SEATTLE POST-INTELLIGENCER
http://seattlepi.nwsource.com/opinion/115509_mentalcon03.shtml
Remember psychiatric patient's civil rights
Thursday, April 3, 2003
By THOMAS SZASZ
PSYCHIATRIST
"The madman is not the man who has lost his reason. The madman is the
man who has lost everything except his reason." -- Gilbert K.
Chesterton
The Washington Legislature is considering two bills that ostensibly
deal with psychiatric advance directives. I say "ostensibly"; because
these bills, and all others like them, are reaffirmations of the
mental patient's status as de jure medical patient and de facto
psychiatric slave.
Barely a century and a half ago, a black man in America was treated
as a slave or as not a slave. Today, every American is potentially in
such a position: He is treated as a mental patient deprived of civil
rights or as not a mental patient possessing civil rights. Once
placed in the role of mental patient, he is, for all practical
purposes, a slave of the mental health system.
What is the purpose of a psychiatric advance directive? There are
only two options: A PAD can enhance the powers of relatives and
psychiatrists who want to "treat" people whom they regard as mentally
ill or it can enhance the powers of people designated as mentally ill
who want to reject the role of mental patient and rely on the legal
system to support their right to divorce their would-be benefactors.
There is no third possibility.
The supporters of House Bill 1041 and Senate Bill 5223 claim that
mental illnesses are brain diseases. If true, there would be no need
for PADs.
No neurological patient -- suffering from multiple sclerosis or
Parkinson's -- can be treated against his will. We have no
neurological health laws but we do have mental health laws.
It is bad faith and hypocrisy to ignore the identity of the parties
that support the enactment of mental health laws and PADs.
They are the relatives of so-called mental patients, their powerful
lobby, the National Alliance of the Mentally Ill, and most important,
the American Psychiatric Association. Organizations of former mental
patients, who correctly call themselves victims and survivors
of "psychiatric abuse," are conspicuous by their absence.
The aims of the supporters of PADS and of the politicians who endorse
their efforts are thinly disguised: They wish to expand the state's
power to "treat" people for mental illness and obstruct the
individual's power to reject coercion by psychiatric agents of the
state, provided their use of force is called care or treatment.
Here are three statements from HB1041 that illustrate its aim to
tighten the shackles already fastened on America's psychiatric
slaves: Only an "individual with capacity has the ability to control
decisions relating to his or her own mental health care."; The
proposed PAD does not "supersede a determination of medical
necessity." The proposed PAD may not "be used as the authority for
inpatient admission for more than 14 days in a 21-day period."
In other words, in vain would a person execute a PAD for the purpose
of rejecting involuntary psychiatric interventions of all kinds: He
could still be committed and treated against his will. The avowed
desires of patients and doctors conflict far more often in
psychiatry -- in which "therapeutic" interventions are routinely
imposed on patients against their will -- than in any other branch of
medical practice.
Thus, advance directives are particularly important and useful for
potential psychiatric patients, not to permit treatment but to refuse
it. Any PAD that does not offer this option, valid even if contested
by psychiatric expert opinion, serves the interest not of the
denominated patient but the interest of his "benevolent"; adversaries.
It may be well for us to remember some remarks on involuntary
servitude that, unhappily, apply equally to our country's practice of
involuntary psychiatry.
James Madison said: "We have seen the mere distinction of color made
in the most enlightened period of time, a ground of the most
oppressive dominion ever exercised by man over man" while Jefferson
Davis said: "[Slavery is] a moral, social, and political
blessing . . . [It is] the most humane relations of labor to capital
which can permanently subsist between them.";
The problem we now face is just as clear and just as tragically
intractable. Anglo-American law assumes, as a matter of fact, that
the relationship between a person and a legal agent of the state is
adversarial. The student of law is taught the duties and roles of
both prosecuting attorney and defense attorney. Both jobs are
legitimate and proper.
Anglo-American psychiatry assumes, as a matter of law and psychiatry,
that the relationship between a person and a psychiatric agent of the
state is therapeutic. The student of psychiatry is taught only the
duties and roles of psychiatrist administering treatment; the
psychiatrist has no other legitimate duties or roles.
Only the job of the coercive psychiatrist is legitimate and proper.
The psychiatrist who tries to help the coerced patient reject the
patient role is likely to be cast out of the profession as a renegade
and rejected by the court as an expert.
All the so-called ethical problems of psychiatry flow from this
source. Washington state's proposed psychiatric advance directive
pretends to extend the mental patient's civil rights but does the
opposite: It asks the unsuspecting patient to sign away his right to
be free of psychiatric meddling.
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Thomas Szasz, M.D., is professor of psychiatry emeritus at SUNY
Health Science Center in Syracuse, N.Y. His most recent book
is "Liberation By Oppression; A Comparative Study of Slavery and
Psychiatry"; (Transaction Publishers 2002).
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