Newsgroups: sci.med.psychobiology
From: [s--v--c] at [netcom.com] (Sylvia Caras)
Subject: Szasz:Cruel Compassion (24K)
Date: Tue, 5 Jul 1994 03:02:07 GMT




Thomas Szasz.  _Cruel Compassion: Psychiatric Control of
Society's Unwanted_, Wiley, 1994.


Thomas Szasz, MD, Professor of Psychiatry Emeritus at the
SUNY Health Science Center in Syracuse, is recognized as the
premier critic of psychiatric coercions and excuses and on
of the most important social observers of our age.  

_Cruel Compassion_ is the capstone of Thomas Szasz's
critique of psychiatric practices.  Reexamining psychiatric
interventions from a cultural-historical and political-
economic perspective, Szasz demonstrates that the main
problem that faces mental health policy makes today is adult
dependency.

Millions of Americans, diagnosed as mentally ill, are
drugged and confined by doctors for noncriminal conduct, go
legally unpunished for the crimes thy commit, and are
supported by the state--not because they are sick, but
because they are unproductive and unwanted.  Obsessed with
the twin beliefs that misbehavior is a medical disorder and
that the duty of the state is to protect adults from
themselves, we have replaced criminal-punitive sentences
with civil-therapeutic 'programs.'  The result is the
relentless los of individual liberty, erosion of personal
responsibility, and destruction of the security or persons
and property--symptoms of the transformation of a
Constitutional Republic into a Therapeutic State,
unconstrained by the law.

Szasz shows convincingly that not until we separate therapy
from coercion--much as the founders separated theology from
coercion--shall we be able to get a handle on our seemingly
intractable psychiatric and social problems.

(From the jacket)

Excerpts follow in the order of the book.

(W)e should reject infantilizing mental patients and the
coercive psychiatric paternalism that hoes with it, and
accord the same rights to, and impose the same
responsibilities on, these patients as we accord to and
impose on patients with bodily illness or with no illness. 
p xiii

Classifying a person as a mental patient is an especially
treacherous enterprise, encouraging abstract compassion
toward him as a patient, and concrete indifference toward
him as a person." p 5

(St Augustine began the Christian policy of coercion for the
perfection of the person.  This laid a moral foundation for
secular force as therapy.  Heresy evolved into insanity as
is as little tolerated.  Charity combined with coercion
guarantee adult dependency.  The classical sins are now
symptoms.  The former agent, misusing his free will,
behaving wrongly, is now mentally ill.)

The ethics of psychiatric therapy is the very negation of
the ethics of political liberty.  The former embraces
absolute power, provided it is used to protect and promote
the patient's mental health.  The latter rejects absolute
power, regardless of its aim or use.  By definition, the
powers of constitutional government are limited.  Hence,
there is no room, in such a political framework, for
psychiatric power over mental patients that, by definition,
is unlimited. ... The whole history of psychiatry then, may
be said to come down to the history of the repudiation of
limited therapeutic powers.  ... (E)very so-called
psychiatric advance has consisted of a shameless celebration
of the psychiatrist's unlimited power over his patient.  p 6

The promise of curing sick people against their will--
especially people whose illnesses we don not understand or
who may, in fact, not even be ill--is fraught with perils we
seem determined to deny.  Despite the ghastly mayhem wrought
by psychiatrists in Nazi Germany and The Soviet Union, we
continue to venerate the coercive-compassionate
psychiatrist.  Indeed, there is no popular interest in, or
professional support for, a psychiatry stripped of political
power.  On the contrary, improving the Other by coercion in
the name of mental health has become a characteristic
feature of our age. p 6

Why do I want to help him?  What do I want to help him be or
do?  p 7

In the United States today, the most unwanted are drug
abusers, chronic mental patients,and the homeless.  Every
politician and psychiatrist now proclaims his determination
to help these persons, by enlisting the coercive apparatus
of the state in a therapeutic crusade against the sickness
that supposedly causes their being unwanted.  What the
politicians and psychiatrists actually mean is that it is
their duty to lead, and the taxpayers' to fund,
prohibitively expensive campaigns to save the victims,
viewed as defective objects, devoid of both rights and
responsibilities. p 7

On p 8, Szasz quotes C. S. Lewis:

     Of all the tyrannies a tyranny sincerely exercised for
     the good of its victims may be the most oppressive. 
     ...  To be "cured" against one's will and cured of
     states which we may not regard as disease is to be put
     on a level with those who have not yet reached the age
     of reason or those who never will; to be classed with
     infants, imbeciles, and domestic animals.  ...  For if
     crime and disease are to be regarded as the same thing,
     it follows that any state of mind which our masters
     choose to call :disease: can be treated as a crime; and
     compulsorily cured.  ...  Even if the treatment is
     painful, even if it is life-long, even if it is fatal,
     that will be only a regrettable accident; the intention
     was purely therapeutic.  

I shall address the (familiar subject of mental
hospitalization) as a problem of adult dependency and
unwantedness, that is, as a problem of the political-
economic and power relations between producers and
nonproducers, stigmatizers and stigmatized, intrinsic to
modern society. p 9

(W)e need not decide whether mental patients suffer from
brain diseases; or if they do, whether such diseases account
for their unproductiveness and lawlessness.  p 9

(O)ur mental health policies will rest on the principle that
adults have rights and responsibilities that are unaffected,
much less annulled, by psychiatric diagnoses.  In practice,
that would mean treating the psychiatrically diagnosed
person as a moral agent who is expected to cope with his
problems and obey the law.  If he asks for help, we offer to
help him on terms agreeable to both him and us.  If he does
not, we leave him alone.  And if he breaks the law, we treat
him as we would want to be treated by a policeman who
stopped us for a traffic violation. p 10

I view our statist-institutional psychiatric practices not
as specialized medical technics for treating mental
diseases, but as socially approved procedures for disposing
of unwanted persons, similar to such past social practices a
segregating paupers in workhouses, incarcerating defaulting
debtors in prisons, and exiling epileptics to colonies. p 11

(C)ruelty is intrinsic to the mental hospital and accounts
for the futility of mental health reforms. p 20

The cruelty intrinsic to the workhouse system was excused by
the need to discourage idleness, much as the malice
intrinsic to the mental hospital system has been excused by
the need to provide treatment. p 22

Not so long ago, people thought they could distinguish
between the "beggar," the "sturdy beggar," the "industrious
poor," the "laboring poor," the "pauper," the "indigent,"
and the "impotent."  Their strategic fictions, whose aim was
to regulate poor relief, were no more or less ridiculous
than are our strategic fictions for regulating psychiatric
relief, which include categories such as "pathological
gambling," "pyromania," factitious disorder," and
"insomnia." p 24

... our present practice of imprisonment for failing to
respect personal and social obligation (mental illness). p
27

Nearly everyone realizes that psychiatric coercion does not
cure the mental patient and aggravates his conflicts with
his relatives, but it punishes the patient (by means of so-
called treatments) and discourages people from taking
advantage of the largess of the state (free room and board
in return for being "psychotic").

Similarly, once commitment laws are enacted, they become an
engine of oppression; other laws are then enacted to prevent
this from happening, such as laws guaranteeing the patient's
right to treatment, to refuse treatment, to a lawyer, to a
hearing,and so on; and the more laws, the less protection
for the patient, and the more power for his oppressors. p 38

The mental patient:

     Is (typically accused by a parent or spouse--a person
     with close and important emotional and economic ties to
     him--of defaulting on his personal obligation to him
     (being mentally ill).

     Is brought to the mental hospital (or some intermediate
     place of detention) by his relative (or an agent of the
     state he has summoned).

     Is involuntarily hospitalized--because that is what his
     relative wants (the concerned kin has the option of
     taking the patient into his home or leaving him to his 
     won devices).

     Ergo, the mental patient forfeits his liberty to his
     kin (or to a psychiatrist who is his kin's agent).  p 41

With respect to the mental patient, the role of the state
goes far beyond enforcing laws.  Prosecutors and judges
regularly instigate and initiate commitment proceedings,
especially if the patient is indigent and deemed to be
dangerous to himself or others.  At the same time, the state
plays, or pretends to play, the role of umpire as well,
courts being entrusted with the duty of protecting the
citizen from abuses of the mental health laws.  This dual
role of the state makes the practice of civil commitment
especially corrupt, farcical, and tragic. p 42

(P)sychiatrists now treat some mental patients with
convulsions, others with anticonvulsant drugs, maintain that
both are cures for mental diseases--and most people believe
them. p 56

The differences between the neurological and psychiatric
attitudes toward patients could hardly be more dramatic. 
The neurologist eschews dominating, much less coercing,
patients suffering from _demonstrable_ brain diseases.  The
psychiatrist, protesting more stridently than ever that
mental patients suffer from brain diseases, clings to his
power to impose unwanted interventions on nonconsenting
nonpatients. p 59

Unlike Nazi psychiatrists, democratic psychiatrists do not
literally kill their patients.  They kill them
metaphorically, by incarcerating, shocking, and drugging
them.  p 60

(P)eople find it intolerable to witness a person talking to
himself, depressed, contemplating suicide.  The public want
to be spared this spectacle.  To accommodate this desire,
psychiatrists declare that (seriously ill) mental patients
need to be confined in institutions.  That is not the
official version of the story.  It is considered
unprofessional to acknowledge that doctors dispose of
unwanted persons at the behest of society. p 61

If the psychiatrist has no effective remedies for mental
illness, then he cannot appeal to treatment as a
justification for depriving the patient of liberty.  And if
the psychiatrist does possess effective treatments for
mental illness, then ... the patient's alleged need for
treatment ceases to be a legitimate reason for depriving him
of liberty. p 62

Anyone familiar with the mental health industry knows that
suicide is now the single most effective tool for promoting,
justifying, and selling psychiatry.  The threat of suicide,
fear of suicide, gesture of committing suicide, attribution
of wanting to commit suicide, promise of preventing suicide,
claim of having successfully prevented suicide, each of
these fears, threats, and promises stokes the furnaces of
the madhouse industry, especially of its children's
division. p 80

The United States loves to dispose of its unwanted children
by means of psychiatric storage ... .  ... the countless
catastrophic consequences of child psychiatry, such as the
wholesale psychopathologizing of child misbehavior and the
mass poisoning of "hyperactive" children with Ritalin and
other neuroleptic drugs. p 84

Unlike the regular doctor, the early psychiatrist, called
mad-doctor, treated persons who did not want to be his
patients, and whose ailments manifested themselves by
exciting the resentment of their relatives. ...
Unconventional behavior must have existed for as long as
human beings have lived together in society.  Psychiatry
begins when people stop interpreting such behavior in
religious and existential terms, and begin to interpret it
in medical terms.  The fatal weakness of most psychiatric
historiographies lies in the historians' failure to give
sufficient weight to the role of coercion in psychiatry and
to acknowledge that mad-doctoring had nothing to do with
healing. p 104

Stripped of three hundred years of psychiatric-semantic
embellishments, the fact is that a mad person appears to his
relatives as an unpleasant individual whose company they
would rather avoid.  to deny their embarrassing lack of love
for their lunatic kin, people burdened by a crazy relative
now call him their "loved one," especially when they enlist
a psychiatrist to dispose of him. p 104

Both the medicalization of madness and the infantilization
of the insane were, and are, needed to reconcile a society's
devotion to the ideals of individual liberty and
responsibility with its desire to relieve itself of certain
troublesome individuals my means other than those provided
by the criminal law. p 105

(B)etween his teens and his twenties, the young person must
learn to become useful to others and stand on his own feet. 
If he fails to accomplish this task, he and his family are
destined to face serious difficulties, nowadays often
conceptualized in psychiatric terms, typically as the
manifestations of schizophrenia. p 144

(T)he condition (psychiatrists) call schizophrenia refers to
a young person's idleness, not is illness. p 146

If this road map to the destination of a schizophrenic
career is accurate, then it is clear why psychiatric
treatments cannot help such persons.  By conceptualizing the
young adult's uselessness as an illness, psychiatric
interventions can only harm him because they render his
chances of becoming useful, self-respecting person even
slimmer. p 146

(R)esponsibility for the care of children, old people, and
the sick was gradually transferred from the family to the
state.  Sociologist David Poponoe calls the result a "client
society ... in which citizens are for the most part clients
of a large group of public employees who take care of them
throughout their lives." p 149

The state assumed the dual obligation of protecting itself
from the madman and the madman from himself, and authorized
the mad-doctor to implement and enforce this principle. 
Thus did the systematic, forcible incarceration of unwanted
persons, qua dangerous mental patients, become the social
policy, called "mental hospitalization." p 151

The contrast drawn between the mental hospital and the
community is a lie.  The domiciles now housing chronic
mental patients are neither more nor less a part of the
community than the state hospital. p 152

I maintain that neither long-term mental hospitalization nor
deinstitutionalization has anything to do with illness,
treatment, or medicine.  Both are legal and socioeconomic
policies, using medical rhetoric as justificatory pretexts.
p 152

Today, virtually every mental patient is "on drugs" and the
result is that there are now more mental patients than ever,
the cost of caring for them is greater than ever, and the
patients are more disabled, more destructive, and more
dissatisfied with psychiatry than ever.  p 161

Although no one in an official position would admit it,
deinstitutionalized mental patients became homeless not
because they were discharged prematurely, nor because they
stopped taking their medication, nor because they are
schizophrenics, but because the hospitals were their only
homes.  E. Fuller Torrey's book on the homeless mentally
ill, _Nowhere To Go_, is aptly titled.  However, having
nowhere to go is a tragedy, not a brain disease. p 164

The insane person could now be controlled with a chemical,
instead of a mechanical, straight-jacket: The restraint
could be put _in_ him, instead of _on_ him. p 166

Restraint by chemical means does not make (the psychiatrist)
feel guilty; herein lies the danger to the patient. p 167

supported by politicians and journalists, psychiatrists
managed to convince the public that the care of mental
patients had been revolutionized by antipsychotics, much as
the care of patients with infectious diseases had been
revolutionized by antibiotics.  This preposterous claim
helped psychiatrists conceal the true nature of the problems
mental patients present and the solutions psychiatrists
offer to solve them--specifically, that the typical chronic
mental patient is homeless and is economically dependent on
his family or society; that he violates marginal (or not so
marginal) social rules; and that he is restrained, during
hospitalization as well as after discharge, by drugs, the
threat of commitment, and involuntary mental
hospitalization.
     Today the traditional functions of the madhouse are
exercised by many other institutions as well, especially the
public facilities of our large cities, such as libraries,
bus stations, and so forth.  Bedlam is now everywhere,
making our streets and parks both ugly and unsafe.  Ugly,
because we tolerate unacceptable behavior by persons so long
as, de jure, they are classified as mental patients; and
unsafe, because many of these individuals engage in de facto
aggression, depriving others of property, liberty, and even
life. p 168

Excerpting and paraphrasing: Nursing homes are really the
psychiatric institutions of the 90s, nursing homes where,
embalmed in neuroleptic drugs, residents are stored until
they can be properly buried.  Fearing nursing homes is a
major cause of suicide overshadowing depression, chronic
illness, and pain. p 171-2 

The commingling of crime and disease, which began to infect
the body politic in the nineteenth century, has now reached
the stage of a far-advanced parasitic infestation of both
the criminal justice and mental health systems.
     The term _deinstitutionalization conceals some simple
truths, namely, that old, unwanted persons, formerly housed
in state hospitals, are now housed in nursing homes; that
young, unwanted persons, formerly also housed in state
hospitals, are now housed in prisons or parapsychiatric
facilities; and that both groups of inmates are
systematically drugged with psychiatric medications. p 174

(T)here is pressure to define ever more types of undesirable
behaviors as mental disorders or addictions and to spend
ever more tax dollars on developing new psychiatric
diagnoses and facilities for storing and treating the
victims of such diseases, whose members now include
alcoholics, drug abusers, smokers, overeaters, self-
starvers, gamblers, etc.  p 177

De jure, the psychiatrist functions as a physician
diagnosing and treating mental illness; de facto, he is an
agent of the state empowered to confine persons in mental
hospitals and charge their insurance carriers for the
"service."  Calling this practice the "delivery of mental
health services," and a "market transaction" to boot, is a
debauchment of language worthy of Orwell's Newspeak. p 178

The phrase _in the community_ is a psychiatric euphemism
intended to conceal the fact that the patient was
transferred from one psychiatric facility to another, the
first called a "hospital," the second not called a
"hospital." p 180

Psychiatrists estimate that from 50 to 90 percent of
patients discharged from mental hospitals on drugs exhibit
such "noncompliance."  Why do they?  Is it because they have
no insight into their illness and need for medication?  Or
because they do not like the effects of the drugs and prefer
being psychotic?  Or because they want to relapse and be
readmitted to the hospital?  The explanation we choose says
more about us than about the patients. p 180

The forcible eviction of desocialized patients from mental
hospitals is a moral scandal on par with the forcible
involuntary mental hospitalization of persons who are not
desocialized.  The responsibility for both rest squarely on
the shoulders of psychiatrists. p 184

Ever since individuals deemed to be insane were first
incarcerated in madhouses, each new method of coercing them-
-from replacing chains with commitment laws, or exchanging
camisoles for chemicals--has been romanticized as a reform
and defined as a "patient liberation."  Indeed, one of the
most ironic features of psychiatric history is that the
greatest oppressors of the mental patient--Philippe Pinel,
Eugen Bleuler, Karl Menninger--are officially venerated as
their most compassionate champions.  In their zeal to
diagnose and doctor madness, psychiatrists have tried
everything except eschewing coercion and treating the
patient as a responsible person.  p 187

It is not possible to understand the ugliness of the policy
of drugging and deinstitutionalization unless we recognize
that, once more in the history of psychiatry, it is
something psychiatrists have done to involuntary mental
patients.  In the past, psychiatrists used their power to
imprison individuals in mental hospitals for life.  Now they
use their power to drug patients for life. p 189

The mental hospital system endures because it fulfills
important personal and social needs.  It segregates and
supports adult dependents--who embarrass, burden, and
disturb their families and the community.  It incarcerates
and incapacitates troublesome lawbreakers--who embarrass,
burden, and disturb the judicial and penal systems.  And,
most importantly, it performs these functions by means of
civil law sanctions--in a manner that pleases and pacifies
the consciences of politicians, professionals, and the
majority of the people.  Hence, not only is there no popular
interest in abolishing involuntary psychiatric
interventions, but, on the contrary, there is intense
pressure--especially from the parents of mental patients,
the judiciary, and the media--to reinforce the institution
of psychiatry. p 200

(I)nvoluntary mental hospitalization is counterproductive,
because it deprives the subject of dignity and liberty,
excuses him from responsibility for his behavior, and
prevents him from learning by suffering the consequences of
his selfish or unwise actions. ...   p 204

If civil commitment were abolished, mental hospitals as we
know them would disappear.  Regardless of their psychiatric
diagnosis, persons who break the law would have to be
accused of a crime, tried, and, if found guilty, punished in
the criminal justice system; whereas persons innocent of
crime would have to be left unmolested by the legal and
psychiatric systems.  Only then would mental illness be
destigmatized and psychiatrists resemble regular physicians
whose practice is limited to treating voluntary patients. p
204

It is dishonest to pretend that caring coercively for the
mentally ill invariably helps him, and that abstaining from
such coercion is tantamount to "withholding treatment" from
him.  every social policy entails benefits as well as harms. 
although our ideas about benefits and harms vary from time
to time, all history teaches us to beware of benefactors who
deprive their beneficiaries of liberty. p 205
-- 
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[S--v--C] at [netcom.com]                        v/f:408 426 5335
Sylvia Caras, 146-5 Chrystal Ter, Santa Cruz CA 95060

     It is not up to you to finish the work, but 
       neither are you free to not take it up.

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