The Therapeutic State
SEPTEMBER
2001
The Psychiatric
Collaborator as "Critic"
C ritics of religious and political despo-
tisms do not defend the oppressive
practices of the institutions they oppose. Reli-
gious and political tyrants are brutally intoler-
ant toward those who defy their doctrines,
and recognize such opponents as enemies.
Huss was burned at the stake. Galileo was
silenced. The Nazis and communists killed,
imprisoned, persecuted, and defamed their
opponents.
In modern psychiatry, the opposite situa-
tion prevails: So-called psychiatric critics
defend coercive psychiatric practices and are,
in turn, celebrated as anti-dogmatists.
In the late 1960s, Ronald Laing postured as
a radical critic of psychiatry. His close collab-
orator, psychiatrist David Cooper, coined the
term "antipsychiatry" to identify their work.
Psychiatry and the media embraced them as
dissident psychiatrists. However, Laing
"worked with" involuntary mental patients,
"treated" schizophrenics with drugs (LSD),
and never criticized psychiatry’s paradigmatic
procedures: civil commitmentand the insani-
ty defense.
Although Laing is often said to have repu-
diated the idea of mental illness, this view is
erroneous.
Today in Sally Satel, the media has discov-
ered another radical critic of psychiatry who
loves psychiatric coercion. In an article,
Thomas Szasz (tszasz@aoLcom), M.D., is professor
of psychiatry emeritus at SUNYUpstate Medical Uni-
versity in Syracuse. He is the author of Pharmacracy:
Medicineand Politics in America,just publishedby
Praeger.
29
by ThomasSzasz
titled "A Critic Takes On Psychiatric Dogma,
Loudly," a reporter for the NewYork Times
describes Satet as a psychiatrist at a
methadone clinic in Washington, who has
been "dubbed the most dangerous psychiatrist
in America," and applauds her "relentless
questioning of psychiatric dogma."
What dogma does Satel question?
"I reject," she writes, "the notion that
addicts . . . are not responsible for anything
they do .... [A]ddiction is fundamentally a
problem of behavior, over which addicts have
voluntary control?’ If addiction is voluntary
behavior, what is Satel doing "treating" it
with methadone?
Addressing Robert DowneyJr.’s run-ins
with drug police, Satel reiterates that addic-
tion is "a decision, not a disease" and adds:
"[Downey’s] situation shouldn’t be used to
argue against the virtues of drug treatment."
Satel’s position regarding drug addiction and
drug policy is self-contradictory, to put it
mildly.
The principal dogmasof psychiatry are that
certain unwantedbehaviors are diseases, that
coercion is a treatment, and that excusing
guilty persons of their crimes and depriving
them of liberty is a merciful and scientific
form of therapeutic justice. Satel supports
every one of these beliefs and the practices
based on them. She states:
¯ NewYork State "should put a statute
on the books that allows outpatient
commitment?’
¯ "The Colin Fergusons and John Hinck-
30 IDEAS ON LIBERTY * SEPTEMBER 2001

leys must be treated for a severe mental explains, "is to help patients attain autonomy,
illness and society needsto be kept safe to help them break out of the figurative
from them." straightjacket bindingthoughtand will."
¯ "Force is the best medicine.... [L]egal This is plainly wrong.Thepatients’ thought
sanctions--either imposed or threat- and will are not bound,as evidencedby their
ened--mayprovide the leverage needed refusal to take the drugs psychiatrists want
to keep them alive by keeping them in themto take. But not to worry: being drugged
treatment. Voluntary help is often not against your will by psychiatric doctors is a
enough." "right" you are incapable of exercising:
"Manypeople with untreated schizophrenia
Although manymembersof the media are become incapable of... exercising their
charmedby Satel’s self-contradictions, not rights as individuals. Beingrequired to take
everyoneis fooled. In his review of Satel’s medicationis hardly a violation of the civil
book, PC, M.D.:HowPolitical CorrectnessIs rights of a person whois too ill to exercise
Corrupting Medicine, Jacob Sullumwrites: free will in the first place. Thefreedomto be
"[In Satel’s view], while coercingthe schizo- psychoticis not freedom."
phrenic is justified becausehe can’t control Somecritic of psychiatric dogma.Satel’s
his behavior, coercingthe addict is justified fatuities about liberation by oppression are
becausehe can." standard psychiatric cant. Along time ago,
This, of course,is classic psychiatricdogma. ThomasG. Gutheil, professor of psychiatry at
Bydefinition, psychiatriccoercionis a "good," Harvard, asserted: "The physician seeks to
a valuethat trumpslogic, truth, andliberty. liberate the patient fromthe chainsof illness;
the judge from the chains of treatment. The
wayis paved for patients to rot with their
Critic or Collaborator? rights on."
Satel identifies herself as a conservative;is Comparethese psychiatrists’ doubletalk
a fellow at the AmericanEnterprise Institute, with the plain talk of Sir James Coxe, a
a prestigious conservative think tank; and nineteenth-century English MPtestifying
often publishes in the editorial pages of the before the House of Commons Select Com-
Wall Street Journal. Is she a conservative? mittee on the Operation of the LunacyLaws
Conservatives are supposed to meanwhat in 1877:"I think it is a very hard case for a
they say and say what they mean. Wedon’t manto be locked up in an asylum and kept
call just anypiece of metal a key, unless it is there; youmaycall it anythingyoulike, but it
usedto opena lock. Similarly, weoughtnot to is a prison."Clearly,there is no endto the pre-
call just any medicalintervention a treatment tentious nonsensethat psychiatrists dreamup
unless the phenomenon it intends to amelio- about disapprovedbehaviorsand their "treat-
rate is a disease--and,mostimportantfor tra- ment" by drugs and coercions.
ditional conservativesand libertarians, unless RegardingSatel’s enthusiasmfor the invol-
the person subjected to it consents. If we untarytreatmentof addicts, I submitthat such
regard other people’s bad habits as diseases "treatment"stands in the samerelation to the
and enact laws that prohibit and punish such voluntary treatment of diabetics as rape
behaviorsas treatments, wereplace discover- stands to sex betweenconsentingadults.
ing diseases with decreeing diseases--in As long as they accept that certain misbe-
short, we abandon limited government and haviors are diseases and that coercingmisbe-
democracy in favor of unlimited medical having persons is a treatment, conservatives
caprice and pharmacracy. delude themselves whenthey complainabout
Satel, concludesSullum, "ends up defend- the "nannystate." Nanniesdon’t treat diseases
ing authoritarian policies." She ends up and have no power to prohibit or prescribe
defending psychiatric correctness as well. drugs, muchless forcibly administer themto
"The point of imposing treatment," she innocent people. Doctors do. []