PETER SEDGWICK'S PSYCHOPOLITICS
Peter Sedgwick ( -1983) was a left wing writer who argued that anti-
psychiatry diverted people from more important issues. Sedgwick described
himself as a revolutionary socialist. His book, PsychoPolitics, was
published in 1982. It contains detailed critiques of four libertarian
writers whose work was influential in creating the anti-psychiatric tone of
radical literature in the 1970s. The four authors are: Thomas Szasz (who we
have already discussed), Erving Goffman (who wrote Asylums), a
psychiatrist, Ronald Laing and a historian, Michel Foucault. The gist of
Sedgwick's complaint against these four authors is that their anti-
psychiatric concern has stifled the development of a political alliance for
better services for mentally ill people. I am only going to look at what
Sedgwick has to say about Szasz.
SEDGWICK AND THE CONCEPT MENTAL ILLNESS
Sedgwick does not agree with Szasz's radical separation of mental
disturbances and physical illnesses. Szasz thinks mental illness is
socially constructed, but physical illness is natural. Sedgwick argues that
both are socially constructed. (Sedgwick 1982 p.29). He believes that
society can decide to include in the category illness, whatever it likes.
Medical technology, he writes, has succeeded in classifying illnesses as
particular states of the body only. But he says this link of illness with
physical damage is not essential.
Both Szasz and Sedgwick agree that mental illness is disabling. And it
seems that Sedgwick would like society to make disability the factor that
decides if something is an illness. I pointed out earlier that disability
is the one thing Szasz thinks mental and physical illness have in common.
The reason that Sedgwick is so anxious for mental disabilities to be called
illnesses is political: Without the concept of mental illness, he argues we
shall be unable to make demands on the health service facilities of the
society we live in (Sedgwick 1982 p.40).
SEDGWICK: POSITIVE, NOT CONTRACTUAL AND LEGAL FREEDOMS
I now turn to what Sedgwick has to say about the case against
compulsory psychiatry. He says that Szasz is concerned with contractual and
legal freedoms at the expense of positive freedoms. Let us look at these
one at a time:
CONTRACTUAL FREEDOM: Sedgwick describes Szasz's ideal of contractual
freedom as the freedom to pay up or perish (Sedgwick 1982 p.179). It is the
freedom to pay up because Szasz is an advocate of private psychiatry for
which the patient pays. The contract is the contract between the
psychiatrist and his patient to deliver therapy in exchange for cash. Szasz
depicts public health provision as necessarily coercive. So he wants to
replace it by a fee-paid two-person psychotherapy in order to maintain the
patient's control over the situation (Sedgwick 1982 p.154). But, as
Sedgwick points out, this would be of no value to poor or chronically
disabled people. The poor could not afford it and psychotherapy is not what
chronically ill people need.
Sedgwick also points out that the picture of public provision as
coercive does not fit the situation in this country where involuntary
hospitalisation is a minority procedure. Even in America, he says, it is of
decreasing importance. (Sedgwick 1982 p.153)
LEGAL FREEDOM: Szasz wants the law to stop psychiatrists forcing help
on unwilling people. Sedgwick concentrates on two aspects of this position.
First Szasz's belief that people should be allowed to commit suicide, and
second, his similar belief that drug addicts should be free to destroy
themselves with drugs if they chose to. These beliefs, according to
Sedgwick, reflect an individualisation of social problems. You may have
heard the following quotation from a sermon by John Donne (1572-1631): any
man's death diminishes me, because I am involved in mankind. Sedgwick says
this is a higher statement of ethics than Szasz's laissez faire attitude
(Sedgwick 1982 p.165). His implication would seem to be that we have both a
duty and a personal interest in intervening to prevent people destroying
themselves.
Sedgwick quotes a newspaper report that tens of thousands of patients
in the USA have been released as a result of court cases over the last ten
years. This is legal freedom, but what value is it? Hospitals have been
shut but there has been nowhere for the patients to go. As a result some
ex-patients have ended up in prison. Others are exploited by private
landlords. Some were re-admitted to other mental hospitals and some had
just died. (Sedgwick 1982 pp.216-217).
POSITIVE FREEDOM: Positive freedom is the concept of freedom that
Sedgwick considers superior to Szasz's contractual and legal freedoms. The
ideal of positive freedom, he says, is to maximise the power of all members
of society alike to make the best of themselves. He says we should not be
arguing over which sort of suicidal patients should be let looseşto go and
kill themselves (Sedgwick 1982 p.179). Instead we should be providing
community facilities to allow mental patients to live positive lives
outside mental hospitals.
So: positive freedoms are those that alow people to live positive
lives. You should notice that Sedgwick's version of freedom involves public
expenditure. I recall Linda Chalker telling a MIND conference that a
Conservative Government might well favour more rights for mental patients
as it was a reform that would not cost much money. Her idea of freedom, on
this occasion, was more like Szasz's than Sedgwick's.
Sedgwick thinks the anti-psychiatrists were wrong to put their efforts
into arguing a civil liberties case when the important issue is community
care. To secure meaningful freedoms he thinks we should be re-organising
our social life to provide what he calls substitute family units for
mentally ill people. These would allow them to live in the heart of the
community and so permit the closure of mental hospitals without causing the
distress to ex-patients that the American report spoke of.
Bibliography
Clare, A.W. 1978 In Defence of Compulsory Psychiatric Intervention
The Lancet 3.6.1978
Clare, A.W 1980 (2nd edition) Psychiatry in Dissent. Controversial
Issues in Thought and Practice.
Hunter, R.A. and Macalpine, I. 1963 Three Hundred Years of
Psychiatry 1535-1860
Mill, J.S. 1859 On Liberty
Sedgwick, P. 1982 PsychoPolitics.
Szasz, T. 1961/1972 The Myth of Mental Illness. Foundations
of a
Theory of Personal Conduct. (Paladin edition, abbreviated with a
summary, 1972)
Szasz, T. 1963 Law, Liberty and Psychiatry
Szasz, T. 1971 The Manufacture of Madness: A Comparative
Study of
the Inquisition and the Mental Health Movement.
Szasz, T. 1978 The Case Against Compulsory Psychiatric
Interventions
The Lancet 13.5.1978
© Andrew Roberts 9.1996-
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