Steven Soderbergh's “Unsane” Exposes the Nightmare of Involuntary Commitment

The only thing scarier than losing your mind is everyone else believing you’ve lost it.

Sawyer Valentini is a woman with problems. She’s had to move halfway across the country to avoid a stalker, and now she never feels safe. Unsure of where to turn, she seeks out a therapist to whom she confesses her anxieties, even the suicidal thoughts she sometimes has. Talking makes her feel better, and she breathes a sigh of relief as she turns to go. But not so fast. In return for her candor, the therapist has branded her “a danger to herself and others,” which means that Sawyer is now in the legal custody of a mental hospital. Whoops.

So begins the plot of the new thriller Unsane, and it’s a familiar enough one. The idea of involuntary commitment taps deep into many of mankind’s greatest fears and is, therefore, the perfect fodder for horror movies. As distinct from wrongful imprisonment, commitment not only robs the “patient” of her freedom, but also of her status, her credibility, and her very humanity. No one doubts that there are intelligent, competent people in prison. Get tagged with the epithet “crazy,” however, and people refuse to believe anything you say. The only thing scarier than losing your mind is everyone else believing you’ve lost it, and in practical terms of how you interact with and influence the world, there’s not much difference between the two.

"For Your Own Good"

Sadly, like most truly terrifying things, the events in Unsane are not without a basis in reality. It is true that once the state, on the advice of the medical establishment, designates someone to be dangerous, the most basic rights you and I take for granted fly quickly out the window. People who have never committed a crime can be, and are, deprived of their liberty with relative ease.

Consent becomes irrelevant, and the state is free to subject individuals to any number of often-violent and destructive interventions at will.

Such interventions are invariably couched in euphemistic terms like “therapy” and “treatment.” A piece of 2014 legislation which would have allowed parents to violate the privacy of their adult children and make decisions on their behalf was called the Helping Families in Mental Health Crisis Act.” The phrase “for your own good” is frequently employed. All this with the aim of making coercion seem in some way helpful.

With ordinary medicine, the patient generally has the right to refuse treatment. Someone who prefers to live with an illness rather than submit to invasive and dangerous surgery is permitted to do so on the grounds that cutting into a person without her consent is assault. But when the ability of the mind to make rational decisions is called into question, everything changes. Consent becomes irrelevant, and the state is free to subject individuals to any number of often-violent and destructive interventions at will.

If anyone doubts this, I urge them to review the literature of psychiatric treatment over the last century. The profession has enthusiastically embraced techniques such as lobotomy and insulin shock therapy. These two procedures involve inflicting deliberate brain damage to the “patient,” one with an intentional chemical overdose, the other with an ice pick. In recent years, psychiatrists have largely phased out these techniques, once hailed as revolutionary advances in the field, in favor of mind-altering drugs, finding that a physical straightjacket is not required when a chemical one will suffice.

"Irrational"

The question for the legal and medical professions alike is this: how can we reliably determine that a person is irrational and therefore incapable of consenting to treatment or of withholding said consent? Economist Ludwig von Mises spent a large part of his career thinking about the idea of rationality. In his book, Epistemological Problems of Economics, he concludes:

“The assertion that there is irrational action is always rooted in an evaluation of a scale of values different from our own. Whoever says that irrationality plays a role in human action is merely saying that his fellow men behave in a way that he does not consider correct.”

He elaborates on this view in his definitive work Socialism, writing:

“If a man drinks wine and not water I cannot say he is acting irrationally. At most I can say that in his place I would not do so. But his pursuit of happiness is his own business, not mine.”

We may think that the distinction between sanity and insanity is obvious; someone who hears voices we cannot hear, or believes things that we know to be false, must have a screw loose somewhere. But a little examination reveals the danger of this position. The religious mystic hears voices other people can’t hear, as does the inspired poet and the brilliant composer. Research indicates that auditory hallucinations are remarkably common, and can provide useful and meaningful life guidance to those who experience them.

"Delusional"

As for believing things that are untrue, almost everyone holds some belief that others will dispute. It’s obviously possible to be wrong without being irrational, but it’s impossible to see where to draw that line. And while the belief that one is actually Napoleon may seem like a straightforward case of madness, it quickly becomes hard to make such an easy distinction. Are people who believe the Earth is flat crazy? What about those who believe 9/11 was an inside job or that the moon landing was a hoax? What about those who believe that they consume the literal body and blood of Christ every Sunday morning or that there’s no such thing as global warming? It’s easy to see how quickly the lines become blurred, and in fact, leftists have already been laying the groundwork for classifying minority beliefs as mental illness, asserting that there’s something “wrong” in the brains of conservatives.

There’s precedent for the use of psychiatry as a weapon against political dissent.

There’s precedent for the use of psychiatry as a weapon against political dissent. The Soviet Union classified Party disloyalty as a mental illness, and Benjamin Rush, a signer of the Declaration of Independence and the father of American psychiatry, identified opposition to the American revolution, as well as excess zeal for liberty, as forms of insanity. If there’s no way to tell the difference between a delusion and a misapprehension, how can we justify using delusion as a criterion for taking away people’s freedom?

In the film, one of Sawyer’s fellow residents in the hospital is a journalist, working undercover to expose the injustice of involuntary commitment. This, too, is not without precedent.

In 1887, Nellie Bly, a journalist for the New York World undertook to get herself committed to the Women’s Lunatic Asylum in Manhattan. Feigning poverty and insanity, she was quickly admitted, at which point she immediately reverted to her normal habits, always maintaining that she was perfectly sane. The doctors merely interpreted this as a manifestation of Bly’s delusions and refused to believe that they had made a mistake in admitting her. In writing about the event, Bly insisted that the other women with whom she was housed were just as sane as she was.

"We've Come a Long Way"

I anticipate the immediate objection that this experiment took place in the dark ages of psychiatry and that the intervening years have led our doctors to a more enlightened approach to mental health care. If 19th-century doctors couldn’t do their jobs, that’s only because they were living in the 19th century. Science marches on!

If trained professionals can’t tell the difference between the sane and the insane, it’s likely that no one can.

Perhaps, but this is less than reassuring when we consider that in 1972, psychologist David Rosenhan undertook the same experiment, with the same results. In an article published by the prestigious Science journal, Rosenhan described how, in his experiment, eight sane people gained admittance to twelve mental hospitals. The actors visited emergency rooms and confessed to hearing indistinct voices. They were promptly diagnosed with schizophrenia and admitted into psychiatric institutions. As soon as they were admitted, they admitted that there were no voices and proceeded to behave normally. Not one of the actors was detected as a fraud, and they were eventually released with a diagnosis of “schizophrenia in remission.” It appears as though nearly a century of medical science was insufficient to allow doctors to distinguish between the sane and the insane, which, given the potential consequences for the patients, is more frightening than any film I’ve yet seen.

Rosenhan’s study was praised as providing insight into the field of psychiatry, but there appears to have been no public outcry, no demand for reforms, and very few willing to ask the obvious questions raised by his findings.

If trained professionals can’t tell the difference between the sane and the insane, it’s likely that no one can. And if no one can detect a difference, it’s fair to ask whether that difference really exists at all.

I confess to reveling in the cheap thrills of horror movies set in lunatic asylums, but anyone interested in human freedom, justice, or truth should speak out against the practice of involuntary commitment, and demand that these abuses only occur in the realm of fiction.

Further Reading

{{article.Title}}

{{article.BodyText}}