Improper Commitments

I mentioned a while back that I was having trouble finding evidence that the due process revolution that affected mental hospitals in the 1960s actually involved a widespread problem. Other than Bruce J. Ennis's Prisoners of Psychiatry (1972), which a little research suggested was too incomplete in its information to completely trust as evidence on this, I just wasn't finding evidence of widespread abuses.

I just finished reading a 1963 subcommittee report. To Protect the Constitutional Rights of the Mentally Ill, Hearings before the Subcommittee on Constitutional Rights of the Committee on the Judiciary, United States Senate (88th Cong., 1st sess.) The title alone emphasizes how focused they were on the rights of the mentally ill. There is an enormous amount of discussion of the dangers of people being improperly committed, and why the mental health laws for the District of Columbia needed to make sure that this didn't happen--but what is really odd is that every witness who testified about this subject was confident that this had not been a problem in D.C., and was rare elsewhere in America.

One of the other issues that the bill raised was concerns about improper commitments—-or “railroading” a sane person, as several witnesses colorfully referred to it. But in spite of multiple witnesses who expressed concern that this could happen, and almost certainly, somewhere, did happen, there are no horror stories presented by any of the witnesses. Indeed, Judge Holtzoff admitted, “Such cases are rare….” Chief Judge of the D.C. District Court, Matthew H. McGuire went even further, and claimed that he was not aware of any cases where the existing D.C. law had led to such improper commitments. “We have had outstanding success here in the District of Columbia… and certainly the so-called railroading of an individual to a mental institution under its provisions is something that couldn’t possibly happen.” Many other witnesses, even those that one might expect to be concerned about this possibility generally discounted that this had been a problem.

Even the ACLU’s representative at the hearings, Elyce H. Zenoff, was careful not to claim that there was an existing problem. Referring to St. Elizabeth’s Hospital, “There are many dedicated men and women on its staff who, we know, are solicitous of the legal rights of patients. However, there is no way of knowing whether those who may join the staff in the future will be equally solicitous.”

The one witness who was prepared to admit that some inmates might be hospitalized somewhere improperly or for too long, was Dr. Dale Cameron, superintendent of St. Elizabeth’s (D.C. mental hospital):

I question very seriously, and you have not suggested it, that many persons are “railroaded” into mental hospitals. But I do agree that they can be forgotten or lost sight of in a badly understaffed institution.

In short, the ACLU’s zealous concern about the fine details of due process—-for example, their insistence that the normal rules of evidence should apply to competency hearings, requiring those who filed written reports appear in person to be cross-examined-—seems far more focused on a problem that everyone at the hearings, even the ACLU, believed was not present in D.C.’s mental hospitals, and was rare elsewhere in the United States.

Even one person locked up in a mental hospital improperly is a tragedy to be avoided, of course, but any system that has people involved is going to make mistakes, and be subject to abuse of power. The only way to build a perfect system--one that never screws up and does X is to build a system that never does X.