Thomas M. Krapu

The subject of slavery, mentioned by Szasz (July 1982, p. 762) in his article on the psychiatric will, deserves further comment. The changes in attitude toward involuntary commitment of the mentally ill in the United States are following the same pattern of change found in the attitudes toward the black minority in the past. Of course there was always an economic motive that encouraged slavery, but prior to the 1830s slavery was also rationalized as a necessary evil designed with religious conversion in mind (Carroll & Noble, 1977, p. 53). Thus it became America's religious duty to deprive blacks of their freedom as part of this necessary evil. Szasz (I 982) has pointed out the similarity in reasoning toward the mentally ill when he stated that "in the past psychiatrists acknowledged that psychiatric confinement entailed depriving patients of their freedom" (p. 764, emphasis added). Defined as a necessary evil, such practices, whether they be slavery or involuntary commitment, become institutionalized and are applied indiscriminately to whoever meets the criteria. The absence of civil and personal liberties for the given minority is simply taken for granted.

In the 1830s the rationalization for slavery as a necessary evil was questioned, primarily by northern abolitionists. In response to this, supporters of slavery changed their position on slavery from a necessary evil to a positive good. This new rationalization viewed blacks as naturally inferior to whites, and so to be a slave was their lot in life (Carroll & Nobel, 1977, p. 159). Slavery from this position became a positive good since it provided a place for this inferior race within American society. Szasz (1982) reveals psychiatry's current attitude toward involuntary commitment as a positive good when he states that "now they [psychiatrists] are beginning to claim that confinement serves only to enable the patients to achieve 'true freedom' " (p. 764).

Another argument that arises in support of involuntary commitment is that mental patients are-happier, freer, treated better, or living in better conditions in "a community composed of specialists in dealing with the mentally ill, i.e., an asylum" ("Patient's Right," 1980, p. 28). This is similar to the justification for slavery, citing evidence that blacks in slavery were living in conditions that were better than the conditions of many northern whites. Although this claim may be somewhat factual, it obviously does not address the moral issues involved.

This example from history might help illuminate Szasz's position on patients' rights. Szasz's (1982) proposal of a psychiatric will offers an opportunity to allow for some measure of civil and personal liberties for the minority we mental health professionals categorize as the mentally ill. This could eventually result in social policies that allow for some interaction between events in the world and human choice, as it has for blacks.

REFERENCES'

Carroll, P. N., & Noble, D. W. The free and the unfree: A new history of the United States. New York: Pelican, 1977.

Patient's right to receive adequate care explored. Psychiatric News, December 5, 1980, pp. 1; 28.

Szasz, T S. The psychiatric will: A new mechanism for protecting persons against "psychosis" and psychiatry. American Psychologist, 1982, 37, 762-770.

March 1983, American Psychologist, Page 343