Psychiatry Institutional

Tn ort, 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. geing 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 Hopital Gen-ejral of JParis alone contained six thousand persons, or around one percent of the population. As a means of social control and.of the. ritualized affirmation o f the dominant social ethic, Institutional Psychiatry imniediately showed itself to be a worthy successor to the Inquisition. Its subsequent record, as we shall see, has been equally distinguished. 

This intolerance is understandable. Doubt about the existence or dangerousness of mental patients would limit the methods permitted to institutional psychiatrists in combating mental illness, just as doubt about the existence or dangerousness of witches would have limited the methods permitted to inquisitors in combating witchcraft. The Inquisition thus flourished so long as its agents were entrusted with special powers by the society they served. Institutional Psychiatry now flourishes for the same reason. Only when these powers are curbed does such an institution wither away. 

This is the myth of nonbenefits for coercive therapists its corollary is the myth of immense benefits for those coercively helped (even if these benefits are temporarily unappreciated by them). Without this imagery, the social inequities of therapeutic exploitations—selfless helpers growing rich at the expense of their selfish victims, so obvious a feature of both the Inquisition and Institutional Psychiatry—could not be maintained with it, they have been, and continue to be, readily justified. 

Common justice demands, say Sprenger and Kramer in the Malleus, that a witch should not be condemned to death unless she is convicted of her own confession. 2 According to Robbins, Once accused, the victim had to endure torture and inevitably make a confession of guilt. Every witch trial had its confessions. Similarly, every sanity hearing has its psychiatric self-incrimination the state-employed psychiatrist demonstrates to the court, from statements made by or attributed to the victim, that the patient is suffering from mental illness. The records of witch trials are as full of documented confessions of pacts with the devil and other evidences of witchcraft, as are the records of modern Institutional Psychiatry of hallucinations, delusions, and other evidences of insanity. One example of this should sufi ce here. ... 

The person accused of mental illness is in a similar situation. He too, instead of being treated as a respectable adult suspected of crime, is treated in a paternalistic fashion, as might a naughty child by a father who knows best. Accounts of involuntary psychiatric interventions—and by this I mean any contact with a psychiatrist not actively sought by the patient—illustrate the similarities between the procedures characteristic of Institutional Psychiatry and of the Inquisition. A brief example should suffice here. 

In short, the inquisitor was not concerned with overt, antisocial acts that was a problem for the secular courts. He was interested in heresy, which was a crime against God and the Christian religion, and was therefore defined in theological terms. The institutional psychiatrist is likewise not concerned with overt, antisocial acts that is a problem for the criminal courts. He is interested in mental illness, which is an offense against the laws of mental health and the psychiatric profession, and is therefore defined in medical terms. Mental illness is the pivotal concept of institutional psychiatry, just as heresy was of inquisitorial theology. ... 

Social control by means of the lettre de cachet thus constitutes a transitional stage between control by means of the old, religious Inquisition and the new, psychiatric one. The procedures of all three institutions rest on the same principles of paternalism only the identity of the father, in whose name control is exercised, differs. In the case of the Inquisition, it is the Holy Father, the Pope in that of the lettre de cachet, it is the National Father, the King and in that of Institutional Psychiatry, it is the Scientific Father, the Physician. 

Once this therapeutic view—whether of the Inquisition or of Institutional Psychiatry—is accepted, everything else follows logically. For example. Lea notes that By a legal fiction, the inquisitor was supposed to look at both sides of the case and to take care of the defense as well as of the prosecution. gy (hg same legal fiction, the state hospital psychiatrist is supposed to look at both sides of the case and protect the community as well as the mental patient. Thus on the one hand, psychiatrists plead, as we saw earlier, that they want to be considered doctors, not jailers on the other, they proudly assert that their duty is to protect society. Tomorrow s psychiatrist will be, as is his counterpart today, one of the gatekeepers of the community, declares Robert H. Felix, dean of the St. Louis University Medical School and former director of the National Institute of Mental Health. ... 

We need not dwell here on the disastrous consequences of the widespread and unopposed practices of the inquisitors. It should suffice to re-emphasize that by combating witchcraft, the inquisitors actually created it. The continuous teachings of the Church, observes Lea, led its best men to regard no act as more self-evidently just than the burning of the heretic, and no heresy less defensible than a demand for toleration.. . . The fact is that the Church not only defined the guilt and forced its punishment, but created the crime itself. The same, of course, may be said for Institutional Psychiatry. ... 

The Inquisition and Institutional Psychiatry thus fulfill the same sort of function as has been attributed to modem totalitarian rtipye- nehfsf Each tranquilizes the massive anxieties mobilized by what is generally experienced as an excess of choy j and a lack of worth-... 

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