Only at first glance is psychiatry an “ordinary” branch of medicine. Upon closer examination, we find that psychiatry is involved in various processes that shape the face of society:
- arranging it in a certain order;
- influencing its views on normality and abnormality, and on good and evil;
- setting values and determining reactions to violations of those values.
- Psychiatry is not about mainstream society, normality, or political correctness. It is about the other side of society.
Every society maintains explicit and implicit ideals of the model citizen. Every society has its processes of exclusion and marginalization. Every society has its drop-outs, deviants, and outcasts. Who those will be is at least partially determined by social processes. In industrialized societies, the task of classifying and isolating individuals who do not meet social expectations falls to judges and psychiatrists. Precisely psychiatry exposes the shadow side of maintaining public order.
In our society, the psychiatric expert is the final arbiter in “identifying” someone as psychiatrically disordered. Therefore psychiatry warrants the interest of outsiders as well as insiders. Not only should the identification and definition (diagnosing) of society’s rejects command attention, but also and in particular how these people are subsequently treated. Yet there seems to be little of such concern. Perhaps the entire issue does not evoke interest as long as the institutions designated to deal with it do the job expected of them. Outsiders’ involvement is generally limited to stigmatizing the so-identified people.
Another reason for the apparent disinterest in psychiatry may be that it doubles as a professional-technical, applied, empirical science. This impedes outsiders from meaningful participation in psychiatric matters. Those outside parties who are interested tend to step aside and rule themselves unqualified regarding what is considered the professional domain of psychiatry. Such a position holds that legally the only experts are the psychiatrists.
From time to time certain psychiatry-related issues rise to the headlines, for instance after a violent crime has been committed by a psychiatric patient. This sparks off an impassioned but temporary debate on psychiatry in the media. The public’s usual response is to demand closer supervision of psychiatric patients. But aside from such incidental discussions, interest in the processes psychiatry employs for handling the job assigned to it by society is scant.
This book solicits attention to precisely these processes by clarifying the dilemmas they pose and the daily realities of psychiatric practice. Two aspects in particular are discussed. The first is the question: What exactly are psychiatric disorders? How can they be defined? What are their parameters? The second aspect involves the actual functioning of these definitions in practice when treatment methods are applied, whether voluntarily or not; their influence on the exercise of power; the role of various conflicts of interest; and the fulfillment of the social role of psychiatry.
These are issues to which Szasz has addressed his almost entire professional life. My interest in his work was aroused by my own experiences as a physician in psychiatric institutions and as a psychiatrist. I will elaborate on these experiences first and afterwards turn to the reasons for writing this book as a commentary on Szasz's works.