Merriam-Webster defines psychiatry as "a branch of medicine that deals with mental, emotional, or behavioral disorders"; Wikipedia, as "a medical specialty which exists to study, prevent, and treat mental disorders in humans." These descriptions do not tell us what the psychiatrist does and is expected, legally and professionally, to do. That non-disclosure disguises the ugly truth: psychiatry is coercion masquerading as care. It is testimony to the effectiveness of that feeble disguise — and of our aversion to recognizing embarrassing truths about ourselves and our honored institutions — that most libertarian writers have given, and continue to give, psychiatry a free ride.
Medical specialists are distinguished by the diagnostic and therapeutic methods that characterize their work: the pathologist examines cells, tissues, and body fluids; the surgeon cuts into the living body, removes diseased tissues, and repairs malfunctioning body parts; the anesthesiologist renders the patient unconscious and insensitive to pain; and the psychiatrist coerces and excuses: he identifies innocent persons as "mentally ill and dangerous to themselves and others" and deprives them of liberty, and he excuses people of their responsibilities for their actions and obligations by testifying in court under oath that persons guilty of lawbreaking are not responsible for their criminal acts. The former practice is called "civil commitment," the latter, "the insanity defense." These legal-psychiatric interventions constitute the pillars upon which the edifice called "psychiatry" rests.
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To be sure, psychiatrists also listen and talk to persons who seek their help. However, this does not distinguish them from others; nearly everyone does that. The difficulty peculiar to psychiatry — obvious yet often overlooked — is that the term refers to two radically different kinds of practices: curing-healing “souls” by conversation, and coercing-controlling persons by force, authorized and mandated by the state. Critics of psychiatry, journalists, and the public alike regularly fail to distinguish between the linguistic practice of counseling voluntary clients and the forensic practice of coercing-and-excusing captives of the psychiatric system.
The bread and butter of the modern psychiatrist is: 1) writing prescriptions for psychoactive drugs and pretending that they are therapeutically effective against mental illnesses; 2) prescribing these drugs to persons willing to take them and forcibly compelling persons deemed "seriously mentally ill" to take them against their will; and 3) converting voluntary mental patients who appear to be "dangerous to themselves or others" to involuntary mental patients. Indeed, the modern psychiatrist no longer has the option to reject the use of force vis-à-vis patients: such conduct is considered dereliction of professional responsibility.
In 1967, my efforts to undermine the moral legitimacy of the alliance of psychiatry and the state suffered a serious blow: the creation of the antipsychiatry movement. Voltaire's famous aphorism, "God protect me from my friends, I'll take care of my enemies," proved to apply perfectly to what happened next: although my critique of the alliance of psychiatry and the state antedates by two decades the reinvention and popularization of the term "antipsychiatry," I was smeared as an antipsychiatrist and my critics wasted no time identifying and dismissing me as a "leading antipsychiatrist."
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The psychiatric establishment's rejection of my critique of the concept of mental illness and its defense of coercion as cure and of excuse-making as humanism posed no danger to my work. On the contrary. Contemporary "biological" psychiatrists tacitly recognized that mental illnesses are not, and cannot be, brain diseases: once a putative disease becomes a proven disease it ceases to be classified as a mental disorder and is reclassified as a bodily disease; or, in the persistent absence of such evidence, a mental disorder becomes a nondisease. That is how one type of madness, neurosyphilis, became a brain disease, while another type, masturbatory insanity, became reclassified as a nondisease.
Not surprisingly, the more aggressively I reminded psychiatrists that individuals incarcerated in mental hospitals are deprived of liberty, the more zealously psychiatrists insisted that "mental illnesses are like other illnesses" and that psychiatric institutions are bona fide medical hospitals. The psychiatric establishment's defense of coercions and excuses thus reinforced my argument about the metaphorical nature of mental illness and importance of the distinction between coerced and consensual psychiatry.
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I have long maintained that mental illnesses are counterfeit diseases (nondiseases), that coerced psychiatric relations are like coerced labor relations (slavery), and spent the better part of my professional life criticizing the concept of mental illness, objecting to the practices of involuntary-institutional psychiatry, and advocating the abolition of psychiatric slavery.
In the late 1960s, a group of psychiatrists, led by David Cooper (1931–1986) and Ronald D. Laing (1927–1989), began to criticize conventional psychiatry, especially so-called somatic treatments. But instead of advocating the abolition of Institutional Psychiatry, they sought to replace it with their own brand, which they called "Anti-Psychiatry." By means of this dramatic misnomer, they attracted attention to themselves and deflected attention from what they did, which continued to include coercions and excuses based on psychiatric authority and power. Thus, antipsychiatry is a type of psychiatry. The psychiatrist qua health-care professional is a fraud, and so too is the antipsychiatrist. In Psychiatry: The Science of Lies, I showed that psychiatry — an imitation of medicine — is a form of quackery. In this volume, I show that antipsychiatry — a form of alternative psychiatry — is quackery squared.
My writings form no part of either psychiatry or antipsychiatry and belong to neither. They belong to conceptual analysis, social-political criticism, the defense of liberty, and common sense. This is why I rejected, and continue to reject, psychiatry and antipsychiatry with equal vigor.
This essay is an edited extract from Antipsychiatry: Quackery Squared, by Thomas Szasz, to be published by Syracuse University Press, September 2009.
July 14, 2009
Thomas Szasz is professor of Psychiatry Emeritus at the State University of New York Health Science Center in Syracuse, New York. Visit his website.