Psychiatry has become too powerful and something must be done to limit its power, warns Jonas Robitscher, psychiatrist and lawyer, professor of law and behavioral sciences of Emory University's schools of law and medicine and author of The Powers of Psychiatry. Bascially, Robitscher is skeptical of psychiatric authority that "comes to us with the imprimatur of science although it is not always scientific, that carries the weight of medical authority although it is only occasionally truly medical." He is also convinced that over the years psychiatry has created as many problems as it purports to have solved.
For instance, the much touted major tranquilizers which have helped lower the population of our nation's mental hospitals have done so at the cost of burdening thousands of patients with grotesque and so far untreatable movement disorders. And the present epidemic of Valium and barbiturate dependence is at least partly the result of the widespread reliance many psychiatrists place on chemical panaceas directed at their patients' problems in living. In addition, psychiatry has contributed to our present attitudes towards the use of "recreational drugs." "The model of drug intervention for emotional symptomatology has led to a widespread use of drugs and other chemical substances throughout the pouplation to maintain optimistic and stable moods."
But Robitscher is even more disturbed by the threatened arrival of the "psychiatrocracy," a state in which psychiatrists replace judges, policemen, social workers, educators, even our political leaders.
"Psychiatry, which had its beginnings in the care of the sick, has expanded its net to include everyone, and it exercises its authority over this total population by methods that range from enforced therapy and coerced control to the advancement of ideas and the promulgation of values."
But lawyer-psychiatrist Robitscher's most scathing criticism is reserved for the intimate and mutually self-serving relationship psychiatry has established over the years with the legal system. "Not only life and health, but also liberty, can depend on the psychiatrist's diagnostic label," writes Robitscher. "The opinions of psychiatrists are used for many legal purposes that have little to do with health."
On the basis of psychiatric opinion, accused persons are deemed fit or unfit for trial; prisoners are recommended for confinement in mental institutions, often for indeterminate periods of time; in certain states juries are advised concerning the appropriateness of the death penalty -- in these instances the psychiatrist, according to Robitscher, "has more power than most government officials and he can apply it to people who have done nothing more than think in ways he sees as pathological."
Psychiatrists' judgements are in fact often wrong, and Robitscher cites studies which show that ward attendants are often better at predicting dangerousness in mental patients than highly trained psychiatrists and psychologists.
Such criticisms raise a disturbing question: If psychiatrists are really so imcompetent in medical legal matters, why is there such a reliance on psychiatric expertise in the courtroom? Robitscher's answer: "One reason that psychiatrists are found useful in the legal process is that their testimony allows courts to achieve flexibility, sometimes to temper justice with mercy, sometimes to bend the law to conform to popular opinion."
Robitscher refers to psychiatry as a "Kafkaesque world," which is more than an effort at literary allusion. Both psychiatry and the law are closed, self referential systems where disagreement usually serves only to further ensnare the dissenter within the system, and usually its more unpleasant aspects. The accused who expresses a critical attitude towards his judge thereby runs the risk of incurring a contempt citation which, itself, leads to further entanglement with legal procedures.
The person labelled by the psychiatrist as "mentally ill" and who rejects the label finds his expression of disagreement regarding his diagnosis used as further proof of his "lack of insight" or perhaps even as evidence of a "delusion." In the psychiatric setting, ideological disputes are routinely translated into the language of psychobabble.
Given the fondness of both psychiatry and the law for taking absolutist approaches to highly diverse and complex situations, it's not surprising that the two disciplines have lately come into bitter conflict.
To the psychiatrist, the legal process itself is susceptible to psychiatric interpretation. "The scientific method as shown in psychiatry must sooner or later totally displace existing legal methods," wrote psychiatrist Karl Menninger. He asked, further, if lawyers "still continue solemnly to apply medieval stupidities in the name of 'established precedent,' 'public policy,' and other mouthly archaisms?"
Psychiatrists are also uncomfortable with the adversary system and feel that they should be given a protected status as an official of the court. Robitscher strongly disagrees: "The adversary process should be encouraged, contrary to the recommendations of many psychiatrists who would like to have their testimony considered impartial and to act as advisors to judges rather than witnesses."
Lawyers, on the other hand, resent the psychiatrists' elitism, their unaccountability to the public and their sometimes absurd posturing in the areas of psychiatric diagnosis and treatment. Lawyers are also disappointed in psychiatry's failure to provide "scientific" ways to decide questions of guilt, responsibility, likelihood for change and degrees of dangerousness.
As a result of this interdiciplinary conflict, some psychiatrists and lawyers are now suggesting that psychiatrists stay out of the courtroom altogether. After all, judges and lawyers evaluated competency long before there were any psychiatrists, Robitscher reminds us.
The divorce of psychiatry and the law isn't imminent, however. For one thing, psychiatrists aren't likly to willingly relinquish their power. Judges are equally unlikely to want to take on once again the burden of deciding questions which, too often, must appear to them undecidable. Besides, as criminologist Abraham Blumberg wrote several years ago, "the bureaucratic admonition to cover yourselves applies as well to the judge as to any other individual in the organizational world."
Psychiatry by employing opinion and calling it science relieves the law of its heady responsibility for deciding who shall live and who shall die, who shall be free and who shall be buried within the dungeons of our nation's prisons. The law, in turn, elevates psychiatric opinion to the level of dogma, thus clothing deeply subjective decisions with a pseudoscientific respectability.
As a result of this folie a deux, we are now left in this country with a dual justice system: one aimed at dealing with the wrongdoer as a "criminal" and thus punishable, and the other in which criminality is replaced by "sickness." Further, whichever alternative model happens to be employed in the individual instance often depends on the defendent's wealth or notoriety, or simply his "luck of the draw": securing the services of a lawyer familiar with the complicated ins and outs of employing the insantiy defense.
Overall, Robitscher's indictment of psychiatry as set forth in the persuasive, brilliant and troubling book is unlikely to endear him to his psychiatric associates. But psychiatrists would be well advised to somehow "deal with" their anger and resentment so that they might take some of Robitscher's criticisms to heart and become what he calls discerning psychiatrists: "The problem for the discerning psychiatrist, then, is to preserve enough of this belief in his ability to help that he can continue to work intimately with people caught up in powerful struggles, but not to be so enamored of his authority that he relies too heavily on it or proclaims it to be more scientific than it is. The discerning psychiatrist must acknowledge that society has given him too much authority, and he has to begin to define the limits of his authority."