Therapeutic Censorship

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The Therapeut ic State

Therapeutic Censorship

B Y T H O M A S S Z A S Z

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reedom of speech is one of the most distinctly

Am erican polit ical values. In many Europea n

democracies people take for granted that their

freedom requires criminal sanctions against the expres

sion of certain od ious ideas, exemp lified by the denial of

the Ho locaust . In the U nite d States, that would be a

clear violat ion of the First Amendment.

To be sure, there are limits to our freedom of expres

sion, mo st famously the proh ibition against speech or

public ation that creates a clear and present dang er such

as Con gress has a righ t to preve nt. Exc ept for this cri

terion, plus the limits placed on the dissemination ot

obscen e or porn ogra phic speech and publicat ion and

commercial speech, the First Amendment seemingly

carves c^ut a large arena in which we may freely express

and hear the human voice.

I say seemingly because we in the United States take

for granted the government's right, indeed its duty, to

prohibi t persons from expressing opinions deemed to be

the products ot me ntal i llness. An Am erican has the

right to deny the Holocaust but not the right to deny

his identity and dec lare he is Jesus. Th e pe rson w ho

does that is diagnosed as having schizophrenia, being

dangerou s to himself and others , and incarcerated in

a hospital. This type of depr ivation of liberty is not

considered a violat ion of the First Amendment because

psychiatric c om mit me nt is defined as a civil , not crim i

nal, procedure, i ts ostensible purpose being therapy not

punishment .

This is familiar territory. Much less familiar is an

episode in which organized psychiatry was responsible

for a different kind of limitation of free speech , one I call

therapeutic censorship.

The Titicut ollies

I

n the 1960s, doc um entar y filmmaker Frederick W ise

man received permission to film for 29 ciays inside the

Bridgewater State Hospital, a Massachusetts institution

for the criminal ly insane. Th e m ovie he m ade there

his first documentarywas shown to great acclaim at

the N ew York F ilm Festival in 1967. Th e Massachusetts

at torney general proceede d to bar public screenings, and

the state ' s Supreme Court ruled that the movie const i

tuted an invasion of the privacy ot the Bridgewater

guards and patients. Th e film was banne ti. Today

The

Titicut Follies, if rem em be red at all, is dismissed as pr e

sent ing the kinds of inhumane psychiatric condit ions

that, thanks to drugs and deinstitutionalization, we have

put behind us.

TlieTiticut Follies is and was intended to be an expose,

the cinematic equivalent of invest igat ive journal ism . The

claim that it violated the privacy of the guards is as

absurd as wo uld be the c laim that a new spap er story

exposing the unsavory behavior of a politician is an

invasion of his privacy.

In May 1987 The Titicut Follieswas the subject of a

forum at the Unive rsity ot Massach usetts. At the time ,

the reviewer for the New YorkTimes repo rted; It was a

rare screening of the film that, under court guidelines,

can be shown only to professionals in the legal, human

services, mental h eal th and related fields. . . . A do cu

me ntar y film . . . ma de 2 0 years ago and pro mp tly

banned, has prcwed that its power to provoke debate has

not dimin ished . . . . [It] is the o nly Am erica n film ever

censored for reasons other than obscenity or national

security.

The t i t le of the documentary comes from an annual

variety show given by inmates a nd guards. After th e

1987 showing, W isema n said in an interview : If the

Fi rs t Am end me nt of the Con s t i tu t ion pro tects any

thing , it's a journ alist 's righ t to rep ort o n c ond itions in

a prison. Neve rtheless, the U.S. Supr eme C ou rt has

twice refused to hear Wisem an's appeal . Acc ording to

llioiiiai S:as~ (rs~as~(ci iiol.i'ouil ii professor of psycliiatryemeritus at

Sl XY I pstdtc Medical Uiiiecrsity in Syraaise. Hisfortlicoiiiiiiifbool^ is

C,oercion as Cu re: A Critical H istor y of Psvchiatrv(Traiisaclioii).

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T h e r a p e u t i c C e n s o r s h i p

the T(';/;c.s\ Blair e Perry , a lawy er tor M r. W isem an w ho

was on th e pan el, said, ' In 20 years, no t on e p atient or

his family has ever objected to the showing of the

film.'

Today, the hosp ital is m a m od er n building. By all

accounts , the Times reporter assured us , the staff is bet

ter trained and there are more legal safeguarcis protect

ing the patients, many ofwlioni liavenever been coiu/ictcd of

(1 crime.But the hospital is still surr oun ded by ba rbed

wire, staffed by 220 p rison guards. . . .Th ere are 25 nu rs

es and 49 psychiatrists, psychologists and social workers

for 436 pat ients , according to Mary McGeown, a

spokeswoman tor the Correct ions Depar tment . Br idge-

water is still overcrowded, understaffeci and underfi

nanced.

W hat IS the staff bette r tra inedfor?

No matter how many psychiatris ts ,

psychologists, nurses, and social work

ers are m such a hos pital, they are all

jailers.

On April 6, 199326 years after it

was banneci Tlic Titicut Follies was

shown on the Public Broadcast ing

System and reviewed by film critic

Walter Goodman in the New York

limes:

Frederick Wiseman's remarkable first documentary, an

unsparing visit to the Bridgewater State Hospital for

the Criminally hisane, in Massachusetts, was banned.

. . . As in all his repo rts, Mr. W isem an abjures na rra

tion.The pictures tell his stories, and he has never pre-

sentecl mo re powerful p ictures. T he 90- inin ute film

opens and ends with a chorus line from what was

evidently an annual shcnv called T he Titicut F ollies.

You' l l have to guess who among these costumed per-

torm ers are inma tes, w ho are guarcis. . . . O ne man

outtalks the doctors with a fervent yet coherent plea

to be sent back to an ordinary prison. . . . Many of the

enco unters have an unset t l ing ambiguity. A psychia

trist . . . questions an inm ate abo ut his sexual pro chv -

ities: W ha t are you interested in, big breasts or small

breasts? Is he wo rkin g or just curious? Th e hardest

scene to w atch is of a forced feeciing. Th e doc tor

smokes a cigarette as he inserts a long rubber tube

into the patient 's nostril and pours a liquid into a fun

nel;

you w ant to call out to him to flick the len gth

ening ash onto the floor before it drops into the

funnel.

heTit

Nest,

This unique

violation of the First

A m en d m en t h a s

escaped both legal

and psychiatric

at tention.

ehumanization of Mad Persons

he Titicut F ollies, unlike One Flew Over the Cuckoo s

was a unique film. It depicted in gripping pic

torial detail the psychiatric invalidation, persecution, and

dehum anizat ion of so-called mad per

sons at the hands of so-called mental-

health professionals. For that offense,

the Am erican psychiatric establish

ment, assisted by the American legal

establ ishment , banned the showing of

the film. This unique violation of the

First Am end me nt has escaped bo th

legal and psychiatric attention.

Today the Bridgewater State Hos

pital IS a he alth care facility affiliated

with the University of Massachusetts

Medical School . In 2003 the National Com mission on

Co rrec tiona l H ealth C are lauded it as its Facility of the

Year. A 2003 essay by Jaim e Shim kus, publications edi

tor of the organization, presents a brief history of the

hospital , but does not mention The Titicut Follies or the

conditions described in the film.

In the old days of insane asylums, the truth about

psychiatry was apparent: the madhouse was a snake pit,

and snake pits were limited to insane asylums. Today's

snake pi tsciispersed throughout societyare con

cealed by a facade of pseudomedical diagnoses, thera

pies, t reatm ent- adv oca cy cente rs , al l iances for the

men tally ill, and the r ena min g of insane asylums as

health care facilities. ml

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''Deliberative D em ocra cy D em entia

B Y J A M E S B O V A R O

A

specter is haunting America's politicians anci

professorsthe specter of i l legi t imacy. The

political-intellectual elite fear that millions of

Americans wil l conclude that the current democracy is

a traudthat they are being given bogus choices at the

bal lot box and that the phrase wil l of the peo ple now

me ans as little as th e ch eck is in the mail.

In the era of the Founding Fathers , government was

fairly simple and straightforward. But in the last 70 years

government has become far more complex, powerful ,

and seemingly impossible to leash. Ra ther than a rep ub

lic,

we have a Leviathan Dem ocracy. Th e U.S. gove rn

ment s t i l l has the formal t rappings ot the old

republiccandidates, elect ions, congressional proceed

ings,

judges draped m long black robes. But hol low

forms offer little solace to citizens caught in bureaucrat

ic crosshairs.

And, unfortunately, most citizens know little about

the system that do min eer s their lives. Mo st Am ericans

do not know the name of their congressman, the length

of terms of House or Senate members, or what the Bil l

of Rights purp orted ly guarantees. A survey after the

2002 congressional election revealed that less than a

third of Ame ricans knew that the Repub licans c on

trol led the House of Representat ives prior to the elec

t ion. Almost two-thirds of Am ericans canno t name a

single Sup reme Co urt just ice. Almost 60 percent of

Am ericans canno t name a s ingle cabinet departm ent in

the federal government .

Since voters routinely do not know what their rulers

are doing, those rulers cannot claim they are toUowing

the people's will when they impose new taxes and

penalties. Instead of being a triumph of the people's will,

government act ion becomes old-t ime exploi tat ion and

repression.The whole thing looks a bit unseemly, at least

to those who see politics as potentially uplifting.

As polls have shown that more Americans distrust

government, professors have searched for the holy

grai l a way to give legit imacy to Leviathan De mo cra

cy Delibe rative De mo cra cy is the latest fix from the

halls ot academia.

Deliberative D em ocra cy is different things to differ

ent peoplebut the common thread is that we wil l

gather and be coached on how to ciiscuss politics. Sup

posedly, it citizens me et anci use ptiblic reason to delib

erate on the major issues ot the day, gov ern me nt policies

will achieve new legitimacy and citizens will again trust

Wiishington.

Deliberative De moc racy is a favori te of Iw League

protessors and editorial wr iters. Sen. Barack Ob am a (D -

Illinois), a frontr unne r for the D em ocr atic presidential

nomination, is hailed as a visionary for invoking Delib

erative Democracy. In his latest bestseller. The Audacity of

Hope,

Oba ma declared that all the Con st i tut ion's elab

orate machineryits separat ion ot powers and checks

and balances and federalist principles and Bill ot

Rig hts are designed to force us into a conversation, a

'cieliberative democracy,' in which all citizens are

required to engage in a process of testing their ideas

against an extern al reality, persu ading others of their

point of view and building shifting alliances of consent.

In one sense, Ob ama 's co m me nt is typical of the

rhetorical clouds that blanket the landscape when De lib

erative Democracy is raised. His comment has little or

nothing to do with how government works in the real

Jaities BoHV'd (jiiiKdjiiiiboi'ard.coiii) is the authoro/ Attention Deficit Den

(Palijrai e, 2006). T errorism and T\Tanny (Pal{;rai c, 2006), and Lost

Ris 'h t s iThe l^estr t ic t ion of American R id its

(St. Martin s, 1994).

T H E F R E E M A N : I d e a s o n L i b e r t y

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Therapeutic Censorship