few of us escape the ravages of mental illness. We may not suffer from it ourselves, but even then we feel the pain it inflicts on friends or family. And no one escapes its social burdens. Psychiatry seeks to lessen these afflictions, but too often it has increased them. In this book, I have attempted to provide a skeptical assessment of the psychiatric enterpriseits impact on those it treats and on society at large. I have focused most of my attention on the United States, because it is here

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... at these interventions stand out in the starkest relief and because, by the closing de cades of the twentieth century, American psychiatry had achieved a worldwide hegemony, its categorizations of and approaches to mental illness sweeping all before it. But many of the interventions I examine had their origins in Eu rope, including the drugs that are now so central to psychiatric identity and operations. So Eu ro pean developments loom large in this story and are woven through the narrative that follows. For two centuries and more, most informed opinion has embraced the notion that disturbances of reason, cognition, and emotion-the sorts of things we used to gather under the umbrella of "madness"-properly belong in the domain of the medical profession. More precisely, such maladies are seen to be the peculiar province of those whom we now call psychiatrists. Mental illness, we are informed, is an illness like any other-one that is treated by a specialist group of doctors whose primary goals are to relieve suffering and, more ambitiously, to restore the alienated to the ranks of the sane. These are worthy goals, to be sure. How have psychiatrists sought to realize them? How have psychiatrists attacked the prob lem of mental illness? What weapons have they chosen and why? And have those