As an arm of the state, psychiatry has long been used for political purposes as an instrument of state-sanctioned social control. This is well-recognized by historians of psychiatry and those who study the sociology of psychiatry through a critical but inquiring lens.
Though cast by the modern biopsychiatrists as an inherently medical specialty along the same lines as cardiology and ophthalmology, psychiatry (and its diagnosis) has always carried with it a great social weight that distinguishes it from these former disciplines. What is different about psychiatry is that it deals assuredly with behavior, the classification of which as disease or disorder is a purely social determination. I have written about this elsewhere (see Ruffalo, 2015).
In the absence of biological testing in psychiatry, there exists an essentially limitless range of human behavior that can be medicalized for a variety of reasons, and with a variety of consequences. The driving forces of psychiatric medicalization, as Frances (2013) so eloquently describes, include the pharmaceutical and insurance industries, the psychiatric classification system, and professional turf wars, among others. The end result is always a deprivation of freedom and responsibility. A frequently overlooked cause of medicalization amongst contemporary writers, particularly psychiatrists, is social control.
What do I mean when I say social control? It is a term native to sociology that refers to a process undertaken societally through various means—usually government-driven—to convert the individual to conformity. Deviation from the norm, therefore, is the target of social control. It is well-noted amongst scholars who study deviance and social control that psychiatry—and, by extension, social work, psychology, and the other mental health disciplines—are major mechanisms of state social control over the population.
There is perhaps no greater example of the use of psychiatry as a means of government-fueled social control than the application of the diagnosis of schizophrenia to political dissidents in the ex-Soviet Union. Called “sluggish schizophrenia” or “creeping schizophrenia,” the condition was diagnosed in individuals with no apparent psychotic symptoms, on the assumption that these symptoms would appear in the future. Persons so diagnosed were imprisoned in psychiatric hospitals, forcibly medicated with psychotropics, and subjected to other forms of coercion masquerading as “treatment.” The diagnosis of creeping schizophrenia was limited to the Soviet Union and the Eastern Bloc and largely disappeared after the fall of the USSR in 1989.
After those so labeled were discharged from the hospital, they were frequently deprived of their civil rights, denied employment, and suffered the problems with credibility that typically accompany psychiatric incarceration. Without question, the diagnosis was given almost exclusively to persons who challenged the totalitarian Soviet system; it is widely accepted as a sham diagnosis, despite the fact that it remains listed in the Russian version of the International Classification of Disease, a testament to the continued reign of authoritarianism in Russia.
What are the lessons of so-called creeping schizophrenia? One lesson is that psychiatric diagnosis is weaponized when it is applied to individuals against their will. As the psychiatrist Szasz (1961) routinely pointed out, psychiatric diagnosis loses its meaning when it is applied coercively. Its utility is limited to consenting adults. Secondly, psychiatry can be used in the hands of the state to repress political opposition, silence dissent, and pathologize differences in political opinion.
When psychiatrists, psychotherapists, and political pundits label Donald Trump as mentally ill, they (seemingly unknowingly) excuse his behavior as “illness,” absolve him of moral responsibility for his actions, and resort to the same type of behavior that characterized Soviet psychiatry. While claiming to say something about Trump’s “mental health,” these armchair diagnosticians are actually saying a whole lot more about themselves. Their misguided and unethical application of psychiatric diagnosis reveals paradoxically that to fight what they see as authoritarianism, they will resort to authoritarian tactics!
As Mark Twain famously quipped, “To those who want to use a hammer badly, a lot of things look like nails that need hammering.” Instead of resorting to psychiatric name-calling, political debate should focus on the issues at hand and the merits of our leaders’ ideologies and decisions. To weaponize psychiatric diagnosis for political purposes is to make it a tool for political repression. It also renders it clinically meaningless.
Frances, A. J. (2013). Saving normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. New York: HarperCollins.
Ruffalo, M. L. (2015). The great paradox of psychiatry. Library of the Academy for the Psychoanalytic Arts. Retrieved from http://www.academyanalyticarts.org/great-paradox-psychiatry
Szasz, T. S. (1961). The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper & Row.