Thomas Szasz is
Professor of Psychiatry Emeritus at the State University of New York
Upstate Medical University, in Syracuse, New York. He is the author of
31 books, among them the classic, The Myth of Mental Illness
(1961; revised edition, New York: HarperCollins, 1974). He is widely
recognized as the world's foremost critic of psychiatric coercions and
excuses. He maintains that just as we reject using theological claims
about people's religious states (heresy) as justification for according
them special legal treatment, we ought to reject using psychiatric
claims about people's mental states (mental illness) as justification
for according them special legal treatment.
Dr. Szasz has received many awards for his defense of individual
liberty and responsibility threatened by this modern form of
totalitarianism masquerading as medicine. A frequent and popular
lecturer, he has addressed professional and lay groups, and has
appeared on radio and television, in North, Central, and South America
as well as in Australia, Europe, Japan, and South Africa. His books
have been translated into every major and many less than major
languages. His website is: http://www.szasz.com/.
The following is an edited (eponymous) version of the preface to Dr.
Szasz's forthcoming book. It first appeared on Ilana Mercer's Barely a Blog. Mercer is a FMNN columnist.
COERCION AS CURE: A CRITICAL HISTORY OF PSYCHIATRY
By Thomas Szasz
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
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 it is the unanimous sense of this
convention that the attempt to abandon entirely the use of all means of
personal restraint is not sanctioned by the true interests of the
insane." The APA has never rejected its commitment to the twin claims
that insanity is a medical illness and that coercion is care and cure.
In 2005, Steven S. Sharfstein, president of the APA, reiterated his and
his profession's commitment to coercion. Lamenting "our [the
psychiatrists'] reluctance to use caring, coercive approaches," he
declared: " A person suffering from paranoid schizophrenia with a
history of multiple rehospitalizations for dangerousness and a
reluctance to abide by outpatient treatment, including medications, is
a perfect example of someone who would benefit from these [forcibly
imposed] approaches. We must balance individual rights and freedom with
policies aimed at caring coercion." Seven months later, Sharfstein
conveniently forgot having recently bracketed caring and coercion into
a single act, "caring coercion." Defending "assisted treatment"–a
euphemism for psychiatric coercion– he stated: "In assisted treatment,
such as Kendra's Law in New York, psychiatrists' primary role is to
foster patient improvement and help restore the patient to health."
Psychiatry and society face a paradox. The more
progress scientific psychiatry is said to make, the more intolerable
becomes the idea that mental illness is a myth and that the effort to
treat it a will-o'-the-wisp. The more progress scientific medicine
actually makes, the more undeniable it becomes that "chemical
imbalances" and "hard wiring" are fashionable clichés, not evidence
that problems in living are medical diseases justifiably "treated"
without patient consent. And the more often psychiatrists play the
roles of juries, judges, and prison guards, the more uncomfortable they
feel about being in fact pseudomedical coercers — society's well-paid
patsies. The whole conundrum is too horrible to face. Better to
continue calling unwanted behaviors "diseases" and disturbing persons
"sick," and compel them to submit to psychiatric "care." It is easy to
see, then, why the right-thinking person considers it inconceivable
that there might be no such thing as mental health or mental illness.
Where would that leave the history of psychiatry portrayed as the drama
of heroic physicians combating horrible diseases?
Alexander Solzhenitsyn is right: "Violence can
only be concealed by a lie, and the lie can only be maintained by
violence. Any man who has once proclaimed violence as his method is
inevitably forced to take the lie as his principle."
Scientific discourse is predicated on
intellectual honesty. Psychiatric discourse rests on intellectual
dishonesty. The psychiatrist's basic social mandate is the
coercive-paternalistic protection of the mental patient from himself
and the public from the mental patient. Yet, in the professional
literature as well as the popular media, this is the least noted
feature of psychiatry as a medical specialty. Pointing it out is
considered to be in bad taste. It would be difficult to exaggerate the
extent to which historians of psychiatry as well as mental health
professionals and journalists ignore, deny, and rationalize the
involuntary, coerced, forcibly imposed nature of psychiatric
treatments. This denial is rooted in language. Psychiatrists, lawyers,
journalists, and medical ethicists routinely call incarceration in a
psychiatric prison "hospitalization," and torture forcibly imposed on
the inmate "treatment." Resting their reasoning on the same faulty
premises, psychiatric historians trace alleged advances in the
diagnosis and treatment of mental illnesses to "progress in
neuroscience." In contrast, I focus on what psychiatrists have done to
persons who have rejected their "help" and on how they have
rationalized their "therapeutic" violations of the dignity and liberty
of their ostensible beneficiaries.
I regard consensual human relations, however
misguided by either or both parties, as radically different, morally as
well as politically, from human relations in which one party, empowered
by the state, deprives another of liberty. The history of medicine, no
less than the history of psychiatry, abounds in interventions by
physicians that have harmed rather than helped their patients.
Bloodletting is the most obvious example. Nevertheless, physicians
have, at least until now, abstained from using state-sanctioned force
to systematically impose injurious treatments on medically ill people.
Misguided by fashion and lack of knowledge, sick people have often
sought and willingly submitted to such interventions. In contrast, the
history of psychiatry is, au fond, the story of the forcible imposition
of injurious "medical" interventions on persons called "mental
patients."
In short, where psychiatric historians see
stories about terrible illnesses and heroic treatments, I see stories
about people marching to the beats of different drummers or perhaps
failing to march at all, and terrible injustices committed against
them, rationalized by hollow "therapeutic" justifications. Faced with
vexing personal problems, the "truth" people crave is a simple,
fashionable falsehood. That is an important, albeit bitter, lesson the
history of psychiatry teaches us.
One of the melancholy truths of the story I
have set out to tell is that, stripped of its pseudomedical
ornamentation, it is not a particularly interesting tale. To make it
interesting, I have tried to do what, according to Walt Whitman
(1819-1892), the "greatest poet "does: He "drags the dead out of their
coffins and stands them again on their feet … He says to the past, Rise
and walk before me that I may realize you." To this end, I have, where
possible, cited the exact words psychiatrists have used to justify
their stubborn insistence, over a period of nearly three centuries,
that psychiatric coercion is medical care.