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Wednesday, June 17, 2009

The Shame of Medicine: The Depravity of Psychiatry

Responding to my May 2009 column, George Mason University economics professor Bryan Caplan commented: “In the last couple of decades, a lot of

people have apologized for the past crimes of the groups with which they identify: the U.S. for Japanese internment, the Church for Galileo, Swiss bankers for Nazi money laundering, even the Japanese (kind of) for their war crimes. I’d like to see psychiatrists do the same—to admit that unusual preferences are not ‘disease,’ affirm that it is wrong to treat people against their will, and turn their backs on the ‘greats’ of their profession who believed in and practiced coercive therapy.”

I am grateful to Caplan for calling attention to a problem most people prefer to ignore. His expectation will, however, not be fulfilled, and it is important to understand why. Claiming competence in astronomy and incarcerating heretics are not integral to the identity of the Catholic Church. In contrast, claiming competence in predicting “dangerousness” and incarcerating persons alleged to be so because of “mental illness” are integral to the psychiatric enterprise. Wikipedia defines civil commitment as “the practice of using legal means or forms as part of a mental health law to commit a person to a mental hospital, insane asylum or psychiatric ward against their will and/or over their protests. . . . A common reason given for involuntary commitment is to prevent danger to the individual or society.”

Psychiatrists alternately deny and delight in possessing special professional skill at detecting future “dangerousness” that entitles them to the special power to incarcerate individuals they so stigmatize in prisons that masquerade as hospitals. The American legal system makes heavy use of psychiatric determinations of dangerousness, as a result of which vast numbers of Americans are deprived of liberty and, at the same time, of opportunity to demonstrate the injustice of their detention. Examples abound.

Kafka in Court

In March 2004 Susan Lindauer was arrested in Maryland and charged with “acting as an unregistered agent of a foreign government.” She faced up to 25 years in prison. Instead of trying Lindauer, government psychiatrists declared her mentally incompetent to stand trial and incarcerated her at the Carswell Federal Medical Center in Texas, a facility described as providing “medical and mental health services to female offenders.” But Lindauer was not an offender. She was an innocent American.

After “hospitalizing” Lindauer for 18 months, her “medical” torturers concluded that, although she was still mentally ill and incompetent to stand trial, she no longer needed psychiatric “care.” Released from detention, she returned to Maryland where federal court services referred her to a private agency for counseling. According to a motion filed by her attorney, her counselor, Dr. Bruke Tadessah, said, “That evaluation showed a diagnosis of post traumatic stress disorder due to her experiences at Carswell.” Last January the federal government dropped its case against Lindauer as ”no longer in the interest of justice,” implying that her psychiatric persecution had been in the interest of justice.

Consider the contrast. Inmates of American mental-health facilities are stigmatized as “mental patients”; their torture is called “treatment”; and they are regarded as the beneficiaries of a caring government’s therapeutic services. The inmates at the Abu Ghraib prison in Iraq were not stigmatized as “mental patients”; their torture was not called “treatment”; and they were regarded as the victims of government-sponsored “detainee abuse.”

Indefinite Incarceration

When Donald Schmidt was 16, he molested and drowned a 3-year-old girl. Under California law juvenile offenders who commit serious crimes can be kept in the system only until they are 25. But Schmidt’s detention has been extended under the state code that allows “continued detention if a jury finds the inmate has a mental disorder, defect or abnormality that causes the person to have serious difficulty controlling his or her dangerous behavior.”

What is Schmidt expected to do to get a divorce from his “doctors” and regain his liberty? Every two years he can petition for release and hope that a judge will order a “trial,” letting jurors decide whether he remains a “danger to society.” Anticipating another such contingency, a Santa Cruz County district attorney Bob Lee declared, “We believe he’s a psychopath.” Richard A. Starrett, a clinical psychologist, agreed that Schmidt was still a danger, though “not a psychopath.” Barry Krisberg, president of the National Council on Crime and Delinquency in Oakland, California, called Schmidt’s situation “one in a million.”

The claim that Schmidt’s indefinite psychiatric sentence is unusual is typical of the deceit and depravity intrinsic to forensic psychiatry. John Hinckley, Jr., never convicted of a crime, is serving his 28th year of psychiatric imprisonment. Evidently the government’s greatest psychiatrists need more time to cure him of dangerousness.

Psychiatry is the political legitimation of the incarceration of innocent individuals under psychiatric auspices, a practice that appears to enjoy near-universal approval by people in modern societies. Recognition of the fact that noncoercive psychiatry is an oxymoron is obscured by the concurrent practice of seemingly consensual “therapy.” I say “seemingly” because the mental-health professional retains the privilege and obligation to deprive his patient of liberty if he “poses a danger to himself or others.” As a result, psychiatrists and the press regularly tout psychiatric “reforms,” while the “doctors” engage in ever-increasingly refined forms of psychiatric depravity, supported by the unquestioned and unquestionable premise that “dangerousness” justifies imprisonment called “hospitalization.”

In the published report of a 1981 workshop titled Behavioral Science and the Secret Service, sponsored by the prestigious Institute of Medicine, Robert Michels, University Professor of Medicine and of Psychiatry at Weill Cornell Medical College in New York, asserted that “most mental health professionals believe that there is no major ethical dilemma if it is in the patient’s interest to violate his confidentiality, and that it is generally in the patient’s (as well as society’s) interest to prevent a major violence.” The assertion that “most mental health professionals believe” that violating a defendant’s Sixth Amendment right to trial serves his interest is evidence of psychiatric depravity, not morality.

To make matters worse, a few pages later the workshop reporter informs us that “Some conferees, including psychiatrists Robert Michels and Loren Roth [a prominent forensic psychiatrist and professor at the University of Pittsburgh], questioned the utility of making dangerousness determinations at all, because such decisions at any one time are likely to be highly unreliable and invalid. . . . Mental health professionals in general have not been shown to be better than anyone else in making predictions about behavior which might occur in the distant future under changing conditions.”

None of this evidence impairs the professional standing of psychiatry as an ethical and scientific medical discipline. The psychiatric enterprise is so deeply rooted in social control and so strongly supported by pseudoscientific magic and prejudice that psychiatrists must either cling to and justify the coercive services they render or repudiate and abolish their profession as they and we know it.

  • Dr. Thomas Szasz (1920-2012) was a Psychiatrist, academic, and champion of individual rights. He devoted much of his life to campaigning against many aspects of conventional psychiatry, in particular involuntary psychiatric treatment and commitment.