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The Therapeut ic State
Therapeutic Censorship
B Y T H O M A S S Z A S Z
VyfjW ^ i
W i
F
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).
T H E F R E E M A N : I d e a s o n L i b e r t y 24
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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
25
M A Y 2 7
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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
26
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