Thomas Szasz ‘Coercion as Cure’

Ch 1: Mental Hospitalisation: Therapeutic ImprisonmentIncarceration is the job of the psychiatrist. There is no such thing as mental illness, and MH is rightly stigmatised because it is another form of prison. Psychiatric identities are imposed on millions, as are treatments. Objective methods cannot be used t detect MH. Eg someone with a microbiological diseases will respond to antibiotics whether given voluntarily or involuntarily. People with schizophrenia are deemed to have no insight. The idea of MH and asylums is a recent development, starting in the late 18th century with Bedlam and Bicetre. (Me: there were no mental hospitals in the Bible and none for Henry VIII to plunder.) Idea of illness is a fallacy and is an excuse for detention. Detention is the main outcome. This may be to protect the public. However coercion and detention are not for public health like with a contagion. It is not like with a true medical phenomenon. Psychiatric coercion as medical treatment may be a hoax. I.e. To describe IT as therapy is fallacious as all it is, is menial labour. (Slave labour as Margaret said.) Institutions and MH can be a political football with each side vying to outdo each other. (Me: competitive stigmatisation of MH.) Impaired awareness of illness is called anosognosia – lack of insight. Therefore it is necessary to have forced treatment. Anosognosia may be the result of a brain lesion (sic), maintain its supporters. Szasz proposes the abolition of psychiatric coercion (p21). The idea of caring coercion for those who have no insight. It is said that anosognosia is the single largest reason for non-compliance with medication by those with schizophrenia and bipolar. What about horrendous side effects as disincentive? (me). Thomas says a main reason for coercive control is that many mentally ill persons reject or would like to reject, role of

mental patient. (cf guy who denies need for new identity and who wants his job in London back).Thomas points to Shakespeare not referring to madhouses (me: neither are they in the Bible nor were plundered by Henry VIII.) They are a modern invention. Rich people were incarcerated in private madhouses, later extended to pauper lunatics in public insane asylums. That is an oxymoron, that places for the insane can be asylums, refuges. For the inmate, an asylum is a place of detention. Predicament: how to square rights to liberty and property with detention? This was squared by using duty of care towards incapacitous insane person. This was a service for the propertied classes which began in England and France in 1700’s. (written up by Michel Foucault.) Szasz revisits his themes on Mediaeval witchcraft when he says that the mad could be tortured to improve their chances in the afterlife. Detention by the clergy was replaced by detention by psychiatric coercion. There was collusion between madhouse keepers and their paymasters. ‘The pecuniary interest of the proprietor and the secret wishes of the lunatic’s relatives, led not only to the neglect of all means of a cure, but also the prevention and delay in recovery.’ (p31.) Is there something of this today (me)? Szasz states that he disagrees with the deprivation of liberty of the mentally ill (as he always does). Individuals can be detained because it is in the interests of others (Reg, drug dealers, and someone at Reading University). Wives were detained (eg Grace). 1958: mental hospitals are ‘bankrupt beyond remedy’ (p 34). After WW2, in America they sought to regenerate the force of the Manhattan Project by seeking victory in the War on Mental Illness. There was hope around the use of drugs, there was less scrutiny around compulsions to expedite progress. Szasz states that mental illness is a public health and social problem. This is because the typical mental patient is ‘unemployed and unemployable,

homeless, economically dependent on his family or society, and inclined to violate marginal or not-so-marginal social rules.’ This is what Szasz believes (p36). Hospitals were closed not because of drug advances, or because of other cure, but because the federal government ordered it. Szasz bemoans the taboo against scrutinising the concept of mental illness. 1989: Congressional committee pronounced on ‘national tragedy’ of homes staffed by poorly paid dispensing complicated doses of psychotropic drugs. When mental hospitals were closed, they didn’t ask question: where will people live? (We have community care in the UK). Szasz himself is blamed for this by being associated with move to close hospitals from 1960’s on. Szasz is not pleased by the claim that he was part of Laing’s counter-culture because they did not deny the existence of mental illness, and did not repudiate involuntary incarceration in hospitals. He says metal illness is here because society itself is sick. Szasz names Charen, Isaac, and Armat as associating him with the movement to close asylums, calling him a ‘do-badder’ depriving sick people of the care they need. He quotes: Szasz says mental illness is a social construct, a prejudice, not a diagnosis. Szasz is associated with Ken Kesey. Kesey wrote ‘One Flew Over’ and Thomas doubts that this liberated patients with the closure of the asylums. Thomas instead likes ‘The Titicut Follies’, which was banned. All hospital staff are jailers. Media proclaim chemical causes and cures for MH (Terry Hammond). (Me: if identity is a social construct then there is influence of media profiles.) Psychiatrists’ old foe is freedom. ‘Freedom will not cure MH, as witnessed by condition of many who are deinstitutionalised.’ (Applebaum of AMA...American Medical Association?) Me: Should ask: how can we cope with freedom? ‘Most homeless mentally ill are grateful for a safe and warm hospital

bed’ (Krauthammer – look up in index). No, really, we want you to have the confidence that there is indeed a good and quality life for you out of hospital, including being looked after by the state (Me). In US, state hospitals are being turned into homes, as in UK.Hospitals have been phased out, but psychiatric coercion has not. All MH professionals now have the duty to give neuroleptic drugs, and to incarcerate in case of danger to self or others. Like Patricia Deegan’s ‘prediction of her future.’ Some SU’s subscribe to the medical model and authorise ECT if they get ill. Szasz criticises SCT as law-ordered treatment under the threat of involuntary hospitalisation. Torrey talks of the schizophrenic’s ‘lack of insight.’ (p49). There is no biological evidence for this. P 49 he mentions depot injections and a SU dropping his pants. A few lines on he talks of the ‘bottom line.’ Psychiatry is the prevention of harm, not provision of treatment. Criticises MHA as indefinite treatment regardless of response to drugs or other treatment (yes for Michael W, but not true of me.) He says all admissions are potentially coercive, and not voluntary as they are all backed up with threat of detention. (Me: where is this going?) Szasz says all places of involuntary detention should be called jails. (cf Hellingly identity for me: old lag but not valued student.) People escaped ‘grim conditions and sometimes brutal treatment’ when the institutions were closed. (But where is this going?) Szasz states that many mentally ill people now end up in prison. All enquiry, even well meant enquiry, into the world of mental illness, results only in repetition of portraits of the mentally ill as mostly violent subhumans who can be treated as such. Those who gain are highly paid psychiatrists and drug companies. Coercion, handcuffs etc:- what kind of message does this give to the patient? Over the last century, forced admissions as a result of mental illness have increased 15-fold. From 1967 to 2000, the number of forensic

psychiatrists increased 250-fold. Szasz says that ‘chlorpromazine era’ should really read ‘the era of chemical lobotomy.’ Szasz mentions depot injections (p58 bottom of page.) The first psychiatric practice was incarceration. This saw in the era of treating madness as an illness. Before, it was not treated as a medical matter. Medicalisation justified medical management. Diagnosis prevailed (without proof, as remains today). Diagnosis became the tool for detention. Question of civil liberties we seldom ask: how can it be that innocent people are incarcerated and guilty people excused? Two hundred years ago, people knew that madhouses were coercive places. Today that coercion is covert as psychiatry is now located in the community.

psychiatrists increased 250-fold. Szasz says that ‘chlorpromazine era’ should really read ‘the era of chemical lobotomy.’ Szasz mentions depot injections (p58 bottom of page.) The first psychiatric practice was incarceration. This saw in the era of treating madness as an illness. Before, it was not treated as a medical matter. Medicalisation justified medical management. Diagnosis prevailed (without proof, as remains today). Diagnosis became the tool for detention. Question of civil liberties we seldom ask: how can it be that innocent people are incarcerated and guilty people excused? Two hundred years ago, people knew that madhouses were coercive places. Today that coercion is covert as psychiatry is now located in the community.