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Introduction to Epilogue

More than twenty years have passed since the main body of this book was written. During these years, many, sometimes surprising, developments occurred both inside and outside of psychiatry. How relevant today are the problems of two decades ago? In this epilogue I will show that the issues raised in my book are presently as current as they ever were.

Developments in psychiatry as a branch of medicine are closely linked to developments in medicine as a whole, and to developments in mental health care. Psychiatry as a social institution develops along the lines of processes in society as a whole.

In this epilogue I will first discuss the development of ideological aspects in psychiatry. Here the first quandary mentioned in the preface will return: the extent of the psychiatric realm that must be considered relevant. These processes are mirrored to an important degree in the way the state deals with health care, for instance through legislation. I will discuss these, using developments in the Netherlands as an example. Next I will discuss the current state of affairs regarding coercion in psychiatry, as the foregoing aspects are reflected and come together in the subject of coercion. Here the second quandary mentioned in the preface will return: the social function of psychiatry. Finally, returning to the question asked in the preface, whether there can be alternatives for today’s social and psychiatric practices, I will suggest some possible alternatives to coercion.

This epilogue is different from the previous chapters in two ways. Firstly, in it I describe developments rather than states of affairs. Secondly, I will be more concerned in gaining insight into these developments than making a thorough analysis.

These aspects will be discussed also in light of developments in Szasz’s writings.
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