Allen Frances, through a series of blogs about Eleanor Langdon and his email exchanges with her following “An Open Letter to Allen Frances,” has attempted to grapple with their two perspectives, finding both common and divergent ground. In his most recent blog, Frances adds to these dialogues his dinner conversation with Thomas Szasz from 35 years ago, and the difficult questions of social coercion that persist.
I find Allen Frances’ statements problematic on many levels:
– An anecdote of 35 years ago is hardly the official position of Thomas Szasz’s on the matter. This video from a talk he gave at the CATO institute 10 years ago refutes Frances’ assertion http://www.cato.org/multimedia/events/libertarian-principles-psychiatric-practices-are-they-compatible .
– With no data to back it up, he says “the majority of patients who do well come to recognise the necessity of the intervention and are thankful for the protection it afforded. Advance directives are a useful way to handle the risk of future recurrence”
I have asked many times for a scientific study that supports that statement, I haven’t gotten any. All I have gotten from different psychiatrists is an anecdotal “in my experience…”. Such a study, to be of any value, would have to eliminate the bias of the captive nature of the relationship psychiatrist/person coerced into psychiatry, which would be hard to do. Ariel Castro is on record saying that while the girls he kidnapped were in captivity http://tv.msnbc.com/2013/08/01/cleveland-kidnapper-ariel-castro-the-sex-was-consensual/ “most of the sex that went on in that house, probably all of it, was consensual.” Given that in our current legal regime, psychiatrists’ threat of “coercion” doesn’t end when people get their freedom of the hospital back, any “retrospective validation” of coercive psychiatry should be looked with suspicion.
– Fundamentally, this is about human rights. Even if such a study was possible, and even if 99.99% of those forcibly treated reach the conclusion that they were happy with the coercion, that should have no bearing on the right of the individual to reject coercive psychiatric treatment in the absence of a crime. It is really this simple. Statistically speaking, being a young black male who is drug user in an inner city is a better predictor of violence than any of the DSM labels. Yet, we do not preemptively lock up every such young black male for what “they might do and to treat them for drug addiction” even if we could have suspicions that said black male might be retrospectively grateful. As Jacob Sullum said http://www.cato-unbound.org/2012/08/24/jacob-sullum/legal-moral-problems-involuntary-commitment “then, too, retrospective gratitude could be used to justify all manner of paternalistic interventions, whether or not they involve a psychiatric diagnosis. If the government began kidnapping obese people and forcing them into a strict diet-and-exercise program, how many newly thin former captives would eventually be thankful for the help? Let’s not find out.”
At the end of the day, the positioning with respect to coercive psychiatry is what separates those who believe in inalienable human rights and those who don’t.
I have mixed feelings about the dialogue presented here.
Sure having better treatment for mental distress would be something I share, however I do wonder what is really on offer when it comes to “advance directives” and less use of force. Does it mean that there would be greater effort to persuade a person to take a drug before they are forced? Does it mean that an advance directive would be drawn up to show how a person would prefer to be treated?
In the UK an advance directive in respect of mental health treatment is pretty much worthless, due to it having no legal standing. I could draw up an advance decision to refuse medical treatment in respect of physical health conditions but such a right does not extend to mental health conditions. You may be able to get some leeway with some psychiatrists but there is no security that if hospitalized treatment given would be anything other than the “as usual”.
A big issue for me is the type of treatments that are forced on people who may be deemed psychotic or manic. The treatments are neuroleptic drugs that are damaging and ineffective over the long term. These are drugs that are “recommended” for a long period (years) and they are extremely difficult to stop taking. I appreciate crisis situations exist, and as such I feel a short-term approach with drugs, and not necessarily neuroleptics, is most often the best, especially when dealing with a person at early contact with mental health services.
Perhaps the “silly bickering” seems more serious when it’s your arse on the wrong side of the hypodermic full of clopixol? Personally I feel the problems with psychiatric drugs, especially those coerced/forced need to be addressed before any moving on can be done.
This whole discussion is worth a read…
Thomas Szasz supported abolition of coercive psychiatry, he was against reform. Ergo, he would have said, joining with the chorus from Allen Frances first sentence, “Never.” Another thing, he would have never referred to Philip Pinel as a liberator. He exposed Pinel’s throwing off of chains for the theater that it was. Okay, so you remove the chains your prisoner was wearing from your prisoner. Is she free to come and go at will? No, she’s a prisoner. If she objects, you can always throw her into solitary confinement. What words passed between Thomas Szasz and Allen Frances in a more relaxed and jocular moment mean very little. Allen Frances should read some of Thomas Szasz’s many published works sometime. Apparently, he didn’t know the man very well at all.
It’s Longden. Eleanor LONGDEN. L-O-N-G-D-E-N.
Since Thomas Szasz is no longer with us and therefore unable to respond to Allen Frances’s dinner conversation I have asked Jeffrey Schaler, lifelong friend of Szasz and owner of the Szasz.com website for his opinion. He states that Frances’s anecdote has ‘zero credibility’.
From Thomas Szasz, Law, Liberty and Psychiatry, New York: Macmillan, 1963, pp. 153-4, Szasz asks: “Which should we prefer, the integrity of the family or the autonomy of the individual?” For Szasz the choice is easy. He declares “Autonomy is my religion.”
Thomas Szasz took the decision to end his own life and remains a man of integrity, true to his words.
Jeffrey Schaler has responded by email as follows.
“I just don’t have time to keep up with the kind of nonsense that Allen thinks is important, and that the Huffington Post should not have published — Hearsay.
I simply do not find Dr. Frances’s comments worthy of response. Moreover, Professor Szasz’s numerous writings and lectures since at least 1960, speak for themselves. I discussed these and related issues with Dr. Frances at
an online invited debate at the Cato Blog. In my opinion, he is engaging in “damage control.” He failed miserably in addressing the issue of psychiatric slavery, and now he’s using a classic “red-herring” approach to try to deflect attention away from the errors of his ways.”