Date:         Wed, 3 Jan 1996 21:57:06 EST
From: "Dr. Jeffrey A. Schaler" <JSCHALE@AMERICAN.EDU>
Organization: The American University
Subject:      The myth of treatment
To: Multiple recipients of list NUVUPSY <NUVUPSY@SJUVM.STJOHNS.EDU>
 
     There are basically three situations in which medical
treatment without consent is considered legally/ethically
acceptable:
 
1.  When the designated patient is literally unconscious.
For example, you're in an automobile accident and an
ambulance arrives.  You're unconscious.  They don't wait for
you to give consent to treatment.  You are treated without
consent.  No problem.
 
2.  When the designated patient is literally a child.  For
example, your child is sick, you need to get a throat culture
or blood test.  Your child objects.  The culture or blood
test is taken despite their objections.  (My daughter is now
21 years old.  Thank god I don't have to go through that any
more!  However, I remember it well, as I'm sure many of you
do!)
 
3.  When the designated patient is literally contagious with
disease.  For example, a student at the university comes down
with contagious meningitis.  The student is quarantined.
Really the treatment and quarantine is not necessarily for
the designated patient's welfare.  It's to protect the
welfare of others.
 
     Let's look at (3) from another point of view:  No
smoking allowed in class.  Is that to protect the smoker or
those who do not want to inhale second-hand smoke?  Clearly
the latter.  (What FDA Administrator David Kessler wants to
do is protect the smoker from him/herself.)
 
     What's happened is that those three conditions where
treatment without consent is allowed has been cleverly
extended to "sick" behaviors.  Only the literal conditions
are not present, i.e., metaphorical ones are.  Moreover,
their applications, i.e., treatment without consent for
"sick" behaviors, are strategic maneuvers, not factual
assessments.  They are designed to accomplish a particular
goal of social control under the masquerade of treating
illness.
     Here's the difference between a strategic maneuver and a
factual assessment:  I tell my students they cannot smoke in
class.  That's a strategic maneuver masquerading as a factual
assessment.  They CAN smoke in class, i.e., they are capable
of doing so.  I say they CANNOT smoke in class as a way of
imposing a social rule, acceptable behavior (Szasz,
Psychiatric Justice).
 
     Let's remember that behavior can never be sick.  It can
only be sick in the way a joke can be sick.  Additionally,
let's keep in mind that "patient" is an assigned role.  Just
because a person is either assigned the role of "patient" or
assumes the role of "patient" does not mean that he or she is
in fact literally sick.  And of course, a person can be sick
and not be a patient.
 
     The rationalizations for treatment against one's will or
consent for "mental illness" are based on the three
conditions listed above for real illness, only in the case of
"treatment" for "mental illness" without consent we have
three metaphorical conditions present, in place of the
literal ones.
 
1.  Persons are "treated" against their will for "mental
illness" because they are said to be unconscious.  But they
are not literally unconscious.  They are metaphorically
unconscious.  There's a big difference.  One of the "signs"
of being metaphorically unconscious is denying that you are
unconscious.
 
2.  Persons are "treated" against their will for "mental
illness" because they are said to be like children.  But they
are not literally children.  They are metaphorically
children, e.g., they may be dependent, they may not be acting
responsibly, they may not be taking care of themselves, etc.
Again, there's a big difference.  Literal children may not be
actually capable of taking care of themselves in certain
ways.  Metaphorical children theoretically can't take care of
themselves.  They are choosing not to care for themselves in
certain ways.  They are theoretically a danger to themselves.
Thus, benevolent paternalism is justified.
 
3.  Persons who are "treated" against their will for "mental
illness" are dangerous to others (contagious).  The fact of
the matter is we cannot predict dangerousness in people.
Moreover, we cannot arrest and deprive someone of liberty
simply on the basis of suspicion of dangerousness.  Our
constitution protects us from that.  The "contagion" is
metaphorical, not literal.  The disease metaphor is used to
circumvent constitutional protections.
 
 
     When people are "treated" against their will they are
not treated at all:  Medical treatment is by consent only,
except in those first three cases where literal conditions of
unconsciousness, childhood and contagious disease are
actually present.  The metaphorical versions of those three
conditions are strategic maneuvers justified through alleged
factual (literal) assessments.  Treatment without consent is
never treatment at all--it is assault and battery.
 
 
     I think it is also important to differentiate between
criminal behavior and "mental illness" as the cause of
criminal behavior.  What does giving an anti-psychotic drug
have to do with criminal behavior?
 
     And further still, let me ask this:  What if a person
imprisoned for murder requests a drug to commit suicide.
Shall we give it to him/her?  I say yes.
 
 
Jeff
jschale@american.edu