The Unjustified rise of Psychiatry
Rob Ryley
Although human suffering and distress is a universal human phenomena, considering
it a medical problem is relatively recent. For thousands of years, those who
acted "mad" were generally considered possessed by spirits, demons,
or touched by God. Lewontin, Kamin and Rose (1985) explain that this change
in what people consider "normal" is a relatively recent, cultural
development. "It is clear that definitions of normality are themselves
time--and culture--bound. Joan of Arc--who heard voices which she claimed were
those of angles telling her to crown the French Dauphin and drive out the English-became
a heroine of the French nation... Today she would almost certainly be diagnosed
as schizophrenic..." (199). It is only in the past two hundred years that
madness has been considered a medical "problem" requiring special
intervention (usually involuntarily) by trained professionals (psychiatrists,
psychologists, etc.). This change of perspective had less to do with science
and more to do with politics, economics, and social upheaval. In short, mental
health was a solution to difficult problems that society wanted to avoid.
The orthodox history of psychiatry claims that during the Enlightenment, intellectuals
gradually discarded the theological view of mental illness as being caused by
divine spirits, demons, or supernatural agencies. It was increasingly recognized
that madness was probably a product of a diseased brain, making medical interest
in madness acceptable. During this change in perspective, horrible abuses still
occurred. However, in Europe, especially in England and France, the philosophy
of moral treatment became adopted and allowed the mental patient to be treated
with relatively more respect and dignity. Focus on accurate "diagnosis"
became important. Research aimed to identify the underlying brain pathology
or environmental characteristics that "caused" the illness. Advances
in medical treatments in this century, such as drugs and electro-convulsive
therapy brought an increased optimism and belief that mental illness could effectively
be treated. Society later emphasized integrating the ill back into the community,
so outpatient clinics and other programs were adopted (Johnstone 1989, 173).
Although the view presented above is generally accepted, there are many who
consider it a self-serving and biased piece of propaganda. Andrew Scull, for
instance, argues that the supposed legal advances concerning the insane are
based on a view"'... which is hopelessly biased and inaccurate: one which
relies, of necessity, on a systematic neglect and distortion of the evidence'"
(Johnstone, 173). He portrays a less flattering, and more sinister, picture
of psychiatry's development a powerful political special interest fighting for
recognition and power.
Robert Castel (1988) traces the development of psychiatry in France from the
late 1700's (just after the French Revolution) through the 19th century. He
vividly shows how those often victimized by political or economic circumstances
were often rounded up and sent off to "charities" sponsored by the
government (Castel, 33). He describes the problems French officials faced. They
wanted to guarantee everyone freedom from arbitrary detention, yet still wanted
to use force and coercion against those who disrupted the social order. Before
the development of psychiatry, in order to be deprived of legal
rights, various legal procedures were required.
There were two official ways a person could be deprived of legal rights.
The first were either "special orders" or "judicial orders"
provided by the judicial branch. They were defended by the obligation of
the state to maintain law and order. The other method to legally hold a
person was by "royal orders" called "lettres de cachet."
They could be written by the king or any of his appointees, or could
be requested by the family of the person in question. These were the
most elaborate and complicated ways of restraining a person. (15-16)
However, both of these methods were unsatisfactory.
The citizens of France viewed the judicial orders as arbitrary and dangerous
to civil liberties. This sentiment grew greatly as the impending French Revolution
approached. The lettres de cachet were ineffective because the whole legal procedure
was costly, which prevented many poor people from using it. It was also under
increasing suspicion for being arbitrary and tyrannical because these orders
were not only used against the insane, but other groups as well. "Thus
the problem relating to the mentally deranged only represented one subcategory
of kinds of offenses... The different types of deviance were therefore
less lumped together but rather assembled upon the basis of common repressive
requirements" (Castel 20).
The other group that threatened the French social order were the poor and
indigent. Although these people had not broken any laws, there presence was
bothersome (just like the panhandlers and homeless in New York City) and it
was thought there should be ways to gather these people from the streets. But
there was a problem. If society condemns and punishes these people, it assumes
that they are mostly responsible for their plight. But if there were factors
that lead to their poverty that was out of their control, then punishment
was cruel and unjust. There was also a responsibility on society to aid them
in some way. Laws were created that rounded up the poor into special institutions,
and were defended on under the guise of "philanthropy." Supporters
argued that although we condemn their behavior, they are entitled to some assistance.
In this way, social repression and government assistance were presented as inseparable
(Castel, 32-33).
The person considered mad or insane posed a particular problem because his behavior
could not be understood like a criminal. A criminal willfully broke the social
contract. The mad, however, could act strangely with or without breaking laws.
Either way, his behavior was not able to be understood as reasonable. The insane
were considered to be suffering from a disease that prevented the use of
reason. If a mad person has no reason, then it is senseless to punish them,
but something must be done about them. This is where the "philanthropy"
of the government steps in. Since he cannot be classified in any legal
category, society feels pity and must take care for him, as he does not know
his own best interests.
Although most detained by the judicial or royal orders (except criminals), were
all warehoused in the same institution, this system was increasingly being attacked.
The whole institution system cost a lot of money, and the poor were not
benefiting from it. There were moves to create programs were the poor would
not be moved from their place in the community, but were aided in the community
by the government. This was to prevent the "fit poor" from being admitted
into a hospital when there was no need (Castel, 54-55). This process did not
happen for the insane. The medical intervention for insanity only began to increase
at this time because various doctors and "experts" claimed madness
should be considered a medical matter (Castel, 48-50). The government did not
mind delegating authority to the doctor because this would present less problems
for the legal system, and it would look as if truly scientific decisions were
being made about who should be deprived of his or her rights. It also gave the
liberal a good feeling, thinking he was helping the sick regain his health.
As society and lawmakers viewed insanity as a medical matter, it was only logical
to create "hospitals" for these "sick" people. As institutions
were created for them, there had to be a new profession in charge of running
the institution. The benevolent doctor was the perfect candidate. Who else does
a sick person go to when he or she needs to regain health?
As the profession grew, gained status and became more organized, well-respected
"experts" developed theories about the causes of insanity and what
were the most effective treatments. The two schools of thought developed at
the time were "moral" (psychological) and "medical" (physical
interventions i.e..: bloodletting, various medicines, etc.).
Moral treatment philosophy stated the mentally disordered could be taught better
ways of behaving. They had an essentially educational approach. The important
values were teaching self-control and responsibility. The medical model emphasized
the physical interventions and reiterated the ideology of insanity as a sickness.
As the effectiveness of moral treatment became more evident, some started to
question the need for doctors to treat the insane. This and other issues were
the focus of debate in the early 1800's. Moral treatment founders asserted that
care for the insane required no special skills other than compassion and common
sense. Although the evidence was on their side, they still referred to the asylum
inmates as "patients" and their intervention as "treatment."
This allowed doctors to argue that they had cures for the illness
of insanity, and that doctors were the most qualified to apply both the
techniques of moral treatment and medicine (Johnstone, 174-76). [History does
indeed repeat itself. There was a similar turf war between the psychiatry and
psychology when mental hospitals were being shut down and community mental health
was being marketed in the 1960's.]
This debate ended with the medical professional becoming the dominant leader
and administrator of the asylum. He was granted a vast amount of power. Giving
it to the doctor/administrator was justified on therapeutic grounds. "
'[The doctor] must be in some way the living principle in a hospital for the
insane. It is through him that everything must be set in train. He directs every
action, called upon as he is to regulate every thought... The actions of the
administration, which controls the material means of the institution, the supervision
that this same administration must exercise over all the staff, must be covert;
never will the director question a decision made by the doctor, never will he
intervene... The doctor must be invested with an authority from which none can
be exempt' " (Castel 130-31). With this amount of power, the doctor could
do as he wished.
Since the medical profession claimed medical and moral methods were required
to cure the insane, various "experiments" were done to prove the effectiveness
of medical intervention. Administrations of various drugs and emetics, sudden
immersion in cold water, pouring 10 to 50 buckets of icy water on patients heads,
applying leeches or ants, revolving chairs, and other absurd and cruel "treatments"
were tested and abandoned. Laws were also passed for building enough asylum
space to serve the local population. Most of the time, the buildings were overcrowded
and the alleged treatments were being used for inmate discipline rather than
therapeutic reasons (Johnstone, 178-79).
Considering the pattern of abuse, error, and fraud throughout the history of
the mental health profession, why is it we are always able to see the errors
and sins that our predecessors made, but not begin to question the motives behind
our own actions? Patients, the public, and lawmakers should maintain a healthy
skepticism towards mental health professionals. Few disciplines in recent history
have been as susceptible to fads and unproven claims of success as the mental
health profession. If there is one piece of advice to heed, Albert Einstein
said it best: " 'If you want to find out anything...about the methods they
use, I advise you to stick closely to one principle: Don't listen to their words,
fix your attention on their deeds' " (Szasz 1974,2).
BIBLIOGRAPHY
Castel, Robert. (1988). The Regulation of Madness: The Origins of Incarceration
in France. Berkley, CA: University of California Press.
Johnstone, Lucy. (1989). Users and Abusers of Psychiatry: A Critical Look
at Traditional Psychiatric Practice. New York, NY: Routledge.
Lewontin. R.C.. Kamin. Leon J.. Rose. Steven. (1984). Not in Our Genes:
Biology, Ideology, and Human Nature. New York, NY: Pantheon Books.
Szasz. Thomas. (1974). The Myth of Mental Illness: Foundations of
a Theory of Personal Conduct. New York, NY: Harper and Row Publishers Inc.