488 - The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement

The Manufacture of Madness:
A Comparative Study of the Inquisition and the
Mental Health Movement
By Thomas S. Szasz, M.D.
383 pp. New York, Harper and Row, 1970. $8.95.

The thesis in this latest of Szasz's provocative books is that the modern mental health movement is the direct descendant of the Inquisition. "What these seemingly diverse 'therapeutic' movements have in common not only with one another but also with such modern totalitarian movements as National Socialism and Communism is that each seeks to protect the integrity of an excessively heterogeneous and pluralistic society and its dominant ethic" (p. 59). Persons designated as mentally ill by institutional psychiatry have replaced the witches, Jews, and heretics as the scapegoats of society upon whom the guilt and evil which it cannot tolerate in itself is "dumped." The concept of mental illness itself is a "myth" created by psychiatry in order to control and oppress people, and the problems in living seen in those so designated are created by the interaction of the oppressors and the oppressed.

This thesis is substantially documented with quotations from historians, witchhunters, and the psychiatrists themselves. It is elaborated in great detail, in fact to the point of tedium. In its central focus on the homosexual as a case of "product conversion," in which the homosexual is seen to have replaced the heretic as the prime target of the oppressor group, it is convincing. (Szasz points out the historical connection embodied in the slang word "bugger" which means either a heretic or a homosexual-frequently equated in the middle ages.)

Apart from this point about homosexuals and heretics Szasz has seriously weakened his case by grossly overstating it. Anyone who has spent some time around state operated mental institutions will recognize that

489 - The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement

institutional psychiatry does sometimes have the oppressive effects that Szasz; holds to be not only their universal effect, but also the intended effect of administrators and psychiatrists who do have as a dominant motivation that of controlling and dominating their patients. But Szasz has blown these phenomena up into a single-minded purpose of such proportions that it is hard to believe that a man of his obvious intelligence could entertain the idea of so simplifying the multifaceted motives of such diverse a group of men. Psychiatrists are human, and power does corrupt, but their power is not absolute, and their motives are not always so mixed as to confuse controlling with healing. How does he regard the fact (which he does not mention) that mental hospital populations are actually declining, due in part to the community mental health movement (which he treats as a witch hunt) which tends to decrease the control of psychiatry, if not its influence?

Nor can his distinction between institutional psychiatry (state controlled) and contractual psychiatry (private, fee-based practice) be sustained on the absolute terms in which he states it. As he acknowledges, most psychiatrists are both institutional and contractual (p. 235). Are these persons all Jekylls and Hydes who never mix their helpful and benign private practices with their diabolical and destructive institutional practices? In fact many often mix them, hospitalizing, as needed, patients under their care. Szasz extolls contractual psychiatry, but does not his rejection of the concept of mental illness make all such practice foolish at best and fraudulent at worst, since these psychiatrists purport to be treating persons who are mentally ill? His position that such persons are suffering from problems in living (who is not?) does not appear to be a sufficient ground for consulting a psychiatrist for psychotherapy, which is by definition healing.

These points should not be construed to mean, however, that Szasz has no point to make. He deals with a serious problem in the way our society treats those called mentally ill, and sometimes, indeed, such designations are the product of the interaction of the oppressor and the oppressed. Further, anyone acquainted with the field of mental health knows there is a problem in defining precisely what mental illness is. But it cannot be solved by writing off the concept as an historical fraud (albeit a partially unconscious one).

I hope that Szasz's next work will be a case book of actual cases of oppression (which I agree would not be too hard to find) of the mentally ill, rather than another over-generalized broadside.

James N. Lapsley
Princeton Theological Seminary
Princeton, New Jersey