Faith in Freedom

Libertarian Principles and Psychiatric Practices

Thomas Szasz

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351520744
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

The libertarian philosophy of freedom is characterized by two fundamental beliefs: the right to be left alone and the duty to leave others alone. Psychiatric practice routinely violates both of these beliefs. It is based on the notion that self-ownership—exemplified by suicide—is a not an inherent right, but a privilege subject to the review of psychiatrists as representatives of society. In Faith in Freedom, Thomas Szasz raises fundamental questions about psychiatric practices that inhibit an individual's right to freedom.

His questions are fundamental. Is suicide an exercise of rightful self-ownership or a manifestation of mental disorder? Does involuntary confinement under psychiatric auspices constitute unjust imprisonment, or is it therapeutically justified hospitalization? Should forced psychiatric drugging be interpreted as assault and battery on the person or is it medical treatment?

The ethical standards of psychiatric practice mandate that psychiatrists employ coercion. Forgoing such "intervention" is considered a dereliction of the psychiatrists' "duty to protect." How should friends of freedom—especially libertarians—deal with the conflict between elementary libertarian principles and prevailing psychiatric practices? In Faith in Freedom, Thomas Szasz addresses this question more directly and more profoundly than in any of his previous works.

II
Profiles: Where Some Famous Libertarians Went Wrong

A.Civil Libertarians

5
John Stuart Mill

The name of John Stuart Mill (1806-1873) is, or ought to be, familiar to every educated person. There is a vast literature on his life and work, on which I shall touch only in so far as it is relevant to the theme of my book.

Mill’s father, James Mill (1773-1836), was the son of a Scottish cobbler. A self-made man, he created a meteoric career for himself as philosopher, educator, and man of letters. He married Harriet Burrow, whose mother—Mill’s grandmother—“kept an asylum for lunatics in Hoxton.”¹

Unlike many of his famous contemporaries, John Stuart Mill had no inherited wealth and had to make a living by working. In his Autobiography, Mill tells us: “In May, 1823, my professional occupation and status for the next thirty-five years of my life, were decided by my father’s obtaining for me an appointment from the East India Company, in the Office of the Examiner of India Correspondence, immediately under himself.”² It is reasonable to assume that these circumstances contributed to his paternalistic attitude toward colonial people, and antipaternalistic attitude toward persons we call “users of illegal drugs,” but who in Mill’s time were users of legal products.

The East India Company was the commercial flagship of British colonialism. One of its principal sources of revenue was the opium trade. The Mills—both father and son—were, in current parlance, employees of the greatest drug cartel of all times. This occupation happened to be consistent with their utilitarian ideology. After all, there is probably no more direct and effective method for facilitating “the greatest happiness for the greatest number” than by giving people access to opium in the free market.

Mad-doctoring and On Liberty

By the time Mill began to address the conflict between psychiatric incarceration and individual liberty, the English people were familiar with the subject, often sensationalized in the popular press. As early as 1728, Daniel Defoe (1661-1731), the famed author of Robinson Crusoe, denounced what we now call “psychiatric abuses.” He wrote:

This leads me to exclaim against the vile Practice now so much in vogue among the better Sort, as they are called, but the worst sort in fact, namely, the sending their Wives to Mad-Houses at every Whim or Dislike, that they may be more secure and undisturb’d in their Debaucheries: Which wicked Custom is got such a Head, that the number of private Mad-Houses in and about London, are considerably increased within these few Years. This is the height of Barbarity and Injustice in a Christian Country, it is a clandestine Inquisition, nay worse.³

In 1858, a year before publishing On Liberty, Mill criticized what later became known as “false commitment.” In a letter to the London Daily News, he warned:

Sir,—It has become urgently necessary that public attention should be called to the state of the law on the subject of Lunacy and the frightful facility with which any persons whom their heirs or connections desire to put out of the way, may be consigned without trial to a fate more cruel and hopeless than the most rigorous imprisonment.... The obvious remedy is to require the same guarantees [as for imprisonment for crime] before depriving a fellow-creature of liberty on one pretext as on another. The inquiry by a jury, which is now the exception, ought to be the rule.... Juries, in such cases, are foolish and credulous enough, and only too willing to treat any conduct as madness which is ever so little out of the common way; but at least the publicity of the inquiry is some protection, and tends to fix attention on any unavowed motive which may actuate the promoters of the proceeding.... I earnestly intreat you to continue your efforts at rousing public opinion on a matter so vital to the freedom and security of the subject.⁴

Mill did not oppose psychiatric imprisonment, as such. He opposed only the laxity of the procedures used to implement the “lunacy laws.” Mill’s statement, “Juries...[are] only too willing to treat any conduct as madness which is ever so little out of the common way,” implies that if the conduct is “out of the common way” more than “ever so little,” then it may justify the use of psychiatric segregation. Here begins the descent down the slippery slope. Once we grant power to medical agents of the state to coerce innocent persons—in the name of undefined and undefinable “dangers” to themselves or others—there is no practical way to prevent them, and their social superiors, from “abusing” the law.

On Liberty is one of the most famous books in the literature of political philosophy generally, and of libertarianism in particular. The views Mill expresses in it have far-reaching implications on all our policies toward all so-called victimless crimes. Its implications on psychiatric practices are less obvious, but no less relevant. In this book, Mill famously declared:

Over himself, over his own body and mind, the individual is sovereign. It is, perhaps, hardly necessary to say that this doctrine is meant to apply only to human beings in the maturity of their faculties. We are not speaking of children.... Those who are still in a state to require being taken care of by others, must be protected against their own actions as well as against external injury. For the same reason, we must leave out of consideration those backward states of society in which the race itself may be considered as in its nonage.... Despotism is a legitimate mode of government in dealing with barbarians, provided the end be their improvement, and the means justified by actually effecting that end.⁵

Without saying whether insane persons are fit or unfit for political freedom, Mill added this prescient warning: “Each [person] is the proper guardian of his own health, whether bodily, or mental and spiritual. Mankind are greater gainers by suffering each other to live as seems good to themselves, than by compelling each to live as seems good to the rest.”⁶ Few people then shared this view, and even fewer share it today. According to today’s conventional wisdom, a person diagnosed as mentally ill is not the proper guardian of his own health, wealth, or anything else.

Mill continued: “The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”⁷ Mill called behaviors that concern only the self “self-regarding,” and behaviors that concern others as well “other-regarding.” Although people disagree about where to draw the line between these two classes of actions, the distinction remains one of the guiding principles of the free society. Although rarely phrased in these terms, one of the most important political questions that faces us is: Which acts concern the actor only and thus fall outside the scope of legislative control, and which concern the public as well and are properly the business of the state?

Acts generally considered self-regarding range from reading books to practicing religion, rights guaranteed by the First Amendment. Some may grant self-regarding status also to certain behaviors that are potentially or actually self-destructive, such as hang-gliding, skydiving, and suicide. Acts generally considered other-regarding range from creating a public disturbance to crimes such as driving while intoxicated, assault, and murder. Overeating, drinking alcohol to excess, and smoking cigarettes, marijuana, or opium in private exemplify acts that some people regard as self-regarding and others as other-regarding. In this respect, another point needs to be emphasized. For example, masturbation in private is self-regarding, while heterosexual coitus, especially if it results in procreation, is clearly other-regarding. Yet, it does not follow that it ought to be subject to regulation by the state, much less prohibited by it.

Since the latter half of the nineteenth century, the ideology of public health and psychiatry together with socialist politics have endeavored to erase the differences between the interests of the self and interests of society, between injuring oneself and injuring others. “Every injury to the health of the individual is, so far as it goes, a public injury,” declared English philosopher Thomas Hill Green (1836-1882).⁸ With this dictum as their creed, health statists—led by the mental health lobby—have largely succeeded in convincing Americans that such radically different behaviors as killing oneself and killing others are similar: each is a manifestation and/or consequence of mental illness. The result is a negation of the differences between dangerousness to self and dangerousness to others: the private sphere, free of state regulation, merges into the public sphere, the object of state regulation. The professionals charged with destroying the differences between self- and other-regarding behaviors and coercing troublesome persons—some of whom are guilty of breaking the law, and most of whom are not—are psychiatrists, in Mill’s day called “mad-doctors.” Mill denounced their work with these scathing words:

But the man, and still more the woman, who can be accused either of doing “what nobody does,” or of not doing “what everybody does,” is the subject of as much depreciatory remark as if he or she had committed some grave moral delinquency.... [F]or whoever allow themselves much of that indulgence, incur the risk of something worse than disparaging speeches—they are in peril of a commission de lunatico, and of having their property taken from them and given to their relatives.... There is something both contemptible and frightful in the sort of evidence on which, of late years, any person can be declared judicially unfit for the management of his affairs; and after his death, his disposal of his property can be set aside, if there is enough of it to pay the expenses of litigation.... These trials speak volumes as to the state of feeling and opinion among the vulgar with regard to human liberty.... In former days, when it was proposed to burn atheists, charitable people used to suggest putting them in a madhouse instead; it would be nothing surprising now-a-days were we to see this done.⁹

Although On Liberty is a short book, Mill used it to state and restate his commitment to the adult person’s right to self-determination, even if it entails self-harm:

But neither one person, nor any number of persons, is warranted in saying to another human creature of ripe years, that he shall not do with his life for his own benefit what he chooses to do with it.... Considerations to aid his judgment, exhortations to strengthen his will, may be offered to him, even obtruded on him, by others: but he himself is the final judge. All errors which he is likely to commit against advice and warning are far outweighed by the evil of allowing others to constrain him in what they deem his good.... Acts injurious to others require a totally different treatment.... The distinction between the loss of consideration which a person may rightly incur by defect of prudence or of personal dignity, and the reprobation which is due to him for an offense against the rights of others, is not a merely nominal distinction.¹⁰

Mill’s following remarks are even more timely today than they were when he offered them, 150 years ago:

If protection against themselves is confessedly due to children and persons under age, is society not equally bound to afford it to persons of mature years who are equally incapable of self-government? If gambling, or drunkenness, or incontinence, or idleness, or uncleanliness, are as injurious to happiness, and as great a hindrance to improvement, as many or most of the acts prohibited by law, why (it may be asked), should not law, so far as is consistent with practicality and social convenience, endeavor to repress these also?... I fully admit that the mischief which a person does to himself may seriously affect, both through their sympathies and their interests, those nearly connected with him and, in a minor degree society.... No person ought to be punished simply for being drunk; but a soldier or a policeman should be punished for being drunk on duty.¹¹

Why did Mill believe that adults should have such a far-reaching right to self-determination? Because he viewed children as the prisoners (my metaphor, not his) of society:

Society has had absolute power over them during all the early portion of their existence: it had the whole period of childhood and nonage in which to try whether it could make them capable of rational conduct in life.... If society lets any considerable numbers grow up mere children, incapable of being acted on by rational considerations of distant motives, society has itself to blame for the consequences.... [I]t is not difficult t...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Preface
• Introduction: Liberty from Psychiatry
• I. Principles: Why Libertarianism and Psychiatry are Incompatible
• II. Profiles: Where Some Famous Libertarians Went Wrong
• Finale
• Acknowledgments
• Notes
• Bibliography
• Index