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The abuse of psychiatry 

The abuse of psychiatry
The abuse of psychiatry

Paul Chodoff

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date: 28 June 2022

The profession of psychiatry is not immune from abuse of its aims and procedures. Such derelictions are dealt with below as they have occurred since the beginning of the Second World War. They include brief accounts of issues covered more fully elsewhere in the book, as well as topics not otherwise considered.

Defining abuse is essential since it may be confused with malpractice or with an error in a clinical judgment that is made in good faith. The latter is self-explanatory. All practitioners may err from time to time. Malpractice refers to the situation in which the clinician applies his expertise in an unskilled way. An example is prescribing psychotropic medication in response to a request from nursing staff who indicate that they feel under considerable pressure from a ‘few difficult patients who need containment if we are to cope with a busy ward’. By contrast, abuse refers to the intentional, improper application of the knowledge, skills and technology of psychiatry for a purpose other than serving the patient's interests or to harm, in diverse ways, people who do not warrant psychiatric status in the first instance. Abuse is invariably perpetrated by psychiatrists (and other mental health professionals) in collaboration with other persons or agencies, such as a state security service or political authority and, then, often as part of a totalitarian system.

Psychiatric abuse is always unethical in that the offending psychiatrist is always aware that the act is intrinsically wrong (whether or not it turns out to harm anyone), and explicitly violates professional ethics. A psychiatrist who acts in this way, claiming that he is obliged to follow the orders of superiors, is inexcusably rejecting a responsibility to ensure that regulations serve good, not bad, goals. In these circumstances, even if psychiatrists covertly seek to ameliorate the welfare of the patient, claiming that this is the sole means to maintain an ethical stance, their behaviour, by virtue of colluding in an abusive practice itself becomes abusive.The abuse of psychiatry may occur in two distinct but inter-related settings, the first when the clinician's loyalties are divided between patient and another agency (e.g. government department, military unit or academic institutions), and the second in the context of a direct therapeutic relationship.

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