As the dominant social ethic changed from a religious to a secular one, the problem of heresy disappeared, and the problem of madness arose and became of great social significance. In the next chapter I shall examine the creation of social deviants, and shall show that as formerly priests had manufactured heretics, so physicians, as the new guardians of social conduct and morality, began to manufacture madmen.

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We speak of a person being “under the influence” of alcohol, or heroin, or amphetamine, and believe that these substances affect him so profoundly as to render him utterly helpless in their grip. We thus consider it scientifically justified to take the most stringent precautions against these things and often prohibit their nonmedical, or even their medical, use. But a person may be under the influence not only of material substances but also of spiritual ideas and sentiments, such as patriotism, Catholicism, or Communism. But we are not afraid of these influences, and believe that each person is, or ought to be, capable of fending for himself.

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By pretending that convention is Nature, that disobeying a personal prohibition is a medical illness, they establish themselves as agents of social control and at the same time disguise their punitive interventions in the semantic and social trappings of medical practice.

Prostitution is said to be the world’s oldest profession. It is, indeed, a model of all professional work: the worker relinquishes control over himself … in exchange for money. Because of the passivity it entails, this is a difficult and, for many, a distasteful role.

Judges and prosecutors, lawyers and psychiatrists, all protest their passionate desire to know why a person accused of a crime did what he did. But their actions completely belie their words: their efforts are now directed toward letting everyone speak in court but the defendant himself -- especially if he is accused of a political or psychiatric crime.

The disease concept of homosexuality—as with the disease concept of all so-called mental illnesses, such as alcoholism, drug addiction, or suicide—conceals the fact that homosexuals are a group of medically stigmatized and socially persecuted individuals. … Their anguished cries of protest are drowned out by the rhetoric of therapy—just as the rhetoric of salvation drowned out the [cries] of heretics.

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Why is self-control, autonomy, such a threat to authority? Because the person who controls himself, who is his own master, has no need for an authority to be his master. This, then, renders authority unemployed. What is he to do if he cannot control others? To be sure, he could mind his own business. But this is a fatuous answer, for those who are satisfied to mind their own business do not aspire to become authorities.