Mental Hospitals vs. Human Freedom (Psychiatric Ideologies and Institutions, by Anselm Strauss, Leonard Schatzman, Rue Bucher, Danuba Ehrlich, Melvin Sabshin)
Maisel, Robert
PSYCHIATRIC IDEOLOGIES AND INSTITUTIONS, by Anselm Strauss, Leonard Schatzman, Rue Bucher, Danuba Ehrlich, Melvin Sabshin. New York: Free Press. 418 pp. $8.50. The state mental hospital...
...The state mental hospital system, which took shape in the late 19th century, was extravagantly heralded as a cheap and humane solution for the problem of mental illness...
...But denial of liberty, abrogation of rights, and arbitrary authority are private sins which unfortunately become the stuff of public virtues...
...To be sure, the despot is a scientist, his rulings are psychiatric generalizations and his motives are theoretically disinterested...
...A man of remarkable courage, Hass joined the Polish Trotskyists in 1938...
...Released in 1957, under the Polish Russian repatriation agreement, he promptly returned to political activity, joining the Communist party...
...But the mental hospital is no democracy...
...The problems of dealing with mental disorders within an institutional context are best illustrated in situations where the aims of social control and therapy cannot be easily reconciled...
...Only the insensitive can ignore the Star Chamber atmosphere of commitment proceedings, where a person is tried for what he is ("mentally ill") rather than for what he has done...
...The authors thoroughly dispel any suspicion that the therapist-patient relation is a mutual and candid exchange...
...In a vigorous protest, published as an "Open Letter to WIadysIaw Gomulka," Isaac Deutscher observes that, in 1957, "No one asked him ever to renounce his past, and he did not deny his old Trotskyist views even for a moment...
...Strauss and his co-workers, in their book Psychiatric Ideologies and Institutions, demonstrate how the language of psychiatry provides an overarching metaphor of medical treatment which binds together the institutional apparatus of the mental hospital...
...The psychiatrist, in his hospital and court roles, becomes the benevolent despot who recruits and rules a small but selfcontained fiefdom of dependent subjects...
...The rhetoric of therapy is suppressed, except for the acute treatment wards...
...This was a system which had been transplanted from the USSR to nearly all Communist parties . .. We have finished, or rather we are finishing with that system once and for all.' (Your italics...
...By law and common consent, care for those officially declared mentally disturbed is entrusted to institutions administered by the medical profession...
...To this caricature of the judicial process must be added the supreme indignity suffered by its victims: once labeled "ill" and hospitalized they are subject to total invasion of privacy...
...The cult of the personality was not a matter just of Stalin's person,' you stated then...
...Moreover, psychiatrists do more than diagnose illness...
...Moscow 'rehabilitated' the Polish party and its leaders only after 17 or 18 years...
...You knew that I had been one of those very few Communists who, in 1938, protested against that crime and against the disbandment and denigra tion of what had once been our common party...
...The state hospital faces overwhelming logistic problems in caring for its 4000 patients—inadequate staff, crowded facilities, meager budget...
...It is only logical to find there the prevailing theories of mental disorder couched in medical imagery: these embrace "doctors" and "patients," and "therapies" which halt or reverse the course of the "illness" or fail to keep the person from "regressing...
...and then you, Wladyslaw Gomulka, apologized for having kept silent in 1938, although you had not believed the Stalinist slanders...
...When the Russians invaded Eastern Poland, under the terms of the Nazi-Soviet Pact, he was arrested and spent the next 17 years in Stalin's slave camps—the first eight at the infamous Vorkuta, and the next nine beyond the Arctic Circle...
...They compare psychotherapy as practiced in hospitals to an elaborate game of chess—with the patients the pawns...
...Do you, Wladyslaw Gomulka, really believe that you have in your 'apparatus' and administration many people of comparable disinterestedness and idealism...
...This routinized equivocation, similar to what George Orwell might have called "double-speak," apparently works well enough in blurring the distinction between authoritative command and therapeutic diagnosis...
...Strauss and his co-workers, despite a professed neutrality concerning their subject matter ("there are no villains in this place") disparage the patient's uncomplimentary view of the hospital and tacitly accept the reality of hos pital life as defined by the medical staff...
...In the private hospital things are different, yet the same in a different way...
...As therapist the doctor needs the voluntary assistance of his patients to treat them...
...The patient is left defenseless against numerous indignities...
...Institutional requirements are clearly and systematically expressed in contrasting moral categories applied to patients and wards (worker or idle, tidy or untidy, ambulatory or bedridden...
...But are you not to some extent re-establishing that system...
...It also attacked the clergy for its "reactionary role," declared that the workers' councils of Yugoslavia did not democratically represent the workers and called for "return to proletarian internationalism...
...A statement was signed by faculty members, the executive committee of the Berkeley W. E. Du Bois Club, by Hal Draper of the Independent Socialist Club, Brian O'Brien, President of Local 1570 of the American Federation of Teachers, and by others...
...To be sure, most hospitals probably do the best they can for patients, given a restrictive mandate and limited resources...
...Look around you, look at the crowds of time-servers that surround you, at all those opportunists without principle and honor who fawn on you as they fawned on Bierut, and as some of them even fawned on RydzSmigly and Pilsudski...
...PSYCHIATRIC IDEOLOGIES AND INSTITUTIONS, by Anselm Strauss, Leonard Schatzman, Rue Bucher, Danuba Ehrlich, Melvin Sabshin...
...The medical view of mental illness has the plausibility of symmetry and authority, but at best it engages only tangentially those aspects of mental disorder which do not fit the "disease" metaphor...
...Staffing and financial support are ample...
...This circumstance alone testifies to his courage and integrity...
...but as a member of the hospital staff he must face questions of authority, discipline, and social control of the same patients...
...They appeal for the pressure of protest on the Polish government by radicals everywhere...
...work, self-care and mobility are explicitly geared to organizational efficiency and survival...
...The American mental hospital, like any social institution, works within a framework of custom and convention...
...Do you wish these trials to mark the tenth anniversary of your own rehabilitation and of that 'spring in October,' during which you raised so many hopes for the future...
...Two such situations are examined by the authors: one a large state hospital, the other a small psychiatric wing of a private general hospital...
...Further, "The physicians themselves play into this ubiquitous lingual system, because they use these very terms as a shorthand for giving both orders and managerial suggestions...
...In the authors' words: "Virtually all the terminology used by and to nurses, except for certain strictly psychiatric terms like 'hallucination' has dual meanings...
...But this completely misses the point at issue...
...And he adds: "In those far-off days, just after the 'Polish spring in October,' you held that Polish Communists ought to know my account of the havoc that Stalin made of their party, delivering nearly all its leaders to the firing squad...
...It must emphasize order, discipline and decorum—in short, social control—and has few resources left for "therapy...
...the patients have no rights but only "privileges...
...But this high hope proved unjustified: the mental hospital merely became a repository for increasing numbers of social rejects whose subordination to hospital life was assured by rigid discipline and authoritarian organization...
...No pretense is made of linking these terms to psychiatry...
...They act as judges who certify insanity and give expert testimony in pre-trial psychiatric examinations which alter the status of persons whose behavior is offensive, burdensome, puzzling to others, or who have otherwise come to the attention of the courts...
...Doctors in mental institutions are confronted not merely with a spectrum of illnesses waiting to be treated, but with a mass of captive humans, many of whom deny that they are ill and live only to regain their freedom...
...Treatment or therapy is the conscious aim of the institution...
...He did not relinquish his principles, and so protested the suppression of Po Prostu, the independent student paper, and openly declared himself a Trotskyist...
...If one is armed with a view of the American legal system as a middleclass bias, one can talk blandly (as do the authors) about the hospital as "a place where people live," and be at ease with the dismal fact that patients who recover often don't get released unless they have "a bridge to the outside...
...On the witness stand at the first trial, Ludwik Hass proudly acknowledged the accusation that he was a Trotskyist and affirmed his revolution ary socialist convictions...
...A committee of 100 has been formed on the Berkeley campus to protest this attack upon freedom...
...The role of warden inevitably is grafted onto that of psychiatrist-as-therapist...
...However, coercion in a subtle form remains a steady feature of the patient's life...
...He must learn to define himself as sick in order to play his role vis-A-vis his therapist...
...Reminding Gomulka that he protested "when you, Wladyslaw Gomulka, were imprisoned and slandered in the last years of the Stalin era," Deustcher goes on to say that "in their case as in yours I think I can recognize reactionary police terror for what it is and tell slander from truth...
...ROBERT MAISEL POLAND: THE CRIME OF OPINION (continued from page 338) the working class...
...Its use would be inconsistent with the professed aims of the institution...
...The administrative staff, however, is not likely to invoke the language of political authoritarianism to describe their actions, for they view themselves as healers, not jailers...
...hospital privileges are the reward for patients who "respond well to firm controls," and patients find it impossible to influence or choose their therapists...
...I do not believe that you are now right in persecuting and imprisoning members of your own party and your critics on the Left...
...They are concerned with the injustice of confining people who have broken no laws nor been tried for illegal acts...
...May I remind you of your own words spoken at the famous eighth session of the Central Committee in October 1956...
...Over all floats an esoteric, "dynamic" terminology which pretends to deeper interpretation of "symptoms" than shallow common sense can reach...
...Responsible critics of the mental hospital and psychiatry are not primarily concerned with custodialism — overcrowding, mass diets and the material regimentation of life in the hospital...
...Given this heavy commitment to treatment, it is not surprising that the language of authority is de-emphasized...
...The authors of the present monograph show how the paradox is translated into action by the staff: the language of psychiatric analysis is used to conceal the directives of authority...
...This is their reply to the numerous critics of the state mental hospital, both ex-patients and social scientists, who have condemned the system as punitive, cruel and degrading: "Viewing an institution with middle-class ideals of privacy, human dignity and independence, these observers are understandably horrified by what they see—and pose their humanistic orientation against the custodialism of the state hospital...
...in the course of which he is usually forced to undergo a psychiatric examination which may seal his fate with a verdict that he is "sick," followed by an indeterminate confinement in a state hospital...
...Hospital wards become "therapeutic milieux" and nurses and aides serve as accessories to the over-all therapeutic plans of the psychiatrist...
...The two roles are incompatible...
...one can disregard gross restraints imposed on patients merely suspected of being troublesome or suicidal, and privileges (freedoms) awarded to patients on the staff's own terms...
...and I cannot keep silent...
...It is the erosion of individual liberties stemming from the prevalent conception of "mental illness" that disturbs and alarms thoughtful sociologists...
Vol. 13 • July 1966 • No. 4
