Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.
When I use the term therapeutic state, I use it ironically, it’s therapeutic for the people who are doing the locking up, who are doing the therapy, it’s not therapeutic for the victims, for the patients.
In the therapeutic state, treatment is contingent on, and justified by, the diagnosis of the patient’s illness and the physician’s prescription of the proper remedy for it… Today, the therapeutic state exercises authority and uses force in the name of health.” The Founding Fathers “could not have anticipated…that an alliance between medicine and the state would then threaten personal liberty and responsibility exactly as they had been threatened by an alliance between church and state.
In as much as we have words to describe medicine as a healing art, but have none to describe it as a method of social control or political rule, we must first give it a name. I propose that we call it pharmacracy, from the Greek roots pharmakon, for ‘medicine’ or ‘drug,’ and kratein, for ‘to rule’ or ‘to control.’
Formerly, people rushed to embrace totalitarian states. Now they rush to embrace the therapeutic state. When they discover that the therapeutic state is about tyranny, not therapy, it will be too late.
This phenomenon illustrates what I call the creeping therapeutic state. I see it as insidious, especially given the cooperation between the government and the media. This is allowed on television. But advertising Scotch, a legal drink, is not allowed. This subtly undermines the rule of law, the principle that if something is legal, then it’s legal, and if it’s illegal, then it’s illegal. A prescription drug is illegal; pharmacists cannot sell it to you unless you have a prescription. These are illegal drugs, but nobody calls them illegal drugs. So I see this as pernicious, as an example of what F.A. Hayek and Ludwig von Mises talked about—that the opposite of freedom is not brutal tyranny but capriciousness.
The therapeutic state seeks to remedy personal and social problems defined as diseases; its beneficiaries are often ‘helped’ against their will; it is a totalitarian state, governed by the rule of therapeutic discretion. The recipient of psychiatric medication who gives the drug to a friend or refuses to avail himself of its ‘benefits’ is persecuted and punished by agents of the therapeutic state.
Coercion masquerading as medical treatment is the bedrock of political medicine. Long before the Nazies rose to power, physician-eugenicists advocated killing certain ill or disabled persons as a form of treatment for both patient and society. What transforms coercion into therapy? Physicians diagnosing the subject’s conditon as a ‘disease,’ declaring the intervention they impose on the victim a ‘treatment,’ and legislators and judges ratifying these categorizations as ‘diseases’ and ‘treatments.’
Every American recognizes that when the government controls religion, all religion becomes the state. But few Americans are willing to accept that when the government controls health, all health becomes public health and all privacy is lost. The erosion of our liberties is not a mystery. It is largely the result of the frightening alliance between medicine and the state….