The British Journal of Psychiatry
Slavery and psychiatry
J. A. Schaler

Raj Persaud ( 2003) begins his review of Thomas Szasz’s book Liberation by Oppression: A Comparative Study of Slavery and Psychiatry by asserting that something false is true: ‘Thomas Szasz became famous for being at the vanguard of the anti-psychiatry movement’. First, Szasz has never been part of the anti-psychiatry movement, much less at the vanguard of it. Second, there is as much truth in Persaud’s assertion as there is in asserting that the Nazis were simply practising medicine. Szasz has made it absolutely clear for over 50 years now that he supports psychiatry between consenting adults, that is, he supports contractual psychiatry. Third, Dr Persaud then asserts that Szasz is an ‘ally rather than an enemy of the National Health Service general adult psychiatrist’. This is another fiction masquerading as fact. Szasz is not an ally of National Health Service psychiatrists, none of whom, to my knowledge, has denounced or renounced the practice of psychiatric slavery. Moreover, Szasz is a classical liberal, not a socialist. The two cardinal principles of the classical liberal credo are the affirmation of the right to bodily and mental self-ownership and the prohibition against initiating violence.

These rather serious misrepresentations aside, Persaud ignores the core ideas in Szasz’s book. Institutional psychiatry is an extension of law: institutional psychiatrists are agents of the state, not of their patients. Doctors who practise contractual medicine are agents of their patients, not of the state. The importance of this difference cannot be overemphasised.

People labelled by institutional psychiatrists as mentally ill are concurrently defined by the courts as less than human, in much the same way ‘Negroes’ in America were once defined as three-fifths persons. This is how Black people were, and people with mental illnesses are, deprived of liberty and justice by the state. Labelling of anyone as less than human is legal fiction, something false that is asserted as true, that the courts will not allow to be disproved. Just as defining Negroes as three-fifths persons served to maintain the institution of slavery, defining people as mentally ill serves to maintain the institution of psychiatry.

A person has a right to refuse treatment for cancer. A person does not have a right to refuse treatment for mental illness. If institutional psychiatrists are deprived of their power by the state to deprive mentally ill persons of their liberty, that is, if the state did not allow psychiatrists to enslave their patients in the name of liberating them, institutional psychiatry would go the way of slavery, as well it should.

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