controversies about psychiatry controversies about psychiatry psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. there are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy: 28 and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the united states. in addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. the critical psychiatry network is a group of psychiatrists who are critical of psychiatry. additionally, there are self-described psychiatric survivor groups such as mindfreedom international and religious groups such as scientologists that are critical towards psychiatry. challenges to conceptions of mental illness vienna's narrenturm — german for "fools' tower" — was one of the earliest buildings specifically designed as a "madhouse". it was built in 1784. since the 1960s there have been challenges to the concept of mental illness. sociologists erving goffman and thomas scheff argued that mental illness was merely another example of how society labels and controls non-conformists,: 102 behavioral psychologists challenged psychiatry's fundamental reliance on unchallengable or unfalsifiable concepts, and gay rights activists criticized the apa's inclusion of homosexuality as a mental disorder in the dsm. as societal views on homosexuality have changed in recent decades, it is no longer considered a mental illness and is more widely accepted by society. as another example that challenged conceptions of mental illness, a widely publicized study by professor david rosenhan, known as the rosenhan experiment, was viewed as an attack on the efficacy of psychiatric diagnosis. medicalization conversation between doctor and patient. medicalization, a concept in medical sociology, is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. medicalization can be driven by new evidence or hypotheses about conditions, by changing social attitudes or economic considerations, or by the development of new medications or treatments. for many years, several psychiatrists, such as david rosenhan, peter breggin, paula caplan, thomas szasz, and critics outside the field of psychiatry, such as stuart a. kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality". more recently these concerns have come from insiders who have worked for the apa themselves (e.g., robert spitzer, allen frances).: 185 for example, in 2013, allen frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". the concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological. the term medicalization entered the sociology literature in the 1970s in the works of irving zola, peter conrad, and thomas szasz, among others. these sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. this critique was embodied in works such as conrad's "the discovery of hyperkinesis: notes on medicalization of deviance", published in 1973 (hyperkinesis was the term then used to describe what we might now call adhd), and szasz's "the myth of mental illness." these sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (foucault, 1965; szasz, 1970; rosen). however, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (chorover, 1973). in the 1975 book limits to medicine: medical nemesis (1975), ivan illich put forth one of the earliest uses of the term "medicalization". illich, a philosopher, argued that the medical profession harms people through iatrogenesis, a process in which illness and social problems increase due to medical intervention. illich saw iatrogenesis occurring on three levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural, whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these natural processes. marxists such as vicente navarro (1980) linked medicalization to an oppressive capitalist society. they argued that medicine disguised the underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue. others examined the power and prestige of the medical profession, including use of terminology to mystify and of professional rules to exclude or subordinate others. some argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of the prevailing biomedical ideology, resulting in a disregard for overarching social causes such as unequal distribution of power and resources. a series of publications by mens sana monographs have focused on medicine as a corporate capitalist enterprise. political abuse main article: political abuse of psychiatry in unstable countries, political prisoners are sometimes confined and abused in mental institutions.: 3 the diagnosis of mental illness allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society. in addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.: 94 in a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. the use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, and discredits the individuals and their ideas.: 29 in that manner, whenever open trials are undesirable, they are avoided.: 29 examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the nazi era and the soviet rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments." in the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the soviet union, and occasional in other eastern european countries such as romania, hungary, czechoslovakia, and yugoslavia. the practice of incarceration of political dissidents in mental hospitals in eastern europe and the former ussr damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community. political abuse of psychiatry also takes place in the people's republic of china and in russia. psychiatric diagnoses such as the diagnosis of 'sluggish schizophrenia' in political dissidents in the ussr were used for political purposes.: 77 history of racism in psychiatry in the united states the history of racism in psychiatry dates back to the days of slavery and segregation in the united states. such racism in psychiatry exemplifies the concept of scientific racism, which falsely alleges that science and other empirical evidence supports racism and proves certain racial inferiorities. diagnosis psychiatric diagnoses were influenced by black people's status as free or enslaved. enslaved people were not considered civilized enough to be diagnosed with insanity, while free black people were over-diagnosed with insanity, having much higher diagnosis rates than white people. specific diagnoses in the 19th century were crafted specifically to fit black people – drapetomania and dyaesthesia aethiopica, disorders meant to explain why slaves ran away and why they were lazy or lacked a strong work ethic, respectively, and justify the institution of slavery. prominent political figures such as john c. calhoun used this supposed evidence to argue for slavery, arguing that free black people could not be entrusted with their lives and would ultimately develop lunacy. all in all, throughout the 19th century, psychiatric diagnoses and scientifically racist theories were used to medicalize blackness and uphold systems of slavery and racism, further constraining the rights, freedom, and humanity of black people. scientific racism proponents of scientific racism have historically attempted to "prove" that black people are physiologically and cognitively inferior to white people based on faulty assumptions and prejudices. perpetuated by the inaccurate application of biodeterminism, specialists in neuroanatomy and psychiatry compared disproportionate numbers of brains from black and white individuals to support their racial agendas based on "science." compulsory sterilization main article: compulsory sterilization the proportion of black individuals confined in establishments for "flawed and imbecile" patients increased throughout the late 19th and early 20th century. psychiatry contributed towards the inaccurate and racist belief that if they were left to their respective means, they would not be able to remain in decent condition. at the beginning of the 20th century, black people were disproportionally sterlized in eugenics programs that compulsorarily sterilized those classed as feebleminded or who received welfare payments. the premise that the genes of those deemed mentally ill were undesirable was used to justify sterilization which was frequently supervised by physicians, including psychiatrists. hospitals segregation within mental institutions and hospitals is another example of the history of racism within psychiatry. many psychiatric hospitals in the 19th century either excluded or segregated black patients or admitted black slaves to work at the hospital in exchange for care. the founding fathers of psychiatry themselves supported the notion that black people were inferior, lower class citizens that must be treated separately and differently from white patients. with time, racial segregation within hospitals became interspersed with entirely separate hospitals for white and black patients, each with differential treatment and quality of care. political figures in the post-civil war era argued that emancipation had led to a significant increase in insanity cases amongst black individuals, and they cited the need to accommodate this increase via segregated and black-only insane asylums. many hospitals, especially in the southern united states, did not admit black patients until they were eventually mandated to do so. the last segregated hospital opened in 1933. popular arguments also circulated that black patients were more difficult to take care of in mental institutions, making psychiatric care for them more difficult and justifying the need for segregated facilities. until the late 1960s, many hospitals remained segregated. this affected the experiences of racial minorities accessing psychiatric care in mental institutions and hospitals in the united states. when lyndon b. johnson's administration stated that no segregated hospital would receive federal medicare funds, hospitals began to integrate quickly in order to be able to continue to access such funding. in january 1966, around two-thirds of southern hospitals were segregated facilities and many northern facilities remain segregated in-effect. one year later, by january 1967, there were very few hospitals in the united states that remained segregated. segregation within mental institutions and hospitals is one example of the history of racism within psychiatry. in the profession black psychiatrists often experienced racism as practitioners within the field. some of this history is detailed in jeanne spurlock's book titled black psychiatrists and american psychiatry, published in 1999, in which she profiles black psychiatrists who were influential in american psychiatry and their experiences in the profession. during the civil rights movement, black psychiatrists expressed concerns to the apa that the needs of black communities and black psychiatrists were being ignored by the professional organization. in 1969, a contingent of black psychiatrists presented a list of 9 concerns to the apa board of trustees regarding experiences of structural racism in the field. their '9 points' represented a wide array of experiences of discrimination, both from the experiences of practitioners and patients, and on the institutional and individual level and the group demanded change from within the apa. for example, they called for more black leaders on apa committees as well as the desegregation of all mental health facilities, both public and private, in the united states. as of 2020, within psychiatry, historically underrepresented groups continue to be less represented as residents, faculty, and practicing physicians in comparison to their proportion in the u.s. population. nature of diagnosis arbitrariness psychiatry has been criticized