Academic journal article Independent Review

The Case against Psychiatric Coercion

Academic journal article Independent Review

The Case against Psychiatric Coercion

Article excerpt

"To commit violent and unjust acts, it is not enough for a government to have the will or even the power; the habits, ideas, and passions of the time must lend themselves to their committal."

--Alexis de Tocqueville (1981, 297)

Political history is largely the story of the holders of power committing violent and unjust acts against their people. Examples abound: Oriental despotism, the Inquisition, the Soviet Gulag, the Nazi death camps, and the American war on drugs come quickly to mind. Involuntary psychiatric interventions belong on this list.(1)

When Tocqueville referred to "unjust acts," he was speaking as a detached observer, viewing state-sanctioned violence as an outsider. From the insider's point of view, state-sanctioned violence is, by definition, just. The Constitution of the United States, for example, recognized involuntary servitude as a just and humane economic policy. Throughout the civilized world people now recognize involuntary psychiatry as a just and humane therapeutic policy. Making use of the fashionable rhetoric of rights, a prominent psychiatrist describes adding the "right to treatment" to the existing criteria for assessing civil commitment as a "policy more realistically and humanely balancing the right to be sick with the right to be rescued" (Treffert 1996).

The fact that the psychiatrist is authorized to use force to impose the role of mental patient on legally competent persons against their will is prima facie evidence that the psychiatrist possesses state-sanctioned power. In 1913, Karl Jaspers ([1913] 1963)(2) acknowledged the unique importance of this element of psychiatric practice. He wrote:

Admission to hospital often takes place against the will of the patient

and therefore the psychiatrist finds himself in a different relation to his

patient than other doctors. He tries to make this difference as

negligible as possible by deliberately emphasizing his purely medical

approach to the patient, but the latter in many cases is quite convinced

that he is well and resists these medical efforts. (839-40)

The systematic exercise of force requires legitimation. Formerly, Church and State, representing and implementing God's design for right living, performed this function. Today, Medicine and State perform it. W. H. Auden ([1962] 1968) put it thus:

What is peculiar and novel to our age is that the principal goal of

politics in every advanced society is not, strictly speaking, a political

one, that is today, it is not concerned with human beings as persons and

citizens, but with human bodies.... In all technologically advanced

countries today, whatever political label they give themselves, their

policies have, essentially, the same goal: to guarantee to every member

of society, as a psychophysical organism, the right to physical and

mental health. (87)

So long as the idea of mental illness imparts legitimacy to psychiatric coercion, the myriad uses of psychiatric compulsions and excuses cannot be reformed, much less abolished. Hence, for those opposed to psychiatric coercion, the principal adversary is its legitimacy.

The Varieties of Power

In social affairs, power is usually defined as the ability to compel obedience. Its sources are coercion from above and dependency from below. By coercion I mean the legal or physical ability to deprive another person of life, liberty, or property, or to threaten such "punishment." By dependency I mean the desire or need for others as protectors or providers.(3) "Nature," observed Samuel Johnson ([1709-84] 1981), "has given women so much power that the law has very wisely given them little" (172). The sexual control women wield (over men who desire them) is here cleverly contrasted with their legal subservience (a condition imposed on them by men). …

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