Medicine

Will Britney Spears Place a Call to Thomas Szasz?

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Pop diva (whatever that means!) Britney Spears is back in the hospital, this time apparently committed for psychological evaluation by her doctor and/or family:

Los Angeles Police officers physically removed pop star Britney Spears from her home early today, placing the troubled celebrity on a "mental health evaluation hold," authorites said….

This is the second time in a month that Spears has been placed on a 72-hour welfare hold. The first occurred on Jan. 3, when Spears declined to give up custody of her children to ex-husband Kevin Federline.

More here.

I am curious as to what Hit & Run readers–and the wide, wide world, too, of course–think generally about the topic of involuntary commitment. Is it ever justified? If so, when? And if so, shouldn't Britney have been committed at some point before or at the very latest during her infamous Video Music Awards number?

reason on the topic here.

Brian Doherty on the chilling catalog of mental-health industry abuses Mad in America here.

Jacob Sullum interviewed contributing editor and arch-critic of the "medicalization" of American life, Tom Szasz, in 2000. Whether you agree with Szasz in part or whole or not at all, that Q&A is well worth reading.

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  1. think generally about the topic of involuntary commitment. Is it ever justified? If so, when? And if so, shouldn’t Britney have been committed at some point during her Video Music Awards number?

    I would guess that there are times when it’s justified, probably more so when they’re a danger to others than themselves, but there needs to be a strong bias against doing so.

    The VMA was just sad, people dog her too much about it. It was just sad.

  2. “I am curious as to what Hit & Run readers–and the wide, wide world, too, of course–think generally about the topic of involuntary commitment. Is it ever justified? If so, when?”

    Very, very rarely, only when the person is shown to be a danger to self/others either beyond a reasonable doubt or by a clear and convincing amount of the evidence. I don’t think a preponderance will do.

    I think she’s certainly guilty of hotness in that photo. If only the young lass had some brains and talent…

  3. We use the “reasonable person” standard in torts, and it works fairly well. By that same standard (which, in this context, is admittedly circular), if someone is a danger to himself or others, and there are procedural safeguards to ensure that the commitment is no longer than necessary, and no more coercive than necessary, then I definitely see the usefulness of involuntary commitment.

    I can also see the potential danger, but I think in the cost/benefit calculus, involuntary commitment is justified.

  4. Today’s regular headline: “Erstwhile popstar, turned residual cultural phenomenon turns out to be bat shit crazy.”

    In other news, Cincinnati has just been bombed with live turkeys…. Film at 11

  5. I think that it can be justified if the person is an immenent threat to themselves or others, but from what I know of Britney Spears this isn’t the case, so long as they keep the kids away from her.

  6. Poor Britney’s problems are mostly due to the fact that 1) she has kids and 2) the kids are subject to a variety of court orders dealing with joint custody with her ex, and, so it would appear, Britney keeps violating those orders. I’ve always been a Britney fan, but she’s managed to piss off a variety of municipal court types with her repeated temper tantrums. When you make Kevin Federline look like the responsible one, you’re doing something wrong.

    As for the Video Music Awards gag, ha ha ha. What’s wrong with love handles, huh? Us country boys like a little something to hold onto. I sure wouldn’t kick Britney out of my trailer. Come on home, Britney, honey! I got waffles in the toaster!

  7. Generally agree with statements about being a danger to oneself or others…the key issues to me are about what happens when one is involuntarily commitment…should one be forced to take drugs that can help them? Should one be forced to abstain from risky behavior prior to being released?

    I think these questions are best answered with a bias against involuntary commitment…just as I would hope that the legal system hold a bias against incarceration when there is a shadow of a doubt, even if it means allowing an occassional criminal to walk in the interest of protecting individual freedoms…

  8. Poor Britney’s problems are mostly due to the fact that 1) she has kids and 2) the kids are subject to a variety of court orders dealing with joint custody with her ex

    The (alleged) bipolar diagnosis may have a little to do with it too…

  9. Everytime I see someone giving her any press I feel the need to have myself committed. She is the media whore darling of the decade and to be honest I don’t care who, what, when, where or how, just make the bitch go away.

  10. I am curious as to what Hit & Run readers–and the wide, wide world, too, of course–think generally about the topic of involuntary commitment. Is it ever justified? If so, when? And if so, shouldn’t Britney have been committed at some point before or at the very latest during her infamous Video Music Awards number?

    Despite the potential for abuse, I’m inclined to lean toward a short commitment for evaluation rather than a long incarceration that could have been prevented, or worse. I guess the key is determining when a person is actually out of control vs. making choices that others don’t like. I don’t have a good answer for how to make that determination.

  11. Involuntary commitment is very, very dangerous and needs to be treated as such, with extensive safeguards and review. When one person (a judge) can order someone held against their will without a trial (even if they are getting “expert” advice from a psychiatrist), that’s scary shit.

    I would say that such involuntary commitment, which is probably necessary in cases of imminent danger to others, should require more than one judge to sign off on it, with each judge receiving testimony from multiple psychologists. Then, the commitment cannot be indefinite and must be reviewed within a few days by yet another judge. Something like that.

    And gaijin raises the question of forced drug regimens–can they be forced to take drugs?

  12. Now that the serious post is out of the way, has anyone seen the MAD TV skits about K-Fed and Britney? Fantastic.

    Also, if the press is going to follow anybody around, Lindsey Lohan is way preferable to Britney.

  13. Dee (@ 8:44) makes a good point, but there is something fascinating about freak shows and train wrecks, and she’s both.

  14. She should not be involuntarily committed unless she is a danger to others. If her kids can be takn by their father, she can just be left alone at that point. If she then tries to go after them she can be stopped. Other than that, she owns herself so she has a right to decide whether or not to seek treatment or be treated or destroy her own life. It is up to her family to convince her to be helped, not for the state to decide she should be held against her will.

    I would make the same case whether she were famous or not. I think some people are not separating her celebrity status from their thought process, as if it makes some difference.

  15. And gaijin raises the question of forced drug regimens–can they be forced to take drugs?

    They shouldn’t be, no. Of course this means that they should be held responsible for their behavior even if they refuse treatment, but no one should be forced to take medication against their will, especially given the potential side effects of anti-psychotic meds, such as tardive dyskinesia, seizures, akathisia, parkinsonism, etc.

  16. She should not be involuntarily committed unless she is a danger to others.

    Have you spent much time with mad people? I don’t think it’s quite as simple as you seem to think…

  17. I can see how it could be necessary sometimes, but look at the fallout; now this mentally ill person is going to lose it around cops and medical staff. That’s not good.

  18. Pop diva (whatever that means!)

    It means the same as “supermodel” means: nothing.
    It’s one of those handy and superficial cultural terms, the sum of which equals zero.

  19. What does it say about me that I never found Britney attractive until she became fat & trashy?

  20. People who are incapable of looking after themselves routinely have guardians appointed for them by the courts, even if they are not a danger to anyone else. I don’t see anything wrong with that.

    Depending on the scope of the guardianship order, the guardian could have their ward committed for mental treatment. I’m not sure how meaningful the distinction is between having a court-appoint guardian commit someone, and having the court do it.

    OTOH, most health care power of attorney statutes (which allow you to appoint someone to make health care decisions for you if you are incapable) restrict to some degree the surrogate decisionmaker’s authority to consent to mental health treatment to have you committed. Go figure.

  21. What does it say about me that I never found Britney attractive until she became fat & trashy?
    Was she ever not trashy (oops, I did it again)? The fact that you find her flesh more appealing when she isn’t starving herself, I find that encouraging. Maybe it’s catching on.

    Britney Spears should not be committed. But anyone who gives a rats ass about Britney Spears should be evaluated.

  22. I can’t speak for other states, but in Illinois I think the scarier issue is voluntary commitment. Illinois law says that you can coerce somebody into voluntarily committing themselves as long as you’re prepared to involuntarily commit them should they refuse to do so voluntarily. Why is this so scary? Well, when you’re involuntarily committed, you’re entitled to due process under both the state and U.S. constitutions. When you voluntarily commit yourself, however, you don’t get due process until you ask to leave, which can be more difficult than you’d imagine. I’m okay with involuntary commitment where the person poses an imminent danger to their self or others; I think the real issue is what the proper procedural safeguards are.

  23. Why not use the same rules we already have? A person can be arrested on short notice without a trial, but must be promptly charged or released, and to be convicted, the charge must be proven beyond a reasonable doubt (in theory).

  24. “More than a dozen motorcycle officers and a Los Angeles Fire Department ambulance swept through the front gates of Spears’ hilltop Studio City residence shortly before 1 a.m., as a police helicopter hovered overhead. At 1:08 a.m., officers inside the home radioed to commanders that “the package is on the way out.”

    Can you say “Overkill”?

  25. Having lived with a bi-polar teenager for several years I can attest that there comes a time when involuntary committment is necessary and the path to getting there can be devastating to everyone within shouting distance of the soon-to-be committed.

  26. Thomas Szasz should be involuntarily committed

  27. I actually feel sorry for Britney. Everything she does is viewed under a microscope and then analyzed by people who have no understanding of the situational context.

    If I were picked apart everytime I did something some asshole didn’t agree with (I “taught” my girls to drive on my lap, let them have sips of my wine, etc.) I’d go a little crazy too.

    That said, there may be a time to commit someone to a hospital, but I don’t think Britney’s situation is an example of such a time.

  28. 12 Officers and a Police helicopter? The police chief, and any other government official involved need to be involuntarily committed, and fired. What a waste of tax payers money….

  29. I see a lot of young men and women with adjustment disorders in my line of work (Air Force First Sergeant at a technical training squadron.) Occassionally I get Airmen who express suicidal ideation or make suicide gestures/attempts. I’m almost always successful at convincing them to voluntarily seek psychiatric assistance, but if they don’t, the military has a process by which a commander can involuntarily refer someone to psychiatry (which we euphemistically call the “Life Skills” clinic.) If the Airman is deemed to be a danger to him/her self or others, they usually will be admitted to an inpatient facility for observation and evaluation. Sometimes they do this voluntarily, sometimes involuntarily. The “how” of involuntarily admitting someone to a psychaitric facility varies from state to state. Here in Florida, the Baker Act restricts initial involuntary hospitalization to 72 hours for observation and evaluation.

    In abstract, the concept of hospitalizing someone against his or her wishes horrifies me. And even as a practical matter, although I understand the pressure we’re under to prevent suicides in the AF, I’d have to say that if someone is intent on killing themselves, they’ll evntually do it. The overwhelming majority of potential suicides I have dealt with have not truly been dangers to themselves. Many have benefitted from therapy and continued to serve in the AF. But the few who were deemed to be truly suicidal were almost always medically discharged due to “personality disorders”. But until we send them home, they’re under an almost constant suicide watch, which is a true pain in the butt. Under those circumstances, I must admit I hypocritcally try to see if I can find a way to get Life Skills to have them involuntarily admitted to a facility where they can be protected from themselves. Nobody wants to have a troop commit suicide on their watch.

  30. If it’s only an ironclad 72-hour evaluation hold, I have less problem with (though it still creeps me out a little). I think most of us are imagining “One Flew Over The Cuckoo’s Nest” horror stories if it goes beyond that. These are tough calls from a libertarian perspective, I believe.

    As to Ms. Spears, was I the only one who thought of Nancy Sinatra and “These Boots Are Made For Walking” when Britney did that VMA performance? I thought it was kind of hot, in a trashy way.

  31. To answer Nick’s question, we involuntarily committed my grandmother to a nursing home, she fell and couldn’t get up with increasing frequency. She lived with my mom…who didn’t give a shit half the time. To the rest of us, we thought being thrown in prison would be more pleasant than living with my mom.

    Definitely a question of the lesser of two evils.

  32. I think most of us are imagining “One Flew Over The Cuckoo’s Nest” horror stories if it goes beyond that.

    Don’t forget that not all of those patients were there involuntarily. Mixing the voluntary with the involuntary might have made the horros worse. Heck, that’s the general problem with school.

  33. I’m kind of surprised how many libertarians are just fine with involuntary committment if the person is only a threat to themselves. If they are a threat to others, fine, do what is needed to protect others, but who has any right to protect people from themselves. Drug warriors say that’s OK. I thought we all understood we own ourselves and if we decide to destroy ourselves, that’s our business…as long as we are not a threat to others.

    Now, I’m not saying Brittney wasn’t a threat to others. Her kids come to mind, but a lot of people here are saying she should be committed even if she were only a threat to herself.

  34. “I am curious as to what Hit & Run readers–and the wide, wide world, too, of course–think generally about the topic of involuntary commitment. Is it ever justified?”

    Allow me to introduce my x-wife Marge…

  35. “It means the same as “supermodel” means: nothing.
    It’s one of those handy and superficial cultural terms, the sum of which equals zero.”

    No, supermodle actually means something.

  36. Thomas Szasz should be involuntarily committed

    Ah, so someone beat me to it. Well, I can see I’m not needed here today.

  37. about the topic of involuntary commitment. Is it ever justified? If so, when?

    Of course it is. Follow link for example… sheesh.

  38. Aaaargh!!! Hit & Run doing stories on Britney!! I definitely have to cancel my subscription now!

  39. There is an established procedure for involuntary institutionalization of people who are a danger to themselves and others… it is called a criminal jury trial.

    If the person was really all that dangerous, then it shouldn’t be hard to lock them up on an actual criminal charge, and give them psychological treatment during incarceration.

    If there is absolutly no criminal charge you can bring them up on (extremly unlikely, given the universal criminalization of just about everything), then those people are most certainly not a danger in any conventional sense.

  40. MADONNA IS A SUCCUBUS!

    All of Britney’s problems began with that infamous kiss. Madonna sucked out Brit’s meager talents and mental stability.

  41. I’m kind of surprised how many libertarians are just fine with involuntary committment if the person is only a threat to themselves.

    I’m with you on that one.

  42. A 5150 requires belief that the person is a danger to themselves or others. I have never heard that Britney was sucidial or violent, so I suspect that the order is bullshit. A good judge will also think so (apparently in 3 days it may go to a court where a judge determines whether or not to extend the order).

  43. I’m kind of surprised how many libertarians are just fine with involuntary committment if the person is only a threat to themselves.

    If this is a comment which is vaguely making reference to say, drug use, let me assure you, there are many ways in which a person can be a danger to themselves.

    Believe it or not, there are conditions which people can suffer from that pretty much render them completely and utterly insane. It’s not imcompatible with libertarianism to recognize this and treat people with some compassion.

    In fact, the modern system we have for involuntary commitment is quite libertarian. It was the old system that was highly collectivist (and evil) in nature.

    People could be committed simply because their actions were percieved as “irrational”, and thus this led to massive abuses by the system, and often the people demanding the commitment (jealous family members coveting an inheritence, say).

  44. Paul,
    My reading of that comment (and meaning in my response) is that even if people endanger themselves (but nobody else), involuntary commitment isn’t compatible with libertarian thought. I think that if there’s a demonstrable risk to others, there is perhaps some wiggle room for involuntary commitment but I’m unsure how compatible that is with hard-line libertarianism. Part of me thinks that even if the person is a risk to others, he shouldn’t be locked up against his will until there is actually harm.

  45. In the case of Ms. Spears, the correct solution isn’t involuntary commitment, but simply exile.

    Send her somewhere as far as humanly possible from the so-called “entertainment industry”, and I imagine she’d probably snap out of it within a month.

  46. The pretext is danger to self and others. All libertarians should support the right to take risks or to commit suicide, so that shouldn’t be an issue. Risk to others should be treated the same for all people, with no reference to psychiatry. A menacing person should be arrested and taken to jail, not imprisoned in a pseudomedical facility and involuntarily drugged. If a person is not an immediate physical threat, he might still be a nuisance and be arrested for trespassing, but this is still not a matter for psychiatrists. As Szasz has noted, the National Alliance for the Mentally Ill has actually described how to lie to the police so that the “mentally ill” they are “for” will be involuntarily committed.

    MENTAL ILLNESS: FROM SHAME TO PRIDE
    http://www.szasz.com/iol19.html

    Leave Britney Spears the hell alone. If there is any madness involved it is on the part of the gossip media and their consumers.

  47. Part of me thinks that even if the person is a risk to others, he shouldn’t be locked up against his will until there is actually harm.

    I disagree profoundly. There are mental conditions which objectively put people outside of normal, healthy behavior. I understand, however, that opinion on the subject may be divided. Over here, we have the entire medical establishment, over there, some posters on hit&run.

    But seriously.

    Involuntary commitment, despite what you’ve witnessed in fine Hollywood films everywhere, is a very intensive process. A process involving a courtroom and judge. It’s an imperfect system, but one that actually works pretty well. I should also note that the system is so sensitive about involuntary commitment that often times, harm is done before any involuntary hospitalization takes place.

    The other side of the issue is mental illness vs. dangerous asshole. The medical establishment struggles with this constantly, and has a large number of highly trained professionals whose job it is to root out the difference. The dangerous asshole goes to prison, the mentally ill person with the tinfoil hat who’s getting orders from the Catholic Church to…hurt people… should NOT be in prison with other dangerous assholes.

    It is precisely our compassion for the latter which compels us to protect them from the former. Allowing a muttering schizophrenic to go to simple prison (that’s an example of a ‘psuedomedical facility’) when he or she should be receiving treatment is, by definition, cruel and unusual punishment.

  48. As much as I’ve come to loathe Reason and Nicky Sideburns, at least it was a Britney free publication. Gillespie seems hell-bent on removing any vestigial redeeming qualities from a once unterrible website and magazine.

    Hey Fonzie, why don’t you, Potsie Welch and Richie Balko go sit on it.

  49. Involuntary commitment is never justified under any circumstances.

    If she is breaking the law arrest her.
    If she is actually endangering her children, take them away for their own safety
    I suppose Idon’t have a problem with offering “voluntary” commitment as an alternative to incarceration (if adjudicated guilty of a jailable offense) or as a path to potentially regaining custody of children.

    Those who think Dr Szasz should be involuntarily committed prove one of his main points.

  50. Paul,
    I infer from your post that you are in the medical field and might have some experience with the business of psychiatry. I’ve some experience in the medical industry (direct & indirect) and I understand the humane concern for differentiating between criminal and crazy. The problem is that while criminal activity is generally defined in nearly same terms (theft & murder) throughout time and culture, crazy’s definition changes according to decade.

    Van Gogh was considered a freak when he was young. He disregarded any sense of normality and painted. He got drunk and cut off his ear. He was institutionalized, released and killed by his own hand. We celebrate his work today. Involuntary commitment as we know it could deprive the person detained, and even humanity, what should be celebrated once evolved.

  51. I’m kind of surprised how many libertarians are just fine with involuntary committment if the person is only a threat to themselves.

    You can’t always distill morality into simplistic libertarian axioms. Reality is never that nice and neat. A close family member of mine once had a drug reaction that led to a state of extreme paranoid schizophrenia. She was an imminent danger to herself. Literally. So my family had her committed for 72 observation. The pharmaceuticals got out of her system, and she recovered.

    Some libertarians love to take extreme in-your-face positions. Like denying you the right to save someone’s life without their express permission. So you if find someone asleep on the railroad track, in imminent danger of death, you may not grab them and pull them away. They would then be justified in shooting you for touching them without permission. And even if they don’t, you can still get sued for trespass by the railroad. All you can do is yell at them from a distance hoping that you can wake them in time.

    Sometimes committing someone involuntarily is the moral equivalent of pulling them off the train tracks.

  52. Those who think Dr Szasz should be involuntarily committed prove one of his main points.

    No one is seriously suggesting he be committed. Some of us, however, think he is seriously, possibly dangerously wrong.

    And, frankly, I don’t see why your solution of simply locking mentally ill people in jail is preferable to involuntary commitment. Mental hospitals aren’t nice places, but most jails are worse. I’d certainly rather be in a hospital than a jail, crazy or not. Where do you really think Britney Spears, to take the example we’ve been given, would rather be?

  53. I’m kind of surprised how many libertarians are just fine with involuntary committment if the person is only a threat to themselves.

    I’m not sure that it’s that simple. If someone decides to do a swan dive off of a freeway overpass, are they posing a danger to others? Do you have a right to inflict mental anguish on a train engineer by lying on railroad tracks?

  54. MADONNA IS A SUCCUBUS!

    All of Britney’s problems began with that infamous kiss. Madonna sucked out Brit’s meager talents and mental stability.

    I rewatched that on youtube a number of times. Ah, fond memories.

  55. MADONNA IS A SUCCUBUS!

    All of Britney’s problems began with that infamous kiss. Madonna sucked out Brit’s meager talents and mental stability.

    Actually Carlos Leon is the Succu-bi. All of Madonna’s problems started when his seed was implanted in her.

  56. Leave. Britney. ALONE.

  57. “I am curious as to what Hit & Run readers–and the wide, wide world, too, of course–think generally about the topic of involuntary commitment. Is it ever justified? If so, when?”

    Sadly, and as the above comments suggest, most readers on here don’t really care about psychiatric slavery. Unfortunately this is also true of many libertarians. I must applaud Reason magazine on your continuing coverage of Dr Szasz, and urge you to take up the fight to an even greater extent. The amazing thing about Szasz’s critics is that they very rarely understand his point, despite the elegant simplicity of his message. Of central importance is keeping in mind that it is a political matter, and not a medical one. I am almost ashamed that so few libertarians (or at least folk who hang our at Hit&Run) can see this, and worse, practically write the script for psychiatric slave owners to justify their disgusting behaviour.

    http://www.szasz.com had many free resources. I urge anyone who is even unsure of the legitimacy of psychiatric coercion to spend some time there.

  58. I support involuntary commitment if the person is an imminent danger to others.

    As for ‘danger to oneself’ – I believe healthy people should have the right to set down a ‘will’ about the matter. Not everyone is the same, and freedom is not valued to the same degree by different people. Clearly, a lot of people believe that taking over someone else’s freedom is justifiable on compassionate grounds. They would presumably that in the event of a mental calamity befalling them, they should be placed under involuntary commitment/guardianship in their own best interests. There are some others however (and I am among them) for whom a life without freedom, where you no longer are allowed to decide whats best for you, is never acceptable. Such people , I think should never be committed, even if they are a danger to themselves. A legal document (prepared by the person in advance) seems the best way to decide which alternative to take.

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