In 1961, the French historian Michel Foucault published a book, Le folie et la raison, which was translated into English in 1965 as Madness and Civilization. The book made Foucault one of the most famous intellectuals in the world, and enormously popular in California, where he taught as a guest lecturer during the mid-1970s. Foucault’s book had a major impact on how we treat, and don’t treat, the seriously mentally ill.
Foucault argued that the supposedly humanistic treatment of the mad as suffering from mental illness was, in fact, a more insidious form of social control. Before 1500, the mad wandered freely in Europe, Foucault argued. After 1500, Europeans began to medicalize madness, treat it like an illness, as a way not just to control the mad but also to establish what was rational, normal, and healthy for the rest of society. Mental hospitals emerged at a time, Foucault argued, when the state was seeking to impose rational order on societies. And that started with policing the boundary between sane and insane. Foucault even criticized a humanistic asylum in England whose pioneering psychiatrist no longer used physical restraints, which the mentally ill today testify are terrifying and even constitute a kind of torture, on his patients. Said the psychiatrist, “these madmen are so intractable only because they have been deprived of air and freedom.”
Foucault wasn’t alone in his attack on psychiatry and mental hospitals. In 1961, an American sociologist, Erving Goffman, published an influential book, Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, which compared mental hospitals to concentration camps. That same year, a psychiatrist named Thomas Szasz published The Myth of Mental Illness, which argued that psychiatrists and others invented the concept of mental illness, with no biological evidence, in order to punish people who were different from the norm.
The anti-psychiatry movement became a cultural phenomenon in 1962 with the publication of Ken Kesey’s best-selling novel, One Flew Over the Cuckoo’s Nest. It revolves around a socially deviant but nonetheless sane man who feigns mental illness so he can go to a mental hospital rather than prison. He is drugged, electro-shocked, and eventually lobotomized. The novel was adapted as a Broadway play and an Oscar-winning 1975 film starring Jack Nicholson.
Szasz formed an alliance with the ACLU, which began to crusade politically, and litigate through the courts, for an end to involuntary treatment of the mentally ill. Because psychiatrists were no more reliable at diagnosing mental illness than flipping coins, argued the ACLU’s most influential attorney on the matter in 1972, they “should not be permitted to testify as expert witnesses.” Said another leading civil rights attorney in 1974, “They [the patients] are better off outside the hospital with no care than they are inside with no care. The hospitals are what really do damage to people.”
In early 1973 the journal Science published an article, “On Being Sane in Insane Places,” by a Stanford sociologist, David Rosenhan, who claimed to have sent research assistants into several mental hospitals where they were misdiagnosed with mental illness. “We now know that we cannot distinguish insanity from sanity,” he concluded. The study received widespread publicity and “essentially eviscerated any vestige of legitimacy to psychiatric diagnosis,” said the chairman of Columbia’s Department of Psychiatry. “Psychiatrists looked like unreliable and antiquated quacks unfit to join in the research revolution,” wrote another psychiatrist.
Rosenhan’s study became one of the most read and reprinted articles in the history of psychiatry, but a journalist in 2019 published a book describing so many discrepancies that she questioned whether it had ever even occurred. She only found one person who said he had participated in the study, and he said he was treated well by the hospital and had been discharged simply because he asked to leave.
“Before 1500, the mad wandered freely in Europe, Foucault argued.”
In the hard world before 1500, it is a good guess that every person — except for the mad offspring of the elite — had to work, and work hard, every day to get enough food to eat. Wander around truly mad, making no preparations for the coming winter with its freezing temperatures and starvation — early death was inevitable. Problem of mad people solved.
Foucault just made stuff up. Maybe a sign of madness? Maybe simply a manipulative personality?
Unquestionably, some psychiatrists have had long careers with no malpractice. Unfortunately, malpractice exists in every branch of the medical profession. The difficulty is in accurate investigation and prosecution. Full disclosure: I am in the camp that demands more stringent prosecution of malpractice.
Some groundbreaking psych professionals, such as Kevin Dutton, are absolutely beneficial to society because they expose the damage done by psychopaths. (Michel Foucault may have been a psychopath; I do not condone any of Foucault’s actions. I believe anti-psychiatry is a valid view, but I do not condone unethical or psychopathic actions done in the name of anti-psychiatry.)
Many psych professionals operate in a murky gray area, where reasonable people cannot agree on their honesty. Trying to get a consistent evaluation of (e.g.) Jordan Peterson is futile; his fans love him, his enemies hate him, and many of his former customers simply regret spending money on his products but are not willing to explore whether he is deceptive or simply a bad fit for their needs. Whether or not he might be guilty of malpractice, he is certainly not a menace like the infamous John Money of New Zealand.
Unquestionably, some theoretically inclined psychiatrists have committed scientific fraud. Sigmund Freud and Alfred Kinsey were committed liars. A few theorists such as William James deserve praise.
I cannot hold out any realistic hope for any intelligent reform of the psychiatric profession. However, I can say that a large fraction of the public is aware of the abuses of John Money, Alfred Kinsey, and the like. I tremble for the psychiatric profession when I reflect that God is just and that his justice cannot be indefinitely delayed.
God’s justice can quite wait until decades after the deaths of the above mentioned liars and psychopaths.
I’d settle for them all being out of power.
If one considers the effects of any policy one sees the actual policy. In this case the policy was to let the mad wander the streets, to the benefit of those who sow chaos then build prisons.
For all public policy purposes whatsoever, there are three categories of people:
1 Those who are a danger to no one.
2 Those who are a danger to themselves but not to others.
3 Those who are a danger to others.
Crazy or sane? Good or evil? Smart or stupid? Those are distinctions without distinction. Only the three categories matter, and they’re easy to apply.
Any policy that fails to focus on the three categories will be disastrous.