Mental Illness and Liberty 

                                           -Sudeep Duggal

Here is a slightly edited part of one of my blog posts. I had this talk with my psychiatrist. Read on!

 “Another thing I asked my doc was whether he had heard of Dr. Thomas Szasz, and his views on libertarian principles for the mentally ill. What I knew about him was that he proposed that schizophrenics should be allowed to decide whether they want to take their medications or not. My doc told me that Szasz's saying about schizophrenia was that "It's a sane response to an insane world." This guy wrote all that in the 60's, when there was still no known biological cause of schizophrenia, and when the meds had just started coming out. This was also the time when Freud's psychoanalysis was very strongly governing the mental illness scenario, and the common thought was that the socio-cultural environment and especially the family's attitude triggers schizophrenia. As someone recently commented on my blog "Coffee has caffeine...", that the norm amongst psychoanalysts today is about measuring the expressed emotion (EE).

Coming back from the digression, I then told my doc that these are the same kind of views as of R.D. Laing! And he said yes. He then went on to tell me a very interesting thing. He told me about this old, prerecorded interview of R.D. Laing that was aired on BBC 7-8 years back. Laing was asked whether he would take meds if he were suicidal. He paused and thought for some time and said "yes". The interviewer then asked him whether he would take ECT treatment if he was in a really bad mental condition (completely suicidal and all that...), and he paused a bit longer and said that "if my doctor thinks necessary"! We now know that mental illnesses have a biological cause, and not a socio-cultural cause. A socio-cultural environment is not a cause, not a precursor towards causing mental illness; rather, it is, as in the concept of Expressed Emotion, a trigger for further relapses.

I then asked my doc as to how would one then relate libertarian principles for the mentally ill, and what about personal freedom in that case. He said that if you want the mentally ill person to make a choice, he should be in a state to make that choice. He cannot even make that choice because he is not in the right state to make an informed decision. And that is where medication helps in helping the person make a choice. I then added that then you can create that incentive structure for the patient that ok, if you don't want to take meds, I'll not support you financially. You support yourself. And since the person will be in no state to do that, you give him the alternative that you will support him if he agrees to take the meds.

My doc then said "freedom is in the attitude". I was confused as to what he meant by 'attitude', and he went on to explain. He gave me an example of this Jewish psychiatrist (Dr. Victor E Frankel, if I remember the name correctly), who was also a communist, and was put in a concentration camp by the Nazi's. He survived and eventually came out. He was then interviewed and asked how he survived it, and whether he was happy there? He said that I was happy all the time over there! The interviewer then asked as to how he managed to stay happy with all that torture, to which he replied, and I paraphrase, "no one can control the circumstance he/she is in, but the only thing that one can control is the response/attitude towards that circumstance. And I decided that I will stay happy even here."”