Intended for healthcare professionals

Ward Round

The psychiatric protection order for the “battered mental patient”

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1449

Thomas Szasz, the Critical Psychiatry Network and the psychiatric protection order

Thomas Szasz's proposal for a psychiatric protection order1 needs to be taken seriously. After all, he was one of the first to suggest a "psychiatric will".2 The potential advantages of advanced directives, which derive from this notion and may have wider aspects of concern than involuntary hospitalisation, are now generally accepted.3 We may similarly look back favourably on the idea of a psychiatric protection order.

In promoting human freedom, Szasz has consistently opposed psychiatric coercion. The history of abuse in psychiatric treatment does need to be acknowledged. The problem I have with Szasz's position is that his dogmatism polarises attitudes and undermines the cultural critique of psychiatry.4 The views of Szasz and other criticisms of the reductionistic tendency within psychiatry have been conflated and identified together as "anti-psychiatry". Although Szasz himself has persistently disavowed the use of the term, its effect has been to marginalise the critique of the biomedical model in psychiatry.5

Over recent years, a small group of psychiatrists in the UK have formed the Critical Psychiatry Network ( Use of the term "critical psychiatry" represents an attempt to move on from the misunderstanding of "anti-psychiatry". "Critical" is not so much meant to imply fault-finding, as its other meanings, such as "careful and exact evaluation" and even "of the greatest importance to the way things might happen".

The Critical Psychiatry Network has responded to the consultation on the UK draft Mental Health Bill 2002 and emphasised the rights of people subjected to the Mental Health Act. We are still waiting for the government to present the Bill before parliament. In theory, there may be no reason why the mental health tribunal set up by the new Act, if given sufficient powers, should not be able to direct a psychiatric protection order in appropriate circumstances. The Government, in taking the consultation on the draft Bill into account, should ensure that the new tribunal protects patients' rights.


  1. Szasz T. The psychiatric protection order for the "battered mental patient". BMJ 2003; 327: 1449-51 (20th December) [Full text]
  2. Szasz TS. The psychiatric will. A new mechanism for protecting persons against "psychosis" and psychiatry. Am Psychol 1982; 37: 762-70
  3. Papageorgiou A, King M, Janmohamed A, Davidson O. Advanced directives for patients compulsorily admitted to hospital with serious mental illness. Br J Psychiat 2003; 181: 513-9
  4. Double DB. Review of Pharmacracy. Medicine and Politics in America by Thomas Szasz. Journal of Critical Psychology, Counselling and Psychotherapy 2001; 1: 280-2
  5. Double DB The history of anti-psychiatry: An essay reviewHistory of Psychiatry 2002; 13: 231-236

Competing interests:
None declared

Competing interests: No competing interests

12 January 2004
D B Double
Consultant Psychiatrist
Norfolk mental Health Care NHS Trust, Norwich NR6 5BE