THE CASE AGAINST PSYCHIATRIC COERCION*

        by Thomas Szasz**



             * Address to be presented at the Foucault Tribunal, University of Berlin, May 1-2, 1998.
             ** Professor of Psychiatry Emeritus, SUNY Health Science Center, 750 East Adams Street, Syracuse, New York 13210.


        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  

        1

        Political history is largely the story of the holders of power committing violent and unjust acts against their own people. Examples abound: Oriental despotism, the Inquisition, the Soviet Gulag, and the Nazi death camps come quickly to mind. Involuntary psychiatric interventions belong on this list.
        When Tocqueville spoke of "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 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" -- a euphemism for coercive drugging and so-called "outpatient commitment" -- to civil commitment as a "policy more realistically and humanely balancing  the right to be sick with the right to be rescued."

        In modern, Western medicine, it is a well-established moral and legal principle that a person's body belongs to him and that medical intervention without the permission of the patient is tantamount to assault and battery. In 1891, in an often-cited decision, the United States Supreme Court ruled that "No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to possession and control of his own person, free from all restraint or interference of others ... The right to one's person may be said to be a right of complete immunity: to be let alone."
        In 1928, Justice Louis D. Brandeis repeated that famous phrase. He stated: "The makers of our Constitution sought to protect Americans in their beliefs, their thoughts, their emotions, and their sensations. They conferred, as against the Government, the right to be let alone -- the most comprehensive of rights, and the right most valued by civilized men."

        It is difficult to reconcile these opinions with the practices of coercive psychiatry, except by assuming that a diagnosis of mental illness automatically removes the "patient" from the class of human beings called "persons."  However, that interpretation becomes untenable in the light of an opinion -- handed down by  Chief Justice (then Circuit Judge) Warren Burger in 1964 -- that all but declares that the right to be let alone attaches to "irrational" mental patients no less than to anyone else. In an landmark decision concerning the con-stitutionality of letting Jehovah's Witnesses reject life-saving blood transfusion, Burger cited Brandeis' famous admonition and then added: "Noth-ing in this utterance suggests that Justice Brandeis thought an individual possessed these rights only as to sensible beliefs, valid thoughts, reasonable emotions, or well-founded sensations. I suggest he intended to include a great many foolish, unrea-sonable, and even absurd ideas which do not con-form, such as refusing medical treatment even at great risk."  Like the Jehovah's Witness who rejects life-saving treatment for reasons right for him but wrong for others, the mental patient rejects coercive psychiatric treatment for reasons right for him but wrong for others. If the former has a constitutional right to do so, why not also the latter?

        A recent judicial ruling affirming the right to reject treatment for non-mental illness supports my interpretation that such a right applies to rejecting treatment for mental illness as well. In 1993, a prison physician in California "initiated ex parte proceedings seeking order allowing him to use a surgical tube to feed and medicate a quadriplegic prisoner who had refused such medical treatment." The court ruled:
        Right to refuse medical treatment is equally "basic and fundamental" and integral to the concept of informed consent.  Individual's right of personal autonomy to refuse medical treatment does not turn on wisdom, i.e., medical rationality ... Because health care decisions intrinsically concern one's subjective sense of well-being....the state has not embraced an unqualified or undifferentiated policy of preserving life at the expense of personal autonomy. ... As a general proposition, the notion that the individual exists for the good of the state is, of course, quite antithetical to our fundamental thesis that the role of the state is to ensure a maximum of individual freedom or choice and conduct.

        This decision is noteworthy for two reasons. First, because the condition the physician proposed to treat was the patient's decision to refuse food, which is not a bona fide disease; and because the intervention the physician wanted to impose on the patient was feeding him, which is not a bona fide medical treatment. Second, because the court here explicitly granted the individual, as a matter of principle, the right to refuse treatment irrationally. This specification was long overdue and we ignore it at our peril. The physician questions his patient's rationality and competence only when the patient disagrees with what the physician wants to do for/to the patient. How could it be otherwise? How could the physician question the patient's rationality and competence if the patient agrees with him, without impugning his own rationality?* Ergo, if an irrational prisoner has the right to be unmolested by physicians, on what ground could that right be denied a non-prisoner with a right to be presumed rational?

        Lastly, there is a practical reason why patient consent ought to be required for a medical intervention, but that even that ought not to be sufficient for it, namely, because the principle of consent is readily transferable. "Substituted consent" is a well-established moral principle and legal precept, exemplified by parents giving consent in lieu of their minor children, guardians in lieu of their incompetent wards, and, by extension, the state in lieu of its "child-like" citizens (the doctrine of parens patriae). As a result, the  physician-protector transformed into the physician-persecutor, in service to the modern nation state, casts a dark shadow over this blood-soaked century. German, Japanese, and Soviet physicians were flagrantly guilty of violating the two most basic moral rules of medicine, namely, treating persons against their will and engaging in medical killing (that is, killing qua doctors). Finally, psychiatry -- in free and totalitarian countries alike -- has been, and continues to be, guilty of similar crimes against humanity: Psychiatric practices rest on coercion and result in walking corpses, that is, "mental patients" robbed of their humanity, the permanent subordinates of their psychiatric superiors.
         
        Moreover, when a group engages in evil -- by which I mean that its members perpetrate acts which they would hesitate to carry out alone -- it defines evil as good.
        The participation of physicians, especially psychiatrists, in the Holocaust is an example. Surely, it is not happenstance that the mass murder of Jews, Gypsies, and homosexuals was prepared and preceded by the medicalized mass murder of mental patients. Years later, during the trial of Adolf Eichmann in Jerusalem, there was a stark reminder of the fact that, in this century, the physician as executioner has entered upon the stage of history and that it will take time and effort to dislodge him from that role. In the course of defending Eichmann, Robert Servatius, his lawyer, blandly declared, as if it were the most obvious thing in the world, that "Killing, too, is a medical matter."  Servatius did not say that killing was a medical matter. Perhaps he and his client still believed that if the state "consents" to mass murder by doctors, then "killing is a medical matter," a belief consistent with the image of the physician as a soldier in the war against enemies of the state. In this connection, we ought to keep in mind that the fanaticism with which the Nazis waged therapeutic war against homosexuals differed only in degree, not in kind, from the fanaticism with which, over a much longer period, American psychiatrists waged therapeutic war against them, and now wage therapeutic war against sufferers from "addictive diseases."

        Viewed against the background of the history of psychiatry,  there is a lesson in the history of the Holocaust that we have ignored. That lesson is that the aberrations of National Socialist medicine, which we ostensibly abhor, represent an exaggerated version of a type of conflict-resolution to which all modern nations are susceptible that seek medical-therapeutic solutions for their moral-social problems (Therapeutic States). Germany and the United States -- and many other modern nations -- meet that criterion.

         2

        The fact that psychiatrists are authorized to use fraud and force to impose the role of mental patient on persons against their will is prima facie evidence that they possess state-sanctioned power. In 1913, Karl Jaspers 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."

        This problem is just as acute today as it was in 1913 but, sadly, is even more effectively obscured from the public than it was then. For example, Donald F. Klein and Paul H. Wender -- professors of psychiatry, respectively, at Columbia University in New York and at the University of Utah in Salt Lake City -- declare: "In closing, we would like to offer one piece of advice to the depressed patient receiving therapy, who is like any other medical patient receiving therapy."  The naive reader may be mislead into believing that, like regular physicians, psychiatrists do not treat patients against their will.

        The systematic exercise of fraud and force requires legitimation. Formerly,  Church and State -- representing and implementing God's design for right living  -- performed this function. Today, Medicine and the State perform it.  W. H. Auden 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."

         So long as the idea of mental illness continues to legitimize psychiatric fraud and force, psychiatry -- comprising a complex mosaic of medicalized compulsions and excuses -- cannot be reformed, much less abolished. Hence, for those opposed to psychiatric coercions and excuses, the principal adversary is the medical, moral, and political legitimacy of psychiatry, which is its ultimate source of power.
        Power is the ability to compel obedience. Its sources are force from above, and dependency from below. By coercion I mean the legal and/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.* "Nature," observed Samuel Johnson, "has given women so much power that the law has very wisely given them little."  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).

        Because the definition of power as the ability to compel obedience fails to distinguish between coercive and non-coercive means of securing obedience, it is imprecise and potentially misleading. For example, when Voltaire exclaimed, "Ecrazez l'infame!", he was using the word "l'infame" to refer to the power of the Church to incarcerate, torture, and kill people, not to the influence of the priest to misinform or mislead the gullible. The distinction I draw here is not novel, yet needs to be stated and restated. The English-American philosopher Alfred North Whitehead put it thus: "[The intercourse between individuals and between social groups takes one of these two forms, force and persuasion. Commerce is the great example of intercourse by way of persuasion. War, slavery, and governmental compulsion exemplify the reign of force."
        I use the word "force" to denote the power to harm, or threaten to harm, the other*; and the word "influence" to refer to obedience secured by money or other rewards or temptations. The potency of force, symbolized by the gun, rests on the ability to injure or kill the Other; whereas the potency of influence rests on the ability to gratify the Other's desires. By desire I mean the experience of an (unsatisfied) urge, for example, for food, drugs, or sex. The experience is painful, its satisfaction is pleasurable. The individual who depends on another person for the satisfaction of his needs (or whose needs/desires can be aroused by another), experiences the Other as having power over him. Such (though not such alone) is the power of the parent over his child, of the doctor over his patient, of Circ. over Ulysses. In proportion as we master or surmount our desires, we liberate ourselves from  this source of domination.

        The paradigmatic exercise of psychiatric coercion is the imposition of an ostensibly diagnostic or therapeutic intervention on a subject against his will, legitimized by the state as protection of the subject from madness and protection of the public from the madman. Hence,  the paramount source of psychiatric domination is force. Its other source is dependency, that is, the need of the powerless for comfort and care by the powerful. Involuntary psychiatric interventions rest on coercion, voluntary psychiatric interventions on dependency. It is as absurd to confuse or equate these two types of psychiatric relations as it is to confuse or equate rape and mutually desired sexual relations.  I oppose involuntary psychiatric interventions, not because I believe that they are necessarily "bad"  for patients, but because I object to using the coercive apparatus of the state to impose psychiatric relations on persons against their will. By the same token,  I support voluntary psychiatric interventions, not because I believe that they are necessarily "good" for patients, but because I object to using the power of the state to interfere with contractual relations between consenting adults.*

        When a person suffers -- from disease, oppression, or want -- he naturally seeks the assistance of persons who have the knowledge, skill, or power to help him or on whom he projects such attributes. In ancient times, priests -- believed to possess the ability to intercede with powerful gods -- were the premier holders of power. For a long time, curing souls, healing bodies, and relieving social-economic difficulties were all regarded as priestly activities.** Only in the last few centuries have these roles become differentiated, as Religion, Medicine, and Politics, each institution being allotted its "proper" sphere of influence, each struggling to enlarge its scope and power at the expense of the scope and power of the others.
        The separation of Church and State represents a sharp break in western political history. Although still paying lip service to an Almighty, the American Constitution is, in effect, a declaration of the principle that only the State (Government) can exercise power legitimately, and that the sole source of its legitimacy is the "happiness of the people" insured by securing  "the consent of the governed." Gradually, all western states have adopted this outlook. The Argentinean poet and novelist Adolfo Bioy Casares satirized the resulting "happiness" thus:
        Well then, maybe it would be worth mentioning the three periods of history. When man believed that happiness was dependent upon God, he killed for religious reasons. When man believed that happiness was dependent upon the form of government, he killed for political reasons. After dreams that were too long, true nightmares ... we arrived at the present period of history. Man woke up, discovered that which he always knew, that happiness is dependent upon health, and began to kill for therapeutic reasons.
        Among these therapeutic reasons, the treatment of mental illness occupies a unique place.

         3

        Human beings are intensely susceptible to two types of unpleasant experiences, anxiety-and-guilt and pain-and-suffering. Each is a virtually inexhaustible source of dependency, on soul-doctors, body-doctors, or both. Religion -- providing myth and ritual -- relieves people of anxiety-and-guilt and promises a tranquil eternal life in the hereafter. Medicine -- providing diagnosis and treatment -- relieves people of pain-and-suffering and promises a healthy and endlessly extended life on earth. How does psychiatry fit into this picture?

        The practice of the branch of medicine we call "psychiatry" began with the confinement of troublesome persons in madhouses. As a result, two symmetrical populations came into being: The kept, called "madmen" or "mad women," and the keepers, called "mad-doctors." During the eighteenth century, the idea of insanity and the institution of the insane asylum became established as important -- indeed, socially indispensable -- medico-legal concepts and methods of social control. Soon, law, medicine, and popular opinion came to see the insane asylum as the proper place for housing persons authoritatively declared (diagnosed as) insane. Initially, few  people were troubled by the fact that the situation of the insane in the asylum resembled the situation of the prisoner in jail.

        The philosophy of the Enlightenment undermined this complacency, projecting the idea of human rights onto the center stage of western history. Depriving  mental patients of liberty had to be reconciled with society's ostensible devotion to human rights. This task was accomplished partly by conflating and confusing the concept of illness (a bodily condition) with the concept of incompetence (non compos mentis, a legal concept and, subsequently, a "mental" condition); and partly by subsuming civil commitment under the rubric of  the State's police power, that is, its duty to protect the public from "dangerous" persons (lawbreakers). This dual justification of psychiatric coercion has remained essentially constant for almost 300 years.
         
        In the eighteenth century, psychiatric coercion became legitimized by the conjoining of insanity as a disease characterized by the patient suffering from  irresistible impulses with coercive paternalism as an integral part of its proper medical treatment. In the twentieth century, that legitimation, having lost much of its plausibility, needed to be refreshed. Refreshed it was by two quite different developments: first, beginning around 1910, by literary-scientistic prestige of psychoanalysis, and then, after the 1950s, by the alleged effectiveness of antipsychotic drugs. Today, the legitimacy of psychiatric coercions is further re-enforced by brain scanning methods ostensibly demonstrating that mental diseases are brain diseases -- that, nevertheless, ought to be treated by psychiatrists without the patient's consent, rather than by neurologists with the patient's consent.

        Initially, psychiatry and psychoanalysis were distinct and separate enterprises. However, they soon united in a marriage of convenience that proved to be fateful for the future of the "mental health services" industry. Since much of this story is now only of academic interest, I offer here only a few remarks relevant to our present concerns.

        Notwithstanding the sloppy scholarship of many psychiatric historians, it is important to remember that Sigmund Freud was not a psychiatrist. In late nineteenth-century Europe, the term "psychiatrist" meant a physician working in the public mental hospital system. Because Jews were barred from employment in state-run bureaucracies, they could not be psychiatrists and hence could not force people to be their unwilling patients.

        Not only was Freud not a psychiatrist, most psychiatrists viewed his writings as inimical to psychiatry. They objected to Freud's writings not because he opposed involuntary psychiatric interventions; he enthusiastically supported psychiatric excuses and coercions.  Instead, they disapproved of Freud's work because they wanted to see themselves as physicians whose professional identity is firmly anchored in neurology and neuropathology; and because they wanted to see their patients as suffering from bona fide  diseases, that is, bodily abnormalities with physical causes independent of the sufferer's personal history. By introducing a new set of disease-causative agents -- namely, the patient's life-history (especially "traumas" suffered during childhood) -- Freud spoiled -- or enriched, depending on our point of view -- this purely physicalistic conception of etiology and pathology. Thanks to Eugen Bleuler's embrace of psychoanalysis, the seemingly scientific prestige of psychoanalysis reinforced the established social prestige of psychiatry. After World War I, the psychiatric profession became like a mighty river, formed by the confluence of two large tributaries -- the state hospital system (confining and caring for some of the injured and injurious members of society in institutions), and the theory and practice of psychoanalysis (offering a system of interpreting behavior and counseling to non-institutionalized, fee-paying individuals). As a result psychiatric power became more impervious to criticism than ever.

        I do not propose to offer any new information concerning the collaboration between Bleuler and Freud. However, I do propose to draw some fresh inferences from it. Historians of psychiatry and psychoanalysis have overlooked how Freud's coveting the blessings of psychiatry, combined with Bleuler's perceptive use of psychoanalytic insights, re-enforced the legitimacy of the psychiatric enterprise. Herewith the evidence.
        In 1914, in "The history of the psychoanalytic movement," Freud wrote: "A communication from Bleuler had informed me ... that my works had been studied and made use of in the Burgholzli [the state mental hospital in Zurich]. ... I have repeatedly acknowledged with gratitude the great services rendered by the Zurich school of Psychiatry in the spread of psychoanalysis ..."   What did Freud mean here by "psychoanalysis"? Clearly, he could not have meant that its subjects must be voluntary clients, an element that, nine years earlier, he identified as intrinsic to the practice of psychoanalysis. In 1905, Freud declared: "Nor is the method applicable to people who are not driven to seek treatment by their own sufferings, but who submit to it only because they are forced to by the authority of relatives."  If so, psychoanalysis was even less applicable to people who were forced to submit to "it" by the authority of policemen, judges, and psychiatrists.

        It is reasonable to conclude that, in reference to his alliance with the psychiatrists at the Burgholzli, Freud did not use the word "psychoanalysis" to identify a voluntary relationship between a healer and his subject but rather a body of ideas associated with his name. This interpretation is supported by his remark that "Jung successfully applied the analytic method of interpretation to the most alien and obscure phenomena of dementia praecox [schizophrenia], so that their sources in the life-history and interests of the patient came clearly to light. After this, it was impossible for psychiatrists to ignore psychoanalysis any longer."
        As we know, it was not at all impossible for psychiatrists to ignore psychoanalysis, if the term "psychoanalysis" includes respect for the current life-history and civil rights of the patient. Indeed, Freud himself led the legions that joyously proceeded to ignore the most obvious life-historical event in the life of the schizophrenic patient, namely, that a psychiatrist is depriving him of liberty. I have called attention elsewhere to Freud's glaring neglect of Schreber's incarceration. In 1976, I wrote:
        In his most famous study of schizophrenia, the Schreber case, Freud devotes page after page to speculations about the character and causes of Schreber's "illness," but not a word to the problem posed by his imprisonment or his right to freedom. Schreber, who was "psychotic," questioned the legitimacy of his confinement, and Schreber, the madman, sought and secured his freedom. Freud, who was a "psychoanalyst," never questioned the legitimacy of Schreber's confinement, and Freud, the psychopathologist, cared no more about Schreber's freedom than a pathologist cares about the freedom of one of his specimens preserved in alcohol.

        The writer and literary critic Gabriel Josipovici reminds us that "We do not decipher people, we encounter them."  The psychiatrist’s power to coerce the patient negates the possibility of a humane encounter between them. Indeed, interpreted as a command, the rule that we should not decipher but encounter the Other violates the canons of psychiatry and the laws of the Therapeutic State. To remain a psychiatrist, the psychiatrist must view his client as a "patient" afflicted with a dangerous "mental disease," and himself as a physician whose task is not only to treat mental diseases but also to incarcerate innocent patients deemed to be "dangerous," and exculpate guilty patients deemed to be innocent by reason of insanity. No amount of semantic transfusion from the vocabulary of psychoanalysis can, or was intended to, alter these elementary facts of psychiatry, characteristic of twentieth century life in free and totalitarian societies alike.

        One more observation concerning Freud's contributions to the enhancement and legitimation of psychiatric power must be mentioned. In 1914, in his essay  "On narcissism," Freud wrote: "Patients of this kind [schizophrenics] ... display two fundamental characteristics: megalomania and diversion of their interest from the external world -- from people and things. In consequence of the latter change, they become inaccessible to the influence of psychoanalysis and cannot be cured by our efforts."
        Characterizing the schizophrenic as a person who, by turning away from "things and people," deprives himself of the benefits of psychoanalytic treatment is like characterizing the atheist as a person who, by turning away from God, deprives himself of the benefits of religious salvation. Instead of acknowledging that the schizophrenic's avoidance of the ministrations of a psychoanalyst is a decision, similar to a person's decision to avoid the ministrations of a chiropractor or Christian Science healer, Freud defined it as itself a symptom of schizophrenia and implied that if the schizophrenic were willing to submit to the analyst, psychoanalysis could cure him.

        Although both psychiatrists and psychoanalysts now treat psychoanalysis as a branch of psychiatry, the truth is that before psychoanalysis was absorbed into psychiatry, the two enterprises were almost antithetical. Politically, the essence of the psychoanalytic relationship was the absence of coercions (traditionally present) in relations between psychiatrists and mental patients. Practically, this meant that the analyst's failure to respect the patient's personal autonomy and/or his interference in the client's life were incompatible with the psychoanalytic relationship. The respective aims, values, and practices of psychiatry and psychoanalysis may be summarized as follows:

          *** To effect a cure, the psychiatrist coerces and controls his "patient": he incarcerates the (involuntary) victim and imposes various unwanted chemical and physical interventions on him.
          *** To conduct a dialogue, the psychoanalyst contracts and cooperates with his "patient": he listens and talks to his (voluntary) interlocutor, who pays for the services he receives.
        Before psychoanalysis became institutionalized as a profession, the psychoanalytic relationship represented a genuinely new social development, namely, a non-coercive, secular help ("therapy") for problems in living (called "neuroses"). The term "psychoanalysis" then denoted a confidential dialogue between an expert and a client, the former rejecting the role of custodial psychiatrist, the latter assuming the role of responsible, voluntary patient. The psychiatric and psychoanalytic  enterprises were thus based on totally different premises and entailed mutually incompatible practices:
          *** The traditional psychiatrist was a salaried physician who worked in a mental institution; his source of income was the state; he functioned as an agent of his bureaucratic superiors and the patient's relatives. The typical mental hospital inmate was a poor person, cast in the patient role against his will, housed in a public mental hospital.
          *** The traditional psychoanalyst was a self-employed professional who worked in his private office; his source of income was his patient; he functioned as his patient's agent. The (typical) analytic patient was a rich person (usually wealthier than his analyst), cast in the patient role by himself, living in his own home or wherever he pleased.

        As soon as Freud achieved the recognition he craved, he destroyed the core value of the psychoanalytic relationship. I refer to his assuming the authority of certifying competence in psychoanalysis and requiring that individuals seeking to become psychoanalysts undergo a so-called "training analysis." If voluntariness is an essential element of the psychoanalytic relationship, then a compulsory training analysis is a contradiction of terms.* The betrayal of confidentiality intrinsic to training analysis drove a stake through the heart of the role of the psychoanalyst. The result was the destruction of the moral integrity and healing potential of the strictly voluntary, contractual human encounter called „psychoanalysis."  

        4

        For more than forty years I have argued that the institution of psychiatry rests on civil commitment and the insanity defense and that each is a paradigm of the perversion of medical power. If the person called "mental patient" breaks no law, he has a right to liberty. And if he breaks the law, he has a right to be taken seriously, that is, to being adjudicated and punished in the criminal justice system. It is as simple as that. There was a time when the law distinguished between freemen and serfs, between men and women, between Christians and Jews; we now deem those policies -- albeit some of them were also rationalized as paternalistic protections -- to have been destructive of the humanity of the subordinated persons and hence evil. Today, the law distinguishes between mentally healthy persons and mentally ill persons, ostensibly to protect the latter from their fictitious illness. This policy is also destructive of the humanity of the subordinated persons and is therefore evil. Nevertheless, so long as conventional wisdom decrees that the mental patient must be protected from himself, that society must be protected from the mental patient, and that both tasks rightfully belong to a psychiatry wielding powers appropriate to the performance of these duties, psychiatric power will remain unreformable.

        Let us be clear about what it is that we ought to object to: It is the twin legal policies upon which organized psychiatry rests: Civil commitment and the insanity defense. Specifically, we ought to object, first, to inculpating persons innocent of crimes as mentally ill and to any and all forms of involuntary psychiatric interventions; second, to exculpating persons guilty of crimes as mentally ill and then subjecting them, also, involuntary psychiatric interventions. Civil commitment and the insanity defense are like Siamese twins. Kill one, and both will be dead. That is why it is hopeless to try to abolish civil commitment without coming to grips with the implications of the insanity defense, and vice versa. Civil commitment and the insanity defense both authenticate as "real" the socially useful fictions of mental illness and psychiatric expertise. Both create and confirm the illusion that we are coping wisely and well with vexing social problems, when in fact we are obfuscating and aggravating them. Alas, psychiatric power thus corrupts not only the psychiatrists who wield it and the patients who are subjected to it, but the community that supports it as well.

        As Orwell's nightmarish vision of Nineteen Eighty-Four nears its climax, O'Brien explains the functional anatomy of power to Winston thus:
        No one seizes power with the intention of relinquishing it. Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?

        The empire of psychiatric power is more than three hundred years old and grows daily more all-encompassing. But we have not yet begun to acknowledge its existence, much less to understand its role in our society.


          REFERENCES
         . Tocqueville, A. de, quoted in, Auden, W. H. and Kronenberger, L., eds., The Viking Book of Aphorisms: A Personal Selection (New York: Dorset Press, 1981), p. 297.
         . Traffert, D. A., "Dangerousness" (Letters), Psychiatric News, 31: 14 (January 5) 1996.
         . Union Pacific Railway Co. v. Botsford, 141 U.S. 250, 251 (1891).
         . Olmstead v. United States, 277 U.S. 438 (1928), p. 479.
         . See Szasz, T. S., Psychiatric Slavery.
         . Application of President and Directors of Georgetown Col-lege, 331 F. 2nd, 1010 (D.C. Cir. 1964); emphasis in the original.
         . Thor v. Superior Court (Andrews), 855 P.2d 375 (Cal. 1993); pp. 375, 376, 384. The court was citing In re Osborne (D.C. 1972) 294 A. 2d 372, 375, fn. 5.
         . Servatius, R., quoted in Arendt, H., Eichmann in Jerusalem, p. 64, emphasis added.
         . Jaspers, K., General Psychopathology [1913, 1946], 7th edition, translated by J. Hoenig and M. W. Hamilton (Chicago: University of Chicago Press, 1963), pp. 839-840.
         . Klein, D. F. and Wender, P. H., Understanding Depression: A Complete Guide to Its Diagnosis and Treatment (New York: Oxford University Press, 1993), p. 174.
         . Auden, W. H., The Dyer's Hand, and Other Essays [1962] (New York: Vintage, 1968), p. 87.
         . Johnson, S., quoted in, Auden, W. H. and Kronenberger, L., eds., The Viking Book of Aphorisms: A Personal Selection (New York: Dorset Pres, 1981), p. 172.
         . Whitehead, A. N., Adventures of Ideas [1933] (New York: Free Press, 1961), p. 83.
         . Szasz, T. S., "The psychiatric will," American Psychologist, 37: 762-770 (July), 1982.
         . Bioy Casares, A., "Plans for an escape to Carmelo," New York Review of Books, April 10, 198, p. 7.
         . See, Szasz, T. S., Cruel Compassion: Psychiatric Control of Society's Unwanted (New York: Wiley, 1994), Chapter 6.
         . See Szasz, T. S., Anti-Freud: Karl Kraus's Criticism of Psychoanalysis and Psychiatry [1976] (Syracuse: Syracuse University Press, 1990), especially pp. 136-137.
        IViiiFreud, S., "On the history of the psychoanalytic movement" [1914], in SE., vol. 14, pp. 26-27.
         . Freud, S. "On psychotherapy" [1905], SE., vol. 7, pp. 263-264, emphasis added.
         . Ibid., p. 28, emphasis added.
         . Szasz, T. S., Schizophrenia: The Sacred Symbol of Psychiatry [1976], (Syracuse: Syracuse University Press, 1988), p. 39.
         . Josipovici, G., The Book of God: A Response to the Bible (New Haven: Yale University Press, 1988), p. 307.
         . Freud, S., "On narcissism: An introduction" [1914], in SE., vol. 14, p. 74.
         . Szasz, T. S., The Ethics of Psychoanalysis [1965] (Syracuse: Syracuse University Press, 1988).
         . See, Szasz, T. S., "Psychoanalytic training: A socio-psychological analysis of its history and present status," International Journal of Psychoanalysis, 39: 598-613, 1958; and "Three problems in contemporary psychoanalytic training," A.M.A. Archives of General Psychiatry, 3: 82-94 (July), 1960.
         . Orwell, G., Nineteen Eighty-Four (New York: Harcourt Brace, 1949), p. 266.

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