Positive Liberty

A look at madness, evil, eccentricity, and the boundaries they often share.

Jacob Sullum has a must-read review of the new compilation Szasz Under Fire in Reason Online. The following will give you an idea of Szasz’s take on mental illness and moral evil:

In 1980 Thomas Szasz testified for the prosecution in the trial of Darlin June Cromer, a 34-year-old white woman charged with kidnapping and murdering Reginald Williams, a 5-year-old black boy. There was no question that Cromer, who attracted suspicion because she had a history of talking about “killing niggers” and trying to lure black children into her car, had abducted Reginald from an Oakland, California, supermarket, strangled him, and buried his body near her home. She had told police as much when they questioned her. Neither was her motive in doubt. She explained that “it is the duty of every white woman to kill a nigger child,” telling a jail psychologist she hoped to ignite a race war.

But as the San Francisco Chronicle reported, Cromer’s attorney argued that “his client killed because she is consumed by schizophrenic paranoia–not hate for blacks.” Or as the lawyer put it, “This case does not involve racism; it involves insanity.”…

Asked “what [Cromer] was suffering from, if anything,” on the day of the murder, Szasz offered the following opinion based on her records: “She was suffering from the consequences of having lived a life very badly, very stupidly, very evilly… From the time of her teens, for reasons which I don’t know…whatever she [has] done, she has done very badly.”

If we can’t say that a racist child murderer is evil, then we have entirely lost the meaning of the word.

But besides excusing actual evil, psychiatry can also stigmatize eccentricity as being like evil: A gray middle ground emerges, encompassing everyone from the murderous to the rude.

The gray area is of course political. The obvious example is homosexuality; another might be excessive religious fervor. Certain circles consider each a mental illness–and why? Say this quietly: In their respective corners, the far left and far right would both love to institutionalize their foes.

In some places, they’re already doing it. Consider this story about a young man in reprogramming camp to “correct” his homosexuality. God bless America, he’s blogging the abuse. Hang in there, Zach. You’re my hero.

Conservatives ought to know better than to subject Americans to abuse like this; in the Reason piece, Sullum recalls how communist states likewise used psychiatry to quash dissent. Let us not go down this road. Eccentricity is the heart of freedom, just as it is the heart of mental illness, and those who care about the former would do well to view the latter with caution.

As Szasz writes, “Typically, physical illnesses are identified by observing the patient’s body,” while “typically, mental illnesses are identified by observing the patient’s verbal pronouncements.” Adjust the content of those verbal pronouncements properly, and we may enact any sort of tyranny we wish; the one we have today is merely the tyranny most agreeable to the large majority of Americans.

I want to find these arguments compelling. Quite often I do. Yet I’m not ready to give up on mental illness entirely. As Sullum writes near his conclusion,

To a large extent, then, the issue of involuntary treatment comes down to a question of where the burden of proof should lie and how heavy it should be. Even those who are skeptical of psychiatric pretensions cannot easily dismiss [the] invocation of “the young man, rocking back and forth in a pool of his own urine, responding to voices from ‘a CIA computer’ that are instructing him to kill himself.” If such a person is indeed suffering from an incapacitating brain disease, it should be possible to allow his family to make treatment decisions on his behalf. At the same time, anyone who cares about liberty has to hesitate before imposing treatment on someone who insists he does not want it.

It’s a strong argument, but it leads far into the realms where science is still uncertain. The strongest reply I can offer is that if our young man really is suffering from a debilitating brain illness, then it is pointless to “treat” that illness without a known etiology or even a reliable cure. I am not certain what to do with him, as treating him against his will, to no effect, seems monstrous–yet if he really is ill, then letting him kill himself is equally monstrous, or more.

Is this young man evil? He is clearly living very far from the virtuous life, but so long as I cannot identify a material cause, I am forced to conclude that he may simply be living badly through choices of his own. If this is the case, I may try to reason with him–but nothing more. This sounds provocative, I know, but see my essay “Evil Robots” for an elaboration of the argument.

In the meantime, I would be very interested to hear from my readers and blog neighbors on what they think of the intersection of madness, freedom, and involuntary treatment.