In the eyes of some radical critics, mental illness should properly have no place in a book dealing with the history of sickness. For, they would contend, there is no such disease (in the strict sense of the word) as insanity, ‘ psychiatric disorder ’ being nothing other than a stigma which the psychiatric profession, with the connivance of society at large, pins on those whose thoughts and actions are unacceptably ‘ deviant ’. Society (it has been alleged) finds certain people ‘ disturbing ’ and, by a medicalizing sleight of hand, labels them ‘ disturbed ’, and therefore in need of treatment. Psychiatry is thus essentially a form of social control, a masked and medicalized mechanism of punishment.

This radical claim that ‘ mental illness ’ is itself a delusion commands only a small following even amongst critics of psychiatry. But it does highlight one feature which sets apart the social response to insanity from the handling of any of the other sorts of disease dealt with in this volume. This is the fact that, over the last two or three hundred years, those people suffering from serious mental disturbance have been subjected to compulsory and coercive medical treatment, usually under conditions of confinement and forfeiture of civil rights. Sick people in general (i.e. those suffering from somatic diseases such as measles or gout) have typically had the right to seek, or the right to refuse, medical treatment; have typically enjoyed their own choice of practitioner; and, insofar as they have been cared for in institutions such as hospitals, they have been legally free to come and go as they please.