There is so much that is wrong about the mental health legislation proposed by Pennsylvania Representative Tim Murphy, and reasons to oppose it have been well presented by the National Coalition for Mental Health Recovery. But we want, in this editorial, to add one other element to this opposition. We understand too that time is of the essence, and that objections to members of Congress need to be made today (Monday, March 31.)
The legislation will expand the use of court-ordered treatment. The public is led to believe that the expansion of such mandated treatment is a progressive measure. The mandated treatment brings helpful medical care, e.g. antipsychotic medication, to people who are too sick to realize they need it. But, in fact, people objecting to taking an antipsychotic may have a good reason for doing so, and our societal delusion on this issue obscures the fact that court-ordered “outpatient treatment” represents a fundamental assault on individual liberty.
For the public to embrace this legislation, it needs to believe that antipsychotic medication is a necessary and essential treatment for the “seriously mentally ill.” Support for the law would evaporate if the public knew that antipsychotics have been shown to shrink the brain, and that studies have found that long-term use of these drugs may impair recovery. That is knowledge that comes from research by Nancy Andreasen, the former editor of the American Journal of Psychiatry, and from numerous others, including the NIMH-funded study by Martin Harrow. But American psychiatry and the NIMH have never publicized those findings to the American public, and the result is that we, as a society, are deluded about the merits of antipsychotics. It is that delusion that makes passage of the Murphy Bill possible.
Without a medical rationale, the moral context for court-ordered treatment is this: The state is asserting a right to alter people for its own benefit. The desires of the state trump the person’s individual rights. Indeed, mandated treatment ultimately says to a person: you do not have the right to remain in our society as you are, and even though you may not have committed a crime, society has the legal right to change who you are. Antipsychotics, of course, are designed to alter how a person thinks and experiences the world, and thus court-ordered treatment is asserting state authority over an individual’s mind and body.
We wish that all members of Congress would re-read the opening lines to the Declaration of Independence before voting on the Murphy bill. They would be reminded of how our Founding Fathers declared that all men are endowed by their creator with certain “unalienable Rights,” which include “Life, Liberty, and the pursuit of Happiness,” and thus understand that any law that ordered a person, against his or her will, to take an antipsychotic was profoundly un-American.
The other purported rationale for court-ordered treatment, beyond that of providing a person with helpful medical treatment, is that it will reduce the risk that a “mentally ill” person will commit an act of violence. Assisted outpatient treatment will keep society safe. Now let us put aside the question of whether outpatient commitment laws can be expected to actually achieve that end. The more pertinent point is this: Our Constitution doesn’t allow for locking people up based on the thought that they may be likely to commit a crime in the future. Yet, ordering a person to take an antipsychotic, which is in fact expected to act as a restraint on behavior, is akin to doing just that.
The great sin in American history, of course, is that our society for so long denied the liberty and basic rights of black Americans. First slavery, and then nearly a century of Jim Crow laws. It took the United States nearly two hundred years to enact a law that was designed to protect the civil rights of all Americans. Congress should think of that history as it ponders Murphy’s bill.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.