From Publishers Weekly
Nearly 40 years after psychiatrist Karl Menninger called the medical profession on the carpet for misnaming medical conditions so that various forms of treatment could be justified and, 24 years later, Susan Sontag declared that "illnesses have always been used as metaphors to enliven charges that a society was corrupt or unjust," noted and controversial psychiatrist Szasz (Fatal Freedom), as lively and contentious as ever, pursues similar lines of thought, examining the medicalization of politics and the politics of medicine in contemporary America. At the base of what he calls our modern "pharmacracy" a state where "all sorts of human problems are transformed into diseases and the rule of law extends into the rule of medicine" stands a virulent misunderstanding of disease, in the "literal" or scientific sense. It is, he argues in accord with the theories of 19th-century pathologist Rudolf Virchow, very simply an injury or abnormality in the cells, tissues or organs of the body. Yet, he maintains, the medical profession and politicians have today named as diseases a wide range of human behaviors, from alcoholism and obesity to mental illness and infertility. Moreover, some of these metaphorical diseases are elevated to public health problems subject to government intervention; thus, in Szasz's view, America has created a contemporary fascist health state in which its campaigns aimed at the eradication of smoking and obesity focus not on the responsibility of individuals to quit smoking or to lose weight but on the promise that well-funded research agendas will solve the problem. Plenty of health-care professionals and politicians will disagree with Szasz's definition of disease and his condemnation of the modern "pharmacracy," but no reader can put down this book without having been disturbed, provoked and challenged to see the American medical profession in a new light.
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The idiom, imagery, and technology of medicine have been taken over by politics and society, says longtime dissident psychiatrist Szasz, and that has essentially broadened and weakened the concept of disease. Bureaucrats have supplanted pathologists, and bioethicists have obfuscated the scientific approach. Szasz emphasizes the resultant dangers, especially those stemming from the forceful social influence of psychiatry and the burgeoning domain of mental illness. The current biopsychosocial image of illness is a regression, he says, not an advance. Mental illnesses in general don't have solid physical causes and therefore should not be seen as scientifically
diagnosable, researchable, and treatable conditions. But the powerful and often insidious propaganda of drug companies, mental illness proponents, politicians, and recent surgeons general routinely infects legislation, the public press, and even the major medical journals. Szasz's quotable style, thoughtful delving beneath the surface, and often striking analogies should once again stimulate vigorous discussion in several fields. William BeattyCopyright © American Library Association. All rights reserved
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