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The following essay is reproduced here by permission of Sheldon Richman, Editor, Ideas on Liberty. Ideas on Liberty is published by The Foundation for Economic Education, Irvington-on-Hudson, NY 10533. Szasz, T. The psychiatric collaborator as "critic." Ideas on Liberty, Vol. 51, No. 8, September 2001, 29-30.



Thomas S. Szasz, M.D.

Critics of religious and political despotisms do not defend the oppressive practices of the institutions they oppose. Religious and political tyrants are brutally intolerant toward those who defy their doctrines, and recognize such opponents as enemies. Huss was burned at the stake. Galileo was silenced. The Nazis and Communists killed, imprisoned, persecuted, and defamed their opponents. In modern psychiatry, the opposite situation prevails: So-called psychiatric critics defend coercive psychiatric practices, and are, in turn, celebrated as anti-dogmatists.

Ronald D. Laing and Sally Satel
In the late 1960s, Laing postured as a radical critic of psychiatry. His close collaborator, psychiatrist David Cooper, coined the term "antipsychiatry" to identify their work. Psychiatry and the media embraced them as dissident psychiatrists. However, Laing "worked with" involuntary mental patients, "treated" schizophrenics with drugs (LSD), and never criticized psychiatry's paradigmatic procedures, civil commitment and the insanity defense.

Although Laing is often said to have repudiated the idea of mental illness, this view is erroneous. Among the aims of the Philadelphia Association, a tax-exempt organization he founded in the United Kingdom, were the following:

To relieve mental illness of all descriptions, in particular schizophrenia. To undertake, or further, research into the causes of mental illness. To promote and organize training in the treatment of schizophrenia.

In Sally Satel, the media has discovered another radical critic of psychiatry who loves psychiatric coercion. In an article, titled "A Critic Takes On Psychiatric Dogma, Loudly," a reporter for the New York Times describes Satel as a psychiatrist at a methadone clinic in Washington, who has been "dubbed the ‘most dangerous psychiatrist in America,'" and applauds her "relentless questioning of psychiatric dogma."

What dogma does Satel question? "I reject," she writes, "the notion that addicts ... are not responsible for anything they do. ... addiction is fundamentally a problem of behavior, over which addicts have voluntary control." If addiction is voluntary behavior, what is Satel doing "treating" it with methadone?

Addressing Robert Downey Jr.'s run-ins with drug police, Satel reiterates that addiction is "a decision, not a disease" and adds: "[Downey's] situation shouldn't be used to argue against the virtues of drug treatment." Satel's position regarding drug addiction and drug policy is self-contradictory, to put it mildly.

The principal dogmas of psychiatry are that certain unwanted behaviors are diseases, that coercion is a treatment, and that excusing guilty persons of their crimes and depriving them of liberty is a merciful and scientific form of therapeutic justice. Satel supports every one of these beliefs and the practices based on them. She states:

New York State, "should put a statute on the books that allows outpatient commitment."

"The Colin Fergusons and John Hinckleys must be treated for a severe mental illness and society needs to be kept safe from them."

"Force is the best medicine. .. legal sanctions -- either imposed or threatened --may provide the leverage needed to keep them alive by keeping them in treatment. Voluntary help is often not enough."

Although many members of the media are charmed by Satel's self-contradictions, not everyone is fooled. In his review of Satel's book, P.C., M.D.: How Political Correctness Is Corrupting Medicine, Jacob Sullum writes: "[In Satel's view], while coercing the schizophrenic is justified because he can't control his behavior, coercing the addict is justified because he can." This, of course, is classic psychiatric dogma. By definition, psychiatric coercion is a "good," a value that trumps logic, truth, and liberty." Declares Steven S. Sharfstein, President and Medical Director at the Sheppard Pratt Health System and Clinical Professor of Psychiatry at the University of Maryland: "The coercion [of the mental patient] must be a caring one insofar as there is present a panoply of services -- a full hospital without walls."

Critic or Collaborator?
Satel identifies herself as a conservative, is a fellow at the American Enterprise Institute, a prestigious conservative think tank, and often publishes in the editorial pages of the Wall Street Journal. Is she a conservative? Conservatives are supposed to mean what they say and say what they mean. We don't call just any piece of metal a key, unless it is used as a key to open a lock. Similarly, we ought not to call just any medical intervention a treatment unless the phenomenon it intends to ameliorate is a disease -- and, most importantly for traditional conservatives and libertarians, unless the person subjected to it consents to it. If we regard other people's bad habits as diseases, enact laws that prohibit and punish such behaviors as treatments, we replace discovering diseases with decreeing diseases -- in short, abandon limited government and democracy in favor of unlimited medical caprice and pharmacracy.

Satel, concludes Sullum, "ends up defending authoritarian policies." She ends up defending psychiatric correctness as well. "The point of imposing treatment," she explains, "is to help patients attain autonomy, to help them break out of the figurative straightjacket binding thought and will." This is plainly wrong. The patients' thought and will are not bound, as evidenced by their refusal to take the drugs psychiatrists want them to take. But not to worry: being drugged against your will by psychiatric doctors is a "right" you are incapable of exercising: "Many people with untreated schizophrenia become incapable of ... exercising their rights as individuals. Being required to take medication is hardly a violation of the civil rights of a person who is too ill to exercise free will in the first place. The freedom to be psychotic is not freedom." Some critic of psychiatric dogma. Satel's fatuities about liberation by oppression are standard psychiatric cant. Long time ago, Thomas G. Gutheil, professor of psychiatry at Harvard, asserted: "The physician seeks to liberate the patient from the chains of illness; the judge from the chains of treatment. The way is paved for patients to ‘rot with their rights on.'"

Compare these psychiatrists' double-talk with the plain talk of Sir James Coxe, a nineteenth-century English MP testifying before the House of Commons Select Committee on the Operation of the Lunacy Laws in 1877: "I think it is a very hard case for a man to be locked up in an asylum and kept there; you may call it anything you like, but it is a prison." Clearly, there is no end to the pretentious nonsense that psychiatrists dream up about disapproved behaviors and their "treatment" by drugs and coercions.

According his son, Adrian, Laing was infatuated with "using drugs for therapeutic purposes" and "had great difficulty in accepting the assertion of another's individuality and independence." So much for Laing as the humanizer of madness.

Regarding Satel's enthusiasm for the involuntary treatment of addicts, I submit that such "treatment" stands in the same relation to the voluntary treatment of diabetics as rape stands to sex between consenting adults. As long as we accept that certain misbehavior are diseases and that coercing misbehaving persons is a treatment, conservatives delude themselves when they complain about the "nanny state." Nannies don't treat diseases and have no power to prohibit or prescribe drugs, much less forcibly administer them to innocent people. Doctors do.

Copyright 2001, by The Foundation for Economic Education

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