FOR THE PURPOSE of this chapter, there is no need to define the term “open society” too closely. As Karl Popper delineates it, the open society is an ideal towards which men should strive, rather than an actuality.1 But, however imperfectly realized, the open society is one in which personal freedom is highly valued, in which individuals are, to use Popper’s phrase, “confronted with personal decisions,” and in which decisions, both personal and collective, are based upon reason rather than upon authority or tradition. What part has the psychiatrist to play in such a society; and has he anything special to contribute to it?
A hundred years ago, the role of the psychiatrist in society was both limited and clearly defined. His job was to look after the insane; an occupation which was largely custodial, since the insane were mostly untreatable, or at any rate incurable. As cities grew in size, both in Great Britain and the United States, large institutions had to be constructed to accommodate the mentally ill from these urban populations. These institutions, at first called lunatic asylums, and only recently named mental hospitals, were, at any rate in Britain, often placed at considerable distance from the community whose needs they were designed to serve, in order that the distasteful phenomena of insanity should impinge upon the ordinary citizen as little as possible. Psychiatry was a backwater specialty in which those out of mind were as far as possible put out of sight, while those who cared for them were similarly circumstanced.
Psychiatrists, therefore, tended to be men of little professional distinction. There were honorable exceptions: men like Tuke and Connolly in England or Pinel in France, who were responsible for replacing brutality with enlightened regimes for lunatics; but psychiatrists in the nineteenth century were all too often indolent failures content to carry out a perfunctory “round” of their charges once a day and to spend the rest of their time playing cricket. The idea that such men had a special role to play in society other than that of seeing that their patients were safely confined and treated with reasonable humanity would not have occurred to anyone.
The custodial role of the psychiatrist is still important. In England in 1978, the Department of Health and Social Security estimated that there were 79,165 patients resident in mental illness hospitals and units, representing a rate of 171 per 100,000 population; 26 percent of all hospital beds were occupied by patients with mental illness.2 In 1975, 193,000 people were inpatients in the state and county mental hospitals of the United States. Another 75,000 were patients in private and federal hospitals.3 These figures are not often appreciated by the general public. During the last twenty years, advances in the discovery of tranquilizing drugs and other physical methods of treatment have made it possible for a number of patients to live outside mental hospitals who would formerly have had to remain as inpatients. The news media have publicized this and given the public the false impression that the mental hospitals are rapidly emptying. The figures belie this hopeful supposition.
Although there is certainly a more rapid turnover of patients than there was, many of those discharged are readmitted and there remains a chronic core of patients who are unable to take their place in the ordinary community. How far this chronicity is the consequence of living in a hospital is as yet undetermined. On both sides of the Atlantic a great deal still requires to be done to transform mental hospitals from places of confinement into truly therapeutic institutions; to integrate these hospitals into the community; and to prevent the deterioration which inevitably occurs in persons deprived of liberty who are confined for any long period in any institution.
It is worth noting that, in England, four-fifths of those admitted to mental hospitals are “voluntary patients”; whereas, in America, four-fifths of admissions are involuntary. American psychiatrists working in public mental hospitals are, therefore, compelled to assume the distasteful role of jailers to an even greater extent than are their British counterparts.
That there is bound to be some conflict between the roles of therapist and jailer is obvious. What is not so generally realized is that society’s greater appreciation of the possibilities of psychiatric treatment has resulted in an increased threat to personal liberty. We shall return to this topic at a later point.
Around the beginning of this century, society’s attitude to psychiatrists began to change; very largely because of the rise of psychoanalysis. Psychiatrists started to emerge from their remote seclusion in mental hospitals to become, increasingly, the guides and mentors, not of the insane, but of those troubled people we call neurotic. The popular image of the psychiatrist changed from that of jailer to that of crank or eccentric; a label which has, with some justification, been attached to him ever since. However, as with other eccentrics in other societies, psychiatrists tended to become invested with special, almost magical powers, supposedly gained from dredging in psychic depths to which no ordinary person would care to descend. It was even assumed that their new knowledge of human nature could somehow come to embrace the whole range of human affairs and be used to transform society. Gradually these eccentrics began to be consulted by persons from the upper strata of society; partly because no one else could afford their fees, and partly because psychoanalysis and its offshoots had an intellectual appeal to which the less educated were unable to respond. This tendency was further underlined by the fact that the psychoses, to which psychoanalysis has but a limited application, occur more commonly in the underprivileged; while neurosis, though no respecter of class, is more often found among the sophisticated and complex. In Europe, and later in America, psychoanalysts began to be consulted by intellectuals; a social phenomenon to which, perhaps, too little attention has been paid. On the face of it, it is surprising that the highly educated and socially secure should have apparently demeaned themselves so far as to seek analytical help at a period when self-esteem, far more than today, depended upon position in society. It is, I think, no coincidence that this phenomenon should have been contemporaneous with the decline of belief in conventional Christianity and with the dissolution of a class structure based upon land and family in favor of a less secure hierarchy based more upon the acquisition of wealth. Nowadays, we take it for granted that psychoanalysts will be consulted by distinguished figures, from politicians to philosophers; but in the 1900s it must have seemed an odd thing to do to those who were brought up to think that they were the elite and that no one else was likely to know more than themselves about human nature and the conduct of human relationships and human affairs in general.
Moreover, the idea of progress, of a general tendency towards the improvement of society and the world in general as a result of increasing civilization, so dear to the Victorians, was still operative. Disillusion with Western civilization had not yet overtaken its protagonists, nor had anthropology revealed that so-called “savages” might be better adapted to their environment than we to ours. Psychoanalysis, as it gradually gained recognition, was regarded as a scientific discovery on a par with the discovery of radium or the like; a way of ameliorating man’s lot by abolishing neurosis. Freud himself was no utopian. Indeed he became increasingly pessimistic about psychoanalysis as a therapeutic method, though remaining convinced of its scientific status. Many of his followers, however, both in the early days and even today, believed that psychoanalysis was far more than a therapy designed to relieve a few neurotic sufferers. Melanie Klein, for example, writes in one passage of her hope that child analysis will one day become universal.4 Admittedly, she refers to this hope as “utopian”; but even to imagine that “child-analysis will become as much a part of every person’s upbringing as school education is now” is an extraordinary flight of fancy.
This tendency towards utopianism has persisted to some extent among psychoanalysts, although it is probably rather less than it was. It is reinforced by the fact that many analysts lead isolated, dedicated lives, seeing few people other than patients and colleagues, and playing less part than most other professional men in public affairs. It is easier to sustain the belief that one has the answer to the universe if one has no idea how the universe works. Psychoanalysis is primarily an interpretative discipline; a method of making sense out of the previously incomprehensible, and a way of helping individuals to understand themselves better. Although Freud did apply psychoanalytic interpretation to social phenomena to some extent and, for example, conducted correspondence on the subject of war, he was never unrealistic enough to suppose that a method of individual treatment of neurosis could readily be transferred to solve all the problems of society.
That psychoanalysis has not proved to be a universal panacea, nor even the therapeutic success for which enthusiasts hoped, does not mean that psychiatrists and psychoanalysts have nothing to contribute to the study of society. It is a truism to say that society is composed of individuals and that political institutions are, or in an open society should be, designed to promote the well-being of society’s members. What constitutes individual well-being and what best contributes to this end are both arguable matters. Whether the health and happiness of individuals is best achieved by material prosperity, by sexual fulfillment, through faith or through agnosticism, by being reared in a kibbutz or in a small family, by being encouraged to be, or discouraged from being, competitive; all these and many similar topics are themes to which the psychiatrist may legitimately address himself and upon which he is entitled to something of a special hearing because of his intimate knowledge of the emotional problems of individuals. It does not, however, follow that he should therefore be regarded as an expert upon education, the control of crime, the resolution of color prejudice or the abolition of war. To all these subjects, the psychiatrist has something to contribute, but it is a limited contribution, derived from his experience with comparatively few individuals.
The analytical treatment of neurotics takes a very long time; which is one reason why psychoanalysis has so far been available, with very few exceptions, only to the privileged rich. This state of affairs is bound to create the hope, however utopian, that if only greater resources of time, money, and trained personnel were provided, many of the misfits in society could be better fitted to take their place in it. Moreover, this hope contains the unspoken assumption that psychoanalysis, or some such psychotherapeutic method, is likely to be as effective a treatment for social deviants as it is for neurotics; and that, if only all criminals, drug addicts, sexual perverts, and the like were treated as patients rather than offenders, their problems and the problems they create would be solved. Hence, there is a strong tendency to exaggerate what psychiatric treatment can accomplish and to suggest that more facilities for treatment exist than is in fact the case. Readers of Popper’s The Open Society will be familiar with his thesis that utopianism inevitably leads to tyranny. The present tendency in society to idealize the therapeutic approach to misfits is a good example. I do not mean to suggest that, were greater resources available, nothing further could be done for the mentally ill. There is an enormous amount which could and should be done but, as things are at present, the resources do not exist, and psychiatrists are being asked to undertake more than they can possibly accomplish and to direct their therapeutic efforts towards a clientele who are less likely to respond to their efforts than are neurotics who seek help voluntarily. This has led to a number of abuses, of which unnecessary deprivation of liberty is the most obvious. It has been demonstrated that, as one might expect, the majority of psychiatrists and psychoanalysts are mildly left-wing, liberal, and anti-authoritarian. It is perhaps paradoxical that the therapeutic approach to persons who would, in previous generations, have been considered wicked or feckless has resulted in a decline in liberty, but such is the case. In what follows I am heavily indebted to The Right to Be Different by Nicholas N. Kittrie.5 It is significant that a professor of criminal law should be moved to write such a powerful indictment of what he calls the “therapeutic state.”
In his book, Professor Kittrie demonstrates, with a wealth of examples, that misplaced therapeutic enthusiasm has led to many persons being confined for indefinite periods with few of the safeguards against wrongful confinement which are available to criminals being effectively operative. Thus, thirty-three U.S. states have laws allowing the indefinite commitment of drug addicts to therapeutic institutions from which they can only be released if “cured.”6 Since, even after extensive exposure to the best treatment programs, only about 3 percent of addicts remain abstinent after release, it is obvious that many persons are being confined indefinitely upon false premises.
It is surely the duty of the psychiatrist to society to point out that he has, as yet, no effective method of treating the personality disorder which, it is generally agreed, underlies the phenomenon of addiction to narcotics; and, while pursuing research which may lead to effective treatments, it is his duty to refuse to act as jailer for those he cannot as yet help. He might add that, in the recent exacerbation of anxiety about the taking of drugs, it is often forgotten that the legal control of narcotics is of very recent origin, as is the supposition that crime and addiction are necessarily linked. Before 1914, there were no laws in the United States regulating the traffic in narcotics, and there is little doubt that, in the U.S., the association of drug addiction with crime is the result of punitive legislation.
In Great Britain, the poet Crabbe took opium for over forty years; yet it did not interfere with his literary output and he died at the age of seventy-eight. Wilkie Collins took increasing doses of laudanum (tincture of opium) from 1862 to his death at the age of sixty-five in 1889. His novels may have deteriorated but he did not cease production. Addiction to even heroin and morphine does not cause as much physical damage as does addiction to alcohol; and it is often preferable, as the law allows in Britain, for addicts to be allowed to obtain a regular dose of narcotic upon prescription than to try and fail to forcibly wean them from it.
Similarly, in the mistaken belief that psychiatrists can cure large numbers of alcoholics of their addiction against their will, twenty-six U.S. states have laws which allow the commitment of alcoholics to institutions from which release is conditional upon cure.7 Since the treatment facilities available fall far short of what is required, the effect of this compulsion, intended as a liberal, therapeutic device, is simply to extend the period during which an alcoholic offender is confined, without in fact improving his condition. This is, of course, not to argue that no alcoholics can be cured. Some can and are helped by psychiatric treatment to achieve and sustain total abstinence; but, in my limited experience, this is entirely dependent upon the voluntary cooperation of the alcoholic.
More dubious still are the laws determining the confinement of so-called “psychopaths”; a category of mental abnormality so hard to define that “a 1950 New Jersey report cited twenty-nine different definitions of the condition by twenty-nine medical authorities.” At least twenty states have made use of statutes relating to psychopaths, with the result that mental institutions are overloaded with people for whom they have no effective treatment. Kittrie gives examples of offenders guilty of only trivial offenses—for example, indecent exposure—who have been committed to institutions for indefinite periods. I will add one example from Great Britain. The Mental Health Act of 1959 unfortunately included provision for the forcible confinement of psychopaths. In the words of the act, psychopathic disorder is defined as “a persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient and requires or is susceptible to medical treatment.”
In 1968, Eric Edward Wills, aged twenty-one, who had been charged with larceny and with obtaining money under false pretenses, was sent to a mental hospital for a report. He was there diagnosed as a psychopath. The medical report submitted to the magistrate revealed that he was a compulsive gambler and recommended that the operation of prefrontal lobotomy be performed upon him. The magistrate promptly ordered that this operation be carried out. Fortunately, the press heard of the case, realized the implications, and the decision was rescinded.
Deprivation of liberty on the grounds of insanity, whether or not accompanied by the intention of enforced therapy, is also open to abuse. In the Soviet Union, confinement in a mental hospital may be instituted if the “patient” is regarded as being a “public danger.” More particularly, Soviet law allows for forcible commitment if an individual is said to suffer from a “hypochondriacal delusional condition, causing an irregular, aggressive attitude in the patient towards individuals, organizations or institutions.” Even more sinisterly, the law recognizes that “externally correct behavior and dissimulation” may mask what is supposed to be the individual’s true intention.
It is well known and amply documented that mental hospitals are used in the Soviet Union to confine persons who are thought to be hostile to the regime; and that psychiatrists have cooperated in this misuse of their medical function. Perhaps some psychiatrists are such dedicated Communists that they do in fact believe that anyone who does not share their faith must be insane. Others may well be threatened with dismissal and loss of livelihood if they do not agree to treat as patients those whom the government wishes to remove from society. As readers of A Question of Madness by Zhores and Roy Medvedev will know, whatever the reasons may be, it is clearly not difficult for the Soviet government to find psychiatrists who will cooperate.8
In the West, it is less likely that individuals are wrongly committed to mental hospitals on purely political grounds, although the cases of Earl Long, the governor of Louisiana, and, more especially, of May Kimbrough Jones, both quoted by Kittrie, must give rise to doubt. But it is very easy indeed for individuals to be judged insane upon dubious criteria; to be committed indefinitely to mental institutions where they will receive no treatment; and to be deprived of liberty, perhaps for life, in spite of the fact that they may be causing no harm to themselves or to anyone else.
In the United States, Thomas Szasz, a psychoanalyst, has propounded the thesis that the inmates of mental hospitals are the scapegoats of society, fulfilling the same function for society as did witches in the Middle Ages. He believes that any form of coercion applied to the so-called mentally ill is unjustifiable and that the psychiatrist’s function should be confined to elucidating the “problems in living” of those who voluntarily seek his help.9 This, to my mind, is oversimplifying the issue. There are a number of persons in any society who are, and should be, regarded as mentally ill and who may, unfortunately, require confinement against their will, at any rate temporarily. In his essay on liberty, John Stuart Mill wrote: “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.”10 Although Mill admits of some modification of this principle in the case of juveniles, he does not really consider the case of the mentally ill, in spite of the fact that, in a footnote to a later passage of the essay, he has sharp observations to make about the inadequacy of the evidence as to insanity which is often accepted by jurors. According to Mill, it would obviously be right to certify and confine an individual who was suffering from paranoid schizophrenia and threatening to murder his imagined persecutors. (In this connection it is of interest to note that acute paranoid episodes, in which individuals go berserk and do in fact kill others, are among the few forms of mental illness common to all cultures and are universally recognized as calling for the forcible restraint of the sufferer.)
But how about the sufferer from melancholia who announces his intention of committing suicide? Although it is true that suicide does usually harm those nearest to the suicide, I doubt if Mill would have thought this kind of harm sufficient to come within the category he defines. Suicide is primarily a matter of the individual harming himself; and this, Mill considers, he should be left free to do. Yet every psychiatrist will have had many patients who have been actively suicidal and who may have made more than one attempt to kill themselves but who, on recovery from their disorder, have been extremely glad that they were restrained from doing so and grateful for any treatment which led to their recovery. Moreover, there are patients in a state of mania or hypomania who may undertake all kinds of ill-judged commitments, financial and otherwise, which result in harm to themselves and from which, upon recovery, they have been grateful for being restrained. Should one deny treatment to those suffering from these types of mental disorder on the grounds that it is an unwarrantable interference with their personal liberty to do so?
In Great Britain, it has been the practice to certify and confine against their will not only those who are obviously likely to harm others but also those who are likely to harm themselves, either by suicide or else by overreaching themselves while in that state of high excitement and overconfidence we designate as hypomania. I think it right that this should be so, and I can see no way in which psychiatrists can in conscience entirely avoid the distasteful role of acting as temporary jailers and exercising coercion over some patients, even though this may conflict with their function as therapists.
But I also think that psychiatrists have a special duty, in the open society, to see that this coercion is kept to an absolute minimum. So far as I can see, this involves two principles. First, no psychiatrist should be misled by his own therapeutic enthusiasm or by the well-meaning therapeutic hopes of others into promising treatment for social deviants which he cannot carry out. Thus, because he believes that a criminal or an alcoholic or a psychopath or a psychotic might be helped by a full-scale analysis of fifty minutes five days a week, he should not agree to his confinement in a mental institution where he will get, if he is lucky, a ten-minute interview once a week. It is not disputed that some patients in these categories can be helped by analysis; or indeed by psychotherapies less drastic, although it must be admitted that the patients who benefit most from such treatment are generally those who are too inhibited to be social deviants, rather than the reverse. But there is no point in depriving people of liberty if one has no treatment to offer them. As Norval Morris of the University of Chicago has put it: “The rehabilitative ideal is seen to impart unfettered discretion. Whereas the treaters seem convinced of the benevolence of their treatment methods, those being treated take a different view, and we, the observers share their doubts. The jailer in a white coat and with a doctorate remains a jailer—but with larger power over his fellows.”11 So much is this the case that Professor Morris advises that no criminal should plead not guilty upon grounds of insanity.
Second, no psychiatrist should cooperate in coercion unless he is convinced that the person concerned is a danger to others or to himself. If we exclude the mentally defective, the intoxicated, the physically ill, and the senile, who raise problems beyond the scope of this paper, this will in practice involve only those individuals who are murderous, suicidal, or obviously manic. A few paranoid individuals may remain murderous throughout life, but they are very few. Manic depressives, whether manic or depressed, almost invariably recover from any given attack of their disorder. Therefore, by far the majority of those who are forcibly confined will need to be so for only short periods.
Twenty-five years ago, when I was a newly fledged psychiatrist, I should have been in favor of casting the coercive net far wider. It seemed obvious, for instance, that the schizophrenic with delusions and hallucinations and other clear-cut manifestations of mental illness should be in a mental hospital where, if he could not be cured, he would at least be treated with tolerance and understanding. If he had not the insight to see this, then reluctantly, he should be certified insane. Now I realize that our criteria of mental illness are sadly inadequate; that many harmless people have “delusional systems” by which they live; and I am against depriving anybody of liberty, however “mad” he may appear, unless he is a danger to others or to himself.
In the open society, the psychiatrist has a second duty which is equally important. That is, he must do his best to insure that techniques of psychiatric investigation and treatment are not misused for other purposes by governments or other agencies such as the police or military. I have already drawn attention to the misuse of mental hospitals as places of confinement for those whom society or government finds inconvenient. There are many other possibilities of abuse. Prefrontal lobotomy is an obvious example. The misuse of drugs which alter mood or which release inhibitions so that information can be obtained is another. The techniques of conditioning used in “behavior therapy” could easily be used for the convenience of society, rather than to promote the well-being of the individual. So could the new electronic techniques of modifying brain function by the implantation of electrodes into the brain substance. Such dangers, thanks to the publicity given to them by books and newspapers, are beginning to be widely appreciated. However, there is still a pressing need for vigilance. I shall end this chapter by giving an example of the misuse of psychiatric research by government in which I was personally involved in protest.
The history goes back a long way. In 1960, the late Professor Kennedy, then professor of psychiatry at the University of Edinburgh, was rash enough to reveal that he had been employed, during the last war, at an interrogation center in Cairo, in giving advice as to how methods of psychological pressure could be brought to bear upon prisoners from whom information was wanted. This disclosure created a certain amount of unease; more, I think, among the general public than among the medical profession. What, they asked, was a doctor doing in this context? Surely a doctor’s job was to heal the sick, not to instruct governments in how to break down prisoners mentally in such a way that they would yield up information. I took this point of view myself, although I knew that not all my psychiatric colleagues shared it. At the time, there was considerable interest in “brainwashing” techniques, as practiced by the Russians and the Chinese. The Korean War, with its revelations as to how nearly a third of the Americans captured had been persuaded to “collaborate,” was still fresh in people’s minds. There was still a lingering feeling that the British army did not behave like that, although, of course, no one expected that they would invariably behave to prisoners with saintly forbearance. The best I could do at the time was to write an article, which was published in the New Statesman, entitled “Torture Without Violence.” In it, I deplored the fact that doctors should lend themselves to use by government in the way which Professor Kennedy had indicated, and suggested that this conduct was contrary to the Hippocratic oath, as indeed it was. He made no riposte to the article; perhaps because of ill health, since in fact he died within a few months of its publication. There were various repercussions to this article. One lawyer wrote from Cyprus to say that he had knowledge of British methods of interrogation, and that these included what he called “drug-induced hypnosis.” It emerged that there was a special training center for interrogators—it still exists—at Maresfield in Sussex: though what went on there proved difficult to find out. Eventually, we got so far as to persuade Mr. Francis Noel-Baker to ask a question in the House of Commons of the Prime Minister, then Mr. Harold Macmillan. He evaded the issue, saying that it was not in the public interest to reveal what methods of interrogation were taught to British interrogators since such information might be of use to potential enemies. He did, however, write, “I can give an unequivocal assurance that in the training of British interrogators the use of ‘brain washing,’ drugs or physical violence is expressly and emphatically forbidden.”
I gave up inquiry at this point. It seemed difficult to carry matters beyond the Prime Minister. From time to time, various rather disturbing allegations of brutal conduct on the part of the British forces emerged from Cyprus, Aden, and other trouble spots. Then came the revelations about Northern Ireland. We learned that men were being starved, deprived of sleep, made to assume uncomfortable postures standing spread-eagled against a wall for hours at a time; and, more sinisterly, that they were being hooded and exposed to continuous noise at the same time. These revelations shocked a great number of people, and, eventually, an inquiry was instituted under the chairmanship of the former ombudsman, Sir Edmund Compton. This resulted in a report12 which, though deploring the use of “brutality,” alleged that the methods of interrogation employed in Northern Ireland were not in fact brutal. The hooding, the posture on the wall, and the continuous noise were, so Compton alleged, designed primarily to stop internees communicating with each other. A secondary effect, the report went on, might be to render the men so treated more susceptible to interrogation: “It can also, in the case of some detainees, increase their sense of isolation and so be helpful to the interrogator thereafter.”
I think that any uninformed person reading the Compton Report would have concluded that, although what was done to internees was not pleasant, there was little evidence of severe physical pressure being employed. Some men had complained of being knocked about, or being forced to do unaccustomed physical exercises, or being forced to stand up against the wall again when they had collapsed from fatigue and the effects of being given only one slice of bread and some water every six hours or so. But the tenor of the report was that although more supervision of interrogators was desirable—and it must be remembered that the interrogations were carried out primarily by the Royal Ulster Constabulary and not by British armed forces personnel—not much harm was being done, and possibly some unpleasant procedures were temporarily necessary if the IRA was to be stopped from pursuing its policy of terrorism.
It is at this point, I think, that specialized psychiatric knowledge became relevant. Anyone who had read the literature on sensory deprivation and its effects must have concluded that a variant of sensory deprivation was being used as a method of breaking down internees. The hooding and the continuous noise were designed, not to isolate men from each other, as the Compton Report alleged, but as a deliberate method of producing mental confusion and disorientation. I was no expert in the field of sensory deprivation: but I knew that the effects were so disturbing that, even among healthy volunteers who were acting as experimental guinea pigs and being paid for it, a high proportion pressed the “panic button” long before the experimental period was up. In mild sensory deprivation conditions, male volunteers endured only an average of twenty-nine hours; and in more rigorous conditions, only one man in ten endured more than ten hours. If no limit in time has been set to the termination of the experiment, fears of insanity and confusion may come on within as little as two hours. I knew that many people lost all sense of time; that others became hallucinated; that the experience could, at any rate for some people, be compared with a bad “trip” as a result of taking LSD. I knew, moreover, that an interesting fact had emerged from the Princeton experiments.13 If the experimenters used Princeton students, a number became paranoid, thought the experimenter had abandoned them, and so on. But when the experimenters had run short of their own students, and had to seek volunteers from further afield, the proportion who became paranoid was much higher. If the very mild degree of distrust which one might feel at entrusting oneself to the care of university professors not of one’s own university became so quickly magnified under sensory deprivation, what, one wondered, would be the effect of sensory deprivation upon men who knew themselves to be in the hands of actual enemies?
At the time of publication of the Compton Report I was asked if I would write an article on its psychiatric aspects for the Sunday Times and did so on the following day. In the article, I tried to make it clear that physical brutality was not the only kind of brutality which mattered; that sensory deprivation techniques could be used to produce what was equivalent to a temporary episode of insanity; that no one could possibly know what the long-term aftereffects of such procedures would be upon the men to whom they had been applied; and that the home secretary had no business to say that these methods had no serious sequelae, as he had been rash enough to do in the House of Commons. I thought it important to do this because I surmised that the general public would have no idea that any method of psychological pressure without actual physical torture could be expected to have serious effects. Psychiatrists who spend most of their time only in interchanges with other psychiatrists take for granted a number of things which it is actually rash to assume that non-psychiatrists have any idea of.
After various further protests in the House of Commons and elsewhere, a group of three privy councillors, Lord Parker, Lord Gardiner, and Mr. Boyd-Carpenter, were appointed to investigate the whole question of interrogation further, and I found myself giving evidence before them. I repeated to these distinguished men what I had said in the Sunday Times article, further reinforced by a study of the literature on sensory deprivation. I discovered that some of this literature is still not available, as it comes under the heading of “classified” information. It seems that government departments are quick off the mark in spotting what psychological and physiological techniques might be of use to them in war. A great deal of this research had, of course, been undertaken at the request of governments interested in the effect of isolation, weightlessness, and the like upon potential astronauts. What the Parker Committee was primarily interested in was whether the techniques of sensory deprivation employed in Northern Ireland could, as it were, be used in moderation without much risk of serious aftereffects. They told me that it was undoubtedly true that much useful information had been obtained from internees by the use of these methods, and no doubt many lives had been saved as a result. I was, of course, unable to answer this question, since there was no literature available to me which could tell me whether sensory deprivation employed as an interrogation technique upon enemies had the dire effects which any psychiatrist must guess it would be likely to have. All I could say was that so-called “traumatic” neuroses had been known to result from traumas which were less severe; that producing psychotic symptoms in “normal” people by other methods, like the use of LSD, for instance, was fraught with risk; and that one could only tell what the effects would actually be after a long-term follow-up of the people concerned. In the event, the Parker Committee produced a report in which Lord Parker and Mr. Boyd-Carpenter thought that the methods employed in Ulster could continue to be used if subject to more stringent safeguards; while Lord Gardiner produced a minority report saying that these methods were wholly detestable, their results unpredictable, and that they were unworthy of British traditions in the treatment of prisoners. The Prime Minister, after the publication of the report, said in the House that these methods would henceforth be forbidden.
The moral of this story is not so much that it is possible for psychiatrists, on occasion, to participate effectively in protest, important though this is. It is to underline the fact that psychiatric techniques and research, designed originally to be helpful to disturbed individuals, can, in many instances, be extracted from their therapeutic setting and used for exactly the opposite purpose. It is the duty of the psychiatrist, in the open society, to be aware of this possibility, and to prevent it when he can. In my view, it is also his duty to refrain from giving professional advice or in any way participating in such abuse. “The condition upon which God hath given liberty to man is eternal vigilance; which condition if he break, servitude is at once the consequence of his crime and the punishment of his guilt.”14
NOTES
1. Karl Popper, The Open Society and Its Enemies, 2 vols. (London: Routledge and Kegan Paul, 1945).
2. Jennifer Newton, Preventing Mental Illness (London: Routledge and Kegan Paul, 1988), p. 15.
3. Jonas Robitscher, The Powers of Psychiatry (Boston: Houghton Mifflin, 1980), p. 131.
4. Melanie Klein, Contributions to Psycho-Analysis (London: Hogarth Press/Institute of Psycho-Analysis, 1950), pp. 276–77.
5. Nicholas N. Kittrie, The Right to Be Different (Baltimore: Johns Hopkins Press, 1971).
6. Ibid., p. 236.
7. Ibid., p. 276.
8. Zhores A. Medvedev and Roy A. Medvedev, A Question of Madness (London: Macmillan, 1971).
9. Thomas Szasz, The Myth of Mental Illness (New York: Harper and Row, 1961).
10. John Stuart Mill, On Liberty (Harmondsworth: Penguin, 1974).
11. Norval Morris, “Impediments to Penal Reform,” University of Chicago Law Review 33 (1966):627–37.
12. Report of the Enquiry into Allegations Against the Security Forces of Physical Brutality in Northern Ireland Arising Out of Events on the 9th August, 1971, Sir Edmund Compton, G.C.B., K.B.E., chairman (London: Her Majesty’s Stationery Office, November 1971).
13. Jack Vernon, Inside the Black Room (London: Souvenir Press, 1963).
14. John Philpot Curran, “Speech on the Right of Election of Lord Mayor of Dublin,” July 10, 1790.