John B. Kizer's article about the views of Thomas Szasz [July] grossly misses the point. Kizer writes, "Szasz opposes the application of the medical model to psychiatry mainly because he sees the logic of the diagnosis of conventional organic disease as being different from the logic of the diagnosis of mental illness. The diagnosis of conventional illness, he notes, is scientific and objective, whereas the diagnosis of mental illness by psychiatrists requires a value judgement on their part, which makes it fundamentally different from conventional diagnosis."
He goes on to note that according to at least one authority, organic normality is something less than clear-cut. So, he concludes, Szasz's distinction is nonexistent.
Kizer has either misread Szasz or forgotten one of his key points. It concerns Szasz's reason for drawing a distinction between the two kinds of diagnoses.
Of course, judgements are made in each case, but it is what is being judged that makes the crucial difference. In psychiatry, what is being judged as a symptom of disease is human action, that is, human choice—which is to say that all of this is placed squarely in the court of ethics. In organic diagnosis, what is being judged are non-volitional, that is, non-ethical, matters, for instance, "the serum amylase content" of a person.
A body chemical level that is statistically abnormal is not analogous (in any material way) to statistically abnormal behavior. Such a statement smacks of a reductionism that has been refuted countless times over.
I am puzzled as to where Dr. Szasz contends that when a mental illness can be diagnosed with "only a nominal value judgement they are no longer mental illnesses, but, rather, physical illnesses." It seems to me Dr. Szasz has written on more than one occasion that either an illness is organic or it is no illness at all.
If Mr. Kizer has any doubts about Dr. Szasz's views on schizophrenia, I refer him to the doctor's recent book, Schizophrenia, The Sacred Symbol of Psychiatry.
Kizer's second point concerning involuntary hospitalization falls with the first. Suffice it to say that there is a world of difference between assuming that an unconscious person would want medical treatment and imposing "treatment" over the objections of a conscious "patient."
To assert, as Kizer does, that treatment should be given to "mentally ill" persons who "appear incapable of asking for help" is to load the game on behalf of institutional psychiatry and obliterate ethics and individual liberty at the same time.
Contrary to John B. Kizer's statements, Szasz's rejection of the concept of "mental illness" in no way depends on the existence of clearcut universal standards of physiological health lacking for mental health. Rather, Szasz's argument is that all mental processes (barring physiological abnormalities disrupting the nervous system's workings) are volitional or chosen, and that consequently all standards by which they are judged are moral standards. To say that someone's physiological condition is one of illness means simply that it is unfavorable to survival and/or reproduction. To say that his mental condition is one of illness is to pass unfavorable judgement on his choices, or to condemn him morally. When the "illness" being diagnosed, in other words, is manifested only in the choices a person makes, that "diagnosis" is a moral judgement de facto. One may view "moral" conduct as being that which furthers life through the exercise of choice, making it a species of the same genus as "health"—as Branden does—but the presence of choice is a vital differentia. "Illness," Szasz argues, is understood as something involuntary, something which happens to a person despite his desires, but it is not possible to say this of chosen behavior.
This makes the claim that someone has benefitted from involuntary mental "therapy" problematic. The aim of such therapy is to change his choices. That makes his consent, after the fact, very poor evidence that he would have wanted it. "Deprogramming" or brainwashing or systematic torture could easily be considered voluntary with this standard of evidence. I doubt that Szasz would object to forcibly preventing someone whose mental condition was physiologically disturbed in some way (e.g., drugs) from killing himself, until he returned to a physiologically normal state and could decide for himself whether to live or die; but "psychotherapy" aimed at changing his conduct or ideas, without his prior uncoerced consent, clearly deserves all the criticism he gives it. Consent after the fact is legitimate for treatment of physical illness, but not for forcible moral conversion.
Indeed, anyone who considers that chosen acts can be evaluated by a life-centered ethics should be mistrustful of all such programs of moral retraining. The process of making choices, from that viewpoint, is an essential part of human life. To reject that process or seek to bypass it for the sake of installing correct specific values (judged by this standard) is a self-defeating process: one must encourage reliance on one's own powers of choice, if those powers are ever to be used well. The coercive context of involuntary psychotherapy can only act to prevent such reliance, since it is all too likely to lead "patients" to reject the authority of "therapists" and demand their own freedom. Szasz's claim is that virtually all involuntary psychotherapy is in fact motivated by this very desire to produce moral conformity, which in fact is positively detrimental to the mental functioning of the subjects of such "therapy"; that the concern for their welfare is just a smokescreen for authoritarianism. It is my opinion that he is entirely right.
William H. Stoddard
Chula Vista, CA
Mr. Kizer replies: When Mr. Richman says that psychiatric diagnosis is based on volitional action and medical diagnosis on non-volitional action, his argument involves a petitio principii because it is just this volitional character of so-called insane behavior which is in question. To state simply that one is volitional and the other non-volitional is, it seems to me, to miss the cleverness of Dr. Szasz's reasoning, which was to provide a foundation for believing that "the things being judged" (to use Mr. Richman's words) are essentially different by arguing that they require a different method of diagnosis. To state that mental character is volitional and physical character non-volitional without a buttressing argument is merely to beg the question.
Mr. Stoddard falls into the same logical trap because he assumes that the judged behavior is volitional when this is, in fact, the point at issue in the debate.
As far as involuntary treatment of mental patients is concerned, I fully share Mr. Stoddard's fear concerning the danger of "verifying" the validity of treatment by techniques that could be considered akin to brainwashing. That is the reason I emphasize that those who are merely eccentric or who hold views which others find disagreeable are not eligibles for involuntary hospitalization. Using the same principle that one uses for involuntary medical treatment, I propose that only those who are totally incapable of caring for themselves should be involuntarily treated for mental disorders. My guess is that this would be a fraction of one percent of our present mental hospital population. —J.B.K.
I was surprised that in the July article on defense only one piece, by R.J. Rummel, dealt with the central defense issue of our time—Soviet aggression—and then only in order to make the standard arguments in favor of intervention.
It is not necessary to minimize the Soviet threat—as some libertarians do—in order to justify the practicality of a policy of isolationism. We should not alienate potential libertarians by the constant linkage of isolationism with a minimization of Soviet aggression.
For, given the boundless desire of the Soviet slave-masters to rule the world, isolationism would give us the best assurance of resisting, even neutralizing, the Soviet threat; further, it is the policy of intervention that is sapping the will and ability of the semi-free world to resist. This view could be argued at great length; however, a few comments contrasting the effects of present policy with the probable effects of isolationism should show its plausibility.
The objection often made to free market defense agencies is that there will be free riders, persons not paying for the service, but enjoying the benefit of protection while maintaining a higher standard of living. Those paying for the service will eventually realize this and reduce their contributions to defense, leaving the area vulnerable to outside aggression. This parasitic relationship applies to the U.S. vis-a-vis its allies and client states.
This praxeological reality is the cause of the weakening of the "will of the West" Solzhenitsyn has warned us of—not the loss of Christian values, the decadence of socialism, the natural progression of democratic states, etc.
To statists, the preservation of the State as an independent entity open only to domestic plunderers is the summum bonum. Regardless of ideology, social system, or indifference on the part of the citizenry, the ruling clique will attempt to preserve the independence of the State.
But, given a free ride under the American nuclear umbrella, the United Kingdom and Japan are virtually disarmed, preferring to spend their money on other goods—socialism in the U.K. and economic development in Japan. Other countries, in exchange for U.S. protection and aid, have sacrificed their independence in both foreign and domestic policy and have pledged, under duress, not to break the nuclear monopoly of the superpowers. (The French have been able to pursue a more independent course because they can enjoy the benefit of a first-line defense by the United States and West Germany without making any commitment.)
What would happen if the United States adopted a policy of isolationism? Nuclear proliferation and the emergence of a truly "multi-polar" world order would be the most significant results. In a world in which nations are not disarmed down to police levels, nuclear weapons are essential to defense: just as the gun equalizes the force between the weak and strong, so nuclear weapons equalize the force between small and large countries. And, in a world in which there are nuclear weapons, the country without them is practically disarmed with respect to those who do.
If at present, as Mr. Rummel contends, "without the United States no combination of countries has the power jointly to stand-up to Soviet demands," with nuclear arms they would. The aggregate economic capacity of the threatened countries (West European, Mid-Eastern and Pacific) to sustain military expenditures far exceeds that of the Warsaw Pact nations. True, none of these countries could individually withstand Soviet aggression—so what? The defense of weaker powers, including at one time the United States, has always rested on the strategy of maintaining the ability to inflict casualties on the stronger power that are greater than the value of the threatened state. A Finland with nuclear weapons will end Finlandization.
Consistent with the principle of nonaggression, the United States should institute an open arms trade in which American companies would deal directly with foreign powers and bear all the risks. Given the choice between paying cash for American arms or mortgaging their national independence for Soviet freebies, other States would have a powerful inclination toward the former.
Joe Paul Barnett
Down with Pessimists
I do not share Scott Royce's pessimism regarding the LP's election results [August]. First of all, most of those "top 35" third parties since 1900 have either appeared once and vanished or appeared a few times at irregular intervals. I doubt that this will happen to the LP, since its platform is inspiring, consistent, and principled. After all, the facts of reality are on our side. One cannot say the same things about any other "third party"—mixed economy or socialistic all.
Besides, most of them showed up in the earlier parts of this century. This is not a good time for third parties, only four of which have done better than the '76 LP, counting from 1960. And consider that in just four years the LP has outstripped the Socialist Workers' Party, the Communist Party, and all those other crazies. Well done!
The big problem now is not to worry about pessimists like Scott Royce, but to field candidates for the 1978 Congressional and Senatorial races. Good luck!
Mr. Crane [August] tells us that the great value of the Libertarian Party consists, at least in large part, in its ability to obtain good press coverage for the ideals of liberty, free market, civil liberties, etc. And Mr. Crane also notes that the LP has achieved this end, of getting the press coverage, beyond expectations.
What then are we to make of Roger MacBride's talk at the recent LP national convention in San Francisco? Mr. MacBride took almost on hour to tell us how shamefully the press ignored him and the ideals he tried to communicate to the American public. Mr. Crane and Mr. MacBride really should try to get their act together. The LP probably merits support from us, but if we rely on these gentlemen to tell us why, we will never find out.
Redwood City, CA
Hayek, Friedman, and Money
REASON's interview with Milton Friedman [August] contains some interesting remarks about F.A. Hayek's proposal for denationalization of money. I believe Friedman is correct in his disagreement with Hayek over the consequences of denationalizing money. However, Hayek's proposal would only need one minor addition in order to have the wide ranging effects its author envisions. That addition would be repeal of all laws that forbid counterfeiting. (Repealing all copyright and patent laws would also help.) Fiat money would quickly lose all value as a result of its susceptibility to reproduction. People would switch to making their transactions with valuable commodities instead of Uncle Sam's garbage and Hayek's predictions would come true.
Kenneth A. Hopf
The quotation which you attribute to me in the August issue, "The Interstate Commerce Commission should be abolished, its buildings torn down, and the ground sown with salt," is not mine, but that of an able former colleague at the University of Maryland, Professor Hugh S. Norton, now of the University of South Carolina.
I habitually quote the line in my concluding lecture in the undergraduate transportation course, but I make the point that the recommendation seems to me extreme. The salt would have undesirable ecological consequences. Similarly, the ICC's building is a fine example of work of one of America's best classical architects, Arthur Brown, Jr., and could be used for some useful purpose, such as housing the organization entrusted with levying user charges on the inland rivers, for example.
George W. Hilton
Dept. of Economics, UCLA
Los Angeles, CA
(REASON regrets its error in attributing the comment directly to Prof. Hilton. We picked up the quote verbatim from the Wall Street Journal, which apparently erred in its attribution—Ed.)
As a non-smoking libertarian, I feel compelled to comment on a statement made by Robert Poole in June's editorial titled "Saccharin and Human Liberty." Poole lumps cigarette smoking with swimming, skiing, hang-gliding, etc., as a risky action which an individual has the right to take. Since a very good case can be made that cigarette smoking is dangerous to the innocent bystander as well as to the smoker, it should not be treated as an activity which is risky only to the participant. It just really bugs me to see that nasty habit put in the same category with such healthful activities as skiing and swimming.
If the so-called "side stream" smoke is shown to be harmful to the non-smoker to any measureable extent, the smoker is, in effect, initiating force against the non-smoker. This being the case, the proper libertarian position on smoking must be to outlaw it everywhere except the following places: 1) In private homes, clubs, vehicles, etc., and 2) outdoors in nonpublic places. Since it is impossible to choose to work in a place where there are no smokers (the habit being so widespread), private businesses cannot be exempt. Realizing such a law would be virtually unenforceable, I would be interested in hearing from other libertarians concerning this matter.
La Habra, CA
This article originally appeared in print under the headline "Letters".