revised 12/19/99

Why Outpatient Commitment Laws
Change (Almost) Nothing

by Douglas A. Smith

Many of us in the ex-patients' or psychiatric survivors' antipsychiatry movement, including myself, have been dismayed by the enactment of "outpatient commitment" laws in most states of the U.S.A.  When one version of these laws was enacted in New York ("Kendra's Law"), most of our web sites had initial "blackout" pages to illustrate that the enactment of this law in New York was a black page in the history of the antipsychiatry movement and our campaign for human rights.  However, these victories by the supporters of psychiatric oppression in the form of New York's Kendra's Law and similar laws in other states are largely symbolic.  In terms of their practical effect, these new laws change almost nothing.  My own experience will illustrate why:

Over 30 years ago, I was committed involuntarily by my parents and a psychiatrist they hired who initially insisted my opinion that all human beings have a right to end their lives if they wish was some kind of mental disorder that justified detaining me against my will through involuntary commitment proceedings.  My sorrow because of personal problems and having at times thought about ending my life to escape the pain I felt was what motivated my parents to hire the psychiatrist, but I never did decide to end my life nor had I ever made a suicide attempt, and the psychiatrist didn't actually say anything about how sad I felt or that he thought I might decide to end my life in response to my question about why it was appropriate to subject me to an involuntary commitment.  After about a month of observing me and talking with me on an almost daily basis he told me he'd changed his mind and had decided that while he disagreed with my opinion about everyone having the right to end one's own life, it wasn't really a disorder - and he said he could find no evidence I had a mental illness, just ordinary sorrow that he called "situational, not biological."  According to my parents, about the same time he told them I did "not have a serious mental illness." Two or three weeks later he discharged me from the hospital.  However, about two weeks after my release, my mother made an appointment for me to see him because she thought my mood was too serious or sad.  The main reason I'd been committed was my refusal to resume so-called outpatient psychotherapy I'd tried months before and found worthless, and after my discharge from the hospital I continued to refuse to be a psychiatric or psychotherapeutic outpatient.  I was not being asked to take psychiatric drugs.  My parents and their psychiatrist insisted only that I see him at his office for a consultation or what might have been called "psychotherapy."  Despite his admission to me and my parents about a month before that I did not have a "mental illness" (at least, not a "serious" one), the psychiatrist, with my parents' support, threatened to commit me again if I refused to see him at his office.  I continued to refuse to see him as an outpatient, and for that reason alone - none other - he again committed me against my will to the same hospital, using the "emergency admission" procedure under which I was immediately incarcerated before having any sort of hearing or trial.  Of course, to do this, he had to allege that I had a mental illness and was likely to cause injury to myself or others if I was not immediately hospitalized.  He knew these allegations were false.  They were outright lies.  He knew it, and he knew that I knew it.  But because it suited his purpose of trying to force me to be an outpatient, he nevertheless made these allegations required by law for an involuntary commitment.  This was many years before anybody was even talking about "outpatient commitment" laws such as Kendra's Law, under which people may be incarcerated in a hospital only because they refuse to comply with a program of outpatient "treatment."
        I was able to stop this oppressive use of psychiatric commitment law only by demanding a jury trial.  I'd learned from my first commitment that failure to demand a jury trial always results in involuntary commitment by a judge who automatically and routinely approves physicians' requests for commitment without even pretending to form his own opinion about the appropriateness of the commitment.  For example, the judge who committed me did so without hearing any testimony despite my demand I be permitted to ask the psychiatrist questions (i.e., cross-examine the witnesses against me).  The judge said in response that the psychiatrist had submitted his opinion in writing, and despite my protest the judge insisted that was all that was required.  My court-appointed attorney (who said literally not one word during my conversation with the judge that passed for a "hearing") ignored my repeated demands he appeal.  So the second time I demanded a jury trial.  Rather than attempt to persuade a jury he should be permitted to continue to hold me against my will, the psychiatrist released me from the hospital.  I've had no psychiatric or psychological "therapy" since then.

Psychiatrists, and in most states all licensed physicians, have always had the power to incarcerate people involuntarily for any reason they want if they are willing to allege "mental illness" and "dangerousness" as required by the state's involuntary commitment law.  Since "dangerousness" is a prediction of future conduct, it is always possible to make this allegation.  Since nobody can ever prove he or she isn't going to do something in the future, this allegation is always impossible to disprove.  In the 30 years I've been observing this I've seen psychiatrists routinely make these allegations even when they have no reason to believe they are true and do not really believe the proposed patient is likely to harm anyone.  All Kendra's Law and similar "outpatient commitment" laws do is make it unnecessary for the psychiatrist or other physician to tell these lies.  Since few psychiatrists are constrained by the bounds of honesty, Kendra's Law and similar outpatient commitment laws do not really expand their despotic powers.  The only psychiatrist whose powers are expanded by an outpatient commitment law such as Kendra's Law is one who always tells the truth, at least as he or she sees it.  I think some psychiatrists are honest - even if most of their "expertise" is nonsense - but most psychiatrists I've observed are routinely dishonest.

So let's see Kendra's Law in New York and similar laws in other states for what they are: symbolic victories of those who favor using psychiatry to violate human rights.

There are at least two dangers of these new laws:

First, their enactment shows that our lawmakers still believe myths such as (1) mental illness is a real illness, and it deprives people of free will and of the ability to make rational decisions, (2) mental illnesses are caused by biochemical imbalances that are corrected by psychiatric drugs, and (3) psychiatrists are always honest and are experts in their field, so their "diagnoses" determining who is "mentally ill" and who will become violent are reliable, making safeguards against unnecessary or unjust or oppressive use of involuntary commitment unnecessary.  We need to be more effective in our efforts to make lawmakers, judges, mental health professionals, and ourselves realize that physicians are not perfect examples of honesty and integrity, that "mental illness" is not a valid concept, that psychiatry is a pseudo-science, that unjust psychiatric commitment is commonplace, that psychiatrists routinely violate human rights, and that psychiatric "treatment" usually harms rather than helps people.

Second, these outpatient commitment laws may get psychiatrists and other mental health "professionals" in the habit of incarcerating people only because they refuse to take psychiatric drugs when in the past they might have left us alone.  All psychiatric drugs are harmful.  Nobody should be taking these drugs.  If we can't stop the lawful use of coercive psychiatry, we may need to start an "underground railroad" similar to that used to help blacks escape slavery during the period shortly before the civil war when slavery was legal.  Does anybody know where victims of psychiatric oppression can go to hide from those who would harm them with involuntary commitment or forced use of psychiatric drugs?  Does anybody want to volunteer to provide transportation to such a safe haven?

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