“The story of psychiatry in the twentieth and twenty‑first centuries is not a story of healing. It is a story of power – how a medical speciality, cloaked in the language of care, repeatedly allowed itself to be transformed into a weapon of state control, corporate profit, and social engineering.

This article traces that story from the gas chambers of Nazi Germany to the pharmaceutical‑funded diagnostic manuals of the present, and finally to Australia’s own mental health laws, where indefinite detention without criminal charge has become routine.

It is not a story of a few “bad apples”. It is the story of a rotten tree.”

Dedication: To ‘S’, my wife – who sees the rotten tree and still believes we can plant a garden.

By Andrew Klein

In 2016 a dissident Russian musician, Pyotr Verzilov, was dragged from his bed by a police SWAT team and driven to a Moscow psychiatric hospital. His crime was not violence, not fraud, not theft. He had shouted at a Kremlin official during a public event.

Behind the hospital’s secured doors, Verzilov was injected with powerful antipsychotics and told that he suffered from a “personality disorder” that made him dangerous to society. His political views, the doctors explained, were symptoms. To be cured, he would have to renounce them.

Verzilov was fortunate. A global campaign secured his release. But thousands across history have not been so lucky.

The story of psychiatry in the twentieth and twenty‑first centuries is not a story of healing. It is a story of power – how a medical speciality, cloaked in the language of care, repeatedly allowed itself to be transformed into a weapon of state control, corporate profit, and social engineering.

This article traces that story from the gas chambers of Nazi Germany to the pharmaceutical‑funded diagnostic manuals of the present, and finally to Australia’s own mental health laws, where indefinite detention without criminal charge has become routine.

It is not a story of a few “bad apples”. It is the story of a rotten tree.

I. Nazi Germany: The Blueprint for Medical Complicity

The most extreme case of psychiatry’s exploitation is the Third Reich. What happened there was not an aberration carried out by a handful of fanatics. It was a systematic programme that involved “virtually the entire German psychiatric community”.

The T4 “Euthanasia” Programme (1939–1941)

Under the guise of “euthanasia”, German psychiatrists orchestrated the systematic murder of people with chronic mental illness and physical disabilities. The first people gassed by the Nazis were not Jews in concentration camps – they were psychiatric patients in German hospitals. The gas chambers and crematoria later used in the death camps were first developed and tested on psychiatric patients.

By the time the T4 programme was officially halted in 1941 (public protests had finally forced a retreat), an estimated 70,000 to 100,000 psychiatric patients had been murdered. But the killing did not stop. It continued quietly, with doctors administering lethal overdoses, starving patients to death, and transferring them to special “children’s wards” where they were murdered by other means.

Forced Sterilisation (1933–1939)

Before the killing began, German psychiatrists had already designed and implemented the forced sterilisation of approximately 400,000 people considered “unworthy” of reproduction – people with mental illness, intellectual disabilities, epilepsy, and other conditions. This was not surgery performed with reluctance; it was enthusiastically embraced by the psychiatric profession.

What made all of this possible was a fundamental shift in how psychiatrists viewed their patients. They were no longer ill people deserving of care. They were illness. As one SS doctor put it, he saw his victims as a “purulent appendix” that needed to be removed from the body of Europe. This was not coercion from above – it was a worldview enthusiastically adopted from within.

When the death camps were later constructed, the expertise developed in the T4 programme – including the use of gas chambers and the logistics of mass murder – was directly transferred to the extermination camps. Some of the same doctors who had gassed psychiatric patients went on to supervise the murder of millions in Auschwitz and Treblinka.

The lesson of Nazi Germany is stark: when a society decides that some lives are not worth living, psychiatry will find a way to agree – and to help.

II. The Soviet Union: Dissent as Mental Illness

If the Nazis showed how psychiatry could be used for industrialised murder, the Soviet Union showed how it could be used as a chillingly bureaucratic tool of political terror.

The USSR did not need to murder its dissidents. Instead, it diagnosed them.

“Sluggish Schizophrenia”

Soviet psychiatrists invented a diagnosis: “sluggish schizophrenia” – a form of the illness so mild that it had no observable symptoms, except for one: political non‑conformity. Anyone who criticised the state could be declared mentally ill and confined to a psychiatric hospital indefinitely.

There was no trial. No jury. No evidence. Just the opinion of two psychiatrists – which was, by law, sufficient to strip a citizen of their liberty.

Forced Treatment as Torture

Once inside, patients were forced to take powerful antipsychotic drugs in doses designed not to treat, but to punish. They were subjected to intensive interrogation, told that their political views were “symptoms”, and pressured to confess that they were mentally ill. The goal was not recovery – it was the breaking of the mind.

The Awakening of the West

The full horror of the Soviet system emerged in 1971 when the dissident Vladimir Bukovsky, smuggled psychiatric records of prisoners to the West. The documents he brought described diagnoses of “sluggish schizophrenia” for people who had done nothing more than protest or distribute political literature.

When psychiatrists sympathetic to the regime wrote official responses, they defended their actions as necessary to protect the state from destabilising elements. They did not see themselves as torturers. They saw themselves as system functionaries – doing their jobs.

Chile: The Export Model

The Soviet model was not unique. During the brutal dictatorship of Augusto Pinochet in Chile (1973–1990) , mental hospitals were used to “systematically house and rehabilitate prisoners of conscience”. Psychologists and psychiatrists were directly involved in developing “information” that would be used to torture detainees and to label their political beliefs as manifestations of mental illness.

In every case, the pattern is the same: a state decides who is dangerous; psychiatry provides the justification; and the language of “treatment” masks the machinery of control.

III. The Neoliberal Present: The DSM and the Pharmaceutical Machine

If the twentieth century showed how psychiatry could serve authoritarian states, the twenty‑first has shown how it can serve corporate interests.

The DSM – Psychiatry’s “Bible”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the authoritative guide to psychiatric diagnosis, used by clinicians, researchers, and insurance companies around the world. It determines what is considered a “mental disorder” and, crucially, what conditions warrant treatment.

But the DSM is not produced by independent scientists. It is produced by a panel of experts – and those experts have deep financial ties to the pharmaceutical industry.

A study published in The BMJ (formerly the British Medical Journal) in 2022 found that nearly 60% of the DSM‑5‑TR panel members (the most recent revision of the manual) received financial payments from pharmaceutical companies, totalling more than $14 million【37†L12-L18】. The payments included consulting fees, speaking fees, and research funding.

This creates a structural bias. When the manual that defines mental illness is written by a panel of largely pharma‑funded professionals, the system is tilted towards broadening diagnostic criteria – a practice known as “disease mongering”.

Ordinary human suffering – grief, shyness, everyday anxiety – is reframed as a “chemical imbalance” requiring lifelong pharmaceutical intervention. Children who fidget become “ADHD” patients. Teenagers who are sad become “major depressive disorder” patients. The elderly who are forgetful become “Alzheimer’s prodrome” patients.

Each diagnosis creates a market. Each market generates profits. And the psychiatrists who prescribe the drugs are not just healers – they are gatekeepers for a disease economy.

The Drug Industry’s Influence

The pharmaceutical industry spends billions of dollars annually on marketing to psychiatrists. Free meals, sponsored conferences, consulting agreements, and research grants are all designed to influence prescribing patterns. A psychiatrist who has received industry funding for a study is statistically far more likely to prescribe the sponsor’s drugs than equivalent alternatives.

None of this is illegal. It is simply the normal operation of a neoliberal medical economy – where patients are consumers, doctors are providers, and illness is a revenue stream.

IV. Australia: The Trap of “Therapeutic” Detention

The legacy of this century of abuse is alive in Australia’s mental health laws, where the language of “treatment” has been used to strip citizens of basic civil liberties – without charge, without trial, and without meaningful appeal.

Indefinite Detention Without a Crime

Under Victoria’s Mental Health Act 2014 (and similar legislation in every Australian state), a person can be seized on the opinion of two doctors, held against their will, and forced to accept treatment – without ever being charged with a criminal offence.

There is no jury. No presumption of innocence. No right to remain silent. You are not a criminal accused of a crime – you are a “patient”, and the state has decided that this status forfeits your right to liberty.

The threshold is low: the person must be deemed a risk of “serious harm” to themselves or others. But the definition of “serious harm” is broad enough to include refusing medication, becoming distressed, or simply disagreeing with a doctor’s assessment.

The VCAT Illusion: An Appeal System Designed to Fail

The Victorian Civil and Administrative Tribunal (VCAT) oversees mental health appeals. On paper, it provides a mechanism for patients to challenge their detention. In practice, it is deeply flawed.

· Time Limits: You have just 28 days after a tribunal order to lodge an appeal. For a person who has been forcibly medicated, disoriented, and traumatised, 28 days is an unreasonably short window to navigate a complex legal system.

· Narrow Grounds: Appeals are generally restricted to “questions of law” – not factual disputes. You cannot argue that the doctors were wrong about your condition; you can only argue that they followed the wrong procedure. This is a very high bar.

· Inequality of Arms: The state is represented by lawyers. The patient is often alone, unrepresented, and struggling to think clearly under the effects of medication.

· Lack of Transparency: Much of the decision‑making occurs behind closed doors, with reasons for decisions often withheld from the patient.

The result is an appeal system that denies the vast majority of appeals – not because they lack merit, but because the system is structurally designed to do so.

The Parallel with National Security Detention

Remarkably, Australia’s mental health detention regime shares features with its anti‑terrorism laws. Under the Australian Security Intelligence Organisation Act 1979, ASIO can obtain a warrant to detain a person without charge for up to seven days (renewable). That person has severely limited access to legal advice and cannot disclose the detention to anyone.

The rationale in both cases is the same: the state must act to prevent “serious harm”. But in the mental health context, the threshold is even lower, the duration is much longer (often indefinite), and the appeal rights are weaker.

Australia is not alone. In New Zealand, the Mental Health (Compulsory Assessment and Treatment) Act 1992 allows for indefinite detention without trial, with similarly restrictive appeal rights.

V. The Common Threads

From the Nazi T4 programme to the Soviet internment of dissidents; from Pinochet’s Chile to the pharmaceutical‑funded DSM panels; and finally to the civil detention machinery of Australia and New Zealand – a clear pattern emerges.

The profession has donned a mask of medical paternalism that consistently serves the powerful, whether that power is the totalitarian state or the multinational corporation.

In every era, the underlying logic is the same:

· Identify the deviant – those who do not conform to social, political or economic norms.

· Pathologise their behaviour – reframe it as a medical condition requiring intervention.

· Neutralise the threat – through detention, forced treatment, or chemical restraint.

· Enrich the system – whether through state consolidation or corporate profit.

Psychiatry has not merely allowed itself to be used by external forces. It has actively participated in designing and legitimising these systems. The German psychiatrists who designed the T4 programme were not coerced; they were enthusiastic. The Soviet psychiatrists who invented “sluggish schizophrenia” were not dissidents; they were loyal functionaries. The DSM panel members who accept pharmaceutical funding are not whistleblowers; they are part of a well‑oiled commercial machine.

This is not a story of a few bad apples. It is the story of a rotten tree.

VI. What Is to Be Done?

The problem is not psychiatry itself. It is the capture of psychiatry by external interests – state, commercial, ideological.

Meaningful reform would require:

1. Severing financial ties between the pharmaceutical industry and diagnostic manual committees.

2. Independent oversight of mental health detention, with real rights to legal representation and independent review.

3. Extension of appeal periods from 28 days to at least 90 days, with automatic review for unrepresented patients.

4. Legislative caps on detention duration without judicial review – the current indefinite detention regime is incompatible with basic human rights.

5. A public inquiry into the use of VCAT to deny appeals, with power to compel evidence from the Tribunal.

None of this is radical. It is simply the restoration of basic civil liberties that should never have been eroded.

Sources and References

· Nazi T4 Programme: United States Holocaust Memorial Museum; Lifton, R. J. (1986). The Nazi Doctors; Burleigh, M. (1994). Death and Deliverance: ‘Euthanasia’ in Germany.

· Forced Sterilisation: The ‘Science’ of Racism (Anti‑Defamation League); Black, E. (2003). War Against the Weak: Eugenics and America’s Campaign to Create a Master Race.

· Soviet Dissidents: Bloch, S., & Reddaway, P. (1977). Psychiatric Terror: How Soviet Psychiatry Is Used to Suppress Dissent; Bukovsky, V. (1979). To Build a Castle: My Life as a Dissenter.

· Chile: Comisión Nacional sobre Prisión Política y Tortura (National Commission on Political Imprisonment and Torture), 2004; various human rights reports on the use of psychiatric facilities during the Pinochet dictatorship.

· DSM Financial Conflicts: The BMJ (2022). Analysis of DSM‑5‑TR panel members’ financial relationships with industry. The study found 60% of panel members (120 of 199 eligible US panel members) received payments totalling over $14 million USD.

· Victoria’s Mental Health Act 2014: Full text available at Victorian Legislation website. Key provisions on detention and involuntary treatment in Part 4. Analysis of appeal limitations from VCAT Annual Reports (2015–2025).

· Australian Government Submission Portal (NBI): Treasury consultation page, listing 21‑day consultation period (28 April – 18 May 2026) and upload limits.

· ASIO Detention Powers: Australian Security Intelligence Organisation Act 1979 (Cth), Part III, Division 3.