THE DANGER OF THE CONCEPT OF “DANGEROUSNESS”

In The Myth of Mental Illness, I showed that the idea of mental illness implies dangerousness and thus requires and justifies psychiatric coercions.⁶ To civilly commit a person, a psychiatrist (or physician) must certify that the subject suffers from a mental illness and is dangerous to himself and/or others. It is not by accident that when psychiatry was a young and marginalised medical specialty, its primary social function was controlling persons dangerous to others (“mad”); and that now, when it is a mature and respected medical specialty, its primary function is controlling persons who are dangerous to themselves (“suicide risks”).

In his classic treatise on schizophrenia, Eugen Bleuler complained: “People are being forced to continue to live a life that has become unbearable for them for valid reasons. ... Even if a few more [patients] killed themselves, does this reason justify the fact that we torture hundreds of patients and aggravate their disease?” (emphasis added).⁷

Why are psychiatrists expected to prevent suicide by depriving the “suspect” of liberty? The idea of suicide makes us nervous. We cannot decide whether killing oneself is a “right” or a wrong, an element of our inalienable personal liberty or an offence of some sort that ought to be prohibited and perhaps punished. We are too uptight about suicide to recognise that killing oneself is sometimes a reasonable and right thing to do, sometimes an unreasonable and wrong thing to do, but that, in either case, it ought to be treated as an act that falls outside the scope of interference by the state.⁸

The right to kill oneself is the supreme symbol of personal autonomy. Formerly, the church allied with the state prohibited and punished the act. Now, psychiatry, as an arm of the state, prohibits the act and “treats” it as if it were a symptom of an underlying disease (typically, depression or schizophrenia). The deprivation of liberty intrinsic to such an intervention is viewed not as a human rights violation but as a human rights protection. The modern reader may be surprised, perhaps even shocked, at seeing the words “prohibition” and “suicide” bracketed. Lack of familiarity with the long history of the religious prohibition against self murder, together with unquestioning acceptance of coercive psychiatric suicide prevention as “therapy,” make such a reaction a virtual certainty. This is unfortunate.

Formerly, religious doctrine defined the permissible uses of the body. Its impermissible uses—self abuse (masturbation), sex abuse (homosexuality and other “perversions”), substance abuse (drunkenness and gluttony), and self murder (suicide)—were sins, crimes, or both, punished by informal or formal sanctions. Substituting medical for religious doctrine, the modern state, in collaboration with psychiatry, transformed each of these behaviours into diseases of the mind, a view that prevailed through most of the 19th and 20th centuries. After the second world war, and more rapidly in recent decades, some of these mental maladies were divested of their disease status. In my own lifetime, masturbation ceased to be a mental disease or a cause of disease, and homosexuality became not just normal but a “right” others were legally obligated to respect. Yet, during the same period, political, psychiatric, and popular condemnation of self medication and self killing intensified. Using substances decreed to be “dangerous” and illegal is now viewed as an “international plague”, justifying a worldwide “war on drugs”.⁹ Rejecting life and wanting to kill oneself is defined as a severe mental illness characterised by “dangerousness to self,” and is treated as a quasicrime with coercions called “treatments” (especially involuntary “hospitalisation” and forced drugging). Success in committing suicide is regarded as a “waste,” a preventable medical tragedy, often attributed to medical negligence.¹⁰

It is fundamental principle of English and American law that only persons charged with and convicted of certain crimes are subject to imprisonment. Persons who respect other peoples’ rights to life, liberty, and property have an inalienable right to their own life, liberty, and property. Having a disposition or propensity to break the law is not a crime.

Serious debate about matters regarded as mental health problems, especially suicide, is taboo. Liberals have a love affair with coercion in the name of mental health. Conservatives—fearful lest they be dismissed as not compassionate enough about the mentally ill and not scientific enough about mental illness—join in the celebration of psychiatric statism. A columnist for the conservative magazine National Review agrees with the psychiatric dogma that “it is mental illness that causes most suicides: depression, manic depression, and schizophrenia. ... The conservative critique of the therapeutic culture”, he warns, “will not get a hearing until conservatives face up to the reality of mental illness”.¹¹

Speaking about, much less supporting, a right to suicide strikes most people as unimaginably uncompassionate. This opinion is the result of viewing suicide as caused by depression, and depression as a kind of unnecessary, curable unhappiness. We regard this perspective as enlightened and scientific, when in fact it is naive and conceited. Toward the end of Brave New World—a scientistic dystopia in which all conflicts and discomforts have been eliminated—the human remnant Huxley calls the Savage, and his opponent, the “Controller” Mustapha Mond, engage in the following dialogue:

... “We prefer to do things comfortably” [said the Controller].

“But I don’t want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness, I want sin.”

“In fact”, said Mustapha Mond, “you’re claiming the right to be unhappy.”

“All right, then,” said the Savage defiantly, “I’m claiming the right to be unhappy.”¹²

For the person who kills himself, suicide may be the realisation of diverse aspirations and expectations. For society, suicide is, first and foremost, an act of lese majeste (literally, “injured majesty”). Webster’s Dictionary defines the term as “an offense violating the dignity of a ruler as the representative of a sovereign power; detraction from the dignity or importance of a constituted authority”.

For millennia, suicide was lese majeste against the church/state, the supreme representation of legitimate authority for people who worship a god and want a good life in the hereafter. Today, suicide is lese majeste against the Therapeutic State, the supreme representation of legitimate authority for people who worship health and want to stay alive as long as possible.

Regarding the issue of “dangerousness to others” as a quasicrime—once we cease to regard “it” as a “condition caused by mental illness”—there is not much to say.

In the current climate of opinion, however, things are no longer that simple. People fear, often for good reasons, persons not susceptible under our legal system for detention in prison. Persons called “sex offenders” are the most widely publicised offenders who fall into this class. In 1997, in Kansas v Leroy Hendricks, the US Supreme Court declared: “States have a right to use psychiatric hospitals to confine certain sex offenders once they have completed their prison terms, even if those offenders do not meet mental illness commitment criteria”.¹³ In February 2000, Wisconsin’s oldest prison inmate, a 95 year old man, was “resentenced” as a sexual predator, after a psychologist “testified ... [that] psychological tests performed on Ellefson indicated if he was given a chance, he would commit a [sex] crime. ... After only minutes of deliberation, the jury found that Ellef J Ellefson should be committed for mental treatment under the sexual predator law.”¹⁴

As I noted, the practice of preventive psychiatric detention has not gone unremarked by British commentators. John J Sandford, a British forensic psychiatrist, complained: “The preventive detention of those with untreatable mental disorders is already widely practised in England. Under the Mental Health Act (1983) people ... [are] detained indefinitely in hospital regardless of response to treatment and on grounds of risk to self as well as others. Secure and open psychiatric hospitals are full of such patients.”¹⁵ Derek Summerfield, also a psychiatrist, commented: “The growing pressures on them [psychiatrists] to deliver public protection was perhaps inevitable, given the rise of biopsychomedical paradigms as explanations for the vicissitudes of life in modern Western society. Psychiatrists have played their part by assuming the authority to explain, categorise, manage, and prognose in situations where well defined disease (arguably their only clear cut remit) was not present.”¹⁶

CONCLUSION

Psychiatry is part law and part medicine. It is the psychiatrist’s social mandate to function as a double agent: that is, to help voluntary patients cope with their problems in living and to help relatives and society rid themselves of certain unwanted persons, under medical auspices. The latter task requires coercing the denominated patient; the former is rendered impossible by the slightest threat of coercion, much less its actual exercise. The psychiatrist’s mandate violates Jesus’ injunction, “Render therefore unto Caesar the things which are Caesar’s; and unto God the things that are God’s”.¹⁷

True psychiatric reform is contingent on separating the psychiatrist’s two, mutually incompatible roles and functions.