It’s not often I look at a "civil liberties" issue and see any merit in the libertarian position. To me, the constitution — properly and conservatively understood — does an excellent job of protecting all the personal rights we need, and I tend to be impatient with people who either see a "slippery slope" threat to those freedoms in everything government does, or want to invent entirely new "rights" (as the U.S. Supreme Court did in Griswold and its extension, Roe).
But I have to say that in this case, I can see some legitimate worries. Forcing people who may do a bad thing in the future — but haven’t done a thing yet — to take antipsychotic drugs is disturbing. For those who have trouble getting the link, I’ll explain that the WSJ story is about a "national trend," pushed by a "maverick psychiatrist" named E. Fuller Torrey, to pass laws that force psychotics to take their medicine or have the police come take them away to lock them up in the not-so-funny farm.
The thing is, his main argument is that he believes this helps "prevent crime," and here’s how he has sold the idea:
Dr. Torrey keeps an online database with hundreds of grisly anecdotes about mentally ill people who killed the innocent. They include a jobless drifter who pushed an aspiring screenwriter in front of a subway train and a farmer who shot a 19-year-old receptionist to death. Influenced by such stories, Michigan, New York, Florida and California are among the states that have toughened their mental-health treatment laws since 1998, when Dr. Torrey formed the Treatment Advocacy Center to lobby for forced care.
We have here shades of "Minority Report" and A Clockwork Orange (what with the idea of letting the rozzes lovet a poor bezoomy malchick so some veck can mess with his gulliver rather than letting him make up his rassoodock by his oddy-knocky).
So am I convinced this is a bad idea? No, but I’m willing to concede that I’m not sure either way. Both the libertarian point of view (how can you arrest people who’ve done nothing wrong?) and the societal protection consideration paired with the argument that opponents "want to preserve a person’s right to be psychotic" seem to have merit.
I present this to you folks out there for debate. But first, here are some pros and cons I see. I’ll start with the pros:
- People with untreated mental illnesses are one of South Carolina’s great challenges. It’s a huge factor in homelessness, overcrowded jails and hospital emergency rooms, a lack of proper care (since jailers, for instance, know little of looking after the mentally ill), and yes, crime.
- Medication has been developed that can effect remarkable results with these brain diseases. But one manifestation of mental illness may be that the patient won’t take his meds on his own. In such a situation, when the choice is between someone wandering the streets out of his head and a functioning member of society, maybe the state should step in to act in loco parentis, so to speak, and require him to do what’s good for him — and what’s good for the others affected and potentially affected by his sickness.
- I’ve seen a lot of harm done by overconcern for mental patient’s rights — excessive deinstitutionalization, for one. Why not just act to fix the problem?
And now some cons:
- Suppose the police do haul them in. We don’t have the psych wards to put them in. Taken a step further, we could go a long way toward fixing the problem of the mentally ill wandering the streets by simply properly funding both insitutionalized and community-based care.
- We don’t really understand the brain, and while there’s a plethora of "miracle drugs" out there, they don’t always have the expected effect. Based on my own experience with anti-depressants and anti-anxiety meds, depending upon your dosage and other, metabolic, factors, you can have side effects that make you feel even worse, or create whole new problems. I’ve known too many people have to take one psychiatric drug after another, until their shrink manages to help them by trial and error (or they just quit taking anything, which under the circumstances may not be an irrational reaction).
- Whose standards do we use to define "what’s good for him: Big Nurse‘s or R.P McMurphy’s?
OK, what are your thoughts?
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we are already down this path–earlier laws and cases on quarantines of individuals with transmissible diseases and more recently, indefinite civil confinement for sexual predators; biggest civil liberty concern to me is if our government begins to define dissident views as a mental illness (like the soviets used to do); fortunately, the government probably does not want the liability if it gets in the business of requiring drug taking
Dr. Thomas Szasz, M.D. and libertarian, wrote about this in “The Myth of Mental Illness” back in the 1960s.
This current mania to medicate is another result of the feminization of society, with its anti-male intolerance for boys being boys. Drugs provide women teachers with a new tool to replace beatings.
Lee raises an interesting point. I had some very similar thoughts when I read this item in today’s paper:
I’m not sticking up for bullies, but I find myself wondering how "bully" will be defined.
I also wonder why a small matter such one student picking on or intimidating another can’t be handled by teachers and principals without a lot of red tape. What’s this all about?
The trouble with something like this is, kids who are really being bullied or intimidated aren’t going to report it to anybody. First of all, it’s dangerous; it invites retaliation. Secondly, wouldn’t most kids (boys, anyway) usually not want to admit to anyone that they ARE feeling intimidated?
Hey, I was a runt up until my last year or so or high school, and plenty of people tried to push me around. Some succeeded in intimidating me, at least to the point that I tried to avoid them. And sometimes, without thinking, I just hauled off and popped them one. Pretty stupid, but I survived. They were usually (but not always) too shocked to hit back.
In any case, I wouldn’t have brought adults into it. It just wouldn’t have occurred to me that it was their business. Now as an adult and a parent, my attitude is somewhat different. If I know one of my kids is being bullied, I want to do something about it. But I’m never entirely sure how much to intervene, because I don’t know to what extent my intervention will make things worse.
Nowadays, I would have been hauled off and medicated if anyone had caught me striking out at those thugs from long ago. Something’s happened to the world, and while as a parent I can see the arguments for it, it still sort of runs against my grain.
Force as a model in medicine
Force has always existed as a model in medicine, and for as long as it has existed, it has only rarely been employed, and then only within strict legal parameters. In an open court, in a fully adversarial hearing, doctors present their cases. Other lawyers refute them. One must prove one’s case in open court.
In psychiatry, a force-based model has long existed, with no established legal parameters. Without hearings in open courts, without fully adversarial legal representation the force of psychiatry has acted without balances. The results of that model are clearly documented in history.
Are there situations in which force is necessary in medicine? Yes. In psychiatry? Perhaps, but until there is strong legal precedent protecting psychiatric “patients,” as we protect other patients, tread lightly on liberties. General medicine has no long history of abuse, psychiatry does:
A model of punishment, though unethical, is not at all unusual in mental health:
Consider this: In the 14-year period between 1950 and 1963, more American deaths occurred in state and county mental institutions than in all of the nation’s armed conflicts beginning with the Revolutionary War and ending with the Persian Gulf War. Between 1965 and 1990, the total number of mental-hospital inpatient deaths exceeded the number of battle deaths in the same wars by 70 percent. Inpatient deaths topped out at 1,103,000 during this 25-year period, compared with 650,563 recorded deaths in battles. (Forgotten Dead of St. Elizabeths Magazine article by Kelly Patricia O’Meara; Insight on the News, Vol. 17, August 6, 2001)
The legislature and Nanny State educrats need to butt out of policing “bullies” and let the children learn how to cope with and defeat bullies at an early age. Unfortunately, Zero Judgement does not differentiate between self-defense and agression, so students are not permitted to stop bullying by administering the proper butt-whipping.
The result is a generation of wimpy boys who will not stand up to bullying teachers, police and bureaucrats. That is probably exactly what the government schools intended to achieve.
As I thought about people who don’t take their medicine, visions of Howard Dean come to mind. If you do any travel to large metropolitan areas, one of the hazards is having to side step or step over the hulk of a filthy street bum. Most of these people are out on the streets because liberals believed that placing them in institutions was a violation of their rights. Many insane asylums were closed down in the 70’s and later. Most are harmless but occasionally one of them goes postal. Unfortunately, most of these people are totally incurable and totally incapable of taking care of themselves. The solution seems to be for compassionate liberals to leave their protected neighborhoods and venture to the “bad” side of town to help out in a soup kitchen or halfway house. That keeps the bums near the free food and thus away from the nice neighborhoods. Some solution I say.
“One Flew Over the Cuckoo’s Nest” was a truly good movie. I may even have to rent that one. Nurse Ratchet knew how to handle the mentals!!!!!!!!!!!
How many people would you be willing to lock up in order to prevent one person’s potential (but not assured) crime? 1,000? 10,000?