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THE MORAL DILEMMA OF PSYCHIATRY: AUTONOMY OR HETERONOMY?
THOMAS S. SZASZ
Am J Psychiatry 1964;121:521-528.
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Professor of Psychiatry, State University of New York, Upstate Medical Center, Syracuse, N. Y.

1960 by The American Psychiatric Association

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Abstract

As science, psychiatry is the study of communicative behavior, and, as therapy, the practice of dialectic and rhetoric (and of social control). The principal roles of the contemporary psychiatrist are: moralist, rhetorician, and scientist (and agent of social control); and rarely, physician.The basic moral dilemma of psychiatry is generated by the conflict between the self and the other. This conflict can never be "settled." Instead, if man is to survive, the contenders must achieve a decent mutual accommodation, a creative compromise. Why?Because victory of the self—meaning unrestrained freedom—would, given the types of weapons available today, lead to the certain destruction of man as biological organism. Similarly, victory of the other—meaning unrestrained oppression—would, given the means of coercion available today, lead to the certain destruction of man as moral agent or person.The risks are clear. Should we push too hard, this way or that, in our headlong pursuit of "mental health," we shall do so to our own detriment. "The cure may be worse than the disease" is an adage that acquires special force when the disease is metaphorical, and the cure social.

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