A Critical History of Psychiatry

A synopsis of the book, as seen on Barely a Blog (now with an updated link)

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.

Former Prison Psychologist Acknowledges Prison Sex with Inmate

From the Fresno Bee

A former prison psychologist this week acknowledged having sex with an inmate she was hired to help at California State Prison, Sacramento.

Marilyn A. Windham, 56, pleaded guilty Tuesday to a felony charge of having sex with a male inmate at the Folsom prison in June 2005. A bodybuilder and aspiring crime novelist, Windham is scheduled to be sentenced Feb. 2. She faces 90 days in county jail.

Court documents show a prison guard discovered the psychologist partially nude and "in a compromising position" with an inmate in the B Facility Clinic.

The inmate told investigators that he went to the room to get supplies "and that it 'just happened,'" according to court documents. He said the act was consensual and had not occurred before.

Windham resigned about a month after the incident. She sent the inmate a card saying, "I want you to know how much I enjoyed knowing you. You made me laugh."

The psychologist had initially faced three felony counts, said Steve Secrest, a supervising deputy district attorney in Sacramento County.

Windham has a public MySpace page and described herself as an "existential psychologist," according to The Sacramento Bee.

"Dr. Windham believes in the significance of the relationship between client and doctor," she wrote on the Internet space.

The MySpace page in question has since been made private

British Mental Health Tsar Resigns Over 'Scandal' of Black Patients

The death of 'Rocky' Bennett in 1998 sparked concerns over discrimination in Britain's psychiatric units. But little has changed since then, as seen in this report

The academic who designed the Government's race equality policy on mental health has resigned over fears that not enough is being done to protect ethnic minorities from mistreatment and discrimination.

Lord Patel of Bradford has told ministers he intends to step down as director of the Department of Health's ethnic minority mental health programme because the "scandal" of the treatment of black patients has not been dealt with.

The independent peer says the situation for ethnic-minority patients is " completely unacceptable", and says the Mental Health Bill should have greater "safeguards" to stop black people being mistreated.

In an interview with The Independent on Sunday, he said a national inquiry was needed into why a disproportionate number of black people were being diagnosed, or misdiagnosed, with serious mental health problems, and why their experience of the mental health system was so poor.

Research shows that black men tend to be given higher doses of medication than whites and are five times more likely to be detained on locked wards. Black people and people of mixed race are at least three times more likely to be admitted to hospital for mental health disorders than whites. They are also far more likely to be referred to mental health services by the police, courts or social services ­ and be diagnosed as psychotic and restrained or secluded in hospital.

Lord Patel's resignation will come as a blow to the Government. The peer, who has been in the post for three years, framed policy on tackling race inequalities and is highly regarded in government.

But Lord Patel said he was dismayed at the disproportionate use of control and seclusion orders and said the Government had yet to answer on why so many ethnic minorities were being detained. "I think there is a situation that is completely unacceptable. It's the last remaining care scandal. This is a major scandal," he said.

His resignation follows concerns that the Government has failed to properly conduct an assessment of the impact on race of its Mental Health Bill.

A census of mental health provision to be published in the coming weeks is expected to show that a disproportionate number of ethnic minorities are being detained. The academic, who is head of the Centre for Ethnicity and Health at the University of Central Lancashire, said he resigned to enable him to speak out against discrimination. Lord Patel, who is also chair-man of the Mental Health Commission, believes protections for ethnic minorities ­ and a duty to monitor the impact of the legislation on ethnic minorities ­ should be written into the Mental Health Bill before Parliament.

"Surely any government would want to know why this is happening," Lord Patel said. "We need a committee of inquiry. The census shows they are 50 per cent more likely to receive restraint or seclusion. Nearly 30 per cent of the population in high-security psychiatric care are black. We have an obligation to ensure that any future legislation must mitigate this situation. We should be putting race equality principles on the face of the Bill," he said.

Race discrimination in the mental health services was highlighted by the case of David "Rocky" Bennett, pictured above, who died of asphyxia in 1998 after being restrained for almost half an hour by five members of staff while in a secure mental health unit. The 38-year-old former musician had had an altercation with a fellow patient.

An inquest in 2001 ruled that his death, at a Norvic secure unit in Norwich, had been aggravated by neglect. Mr Bennett became angry that he, not the white patient, was being moved off the ward. His family were not told about his death until two days later.

'Gay Curer' Psychologist Claims Africans 'Better Off' As Slaves

As seen in this item

In the latest episode of the so-called "ex-gay" movement's straying toward racial bigotry, the movement's leaders and its Christian right allies have failed to condemn an essay arguing Civil Rights Movement was "irrational."

A prominent member of the National Association for Research & Therapy of Homosexuality (NARTH) is under fire for publishing an essay in which he argues that Africans were fortunate to have been sold into slavery, and the civil rights movement was "irrational."

"There is another way, or other ways, to look at the race issue in America," writes Gerald Schoenewolf, a member of NARTH's Science Advisory Committee. "Africa at the time of slavery was still primarily a jungle… Life there was savage … and those brought to America, and other countries, were in many ways better off."

NARTH is a coalition of psychologists who believe it's possible to "cure" homosexuality, a position rejected by the American Psychological Association and the American Medical Association. The controversy over Schoenewolf's apology for slavery has battered the so-called "ex-gay" movement with accusations of racial bigotry for the first time. The movement's leaders and their close allies at Christian Right powerhouses like Focus on the Family have failed to condemn Schoenwolf's inflammatory arguments.

Titled "Gay Rights and Political Correctness: A Brief History," Schoenewolf's angry polemic was published on NARTH's website. In addition to his outrageous historical claims about the conditions of life in Africa, he writes that human rights proponents are intellectually stunted. (Schoenewolf draws upon Swiss child psychologist Jean Piaget, who theorized four stages of intellectual development, with the most advanced stage consisting of abstract and complex thinking. "[F]ollowers in the Human Rights Movement," have not reached this stage, according to Schoenewolf.)

Schoenewolf, a psychotherapist who lives in New York City, is director of The Living Center, an online therapy center for people in the arts. He has authored 14 books, among them The Art of Hating, in which he writes, "Many people talk about hate, but few know how to hate well."

When interviewed last week for this article, Schoenewolf stood by his comments on the intellectual inferiority of civil rights movement supporters. "The civil rights movement has from the beginning and today seen itself as good and others are evil, like slaveowners are evil," he said.

During the interview, Schoenewolf lambasted civil rights, women's rights, and gay rights. "All such movements are destructive," he said. He also claimed the American Psychological Association, of which he is a member, "has been taken over by extremist gays."

Schoenewolf's essay first appeared on NARTH's website in the fall of 2005, but apparently went unnoticed by critics until mid-September, around the time the executive director of the National Black Justice Coalition, a black gay and lesbian advocacy organization, delivered to NARTH a formal letter of protest. "In the name of propriety, respect, common decency and professional integrity, the National Black Justice Coalition strongly urges NARTH to issue a public apology on the front page of its website for publishing such an outrageous and offensive article," wrote H. Alexander Robinson. "We also hope that you reevaluate your relationship with Dr. Schoenewolf, whose peculiar views have no place in civilized discourse."

Then, in late September, the gay rights group Truth Wins Out called on Focus on the Family to cancel a speaking appearance by NARTH executive director Joseph Nicolosi scheduled for a Focus on the Family conference held September 23 in Palm Springs, Calif.

Nicolosi appeared as planned. But the Schoenewolf essay was erased from NARTH's website the same day as the Focus on the Family conference. Then, on October 6, NARTH posted this statement to its website: "NARTH regrets the comments made by Dr. Schoenwolf about slavery which have been misconstrued by some of our readers. It should go without saying that we do not wish to minimize the suffering of those who have been mistreated because of race, sex, religious beliefs or sexual orientation." The statement makes no mention of the civil rights movement.

Nicolosi has yet to publicly address the future of Schoenewolf's relationship with NARTH. He also did not respond to multiple voice mail messages and E-mails seeking comment for this article. Michael Haley, manager of Focus on the Family's homosexuality and gender department, likewise did not respond. Calls and E-mails to Focus on the Family press managers went unanswered.

For now, Schoenewolf remains a member of NARTH's Science Advisory Committee. This committee has "the authority of opinion and the authority of their recommendations," over what is published by NARTH, according to former committee member David Blakeslee, who resigned in protest over the Schoenewolf essay Sept. 29.

"Whenever a scientific organization speaks inaccurately about science and conflates it with politics, the general public can be significantly misled and harmed," he wrote in his letter of resigation.

In an interview for this report, Blakeslee said: "Schoenewolf's article was so over the line that it justifiably outraged a number of people."

Even so, other NARTH members have leapt to Schoenewolf's defense on the organization's official blog, whose administrator, "Sojourneer," summed up the outcry over the essay as "lies and distortion, in an attempt to discredit Narth [sic] and Dr. Shoenewolf [sic]."

"Just because Schoenewolf said some good can come out of a bad situation [slavery] does not make him a racist," the NARTH administrator wrote. "It was just his opinion and does not reflect Narth's [sic] position on the topic."

So what exactly is NARTH's position on equal rights for non-whites? On the NARTH website, the section marked "NARTH and Civil Rights" states: "It is NARTH's position that science, not activism, should inform legal decisions and public policies," a position that could easily be read to support Schoenewolf's hostility towards the civil rights movement. NARTH's position statement is particularly ironic in light of the organization's close relationship with Focus on the Family, which clearly engages in political activism.

Blakeslee isn't the only NARTH supporter to sever ties with the organization over its failure to denounce Schoenewolf.

"This was a slam dunk. They should have said, 'These are not our views.' People have asked them to clarify what they meant by this and [instead] they've in fact defended it," says Warren Throckmorton, a professor of psychology at Grove City College and a former member of NARTH.

Before the Schoenewolf controversy, Throckmorton was slated to present at NARTH's annual conference in November in Orlando, Fla. Now, he's pulled out, and wants nothing to do with the group.

"This stuff about political correctness and slavery is very far outfield," he said. "I'm appalled by it, and a lot of people within NARTH are as well, but they don't have the authority to speak out on it. And those who do have the authority aren't."

Psychiatrist's Racist Comments gets Talk Show in Trouble.

The Canadian Radio-television and telecommunications Commission has reprimanded Quebec's top-rated Sunday night talk show Tout le Monde en Parle (All the World in Talk, i.e., Everyone's Talking About It) over racist comments by one of its guests, Psychiatrist Pierre Mailloux. As seen in this report:

Quebec's top-rated Sunday night talk show was reprimanded by the Canadian Radio-television and telecommunications Commission last week over racist comments by one of its guests.

Canada's broadcast regulator found that Pierre (Doc) Mailloux made comments about blacks on the Radio-Canada program Tout le monde en parle that were "denigrating, insulting and offensive."

On the Sept. 25, 2005 program, psychiatrist Mailloux claimed to have studies that "demonstrate that the average intelligence quotient of blacks and American Indians is clearly lower than 100."

The CRTC's reprimand came as Quebec National Assembly committee conducted hearings last week on racism and discrimination affecting the seven per cent or close to 500,000 Quebec citizens who are classified as visible minorities.

Senegal-born professor-turned-humourist Boucar Diouf, who provides a look "at Quebec culture through African eyes" on Radio-Canada's morning radio show in Quebec City, said Mailloux's extreme statements are not an isolated case.

"There are lots of Doc Mailloux in the media," he said. "I don't call them racists. They are I-don't-give-a-damns (je-m'en-fou'istes). Because they do it to increase their ratings."

Diouf appears on Radio-Canada television's La fosse aux Lionnes and does humorous folk-wisdom capsules on the morning radio show.

"My role is to get up on stage to knock down these images," he said.

Racism and discrimination have no place in a responsible society, said Diouf, who has been following the National Assembly hearings.

"Otherwise we will get to the point where they are in France today with people who were born in the country, who grew up in the country and who absolutely do not feel French."

Documents prepared for the hearings suggest overt statements such as Mailloux's are only one of the types of discrimination facing visible minorities.

They note that while unemployment among Quebec blacks, Arabs, Asians and other visible minorities can be as high as 20 per cent, well above the eight-per-cent provincial average, 22 per cent of visible minorities have university degrees, above the 14-per-cent provincial average.

Among black Quebecers, 15 per cent have university degrees, while 32 per cent of Arab Quebecers, the province's fastest-growing visible minority, have university degrees.

But Alexandre Boulerice, of the Canadian Union of Public Employees, said repeated public commitments by ministers in favour of minority hiring do not always translate into jobs.

"There is an old-boys club," he said.

While the Quebec Treasury Board has a goal of 25 per cent visible minorities, aboriginals, anglophones and handicapped, and 14 per cent of recent hirings are from these groups, the average remains near four per cent.

Inquiry finds British National Health Service 'racist to the core'

A probe into the death of a schizophrenic man at a mental health clinic near Norwich has slammed the NHS as "racist to the core". Racism and outdated techniques have been blamed for the death of David 'Rocky' Bennett. Mr Bennett, 38, died while being held face-down in the Norvic Clinic, in Thorpe St Andrew, in October 1998, after fighting with a fellow patient and hitting a nurse. On the final day of an independent inquiry sanctioned by the Government, the National Health Service was accused of institutional racism.

Sadiq Khan, the lawyer of Dr Joanna Bennett, Mr Bennett's sister, who lectures on the care of psychiatric patients, said: "We believe there is a hierarchy among NHS patients, with young black men at the bottom. There is a stark difference in the treatment of a young black man and a middle-aged white man, with the same symptoms or condition. The way black people are treated is staggering — we are in no doubt there is institutional racism in the National Health Service."

Now there is proof

Townhill Hospital to be Investigated

Pietermaritzburg, South Africa - Allegations of abuse and neglect at Townhill Hospital have prompted the health department to appoint a three-person investigating team. The mental facility's record of negligence took a turn for the worse last week when yet another patient was reported missing. "Veronica Mondi went missing from the psycho-geriatric ward and the hospital had the dog unit out to look for her," said a source close to the hospital. In another incident, Bhekisile Dlamini was trying to escape from a seclusion room in one of the hospital's high security female sections when she strangled herself by accident.

A dog unit?, but there's more ....

One person describer the place as follows: "Some staff members still come to work drunk, they hit the patients and eat their food. How can they have children at a place like this?"

It is also alleged that in June last year a patient was sexually molested by other patients in a gruesome incident.