Patient or Prisoner?
On Whose Side Is the Psychiatrist?
JANUARY 01, 2002 by THOMAS S. SZASZ
Many people, especially libertarians, view the government as a bottomless source of political mendacity. Psychiatry has, by definition, always been an arm of the government, since it is authorized by the state to deprive individuals of liberty if they are deemed mentally diseased and dangerous to themselves or others. Nevertheless, most people, including many libertarians, have refused to view the pronouncements of these agents of the state as a bottomless source of medical mendacity.
“Police probe attack by prisoners,” reads the headline of a story in the Detroit Free Press. Subtitle: “Aides hurt in fracas at psychiatric center.” The center is identified as the “Hudson Valley Center, a psychiatric hospital for prisoners.”
Today, the names of madhouses no longer contain terms such as “insanity,” “madness, “mental hospital,” or even “hospital.” They are “centers”—named after a locality or person, the latter typically honoring the memory of a former madhouse keeper. Thus do psychiatrists destigmatize mental institutions, legitimize themselves as physicians, and even more easily restigmatize mental patients as dangerous quasi-criminals. Politicians and psychiatrists prattle about “parity” between medical illnesses and mental illnesses, but this is the farthest thing from their minds. Parity would mean treating people guilty of crimes as criminals, not patients, and treating people called “(mental) patients” as persons, not criminals.
The Hudson Valley Center is a de facto prison. However, not only is the center not called a prison, the arm of the state that operates it is not called the correctional or prison system. It is called the “Michigan Department of Community Health.” Why were the attackers assaulting the personnel administering “community health” to them? “There may have been the intent of trying to escape,” explained a spokeswoman. The term “escape” implies imprisonment.
Embarrassing truths and evil deeds have often been concealed by the deceptive use of language. The sign at the entrance of Nazi concentration camps read: “Arbeit macht frei” (“Work liberates”). We call psychiatric prisons “centers.”
Why do the media, the public, and even many scientists fail to acknowledge the untruths of psychiatry? One reason, illustrated above, is that psychiatrists use medical metaphors as if they named genuine medical diseases, treatments, and institutions. Yet the evidence tells us that psychiatric diseases, patients, and doctors are quite unlike medical diseases, patients, and doctors. Psychiatric doctors listen and talk to patients. Medical doctors examine patients’ bodies. Psychiatrists have “criminally insane patients” and incarcerate them in special “hospitals.” Cardiologists have no criminally ischemic patients; neurologists have no criminally paralyzed patients; ophthalmologists have no criminally astigmatic patients. And that is only the tip of the proverbial iceberg.
Nevertheless, the most eminent psychiatrists maintain that psychiatric diseases are physical diseases. Donald F. Klein, professor of psychiatry at Columbia University, and Paul H. Wender, professor of psychiatry at the University of Utah, state: “Depression and manic-depression are among the most common physical disorders seen in psychiatry.” Yet neither depression nor manic-depression is diagnosed by physical examination (or laboratory tests).
Another reason that people fail to appreciate the deceptions and untruths of psychiatry is that psychiatrists fulfill, and are allowed to fulfill, multiple, often mutually contradictory, social functions. Thus psychiatrists pretend to be—and are accepted as—neuroscientists, studying the brain; neurologists, treating patients with brain diseases, with their consent; mental health professionals, treating patients with mental diseases, with or without their consent; public health physicians, protecting society from dangerous mental illnesses and dangerous mental patients; philosophers and judges, deciding who has free will and responsibility for his actions and who has not, who should be punished and who should be “treated”; guardians of incompetent persons, with power to decide every detail of their ward’s life; and jailers, managing institutions for the confinement of persons deemed “dangerous to themselves or others.”
No other human beings—no physician, no politician, no priest, no lawyer—has this much power over other human beings. Psychiatrists pretend—and society allows them to pretend—that they, they alone, can serve the interests of their adversaries. Prima facie, the interests of involuntary mental patients and psychiatrists conflict. Nevertheless, psychiatrists claim to represent the interests of such “patients.” How do they justify this role? By defining their power to coerce as an exercise in “beneficence.” A professor of psychiatry at the Medical College of Virginia explains: “Psychiatrists and other mental health professionals are charged by society with a mission to relieve the suffering of mental illness. . . . We have a collective responsibility to prevent harm and to prevent needless suffering and death. This obligation is what ethicists call the duty of beneficence.” What psychiatrists call “beneficence” and “collective responsibility,” the victims of psychiatric coercions regard as brutality and legally legitimized violence.
Conflicts Are Not Diseases
Psychiatrists deal with people in conflict with other people or with people conflicted within their own souls (often the two go together). Psychiatrists who hospitalize or treat people against their will deal with individuals who are in conflict with them and with whom they are in conflict. This is why psychiatry resembles religion and criminology more than it resembles medicine. And this is why the legitimacy of psychiatry as a medical specialty depends on the denial that psychiatrists deal with conflicts.
The person who becomes a psychiatrist, rather than, say, a neurologist or veterinarian, chooses to be a party to conflicts and must honestly acknowledge where he stands: is he his patient’s agent or is he the agent of the patient’s adversaries? If the psychiatrist does not acknowledge where he stands, he deserves the fate that Dante believed awaits those who, faced with a conflict between Good and Evil, choose to remain neutral (Canto III, The Inferno, by Dante Alighieri). “They are neither in Hell nor out of it. . . . The law of Dante’s Hell is the law of symbolic retribution. . . . They took no sides, therefore they are given no place.”