• About the Current Issue: Mental Health and the Law

Lead Essay

• Strategies of Psychiatric Coercion by Jeffrey A. Schaler

  Professor Schaler notes that mental illness differs in several important ways from physical illness, and these ways make a mockery of conventional diagnosis. Nonetheless mental illness plays an important role in our legal system; it permits psychiatrists to exercise a significant degree of coercion. Schaler challenges this arrangement and argues that those whom we may classify as mentally ill are still deserving of their liberties, including the liberty to refuse treatment. Schaler also questions whether "insanity" is an appropriate legal fiction at all.

Response Essays

• A Clinical Reality Check by Allen Frances

  Professor Frances agrees that mental disorders are not diseases properly speaking, but he maintains that they are nonetheless useful analytic constructs. As to coercive psychiatric treatment, he argues it can indeed be a horrific abuse. Still, in some especially desperate cases it will be necessary to save lives and to prevent even greater harms. He recommends several practices designed to minimize the frequency and risks of coercive treatments.

• Psychiatrists Create Their Own Reality by Jacob Sullum

  Jacob Sullum asks the mental health establishment for consistency: If mental disorders are not diseases, what justifies involuntary treatment? Evidence of criminal conduct is a matter for law enforcement, not mental health. And how is it that we punish sexual predators (on the theory that they are responsible) — then treat them afterward (on the theory that they aren't)? Psychiatric diagnoses are ultimately arbitrary, Sullum argues, and they lead to the arbitrary exercise of power.

• Calling Mental Illness "Myth" Leads to State Coercion by Amanda Pustilnik

  Amanda Pustilnik argues that the most profound violations of liberty in this area don't come from coercive psychiatry, but from the warehousing of the mentally ill in our criminal justice system. Such people aren't more likely to commit crimes, but they fare badly in the criminal justice system, where unusual behavior leads to convictions, longer sentences, parole violations, and reincarceration.

  Pustilnik argues that the mind is an abstraction, not a metaphor, and that we may indeed properly discuss minds that function well or badly as being diseased or not. Those who suffer from diseases of the mind don't belong in the criminal justice system, but in the mental health system — were they very often would prefer to be. Saying that mental illness is a myth perpetuates the misconception that their behavior is their own fault—and that they therefore deserve to be in prison.

The Conversation

• In Search of a Middle Ground by Allen Frances
• Reply to Allen Frances by Jeffrey A. Schaler
• A Way Forward? Or, Libertarianism Is Not Equal to Indifference by Amanda Pustilnik
• Mental Disorders Are Not a Myth by Allen Frances
• Finding a Place for the Mentally Ill by Jacob Sullum
• Reply to Amanda Pustilnik by Jeffrey A. Schaler
• One Last Try at Synthesis by Allen Frances
• The Legal and Moral Problems of Involuntary Commitment by Jacob Sullum
• Access to Voluntary Treatment by Amanda Pustilnik
• Reply to Amanda Pustilnik by Jeffrey A. Schaler

Letters

• A Libertarian's Proposal to Reform Involuntary Commitment by DJ Jaffe.
• The Pathology and Reality of Schizophrenia by Ronald Pies.
• Diagnosis Isn't the Problem. Coercion Is. by Raymond Raad.
• Recycling Thomas Szasz by Rael Jean Isaac.

Related at Cato

• Lecture by Dr. Thomas Szasz, "Libertarian Principles and Psychiatric Practices: Are They Compatible?" September 25, 2003.
• Essay "Fifty Years After The Myth of Mental Illness," by Dr. Thomas Szasz.