American Iatrogenic Association Library
Information that improves understanding of medical error, philosphy, and practice
|
Book Review The history of man’s unsuccessful and sorry efforts to deal with his mental problems is well documented but seldom read. Moreover, its message has never been accepted and acted upon. We have learned little from our misguided efforts in the name of healing, despite our vaunted scientific progress. The assumption that mental health is synonymous with physical health is a catastrophic mistake and a glaring failure to understand the basic nature of the human being. This erroneous assumption is the foundation and guiding principle of the pseudoscientific branch of modern medicine we call psychiatry. To correct this error and to completely revolutionize the way that modern medicine regards and treats those individuals whose behavior deviates from the norm has been the lifelong crusade of the 82-year-old psychiatrist, Thomas Szasz. Throughout his brilliant and distinguished career, and in the pages of some 30 books and hundreds of articles in scientific, medical, and popular journals, Szasz has waged an often solitary, unrelenting battle against medical misunderstanding, medical error, medical mistreatment, medical abuse, and medical injustice in its dealings with people whose behavior is odd or deviant, and who, therefore, are labeled “mentally ill.” According to Szasz, the very concept of “mental illness” is colossal mistake and error of judgment. From his first scholarly article in 1947, Szasz has issued a steady stream of publications defending human freedom and individual liberty. He has offered principled opposition to all that infringes on the individuals right to medical self-determination. His first book, Pain and Pleasure (1957) was a mild criticism of the psychiatric (medical) view that all pain has a physical origin for which medication is the answer. His second book, The Myth of Mental Illness (1961) notified the medical world that he was a major intellectual force to be reckoned with. He shocked the psychiatric profession by arguing that in no way was “mental illness” akin to those disorders caused by bacteria or viruses. Labeling people as “mentally ill” freed them from personal responsibility for their actions, gave psychiatrists the power to commit people involuntarily to “mental hospitals,” and promoted the erroneous view that diseases of the mind and diseases of the brain were identical. Almost all so-called mental disorders are emotional disorders, that is disorders of thinking and behavior that cannot be likened to physical disorders, like cancer and pneumonia. As it continues to do, when The Myth of Mental Illness was published psychiatric thinking held that all “mental” disorders were “physical,” and if no physical or neurological defect had been found to explain a disorder, eventually it would turn up. The quintessential example of this logical error is psychiatry’s futile 200 year search for the biological cause and physiological marker for “schizophrenia,” — a categorical error analogous to attempting to photograph a dream. Szasz has maintained from the outset that involuntary psychiatric commitment is worse than being sentenced to prison because prisoners are released after serving their time. Not so with hospital inmates. They are incarcerated at the discretion of psychiatrists, often for a lifetime, and often because they are said to be dangerous. Szasz correctly notes that it isn’t the alleged dangerousness of “mental patients” that is really matters, but who the person is and in what manner he is dangerous. For example, drunk drivers kill many more people than paranoids, yet paranoids are readily subject to psychiatric commitment while drunk drivers are not. The “mental hospitals” (prisons staffed by medical guards) where the “mentally ill” are committed, do not make their inmates better, they make them worse as they soon adapt to being institutionalized, losing the social skills they had before confinement. Szasz’s third book, Law, Liberty and Psychiatry (1963) earned him even more attention and respect, as well as making his views more controversial and himself more despised by the psychiatric establishment, who did their damnedest to blacken his name and ridicule his views. Szasz coined the term “Therapeutic State” in 1963 to describe a society that invokes medical justifications for stripping individuals of their rights and lives. He has unflinchingly confronted psychiatry’s “medical model,” the pseudoscientific excuse for managing and controlling every aspect of human behavior. Despite his efforts, the Therapeutic State has only grown in reach and power, with its biological theories and genetic speculations having lead to the “diseasing,” “shrinking” and tranquilizing of Americans. Obeisance to the Therapeutic State is why we are now a “nation of victims.” Rather than succeeding in its avowed aim of producing and maintaining “mentally healthy citizens,” psychiatry has instead created a nation of whining, self-pitying, and irresponsible “drug” and “therapy” addicts, increasingly incapable of living free, independent, and spontaneous lives, which are, paradoxically, what psychiatry claims are its goals. Szasz has courageously fought the Therapeutic State in a series of books and papers attacking its fundamental assumptions, and contentions: The Manufacture of Madness (1970), The Therapeutic State (1984), The Theology of Medicine (1977), The Myth of Psychotherapy (1978), Ceremonial Chemistry (1974), Schizophrenia: The Sacred Symbol of Psychiatry (1976), and Pharmacracy: Medicine and Politics in America (2001). In Our Right to Drugs (1992), Szasz shows that under the paternalistic guise of protecting the vulnerable members of our society — children, minorities, the infirmed— government has persecuted and injured them. Instead of offering useless “protection” to blacks and Hispanics from “dangerous” drugs, our “holy war” on people who self-medicate (dishonestly called a “war on drugs”) has allowed us to persecute them in the name of therapy. Just as tragically, millions of sick Americans are deprived of valuable medications they need because we have made effective painkillers illegal or available only through a prescription that most physicians are afraid to provide lest they come to attention of state medical boards and lose their licenses. In Liberation by Oppression, his latest thrust at the Therapeutic State and psychiatric mendacity, Szasz leaves no doubt as the to legitimacy and credibility of his arguments. Masquerading as therapy, and in the name of medicine, present-day psychiatry subjects its patients (victims) to the most heinous forms of mental and physical oppression. Comparing psychiatry with slavery may seem extreme at first glance, but as Szasz expands his argument we find his reasoning profound and convincing. Since the state proclaims that psychiatry is a branch of medicine and that all mental diseases are brain diseases, psychiatry takes ever-greater control of people and their behaviors. With the power to forcibly drug, restrain, and imprison, psychiatry occupies the throne of the Therapeutic State. Despite all of its self-proclaimed efforts to “free” persons from their “illnesses,” it actually oppresses and confines them. Therapeutic enslavement by psychiatry is worse than all the forms of political slavery the world has thus far endured. In his introduction, Szasz points out that psychiatrists, aided by uncritical judges, have the power to diagnose and treat an individual against his will. He details the similarities between chattel slavery and coercive psychiatric interventions. He observes that psychiatric diagnoses, treatments, and incarcerations —like the Spanish Inquisition— allow for no dissent since the doctors have the power to enforce obedience. Standard psychiatric practice relies on coercion, but coercive control of bad behavior should be invoked on moral and political, not medical and therapeutic grounds. Psychiatric slavery is, in every way inimical to individual liberty and responsibility, to the rule of law and the very existence of a free society. And criminal behavior is by no means the only thing that qualifies a person to be forcibly treated by psychiatry. With the creative expansion of psychiatric diagnoses, virtually everyone now qualifies as “mentally ill” and is vulnerable to forced treatments. Whereas in the past mental patients were restrained physically, today they are restrained chemically, with pharmacological restraint masquerading as therapy. In the view of psychiatrists, the right to refuse treatment is one right too many. In 1900, 67 percent of the “mentally ill” were deemed “recovered” and released from confinement in an average of 3.9 months. That was a much better outcome than coercive drugging produces today. Unfortunately, most Americans now believe that giving psychiatrists more power is beneficial, and most psychiatrists believe that people have the “right” to be rescued but not to be left alone. But while the evidence for the positive effects of psychiatry is lacking, the proofs of its harm are voluminous, as Szasz powerfully demonstrates. In the first chapter of Liberation by Oppression, Szasz explains that two kinds of people are psychiatrically imprisoned: criminals and crazies. Here he also reviews the way the “mentally ill” were treated in the past, and addresses critical questions. Why do so many people refuse treatment? If psychiatric medications really help, why do so many people stop taking them? And why do so many people labeled crazy by psychiatry not consider themselves crazy? Szasz says that psychiatric practices will always remain controversial and problematic as long as we cannot decide how to regard patients, therapists, and mental hospitals. Are patients competent adults who ought to be treated as moral agents, or incompetent wards of the state who need to be sheltered by depriving them of liberty? Are psychiatrists primarily physicians or jailers? Are psychiatric institutions hospitals or prisons? Szasz looks at the psychiatrist’s role as putative public protector. Assuming the duty to warn about dangerous madmen and to protect both patient and public, psychiatrists greatly expand their power. Accepting the role of rescue agents, psychiatrists wholeheartedly embrace the Tarasoff ruling that gave them the duty to warn about the dangerousness of their patients, despite the fact that neither they nor anyone else has the ability to predict future violent behavior. Psychiatrists frequently make contradictory claims about their ability to predict patient behavior, but if they could actually predict violence they would not be such frequent victims of their own patients’ assaults. Nonetheless, claiming that “dangerousness” is a disease further enhances psychiatry’s claim to exercise repressive powers. Szasz proposes the creation of an ingenious new legal instrument, the Psychiatric Will, a living will that would protect people against psychiatric predations. This will would clarify, mediate, and eventually resolve conflict between the coercive psychiatrist and the coerced patient. The Psychiatric Will would preserve the right of the psychiatrist to administer and the patient to receive treatment, providing the patient agrees. This new will would compel lawyers and psychiatrists to confront and transcend the misleading conflation of “mental illness” with decisional impairment and legal incompetence. The Psychiatric Will would facilitate the gradual emancipation of the mental patient from psychiatric tutelage and lead to the eventual abolition of psychiatric slavery. Patient and doctor together could use the will to transform a potentially coercive relationship into a consensual one. In Szasz’s view, psychiatry’s fundamental reason for existing is to create two classes of people: the many who are stigmatized as mentally ill and subject to coercive psychiatric intervention, and the few who are left unmolested In the “peculiar institution,” the very idea of the self-determination of the slave was an insult to his master. In the Therapeutic State the Patient’s Self-Determination Act (PSDA) insults the psychiatrist and strikes him as absurd. The PSDA was enacted by Congress in 1991 to protect common law rights and affirm patients’ rights to reject certain treatments and interventions. Because of the inherently coercive nature of psychiatry, this Act has never been properly extended to psychiatric patients, who are deemed as unworthy of constitutional protections as were black slaves. In his last two chapters, Szasz deals with psychiatry’s current efforts to expand and solidify its dominion. The first major technique of expansion is outpatient commitment. Incredible as it may seem, Szasz has been blamed for the large-scale deinstitutionalization of mental patients that took place in the 1960s and 1970s. The fiction perpetuated by his critics is that the mental hospitals kicked out their patients because Szasz declared that mental illness was a myth. That claim is as dishonest as it is historically inaccurate. The real justification for deinstitutionalization was economic: it cost a lot of money to keep a large number of people incarcerated in the psychiatric prisons. The “solution,” agreed to by liberals and conservatives, Democrats and Republicans, has been a tacit agreement that “the only good mental patient is a drugged mental patient.” Since most mental health professionals, and most of the general public, believe that forcing people to take drugs is treatment, implementing outpatient commitment and then investigating its effectiveness is very big business for the Psychiatric Industrial Complex. An old joke in the mental health business goes, “The neurotic builds castles in the air. The psychotic lives in them. And the psychiatrist collects the rent.” He also collects the taxes and tyrannizes the patient under the guise of liberating him. In this connection Szasz quotes C.S. Lewis’s sage observation: “Of all the tyrannies, a tyranny sincerely exercised for the good of the victims may be the most oppressive…To be ‘cured’ against one’s will and to be ‘cured’ of states which we do not even regard as disease, is to be put on a level with those who have not yet reached the age of reason or those who never will, to be classed with infants, imbeciles, and domestic animals.” In his Epilogue, titled “Liberty is the prevention of control by others,” Szasz poignantly explains, “All my professional life I have opposed the basic principles and practices of psychiatry — mental illness, civil commitment, and the insanity defense. I was not the first person, nor will I be the last, to find himself in opposition to some of the sacred principles of the society and group…” He then quotes Lord Acton as saying, “It takes a gentleman to live on terms of hearty friendship and kindness and intimacy with men whose ideas and conduct he abhors and when he well knows that they view with contempt and horror the principles on which he shapes his own character and life.” “As I look back on my life,” Szasz observes, “I pride myself on having been able to follow Acton’s example, at least in this regard.” For more than five decades, the gentleman Thomas Szasz has stood resolute in defying a powerful profession that has tried its best but failed to destroy him. As a staunch defender of liberty and a champion of the most vulnerable among us, Dr. Szasz deserves our deepest gratitude and respect. History will remember him kindly for his unwavering battle against psychiatric error, pseudoscience, and medical tyranny that, in the name of the Therapeutic State, continues to do irreparable and unforgivable harm. Liberation by Oppression is a valiant and worthy effort by one of the great modern thinkers to keep the flame of liberty burning. It is a bold, powerful, and intellectually spirited debunking of the psychiatric pseudoscience that debases the human spirit and damages countless lives. Dr. Szasz’s message urgently needs to reach both those who value science, and those who share the values of the Declaration of Independence. It is masterful defense of both reason and individual rights. Robert A. Baker is Professor of Psychology Emeritus, University of Kentucky. He is a a member of The Council for Scientific Mental Health Practice, and a prolific author. Among his many books is Mind Games: Are We Obsessed with Therapy? (Prometheus Books, 1996.) © 2002, American Iatrogenic Association AiA Home Site Contents American Iatrogenic Association 2513 S. Gessner, #232 Houston, Texas 77063 www.iatrogenic.org aia@iatrogenic.org
|
|
||||||