THE THERAPEUTIC STATE : Psychiatry in the Mirror of Current Events
Although mental illness is said to be an illness “like any other,” and although psychiatry is said to be a medical specialty “like any other,” it is obvious that neither assertion is true. Specialists in neurology, cardiology, gynecology, urology, rheumatology, hematology, immunology, and the other branches of medicine are concerned with the workings of various body parts and systems and with helping persons suffering from diseases that affect these parts or systems. But what are psychiatrists concerned with?
The answer to this question has been a matter of debate ever since psychiatrists first came on the scene of human history, about two hundred years ago. The basic reason for the controversy over the nature of psychiatry lies in, and is revealed by, the embarrassing contradiction between the ostensible and the actual practices of psychiatrists. This should not surprise us. The same has been true for every important institutionalized ideology throughout history. That it is true for psychiatry too—indeed, that it is true for psychiatry but not for, say, cardiology or neurology—can make us draw two quite different inferences: One is that psychiatry is less developed than other branches of medicine and hence more time and effort are needed to bring it up to par with its sister specialties.
This is the position today not only of the leading psychiatric authorities but also of the leading opinion-makers of our society, from justices of the Supreme Court to editorial writers for the New York Times. Another inference is that this contradiction is an important feature of psychiatry that we must treat as a clue to its true character. This has been the position I have espoused ever since I started to write about psychiatry, more than thirty years ago.
Although the pieces assembled in this volume arc as varied as the daily events of our life—each taking off from some newsmaking political event, criminal trial, or literary happening—they all share a particular point of view on psychiatry. I have stated that view in several scholarly publications and there is no need for me to restate it here. Furthermore, it is set forth—perhaps better than in my more formal works—in the editorials, essays, and reviews that follow. Let me note here, however, that there is nothing particularly original in my approach, although its application to psychiatry has been astoundingly neglected.
People have always known that actions speak louder than words. This insight was given a more sophisticated form by the great American philosopher Charles Sanders Peirce, who asserted that “What a thing means is simply what habits it involves.”
So we must inquire into, and familiarize ourselves with, the habits of psychiatrists. It is not hard to do this. Of course we must not let ourselves be distracted by the psychiatrists’endless self-serving chatter about what they do or think or by their gothic tales of miraculous cures in the private spaces of their cloistered offices. Instead, we must keep our eyes on their observable performances in mental hospitals, courts of law. and other public places.
By laying bare the professional habits of psychiatrists. I believe I have gone a long way in answering the questions people most often ask about the mental-health profession, such as: What is mental illness? Is psychotherapy effective? Is electroshock a treatment or a torture? Should it be banned? Does it help or harm patients to be confined in mental hospitals? Is the insanity defense necessary?
There is an obvious reason why we have so much difficulty giving satisfactory answers to these important questions. It is because, as the great English legal scholar James Fitzjames Stephen observed, “Men have an all but incurable propensity to try to prejudge all the great questions which interest them by stamping their prejudices upon their language.”
Accordingly, to answer the questions that puzzle people about matters of so-called mental illness, we must make ourselves aware of the ways in which both psychiatrists and mental patients use language—to impose their “reality” on each other, and everyone else. Perhaps only in this way will we be able to see that two and two make four—that fraud is fraud and force is force—regardless of who deceives or coerces or of how one justifies one’s behavior.
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