Big Brother Psychiatry

The mayor of my hometown, Albuquerque, has proposed to follow in New York State’s footsteps and legalize the forced medication of the “mentally ill.” Given the sordid history of government involvement with “mental illness,” Mayor Martin J. Chávez is leading Albuquerque—and the rest of the country in his wake—down a very slippery slope.

Chávez (whose other recent proposals include a draconian curfew and a program to take away the vehicle of anyone arrested for—not convicted of—drunk driving) wants to give the state the power to coerce the most vulnerable members of society into taking medicine, supposedly for their own good. Under a New York-style “Kendra’s Law,” the courts can define who is “mentally ill,” and—even before an individual has done anything wrong—force them to undergo treatment and take psychiatric medicine.

Of course, “mental illness” is a notoriously ill-defined ailment and subject to great manipulation by the psychiatric establishment and the state. Thomas S. Szasz, professor emeritus of psychiatry at the State University of New York in Syracuse, Michel Foucault, historian and philosopher, and others have shown that governments have frequently applied labels of “madness,” “insanity,” and “mental illness” to political and social dissidents.

The Nazis’ misuse of psychiatry is one of the more recent examples. During Operation T4, German psychiatrists branded those citizens who did not meet the Nazi criteria for normality as “feebleminded” and subsequently had them “euthanized” in German psychiatric hospitals. The Soviet government operated in a similar fashion, labeling those who chafed under the yoke of communist dictatorship as insane and forcing them to take mind-altering drugs.

As Foucault argues, governments initially began the practice of managing “lunacy” toward the end of the Middle Ages, creating asylums for those whose behavior was deemed abnormal. With little scientific understanding of mental illness, “lunatic” was a broadly defined label that too frequently included the deaf, the mute, and the intellectually slow. “Treatment” meant squalid living conditions and physical abuse. Beginning in the 18th century, some steps were taken to make treatment of the mentally ill more “humane,” but well into the 20th century these people were still confined to asylums and forcibly subjected to terrifying treatments like shock therapy. With reason, such institutions acquired the label “snake pit.”

By the 1960s, many states in the U.S. began reassessing hospitalized mental patients, releasing those not deemed to be a danger to themselves or others and passing laws making it more difficult to commit individuals without their consent. Many asylum patients were released, albeit with mixed results.

Now some states are trying to bring the mentally ill back under state control. Kendra’s Laws, which force non-hospitalized individuals to take medication to control some condition defined by the government as mental illness, are just one more chapter in this long history of state-controlled psychiatry.

But is this what the public really wants?

The temptation to misuse psychiatry is ever present. The practice of declaring dissidents insane in order to control their behavior did not end with Hitler or Stalin. Today, in Russia, as the Los Angeles Times reported on May 30, local governments quietly hustle off to mental asylums those individuals who get on the wrong side of local politicians. Considering the Russians’ track record under Soviet rule, perhaps that’s no surprise.

But the U.S. has its own past and present abuses of the term “mental illness” to live down. Here, the label has been applied to a wide range of behaviors that deviate from accepted social norms. Homosexuality, for example, was defined as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1987. Transgendered persons are still labeled mentally ill, although it’s hard to see what danger they pose to themselves or others. While New Mexico human rights laws prohibit discrimination on the basis of gender identity, transgendered behavior remains in the latest DSM, which lists “Transgendered Fetishism and Gender Identity Disorder” as a mental health problem.

Chávez, of course, is not proposing to forcibly medicate the transgendered, but these kinds of classifications raise troubling questions for proponents of Kendra’s laws. The disorders in the DSM are defined so broadly that nearly everyone could be classified as having something wrong with their head. Do citizens really want to open this can of worms?

I think not. A far better approach would be to promote informed choice. Mental health advocates should disseminate information to the mentally ill about the treatment options available, which should be varied and easily accessible. Potential patients should know the possible benefits and risks (especially in the case of dangerous psychotropic drugs) of various treatment options.

Furthermore, giving patients choice in their mental health care would significantly improve the outcome of their therapy. A British research institute last March concluded that giving mental health vouchers that allow patients to select their treatment would “improve services and ultimately help to improve our mental health.” Chávez needs to seriously consider some of these less coercive options before forcibly drugging some of our fellow adult citizens and setting a terrible precedent for the rest of the country.



Alex Harris ’08 is a social studies concentrator in Winthrop House. He is president of the Harvard Libertarian Forum.