Insanity and Intolerance

Psychiatric Slavery Is a Fatal Flaw in the American Ideal

In the Age of Faith, the Church, viewed as having been established by Christ, was perceived as a perfect society. Hence, it was reasonable that it be empowered to make laws and inflict penalties for their violation, which were viewed as striking at her very life, the unity of belief. The result was the concept and crime of “heresy”—an offense that vanishes when religious tolerance replaces religious fundamentalism. “It does me no injury for my neighbor to say there are twenty gods, or no God,” said Jefferson.

I say it does me no injury for my neighbor to say he is Napoleon or that God is talking to him. That is psychiatric heresy. Everyone knows that individuals who display such behavior are severely mentally ill, suffering from “delusions.” True, such persons make assertions that we regard as untrue. But why should that be a reason for depriving them of liberty and “treating” them for diseases they claim they do not have?

Psychiatric intolerance is one of the pillars of the therapeutic state. Its trinity—psychiatric diagnosis, psychiatric treatment, and psychiatric incarceration—is a mask for justifying coercion as care. Rejecting psychiatric treatment and rejecting life—by attempting suicide—are psychiatric heresies, punishable by psychiatric incarceration and involuntary psychiatric treatment. Opposition to coercive psychiatric suicide prevention is reflexively dismissed as so lacking in compassion as to be unworthy of consideration.

The repentant Catholic heretic often embraced the faith more ardently than his persecutor, if for no other reason than to demonstrate his reliability and insure his own safety. The repentant psychiatric heretic does the same. Commenting on the Surgeon General’s declaration of war on mental illness, Kay Redfield Jamison, professor of psychiatry at John Hopkins Medical School, declares: “As someone who studies, treats and suffers from a severe mental illness—manic depression—I commend the surgeon general for his excellent, thoughtful and fair report on mental illness.” Not satisfied with embracing involuntary mental hospitalization and involuntary electric shock treatment for herself, Jamison advocates imposing psychiatric coercions on others, and asserts that “the distinction between voluntary and involuntary commitment is misleading and arbitrary.”

Psychiatric slavery—that is, confining individuals in madhouses—began in the seventeenth century, grew in the eighteenth, and became an accepted social custom in the nineteenth century. Because the practice entails depriving law-abiding individuals of liberty, it requires moral and legal justification. The history of psychiatry, especially its relation to law, is largely the story of the mutating justifications for psychiatric incarceration. The metamorphosis of one criterion for commitment into another is typically called “psychiatric reform.” It is nothing of the kind. The bottom line of the psychiatric balance sheet is fixed: Individuals deemed insane are stigmatized, incarcerated, and forcibly “treated.” For more than 40 years I have maintained that psychiatric reforms are exercises in prettifying plantations. Slavery cannot be reformed; it can only be abolished.

Like the inquisitor, the contemporary psychiatrist has a hard time distinguishing between repudiating the Other’s (false) ideas, which he calls “delusions,” but tolerating him, and persecuting the Other to help him see the “truth,” which he calls “treatment.” In the zealot’s eyes, tolerance of psychiatric heresy is tantamount to a declaration of war on psychiatry. Why? Because, unlike standard medical practice, which rests on cooperation, standard psychiatric practice rests on coercion. This is what makes opposition to psychiatric coercion seem to be the same as opposition to psychiatry in toto.

Tolerating Falsehood, Punishing Crime

Psychiatric slavery is the oldest and most characteristic feature of the therapeutic state, which, in turn, is the modern, secular incarnation of the theocratic state. Each is a species of political absolutism, one based on the pharmacratic rights of medical protectors, the other on the divine rights of royal protectors. Since its inception, the power and prestige of psychiatric slavery have steadily grown and the coercive psychiatric system is now an integral and respected part of every modern society. Why, then, do I oppose it? Because I believe that the coercive control of bad behavior ought to be a moral and political, not a medical or therapeutic, function; and that the state ought to punish only illegal behavior and ought to do so only by criminal sanctions. In short, I oppose psychiatric slavery because I believe it is inimical to individual liberty and responsibility, to the rule of law, and to the very existence of a free society.

However, most people see psychiatry not as enslavement to a destructive ideology, but as liberation from a dangerous illness. This is a recent development, due in large part to psychiatrists’ wisely emphasizing diagnosis and prescribing medication—rather than relying on mass incarceration of deviants in madhouses—which makes them look like real doctors, who tend to be perceived as benevolent. Accordingly, most people accept the claims that psychiatry is a medical science and that psychiatric interventions are medical treatments for real diseases, and fail to see that the lot of psychiatric slaves is as miserable as ever.

Near-unanimous support for psychiatric slavery by public policy and public opinion deprives the critic of a forum for effective dissent, regardless of the absurdity of the psychiatric claim he criticizes. The medical patient has a right to reject treatment; the mental patient does not. This is how Stephen Rachlin, professor of psychiatry at Columbia University College of Physicians and Surgeons, justifies this limitation: “It is axiomatic in medicine that the patient is hardly in the best position to prescribe his own treatment.” Rachlin equates the medical patient’s right to reject treatment prescribed for him by a physician, with his “right” to dictate the treatment the physician should provide for him. This, of course, is patent nonsense and has nothing to do with the legal rule limiting physicians to treating only those persons who agree to their treatment. In medicine, involuntary treatment is assault and battery. In psychiatry, involuntary treatment is the basic model and is viewed as “beneficence.” Rachlin’s distortion enables him to say: “In my experience, the psychiatric inpatient refusing treatment does so for reasons related to his psychosis and thought disorder. . . . [I]f freedom is to be more than just another word, the right to refuse treatment is one right too many.”

Chattel slavery was the original sin of the American ideal of individual liberty, a sin the nation has still been unable fully to expiate. Psychiatric slavery is its Achilles’ heel, a fatal flaw that may yet transform the American dream into an American nightmare.