MISTREATMENT OF THE MENTALLY ILL

Current psychiatric formulations along the lines of "[he is] . . . withdrawing into psychosis as an escape from reality" or "the patient is a passive-dependent person who wants to be taken care of by others" appear to be modern restatements of medieval phrases like "he has surrendered himself to the devil." Until the etiology of the functional psychoses becomes clearly established, treating such patients as if they were physically ill manifesting mental symptoms would seem to expose us to a less harmful philosophical-moral error than behaving towards them as if the disordered behavior reflects psychological causes primarily. Irrespective of etiology, however, depriving a person of all opportunity to be gainfully employed while undergoing an active psychotic condition is to add insult to injury. We must offer the mentally ill person an opportunity to contribute towards his own support despite his handicap. In addition to rehabilitative devices and "ego strengthening" techniques such as so-called halfways houses, we need to expand tremendously special work setups such as CHIRP both in hospitals and in the community. In addition, we must recognize that perhaps for some time to come there will be a not inconsiderable subgroup of patients who may have to make a life career of special employment. A final modification of our traditions must be the acceptance, until more definitive treatment techniques are developed, of certain patients as maximally restored if they can hold even part-time special employment in a psychiatric setting. Like other handicapped persons, the ability of the mental patient to make a living ought to be minimally interfered with by his affliction. Only a truly enlightened society can provide the necessary atmosphere, support and guidance to make such adjustment possible, however, and diminish, if not eliminate entirely, mistreatment of the mentally ill. I hope that Szasz's concern with civil rights of the mentally ill will lead him to view with favor the present observations.