On Legal Abuses of Psychiatry (Psychiatric Justice, by Thomas S. Srasz)
Volkman, Edward A.
PSYCHIATRIC JUSTICE, by Thomas S. Szasz. New York: Macmillan. 283 pp. $6.95. Dr. Thomas S. Szasz, in his latest essay into the abuses of psychiatry, considers what he calls the...
...He contends that the terms used to label abnormal behavior phenomena are primarily useful as diagnostic categories in the clinical practice of psychiatry...
...EDWARD A. VOLKMAN...
...The judge is the referee, familiar with the rules and charged with the responsibility of insuring that the scoring is in accord with these rules (which are, in turn, agreed to a priori...
...By this usurpation, the defense attorney is stripped of responsibility and can no longer aid his client...
...The end result of this wholesale abdication is that the psychiatric expert dictates the patient /defendant's fate...
...There are two ways of looking at the problem...
...The State's attorney, by asserting his unwillingness to press charges against an individual because he is mentally incompetent, purports to act as the defendant's agent...
...Leukemia, for instance, is a serious illness, but it does not necessarily impair a man's ability to assume the role of defendant in a trial...
...But in any case, it is necessary to remove the psychiatrist from the role of judge...
...Similarly, if defense counsel informs the court that his client is unable to understand the charge against him and/or is unable to assist in making his defense, the court has good evidence of incompetence...
...They are little more than penal custodial institutions, not more beneficial to their inmates than prisons, and perhaps less so...
...It is Szasi s contention that the re lationship of psychiatry to authority is much too close, and that this results in a serious threat to individual liberty...
...The incarceration in a state mental hospital which follows from a finding of incompetency, is supposed to remedy the defect and to return the defendant to trial...
...Therefore he becomes incompetent to fulfill his role as arbiter...
...That is, such information is not protected by the privilege traditionally surrounding medical consultations...
...Not surprisingly, the examiner's judgment usually confirms the suspicion that the accused is incompetent to stand trial...
...Often enough, in practice, the time is never...
...Nor is the accused provided access to free non-government psychiatrists, as he is to free non-government counsel...
...Or, the use of the present procedure can be defended and the means of deciding competence altered...
...The responsibility can be put back into the hands of the judge—whose role is that of arbiter—and into those of the defense counsel—whose role demands that he be concerned with the defendant's best interests...
...You can get out of prison within a stated time, but you cannot become "competent" within a stated time...
...The incompetency device is used in cases where the legal means of punishment are either not available or not consonant with what judge or prosecutor deems the defendant's threat to society...
...He argues that, in a question of competence, we are—or ought to be—only interested in the defendant's capacity to play his assigned role, rather than in his health, mental or otherwise...
...But, since aberrations in mental behavior are not analogous to physiological dysfunctions, such clinical terms cannot be applied with an equivalent medical authority...
...Usually the psychiatrist is called into the proceedings by the prosecutor or the judge (in New York City, the police can take this step before the accused is even indicted...
...In such a case, the initiative for seeking relief on the grounds of inability to stand trial is left to the defendant and his counsel...
...But hospitals for the criminally insane are understaffed, underequipped, and they have an extremely low priority in the community's scale of interests...
...The foundation of this system is the conception of the defense attorney and the State's attorney as opposing duelists who score by obtaining convictions or acquittals, depending on their role...
...This can be simply decided, precisely because incompetence is not a beneficial defense strategy...
...Thomas S. Szasz, in his latest essay into the abuses of psychiatry, considers what he calls the psychiatric denial of the right of trial: the procedure by which the accused is denied trial on the grounds of mental incompetence...
...he does not say "crazy," but "the patient suffers from manic-depressive psychosis," or "the patient exhibits the behavior pattern of a paranoid schizophrenic...
...But in psychiatric proceedings, a non-legal discipline is brought in, not only where it is not needed and will provide no extra information, but where it can work counter to a principal's interests...
...That is, they are seen as men whose rewards reinforce their roles...
...One is to challenge the place of mental competence in a criminal trial as a deciding factor in the issue of guilt or innocence—which is a question of fact...
...Whenever these names are transmogrified—as they are when used out of a psychiatric context —they invariably translate as crazy or mentally ill...
...His psychiatric examinations (as opposed to those in which the defense is "not guilty by reason of insanity") are almost never initiated at the behest of the accused...
...Challenging more than the precision or accuracy of psychiatric determinations, Szasz challenges their relevance to the right to stand trial...
...One could hardly imagine a prose cutor seeking to declare a defendant incompetent to stand trial on somatic medical grounds, over the defendant's objection...
...The whole purpose of the incompetency device is obviously to refrain from trying and punishing mental defectives of one sort or another...
...That is, the whole issue can be postponed until after the substantive trial—and then brought in only to abet the judge in deciding the nature and duration of punishment, as probationer's reports are used...
...The severest attack the incompetency proceeding makes on our libertarian institutions is its disruption of our adversary system of justice...
...but he also loses his formal protections against this aggression...
...But the psychiatrist is invariably an agent of the state, and, as such, not impartial...
...When a man is labelled "crazy," his denial is often taken to demonstrate the severity of his disease...
...Since this device can be employed even in misdemeanor offenses, and since the defendant's desire to plead guilty is no defense against it (because the substantive issue never comes to trial), it provides a means of incarceration which by-passes the rudiments of due process...
...The finding of mental incompetence is often a life sentence with no appeal except to him who has initially served as judge and executioner—the psychiatrist...
...By the mystical nature of the proceedings—a result of the introduction of psychiatric expertise—the judge loses his unique grasp of the rules...
...The psychiatrist—testifying in court— practices a vaguely mystical art...
...That is, the charge remains pending, and the defendant is remanded to custody (usually in a state hospital for the criminally insane), until he is competent to stand trial...
...If a man is a raving maniac, and manifests this condition by inappropriate behavior in court, the judge can easily judge him incompetent to stand trial...
...The role of the examining psychiatrist as an agent of the state—and therefore as an adjunct to the prosecutor and antagonist of the defendant —is insufficiently recognized...
...But the psychiatric proceeding undermines all of these functions...
...That is, the defendant is transformed into a patient and thus is no longer the object of the prosecutor's legal aggression...
...One of the less lovely ancillary results of the directed examina tion is that information pertaining to the alleged offense elicited by the examining psychiatrist can be used by the prosecutor...
...Szasz attacks the conception that the behavioral phenomena loosely grouped under the name of mental diseases are illnesses analogous to somatic diseases...
...Once such a diagnosis is formally made, a man loses stature and rights in a host of ways, not the least being the loss of his rights in law (which includes the management of his civil affairs, and his rights in a criminal proceeding...
Vol. 13 • November 1966 • No. 6
