patients should be protected from compulsory treatment , argues long-time
critic of psychiatry
critic of psychiatry, Thomas Szasz, has argued that psychiatric
patients should be safe-guarded from compulsory treatment by being
issued with "protection orders".
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views are out of date, cliched and naive.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.
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.
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."
protection orders that protect wives from abusive husbands, 'psychiatric
protection orders' would protect patients from coercive psychiatric
online replies on the BMJ website to Szasz's article were of particular
note because they were by psychiatrists who were also service users.
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increasingly out of date views unchallenged."
added: "Szaszs 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 hasnt. Consent
and compulsion are difficult issues in psychiatry: is it evident
that Szaszs article considers their complexity fully?"
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.
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.
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.
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.
it not for the interventions of psychiatrists, alongside my GP,
in the past I wonder whether I would be here to write this now.
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. "
20: The psychiatric protection order for the "battered mental
patient" - Thomas Szasz. British Medical Journal
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