Freedom, Psychiatry, and Responsibility

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VOLUME 1, ISSUE 4 PSYCHNEWS INTERNATIONAL July 1996

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 and meet the actual legal criteria for competency to stand trial (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. The law is applied to support bias and partiality.

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 dictates 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. During the Inquisition, denying the existence of witches was viewed as a "sign" of being a witch. Today, denying the existence of mental illness 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 such 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 is hypothesized.

LIBERTY AND RESPONSIBILITY

Responsibility and liberty are positively correlated. The more we expect people to be responsible for their behaviors, the more we increase liberty. 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 all 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 to support bias and partiality.

It discriminates between mentally health 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

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