people have apologized for the past crimes of the groups with which they identify: the U.S. for Japanese internment, the Church for Galileo, Swiss bankers for Nazi money laundering, even the Japanese (kind of) for their war crimes. I’d like to see psychiatrists do the same—to admit that unusual preferences are not ‘disease,’ affirm that it is wrong to treat people against their will, and turn their backs on the ‘greats’ of their profession who believed in and practiced coercive therapy.”

I am grateful to Caplan for calling attention to a problem most people prefer to ignore. His expectation will, however, not be fulfilled, and it is important to understand why. Claiming competence in astronomy and incarcerating heretics are not integral to the identity of the Catholic Church. In contrast, claiming competence in predicting “dangerousness” and incarcerating persons alleged to be so because of “mental illness” are integral to the psychiatric enterprise. Wikipedia defines civil commitment as “the practice of using legal means or forms as part of a mental health law to commit a person to a mental hospital, insane asylum or psychiatric ward against their will and/or over their protests. . . . A common reason given for involuntary commitment is to prevent danger to the individual or society.”

Psychiatrists alternately deny and delight in possessing special professional skill at detecting future “dangerousness” that entitles them to the special power to incarcerate individuals they so stigmatize in prisons that masquerade as hospitals. The American legal system makes heavy use of psychiatric determinations of dangerousness, as a result of which vast numbers of Americans are deprived of liberty and, at the same time, of opportunity to demonstrate the injustice of their detention. Examples abound.

Kafka in Court

In March 2004 Susan Lindauer was arrested in Maryland and charged with “acting as an unregistered agent of a foreign government.” She faced up to 25 years in prison. Instead of trying Lindauer, government psychiatrists declared her mentally incompetent to stand trial and incarcerated her at the Carswell Federal Medical Center in Texas, a facility described as providing “medical and mental health services to female offenders.” But Lindauer was not an offender. She was an innocent American.

After “hospitalizing” Lindauer for 18 months, her “medical” torturers concluded that, although she was still mentally ill and incompetent to stand trial, she no longer needed psychiatric “care.” Released from detention, she returned to Maryland where federal court services referred her to a private agency for counseling. According to a motion filed by her attorney, her counselor, Dr. Bruke Tadessah, said, “That evaluation showed a diagnosis of post traumatic stress disorder due to her experiences at Carswell.” Last January the federal government dropped its case against Lindauer as ”no longer in the interest of justice,” implying that her psychiatric persecution had been in the interest of justice.

Consider the contrast. Inmates of American mental-health facilities are stigmatized as “mental patients”; their torture is called “treatment”; and they are regarded as the beneficiaries of a caring government’s therapeutic services. The inmates at the Abu Ghraib prison in Iraq were not stigmatized as “mental patients”; their torture was not called “treatment”; and they were regarded as the victims of government-sponsored “detainee abuse.”

Indefinite Incarceration

When Donald Schmidt was 16, he molested and drowned a 3-year-old girl. Under California law juvenile offenders who commit serious crimes can be kept in the system only until they are 25. But Schmidt’s detention has been extended under the state code that allows “continued detention if a jury finds the inmate has a mental disorder, defect or abnormality that causes the person to have serious difficulty controlling his or her dangerous behavior.”

What is Schmidt expected to do to get a divorce from his “doctors” and regain his liberty? Every two years he can petition for release and hope that a judge will order a “trial,” letting jurors decide whether he remains a “danger to society.” Anticipating another such contingency, a Santa Cruz County district attorney Bob Lee declared, “We believe he’s a psychopath.” Richard A. Starrett, a clinical psychologist, agreed that Schmidt was still a danger, though “not a psychopath.” Barry Krisberg, president of the National Council on Crime and Delinquency in Oakland, California, called Schmidt’s situation “one in a million.”

The claim that Schmidt’s indefinite psychiatric sentence is unusual is typical of the deceit and depravity intrinsic to forensic psychiatry. John Hinckley, Jr., never convicted of a crime, is serving his 28th year of psychiatric imprisonment. Evidently the government’s greatest psychiatrists need more time to cure him of dangerousness.

Psychiatry is the political legitimation of the incarceration of innocent individuals under psychiatric auspices, a practice that appears to enjoy near-universal approval by people in modern societies. Recognition of the fact that noncoercive psychiatry is an oxymoron is obscured by the concurrent practice of seemingly consensual “therapy.” I say “seemingly” because the mental-health professional retains the privilege and obligation to deprive his patient of liberty if he “poses a danger to himself or others.” As a result, psychiatrists and the press regularly tout psychiatric “reforms,” while the “doctors” engage in ever-increasingly refined forms of psychiatric depravity, supported by the unquestioned and unquestionable premise that “dangerousness” justifies imprisonment called “hospitalization.”

In the published report of a 1981 workshop titled Behavioral Science and the Secret Service, sponsored by the prestigious Institute of Medicine, Robert Michels, University Professor of Medicine and of Psychiatry at Weill Cornell Medical College in New York, asserted that “most mental health professionals believe that there is no major ethical dilemma if it is in the patient’s interest to violate his confidentiality, and that it is generally in the patient’s (as well as society’s) interest to prevent a major violence.” The assertion that “most mental health professionals believe” that violating a defendant’s Sixth Amendment right to trial serves his interest is evidence of psychiatric depravity, not morality.

To make matters worse, a few pages later the workshop reporter informs us that “Some conferees, including psychiatrists Robert Michels and Loren Roth [a prominent forensic psychiatrist and professor at the University of Pittsburgh], questioned the utility of making dangerousness determinations at all, because such decisions at any one time are likely to be highly unreliable and invalid. . . . Mental health professionals in general have not been shown to be better than anyone else in making predictions about behavior which might occur in the distant future under changing conditions.”

None of this evidence impairs the professional standing of psychiatry as an ethical and scientific medical discipline. The psychiatric enterprise is so deeply rooted in social control and so strongly supported by pseudoscientific magic and prejudice that psychiatrists must either cling to and justify the coercive services they render or repudiate and abolish their profession as they and we know it.

The core psychiatric practice of suicide prevention implies that we have no right to kill ourselves: the state — through its mental health laws and psychiatric agents — has the right to forcibly prevent us from killing ourselves.

That is not all. “Suicide prevention” — a euphemism for incarceration in a mental hospital — is preventive detention, par excellence. From a civil-rights viewpoint, depriving a person of liberty because he might commit a crime in the future is anathema. Doing so to prevent a person from perhaps committing an act that is not a crime is an outrageous injustice.

Mental-health laws authorize and obligate the psychiatrist to incarcerate his patient if he deems him to be “mentally ill and dangerous to himself or others.” Marcia Goin, president of the American Psychiatric Association for 2003, states: “We can make contracts with builders, insurers, and car dealers, but not with patients.” (Marcia Goin, “From the President,” Psychiatric News, July 18, 2003; http://pn.psychiatryonline. org/cgi/content/full/38/14/3.) Goin offered her unqualified rejection of contracting with mental patients in the context of the so-called “no suicide contract.” That absurd term refers to the psychiatrist’s promising the “suicidal” patient that he will forgo committing him, provided the patient promises that, as long as he is under the psychiatrist’s care, he will not kill himself.

Whether such a “contract” is or is not effective in preventing suicide does not concern me here. What concern me, instead, are the psychiatric premise that the patient has no right to kill himself; the psychiatrist’s professional duty to prevent the patient from killing himself; and the incompatibility between this psychiatric practice and the libertarian principle of self-ownership.

Both de facto and de jure, once a person enters into a professional relationship with a psychiatrist, he forfeits his right of self-ownership, and the psychiatrist acquires the fiduciary duty of protecting the person — henceforth “mental patient” — from himself (and of protecting others from the patient). Should the psychiatrist, in his judgment, deem the patient to be a danger to himself (or others), he is professionally obligated to initiate violence against him, called “civil commitment” and “suicide prevention.” If the psychiatrist fails to do so and the patient injures or kills himself (or others), the psychiatrist can expect to be the defendant in a tort action for medical negligence (“failure to prevent harm to self or others”).

There is no evidence that suicide prevention prevents suicide. The rate of suicide among psychiatrists is at least two or three times that among the general public. Psychiatrists and psychiatric hospitals are regularly found liable for patient suicides (and for harm to others).

Given these circumstances, why do psychiatrists assume — indeed, demand to shoulder — such a risk? As I show in my book Fatal Freedom, therein lies the answer to why psychiatry cannot be reformed and must be abolished. Suffice it to say here that, from its earliest beginnings in the late seventeenth century, psychiatry (formerly “mad-doctoring”) was synonymous with the control of the patient by the psychiatrist. It still is.

Psychiatry and the Abolition of Contract

Famed English jurist Sir Henry Sumner Maine (1822–1888) aptly observed: “The movement of the progressive societies has hitherto been a movement from Status to Contract.” In other words, in liberal (free) societies the law treats persons as contracting individuals, not as members of status groups (men/women, sane/insane).

Modern psychiatric ethics has declared war on this principle, as Marcia Goin’s reaffirmation of the psychiatrist’s unyielding commitment to coercion illustrates. She asserts that psychiatrists cannot make contracts with the persons they call “patients.” Builders, insurers, and car dealers make contracts with such persons. Why can’t psychiatrists make contracts with them? Because contracting implies two (or more) legally equal parties, each putting his cards on the table. It implies mutual obligations, each party having legal power to compel his partner to fulfill the contract or compensate him for failure to do so.

Such mutuality is contrary to psychiatric ethics. Specifically, psychiatrists reject the ethics of commerce in favor of the “loftier” ethics of care. The seller of plumbing services is obligated to deliver only that which his customer has requested and he has promised to provide. The seller of psychiatric services is obligated to deliver something more: he must protect the customer from himself, even at the cost of depriving him of liberty.

In contrast to such control-command relationship between psychiatrist and patient, modern psychotherapy, exemplified by psychoanalysis, was characterized by a cooperative-contractual relationship between therapist and client. Yet psychoanalysts never emphasized this essential element of the enterprise. Worse, the integrity of the analytic contract was, almost from the start, eagerly compromised by Freud and his followers. In one breath Freud declared, “With the neurotics, then, we make our pact: complete candor on one side and strict discretion on the other.” In the next breath he took it all back: “I make use of his [the patient's] communication without asking his consent, since I cannot allow that psychoanalytic technique has any right to claim the protection of medical discretion.”

A contract is an agreement equally binding on both parties. Psychiatrists reject contracting with patients. They refuse to be bound by agreement. Instead they claim, and the law grants them, the power to impose unwanted (suicide prevention) “services” on patients, whenever they, the psychiatrists, decide that depriving the patient of liberty serves “his best interests.”

Of all the complex issues of social policy that we face, probably the most vexing — and undoubtedly the most neglected — is the conflict between libertarian principles and psychiatric practices.