Thomas Szasz argues that mental illness is a myth used to justify incarcerating people against their will. He asserts that psychiatry functions primarily to imprison people under the guise of treatment. While asylums and mental hospitals have closed, psychiatric coercion continues through forced treatment and incarceration justified by diagnoses that are not scientifically valid. Szasz advocates abolishing psychiatric coercion and involuntary treatment.

1. Thomas Szasz ‘Coercion as Cure’
Ch 1: Mental Hospitalisation: Therapeutic Imprisonment
Incarceration is the job of the psychiatrist. There is no such thing
as mental illness, and MH is rightly stigmatised because it is another
form of prison. Psychiatric identities are imposed on millions, as are
treatments. Objective methods cannot be used t detect MH. Eg
someone with a microbiological diseases will respond to antibiotics
whether given voluntarily or involuntarily. People with schizophrenia
are deemed to have no insight. The idea of MH and asylums is a
recent development, starting in the late 18th century with Bedlam
and Bicetre. (Me: there were no mental hospitals in the Bible and
none for Henry VIII to plunder.) Idea of illness is a fallacy and is
an excuse for detention. Detention is the main outcome. This may
be to protect the public. However coercion and detention are not for
public health like with a contagion. It is not like with a true medical
phenomenon. Psychiatric coercion as medical treatment may be a
hoax. I.e. To describe IT as therapy is fallacious as all it is, is menial
labour. (Slave labour as Margaret said.) Institutions and MH can be a
political football with each side vying to outdo each other. (Me:
competitive stigmatisation of MH.) Impaired awareness of illness is
called anosognosia – lack of insight. Therefore it is necessary to
have forced treatment. Anosognosia may be the result of a brain
lesion (sic), maintain its supporters. Szasz proposes the abolition of
psychiatric coercion (p21). The idea of caring coercion for those
who have no insight. It is said that anosognosia is the single largest
reason for non-compliance with medication by those with
schizophrenia and bipolar. What about horrendous side effects as
disincentive? (me). Thomas says a main reason for coercive control is
that many mentally ill persons reject or would like to reject, role of

2. mental patient. (cf guy who denies need for new identity and who
wants his job in London back).
Thomas points to Shakespeare not referring to madhouses (me:
neither are they in the Bible nor were plundered by Henry VIII.)
They are a modern invention. Rich people were incarcerated in
private madhouses, later extended to pauper lunatics in public insane
asylums. That is an oxymoron, that places for the insane can be
asylums, refuges. For the inmate, an asylum is a place of detention.
Predicament: how to square rights to liberty and property with
detention? This was squared by using duty of care towards
incapacitous insane person. This was a service for the propertied
classes which began in England and France in 1700’s. (written up by
Michel Foucault.) Szasz revisits his themes on Mediaeval witchcraft
when he says that the mad could be tortured to improve their
chances in the afterlife. Detention by the clergy was replaced by
detention by psychiatric coercion. There was collusion between
madhouse keepers and their paymasters. ‘The pecuniary interest of
the proprietor and the secret wishes of the lunatic’s relatives, led
not only to the neglect of all means of a cure, but also the
prevention and delay in recovery.’ (p31.) Is there something of this
today (me)? Szasz states that he disagrees with the deprivation
of liberty of the mentally ill (as he always does). Individuals can
be detained because it is in the interests of others (Reg, drug
dealers, and someone at Reading University). Wives were detained
(eg Grace). 1958: mental hospitals are ‘bankrupt beyond remedy’ (p
34). After WW2, in America they sought to regenerate the force of
the Manhattan Project by seeking victory in the War on Mental
Illness. There was hope around the use of drugs, there was less
scrutiny around compulsions to expedite progress. Szasz states that
mental illness is a public health and social problem. This is because
the typical mental patient is ‘unemployed and unemployable,

3. homeless, economically dependent on his family or society, and
inclined to violate marginal or not-so-marginal social rules.’ This
is what Szasz believes (p36). Hospitals were closed not because of
drug advances, or because of other cure, but because the federal
government ordered it.
Szasz bemoans the taboo against scrutinising the concept of
mental illness. 1989: Congressional committee pronounced on
‘national tragedy’ of homes staffed by poorly paid dispensing
complicated doses of psychotropic drugs. When mental hospitals
were closed, they didn’t ask question: where will people live? (We
have community care in the UK). Szasz himself is blamed for this
by being associated with move to close hospitals from 1960’s on.
Szasz is not pleased by the claim that he was part of Laing’s
counter-culture because they did not deny the existence of
mental illness, and did not repudiate involuntary incarceration in
hospitals. He says metal illness is here because society itself is sick.
Szasz names Charen, Isaac, and Armat as associating him with the
movement to close asylums, calling him a ‘do-badder’ depriving sick
people of the care they need. He quotes: Szasz says mental illness
is a social construct, a prejudice, not a diagnosis. Szasz is
associated with Ken Kesey. Kesey wrote ‘One Flew Over’ and Thomas
doubts that this liberated patients with the closure of the asylums.
Thomas instead likes ‘The Titicut Follies’, which was banned. All
hospital staff are jailers.
Media proclaim chemical causes and cures for MH (Terry Hammond).
(Me: if identity is a social construct then there is influence of
media profiles.) Psychiatrists’ old foe is freedom. ‘Freedom will not
cure MH, as witnessed by condition of many who are
deinstitutionalised.’ (Applebaum of AMA...American Medical
Association?) Me: Should ask: how can we cope with freedom? ‘Most
homeless mentally ill are grateful for a safe and warm hospital

4. bed’ (Krauthammer – look up in index). No, really, we want you to
have the confidence that there is indeed a good and quality life for
you out of hospital, including being looked after by the state (Me).
In US, state hospitals are being turned into homes, as in UK.
Hospitals have been phased out, but psychiatric coercion has not.
All MH professionals now have the duty to give neuroleptic drugs,
and to incarcerate in case of danger to self or others. Like Patricia
Deegan’s ‘prediction of her future.’ Some SU’s subscribe to the
medical model and authorise ECT if they get ill. Szasz criticises SCT
as law-ordered treatment under the threat of involuntary
hospitalisation. Torrey talks of the schizophrenic’s ‘lack of insight.’
(p49). There is no biological evidence for this. P 49 he mentions
depot injections and a SU dropping his pants. A few lines on he talks
of the ‘bottom line.’ Psychiatry is the prevention of harm, not
provision of treatment. Criticises MHA as indefinite treatment
regardless of response to drugs or other treatment (yes for
Michael W, but not true of me.) He says all admissions are
potentially coercive, and not voluntary as they are all backed up with
threat of detention. (Me: where is this going?) Szasz says all places
of involuntary detention should be called jails. (cf Hellingly identity
for me: old lag but not valued student.) People escaped ‘grim
conditions and sometimes brutal treatment’ when the institutions
were closed. (But where is this going?)
Szasz states that many mentally ill people now end up in prison. All
enquiry, even well meant enquiry, into the world of mental illness,
results only in repetition of portraits of the mentally ill as mostly
violent subhumans who can be treated as such. Those who gain are
highly paid psychiatrists and drug companies. Coercion, handcuffs
etc:- what kind of message does this give to the patient? Over
the last century, forced admissions as a result of mental illness have
increased 15-fold. From 1967 to 2000, the number of forensic

5. psychiatrists increased 250-fold. Szasz says that ‘chlorpromazine
era’ should really read ‘the era of chemical lobotomy.’ Szasz
mentions depot injections (p58 bottom of page.) The first
psychiatric practice was incarceration. This saw in the era of
treating madness as an illness. Before, it was not treated as a
medical matter. Medicalisation justified medical management.
Diagnosis prevailed (without proof, as remains today). Diagnosis
became the tool for detention. Question of civil liberties we seldom
ask: how can it be that innocent people are incarcerated and
guilty people excused? Two hundred years ago, people knew that
madhouses were coercive places. Today that coercion is covert as
psychiatry is now located in the community.

6. psychiatrists increased 250-fold. Szasz says that ‘chlorpromazine
era’ should really read ‘the era of chemical lobotomy.’ Szasz
mentions depot injections (p58 bottom of page.) The first
psychiatric practice was incarceration. This saw in the era of
treating madness as an illness. Before, it was not treated as a
medical matter. Medicalisation justified medical management.
Diagnosis prevailed (without proof, as remains today). Diagnosis
became the tool for detention. Question of civil liberties we seldom
ask: how can it be that innocent people are incarcerated and
guilty people excused? Two hundred years ago, people knew that
madhouses were coercive places. Today that coercion is covert as
psychiatry is now located in the community.