Abstract
A woman, about 40 years old, is observed living in a refrigerator packing case placed over a heated grate on a street in a large city. She has lived there for about 2 years. She is filthy, and is sometimes seen defecating and urinating on the street. She sometimes curses passersby. She sometimes accepts handouts, sometimes burns paper money given to her. It is midwinter, and temperatures are below freezing. Approached by city social workers, she refuses to enter a city shelter, claiming that the shelters are dangerous and that she prefers the streets. She claims that she manages very well the way she is. Approached by psychiatrists on a number of occasions, and asked to enter a hospital, she is abusive and refuses to speak with them. She is forcibly brought to a psychiatric hospital and involuntarily committed under a law that says such hospitalization is permissible if psychiatrists judge that a person is either a danger to himself/herself or a danger to others, or unable to appreciate that he/she needs psychiatric or medical treatment.
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Notes
That is, to psychiatry, clinical psychology, and to some aspects of social work. Since this book is geared to physicians, we will use the term “psychiatry” throughout.
We will generally not distinguish among the terms “mental disorder,” “mental disease,” and “mental illness” in our discussions.
Although Aristotle, the “founder” of natural law theory, claimed to have derived his ideas about the essence of normal human-hood from his empirical observations of statistically normal behavior.
cf. Chapter 1.
The foremost proponent of this point of view is the psychiatrist, Dr. Thomas Szasz. Thomas S. Szasz, The Myth of Mental Illness (New York: Hoeber-Harper, 1961).
Consider, is infertility a disease? If so, is the physician who does a tubal ligation or vasectomy making his patient ill?
Plato, The Republic, e.g., 61.
For example, Darwinian theory discards the natural law notion that living species were designed with constant and unchangeable purposes, and replaces it with the idea that species can change as a result of environmental changes.
Jean Jacques Rousseau, The Social Contract, revised and edited Charles Frankle. (New York: Hafner, 1947).
For example, Skinnerian behaviorism and some versions of Freudian theory.
Immanuel Kant, Anthropology from a Pragmatic Point of View, Trans. V. L. Dowdell (Carbondale: Southern Illinois University Press, 1978).
We are not claiming that there is a direct causal connection between the acceptance of autonomy ethics and the changes in psychiatric theory. More likely, it is a Zeitgeist phenomenon.
Perhaps the most dramatic recent example of this change was the decision of the American Psychiatric Association to remove the diagnosis of homosexuality from its nosology of mental disorders.
Diagnostic and Statistical Manual of Mental Disorders (3rd edition) (Washington, D.C.: American Psychiatric Association, 1987), p. xxii.
O’Connor v. Donaldson, 422 U.S. 563 (1975). In fact, as we shall see, a general right to treatment for the involuntarily committed has never been established as a legal right in this country. We shall have more to say about the case when we speak of the right to refuse treatment and the right to treatment.
Natural law theorists usually held to the belief that we have an innate desire to stay alive.
Wyatt v. Stickney, 325F. Supp. 781 (M.D. Ala. 1971).
Szasz, op. cit.
We shall speak about this more when we deal with the insanity defense and the problem of free will.
Kantian autonomy theory is based on the belief that instincts can be willfully overcome.
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Wyatt v. Stickney, 325F. Supp. 781 M.D. Ala. 1971.
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Kantor, J.E. (1989). Psychiatric Ethics. In: Medical Ethics for Physicians-in-Training. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1672-3_5
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