1) Most emphatically, I have not agreed with Professor Schaler that mental disorders are a myth. Quite the contrary, my strongly held view (stated several times and in very plain language) is that mental disorders are very useful constructs, not well established diseases—but certainly not myths.
2) Professor Schaler claims that I “avoid any mention of the nefarious ways psychiatrists coerce innocent persons in the name of practicing medicine.” Again, please reread my first response where I provide specific examples of the risks of coercion drawn from the United States, China, Russia, and Australia. And in more than a dozen papers and postings, I have relentlessly exposed the abuse of involuntary commitment in Sexually Violent Predator hearings. I am anything but blind to the risks, but unlike Professor Schaler, I understand the occasional necessity.
3) Professor Schaler attributes statements to me that I simply didn’t make—that all patients lack insight, that this is equivalent to unconsciousness, that patients are children.
4) I have written often that psychiatrists cannot accurately predict precisely who is going to harm self or others and precisely when such violence will occur. The prediction issue came up recently in regard to discussions about the relative roles of psychiatry and gun control in reducing the harms done by mass murderers. Psychiatrists can’t mind read or pull needles out of haystacks—we can do no more than identify a group of people at high general risk, the overwhelming majority of whom require no hospitalization at all. Clearly, involuntary commitment should be invoked very rarely and as a last resort—only under the most extreme circumstances when it would be irresponsible to ignore risks that are urgent, obvious, immediate, and terrifying and only when it is impossible (at least for a time) to forge a voluntary therapeutic relationship. There should always be careful clinical quality control and by law there is always a judicial monitoring process.
5) Just as psychosis is no “myth,” the laws governing involuntary commitment are not a “legal fiction.” They are in place throughout the world for the simple reason that involuntary commitment is sometimes a necessary practical response to a difficult problem that has no other solution. Nothing in Professor Schaler’s ivory tower ideology changes this clinical or legal reality.
Jeffrey Schaler’s response is not really a response; it is just a repetition. He misstates my views and offers no practical solutions to the problems I raise and none to the even bigger problems raised in Amanda’s brilliant discussion of the inappropriate warehousing of mental patients in the prison system.