Reply to Amanda Pustilnik

Professor Amanda Pustilnik’s contribution to this discussion is, unfortunately, disappointing. In my opinion, she has an ethical and moral obligation to explain to us why she advocates a particular policy—whatever that may be—instead of making such profoundly naïve pronouncements about how we should work together to help the mentally ill—do what? So that “ill people who get out of hospitals don’t need a Ph.D. and a team of administrative assistants to figure out how to continue their care at home”?


This, followed by high school–level “rah, rah, sis, boom, bah, … gooo… team!” … is a pathetic, if not naive attempt to insult those who take the issues of liberty and responsibility seriously, be they “libertarian” or not.

Back to square one, Professor. What do you mean by “mental illness”? How do you define “mental illness”? How do you describe “it”? How does “it” compare to real illness? Why isn’t it included in standard textbooks on pathology? What do you mean by treatment? What about due process? What about the failure to accurately predict who will and who will not harm self and others? How do you explain “it”? What are the various implications for legal, clinical, social and public policy, when you define, describe, and explain “it” one way compared to another?

Until you can answer some of these questions, I’m afraid it’s hard to take you seriously.

Also from this issue

Lead Essay

  • 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

  • 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.

  • 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.

  • 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.