Madness becomes mental illness through the joint project of psychiatry and the community of consensus lent to it. The psychiatrist, like the shaman (to paraphrase Leve'-Strauss), acts through the cultural plasma of his times. And the psychiatrist provides a definition for events, making mental illness of madness, while occupying a unique position within the scheme of society.

Psychiatry has been attacked from many directions in recent years. Despite these varied challenges, however, its power appears to have abated little if at all. How can we account for this fact? On the surface one might assume that the scientific basis or the treatment success of psychiatric practice provides the buttress to repel the ongoing attacks. But we suggest here that the continuing power and the prestige of psychiatry can be understood more clearly by examining its relation to society at large rather than the relation to its patients. There appear to be two analytically separate but empirically interrelated factors at work. First, and of main importance, is the absence of an acceptable alternative to psychiatric practice in American society and Western culture in general. The stress must clearly be placed upon the condition of acceptability. Second, and growing out of the first, is the professional and organizational "status" psychiatry enjoys and the benefits implied therein. The ensuing discussion will elaborate these points and attempt a critical examination of the relationship between psychiatry and society.

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