On Being Sane in an Insane Place—The Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus

On Thursday, September 11, 2014, I was honored to present the Grand Rounds lecture to the Department of Psychiatry at Upstate Medical University in Syracuse, New York. This was the department of which Dr. Thomas Szasz was formerly a member and, to celebrate his work, the department has been hosting a number of events to celebrate his prolific career. More information about the Grand Rounds celebration is available at Szasz.com, hosted by Dr. Jeffrey Schaler.  Jeff himself gave the first Szasz-themed Grand Rounds lecture back in February 2014. I found my hosts—Szasz’s colleagues—a gracious and thoughtful group, eager to discuss ideas and explore their consequences with surprising candor.

The title of my talk was ‘On Being Sane in an Insane Place—The Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus.’ I adapted it from my 2013 Current Psychology paper.  My starting point is David Rosenhan’s 1973 “experiment,” in which he and a number of confederates pretended to hear voices in order to gain admission to psychiatric hospitals.  Once they had been admitted they had trouble getting back out.  Rosenhan’s stated aim was to prove that psychiatric diagnoses lack validity.  I argue that a stage comedy written some 2200 years ago by the ancient Roman playwright T. Maccius Plautus anticipates Rosenhan’s experiment in virtually identical form. It too casts doubt on the medical model of madness, but it seems to go beyond Rosenhan’s attempt to limit the problems his actions exposed to questions of diagnosis, and more closely approaches the view of Thomas Szasz that mental illness is not a medical matter.


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  1. The other side of the coin is represented by Gurt Postel, a postman who decided to pretend to be a psychiatrist in Germany. Hugely successful he reduced the compulsory admission rate by 86% as the medical director of his hospital. He made up and lectured to psychiatrists on “Bi polar of the third degree”….. his audience of psychiatrists lapped this nonsense up without batting an eyelid.

    Caught out when he was recognised…. not because of anything he did. Hero. Champion imposter of imposters.



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    • Thanks, Theinarticulatepoet. You are right to bring Postel into this context. Dr. Szasz discussed his activities in one of his last books, Psychiatry: The Science of Lies, pp. 82-3, in comparison with and immediately after his critique of Rosenhan. Szasz also reminds readers in those pages of Donald Naftulin’s “Dr. Fox” pretense. (There’s a wikipedia page, http://en.wikipedia.org/wiki/Dr._Fox_effect, but it’s not very informative — I refer you to Szasz’s critique).

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      • Thanks… thats interesting, I didn’t know Szasz had ever refered to Postel…

        Stretching the point a little I feel this is also might interest people along the lines of the Dr. Fox effect.

        The Seductive Allure of Neuroscience Explanations

        Explanations of psychological phenomena seem to generate more public interest when they contain neuroscientific information. Even irrelevant neuroscience information in an explanation of a psychological phenomenon may interfere with people’s abilities to critically consider the underlying logic of this explanation…..Crucially, the neuroscience information was irrelevant to the logic of the explanation, as confirmed by the expert subjects. Subjects in all three groups judged good explanations as more satisfying than bad ones. But subjects in the two nonexpert groups additionally judged that explanations with logically irrelevant neuroscience information were more satisfying than explanations without.

        You couldn’t make it up… or actually it seems you can make it up… and get away with it…

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    • There is much drama in life, and much life in drama. Thomas Szasz, for one, would go so far as to call a fraud a fraud in a field that was fraught, nay, saturated, with fraud. I guess the question becomes, in the end, who are the actors, and who is the audience. The Rosenhan Experiment, too. Was it mock theater, or genuine science, a little bit of both, or complete fraud? The problem I have, I suppose, is that if there is any point to made from this sort of comparison, and analysis, it becomes very muted in effect. In a field with as much deception as you find in the mental health field, a confidence game such as that which was perpetuated so effectively by Gurt Postel is almost inevitable. Excuse me, scratch the almost.

      Also, just a technical matter, I don’t know that hellebore compares with Prozac so much as it does with Thorazine, and derivatives, being the ancient chemical fix for insanity rather than melancholy. Nonetheless, I do imagine all three to be poisonous or toxic substances, and all too often, unrecognized as such.

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        • Fraud

          A false representation of a matter of fact—whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury.


          Actually, Rosenhan lied, and that could be construed as fraud, while hospitals, responding in kind, found pseudo-patients who weren’t pseudo-patients, again, if your aim is to say you’ve got “unreal” patients, fraud.

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          • Blind experiment
            A blind or blinded experiment is an experiment in which information about the test that might lead to bias in the results is concealed from the tester, the subject, or both until after the test.

            The hospital volunteered to participate, to my knowledge.

            How else (a lie/fraud) do you test a new medicine Frank?

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  2. “The psychiatrist ’s questions are all in line with Hippocratic medicine, but no matter the answer, Menaechmus cannot win. His gestures, perplexity, irritation, frustration,and especially his anger — all are taken as symptomatic of an abnormal mental condition. Yet even his cooperation and compliance are, too.” (p.11)

    From your article Michael. I wonder if you have heard the term Kafka trapping?

    “The aim of the kafkatrap is to produce a kind of free-floating guilt in the subject, a conviction of sinfulness that can be manipulated by the operator to make the subject say and do things that are convenient to the operator’s personal, political, or religious goals. Ideally, the subject will then internalize these demands, and then become complicit in the kafkatrapping of others.”


    I know that my experience is reflected in your description of the assessment process. The amount of kafka trapping I have seen done by psychiatrists leads me to believe that it is not done unconsciously. Your denial that you are mentally ill is proof that you are mentally ill.

    Any thoughts on this?


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    • Thank you, Boans. I know Kafka’s Trial but did not know the term “Kafka trapping.” I’ll have a look at that link.

      You raise a more general issue that I sometimes discuss with a class I do. What’s the difference between delusion and collusion? It’s easy and tempting to see collusion–witness any conspiracy theory–where it’s probably a case of delusion. That doesn’t make the outcome any less tragic, though it can certainly make it more tragic. How we decide people are colluding against us rather than are deluded in acting as they do, is a question that you’re likely to answer based on whether you sympathize with or against the person. I think Rosenhan was right to say doctors are more likely to call a healthy person sick than a sick person healthy. In most aspects of life that kind of caution is a good thing. It’s obviously not so in all aspects of life.

      Thanks again for your thoughts.

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      • Thanks Michael.

        Just an example that comes to mind. As a result of a family conflict my wife rings mental health services. They assume that she is afraid of me.

        Psychiatrist; your wife was afraid of you.

        Me; but that’s simply not true, she is a strong independent woman, and has told me she is not afraid of me.

        Psychiatrist; She is too afraid of you to tell you she is afraid of you.

        Absolutely poisonous. Leaves me wondering if my wife is simply lying when she says she is not afraid of me. Worth thinking about what results from such abusive behaviour. Of course when I raised this with a psychologist he said it was probably part of the ‘treatment’. Really? Sew seeds of doubt that are destructive to a persons marriage? How does that work?

        On a lighter note I loved Life of Brian where Brian’s denial of being the Messiah is met with claims that only the true Messiah would deny his divinity lol.

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        • The exchange between Menaechmus and the Psychiatrist seems to be one where the psychiatrist lays ‘kafka traps’ which his patient does not fall into (“you inquisitive ass”). This of course would lead the psychiatrist to conclude that the flaw is with the trap and not the patient. A better designed trap is what’s required.

          It becomes a psychological or intellectual game of chess. The patient does not wish to be labelled insane, and the psychiatrist must design ever more complex traps to expose the insanity. It becomes a matter of time before the patient falls into one of the traps.

          I’m sure there are those here who can relate to what I’m saying.

          “A traveler journeys along a fine road. It has been strewn with traps. He falls into one. Do we say it is the fault of the traveler, or the scoundrel who laid the traps?” Marquis de Sade.

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          • I totally relate with that. I’ve read my “medical” files and basically everything I said or did was interpreted as a symptom. Just like in Rosenham’s experiment. It does not matter if you agitated or calm, smart or acting stupid, talk to them or give them silent treatment – everything is a sign of delusional thinking, unstable emotionality and screwed up personality. I’d disagree there is much chess in it – it’s a game sure, but the kind of a psychopath would play with his victim, which is already tied up in a basement – nothing the victim says or does alters the outcome.

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        • “Absolutely poisonous.”

          Psychiatrist to me (trying to diagnose my “personality disorder”):
          – Do you have problems forming stable relationships?
          – No, I have good friends I know from kindergarden and they still like me years later
          – Maybe they don’t tell you they have a problem with you
          – Why would they not tell me that?
          – Because they may be afraid of how you’ll react

          He tried to do similar tricks with my family relationships – basically trying to convince me I was somehow abused and when that didn’t fly – “Well, they were probably to good for you. They spoiled you and that’s why you have problems now.”
          This is a catch 22 that caused a major facepalm from my side and decision to stop talking to that moron.

          The problem is – I had one very toxic person in my life and that person was, I believe at least partly consciously, trying to drive me mad. But for a psychiatrist the problem had to lie in me, not anywhere else (let’s ignore all the real life context, shall we?), so I must have been screwed up and it was just a matter of digging to find that out.

          I saw through this and left immediately (and very pissed) but I’m pretty sure there are people who get manipulated into this kind of thinking and have their relationships destroyed in addition to their mental and physical health (by drugging, labelling, coercion and stuff). Good job psychiatry.

          Btw, I love “Life of Brian”

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          • This look like a multi disciplinary team to you B?


            Replace Messiah with Mentally Ill, and sign/miracle with symptom. Fits with what is said below about the Roman Empire and modern day US lol.

            The Rosenhan experiment basically ‘sprung’ the trap that is set for anyone entering the arena. There was no need to lay hidden traps as the psuedo patients walked right into one willingly. Once caught you either chew your leg off, or bleed to death.

            This differs from real medicine which does not require the laying of traps to identify pathology. No mind games required.

            I can’t help but wonder if psychiatrists sometimes get caught up in the hunt, and shoot a squirrel thinking it’s a bear. Easily done when your scared of your own shadow.

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  3. I saw an absolutely brilliant version of Kafka’s The Trial performed by a student group a few years ago and I was amazed at how like the psychiatry it play is. I spoke to one of the performers afterwards who clearly didnt’ get what I was on about, but I’m glad someone else has highlighed this.

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  4. I want to thank those of you who have watched and commented so far and to raise a general and open-ended question here that I don’t in the video. It’s this:

    What do you make of the fact that mental illness is being medicalized 2000 years ago? What does that fact say to you?

    I ask because as many of you know already, that’s not invariably the case in the ancient world (Greece, Rome) and wasn’t usually the case, as far as we know, before the Enlightenment.

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    • Hello,
      thanks for sharing the presentation, I thought it was very insightful!
      The way the playwright Plautus seems to realize and see through all these difficult things so easily, to me it’s very refreshing. 🙂

      Regarding the question (I am no scholar and native English speaker, so please forgive me if this may sound “outlandish”): If “mental illness” has been partially medicalized 2000 years ago in ancient Greece and ancient Rome, I wonder if certain societies, or certain governments today utilize the same basic power structures that existed back then?
      I think the US government for example, identifies very much with ancient Rome in many ways. For example with their symbolism, like the “Fasces” symbols on the US senate floor (also the namesake of “fascism”) and in their iconography. In the way it manages and expands its “Empire”.

      I wouldn’t be surprised, if the medicalization of “mental illness” could have been also used as a form of social control back then, as in today’s world, maybe not as much though, since, like you said, it wasn’t invariably the case in the ancient world.

      I think in today’s world, we see an extreme accumulation of power in certain places, probably even more so than in ancient Greece or Rome.
      To me it seems, the medicalization of “mental illness” is one of the “best” or “most effective” ways, to impose a certain way of thinking onto a population.

      Then I would have a question: How did the Hippocratic school of medicine develop in the ancient world and later on, did it grow, or did it decline at some point, only to be rediscovered centuries later during, like you said, the “Enlightenment” (in late 17th-century Europe I think)?

      Again, thanks for sharing the presentation, makes me wonder how much has really changed since that time :).

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      • You are more than on to something when you say “I think the US government for example, identifies very much with ancient Rome in many ways.” Actually, it’s much odder than that. After getting rid of colonial rule amid the American Revolution the Founders had to come up with a new political system. They cast about for all kinds of models and settled on the Roman Republic of 1800 years past (conventionally dated 509 – 27 BC).

        That is really quite weird if you think about it. The world and especially Europe provided many models the Americans could have emulated, but instead they chose to consciously imitate a form of pre-Christian government from long in the past. That is one reason why the US is usually considered the Enlightenment project par excellence.

        We call Rome back then – and that is precisely the time that Plautus (254-184 BC) was active – a “republic” but it’s really an imperial republic. That’s to say, it was a government characterized by representative democracy for its citizens, but it controlled non-citizen territories that were imperial-like. Not so different, some say, from the US today.

        All that said, ancient Rome had nothing like institutional psychiatry. Back then if you were considered mad you were kept at home by your relatives. Scholars right now are digging into the evidence but it doesn’t look like most of what we’d call mental illness today was considered a medical matter. The Roman court system considered it a social matter, as a brand-new paper I’ve just read points out.

        You ask about the Hippocratic school’s development and you’re spot-on. It flourished in the ancient world and was spreading to Rome at exactly the time Plautus’ play was staged, where it met resistance and suspicion. A famous Roman writer named Cato the Elder wondered why doctors would need to swear any kind of oath. We think the Hippocratic Oath is a great thing; he thought it was some kind of conspiracy and that the doctors would kill you. (Romans had traditional cures already, of course, so in rejecting Hippocratic medicine that doesn’t mean they were rejecting medicine entirely.)

        Hippocratic medicine was consolidated in the Greek writings of Galen, a medical doctor from the early part of the Roman empire. Those writings formed the basis of bodily medicine until about 1800, give or take. But with the rise of Christianity in Europe, mental illness mostly became a matter of sin or virtue, so the medical writings weren’t relevant. With the decline of the Church in the Enlightenment, people began to look and find material (bodily) explanations for some of those sins.

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        • The ancient Greeks and Romans didn’t know the source of disease. Hippocratic medicine was a matter of attributing disease to imbalances in four humors. The line between physical and mental was blurred because they had to explain disease on the basis of patient complaints. I’ve heard people in the mental health system praise ancient medicine for being holistic. Holistic it may have been, but it wasn’t scientific, that is, it was a big fantasy. Once we’d discovered pathogens and organic lesions, the mystification dissolves, and Hippocratic medicine loses its whole nebulous foundation. As “mental illness” has never been proven to be disease, I guess it follows that one fantasy for treating it is probably as good as another. Biological psychiatry pins its hopes on the psychiatric being proven neurological, and opts for the use of chemicals to correct questionable behaviors, but proof is lacking in the whole enterprise. Disease exists in physical universe, “mental illness”, on the other hand, by definition eludes the physics. It is one thing when you are treating an infected organ, or an injured organ, it’s quite another thing when you are treating a breach of standard behavior, or an imagined injury. Healing an imaginary injury becomes very problematic indeed when the injury imagined has a “reality” impugned to it on the part of both afflicted and healer.

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          • Medicalization at this time was on a much smaller scale. You didn’t have a DSM categorizing nearly 300 disorders, nor did you have a NIMH claiming that 1 in 5 US citizens have one, nor did you have a mental health movement asking for the tax payer to pay for it.

            You’ve still got more than 1,500 years to go before you get to the origins of coercive psychiatry, or what Michel Foucault called ‘the Great Confinement’…

            Foucault contends that in the mid-seventeenth century, in the depths of the age of reason, the rational response to the mad, who until then had been consigned to society’s margins, was to separate them completely from society by confining them, along with prostitutes, vagrants, blasphemers and the like, in newly created institutions all over Europe – a process he calls “the Great Confinement.”

            With Foucault, Szasz, and others, I believe this is the time in which what we call forced treatment, or institutionalization, really got off the ground.

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        • “What do you make of the fact that mental illness is being medicalized 2000 years ago? What does that fact say to you?”

          That inquisitive asses have been around a long time?

          Seriously though the translation of the Greek texts into Arabic in Baghdad (8C-), leading to the notion of a ‘germ theory’ of disease, and that sick patients should be quarantined had a significant effect on medicine.

          Is it at this point that a shift occurs from caring for the mad at home, to isolating them from others lest it spread? That shift from praying to the bones of a dead saint for a cure, to seeking answers in the laws of the natural world?

          Raises some fascinating questions for me.

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        • The United States has always had a fascinating contradiction going on in its system of government and society at large.

          On the one hand, as you say, it was built on the Enlightenment ideas of natural/divine rights of men and that all men are created equal. That creed is in the declaration of independence and it is delightful to read.

          On the other hand, the United States has always had a ruling elite that sees itself as above everybody else. Thomas Jefferson for example wrote about the “natural aristocracy” among men. This “elite” has always been fond of restricting the rights of others through ways they deemed “compatible” with the enlightenment such as slavery (after all blacks were deemed soulless animals for a long time), racist laws, eugenics (in case you are unaware of it, Bob Whitaker wrote about this connection in his first book on psychiatry, here is a talk about the subject https://www.youtube.com/watch?v=H4vL2CBdDr4 ) and now psychiatry.

          So while I find myself a victim of the fad today’s elites use to control those they deem “lesser human beings”, I am under no illusion that these elites will come up with something else once psychiatry is sent to the ash heap of history. My only hope is that that “something else” will not be something I need to worry about as much as I worry today about coercive psychiatry.

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          • Great analysis. I’d just add that this problem is not unique to US – it has existed through history of mankind and was true as much in ancient Greece and Rome as it is now. Some people, especially rich, want to have power over others in order to preserve and acquire more wealth. Money and power go together and with them the need to control and subdue the masses and the idea of “natural aristocracy” in its various incarnations is just a useful philosophical framework to justify oppression.

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        • Pretty much every empire or aspiring empire since the Romans has modeled itself, at least declarative on the ancient Rome. And since all empires seem to have certain common characteristics you will always find evidence for the claim.

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          • The point I was making above was that ancient Greece and Rome didn’t have mental institutions, and since they didn’t have mental institutions, mental health care was up to families and communities, and a matter to be negotiated with a physician.

            Playwrights such as Homer, Sophocles and Euripides described madmen driven insane by the gods, imbalanced humors or circumstances. As well as the triad (of which mania was often used as an overarching term for insanity) there were a variable and overlapping range of terms for such things as delusion, eccentricity, frenzy, and lunacy. Physician Celsus argued that insanity is really present when a continuous dementia begins due to the mind being at the mercy of imaginings. He suggested that people must heal their own souls through philosophy and personal strength. He described common practices of dietetics, bloodletting, drugs, talking therapy, incubation in temples, exorcism, incantations and amulets, as well as restraints and “tortures” to restore rationality, including starvation, being terrified suddenly, agitation of the spirit, and stoning and beating. Most, however, did not receive medical treatment but stayed with family or wandered the streets, vulnerable to assault and derision. Accounts of delusions from the time included people who thought themselves to be famous actors or speakers, animals, inanimate objects, or one of the gods. Some were arrested for political reasons, such as Jesus ben Ananias who was eventually released as a madman after showing no concern for his own fate during torture.

            Emphasis added.


            Understand the perspective you are getting above is made after the fact of 400 years of forced mistreatment, (i.e. enlightened views towards “mental health”.) Question becomes, as it still is today, where does the greatest danger lie, in assault and derision, or in the harm that can come of treatment that is worse than the “disease”. In freedom, or in the loss of freedom that comes with the tyranny and imprisonment employed by institutes of psychiatric oppression.

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          • B: interesting discussion. I have not spent much time on Rome, but our long time, now deceased Senator also Senate Majority leader Robert Byrd fancied himself both a scholar of the Constitution and also of Rome. Early in his career he fell in with the Dixiecrats and the warmongers, but later had a change of heart by denouncing the unconstitutionality of the Iraq War on the Senate floor.

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  5. We don’t really need to focus on what happened 2000 years ago.

    Psychiatry, big pharma, that’s a problem today, now, and a lot of people know it is.

    Unless they had a method for the truth winning out back then that is capable of overturning the behemoth of self intrest and corruption faced now, today, then what can really be learned ?

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    • As I tried to point out above, if anybody was paying attention, 2000 years ago things weren’t so bad. It’s today when we’ve really got a problem. Let me try again…

      Most, however, did not receive medical treatment but stayed with family or wandered the streets, vulnerable to assault and derision.

      The Greek and Roman states didn’t incarcerate mad folk in prisons called hospitals or asylums. Not like is done today. That kind of thing, segregating and locking people up in places called Lunatic Asylums, wasn’t taking place on any sort of scale in the western world until the latter half of the seventeenth century.

      Psychiatry, in other words, was much less of a problem then than it is today. For this reason, maybe it is a good idea to look back, huh? What do you think?

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      • Frank: both Szasz and Foucault provide an historical context in order to demonstrate that Western Civilization chose the path of institutional. It was not forced upon them. Foucault focuses on this process of institutionalization in France that occurred a little earlier than in England. Szasz focuses more England because he believes that the roots of modern psychiatry can be more accurately be traced there. Szasz sees Psychiatry as an end run around the English system of law because English law was more protective of individual rights than other emerging nation states.

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        • Frank: both Szasz and Foucault provide an historical context in order to demonstrate that Western Civilization chose the path of institutional.

          Western Civilization, of course, not meaning ancient Greece and Rome, no, by western civilization you’re referring to a more recent France and England.

          It was not forced upon them.

          Define “them”. It was forced on that part of them that was identified as patient, or presumed allegedly “ill”, by that part of them that was identified as state, or institutional authority. I’m not excluding either from western civilization.

          I have some understanding of the origins of institutional psychiatry in England with the advent of the trade in lunacy. I have less understanding of its origins in France. I have read both Szasz (numerous books) and Foucault (Madness and Civilization) on the subject.

          Would you, please, point to the institutional psychiatry that existed in ancient Greece and Rome? As far as I can tell, there wasn’t any. People weren’t imprisoned in places they called mental hospitals or lunatic asylums back then. This doesn’t mean, as the Wikipedia piece shows, that there weren’t people falsely thrown in jail back then, nor that there weren’t some imprisoned by their families. Still, when I think of it, no “medical treatment” is a vast improvement, and the claim is that this ‘no treatment’ is what most received.

          The impetus of my argument here is that the ancients were more tolerant of odd behaviors than we are in our more systematically repressive modern world. I’d say there is a lot that we might be able to learn from the ancients in this regard.

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          • Frank: I am not well versed in either Greek or Roman History, but I have been poking around on Directory of Online Journals to see how non-western countries such as Iran have responded to the western medical model of “mental Illness.” From what I can gather, Iran adheres to bio-psychiatry model, and the Cuba, whose culture and economic system has been influenced by Spain, U.S., and Russia, adapted there mental health system from the French model. Cuba is out of favor with the U.S. Govt. but like Latin America is part of the West, albeit in the Third World. One of Che’s close compatriots in the war of liberation from Batista was a psychiatrist, who was instrumental in overhauling the Cuban Psychiatric system. Zypreza is widely dispensed in Cuba, but there is apparently a lively debate over the use of ECT. I also looked at some of the other ALBA countries such as Bolivia, Ecuador, Nicaragua, and Venezuela. I believe that both Ecuador and Bolivia show a low psychiatrist to population ratio, both with only a few asylums throughout the country. Looking through history or at different cultures currently, helps to dispel common sense assumptions about a society’s institutions. That is what Robert Whitaker stumbled upon, even though he initially assumed most of the claims of psychiatry to be grounded in science, rather than what Szasz terms, scientism.

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          • I imagine mental health treatment must be playing a large role in the shape that western imperialism is presently taking. One of Robert Whitaker’s latest messages is that the results from the World Health Organization studies that figured so prominently in Mad In America, the book, are beginning to longer apply because of the exportation of western pseudo-science. Thomas Szasz, R.D. Laing, and others have been right in taking on scientism. Science isn’t halting this exportation, this pharmacological cough cough industry “revolution” that must eventually overrun the entire world. Psychiatrists have brain scans, gene studies, other studies, suppressed studies, journal articles, ghost written pharmaceutical company articles, etc., etc., to bolster their bias in the biology of “mental disorder”. They don’t care. Psychiatry is their stock and trade, their bread and butter, and the more of it there is, the more secure their position in society is. If there are not 1 in 5 people with a “mental illness” in this country or that, it must be because their skill in diagnosis is not up to the state of the art. Point, all of this business began with institutional psychiatry in the seventeenth century. Shamanic practice may be preferable, but not to the western imperialist who would complain that, not coming from the west, it is ‘old hat’.

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