MEDICAL FASCISM 2 Authoritarianism and Professionalism: Class and perception

1 MEDICAL FASCISM 2 Authoritarianism and Professionalism: Class and perception Preface: My own papers on the various elements of psychiatry will be referenced where appropriate, each containing a multitude of thoughts on each area and on the history of psychiatry. Touched on here: The reliability of Psychiatric ideas. The assertion by Psychiatry, although not asserted openly, that Free Will does not exist. Authoritarian constructs and the modelling of human identity. Doctor reality and lack of testing Student responses 1 The development of psychiatry can reliably be considered through authoritarian constructs which present a specific kind of reality based on limited critical thinking and an inability to take responsibility and accept failures. The current philosophic considerations, that apparently back up its practice examine professional duality but fail to deal with contradictions within professional perception that undermine the self-same practice and thereby psychiatric legitimacy. Jennifer Raddon’s concise overview, The Philosophy of Psychiatry: A Companion 2004: ‘describes the philosophy of psychiatry as encompassing the philosophical assumptions and ideas that arise from, and the application of philosophical method to, not only  2 psychopathology but also psychiatric theorizing, mental health categories, clinical practice, and psychiatric research.’ Raddon expresses the extreme optimism of her craft and art, a bubble which here will hopefully be burst or which will begin the process of bursting it. Such books and such understandings are written for the professional and represent a detachment from experience. The philosophy of psychiatry involves three elements or processes: explanation, reduction, and classification. All three, in providing an understanding of others’ mental health, depend solely on the physician’s experience. The reduction of human character and behaviour to abet understanding presents a specific evaluation of both, each subsequent to other experiences and not justified by themselves. Here several historical events will be examined which support the desire to burst bubbles, considering where psychiatry is a true science or merely a professional smokescreen, and at the same time questioning why and how a false reality has gained hold alongside the use of dangerous treatments. As can be seen by the short extract above, psychiatry takes the scientific evaluation of internal human processes and studies each as an object or as pertinent to itself. Reducing human emotions to another distinct Form invalidates the emotion and does not thereby provide genuine understanding of the nature of emotion. It is a falsity that enables professional judgement. Classification of illnesses serves to increase professional jobs and employment, while ensuring the manufacture of drugs for each classification. Doctors managed and still manage sections of the population. Such sections of the population tend towards extreme independence, and therefore seemingly need to be controlled, or mass dependent types. The most engaging element of psychiatric philosophy is the ongoing discussion between psychopathology and philosophy of mind, somatic v the nature of the mind in all its complexity and uncertainty. Many psychiatrists still decry references to the later believing only mechanistic process are viable as they are measurable. I tend towards the belief that psychiatry has nothing worthwhile to say on the philosophy of the mind as they have replaced the mind with mental illness, with psychosis, depression and anxiety, commodities without genuine dimensions with which are without varieties of thought. The psychiatrist now decides the nature of internal worlds of feeling and thought, not thinkers.  3 Psychiatry as we now understand it gained its genesis in the 19th century with the growth of specialised middle-class groups, a social and political formation connected to social controls and governmental extensions into society. The intrusion of governments into people’s lives was essential to the formation of the so-called mind sciences. Once the hierarchy of rule, feudal lord over his peasantry, had shrunk due to more efficient trade and with the growth of cities other perceptions came into play. Ordinary citizens needed to be controlled. Not just their bodies. Class dynamics were, as yet, not understood. Governments, first through religion, at a time when established religion had political clout, and later through the professional classes established levers of control. Religion had a concept of madness, that is disobedience to God and state, operating as the primal sin, so madness grew out of the same human independence. Such disobedience required the perpetrators to be locked up, a role now given to diagnosis and drugs. The nature of the disobedience was not just against the powers that be, or the community itself, but transcendent and existential. One doubting human being destroying the entire carapace. Doubt provided a new class based on absolute, authoritative knowledge out of already existing elites. Knowledge, although connected to belief, took the place of belief. That class represented the new ‘norm’ on which psychiatric determinates are based, public as distinct from private personas. Robert Louis Stevenson’s ‘Strange Case of Jekyll and Hyde’ provides analyses of this new class, as well as consideration of perception essential in any critique of psychiatry and professionalism, ((19)_Strange_Case_of_Dr_Jekyll_and_Mr_Hyd2.docx | stanley wilkin - Academia.edu), which constructs emotional ideals, emotional and intellectual restraint, suggesting that dangers exist if the human being attempts to be anything other than his or her self, acting instead according to institutionalised norms. The damage done was also existential. Jekyll struggled against a rule based public morality, one reflected within psychiatry. The construction and control of knowledge essential to psychiatry and doctors in general are considered esoteric, standardised and formalised. There is a mystical, magical element to psychiatry. Its standardisation and formulisation packages it for authoritarian consumption. Psychiatry only appears genuine because we are conditioned to its claims and to the legitimacy of Western thinking. We are taught the rightness of physician views and of their supernatural abilities unaware of the social and political ideologies behind such thinking. The medical science of the West is dependent on the economic properties of healing more than any culture before. (Aoife K O’Callaghan: The medical gaze’: Foucault, anthropology  4 and contemporary psychiatry in Ireland published online 2021. Journal of Medical Science). While the above writer dismisses the relevance of the medical gaze in present mental health, he does so by raising the apparent concentration on individualised treatments in mental health without understanding that this may be just another medical mirage, another physician rationalisation. It remains important to understand the apparatus upon which medical judgements and behaviour are formed and perhaps decline to claim its rationalist basis. It has a group basis, its perceptions based on the experiences of the group. It is necessary to note that any powerful community, especially a professional one that is fixed within social advantage and economics, that comes under scrutiny will make cosmetic changes to deter criticism and thereby retain its power. The kind of apparatus that forms medical ideas begins with the fixed nature of certain kinds of thinking within the traditional controls of medical behaviour. Learning required classes, standardised tests. All these required investments over a number of years siphoning out the poor, increasing dependence on financial rewards or say inheritance, and from these a new class evolved. The power of this class grew through consolidation as a group providing managerial roles for public school and Oxbridge graduates. 19th century institutions based on finance multiplied.( (PDF) An Unusual Power Becoming The Ruling Class (researchgate.net) ) Time and consolidation through dynastic appropriation of professional roles is essential. The initial impact of class was described by Robert Louis Stevenson. In any community the doctor became the social and intellectual head, and often its richest citizen. The training involves reducing arguments and descriptions and classification of information and also selection of students for their levels of conformity-where possible. Students will often repeat and believe in what they are told without objection or will focus on end rewards. People who question the information provided them may not be considered suitable. In such institutions where authoritarianism flowers, Self Hood is conditioned by the group and exceptionality is standing out in areas of conformity within these institutions. The information is provided in ‘chunks’, related information gathered together and therefore more easily memorised. The leading psychiatrists express intellectual conformity as a public ideal.1 Authoritative leaders ensure teamwork but not intellectual flexibility. The Self Hood, much used now in 1 Nicholson, I. A. M. (2003). Inventing personality: Gordon Allport and the science of selfhood. American Psychological Association. https://doi.org/10.1037/10514-000  5 descriptions of medical knowledge, is the Self Hood attained by the doctor or medical group, not the patient/client. Illness is understood separately to be identified more easily, leading to consultancies and expert positions and thereby arranged for private rewards. While services are constructed upon internal medical reality, no genuine knowledge is possible. Further, David Brendel concerns himself with future treatments based upon ‘ Conceptual dichotomies between mind and brain, psychology and neuroscience, meaning and causation, and fact and value confound thinking in philosophy of mind, clinical psychiatry, and psychiatric ethics. Paul Churchland's theory of eliminative materialism highlights these dichotomies, stating that advances in neuroscience have restricted, and eventually will eliminate, any need for psychology.2 Returning extreme power back into the hands of the physician. Such drastic changes in treatment will not be discussed outside medical forums, in parliaments and senates, but between doctors and imposed on patients whether they are dangerous or not. Intellectual hubris is common in psychiatry. Of the dangerous psychiatric treatments of the recent past, only lobotomy, a particularly frightening ‘cure’, was stopped by law courts and public outrage, with a very few physicians jailed. At present, dangerous treatments tend not to be recognised as such because of the testimony of psychiatrists. It is psychiatry that affirms their nature not patients. I will point out here and later how psychiatrists rarely mention, indeed if ever, catastrophes created by their profession such as the lobotomising of thousands of patients and the connection of this practice to Nazi practices during the same period. Individualised Medical Self Hood Stevenson’s novel while concerning a time when professionalism coalesced, remains one of the most perceptive. According to Stevenson’s Strange Case of Dr Jekyll and Mr Hyde3, respectability here is everything as well of course Jekyll’s position in the community, which 2 Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry. Harvard Review of Psychiatry 8(4):p 184-191, October 2000. 3 https://www.academia.edu/53283080/The_Strange_Case_of_Dr_Jekyll_and_Mr_Hyd2_docx  6 he accepts initially then emotionally rejects. Mr Hyde acts out his need for genuine if crude expression and experience but by doing so he becomes the other, animal like. A wider view says he is the foreigner, the migrant, the ugly working-class threat to the professional middleclass with symbolic references even to mental illness, the wild part of everyone. Jekyll turns to the foreigner the upstart working class persona to express his genuine needs. His friend and the books narrator, Utterson, represents the culmination of middle-class power and prejudices. It is a very complex book. Dr Jekyll’s positive interactions with the world are reduced as they are no longer subject to the preservation of a false identity, for him, based on medical respectability. The physician finds himself in a straitjacket that destroys him, constantly avoiding scandal. The physician assumes a newly shaped societal position embodying new one-dimensional expressions that act independently and are incompatible. Physicians are divided, fractured and subject to unrealistic demands. In addition, a short attempt to connect psychiatry with religious institutions and practices will be attempted to be continued in greater depth later. The functions of the early Christian church and its larger offspring, such as Roman Catholicism, can be seen in many modern medical institutional practices as well as being evident in the Jesuits. The latter’s pursuit of moral conformity is expressed here as well the weaponization of perception. Inspiration lies within psychiatric functioning as limited intellectual constructs are employed, utilised for new inspirations, while treatments owe a lot to the practices, they equally owe a great deal to professional constructs. Gabriel John Utterson, one of Jekyll’s oldest friends, is the narrator (see above) and serves as both a driver and ‘chorus’ to the events, explaining the horror from his vantage point. As a legal representative, along with doctors, he represents newly arisen bourgeois power of the period. His views represent the views of this new class and powerbase. Utterson is a meddler who believes he knows better than others, often merely reflecting prejudice based on limited knowledge. While he believes his professional background provides access to new forms of knowledge, including insights into others not as privileged as him, he gets everything wrong and his meddling harms others. His possibly homosexual attraction to Jekyll leads him on unrecognised destructive pathways created out of jealousy of Edward Hyde, whom he may believe his friend Jekyll is intimately involved with, involving fear and prejudice of Hyde’s working-class origins. The horrors he recounts may not have actually occurred but instead may have been induced by cocaine or opium or simply Utterson’s prejudices. Whenever a single body effectively controls a narrative, distortions of reality occur.  7 Sciences are not always justified Although we feel sciences are equally justified and profound, some have more association with accepted concepts of science than others. Classification and reductionism are the activities of clerks not scientists. Minimising acceptable processes, evidence for a science’s efficacy is based on professional declarations, devoid of debate. A specific variety of perception has been generated, one which grew out of American racism and the perceptions of others as not like us. Thereby other people are classifiable, although we, the classifiers, are not. While this practice did not create mental illness, to the degree it exists, it provided the means of understanding. Psychiatry grew out of colonialism and ideas of group exceptionality through a middleclass lens. (https://www.academia.edu/105890072/John_Locke_Slavery_and_Psychology) Psychiatry is here considered subject to justifications of profession, model and group, the securing of its methods from other professional groups and thereby the same people who invent psychiatric problems invent their cures and the efficacy of the cures. Connecting these processes again to the religious phenomenon above, certainly monotheism, connects them and their medical legitimacy to the absolutism of religious inspiration and the kind of evidence found in religious groups and institutions. Perception here is weaponised.4 Perception, its capacity for change and use as means of justification. Briefly, I will consider Psychiatric thinking before moving on to contradictions of that thinking. Certainly, I will argue that its academic stance does not necessarily reflect its practice and the good intentions of thinkers and writers may not be seen in psychiatry at its point of delivery, whereby other ideas may prevail. While academic psychiatry claims to provide theories for clinical application often it does so from psychotherapy and psychology, which have little in common with psychiatric provision of practice, nor the theories (sic) which drive that delivery. Psychotherapists allow for doubt and have a greater awareness of the sliding scale of reality. Claims to the contrary are those of association not necessarily practice. The provision of drugs, which, I claim and hopefully will prove, are dangerous and immediately shackle the hopes and dreams of the theorists. They equally reject patient or 4 Kolenchuk, Tracy D. https://www.academia.edu/42411970/A_Definition_and_Exploration_of_Cure_Update_March  8 client Free Will, but not their own. The duality of materialism and phenology are lost within the chemical irresponsibility which both it seems, according to psychiatric theories, lead to. The removal of Free Will from the patient through drug provision indicates only the Free Will of the physician, so thereby all the chatter involving Academic Theory in Psychiatric books is negated. Drug companies play a driver in psychiatry and their effects must be atomised. While, I have suggested a split within psychiatrists’ internal and external dialogues I will attempt to nevertheless pull the two means of thinking together. To do this I first have to ignore psychiatric academic discourse and here reference it obliquely in order to establish psychiatric thinking at the level of practice and only slightly beyond that point. The gulf between theory and practice is extreme. David H. Brendel suggests clinical pragmatism to deal with the opposing views within psychiatry but that, I suggest, offers healing for present but not later fractures.5 Brendel notes the two present models, for him reductionist and esoteric, without understanding that neither provides adequate insight and are part of psychiatric triumphalism that has a basis in forgetfulness (explained later).6 While it is essential to accept that a single professional voice is at work within psychiatry, determining its scientific base through choice of philosophy as well as method, the conviction of many active theoretical or research psychiatrists should be treated with reservation. Reducing human beings to the level of human organs, whereby human beings are understood through kidney or liver functions (although the organ concerned is the brain, it might equally be either of the two mentioned) the present research is clearly influenced by chemical activity and computer functioning. Hane Htut Haung (Med Health Care Philos. 2019; 22(1): 59–69. Published online 2018 May 19. doi: 10.1007/s11019-018-9841-2) considers and opts for the biological explanation leading towards the same possible one note explanation that has been a constant in the past. The biological explanation places immense power again into the physicians grasp and is one reason for its present popularity. Although many psychiatrists think they are God, we do not need to collude with them. Aoife K O’Callaghan above concerns himself with Foucault’s insights, and dismisses them, and he brings into the debate 5 Healing Psychiatry: Bridging the Science/Humanism Divide (Basic Bioethics). Amazon. 6 Reductionism, Eclecticism, and Pragmatism in Psychiatry: The Dialectic of Clinical Explanation avid H. Brendel The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 28, Issue 5- 6, 2003, Pages 563–580.  9 the very nature of wellness, whether it is a state, in the negative, of not being ill or a state attendant on not being ill, a condition before and after this condition. Thereby, is the normal state being ill or not being ill, or should illness be seen as the inevitable consequence of wellness? Should illness constructs be abandoned and seen as the justification of the doctor?7 Why does the word Life to health professionals not seem adequate? One objection to O’Callaghan is that he believes abuse of power in the health services is understood and dealt with, but, as he sees it, through measures understood by the powers-that-be within the service. Checking to make sure other judgements are made, while necessary, may merely involve the reception of different views from the same perspective. 2 Reality and perceptual conditioning Does authoritarianism change perception, providing distance between the thinking of authoritarian groups and other groups they deal with? Does it thereby alter reality? The construction of an absolute ‘madness’ is compared and conditioned by another absolute ‘normality’, understood, I hold, as the professional persona and created from materialist conditions. While I suggest that no useable or genuinely useful theory of normality has been provided so far two assertions seem comfortably near the mark. The first comes from Freud: ‘the capacity to work and love’. The second from practising psychiatry: ‘that which is not mentally ill.”8 I suggest that practising psychiatrists see work as fully descriptive of normality. Not working indicates mental illness alive or dormant and is linked to the notion of a weak character formulated by previous generations. This was mainly understood through work with the hands, glorifying muscle and sweat. And of course, lack of education. The construction of work as a societal format has, at best, a recent history, The link to monotheistic thinking is clear through absolutes and cult inhabitation, which Foucault understood and David H Brendel, a working psychiatrist, seems close to grasping, 7 Kolenchuk, Tracy D. https://www.academia.edu/42411970/A_Definition_and_Exploration_of_Cure_Update_March 8 Concepts of Normality and the Classicification of Psychopathology. Ed. Stack, Stephen. 2005. P235 Handbook of Personology and Psychopathology. John Wiley and Sons.  10 but whether through Socratic Ideals or in line with a cultural flow is of course uncertain. While there are many routes towards such Ideal Forms, Egyptian Kingship and Akkad warrior godlike kings indicate the existence of extreme power and selected actions to create such ideals. The heads of empire require the construction of specific traits, certainly in hostile environments. People fit the occasion and the environment, establishing thereby a political or cultural template. Such Ideals are understood through their particulars. Here, while madness or mental illness is inhabited it is also subject to the view or gaze of others who inhabit further particulars. In a world without order madness goes unnoticed. Except that psychiatry insists on individual suffering of the mentally ill, which may simply be the treatments imposed on them. The perception of the healer is different to the individual sufferer (sic) as the sufferer is suffering, or may feel they are because of the healer. The identity of the healer becomes immersed in obsessive behaviour, demonstrating mental illness, abrogated only by their professional role. The truth remains, the mentally ill are manipulated to inhabit a role which benefits them. The tool they employ is diagnosis. The particular which diagnosis inhabits is presented as an ideal, inhabiting independent Form. Can human behaviour be compressed into Form or is it connected to Form and has no Form itself, no ideal, but merely particulars? There is nothing else that fits the picture. While madness or abnormality and normality are rarely effectively distinguished except as linked to a specific concept of lunacy which inhabits the world of behaviour. At this stage I suggest that these are pointless activity without reward, pointless activity with no material end. Clearly if all are mad, then normality is something else. In the past, madness often became another word, or words, that also expressed other things and made more sense in doing so. There are historical concepts linked to devils, imps, demons or connected to environment disorders. The collapse of a society creates despair, thereby indicates a form of madness when all is lost and hope vanishes. While most of the above constitutes badness, uncomfortable events or feelings, in ancient Sumeria they inhabited their own environment, but now inhabit not human environments but human beings themselves. Briefly, the nature of the city, with one of its earliest and greatest experiments effected in Sumeria, fashioned human nature through constructs of order, within the city, and disorder, outside of the city. Outside of the city hunters relied on their own judgement and inside subjected to the claims of authority at ground level, and a powerful subset of humans in the sky. Religious social development and continuity created urban personalities. The world beyond the city was wild, unclean and dangerous, and can be  11 considered alongside the various demons inside the city complex. 9 Exorcists rid the city of external demons while psychiatry claims to exorcise them internally in the present ensuring thereby the city’s, polity, nations, quietude in the face of uncertainty. Jesus spoke of casting evil spirits into swine, thereby sending them mad, but he used the word legions and perhaps spoke of how the Romans were soon to be thrust out of Judah. Evil spirits are the things that disturb us, are imposed on us, within our social and political environment. In this perspective, psychiatrists are the priests who try but cannot remove the evil spirits that inhabit our environment, evil spirits they identify and name. ´Jesus identified evil as essentially external and emphasised the triumph of goodness and belief, as psychiatry emphasises its own triumphalist nature. Or Saul in early Israel (in fact pre-Israel, perhaps Shephelah, the foothills facing the Philistines where the first Jewish polities emerged) rejected by both god and Samuel, a professional seer who claimed to represent god, becomes mad ((19) KING SAUL'S MADNESS AND MODERN PSYCHIATRY | stanley wilkin - Academia.edu). His sin was one of weakness and disobedience. His sin was political not moral. In the early Iron Age kindness to neighbours was a form of disconnection from reality. Kindness to clan and tribe were the rational approaches. He was unwilling to order the genocide of his neighbours as demanded by both Yahweh and Samuel. Thereby he was insufficiently masculine. Masculinity was sanity. The madness is related to defiance of Yahweh, the greatest sin. By refusing to do as Yahweh ordered, and kill, he was above Yahweh. In this, Yahweh and Samuel were wrong, Saul right. Behaviour is not a sign of sanity but power is the end determinant. In the ancient world behaviour was attached to symbols, usually connected to Gods. While Homer shows a world where the God’s determine individual behaviour madness becomes meaningless. Individuals are just instruments. In order for madness to exist it must be connected to subject, in order for it to exist publicly it is connected to the object. Often people go mad, unable to deal with the world and internalise, through tragic events. The events are replicated in the individual mind. In the East mourning the dead is seen as a necessity while in the West it is uncomfortable to view and deterministically viewed as, if the mourning is not quickly terminated, merely excess and thereby madness. According to psychiatry, mourning too long creates a lasting chemical bond over which the individual has no control. Clinical depression takes place if mourning covers months or years, the absence 9 Konstantopoulos, Gina. Demons and Exorcism in Ancient Mesopotamia. Religion Compass, 2020.  12 of free will psychiatry equally insists on or actual choice? Surely mourning, although culturally based, can be a choice and express loss, and its continuance equally be a choice. Repetitive thoughts and actions based on events creates mental illness, although it is possible that the repetition aids the community. Psychiatry is about excising and treating not understanding the value of a phenomenon. The chemical explanation insisted on by psychiatry abrogates Free Will, but nobody notices and complains at psychiatric hubris. The response to tragic events is a chemical process not an emotional or intellectual one, the human responses noted for thousands of years. Psychiatry has effectively altered reality, but no one fights against it. Another description of mental illness is constructed from those who seek help or help is sought for them. If someone consults the mental health services, for whatever reason, they are mentally ill and in Western medicine that means forever, or at least life-long. Without close relationships everyday problems have become public dependency and resolutions found with strangers who, as with therapy and psychiatry, are ideologically driven. Their medical file then, if they see a doctor, is available to all medical consultants: each nurse, doctor, or medical magician thereby learns this person is mentally ill and this may cause them to reconsider their approaches towards them. It is a life time sentence, never abrogated, therefore forever. Thomas Szasz, a psychiatrist, explores some of this in The Manufacture of Madness (1970) and other books on psychiatry during his long life. Psychiatry, essential for a country’s economiy continues. Psychiatry exhibits western methodologies and thereby the future. In present psychiatric biological perspective, all the above interruptions or catastrophes concomitant with existence are stripped of meaning. The fall of a city gains a biological response but any understanding wrought is ‘which chemicals are in play?’. Is this a science of nihilism, where meaning is only for the physician? A production line for the mental health worker? 3:  13 No one suffers? No one gets hurt? No mistakes made? During my long debate with medicine, I know that psychiatry, according to its enactors, never makes mistakes. It all works. Nobody has ever died or had their lives ruined. ECT works, drugs work, and lobotomies should never have been stopped. I call this Triumphalist Psychiatry or conversely ‘hear no evil, see no evil’. At no point, in the books presented here, is psychiatry seen as enabling madness. Psychiatry is seen only as efficient and from my knowledge mental health professionals are taught this. A long discussion with a psychiatrist consisted of his repeating that psychiatry is effective. In what way he did not say, but such assertions will be considered later. But, no one gets hurt. No one suffers. The psychiatrist receives his money, the drug companies their immense profits. This book does make the claim that human beings have been and are being damaged, saying both why and how. Treatment provides cures but at the same time mental illness resists cures (Dr Thomas Szasz). So, what is treatment doing? Is it an elaborate charade? Remember it is psychiatry not society in general that decides and describes these matters. Rightly so, you may believe, that is their job. But it is precisely because it is their job, diagnosis will be considered later but as a societal tool, that the profession should, as here, be subject to analysis. Madness in the present is a form of governmental and societal legislation. There may be little legitimacy to it. Once diagnosis is created, for it is a creation rather than an objective description, it becomes the subject of professional and government action. This is considered within recent research but also in older acknowledgements on the structure of personality especially within professional groups.10 If the new biological determinates get overall traction many will suffer 10 Organisational Climate and Pro-environmental Behaviours at Work: The Mediating Role of Personal Norms. ORIGINAL RESEARCH article Front. Psychol., 21 September 2021 Sec. Environmental Psychology Volume 12 - 2021 | https://doi.org/10.3389/fpsyg.2021.635739  14 unnecessarily and as usual a small number will be helped! Psychiatry will, as a group, be unable, yes unable, to see those being harmed! Psychiatric treatments can harm patients and harm them irreversibly but no psychiatrist is likely to know that let alone admit it. Here is a huge problem that undermines present psychiatric reasoning on the usefulness of biological treatments. Psychiatry’s understanding of their efforts is based on ‘efficiency’ or ‘effectiveness’ leaving one in mind of car mechanics and engineers, which amounts to the relieving, in their understanding, of symptoms or when synapse goes wrong and needs the use of a chemical spanner. Their understanding of malaise creates more and deeper malaise. There lies a problem. If a psychiatrist is told his or her treatments are dangerous, they look at you in confusion as they are trained to believe in the triumphalism of their craft. As they firmly believe in the efficacy of their craft, they do not have the necessary information to make proper judgements and more they do not learn from their mistakes. Their diagnostic conclusions therefore are unreliable. Of additional note, the loss of Free Will, or perhaps more correctly its confiscation. If the medical profession confiscates our Free Will then, clearly, they have Free Will. True to authoritarian castes, their Free Will grows, and has grown, through the taking of ours. From their emergence, the professional classes expect their ideas and understandings to dominate ours. Training The length of learning of physicians of any kind indicates position in society, knowledge of their subject, and the money they can expect to earn, influence and power they wield. Being able to regurgitate information is essential. Whether that information is true is another matter. The truth of the information concerns its practice on others. The practice creates the truth not its success. Earlier I demonstrated that psychiatry developed from government and societal surveillance, control of the greater population, and over time it has become more commonplace and sophisticated. Part of becoming a doctor, and accepted as such, is the degree of belief in the knowledge taught in group learning. As a doctor, the belief in the  15 practices engaged in. While the nature of psychiatry demands this in fact students of the discipline do not confirm such belief. Confirmation of the discipline is not clear within the training (www.whiteswanfoundation.org/mental-health-matters/understanding-mental- health/the-science-of-psychiatry) Although the above concludes that psychiatry is well attested, again students struggle to accept that testament. Once seen by a doctor a diagnosis is constructed with each psychiatrist believing in the appropriateness of his or her decisions. Before them or in their mind they have a small list of classifications and it’s just a matter of choosing one. This provides the patient or client with a medical identity, more solid, more fixed than the one the client or patient was born with. An identity as agreed on by the profession (the understanding and philosophy behind diagnosis will be considered later), written down but not offered to the client to be reviewed. Writing can work to make ideas in the concrete, so what is intended to be provisional becomes loaded. The diagnosis becomes identity. The construction of professional personas is important in the construction of mental illness. Let’s imagine that the world we all exist in is constantly altered, and different perspectives exist occupied by different groups. For powerful groups this reality is likely to seem fixed, concrete. For those without power it seems wafer thin whenever an individual is not the object of the powerful group. If psychiatry was a language, it would be an isolate unconnected to other languages, but one that mimics other languages in order to associate with other better recognised languages. It does not, like some other sciences, permit justification. Although purporting to be a science concerning people, a substrate of the population, in fact it is about psychiatry-ideology, profession, status and renumeration. Although I have already defined several possible reasons for mental illness I have not decided as yet that it actually exists. Such decisions are not only the bread and blood of psychiatry but frame their individual identities. Moreover, I suggest diagnosis fully represents the authoritarian understanding of an authoritarian group based on the elite nature of that group and that accordingly mental illness is in part, if only in part, an invention of an elite group and that the treatment of these groups create mental illness, not relieve it. Diagnosis enables the distinction of psychiatric thinking but also psychiatric action. The experience of conditions associated with mental health is not  16 here denied only the essence of that experience and its transformation into authoritarian frameworks. The original study and classifications were done within madhouses and asylums, within thereby artificial environments with small populations, many of whom were not mad in our understanding. Many residents were women suffering depressed feelings after the strenuous efforts on giving birth: some were put into the hospitals because they were embarrassments to their families, some victims of their families or the consequences of a birth outside wedlock (https://www.researchgate.net/publication/343019237_JANET_FRAME_Hysteria_Hypnosis _and_Lab_Rats.) Unwanted wives and relatives were at times the mainstay of the madhouses but also alcoholics, senile parents, and vagabonds. The conclusions reached then underpin conclusions on mental illness now. The classifications reflect the Victorian period and its attitudes towards others, especially the working class, the poverty stricken and women, the victims of Victorian society. (https://www.researchgate.net/publication/329033502_Final_Word_The_Intellectual_history_ of_psychiatry). Authoritarian thinking, revisited: That such types construct a reality? This can be viewed in the negative, that is about what they do not do. According to Martha Henderson Hurley and David Hurley in their paper, Enhancing Critical Thinking Skills Among Authoritarian Students, on authoritarian thinking processes, such individuals lack ‘critical thinking’, the capacity to analyse. Therefore, such personalities, amongst whom are most physicians, accept what they are given. Truth is what they are told. Mentor and Dorne11 suggest that authoritarian thinking involves “ an orientation [that favors] subjection to the control and hegemony of powerful social and legal institutions and is opposed to individual autonomy and normative diversity”. At this point I am tempted to 11 Mentor, Kenneth W, Dorne, Clifford, K. The association between right‐wing authoritarianism and the perceived seriousness of deviant acts: A research note Pages 73-87 | Published online: 18 May 2010. Taylor Francis.  17 rest my case as even the most emotionally blind can see that anyone who thinks like this is not the sort capable of understanding people. Difference serves as the red flag to the bull. Well, psychiatry does not accept anything beyond the starched collar, suit and tie of middle- class normalcy. They call it a science because it appears to tackle a set of largely social negatives informed by notions of efficiency. Being psychologically healthy is being efficient thereby to create such efficiency they cleave to the laboratory and even if they employ more user-friendly methods are they actually the right ones to do so. Clients are objects. The doctor is the important, if only, factor in the relationship with clients. The academic ideals I have already referenced flounder in the face of psychiatric processes and treatments, and perhaps are or were not meant to reference the hoi polloi. A huge number of papers are built up on the nature of this kind of understanding above that has nothing to do with the human mind but everything to do with narrow concepts of science and a need to be part of the scientific establishment. This has been one of psychiatry’s main drives, to occupy a scientific platform, one established only by their treatments. Chemical usage is part of scientific study (drugs), electricity (ECT) surgery (Lobotomy). Each mimic scientific or surgical memes, thereby gaining legitimacy for psychiatry. I once read hundreds of psychiatric papers, mostly dealing with chemical imbalance. The haulage model presented struck me as unlikely and over the past decade or so this model has been rejected. At the time when it was still embraced it seemed to me a pseudo science. As it turned out, it was! Below, aspects of authoritarian personality types, seen in Jekyll’s anguish and the demands of the medical profession: conventionalism with strong adherence to the social conventions that are endorsed by society and its established leaders, • submissive to authorities who are perceived to be established and legitimate in the society in which one lives, and • aggressive toward targets perceived by legitimate authorities as threats. To paraphrase, authoritarian personalities prefer the established order, follow official dictates, and are hostile to those perceived as a threat to the norm. Although the norm is difficult to access its possible antecedents are the medical profession itself and material aspects such as work, capitalism, class and wealth. For two centuries, psychiatry has associated poverty and mental illness. Many of those lobotomised in 1930s USA were vagrants picked up off the street.  18 These attributes above are often linked to right wing political views, and will be done so here, widening thereby the context of this discussion. If a profession includes only members of an elite than the views established and inherited by that group will continue. Proof is hard to find on this issue, even if intuitively accepted, but the position of psychiatry towards Fascism and Nazis in the 1930s is evidence enough, perhaps? Nazism established a norm that preferenced a lack of empathy, encouraging violence and passivity or reluctance to engage with this viewpoint resulted in incarceration and often death. The speed and glee that psychiatry traditionally embraces dictatorships is an interesting aspect of the profession’s history. But in the modern world, the scope of Right-Wing politics needs to be widened and includes communist countries and any society that employs fixed views and predetermined modes of behaviour to understand others. Psychiatry was designed to uncover the Other, whoever exists outside society. Psychiatric students Psychiatric triumphalism is, or was, rejected by one group no matter my attempt here to paint everyone with the same brush, authoritism and professionalism usually leads to the same end. Issues such as patient or client brain washing can be viewed later, but all in not and never as bleak. A good, supportive doctor can aid a patient back to society, should they want to go back, but if treatment is continued the comeback will be interrupted. An authoritarian doctor can help as for some people being told what to do and bullied suits them. But they will never ‘regain’ health as the doctor will interrupt their progress to re-establish his or her control over the patient/client. The authoritarian relationship can never and will never be broken. The rebels referenced above, albeit a brief flame of resistance, are medical students. Psychiatric students at least are uncomfortable with the profession and take a generally negative view. To some extent the negativity is based on culture but many who studied it reference the profession 12 as unscientific, with poor treatment efficacy, poor professional prestige, and that dealing with patients can be exhausting. Another again noted a lack of scientific values13 and non-efficacy of treatments. This survey was worldwide. Although psychiatry works hard to create a scientific presence it appears to be failing, and, I suspect for 12 https://www.researchgate.net/publication/40042342 Change of medical student attitudes toward psychiatry: the impact of the psychiatric clerkship Article in Psychiatria Hungarica: A Magyar Pszichiatriai Tarsasag tudomanyos folyoirata · January 2009 13 Attitudes and Views on Psychiatry: A Comparison Between Spanish and U.S. Medical Students Researchgate  19 the reasons given here. A seeming counterpoint is that by the end of their studies a greater number speak positively of the profession, but is that because they see the light, or is it because they are drawn into their ideologies like moths around a night light and its authoritarianism and conviction? Complete control over others can be intoxicating. Summing up Ending this chapter, psychiatry has to face up to the damage it has caused and causes clients/patients otherwise it cannot create a genuinely scientific medicine. The authoritarianism that remains an issue within psychiatry is part of the need to control psychiatry’s public reception and control outside critiques, to camouflage the fakery behind its thinking. Psychiatry´s triumphalism is based on forgetting the past, and effectively reconstructing it, and misunderstanding the present. Its control of narrative, client narrative as well as its own, has provided it with an extremely positive, if false, present.