The Manufacture of Madness

The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, by Thomas Szasz

How is it that every time I read a book by Thomas Szasz, he surprises me with some interesting and intriguing new insight?  Szasz’ book The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement is replete with keen insights and remarkably clear descriptions of the true nature of psychiatry.  In this book, Szasz examines the similarities between the Inquisition and institutional psychiatry.  “In an earlier work, The Myth of Mental Illness,” Szasz writes in his preface to the original edition, “I tried to show how and why the concept of mental illness is erroneous and misleading.  In the present work, I shall try to show how and why the ethical convictions and social arrangements based on this concept constitute and immoral ideology of intolerance.  In particular, I shall compare the belief in witchcraft and the persecution of witches with the belief in mental illness and the persecution of mental patients.” (p. xv)

Although I disagree with Szasz about many of his evaluations of religion, politics, and history, his analogy is appropriate because it exposes the absurdity and the immorality inherent in the modern mental health craze.  The basic premise of this book is that false religious ideologies, namely the superstitions that fueled the Inquisition never really disappeared.  They were simply transformed into false scientific and medical ideologies.  In sum, “medicine replaced theology.”  By the same token, the alienist replaced the inquisitor, and the insane replaced witches.  “The result,” Szasz argues, “was the substitution of a medical mass-movement for a religious one, the persecution of mental patients replacing the persecution of heretics.” (p. xxiv)

Setting aside arguments about the reality or illusion of witchcraft, it is clear that during the Inquisition men fabricated myths about witches in order to hunt them down and persecute them.  As disturbing as this is, I couldn’t help but think of the brilliant scene in Monte Python and the Holy Grail in which a group of frenzied peasants arraigns a supposed witch before the wise Sir Bedevere.  Sir Bedevere’s first question to the group of peasants is “How do you know she is a witch?”  Building on Szasz’ analogies, a similar question might be posed to groups of frenzied mental health advocates when they arraign a victim before a psychiatrist: “How do you know she is mentally ill?”  One of the peasants pipes up: “She looks like one!”  When the supposed witch is brought forward, she insists that she is innocent and that she is not a witch.  Sir Bedevere wonders why she is dressed like a witch, and the supposed witch responds that the rabble rousers dressed her up as one.  They dressed her up as a witch and put a false nose on her.  Still, the peasants insist that she is a witch.  What evidence do these peasants have that the woman is a witch?  One peasant points to a wart.  Another peasant claims that she turned him into a newt, but then he got better.  But the wise Sir Bedevere understands that there are ways to determine whether or not the woman is a witch.  Reasoning backwards, Sir Bedevere teaches the peasants that since witches must be burned, and since wood also burns, witches are made of wood.  The next step, then, is to find out if the woman is made of wood.  Instead of building a bridge out of her (because bridges can also be built out of stone), and instead of throwing her into the pond to see if she floats, the group decides, with the help of King Arthur, to weigh her on a scale with a duck.  When the scale is even, the accused witch admits “It’s a fair cop,” or in other words, she admits that she is guilty of being a witch.

Even as we mock the absurdity of witch trials, Szasz’ point is that there are modern day witch trials taking place all around us.  People are regularly accused of being mentally ill, they are arraigned before psychiatric inquisitors, and when evidence for their supposed “illness” is requested, rabble rousers and psychiatrists point to the modern day equivalents of false noses, warts, newts, wood, ducks, and scales.  Psychiatrists, the general public, and, at times, even mental patients themselves accept these conjectures as proof of “mental illness.”

Szasz argues that, like the witches of yore, mental patients are labeled as social deviants in order to fulfill the societal need for scapegoats: “majorities usually categorize persons or groups as ‘deviant’ in order to set them apart as inferior beings and to justify their social control, oppression, persecution, or even complete destruction.” (p. xxx)  In essence, society manufactures madness, and institutional psychiatry “fulfills a basic human need – to validate the Self as good (normal), by invalidating the Other as evil (mentally ill).” (p. xxxi)  Szasz provides numerous accounts of scapegoating, from the Greeks and the Hebrews to witch trials and beyond, to demonstrate that the practice of scapegoating is nothing new, and that it didn’t end with the burning of witches.

Szasz devotes particular attention to the father of American psychiatry, Benjamin Rush, who was the embodiment of an inquisitor.  Szasz also exposes the absurdity of the theories of Freud and others who contended that insanity is caused by masturbation.  He devotes another chapter to the model psychiatric scapegoat, namely, the homosexual.  Finally, he shows how the struggle for self-esteem produces the need for the expulsion of evil in the form of scapegoats.

The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement is one of Szasz’ most brilliant books.  Although I disagree with much of his commentary, his underlying thesis, namely, that institutional psychiatry is a reflection of the Inquisition, that medicine replaced theology, and that the persecution of mental patients replaced the persecution of heretics, is not only accurate, but perhaps even prophetic.  This book is replete with keen insights and remarkably clear descriptions of the true nature of psychiatry.

Here are a few noteworthy passages:

• “Although I agree with Sigerist and other medical historians that psychiatry developed as the persecution of witches declined and disappeared, my explanation differs radically from theirs.  They say it happened because of the gradual realization that persons supposed to be heretics were actually mentally sick.  I say it happened because of the transformation of a religious ideology into a scientific one: medicine replaced theology; the alienist, the inquisitor; and the insane, the witch.  The result was the substitution of a medical mass-movement for a religious one, the persecution of mental patients replacing the persecution of heretics.” (p. xxiv)
• “The mental patient, especially if so defined against his will, is perhaps best viewed as a ‘deviant,’ either of society as a whole, or of a smaller group, typically the family.  The individual who differs from his peers, who disturbs or scandalizes his family or society, is often branded as insane; sometimes he need not even play a deviant role but is declared mad nevertheless.  Such psychiatric derogation fulfills important needs for the ‘mentally healthy’ members of the group.” (p. xxv)
• “The true believers in mental illness similarly maintain that human problems are caused by madmen and that incarcerating them in mental hospitals is good; whereas those opposed to this theory regard the explanation as false and the measures justified by it as evil.” (p. xxvi)
• “My thesis is quite different: Simply put, it is that there are, and can be, no abuses of Institutional Psychiatry, because Institutional Psychiatry is, itself, an abuse; similarly, there were, and could be, no abuses of the Inquisition, because the Inquisition was the characteristic abuse of Christianity, so Institutional Psychiatry is the characteristic abuse of Medicine.” (p. xxix)
• “For this reason, I repudiate the tacit assumption inherent in designating mental patients as deviants; that, because such persons differ, or are alleged to differ, from the majority, they are ipso facto sick, bad, stupid, or wrong, whereas the majority are healthy, good, wise, or right.  The term ‘social deviants’ for individuals incriminated as mentally is unsatisfactory for another reason: it does not make sufficiently explicit – as the terms ‘scapegoat’ or ‘victim’ do – that majorities usually categorize persons or groups as ‘deviant’ in order to set them apart as inferior beings and to justify their social control, oppression, persecution, or even complete destruction.” (p. xxx)
• “Social transformations of such magnitude do not occur, however, without terrible human sufferings.  The rulers, afraid of losing power, redouble their domination; the ruled, afraid of losing protection, redouble their submission.  In such an atmosphere of change and uncertainty, rulers and ruled unite in a desperate effort to solve their problems; they find a scapegoat, hold him responsible for all of society’s ills, and proceed to cure society by killing the scapegoat.” (p. 6)
• “Significantly, the word witch comes from a Hebrew word that has been rendered venefica in Latin, and witch in English.  Its original meaning was poisoner, dabbler in magical spells, or fortuneteller.  The concept of witch combines occult powers with possibilities of benefaction or malefaction.” (p. 10)
• “As happens also in other professions – especially those pertaining to the regulation of social affairs – psychiatrists have been largely responsible for creating the problems they have ostensibly tried to solve.  But then, like other men, psychiatrists cannot be expected to act systematically against their own economic and professional self-interests.” (p. 15)
• “It is sobering to contemplate the similarities among these inspirational messages.  The good intentions and sincerity of the speakers need not be doubted.  Pope, Prince, President – each claims to be trying to help his suffering fellow man.  What is chilling is that each ignores the possibility that the alleged sufferer, whether of witchcraft or of mental illness, might prefer to be let alone; that each refuses merely to offer his help and grant his beneficiary the right to accept it or reject it; and, finally, that each denies the painful truth that men upon whom the ministrations of the militant Church and the therapeutic State are imposed by force rightly regard themselves not as beneficiaries and patients but as victims and prisoners.” (p. 16)
• “In our day, the effect of obfuscating the differences between madness and dangerousness – psychiatric offense (mental illness) and lawbreaking (crime) – is the replacement of the Bill of Rights with the Bill of Treatments.  The upshot in each case is therapeutic tyranny, clerical in the first instance, clinical in the second.  The Inquisition thus combined the arbitrariness of theological judgments with the punitiveness of then prevalent penal sanctions.  Institutional Psychiatry similarly combines the arbitrariness of theological judgments with the punitiveness of now prevalent penal sanctions.  Moreover, institutional psychiatrists now oppose attempts to undo the mystification inherent in the idea of mental illness, and punish, as enemies of the established therapeutic order, those who persist in such efforts – just as formerly the inquisitors opposed attempts to undo the mystification inherent in the idea of witchcraft and persecuted those (like Weyer) who persisted in such efforts.” (p. 18-19)
• “The intolerance is understandable.  Doubt about the existence or dangerousness of mental patients would limit the methods permitted to institutional psychiatrists in combating mental illness, just as doubt about the existence or dangerousness of witches would have limited the methods permitted to inquisitors in combating witchcraft.  The Inquisition thus flourished so long as its agents were entrusted with special powers by the society they served.  Institutional Psychiatry now flourishes for the same reason.  Only when these powers are curbed does such an institution wither away.” (p. 19)
• “The result is a pervasive conceptualization of social nonconformity as a contagious disease – that is, the mythology of mental illness; a widespread acceptance of the institution which ostensibly protects the people from this ‘disease’ – that is, Institutional Psychiatry; and popular approval of the characteristic operations of this institution – that is, the systematic use of force and fraud, disguised by the architecture of hospitals and clinics, the rhetoric of healing, and the prestige of the medical profession.” (p. 21)
• “In so far as the concept of mental illness functions as a classificatory label justifying the psychiatric denigration of nonconformists, it is logically faulty, not because it fails to identify a socially definable characteristic, but because it mislabels it as a disease; and it is morally faulty, not because the physicians and psychologists who use it are badly intentioned, but because it fosters social control of personal conduct without procedural protections of individual liberty.” (p. 23)
• “These problems of ‘differential diagnosis’ would disappear if we regarded the physician as an expert on diseases of the body only, and recognized mental illness as a fictitious entity similar to witchcraft.  Were we to do this, the physician’s evaluative function would be limited to making an organic diagnosis or concluding that he cannot make one and his therapeutic function, to treating bodily diseases or abstaining from treatment… The problem of who is a fit subject for commitment would likewise disappear if we regarded involuntary mental hospitalization as a crime against humanity.  The question of who was a fit subject for burning at the stake was answered only when witch-hunting was abandoned.  I believe that the question of who is a fit subject for commitment will also be answered only when we abandon the practice of involuntary mental hospitalization.” (p. 25)
• “The inquisitors who opposed and persecuted the heretics acted in accordance with their sincere beliefs, just as the psychiatrists who oppose and persecute the insane act in accordance with theirs.  In each instance we may disagree with the beliefs and repudiate the methods.  But we cannot condemn the inquisitors doubly – first for having certain beliefs, and then for acting upon them.  Neither can we condemn the institutional psychiatrists doubly – first for holding that social nonconformity is mental illness, and then for incarcerating the mental patient in a hospital.  In so far as a psychiatrist truly believes in the myth of mental illness, he is compelled, by they inner logic of this construct, to treat, with benevolent therapeutic intent, those who suffer from this malady, even though his ‘patients’ cannot help but experience the treatment as a form of persecution.” (p. 26)
• “Institutional Psychiatry is a continuation of the Inquisition.  All that has really changed is the vocabulary and the social style.  The vocabulary conforms to the intellectual expectations of our age: it is a pseudoliberal social movement that parodies the ideals of freedom and rationality.” (p. 27)
• “The person accused of mental illness is in much the same position.  If he admits to the signs and symptoms of mental illness imputed to him by his denouncers, it proves that he is mentally ill: he recognizes the gravity of his illness and the need for its treatment in a mental institution.  If he denies the ‘illness,’ it only proves that he lacks ‘insight’ into his condition; this, even more than confession of illness, is thought to justify involuntary confinement and treatment… The basic similarity between the two situations is that the accusers can do no wrong, and the accused can do no right.  For the victim, admission and denial of both witchcraft and mental illness lead to the same destructive end.” (p. 30)
• “The secret police of the modern totalitarian states have faithfully copied this inquisitorial method.  The Mental Health Movements of modern Therapeutic States have improved upon it: Institutional psychiatrists (and psychologists, social workers, etc.) act as and believe themselves to be the individual’s ally, friend, and therapist, when, in fact, they are his adversary.  Should the patient confide his fears or suspicions to them, they will interpret these as signs of ‘mental illness’ and so report to their employer; should the patient fail to ‘co-operate’ with them, they will interpret his refusal as itself a sign of ‘mental illness’ and will again so report to their employer.” (p. 32)
• “It is necessary to recall here the economic aspects of the witch-hunts.  The persecution of witches was exceedingly profitable for both the ecclesiastic and secular authorities and for the individuals engaged in this business as well.  The property of the condemned person was confiscated and distributed among the witchmongers and their institutions.  In addition, towns and cities would pay witch-hunters for their work, the remuneration depending on the number of witches discovered.  Just as the power and prestige of the witch-mongers and rose with the increasing incidence of witch-craft, so has the power and wealth of psychiatrists with the increasing incidence of mental illness.  For a long time it did not occur to people that the ecclesiastic epidemiologists of witchcraft had a vested interest in a high, rather than a low, incidence of this disorder; indeed, as soon as this was fully appreciated, the witch mania was at an end.  For an almost equally long time, it did not occur to people that the medical and psychiatric ‘epidemiologists of mental illness have also a vested interest in a high, rather than a low, incidence of this disorder, indeed, this idea must be socially repressed – and the psychiatric myth of mental illness is accepted as enlightened common sense.” (p. 36)
• “The same may be said for our present situation: no one knows for certain who is, or is not, mentally ill.  Hence, the former need for witch-finders, witch-prickers, and inquisitors, and the present need for psychiatrists, psychologists, and social workers.” (p. 36)
• “The prevalence of mental illness is a problem dear to the hearts of all modern mental health workers.  Like the witchmongers of bygone days, contemporary psychiatrists never tire of emphasizing the prevalence of mental illness and the dangers to society of the mentally ill.  As a result, our ability to see signs of madness all around us now approaches – indeed, perhaps surpasses – that of the medieval inquisitor’s ability to see signs of heresy all around him.  Symptoms of madness appear with increasing frequency and in persons of all kinds – American and foreign, of high and low station, living and dead.” (p. 39)
• “The identical dangers are inherent in the methods of Institutional Psychiatry.  The pious inquisitor would undoubtedly have been enraged at the suggestion that he was the heretic’s foe, not his friend.  Likewise, the institutional psychiatrist angrily rejects the idea that he is the involuntary patient’s adversary, not his therapist.  In denying this interpretation, the inquisitor would have countered with the assertion that his ministrations – including burning the victim at the stake – were aimed at saving the heretic’s soul from eternal damnation; while the psychiatrist replies that his efforts – including lifelong imprisonment, electric convulsions, and lobotomy – are aimed at protecting and promoting the patient’s mental health.” (p. 51)
• “Mental health workers now maintain, just as those assisting the Inquisition maintained formerly, that everything done to the victim is for his own good.” (p. 54)
• “Like the inquisitor, the psychiatrist can ‘sentence’ a person to mental illness, but cannot wipe out the stigma he himself has imposed.  In psychiatry, moreover, there is no pope to grant absolute pardon from a publicly affirmed diagnosis of mental illness.” (p. 56)
• “Perhaps unintentionally and unwittingly, the new vocabulary of psychoanalysis  was thus combined with the traditional vocabulary of psychiatry, generating a rhetoric of rejection of hitherto unparalleled popularity and power.  The result was that everyone’s conduct – living or dead, primitive or modern, famous or infamous – became a fit subject for the psychopathologist’s scrutiny, explanation, and stigmatization.” (p. 69)
• “The physicians most responsible for classifying witches as mental patients were the celebrated French psychiatrists Pinel, Esquirol, and Charcot.  They were the founders not only of the French school of psychiatry but of all modern psychiatry as a positivistic-medical discipline.  Their views dominated nineteenth-century medicine.” (p. 71)
• “In the same way, the usual medical-psychiatric perspective on madness leads to an exclusive focus on the so-called mental patient and a corresponding neglect of the psychiatrist.  For more than a decade, I have insisted that this perspective is in part insufficient, and in part totally false; and that, to understand Institutional Psychiatry (or the Mental Health Movement), we must study psychiatrists, not mental patients.” (p. 98)
• “It seems to me that to maintain that what we call mental illness is not a disease is like asserting that two and two make four; and that to maintain that involuntary mental hospitalization is an immoral practice is like saying that three and three make six.” (p. 112)
• “The idea that mental illness does not exist, except as a myth, likewise cannot be openly acknowledged.  The doctrine that mental illness is a disease has been too firmly established by science to be pronounced false.  The prestige and tradition of the medical profession thus stand in the way of the rapid correction of this monumental error.” (p. 117)
• “The vast majority of the books on the history of psychiatry suffer from the same distortions as do histories of slavery written before the Civil War by men favorable to the pro-slavery position.  Standard texts on the history of psychiatry are accounts of the glories of Institutional Psychiatry.  A history of psychiatry from the point of view of the ‘patient’ has yet to be written.” (p. 126)
• Perceval is thus quite clear that, in the mental hospital, doctor and patient are locked in a struggle for power, the doctor being cast in the role of oppressor, the patient in that of victim.  He is equally clear, moreover – and in this respect, too, modern psychiatry has yet to catch up with him – on the role of the mental patient’s relatives: it is they who empower the physician to control and restrain the patient.” (p. 129)
• “Much of what is now called insanity will be looked upon by future ages with a feeling similar to what we feel toward those who suffered as witches in Salem, Massachusetts.” (p. 131)
• “Ideologies couched in a salvational or therapeutic vocabulary are particularly resistant to criticism.  Such belief-systems command not only obedience to the truth, as revealed to priests or physicians, but also define skepticism as heresy or madness.  The real significance of the therapeutic rhetoric thus lies in its power to disarm both victim and critic.  For in a Christian society, who can be opposed to God?  Only a heretic.  And in a scientific society, who can be opposed to mental health?  Only a madman.” (p. 133)
• “The lesson is that man must forever choose between liberty and such competing values as health, security, or welfare.  And if he chooses liberty, he must be prepared to pay its price – not only in eternal vigilance against malevolent tyrants bent on enslaving their subjects; in eternal skepticism of benevolent priests and psychiatrists, bent on curing souls and minds; but also in eternal opposition to enlightened majorities, bent on reforming misguided minorities.” (p. 134)
• “Psychiatry will not abandon its coercive and violent methods until it repudiates them in its heroes.  This is why I criticize not only Rush’s treatment of the insane, but also contemporary psychiatrists and social scientists’ acceptance of it and apologies for it.” (p. 150)
• “Rush is generally thought of as a great liberal, that is, a lover of liberty.  This is far from the truth.  While he loved liberty, he loved power far more.” (p. 153)
• “It is heartless hypocrisy to pretend that physicians, psychiatrists, or ‘normal’ laymen for that matter, really care about the welfare of the mentally ill in general, or the homosexual in particular.  If they did, they would stop torturing him while claiming to help him.  But this is just what reformers – whether theological or medical – refuse to do.” (p. 168)
• “Zealous efforts to eradicate and prevent such ‘disorders’ actually create the conditions in which the assumption and ascription of such roles flourish.” (p. 174)
• “It is clear that psychiatrists have a vested interest in diagnosing as mentally ill as many people as possible, just as inquisitors had in branding them as heretics.” (p. 175)
• “A new Constitutional Amendment, extending the guarantees of the First Amendment to medicine, would have to state that ‘Congress shall make now law respecting an establishment of medicine, or prohibiting the free exercise thereof…’ At this time in our history, anything even remotely resembling such a declaration would seem to be quite impossible, for Organized Medicine is now as much a part of the American government as Organized Religion had been of the government of fifteenth-century Spain.  Still, a small beginning in this direction might perhaps be made.” (p. 179)
• “As surgical skills and techniques became perfected, more difficult and more destructive operations were devised and employed to cure new iatrogenic disease.  The progression from clitoridectomy to colectomy and thence to lobotomy – as methods of ‘treatment’ not only for insanity but also for a host of other iatrogenic diseases – illustrates this principle… A functional – or strategic – theory of iatrogenic diseases and noxious treatments may thus be constructed.  According to it, physicians discover diseases and attribute them to causes depending on how they would like to intervene in the patient’s life.  Thus, when moral authority was a powerful therapeutic weapon, the physician attributed insanity to masturbation and used suggestion for its treatment; when surgical skills were embryonic, he attributed the disease to the same cause, but treated it with circumcision and clitoridectomy.  As surgical skills improved, the physician attributed insanity to the (anatomically intact) colon and treated it with colectomy; when neurosurgical techniques were perfected, he attributed the disease to malfunctioning frontal lobes and treated it with lobotomy.  The current fashion of treating mental illness with psycho-pharmacological agents may be interpreted similarly.” (p. 192)
• “The passion to interpret as madness that with which we disagree seems to have infected the best of contemporary minds.” (p. 203)
• “It is as if mankind were unable to accept the reality of human conflict.  It is never simply man who offends against his fellow man.  Someone or something – the devil, masturbation, mental illness – always intervenes, to obscure, excuse, and explain away man’s inhumanity to man.” (p. 205)
• “The triumph of medical imperialism is complete when the laity regards normal bodily and mental functions as diseases, and harmful interventions – even against the patient’s will – as treatments.” (p. 206)
• “There is, of course, nothing new in the veneration, even by ‘intellectuals,’ of popular opinion or the will of the masses.  The moral error of mistaking the ‘popular will’ for what is right, and the political error of equating it with liberty or justice, have been exposed by thinkers since antiquity, but especially since the French Revolution, by such men as Edmund Burke, Alexis de Tocqueville, Ortega y Gasset, and George Orwell.” (p. 209)
• “Modern physicians and psychiatrists are the perfect and infallible interpreters of Science and of Nature, just as Renaissance popes had been of the Bible and of God.” (p. 212)
• “In short, psychiatrists are the manufacturers of medical stigma, and mental hospitals are their factories for mass-producing this product.” (p. 237)
• “The faithful Christian hunting witches and the devout mental health worker ferreting out cases of undiscovered mental illness must rely on the covert signs, or hidden stigmata, of witchcraft and mental disease.  These supposed signs are not evident to ordinary persons, or even to the person who allegedly exhibits the sign.  This is what justifies, indeed requires, the employment of specialists – witch-finders and psychiatric diagnosticians – to discover heretical and insane members of the community.  The result is that in both the Inquisition and in Institutional Psychiatry, the well-doer must first gain social authorization for his ‘case-finding’ before being permitted to practice his ‘therapy.'” (p. 239)
• “Of course, anyone could, and often did, accuse anyone else of being a witch; but only the experts on witchcraft – the inquisitors – could make the diagnosis stick.  Similarly, anyone can, and often does, accuse anyone else of being mentally ill’ but only the experts on mental illness – the institutional psychiatrists – can make the diagnosis stick.” (p. 239)
• “In every one of these situations, an din others like them, the victim is not persecuted because he is dangerous or inferior; rather the oppressor declares him dangerous or inferior to justify his aggression as self-defense.” (p. 256)
• “The point of this discussion is to re-emphasize that Institutional Psychiatry is largely medical ceremony and magic.  This explains why the labeling of persons – as mentally healthy or diseased – is so crucial a part of psychiatric practice.  It constitutes the initial act of social validation and invalidation, pronounced by the high priest of modern, scientific religion, the psychiatrist; it justifies the expulsion of the sacrificial scapegoat, the mental patient, from the community.” (p. 267)
• “The scapegoat is necessary as a symbol of evil which it is convenient to cast out of the social order and, which, through its very being, confirms the remaining members of the community as good.” (p. 268)
• “For the animal predator in the jungle, the rule of life is: kill or be killed.  For the human predator in society, the rule is: stigmatize or be stigmatized.  Because man’s survival depends on his status in society, he must maintain himself as an acceptable member of the group.  If he fails to do so, if he allows himself to be cast into the role of scapegoat – he will be cast out of the social order, or he will be killed.” (p. 268)
• “The institutional psychiatrist treating involuntary patients is similarly engaged in a task whose goodness is considered so self-evident that it justifies the vilest of means.  He deceives, coerces, and imprisons his victims, drugs them into stupor, and shock them into brain damage.  Does this lessen the goodness of his work?  Not at all.  He is fighting evil.” (p. 271)
• “The psychiatrist creates mental patients as social objects so that he can act upon them in his own self-interest.  That he conceals his self-interest as altruism need not detain us here, as it is but a fresh ‘therapeutic’ justification of interpersonal coercion.” (p. 273)
• “For centuries, man attributed disease to sin, and endeavored to rid himself of illness by attending to his moral conduct.  Today, he attributes sin to disease, and endeavors to rid himself of evil by attending to his health.” (p. 275)
• “The feared violence of the madman is thus best understood as largely the projection, onto the victim, of the actual violence of his persecutor.” (p. 278)
• “I have tried to show how ‘mentally ill’ evildoers are recruited in our contemporary society.  The massive manpower mobilization in the Mental Health Movement is best understood as an attempt to increase the number of mental patients ‘found’ in society.  Like mine owners hiring more laborers to tear more copper out of the bowels of the earth, the state and federal governments, their subdivisions, and private and philanthropic organizations are hiring more psychiatrists, psychologists, and social workers to tear more madmen out of the bowels of society.  And for whose good?  The answer can only be: for those who hire them, who define their task, and who, of course, pay them.  This is why the transformation of the physician’s role from that of healer of the sick individual to that of the civil servant or bureaucrat is so important.  The implications of this process for psychiatry are especially momentous.” (p. 281)