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VOLUME 1, ISSUE 4 PSYCHNEWS INTERNATIONAL July 1996
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SECTION B: THE FIFTH COLUMN
Note: The Fifth Column is a regular, independent column
written by Jeffrey A. Schaler, Ph.D.
Opinions and comments are invited. Please send them to
the PsychNews Int'l mailbox: pni@badlands.nodak.edu
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1
FREEDOM, PSYCHIATRY, AND RESPONSIBILITY
Jeffrey A. Schaler, Ph.D.
"Congress shall make no law respecting an establishment of
religion, or prohibiting the free exercise thereof..."
-- Amendment I, The Constitution of the United States
In examining the consequences of state-sanctioned
psychiatry in society today, it is instructive to compare
Thomas Jefferson's thoughts about religion and the state with
Thomas Szasz's thoughts about medicine and the state (Szasz,
1987; 1965; 1963). Jefferson was an advocate of the
establishment and free exercise clauses (above), which
guarantee freedom _from_ and _of_ religion, respectively.
Both were written to protect individuals from a despotic
state in unique ways. Szasz has proposed a new
constitutional amendment, extending those guarantees to
medicine: "Congress shall make no law respecting an
establishment of medicine, or prohibiting the free exercise
thereof..." (Szasz, 1970, p. 179).
Jefferson considered "the constitutional freedom of
religion the most inalienable and sacred of all human rights"
(October 7, 1822). With James Madison, he sought to protect
society from the deprivation of liberty that would result
from a theocratic state. Szasz considers freedom of thought
and action the most inalienable and sacred of all human
rights. He warns against the deprivation of liberty caused
by a therapeutic state, i.e., a state entangled with the
institution of medicine.
"To Jefferson...the institution of the Church...was the
enemy of freedom and the ally of obscurantism" (Padover,
1970, p. 43). To Szasz, institutional psychiatry, i.e.,
state-sanctioned psychiatry, is the enemy of freedom and the
ally of obscurantism: "Organized Medicine is now as much a
part of the American government as Organized Religion had
been of the government in fifteenth-century Spain" (Szasz,
1970, p. 179).
Jefferson's critical attitude did not extend to the
ethical teachings of religion, which he accepted, but to
its political alignments and aspects, which he rejected.
Religion was a menace to a free society when it was
either an instrument of the State, as was the case with
Lutheranism in Prussia, or when it used the State for
its sanguinary purposes, as was the case in Inquisition-
ridden Spain. There was sufficient historical evidence
to prove that the partnership of Church and State had
always led, and perforce must lead, to tyranny and
oppression. "In every country and in every age,"
Jefferson said, "the priest has been hostile to liberty.
He is always in alliance with the despot, abetting his
abuses in return for protection of his own."
So long as the Church was woven into the same fabric
as the State, a self-governing commonwealth based upon
justice and freedom was a fool's illusion...What
Jefferson wanted, and ultimately achieved, was liberty --
liberty, fully protected by the law, to believe or not
to believe whatever a man saw fit...(Padover, 1970, pp.
43-44).
Note that Jefferson supported liberty to believe or not
believe whatever a man saw fit, including religious beliefs.
Jefferson was interested in protection of _any_ and _all_
beliefs.
Szasz's critical attitude does not extend to the ethical
teachings of psychoanalysis per se, which he accepts (with
all its variations, i.e. the conversations based in secular
ethics called "psychotherapy"), but to its political
alignments and aspects, which he rejects. Institutional
psychiatry (as opposed to contractual psychiatry) is a menace
to a free society when used as an instrument of the state.
There is sufficient historical evidence to prove that the
partnership of psychiatry and the state has always led, and
perforce must lead, to tyranny and oppression. In every
country and since psychiatry's invention, the institutional
psychiatrist has been hostile to liberty. He is always in
alliance with the despot, abetting his abuses in return for
protection of his own.
So long as institutional psychiatry is woven into the
same fabric as the state, an autonomous, free society based
on the Rule of Law is a fool's illusion. What Szasz wants is
liberty fully protected by the law, liberty to believe or not
to believe whatever people see fit, and the liberty to act
responsibly in relation to others.
Had Szasz been alive in Jefferson's time, he'd have
written and spoken out against the theocratic state. If
Jefferson were alive today, he would write and speak out
against the therapeutic state. Jefferson is a hero; Szasz
is (for the time being) a heretic.
PSYCHIATRY IS THE NEW CHURCH
Today, institutional psychiatry is the church Jefferson
criticized so passionately. Religious concepts of good and
evil have been replaced with psychiatric concepts of mental
health and illness. An unconstitutional alliance exists
between medicine and the state, and criticism of that
alliance is discouraged, if not punished.
Institutional psychiatry is the enemy of freedom in at
least three specific ways: (1) Innocent persons are
regarded as guilty, deprived of liberty and forcibly
committed to psychiatric "treatment" for "mental illness."
(2) Guilty persons are regarded as innocent by reason of
insanity and committed to a psychiatric facility for
treatment of mental illness. (3) Persons accused of a crime
are deprived of their constitutional right to due process
(the Fifth and Sixth Amendments) when they are diagnosed as
mentally incompetent (when those accused meet the legal
criteria for competency, they understand the charges brought
against them, are able to assist counsel with their defense
and understand the proceedings of the court). The legal,
psychiatric circumvention of constitutional protections
against these assaults on individual liberty is the working
of the Rule of Man masquerading as the Rule of Law. These
assaults are discriminatory and partial applications of law.
Psychiatric and religious diagnoses are threats to
liberty only when the state is involved, i.e. when they
exist as formal, not informal, sanctions. If separation of
state and medicine were to occur, in the same way separation
of church and state now exists, the use of institutional
psychiatry to deprive persons of liberty and responsibility
for their behavior would be impossible. Psychiatric
diagnoses are moral judgments disguised as medical ones.
The separation of medicine and state would no more destroy
psychiatry than the separation of church and state has
destroyed religion. People would still be free to find
meaning in psychiatry and psychotherapy, just as they now
find meaning in any number of diverse religious beliefs and
practices. Problems arise when people do not want to abide
by the ethics of psychiatry and religion--and are coerced
into abiding by them.
The authority of religious institutions was unchallenged
in the past because opposition could be punished by the
state. Also, the leaders of those institutions convinced
people they knew more about the purpose and meaning of life
than anyone else. They used mystical language to intimidate
people into obedience, e.g. the fear of something bad
happening if religious teaching was not obeyed. A symbolic
world, i.e. heaven, hell, the soul, God etc., was reified.
Religious rhetoric obscured social control. Recognizing the
tactic, Jefferson and Madison constructed an invisible wall
of separation between church and state to safeguard against
such abuse.
What people often fail to recognize is how institutional
psychiatry is now used in similar ways. Just as denying the
existence of witches was viewed as a "sign" of being a witch
during the Inquisition, denying the existence of mental
illness today is viewed as a "sign" of mental illness. As
Karl Kraus wrote: "The psychiatrist unfailingly recognizes
the madman by his excited behavior on being incarcerated"
(Szasz, 1976, p. 127). The church, in a theocracy, can
punish a person for heresy because the state enforces such
religious diagnoses. When church and state were separated by
the First Amendment, the power to enforce religious diagnoses
was rendered harmless. _Mutatis mutandis_. Institutional
psychiatry can punish a person for medical heresy because the
state has the power to enforce such psychiatric diagnoses.
The individual is no match against the power of the state.
If medicine and state were separate, the power to enforce
psychiatric diagnoses would be rendered harmless.
It is important to remember that religious belief is just
one category of belief. Jefferson was very clear about this.
The Constitution protects _any_ belief. Freedom of religious
belief and practice is the right to believe _whatever_ one
chooses to believe, and to act on that belief in any way, as
long as such action does not infringe upon the freedom of
others.
The free exercise clause protects the right of belief --
especially the right to believe in atheism. The
establishment clause protects against state endorsement of,
i.e. entanglement with, religion. The state must remain
neutral in matters of personal belief. It must not condone
or reject any particular belief system or behavior based on
that belief system. In other words, the state must stay out
of the individual citizen's head. Yet institutional
psychiatry is used by the state to get "inside" a person's
head.
Many people believe God is more real than mental
illness. Denying the existence of mental illness is no
different than atheism. Belief is belief, whether it be
belief in God, aliens, Satan, atheism etc. Beliefs cannot
be protected on the basis of validity. If that were the
case, mental illness would be considered more real than God.
(The idea of mental illness is a historically new phenomenon.
The idea of God is a slightly older one.) While all beliefs
are heretical to some, under our Constitution a person cannot
be deprived of liberty on the basis of any beliefs.
LITERAL VERSUS METAPHORICAL CONDITIONS
We can understand more about how a therapeutic state
deprives people of liberty by examining the situations in
which involuntary treatment, i.e. medical treatment without
one's consent, is _not_ considered unconstitutional.
There are three situations in which medical treatment
may be administered without consent. The first is when a
person is literally unconscious. For example, a person is in
an automobile accident and is rendered unconscious; medical
treatment is administered because the person is literally
incapable of giving consent. To wait for the person to
regain consciousness (if ever) could result in more serious
injury or death.
The second situation occurs when a person is literally a
child. For example, a child is sick and needs a blood test
or throat culture, but the child objects to medical tests and
treatment. Medical procedures are administered despite the
child's objections because the child is viewed as incapable
of understanding the consequences of treatment refusal. An
adult, in contrast, can refuse medical treatment for life-
threatening illness.
The third situation occurs when a person is literally
contagious with an infectious disease. For example, a
student at a university is diagnosed with contagious
meningitis. In such a case, a person can be quarantined and
treated without consent for the protection of others.
In each of these three situations, literal signs
(objective symptoms) and sometimes accompanying symptoms
(subjective signs) are an integral part of treatment without
consent. Rarely is treatment administered without consent
solely on the basis of symptoms alone. In the first case,
the person is incapable of responding to requests for
consent. In the second case, the person is incapable of
understanding the consequences of refusal. In the third
case, the person is treated to protect others. If the person
did not pose a literal threat to others, he or she would not
be treated without consent.
Institutional psychiatrists pervert similar situations
to justify social control measures. They do so by calling
metaphorical conditions literal ones, e.g., mental illness.
Moreover, all diagnoses and treatment of mental illness are
based on symptoms, not signs. With real diseases it is the
other way around. This is the institutional psychiatric
version of religious obscurantism.
Let's use the involuntary commitment procedure as an
example to explore further the justifications used by
institutional psychiatrists. When people exhibit abnormal
behavior, and theoretically constitute a threat to
themselves, they may be committed to a psychiatric facility
against their will. The institutional psychiatrist,
supported by a judge, asserts that these individuals do not
know what they are doing, i.e., they are acting
unconsciously. They are not literally unconscious but
metaphorically unconscious. People cannot "act
unconsciously." "Acting unconscious" (not pretending to be
unconscious) is an oxymoron.
A second justification used by institutional
psychiatrists is claiming that mentally ill persons are like
children. "Being a child" is different from "being like
a child". Because persons designated as mentally ill act
like children, institutional psychiatrists argue they are
incapable of understanding the consequences of refusing
treatment. Thus, they are committed to psychiatric treatment
despite their objections. But an adult labeled mentally ill
is not a literal child. He or she is a metaphorical child.
Jesus is not the literal son of God. He is the metaphorical
son of God.
A third justification used by institutional
psychiatrists to commit persons to a mental hospital is to
claim the persons labeled mentally ill are a threat to
others. That's the metaphorical equivalent of being
literally contagious. Yet no matter how bizarre people's
behavior, their behavior is not literally contagious. It's
contagious only in the metaphorical sense. If people are a
literal threat to others, that's a matter for the criminal
justice system. Moreover, people cannot be deprived of
liberty on mere grounds of suspicion. That's why the
Constitution guarantees due process of law.
In each of these three examples, the institutional
psychiatrist literalizes a metaphorical condition (the means)
in order to justify deprivation of liberty (the end). An
irony here is worth noting: One of the criteria used to
diagnose a person as psychotic is his or her failure to
discriminate between symbolic and real, i.e. the
metaphorical and the literal. If institutional psychiatrists
are incapable of recognizing the difference between
metaphorical and literal unconsciousness, metaphorical and
literal children, and metaphorical and literal contagions,
then they've met their own criteria for psychosis! If they
recognize the difference, on what basis do they have the
right to deprive people of liberty when they have broken
no law?
In each of these three examples, a diagnosis is made on
the basis of the beliefs a person holds concerning self and
others, as well as the expression of those beliefs. Again,
from a constitutional point of view, the accuracy of those
beliefs is irrelevant. People are free to believe in and
express their belief in God; to deny the existence of God;
and to act on the basis of those beliefs. Moreover, freedom
of religion is not contingent upon a physiological correlate.
Neither should freedom of belief and thought be. People
should not be deprived of liberty because a physiological
component to mental illness has been found.
LIBERTY AND RESPONSIBILITY
Liberty and responsibility are positively correlated.
The more we increase liberty, the more we expect people to be
responsible for their behaviors. The inverse is true, too:
We deprive people of liberty when we claim they are not
responsible for their behaviors. Concurrently, the more we
assert that people are not responsible for their behaviors,
the more we treat people as if they were unconscious, as if
they were children or as if they had a contagious disease.
Each of the three justifications for involuntary commitment
by institutional psychiatrists, i.e. deprivations of
liberty, is a claim regarding personal responsibility.
Another way of viewing involuntary commitment is by
examining the imposition of "right" belief systems. When the
state deprives a person of liberty because of mental illness,
the state, through its agent the institutional psychiatrist,
is making a law respecting an establishment of religion and
prohibiting the free exercise thereof. It establishes a
religion when it rewards "right" beliefs and punishes "wrong"
beliefs. It prohibits "the free exercise thereof" when it
deprives a person of liberty for thinking and expressing
beliefs in heretical ways. When people make certain and
unacceptable claims about self and the world, it prohibits
the free speech based in those beliefs.
CONCLUSION
The Constitution was written for common men, women and
children -- not legal, medical or religious experts. It is,
like death, a great equalizer. As such, it should be applied
in an impartial manner, respecting the diversity of beliefs
as beliefs, regardless of whether those beliefs are religious
or not. That's the Rule of Law. A therapeutic state
interprets the Constitution in partial ways. It
discriminates between mentally healthy and mentally ill
citizens. That's the Rule of Man. The only way to safeguard
against such despotism is to interpret the Constitution as it
was intended to be interpreted: Religion masquerading as
medicine has no place in the state.
FOOTNOTE (to title):
1
One of three lectures presented at the Institute for Humane
Studies Liberty & Society Seminar, The First Amendment and
Beyond, Babson College, Babson Park, Massachusetts,
July 24, 1996.
REFERENCES
Padover, S. K. (1970). Jefferson. New York: Mentor
Szasz, T. S. (1987). Insanity: The idea and its
consequences. New York: John Wiley & Sons, Inc.
Szasz, T. (1976). Karl Kraus and the soul doctors. Baton
Rouge, LA.: Louisiana State University Press
Szasz, T. S. (1970). The manufacture of madness: A
comparative study of the Inquisition and the mental
health movement. New York: Harper & Row
Szasz, T. S. (1965). Psychiatric justice. New York:
Macmillan
Szasz, T. S. (1963). Law, liberty and psychiatry: An
inquiry into the social uses of mental health practices.
New York: Macmillan
Jeffrey A. Schaler, Ph.D., lives in Silver Spring, Maryland.
He is an adjunct professor at American University's School of
Public Affairs in Washington, D.C., and teaches psychology
for Johns Hopkins University and Montgomery College in MD.
E-mail: jschale@american.edu