The following is a two-part feature on the relation of psychiatry and the law. The first part discusses the abuses resulting from criminal and civil commitments to mental institutions. The second part, to appear tomorrow, will discuss a recently proposed Massachusetts statute to deal with these problems.

IF CHAPTER 123 of the General Laws of Massachusetts were enforced rigorously, few of us would be able to escape confinement in the mental institutions of this state. The statute provides for the involuntary commitment of any person ". . . subject to a disease, psychosis, psychoneurosis or character disorder which renders him so deficient in judgment or emotional control that he is in danger of causing physical harm to himself or to others, . . . or is likely to conduct himself in a manner which clearly violates the established laws, ordinances, conventions, or morals of the community." (Emphasis supplied.)

And Massachusetts, unfortunately, is not unique. These vague criteria for civil commitment (i.e., for people who have not been charged with any crime), have their counterpart in practically every other state in the country. According to Alan M. Dershowitz, professor of Law at the Law School, "Almost one million persons are today confined behind the locked doors of state mental hospitals, though never convicted of crime." The figure of one million is perhaps overstated, but figures from the National Institute of Mental Health show that between 600,000 and 850,000 people--depending upon which institutions are included--are presently in state mental hospitals.

Free to Leave?

Many of these people are confined against their will. Neither Massachusetts nor NIH makes a distinction between voluntary and involuntary patients in their annual reports--though they do distinguish between voluntary and involuntary admissions each year. But the distinction is problematic, since even those patients who have "voluntary" committed themselves are not free to leave whenever they choose. As Dr. Thomas Szasz, professor of Psychiatry at Syracuse, points out, "Truly voluntary hospitalization is virtually nonexistent in public mental institutions in the United States."

In Massachusetts, as elsewhere in this country, the decision to commit a person against his will is made almost exclusively by psychiatrists. The loose language of the Massachusetts statute--which has not been substantially amended in almost a century--establishes such meaningless criteria for commitment that in practice it usually precludes effective court proceedings and review.

State legislatures have failed to make policy decisions specifying who shall be detained and why. Nor have they specified the necessary degree of likelihood for a person to commit a harm. In other words, it doesn't matter whether a person might commit a harm, is likely to commit a harm, or is more than likely to commit a harm. In practice, all a psychiatrist must say is that a person is "likely to be dangerous to himself or to others" to effect his incarceration.

ABDICATION of legal responsibility has led to a concession of power, by default, to the psychiatric profession. Individual psychiatrists have been empowered to make uncontested pseudo-legal decisions on purely medical bases. The result of this psychiatric involvement in the legal process, says Professor Dershowitz, "has been the gradual introduction of a medical model in place of the laws' efforts to articulate legally relevant criteria." In other words, the presence or absence of "mental illness," a poorly defined and widely questioned concept, about which even psychiatrists disagree, has practically become the exclusive basis for decisions of preventive detention.

Over the past century, these civil commitment procedures have deprived millions of "mentally ill" people of their liberty. And once a person has been committed to a mental institution, he stands a good chance of remaining there for the rest of his life.

W. Blomberg, writing in the American Journal of Psychiatry in 1960, claimed that 40 per cent of patients in state mental hospitals have been hospitalized for ten years or more. He said, "Once a person has remained in a large mental hospital for two years or more, he is quite unlikely to leave except by death."

There are many examples of people wrongly committed to mental institutions who have re-won their freedom. In most cases these people have the help of concerned friends or relatives who manage to secure their release. But wrongly committed people who are alone in the world, or who have been committed with the express consent of their relatives, present the greatest problem of all.

Miss Mae Dean

Take the case of Miss Mae Dean, a 64-year-old registered nurse who was involuntarily committed to a mental institution for four years. The New York Times of July 27, 1960, said:

"The woman, Miss Mae Dean, was admitted to the Jersey City Medical Center on July 4, 1956, while suffering from a severe attack of asthma. Twenty days later she was transferred to the Hudson County Hospital for Mental Disease in Secaucus (N.J.).

'At today's hearing . . . Dr. John J. Scott, assistant medical director of the county medical hospital, testified that as far back as 1957, . . . Miss Dean had been adjudged sane.