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== Challenges to psychiatry == === Civilization as a cause of distress === In recent years, psychotherapists [[David Smail (psychologist)|David Smail]] and [[Bruce E. Levine]], considered part of the anti-psychiatry movement, have written widely on how society, culture, politics and psychology intersect. They have written extensively of the "embodied nature" of the individual in society, and the unwillingness of even therapists to acknowledge the obvious part played by power and financial interest in modern Western society. They argue that feelings and emotions are not, as is commonly supposed, features of the individual, but rather responses of the individual to their situation in society. Even psychotherapy, they suggest, can only change feelings in as much as it helps a person to change the "proximal" and "distal" influences on their life, which range from family and friends, to the workplace, socio-economics, politics and culture.<ref>{{cite book|last=Smail |first=David John |author-link=David Smail (psychologist) |title=Power Interest and Psychology |publisher=PCCS Books |year=2005 |location=Ross-on-Wye, UK |isbn=978-1-898059-71-4}}</ref><ref name=LevineAlterNet>{{cite web |url=http://www.alternet.org/authors/bruce-e-levine |title=Bruce E. Levine's columns |work=Alternet |access-date=2013-12-12 |archive-date=2014-01-23 |archive-url=https://web.archive.org/web/20140123132623/http://www.alternet.org/authors/bruce-e-levine |url-status=live }} at [[AlterNet]]</ref> R. D. Laing emphasized [[family nexus]] as a mechanism by which individuals become [[victimized]] by those around them, and spoke about a dysfunctional society.<ref>{{cite encyclopedia |editor-last=Fadul |editor-first=Jose |title=Anti-psychiatry |encyclopedia=Encyclopedia of Theory & Practice in Psychotherapy & Counseling |date=2014 |publisher=Lulu Press Inc. |isbn=978-1-312-07836-9}}</ref><ref>{{cite book|last=Laing |first=R.D. |year=1960 |title=The Divided Self: An Existential Study in Sanity and Madness |publisher=Penguin Books}}</ref><ref>{{cite book|last1=Laing |first1=R.D. |last2=Esterson |first2=A. |name-list-style=amp |author-link2=Aaron Esterson |year=1964 |title=Sanity, Madness and the Family |place=London |publisher=Penguin}}</ref> === Inadequacy of clinical interviews used to diagnose 'diseases' === Psychiatrists have been trying to differentiate mental disorders based on clinical interviews since the era of Kraepelin, but now realize that their diagnostic criteria are imperfect. Tadafumi Kato writes, "We psychiatrists should be aware that we cannot identify 'diseases' only by interviews. What we are doing now is just like trying to diagnose diabetes mellitus without measuring blood sugar."<ref name=Kato>{{cite journal|last=Kato |first=Tadafumi |title=A renovation of psychiatry is needed |journal=World Psychiatry |date=October 2011 |volume=10 |issue=3 |pages=198–199 |pmc=3188773 |pmid=21991278 |doi=10.1002/j.2051-5545.2011.tb00056.x }}</ref> === Normality and illness judgments === [[File:Samuelcartwright.jpg|thumb|A madness of civilization: the American physician Samuel A. Cartwright identified what he called drapetomania, an ailment that caused slaves to be possessed by a desire for freedom and a want to escape.]] In 2013, psychiatrist [[Allen Frances]] said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".<ref name=frana>{{Cite journal|title=The New Crisis in Confidence in Psychiatric Diagnosis |journal=Annals of Internal Medicine |volume=159 |issue=3 |pages=221–2 |author=Allen Frances |date=17 May 2013 |doi=10.7326/0003-4819-159-3-201308060-00655|pmid=23685989 |doi-access=free }}</ref> Reasons have been put forward to doubt the [[ontic]] status of mental disorders.<ref name=Phillips>{{cite journal |last1=Phillips |first1=James |title=The Six Most Essential Questions in Psychiatric Diagnosis: A Pluralogue. Part 1: Conceptual and Definitional Issues in Psychiatric Diagnosis |journal=[[Philosophy, Ethics, and Humanities in Medicine]] |date=January 13, 2012 |volume=7 |issue=3 |pages=3 |doi=10.1186/1747-5341-7-3 |pmid=22243994 |issn=1747-5341 |pmc=3305603 |last2=Frances |first2=A |last3=Cerullo |first3=MA |last4=Chardavoyne |first4=J |last5=Decker |first5=HS |last6=First |first6=MB |last7=Ghaemi |first7=N |last8=Greenberg |first8=G |last9=Hinderliter |first9=AC |last10=Kinghorn |first10=WA |last11=LoBello |first11=SG |last12=Martin |first12=EB |last13=Mishara |first13=AL |last14=Paris |first14=J |last15=Pierre |first15=JM |last16=Pies |first16=RW |last17=Pincus |first17=HA |last18=Porter |first18=D |last19=Pouncey |first19=C |last20=Schwartz |first20=MA |last21=Szasz |first21=T |last22=Wakefield |first22=JC |last23=Waterman |first23=GS |last24=Whooley |first24=O |last25=Zachar |first25=P |display-authors=9 |doi-access=free }}</ref>{{rp|13}} Mental disorders engender [[ontological]] skepticism on three levels: # Mental disorders are abstract entities that cannot be directly appreciated with the human senses or indirectly, as one might with macro- or microscopic objects. # Mental disorders are not clearly natural processes whose detection is untarnished by the imposition of values, or human interpretation. # It is unclear whether they should be [[Concept|conceived]] as abstractions that exist in the world apart from the individual persons who experience them, and thus instantiate them.<ref name=Phillips />{{rp|13}} In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is [[norm (sociology)|normal]]) while another proposes that it is or could be entirely [[objectivity (science)|objective]] and [[scientific]] (including by reference to statistical norms).<ref>{{cite journal|author=Berrios G E |title=Classifications in psychiatry: a conceptual history |journal=Aust N Z J Psychiatry |volume=33 |issue=2 |pages=145–60 |date=April 1999 |pmid=10336212 |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0004-8674&date=1999&volume=33&issue=2&spage=145 |archive-url=https://archive.today/20120604144233/http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0004-8674&date=1999&volume=33&issue=2&spage=145 |url-status=dead |archive-date=2012-06-04 |doi=10.1046/j.1440-1614.1999.00555.x|s2cid=25866251 }}</ref> Common hybrid views argue that the concept of mental disorder is objective but a "fuzzy [[prototype]]" that can never be precisely defined, or alternatively that it inevitably involves a mix of scientific facts and subjective value judgments.<ref>{{cite encyclopedia |last=Perring |first=C. |year=2005 |url=http://plato.stanford.edu/entries/mental-illness/ |title=Mental Illness |encyclopedia=Stanford Encyclopedia of Philosophy |access-date=2012-01-27 |archive-date=2018-06-11 |archive-url=https://web.archive.org/web/20180611130635/https://plato.stanford.edu/entries/mental-illness/ |url-status=live }}</ref> One remarkable example of psychiatric diagnosis being used to reinforce cultural bias and oppress dissidence is the diagnosis of [[drapetomania]]. In the US prior to the American Civil War, physicians such as [[Samuel A. Cartwright]] diagnosed some slaves with drapetomania, a mental illness in which the slave possessed an irrational desire for freedom and a tendency to try to escape.<ref>{{cite book |last=Sharkey |first=Joe |author-link=Joe Sharkey |title=Bedlam: greed, profiteering and fraud in a mental system gone crazy |publisher=St. Martin's Press |year=1994 |location=NY |page=[https://archive.org/details/bedlamgreedprofi00shar/page/n195 182] |isbn=978-0-312-10421-4 |url=https://archive.org/details/bedlamgreedprofi00shar |url-access=registration }}</ref> By classifying such a dissident mental trait as abnormal and a disease, psychiatry promoted cultural bias about normality, abnormality, health, and unhealth. This example indicates the probability for not only [[cultural bias]] but also [[confirmation bias]] and [[bias blind spot]] in psychiatric diagnosis and psychiatric beliefs.<ref>{{Cite journal |last=Whaley |first=Arthur L. |date=March 1997 |title=Ethnicity/race, paranoia, and psychiatric diagnoses: Clinician bias versus sociocultural differences |url=http://dx.doi.org/10.1007/bf02263226 |journal=Journal of Psychopathology and Behavioral Assessment |volume=19 |issue=1 |pages=1–20 |doi=10.1007/bf02263226 |s2cid=145127517 |issn=0882-2689}}</ref> It has been argued by philosophers like Foucault that characterizations of "mental illness" are [[indeterminacy in philosophy|indeterminate]] and reflect the hierarchical structures of the societies from which they emerge rather than any precisely defined qualities that distinguish a "healthy" mind from a "sick" one. Furthermore, if a tendency toward self-harm is taken as an elementary symptom of mental illness, then humans, ''as a species'', are arguably insane in that they have tended throughout recorded history to destroy their own environments, to make war with one another, etc.<ref>{{cite book|last=Foucault |first=Michel |title=Madness and Civilization: a History of Insanity in the Age of Reason |publisher=Vintage Books |year=1988 |location=New York |isbn=978-0-394-71914-6|title-link=Madness and Civilization }}{{page needed|date=January 2014}}</ref> === Psychiatric labeling === [[File:Cartoon by Emil Kraepelin.jpg|thumb|300px|right|"{{lang|de|Psychiater Europas! Wahret Eure heiligsten Diagnosen!}}" ("Psychiatrists of Europe! Protect your sanctified diagnoses!"), says the inscription on the cartoon by [[Emil Kraepelin]], who introduced the schizophrenia concept, "{{lang|de|Bierzeitung|italics=no}}", Heidelberg, 1896]] Mental disorders were first included in the sixth revision of the [[International Classification of Diseases]] (ICD-6) in 1949.<ref name=Katsching>{{cite journal|last=Katsching |first=Heinz |title=Are psychiatrists an endangered species? Observations on internal and external challenges to the profession |journal=[[World Psychiatry (journal)|World Psychiatry]] |date=February 2010 |volume=9 |issue=1 |pages=21–28 |pmc=2816922 |pmid=20148149 |doi=10.1002/j.2051-5545.2010.tb00257.x }}</ref> Three years later, the American Psychiatric Association created its own classification system, DSM-I.<ref name=Katsching /> The definitions of most [[psychiatric assessment|psychiatric diagnoses]] consist of combinations of phenomenological criteria, such as symptoms and signs and their course over time.<ref name=Katsching /> Expert committees combined them in variable ways into categories of mental disorders, defined and redefined them again and again over the last half century.<ref name=Katsching /> The majority of these diagnostic categories are called ''disorders'' and are not validated by biological criteria, as most medical diseases are; although they purport to represent medical diseases and take the form of medical diagnoses.<ref name=Katsching /> These diagnostic categories are actually embedded in top-down classifications, similar to the early botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori about which classification criterion to use, for instance, whether the shape of leaves or fruiting bodies were the main criterion for classifying plants.<ref name=Katsching /> Since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews.<ref name="Kato"/> ====Experiments admitting "healthy" individuals into psychiatric care==== In 1972, psychologist [[David Rosenhan]] published the [[Rosenhan experiment]], a study questioning the validity of psychiatric diagnoses.<ref name=Rosenhan>{{cite journal|author=Rosenhan D |year=1973 |title=On being sane in insane places |journal=Science |volume=179 |issue=4070 |pages=250–258 |doi=10.1126/science.179.4070.250 |pmid=4683124 |bibcode=1973Sci...179..250R |s2cid=146772269 }} {{link note|note=URL given leads to abstract of study}}</ref> The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a [[Rosenhan experiment#Non-existent impostor experiment|later part of the study]], psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those with mental disorders.<ref name=Rosenhan /> Critics such as [[Robert Spitzer (psychiatrist)|Robert Spitzer]] cast doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.<ref name=Spitzer2005>{{cite journal|author=Spitzer R.L. |author2=Lilienfeld S.O. |author3=Miller M.B. |year=2005 |title=Rosenhan revisited: The scientific credibility of Lauren Slater's pseudopatient diagnosis study |journal=Journal of Nervous and Mental Disease |volume=193 |issue=11 |pages=734–739 |pmid=16260927 |doi=10.1097/01.nmd.0000185992.16053.5c |s2cid=3152822 }}</ref> The challenge of the validity versus the reliability of diagnostic categories continues to plague diagnostic systems. Neuroscientist Tadafumi Kato advocates for a new classification of diseases based on the neurobiological features of each mental disorder.<ref name=Kato /> while Austrian psychiatrist Heinz Katsching advises psychiatrists to replace the term "mental illness" by "brain illness."<ref name=Katsching /> There are recognized problems regarding the diagnostic reliability and validity of mainstream psychiatric diagnoses, both in ideal and controlled circumstances<ref>{{cite journal|last1=Williams |first1=J.B. |title=The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability |journal=Archives of General Psychiatry |volume=49 |pages=630–36 |year=1992 |pmid=1637253 |issue=8 |doi=10.1001/archpsyc.1992.01820080038006|first2=M|last3=First |first3=MB|last4=Spitzer |first4=RL|last5=Davies |first5=M|last6=Borus |first6=J|last7=Howes |first7=MJ|last8=Kane |first8=J|last9=Pope Jr |first9=HG|last10=Rounsaville |first10=B|last2=Gibbon }}</ref> and even more so in routine clinical practice (McGorry ''et al.''. 1995).<ref>{{cite journal|title=Spurious precision: procedural validity of diagnostic assessment in psychotic disorders |first1=PD |last1=McGorry |first2=C |last2=Mihalopoulos |first3=L |last3=Henry |first4=J |last4=Dakis |first5=HJ |last5=Jackson |first6=M |last6=Flaum |first7=S |last7=Harrigan |first8=D |last8=McKenzie |first9=J |last9=Kulkarni |first10=R |last10=Karoly |display-authors=9 |year=1995 |journal=Am J Psychiatry |volume=152 |pages=220–223 |issue=2 |pmid=7840355 |doi=10.1176/ajp.152.2.220|citeseerx=10.1.1.469.3360 }}</ref> Criteria in the principal diagnostic manuals, the DSM and [[International Classification of Diseases|ICD]], are not consistent between the two manuals.<ref>{{cite journal|last1=van Os |first1=J. |title=A comparison of the utility of dimensional and categorical representations of psychosis |journal=Psychological Medicine |volume=29 |pages=595–606 |year=1999 |pmid=10405080 |issue=3 |doi=10.1017/S0033291798008162|first2=C.|last3=Bale |first3=R.|last4=Van Horn |first4=E.|last5=Tattan |first5=T.|last6=White |first6=I.|last7=Murray |first7=R.|last2=Gilvarry |s2cid=38854519 }}</ref> Some psychiatrists in critiquing diagnostic criteria point out that [[comorbidity]], when an individual meets criteria for two or more disorders, is the rule rather than the exception, casting doubt on the distinctness of the categories, with overlap and vaguely defined or changeable boundaries between what are asserted to be distinct disorders.<ref>{{cite web|url=http://www.rossinst.com/trauma.htm |title=The Ross Institute – Trauma |publisher=The Colin A. Ross Institute for Psychological Trauma |url-status=dead |archive-url=https://web.archive.org/web/20080706115955/http://www.rossinst.com/trauma.htm |archive-date=July 6, 2008 }}</ref> Other concerns raised include using standard diagnostic criteria in different countries, cultures, genders or ethnic groups. Critics contend that Westernized, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups. For example, several studies have shown that [[African Americans]] are more often diagnosed with schizophrenia than white people,<ref>{{cite journal|title=The influence of racial factors on psychiatric diagnosis: a review and suggestions for research|journal=Community Mental Health Journal|year=1989|volume=25|issue=4|pages=301–311|doi=10.1007/BF00755677|pmid=2697490|last1=Neighbors |first1=HW |last2=Jackson |first2=JS |last3=Campbell |first3=L |last4=Williams |first4=D|citeseerx=10.1.1.547.8240|hdl = 2027.42/44303|s2cid=11079394}}</ref> and men more than women. Some within the anti-psychiatry movement are critical of the use of diagnosis at all as it conforms with the [[biomedical model]], seen as illegitimate. === Tool of social control === [[File:Whitchurch Hospital Corridor Abandoned West5 Ward.jpg|thumb|right|Whitchurch Hospital]] According to Franco Basaglia, [[Giorgio Antonucci]], and [[Bruce E. Levine]], whose approach pointed out the role of psychiatric institutions in the control and medicalization of [[Deviance (sociology)|deviant behaviors]] and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups.<ref name=LevineAlterNet /><ref name="Antonucci 1986">{{cite book|last=Antonucci |first=Giorgio |title=I pregiudizi e la conoscenza critica alla psichiatria (preface by Thomas Szasz)|trans-title=The prejudices and critical knowledge to psychiatry|editor-last=Coppola|editor-first=Alessio |edition=1st |publisher=Apache Cooperative Ltd |place=Rome |year=1986}}{{page needed|date=January 2014}}</ref><ref name="Sapouna">{{cite book|last1=Sapouna |first1=Lydia |last2=Herrmann |first2=Peter |title=Knowledge in Mental Health: Reclaiming the Social |url=https://books.google.com/books?id=y1-X6iP-m9UC&pg=PA70 |publisher=Nova Publishers |location=Hauppauge |year=2006 |page=70 |isbn=978-1-59454-812-3 |access-date=2014-01-12}}</ref>{{rp|70}} According to Mike Fitzpatrick, resistance to medicalization was a common theme of the gay liberation, anti-psychiatry, and feminist movements of the 1970s, but now there is actually no resistance to the advance of government intrusion in lifestyle if it is thought to be justified in terms of public health.<ref name=Fitzpatrick>{{cite journal|last=Fitzpatrick |first=Mike |title=From 'nanny state' to 'therapeutic state' |journal=[[The British Journal of General Practice]] |date=August 2004 |volume=54 |issue=505 |page=645 |pmc=1324868 |pmid=15517694}}</ref> In the opinion of Mike Fitzpatrick, the pressure for medicalization also comes from society itself. As one example, Fitzpatrick claims that feminists who once opposed state intervention as oppressive and patriarchal, now demand more coercive and intrusive measures to deal with child abuse and domestic violence.<ref name=Fitzpatrick /> According to Richard Gosden, the use of psychiatry as a tool of social control is becoming obvious in preventive medicine programs for various mental diseases.<ref name="Gosden">{{cite book |last=Gosden |first=Richard |title=Punishing the Patient: How Psychiatrists Misunderstand and Mistreat Schizophrenia |year=2001 |publisher=Scribe Publications |location=Melbourne |isbn=978-0-908011-52-0 |page=14 |url=https://sites.google.com/site/punishingthepatient/human-rights/social-control |access-date=2012-01-19 |archive-date=2015-05-14 |archive-url=https://web.archive.org/web/20150514180101/https://sites.google.com/site/punishingthepatient/human-rights/social-control |url-status=live }} {{link note|note=[http://sites.google.com/site/punishingthepatient/home The text of the book in full is available online]}}</ref>{{rp|14}} These programs are intended to identify children and young people with divergent behavioral patterns and thinking and send them to treatment before their supposed mental diseases develop.<ref name="Gosden" />{{rp|14}} Clinical guidelines for best practice in Australia{{Citation needed|reason=What are these clinical guidelines you describe - dubious statement |date=July 2020}} include the risk factors and signs which can be used to detect young people who are in need of prophylactic drug treatment to prevent the development of schizophrenia and other psychotic conditions.<ref name="Gosden" />{{rp|14}} === Psychiatry and the pharmaceutical industry === Critics of psychiatry commonly express a concern that the path of diagnosis and treatment in contemporary society is primarily or overwhelmingly shaped by profit prerogatives, echoing a common criticism of general medical practice in the United States, where many of the largest psychopharmaceutical producers are based.<ref name=LevineAlterNet /><ref>{{cite book |last=Moynihan |first=Ray and Alan Cassels |title=Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All Into Patients |publisher=Nation Books |year=2006 |isbn=978-1-56025-697-7 |url=https://archive.org/details/sellingsicknessh00raym }}</ref> Psychiatric research has demonstrated varying degrees of [[efficacy]] for improving or managing a number of mental health disorders through either medications, psychotherapy, or a combination of the two. Typical psychiatric medications include [[stimulant]]s, [[antidepressant]]s, [[anxiolytic]]s, and [[antipsychotic]]s (neuroleptics). On the other hand, organizations such as [[MindFreedom International]] and [[World Network of Users and Survivors of Psychiatry]] maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of [[adverse drug reaction]]. They and other [[Psychiatric survivors movement|activists]] believe individuals are not given balanced information, and that current psychiatric medications do not appear to be specific to particular disorders in the way mainstream psychiatry asserts;<ref>{{cite journal |url=http://content.karger.com/ProdukteDB/produkte.asp?doi=83999 |title=Rethinking Models of Psychotropic Drug Action |year=2005 |doi=10.1159/000083999 |pmid=15832065 |last1=Moncrieff |first1=Joanna |last2=Cohen |first2=David |journal=Psychotherapy and Psychosomatics |volume=74 |issue=3 |pages=145–153 |s2cid=6917144 |access-date=2006-03-10 |archive-date=2011-12-25 |archive-url=https://web.archive.org/web/20111225150359/http://content.karger.com/ProdukteDB/produkte.asp?doi=83999 |url-status=live }}</ref> and psychiatric drugs not only fail to correct measurable chemical imbalances in the brain, but rather induce undesirable side effects. For example, though children on [[Ritalin]] and other psycho-stimulants become more obedient to parents and teachers,<ref name="Reclaiming">{{cite book|last=Breggin |first=Peter |title=Reclaiming Your Children: A healing Plan for a Nation in Crisis |publisher=Perseus Publishing |year=2000}}</ref> critics have noted that they can also develop abnormal movements such as tics, spasms and other involuntary movements.<ref>{{cite web|url=http://breggin.com/Newstimulants.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://breggin.com/Newstimulants.pdf |archive-date=2022-10-09 |url-status=live |title=Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action |author=Peter R. Breggin}}</ref> This has not been shown to be directly related to the therapeutic use of stimulants, but to neuroleptics.<ref>{{cite news |url=https://www.nytimes.com/2007/05/10/health/10psyche.html |title=Psychiatrists, Children and Drug Industry's Role |author1=Gardiner Harris |author2=Benedict Carey |author3=Janet Roberts |date=May 10, 2007 |newspaper=The New York Times |access-date=February 21, 2017 |archive-date=October 16, 2017 |archive-url=https://web.archive.org/web/20171016134239/http://www.nytimes.com/2007/05/10/health/10psyche.html |url-status=live }}</ref><ref>{{cite news |url=https://www.usatoday.com/news/health/2006-05-01-atypical-drugs_x.htm |title=New antipsychotic drugs carry risks for children |author=Marilyn Elias |others=Contributing: Susan O'Brian |date=May 2, 2006 |newspaper=USA Today |access-date=2017-08-24 |archive-date=2012-05-04 |archive-url=https://web.archive.org/web/20120504031243/http://www.usatoday.com/news/health/2006-05-01-atypical-drugs_x.htm |url-status=live }}</ref> The diagnosis of [[attention deficit hyperactivity disorder]] on the basis of inattention to compulsory schooling also raises critics' concerns regarding the use of psychoactive drugs as a means of unjust [[social control]] of children.<ref name="Reclaiming" /> The influence of pharmaceutical companies is another major issue for the anti-psychiatry movement. As many critics from within and outside of psychiatry have argued, there are many financial and professional links between psychiatry, regulators, and pharmaceutical companies. Drug companies routinely fund much of the research conducted by psychiatrists, advertise medication in psychiatric journals and conferences, fund psychiatric and healthcare organizations and health promotion campaigns, and send representatives to lobby general physicians and politicians. [[Peter Breggin]], Sharkey, and other investigators of the psycho-pharmaceutical industry maintain that many psychiatrists are members, shareholders or special advisors to pharmaceutical or associated regulatory organizations.<ref>{{cite journal |last1=Gosden |first1=Richard |last2=Beder |first2=Sharon |name-list-style=amp |url=http://www.herinst.org/sbeder/corppower/pharm-agenda.html |title=Pharmaceutical Industry Agenda Setting in Mental Health Policies |journal=Ethical Human Sciences and Services |volume=3 |issue=3 |date=Fall–Winter 2001 |pages=147–159 |pmid=15278977 |doi=10.1891/1523-150X.3.3.147 |doi-broken-date=1 November 2024 |access-date=25 February 2013 |archive-date=23 May 2013 |archive-url=https://web.archive.org/web/20130523235807/http://www.herinst.org/sbeder/corppower/pharm-agenda.html |url-status=live }}</ref><ref>{{cite news |author=Thomas Ginsberg |url=http://mindfreedom.org/campaign/media/mf/inquirer-on-drug-firms/ |title=Donations tie drug firms and nonprofits |newspaper=[[The Philadelphia Inquirer]] |date=28 May 2006 |access-date=25 February 2013 |archive-date=30 November 2012 |archive-url=https://web.archive.org/web/20121130194827/http://mindfreedom.org/campaign/media/mf/inquirer-on-drug-firms/ |url-status=live }}</ref> There is evidence that research findings and the prescribing of drugs are influenced as a result. A United Kingdom cross-party [[Requests and inquiries#Parliamentary_inquiry|parliamentary inquiry]] into the influence of the pharmaceutical industry in 2005 concludes: "The influence of the pharmaceutical industry is such that it dominates clinical practice"<ref>{{cite web |url=https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf |title=House of Commons Health Committee: The Influence of the Pharmaceutical Industry (Fourth Report of Session 2002–2005) |page=100 |access-date=2017-08-30 |archive-date=2017-06-23 |archive-url=https://web.archive.org/web/20170623130001/https://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf |url-status=live }}</ref> and that there are serious regulatory failings resulting in "the unsafe use of drugs; and the increasing medicalization of society".<ref>{{cite web |url=https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf |title=House of Commons Health Committee: The Influence of the Pharmaceutical Industry (Fourth Report of Session 2002–2005) |page=101 |access-date=2017-08-30 |archive-date=2017-06-23 |archive-url=https://web.archive.org/web/20170623130001/https://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf |url-status=live }}</ref> The campaign organization ''No Free Lunch'' details the prevalent acceptance by medical professionals of free gifts from pharmaceutical companies and the effect on psychiatric practice.<ref name="no free lunch">{{cite web |url=http://www.nofreelunch.org/ |title=No Free Lunch (main page) |access-date=2014-01-13 |website=Nofreelunch.org |archive-url=https://web.archive.org/web/20140105151357/http://www.nofreelunch.org/ |archive-date=5 January 2014 |url-status=dead}}</ref> The ghostwriting of articles by pharmaceutical company officials, which are then presented by esteemed psychiatrists, has also been highlighted.<ref>{{cite news |url=http://observer.guardian.co.uk/uk_news/story/0,6903,1101680,00.html |title=Revealed: how drug firms 'hoodwink' medical journals | Society | The Observer |newspaper=The Observer |access-date=2006-03-21 |archive-date=2006-05-02 |archive-url=https://web.archive.org/web/20060502162854/http://observer.guardian.co.uk/uk_news/story/0,6903,1101680,00.html |url-status=live }}</ref> Systematic reviews have found that trials of psychiatric drugs that are conducted with pharmaceutical funding are several times more likely to report positive findings than studies without such funding.<ref name="NIHCM 2001">{{cite web |url=https://scholar.google.com/scholar_lookup?title=Prescription+Drug+Expenditures+in+2001:+Another+Year+of+Escalating+Costs&publication_year=2002& |publisher=National Institute for Health Care Management Foundation |title=Prescription Drug Expenditures in 2001: A report by The National Institute for Health Care Management Research and Educational Foundation (May 2002): Another Year of Escalating Costs |access-date=2022-09-08 |archive-date=2022-09-08 |archive-url=https://web.archive.org/web/20220908170524/https://scholar.google.com/scholar_lookup?title=Prescription+Drug+Expenditures+in+2001:+Another+Year+of+Escalating+Costs&publication_year=2002& |url-status=live }}</ref> The number of psychiatric drug prescriptions have been increasing at an extremely high rate since the 1950s and show no sign of abating.<ref name="Whitaker" /> In the United States antidepressants and tranquilizers are now the top selling class of prescription drugs, and neuroleptics and other psychiatric drugs also rank near the top, all with expanding sales.<ref name="NIHCM 2001" /> As a solution to the apparent conflict of interests, critics propose legislation to separate the pharmaceutical industry from the psychiatric profession. [[John Read (psychologist)|John Read]] and [[Bruce E. Levine]] have advanced the idea of socioeconomic status as a significant factor in the development and prevention of mental disorders such as schizophrenia and have noted the reach of pharmaceutical companies through industry sponsored websites as promoting a more biological approach to mental disorders, rather than a comprehensive biological, psychological and social model.<ref name=LevineAlterNet /><ref name=Read>{{cite journal|last=Read |first=John |author-link=John Read (psychologist) |title=Can Poverty Drive You Mad? 'Schizophrenia', Socio-Economic Status and the Case for Primary Prevention |journal=New Zealand Journal of Psychology |year=2010 |volume=39 |issue=2 |pages=7–19 |url=http://www.psychology.org.nz/cms_show_download.php?id=966 |access-date=8 April 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130208205223/http://www.psychology.org.nz/cms_show_download.php?id=966 |archive-date=8 February 2013 }}</ref> === Electroconvulsive therapy === {{Main|Electroconvulsive therapy}} [[File:Bergonic chair.jpg|thumb|A Bergonic chair "for giving general electric treatment for psychological effect, in psycho-neurotic cases", according to original photo description. World War I era.]] Psychiatrists may advocate psychiatric drugs, psychotherapy or more controversial interventions such as electroshock or [[psychosurgery]] to treat mental illness. Electroconvulsive therapy (ECT) is administered worldwide typically for severe mental disorders. Across the globe it has been estimated that approximately 1 million patients receive ECT per year.<ref>{{cite journal|first1=J. |last1=Prudic |first2=M. |last2=Olfson |first3=H.A. |last3=Sackeim |title=Electro-convulsive therapy practices in the community |doi=10.1017/S0033291701003750 |pmid=11459391 |journal=Psychological Medicine |date=July 2001 |volume=31 |issue=5 |pages=929–934 |s2cid=12210381 }}</ref> Exact numbers of how many persons per year have ECT in the United States are unknown due to the variability of settings and treatment. Researchers' estimates generally range from 100,000 to 200,000 persons per year.<ref>{{cite web |url=http://www.ect.org/paper-on-ect-statistics-at-mh-stats-conference |title=Paper on ECT statistics at MH Stats Conference |website=ect.org |url-status=dead |archive-url=https://web.archive.org/web/20060925233153/http://www.ect.org/paper-on-ect-statistics-at-mh-stats-conference/ |archive-date=2006-09-25}}</ref>{{self-published inline |certain=yes|date=April 2022}} Some persons receiving ECT die during the procedure (ECT is performed under a general anesthetic, which always carries a risk). [[Leonard Roy Frank]] writes that estimates of ECT-related death rates vary widely. The lower estimates include: *2–4 in 100,000 (from Kramer's 1994 study of 28,437 patients)<ref>{{Cite journal|last=Kramer|first=B. A.|date=1999-12-01|title=Use of ECT in California, revisited: 1984-1994|journal=The Journal of ECT|volume=15|issue=4|pages=245–251|issn=1095-0680|pmid=10614030|doi=10.1097/00124509-199912000-00002}}</ref> *1 in 10,000 (Boodman's first entry in 1996) *1 in 1,000 (Impastato's first entry in 1957) *1 in 200, among the elderly, over 60 (Impastato's in 1957) Higher estimates include: *1 in 102 (Martin's entry in 1949) *1 in 95 (Boodman's first entry in 1996) *1 in 92 (Freeman and Kendell's entry in 1976) *1 in 89 (Sagebiel's in 1961) *1 in 69 (Gralnick's in 1946) *1 in 63, among a group undergoing intensive ECT (Perry's in 1963–1979) *1 in 38 (Ehrenberg's in 1955) *1 in 30 (Kurland's in 1959) *1 in 9, among a group undergoing intensive ECT (Weil's in 1949) *1 in 4, among the very elderly, over 80 (Kroessler and Fogel's in 1974–1986).<ref>{{cite web|url=http://www.endofshock.com/102C_ECT.PDF |archive-url=https://ghostarchive.org/archive/20221009/http://www.endofshock.com/102C_ECT.PDF |archive-date=2022-10-09 |url-status=live |title=The Electroshock Quotationary |author=Leonard Roy Frank |access-date=2014-01-13 |date=June 2006 |website=Endofshock.com}}</ref>{{page needed|date=January 2014}}<!--this is 154 pages long--> === Political abuse of psychiatry === {{Main|Political abuse of psychiatry}} {{See also|Political abuse of psychiatry in the Soviet Union}} [[File:Guantanamo captive psych ward.jpg|thumb|right|The psychiatric ward at Guantanamo Bay]] Psychiatrists around the world have been involved in the suppression of individual rights by states in which the definitions of mental disease have been expanded to include political disobedience.<ref name=Semple>{{cite book|last1=Semple |first1=David |last2=Smyth |first2=Roger |last3=Burns |first3=Jonathan |title=Oxford handbook of psychiatry |year=2005 |publisher=Oxford University Press |location=Oxford |isbn=978-0-19-852783-1 |pages=6 |url=https://books.google.com/books?id=1MeRuoTs0loC&pg=PA6 |access-date=2014-01-12}}</ref>{{rp|6}} Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions.<ref name="Noll">{{cite book |last=Noll |first=Richard |author-link=Richard Noll |title=The encyclopedia of schizophrenia and other psychotic disorders |year=2007 |publisher=Infobase Publishing |isbn=978-0-8160-6405-2 |page=[https://archive.org/details/isbn_9780816064052/page/n28 3] |url=https://archive.org/details/isbn_9780816064052 |url-access=registration }}</ref><!--|url=https://books.google.com/books?id=jzoJxps189IC&pg=PA3-->{{rp|3}} Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine.<ref name="Medicine betrayed">{{cite book|title=Medicine betrayed: the participation of doctors in human rights abuses |year=1992 |publisher=Zed Books |isbn=978-1-85649-104-4 |page=65 |url=https://books.google.com/books?id=bMTu_oIfVsIC&pg=PA65 |access-date=2014-01-12}}</ref>{{rp|65}} The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favor of ideological conformity and in the broader interests of society.<ref name="Medicine betrayed" />{{rp|65}} In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.<ref name="Medicine betrayed" />{{rp|65}} Under the [[Nazi Germany|Nazi regime]] in the 1940s, the "duty to care" was violated on an enormous scale.<ref name="Check1" /> In Germany alone 300,000 individuals that had been deemed mentally ill, work-shy or feeble-minded were [[Compulsory sterilization|sterilized]]. An additional 200,000 were euthanized.<ref>{{Cite journal | last1 = Strous | first1 = R. D. | title = Nazi Euthanasia of the Mentally Ill at Hadamar | doi = 10.1176/appi.ajp.163.1.27 | journal = American Journal of Psychiatry | volume = 163 | issue = 1 | pages = 27 | year = 2006 | pmid = 16390885}}</ref> These practices continued in territories occupied by the Nazis further afield (mainly in [[eastern Europe]]), affecting thousands more.<ref name="Birley">{{Cite journal | last1 = Birley | first1 = J. L. T. | title = Political abuse of psychiatry | doi = 10.1111/j.0902-4441.2000.007s020[dash]3.x | journal = [[Acta Psychiatrica Scandinavica]] | volume = 101 | issue = 399 | pages = 13–15 | date=January 2000 | pmid = 10794019| s2cid = 144720199 }}</ref> From the 1960s up to 1986, [[political abuse of psychiatry]] was reported to be systematic in the Soviet Union, and to surface on occasion in other Eastern European countries such as [[Socialist Republic of Romania|Romania]], [[Hungarian People's Republic|Hungary]], [[Czechoslovak Socialist Republic|Czechoslovakia]], and [[Socialist Federal Republic of Yugoslavia|Yugoslavia]],<ref name="Medicine betrayed" />{{rp|66}} as well as in Western European countries, such as Italy. An example of the use of psychiatry in the political field is the "case Sabattini", described by [[Giorgio Antonucci]] in his book ''Il pregiudizio psichiatrico''.<ref>Antonucci, Giorgio: Il pregiudizio psichiatrico, Milano, 2020 [1989], ISBN 978-88-33020-76-1, pp. 147-150</ref> A "mental health genocide" reminiscent of the Nazi aberrations has been located in the history of South African oppression during the apartheid era.<ref name="Press conference">{{cite web |title=Press conference exposes mental health genocide during apartheid |date=14 June 1997 |url=http://www.info.gov.za/speeches/1997/06160x76497.htm |publisher=South African Government Information |access-date=16 January 2012 |archive-date=10 January 2012 |archive-url=https://web.archive.org/web/20120110122650/http://www.info.gov.za/speeches/1997/06160x76497.htm |url-status=live }}</ref> A continued misappropriation of the discipline was later attributed to the People's Republic of China.<ref name="van Voren 2010">{{cite journal|last=van Voren |first=Robert |title=Political Abuse of Psychiatry—An Historical Overview |journal=[[Schizophrenia Bulletin]] |date=January 2010 |volume=36 |issue=1 |pages=33–35 |pmid=19892821 |pmc=2800147 |doi=10.1093/schbul/sbp119 }}</ref> K. Fulford, A. Smirnov, and E. Snow state: "An important vulnerability factor, therefore, for the abuse of psychiatry, is the subjective nature of the observations on which psychiatric diagnosis currently depends."<ref name="Fulford">{{cite journal|last1=Fulford |first1=K |last2=Smirnov |first2=A |last3=Snow |first3=E |title=Concepts of disease and the abuse of psychiatry in the USSR |journal=[[The British Journal of Psychiatry]] |year=1993 |volume=162 |pages=801–810 |doi=10.1192/bjp.162.6.801 |pmid=8330112 |issue=6|s2cid=20611990 }}</ref> In an article published in 1994 by the ''[[Journal of Medical Ethics]]'', American psychiatrist Thomas Szasz stated that "the classification by slave owners and slave traders of certain individuals as Negroes was scientific, in the sense that whites were rarely classified as blacks. But that did not prevent the 'abuse' of such racial classification, because (what we call) its abuse was, in fact, its use."<ref name="Szasz, 1994" /> Szasz argued that the spectacle of the Western psychiatrists loudly condemning Soviet colleagues for their abuse of professional standards was largely an exercise in hypocrisy.<ref name="Gosden" />{{rp|220}}<ref name="Szasz, 1994" /> Szasz states that K. Fulford, A. Smirnov, and E. Snow, who correctly emphasize the value-laden nature of psychiatric diagnoses and the subjective character of psychiatric classifications, fail to accept the role of psychiatric power.<ref name="Szasz, 1994">{{cite journal|last=Szasz |first=Thomas |author-link=Thomas Szasz |title=Psychiatric diagnosis, psychiatric power and psychiatric abuse |journal=[[Journal of Medical Ethics]] |date=September 1994 |volume=20 |issue=3 |pages=135–138 |pmid=7996558 |doi=10.1136/jme.20.3.135 |pmc=1376496 }}</ref> He stated that psychiatric abuse, such as people usually associated with practices in the former USSR, was connected not with the misuse of psychiatric diagnoses, but with the political power built into the social role of the psychiatrist in democratic and totalitarian societies alike.<ref name="Gosden" />{{rp|220}}<ref name="Szasz, 1994" /> Musicologists, drama critics, art historians, and many other scholars also create their own subjective classifications; however, lacking state-legitimated power over persons, their classifications do not lead to anyone's being deprived of property, liberty, or life.<ref name="Szasz, 1994" /> For instance, a plastic surgeon's classification of beauty is subjective, but the plastic surgeon cannot treat his or her patient without the patient's consent, so there cannot be any political abuse of plastic surgery.<ref name="Szasz, 1994" /> The bedrock of political medicine is coercion masquerading as medical treatment.<ref name="Szasz, 2001">{{cite journal|last=Szasz |first=Thomas |title=The Therapeutic State: The Tyranny of Pharmacracy |journal=[[The Independent Review]] |date=Spring 2001 |volume=V |issue=4 |pages=485–521 |url=http://www.independent.org/pdf/tir/tir_05_4_szasz.pdf |archive-url=https://web.archive.org/web/20050304030638/http://www.independent.org/pdf/tir/tir_05_4_szasz.pdf |archive-date=2005-03-04 |url-status=live |access-date=20 January 2012 |issn=1086-1653}}</ref>{{rp|497}} In this process, physicians diagnose a disapproved condition as an "illness" and declare the intervention they impose on the victim a "treatment," and legislators and judges legitimate these categorizations.<ref name="Szasz, 2001" />{{rp|497}} In the same way, physician-[[Eugenics|eugenicists]] advocated killing certain disabled or ill persons as a form of treatment for both society and patient long before the Nazis came to power.<ref name="Szasz, 2001" />{{rp|497}}<ref>{{cite book|last=Black |first=Edwin |url=https://books.google.com/books?id=3qBduQAACAAJ |title=War Against the Weak: Eugenics and America's Campaign to Create a Master Race |publisher=Dialog Press|isbn=978-0-914153-29-0|year=2012}}{{page needed|date=January 2014}}</ref> From the commencement of his political career, Hitler put his struggle against "enemies of the state" in medical rhetoric.<ref name="Szasz, 2001" />{{rp|502}} In 1934, addressing the Reichstag, he declared, "I gave the order… to burn out down to the raw flesh the ulcers of our internal well-poisoning."<ref name="Szasz, 2001" />{{rp|502}}<ref name=Kershaw>{{cite book |last=Kershaw |first=Ian |title=Hitler: 1889–1936 |year=1999 |publisher=New York |location=Norton |isbn=978-0-393-04671-7 |url=https://archive.org/details/hitlerhubris00kers }}</ref>{{rp|494}} The entire German nation and its National Socialist politicians learned to think and speak in such terms.<ref name="Szasz, 2001" />{{rp|502}} [[Werner Best]], [[Reinhard Heydrich]]'s deputy, stated that the task of the police was "to root out all symptoms of disease and germs of destruction that threatened the political health of the nation… [In addition to Jews,] most [of the germs] were weak, unpopular and marginalized groups, such as gypsies, homosexuals, beggars, 'antisocials', 'work-shy', and 'habitual criminals'."<ref name="Szasz, 2001" />{{rp|502}}<ref name=Kershaw />{{rp|541}} In spite of all the evidence, people ignore or underappreciate the political implications of the pseudotherapeutic character of Nazism and of the use of medical metaphors in modern democracies.<ref name="Szasz, 2001" />{{rp|503}} Dismissed as an "[[political abuse of psychiatry|abuse of psychiatry]]", this practice is a controversial subject not because the story makes psychiatrists in Nazi Germany look bad, but because it highlights the dramatic similarities between pharmacratic controls in Germany under Nazism and those that have emerged in the US under the [[free market]] economy.<ref name="Szasz, 2001" />{{rp|503}}<ref>{{cite book |last=Klein |first=Naomi |url=https://books.google.com/books?id=C0KIy92V58wC |title=The Shock Doctrine: The Rise of Disaster Capitalism |date=29 July 2008 |publisher=Knopf Canada |isbn=9780676978018 }} Highlights similarity between Psychiatric treatments and disaster Capitalism.</ref>{{page needed|date=January 2014}} === Therapeutic state === The "therapeutic state" is a phrase coined by Szasz in 1963.<ref name=Baker>{{cite journal|last=Baker |first=Robert |author-link=Robert A. Baker |title=Psychiatry's Gentleman Abolitionist |journal=The Independent Review |date=Winter 2003 |volume=VII |issue=3 |pages=455–460 |url=http://www.independent.org/pdf/tir/tir_07_3_baker.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.independent.org/pdf/tir/tir_07_3_baker.pdf |archive-date=2022-10-09 |url-status=live |access-date=12 February 2012 |issn=1086-1653}}</ref> The collaboration between psychiatry and government leads to what Szasz calls the "therapeutic state", a system in which disapproved actions, thoughts, and emotions are repressed ("cured") through pseudomedical interventions.<ref>{{cite magazine |url=http://reason.com/archives/2000/07/01/curing-the-therapeutic-state-t |magazine=Reason Magazine |title=Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum |issue=July 2000 |access-date=2014-01-13 |archive-date=2014-01-14 |archive-url=https://web.archive.org/web/20140114112507/http://reason.com/archives/2000/07/01/curing-the-therapeutic-state-t |url-status=live }}</ref><ref name=Costigan>{{cite book|last=Costigan |first=Lucy |title=Social Awareness in Counselling |year=2004 |publisher=iUniverse |isbn=978-0-595-75523-3 |pages=17 |url=https://books.google.com/books?id=wfCesrlvK-gC&pg=PA17 |access-date=2014-01-12}}</ref>{{rp|17}} Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured.<ref name=Costigan />{{rp|17}} When faced with demands for measures to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that "we must guard against charges of nanny statism".<ref name="Fitzpatrick" /> The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor.<ref name=Fitzpatrick /> Nanny just told people what to do; counselors also tell them what to think and what to feel.<ref name=Fitzpatrick /> The "nanny state" was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive—and even more authoritarian.<ref name=Fitzpatrick /> According to Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion".<ref name="Szasz, 2001" />{{rp|515}} Faced with the problem of "madness", Western individualism proved to be ill-prepared to defend the rights of the individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if once people agree that they have identified the one true God, or Good, it brings about that they have to guard members and nonmembers of the group from the temptation to worship false gods or goods.<ref name="Szasz, 2001" />{{rp|496}} A secularization of God and the medicalization of good resulted in the post-Enlightenment version of this view: once people agree that they have identified the one true reason, it brings about that they have to guard against the temptation to worship unreason—that is, madness.<ref name="Szasz, 2001" />{{rp|496}} Civil libertarians warn that the marriage of the State with psychiatry could have catastrophic consequences for [[civilization]].<ref>{{cite web|url=http://www.fff.org/freedom/fd0411b.asp |title=Bush's Brave New World |publisher=The Future of Freedom Foundation|archive-url=https://web.archive.org/web/20050306053352/http://www.fff.org/freedom/fd0411b.asp|archive-date=2005-03-06|date=March 4, 2005|author=Sheldon Richman}} {{link note|note=Web page changed slightly; [http://fff.org/explore-freedom/article/bushs-brave-world/ this is current page]}}</ref> In the same vein as the [[separation of church and state]], Szasz believes that a solid wall must exist between psychiatry and the State.<ref name="Szasz, 2001" /> === "Total institution" === In his book ''[[Asylums (book)|Asylums]]'', Erving Goffman coined the term '[[total institution]]' for mental hospitals and similar places which took over and confined a person's whole life.<ref name="Davidson">{{cite book|editor1-last=Davidson |editor1-first=Larry |editor2-last=Rakfeldt |editor2-first=Jaak |editor3-last=Strauss |editor3-first=John |title=The Roots of the Recovery Movement in Psychiatry: Lessons Learned |url=https://archive.org/details/rootsrecoverymov00davi |url-access=limited |publisher=John Wiley and Sons |year=2010 |pages=[https://archive.org/details/rootsrecoverymov00davi/page/n166 150] |isbn=978-88-464-5358-7}}</ref><!--|url=https://books.google.com/books?id=tp4L_1zw9ngC&printsec=frontcover#PPA150,M1-->{{rp|150}}<ref name="Wallace">{{cite book|last=Wallace |first=Samuel |title=Total Institutions |url=https://books.google.com/books?id=F7uN3eHD1xQC |publisher=Transaction Publishers |year=1971 |pages=9 |isbn=978-88-464-5358-7 |access-date=2014-01-12}}</ref>{{rp|9}} Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organizations, orphanages, and monasteries.<ref name="Weinstein">{{cite journal|author=Weinstein R.M. |title=Goffman's Asylums and the Social Situation of Mental Patients |journal=Orthomolecular Psychiatry |volume=11 |issue=4 |pages=267–274 |year=1982 |url=http://www.orthomolecular.org/library/jom/1982/pdf/1982-v11n04-p267.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.orthomolecular.org/library/jom/1982/pdf/1982-v11n04-p267.pdf |archive-date=2022-10-09 |url-status=live |access-date=2014-01-13}}</ref> In ''Asylums'' Goffman describes how the institutionalization process socializes people into the role of a good patient, someone 'dull, harmless and inconspicuous'; it in turn reinforces notions of chronicity in severe mental illness.<ref name="Lester">{{cite journal|author=Lester H. |author2=Gask L. |title=Delivering medical care for patients with serious mental illness or promoting a collaborative model of recovery? |journal=British Journal of Psychiatry |volume=188 |issue=5 |pages=401–402 |date=May 2006 |pmid=16648523 |doi=10.1192/bjp.bp.105.015933 |doi-access=free }}</ref>
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