Back to the Cuckoo’s Nest

Theodore Dalrymple’s essay In the Asylum in the summer 2005 issue of City Journal is worth reading. It caught my attention because I have spent a fair amount of time on law and social policy around mental health. Dalrymple was a forensic psychiatrist, and his essay demonstates the professional frustration of the medical psychiatry with human rights laws that restrict that profession’s ability to intervene. He discusses one incident where he obviously thought it best, on behalf of prison authorities, to sedate and treat a psychotic inmate.
His essay is informative but polemical. In Canada, the law permits intervention to treat a patient who lacks capacity to make informed decisions. The focus is on the patient’s capacity, and not on whether the patient’s decisions correspond to a psychiatrist’s assessment of what is a patient’s best interests. For the curious, a link to the 2003 judgment of the Supreme Court of Canada in Starson v. Swayze.
His dissection of the ideas of R.D. Laing and Michel Foucault is adept. I agree with his criticisms of R.D. Laing, whose views were naive, romantic, unscientific and unrealistic. I agree with some his criticisms of Foucault, but I think he has largely failed to deal with the substance of Foucault’s argument. He tries to undermine Foucault with ad hominem arguments – bashing him as gay French intellectual doesn’t help to identify or answer Foucault’s critique of therapeutic justice. Foucault made sound points about the loss of dignity inherent in an institutional life and power struggles between patients and care givers. Foucault pointed out that the rhetoric of helping patients obscures the fact that society intervenes to protect itself, and that human dignity is sacrificed in the quest to make the mentally ill safely invisible.


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