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Psychiatry and the control of dangerousness: a comment
  1. G M Sayers
  1. Consultant Physician and Honorary Clinical Senior Lecturer (Imperial College School of Medicine), Department of Geriatric and General Medicine, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK;

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    The paper by Szasz is about mental illness and its meaning, and like Procrustes, who altered hapless travellers to fit his bed, Szasz changes the meanings of words and concepts to suit his themes.1 Refuting the existence of “mental illness”, he suggests that the term functions in an apotropaic sense. He submits that in this sense it is used to avert danger, protect society, and hence (superstitiously) justify preventive detention of “dangerous” people.

    But his arguments misrepresent the precise meaning of the term “apotropaic”, which is an adjective, defined in Webster’s, Chambers and the New Shorter Oxford dictionaries as averting or turning aside evil. It is possible that amulets and incantations ward off evil, in the same way as garlic repels vampires, but evil and danger are different concepts. Yet Szasz talks of using phrases like ‘“dangerousness to self and others’ as apotropaics to ward off dangers we fear”, and the word “evil” does not appear in his paper.

    I will argue that “dangerousness to self and others” and “psychiatric treatment” have a prosaic rather than an apotropaic function.

    The word “danger” is familiar rather than arcane, and includes many risks. A predatory paedophile is usually both dangerous and evil, but many dangerous people are not evil. For example, a child who plays with a box of matches is dangerous, as is a demented person who drives a car, or a schizophrenic who, acting on delusional beliefs, arms herself with a knife and roams the streets believing she is an avenging angel.

    Suppose …

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