Remember psychiatric patient’s civil rights By THOMAS SZASZ - Response by Fred A. Baughman Jr., MD

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Sent: Thursday, April 03, 2003 10:41 AM
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http://www.szasz.com/updates.htm


The Seattle Post-Intelligencer,Thursday, April 3, 2003

http://seattlepi.nwsource.com/opinion/115509_mentalcon03.shtml



Thursday, April 3, 2003

Remember psychiatric patient's civil rights

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.
===============================================================
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).