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In the debate of involuntary hospitalization, Thomas Szasz and Paul Chodoff hold rather opposing views. This is not a debate of facts, reason, or logic, though both these men, I fear, would violently protest otherwise, for they both present opinion and interpretation as such. The bottom line, as it were, is simply, how these two men perceive human rights, not as they are regarded by society, but how each believes they should be. Szasz contends that, “there are no mental illnesses” and that “no one should be cast into the role of mental patient against his will”. While Chodoff proclaims that, “mental illness does exist” and it is the duty of physicians to treat the ill, even if it is against their will. They argue over right and wrong, moral and immoral, just and unjust, but, the utmost difference in their perceptions of human rights, forces each on opposite sides of the question should one be free of safe?
Thomas Szasz exclaims his horror at “coercive psychiatry” and demands that its practice should be abolished. Because he believes that mental illness is merely a myth, Szasz is outraged that anyone could be held against his/her will in its name. He contents that “patients” are the mental hospital’s euphemism for “inmates”. Szasz compares these patients not only to prisoners, but to slaves, proclaiming that the doctors who commit patients to hospitals involuntarily, do so with the same paternal biases that were implemented by the owners of African slaves in America. Szasz explains that because the afflicted have deviated from societal norms and rejected conformity, these hospitals are used not to cure the sick, but that, “when such persons are hospitalized involuntarily, the primary purpose is to exercise social control over their behavior”. It is in this theft of liberty that Szasz finds an utter lack of justice.
Paul Chodoff holds quite a different perception of involuntary hospitalization. He feels that it is the right of “the mentally ill to be treated and protected”, and that these rights are “being put aside in the rush to give them their freedom at whatever cost”. Chadoff carefully explains the criteria that should be used in determining weather or not to commit a patient, allowing little room for mistakes. Chodoff also makes use of case studies to provide his audience insight into the lives of the severely mentally ill, as to justify their confinement.
The relevance of this issue is extraordinary in our society. It challenges two of our inherent beliefs, that we should help the needy, and that freedom is a self evident, divinely endowed right. To take away this constitutional essential requires extreme circumstances, and to do so without the theft of “life, liberty, of property”(James Madison), is unthinkable. However, this happens every day, weather it be a corrupt police officer, or the institutionalization of the mentally ill without their consent. Freedom, in my opinion, is more important than safety. Although Thomas Szasz and I differ on fundamental ideas, I must concede that he is correct when expressing that involuntary hospitalization is the, “mortal enemy of individualism and self-determination”.
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“Mental illness does exist, Chodoff is right about this. Although major links have been made to mental illness’s biological causes, none of these is definite; no concordance rate is one hundred percent. However it is the contention of your humble narrator that it is an individual’s responsibility to seek and accept treatment for these illnesses, not the state’s responsibility to decide who is ill, and who is sane. It may very well sound “devoid of compassion” to expect a psychotic to recognize his/her illness and seek treatment, but the fact is that most people with mental illnesses seek out help, and many more accept it if it is offered. There can be no freedom without responsibility, and it is the systematic loss of our responsibility at the hands of a government that feels, with the same paternalistic compassion with which Szasz charges psychiatrists, that it has the superiority to run our lives better than we can. They dictate to us morals, garnish from us money so that they may save for our retirement, and they have all but destroyed laissez faire
. What if a man broke his arm, and he did not want to go to the hospital to fix it? Would you risk his infection, mutilation, and death to maintain his liberty? Of course. “Each person is the proper guardian of his own health. Weather bodily, or mental and spiritual”(Mill). A person’s life is they’re own. However, America is submerged in a bog of hypocrisy concerning this point. We cheer Dr, Kevorkian in his compassionate efforts at euthanasia, while it is a crime to drive a car without a seatbelt fashioned. There is a difference you say, Kevorkian is trying to end suffering, while the lack of a seatbelt can cause it. I am sick and tired of this argument of compassion, a mainstay in Chodoff’s paper. If I were to die in a car wreck having moronically not worn a seatbelt how compassionate would you be for me. It was my choice, my responsibility, my own endangerment of my self that led to my death, no one else’s. No one should, “in a free society”, be forced to wear a seatbelt, and no one should be imprisoned against their will unless they have infringed on another’s life, liberty, or property.
Chodoff illustrates that the dangerousness standard seems to be the base to which, almost everyone can agree, when it comes to involuntary hospitalization. If a person displays a likelihood of performing “behavior dangerous to others or self” he/she should be detained for the betterment of themselves and society. This argument has more holes in it than the Aquatic Ape Theory. Does society keep a criminal in prison past his sentence on the presumption that he could commit a crime again? The mere statistical evidence of repeat felons would warrant concern for their safety and the safety of others, and they are let go merrily on their way, but mental patients, if even a suspicion arises, can be kept in confinement. A society based on “the rule of law” does not convict a person before he commits a crime; this radically unjust idea forces glances back to the carefree days of McCarthyism. It can even be taken further, if the “others” were omitted then the statement would simply leave “behavior dangerous to self”. Once again, one is not infringing on anyone else’s life, liberty, or property, by hurting one’s self. There are many causalities in the war for freedom, and if a few die so that many can be free, it is a steep but reasonable price. Just as in this country, the price of the protection of the innocent, and the integrity of the court, is the frequent acquittals of guilty people, who, in extreme cases, may even take lives, and it is those few deaths that guarantee justice for many.
Paul Chodoff proclaims “these severely ill people are not capable of deciding what is best for themselves”. Thomas Szasz addresses this indirectly with his “slave” comments, contending that, just as the Anglo-Americans presumed to know what was best for the heathen African people, so does the “medical model” psychiatrist for the mentally ill. Also an argument can be made that no “people are not capable of deciding what is best for themselves”, for we are all flawed human beings. However, to allow a few to subjectively decide weather or not a person is capable of reasoning is a travesty. No person, no matter the level of intelligence, experience, or knowledge of a perceived disease, has any claim to dictate to a human being his/her rights. Even the most compassionate of doctors is not omnipotent, and should not be granted such authority.
Each man argues his perceptions well, they raise opposing questions and attempt to discredit them. Both are passionate about their opinions, and each employ, at times subtle, and at times obvious, jabs at the other’s character. Szasz compares his opponents to slave masters, Soviet Communists, and even Nazis, while Chadoff appears to mourn the lack of sympathetic compassion in his counterparts. I myself have alluded to McCarthyism while disputing opposing opinions, it is a dirty trick, but it works. Though I believe it is impossible to care for the mental needs of individuals in a society that deems individuality a crime so immense that it warrants the nullification of juris prudence, I would not attempt to pontificate this as truth, it is merely my perception. Because there is no absolute truth in a matter such as this, there can be no right and wrong, merely interpretations of each. In Psychology, as in most of life’s institutions, the middle ground is king. While Chadoff fears that, “instead of acknowledging the difficulty of the problem, the two camps will become polarized, with a consequent rush toward extreme and untenable solutions rather than working toward reasonable ones”, I believe that it is with a dialogue of both of these extremities of perceptions that the cooler heads can form they’re own interpretation, and mold the moderate beliefs that actually govern the system, rather than scrutinize it.
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