The principal elements of the legal-religious mentality are autistic certainty, animistic labeling, and concrete thinking. Concrete thinking supports two stigmatizing beliefs about mental illness: that it is a manifestation of evil spirits, and that it is a myth. Whether or not mental disorders are diabolical or mythical, they are expensive: Mental illness costs the American economy at least $250 billion a year (Harwood, Napolitano, Kristiansen, and Collins, 1984). Though adequate treatment for mental illness would significantly decrease those costs, the legal aristocracy resists realizing such benefits. Perhaps fearing that an uncontrolled, mentally-healthy public would overthrow the aristocracy, the ruling class supports cost-control schemes that undermine effective psychiatric treatment. Confusing benefit-control and cost-control, of course, is one sign of the concrete thinking that underlies legal-religious thought.
Attributing mental illness to demonic possession marks animistic thinking. According to Piaget's theory of cognitive development (Wadsworth, 1971), animistic thinking appears during the pre-operational period. Two- to seven-year-old children project that all objects, living or nonliving, think as they do, believing that objects are sentient, animated by spirits, and motivated by purpose. Normally, animistic thinking is outgrown by age 12, though not all children make the transition. Cultural influences are powerful inhibitors of mental growth. The witch trials at Salem Village were based on the belief that certain people were animated by the devil. Current animistic beliefs imbue cocaine, communism, and psychiatry with evil spirits.
Autistic certainty supports primitive thinking in adults because it is relies on self-reference: I would not believe in something that is not real. I believe in demons; therefore, demons must be real. This principle of autistic certainty supports stigmatic labeling—characterizing the whole person by a single property, real or imagined. Thus stigmatic labeling is not limited to the mentally ill. Because homosexuals participated in church-sponsored charities in Sacramento, California, for instance, several churches withdrew from those charities (Los Angeles Times, 1987). Though such expressions of morality create doubt that Jesus would be a Christian today, stigmata are still applied in his name.
In his times, Jesus putatively healed the sick and the mad by casting out devils, explicitly attributing madness, leprosy, and palsy to possession by unclean devils or sinfulness. The major legal-religious subcultures long ago destigmatized leprosy and palsy by adopting non-animistic models of those illnesses: the infectious disease theory and neuro-physiopathology. Yet they have not replaced animistic models of mental illness with psychiatric models. Exorcism, expulsion, or execution are still preferred by primitive thinkers for eliminating mental illness.
Following ancient religious stigmatizing precedents, government relegates the mentally ill to state mental hospitals—custodial institutions that are indistinguishable from state prisons. Moreover, private insurance companies follow government's example and severely devalue psychiatric treatment. Regrettably, neither government nor the insurance industry respect ethical constraints—only moral—legal ones.
The law is founded on morality, not ethics.Understanding the differences between morality and ethics is critical because those differences account for how legal thought destroys the ethical foundation of medical practice. Morality requires only learning; ethics requires thinking. Moral behavior means adhering to an inflexible set of rules; ethical behavior means making rational decisions based on reality. Because many moral rules contradict each other, moral behavior is typically hypocritical. But since reality is not self-contradictory, ethical behavior is not hypocritical.
Furthermore, legal morality presupposes that human behavior can be controlled by external forces. Psychiatric ethics, in contrast, presupposes that behavior is controlled by the individual's internal goals and perceptions of reality. Though legal morality and medical ethics are incompatible, they are equated by concrete political thinking; thus, because the law is coercive rather than persuasive, legal morality drives out medical ethics.
The autism inherent in legal morality is illustrated by the concepts mad and bad, properties that are defined autistically (by self-reference): I am good. People who resemble me are good. People who are different from me are bad—or mad. Clearly, the terms mad and bad represent a single concept: alien—anyone who is different from the perceiver. Trial by jury and the insanity defense are examples of autistic thinking that have been institutionalized in the common law.
Common law was derived directly from the animistic premises of Canon Law. Good people were thought to be animated by good spirits such as the Holy Ghost, whereas bad people or mad people where considered animated by evil spirits such as Satan and demons. According to animistic theories, evil spirits deserve punishment. In practice, however, the people occupied by those spirits suffer the punishment. In Salem Village under Puritan law, people designated as witches—not devils—were hanged. Today the mentally ill—not demons—are relegated to the streets or prisons under modern instruments of persecution: the commitment laws.
How can primitive institutional models of mental illness be eradicated? It would be futile to try to change them through education because primitive thinking changes only with personal experience or projective identification. For every Congressman who stumbles, drunk, into a Washington, D.C. reflecting pool, for example, a few law-makers begin to recognize alcohol addiction as a real problem rather than a moral weakness. And for every scion of a prominent political family who commits suicide after trying vainly to cope with family problems, a few more politicians join the ranks of the reality-oriented.
Experience with economic reality can also modify primitive thinking. For example, though chronic schizophrenia still carries with it the greatest stigma because it is the most costly mental illness to manage, acute schizophreniform disorders are no longer widely considered manifestations of demon possession. The palliative effects of psychoactive drugs have forced people to conclude that, if schizo-demons exist, they are allergic to neuroleptics. Besides, the cost of pharmacotherapy is much cheaper than the expense of long-term custodial care, so these disorders don't burden the compassion of fiscal bureaucrats.
Because autistic thinking is universal, psychiatrists must attack the stigmatization of the mentally ill by confrontation, not conversation; by attending to process, not content. The legal aristocracy is vulnerable to such a campaign because of its advocacy of Health Maintenance Organizations (HMOs). Not content with having corrupted medical ethics in government hospitals, members of the legal elite have supported HMOs to arrogate control over all of medicine. Short of reaching that goal, the legal establishment nevertheless has already defiled doctor-patient relationships by intruding into private practice as third parties, attending to the costs, but not to the benefits, of treatment. Yet they multiply the costs of medical care by sustaining Robin Hood justice—the tort system. The costs of that social parasite, however, are ignored by the aristocracy which unabashedly permits lawyers to steal from the deep pockets and give to themselves.
In 1980, tort cases cost the taxpayers $300 million in court expenditures alone (Kakalik & Ross, 1983). This figure, however, is dwarfed by the total costs of tort law, which include litigation costs, securing liability insurance, and practicing defensive medicine. The benefits to the extorters are obvious, but how is society benefited by the tort system? By the same kind of rewards received by the parents of a kidnapped child: After paying the extortionists, they might receive their child back alive.
Though adept at finding conflicts of interest for others, the legal elite ignore their own conflicts of interest. The Constitution guarantees equal justice, not equal health care. Nevertheless, lawyers, in writing and interpreting the law, act as if all citizens are entitled to equal health care, conveniently overlooking their entitlement to equal justice. In particular, by fostering the private practice of law, lawyers ensure that the rich can buy better legal services than the poor.
Psychiatrists can help expose the egocentric tyranny of the legal aristocracy by initiating a forceful national movement to socialize the law through National Legal Insurance (NLI). NLI would eliminate the need for public defenders and Legal Aid by bringing the services of the nation's most skillful lawyers to all citizens, regardless of their ability to pay. In short, under NLI, citizens would no longer be terrified of unlimited legal fees or suffer because of representation by overworked public defenders. All citizens could obtain the services of the most adroit lawyers, securing the full bounty of the justice system: imaginative pleadings, ingenuous arguments, ingenious legal theories, and interminable appeals.
Under NLI, lawyers would be permitted to operate private practices—but only after regular working hours, and then only if no NLI cases were pending. Moreover, they would be paid flat fees by Case-Related Groups (CRGS) according to the types of cases they would be assigned. Such payment schedules would eliminate the incentive for lawyers to create conflicts rather than resolve them.
By initiating the NLI movement, psychiatrists would significantly enhance the public's image of psychiatry because this cause would be supported by most citizens—people who have come to trust vigilantism more than the justice system. One likely outcome of the NLI initiative would be that more non-lawyers would be elected to public office; few candidates would resist boarding the NLI bandwagon. Of course, lawyers would desperately fight NLI, dreading the feeding frenzy that would ensue if citizens took control of their own government. Imagine a thief, having been caught red-handed, demanding of F. Lee Bailey: "Get me off, or I'll have Melvin Belli sue you! "
Despite the self-serving excesses of the legal profession, psychiatrists must not treat lawyers as scapegoats, and thus overlook their own sponsorship of primitive thinking. Psychiatrists can't help destigmatize mental illness by faking sincerity as politicians do; they must initiate profound political changes within their own profession, including founding an organization to replace the American Psychiatric Association (APA).
More than any other prominent organization of psychiatrists, the APA has stigmatized psychiatric patients—and psychiatrists—by embracing legal concepts that corrupt psychiatric thought. This prostitution is most obvious in courtrooms, where highly visible psychiatrists nurture autistic thinking by participating in cases involving the insanity defense and the litigation of psychiatric injury. In the former proceedings, rogue psychiatrists discredit themselves and their profession by claiming medical expertise about a fictitious mental disease. In the latter proceedings, they reinforce legal animistic labeling by attributing the symptoms of posttraumatic stress disorder to malingering or moral weakness. Though these psychiatrists identify themselves as forensic psychiatrists, they are correctly identified by their traditional name: allenists. Practicing alienism would be impossible without the active support of the APA.
In its official statement on the insanity defense, the APA (1982) endorsed this defense as a means of segregating the mad from the bad—without once addressing the autistic origins of the concept of insanity. By reinforcing primitive conceptual models of humankind in that way, the APA debased psychiatric science and secured immortality for its alienist ancestor, The Association of Medical Superintendents of American Institutions for the Insane.
Advocates of forensic psychiatry claim that, to be good citizens, psychiatrists must work within the legal system to achieve their therapeutic goals. This argument, however, is nonsense. Adopting legal-religious thinking is precisely what corrupts psychiatric thought. Moreover, the law—a game of deception—welcomes false testimony from fraudulent psychiatrists. Yet contrary to the proclamations of forensic psychiatrists, psychiatrists can testify as expert witnesses—without debasing their specialty. They can refuse to answer questions based on nonpsychiatric notions, for instance, explaining that answering such questions would discredit them as medical experts—regardless of any rulings a judge might make to the contrary. In other words, judges can't arbitrarily legitimize false expertise—or perjury.
In addition to endorsing alienism, the APA also helps characterize mental illness as a myth by earning the scorn of Thomas Szasz, thereby giving his writings undeserved stature (Vatz & Weinberg, 1983). Unlike other medical societies, the APA exists primarily to advance, not psychiatric science, but psychiatrists—a posture that gives credence to Szasz's operational definition of psychiatry as "whatever psychiatrists do" (p. 171).
By supporting psychiatrists, regardless of what they do, APA leaders fail to distinguish psychiatric opinions from psychiatrists' opinions. In so doing, they fail to distinguish the two methods of Hume's Fork: the axiomatic (a priori) and empirical (a posteriori) methods of obtaining knowledge. Applying the axiomatic method results in creating fiction (e.g., religion, law); applying the empirical method results in acquiring knowledge about reality (e.g., science, medicine).Thus, the term empirical psychiatry is redundant: Medicine is an empirical technology, and psychiatry is a medical specialty. The term forensic psychiatry is therefore an oxymoron because forensic methods are axiomatic.
Knowing the difference between the axiomatic and empirical methods is essential for dispelling the contention by Szasz (1974) that mental illness is a myth, a characterization that is nothing more than one man's axiomatic assertion that disorders associated with physical abnormalities are real illnesses, but disorders of function are mythical. According to Szasz's axiom, ventricular fibrillation is a myth because it is a disorder of temporal rather than spatial organization. Ventricular fibrillation—and mental illness—kill real people, as many families know from personal experience.
My son, Scott, was an accomplished poet, artist, songwriter, and philosopher at age 21. But he, like Vincent van Gogh, committed suicide. Both men died because they knew their creative lives were truncated, increasingly disrupted by episodes of mood swings and perceptual distortions. And though Scott received the best modern psychiatric treatment, that treatment was ineffectual. Disorders of brain function are far more disruptive to extraordinary intellects than to ordinary ones. Scott died while nonpsychotic and insightful, grieving and discouraged—but not depressed. Acutely aware of social stigmata, Scott had worried about the effects of his illness on his credibility. Though valid ideas stand on their own merits in reality-based cultures, the legal-religious cultures honor argumentum ad hominum—a fallacy that sustains the practice of alienism.
Because the law respects psychiatric credentials more than psychiatric competence, the American Board of Psychiatry and Neurology currently occupies a strong position to expunge phony psychiatry. Indeed, alienism could not thrive without the credentials conferred by that Board. Psychiatrists could urge the Board to promulgate guidelines and procedures for decertifying psychiatrists who practice oxymoronic pseudopsychiatry. Of course, for all the reasons charlatans advocate false psychiatry, political resistance would develop quickly to such an initiative by the Board. The Board could answer such resistance, however, by suggesting that the pseudopsychiatrists form their own Boards of Alienism and Ideological Psychiatry, and seek the company of libertarian oncologists, Buddhist endocrinologists, and ultraconservative urologists.
The most important reform psychiatrists can achieve is to eliminate the institutionalized pseudopsychiatry perpetuated by the APA. Because of its intrinsic political structure, the APA will not repudiate phony psychiatry because it will not abandon its identity as an association of psychiatrists. Therefore, psychiatrists must permit the APA to die of neglect, and create a new organization—The National College of Psychiatry (NCP)—specifically dedicated to promote psychiatry and eschew alienism.
NCP members would pledge to adhere to empirical thought, methods, and practice; to expunge legal, religious, and other folkloric concepts from psychiatry; and to oppose additional incorporation of primitive thinking into psychiatric thought. In addition to the concept of insanity, the NCP would specifically repudiate the legal fiction of involuntariness because volition is an autistically-derived, immeasurable, fictitious mental property.
Evaluating volition based on what a person says—"I want out of the hospital"—ignores the distinction between conscious thought and unconscious processes, between linguistic surface structure and deep structure (Chomsky, 1968). The law, a game of words without specific meanings, is limited to recognizing surface structures. Psychiatry, in contrast, acknowledges the operation of deep conceptual structures. Thus, by incorporating the label involuntary into their lexicon, people—including psychiatrists—embrace the nonreality principle, the axiomatic method.
The stigmatization of the mentally ill can be eliminated only by overriding the primitive legal-religious thinking that dominates our culture. Obtaining knowledge by applying the empirical method must replace presupposing knowledge by applying the axiomatic method. Among specific actions needed to expunge stigmatic labeling, psychiatrists must decertify psychiatrists who practice alienism, replace the APA with an organization dedicated to psychiatric science, and persuade lawmakers to replace legal commitments based on volition. Only by succeeding in such actions can psychiatrists earn respect for their profession, secure understanding for their patients, and avoid being designated as the jailers of the mentally ill.
Chomsky, N. (1968). Language and mind. New York: Harcourt BraceJovanovich.
Harwood, H. J., Napolitano, D. M., Kristiansen, P.L., & Collins, J.J. (1984). Economic costs to society of alcohol and drug abuse and mental illness: 1980 (Final Report to Alcohol and Mental Health Administration). Research Triangle Park, North Carolina: Research Triangle Institute.
Kakalik, J.S. & Ross, R.L. (1983). Costs of the civil justice system: Court expenditures for various types of civil cases. Santa Monica, California: Rand Publications.
The news in brief: The state. (1987, January 4). Los Angeles Times. Part I, p. 2.
Szasz, T. (1974). The myth of mental illness (rev. ed.). New York: Harper and Row.
Vatz, R.E. & Weinberg, S.L. (Eds.) (1983). Thomas Szasz: Primary values and contentions. Buffalo, New York: Prometheus Books.
Wadsworth, B. (1971). Piaget's theory of cognitive development. New York: David McKay.