4/ Editorial introductions

Chapter 2 - Freedom, Psychiatry and Responsibility by Jeffrey Schaler

Section one commences with a treatise on political philosophy. An odd opening for a text on psychiatric nursing ethics? Consider the assertion by Szasz that 'Organised Medicine is now as much a part of the American government as Organised Religion had been of the government in fifteenth-century Spain'. The point is that the connection between psychiatry and state, psychiatry as an organ of state, is a profoundly undemocratic, not to say unconstitutional development. Jeff Schaler develops this argument methodically and plainly, so that there should be no doubt in the readers mind by the end that something hugely surreal has taken place in our experience, if we believe that mental illness as defined by psychiatrists is any more 'real' than the energy channels in Chinese acupuncture theory or the chakras in Eastern mysticism and yoga. The only difference between these three sets of hypothesised phenomena is that psychiatry is backed up by force of law and the power of the state.

If you are feeling a little overwhelmed by the craziness, the frenetic energy and the insensitivity of people around you and sense that you need to protect yourself from their influence, you may choose to go to your yoga teacher for some sort of guidance. When the teacher gives you some advice based on an idea that you are particularly susceptible to malevolent influences in the ether, you may decide that you don't really believe in all this. If you doubt the potential for psychic transmission and prefer to avoid thinking about the opening of chakras around your third eye, there is not that much your yoga teacher can do about it. However, if your experience becomes a little more exaggerated, and you come before a psychiatrist who can't think what to do about the situation but decides you may be at some risk with these ideas, you may not be wise to assume that you are free simply to take his advice or leave it.

It must be clear that the power within psychiatry to deprive people of their freedom is by no means necessarily good. Which is not to say that people should not, on occasion, be so deprived. Neither have we made any claims so far as to what structures might (or indeed should) take the place of institutional psychiatry as an organ of state to protect people from being harmed by someone out of control, or to protect such people from harming themselves. Nor, indeed, have we said what might be best to help such people calm down. To such matters, contributors to the text will return in due course. For now, let us begin at the beginning, and set the debate in context with a little political philosophy and consideration of the issues of freedom, psychiatry and responsibility