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ABSTRACT: After briefly reviewing the traditional jus- United States until the South had been defeated
tifications for involuntary psychiatric interventions and in a brutal war by the North. It seems unlikely,
previous objections to them, a new legal mechanism then, that ideas and arguments alone could prevail
accommodating the interests of both those who support against the well-established practices of coercive
and those who oppose such interventions is proposed.
psychiatry either.
Fashioned after the model of the last will and the living
will, the psychiatric will provides a mechanism whereby This conclusion should not strike us as in any
individuals could plan, while rational and sane, for how way surprising. It is a plain and simple fact of life
they wish to be treated in the future, should others that just as individuals cannot be talked out of
consider them to be irrational or insane. Individuals personal habits sanctioned by their conscience, so
who dread the power of psychosis and desire protection people cannot be talked out of collective practices
from it by embracing, in case of "need," the use of sanctioned by their historical tradition and law. In
involuntary psychiatric interventions could execute a each case, whether it be personal conduct or social
psychiatric will in keeping with their beliefs. Individuals custom, one pattern of behavior must be replaced
who dread the po,wer of psychiatry and desire protection by another. In this essay my aim is to propose a
from it by rejecting, regardless of "need," the use of new social policy that will respect and protect
involuntary psychiatric interventions could execute a equally the ideas, and interests of both the pro-
psychiatric will in keeping with their beliefs. Thus, no
ponents and the opponents of involuntary psychi-
one who believes in psychiatric protectionism would be
deprived of its alleged benefits, while no one who disbe- atric interventions.
lieves in it would be subjected to its policies arid prac- A brief remark about terminology is in order
tices against his or her will. here. My reference to psychiatrists, to psychiatric
interventions, and to psychiatric wills throughout
The psychiatric examination, diagnosis, treatment, this article is wholly a matter of semantic conve-
and hospitalization of persons against their will nience: Although the issues addressed are tradi-
(in and out of psychiatric, medical, and other in- tionally psychiatric, they are no longer exclusively
stitutions) form a rich web of social policies legit- so. Thus, in most places where the term psychia-
imized by tradition, sanctioned by science, and trist appears, it could be replaced by the term
articulated by law. Although ideas do have prac- psychologist (or social worker): The dilemmas of
tical consequences, and although social policies involuntary "therapeutic" interventions now affect
usually rest on and are justified by ideas, the fact all professionals (as well as nonprofessionals) work-
remains that ideas can be fully effective'only ing in the mental health field. Indeed, as psy-
against other ideas. To put it differently, argu- chologists achieve equal footing with psychiatrists
ments can be used only to rebut other arguments; in institutional as well as in private practice, the
they cannot be used, at least not directly, to change issues considered here become equally relevant to
social policies or legal practices. Witch-hunts and the members of both groups.
the enslavement of blacks in the United States I shall proceed by first briefly restating the tra-
spring to mind as obvious examples. Although ditional justifications for involuntary mental hos-
many people believed, and some even argued, that
witches did not exist and that blacks were persons, Requests for reprints should be sent to Thomas S. sSzasz, De-
partment of Psychiatry, Upstate Medical Center, State Univer-
witch-hunting did not stop until the witch craze sity of New York, 750 East Adams Street, Syracuse, New York
had run its course, and slavery did not end in the 13210.