Psychiatry’s bible, the DSM, is doing more harm than good

Published on April 27, 2012, by Paula J. Caplan in the Washington Post

About a year ago, a young mother called me, extremely distressed. She had become seriously sleep-deprived while working full-time and caring for her dying grandmother every night. When a crisis at her son’s day-care center forced her to scramble to find a new child-care arrangement, her heart started racing, prompting her to go to the emergency room.

After a quick assessment, the intake doctor declared that she had bipolar disorder, committed her to a psychiatric ward and started her on dangerous psychiatric medication. From my conversations with this woman, I’d say she was responding to severe exhaustion and alarm, not suffering from mental illness.

Since the 1980s, when I first made public my concerns about psychiatric diagnosis, I have heard from hundreds of people who have been arbitrarily slapped with a psychiatric label and are struggling because of it. About half of all Americans get a psychiatric diagnosis in their lifetimes. Receiving any of the 374 psychiatric labels — from nicotine dependence disorder to schizophrenia — can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions. And if patients take psychiatric drugs, they risk developing physical disorders such as diabetes, heart problems, weight gain and other serious conditions. In light of the subjectivity of these diagnoses and the harm they can cause, we should be extremely skeptical of them.

Psychiatric diagnosis is unregulated, so the doctor who met briefly with the aforementioned patient wasn’t required to spend much time understanding what caused her heart to race or to seek another doctor’s opinion. If he had, the patient would have realized that her bipolar diagnosis wasn’t necessary or appropriate. Neither on her ER trip nor in later visits to therapists did anyone explain how sleep deprivation impairs the body’s ability to handle pressure.

In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization; even electroshock is still performed.

According to the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines the criteria for doling out psychiatric labels, a patient can fall into a bipolar category after having just one “manic” episode lasting a week or less. Given what this patient was dealing with, it is not surprising that she was talking quickly, had racing thoughts, was easily distracted and was intensely focused on certain goals (i.e. caring for her family) — thus meeting the requisite four of the eight criteria for a bipolar diagnosis.

Continued here

DOES INSANITY CAUSE CRIME

by Thomas S. Szasz, M.D.

The following essay is reproduced here by permission of Sheldon Richman, Editor, Ideas on Liberty. Ideas on Liberty is published by The Foundation for Economic Education, Irvington‐on‐Hudson, NY 10533.

Szasz, T. “Does insanity ‘cause’ crime?” Ideas on Liberty, 50: 31‐32 (March), 2000.

ʺThe madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.ʺ ‐ Gilbert K. Chesterton

For three hundred years we have sidestepped confronting the truth about human desperation and depravity, and the horrors the desperate and the depraved can inflict on us and themselves.

In November 1999, Andrew Goldstein, a man with a long history of psychiatric encounters, was tried for murdering a young woman named Kendra Webdale by pushing her under a New York subway train. The defense was insanity. The jury was unable to agree on a unanimous verdict. Goldstein was retried in the spring of 2000.

Crimes Have Reasons, Not Causes
There was no dispute about the fact that Mr. Goldstein pushed Ms. Webdale to her death. Nor was there dispute about what, regardless of the juryʹs verdict, was to be Mr. Goldsteinʹs fate for the foreseeable future: he would be deprived of liberty (by being incarcerated in jail, a mental hospital, or a hybrid institution called a ʺforensic facilityʺ). The problem is that whenever a person factually guilty of committing a serious crime pleads insanity, the jury is asked to answer an intrinsically nonsensical question, namely, what ʺcausedʺ the defendant to commit his wrongful act: his self or his mental illness? If the former, then he is a guilty victimizer. If the latter, then he is an innocent victim (of insanity). I say the question is nonsensical because, regardless of whether a person is (deemed to be) sane or insane, he has reasons, not causes, for his action. If we regard the actorʹs reasons as absurd or ʺcrazy,ʺ we call him insane or mentally ill. However, that does not prove that an alleged condition (ʺinsanityʺ or ʺmental illnessʺ) caused him to commit the forbidden act. In short, the insanity defense combines and conflates two problematic elements about ʺinsanityʺ: 1) what is ʺitʺ (as a phenomenon or disease)?; 2) does it cause and excuse bad behavior?

Although no one can define insanity, nearly everyone believes that he can recognize it ʺwhen he sees it.ʺ Still, the question remains: What is ʺitʺ? In principle, this question ought to be debatable. In practice, it is not: all socially recognized authorities agree that insanity is a brain disease.

For the sake of clarifying the issue before us, let us admit that (false) claim. In that case, insanity is similar, say, to Parkinsonism or a stroke, brain diseases diagnosed and treated by neurologists. A brain disease may, indeed, be a cause. But a cause of what? Typically, of a behavioral deficit, such as weakness, blindness, paralysis. No brain disease causes complex, coordinated behaviors, such as the crimes committed by Andrew Goldstein or John Hinckley, Jr.

The insane person is, after all, a person, a human being. Only legal tradition and psychiatric‐professional self‐interest, not facts or logic, compel the law to frame the juryʹs task as a choice between deciding whether an insane defendant is bad or mad—guilty (by reason of free will) or not guilty (by reason of insanity). If a ʺmad killerʺ is sick, he could—like an HIV‐infected killer or a tubercular killer—be imprisoned for his crime and ʺtreatedʺ for his illness in prison.

Millions of people are said to be mentally ill or insane. Not all of them commit crimes. Although a mad person such as Mr. Goldstein is regarded as being mad much of the time or even all of the time, he kills only some of the time. When a mad person kills someone—just as when he petitions a court to be released or eats his dinner—he does so because he decides to do so. Hence, if the madman commits a crime, justice demands that we take him seriously and punish him for his deed.

The Insanity Defense: From Solution to Problem
The insanity defense, as we know it, is a relatively new cultural invention. I believe it is not possible to understand the problems it causes unless we understand the problems it solved in the past and solves today.

The ʺcrimeʺ that led to the creation of the insanity defense was not murder, but a deed long considered even more heinous, namely, self‐murder or suicide, punished by both ecclesiastic and secular penalties: the suicide was denied religious burial and his estate was forfeited to the Crownʹs Almoner. Because punishing suicide required doing grave harm to innocent parties—that is, to the suicideʹs children and spouse—men sitting on coronerʹs juries eventually found the task to be a burden they were unwilling to bear. However, prevailing religious beliefs precluded repealing the laws punishing the crime. The law now came to the rescue of the would‐be punishers, offering them the option of finding the self‐killer non compos mentis and hence not responsible for his deed. In the eighteenth century, it became a matter of routine for juries to arrive at the posthumous diagnosis that the suicide was insane at the moment he killed himself. (The criminal law against suicide was repealed only in the nineteenth century, by which time it had been replaced by mental health laws.)

The celebrated English jurist William Blackstone (1723‐1780) recognized the subterfuge and warned against it: ʺBut this excuse [of finding the offender to be non compos mentis] ought not to be strained to the length to which our coronerʹs juries are apt to carry it, viz., that every act of suicide is an evidence of insanity; as if every man who acts contrary to reason had no reason at all; for the same argument would prove every other criminal non compos, as well as the self‐murderer.ʺ It was too late. By validating the fiction that suicides could, post facto, be found to have been non compos mentis, the law had crafted a mechanism for rejecting responsibility—the criminalʹs for his deed, the juryʹs for its duty—and, aided by the medical profession, wrapped the deception and self‐deception in the mantle of healing and science.

We must keep in mind that the impetus for excusing self‐murder did not come from its ostensible beneficiaries, the victims of the law against suicide. Clearly, it could not have come from them: the self‐killer was dead; his family, bereft of means and reputation, was powerless. Instead, the impetus for the insanity defense came from those who needed it and had the political clout to make law and medicine embrace it—that is, judges and lawyers, coroners and mad‐doctors. Coronerʹs juries and judges could thus evade the burden of having to impose harsh penalties on the corpses of suicides and the widows and orphans they left behind; and physicianʹs could pride themselves for saving innocent persons from suffering for the sin‐crimes of ʺinsaneʺ self‐killers.

The result of the practice of routinely excusing suicides of their sin‐crimes by viewing them as insane was that persons suspected of being suicidal began to be incarcerated in insane asylums. Soon that, too, became a routine practice and reinforced the belief that persons who kill themselves or others are insane, and that the insane are likely to kill themselves or others.

Copyright 2001, by The Foundation for Economic Education
Thomas S. Szasz Cybercenter for Liberty and Responsibility:
Copyright © 1998‐2001 by the author of each page, except where noted. All rights reserved.

The Illegality of Forced Drugging and Electroshock

 

POSTED ON MAD IN AMERICA, on MARCH 21, 2012

BY JIM GOTTSTEIN 

Court ordered psychiatric drugging and electroshock is illegal when measured against the constitutional requirements for forcing someone to ingest drugs, or be subjected to electroshock, against their will.

Under the United States Constitution, if a right is considered “fundamental,” in order to infringe on that right, the government is (a) required to have a compelling interest (reason),  (b) the method chosen to further that interest must be reasonably assured to achieve its objective, and (c) the method must be narrowly tailored, meaning there cannot be a less restrictive or intrusive means of achieving the objective.  This was most recently articulated in 2003 by the United States Supreme Court in Lawrence v. Texas, as follows:

Our opinions applying the doctrine known as “substantive due process” hold that the Due Process Clause prohibits States from infringing fundamental liberty interests, unless the infringement is narrowly tailored to serve a compelling state interest.

Let’s apply these principles to forced drugging and electroshock.  In 2003 the United States Supreme Court  also decided Sell v. United States, in which the government wanted to force Dr. Sell, a dentist, to take neuroleptics, to ”restore” him to competence so he could stand trial for health care fraud.  The U.S. Supreme Court held such forced drugging permissible under the constitution only when the following conditions are met:

1. The court must find that important governmental interests are at stake.
2. The court must conclude that involuntary medication will significantly further those concomitant state interests.
3. The court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.
4. The court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.  (emphasis in original).

This is classic analysis of a fundamental right under the due process clause.  I will address each of these requirements in turn.

Governmental Interests

What is the government’s important interest in forcing someone to be psychiatrically drugged or electroshocked against their will?   It depends.  (The answer to all legal questions)   More specifically, there are various situations in which the issue comes up and the government’s interests are different in each one.

Standing Trial On Criminal Charges

In Sell, the government’s interest was to restore Dr. Sell to competency so that he could be put on trial for healthcare fraud.   To be competent to stand trial for a crime, a defendant must be able to understand the nature of the charges and be able to assist his or her lawyer.   Clearly, being able to put someone on trial for murder is an important enough governmental interest.   However, is putting someone on trial for “illegal use of telephone,” such as calling 911repeatedly, an important enough interest to force someone to take psychotropic drugs against their will?   I don’t think so.

 Civil Commitment

Most of the time we think of forced psychiatric drugging and electroshock in the context of civil commitment.   In this setting, there are two justifications (governmental interests).  The first is known as Parens Patriae, which is Latin for ”parent of the nation,” and means the government is stepping in to act as a parent for someone who cannot take care of him or herself.  In other words, “We are from the government and are here to help you.”    In order for the government to be able to assert this right, it has to prove the person is incompetent to decide for him or herself.  These determinations, in themselves, are illegitimate and could be the subject of an entire article, in itself.  However, I will limit this to a couple of comments.

First, one can look at the transcript of Faith Myers’ testimony (pp 0123-0148)) to decide for oneself whether she was incompetent to decline the medication and then look at the judge’s decision (pp  12-14).  To me, the judge’s decision that Faith was incompetent to decline the medication was a travesty.

Second, I will note that the reasoning to find someone incompetent to decline the medication or electroshock, is often circular in that when a person says they don’t want the psych drug(s) or electroshock because it doesn’t work and/or is harmful, that is cited as proof the person is delusional and incompetent.  In the Myers case, the psychiatrist testified in a deposition (pp 39 – 43) that if someone agrees to to take the medication, he decides the person is competent and if not, the person is incompetent.

In fact circular reasoning is enshrined in Alaska Statutes 47.30.837(d)(1)(B), where it provides, “denial of a significantly disabling disorder or impairment, when faced with substantial evidence of its existence, constitutes evidence that the patient lacks the capability to make mental health treatment decisions.”

The second justification for forced drugging and electroshock in the civil commitment context is safety, i.e., that the person must be drugged for their own safety or those of others.  This is known as the “Police Power” justification.  Forced drugging under this justification also tends to be an illegitimate process.  First, the safety risk must be extreme.  For example, under Alaska Statutes 47.30.838 (a)(1), emergency forced drugging is only allowed if, “there is a crisis situation, or an impending crisis situation, that requires immediate use of the medication to preserve the life of, or prevent significant physical harm, to the patient or another person.”

In one of the Bill Bigley cases, I took the deposition (PDf pages 34-37) of the hospital psychiatrist about her use of “emergency” medication, which makes clear that (a) she didn’t know what the legal requirements were and (b) Mr. Bigley was being drugged for non-existent emergencies.

Whether the government has a sufficiently important interest in most civil commitment cases is certainly subject to challenge in many cases.

Prison

Another common setting for forced psychiatric drugging is people convicted of crimes and in prison.  Being convicted of a crime and in prison as opposed to being charged with a crime and in jail is a huge difference, legally.  People in prison have the least legal protection.  Thus, with respect to forced psychiatric drugging in prison, the United States Supreme Court held in Washington v. Harper  that the government doesn’t have to show an important or compelling interest, just that it is ”reasonably related to legitimate penological interests,” holding :

[G]iven the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.

Note, that even here, in order to be constitutional the court ordered drugging must be in the person’s medical interest.

OUTPATIENT COMMITMENT

Outpatient Commitment, where people are court ordered to take psychiatric drugs in the community has taken what I consider a bizarre turn.  In 2004, the high court of New York held in the K.L. case that a finding of incompetence was not required, nor was the fundamental right to be free of forced psychiatric drugging involved, because the outpatient commitment statute did not authorize forced drugging, saying “it  simply triggers heightened scrutiny on the part of the physician, who must then determine whether the patient may be in need of involuntary hospitalization.”  In other words, the New York high court held that an [outpatient commitment] order mandating a person take psychiatric drugs does not really compel the person to take psychiatric drugs.  This is a classic example of a court decision being divorced from reality.

There is, however, a 2008 New Mexico case, Protection and Advocacy System v. City of Albuquerque, that recognizes the delusional (my word) nature of the New York high court’s holding that New York’s outpatient commitment law does not involve court ordered medication:

‘R]egardless of whether there are sanctions in the Ordinance for failure to comply with court-ordered treatment, the coercive nature of a court order requiring treatment would clearly allow an act contrary to the statute’s mandate that an individual’s consent be obtained as long as the individual has capacity.”

However, since the City of Albuquerque  case involved whether the city’s ordinance conflicted with state statute and was therefore invalid, the issue was not front and center.

In any event, with respect to the governmental interests involved, in K.L. the New York high court held the police power justification applied as follows:

Inasmuch as an [outpatient commitment] order requires a specific finding by clear and convincing evidence that the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to self or others, the state’s police power justifies the minimal restriction on the right to refuse treatment inherent in an order that the patient comply as directed.

The court also held the parens patriae justification applied as follows:

[T]he state’s parens patriae interest in providing care to its citizens who are unable to care for themselves because of mental illness is properly invoked since an AOT order requires findings that the patient is unlikely to survive safely in the community without supervision;  the patient has a history of lack of compliance with treatment that has either necessitated hospitalization or resulted in acts of serious violent behavior or threats of, or attempts at, serious physical harm;  the patient is unlikely to voluntarily participate in the recommended treatment  plan;  the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the patient or others;  and it is likely that the patient will benefit from [outpatient commitment].

There are many aspects of this that could be discussed at length, but I will just make two short comments.  The first is that the court held the patient must benefit from the drugging, which is highly dubious, at best.   The second, more over-arching, is that many of the requirements for obtaining an outpatient commitment order in New York cannot, in fact, be properly proven in most cases, such as the person is unlikely to survive without the forced drugging.  Again, that so many of these orders get issued demonstrates where I think the legal system vis-à-vis involuntary commitment and forced drugging is most broken, which is the lawyers assigned to represent people don’t do their job.

Forced Drugging Furthering Governmental Interest

The second Sell requirement is that the involuntary medication will significantly further the state interests justifying the forced drugging.  In other words, the forced drugging must accomplish the goal that justifies it.   So, again, the setting matters because that determines what is the state interest(s).   In the restore-a-criminal-defendant-to-competency situation so the state can put the person on trial, the forced drugging must therefore have a good likelihood of making someone competent to stand trial.   However, while in some cases drugs do knock down psychosis, most of the time they merely sedate the person so they are not bothersome.   This was classically stated in the recent reporting in connection with forced drugging of Jared Loughner:

He was removed from a May 25 court hearing when he lowered his head to within inches of the courtroom table, then lifted his head and began a loud and angry rant. But his psychologist has said that since Loughner has been forcibly medicated, his condition has improved. He sat still and expressionless for seven hours at a hearing in September.

Query:  Is sitting still and expressionless for seven hours an indication someone understands the charges against him and can assist his lawyer?   Of course not, it merely shows that the drugs prevent him from being disruptive.  In other words, the assertion that the drugs cause someone to become competent to stand trial can be challenged.  As an aside, I am not in favor of people using mental illness as a way to avoid criminal responsibility for their actions.

In the civil commitment and outpatient commitment contexts, it is also very dubious that the forced drugging will actually achieve the stated goals.   First, we know from Anatomy of an Epidemic and other sources that psychiatric drugs (a) increase rather than decrease violence, (b) dramatically shorten lives, (c) dramatically increase disability; and (d) dramatically decrease recovery.  Thus, it is quite questionable in many cases whether especially the parens patriae justification, in fact, exists.   However, even though psychiatric drugs, especially the antidepressants and neuroleptics, increase violence, the neuroleptics can also render people incapable of causing much trouble.  Thus, neuroleptics very well may further the governmental police power interest in that.

However, it is most often not true that the drugs accomplish the asserted justification for the forced drugging.  Again, the reason why so many forced drugging orders are issued is because the lawyers assigned to represent people, don’t do so.

Less Intrusive Alternatives

The third Sell requirement is the court must conclude that involuntary medication is necessary to further those interests; that there are no less intrusive alternatives.  The Alaska Supreme Court, in the Bigley case, addressed what the requirement means under the Alaska Constitution,

Although the state cannot intrude on a fundamental right where there is a less intrusive alternative, the alternative must actually be available, meaning that it is feasible and would actually satisfy the compelling state interests that justify the proposed state action.

(p. 31)

As Anatomy of an Epidemic, and many studies and other sources demonstrate, as a factual matter, this is rarely the case, especially if the government has to prove there are no less intrusive alternatives by clear and convincing evidence.

Here too, the lawyers appointed to represent people facing forced drugging rarely fulfill their obligation to assert the right to a less intrusive alternative.  However, proving there is a less intrusive alternative can be difficult even if the attorney tries because the hospital has an automatic “expert,” the testifying psychiatrist, while the defendant often does not have the resources to employ an expert or otherwise prepare a case.

In Bigley,  starting at page 30, the Alaska Supreme Court’s discussion of this issue can give one an idea of the way a court looks at it and the difficulties in prevailing.   In addition to the lawyers assigned to represent people not doing their job properly, one of the biggest obstacles is appellate judges, just like trial court judges, believe the common wisdom that the drugs are helpful and nothing else works.  As I wrote in A Three Pronged Approach to Mental Health System Change, this is one of the reasons why educating the public about the truth is so important.

 Best Interests

The final Sell requirement and the one that ultimately leads me inexorably to the conclusion that forced drugging  and electroshock cannot be properly ordered, is the “court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.”  The truth is that while a small percentage of people might rationally decide to take neuroleptics with full knowledge of their lack of effectiveness for most and harm to all, it is not possible for a court to legitimately find by clear and convincing evidence that forcing someone to take them is in their best interest.   Frankly, I don’t think it is possible under the preponderance of evidence standard.

Space doesn’t allow me go through the evidence on this, but Anatomy of an Epidemic  does.   Much of the evidence has also been compiled as part of PsychRights’ and MindFreedom’s Forced Drugging Defense Package.  It includes an affidavit from Robert Whitaker, the“clickable”  verson of which has hyperlinks to the cited studies.   Also, my 2008, law review article, Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course has much of the same material woven with the legal standards and the perspective of people faced with such court proceedings.  The bottom line is the evidence does not support forcing someone to take psychiatric drugs against their will is in their best interests.

The same is true of electroshock in light of the harm and lack of benefit from electroshock.  In contrast to the neuroleptics, however, I think electroshock should be abolished altogether in light of its complete lack of benefit and extreme harm.

 Conclusion

Under the United States Constitution, as well as state constitutions, the government is not allowed to force someone to take psychiatric drugs or be electroshocked against their will unless it can prove such drugging or electroshocking is (1) necessary to achieve a compelling governmental interest, (2) the least intrusive alternative, and (3) in the person’s best interest.   In most cases, neither the 1st or 2nd requirement is met because  (1) the drugging or electroshock does not accomplish the government interest asserted, and (2) there are less intrusive alternatives.   The last element, that the forced drugging or electroshock is in the person’s best interest, however, cannot be legitimately proven, which is why I conclude forced drugging and electroshock in the United States is illegal.

The question that jumps out from these circumstances is why people’s rights are being so pervasively violated?  The short answer, as I indicated in A Three Pronged Approach to Mental Health System Change, is the lawyers and judges believe the conventional wisdom that if the defendant wasn’t crazy she would know it is good for her so we won’t let her pesky constitutional rights get in the way.  This is why educating the public is so important.

In addition to this, however,  a big reason why people’s rights are being violated as a matter of course is the lawyers appointed to represent people faced with forced drugging and electroshock proceedings are not fulfilling their professional obligations when they go along with this.  But that is the subject of a future blog.

 

Electroshock Therapy: Is Oprah Right? Electric Shock Mental Health Treatment, Breeding Psychetruth

Medical Beauty Center, March 21, 2012

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Laura’s law is a VIOLATION of human rights!

San Francisco Chronicle quotes Dr. Mitch Katz saying, ‘psychosis requires medication’… we have one comment for him… ‘GET EDUCATED!!!’

‘Psychosis’, as defined by psychiatry, means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. Depending on its severity, this may be accompanied by unusual, bizarre behavior, or difficulty with social interaction & impairment in carrying out the daily life activities (Wikipedia).

In many countries outside the U.S., the experience of ‘psychosis’ is seen as a spiritual emergence and/or a religious experience and/or enlightenment. Dr. Mitch Katz has deeply offended many people who perceive ‘psychosis’ as such. He should be educated completely before drawing any conclusions about ‘thought-disordered’ states, unless he is willing to suggest medicating all people who drink an alcoholic drink, take other drugs, including all MEDICATIONS, which affect our thoughts!

To further the confusion, Mayor Newsom has also commented by saying that family members will have another tool to seek help for their loved ones before they harm themselves or others. He doesn’t realize that human & civil rights are at sake here and suggests completely violating the U.S. constitution! Mr. Newsom, dear Major, are you ready to take your family’s opinion about your heart condition or any other ‘condition’ you may have? Ms. Alioto-Pier, are you ready for your family to determine your future, due to your ‘conditions’?

Please e-mail Rachel Gordon at rgordon@sfchronicle.com with your letters and comments about Laura’s Law. Perhaps, she’ll have the curtesy to hear all sides and publish them as well!

The following is from the San Francisco Chronicle… August 4, 2010

Rather than watch her legislation to enact Laura’s Law in San Francisco go down to defeat Tuesday, Supervisor Michela Alioto-Pier at the last minute sent the proposal back to committee for further debate in the early fall.

Alioto-Pier’s decision came after San Francisco’s public health director, Dr. Mitch Katz, made a forceful argument to reject the legislation that would allow the city’s mental health chief to petition the civil court to order people with severe mental illness into outpatient treatment.

“Psychosis requires medication and Laura’s Law does not increase our ability to require medication,” Katz told supervisors.

“There is a basic ethical principle in public health,” he added. “Ethical principle is not infringing on someone’s rights unless you have an efficacious treatment. And because Laura’s Law doesn’t allow for medication, I do not believe it fulfills that ethical principle.”

Alioto-Pier knew heading into the board meeting that the vote could go either way. But after Katz made clear his opposition during testimony before the board, winning approval would be “hard but not impossible,” Alioto-Pier said after keeping her legislation from a vote.

However, she said afterward, “I’m committed to getting this done.”

She will have the support of Mayor Gavin Newsom, who bucked his public health director’s opinion, and said Tuesday that he supports Alioto-Pier’s efforts and would like to see San Francisco give Laura’s Law a try. It would give families another tool, he said, to seek help for their loved ones before they harm themselves or others.

Mental health professionals have been split over the state law, which was enacted in 2002.

It was named after Laura Wilcox, a 19-year-old college student who was working in a Nevada County public mental health clinic when she was gunned down by a 41-year-old man with a history of violence who resisted his family’s efforts to get him treatment.

The state left implementation to individual counties, and so far only Nevada County has enacted it fully; Los Angeles County implemented a limited pilot program.

In making her case, Alioto-Pier said that criminal defendants with mental health problems who go through the city’s Behavioral Health Court system and are provided with treatment services as an alternative to incarceration have shown a decrease in psychiatric hospitalization, violence and homelessness.

“Unfortunately in San Francisco, an individual has to commit a crime before receiving these structured treatments,” she said.

Opponents said a chief concern was that the city doesn’t have enough money now to provide services for mentally ill people who voluntarily want them.

“We do not have the resources to be able to enact Laura’s Law,” said Supervisor John Avalos.

Supervisor Chris Daly added, “It’s bad politics, it’s bad form, and having been here fighting to save a $2 million cut here, a $3 million cut there (in existing mental health services), this is frustrating.”

Even if Laura’s Law never is put on the books in San Francisco, Katz said supporters shouldn’t despair.

“The best thing that can come out of this debate is a renewed commitment on the part of San Franciscans to do something meaningful both for people who are impacted themselves and for their family members who are often made to feel disempowered by the system, who are often sort of on the fringes crying, watching their relatives deteriorate,” Katz said.

“Maybe,” he said, “we haven’t put enough attention into this issue.”

US Court Rules in Favour of Free Speech on Health Claims

Will this precedent influence European policy on health claims
for foods and food supplements?

DORKING, UK: The US Food and Drug Administration (FDA) lost its bid to overturn a health claim for selenium‐containing dietary supplements last Thursday in the United States District Court for the District of Columbia. District Court Judge Ellen Huvelle ruled unconstitutional the FDA’s censorship … press to continue

“Behavior is not Disease”, Dr. Szasz

By Dr. Jeffrey Schaler
Assistant Professor of Justice, Law & Society

It is fifty years now since Thomas Szasz rocked the world of psychiatry by writing The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. His work continues to have a profound impact on how we think about disease, behavior, liberty, justice, responsibility, and most important of all, what it means to be human.  Szasz has shown us how the idea of mental illness is used by the state to deprive innocent people of freedom, and guilty persons of justice. Without the state involved, the medicalization of behavior means nothing.

He has shown us how the idea of mental illness functions as legal fiction within our legal system. In this sense, the idea of mental illness has been used much as the idea that African American slaves were considered three-fifths of a person. Persons labeled as mentally ill are now considered three-fifths of a person. It is as if there was a postscript at the bottom of the Bill of Rights that reads: “PS: For mentally healthy people only.”

The courts will not allow the idea of mental illness to be disproved, in much the same way that the idea that slaves could be three-fifths person was not allowed to be disproved. Today, mental illness as legal fiction maintains the institution of psychiatric slavery.

Mental illness diagnoses have more to do with politics and science fiction, than medicine and science. Take for example the idea that people with a homosexual orientation are mentally ill. The category was excluded from the Diagnostic and Statistical Manual of Mental Disorders – our contemporary “Malleus Maleficorum,” or “Hammer of Witches” – the same way it was included, for political reasons, not scientific reasons. No one discovered that homosexuality was a disease, and no one discovered that it isn’t a disease. They pronounced it as such, in each case, because of political pressure.

About two years after The Myth of Mental Illness was first published, Szasz published another book that has had an equally profound impact on freedom and responsibility. In Law, Liberty and Psychiatry he predicted the following:

“Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.”

Thomas Szasz wrote that in 1963.

We live in a Therapeutic State today. Moral management now masquerades as medicine. The state dictates a “duty to be healthy.”

Seventy years ago another state, Nazi Germany, dictated a “duty to be healthy.” Back then, murder masqueraded as medicine. I think you all know what I’m referring to. We don’t need a weatherman to know which way the wind blows.

Today, good health practices have become a social responsibility. Bad health practices are viewed as socially irresponsible behavior. When health and illness are applied to the mind and behavior, this means that people must think and speak and act the right way. Otherwise, they may end up in a prison called a mental hospital.

I am one of the few college professors in the United States, if not in the world, who teaches Szasz’s ideas on a regular basis in college. And in every course, my students have always said at least two things to me: This stuff by Szasz is changing my life. And why hasn’t anyone ever taught his work in class before?

Because professors are punished for teaching Szasz; they can lose their jobs if they do so. I know. I have the scars to prove it. If you read my book, Szasz Under Fire, you will see how the same thing almost happened to Thomas Szasz. He came a hair away from being fired for teaching Thomas Szasz!

The Myth of Mental Illness and the subsequent Law, Liberty and Psychiatry are not so unsophisticated as to deny the existence of behaviors that people find disturbing. Quite to the contrary, Szasz’s writings clarify the difference between behavior and disease, description and explanations for behavior, and the consequences of labeling behavior as a disease within the arenas of law, medicine, social and public policy.

Szasz has simply pointed out what pathologists have always known: A disease refers to cellular pathology. Period. A behavior cannot be a disease. And he has also fought endlessly for the rights of persons labeled mentally ill. He will be ninety years old on April 15. He is still writing one book after another. He writes books faster than I can read them!

He has also shown us how behavior is strategic, the expression of what philosophers call moral agency. Today’s neuroscientists, psychiatrists and clinical psychologists have attempted to reduce man to the category of things. They deny the existence of moral agency. Let me give you one simple example of how this is so.

Conventional wisdom, particularly as it appears in the media, leads people to believe that brains cause behavior, as if the brain could act. Psychiatrists and the neuroscientists they aspire emulate, regard man as a machine, an incredibly complicated machine, but a machine nevertheless. Everything that is human is ultimately reducible to electrical and chemical interactions.

This is especially so when it comes to socially unacceptable, abnormal, disturbing and criminal behavior. Bad brains are said to cause bad behavior. Bad brains, in this, sense refers to problems in the structure and function of the brain.

Now if bad brains cause bad behavior, it only follows that good brains must cause good behavior. In other words, brains that work correctly, brains that are structurally and functionally healthy, cause good and admirable behaviors.

While psychiatrists try to excuse bad behaviors by ultimately blaming bad brains, they inadvertently (or perhaps intentionally) are removing personal responsibility for the good things that people do. When someone commits a heroic deed, for example, shows courage, compassion, and care for others at great personal expense and with great risk of danger, the person is then not choosing to do what is clearly important to do.

The brain, according to this way of thinking, is causing the person to do this good thing, in the same way that a bad brain causes someone to prey on others. There is no need to praise someone for his altruism, heroism, and courage, his brain made him do it.

Some psychiatrists have equated human behavior with seizure activity: An alcoholic reaching for that drink too many is having an epileptic seizure. So is the mother sacrificing her own life for the life of her child.

What is left of the person, if this is so? What is left of the person if brains cause bad and good behavior? What is that represented by the pronoun “I?” What happens to moral agency?

Nothing. From this way of thinking, human beings are reduced to the category of things. Things do not choose, they are caused. Things do not feel. Things are not alive. Things have no conscience, no values, no morality, no ethics. And most important, things do not care, for self or others.

This is the legacy of psychiatry and neuroscience today, when it comes to entertaining biological explanations for behavior. Mind is equated with brain, behavior with disease, good with bad, morality with medicine, and ethics with mechanics. In other words, there is no soul. That which we consider uniquely human is destroyed by psychiatry and neuroscience.

How does this fit into law? Through a simple equation. Liberty and responsibility are two sides of the same coin. If we increase one, we increase the other. If we decrease one, we decrease the other. The more free man is, the more responsible he must be. The more responsible man is, the more he is captain of his own ship.

What institutional psychiatry as an extension of the state would have us believe is this: The more we decrease responsibility, the more we increase freedom. In other words, the more you allow us to be in charge of your life, the more you abdicate responsibility, the more you embrace the paternalism we say is good for you, the more you will be free. For obedience to authority is the greatest political virtue.

What then must we do? Szasz has done his job, what is ours? I believe our job is this: We get psychiatry out of the courthouse. We do not need to destroy psychiatry. It will destroy itself if we sever its invisible umbilical cord to the mother-state. Once psychiatry is available to people by choice only, it will die a natural death. Very few people will seek out psychiatrists if they cannot hire and fire them at will.

Psychiatrists know this. That is why they are so afraid of Thomas Szasz.

And that is why they are so afraid of those who understand what I am saying here. As I tell my students every semester, “don’t believe a word I say. Just think about it and come to your own conclusion.” That kind of independence and autonomy scares institutional psychiatrists and those who run the therapeutic state.

It should.

Jeffrey A. Schaler is an assistant professor of justice, law, and society at American University’s School of Public Affairs in Washington, D.C. Professor Schaler’s work is focused on the “therapeutic state”—the union of medicine and state. He completed his doctoral and master’s degrees in human development at the University of Maryland College Park, where the major emphasis of his research was addiction and social policy. Dr. Schaler is particularly interested in how research in the behavioral sciences is interpreted and applied in public, social, and legal policy arenas. He writes and speaks extensively on the relationship between liberty and responsibility.

Dr. Thomas Szasz is a Professor of Psychiatry Emeritus, State University of New York. He is a well known critic of the moral and scientific foundations of psychiatry and has authored more than 30 books on the subject including the Manufacture of Madness, The Myth of Mental Illness and The Therapeutic State. He is the co-founder of the Citizens Commission on Human Rights (CCHR) and has said of the organization, “We should all honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before.”

Urgent appeal to UN for torture of Special Students in U.S. school

Last week the Mental Disability Rights International (MDRI) alleged torture against children and adults with disabilities in the United States. The MDRI has found children and adults with disabilities tortured and abused at a “special needs” residential facility in Massachusetts and has filed an “urgent appeal” with the United Nations Special Rapporteur on Torture to demand the United States government end the torture immediately.

The Judge Rotenberg Center (JRC) uses punishments as treatment and US advocates have been trying for decades to close the school. At the school, shock treatments are used to punish the students’ behavior and parents take their children there after psychiatrists and psychologists have told them that their children need medication for life in order to function in society. Parents who do not want their children on medications and are discouraged by the medical field, resort to taking their children to this boarding school.

In MDRI’s latest report, Torture not Treatment: Electric Shock and Long-Term Restraint in the United States on Children and Adults with Disabilities at the Judge Rotenberg Center (JRC), it has been documented that this kind of toture: the use of electric shocks on the legs, arms, torsos and soles of feet of people with disabilities goes on for weeks, months and sometimes years at the JRC. MDRI calls for the immediate end to the use of electric shock and long-term restraints as a form of behavior modification or treatment and says, “Torture as treatment should be banned and prosecuted under criminal law.”

MDRI calls on the Special Rapporteur, along with the Obama Administration and the Department of Justice, to end the abuses against people with disabilities at JRC. MDRI is an international human rights and advocacy organization dedicated to the rights protection and full participation in society of people with disabilities worldwide.