Psychiatry Endorses Prejudice
By: Joshua Koerner

"A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient." That’s from the Principles of Medical Ethics of the American Medical Association. It is a principle that psychiatry honors only in the breach.

Prejudice becomes deeply rooted when institutions and systems that should protect us from prejudice instead embrace it. The Supreme Court once ruled that segregation was constitutional. Politicians who pander to the lowest common denominator and our basest fears enact laws that disregard the Bill of Rights. Mental hygiene laws that condone the forced treatment of persons diagnosed with mental illness ignore the Fifth Amendment, which states, "No person shall be deprived of life, liberty, or property, without due process of law." Forced treatment, involuntary commitment, the things that happen on locked psychiatric units, are fundamental violations of due process. Due process isn’t even a consideration.

But there’s greater damage done than that which the individual suffers. The community knows that some politicians are craven meretricious hacks who follow the winds of public opinion. And the press, whose often distorted portrayal of mental illness certainly contributes to fear and prejudice, is itself viewed with deep suspicion. But doctors still hold some position of esteem in this country. When doctors endorse and participate in forced treatment they send out a clear message: the mentally ill are so dangerous that they don’t deserve the same basic protections the rest of America enjoys. Mental patients are sub"citizens.

It isn’t what the mental health system tells itself, of course. They justify forced treatment by saying it saves lives. But couldn’t we save millions of lives if we involuntarily treated the obese, smokers, diabetics who don’t watch their blood sugar, and everyone else whose health was at risk because they won’t seek treatment on their own? And couldn’t we catch many more criminals if we ignored the Bill of Rights? If we didn’t need search warrants or due process of law we could arrest many more guilty people.

But for most Americans the rights are more important than lives saved. There’s even the well"known expression that "better ten guilty go free than one innocent convicted". For people with mental illness that gets turned on its head: you get locked up first and then have to prove yourself sane to get out. The mental health system, by failing to protest these laws, gives its approval to them and becomes an enforcement arm of discrimination. If the doctors believe it, it must be true.

I don’t know of a single mental health practitioner who doesn’t decry prejudice and discrimination against people with a diagnosis. Yet hospitals and hospital administrators and psychiatrists continue to take advantage of these cruel and discriminatory laws. To do so is an endorsement of cruelty and discrimination.

Even silence in the face of these laws is an endorsement. I have seen doctors use their positions of influence in society to literally march in the street. I’ve seen hospital emergency rooms and trauma centers closed for a day in support of a principle. That principle was lower insurance rates for doctors. For that they will storm the Capitol. For us they say nothing.

Psychiatry has been used as a tool of social oppression as far back as the founding of the Republic. The seal of the American Psychiatric Association is a portrait of Benjamin Rush, one of the signers of the Declaration of Independence. "Terror," he wrote, "acts powerfully upon the body, through the medium of the mind, and should be employed in the cure of madness."

Psychiatry becomes an enforcer of social norms when we give it the power of forced treatment because it defines pathology as a belief in something outside the social norm. Consider this statement from the American Psychiatric Association, issued September 2003:

"In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by the person who has the mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population"based norms for cognitive processes, mood regulation, or other indices of thought, emotion and behavior."

In other words, mental illness is what we say it is. Ever hear of drapetomania? It isn’t diagnosed much any more. It’s "an irrestrainable propensity to run away", a psychotic disorder to which slaves were prone. The treatment was amputation of the toes. If you think that’s ancient history, homosexuality wasn’t removed from the Diagnostic and Statistical Manual of Mental Disorders until 1974, and "ego"dystonic homosexuality" (in other words, being in the closet) wasn’t removed until 1986.

If we send the modern criteria of mental illness — "distress", "deviation from social norms" — back to the 18th century, the urge of slaves to run away still fits. However, the "population"based" norms did change — slavery is no longer an acceptable behavior, and so the diagnosis vanished. What is so horribly ironic is that forced treatment itself is still the acceptable social norm; thus, when we the psychiatrically labeled object, our objection to treatment becomes itself evidence of illness.

Psychiatry, rather than taking a leadership role in combating prejudice, gives its medical imprimatur to hatred. Then again, perhaps we should consider ourselves fortunate that they aren’t cutting off our toes to ensure our compliance with treatment.