Today most people in the West regard killing oneself as an abhorrent temptation and avoid thinking about it. When they do think about suicide, they view such thinking as prima facie “abnormal” and readily accept the concept of “suicidal ideation,” a common medical term for thoughts about suicide.

We do not talk about “sex ideation” or “eating ideation” or “vacation ideation.” Why do we need and make up the special term “suicidal ideation”? To enable us to categorize it as a “psychiatric symptom,” a hidden manifestation of “serious mental illness” and “dangerousness to self and others,” a violation of the mental health laws, punished by incarceration in a mental health facility, and augmented by coerced psychiatric drugging. Failed suicide is also illegal, punished by similar psychiatric sanctions. The psychiatrist is regarded as an expert in “evaluating” and “detecting” this symptom and conducting himself accordingly as a coercive agent of the State. Although the psychiatrist who functions thus is an adversary of the nominal patient, law, medicine, and the public define and regard him as a “caring doctor,” an ally of his involuntary “patient.”

Merriam-Webster defines “ideation” as a noun: “the capacity for or the act of forming or entertaining ideas <suicidal ideation>.” This conceptualization is both the cause and the consequence of the psychiatric view of suicide as psychopathological. Thinking about sex, eating, or vacation is “reflection,” “longing,” “planning,” “pondering,” or simply “thinking”—not “ideation.” The psychiatric premise that thinking about suicide is a symptom of the disease “clinical depression” is justificatory rhetoric: Thinking about suicide is simply thinking. It is also, as Nietzsche famously observed, a tool of self-preservation: “The thought of suicide is a powerful solace: by means of it one gets through many a bad night.” The difference between the psychiatric and Nietzschean concepts of thinking about suicide illustrates the problem: For psychiatry it is a disease to be forcibly prevented and treated; for Nietzsche it is a remedy to be appreciated and understood.

The unlawfulness of suicide is further affirmed by the illegality of assisting the act. Assisting legal acts is legal. Assisted cooking, for example, is a common practice, performed and provided by family, friends, restaurants, schools, and other institutions. However, assisted suicide is a criminal offense unless the assistance is provided by a licensed physician in a jurisdiction in which specific legislation explicitly permits it: Then it is a medical service. The truth is that the only thing that makes physician-assisted suicide a medical service is that the means used for it is a prescription for a barbiturate, a document the law treats as if it were a prescription for insulin for a diabetic. Suppose doctors assisted suicide by shooting, stabbing, or strangling us at our request. Would we still call it “physician-assisted suicide”? Would we still classify and condone it as a medical treatment?

Socrates, let us recall, died of assisted suicide: He killed himself by ingesting a lethal dose of a substance the Greeks called pharmakon—a word that means both medicine and poison—procured for him by others. Socrates did not need medical help to kill himself. Why do we act as if we do? Because we like to die peacefully with the help of a drug that puts us to sleep forever; and because, at the same time, we wage wars on drugs especially useful for this purpose and suborn physicians to bootleg them. In the absence of prescription laws—and, more generally, of drug laws—there would be no need for, and no special problem of, physician-assisted suicide.

Although the air we breathe is polluted with anti-suicide propaganda, no amount of psychiatric smoke can obscure our knowledge that at bottom suicide is a solution. Authoritatively repressed, this truism reemerges as humor: “I was depressed last night so I called Lifeline. . . . Got a freakin’ call center in Pakistan. I told them I was suicidal. . . . They got all excited and asked if I could drive a truck.”

Suicide and the Identity of the Psychiatrist

Contemporary discourse about suicide seems to be about understanding the individual who says he intends to kill himself or to whom such intention is attributed by others. In fact the true subject of such discourse is the professional identity of the psychiatrist as bona fide physician, contingent on his presumed medical competence and legal duty to “save lives,” especially the lives of persons who do not want to live.

As a phenomenon, suicide is ancient. As medical problem it is recent. The medicalization of homicide—both auto- and heterohomicide—is an aspect of the birth and growth of pharmacracy and the Therapeutic State. Medical historians William F. Bynum and Michael Neve observe: “By early Victorian times, suicide had been more or less completely medicalized.” What do these writers mean when they use the term “medicalization?” They mean that melanoma is a medical problem by nature, whereas masturbation is a medical problem by culture. One is a disease intrinsically, the other is a disease by imputation. That is why we do not talk about the medicalization of bodily diseases, such as infections and malignancies, but do talk about the medicalization of mental diseases, such as dangerousness and depression.

Understanding a person and coercing him are mutually antagonistic and incompatible functions and roles—and we all know this. I have long objected to the social expectation that the psychiatrist be both his patient’s ally and adversary, and the psychiatrist’s willingness to play both roles. The dilemmas and depravities of double agency are intrinsic to psychiatry and will not go away. Honest psychiatrists cannot help but confront it. Hapless patients are doomed to be injured by it.

That medicalization forms an integral part of the modern zeitgeist is obvious. Some 50 years ago I coined the term “Therapeutic State” and suggested that coercive psychiatric suicide prevention is one of its defining emblems. Opposing this revered ritual is a thankless task but a worthy goal.

“The time is out of joint—O cursed spite, / That ever I was born to set it right!,” soliloquizes Hamlet (act 1, scene 5, 188–190). For the lover of liberty and responsibility, the time always seems out of joint. Setting it right will always be a thankless task.

If suicide be deemed a problem, it is a moral and political problem, not a disease in need of diagnosis, prevention, punishment, or treatment. Managing suicide as if it were a medical problem will succeed only in debasing medicine and corrupting the law. Pretending to be the pride of medicine, psychiatry is its shame.

In contemporary English the meaning of the noun “coercion” is clear and uncontroversial. The Merriam-Webster online dictionary defines it as “the act, process, or power of coercing; . . . <a promise obtained by coercion is never binding> . . . synonyms: arm-twisting, force, compulsion, constraint, duress, pressure . . .; near antonyms: agreement, approval, consent, permission.” Coercion is emphatically not the private “subjective response” of the oppressed person; it is the objective, publicly observable action of the oppressor. According to the authoritative Black’s Law Dictionary (Fourth Revised Edition), the relationship between hospital psychiatrist and patient clearly constitutes coercion: “COERCION. Compulsion; constraint; compelling by force or arms.”

Contemporary practitioners of psychiatry, enlightened by neuroscience, brag about their love of the naked power they exercise over their captives.

In her book Weekends at Bellevue, Julie Holland explains:

So why am I so attracted to this patient population? I’ve always been enthralled by insanity. . . . [N]ow I am the doctor in charge of Bellevue’s psychiatric emergency room. . . . I run two fifteen-hour overnight shifts on Saturday and Sunday nights. They call me “the weekend attending.” It feels just like rock-and-roll psychiatry to me. This is my Saturday night gig. . . . [The police deliver a prisoner receiving methadone detoxification.] I go inside to talk to Nancy [the nurse]. “The cop wants dead weight, the prisoner wants methadone. Looks like we should probably just take advantage of the situation.” We agree to do something that everyone knows damn well is completely against the rules. I have never done it before or since: I tell the patient we are going to give him an injection of methadone, and we give him Thorazine. . . . [S]ometimes down here, the end justifies the means. This way, he calms down, the cop is happy, they both leave and we can go on with our night.

The State-sanctioned forcible control of one group of innocent persons by another group of persons authorized to control them is, of course, as old as civilization. We call its prototype “slavery.” Justified by religious and philosophical authorities, the supporters of such systems of institutionalized domination-submission always felt morally superior to those who rejected their reasoning and opposed their power. Today, the system based on the same age-old rationalizations is called “psychiatry.” I have renamed it “psychiatric slavery.”

“If slavery is not wrong,” declared Abraham Lincoln, “nothing is wrong. I cannot remember when I did not so think, and feel.” Slavery is wrong because it empowers one group of persons to deprive another group of liberty on the ground of who they are, not of what they do. I knew very little about Lincoln when I grew up in post-World War I Hungary. But I did recognize, as a gut feeling, that if the domination of the mental patient by the psychiatrist is not wrong, then nothing is wrong. I cannot remember when I did not so think and feel.

Wrong but Necessary

Many decades later I learned about Lincoln’s more complex, confused, and conflicted opinions about slavery, and also about the inconsistency of libertarians’ passionate commitment to the principle of self-ownership as a pillar of individual liberty and their penchant to turn their gaze away from psychiatric slavery as an integral part of the political-social fabric of modern Western societies.

In 1999 an editorial in the British Medical Journal warned, “The growing pressures on them [psychiatrists] to deliver public protection was perhaps inevitable, given the rise of biopsychomedical paradigms as explanations for the vicissitudes of life in modern Western society. Psychiatrists have played their part by assuming the authority to explain, categorize, manage, and prognose in situations where well defined disease (arguably their only clearcut remit) was not present.”

Such warnings have not deterred prominent psychiatrists from making brazen claims about the nature of psychiatry as a medical specialty. In an editorial in the September 2010 issue of Current Psychiatry, titled “Integrating Psychiatry with Other Medical Specialties,” psychiatrist Henry A. Nasrallah—professor of psychiatry at the University of Cincinnati College of Medicine (my alma mater)—writes, “As a specialty that deals with brain disorders, psychiatry is now much more integrated with other medical and surgical specialties than in the past. Psychiatry is no longer perceived as a ‘different’ discipline. . . .” Where is the outrage at this shameless mendacity? Nowhere.

Forgotten Human-Rights Violations

The human-rights violations of chattel slavery, colonialism, the Inquisition, national socialism, and communism have been well documented. Sporadic reports of the human-rights violations of psychiatry abound in our newspapers and magazines. They are quickly forgotten as exceptional “abuses.” More than 50 years ago I set myself the task of not letting the profession and the public forget that psychiatry—the oppression of the patient by the psychiatrist, today justified as the patient’s liberation from an illness that robs him of freedom and responsibility—belongs in the same pantheon of brutal oppressions as do chattel slavery, colonialism, the Inquisition, national socialism, international socialism (communism), and institutions dedicated to the coercive betterment of humanity not yet invented.

Sixty years ago, when I was young, the psychiatrist was embarrassed by his role as coercer. Now, when I am old, he is proud of it. That, in my opinion, is the sum total of the “progress” achieved by modern, “scientific psychiatry.” It is a fearful truism that we learn from history that we do not learn from history: “The time to guard against corruption and tyranny, is before they shall have gotten hold on us. It is better to keep the wolf out of the fold, than to trust to drawing his teeth and talons after he shall have entered.” (Thomas Jefferson, 1782)

But this wolf does not enter. He is inherent in human nature, and we must purge it from our own souls, one soul at a time.

Almost 50 years ago Szasz published The Myth of Mental Illness. It changed the political framework in which mental illness was addressed by laying the foundation for a concept Szasz developed through a series of books, including The Manufacture of Madness (1970). That concept was “the Therapeutic State”—a collaboration between psychiatry and the State through which “undesirable” actions, thoughts, and behavior patterns were suppressed. Thus Szasz not only disputed the moral and scientific basis of psychiatry but also argued that modern medicine was an engine of social control, with pharmaceuticals as primary tools.

A new slate of drugs now addresses a wide range of so-called disorders, or dysfunctions, that former generations considered environmental problems or lifestyle choices: from obesity to attention deficit, from erectile dysfunction to social anxiety (shyness), from menopause to alcoholism. Indeed, laziness is now being discussed as “a neuro-developmental dysfunction” for which drugs are being developed. The current Therapeutic State may be best analyzed as a collaboration between modern medicine, the pharmaceutical industry, and the State.

The debate stirred by Szasz has muted. The medical establishment and mainstream media are now advocates of the Therapeutic State. Similar advocates dominate universities, studies, prestigious committees, FDA hearings, and governmental bodies. Since writing The Myth, Szasz himself has noted that “the formerly sharp distinctions between medical hospitals and mental hospitals, voluntary and involuntary mental patients, and private and public psychiatry have blurred into nonexistence. Virtually all medical and mental health care is now the responsibility of and is regulated by the federal government, and its cost paid, in full or in part, by the federal government.” Problems of everyday life have been medicalized, and people are viewed as having little or no ability to “cure” conditions such as alcoholism or drug abuse through willpower or change of habit. The focus Szasz tried to foster on the individual’s responsibility for his or her own dysfunctions has eroded.

Happily, a backlash against the medicalization of everyday life is occurring. Alas, it is being fought on the wrong ground.

In this regard, a fascinating book has just been published. Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction by Ray Moynihan and Barbara Mintzes is a work of investigative journalism that explores the close financial relationship between the medical experts who define and develop the “science” behind new dysfunctions and the $500-plus billion pharmaceutical industry that profits from treating them. For example, Moynihan examines the makeup of experts on committees that define dysfunctions for the extremely influential Diagnostic and Statistical Manual of Mental Disorders (DSM); it is from the DSM that “social anxiety disorder” derives. (Revealingly, homosexuality was only delisted as a disorder in 1970.) Moynihan observes, “The DSM has been criticised for the closeness between the expert committees who write the definition of diseases and the pharmaceutical companies that sell the drugs prescribed to treat them. One study that looked closely at the affiliations of the men and women on those committees found that more than half of them had ties to drug companies. On the committees revising mood disorders, including depression, the figure was closer to 100 per cent.”

In short, he constructs a strong case for endemic bias within the medical establishment in favor of drug companies and the creation of disease.

Another sign of backlash is the emergence of grassroots rebellions against specific “diseases,” such as the currently emerging “female sexual dysfunction,” and against the use of drugs, such as Ritalin, to “cure” attention deficit disorder in children.

A reopening of debate on medicalizing everyday life is to be applauded. But, unlike Szasz, the new critics, such as Moynihan, do not take aim at the Therapeutic State; instead they focus on the therapeutic industry—that is, the flow of money between the medical establishment and the pharmaceutical companies. The culpability of the government in the creation of disease is either marginalized or denied.

Other pharmaceutical dissidents tend to view the State as the solution, not part of the problem. For example, feminist activist Leonore Tiefer works through the World Health Organization to impose new legislation that promotes such “rights” (or entitlements) as “the right to comprehensive sexuality education” and “the right to sexual health care, which should be available for prevention and treatment of all sexual concerns, problems, and disorders.”

It is possible that critics like Moynihan and Tiefer will accomplish some good. Perhaps they will be able to reduce the widespread prescription of the powerful Ritalin to grade-school children. But without understanding the essential role played by the State in the medicalization of everyday life, critics can never strike at the root of the problem. Indeed, they may well worsen matters by shifting blame and giving more authority to the very agency most responsible for the creation of disease.

The Need for a New Focus

The focus of the reemerging debate needs to shift onto Szaszian grounds, onto an analysis of the Therapeutic State, in at least four ways.

First, it must be clear that government defines the framework for all medical practices within North America. Second, the protection offered to pharmaceutical companies should be analyzed as legal privilege. Third, the relatively new and influential “private-public partnerships”—a marriage between the corporate sector and government institutions—should be examined and exposed. And, fourth, the role government plays in “marketing” drugs through institutions like the public school system and social services must be examined.

Government framework. There is no genuine competition allowed in the practice of medicine or the administration of drugs. Both of these vital functions of society are monopolies that the government assigns to those who meet State requirements and abide by State rules. Thus the American Medical Association (AMA) is able to exert monopoly control of medical care, such as hospitalization, and has a long history of persecuting competitors such as midwives.

But licensing is only the most obvious way in which the State and AMA define medical care. There are many other labyrinthine ways in which the medical establishment partners with authority. In reporting on the AMA’s support of Obamacare, for example, the Wall Street Journal explained last year, “The organization wants to protect a monopoly that the federal government has created for it—a medical coding system administered by the AMA that every health-care professional and hospital must use if they wish to get paid for the services they provide. This monopoly generates income of $70 million to $100 million annually for the AMA. That makes the AMA less an association looking out for doctors and more a special-interest group beholden to Congress and the White House.”

FDA Approved

Legal privilege. All prescription drugs must be approved by the FDA; but, again, the monopoly privilege of being the sole legal drug dealers in society is only the most obvious one granted the pharmaceutical industry and hardly captures the extent of partnership. Moynihan chronicles a less obvious privilege in writing about “one of the biggest healthcare frauds in U.S. history. Pfizer was accused of illegally promoting an anti-arthritis drug for unapproved uses and, so, creating a health risk to users. Pfizer admitted to limited guilt and paid a criminal fine of $1.2 Billion and civil penalties of $1B.” Despite the hefty financial hit, not one executive was held personally responsible; no retribution was sought. The sentencing judge, federal District Court Judge Douglas Woodlock (Massachusetts) commented in his concluding remarks, “This is a case in which no human being, apparently, is going to be held responsible for substantial criminal activity by a corporation.” He notes that Pfizer absorbed the financial hit as a “cost of doing business” and still returned record profits.

Private-public partnerships (PPP). A PPP is a collaboration between government and the private sector in which a venture is funded (in part or in full) by tax dollars and operated through the private sector, or else the private sector raises capital under contract with the government to provide services. Although PPPs are most often associated with infrastructure projects, such as the repair of roads or building of bridges, this sort of ersatz capitalism is rampant within medical research and drug promotion. According to a 2001 study, “hundreds of millions of dollars” have been invested in the United States to promote partnerships around health issues, creating “thousands of alliances, coalitions, consortia and other health partnerships.” That trend has only increased in the ensuing years. Tax-funded research is commonly funneled through nominally private organizations or researchers. Conferences, studies, reports, and such are conducted at taxpayer expense. Arguably, such funding constitutes the greatest barrier to alternative, independent research.

Uncle Sam the Pusherman

Government peddling of pharmaceuticals. It is not merely that private for-profit organizations have used tax dollars to climb aboard the public health bandwagon. The government uses its agencies to create a market base. Just one example is the role of the public schools as a “pusher” of Ritalin—a form of speed more potent than cocaine—to millions of school-age children. Overwhelmingly, it is prescribed to boys who are “unruly” in class. A 2001 report stated, “If Huckleberry Finn and Tom Sawyer were in a school in Massachusetts today, they’d be drugged with Ritalin, according to many psychiatrists and other experts.” As a recent September Huffington Post headline asked, “Do 2.5 Million Children Really Need Ritalin?” Dr. Sanford Newmark continued, “What is going on here? Have millions of our children become so hyperactive and unable to focus that they are incapable of succeeding at school or dealing with the demands of normal life? Or are we creating an illness where there is none, calling normal variations in temperament and personality a ‘disease’ that requires the intervention of long term, and extremely profitable, pharmaceutical medication?”

Monopoly, legal privileges, the rise of PPPs, the use of tax dollars to create disease and eliminate competition, the peddling of pharmaceuticals through government agencies—these issues must be prominent in any productive discussion of the medicalization of everyday life. If the discussion focuses on corporate greed, then the Therapeutic State will have merely entered a new phase.

This is not news. More than 200 hundred years ago Johann Wolfgang von Goethe (1749–1832) warned: “I believe that in the end humanitarianism will triumph, but I fear that, at the same time, the world will become a big hospital, each person acting as the other’s humane nurse.”

Moreover, Goethe foresaw the moral hollowness of the “humanitarian science” on which such therapeutic tyranny would rest: “I could never have known so well how paltry men are, and how little they care for really high aims, if I had not tested them by my scientific researches. Thus I saw that most men only care for science so far as they get a living by it, and that they worship even error when it affords them a subsistence.”

The depths to which such men would happily sink when worshiping error brings them fame and fortune became obvious only in the twentieth century.

Joaquim Maria Machado de Assis (1839–1908), the great Brazilian novelist and playwright, advanced the prescient literary satirization of the dark art of psychiatric diagnosis and the engine that drives it: the phony expert’s insatiable vanity and thirst for controlling his fellow man. His short story “O alienista” (1882, “The psychiatrist”) is a fable of a celebrated doctor retiring to a small town to pursue his scientific investigation of the human mind, gradually finding more and more of the townsfolk insane and needing to be incarcerated in his private asylum. Eventually he alone is left at liberty. As soon as modern psychiatry became a legitimate branch of medicine, Machado de Assis recognized and exposed its quintessentially unscientific-sadistic character.

It remained for the French playwright Jules Romains (1885–1972) to call public attention to the corruption of modern medicine by political power. “It’s a matter of principle with me,” declares his protagonist, “Dr. Knock” (1923), “to regard the entire population as our patients. . . . ‘Health’ is a word we could just as well erase from our vocabularies. . . . If you think it over, you’ll be struck by its relation to the admirable concept of the nation in arms, a concept from which our modern states derive their strength.”

Sigmund Freud (1856–1939), too, has played an important part in persuading people that health is an abnormal state. This old joke is illustrative: “If the patient is early for his appointment, he is anxious; if he is on time, he is obsessive-compulsive; if he is late, he is hostile.”

Particular psychiatric diagnoses have not escaped professional criticism. Wishing to make a name for themselves as psychiatrists, “critics” object to one or another diagnosis (homosexuality)—or to “overdiagnosis” (ADHD)—but continue to respect the American Psychiatric Association (APA) as a scientific organization and regard the various incarnations of the DSM as respectable legitimating documents. This is dishonest. Confronted with the DSM, the challenge we face is to delegitimize the authenticators, the APA and DSM, not distract attention from their fundamental phoniness by ridiculing one or another “diagnosis” and trying to remove it from the magical list.

I have consistently rejected this piecemeal approach. In my essay “The Myth of Mental Illness,” published in 1960, and in my book with the same title that appeared a year later, I stated my view forthrightly. I proposed that we view the phenomena conventionally called “mental diseases” as behaviors that disturb others (or sometimes the self), reject the image of “mental patients” as helpless victims of patho-biological events outside their control, and refuse to participate in coercive psychiatric practices as incompatible with the foundational moral ideals of free societies. In short, I rejected the authority of the APA as a legitimating organization and of the DSM as a legitimating document. I believe nothing less can undo the mischief wrought by the successive editions of the “psychiatric bible.”

Settled by Political Power

But times have changed. Fifty years ago it made sense to assert that mental illnesses are not diseases. It makes no sense to do so today. Professional debate about what counts as mental illness has been replaced by political-judicial decree. The controversy about the nature of so-called mental diseases/disorders has been settled by the holders of political power: They have decreed that “mental illness is a disease like any other.” Political power and professional self-interest have united in turning false beliefs into lying facts: “Mental illness can be accurately diagnosed, successfully treated, just as physical illness” (President William Clinton, 1999). “Just as things go wrong with the heart and kidneys and liver, so things go wrong with the brain” (Surgeon General David Satcher, 1999).

The claim that “mental illnesses are diagnosable disorders of the brain” is not based on scientific research; it is a deception and perhaps self-deception. My claim that mental illnesses are fictitious illnesses is also not based on scientific research; it rests on the pathologist’s materialist-scientific definition of illness as the structural or functional alteration of cells, tissues, and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor, and asserting that view is stating an analytic truth not subject to empirical falsification.

For centuries the theocratic State exercised authority and used force in the name of God. The Founders sought to protect the American people from the religious tyranny of the State. They did not anticipate, and could not have anticipated, that one day medicine would become a religion and that the alliance between medicine and the State would then threaten personal liberty and responsibility exactly as they had been threatened by the alliance between church and State.

The Founders faced the challenge of separating the cure of souls by priests from the control of people by politicians. Today the therapeutic State exercises authority and uses force in the name of health. We face the challenge of separating the consensual treatment of patients by medical doctors from the coercive control of persons by agents of the State pretending to be healers.

When psychiatry was in its infancy the belief that all human “dysfunctions” are manifestations of brain diseases was a naive error. In its maturity the mistake was treated as a valid scientific theory and the justification for a powerful ideology and the powerful institutions based on it. Today, in its senescence, psychiatry is deceit and self-deceit—coercion concealed as objective science (“medical diagnosis”) and benevolent help (“medical treatment”). As a result, paraphrasing Orwell, telling the truth becomes “a revolutionary act.”

In the medieval world Saint Augustine and Saint Thomas Aquinas had declared that whoever deliberately took the life given to him by his Creator showed disregard for the will and authority of God and was guilty of a mortal sin. In the modern world “self-slaughter” was declared a crime. In Great Britain the crime of suicide was repealed by the Suicide Act of 1961; those who failed in the attempt would no longer be prosecuted.

After 1776 the United States adopted English criminal penalties against suicide, but American courts never enforced them. Nevertheless, as late as 1963 attempted suicide still was a felony in six states—North and South Dakota, New Jersey, Nevada, Oklahoma, and Washington. Today, everyone “knows” that suicide is a mental illness, proving the wisdom of Johann Wolfgang von Goethe’s (1749–1832) observation, “In the newspapers and encyclopedias, in schools and universities, everywhere error rides high and basks in the consciousness of having the majority on its side.”

Because medicalization suffuses our thinking about all manner of human problems, we bracket the term “suicide” with “prevention,” implying a claim for which there is no evidence—namely, that suicide is a “medical problem.” We prevent diseases but prohibit crimes. Disease is said to be prevented, not prohibited, even when a State mandate is involved, as with vaccination. Driving while intoxicated is a crime though the purpose of the law is to prevent accidents committed by drunk drivers.

Suicide prevention ought to be called “suicide prohibition.” Why is this important? Because suicide is action-doing, not disease-enduring, and because the basic tool of the State is coercion not therapy. Preventive measures are aimed at keeping undesirable events from happening, prohibitions at preventing persons from engaging in behaviors defined as “dangerous” to themselves or others. The differences between these two modes of influencing/controlling the conduct of others are illustrated by the differences between the “war on cancer” and the “war on drugs.” The former is fought with money and medical technology, the latter with laws and prisons.

The psychiatric perspective on life began to seep into the zeitgeist of modern Western culture in the nineteenth century and was ripe when Freud arrived on the scene in the 1880s. His influence lay mainly in his successful elaboration and popularization of the language of psychopathology and psychotherapy. By the time he died, in 1939, Wystan Auden was moved to offer this marvelously perceptive memorial tribute to him: “. . . if often he was wrong and, at times, absurd, / to us he is no more a person / now but a whole climate of opinion / under whom we conduct our different lives.”

“Mental Illness” and the Loss of Credibility

People know but do not experience that our everyday language refracts social reality in accordance with prevailing cultural beliefs. As long as a person remains unentangled in the State’s psychiatric control system, he is not likely to understand its actual functioning and its threat to basic human rights. Once he becomes a “mental health consumer,” he is considered credible only when he praises the system. When he criticizes it he is dismissed as lacking insight into his illness. (Psychiatric critics who are not mental health consumers are also likely to be dismissed.)

Today, suicide prohibition is a vast, bureaucratic legal-psychiatric enterprise. From the lawyer’s and psychiatrist’s point of view, it is medical treatment. From the would-be suicide’s point of view, it is deprivation of liberty. The following excerpt from an email I received some time ago is a typical example of a “suicide prevention intervention” presented by and from the point of view of a “prevented” subject:

I am a doctoral student in psychology. . . . I was depressed and, seeking support, had called my parents and told them that I was suicidal. They promptly called the police, who arrived at my apartment, handcuffed me, and transported me to the local “psychiatric center.” After many hours of waiting, the student—now called a “patient”—was “evaluated.” The psychiatrist “spoke to me for approximately 10 minutes before she decided that it was in my ‘best interest’ for me to be committed to a psychiatric ward. I protested, of course, believing that wrenching me away from life would cause far more harm than good. She expressed no empathy, however. . . . I was finally released from the hospital five days after my arrival. I can certainly say that I received no benefit from my stay in the psychiatric ward. I am more depressed than I was before, having been traumatized by my experience with the mental health care system.

Educational authorities deny the real consequences of suicide prevention for college and university students and persist instead in restating their medicalized mendacities. Following three suicides within a period of a few months, Cornell University President David J. Skorton basks in his own platitudes: “On and off campus, there is an epidemic of suicide among young people. . . . As a father, teacher, physician and president of a university where we have recently experienced the horror of multiple suicides, I have long been concerned about this national public health crisis.”

Every death is a crisis for the affected family, but three deaths, or 30 deaths, do not constitute an “epidemic” or a “national public health crisis” in a nation of 300 million people.

“What is the way ahead?” Skorton asks. His answer: “[W]e need more research into the factors that lead to suicide in this age group and how to identify those at greatest risk. . . . [S]tudents must learn that it is smart to ask for help.”

This is a lie. The college student who trusts college mental health personnel is misguided. The psychiatrist, psychologist, or social worker employed by the college serves the interests of the college not the student: The student who seeks such a professional’s “help” is more likely to be entrapped and harmed than empowered and helped.

So what can the parents of young-adult children, struggling with the hazards inherent to that period of life, do to protect them? They can avoid defining them as “mentally ill,” enlighten them about the true function of school mental health services, and thus shield them from their “care.” And they can continue to fulfill their responsibilities, as the parents of nearly grown-up children, to demonstrate their love by listening, advising, and supporting them in their struggle.

As is customary with Szasz’s work, there is painstaking historical analysis, beginning with the term “anti-psychiatry movement.” That term originated not, as might be thought, in the 1960s, when it became synonymous with the work of Scottish psychiatrist R. D. Laing and his colleague David Cooper, but in late nineteenth-century Germany. Then as now the term was employed, Szasz writes, to “divert people’s attention from the core moral-political problems of psychiatry, coercion and excuse making.” In short, it was a dismissive label to prevent serious criticism of psychiatry.

The “antipsychiatry movement” was largely ignored until the late 1960s when Laing and his allies sought to draw attention to themselves by appropriating the label for their critique of conventional psychiatry. Szasz argues that despite some differences between mainline psychiatry and Laing and his followers, their actions were in fact fully in accord with psychiatry’s central precepts. Laing and his allies held a core belief in the existence of mental illness as a medical entity—to be treated with drugs if necessary—and a belief in their own power to cure people of purported mental illness, with the use of force if required. As such, rather than challenging, as is usually thought, psychiatry’s customary mores, Laing and his associates are described as practicing an alternative form of it and thereby reinforcing the myth of mental illness that Szasz has correctly challenged for almost 50 years now.

Readers coming to the book with some knowledge of Laing’s work will be disappointed and somewhat shocked to see his inconsistencies exposed. His employment of forced “treatment” at Kingsley Hall (the anti-psychiatric “residence” in the East End of London ) is dissected in detail. Disconcerting though it may be, we are better and wiser for this knowledge. As is well known, Laing’s behavior, often fueled by alcohol, could be particularly unpleasant. Szasz highlights his inconsistencies: While he made lucid attacks on the barbaric nature of psychiatric treatment, he was ultimately incapable of rejecting the movement that gives rise to them. Laing compromised and sacrificed the potential strength of his arguments in pursuit of establishment recognition and fame.

Szasz meticulously documents Laing’s desire to work both within and outside the established system at the same time and depicts him as a “trickster”—willfully exposing psychiatric brutality at the start of his career, but subsequently endorsing the “standard of care” of modern biological psychiatry as his swan song. Laing and Cooper emerge as sad and rather disturbing people, notwithstanding the effect they had on others.

To describe Laing as a “bad person,” as Szasz does, seems somewhat harsh, but that probably reflects Szasz’s disappointment in him. Laing had the potential to contribute greatly by exposing the medical myth-making at the dark heart of psychiatry, but threw it away amidst a trinity of drink, abuse, and desire for celebrity.

In sum, Szasz makes a strong argument that the “antipsychiatrists” have presented only a very limited vision of liberation for the psychiatric service user. The changes that are required in society to restore freedom and dignity to those said to be “mentally ill” need a greater vision than theirs.

This is an important book, and it deserves to be read closely alongside Szasz’s other works. For those with an earnest desire to support human freedom, it provides more food for thought about the damage wrought, under the guise of benevolence, by the relentless psychiatric machine.

He explores that question, and offers many stinging rebukes, in his latest book, Faith in Freedom: Libertarian Principles and Psychiatric Practices. Its focus makes this very much an “inside baseball” book for those interested in libertarianism’s philosophical and intellectual history. It’s not a good place to begin dipping into the intellectual richness of Szasz’s huge oeuvre. Often he seems to assume a ready familiarity with his own heterodox thinking about the real nature of mental illness and how contemporary psychiatry deals with it. Szasz condemns as a pernicious myth the popular notion that the behaviors for which people are labeled “mentally ill” are caused by organic brain diseases that segregate those thus labeled from the liberal world of freedom and responsibility. Psychiatry, Szasz asserts, has built a citadel of coercion around that myth, one whose dual purposes are to incarcerate the innocent, through involuntary hospitalization, and exonerate the guilty, through the insanity defense.

Szasz presents his case for these ideas at length elsewhere—most vividly and convincingly, to this reader’s judgment, in his 1987 work Insanity: The Idea and Its Consequences. But here he uses his ideas about mental illness mostly as a set point from which to condemn other liberal and libertarian thinkers for abandoning their frequent bravery and good sense when it comes to psychiatry. Chapters are devoted to how libertarian or liberal thinkers and institutions, including John Stuart Mill, the American Civil Liberties Union, Ayn Rand, Nathaniel Branden, Ludwig von Mises, F. A. Hayek, Murray Rothbard, and Robert Nozick, have dealt with—or not dealt with—these issues to which Szasz has dedicated his career. He finds them all wanting, either through failures of omission or commission.

“I believe that all Americans—especially libertarians—have a moral and intellectual duty to confront the conflict between liberty and psychiatry and articulate their position regarding the idea of mental illness and the psychiatric coercions and excuses it justifies,” Szasz insists. Only the Libertarian Party among contemporary libertarian institutions, he says, fully applies libertarian ideas of self-ownership and the rule of law to the world of psychiatry.

I think Szasz is being somewhat unfair through much of this book. He doesn’t pay proper heed to the economic principles of comparative advantage and opportunity cost. It ought not necessarily be the task of every advocate of libertarianism to man the barricades on every specific application of libertarian ideas to the real world, despite Szasz’s lament that “many libertarians . . . dwell on the importance of free markets, except in psychiatry, and tirelessly recite the mantra that ‘people should be free to do whatever they want in life as long as their conduct is peaceful,’ but do not mention mental health laws, much less advocate their repeal.”

Given the idea, going back within the libertarian tradition at least to Mill, that liberty applies fully only to adults competent to handle their own affairs responsibly, it takes a particularly fierce independence of mind, combined with careful study of his work, to endorse Szasz’s application of classical-liberal principles to the so-called insane. To someone who has aimed his intellectual efforts in other directions—who has not, as Szasz has, studied the world of psychiatry extensively and from the inside—it is a perfectly excusable error for an “educated layman” libertarian to presume, as all the experts insist, that the so-called insane are not, any more than children or Alzheimer’s victims would be, competent individuals deserving all the rights and privileges of such, but are in fact people who require paternalistic care. (Szasz himself has criticized Rand for not recognizing the existence of innocent dependency in the human world, as witness her lack of children or the extremely aged in her work.)

When his complaint is that the writers in question don’t mention the psychiatric-control issues that Szasz has built his career on, not that they have openly advocated the incarceration of the “mentally ill,” his barbs seem especially ill-aimed.

Szasz is a brilliant and brave thinker, and I can understand his frustration that he has slashed and walked paths that few have been prepared to join him on. In this case, that frustration has led to a book not quite up to his highest standards in all its parts, although it still contains valuable chunks of his brilliant and passionate defenses of liberty and responsibility.

“Nature,” observed Thomas Carlyle (1795-1881), “admits no lie.” While nature neither lies nor tells the truth, persons habitually do both. As the famous French mathematician and philosopher Antoine Augustin Cournot (1801-1877) observed, “It is inconceivable that [in the science of politics] telling the truth can ever become more profitable than telling lies.” Indeed, deception and prevarication are indispensable tools for the politician and the psychiatrist—experts expected to explain, predict, and prevent unwanted human behaviors.

The integrity of the natural scientific enterprise depends on truth-seeking and truth-speaking by individuals engaged in activities we call “scientific,” and on the scientific community’s commitment to expose and reject erroneous explanations and false “facts.” In contrast, the stability of political organizations and of the ersatz religions we call “behavioral sciences” depends on the loyalty of its practitioners to established doctrines and institutions and the rejection of truth-telling as injurious to the welfare of the group that rests on its commitment to fundamental falsehoods. Not by accident, we call revelations of the “secrets” of nature “discoveries,” and revelations of the secrets of powerful individuals and institutions “exposés.”

Because nature is not an agent, many of its workings can be understood by observation, reasoning, experiment, measurement, and calculation. Deception and divination are powerless to advance our understanding of how the world works; indeed, they preempt, prevent, and substitute for such understanding.

Psychiatry is one of the most important institutions of modern American society. Understanding modern psychiatry—the historical forces and the complex economic, legal, political, and social principles and practices that support it—requires understanding the epistemology of imitation and the sociology of distinguishing “originals” from “counterfeits.” With respect to disease, the process consists of two parts: One part is separating persons who suffer from demonstrable bodily diseases from those who do not, but pretend or claim to; another part is separating physicians who believe it is desirable to distinguish between illness and health, sick persons and healthy, from physicians who reject this desideratum and insist that everyone who acts or claims to be sick has an illness and deserves to be treated. In an effort to clarify the difference between medicine and psychiatry—between real medicine and fake medicine—I proposed a satirical definition of psychiatry, slightly revised as follows:

The subject matter of psychiatry is neither minds nor mental diseases, but lies, beginning with the names of the participants in the transaction—the designation of one party as “patient,” even though he is not ill, and the other party as “therapist” even though he is not treating any illness. The lies continue with the deceptions that comprise the subject matter proper of the discipline—the psychiatric “diagnoses,” “prognoses,” and “treatments”—and end with the lies that, like shadows, follow ex-mental patients through the rest of their lives—the records of denigrations called “depression,” “schizophrenia,” or whatnot, and of imprisonments called “hospitalization.” If we wished to give psychiatry an honest name, we ought to call it “pseudology,” or the art and science of lies and lying.

The imitation of illness is memorably portrayed by Molière (1622–1673) in his famous comedy, The Imaginary Invalid (Le malade imaginaire). The main character is a healthy individual who wants to be treated as if he were sick by others, especially doctors. Since those days, we in the West have undergone an astonishing cultural-perceptual transformation of which we seem largely, perhaps wholly, unaware. Today medical healing is regarded as a form of applied science. At the same time, the medical profession defines imaginary illnesses as real illnesses, in effect abolishing the notion of pretended illness: Officially, malingering is now a disease “just as real” as melanoma.

The view that pretending to be mentally ill is itself a form of mental illness became psychiatric dogma during World War II. Kurt R. Eissler (1908-1999), then the quasi-official pope of the Freudian faith in America, declared: “It can be rightly claimed that malingering is always the sign of a disease often more severe than a neurotic disorder. . . . The diagnosis should never be made but by the psychiatrist.” Now, more than 50 years later, this medicalized concept of malingering is an integral part of the mindset of every well-trained, right-thinking Western psychiatrist. For example, Phillip J. Resnick, a leading American forensic psychiatrist, declares: “Detecting malingered mental illness is considered an advanced psychiatric skill, partly because you must understand thoroughly how genuine psychotic symptoms manifest.”

In World War I soldiers afraid of being killed in battle malingered; psychiatrists who wanted to protect them from being returned to the trenches diagnosed them as having a mental illness, then called “hysteria.” Today, almost a hundred years later, soldiers returning home and afraid of being without “health care coverage” diagnose themselves as having a mental illness, called “post-traumatic stress disorder (PTSD)”: Almost 50 percent of the troops returning from Iraq suffer from post-traumatic stress disorder (PTSD) and depression “because they want to make sure that they continue to get health care coverage once their deployments have ended.” (Syracuse Post-Standard, Nov. 25, 2007, E1).

Psychiatrists and the science writers they deceive—and who eagerly deceive themselves—love to dwell on how far psychiatrists have “progressed” from their past practices. They have indeed, if we consider creating ever more mental illnesses/psychiatric diagnoses “progress.” Today psychiatrists assert that the person who regards himself as a mental patient suffers from a bona fide illness and laud him for his insight into his “having a disease” and “need for treatment.”At the same time, they lament the person who “denies” his mental illness, his “lack of insight” into being ill, and his “negative attitudes toward treatment seeking.” For example, from the International Journal of Eating Disorders we learn: “Considering that males have negative attitudes toward treatment-seeking and are less likely than females to seek treatment, efforts should be made to increase awareness of eating disorder symptomatology in male adolescents.”

Counterfeit art is forgery. Counterfeit testimony is perjury. But counterfeit illness is still illness—mental illness, officially decreed “an illness like any other.” The consequences of this policy—economic, legal, medical, moral, personal, philosophical, political, and social—are momentous: counterfeit disability, counterfeit disease, counterfeit doctoring, counterfeit rehabilitation, and the bureaucracies, courts, industries, and professions studying, teaching, practicing, administering, adjudicating, and managing them make up a substantial part of the national economies of modern Western societies and of the professional lives of the individuals in them.

When a psychiatrist gives expert testimony in a murder case, neither the identity of the killer nor the cause of the victim’s death is in doubt. What is in doubt is the killer’s “criminal responsibility”for the crime:

Did he or did he not possess “mens rea”(guilty mind) at the time of his offense?

Pro forma, the psychiatrist testifies about whether the killer was or was not insane at the time of the killing. De facto, because of the function of the term “insanity,” especially in the context of a murder trial, the psychiatrist-physician testifies about the defendant’s guilt or innocence. Moreover, his “expert opinion” is attributed to his medical expertise.

Law, psychiatry, and the public treat the term “insanity” (“mental illness”) as if it were a property inherent in, or attributable to, a person, a moral agent; that is, as if it were a phenomenon or fact, like having brown eyes or a broken arm. However, the insanity defense–like any courtroom defense against an accusation–is a tactic, not a fact. Debating the “validity” of insanity defenses is shadowboxing: The “experts” argue about dispositional tactics as if they were empirically verified or verifiable medical observations or facts; they disagree about how the criminal justice system ought to deal with the defendant, not about what the defendant did to his victim.

Murder trials are stages for the enactment and resolution of real-life tragedies. They are not settings devoted to truth-seeking. The script defines what the actors must say, and the play must end in acquittal, conviction, or a psychiatric verdict of “not guilty by reason of insanity”/“diminished capacity.”

In July 2008 a Welsh couple–Brian Thomas, 59 and his wife, Christine, 57–were vacationing in their camper. One night Brian strangled Christine, then called the police and told them he did it while he was sound asleep “dreaming” he was defending himself from an intruder. At Thomas’s criminal trial in November 2009 the court was told that “the couple had been asleep in their camper van in a car park when they were disturbed by youths in cars performing wheel spins and so moved elsewhere. However, Thomas then had a nightmare that one of the youths had broken into the van and later woke to find himself next to his wife’s body, at which point he called the police.” Court, prosecution, and defense agreed that Thomas suffered from “a sleep disorder and so had no control over his body when he attacked his wife of 40 years while they were both asleep.”

Thomas, we learned from press accounts, “regularly took anti-depressant drugs which made him impotent,” and the couple slept in separate bedrooms at home. He had stopped his medication before the holiday, allegedly to be able to have intercourse with his wife. Medical experts testified that “the sudden withdrawal of the drugs could have led to him having very vivid dreams.”

The defense claimed that Thomas was suffering from the “non-insane” form of automatism and asked for an acquittal. The consequences of finding Thomas “not guilty by reason of insanity,” explained Chief Crown Prosecutor Iwan Jenkins, “would have meant Mr. Thomas’s detention in a psychiatric hospital, but it is now clear that the psychiatrists feel that that would serve no useful purpose. . . . It is only because of highly sophisticated tests carried out by sleep experts that Mr. Thomas’s condition could be confirmed.”

According to reports, the jury was “directed to return a not-guilty verdict, allowing Mr. Thomas to leave court an innocent man.” The judge reassured Thomas “that in the eyes of the law he bore no responsibility for what he had done”and added that “he was a decent man and devoted husband.” If any words of praise were offered about Mrs. Thomas, they were not reported.

After the trial one defense expert–Dr. Chris Idzikowski, director of the Edinburgh Sleep Centre–was reported to have been “still unsure which form of sleep disorder caused Thomas to kill his wife, but he supports the court’s decision. . . . I’m sure there are people who have the disorder, commit a crime, and try to lean back on it to get away with it. . . . ‘I’m convinced he was not guilty. That said, you never know. Maybe he’s a genius who’s tricked me and everybody else and is now going to claim lots of insurance money for his wife’s death.’”

Prosecutor Jenkins alleged that “the circumstances of this case are almost unique in the UK.” Well, not quite. Under the heading “Homicidal Somnambulism,” Wikipedia lists 68 similar cases, many from Britain.

Sleep Driving

Kenneth Parks, a 23-year-old married man, lost money gambling, stole from his in-laws and employer, and was fired from his job. On Sunday, May 24, 1987, he planned to confess his misdeeds to his in-laws. But while he slept, he got up early, drove more than 14 miles to his in-laws’ home, broke in, assaulted his father-in-law, and stabbed his mother-in-law to death. He then drove himself to the police station, saying, “I think I have killed some people.”

“Sleep driving,” anyone?

A. F. kept loaded firearms in his room. His father slept in the adjoining room. Hearing a bump against the connecting door early one morning, A. F., allegedly still asleep, hollered. “You dog, what do you want here?” and fired the gun near to his hand, killing his father.

Willis Boshears, an American army sergeant stationed in England, was drinking in a pub, returned to his apartment with a young couple, and went to sleep on the floor. When he woke up, he found he had killed the woman. He then hid her body miles away.

All these “sleepwalkers” were acquitted.

Let us put ourselves in the position of a person charged with the duty of determining a defendant’s responsibility for killing while allegedly asleep. What information would help us arrive at a correct determination? Mainly, we would want to know as much as possible about the defendant’s relationship to his victim. The accounts of the Thomas case tell us very little about this. Instead, they dwell on the defendant’s alleged “sleep disorder,” his abnormal EEG, his being on and off “antidepressant” drugs, and his impaired sexual potency. None of this information helps a jury determine whether Thomas should be held responsible for killing his wife.

I am not an expert on sleep. What I do know is that sleep involves a general relaxation of the voluntary neuromuscular system, including that part of it necessary for keeping a person standing upright. Horses can sleep standing because their legs can lock, but human beings cannot do so. And horses too need to lie down to sleep deeply. The idea that a person may be able to rape and murder while asleep and not be responsible for his behavior is a product of the modern technology-based misunderstanding of the brain, the mind, sleep, and responsibility.

The bare facts of the story, as reported in the press, are as follows. For nine months the trio hid in plain sight, made frequent trips to the city, was seen at a grocery store and a restaurant, and for about a week lived one block from the Salt Lake City police headquarters. A freelance photographer has a picture of the trio dressed in white robes.

In March 2003, when the police found her, Elizabeth was wearing a gray wig and dark glasses, and her head and face were covered. Approached by officers, Elizabeth identified herself as Augustine, claiming to be Mitchell’s daughter. “We took her aside,” one of the officers related. “She kind of just blurted out, I know who you think I am. You guys think I’m that Elizabeth Smart girl who ran away [sic].” When the officers insisted that she was Elizabeth Smart, she replied, “Thou sayest” and “showed concern only for their [Mitchell’s and Barzee’s] welfare, not her own.”

Mitchell, a devout Mormon, was no stranger to the Smarts. In 2001 Elizabeth’s father, Edward Smart, employed him as a handyman. “He was astonished,” the press reported, “at Mr. Mitchell’s mastery of deception. ‘When I was up there on the roof with him, I never could have guessed. He was so soft-spoken; he was so quiet. I never would have guessed that such an animal would have existed behind such a person.’’’

All that was more than six years ago. Mitchell and Barzee have still not been tried, and we still have no idea about what actually happened to Elizabeth Smart. While mental health professionals prevented the defendants from defending themselves in court, the Smarts convicted Mitchell and Barzee in the media as “sexual predators.”

Defenseless Defendants

Actually, there was no hard evidence that Elizabeth had been kidnapped, much less raped. Eccentric and poor, the defendants inspired no one to protect their constitutional right to trial. That would have required Elizabeth to be cross-examined and testify under oath about why she made no attempt to escape her alleged captors and why she lied to the police about who she was and referred to herself as “the girl who ran away”—not “was kidnapped.”

Elizabeth’s parents, Edward and Lois Smart, rushed into print with a book, titled “Bringing Elizabeth Home: A Journey of Faith and Hope,” a boring protestation of their Mormon faith and belief in “miracles.” “If you want just the straight story, as I did,” comments a reader on Amazon.com, “you’ve come to the wrong place. . . . The excruciating details of the family’s faith were belabored and preached and whined about until I wanted to scream and I couldn’t finish the book.” The Smarts’ book was used as the basis of the television movie The Elizabeth Smart Story, aired on CBS on November 9, 2003.

On March 9, 2006, Elizabeth Smart went to Congress to support sexual predator legislation. In 2008 she contributed to a pamphlet sponsored by the U.S. Department of Justice, titled “You’re Not Alone: The Journey from Abduction to Empowerment”: “Like you, I am also a survivor. . . . Do not feel obligated to tell people your experience. . . . [J]ust because they ask, or do something nice for you, does not give them the right to know what you went through. What happened is your story, which you can choose to share or to keep private.” Should a person allegedly kidnapped and raped be able to choose to keep silent while her silence is used to indefinitely incarcerate the persons accused of the crime?

Early in 2004 Mitchell was declared competent to stand trial and answered “not guilty” to six different charges related to the kidnapping of Elizabeth Smart. After he began singing the Christmas hymn “Oh come, oh come, Emmanuel” at the hearing, he was ordered to submit to a new competency evaluation. (Emmanuel is the name Mitchell used as a street preacher.)

In January 2005 attorneys for Mitchell requested Elizabeth’s school and medical records. Attorneys for the Smart family refused on the ground that “efforts to obtain the records are merely a ploy to get the family to agree to a lenient plea agreement.” Edward Smart declared that he would rather see prosecutors make a plea bargain with Mitchell “than having his family go through the trauma of a trial.”

In July 2006, TV pundit and victims’ rights advocate Nancy Grace interviewed Elizabeth Smart and repeatedly asked her for information about her experience. Elizabeth asked Grace to stop and stated, “I really am here to support the bill and not to go into what—you know, what happened to me.” Grace persisted, asking Elizabeth what it was like to see out of the burqa she was wearing. Elizabeth replied, “I’m really not going to talk about this at this time.”

Mitchell continued to play the part of a Mormon prophet, interrupting one of his 2005 competency hearings “by singing religious songs, the third time he has done so.” A defense expert testified that Mitchell is incompetent to stand trial “because he is consumed by ‘messianic delusions’ and wants to be crucified.”

The psychiatrists “treating” Mitchell, confined in a Utah state mental hospital, sought to drug him to restore his competence. He refused and the courts were unwilling to authorize forced drugging. This prompted U.S. Attorney Brett Tolman, in October 2008, to announce his intention to prosecute Mitchell in federal court. A competency hearing for Mitchell was scheduled to begin in November. As a prelude to it, Elizabeth Smart testified in court for the first time—in a hearing ostensibly about Mitchell’s mental competence to stand trial—about being raped by Mitchell “three or four times a day.” According to the press, “Smart testified early because she is going on a religious mission for the Mormon church in Paris.” She was not cross-examined and Mitchell—whose physical appearance belies the sexual prowess attributed to him by Smart—was excluded from the proceedings.

My brief remarks in this column are intended to call attention to still another case of the psychiatric denial of the right to trial of socially embarrassing defendants. Despite their publicity, such stories make no dent in dispelling the widely held belief that no American accused of a crime is deprived of liberty indefinitely without trial. The canard that psychiatry is a “helping profession” is even more impregnable.