Much overdue attention has rightly been lavished upon the subtle imbalances of power in psychiatrist-patient relationships and their perils of emotional and sexual exploitation. Just as oncologists often become numb to death, so do psychiatrists tend to grow insensitive to the everyday exercise of what is, after all, an incredible degree of social power. Medical students are typically amazed to learn that by filling out a simple form, any psychiatrist, even one just out of medical school, can effectively force a patient to be detained against his or her will until a court hearing occurs, which can take up to a month, at least where I work. Residents' familiarity with commitment often breeds a certain contempt, and the procedure soon becomes routine on a busy inpatient service. In fact, we time-pressed residents even tend to become a bit cross when we are called to court to testify, as if we had received an unwelcome rebuff to our authority.
Psychiatrists sometimes seem a bit insecure in the medical world.
Our frenzied attempts to establish diagnostic criteria and gather neurobiological data give us away. We are trained to demonstrate that we have as much diagnostic and therapeutic power as our medical and surgical colleagues. Thomas Szasz, M.D., himself a psychiatrist, has written about the theme of psychiatry as a means of social control masquerading as medicine. These claims have prompted rebuttals by many who feel that they represent an extremely romanticized view of mental illness, and in general, I agree with this assessment. What bothers me most, however, is that these formidable critiques of psychiatry are ignored almost without exception in mainstream psychiatric journals, textbooks and residency programs.