Institutional Psychiatry social function

Psychiatry, like religion, is an institution for the regulation of human behavior—by rhetoric and repression, that is, by propaganda, persuasion, the threat of force, and the use of force. A person may abide by rules voluntarily or he may be compelled to do so by individuals or institutions authorized to use force. Medicine, especially psychiatry, now fulfills many of the existential and social functions previously fulfilled by religion. 

To be sure, all history is selective. My point is only that the standard histories of psychiatry—mixing as they do Institutional Psychiatry, psychoanalysis, and other social interventions considered psychiatric —blur the differences between procedures that help society (and often harm the patient), and those that help the patient (and sometimes harm society) and having blurred these differences, they emphasize the therapeutic value, to the so-called patient, of virtually all psychiatric methods. In contrast, my bias, which I have made explicit, has been to separate Institutional Psychiatry (which rests on coercion and whose function is to protect society) from Contractual Psychiatry (which rests on cooperation and whose function is to protect the individual client). I have therefore confined myself here to selecting materials relevant to the history of Institutional Psychiatry. 

To illustrate in depth the ways in which Institutional Psychiatry serves the function of stigmatizing individuals as mentally ill, thus producing psychiatric scapegoats, 1 shall review some representative medical, journalistic, legal, and psychiatric writings on the nature of mental illness, psychiatric care, and mental health services. I shall begin with the views of an important authority in public health, a discipline often taken as the model of modern socially oriented psychiatry, and work my way toward specifically psychiatric contributions. 

In this chapter, I have tried to show some of the ways in which Institutional Psychiatry constitutes a social system whose function is to create certain kinds of medical stigmata and to impose them on certain persons. To be sure, contemporary American psychiatry comprises, as we have already noted, more than just Institutional Psychiatry. This has been true, however, only since the early decades of this century. Elsewhere, Institutional Psychiatry is still the only kind of psychiatric practice in existence. And even in the United States, the scope and significance of Institutional Psychiatry... 

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