Involuntary mental hospitalization is like slavery. Refining the standards for commitment is like prettifying the slave plantations. The problem is not how to improve commitment, but how to abolish it.
In my view, involuntary hospitalization and the insanity defense ought to be abolished, exactly as slavery was abolished, or the disfranchisement of women was abolished, or the persecution of homosexuals was abolished. Only then could we begin to examine so-called ‘mental illnesses’ as forms of behavior, like other behaviors.
The most important deprivation of human and constitutional rights inflicted upon persons said to be mentally ill is involuntary mental hospitalization….
For centuries, involuntary psychiatric interventions were regarded as things done for the so-called patient rather than as things done to him…increasing numbers of persons, both in the mental-health professions and in public life, have come to acknowledge that involuntary psychiatric intervention are methods of social control. On both moral and practical grounds, I advocate the abolition of all involuntary psychiatry.
Since civil commitment results in the loss of liberty, and subjects the victim to health hazards at the hands of medical criminals whose ostensible healing function is legitimized by the state, it entails a far greater deprivation of rights than does incarceration in prison, a penalty carefully circumscribed by constitutional guarantees and judicial safeguards.
It is dishonest to pretend that caring coercively for the mentally ill invariably helps him, and that abstaining from such coercion is tantamount to ‘withholding treatment’ from him. Every social policy entails benefits as well as harms. Although our ideas about benefits and harms vary from time to time, all history teaches us to beware of benefactors who deprive their beneficiaries of liberty…. There is neither justification nor need for involuntary psychiatric interventions….
[I]f we do not discourage easy commitment, there will never develop the social tension which may be necessary for creating adequate facilities for, say, indigent old people.
[V]oluntary mental hospitalization is always potentially and often actually a covert form of involuntary mental hospitalization” with patients often “enter[ing] a psychiatric institution under the threat of commitment. Once confined, they cannot secure their release as can medical patients, and when they insist on release against psychiatric advice, they may be committed by their relatives and physicians.
Institutional psychiatry is a continuation of the Inquisition. All that has really changed is the vocabulary and the social style. The vocabulary conforms to the intellectual expectations of our age: it is a pseudo-medical jargon that parodies the concepts of science. The social style conforms to the political expectations of our age: it is a pseudo-liberal social movement that parodies the ideals of freedom and rationality.
The psychiatric enterprise is founded on force and fraud. I call any and all forms of involuntary psychiatry—which today means virtually all psychiatry-psychiatric slavery. The battle for psychiatric abolition is a noble struggle, just as the battle for the abolition of slavery was a noble struggle. We must continue and intensify our efforts until—to paraphrase Voltaire—’ecrasez l’infame’: the infamous thing is crushed.
To be sure some people are dangerous. We in America—especially if we live in the big cities—need hardly be reminded of this painful fact. But in American law, dangerousness is not supposed to be an abstract psychological condition attributed to a person; instead, it is supposed to be an inference drawn from the fact that a person has committed a violent act that is illegal, has been charged with it, tried for it, and found guilty of it. In which case, he should be punished, not ‘treated’—in a jail, not in a hospital.
To attain the goal of abolishing involuntary psychiatry, we would also have to acknowledge that so-called psychiatric diagnoses, prognoses, hospitalizations, and treatments not explicitly sought by clients for their own use are coercive.
What would become of psychiatry if involuntary psychiatric diagnoses, hospitalizations, and treatments were abolished? In principle, psychiatry would then become more like any other medical specialty, such as dermatology or opthalmology—practiced only on voluntary clients. More generally, it would become like any other profession, such as accounting or architecture—contracting for the sale of certain services and products with informed buyers. In practice psychiatry would then have to identify and define—as it never has to before—the services it offers for sale. Clearly, such a change would spell doom of psychiatry as we now know it.