A Summation, but Not a Middle Ground

It is difficult for me to add to what Jacob Sullum writes so well. So far I agree with everything he contributes here. As a layman, Sullum knows more about psychiatry and psychology than most psychiatrists and psychologists. Much of the policy created about “mental illness,” as well as much of the pseudo-science, is clearly contradictory and illogical to a clear thinking layman, especially to one who shares our deep concern about the rule of man masquerading as the rule of law.

That is also why we will not budge. There is no possibility of reforming psychiatric slavery. The only thing that will do is the abolition of institutional psychiatry, the abolition of involuntary commitment procedures, and the abolition of the insanity defense. Psychiatrists must be kept out of the courtroom. Of course people should be free to engage in contractual and consensual psychiatry. They should be free to believe as they wish, just as people are free to attend the synagogue, church, or mosque of their choice, or to deny the existence of God.

Before I continue, I would like to state something about my relationship with Thomas Szasz, as well as some history regarding related matters. What I want to emphasize is that there are many colleagues of mine, and Tom’s, who think the same way we do about the abolition of institutional psychiatry. When Tom dies, his work and his ideas will not die. There are many people, particularly in academic settings, who have led a very precarious intellectual life saying the same things that Tom has said and written. As we voice our opinions on these and related matters, we could very easily lose our jobs. If you read the introduction I wrote to Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics, you will understand more about what I mean. Some people at the universities I’ve taught at have made my life a living hell, especially when the students want to learn more and more about the ideas Szasz has developed, and that our colleagues have developed as a result of his work.

One thing I’ve always heard from students over the twenty-three years I’ve been teaching is “why haven’t we heard more about these ideas before?” I know many students who dropped their majors in psychology and medicine once they learn about the nonsense masquerading as scholarship in psychiatry and psychology. I’ve received two calls from the White House’s Office of National Drug Control Policy demanding to know what and why I am teaching about the myths of addiction as a treatable disease. I’ve been told by former chairs of my departments that they received phone calls from people at the National Institute of Mental Health again demanding to know why I’m being allowed to teach the ideas you are reading about here. Fortunately I’ve managed to teach thousands and thousands of students over the years, and they have all been extremely grateful to learn about the activities and protocols of institutional psychiatrists.

Tom blazed a trail that will never be erased. He turned the world on its head when he wrote The Myth of Mental Illness and Law, Liberty and Psychiatry. I have always invited leaders in institutional psychiatry as well as the General Counsel from the National Association for the Mentally Ill to come in and tell my students why they think I am not only wrong but dangerous for teaching about how to think about these and related matters. That’s because I do teach my students how to think, not what to think. Yet I find if anything their visits only serve to strengthen students’ convictions regarding the things they’ve learned in my classes.

Too many people have stolen Szasz’s ideas and writings without giving proper credit to him. See my review of James Nolan’s book The Therapeutic State: Justifying Government at Century’s End—a book originally praised by Robert Higgs in The Independent Review some years ago, without a hint of acknowledgement to Szasz’s work, despite the fact that Szasz coined the term the “therapeutic state.” I put a lot of blame on New York University Press for the shoddy editorial work that they did publishing the manuscript. Writers, especially those in academia, have an ethical obligation and responsibility to acknowledge the work done by others writing on the same topic, but NYU Press did nothing.

Far too many people think they are experts on policy regarding persons labeled as mentally ill because they’ve had a family member they were terribly troubled by, someone who may have embarrassed himself and the family by acting in a disturbing fashion, or actually harming himself and/or others. Often families feel terribly guilty for coercing their loved ones into the hands of institutional psychiatrists, knowing full well they are putting them through hell. They try to ease their guilt by saying over and over again that they’ve done the right thing, and by attacking those who try to protect the civil liberties of those treated as less than human beings. One thing that too many people forget is that we don’t have to do something. Letting a person be, especially as an adult, should be our first rule of thumb. Posing the scenario of a person waving a gun in the street is a red herring: When people break the law they should be arrested. They are entitled to due process. They are found guilty or not guilty of a criminal act, and they experience the consequences.

Why do the heathen rage … ?

It seems to me that Dr. Frances and Professor Pustilnik are becoming increasingly and understandably upset. According to Dr. Frances, Sullum and I repeat ourselves. From our point of view, Frances and Pustilnik recommend slavery reform instead of the abolition of slavery. As long as psychiatric slavery reform is proposed in place of abolition, we will always repeat ourselves. Slavery is not freedom. You cannot reform the practice of slavery. You can only abolish it in its entirety.

The heart of the matter remains the premise of legal fiction—the belief that the mind can be diseased just as the brain can be diseased—and what they seek to accomplish via this legal fiction—the circumvention of basic constitutional rights and protections. This is also a battle concerning the rule of law versus the rule of man. There is no due process of law when people are committed to prisons called mental hospitals against their will. Depriving people of liberty in the name of treatment for mental illness is the rule of man. There can be no such thing as a middle ground. Hayek made this clear in The Road to Serfdom; Orwell wrote about doublethink as a way for totalitarians to maintain power and control over people.

According to the advocates of institutional psychiatry, there would appear to be two kinds of human beings. There are the authorities on how to live, that is, the institutional psychiatrists who claim to know who is most likely to harm self and others. These are the Übermenschen, the supermen and superwomen, the people above people, the people above the law. Then there are the Üntermenschen, the people who are metaphorically unconscious, those who lack insight on how to live, the adults called children. The Übermenschen pretend they have magical powers that run contrary to statistical accuracy and prediction. They know the future by intuition. It doesn’t matter to them that no one can determine who is likely to hurt self or others with an accuracy beyond that expected by chance. They believe they alone can tell who is going to commit homicide or suicide, and who is not. It doesn’t matter what pathologists say is a disease, institutional psychiatrists believe they are above pathologists.

Those who support involuntary commitment look down paternalistically on those they consider below the law. They consider the mentally ill who reject treatment to be a different species of human being, the Üntermenschen. Society tends to support them, because scapegoating is always appealing. Scapegoating is a way of expelling evil, a way of affirming the dominant ethic. We’ve seen this movie before; that’s why it seems familiar. It has been repeated throughout history many times, including in the Inquisition.[1]

Yet the Bill of Rights applies equally to all people. It does not state “for whites only.” It does not state “for heterosexuals only.” It does not state “for people designated by institutional psychiatrists as mentally healthy only.” Can anyone be surprised that former mental patients—forcibly injected with drugs, deprived of their freedom, forced to have electricity shot through their brains—sometimes want to kill you and your kind? I don’t see how anyone can be surprised when a former “patient” kills or attacks his psychiatrist. Frankly, I’m surprised it doesn’t happen more often. What we usually hear about in the press is how such a person should have been involuntarily committed to a mental institution earlier in his life.

Myths, Worthless Myths, and Statistics

Like Jacob Sullum, I pointed out the concession that Dr. Frances has made, yet now Frances backpedals furiously, claiming he never said mental illnesses were a myth. They are “bullshit,” apparently, but not “worthless myths!” Res ipsa loquitur.

Professor Pustilnik’s understanding of neuroscience and genetics is so incomplete, and her point about the difference between abstraction and metaphor is so much ado about nothing, that it is difficult for me to know what else to say to her. Think on these things, Professor Pustilnik: We are each genetically programmed to die. Does that mean that life is a disease? What does asymptomatic depression look like? Eye color, skin color, and other traits are genetically determined; does that mean they are the expressions of disease? At least Dr. Frances appears have a crisis in conscience brewing, that’s why he’s getting so upset. Good for him. It’s about time.

If Dr. Frances remembers anything about scientific methodology and statistics, he knows there will never be a discrete variable called behavior that we can correlate in any meaningful way with genes, alleles, and structural and functional brain abnormalities. Brains don’t act; persons do. It takes one person to develop a literal disease such as cancer. It takes at least two people to have a mythical mental illness. Why is that?

When it comes to a variable called behavior, clearly the expression of moral agency, no two people are identical. We cannot generalize findings in one person to another in any meaningful way. If hypothesized abnormal brains cause people to do socially unacceptable things, then it only stands to reason that normal brains cause people to do socially acceptable things, or noble or virtuous ones.

The mechanistic perspective where everything human is reducible to chemical and electrical interaction is the ultimate in the dehumanization of man. We praise and admire virtuous acts because they are expressions of choice. But if we hold that bad acts and bad behaviors are caused by “bad” brains, on the one hand, we must hold that good (healthy) brains cause good behaviors on the other. What then becomes of that represented by the pronoun “I”? What do we mean by the word “person”? The exercise of free choice is precisely what we cherish and admire as human, and it is why we hold people responsible for their behaviors.

In my opinion, this is exactly what Dr. Frances and Professor Pustilnik target as an existential enemy—the exercise of free choice and personal responsibility. It does not matter what their intentions are. The end product of coercion is deprivation of liberty and responsibility. Liberty and responsibility are two sides of the same coin. We cannot decrease one to increase the other. The two are positively related.

The arbitrary exercise of state power, with psychiatrists as agents of the state, runs contrary to the rule of law. It is a prime example of the rule of man. This is also why Thomas Szasz’s writings regarding the structure and function of the therapeutic state, that union of medicine and the state that has come to replace the theocratic state, are so very important. In a theocratic state, the arbitrary imposition of power and coercion is obvious. In the therapeutic state it is difficult for many people to see because it is hidden within a cloud of medico-scientific obscurantism.

Institutional psychiatry can never be reformed. It can only be abolished in its entirety. This is why we are at an impasse here in the conversation. I will not budge, and I imagine Jacob will not budge, either. Any compromise is like being a little bit pregnant. One is either pregnant or one is not. One is either engaged in slavery or one is not. One is either using state-empowered psychiatry to destroy the rule of law, or one is not. There is no middle ground. And this is why Dr. Frances is so terribly wrong when he proposes a “middle ground.” He wants to have it both ways, let the people he chooses to be free be free, and keep imprisoned the people he chooses to imprison.

There is no middle ground with regard to numbers, either. Were it so, we wouldn’t get very upset about “just one lynching.” All it takes is one injustice to count, unless you see people only groups, not as individuals, but as a collective. There is an Israeli saying, at least I know it as an Israeli saying: Save one person and you save the world. Don’t ever think it’s not worth fighting for, when it comes to helping one person being assaulted by the state, especially when that assault by the state is masquerading as medicine.

The New York Times published a letter of mine several years ago about how a jury in North Carolina awarded a huge settlement to a young man who sued his psychiatrist for not warning him that he could end up spending the rest of his life in a mental hospital for shooting two people on the street in downtown Chapel Hill. They published a similar letter by Thomas Szasz on the same day, same page:

When a Killer Blames His Doctor

To the Editor: Why did a jury hold a psychiatrist, Myron B. Liptzin, accountable for Wendell Williamson’s murderous acts (front page, Oct. 10)?

Because psychiatrists invented and perpetuate the myth of mental illness. As long as people believe in mental illness as a cause for behavior, those who receive such a “diagnosis” will be exculpated — and someone else will be culpable.

Since psychiatrists removed the blame, it is only fitting that they should be saddled with it.

JEFFREY A. SCHALER Oct. 10, 1998

If institutional psychiatrists are going to be responsible for removing responsibility for murder, it should come as no surprise they will be increasingly held responsible for their actions. Saying that mind is caused by genetics and neurotransmitters begs the question; life is more complicated than that.

The British philosopher Gilbert Ryle wrote about category errors, or category mistakes. Part of the problem is an error of this type. We cannot use the language of mind, consciousness, and behavior in a way that makes sense when we talk about concrete reality.

Both Dr. Frances and Professor Pustilnik want to make the institutional psychiatric plantation look humane. They want to make it look pretty. They want to reform psychiatric slavery, not abolish it. That means they want to preserve slavery, for abolishing and reforming are two very different acts. Many psychiatrists have stopped playing the game of slave-master, earning a very dishonest living by depriving innocent people of freedom, and disregarding, no, punishing those who don’t want their idea of help. Suicide rates among psychiatrists are second only to those among dentists, last time I checked, and while I cannot come up with a good reason why dentists may be inclined to commit suicide—because it’s so boring?—it’s much easier to come up with accurate explanations for why so many psychiatrists commit suicide. I believe many psychiatrists may realize they’ve made a horribly bad career choice and investment. Look at the difference between an ethical internist, cardiologist, ophthalmologist, dermatologist, and an institutional psychiatrist. What a bad joke to try and compare the two.

Some institutional psychiatrists respond to their enormous mistake by switching careers. Others, as was pointed out about true believers in When Prophecy Fails: A Social and Psychological Study of a Modern Group That Predicted the Destruction of the World by Leon Festinger, Henry W. Riecken and Stanley Schachter (1964), dive more deeply into their delusions, constantly trying to convince themselves and others that they are right. They often try to base their methods on scientific obscurantism.

In my opinion, any psychiatrist who relies on drugs to change the way a person feels—instead of achieving a jointly agreed upon goal with a client through conversation—is simply acknowledging his failure as a skilled psychotherapist. If you’re a therapist writing prescriptions for your clients to change the way they feel, I think you ought to get out of the field of psychiatry. You obviously don’t know what you’re doing when it comes to listening and conversing with clients. Just as there are frauds and charlatans in the free market when it comes to selling any product, there are frauds and charlatans in the practice of consensual/contractual psychotherapy (conversation). Those who advise clients to take antidepressant drugs as well as any other drugs to change the way they feel are failures as psychoanalysts. (Note that by psychoanalyst I do not necessarily mean that in the Freudian or related theory sense.)

It’s the Cultural Context, Stupid!

Note how Islamic terrorists never use an insanity defense when on trial for various crimes, nor do American prosecutors, military or otherwise, try to impose an insanity defense on those Islamic terrorists who claim they are motivated by religious belief. Psychiatric diagnoses are ethnocentric expressions. Imagine a “God-man” in India, wrapped in his prayer shawl, who wanders for years, drinking rain water, eating seeds, if not bird droppings, sitting in meditation for 17 hours a day; or the yogi whose photograph appeared in The New Yorker years ago with about 25 pounds of stones wrapped in rope and suspended from his scrotum and his testicles. Consider another person with his arm extended toward the sky for a year; and another rolling on the ground to a holy spot, from perhaps hundreds of miles away. In that culture, they are ignored, or revered for their devotion and discipline, or described as God “intoxicated.” Those who give them money or food may very well practice or believe in Karma Yoga, or just karma theory—“helping” them gets them a good seat in heaven, according to their beliefs.

Now imagine that same God-man, wrapped in his prayer shawl, walking across the quad at American University here in Washington, D.C. What do you think the response from others might be? From the university’s “public safety” officials? From the Metropolitan Police Department? He is very likely to be handcuffed and taken to a psychiatric facility, and injected with major tranquilizers, especially if he objects to being forced to go anywhere, let alone to a place he does not want to “visit.” The more he objects, the more likely his diagnosis is to be “serious” borderline personality disorder.

This is the point that Dr. Frances and Professor Pustilnik refuse to acknowledge. This is the very crux of the matter. As Sir Karl Popper put it, it is not a matter of finding the best person to be in charge, the best ruler, the best president, king, benevolent dictator, what have you. The really important thing is to recognize that when we let “good” people have power over others, we pave the way for bad people to have power over others. Bad people will always replace good people in power, and when they inherit the power to do harm, that is when we have real trouble on our hands.

In the over twenty years of college teaching I have always noted how students, be they undergraduate, graduate, medical and/or law students who came from a current or former communist, fascist, dictatorial, or socialist state, always err in the direction of being careful when it comes to power and authority given to government. Their perspective makes them wary of creating positions of arbitrary power and then trusting that only good people will fill them.

The late psychologist Theodore Sarbin wrote a terrific article “Toward the Obsolescence of the Schizophrenia Hypothesis,” (The Journal of Mind and Behaviour 11 nos 3–4 Summer and Autumn 1990, pp 259(131)–284. It is one of the clearest indictments of the theory of schizophrenia ever written. Sarbin accurately defined hallucinations as self-reported imaginings. Believing in God or believing in angels are indications that a person is schizophrenic as much as believing in Martians beaming messages to you through the fillings in your teeth. Both are self-reported imaginings, that is, both are hallucinations. The difference is socially constructed, based on prevailing beliefs and values in a given culture or society. This is not a genetic or biological issue. Just because drugs change behavior doesn’t mean that a person needed those drugs. While many people may object to such a comparison on the grounds that it is denigrating to religious believers, one could just as easily say that equating schizophrenia with religious or spiritual belief is just as stigmatizing, if not more so.

Since Dr. Frances brought up the issue of sex offenders being committed to mental hospitals in Kansas following serving time in a penitentiary, readers may be interested in the transcript (pdf) of a debate Thomas Szasz, George J. Alexander and I had with Carla Stovall and two others, challenging her views on Kansas v. Hendricks (1997). Attorney General Stovall argued that persons convicted of sex offenses must be involuntarily committed to mental hospitals after serving prison sentences. Apparently sex offenders such as Mr. Hendricks have the necessary mens rea and actus reus to be found guilty and sentenced to a prison for their crimes. But once Mr. Hendricks served his time, his mens rea mysteriously disappeared. He then became sick because, according to Attorney General Stovall, he couldn’t control his sexual addictions. However, once the Kansas State Supreme Court decision reached the U.S. Supreme Court, Justice Clarence Thomas decided that Hendricks did not make others suffer from his sexual sickness, he made others suffer via sexual molestation because he was mentally abnormal. Thomas was smarter than Stovall: He recognized that if Hendricks was sick, he could never have been found guilty.

Note

[1] See Szasz, T.S. (1970). The manufacture of madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York: Dell.

Also from This Issue

Lead Essay

  • Strategies of Psychiatric Coercion by Jeffrey A. Schaler

    Professor Schaler notes that mental illness differs in several important ways from physical illness, and these ways make a mockery of conventional diagnosis. Nonetheless mental illness plays an important role in our legal system; it permits psychiatrists to exercise a significant degree of coercion. Schaler challenges this arrangement and argues that those whom we may classify as mentally ill are still deserving of their liberties, including the liberty to refuse treatment. Schaler also questions whether “insanity” is an appropriate legal fiction at all.

Response Essays

  • A Clinical Reality Check by Allen Frances

    Professor Frances agrees that mental disorders are not diseases properly speaking, but he maintains that they are nonetheless useful analytic constructs. As to coercive psychiatric treatment, he argues it can indeed be a horrific abuse. Still, in some especially desperate cases it will be necessary to save lives and to prevent even greater harms. He recommends several practices designed to minimize the frequency and risks of coercive treatments.

  • Psychiatrists Create Their Own Reality by Jacob Sullum

    Jacob Sullum asks the mental health establishment for consistency: If mental disorders are not diseases, what justifies involuntary treatment? Evidence of criminal conduct is a matter for law enforcement, not mental health. And how is it that we punish sexual predators (on the theory that they are responsible) — then treat them afterward (on the theory that they aren’t)? Psychiatric diagnoses are ultimately arbitrary, Sullum argues, and they lead to the arbitrary exercise of power.

  • Calling Mental Illness “Myth” Leads to State Coercion by Amanda Pustilnik

    Amanda Pustilnik argues that the most profound violations of liberty in this area don’t come from coercive psychiatry, but from the warehousing of the mentally ill in our criminal justice system. Such people aren’t more likely to commit crimes, but they fare badly in the criminal justice system, where unusual behavior leads to convictions, longer sentences, parole violations, and reincarceration.

The Conversation