Psychiatry and the state: the federal government plans a new role in delivering mental health care. Historically, however, governments have used psychiatric techniques for harm rather than for good.

On April 29, 2002, President George W. Bush issued an executive order creating a new commission charged with finding ways to "improve America's mental health service delivery system." One year later, the Orwellian-sounding New Freedom Commission on Mental Health released its findings. Its final report recommended mental health screening for all Americans and, in a proposal that should alarm parents everywhere, recommended that the nation's schools be used to assess the mental health of all schoolchildren.

While each new federal plan or program seems more ludicrous than the last, the commission's desire to screen the mental health of all Americans is not just another big government boondoggle. From its "newspeak" name to its ambitious proposals, the plan to assess the mental health of all Americans is similar to the Bush administration's other totalitarian constructions, from the Department of Homeland Security to the infamous Patriot Act.

It may not seem obvious, but the authoritarian impulse has been an ever-present undercurrent within the mental health industry. Indeed, totalitarian governments of the recent past, and some of the present, have sought to use dehumanizing and compulsory psychological controls to manage public opinion and pathologize dissent. These efforts have included sophisticated propaganda campaigns, psychological indoctrination in the schools, concentration camps used to "re-educate" those who, in holding opinions dissenting from those of the ruling regime, were considered "insane," and a variety of invasive brainwashing techniques.

Certainly, the Bush administration would prefer to portray its interest in federal oversight of the nation's mental health as a plank in its platform of "compassionate conservatism," rather than as a potential giant step toward the total state. But given the authoritarian background of the mental health industry, the past abuses visited upon innocent civilians by oppressive governments, and the Bush administration's history of promulgating potentially oppressive policy, the prospect of an unprecedented and unconstitutional role for the federal bureaucracy in mental health care bodes ill for the cause of liberty.

Coercion and Control

It has become commonplace to think of psychiatric diagnoses in the same way that one thinks of medical diagnoses. The two, however, are radically different. Medical diagnoses are based on actual physical malfunctions. Psychiatric diagnoses, though, are based on mental abnormalities. The latter are, by definition, nonphysical. Consequently, most treatments advocated and prescribed by the mental health industry are not cures for diseases in the traditional, medical sense. While consultations with mental health care providers may benefit or "treat" many people, systemically mental health treatments have more in common with behavior modification and thought control than with normal medical practices.

No one has been more critical of the mental health industry than Thomas Szasz. A psychoanalyst by training and a libertarian by choice, Szasz began courting controversy in a serious way in 1961 with the book The Myth of Mental Illness. He has argued, persuasively, that there is a substantial and crucial difference between diseases of the body and diseases of the mind. Diseases of the physical body, like pneumonia, can be diagnosed accurately based on work done in the laboratory, but mental disorders like schizophrenia cannot. "Most educated people," Szasz said in an interview with Reason magazine in July 2000, "know how real disease is diagnosed, lf a person ... says he is tired, he has no energy, and he looks very pale, the physician may think he is anemic. But the diagnosis is not made until there is a finding in the laboratory that he has a diminished blood count, a diminished hemoglobin level.... As soon as that can be done with schizophrenia, it will be a brain disease, exactly as neurosyphilis was recognized as a brain disease."

Perhaps the best example that so-called mental illnesses have little or no basis in biological function is Attention Deficit Hyperactivity Disorder (ADHD). Though millions of children are given amphetamines (Ritalin) to treat this "disease," there is no biological basis for the disorder. This is the view of pediatric neurologist Fred Baughman, who calls ADHD "a contrived epidemic." In fact, in 1998 the National Institutes of Health (NIH) Consensus Development Conference on the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder admitted as much, concluding: "We don't have an independent, valid test for ADHD; there are no data to indicate that ADHD is due to a brain malfunction.... " Says Szasz: "No one explains where this disease came from, why it didn't exist 50 years ago. No one is able to diagnose it with objective tests. It's diagnosed by a teacher complaining or a parent complaining."

The lack of a biological basis for mental illness is not confined to just ADHD and schizophrenia. A number of medical practitioners have pointed out that this is true of other mental disorders as well. Writing in the journal Psychiatric Times in 1996, Dr. David Kaiser noted: "[M]odern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness." More recently, Harvard Medical School psychiatrist Joseph Glenmullen observed in the book Prozac Backlash that "we do not yet have proof either of the cause or the physiology for any psychiatric diagnosis."

Clearly, mental health is not about treating disease in the normal sense, since "mental illnesses" like ADHD and schizophrenia have no biological basis. Instead, Szasz and others believe that psychiatrists and other mental health professionals are in the business of thought control and coercion. Attorney Lawrence Stevens, a frequent critic of psychiatry, points out that "people are thought of as mentally ill only when their thinking, emotions, or behavior is contrary to what is considered acceptable, that is, when others (or the so-called patients themselves) dislike something about them."

In fact, Szasz argues that the mental health profession, in defining behaviors as deviant and in treating behaviors as diseases, despite finding no physiological basis for these diseases, is really exercising control over the population. "Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish," Szasz has written. This is an error with dangerous and troublesome consequences, he says. "The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control."

Lessons from History

That psychiatry could be a powerful tool of coercion and control was not lost on the dictators and totalitarian regimes of the past century. They were quick to use thought-control and behavior-modification techniques on their hapless subjects and to deem "mentally ill" anyone who opposed the party line. They were not content merely to enslave the bodies of their subjects; they wanted to enslave their minds as well.

The most sophisticated of these efforts have been those conducted by the Communist Chinese. In the 1950s the Chinese program of thought control was begun in a serious way. At the time, Yale University psychiatrist Robert Jay Lifton traveled to Hong Kong to conduct interviews with both Westerners and Chinese nationals who lead been subjected to the Communist program.

In Thought Reform and the Psychology of Totalism: A Study of "Brainwashing" in China, the book that details the results of his study, Lifton observed that "the official Chinese Communist program of szu-hsiang kai-tsao (variously translated as 'ideological remolding,' 'ideological reform,' or as we shall refer to it here, 'thought reform') has, in fact, emerged as one of the most powerful efforts at human manipulation ever undertaken. To be sure, such a program is by no means completely new: imposed dogmas, inquisitions, and mass conversion movements leave existed in every country and during every historical epoch. But the Chinese Communists have brought to theirs a more organized, comprehensive, and deliberate--a more total--character, as well as a unique blend of energetic and ingenious psychological techniques."

The Chinese program of thought control consisted of two major elements, "confession, the exposure and renunciation of past and present 'evil'; and re-education, the remaking of a man in the Communist image," Lifton reported. The effort intended to "bring into play a series of pressures and appeals--intellectual, emotional, and physical--aimed at social control.... " The program was thoroughly employed through most of the institutions of Chinese society, including primary and secondary schools. The locus of the effort, however, was in the Communist brainwashing centers, the so-called "revolutionary universities" that were, in fact, created solely to tear down the individualist psyches of those admitted there and create instead good Communists. Some in China, seeking to ingratiate themselves with the Party, voluntarily committed themselves to the institutions. Many others, though, says Lifton, "came to revolutionary universities in response to thinly veiled coercion--the strong suggestion that they attend."

The intention of the Chinese program was to stifle dissent by first defining it as deviant and causing overwhelming feelings of guilt in the subject, followed by psychological conditioning that rewarded newfound devotion to the party line. The overall result of this program was that Chinese citizens were conditioned to accept, and indeed, to love, the Communist regime, in the same sense that Winston Smith, the protagonist in Orwell's Nineteen Eighty-Four, was conditioned to love Big Brother. It was a powerful and successful program. Lifton noted that, despite the fact that those he interviewed had managed in the end to escape the clutches of the Chinese tyranny, "the great majority ... are partially convinced" of the validity of the Communist line following their psychological reconstruction.

It is important to note, however, that governmental use of invasive and coercive psychological measures to stifle dissent is not just a relic of history, but is instead still a facet of life in some countries today. It is still happening to a large extent in China, and Castro's oppressive regime in the Caribbean is a case in point. In an article in the Wall Street Journal in 1991, Frank Calzon of the Center for a Free Cuba described the experience of Jose Luis Alvarado, a student who had attempted to escape Castro's "worker's paradise."

After his capture, Alvarado was imprisoned in Havana's Psychiatric Hospital where, Calzon writes, "he was given electroshocks and psychotropic drugs. He witnessed beatings, insane inmates wandering around naked, and walls and floors covered with urine, vomit and excrement." When complaints on his behalf were made by the wife of a human rights activist to the director of the hospital, they fell on deaf ears. There was nothing that could be done. "The ward was under the control of 'state security,' Castro's political police."

Coming to a Government Near You

To "liberal" Western minds, accustomed to the natural right to freedom of thought and speech, it seems logically incongruous, and decidedly barbarous, to incarcerate in psychiatric hospitals those who hold opinions contrary to the beliefs of the ruling regime. To the totalitarian mind, however, this strategy makes complete sense, both on a functional and a logical level. Functionally, as the Chinese Communists demonstrated through their comprehensive thought reform programs, sophisticated "brainwashing" techniques can convert a population that may be innately hostile to tyrannical domination to one that is ready to meekly accept, and even love, their own enslavement. Logically, to the dedicated, egomaniacal tyrant, any opposition to or deviation from the state-sanctioned or politically correct line must be driven by insanity. This, in fact, was the view taken by the Soviets.

In their study Utopia in Power, Russian writers Mikhail Heller and Aleksandr Nekrich point out that those dissidents who persisted in violating Article 190 of the Soviet penal code criminalizing dissent could be confined in a mental hospital. "This meant," Heller and Nekrich noted, "in reality that anyone could be institutionalized on the basis of a doctor's 'expert testimony' for openly questioning the correctness of a political decision.... "

Among those victimized in this manner by the Soviet "mental health" industry was Vladimir Bukovsky, a dissident who spent 12 years in the gulag, the Soviet prison system. Part of that time was spent in the psihuska, or psychiatric prison. In his memoir To Build a Castle: My Life as a Dissenter, Bukovsky explained the logic of Soviet psychiatry. The commissars, he wrote, "figured that it was impossible for people in a socialist society to have an antisocialist consciousness." Of his own experience with Soviet re-education, he recalled that Soviet psychiatrists "tried to prove to us that we really were crazy: first, because we bad come into conflict with society, whereas a normal person adapts to society; and second, because we had risked our freedom for the sake of stupid ideas, neglecting the interests of our families and careers."

Currently, Western nations do not use such extreme and oppressive methods to stifle dissent. Nevertheless, some intellectuals hold views that, if they gained wide currency, could lead to similar sorts of abuse. One of these intellectuals is Wolf Singer, the head of the Max Planck Institute for Brain Research in Frankfurt, Germany. According to an August 12th report in the British newspaper The Guardian, Singer argued in a recent edition of the Frankfurter Allgemeine Zeitung, one of Germany's leading newspapers, "that crime itself should be taken as evidence of brain abnormality, even if no abnormality can be found, and criminals treated as incapable of having acted otherwise."

The basis of Singer's view is the idea that all complex systems are reducible to their component parts and that, consequently, the behavior of any given complex system can be understood as a manifestation arising from the functioning of the system's components. Taking this doctrine of reductionism to its ends, Singer argues that people can only act in ways dictated by the functioning of the individual components of the brain. Behavior contrary to societal norms, then, is indicative of mental defect or malfunction in one or more of the brain's components. "[W]e should grant that for everybody there is a neurobiological reason for being abnormal," says Singer.

Behavior or beliefs held in contradiction to politically correct norms then become a manifestation of psychopathology. This is, in fact, what one leading mental health professional in the United States has recommended. In a New York Times op-ed published on August 26, 1999, Harvard psychologist Alvin F. Poussaint argued: "It's time for the American Psychiatric Association [APA] to designate extreme racism as a mental health problem. Clinicians need guidelines for recognizing delusional racism in all its stages so that they can provide treatment."

Racism is both illogical and detestable. Nevertheless, the right to hold controversial and inappropriate opinions, and to publicize those opinions, is protected by the First Amendment. Pathologizing "extreme racism," as defined by the state of course, would establish a precedent for pathologizing other, less extreme views. Eventually, any opinion seeming to run counter to prevailing politically correct opinion could be conceived to be evidence of insanity, despite our First Amendment protections.

Consider, also, the ongoing assault against the Second Amendment. Could opinions favoring private gun ownership someday be considered a sign of an antisocial psychosis?

There's a Government in My Brain

In its Final Report, the president's New Freedom Commission on Mental Health advocates screening "for consumers of all ages" and recommends, therefore, that "Service providers across settings will also routinely screen lot co-occurring mental illnesses and substance abuse disorders." The report recommends, in particular, that "quality screening and early intervention will occur in both readily accessible, low-stigma settings, such as primary health care facilities and schools." Moreover, while the nation's schools will be used extensively to screen the nation's children, "Both children and adults will be screened for mental illnesses daring their routine physical exams."

As commentator Sheldon Richman pointed out in a recent column in the Baltimore Chronicle, "If this proposal is carried out, which is Bush's intention, no adult or child will be safe from intrusive probing by 'experts.'" in opposing the Bush measure, Republican Congressman Ron Paul of Texas pointed out that the Soviets once considered all those who opposed the total state to be mentally ill.

Now, the Bush administration seems poised to take a first step in that direction. "It's not hard to imagine a time 20 or 30 years from now," Paul said, "when government psychiatrists stigmatize children whose religious, social, or political values do not comport with those of the politically correct, secular state." Indeed, with the creation of the Department of Homeland Security, the passage of the Patriot Act, and now with the proposal to screen all Americans for mental illness, the federal bureaucracy is looking less like the limited government envisioned by the Founding Fathers and more like the total state as envisioned by Lenin, Stalin, and Mao.

Fortunately, America is not a total state. By and large, the freedoms that we cherish remain, despite repeated attempts by totalitarians of all stripes to undermine them. The bullwark of the Constitution, though pitted and charred by frequent attack, has nevertheless remained intact. Because of this, those who seek to protect this nation's tradition of liberty work, in fact, from a position of strength. The Constitution mandates that all legislation be enacted by Congress, and it is in the Congress that watchful citizens can have the greatest impact on the course of the nation. As long as the citizenry remains alert to proposals that may undermine freedom, those proposals can be stopped in Congress long before they become the law of the land.