Compulsory Commitment

One of the most shameful areas of involuntary servitude in our society is the widespread practice of compulsory commitment, or involuntary hospitalization, of mental patients. In former generations this incarceration of noncriminals was frankly carried out as a measure against mental patients, to remove them from society. The practice of twentieth-century liberalism has been superficially more humane, but actually far more insidious: now physicians and psychiatrists help incarcerate these unfortunates “for their own good.” The humanitarian rhetoric has permitted a far more widespread use of the practice and, for one thing, has allowed disgruntled relatives to put away their loved ones without suffering a guilty conscience.

In the last decade, the libertarian psychiatrist and psychoanalyst Dr. Thomas S. Szasz has carried on a one-man crusade, at first seemingly hopeless but now increasingly influential in the psychiatric field, against compulsory commitment. In numerous books and articles, Dr. Szasz has delivered a comprehensive and systematic attack on this practice. He has insisted, for example, that involuntary commitment is a profound violation of medical ethics. Instead of serving the patient, the physician [p. 91] here serves others — the family, the State — to act against, and tyrannize over completely, the person he is supposed to be helping. Compulsory commitment and compulsory “therapy,” moreover, are far more likely to aggravate and perpetuate “mental illness” than to cure it. All too often, Szasz points out, commitment is a device for incarcerating and thereby disposing of disagreeable relatives rather than a genuine aid to the patient.

The guiding rationale for compulsory commitment is that the patient might well be “dangerous to himself or to others.” The first grave flaw in this approach is that the police, or the law, is stepping in, not when an overt aggressive act is in the process of occurring, but on someone’s judgment that such an act might someday take place. But this provides an open sesame for unlimited tyranny. Anyone might be adjudged to be capable of or likely to commit a crime someday, and therefore on such grounds anyone may legitimately be locked up — not for a crime, but because someone thinks he might commit one. This sort of thinking justifies not only incarceration, but permanent incarceration, of anyone under suspicion. But the fundamental libertarian creed holds that every individual is capable of free will and free choice; that no one, however likely to commit a crime in the future based on a statistical or any other judgment, is inevitably determined to do so; and that, in any case, it is immoral, and itself invasive and criminal, to coerce anyone who is not an overt and present, rather than a suspected, criminal.

Recently Dr. Szasz was asked, “But don’t you think that society has the right and the duty to care for those individuals adjudged to be ‘dangerous to themselves and others’?” Szasz cogently replied:

I think the idea of “helping” people by imprisoning them and doing terrible things to them is a religious concept, as the idea of “saving” witches by torture and burning once was. As far as “dangerousness to self” is concerned, I believe, as did John Stuart Mill, that a man’s body and soul are his own, not the state’s. And furthermore, that each individual has the “right,” if you will, to do with his body as he pleases — so long as he doesn’t harm anyone else, or infringe on someone else’s right.

As far as “dangerousness to others” goes, most psychiatrists working with hospitalized patients would admit this is pure fantasy . . . . There have in fact been statistical studies made which show that mental patients are much more law-abiding than the normal population.

And civil liberties lawyer Bruce Ennis adds that:

We know that 85 percent of all ex-convicts will commit more crimes in the future and that ghetto residents and teen-age males are far more likely to commit [p. 92] crime than the average member of the population. We also know, from recent studies, that mental patients are statistically less dangerous than the average guy. So if what we’re really worried about is danger, why don’t we, first, lock up all former convicts, and then lock up all ghetto residents, and then why don’t we lock up all teen-age males? . . . The question Szasz has been asking is: If a person hasn’t broken a law, what right has society to lock him up?8

The involuntarily committed may be divided into two classes: those who have committed no crime, and those who have. For the former, the libertarian calls unconditionally for their release. But what of the latter, what of criminals who, through insanity or other pleas, supposedly escape the “brutality” of prison punishment and instead receive medical care at the hands of the State? Here again, Dr. Szasz has pioneered in a vigorous and devastating critique of the despotism of liberal “humanitarianism.” First, it is grotesque to claim that incarceration in a state mental hospital is somehow “more humane” than equivalent incarceration in prison. On the contrary, the despotism of the authorities is likely to be more severe, and the prisoner is likely to have far less recourse in defense of his rights, for as someone certified as “mentally ill” he is placed into the category of a “nonperson” whom no one feels obliged to take seriously any longer. As Dr. Szasz has jocularly said: “Being in a state mental hospital would drive anyone crazy!”

But furthermore, we must question the entire notion of taking anyone out from under the rule of objective law. To do so is far more likely to be damaging than helpful to the people thus singled out. Suppose, for example, that two men, A and B, commit an equivalent robbery, and that the usual punishment for this crime is five years in prison. Suppose that B “gets off” this punishment by being declared mentally ill, and is transferred to a state mental institution. The liberal focusses on the possibility, say, that B may be released in two years by the State psychiatrist through being adjudged “cured” or “rehabilitated.” But what if the psychiatrist never considers him cured, or does so only after a very long time? Then B, for the simple crime of theft, may face the horror of lifelong incarceration in a mental institution. Hence, the “liberal” concept of indeterminate sentence — of sentencing someone not for his objective crime but on the State’s judgment of his psyche or spirit of cooperation — constitutes tyranny and dehumanization in its worst form. It is a tyranny, furthermore, which encourages the prisoner into [p. 93] deceptive behavior to try to fool the State psychiatrist — whom he perceives quite correctly as his enemy — into thinking that he is “cured” so that he can get out of this incarceration. To call this process “therapy” or “rehabilitation” is surely cruel mockery of these terms. It is far more principled, as well as more truly humane, to treat every prisoner in accordance with objective criminal law.

• 8Quoted in Maggie Scarf, “Dr. Thomas Szasz . . . .” New York Times Magazine (October 3, 1971), pp. 42, 45. Among other works, see Thomas S. Szasz, Law, Liberty, and Psychiatry (New York: Macmillan, 1963). [p. 94]