The Commission on Judicial Action of the American Psychiatric Association: origins and prospects--a personal view.

The Commission on Judicial Action of the APA was fonned by then President Alfred Freedman at my urging, based on the following considerations: First, there had been a recent proliferation of important legal decisions affecting the provision of mental health care. Those decisions reHected no input from organized psychiatry; indeed, they could not, since no such input had been offered. The tone and content of those new decisions were bitterly critical of institutional psychiatry and cynically distrustful of psychiatry as a discipline. I have in mind such judicial opinions as Jlllmilillli 1'. /)l'jJIl 1'1 IIII'II t of Pull/it H('al/h.1 I.('ssard v. Schmidt.~ DOllaldson v. O·Col/l/or.:1 and lI'ylltt 11, Stichl/ey .• Second. it was clear that a new mental health bar had emerged which was detennined to litigate every question of patients' rights both before and after admission to the hospital without regard for the impact of such litigation on the provision of mental health care, If the APA remained inert. I feared that future generations of psychiatrists would be faced with a set of legal decisions and precedents which would sharply restrict their ability to care for patients and to practice psychiatry. Every significant psychiatric decision was to be recast and examined from the perspective of civil liberties-not only future p,ychiatric decisiollS. but past psychiatric decisions. Judges announced their view, about psychiatry with quotations from Dr. Szasz and Bruce Ennis (d. Lessard v. Schmidt). and from that perspecti,'e any kind of psychiatric hospitalization was deemed worse than prison. Any kind of p,ychiatric decision-making seemed to be arbitrary and destructi"e both of civil rights and of the patients' mental and physical health. The legal trends I describe were obvious and imminent not only in decisions, but in what law students and practicing lawyers were being taught. Law reviews and journals all OH,[ the country became interested in the civil rights of the mentally ill, but scant consideration was given to the pro"ision of mental health care. Law reform groups offered clinical teaching se"ions around the country. instructing public interest practitioners in the art of bringing 19R3 actions against psychiatric facilities and the doctors who staffed them.5 The 19R3 action was the legal procedure followed in DOllaldson p. O'Conllor. Decided by the Supreme Court this past summer. ti it is the legal action now being brought agaillSt the Boston State Hospital and against mental hospitals in MissiSSippi and elsewhere. 1'\ineteen-eighty-three actions are based on federal statutes which deal with the violation of civil rights under the color of law. 7 Doctors treating involuntary patients are. for reasons beyond thi~ discussion, included among those who act under color of law. A 1983 action provides not only for the possibility of various kinds of injunctive relief. hut also for damages agaillSt those who. acting under color of law, deprive persons of their civil liberties. Such deprivation may include seclusion (the Boston State case) ,8