Defining Psychiatry

By Szasz, Thomas | Freeman, July/August 2007 | Go to article overview

Defining Psychiatry


Szasz, Thomas, Freeman


In the United States today everyone considers himself an expert on psychiatry, especially in the aftermath of a mass murder by a "deranged madman." Yet academically and legally qualified experts in the field keep telling us that they cannot even define psychiatry.

In 1886 Emil Kraepelin, the undisputed founder of modern psychiatry as a medical specialty and science, 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." Eighty years later, the encyclopedic American Handbook of Psychiatry opened with this statement: "Perhaps no other field of human endeavor is so . . . difficult to define as that of psychiatry." Two years ago, Andrew Lakoff, a professor of sociology at the University of California in San Diego, airily opined: "Two centuries after its invention, psychiatry's illnesses have neither known causes nor definitive treatments." This did not prevent him from writing a book about the diagnosis and treatment of a particular mental illness in a particular country: "bipolar illness" in Argentina.

Contrary to these and similar assertions, I submit that it is easy to define psychiatry. The problem is that doing so-acknowledging its self-evident ends and the means used to achieve them-is socially unacceptable and professionally suicidal. The law, social expectation, and psychiatric tradition and practice point to coercion as the profession's paradigmatic characteristic. Accordingly, I define 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. It is impolite and impolitic to take this truism and its consequences seriously.

Consider this parallel between psychiatry and 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. Similarly, 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 façade 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. According to the Unabridged Webster's, psychiatry is "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 have shown elsewhere, it is necessary therefore 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 nor any popular understanding of the varied practices called "psychiatric treatments."

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.

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