Therapeutic Optimism and the Treatment of the Insane

66Psychiatry has been subjected to a number of criticisms in the last decade or so, often on the grounds that as social practice it is not objective and value free, as it often purports to be, but contains within itself a large amount of evaluational and moral content. In other words to treat someone as insane or mentally ill involves not only the use of scientific knowledge but also the invocation of social and moral norms of how people ought to act. Given the increasing influence of psychiatric knowledge it is surprising that so few attempts have been made to uncover just what those norms are and how it is that psychiatry has been able to reify them into apparently objective knowledge. Thomas Szasz’s Manufacture of Madness, ¹ Ronald Laing’s Politics of Experience, ² and Michel Foucault’s Madness and Civilization ³ are three works which have become widely known for the provocative way they have stimulated debate of these issues. All three have been severely criticised on a number of grounds, not least that they are short on evidence. Nevertheless they have raised questions about the nature of psychiatric knowledge which at the very least have disturbed the complacency of orthodox psychiatry. At the same time it must be said that these critiques have often been less than influential because the force of their criticism appeared to rest on an assumption that a psychiatry could exist that did not involve social control and moral prescription. The utopianism of the 1960s is now over, but that is no reason why the radical critiques which that period stimulated, should not themselves be placed on a more stable basis.