Psychiatry as a Social Institution
Psychiatry can be described as a social institution as well as a humanity, an applied science, and a profession. Szasz uses this concept in the sense that Feibleman does. It means “stable patterns of group behavior, usually pertaining to the regulation of one or another of the functional prerequisites of society.” (Law, Liberty, and Psychiatry, p. 86)
Institutional behavior, the objectives of the institution, and its rules can be contrasted to personal behavior, individual objectives, and less conventional rules.
Accordingly, an individual’s belief can be contrasted to organized religion with established public opinions and political power. Religion, education, family, and health care can all be considered and described as social institutions this way. So a social institution is not a thing or fact or organization, but an abstraction that is expressed in the behavior of individuals and groups. As institutions imply regular and thus predictable behavior, they form a part of a larger system of social control.
Psychiatry’s structure as a social institution includes the following components: psychiatrists and psychiatric patients; psychiatric hospitals and institutions; the state regulating agency; complex rules of conduct regarding what may and may not be done with psychiatric patients; parapsychiatric professions such as psychology and psychiatric nursing; and the psychiatrists’ professional organization.
The functions include testing and treating psychiatric patients, and removing some people from the community. The latter is, historically speaking, the oldest function. It is practiced in part by scientific and rational maneuvers, and in part by symbolic maneuvers. The term “mental illness” itself is in part a rational and in part a symbolic maneuver. So are psychiatric diagnoses. A diagnosis can be considered rational inasmuch as it describes a certain behavior. It is symbolic inasmuch as it evokes a certain feeling that in turn evokes a certain action. Examples of the latter are psychopathy and hysteria, and even more so the words psychopath and hysteric. The result of the symbolic meaning, if not the purpose, is uplifting the institution and its practitioners and dragging down the person so diagnosed. I notice that here Szasz apparently ascribes a certain rational significance to the diagnosis. In later works the diagnosis to him turns into an instrument the sole purpose of which is to discriminate and dehumanize the person diagnosed.
According to Szasz, psychiatry as an institution derives its authority from the fact that psychiatrists are physicians. This, too, is a symbol, because owing to this authority, psychiatrists can define and redefine reality: anybody can declare somebody else to be crazy, but only when a psychiatrist does so – serious – social consequences follow.
The most important feelings that the institutional symbols of psychiatry evoke are feelings of aversion to psychiatric patients.
The purpose of psychiatry as a social institution, inasmuch as these are apparent from the way psychiatry works, are: in the first place, raising one’s own status and power; and secondly, protecting the status quo and the principal established interests of the community at any given moment. In this sense, a concept like mental health works. It cannot be separated form other core values in society, such as the socialization of citizenry and the maintenance of internal order. Viewed as such, psychiatry presents itself as a social power that contradicts reason, personal responsibility, and human dignity. This can be illustrated by two important effects. The first is the psychiatrization of law, politics, and decency. Economic, religious, and social problems are converted to psychiatric problems, problems suggesting illness. The second effect is that psychiatry is elevated to a religion. Hence psychiatry has become an example of an institution that has changed and in fact destroyed its own purpose. It started out to help patients live as they wish. It turned into a servant of the community, and is willing to understand and assist the individual only to the extent that such assistance will contribute to greater glory and stability of the group.
Szasz opines that only in the twentieth century did psychiatry assume the character of a social institution, and as such is still in an early stage of development. He advocates that psychiatry as an institution seek a balance between serving the interests and needs of individuals and groups, being aware that these interests can – in fact, must – contradict. It is difficult to imagine how this is possible for Szasz. After all, to him, serving both the individual and the group is always to the individual’s detriment. Probably his intention here is to create space for contractual psychiatry next to institutional psychiatry.
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