Originally called mad-doctoring, psychiatry began in the
seventeenth century with the establishing of madhouses and the
legal empowering of doctors to incarcerate persons denominated as
insane. Until the end of the nineteenth century, every relationship
between psychiatrist and patient was based on domination and
coercion, as between master and slave. Psychiatry, its emblem the
state mental hospital, was a part of the public sphere, the sphere
of coercion.
The advent of private psychotherapy, at the end of the
nineteenth century, split psychiatry in two: some patients
continued to be the involuntary inmates of state hospitals; others
became the voluntary patients of privately practicing
psychotherapists. Psychotherapy was officially defined as a type of
medical treatment, but actually was a secular-medical version of
the cure of souls. Relationships between therapist and patient,
Thomas Szasz argues, was based on cooperation and contract, as is
relationships between employer and employee, or, between clergyman
and parishioner. Psychotherapy, its emblem the therapist's office,
was a part of the private sphere, the contract.
Through most of the twentieth century, psychiatry was a house
divided-half-slave, and half-free. During the past few decades,
psychiatry became united again: all relations between psychiatrists
and patients, regardless of the nature of the interaction between
them, are now based on actual or potential coercion. This situation
is the result of two major "reforms" that deprive therapist and
patient alike of the freedom to contract with one another:
Therapists now have a double duty: they must protect all mental
patients-involuntary and voluntary, hospitalized or outpatient,
incompetent or competent-from themselves. They must also protect
the public from all patients.
Persons designated as mental patients may be exempted from
responsibility for the deleterious consequences of their own
behavior if it is attributed to mental illness. The radical
differences between the coercive character of mental hospital
practices in the public sphere, and the consensual character of
psychotherapeutic practices in the private sphere, are thus
destroyed. At the same time, as the scope of psychiatric coercion
expands from the mental hospital to the psychiatrist's office, its
reach extends into every part of society, from early childhood to
old age.
General
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