ETHICAL ISSUES IN MENTAL ILLNESS

This page intentionally left blank

Ethical Issues in Mental Illness

CAROLINE DUNN
First published 1998 by Ashgate Publishing

Published 2016 by Routledge

2 Park Square, Milton Park, Abingdon, Oxon OXI4
OX14 4RN
711 Third Avenue, New York, NY 10017, USA

Routledge is an imprint of the Taylor &

a/the & Francis Group, an informa
i'?forma business

Copyright © CJ.
C.J. Dunn 1998

All rights reserved. No part of this book may be reprinted or reproduced or

utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.

Notice:
Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.

British Library Cataloguing in Publication Data

Dunn, Caroline
Ethical issues in mental illness. - (Avebury series in
philosophy)
I. Moral illness - moral and ethical aspects 2. Mental
illness - Treatment - Moral and ethical aspects
1.
I. Title
616.8'9'06

Library of Congress Catalog Card Number: 97-76954

ISBN 13: 978-1-85972-608-2 (hbk)

ISBN 13: 978-1-138-26914-9 (pbk)
Contents

Acknowledgements vi

1 Introduction 1
2 Mental illness and autonomy 8
3 Autonomy and treatment models of mental illness 22
4 Involuntary hospitalisation and treatment 38
5 Psychotropic medication 60
6 ECT and psychosurgery 82
7 Psychotherapy 102
8 Community care 129
9 Conclusion 154

Appendix
AppendiX 175
Bibliography 178
Index 197

v
Acknowledgements

First and foremost I would like to thank all those who shared their experiences of
mental illness with me; their help enabled me to locate mental illness in the lives
of people, instead of approaching it as a purely theoretical issue.
Ir cannot adequately express my thanks to Harry Lesser, of the Department of
Philosophy at the University of Manchester, whose perceptive and constructive
criticism was always accompanied by an enlivening degree of humour. Finally, and
most importantly of all, I would like to thank my husband, without whose patience,
kindness and love, this book would never have been written.

VI
1 Introduction

People have always been fascinated by the human mind and its functions and
dysfunctions. Over the centuries, philosophers and scientists have suggested a
variety of explanatory models for the nature of the mind and its relationship to the
body; the causes of mental dysfunction have been examined and treatments for it
prescribed. Today we may marvel at the explanations offered in times past for
mental illness and shudder at the barbarity of the treatments inflicted upon the
mentally ill. We consider ourselves to be more enlightened, both in our
explanations of, and treatments for, mental illness. In the contemporary world,
with ever-increasing amounts of knowledge, specialisation has entered the arena,
and mental illness is now the province of a variety of 'experts'; doctors, nurses,
psychologists, psychotherapists and social workers all have their part to play in the
care and treatment of the mentally ill. These experts, whose assumptions in the
main often appear unchallenged and even unacknowledged within in their own
fields of expertise, and in some cases, outside them, all have their corners to fight
in the professional hierarchy and power stakes. All these different experts have
their own models of mental illness; these may overlap and share significant
characteristics, or they may diverge sharply from each other, often causing
hostility and friction between their protagonists; and there may be little real
understanding of these different models by professionals from the different fields
whose jobs involve them in treating the mentally ill. All too often opinions
polarise, the result of simplistic stances on both sides, and meaningful debate is
stifled before it even begins. Thus the ethical issues involved in mental illness may
be reduced to antagonistic posturing by tlle most vociferous members of the
opposing sides in the debate; those who stand to lose most from this unseemly
wrangle are the mentally ill.
Predominant amongst the experts are psychiatrists, for nowadays, the disorders
of the mind are fundamentally considered to be the province of medicine. The
discipline of psychiatry has sought, and some would argue, increasingly achieved,
scientific exactness. Psychiatry seeks to organise the phenomena of mental illness
into patterns of symptoms in order to classify different types of mental illness;
applying the classification system to the experiences described by a mentally ill
person then enables the 'expert' to diagnose what type of illness the patient is

1
 suffering from, and this in its turn indicates the appropriate treatment. Not
surprisingly, such a relatively simple approach to the complexity of mental illness,
resulting as it frequently does in the application of a simplistic medical model to
the definition and treatment of mental illness, has its limitations; when it is
coupled with an appalling catalogue of abusive practice in the treatment of the
mentally ill, it is hardly surprising that a vociferous anti-psychiatry movement has
developed. The term 'anti-psychiatry' is not used to imply any homogeneity
amongst theorists who may be included under this heading, for the theoretical
stances of those opposed to psychiatry are many and varied. Notwithstanding the
valuable work such theorists have done in exposing the limitations of a purely
medical model of mental illness, and the abuse of much mental health practice,
these theories purporting to offer explanations other than medical ones for the
causes of mental illness, and alternative suggestions for its treatment, are often as
dogmatic and simplistic as those of the medical profession.
Mental illness involves behaviour which is often a problem to society; it often
results in behaviour that is perceived by others as irrational, and consequently it
poses questions relating to autonomy which have considerable implications for the
treatment of the mentally ill. I have considered the general issue of autonomy and
mental illness in the Chapters 2 and 3; in Chapters 3 to 6 I have considered the
specific issues raised by different forms of treatment for mental illness. I suggest
that there are two fundamental models of autonomy that inform treatment of the
mentally ill, each of which is essentially too impoverished to deal with the
complexities of mental illness; each model may result in grave injustice, even
though in the best cases of its application it may be intended to do good.
In Chapter 8 I have considered community care, the aim of which was to
improve the care and treatment of the mentally ill, but in a great many cases, and
for a variety of reasons, it has failed them. Finally, in the Conclusion, I consider
what improvements are necessary to present care systems in order to try and
provide humane treatment for the mentally ill.
I have based my arguments wherever possible on the stories of those affected by
mental illness; in some cases I have used written material sent to me in response to
advertisements I placed asking for people's experience of mental illness in users'
magazines such as Open Mind. I have also used material already published which
gave accounts of the experiences of the mentally ill and/or their loved ones, and
newspaper reports, of which t11ere have been a significant number in the past few
years, as concern mounts about the implementation of the policy of community
care for the mentally ill. There are dangers in such an approach; one only has one
side of the story; certainly newspaper reports often seem to have a particular slant
to them; and there is always the likelihood that such material will be biased
towards those who have had unhappy experiences. Nevertheless, I chose this
approach because it seemed to me that in all the vast 'expert' literature on the
subject of mental illness, the voices of the mentally ill and their loved ones were
conspicuous by their absence. I can therefore claim no scientific, 'objective' status

2
for any of the evidence I have used to support arguments; it was not my intention
to carry out a sociological survey, however, so I do not consider this to be a
problem. If nothing else, one can accord the status of 'thought experiments' to the
cases discussed, as a valid method of exploring the issues they raise. But wherever
the mentally ill and their loved ones do try and make their voices heard, there is
such an overwhelming catalogue of misery reported that I do not have the slightest
doubt that there is very considerable cause for concern about their treatment. If I
had to sum it up in one brief sentence, I would say that the overwhelming
complaint made by the mentally ill and their families is that of not being listened
to or not being taken seriously.
For despite the growth of user groups, special interest groups such as MIND and
SANE, the various protests made by made by those who take an 'anti-psychiatry'
stance, and the community care movement, it is still hard to avoid the conclusion
that the mentally ill do not have a voice, or, if they do, it is one that is not taken
very seriously. The mentally ill appear to be largely inaudible and invisible until
and unless they are perceived to pose a danger or nuisance to society. Then there
appears a spate of articles in the press asking what went wrong with the system,
following another tragic case concerning a mentally ill patient who has killed
someone whilst in the care of the community; or perhaps the increasing numbers
of mentally distressed people occupying the gutters of our cities causes concern or
offence to 'normal' society.
I have also relied quite heavily on the two volumes of the Report of the National
Enquiry into the Human Rights of People with Mental Illness carried out under the
auspices of the Australian Federal Human Rights Commissioner, Brian Burdekind,
and published in 1993. This report received many oral and written submissions
from people affected by mental illness, their loved ones, professional carers,
community organisations, members of the public and Federal, State and Territory
governments. It is an up-to-date, comprehensive report; an interesting,
illuminating and thought-provoking document. Although it relates to another
country, I am satisfied that the nature of society in Australia is sufficiently similar
to that in the United Kingdom to make the issues raised in this report equally
applicable here; in the absence of any comparable British document, it has proved
extremely valuable, and the British government might be well advised to consider
a comparable exercise in the UK.
The issues surrounding mental illness are great, and I am acutely aware that
there are many gaps in this book; I have not, for example, had the space to
consider specific groups, such as the elderly, children, women or ethnic minorities,
all whom could be argued to raise specific issues within the overall ethical issues
which mental illness raises. All the issues that have been considered would
warrant an entire book being devoted to them, not merely a chapter. And over and
above all these issues there is the fundamental question of whether or not mental
illness can be considered to be a valid category.

3
 In its starkest terms, the debate about the validity of the concept of mental illness
may be reduced to those who accept the term at face value and those who deny the
very existence of mental illness. This issue must be acknowledged because what is
termed 'mental illness' expresses itself in deviant behaviour which frequently
causes problems to society at large. Consequently, it has been argued, most notably
by Szasz, that the concept of mental illness is merely a myth, a convenient way of
controlling those whose behaviour and beliefs pose a threat to the established
social order. Szasz considers that the term 'illness' relates only to physical
conditions, and that physical illness can be approached in a value-free, scientific
manner; whereas 'mental illness' relates to behaviour, and because 'human
behaviour is fundamentally moral behaviour' (Szasz, 1972, p. 27) conditions
considered to be mental illness are really moral issues.
This then begs such questions a what is meant by 'illness' and how is 'mental' to
be defined? And it begs consideration of the issues raised by the mind-body debate,
for classifying illnesses as either physical or mental immediately suggests that a
dualist approach to the mind-body problem is being adopted; Szasz's approach to
mental illness is certainly unrelentingly dualist.
These issues, fascinating and important though they be, must remain outside the
scope of this book; I have chosen to accept mental illness as a valid concept. as I
believe that there are convincing arguments to support this stance, and to consider
the ethical issues raised when considering the care and treatment of the mentally
ill, but these issues must be acknowledged for they are fundamental questions in
the consideration of the ethical issues involved in mental illness.
All illness has an ethical dimension because illness alters one's moral status; as
Sontag has pointed out, it suggests 'judgements of a deeper kind, both moral and
psychological, about the ill.' (Sontag, 1990, p. 43) Illness may cause a paradoxical
moral state, for the ill are likely to lose certain rights, but at the same time acquire
others, and will be excused certain moral obligations while at the same time
acquiring others. Such changes in moral status will at least partly depend upon the
meaning that is ascribed to an individual's illness.
Meaning and morality are social enterprises into which an individual is inducted
and becomes a participant; thus the experiences of the ill person are greatly
influenced by the meaning that is attached to illness. In earlier ages the meaning of
illness frequently had an overt moral element, often being associated with evil, sin
and bewitchment; contemporary sociological analysis of illness has illustrated that
this moral element, although different in form is no less present. (see, for example,
Parsons, 1951, 1958, 1978). Such work shows that being classified as 'ill' is far
from being merely a straightforward, scientific medical decision, but is also a
culturally determined, social state, as indeed, are attitudes to illness and health.
The ethical implications of being defined as 'ill' will depend upon the time and
place inhabited by a given patient - that is, a given society at a particular time in
its history. For the inhabitants of Butler'S Erewhon, illness was treated as a crime,
crime treated as an illness. The inhabitants of Erewhon are taken to hospital and

4
treated as if they were ill if they commit what would be regarded as a crime in the
narrator's world: fraud, arson, robbery with violence are all met with sympathetic
understanding. The 'cure' for such behaviour may be unpleasant, and the 'sufferer'
is expected to pursue the relevant treatment regardless of its degree of
unpleasantness, but nevertheless, she is regarded as unfortunate rather than
morally deficient.

The strange part of the story, however, is that though they ascribe moral
defects to the effect of misfortune either in character or surroundings, they
will not listen to the plea of misfortune in cases that in England meet with
sympathy and commiseration only. III luck of any kind, or even ill treatment
at the hands of others, is considered an offence against society, inasmuch as it
makes people uncomfortable to hear of it. (Butler, 1987, p. 102, emphasis
mine)

It is easy to dismiss this as the artistic licence of the author, but in certain forms,
illness, sin and crime have had a perilously close relationship throughout most
periods of Western civilisation. Butler's perceptive comment on the discomfort
caused to the Erewhonians by hearing of the misfortunes of others is particularly
relevant when considering the meanings attributed to illness, for sickness that is
perceived as in some way carrying a potential threat to the non-sick can cause
considerable discomfort, and with such discomfort the treatment of the sick person
is affected. Such threat is not limited to a direct threat to the non-sick person's
health; it can be the fear provoked by the realisation of one's own ultimate
mortality, or the feeling of 'there, but for the grace of God, go I.' Cancer patients
tell of being avoided by friends when the nature of their sickness is disclosed:
parents of handicapped children tell of attitudes which express disgust towards
their children, remarks such as, 'You should have let it die'; 'Why are you
bringing it out in public?' 'Spastic' is used by some as a term of abuse. Our
supposedly rational and scientific era is far from relinquishing guilt and shame as
possible meanings attached to sickness. Sontag, examining the metaphors relating
to AIDS, argues that:

With AIDS, ... shame is linked to an imputation of guilt; ... Indeed, to get
AIDS is precisely to be revealed, in the majority of cases so far, as a member
of a ... community of pariahs .... The unsafe behaviour that produces AIDS is
judged to be more than just weakness. It is indulgence, delinquency -
addictions to chemicals that are illegal and to sex regarded as deviant.
(Sontag, 1990, p. 24)

Perhaps we are less removed from the citizens of Erewhon than we might like to
think.

5
 Certain forms of illness have meanings whose implications are even worse; such
illnesses appear to remove the sufferer from the ranks of humanity altogether, and
in the process remove rights which are nonnally taken for granted; morality often
appears to become irrelevant if the sick person is not perceived as human. Kafka's
Metamorphosis conveys this situation starkly. Gregor Samsa's metamorphosis into
a giant insect is perceived as repulsive by his family; their initial reaction to his
metamorphosis is one of shock and disbelief as they struggle to come tenns with
what Gregor's illness means to them; Gregor's metamorphosis represents to the
Samsa family a fonn of moral judgement upon them, but for what they do not
know. Although Gregor retains his human feelings, his family begin a slow
process of dehumanising him; dirt is allowed to accumulate in his room and it is
used as a repository for any unwanted items in the apartment. His metamorphosis
creates a 'spoiled identity' for Gregor, and he is increasingly regarded as
contaminated and potentially contaminating until eventually there is no pretence at
regarding him as the person he was: Gregor suffers as Donne described, centuries
earlier:

As Sicknesse is the greatest misery, so the greatest misery of sicknes is

solitude; when the infectiousnes of the disease deterrs them who should assist,
from comming; Even the Phisician dares scarse come. Solitude is a tonnent,
which is not threatened in hell it selfe .... When I am dead, & my body might
infect, they have a remedy, they may bury me; but when I am but sick, and
might infect, they have no remedy, but their absence and my solitude ... it is
an Outlawry, an Excommunication upon the patient, and separates him from
all offices ... (Donne, ed. Raspa, 1987, p. 25)

Mental illness may result in sufferers experiencing many of the injustices so

graphically described in Kafka's fictional story because mental illness is associated
with the loss of rationality, which is considered to be a prerequisite for being
considered fully human. Just as Gregor's metamorphosis strips him of his
humanity and denies him the moral considerations which we take to be a right, so
too do the moral consequences resulting from the pejorative meanings ascribed to
mental illness have great ethical implications for the mentally ill. It seems that for
many people, the degree of humanity, and !1ICrefore human rights, that is
attributed to anyone bears a direct relationship to her conforming to an acceptable
(and by implication, non-threatening) model of a human being.
It is these issues which I propose to address in this book. I am very conscious
that it is alarmingly easy to inhabit an ivory tower and offer tidy theoretical
solutions to those whose profession it is to care for the mentally ill, secure in the
knowledge that one will never be faced by the intractable problems that mental
illness often poses in the 'real' world. I would therefore like to have included more
views and experiences from professionals, in order to consider the issues mental
illness poses for those in the difficult position of trying to provide care and

6
treatment for the mentally ill, but response from the institutions that I approached
was virtually zero, and constraints of time meant that it was not possible to
approach a larger number of institutions knowing that this only might result in a
better response.
Despite the omissions that are inevitable when one considers all the many ethical
issues raised by mental illness, I hope that this attempt to address what I consider
to be some of the fundamental ethical issues raised by mental illness will be a
small step on the way to raising the most basic issue of all, the right of the
mentally ill and their loved ones to have their voices heard and what they say
taken seriously.

7
References

Table of Contents

Index v vi 1 8 22 38 60 82 102 129 154 175 178

197 ix

1
Bibliography

Abbott, R. 1., and L. A. Loizou (1986), 'Neuroleptic Syndrome', British Journal of

Psychiatry, Vol. 148, pp. 47-51.
Abraham, F., and B. Webb (1989), Mental Health and Self Help Support,
Community Organisations, Voluntary Action and Social Welfare Occasional
Paper No.5, Tavistock Publications, London.
Ackner, B., A. Harris, and A. 1. Oldham (1957), 'Insulin Treatment of
Schizophrenia - A Controlled Study', Lancet, Vol. 2, pp. 607-11.
Adams, M. M., and R. M. Adams (eds) (1992), The Problem of Evil, OUF, Oxford.
Alexander, F. (1957), Psychoanalysis and Psychotherapy, Allen and Unwin,
London.
Allderidge, P. (1979), 'Hospitals, Madhouses and Asylums: Cycles in the Care of
the Insane', British Journal of Psychiatry, Vol. 134, pp. 321-34.
Alper, B. (1973), 'Foreword', in Bakal, Y. (ed.), Closing Correctional Institutions,
Lexington Books, Lexington, Mass.
American Psychiatric Association (1978), Task Force Report 14:
Electroconvulsive Therapy, Washington DC.
Anonymous (1965), 'The Experience of Electroconvulsive Therapy by a Practising
Psychiatrist', British Journal of Psychiatry, Vol. Ill, pp. 365-7.
Appelbaum, P., and T. G. Gutheil (1980), 'Drug Refusal: A Study of Psychiatric
Inpatients', American Journal of Psychiatry, Vol. 137, No.3, pp. 340-45.
Appelbaum, P. S. (1988), 'The Right to Refuse Treatment With Antipsychotic
Medications: Retrospect and Prospect', American Journal of Psychiatry, Vol.
145, pp. 413-9.
Aristotle (1986), Ethics, trans. J. A. K. Thomson, Penguin, Harmondsworth.
Arlidge, 1., and C. Hall (1992), 'Crisis Talks Over "Irresponsible" Aids Virus
Carrier', The Independent, 24 June, p. 1.
Association of Psychiatrists in Training (1979), Who Puts Medical Students Off
Psychiatry?, Smith, Kline and French Laboratories, London.
Bachrach, L. (1989), 'Deinstitutionalisation: A Semantic Analysis', Journal of
Social Issues, Vol. 45, No.3, pp. 161-71.
Bakal, Y. (ed.) (1973), Closing Correctional Institutions, Lexington Books,
Lexington.

178
Barham, P. (1992), Closing the Asylum: The Mental Patient in Modem Society,
Penguin, Hannondsworth.
Barker, 1., and E. Peck (eds) (1987), Power in Strange Places: Good Practices in
Mental Health, London.
Barker, P. J., and S. Baldwin (eds) (1991), Ethical Issues in Mental Health,
Chapman and Hall, London.
Barraclough, B. (1974), 'A Hundred Cases of Suicide', British Journal of
Psychiatry, Vol. 125, pp. 355-73.
Baruch, G., and A. Treacher (1978), Psychiatry Observed, Routledge Kegan Paul,
London.
Bavidge, M. (1989), Mad or Bad?, The Bristol Press, Bristol.
Bean, P. (1980), Compulsory Admissions to Mental Hospitals, John Wiley,
Chichester.
Bean, P. (ed.) (1983), Mental JIIness: Changes and Trends, John Wiley,
Chichester.
Bean, P. (1988), Mental Disorder and Legal Control, CUP, Cambridge.
Beauchamp, T. L., and 1. F. Childress (1983), Principles of Biomedical Ethics,
second edition, OUP, Oxford.
Bebbington, P. E. (1977), 'Psychiatry: Science, Meaning and Purpose', British
Journal of Psychiatry, Vol. 130, pp. 222-8.
Beck, E. R., 1. L. Francis, and R. L. Southam (1977), Tutorials in Differential
Diagnosis, Pitman Medical, Tonbridge Wells.
Belmaker, R. H., and D. Ward (1977), 'Haloperidol in Normals', British Journal
of Psychiatry, Vol. 131, p. 222.
Bentall, R. (1992), 'A Proposal to Classify Happiness as a Psychiatric Disorder',
Journal ofMedical Ethics, Vol. 18, pp. 94-8.
Bentall, R., H. Jackson, and D. Pilgrim (1988), 'Abandoning the Concept of
"Schizophrenia": Some Implications of Validity Arguments for Psychological
Research into Psychotic Phenomena', British Journal of Clinical Psychology,
Vol. 27, pp. 303-24.
Bentall, R. P. (ed.) (1992), Reconstructing Schizophrenia, Routledge, London.
Bergin, A. E. (1971), 'The Evaluation of Psychotherapy Outcomes', in Bergin,
A.E. and S. Garfield (eds), Handbook of Psychotherapy and Behavior Change,
Wiley, New York.
Bergsma, 1., and D. C. Thomasma (1982), Health Care: Its Psychosocial
Dimensions, Duquesne University Press, Pittsburgh.
Birtclmell, 1. (1987), 'A Psychiatrist Speaks Out', British Journal of Clinical and
Social Psychiatry, Vol. 5. No.2, pp. 223-5.
Bloch, S., and P. Chodoff (eds) (1984), Psychiatric Ethics, OUP, Oxford.
Bloch, S. (ed.) (1986), An Introduction to the Psychotherapies, second edition,
Oxford Medical Publications, Oxford.
Blom-Cooper, L., H. Hally, and E. Murphy (1995), The Falling Shadow: One
Patient's Mental Health Care 1978-1993, Duckworth, London.

179
Bluglass, R. (1984), A Guide to the Mental Health Act 1983, Churchill
Livingstone, London.
Boorse, C. (1981), 'On the Distinction Between Disease and Illness', in Cohen,
M., T. Nagel, and T. Scanlon (eds), Medicine and Moral Philosophy, Princeton
University Press, Princeton.
Bott, E. (1976), 'Hospital and Society', British Journal of Medical Psychology,
Vol. 46, pp. 97-140.
Bottoms, A. E., and R. Brownsword (1982), 'The Dangerousness Debate After the
Floud Report', British Journal of Criminology, Vol. 22, No.3, pp. 229-54.
Brackx, A., and C. Grimshaw (eds) (1989), Mental Health Care in Crisis, Pluto
Press, London.
Brain, L. (1960), Brain's Clinical Neurology, 5th edition, OUF, Oxford.
Braine, D., and H. Lesser (eds) (1988), Ethics, Technology and Medicine,
Avebury, Aldershot.
Brazier, M. (1987), Medicine, Patients and the Law, Penguin, Harmondsworth.
Breggin, P. (1972), 'The Return of Lobotomy and Psychosurgery', Congressional
Record, Vol. 118. pp. EI603-12.
Breggin, P. (1993), Toxic Psychiatry, Fontana, London.
British Association for Counselling (1984), Code of Ethics and Practice for
Counsellors, British Association for Counselling, Rugby.
British National Formulary (1994), British National Formulary, BMA and British
Pharmacological Society, London.
Brohn, P. (1986), Gentle Giants, Century Publishing, London.
Brown, G. (1973), 'The Mental Hospital as an Institution', Social Science and
Medicine, Vol. 7, pp. 407-24.
Brown, G. W., and T. Harris (1978), The Social Origins of Depression: A Study of
Psychiatric Disorder in Women, Tavistock Publications, London.
Brown, R. (1977), 'Physical Illness and Mental Health', Philosophy and Public
Affairs, Vol. 7, pp. 17-38.
Browning, R., (1968), Browning: Poems and Plays, vol. two, Dent Everyman's
Library, London.
Bruce, E. M., N. Crone, G. Fitzpatrick, S. 1. Frewin, A. Gillis, C. F. Lascelles, L.
1. Levene, and H. Merskey (1960), 'A Comparative Trial of ECT and Tofranil',
American Journal of Psychiatry, Vol. 117, p. 76.
Buchanan, A. (1978), 'Medical Paternalism', Philosophy and Public Affairs, Vol.
7, pp. 370-90.
Burns, C. R. (1976), 'The Non-naturals: A Paradox in the Western Concept of
Health', Journal of Medicine and Philosophy, Vol. 1, pp. 202-11.
Burton, L. (1975), The Family Life of Sick Children, Routledge and Kegan Paul,
London.
Butler, A., and C. Pritchard (1983), Social Work and Mental J//ness, Macmillan
Education, Basingstoke.
Butler, S. (1987), Erewhon, Penguin, Harmondsworth.

180
Campbell, R. (1992), Philosophy and Suicide, The Second Richard Finlayson
Lecture edition, The Samaritans, London.
Camus, A. (1975), The Myth ofSisyphus, Penguin, Hannondsworth.
Caplan, A. L., H. T. Engelhardt, and 1. 1. McCartney (eds) (1981), Concepts of
Health and Disease: interdisciplinary Perspectives, Addison-Wesley, Reading,
Massachusetts.
Castoriadis, C. (1991), Philosophy, Politics, Autonomy: Essays in Political
Philosophy, OUP, New York.
Cavadino, M. (1989), Mental Health Law in Context: Doctors' Orders?,
Aldershot, Dartmouth.
Chalmers, A. F. (1982), What Is This Thing Called Science? An Assessment of the
Nature and Status of SCientific Method, second edition, Open University Press,
Milton Keynes.
Chatterton v. Gerson and Another (1980), All ER 257 The Times, London, 7th
February.
Chesler, P. (1972), Women and Madness, Avon Books, New York.
Chitty, S. (1985), Now to My Mother, Weidenfeld and Nicholson, London.
Chodoff, P. (1976), 'The Case for the Involuntary Hospitalisation of the Mentally
Ill', American Journal of Psychiatry, Vol. 133, pp. 496-501.
Chodoff, P. (1984), 'Involuntary Hospitalisation of the Mentally III as a Moral
Issue', American Journal of Psychiatry, Vol. 141, pp. 384-89.
Clare, A. (1980), Psychiatry in Dissent, Tavistock Publications, London.
Clark, A. F., and N. L. Holden (1987), 'The Persistence of Prescribing Habits: A
Survey and Follow-Up of Prescribing to Chronic Hospital In-Patients', British
Journal of Psychiatry, Vol. 150, pp. 88-91.
Clark, P., and C. Wright (eds) (1988), Mind, Psychoanalysis and Science, Basil
Blackwell, Oxford.
Clouser, K. D., C. M. Culver, and B. Gert (1981), 'Malady: A New Treatment of
Disease', Hastings Centre Report, Vol. 11, No.3, pp. 29-37.
Coate, M. (1964), Beyond A II Reason, Constable, London.
Cocozza, 1., and H. Steadman (1976), 'Predictions in Psychiatry: An Example of
Misplaced Confidence in Experts', Social Problems, Vol. 25, No. 23, pp.
265-70.
Cohen, D. (1989), Soviet Psychiatry, Paladin, Grafton Books, London.
Cohen, D. (1988), Forgotten Millions: The Treatment of the Mentally III - A
Global Perspective, Paladin, London.
Cohen, D. (ed.), (1990), Challenging the Therapeutic State: Critical Perspectives
on Psychiatry and the Mental Health System, The Institute of Mind and
Behaviour, New York.
Cohen, S. (1972), Folk Devils and Moral Panics, McGibbon and Kee, London.
Coles, E. M. (1975), 'The Meaning and Measurement of Mental Health', Bulletin
of the British Psychological Society, Vol. 28, March, pp. 111-13.

181
Committee of Enquiry (1976), Report of the Committee of Enquiry, St Augustine's
Hospital, Chatham, Kent, South East Thames Regional Health Authority,
London.
Conrad, 1. P. (1982), 'The Quandary of Dangerousness', British Journal of
Criminology, Vol. 22, pp. 255-67.
Conrad, 1. P., and S. Dinitz (eds) (1977), In Fear of Each Other: Studies of
Dangerousness in America, Lexington Books, Lexington.
Costello, C. G. (1976), Electroconvulsive Therapy: Is Further Investigation
Necessary?, Canadian Psychiatric Association Journal, Vol. 21, pp. 761-7.
Coulter, 1. (1973), Approaches to Insanity: A Philosophical and Sociological
Study, Martin Robertson, London.
Covi, L., R. S. Lipman, and 1. H. Pattison (1973), 'Length of Treatment with
Anxiolytic Sedatives and Responses to Their Sudden Withdrawal', Acta
Psychiatrica Scandinavia, Vol. 49, pp. 51-64.
Cresswell, 1., and N. Johnson (1990), 'The One-Sided Wall', in Plays By Women,
ed. M. Remnant, Vol. 8, Methuen, London.
Crichton, 1. (ed.) (1995), Psychiatric Patient Violence: Risk and Response,
Duckworth, London.
Cronholm, B., and 1. O. Ottosson (1960), 'Experimental Studies of the
Therapeutic Action of Electroconvulsive Therapy in Endogenous Depression',
Acta Psychiatrica et Neurologica Scandinavica, Vol. 35, Suppl. 145, pp. 69-97.
Crow, T. 1., 1. S. Macmillan, A. L. Johnson, and E. C. Johnson (1986), 'The
Northwick Park Study of First Episode Schizophrenia: A Controlled Study of
Neuroleptic Treatment', British Journal of Psychiatry, Vol. 148, pp. 120-27.
Culver, C. M., and B. Gert (1982), Philosophy in Medicine, OUF, Oxford.
Dahlberg, C. (1970), 'Sexual Contact Between Patient and Therapist',
Contempormy Psychoanalysis, Vol. 6, pp. 107-24.
Dalley, G. (1988), Ideologies of Caring, Macmillan, London.
Daniel, S. L. (1986), 'The Patient as Text: A Model of Clinical Hermeneutics',
Theoretical Medicine, Vol. 7, pp. 195-210.
Davidson, D. (1982), 'Rational Animals', Dialectica, Vol. 36, pp. 318-27.
Davidson, D. (1989), 'Psychology as Philosophy', in The Philosophy of Mind, ed.
1. Glover, OUF, Oxford.
Davidson, V. (1977), 'Psychiatry's Problem With No Name: Therapist-Patient
Sex', American Journal of Psychoanalysis, Vol. 37, pp. 43-50.
Delgado, 1. M. R. (1969), PhYSical Control of the Mind: Toward a Psychocivilised
Society, Harper and Row, New York.
Department of Health and Welsh Office (1993), Code of Practice: Mental Health
Act 1983, HMSO, London.
Department of Health: Mental Health Task Force (1994), London Project, HMSO,
London.
Deveson, A. (1992), Tell Me I'm Here, Penguin, Hannondsworth.
Dinnage, R. (1988), One to One: Experiences of Psychotherapy, Viking, Penguin
Books, New York.

182
Donne, 1. (1987), Devotions Upon Emergent Occasions, ed. A. Raspa, OUP, New
York.
Dowie, 1., and A. Elstein (eds) (1988), Professional Judgement: A Reader in
Clinical Decision Making, CUP, Cambridge.
Downie, R. S., and K. C. Caiman (1987), Healthy Respect: Ethics in Health
Care, Faber and Faber, London.
Dubos, R. (1987), The Mirage of Health: Utopias, Progress and Biological
Change, Rutgers University Press, New Brunswick.
Duff, A. (1977), 'Psychopathy and Moral Understanding', American Philosophical
Quarterly, Vol. 14, No.3, pp. 189-200.
Durkheim, E. (1952), SUicide, Routledge Kegan Paul, London.
Dworkin, G. (1988), The Theory and Practice ofAutonomy, CUP, Cambridge.
Dyer, A. R., and S. Bloch (1987), 'Informed Consent and the Psychiatric Patient',
Journal of Medical Ethics, Vol. 13, pp. 12-16.
Editorial (1989), 'Clozapine', Lancet, Vol. 2, p. 1430.
Editorial (1993), 'Therapy that Women Could Do Without', The Independent, 6
April, London.
Editorial (1993), 'Clozapine: Progress in Treating Refractory Schizophrenia',
British Medical Journal, Vol. 306, p. 1427.
Edwards, R. B. (1981), 'Mental Health as Rational Autonomy', Journal of
Medicine and Philosophy, Vol. 6, pp. 309-22.
Edwards, S., and V. Kumar (1984), 'A Survey of Prescribing and Psychotropic
Drugs in a Binningham Psychiatric Hospital', British Journal of Psychiatry,
Vol. 145, pp. 502-7.
Eisenberg, N., and D. Glasgow (eds) (1986), Current Issues in Clinical
Psychology, Gower, Aldershot.
Ellenberger, H. F. (1970), The Discovery of the Unconscious, Allen Lane, London.
Elliott, D. W., and 1. C. Wood (1974), A Casebook of Criminal Law, 3rd edition,
London.
Ennis, B. 1., and T. R. Litwak (1974), 'Psychiatry and the Presumption of
Expertise: Flipping Coins in the Courtroom', California Law Review, Vol. 62,
No.5, pp. 693-752.
Ennis, B. 1., and T. R. Litwak (1976), 'Prediction in Psychiatry: An Example of
Misplaced Confidence in Experts', Social Problems, Vol. 25, No. 23, pp.
265-70.
Eysenck, H. 1. (1986), Decline and Fall of the Freudian Empire, Penguin,
Harmondsworth.
Eysenck, H. 1. (1952), 'The Effects of Psychotherapy: An Evaluation', Journal of
Consulting Psychology, Vol. 16, pp. 319-24.
Eysenck, H. J. (1969), The Effects of Psychotherapy, Science House, New York.
Fabrega, H. (1978), 'Disease Viewed as a Symbolic Category', in Mental Health:
Philosophical Perspectives, eds T. Engelhardt and S. F. Spieker, D. Reidel,
Dordrecht.
Farrell, B. A. (1981), The Standing of Psychoanalysis, OUP, Oxford.

183
Fields, L. (1987), 'Exoneration of the Mentally Ill', Journal of Medical Ethics,
Vol. 13, pp. 201-5.
Flew, A. (1973), Crime or Disease?, Macmillan, London.
Floud, J. (1981), Dangerousness and Criminal Justice, Heinemann, London.
Floud, J. (1982), 'Dangerousness and Criminal Justice', British Journal of
Criminology, Vol. 22, pp. 213-28.
Floud, J. (1985), 'Dangerousness in Social Perspective', in Psychiatry, Human
Rights and the Law, eds M. Roth, and R. Bluglass, CUP, Cambridge.
Fodor, 1. A. (1994), 'The Mind-Body Problem', in The Mind-Body Problem: A
Guide to the Current Debate, eds R. Warner and T. Szubka, Blackwell, Oxford.
Ford, M. D. (1980), 'The Psychiatrist's Double Bind: The Right to Refuse
Medication', American Journal of Psychiatry, Vol. 137, No.3, pp. 332-9.
Freidson, E. (1970), Profession of Medicine: A Study of the SOCiology of Applied
Knowledge, Dodd, Mead and Co., New York.
Fromm, E. (1950), Psychoana~ysis and Religion, Yale University Press, New
Haven.
Fulford, K. W. M. (1989), Moral Theory and Medical Practice, Press Syndicate of
the University of Cambridge, Cambridge.
Fulford, K. W. M., G. Gillett and 1. M. Soskice (eds) (1994), Medicine and Moral
Reasoning, CUP, Cambridge.
Furrow, B. (1980), Malpractice in Psychotherapy, Lexington Books, Lexington.
Gardos, G., and J. o. Cole (1980), 'Overview: Public Health Issues in Tardive
Dyskinesia', American Journal of Psychiatry, Vol. 137, pp. 776-81.
Garfield, S. L., and A. E. Bergin (eds) (1978), Handbook of Psychotherapy and
Behaviour Change: An Empirical AnalYSiS, John Wiley and Sons, New York.
Gartrell, N., 1. Herman, S. Olante, M. Feldstein, and R. Localio (1986),
'Psychiatrist-Patient Sexual Contact', American Journal of Psychiatry, Vol.
143, No.9, pp. 1126-31.
Gaylin, W. M., J. S. Meister, and R. C. Neville (eds) (1975), Operating on the
Mind: the Psychosurgery Debate, Basic Books, New York.
Geller, 1. L. (1986), 'Rights, Wrongs and the Dilemma of Coerced Community
Treatment', American Journal of Psychiatry, Vol. 143, No. LO, pp. 1259-64.
Ger!, B. (1988), Morality: A New Justification of the Moral Rules, OUP, Oxford.
Gillon, R. (1986), Philosophical Medical Ethics, John Wiley, Chichester.
Glover,1. (cd.) (1989), The Philosophy ofMind, OUP, Oxford.
Goffman, E. (1987), Asylums: Essays on the Social Situation ofMental
Patients and Other Inmates, Peregrine, London.
Goldberg, D., and P. Huxley (1992), Common Mental Disorders: A Bio-Social
Model, Routledge, London.
Goodwin, S. (1990), Community Care and the Future of Mental Health Service
Provision, Avebury, Aldershot.
Gordon, R. A. (1982), 'Preventive Sentencing and the Dangerous Offender',
British Journal of Criminology, Vol. 22, pp. 285-314.

184
Gorman, 1. (1990), The Essential Guide to Psychiatric Drugs, St Martin's Press,
New York.
Gostin, L. (1985), 'Human Rights in Mental Health', in Psychiatry, Human Rights
and the Law, eds M. Roth and R. Bluglass, CUP, Cambridge.
Gostin, L. (ed.) (1985), Secure Provision: A Review of Special Services for the
Mentally 1// in England and Wales, Tavistock Publications, London.
Granville-Grossman, K. (1971), 'Convulsive Therapy', in Recent Advances in
Clinical Psychiatry, ed. K. Granville-Grossman, 1. and A. Churchill, London.
Griffiths, S. R. (1988), Community Care: Agenda for Action - A Report to the
Secretary of State for Social Services, HMSO, London.
Gross, H. (1978), The Psychological SOCiety, Random House, New York.
Grubb, A. (ed.) (1994), Decision-Making and Problems of Competence, John
Wiley, Chichester.
Grunbaum, A. (1985), The Foundations of PsychoanalYSis: A Philosophical
Critique, University of California Press, London.
Gustafson, D. A. (ed.) (1967), Essays in Philosophical Psychology, Macmillan,
London.
Gutheil, T., R. Shapiro, and L. St. Clair (1980), 'Legal Guardianship in Drug
Refusal: An Illusory Solution', American Journal of Psychiatry, Vol. 137, pp.
347-5l.
Habermas,1. (1972), Knowledge and Human Interests, Heinemann, London.
Hall, 1. E., and R. T. Hare-Mustin (1983), 'Sanctions and the Diversity of Ethical
Complaints Against Psychologists', American Psychologist, Vol. 38, pp.
714-29.
Hall, S. A. (1992), 'Should Public Health Respect Autonomy?" Journal of
Medical Ethics, Vol. 18, pp. 197-20l.
Hands, T. (ed.) (1976), Pleasure and Repentance, A Wheaton & Co., Exeter.
Hankinson, 1. (1989), Bluff Your way in Philosophy, Ravette Books, Horsham.
Harris, J. (1985), The Value of Life: An Introduction to Medical Ethics, Routledge
Kegan Paul, London.
Hart, H. L. A. (1961), The Concept ofLaw, Clarendon Press, Oxford.
Hays, P. (1964), New Horizons in Psychiatry, Penguin, Harmondsworth.
Healy, D. (1990), The Suspended Revolution, Faber and Faber, London.
Healy, D. (1993), Images of Trauma: From Hysteria to Post-Traumatic Stress
Disorder, Faber and Faber, London.
Heelas, P., and A. Lock (eds) (1981), Indigenous Psychologies: the Anthropology
of the Self, Academic Press, London.
Hemmenki, E. (1977), 'Polypharmacy Among Psychiatric Patients', Acta
Psychiatrica Scandinavia, Vol. 56, pp. 347-56.
Herink, R. (1981), The A -Z Guide to Different Therapies in Use Today, New
American Library, New York.
Hervey, N. (1986), 'Advocacy or Folly: the Alleged Lunatics' Friends Society,
1845-63', Medical History, Vol. 30, pp. 245-75.

185
 Herxheimer, A. (1976), 'Ignorance: Educating Doctors to Use Drugs Well', British
Journal of Clinical Pharmacology, Vol. 3, pp. 111-12.
Hill, D. (1985), The Politics of Schizophrenia, University Press of America,
London.
Hinton, 1. (ed.) (1982), Dangerousness: Problems of Assessment and Prediction,
Allen and Unwin, London.
Hobson, R. F. (1985), Forms of Feeling: The Heart of Psychotherapy, Tavistock
Publications, London.
Holly, L., and B. Webb (1992), The Four Projects in the Advocacy Alliance: Some
Commonalities and Differences, Evaluation Development and Review Unit
edition, Evaluation Workshop No.2, The Tavistock Institute, London.
Holyroyd,1. c., and A. M. Brodsky (1977), 'Psychologists' Attitudes and Practices
Regarding Erotic and Non-erotic Physical Contact With Patients', American
Psychologist, Vol. 32, pp. 843-9.
Honderich, T. (1982), 'On JustifYing Protective Punishment', British Journal of
Criminology, Vol. 22, pp. 268-75.
House of Commons Health Committee (1993-94), Better Off in the Community?
The Care of People Who Are Seriously Mentally JIl, vol. I & 2, HMSO, London.
Howe, G. (1991), The Reality of Schizophrenia, Faber and Faber, London.
Howell, M., and P. Ford (1980), The Elephant Man, Allison and Busby, London.
Human Rights and Equal Opportunities Commission (1993), Human Rights and
Mental JIlness: Report of the National Enquiry into the Human Rights of People
with Mental JIlness, vol. 1&2, Australian Government Publishing Service,
Canberra.
Hume, D. (1978), A Treatise of lilll1JaI1 Nature, ed. L. A. Selby-Brigge and P. H.
Nidditch, 2nd edition, Clarendon Press, Oxford.
Humphrey, N. (1992), A History of the Mind, Chatto and Windus, London.
Huxley, P. 1., T. Hagan, R. Henelly and 1. Hunt (1990), Effective Community
Mental Health Services, Avebury, Aldershot.
Ignatieff, M. (1990), The Needs of Strangers, Hogarth Press, London.
IIIich, I. (1988), Limits to Medicine, Pelican, London.
IIIich, I. (1977), Medical Nemesis: The Expropriation of Health, Penguin,
Harmondsworth.
Ingleby, D. (ed.) (1981), Critical Psychiatry: The Politics of Mental Health,
Penguin, Harmondsworth.
Jameson, A. (1984), NurSing Practice: The Ethical Issues, Prentice-Hall,
Eaglewood Cliffs, New Jersey.
Jeffrey, R. (1979), 'Deviant Patients in Casualty Departments', SOCiology of
Health and JIlness, Vol. 1, pp. 90-98.
Johnson, D. Mcl., and N. Dodds (eds) (1957), Plea for the Silent, Christopher
Johnson, London.
Johnstone, E. c., 1. F. W. Deakin, P. Lawler, C. D. Frith, M. Stevens, K.
McPherson and T. 1. Crow (1980), 'The Northwick Park ECT Trial', Lancet,
Vol. ii, pp. 1317-20.

186
Johnstone, L. (1989), Users and Abusers of Psychiatry, Routledge, London.
Jones, K. (1988), Experience in Mental Health, Sage Publications, London.
Jones, K., and A. Poletti (1986), 'The "Italian Experience" Reconsidered', British
Journal of Psychiatry, Vol. 148, pp. 144-50.
Joseph, Sir K. (1971), Hospital Services for the Mentally Ill, White Paper, HMSO,
London.
Kafka, F. (1961), Metamorphosis and Other Stories, Penguin, Harmondsworth.
Kardener, S. H., M. Fuller and I. N. Mensch (1973), 'A SUlvey of Physicians'
Attitudes and Practices Regarding Erotic and Non-erotic Contact with Patients',
American Journal of Psychiatry, Vol. 130, pp. 1077-8l.
Kellam, A. M. P. (1987), 'The Neuroleptic Syndrome, So-called: A Survey of the
World Literature', British Journal of Psychiatry, Vol. 150, pp. 752-9.
Kendell, R. E. (1975), 'The Concept of Disease and Its Implications for
Psychiatry', British Journal of Psychiatry, Vol. 127, pp. 305-15.
Kerwin, R. (1993), 'Adverse Reporting and the New Antipsychotics', Lancet, Vol.
342, p. 1440.
Kidel, M., and S. Rowe-Leete (eds) (1988), The Meaning of Illness, Routledge,
London.
Kington, M. (1992), 'Vacant Places Upstairs', The Independent, 7 May, p. 28.
Klass, A. (1975), There's Gold in Them Thar Pills: Enquiry into the Medical
Industrial Complex, Penguin, Harrnondsworth.
Kleinig, J. (1985), Ethical Issues in Psychosurgery, Allen and Unwin, London.
Klerman, G., and G. Schechter (1984), 'Ethical Aspects of Drug Treatment', in
Psychiatric Ethics, eds S. Bloch and P. Chodoff, OUP, Oxford.
Klerman, G. L. (1972), 'Psychotropic Hedonism versus Pharmacological
Calvinism', Hastings Center Report, Vol. 2, pp. 1-3.
Komrad, M. S. (1983), 'A Defence of Medical Paternalism: Maximising Patients'
Autonomy', Journal ofMedical Ethics, Vol. 9, No.1, pp. 38-44.
Kovel, 1. (1978), A Complete Guide to Therapy, Penguin, Harmondsworth.
Kramer, P. D. (1994), Listening to Prozac: A Psychiatrist Explores Antidepressant
Drugs and the Remaking of the Self, Fourth Estate, London.
Kraupl-Taylor, F. (1976), 'The Medical Model of the Disease Concept', British
Journal of Psychiatry, Vol. 128, pp. 588-94.
Kubie, I. S. (1971), 'Retreat from Patients', Archives of General Psychiatry, Vol.
24, pp. 98-106.
Kuhn, A. (1985), The Power of the Image, Routledge Kegan Paul, London.
Lacey, R. (1991), The Complete Guide to PsychiatriC Drugs, Ebury Press, London.
Lader, M., and H. Petursson (1983), 'Long-term Effects of Benzodiazepines',
Neuropharmacology, Vol. 22, pp. 527-33.
Laing, 1., and D. McQuarrie (1992), Fifty Years in the System, Corgi Books,
London.
Laing, R. D. (1967), The Politics of Experience and The Bird of Paradise,
Penguin, Harmondsworth.
Laing, R. D. (1969), Politics and the Family, Penguin, Harmondsworth.

187
Laing, R. D. (1979), The Divided Self, Penguin, Harmondsworth.
Lakin, M. (1988), Ethical Issues in the Psychotherapies, OUP, Oxford.
Lakin, M. (1991), Coping with Ethical Dilemmas in Psychotherapy, Pergamon
Press, Oxford.
Lamb, D. (1988), Down the Slippery Slope: Arguing in Applied Ethics, Croom
Helm, London.
Lambert, M. 1., A. E. Bergin, and 1. L. CoIlins (1977), 'Therapist-induced
Deterioration in Psychotherapy', in The Therapist's Contributions to Effective
Treatment, eds A. M. Gurman and A. M. Rogers, Pergamon, New York.
Lambourn, 1., and D. Gill (1978), 'A Controlled Comparison of Simulated and
Real ECT', British Journal of Psychiatry, Vol. 133, pp. 514-9.
Langan, M. (1990), 'Community Care in the 1990s: The Community Care White
Paper Caring for People', Critical Social Policy, Vol. 29, pp. 58-70.
Langs, R. (1985), Madness and Cure, Newconcept Press, Emerson, N1.
Langsley, D. G. (1980), 'The Community Mental Health Center: Does it Treat
Patients?', Hospital and Community Psychiatry, Vol. 31, pp. 815-9.
Lasch, C. (1991), The Culture of Narcissism , W W Norton & Co., London.
Ledermann, E. K. (1984), Mental Health and Human Conscience: the True and
the False Self, Avebury, Amersham.
Ledermann, E. K. (1986), Philosophy and Medicine, Revised edition, Gower,
Aldershot.
Leif, 1. P., and 1. K. Wing (1971), 'Trial of Maintenance Therapy in
Schizophrenia', British Medical Journal, Vol. 5, pp. 559-606.
Lesser, H. (1983), 'Consent, Competency and ECT: A Philosopher's Comment',
Journal ofMedical Ethics, Vol. 9, pp. 144-5.
Levitt, E. E. (1977), 'Unpublished Paper on Sexual Transgressions Between
Physician and Patient Presented at American Medical Association Annual
Convention', AMA Annual Convention, June 21.
Loga, S., S. Curry, and M. Lader (1975), 'Interactions of Orphenadrine and
Phenobarbitone With Chlorpromazine: Plasma Concentrations and Effects in
Man', British Journal of Clinical Pharmacology, Vol. 2, pp. 197-208.
Lomas, P. (1981), The Case for a Personal Psychotherapy, OUP, Oxford.
Lorber, 1. (1975), 'Good Patients and Problem Patients: Conformity and Deviance
in a General Hospital', Journal of Health and Social Behaviour, Vol. 16, pp.
213-25.
Lowe, C. M. (1969), Value Orientations in Counselling and Psychotherapy: The
Meaning ofMental Health, Chandler, San Francisco.
Luborsky, L., B. Singer, and B. Luborsky (1975), 'Comparative Studies of
Psychotherapies: Is it True that "Everyone Has Won and All Must Have
Prizes?"', Archives of General Psychiatry, Vol. 32, pp. 995-1008.
Macalpine, I., and R. Hunter (1974), The Pathography of the Past, TLS, March 15,
p.256.
Mack, 1. E., and H. Hickler (1981), Vivienne: The Life and Suicide of an
Adolescent Girl, Little, Brown and Company, Boston.

188
Mackie, 1. L. (1977), Ethics: Inventing Right and Wrong, Penguin,
Hannondsworth.
Macklin, R. (1982), 'Refusal of Psychiatric Treatment: Autonomy, Treatment and
Paternalism', in Psychiatry and Ethics, ed. R. Edwards, Prometheus, New York.
Marks, 1. M., 1. L. T. Birley, and M. G. Gelder (1966), 'Modified Leucotomy in
Severe Agoraphobia: A Controlled Series Inquiry', British Journal of
Psychiatry, Vol. 113, pp. 53-73.
Masson, 1. (1989), Against Therapy, Collins, London.
Mayer, J., and N. Timms (1970), The Client Speaks, Routledge Kegan Paul,
London.
Mays, D. T., and C. M. Frank (1985), Negative Outcomes in Psychotherapy and
What to do About It, Springer, New York.
McCall-Smith, A. (1987), 'Commentary: Exoneration of the Mentally Ill', Journal
ofMedical Ethics, Vol. 13, pp. 206-8.
Mcintyre, K., M. Farrell, and A. David (1989), 'What Do Psychiatric Inpatients
Really Want?', British Medical Journal, Vol. 298, pp. 159-60.
Mechanic, D. (1980), Readings in Medical Sociology, Free Press, New York.
Medical Research Council (1965), 'Report by Clinical Psychiatry Committee on
ECT', British Medical Journal, Vol. 1, pp. 88l.
Mental Health Act Commission (1991-93), Fifth Biennial Report, HMSO, London.
Mental Health Foundation (1994), Creating Community Care: Report of the
Mental Health Foundation Inquiry into Community Care for People with Severe
Mental Illness, Mental Health Foundation, London.
Michel, K., and T. Kolakowska (1981), 'A Survey of Psychotropic Drug
Prescribing in Two Psychiatric Hospitals', British Journal of Psychiatry, Vol.
138, pp. 217-21.
Midgley, M. (1986), Wickedness: A Philosophical Essay, Ark Paperbacks,
London.
Midgley, M. (1991), Can't We Make Moral Judgements?, The Bristol Press,
Bristol.
Miller, J. (1991), Madness, BBC2, 3 November.
Miller, J. (1991), 'The Doctor's Dilemma: Miller on Madness', Open Mind, Vol.
49, pp. 3l.
Milton, 1. (1972), Paradise Lost, Book J, ed. C. A. Patrides, Macmillan,
Basingstoke.
MIND (1986), Special Report on the Major Tranquillisers, MIND Publications,
London.
Monahan, 1. (1981), The Clinical Prediction of Violent Behavior, U S Department
of Healtll and Human Services, Rockville.
Montandon, C., and T. Harding (1984), 'The Reliability of Dangerousness
Assessments', British Journal of Psychiatry, Vol. 144, pp. 149-55.
Moore, M. (1975), 'Some Myths About Mental Illness', Archives of General
Psychiatry, Vol. 32, pp. 1483-97.

189
Moore, M. (1980), 'Legal Conceptions of Mental Illness', in Mental Illness: Law
and Public Policy, eds B. Brody and H. T. Engelhardt, Reidel Publishing,
Boston.
Murphy, E. (1991), After the Asylums: Community Care for People with Mental
Illness, Faber and Faber, London.
Neville, R. C. (1975), 'Zalmoxis or the Morals of ESB and Psychosurgery', in
Operating on the Mind: The Psychosurgery Conflict, eds W. M. Gaylin, 1. S.
Meister and R. C. Neville, Basic Books, New York.
Newton, 1. (1988), Preventing Mental J//ness, Routledge Kegan Paul, London.
North, C. (1988), Welcome Silence, Simon and Schuster, London.
Office of Health Economics (1990), Mental Health in the 1990s - j'rom Custody to
Care?, HMSO, London.
Ottosson, 1. O. (1979), 'Simulated and Real ECT', British Journal of Psychiatry,
Vol. 134, p. 314.
Parsons, T. (1951), The Social System, Free Press, Glencoe, Illinois.
Parsons, T. (1958), 'Definitions of Health and Illness in the Light of American
Values and Social Stmctures', in Patients, PhYSicians and Illness, ed. E. G.
Jaco, Free Press, New York.
Parsons, T. (1978), 'Health and Disease: A Sociological and Action Perspective',
in Encyclopaedia ofBioethics, ed. W. T. Reich, Free Press, New York.
Pellegrino, E. D., and D. C. Thomasma (1981), A Philosophical Basis of Medical
Practice, OUF, New York.
Penfold, P. S., and G. A. Walker (1984), Women and the Psychiatric Paradox,
Open University Press, Milton Keynes.
Perriam, W. (1991), Fifty-Minute Hour, Paladin, London.
Pfohl, S. (1977), 'The Psychiatric Assessment of Dangerousness: Practical
Problems and Political Implications', in In Fear of Each Other, eds 1. P. Conrad
and S. Dinitz, Lexington Books, Lexington.
Pies, R. (1979), 'On Myths and Countermyths: More on Szaszian Fallacies',
Archives of General Psychiatry, Vol. 36, pp. 139-44.
Pilkonis, P. (1984), 'A Comparative Outcome Study of Individual, Group and
Conjoint Psychotllerapy', Archives of General Psychiatry, Vol. 41, pp. 431-7.
Podvoll, E. M. (1990), The Seduction ofMadness, Century, London.
Pope, K. S., P. Keith-Spiegel and B. G. Tabachnik (1986), 'Sexual Attractions to
Clients: The Human Therapist and (Sometimes) Inhuman Training System',
American Psychologist, Vol. 41, pp. 147-58.
Pope, K. S., L. R. Schover and H. Levenson (1980), 'Sexual Behavior Between
Clinical Supervisors and Trainers: Implications for Professional Standards',
ProfeSSional Psychology, Vol. 11, pp. 157-62.
Porter, R. (1987), A Social fIistory of Madness: Stories of the Insane, Weidenfeld
and Nicholson, London.
Porter, R. (1990), Mind Forg 'd Manacles: A History of Madness in England from
the Restoration to the Regency, Penguin, Harmondsworth.
Porter, R. (ed.) (1991), The Faber Book ofMadness, Faber and Faber, London.

190
Presthus, R. V. (1962) 'Authority in Organisations', in Concepts and Issues in
Administrative Behaviour, eds S. Mailick and E. H. van Ness, Prentice-Hall,
Englewood Cliffs, New Jersey.
Price, T. R. P., T. B. Mackenzie, G. 1. Tucker, and C. Culver (1978), 'The Dose
Response Ratio in Electroconvulsive Therapy', Archives of General Psychiatry,
Vol. 35, pp. 1131-6.
Priest, S. (1991), Theories of the Mind, Penguin, Harmondsworth.
Psychosurgery Review Board (1993), Annual Report of the Psychosurgery Review
Board (1993), Melbourne.
Rachman, S. (1971), The Effects of Psychotherapy, Pergamon Press, Oxford.
Radden, 1. (1985), Madness and Reason, Allen and Unwin, London.
Ramon, S., and Giannichedda (eds) (1991), Psychiatry in Transition: The British
and Italian Experiences, Pluto Press, London.
Rawls, 1. (1989), A Theory ofJustice, OUP, Oxford.
Redlich, F., and R. F. Moilica (1976), 'Overview: Ethical Issues in Contemporary
Psychiatry', American Journal of Psychiatry, Vol. 133, pp. 125-36.
Reiman, E. M. (1989), 'Neuroanatomical Correlates of Anticipatory Anxiety',
Science, Vol. 243 (4894, Pt 1), pp. 1071-4.
Reiser, S. 1. (1980), 'Refusing Treatment for Mental Illness', American Journal of
Psychiatry, Vol. 137, No.3, pp. 329-31.
Report into the Care and Treatment of Christopher Clunis (1994), HMSO, London.
Reznek, L. (1991), The Philosophical Defence of Psychiatry, Routledge, London.
Rickels, K., W. G. Case, and R. W. Downing (1983), 'Long-term Diazepam
Therapy and Clinical Outcome', Journal of the American Medical Association,
Vol. 250, pp. 767-71.
Rickels, K., and E. E. Schweizer (1986), 'Low-dose Dependence in Chronic
Benzodiazepine Users: A Preliminary Report on 119 Patients',
Psychopharmacology Bulletin, Vol. 22, pp. 407-15.
Ricoeur, P. (1988), Hermeneutics and the Social Sciences, CUP, Cambridge.
Robertson, G. (1981), 'Informed Consent to Medical Treatment', The Law
Quarterly Review, January, pp. 102-26.
Robitscher, J. (1980), The Powers of Psychiatry, Houghton Mifflin, Boston.
Rogers, A., D. Pilgrim, and R. Lacey (1993), Experiencing Psychiatry: Users'
Views of Services, Macmillan in association with MlND Publishing,
Basingstoke.
Rogers, W. S. (1991), Explaining Health and l//ness, Harvester Wheatsheaf,
London.
Ross, W. D. (1930), The Right and the Good, Clarendon Press, Oxford.
Roth, 1. (1972), 'Some Contingencies of the Moral Evaluation and Control of
Clientele: The Case of the Hospital Emergency Service', American Journal of
Sociology, Vol. 77, pp. 839-55.
Roth, M. (1976), 'Schizophrenia and the Theories of Thomas Szasz', British
Journal of Psychiatry, Vol. 129, pp. 317-26.

191
Roth, M., and R. Bluglass (eds) (1985), Psychiatry, Human Rights and the Law,
CUP, Cambridge.
Rowe, D. (1988), Choosing Not Losing: The Experience of Depression, Fontana
Paperbacks, London.
Royal College of Psychiatrists (1977), 'Memorandum on the Use of
Electroconvulsive Therapy', British Journal of Psychiatry, Vol. 131, pp.
261-72.
Rubenstein, L. S. (1986), 'Treatment of the Mentally III: Legal Advocacy Enters
the Second Generation', American Journal of Psychiatry, Vol. 143, pp. 1264-9.
Rutter, P. (1990), Sex in the Forbidden Zone: When Men in Power - Therapists,
Doctors, Clergy, Teachers and Others - Betray Women's Trust, Unwin
Paperbacks, London.
Ryle, A. (1982), Psychotherapy: A Cognitive Integration of Theory and Practice,
Academic Press, London.
Sacks, O. (1982), Awakenings, Picador, London.
Sacks, 0. (1986), The Man Who Mistook His Wife for a Hat, Picador, London.
Sainz, A. (1959), 'Clarification of the Action of Successful Treatments in the
Depressions', Diseases o/the Nervous System, Vol. 20, pp. 53-7.
Salzman, C. (1977), 'ECT and Ethical Psychiatry', American Journal of
Psychiatry, Vol. 134, No.9, pp. 1006-9.
Sargant, W., and E. Slater (1972), Introduction to PhYSical Treatments in
Psychiatry, fifth edition, Livingstone, Edinburgh.
Scheff, T. (1966), Being Mentally Ill, Aldine, Chicago.
Schrag, P. (1980), Mind Control, Marion Boyars, London.
Schreiber, F. R. (1974), Sybil, Penguin, Harmondsworth.
Scott, W. A. (1958), 'Research Definitions of Mental Health and Mental Illness',
Psychological Bulletin, Vol. 55, pp. 29-45.
Scull, A. (1976), 'The Decarceration of the Mentally Ill: A Critical View', Politics
and Society, Vol. 6, pp. 173-211.
Scull, A. (1984), Decarceration: Community Treatment and the Deviant, second
edition, Polity Press, Cambridge.
Scull, A. (1991), 'Deinstitutionalisation: Cycles of Despair', Journal of Mind and
Behavior, Vol. 11, Nos. 3&4, pp. 301-12.
Searle, 1. (1984), Minds, Brains and Science: the 1984 Reith Lectures, Penguin,
Harmondsworth.
Sedgwick, P. (1982), Psychopolitics, 2nd edition, Pluto Press, London.
Shakespeare, W. (1967), Macbeth, New Penguin Shakespeare edition, Penguin,
Harmondsworth.
Shakespeare, W. (1980), Hamlet, New Penguin Shakespeare edition, Penguin,
Harmondsworth.
Shakespeare, W. (1981), As You Like It, New Penguin Shakespeare edition,
Penguin, Hannondsworth.

192
Shapiro, D. A., and D. Shapiro (1982), 'Meta-analysis of Comparative Therapy
Outcome Studies: A Replication and Refinement', Psychological Bulletin, Vol.
92, pp. 581-604.
Sheppard, C., L. Collins, D. Florentino, 1. Fracchia, and S. Merliss (1969),
'Polyphannacy in Psychiatric Treatment: Incidence in a State Hospital', Current
Therapeutic Research, Vol. 11, pp. 765-74.
Sherlock, R. (1983), 'Consent, Competency and ECT: Some Critical Suggestions',
Journal ofMedical Ethics, Vol. 9, pp. 141-3.
Shields, P. (1985), 'The Consumer's View of Psychiatry', Hospital and Health
Services Review, May, pp. 117-9.
Showalter, E. (1987), The Female Malady: Women, Madness and English Culture,
1830-1980, Virago, London.
Sider, R. C. (1984), 'The Ethics of Therapeutic Modality Choice', American
Journal of Psychiatry, Vol. 141, No.3, pp. 390-94.
Siegler, M., and H. Osmond (1966), 'Models of Madness', British Journal of
Psychiatry, Vol. 112, pp. 1193-1203.
Siegler, M., and H. Osmond (1974), 'The Sick Role Revisited', Hastings Centre
Studies, Vol. 1, No.3, pp. 41-58.
Simons (1993), Citizen Advocacy: The Inside View, Norah Fry Research Centre,
Bristol.
Sims, A. C. P. (1986), Symptoms in the Mind, Balliere Tindall, London.
Sims, A. C. P. (1988), 'The Psychiatrist as Priest', J. Roy. Soc. Health, Vol. 5, pp.
160-63.
Sims, A. C. P. (1992), 'Symptoms and Beliefs', J. Roy. Soc. Health, Vol. 112, No.
1, pp. 42-6.
Sloane, R. B., A. H. Cristol, N. 1. Yorkston, and K. Whipple (1975), 'Short-term
Analytically Oriented Psychotherapy vs. Behavior Therapy', American Journal
of Psychiatry, Vol. 132, pp. 373-7.
Smail, D. (1987), Taking Care: An Alternative to Therapy, 1. M. Dent & Sons,
London.
Smith, F. B. (1982), Florence Nightingale: Reputation and Power, Croom Helm,
London.
Smith, 1. C., and B. N. Hogan (1973), Criminal Law, 3rd edition, London.
Smith, M. L., G. V. Glass and T. I. Miller (1980), The Benefits of Psychotherapy,
Johns Hopkins University Press, Baltimore.
Smith, P. S., and O. R. Jones (1988), The Philosophy ofMind, CUP, Cambridge.
Sontag, S. (1988), Illness as Metaphor, Penguin, Harmondsworth.
Sontag, S. (1990), AIDS and Its Metaphors, Penguin, Harmondsworth.
Spring, 1. (1987), Cry Hard and Swim: The Story of an Incest Survivor, Virago,
London.
Steere, 1. (1984), Ethics in Clinical Psychology, OUP, Cape Town.
Steering Committee of the Confidential Inquiry into Homicides and Suicides by
Mentally III People (1994), A Preliminary Report on HomiCide, Confidential
Enquiry Steering Committee, London.

193
Stone, A. A. (1982), 'Psychiatric Abuse and Legal Refonn: Two Ways to Make a
Bad Situation Worse', International Journal of Law and Psychiatry, Vol. 5, pp.
9-28.
Stone, A. A. (1984), Law. Psychiatry and Morality, American Psychiatric
Association Press, Washington, DC.
Storr, A. (1970), Human Aggression, Pelican, Hannondsworth.
Storr, A. (1987), The Art of Psychotherapy, Seeker and Warburg, London.
Styron, W. (1991), Darkness Visible: A Memoir of Madness, Jonathan Cape,
London.
Sutherland, 1. D. (1968), 'The Consultant Psychotherapist in the National Health
Service: His Role and Training', British Journal of Psychiatry, Vol. 114, pp.
509-15.
Sutherland, S. (1987), Breakdown, Weidenfeld and Nicholson, London.
Symonds, B. (1991), 'Sociological Issues in the Conceptualization of Mental
Illness', Journal ofAdvanced Nursing, Vol. 16, pp. 1470-77.
Szasz, T. (1970), The Manufacture of Madness: A Comparative Study of the
Inquisition and the Mental Health Movement, Harper and Row, New York.
Szasz, T. (1971), 'The Ethics of Suicide', The Antioch Review, Vol. 31, pp. 7-17.
Szasz, T. (1972), The Myth ofMental IlIness, Paladin, London.
Szasz, T. (1983), Ideology and Insanity, Marion Boyars, London.
Szasz, T. (1989), Law. Liberty and Psychiatry, Syracuse University Press,
Syracuse.
Tarasoffvs the Regents ofthe University of California (ed.) (1974),118 California
Reporter, 129, 529, P 2d 553.
Taussig, M. (1980), 'Reification and the Consciousness of the Patient', Social
Science and Medicine, Vol. 14b, pp. 3-13.
Thompson, A. (1990), Guide to Ethical Practice in Psychotherapy, John Wiley,
Chichester.
Thorogood, M., P. Cowen, J. Mann, M. Murphy, and M. Versey (1992), 'Fatal
Myocardial Infarction and Use of Psychotropic Medication', Lancet, Vol. 340,
p. 1067.
Tomlinson, D. (1991), Utopia. Community Care and the Retreat from the
Asylums, Open University Press, Milton Keynes.
Toombs, S. K. (1993), The Meaning of Jl/ness: A Phenomenological Account of
the Different Perspectives of Physician and Patient, vol. 42, Philosophy and
Medicine, Kluwer Academic Publishers, Dordrecht.
Torrey, E. F. (1989), Nowhere to Go: The Tragic Odyssey of the Homeless
Mentally JI/, Harper and Row, New York.
Townsend, P., and N. Davidson (eds) (1988), 'The Black Report', in Inequalities
in Health, Penguin, Harmondsworth.
Tschudin, V. (1986), Ethics in Nursing: The Caring Relationship, Heinemann,
London.

194
Tyrer, P. (1987), 'Benefits and Risks of Benzodiazepines: The Benzodiazepines in
Current Practice', Royal Society of Medicine International Congress and
Symposium Series, Vol. 114, pp. 7-1l.
US National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research (1977), Report and Recommendations: Psychosurgery, US
Department ofHeaIth, Education and Welfare, Bethesda.
Valenstein, E. S. (1977), 'The Practice of Psychosurgery', in US National
Commission for the Protection of Human Subjects of Biomedical and
Behavioural Research, vol. (OS) 77-0002, US DHEW, Bethesda.
Valenstein, E. S. (ed.) (1980), The Psychosurgery Debate: SCientific, Legal and
Ethical Perspectives, Freeman, San Francisco.
Vardy, P. (1992), The Puzzle of Evil, Fount Paperbacks, London.
Veatch, R. M. (1974), 'Drugs and Competing Drug Ethics', Hastings Center
Studies, Vol. 2, No.1, pp. 68-80.
Vice, 1. (1989), 'The Morality of Mental Illness: Thomas Szasz's Critique of
Psychiatry', Journal ofHumanistic Psychology, Vol. 29, pp. 385-93.
Virchow, R. (1971), Cellular Pathology as Based Upon Physiological and
Pathological Histology, trans. F. Chance, Dover, New York.
Walker, N. (1982), 'Unscientific, Unwise, Unprofitable or Unjust?', British
Journal of Criminology, Vol. 22, pp. 276-83.
Wallace, M. (1987), The Forgotten J/lness, Times Newspapers and SANE, London.
Warner, R. (1985), Recovery from Schizophrenia: The Political Economy of
Psychiatry, Routledge Kegan Paul, London.
Warner, R., and T. Szubka (1994), The Mind-Body Problem, Blackwell, Oxford.
Waterhouse, R. (1993), 'Mother Gets £352,777 After Attack By Her Son', The
Independent, 27 January, p. 9.
Watt, 1. A. G. (1979), 'Simulated and Real ECT', British Journal of Psychiatry,
Vol. 134, pp. 314.
WelJings, K. (1983), Sickness and Sin: the Case of Genital Herpes, Paper
presented to the British Sociological Association Medical Sociology Group
Annual Conference 1983.
White, A. (1982), Beyond the Glass, Fontana Paperbacks, Glasgow.
Whitehead, M. (1988), 'The Health Divide', in Inequalities in Health, Penguin,
Harmondsworth.
Williams,1. (1990), The Law ofMental Health, Fourmat Publishing, London.
Wilson, H. S. (1982), Deinstitutionalised Residential Care for the Mentally
Disordered: The Soteria House Approach, Grune and Stratton, New York.
Wilson, I. C., 1. T. Vernon and T. Guin (1963), 'A Controlled Study of Treatments
of Depression', Journal of Neuropsychiatry, Vol. 4, pp. 331-7.
Wilson, O. M. (1976), '''The Normal" as a Culture-related Concept: Historical
Considerations',Mental Health SOCiety, Vol. 3, pp. 57-71.
Wing, K. (1988), 'Abandoning What?', British Journal of Clinical Psychology,
Vol. 27, pp. 325-8.

195
Winokur, A., K. Rickels, and D. 1. Greenblatt (1980), 'Withdrawal from
Long-term, Low Dosage Administration of Diazepam: A Double-blind, Placebo
Controlled Case Study', Archives of General Psychiatry, Vol. 37, pp. 10 1-5.
Wittgenstein, L. (1972), Blue and Brown Books, OUP, Oxford.
Woodman, T. (1987), 'First Person Account: A Pessimist's Progress',
Schizophrenia Bulletin, Vol. 13, No.2, p. 330.
Wootton, B. (1959), Social Science and Social Pathology, Allen and Unwin,
London.
Wulff, H. W., S. A. Pedersen and R. Rosenberg (1990), Philosophy of Medicine:
An Introduction, second edition, Blackwell Scientific Publications, Oxford.

196