On April 29, 2002, President George W. Bush issued an executive order creating a new commission charged with finding ways to "improve America's mental health service delivery system." One year later, the Orwellian-sounding New Freedom Commission on Mental Health released its findings. Its final report recommended mental health screening for all Americans and, in a proposal that should alarm parents everywhere, recommended that the nation's schools be used to assess the mental health of all schoolchildren.

While each new federal plan or program seems more ludicrous than the last, the commission's desire to screen the mental health of all Americans is not just another big government boondoggle. From its "newspeak" name to its ambitious proposals, the plan to assess the mental health of all Americans is similar to the Bush administration's other totalitarian constructions, from the Department of Homeland Security to the infamous Patriot Act.

It may not seem obvious, but the authoritarian impulse has been an ever-present undercurrent within the mental health industry. Indeed, totalitarian governments of the recent past, and some of the present, have sought to use dehumanizing and compulsory psychological controls to manage public opinion and pathologize dissent. These efforts have included sophisticated propaganda campaigns, psychological indoctrination in the schools, concentration camps used to "re-educate" those who, in holding opinions dissenting from those of the ruling regime, were considered "insane," and a variety of invasive brainwashing techniques.

Certainly, the Bush administration would prefer to portray its interest in federal oversight of the nation's mental health as a plank in its platform of "compassionate conservatism," rather than as a potential giant step toward the total state. But given the authoritarian background of the mental health industry, the past abuses visited upon innocent civilians by oppressive governments, and the Bush administration's history of promulgating potentially oppressive policy, the prospect of an unprecedented and unconstitutional role for the federal bureaucracy in mental health care bodes ill for the cause of liberty.

Coercion and Control

It has become commonplace to think of psychiatric diagnoses in the same way that one thinks of medical diagnoses. The two, however, are radically different. Medical diagnoses are based on actual physical malfunctions. Psychiatric diagnoses, though, are based on mental abnormalities. The latter are, by definition, nonphysical. Consequently, most treatments advocated and prescribed by the mental health industry are not cures for diseases in the traditional, medical sense. While consultations with mental health care providers may benefit or "treat" many people, systemically mental health treatments have more in common with behavior modification and thought control than with normal medical practices.

No one has been more critical of the mental health industry than Thomas Szasz. A psychoanalyst by training and a libertarian by choice, Szasz began courting controversy in a serious way in 1961 with the book The Myth of Mental Illness. He has argued, persuasively, that there is a substantial and crucial difference between diseases of the body and diseases of the mind. Diseases of the physical body, like pneumonia, can be diagnosed accurately based on work done in the laboratory, but mental disorders like schizophrenia cannot. "Most educated people," Szasz said in an interview with Reason magazine in July 2000, "know how real disease is diagnosed, lf a person ... says he is tired, he has no energy, and he looks very pale, the physician may think he is anemic. But the diagnosis is not made until there is a finding in the laboratory that he has a diminished blood count, a diminished hemoglobin level.... As soon as that can be done with schizophrenia, it will be a brain disease, exactly as neurosyphilis was recognized as a brain disease. …