Coercion As Cure

Understanding the history of psychiatry requires an accurate view of its function and purpose. In this provocative new study, Szasz challenges conventional beliefs about psychiatry. He asserts that, in fact, psychiatrists are not concerned with the diagnosis and treatment of bona fide illnesses. Psychiatric tradition, social expectation, and the law make it clear that coercion is the profession's determining characteristic. Psychiatrists may "diagnose" or "treat" people without their consent or even against their clearly expressed wishes, and these involuntary psychiatric interventions are as different as are sexual relations between consenting adults and the sexual violence we call "rape." But the point is not merely the difference between coerced and consensual psychiatry, 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 coercive character of psychiatry was more apparent in the past than it is now. Then, insanity was synonymous with unfitness for liberty. Toward the end of the nineteenth century, a new type of psychiatric relationship developed, when people experiencing so-called "nervous symptoms," sought help. This led to a distinction between two kinds of mental diseases: neuroses and psychoses. Persons who complained about 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. Coercion as Cure is the most important book by Szasz since his landmark The Myth of Mental Illness.

Understanding the history of psychiatry requires an accurate view of its function and purpose. In this provocative new study, Szasz challenges conventional beliefs about psychiatry. He asserts that, in fact, psychiatrists are not concerned with the diagnosis and treatment of bona fide illnesses. Psychiatric tradition, social expectation, and the law make it clear that coercion is the profession's determining characteristic. Psychiatrists may "diagnose" or "treat" people without their consent or even against their clearly expressed wishes, and these involuntary psychiatric interventions are as different as are sexual relations between consenting adults and the sexual violence we call "rape." But the point is not merely the difference between coerced and consensual psychiatry, 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 coercive character of psychiatry was more apparent in the past than it is now. Then, insanity was synonymous with unfitness for liberty. Toward the end of the nineteenth century, a new type of psychiatric relationship developed, when people experiencing so-called "nervous symptoms," sought help. This led to a distinction between two kinds of mental diseases: neuroses and psychoses. Persons who complained about 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. Coercion as Cure is the most important book by Szasz since his landmark The Myth of Mental Illness.

"The book is readable and challenging; readers will never see psychiatry in the same way again." -- Choice Reviews Originally called mad-doctoring, psychiatry began in the seventeenth century with the establishing of madhouses and the legal empowering of doctors to incarcerate persons denominated as insane. Until the end of the nineteenth century, every relationship between psychiatrist and patient was based on domination and coercion, as between master and slave. Psychiatry, its emblem the state mental hospital, was a part of the public sphere, the sphere of coercion. The advent of private psychotherapy, at the end of the nineteenth century, split psychiatry in two: some patients continued to be the involuntary inmates of state hospitals; others became the voluntary patients of privately practicing psychotherapists. Psychotherapy was officially defined as a type of medical treatment, but actually was a secular-medical version of the cure of souls. Relationships between therapist and patient, Thomas Szasz argues, was based on cooperation and contract, as is relationships between employer and employee, or, between clergyman and parishioner. Psychotherapy, its emblem the therapist's office, was a part of the private sphere, the contract. Through most of the twentieth century, psychiatry was a house divided-half-slave, and half-free. During the past few decades, psychiatry became united again: all relations between psychiatrists and patients, regardless of the nature of the interaction between them, are now based on actual or potential coercion. This situation is the result of two major "reforms" that deprive therapist and patient alike of the freedom to contract with one another: Therapists now have a double duty: they must protect all mental patients-involuntary and voluntary, hospitalized or outpatient, incompetent or competent-from themselves. They must also protect the public from all patients. Persons designated as mental patients may be exempted from responsibility for the deleterious consequences of their own behavior if it is attributed to mental illness. The radical differences between the coercive character of mental hospital practices in the public sphere, and the consensual character of psychotherapeutic practices in the private sphere, are thus destroyed. At the same time, as the scope of psychiatric coercion expands from the mental hospital to the psychiatrist's office, its reach extends into every part of society, from early childhood to old age. Thomas Szasz is professor of psychiatry emeritus at the State University of New York Health Science Center in Syracuse, New York and Adjunct Scholar at the Cato Institute, Washington, DC. He is the author of over two dozen books in fifteen languages, including The Myth of Mental Illness and most recently, Pharmacracy: Medicine and Politics in America. "The book is readable and challenging; readers will never see psychiatry in the same way again."--Choice "Szasz now appears to have been transformed into an ally rather than an enemy of the National Health Service general adult psychiatrist. Szasz's project has always been to argue passionately for a boundry of demarcation around the responsibility and power of psychiatry....But what saves this book from being just another mugging of psychiatry is that Szasz does raise a fundamental question at the core of our discipline. If we restricted our attention only to those clients who wanted to see a psychiatrist, and disengaged from all those who really didn't, how different might our professional practice and experience be?"--The British Journal of Psychiatry

Every year, over one million Americans are coerced into 12-step treatments. Peele, a psychologist, attorney, and outspoken critic of the addiction treatment industry, provides intellectual, practical, and scientific background for lay people and professionals to fight against coerced referrals to 12-step addiction treatment and groups. He refutes the disease concept of alcoholism and addiction, describes ways people are coerced into treatment, analyzes evidence for the effectiveness of 12-step treatment, and looks at alternativesAnnotation copyrighted by Book News, Inc., Portland, OR.

“The landmark book that argued that psychiatry consistently expands its definition of mental illness to impose its authority over moral and cultural conflict.” — New York Times The 50th anniversary edition of the most influential critique of psychiatry every written, with a new preface on the age of Prozac and Ritalin and the rise of designer drugs, plus two bonus essays. Thomas Szasz's classic book revolutionized thinking about the nature of the psychiatric profession and the moral implications of its practices. By diagnosing unwanted behavior as mental illness, psychiatrists, Szasz argues, absolve individuals of responsibility for their actions and instead blame their alleged illness. He also critiques Freudian psychology as a pseudoscience and warns against the dangerous overreach of psychiatry into all aspects of modern life.

Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge. This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment. Coercive Treatment in Psychiatry is a much needed contribution to the literature. The first three sections deal with the conceptual and clinical aspects of coercive treatment, the legal aspects and the ethical aspects of coercive treatment. In detail, these sections cover a broad spectrum of issues: coercion in institutions and in the community, coercive treatment and stigma, the definition of best practice standards for coercive treatment, de-escalation of risk situations, recent developments in mental health legislation, mental health care and patients' rights, cross-cultural perspectives on coercive treatment, historical injustice in psychiatry, and paternalism in mental health. The fourth section features users' views on coercive treatment: giving voice to an often-unheeded population. Finally, the book addresses the original topic of coercion and undue influence in decisions to participate in psychiatric research. This book presents the first comprehensive review of the issue of coercion in psychiatry. With chapters written by the leading experts in the field, many of whom are renowned as clear thinkers and experienced clinicians, it may be seen as a starting point for international discussions and initiatives in this field aiming to minimize coercion. Highly Commended in the Psychiatry section of the 2012 BMA Book Awards.

This collection of impassioned essays, published between 1973 and 2006, chronicles Thomas Szasz’s long campaign against the orthodoxies of “pharmacracy,” that is, the alliance of medicine and the state. From “Diagnoses Are Not Diseases” to “The Existential Identity Thief,” “Fatal Temptation,” and “Killing as Therapy,” the book delves into the complex evolution of medicalization, concluding with “Pharmacracy: The New Despotism.” In practice, society must draw a line between what counts as medical practice and what does not. Where it draws that line goes far in defining the kinds of laws its citizens live under, the kinds of medical care they receive, and the kinds of lives they are allowed to live.

The Lobotomist explores one of the darkest chapters of American medicine: the desperate attempt to treat the hundreds of thousands of psychiatric patients in need of help during the middle decades of the twentieth century. Into this crisis stepped Walter Freeman, M.D., who saw a solution in lobotomy, a brain operation intended to reduce the severity of psychotic symptoms. Drawing on Freeman’s documents and interviews with Freeman's family, Jack El-Hai takes a penetrating look at the life and work of this complex scientific genius. The Lobotomist explores one of the darkest chapters of American medicine: the desperate attempt to treat the hundreds of thousands of psychiatric patients in need of help during the middle decades of the twentieth century. Into this crisis stepped Walter Freeman, M.D., who saw a solution in lobotomy, a brain operation intended to reduce the severity of psychotic symptoms. Although many patients did not benefit from the thousands of lobotomies Freeman performed, others believed their lobotomies changed them for the better. Drawing on a rich collection of documents Freeman left behind and interviews with Freeman's family, Jack El-Hai takes a penetrating look into the life of this complex scientific genius and traces the physician's fascinating life and work.

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