Psychiatry, civil liberty, and involuntary treatment

Growing concern for involuntary patients' civil rights has engendered criticism of psychiatry. Critics have disputed the reality of mental illness and have alleged that psychotic disturbances result from diagnostic "labels". Media accounts continue to depict the psychotically ill as abused victims rather than as patients requiring treatment. In the face of such attacks, psychiatrists need public support from their medical colleagues as well as from members of the lay public. The historical and socioeconomic factors germane to psychiatry are reviewed in an attempt to understand the current dispute about involuntary treatment. It is argued that the concept of civil liberty requires consideration of psychological freedom. Since psychotic patients are without psychological freedom, it is meaningless to respect their apparent liberty at the expense of allowing them to go untreated. Those who refuse treatment for what are deemed to be irrational reasons should receive treatment involuntarily. If society cannot trust psychiatrists to make such treatment decisions, the courts should make them.