The Manufacture of Madness: Comparative Study of the Inquisition and the Mental Health Movement
Published by Paladin, 1973, softcover, 410 pages, condition: very good,
In this seminal work, Dr. Szasz examines the similarities between the Inquisition and institutional psychiatry. His purpose is to show "that the belief in mental illness and the social actions to which it leads have the same moral implications and political consequences as had the belief in witchcraft and the social actions to which it led."
This book really is a comparison between modern institutional psychiatry and the inquisitions against witches and Szasz manages four hundred pages of such without becoming overly redundant or facile. The predication of "psychiatry" as "institutional" is vital to Szasz' arguments. Himself a psychoanalytically trained psychiatrist, he has no problems with voluntary contracts between individuals. What exercises his ire is coercion, stigmatization and the confusion of categories.
The primary categorical confusion discussed in this book is that of treating certain behaviors as if they were symptomatic of disease despite the lack of any testable evidence of aetiology. Much of what passes for "mental illness", the object of psychiatric attention, is not, by this standard, a medical condition at all--not, at least, if psychiatry is presumed to be a medical science. More properly, certain behaviors are representative of social conditions, their interpretations being instrumental to methods of social control. Having been trained for a career as a psychotherapist myself and having, for at least a decade, expected to head in that direction, I have always found Dr. Szasz' works to be challenging. He may, along with such "anti-psychiatrist" figures as R.D. Laing, have contributed to my increasing disenchantment with the profession and failure to pursue that path.
One of the big issues in my social world is alcohol, some of my friends and relatives being identified as "alcoholics"--some contesting this identity, some embracing it. But what might this mean? Alcoholism is commonly treated as a genetic predisposition, stemming from upbringing or biology or both, the one reinforcing the other, fashionably conceptualized nowadays as a medical condition, a disease, whereas the more traditional view held it to be a moral condition, a sin. Szasz would question the category itself, seeing it as a questionable reification of a host of discourses and behaviors involving alcohol or its avoidance. Unless or until a certain aetiology can be demonstrated, the concept of "alcoholism", like that of the broader concepts of addiction or "addictive personality", confuses more than clarifies various modalities of the human condition. Yet, despite this, I find myself repeatedly falling back into the common sense of all of us living in a world where there are persons who suffer, or don't suffer, from alcoholism, addiction, schizophrenia, bipolarism, borderline personality disorder, ADHD, anorexia etc--despite the paucity of scientific evidence for the existence of such supposed diseases. In order to impress his point upon the reader Szasz devotes much of this book to the exposition of conditions once considered as existentially defining, but now rejected. The primary condition treated is witchcraft, but lengthy attention is also given to negritude (as a medical condition related to leprosy), to homosexuality and to masturbative insanity. A similar exposition might be essayed as regards the various editions of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, homosexuality-as-disease, for instance, being a condition which has disappeared from its pages in my adult lifetime.
