Thomas Stephen Szasz
April 15, 1920
|Died||September 8, 2012 92) (aged|
Manlius, New York, U.S.
|Citizenship||Hungary, United States|
|Alma mater||University of Cincinnati|
|Known for||Critique of psychiatry|
|Spouse(s)||Rosine Loshkajian (m. 1951; died 1971)|
|Awards||Award for Greatest Public Service Benefiting the Disadvantaged (1974), Martin Buber Award (1974), Humanist Laureate Award (1995), Great Lake Association of Clinical Medicine Patients' Rights Advocate Award (1995), American Psychological Association Rollo May Award (1998)|
|Institutions||State University of New York, State University of New York Upstate Medical University, American Association for the Abolition of Involuntary Mental Hospitalization|
|Influences|| Karl Kraus |
Thomas Stephen Szasz ( // SAHSS; Hungarian : Szász Tamás István [saːs] ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic, psychiatrist and psychoanalyst. He served for most of his career as professor of psychiatry at the State University of New York Upstate Medical University in Syracuse, New York. A distinguished lifetime fellow of the American Psychiatric Association and a life member of the American Psychoanalytic Association, he was best known as a social critic of the moral and scientific foundations of psychiatry, as what he saw as the social control aims of medicine in modern society, as well as scientism. His books The Myth of Mental Illness (1961) and The Manufacture of Madness (1970) set out some of the arguments most associated with him.
Szasz argued throughout his career that mental illness is a metaphor for human problems in living, and that mental illnesses are not "illnesses" in the sense that physical illnesses are; and that except for a few identifiable brain diseases, there are "neither biological or chemical tests nor biopsy or necropsy findings for verifying DSM diagnoses."
Szasz maintained throughout his career that he was not anti-psychiatry but was rather anti-coercive psychiatry. He was a staunch opponent of civil commitment and involuntary psychiatric treatment but believed in, and practiced, psychiatry and psychotherapy between consenting adults.
His views on special treatment followed from libertarian roots, based on the principles that each person has the right to bodily and mental self-ownership and the right to be free from violence from others, and he criticized the "Free World" as well as the communist states for their use of psychiatry.
Szasz was born to Jewish parents Gyula and Lily Szász on April 15, 1920, in Budapest, Hungary. In 1938, Szasz moved to the United States, where he attended the University of Cincinnati for his Bachelor of Science in physics, and received his M.D. from the same university in 1944.Szasz completed his residency requirement at the Cincinnati General Hospital, then worked at the Chicago Institute for Psychoanalysis from 1951–56, and then for the next five years was a member of its staff – taking 24 months out for duty with the U.S. Naval Reserve.
In 1962 Szasz received a tenured position in medicine at the State University of New York.Szasz had first joined SUNY in 1956.
Szasz's views of psychiatry were influenced by the writings of Frigyes Karinthy.
Thomas Szasz ended his own life on September 8, 2012. He had previously suffered a fall and would have to live in chronic pain otherwise. Szasz argued for the right to suicide in his writings.
Szasz first presented his attack on "mental illness" as a legal term in 1958 in the Columbia Law Review . In his article he argued that mental illness was no more a fact bearing on a suspect's guilt than is possession by the devil.
In 1961 Szasz testified before a United States Senate Committee, arguing that using mental hospitals to incarcerate people defined as insane violated the general assumptions of the patient-doctor relationship, and turned the doctor into a warden and keeper of a prison.
Szasz was convinced there was a metaphorical character to mental disorders, and its uses in psychiatry were frequently injurious. He set himself a task to delegitimize legitimating agencies and authorities, and what he saw as their vast powers, enforced by psychiatrists and other mental health professionals, mental health laws, mental health courts, and mental health sentences. 22:
Szasz was a critic of the influence of modern medicine on society, which he considered to be the secularization of religion's hold on humankind. Criticizing scientism, he targeted psychiatry in particular, underscoring its campaigns against masturbation at the end of the 19th century, its use of medical imagery and language to describe misbehavior, its reliance on involuntary mental hospitalization to protect society, and the use of lobotomy and other interventions to treat psychosis. To sum up his description of the political influence of medicine in modern societies imbued by faith in science, he declared:
Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors. [ page needed ]
Szasz consistently paid attention to the power of language in the establishment and maintenance of the social order, both in small interpersonal and in wider social, economic, and/or political spheres:
The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?... [the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed. 85:
His main arguments can be summarized as follows:
"Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behavior, such as packaged under the wide-ranging term, schizophrenia, as an "illness" or "disease". Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic." 85 He maintained that, while people behave and think in disturbing ways, and those ways may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease. To Szasz, disease can only mean something people "have", while behavior is what people "do". Diseases are "malfunctions of the human body, of the heart, the liver, the kidney, the brain" while "no behavior or misbehavior is a disease or can be a disease. That's not what diseases are." Szasz cited drapetomania as an example of a behavior that many in society did not approve of, being labeled and widely cited as a disease. Likewise, women who did not bend to a man's will were said to have hysteria. He thought that psychiatry actively obscures the difference between behavior and disease in its quest to help or harm parties in conflicts. He maintained that, by calling people diseased, psychiatry attempts to deny them responsibility as moral agents in order to better control them.:
In Szasz's view, people who are said by themselves or others to have a mental illness can only have, at best, "problems in living". Diagnoses of "mental illness" or "mental disorder" (the latter expression called by Szasz a "weasel term" for mental illness) are passed off as "scientific categories" but they remain merely judgments (judgments of disdain) to support certain uses of power by psychiatric authorities. In that line of thinking, schizophrenia becomes not the name of a disease entity but a judgment of extreme psychiatric and social disapprobation. Szasz called schizophrenia "the sacred symbol of psychiatry" because those so labeled have long provided and continue to provide justification for psychiatric theories, treatments, abuses, and reforms.
The figure of the psychotic or schizophrenic person to psychiatric experts and authorities, according to Szasz, is analogous with the figure of the heretic or blasphemer to theological experts and authorities. According to Szasz, to understand the metaphorical nature of the term "disease" in psychiatry, one must first understand its literal meaning in the rest of medicine. To be a true disease, the entity must first, somehow be capable of being approached, measured, or tested in scientific fashion. Second, to be confirmed as a disease, a condition must demonstrate pathology at the cellular or molecular level.
A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. "Mental illnesses" are really problems in living. They are often "like a" disease, argued Szasz, which makes the medical metaphor understandable, but in no way validates it as an accurate description or explanation. Psychiatry is a pseudoscience that parodies medicine by using medical-sounding words invented especially over the last one hundred years. To be clear, heart break and heart attack, or spring fever and typhoid fever belong to two completely different logical categories, and treating one as the other constitutes a category error. Psychiatrists are the successors of "soul doctors", priests who dealt and deal with the spiritual conundrums, dilemmas, and vexations – the "problems in living" – that have troubled people forever.
Psychiatry's main methods are assessment, medication, conversation or rhetoric and incarceration. To the extent that psychiatry presents these problems as "medical diseases", its methods as "medical treatments", and its clients – especially involuntary – as medically ill patients, it embodies a lie and therefore constitutes a fundamental threat to freedom and dignity. Psychiatry, supported by the state through various Mental Health Acts, has become a modern secular state religion according to Szasz. It is a vastly elaborate social control system, using both brute force and subtle indoctrination, which disguises itself under the claims of being rational, systematic and therefore scientific.
According to Szasz, many people fake their presentation of mental illness, i.e., they are malingering. They do so for gain, for example, in order to escape a burden like evading the draft, or to gain access to drugs or financial support, or for some other personally meaningful reason. By definition, the malingerer is knowingly deceitful (although malingering itself has also been called a mental illness or disorder). Szasz mentions malingering in many of his works, but it is not what he has in mind to explain many other manifestations of so-called "mental illness". In those cases, so-called "patients" have something personally significant to communicate – their "problems in living" – but unable to express this via conventional means they resort to illness-imitation behaviour, a somatic protolanguage or "body language", which psychiatrists and psychologists have misguidedly interpreted as the signs/symptoms of real illness.So, for example, "analyzing the origin of the hysterical protolanguage Szasz states that it has a double origin: - the first root is in the somatic structure of human being. The human body is subject to illnesses and disabilities expressed through somatic signs (like paralysis, convulsions, etc.) and somatic sensations (like pain, tiredness, etc.); - the second root can be found into cultural factors."
If we accept that "mental illness" is a euphemism for behaviors that are disapproved of, then the state has no right to force psychiatric "treatment" on these individuals. Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of psychotropic drugs or psychiatric medication). The medicalization of government produces a "therapeutic state", designating someone as, for example, "insane" or as a "drug addict".
In Ceremonial Chemistry (1973), he argued that the same persecution that targeted witches, Jews, gypsies, and homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as scapegoats of the community in ritual ceremonies. To underscore this continuation of religion through medicine, he even takes as example obesity: instead of concentrating on junk food (ill-nutrition), physicians denounced hypernutrition. According to Szasz, despite their scientific appearance, the diets imposed were a moral substitute to the former fasts, and the social injunction not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. As with those thought bad (insane people), and those who took the wrong drugs (drug addicts), medicine created a category for those who had the wrong weight (obesity).
Szasz argued that psychiatrics were created in the 17th century to study and control those who erred from the medical norms of social behavior; a new specialization, drogophobia, was created in the 20th century to study and control those who erred from the medical norms of drug consumption; and then, in the 1960s, another specialization, bariatrics (from the Greek βάρος baros, for "weight"), was created to deal with those who erred from the medical norms concerning the weight the body should have. Thus, he underscores that in 1970, the American Society of Bariatric Physicians had 30 members, and already 450 two years later.[ citation needed ]
Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused.
In an analogy to birth control, Szasz argued that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. He considered suicide to be among the most fundamental rights, but he opposed state-sanctioned euthanasia. In his 2006 book about Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice.
Szasz believed that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrists testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts. Insanity was a legal tactic invented to circumvent the punishments of the Church, which at the time included confiscation of the property of those who committed suicide, often leaving widows and orphans destitute. Only an insane person would do such a thing to his widow and children, it was successfully argued. This is legal mercy masquerading as medicine, according to Szasz.
No one should be deprived of liberty unless he is found guilty of a criminal offense. Depriving a person of liberty for what is said to be his own good is immoral. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment.
Drug addiction is not a "disease" to be cured through legal drugs but a social habit. Szasz also argues in favor of a free market for drugs. He criticized the war on drugs, arguing that using drugs is in fact a victimless crime. Prohibition itself constituted the crime. He argued that the war on drugs leads states to do things that would have never been considered half a century before, such as prohibiting a person from ingesting certain substances or interfering in other countries to impede the production of certain plants, e.g. coca eradication plans, or the campaigns against opium; both are traditional plants opposed by the Western world. Although Szasz was skeptical about the merits of psychotropic medications, he favored the repeal of drug prohibition.
Szasz also drew analogies between the persecution of the drug-using minority and the persecution of Jewish and homosexual minorities.
The Nazis spoke of having a "Jewish problem". We now speak of having a drug-abuse problem. Actually, "Jewish problem" was the name the Germans gave to their persecution of the Jews; "drug-abuse problem" is the name we give to the persecution of people who use certain drugs. 64:
Szasz cites former U.S. Representative James M. Hanley's reference to drug users as "vermin", using "the same metaphor for condemning persons who use or sell illegal drugs that the Nazis used to justify murdering Jews by poison gas – namely, that the persecuted persons are not human beings, but 'vermin.'"
The "Therapeutic State" is a phrase coined by Szasz in 1963. 17 Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured. :17 When faced with demands for measures to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that "we must guard against charges of nanny statism." The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. Nanny just told people what to do; counselors also tell them what to think and what to feel. The "nanny state" was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive – and even more authoritarian.The collaboration between psychiatry and government leads to what Szasz calls the therapeutic state, a system in which disapproved actions, thoughts, and emotions are repressed ("cured") through pseudomedical interventions. :
According to Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion." 515 Faced with the problem of "madness", Western individualism proved to be ill-prepared to defend the rights of the individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if once people agree that they have identified the one true God, or Good, it brings about that they have to guard members and nonmembers of the group from the temptation to worship false gods or goods. :496 A secularization of God and the medicalization of good resulted in the post-Enlightenment version of this view: once people agree that they have identified the one true reason, it brings about that they have to guard against the temptation to worship unreason – that is, madness. :496:
Civil libertarians warn that the marriage of the state with psychiatry could have catastrophic consequences for civilization.In the same vein as the separation of church and state, Szasz believes that a solid wall must exist between psychiatry and the state.
Believing that psychiatric hospitals are like prisons not hospitals and that psychiatrists who subject others to coercion function as judges and jailers not physicians,Szasz made efforts to abolish involuntary psychiatric hospitalization for over two decades, and in 1970 took a part in founding the American Association for the Abolition of Involuntary Mental Hospitalization (AAAIMH). Its founding was announced by Szasz in 1971 in the American Journal of Psychiatry and American Journal of Public Health . The association provided legal help to psychiatric patients and published a journal, The Abolitionist .
In 1969, Szasz and the Church of Scientology co-founded the Citizens Commission on Human Rights (CCHR) to oppose involuntary psychiatric treatments. Szasz served on CCHR's Board of Advisors as Founding Commissioner.In the keynote address at the 25th anniversary of CCHR, Szasz stated, "We should all honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before."
In a 2009 interview aired by the Australian Broadcasting Corporation, Szasz explained his reason for collaborating with CCHR and lack of involvement with Scientology:
Well I got affiliated with an organisation long after I was established as a critic of psychiatry, called Citizens Commission for Human Rights, because they were then the only organisation and they still are the only organisation who had money and had some access to lawyers and were active in trying to free mental patients who were incarcerated in mental hospitals with whom there was nothing wrong, who had committed no crimes, who wanted to get out of the hospital. And that to me was a very worthwhile cause; it's still a very worthwhile cause. I no more believe in their religion or their beliefs than I believe in the beliefs of any other religion. I am an atheist, I don't believe in Christianity, in Judaism, in Islam, in Buddhism and I don't believe in Scientology. I have nothing to do with Scientology.
Szasz was a strong critic of institutional psychiatry and his publications were very widely read. He argued that so-called mental illnesses had no underlying physiological basis, but were unwanted and unpleasant behaviors. Mental illness, he said was only a metaphor that described problems that people faced in their daily lives, labeled as if they were medical diseases. Szasz's ideas had little influence on mainstream psychiatry but were supported by some behavioral and social scientists. Sociologist Erving Goffman, who wrote Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, was skeptical about psychiatric practices. He was concerned that the stigma and social rejection associated with psychiatric treatment might harm people. Thomas Scheff, also a sociologist, had similar reservations.
In the summer of 2001, Szasz took a part in a Russell Tribunal on Human rights in Psychiatry held in Berlin between June 30 and July 2, 2001.The tribunal brought in the two following verdicts: the majority verdict claimed that there was "serious abuse of human rights in psychiatry" and that psychiatry was "guilty of the combination of force and unaccountability"; the minority verdict, signed by the Israeli Law Professor Alon Harel and Brazilian novelist Paulo Coelho, called for "public critical examination of the role of psychiatry".
Szasz was honored with over fifty awards including:
Robert Evan Kendell presents (in Schaler, 2005) a critique of Szasz's conception of disease and the contention that mental illness is "mythical" as presented in The Myth of Mental Illness . Kendell's arguments include the following:
Shorterreplied to Szasz's essay "The myth of mental illness: 50 years later", which was published in journal The Psychiatrist (and delivered as a plenary address at the International Congress of the Royal College of Psychiatrists in Edinburgh on 24 June 2010) – in recognition of the 50th anniversary of The Myth of Mental Illness – with the following principal criticisms:
The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria.
A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as a single episode. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional.
Psychiatric hospitals, also known as mental health hospitals, and mental health units, are hospitals or wards specializing in the treatment of serious mental disorders, such as major depressive disorder, schizophrenia and bipolar disorder. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on a voluntary basis, but people whom psychiatrists believe may pose a significant danger to themselves or others may be subject to involuntary commitment. Psychiatric hospitals may also be referred to as psychiatric wards or units when they are a subunit of a regular hospital.
Anti-psychiatry is a movement based on the view that psychiatric treatment is more often damaging than helpful to patients. It considers psychiatry a coercive instrument of oppression due to an unequal power relationship between doctor and patient, and a highly subjective diagnostic process. Wrongful involuntary commitment is an important issue in the movement. It has been active in various forms for two centuries.
A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, therefore lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries and the reasons for the relapses are under research.
The Myth of Mental Illness: Foundations of a Theory of Personal Conduct is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, and has become a classic, well known as an argument against the tendency of psychiatrists to label people who are "disabled by living" as "mentally ill".
There was systematic political abuse of psychiatry in the Soviet Union, based on the interpretation of political opposition or dissent as a psychiatric problem. It was called "psychopathological mechanisms" of dissent.
Medicalization or medicalisation is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.
Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is that branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.
Abram Hoffer was a Canadian biochemist, physician, and psychiatrist known for his "adrenochrome hypothesis" of schizoaffective disorders. According to Hoffer, megavitamin therapy and other nutritional interventions are potentially effective treatments for schizophrenia and other diseases. Hoffer was also involved in studies of LSD as an experimental therapy for alcoholism and the discovery that high-dose niacin can be used to treat high cholesterol and other dyslipidemias. Hoffer's ideas about megavitamin therapy to treat mental illness are not accepted by the medical community.
Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.
Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home, in halfway houses and clinics, and in regular hospitals.
Child and adolescent psychiatry or pediatric psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of these psychiatric disorders and treatment responses to various interventions.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
This is a timeline of the modern development of psychiatry. Related information can be found in the Timeline of psychology and Timeline of psychotherapy articles.
The Citizens Commission on Human Rights International (CCHR) is a nonprofit organization established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz, headquartered in Los Angeles, California. Its stated mission is to "eradicate abuses committed under the guise of mental health and enact patient and consumer protections." Many critics regard it as a Scientology front group whose purpose is to push the organization's anti-psychiatric agenda.
The Critical Psychiatry Network (CPN) is a psychiatric organization based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the 1983 Mental Health Act (MHA). They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom's National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.
The following outline is provided as an overview of and topical guide to psychiatry:
Joanna Moncrieff is a British psychiatrist and a leading figure in the Critical Psychiatry Network. She is a prominent critic of the modern 'psychopharmacological' model of mental disorder and drug treatment, and the role of the pharmaceutical industry. She has written papers, books and blogs on the use and over-use of drug treatment for mental health problems, the mechanism of action of psychiatric drugs, their subjective and psychoactive effects, the history of drug treatment, and the evidence for its benefits and harms. She also writes on the history and politics of psychiatry more generally. Her best known books are The Myth of the Chemical Cure and The Bitterest Pills.
As long as psychiatry has existed it has been subject to controversy. Psychiatric treatments are sometimes seen to be ultimately more damaging than helpful to patients. Psychiatry is sometimes thought to be a benign medical practice, but at times is seen by some as a coercive instrument of oppression. Psychiatry is seen to involve an unequal power relationship between doctor and patient, and critics of psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations. In 2013, psychiatrist Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". Every society permits compulsory treatment of mental patients.
The significance of the affective use of body language – or generally, of the language of illness – can hardly be exaggerated.... It is part of our social ethic that we ought to feel sorry for sick people and should try to be helpful to them. Communications by means of body signs may therefore be intended mainly to induce the following sorts of feelings in the recipient: "Aren't you sorry for me now? You should be ashamed of yourself for having hurt me so! You should be sad seeing how I suffer...." and so forth.... [T]he flamboyant "schizophrenic body feelings" encountered today, represent communications in the contexts of specific social situations. Their aim is to induce mood rather than to convey information. They thus make the recipient of the message feel as if he had been told: "Pay attention to me! Pity me! Scold me!" and so forth.... [C]hildren and women often can get their way with tears where their words would fall on deaf ears – and so can patients with symptoms. The point is that when some persons in some situations cannot make themselves heard by means of ordinary language – for example, speech or writing – they may try to make themselves heard by means of protolanguage, for example, weeping or "symptoms".... We have come thus to speak of all these silent and not-so-silent cries and commands, pleas and reproaches – that is, of all these endlessly diverse "utterances" – as so many different mental illnesses!