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Thursday, February 24, 2011

The Shame of Medicine: Celebrating Coercion

“Coercion is a subjective response to a particular intervention and has been considered an unfortunate but necessary part of the care of people with psychiatric illness.” That definition of the State-sanctioned forcible control of innocent persons labeled mentally ill by persons labeled psychiatrists was offered by Giles Newton-Howes—honorary senior lecturer in the department of psychological medicine, Imperial College London, and consultant psychiatrist at Hawkes Bay District Health Board, Napier, New Zealand—in the editorial in the June 2010 issue of The Psychiatrist, a journal of the Royal College of Psychiatrists (United Kingdom).

In contemporary English the meaning of the noun “coercion” is clear and uncontroversial. The Merriam-Webster online dictionary defines it as “the act, process, or power of coercing; . . . . . . synonyms: arm-twisting, force, compulsion, constraint, duress, pressure . . .; near antonyms: agreement, approval, consent, permission.” Coercion is emphatically not the private “subjective response” of the oppressed person; it is the objective, publicly observable action of the oppressor. According to the authoritative Black’s Law Dictionary (Fourth Revised Edition), the relationship between hospital psychiatrist and patient clearly constitutes coercion: “COERCION. Compulsion; constraint; compelling by force or arms.”

Contemporary practitioners of psychiatry, enlightened by neuroscience, brag about their love of the naked power they exercise over their captives.

In her book Weekends at Bellevue, Julie Holland explains:

So why am I so attracted to this patient population? I’ve always been enthralled by insanity. . . . [N]ow I am the doctor in charge of Bellevue’s psychiatric emergency room. . . . I run two fifteen-hour overnight shifts on Saturday and Sunday nights. They call me “the weekend attending.” It feels just like rock-and-roll psychiatry to me. This is my Saturday night gig. . . . [The police deliver a prisoner receiving methadone detoxification.] I go inside to talk to Nancy [the nurse]. “The cop wants dead weight, the prisoner wants methadone. Looks like we should probably just take advantage of the situation.” We agree to do something that everyone knows damn well is completely against the rules. I have never done it before or since: I tell the patient we are going to give him an injection of methadone, and we give him Thorazine. . . . [S]ometimes down here, the end justifies the means. This way, he calms down, the cop is happy, they both leave and we can go on with our night.

The State-sanctioned forcible control of one group of innocent persons by another group of persons authorized to control them is, of course, as old as civilization. We call its prototype “slavery.” Justified by religious and philosophical authorities, the supporters of such systems of institutionalized domination-submission always felt morally superior to those who rejected their reasoning and opposed their power. Today, the system based on the same age-old rationalizations is called “psychiatry.” I have renamed it “psychiatric slavery.”

“If slavery is not wrong,” declared Abraham Lincoln, “nothing is wrong. I cannot remember when I did not so think, and feel.” Slavery is wrong because it empowers one group of persons to deprive another group of liberty on the ground of who they are, not of what they do. I knew very little about Lincoln when I grew up in post-World War I Hungary. But I did recognize, as a gut feeling, that if the domination of the mental patient by the psychiatrist is not wrong, then nothing is wrong. I cannot remember when I did not so think and feel.

Wrong but Necessary

Many decades later I learned about Lincoln’s more complex, confused, and conflicted opinions about slavery, and also about the inconsistency of libertarians’ passionate commitment to the principle of self-ownership as a pillar of individual liberty and their penchant to turn their gaze away from psychiatric slavery as an integral part of the political-social fabric of modern Western societies.

In 1999 an editorial in the British Medical Journal warned, “The growing pressures on them [psychiatrists] to deliver public protection was perhaps inevitable, given the rise of biopsychomedical paradigms as explanations for the vicissitudes of life in modern Western society. Psychiatrists have played their part by assuming the authority to explain, categorize, manage, and prognose in situations where well defined disease (arguably their only clearcut remit) was not present.”

Such warnings have not deterred prominent psychiatrists from making brazen claims about the nature of psychiatry as a medical specialty. In an editorial in the September 2010 issue of Current Psychiatry, titled “Integrating Psychiatry with Other Medical Specialties,” psychiatrist Henry A. Nasrallah—professor of psychiatry at the University of Cincinnati College of Medicine (my alma mater)—writes, “As a specialty that deals with brain disorders, psychiatry is now much more integrated with other medical and surgical specialties than in the past. Psychiatry is no longer perceived as a ‘different’ discipline. . . .” Where is the outrage at this shameless mendacity? Nowhere.

Forgotten Human-Rights Violations

The human-rights violations of chattel slavery, colonialism, the Inquisition, national socialism, and communism have been well documented. Sporadic reports of the human-rights violations of psychiatry abound in our newspapers and magazines. They are quickly forgotten as exceptional “abuses.” More than 50 years ago I set myself the task of not letting the profession and the public forget that psychiatry—the oppression of the patient by the psychiatrist, today justified as the patient’s liberation from an illness that robs him of freedom and responsibility—belongs in the same pantheon of brutal oppressions as do chattel slavery, colonialism, the Inquisition, national socialism, international socialism (communism), and institutions dedicated to the coercive betterment of humanity not yet invented.

Sixty years ago, when I was young, the psychiatrist was embarrassed by his role as coercer. Now, when I am old, he is proud of it. That, in my opinion, is the sum total of the “progress” achieved by modern, “scientific psychiatry.” It is a fearful truism that we learn from history that we do not learn from history: “The time to guard against corruption and tyranny, is before they shall have gotten hold on us. It is better to keep the wolf out of the fold, than to trust to drawing his teeth and talons after he shall have entered.” (Thomas Jefferson, 1782)

But this wolf does not enter. He is inherent in human nature, and we must purge it from our own souls, one soul at a time.

  • Dr. Thomas Szasz (1920-2012) was a Psychiatrist, academic, and champion of individual rights. He devoted much of his life to campaigning against many aspects of conventional psychiatry, in particular involuntary psychiatric treatment and commitment.