December 20, 2003

Long-time critic of psychiatry, Thomas Szasz, has argued that psychiatric patients should be safe-guarded from compulsory treatment by being issued with "protection orders".

But his British Medical Journal (BMJ) article provoked criticism from psychiatrists who are also service users. They argued that Szasz's views are out of date, cliched and naive.

Szasz, professor of psychiatry at the University of New York and author in 1961 of the seminal Myth of Mental Illness, argued in the BMJ that the reality of "battered mental patients" should be acknowledged.

He wrote: "Psychiatric patients are routinely treated against their will. Legally enforceable psychiatric protection orders would protect patients from coercive psychiatric interventions."

" I suggest we... acknowledge the unhappy fact of 'battered mental patients' and the need to protect them from their batterers," wrote Szasz, who is now in his eighties and this month carried out a lecture tour in the UK.

He added: "In the absence of a protection order the power relations between psychiatrist and involuntary patient will continue to generate 'psychiatric abuse', rationalised as protection and treatment. Indeed, it is precisely because psychiatrists reject advance psychiatric directives authorising abstinence from further treatment (a request that non-psychiatric doctors accept) that makes a legal mechanism such as the psychiatric protection order necessary."

"Like protection orders that protect wives from abusive husbands, 'psychiatric protection orders' would protect patients from coercive psychiatric interventions."

The online replies on the BMJ website to Szasz's article were of particular note because they were by psychiatrists who were also service users.

Daniel Beales, a specialist registrar psychiatrist at Ashworh Hospital in Merseyside, wrote: "As someone who has experienced mental illness that did not require compulsory treatment, and a relative of someone with a mental illness that did, as well as a psychiatrist and trainee psychotherapist, it is sad to see Szasz being given yet another platform from which to present his clichéd and increasingly out of date views unchallenged."

He added: "Szasz’s denial that 'mental illnesses are real diseases and that psychiatrists are regular doctors' illustrates the degree to which his argument has grown in sophistication since his Myth of Mental Illness . In other words, it hasn’t. Consent and compulsion are difficult issues in psychiatry: is it evident that Szasz’s article considers their complexity fully?"

Specialist registrar psychiatrist Jayne Sercombe, who works in Bristol, wrote that she supported compulsory treatment and was eager to emphasise the "compassion" of many of her colleagues.

She said: "As someone who has been troubled with major mental illness episodically for some years and who has seen psychiatry from both ends of the couch, I would like to make a few points.

"I have an unfortunate, real and at times life threatening illness, which I have been successfully treated for by kind, compassionate psychiatrists and other mental health staff.

"Though I would clearly never welcome detention under the Mental Health Act for myself were it unavoidable, I am aware that there may be times for myself when this could be potentially lifesaving. It would concern me to think that when my thoughts become so changed as to put me at risk there would be no safeguard for me to allow for help.

"Were it not for the interventions of psychiatrists, alongside my GP, in the past I wonder whether I would be here to write this now.

And with comments directed at Szasz, Sercombe added: "It is well enough to philosophise about these things - injustices have surely been done in the name of psychiatry. However what is important for me and my family is that I am alive and well. I am certain that this is so for the majority of patients that we see. "

See:
Dec 20: The psychiatric protection order for the "battered mental patient" - Thomas Szasz. British Medical Journal

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