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Subject Area: Political Theory

Liberty and Mental Illness - Leonard P. Liggio, Literature of Liberty, July/September 1979, vol. 2, No. 3 [1979]

Edition used:

Literature of Liberty: A Review of Contemporary Liberal Thought was published first by the Cato Institute (1978-1979) and later by the Institute for Humane Studies (1980-1982) under the editorial direction of Leonard P. Liggio.

Part of: Literature of Liberty: A Review of Contemporary Liberal Thought, 20 vols. 19781-982

About Liberty Fund:

Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.


Liberty and Mental Illness

Michael Nedelsky and Peter Schotten

“Civil Commitment and the Value of Liberty.” Social Research 46 (Summer 1979): 374–397.

A difficult problem in the study of liberty concerns the rights of the mentally ill. Specifically, may persons suffering from treatable mental illnesses be hospitalized against their will? The claim that they can be committed has been challenged on two grounds, especially by Thomas Szasz. First, Szasz contends that the concept of mental illness is a myth. If true, this would rule out involuntary commitment. Second, Szasz argues that to hospitalize someone against his will is incompatible with the ethics of a free society. The authors contend that neither of these arguments can be accepted, and the practice of involuntary commitment is in fact a means of advancing “the vitality of the principle of liberty.”

An objective criterion for mental illness exists if it is defined as a lack of a capacity for rational behavior. The irrationality in question must be gross, i.e., markedly below even minimum standards. Furthermore, the determining factor is not occasional irrational behavior, but the lack of any ability to act rationally. Szasz has objected to this approach on the grounds that there are no objective standards of rationality. To allege that someone is irrational is, on this view, simply to express disapproval of his conduct. Szasz's argument is inconsistent with his practice as a psychiatirst, even if he treats patients only on a voluntary basis. If there are no objective standards, he can be guided by nothing more than his personal preferences. Szasz's objection has nihilistic consequences for psychiatry.

The objective nature of mental illness does not by itself justify voluntary commitment. The practice might be objected to on the grounds that it is inconsistent with liberty to prevent a mentally ill person from acting as he desires, so long as he does not harm others. To this the authors reply that political theory has tended to value liberty as a means to promote human welfare: everyone should be free to pursue the good life as he sees fit. This, however, does not mean that they are unable to act rationally. The same answer applies to the claim that liberty cannot be infringed because free inquiry is essential to discover the truth. The process of discussion presupposes rationality. One may, in summary, distinguish between the mentally ill person's desires at the moment and his long-term interests. It is the role of the psychiatrist to help secure the latter, even at the expense of the former.