• psychiatry
• ethics of psychiatry
• mental disorder
• responsibility
• dangerousness

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder (hereafter DSPD) have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.¹ It is good that a commentator as well known as Professor Szasz is speaking out on this issue.

Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like dangerousness and mental illness.² There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.

This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.

Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.³ The science is much better, we have much better medications, and psychiatrists (at least all the psychiatrists that I know) are acutely aware of the tension between treating their patient and their obligations to the public interest.

So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …