A comparative look into the history of the mental health field — excerpts from Dr. Thomas Szasz’s book “The Manufacture of Madness”

Following are transcribed tidbits from a book by Dr. Thomas Szasz titled The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (1970), beginning with pages 13-15:

With the decline of the power of the Church and of the religious world view, in the seventeenth century, the inquisitor-witch complex disappeared and in its place there arose the alienist-madman complex.

In the new—secular and “scientific”—cultural climate, as in any other, there were still the disadvantaged, the disaffected, and the men who thought and criticized too much. Conformity was still demanded. The nonconformist, the objector, in short, all who denied or refused to affirm society’s dominant values, were still the enemies of society. To be sure, the proper ordering of this new society was no longer conceptualized in terms of Divine Grace; instead, it was viewed in terms of Public Health. Its internal enemies were thus seen as mad, and Institutional Psychiatry came into being, as had the Inquisition earlier, to protect the group from this threat.

The origins of the mental health hospital system bear out these generalizations. “The great confinement of the insane,” as Michel Foucault aptly calls it, began in the seventeenth century: “A date can serve as a landmark: 1656, the decree that founded, in Paris, the Hôpital Général.” The decree founding this establishment, and others throughout France, was issued by the king, Louis XIII: “We choose to be guardian and protector of said Hôpital Général as being of royal founding . . . which is to be totally exempt from the direction, visitation, and jurisdiction of the officers of the General Reform . . . and from all others to whom we forbid all knowledge and jurisdiction in any fashion or manner whatsoever.”

The original, seventeenth-century definition of madness—as the condition justifying confinement in the asylum—conformed to the requirements for which it was fashioned. To be considered mad, it was enough to be abandoned, destitute, poor, unwanted by parents or society. The regulations governing admission to the Bicêtre and the Salpêtrière—the two Parisian mental hospitals destined to become world famous—put into effect on April 20, 1680, provided that “children of artisans and other poor inhabitants of Paris up to the age of twenty-five, who used their parents badly or who refused to work through laziness, or, in the case of girls, who were debauched or in evident danger of being debauched, should be shut up, the boys in the Bicêtre, the girls in the Salpêtrière. This action was to be taken on the complaint of the parents, or, if these were dead, of near relatives, or the parish priest. The wayward children were to be kept as long as the directors deemed wise and were to be released only on written order by four directors.” In addition to these persons “prostitutes and women who ran bawdy houses” were to be incarcerated in a special section of the Salpêtrière.

The consequences of these “medical” practices are described by a French observer after the Salpêtrière had been in operation for a century:

In 1778, the Salpêtrière is the largest hospital in Paris and possibly in Europe: this hospital is both a house for women and a prison. It receives pregnant women and girls, wet nurses and their nurselings; male children from the age of seven or eight months to four or five years of age; young girls of all ages; aged married men and women; raving lunatics, imbeciles, epileptics, paralytics, blind persons, cripples, people suffering from ringworm, incurables of all sorts, children afflicted with scrofula, and so on and so forth. At the center of this hospital is a house of detention for women, comprising four different prisons: le commun, for the most dissolute girls; la correction, for those who are not considered hopelessly depraved; la prison, reserved for persons held by order of the king; and la grande force, for women branded by order of the courts.

Surveying this scene, George Rosen bluntly states that “the individual was committed not primarily to receive medical care but rather to protect society and to prevent the disintegration of its institutions.”

As recently as 1860, it was not necessary to be mentally ill to be incarcerated in an American mental institution; it was enough to be a married woman. When the celebrated Mrs. Packard was hospitalized in the Jacksonville State Insane Asylum for disagreeing with her minister-husband, the commitment laws of the state of Illinois explicitly proclaimed that “Married women . . . may be entered or detained in the hospital at the request of the husband of the woman or the guardian . . . without the evidence of insanity required in other cases.”

In short, it is only a relatively recent rationalization in the history of psychiatry that a person must “suffer” from a “mental disease”—like schizophrenia or senile psychosis—to justify his commitment. Being an unemployed young man, a prostitute, or a destitute old person used to suffice. “We must not forget,” remarks Foucault, “that a few years after its foundation [in 1656], the hôpital général of Paris alone contained six thousand persons, or around one percent of the population.” As a means of social control and of the ritualized affirmation of the dominant social ethic, Institutional Psychiatry immediately showed itself to be a worthy successor to the Inquisition. Its subsequent record, as we shall see, has been equally distinguished.

The French hôpital général, the German Irrenhaus, and the English insane asylum thus become the abodes of persons called mad. Are they considered mad, and therefore confined in these institutions? Or are they confined because they are poor, physically ill, or dangerous, and therefore considered mad? For three hundred years, psychiatrists have labored to obscure rather than clarify this simple problem. Perhaps it could not have been otherwise. As happens also in other professions—especially in those pertaining to the regulation of social affairs—psychiatrists have been largely responsible for creating the problems they have ostensibly tried to solve. But then, like other men, psychiatrists cannot be expected to act systematically against their own economic and professional self-interests.

Picking back up on pages 51-53:

We would like our hospitals . . . to be looked upon as treatment centers for sick people, and we want to be, of course, considered as doctors and not jailers. . . . It is well known that there are legal safeguards against what is commonly called railroading people into mental hospitals, and we contend that people are well protected in all of the States. I have never in 30 years of constant living with this problem seen anyone whom I thought was being railroaded. . . . The opposite is true, however. People are railroaded out of mental hospitals before they should be, because these institutions are so crowded . . .

. . . I wish to point out that the basic purpose [of commitment] is to make sure that sick human beings get the care that is appropriate to their needs . . .

We, as doctors, want our psychiatric hospitals . . . to be looked upon as treatment centers for sick people in the same sense that general hospitals are so viewed.

If psychiatrists really wanted these things, all they would have to do is to unlock the doors of mental hospitals, abolish commitment, and treat only those persons who, like in nonpsychiatric hospitals, want to be treated. This is exactly what I have been advocating for the past fifteen years.

Lea describes the social function of the Inquisition thus: “The object of the Inquisition is the destruction of heresy. Heresy cannot be destroyed unless heretics are destroyed. . . . [T]his is effected in two ways, viz., when they are converted to the true Catholic faith, or when, on being abandoned to the secular arm, they are corporally burned.” This statement is readily converted into a description of the social function of the Mental Health Movement: “The object of Psychiatry is the eradication of mental illness. Mental illness cannot be eradicated unless the mentally ill are eradicated. . . . [T]his is effected in two ways, viz., when they are restored to mental health, or when, on being confined in state mental hospitals, they prove incurably sick and are therefore removed from contact with healthy society.”

Perhaps more than anything else, the claim of a helping role by the prosecutors and the judge made the witch trial a vicious affair. “The accused was,” Lea tells us, “prejudged. He was assumed to be guilty, or he would not have been put on trial, and virtually his only mode of escape was by confessing the charges made against him, abjuring heresy, and accepting whatever punishment might be imposed on him in the shape of penance. Persistent denial of guilt and assertion of orthodoxy . . . rendered him an impenitent, obstinate heretic, to be abandoned to the secular arm and consigned to the stake.”

The assumption of a therapeutic posture by the institutional psychiatrist leads to the same heartless consequences. Like the accused heretic, the accused mental patient commits the most deadly sin when he denies his illness and insists that his deviant state is healthy. Accordingly, the most denigrating diagnostic labels of psychiatry are reserved for those individuals who, although declared insane by the experts, and confined in madhouses, stubbornly persist in claiming to be sane. They are said to be “completely lacking in insight,” or described as “having broken with reality,” and are usually diagnosed as “paranoid” or “schizophrenic.” The Spanish inquisitors also had a demeaning name for such persons: they called them “negativos.” “The negativo,” Lea explains, “who persistently denied his guilt, in the face of competent testimony, was universally held to be a pertinacious impenitent heretic, for whom there was no alternative save burning alive, although . . . he might protest a thousand times that he was a Catholic and wished to live and die in the faith. This was the inevitable logic of the situation. . . .”

One of the important differences between a person accused of crime and one accused of mental illness is that the former is often allowed bail, whereas the latter never is.

Moving along to page 58:

The conduct of a society’s business, as that of an individual’s, may be likened to playing a game. The religions, laws, and mores of society constitute the rules by which people must play—or else they will be penalized, one way or another. Obviously, the simpler the games and the fewer in number, the easier it is to play them. This is why open societies and the freedoms they offer represent an onerous burden to many people. As individuals find it difficult and taxing to play more than a single game, or at most a few, at any one time, so societies find it difficult and taxing to tolerate the existence of a plurality of games, each competing for the attention and loyalty of the citizens. Every group—and this includes societies—is organized and held together by a few ideas, values, and practices which cannot be questioned or challenged without causing its disruption, or at least a fear of its disruption. This is why independent thought often undermines group solidarity, and group solidarity often inhibits independent thought. “We belong to a group,” says Karl Mannheim, “not only because we are born into it, not merely because we profess to belong to it, nor finally because we give it our loyalty and allegiance, but primarily because we see the world and certain things in the world the way it does . . .” To see the world differently than our group does thus threatens us with ostracism. Hypocrisy, then, is the homage intellect pays to custom.

[Italicized emphasis his — bold emphasis mine]

Dr. Thomas Szasz really helped me flesh out my understanding on the subject of mental health, along with the writings of psychoanalyst Erich Fromm. Both I highly recommend others to check out. Because these are extremely important dots needing to be connected in the minds of people today who naively assume the field of psychiatry, along with the biopharmacology industry, to be looking out for people’s best interests. No, they are agents of something outside of us, namely 1.) the State and 2.) the economy. Even when well-intending people join its professional ranks, this does little to undermine its overarching agenda to press for a new kind of conformity among the masses.

Independent thought is indeed being pushed to the fringes, particularly if it demonstrates no economic value or seeks to undermine the status quo on any level.

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