 Thank you very much, Ms. Nathan, Mr. Greenberg, ladies and gentlemen, I'm very impressed that so many people get up at 8.30, and even earlier. However, I'm going to forego the customary jokes because of the shortness of time. I do want to thank Mr. Greenberg and the organizers of the program for inviting me. I can hardly think of an audience I rather address than one composed of libertarians. But instead, thank you. But I must say that insofar as liberty is, as I understand it and as I'm sure we all understand it, is fundamentally tied to the idea of protecting one's life, liberty, and property. It seems to me that a speaker's time should also be protected. And I feel a little deprived starting with 15 minutes deprivation, especially since I prepared a rather serious presentation, since I thought that although the title is accurate and the one that I myself agreed to, it seemed to me that it should be, I hope it is, and if it isn't, it should be fairly obvious to an audience like this in what ways psychiatry is used as a weapon by the state. And if it isn't obvious, I can tell you in about two minutes. So I have plenty of time to talk about something very closely related to this, but a little more meaty. Now let me just run through quite seriously in about two minutes or less the ways in which psychiatry is a weapon of the state and then go behind the scenes as it were. But first of all, it's obvious that psychiatry couldn't be a weapon of the state unless there was an alliance between psychiatry and the state similar to what used to prevail between church and state in theological societies, or for that matter, in all Western societies, and that still prevails in Iran, in Israel, in Ireland, and many other countries. So what are some of these ways? Involuntary mental hospitalization, obviously, is at the top of the list, which is a fancy psychiatric way of saying, imprisoning the innocent. And of course, so-called involuntary treatment, which is a euphemism for electrical and pharmacological torture. Parallel runner of this is the insanity defense. I like to think of involuntary mental hospitalization as depriving innocent people of liberty and of the insanity defense as depriving innocent people from protection, from guilty people, by psychiatrists going to court and claiming that guilty people are innocent. These two things really go quite hand in hand. And those of you who have seen the play Agnes of God can see how, in another sensitive play, these issues are completely mixed up. I don't know who is more mixed up, the playwright, or the lead character in the play. Now, in addition to that, to these things, there are a myriad of interminglings between psychiatry, politics, and the law exemplified by such things as contesting of last wills, such as has been in the news recently with Tennessee Williams's, will divorce and custody cases. The whole area of psychohistory, which should really be called psycho assassination, and so forth. Well, I think I have done this now in a couple of minutes. So let me now present to you what seems to me the historical and philosophical background or some of the underpinnings of this phenomenon. I have done this partly for this occasion and partly for another one by trying to reconstruct the relations between psychiatry and the state in a way that's analogous to the thinking and analysis that's been devoted to the relations between church and state. And so naturally, I have to say some things about the two major religions which have influenced our society, namely Judaism and Christianity. I will skip most of that. It suffices to say that I look upon freedom as being one of the things which human beings seem to want. But evidently, people want something unfreedom even more because the three major social institutions to which in historical sequence, religion, the state and psychiatry are, after all, all devoted to taking people's freedom away. In other words, to controls by external sanctions in the last analysis. And if you look upon religion, and I should add here that I am, of course, personally not religious, but I am speaking respectfully of religion but in a non-religious, if you like, anthropological secular way, if you look upon religion, what impresses one is the image of man as helpless and powerless and of God as extremely powerful and men submitting to this force. Well, this is not exactly an image of freedom. Now, with this background, let me read to you, in large part, perhaps with some aside, what I have prepared. How did it come to be then that over long stretches of history, and in some parts of the world even today, religious ideas have justified the most absolute unlimited uses of power. Although the details of the theological justifications of repression are numerous and complicated, they all seem to come down to a single image, namely to a monotheistic male God who rules from heaven over all of mankind as a father on earth rules over his children. Perhaps the most classic exposition of this religious perspective on power is Sir Robert Filmer's treatise tellingly titled, Patriarcha. Written in 1640, this work, which bears the arresting subtitle, quotes, a defense of the natural power of kings against unnatural liberty of people. I didn't make that up. This work was made famous, would perhaps be forgotten if it hadn't been for, because there have been many such works. But this work was made famous by John Locke's satirical attack on it. Locke ridiculed this author for trying to, quote, provide chains for all of mankind, unquote, which Filmer, in fact, did extremely well. What should interest us, and should perhaps have interested Locke a bit more also, was how Filmer justified the benefits, one might now say, cures or treatments which redound it to those enlightened enough to fasten those chains on themselves and others. What Filmer provided in his book was, of course, nothing novel, do you know, but was nevertheless very important, namely a patriarchal and specifically Judeo-Christian justification of political authority. Filmer maintained that kings were entitled to absolute power over the subjects who, in turn, owed their rulers absolute obedience. Why? Because both the king's wielding of power and the subjects yielding to it were decreed by God, the divine lawgiver. How did Filmer know this? The Bible told him so. Now, the image, of course, as you know, was that until God created Adam, God himself ruled directly. With Adam, God created a paternal authority to rule in his place. Now, a number of concepts and images come together here, such as patriarchalism, paternalism, the divine rule of kings or other sovereigns, absolutism, slavery, and last but not least, revealed religion, particularly Judaism and Christianity. What characterizes all of these ideas and images is that in each sees the political order as naturally hierarchical, familial. On the one side is a father, lower case F, or a father, or Lord, God, or his vicar on earth, king or pope. On the other side are the people, seen as children, slaves, sinners, or a flock tended by a shepherd. In such an image, as Alfred Soshet, student of patriarchalism, reminds us, quotes, this is an extremely important sentence, which I quote from Soshet. Quotes, childhood was not something that was eventually outgrown. Rather, it was enlarged to include the whole of one's life. Now, instead of childhood, we have included in patienthood the whole of one's life. It might seem unseemly and indeed unnecessary to belabor that this is a basic image of what life is and indeed ought to be, of how power ought to be distributed among human beings that informs both the Jewish and Christian worldviews. God is our father in heaven. The priest is called father, we are his children. Just a master metaphor, you might say, but if so, it sure is a master metaphor that continues to pack a powerful wallop of real, literal power. The fact is that for millennia, there were no individuals at all. As Sir Henry Mann observed a long time ago, ancient law quotes knows next to nothing of individuals. It is concerned not with individuals, but with families, not with single human beings, but with groups and, of course, from men. Clearly then, our rhetoric justifying use of power not only reinforces our image of it, but also ultimately determines how or whether we try to limit it. Consider, if God is seen as all-powerful, demanding total submission to His will, and if power is wielded in the name of such a God, then not only will the wielders of power demand total submission, but those subject to such authority and sharing its claims to legitimacy will also be eager to totally submit to it. To be sure, they may chief under the yoke, but their complaints couch in terms of misrule will not challenge the principles of legitimizing their own submission. I can't think of anyone better, more famous than Alexander Salzenetzin to illustrate this view of enchantment with submission, but to the right authority. If God's power is total and is legitimacy even in secular politics unquestioned and indeed unquestionable, then the religious justification for the use of political power becomes irrefutable in principle and totalitarian in practice. These are merely consequences that flow from premises. If God is totally good and totally powerful, it is absurd to try to limit his power or the power of those who act in his name. It is not an accident then that the idea of limited government, the central principle behind the American revolution and political system is a secular notion presupposing the destruction of the legitimacy of priestly power, not just its reality, but its legitimacy. It is important to emphasize in this connection that the great historical struggles for religious liberty in Europe and especially in America and to date the modern struggles for national independence. Sadly, but not surprisingly, liberation from oppression by the priests led in most cases to oppression by the politician. The interests of the state replacing the interests of God as a leading symbol for sanctioning power. I shall not and cannot be concerned here with this tragic but perhaps often inevitable metamorphosis in the grand human drama of domination and submission. Instead, I want to comment briefly on the specifically American historical experience vis-à-vis a problem of religious oppression and religious liberty and then bring in psychiatry. Leaning heavily on the great thinkers of the European Enlightenment, the men of the American Enlightenment saw their task clearly. Simply put, it was this. For centuries, the soil of Europe was bathed in the blood shed in the name of God. Catholics persecuted Protestants, Protestants persecuted Catholics, and both persecuted the Jews. For men who worshiped liberty as well as a loving God, it was not a pretty sight to behold. Because in these persecutions, the use of force was justified by appeals to gods and churches and because the actual use of force making the persecutions possible rested on an alliance between priest and king, the mechanism for controlling this sort of violence seemed obvious enough, separate church and state, authority and power. The great writings of Thomas Jefferson and James Madison are sharply focused on this one theme, taming the abuse of power justified by faith and God. Their words are true and timely today as ever. Let me quote one of Jefferson's pertinent comments, one that you all know, I'm sure. It is error alone, Roe Jefferson, which needs the support of government. Truth can stand by itself. The way to silence religious disputes is to take no notice of them. It does me no injury for my neighbor to say there are 20 gods or no God. It neither picks my pocket nor breaks my leg. I can't imagine. This is surely not the rhetoric of Mrs. Carter or Mr. Reagan. Well, I will skip an equally eloquent quote from Madison to move along. For Jefferson and Madison then, and their spiritual friends and allies, religious freedom, which is in plain English, freedom from constraint or coercion of any kind enforced in the name of God, was the crux of the struggle for personal and political freedom in general. Although this fact is familiar enough to historians and educated persons generally, I am not sure that they or we have made enough of its psychological and political significance. Namely that men like Jefferson and Madison, who were themselves genuinely independent human beings, recognized that it's so long as a people want to submit themselves to a higher authority, whether it be Pope or King, Church or Crown, they didn't think of the American Psychiatric Association. Their struggle for freedom is doomed to failure by their own refusal to accept the indivisibility of rights and responsibilities across as many areas of human concern as possible. So inspired, the founders of American freedom did two historically monumental things. First, they undermined and destroyed the idea of God as a morally legitimate sanction for the use of force, enshrining this bold proposition in the First Amendment to the Constitution of the United States. I think one of the greatest quantum leaps in human thought that ever occurred, including all of physics and chemistry. Second, they foresaw the danger to liberty that lurks in the nation state itself and sought to fashion protection against it in training this bold vision in a constitution explicitly delegitimizing total power. In short, Americans have rejected and continue to reject the religious theological sanctioning of power by appeals to an approving deity and instead have embraced and continue to embrace a rational, prudential principle that since government cannot be perfect, it better be limited. Well, I guess I'm doing all right because I haven't said anything about psychiatry yet and I'm going to. Let me now draw some parallels in between religion and psychiatry and their relation to the state in the following way. Let me do this by focusing on the ideas and acts most abhorred by each of these ideologies and systems of control. I take it for granted that psychiatry is an ideology and system of social control and not medicine. The core act of deviance in religion is and is called blasphemy or heresy. In psychiatry, it is called delusion or psychosis. I will do more with this in a moment. Now, bear with me and forgive me for going back to basics but I think it will be useful. Blasphemy is defined as reviling God or committing any act of sacrilege. Although blasphemy was often regarded as a type of heresy, the latter term is usually defined more broadly. For example, by Webster's as quotes, a religious opinion opposed to the authorized doctrinal standards of any particular church. It's a definition of heresy. In religious history, it did not really matter much whether a person said the wrong thing or did the wrong thing. Since speaking is a type of action, this is really not altogether illogical as also a fault for freedom of speech and only too well. It is worth recalling in this connection that many of history's most famous heretics, for example, Gary Lau and Spinoza, really didn't quotes do anything wrong. They only said the wrong thing and then insisted on saying it again and again until they recanted or as in the case of Spinoza, which always enchanted me, he's the only Jew in 6,000 years who was excommunicated. To appreciate the similarities, to appreciate the similarities between blasphemy and psychosis, we must consider now the idea of freedom of speech. Seems like a simple idea, but psychiatrists don't like to consider it. Commentators on First Amendment freedoms often cite one of Justice Oliver Wendell Holmes's striking phrases to illustrate what this principle ought to mean. And let me cite to you this striking phrase about what freedom of speech ought to mean. Justice Holmes remarked that quotes, the principle of the constitution that most imperatively calls for our attachment is not quotes free thought for those who agree with us, but freedom for the thought we hate. End of quotes. Here then is a little list which I made up for this occasion of the typical utterances that people hated and for which those who uttered them were denounced as heretics in the past and which people hate now and for which they are now diagnosed as psychotic. Very short little statements I will read. Quotes, Jesus is a son of man, not of God. Pause. My life is worthless. I'm going to kill myself. Number three, my human rights are being violated by the secret police. The person who uttered the first of these statements was considered to be heretic in medieval Catholic countries because he was set to deny God. The person who uttered the second or third statement is considered to be a psychotic in the US or USSR respectively because he's set to deny reality. Obviously the secret police is only protecting him. And since the American motto is keep smiling, obviously if you are depressed and want to kill yourself, we better lock you up. Two more examples should be enough. I could go on and on. Let me give you two more examples to show you the parallels if you are only willing to make the mental switch. Quotes, the consecrated bread and wine in the mass are the body and blood of Jesus. Number two, my wife is putting poison in my food and is making me impotent. The person who uttered the first statement was considered to be a heretic by certain Protestants who insisted on the symbolic interpretation of the mass. The person who uttered the second statement is considered to be psychotic by psychiatrists today. Ladies and gentlemen, I think it is false and foolish to try to dismiss such cases as merely instances of religious or psychiatric intolerance or abuse. I am pointing to what I think is the essence of religion and psychiatry. On the contrary, these are paradigmatic instances of religious and psychiatric persecution justified by blasphemy against the sacred beliefs of religious and psychiatric authorities and made possible by the blind adherents of the masses and media to the belief that such deviance amply justifies controlling the deviance. This persecutory position may be best appreciated in contrast with the position explicitly rejecting the use of force for the expression of opinion, which again, I like to exemplify by one of Thomas Jefferson's statements taken from a letter written to his grandson in 1808, quoting Jefferson. When I hear another express an opinion which is not mine, I say to myself, here's a right to his opinion, aside to mine, why should I question it? His error does me no injury. And shall I become a Don Quixote to bring all men by force of argument to one opinion? If a fact be misstated, it is probable that he's gratified by a belief of it. And I have no right to deprive him of the gratification. If he wants information, he will ask for it. And then I will give it in measured terms. But if he still believes his own story and shows a desire to dispute the facts with me, I hear him and say nothing. It is his affair not mine if he prefers error. End of quotes. Now consider again in this connection that what one century before Jefferson wrote this in 1648 to be exact, the Parliament of England enacted quotes and ordinance for the punishing of blasphemies and heresies, end of quotes, the punishment in each instance of course being death. Now what were some of the acts so punished? They were such things as, and this is just a quick shopping list of the blasphemies, then punishable by death, they were such things as asserting, asserting, stating, I'm quoting, that there is no God, that the Son is not God, or that the Holy Ghost is not God, or that Christ is not God equal with the Father, or that the Holy Scripture is not the Word of God, or that the bodies of men shall not rise again after they are dead. Now some of these utterances, not to mention others, I could easily mention, are still offensive to many people. I hope I'm not offending anyone. Suffice it then, I'm serious, suffice it then to remind you that the long history of persecution for blasphemy was based on a biblical injunction commanding death quotes, you shall not revile God. Exodus 22, line 28. Since the writers of Exodus did not save each God, this phrase was equally useful for Catholics and Protestants. Jefferson, who did not mince words when it came to denouncing religious bigotry, spoke contemptuously quotes of the incomprehensible jargon of the Trinitarian arithmetic, that three are one and one is three. Had Jefferson been fighting against Jewish instead of Christian religious constraints, he would no doubt have been equally contemptuous towards restraints on diet laid down in the Old Testament or towards restraints on the diggings of archeologists or the schedule of the Israeli national airline, now justified by Jewish theological dogma. Well enough then of religious blasphemies, there is of the thoughts that the devoutly religious hate. What about psychiatric blasphemies? The thoughts that the devoutly rational quotes, hate. Psychiatrists, as I have been at pins to point out for 30 years, have long had their index of prohibited behaviors called psychiatric diagnosis. In 1982, the American Psychiatric Association published its current catalog of blasphemies, called DSM-3, punishable with involuntarily imposed or otherwise unwanted psychiatric meddling interventions and a broad range of other social sanctions, especially when associated with the additional heresy of quotes, dangerousness to self or others. A few examples of these psychiatric offenses and blasphemies must suffice here. And I'm now going to be quoting ladies and gentlemen from DSM-3 with some interjections which I will indicate. Elective, unless I indicate this is from DSM-3, elective mutism, my comment. A blasphemy usually committed by children manifested by, back to DSM-3, continuous refusal to speak in almost all situations, including at school. School refusal and other oppositional behavior. Number two, anorexia nervosa manifested by the intense fear of becoming obese and refusal to maintain minimal body weight. Tobacco dependence, a blasphemy we are warned that is obviously widespread. These are in DSM-3. Pathological gambling, this is my comment on it. Uneducated persons tend to confuse this with bad luck. If they are especially dense, they may confuse it with losing. Just as they have tended for decades now to confuse kleptomania with a crime of ordinary stealing. Then there is a disease or blasphemy, excuse me, called transsexualism manifested by a persistent, I'm quoting from DSM-3, persisted by a persistent wish to be rid of one's genitals and to live as a member of the other sex. When older people want to be younger, that's not called trans-chronologicalism yet. They are looking at, not to mention that when poor people want to be rich, that's trans-economical. You see, to discover the cause of AIDS, let's say, you have to be an expert in immunology, but to discover disease in psychiatry, all you have to do is make new words. Well, I will skip the rest of the entertainment from DSM-3. Surely, this almost sounds familiar and I hope troubling to many of you. Why do we need this master list of contemporary blasphemies and heresies? What are these categories for? So compilers are eager to tell us if you only know how to read the fine print in this absurd and ridiculous document. The purpose of the list is to help the sinners repent. I quote from DSM-3, making a DSM-3 diagnosis represents an initial step in a comprehensive evaluation leading to the formulation of a treatment plan. Now, I hope you are listening, because there are two important ideas implicit in this simple but incredibly smug claim. One is that every disorder assembled by these idiots is not only a bona fide illness, but is also remediable by a bona fide treatment. The other is that the treatment to be applied to the blasphemer is chosen by the psychiatrist, not the patient, on the basis of the diagnosis. In the age of faith, I quote, the Augustinian principle of persecution to promote salvation of souls constituted the foremost justification for prosecuting blasphemy, I'm quoting from a text by a gentleman named Levy on blasphemy. Today in the age of therapy, the psychopharmacological principle of treatment to promote mental health and quotes through liberty, as psychiatrists call it, through liberty submitting to chemical treatment, constitutes a foremost justification for persecuting psychiatric blasphemy. Curiously, not only psychiatrists, but historians and legal scholars seem to turn a blind eye towards seeing that if you want to secure freedom of conscience, qua psychiatric deviance, we must now address the same issues that the founding fathers addressed when they struggled to secure freedom of conscience, qua religious deviance. Medicine's prescription for religious rights is directly applicable to what we might now call psychiatric rights. Medicine said, quotes, in a free government, the security for civil rights must be the same as that for religious rights. Surely, surely, if a man has a right to declare that there is one God, or three, or 13, or that there is no God, then he must also have the right to declare that he has three personalities, or 13, or none, or that he belongs in the body of a person of the opposite sex, or that he is God, or any other idea that we may deem to be true or false, religion or heresy, reality or delusion, depending only on whether we agree or disagree with him. But we cannot simply leave it at this. We know that human beings are incapable of forming even a small group, much less a large, complex society, without resorting to some use of force. The practical question before us just comes down to choosing between those uses of force of which we approve and of those of which we disapprove. Since the use of coerced psychiatric interventions and their justification on the grounds of therapy bear an alarming resemblance to coerced religious observances and their justification on the grounds of theology, I completely reject and always have rejected the psychiatric use of force. On the other hand, to those who believe that health is more important than freedom, and I don't have to tell you how many such people there are, coerced psychiatric practices will be justified by their therapeutic rationale. Just as to those who believe that faith and salvation were more important than freedom, coerced religious practices were justified by their theological rationale. Well, I only have a few minutes and I want to conclude on what I wanted to conclude on. One second. Give me one second. I will go to the conclusion. All right. I really think, well, I won't blame Mr. Greenberg again for depriving me of all this time. I have put before you certain facts and reflections about freedom and power and the role of psychiatry in the grand human drama of regulating behavior. I have argued that our basic psychiatric problems are not scientific, medical, or technical, albeit that is how they are now presented and made to appear. Instead, these problems present us quite simply, but in ever-changing new cultural forms with an age-old problem of political philosophy, in particular with the justifications for maintaining and supporting a social institution and more specifically for its use of force, in this case psychiatry. The basic formula is and always has been this. As the agents of a particular repressive institution, men, and of course women too, men always claim to be acting and using force to quotes do good. The justificatory image and idiom used for doing good thus typically covers both consensual and coerced actions. Therein lies a gigantic logical error and moral mischief that we must expose and reject. In a free society, acts between consenting adults are permissible in a sense good because they be token the freedom of the actors, not because the consequences of the acts are necessarily beneficial to them. That is why I support electroshock or any other idiocy between consenting adults. If more people would electroshock themselves who are stupid, who are like Senator Eagleton, then the rest of us would have more peace and quiet. I don't have to be laborious to you, but I am going to. We can and do sell our mobiles, vacations, stocks and bonds regardless of whether buying them benefits a purchaser. Moreover, benefits do not justify coercion. You cannot force a person to buy a stock or a bond even if you could prove that it was good for him because he would make a profit on the purchase. It's rather obvious. The logic and ethics of paternalism, especially psychiatric paternalism, entails and is based on a totally different rule and standard. It goes back to the old paternalistic standard, or not so old. Thus in their dealings with voluntary patients, psychiatrists typically de-emphasize the issue of whether their clients want their services and instead dwell on the beneficial effects of their quotes therapy. Similarly, in their dealings with involuntary patients, psychiatrists justify their coercions and lies, especially nowadays by insisting on the therapeutic indeed life-saving powers of their practices. Again, the play Agnes of God is a rather odd example of this. This perspective is sometimes referred to as a thank you theory because it refers to the idea that the recovered psychotic, it refers to the idea that the recovered psychotic gratitude for getting involuntary electroshock or neuro-laptics is an adequate justification for these coerced psychiatric practices. What I am suggesting is that all of our traditional efforts to bring about psychiatric reforms, so-called, even that term is, I think, stupid, have been misconceived and misdirected and so are our present preoccupations with what psychiatrists like to call psychiatric abuses. We stubbornly conflate and confuse two different problems and questions. One question is, what are the proper or improper uses of psychiatry? The other question is, should psychiatric practice be based on the principle of paternalism, legitimizing unlimited psychiatric power, or on the principle of contract, rendering all such power illegitimate? Psychiatrists who like to debate the problem of psychiatric abuses, especially American psychiatrists who glory in righteously condemning psychiatry in the Soviet Union, are, without exception, psychiatric paternalists and totalitarians. The premise behind their posture is that if only psychiatry were practiced properly, whatever that means, quote, and were not politically abused, then psychiatric paternalists would be a valid principle for the practice of the profession and there would be no need to limit the powers of psychiatry. But this is a tragically false and futile position. To begin with, it is totally impossible to know or establish in a morally and politically unbiased or neutral way what is or is not psychiatric abuse. As all history teaches us, oppressors tend to view their use of power as good, whereas your press tend to view their coercion, their course conditions as bad. Thus, American psychiatrists calling Russian psychiatric practices abuses is but a feeble and ironic echo of American mental patients calling psychiatric practices in the US abuses. In addition, we know, as Lord Acton emphasized, that power corrupts and absolute power corrupts even more. We also know that Thomas Jefferson never tired of telling us that if man were angels, there would be no need for limited government or for any kind of government. My point is that the currently fashionable efforts to combat psychiatric abuses are either, are either stupid or is, this effort is either a stupid and misdirected enterprise or, verse, a ploy to preserve unlimited psychiatric power or both. The only way to limit psychiatric abuses is by limiting psychiatric power. That is by curtailing the power of psychiatrists. And that puts a problem of psychiatric power back where it squarely belongs in the realm of religion, morals and law in a word, in the realm of politics. Although my reflections might seem far ranging, they come down to reinforcing an old adage, namely that the pen is at least sometimes my tears and the sword. For our present purposes, I would re-articulate this idea as follows. Power is force that man wield over other men. Since those who wield power are always fewer in number than those over whom power is wielded, no man could rule much less govern without his power being credibly legitimized by certain ideas. It is these ideas that sanction some to use power and require others to submit to it. In the end, the whole structure of power, in religion, politics, psychiatry, call it what you will, rests on certain ideas packaged in the master metaphors of our language. As psychiatrists, psychologists and professionals in allied disciplines and others, it behooves us then to scrutinize our own ideas, particularly the ideas of mental health and mental illness, which we must judge, of course, by their uses and consequences. I, for one, find these ideas wanting not only as conceptual aids, but most importantly, as sanctioners of violence against those who act or think differently than we do. Thank you.