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Psychiatric Slavery?

Manlius, N.Y.

In her column in the July 18 issue titled "The ‘Suicide-Prevention Contract’: A Dangerous Myth," APA President Marcia Goin, M.D., asserted: "We can make contracts with builders, insurers, and car dealers, but not with patients." Mental patients are not legally incompetent. Builders, insurers, and car dealers make contracts with mental patients. Why can’t psychiatrists make contracts with them?

Dr. Goin makes her sweeping statement in the context of rejecting the so-called no-suicide contract, but her statement places no limits on the no-contract principle with mental patients. On the contrary, she tacitly underscores that coercive paternalism is the bedrock principle of psychiatry: "When entrepreneurs break a contract, the rupture stirs a multitude of negative feelings, and legal action may follow. But a broken ‘no-suicide’ contract stirs tragic feelings for all involved. No amount of legal action can restore the patient’s life."

I wish to offer three brief observations:

• Dr. Goin is a psychoanalyst, a member of the American Psychoanalytic Association. If the relationship between analyst and patient is not a contract, what is it? Do psychoanalytic patients fall outside Goin’s category of "our patients"?

• Suicide is not illegal. Americans have a right to kill themselves. Psychiatrists deny the basic right of self-ownership to patients, but not to themselves. The patient who commits suicide does not "lose" his life. He takes it (into his own hands). Hence, there is nothing to "restore."

• Dr. Goin noted that the damage caused by broken contracts is remedied by legal action, but she fails to mention that the principle applies to the suicide-prevention "contract" as well. When mental patients commit suicide, survivors hold the psychiatrists responsible for defaulting on their contracts to protect patients from themselves.

Without Consent or Contract is the title of historian Robert William Fogel’s important book on slavery. Those words summarize the essence of the immorality of the institutions of chattel slavery and psychiatric slavery. The concepts of consent and contract imply relations between persons who recognize one another’s personhood. That recognition was incompatible with slavery and is, according to the president of APA, incompatible with psychiatry.

I thank Dr. Szasz for taking the time to communicate his thoughts on my recent column. A collaborative working relationship between patient and physician is important in all fields of medicine. This is particularly true in psychiatry, where so much is dependent upon patients’ ability and emotional freedom to talk about how they feel, their desires, and their impulses. Suicidal ideation is a case in point. Collaboration, not slavery, is the answer.

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