notes from Thomas Szasz's 'Ideology & Insanity'

As I suggested some time ago [review of The Economics of Mental Health, by Rashi Fein, NY: Basic Books, (1958), AMA Archives of Psychiatry, I: 116-118, July, 1959], in the US mental hospitalisation serves a twofold socioeconomic function.  First by defining people in mental hospitals as unfit for work (& often preventing them from working even after their discharge), the mental health system serves to diminish out national pool of employment; large numbers of people are classified as mentally ill rather than as socially incompetent or unemployed.  Second, by creating a vast organisation of psychiatric hospitals and affiliated institutions, the mental health care system helps to provide employment; indeed, the number of psychiatric and parapsychiatric jobs thus created is staggering.  As a result, major cutbacks in the expenditures of mental health bureaucracy threaten the same kind of economic dislocation as do cutbacks in the expenditures of the defence establishment and are, perhaps, equally 'unthinkable'.


It seems to me, therefore, that contrary to the oft-repeated propoganda about the high cost of mental illness, we have a subtle economic stake in perpetuating, and even increasing, such 'illness'.  Faced as we are with overproduction and underemployment, we can evidently afford the 'cost' of caring for hundreds of thousands of 'mental patients' and their dependants.  But can we afford the 'cost' of not caring for them, and thus adding to the ranks of the unemployed not only the so-called mentally ill, but also the people who now 'treat' them and do 'research' on them?

Whatever the ostensible aims of community psychiatry may be, its actual operations are likely to be influenced by socio-economic and political considerations and facts such as i have discussed here.