal, medical, psychiatric, and social denial of this simple distinction and its far-reaching implications undergirds the house of cards that is modern psychiatry.

Of course the principle that each person should be allowed to decide for themselves whether to accept medical intervention or not is valid in much wider fields than psychiatry. Talking about abortion and euthanasia today, I realized that even with such controversial topics, the right to personal self-determination provides a key for finding our way out of these most difficult moral quandaries.

Here are Szasz and Frank on psychiatry:

- - -

COERCION AS CURE: A CRITICAL HISTORY OF PSYCHIATRY

By Thomas Szasz

(found on Ilana Mercer's Barely A Blog)

All modern history, as learnt and taught and accepted, is purely conventional. For sufficient reasons, all persons in authority combined, by a happy union of deceit and concealment, to promote falsehood.

Lord Acton (1834 - 1902)

For more than a century, leading psychiatrists have maintained that psychiatry is hard to define because its scope is so broad. In 1886, Emil Kraepelin, considered the greatest psychiatrist of his age, declared: “Our science has not arrived at a consensus on even its most fundamental principles, let alone on appropriate ends or even on the means to those ends.”

Contrary to such assertions, I maintain that it is easy to define psychiatry. The problem is that defining it truthfully — acknowledging its self-evident ends and the means used to achieve them — is socially unacceptable and professionally suicidal. Psychiatric tradition, social expectation, and the law — both criminal and civil — identify coercion as the profession’s determining characteristic. Accordingly, I regard psychiatry as the theory and practice of coercion, rationalized as the diagnosis of mental illness and justified as medical treatment aimed at protecting the patient from himself and society from the patient. The history of psychiatry I present thus resembles, say, a critical history of missionary Christianity.

The heathen savage does not suffer from lack of insight into the divinity of Jesus, does not lack theological help, and does not seek the services of missionaries. Just so, the psychotic does not suffer from lack of insight into being mentally ill, does not lack psychiatric treatment, and does not seek the services of psychiatrists. This is why the missionary tends to have contempt for the heathen, why the psychiatrist tends to have contempt for the psychotic, and why both conceal their true sentiments behind a facade of caring and compassion. Each meddler believes that he is in possession of the “truth,” each harbors a passionate desire to improve the Other, each feels a deep sense of entitlement to intrude into the life of the Other, and each bitterly resents those who dismiss his precious insights and benevolent interventions as worthless and harmful.

Non-acknowledgment of the fact that coercion is a characteristic and potentially ever-present element of so-called psychiatric treatments is intrinsic to the standard dictionary definitions of psychiatry. The Unabridged Webster’s defines psychiatry as “A branch of medicine that deals with the science and practice of treating mental, emotional, and behavioral disorders.”

Plainly, voluntary psychiatric relations differ from involuntary psychiatric interventions the same way as, say, sexual relations between consenting adults differ from the sexual assaults we call “rape.” Sometimes, to be sure, psychiatrists deal with voluntary patients. As I explain and illustrate throughout this volume, it is necessary, however, not merely to distinguish between coerced and consensual psychiatric relations, but to contrast them. The term “psychiatry” ought to be applied to one or the other, but not both. As long as psychiatrists and society refuse to recognize this, there can be no real psychiatric historiography.

The writings of historians, physicians, journalists, and others addressing the history of psychiatry rest on three erroneous premises: that so-called mental diseases exist, that they are diseases of the brain, and that the incarceration of “dangerous” mental patients is medically rational and morally just. The problems so created are then compounded by failure — purposeful or inadvertent — to distinguish between two radically different kinds of psychiatric practices, consensual and coerced, voluntarily sought and forcibly imposed.

In free societies, ordinary social relations between adults are consensual. Such relations — in business, medicine, religion, and psychiatry — pose no special legal or political problems. By contrast, coercive relations — one person authorized by the state to forcibly compel another person to do or abstain from actions of his choice — are inherently political in nature and are always morally problematic.

Mental disease is fictitious disease. Psychiatric diagnosis is disguised disdain. Psychiatric treatment is coercion concealed as care, typically carried out in prisons called “hospitals.” Formerly, the social function of psychiatry was more apparent than it is now. The asylum inmate was incarcerated against his will. Insanity was synonymous with unfitness for liberty. Toward the end of the nineteenth century, a new type of psychiatric relationship entered the medical scene: persons experiencing so-called “nervous symptoms” began to seek medical help, typically from the family physician or a specialist in “nervous disorders.” This led psychiatrists to distinguish between two kinds of mental diseases, neuroses and psychoses: Persons who complained of their own behavior were classified as neurotic, whereas persons about whose behavior others complained were classified as psychotic. The legal, medical, psychiatric, and social denial of this simple distinction and its far-reaching implications undergirds the house of cards that is modern psychiatry.

The American Psychiatric Association, founded in 1844, was first called the Association of Medical Superintendents of American Institutions for the Insane. In 1892, it was renamed the American Medico-Psychological Association, and in 1921, the American Psychiatric Association (APA). In its first official resolution, the Association declared: “Resolved, that