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perience told me, they would live to viously, has it been subjected to any
Alan J. Pollack regret), I decided to develop this con- legal tests. I have not yet offered it to
Permanente Medical Group tract. The majority of my patients other types of patients, although I
Southern California have been quite desirous of giving me plan on keeping the possibility in
I present my version of the "psychi- authority to hospitalize, while a few mind.
atric will." It is a simple contract be- have rejected the idea or have re-
tween my patient and me. I developed mained ambivalent. I generally do not
it about a year ago in response to my offer it until after I have established
frustration in working with the re- some rapport and after the patient has
currently manic patient. Torn be- demonstrated behavior (i.e., during The Psychiatric Will: II.
tween my personal, noncoercive phi- an acute manic episode) that would Whose Will Is It Anyway?
losophy, the state's legal require- warrant a therapeutic move of this
ments, and distress over my patients' kind. To date, I have not had to in- Thomas S. Szasz
State University of New York
Upstate Medical Center, Syracuse
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP My article on the psychiatric will
6855 DE SOTO STREET WOODLAND HILLS. CALIFORNIA 91367 TELEPHONE (213) 884-3724 (Szasz, July 1982) elicited a large vol-
ume of mail, including a communi-
cation from Paul S. Appelbaum, call-
To whom it may concern: ing my attention his letter to the ed-
itor of The New England Journal of
Dr. Alan Pollack has discussed with me that there may be times when my emotional
condition deteriorates to a point where I am functioning very poorly and because of Medicine in 1979. In that letter, Ap-
this, may jeopardize my job, my health, my relations with family and friends. At such pelbaum (1979) proposed a type of
times, my judgment about the need for intensive medical care, in the form of hospi- psychiatric will, without calling it
talization, can be quite impaired. Despite my serious disability, I may not fully meet that, whose function is the exact op-
the criteria which would legally require Dr. Pollack to hospitalize me involuntarily; posite of the will that I proposed. I
namely, I am neither suicidal, nor homicidal, nor unable to provide for food, clothing was unaware of his communication,
and shelter. Nevertheless, with this document 1 am hereby requesting that Dr. Pollack which deserves comment, and would
place me in a Kaiser designated psychiatric facility on a 72 hour hold if: 1) in his therefore like to offer some brief re-
judgment he believes I am seriously jeopardizing my job, health, and/or relationships marks about it.
because of a relapse in my emotional condition; 2) I am rejecting the offer of voluntary
hospitalization; 3) he has the concurrence of whom I may ask him Appelbaum proposes a living
to confer with. will allowing a person to appoint a
surrogate who, should the person be-
I understand that after 72 hours, I am free to leave the hospital provided that I continue come psychotic, would give consent
to not meet the legal criteria for involuntary hospitalization. Or, I may choose to remain for his or her psychiatric treatment.
voluntarily for continued care. This would permit the psychiatrist to
I hereby release Dr. Alan Pollack from any liability for doing this which I have requested impose involuntary treatment on a
of him. psychotic patient with valid consent,
inasmuch as the patient consented to
I understand that I may withdraw this request at anytime other than during those times
of impaired functioning as described above. it when the patient was not psychotic
and appointed a proxy to implement
consent in his or her "absence." Ap-
(Signature of Witness) (Signature of Patient) pelbaum's version of the psychiatric
will thus expresses the beliefs of a psy-
chiatric protectionist: In case of psy-
(Relationship) (Date) chosis, treat. His communication il-
lustrates how the language of coercive
psychiatry precludes the psychiatrist
I have read the forgoing and choose not to give Dr. Alan Pollack the authority described.
Rather, I hereby release him from any liability for damages that may accrue because from formulating any other policy.
of my impaired mental state which, tho impaired, does not fully meet the legal re- I shall consider the key pieces of
quirement for Dr. Pollack to hospitalize me against my will. Appelbaurn's argument, sentence by
sentence, adding brief comments as
I go along.
(Signature of Witness) (Signature of Patient) 1. "Many psychiatric illnesses induce acute
psychotic episodes, during which the need
for treatment is frequently denied."
(Relationship) (Date)
If psychosis is a disease (of the
mind or brain) that renders the pa-
cc: patient
chart tient irrational and incompetent, then
one would expect it to have a random
AP/bjs effect on decisions concerning illness
Straightening the Record was different from those of my stu- be likely to experience the thrill of
dent days because it was written in a victory or agony of defeat, should tell
R. Abbot Hunter humorous and entertaining fashion it the way it really may have hap-
The other day, while meandering with lots of cute phrases and funny pened.
through the stacks of our local Car- anecdotes and examples. But now I'd It was 1962 and JFK was presi-
negie Library looking for a copy of better get on with my story, because dent. Sid Bijou gave away his whole
Lester G. Crocker's abridged trans- I know how valuable journal space is pipe collection. William S. Verplanck
lation of Miguel de Cervantes Saa- and how trees must die in order for was a visiting professor. And physio-
vedra's Don Quixote, I ran across careers and science to progress. logical-psychology graduate student
something which has inspired me to What I want to bring to the at- Ronald Pool was teaching an intro-
take pen to paper and write of what tention of the readers of Ihe American ductory psychology course through
may be a written wrong. What I'm Psychologist and Whaley and Malott the extension department of the U.
referring to is a dog-eared, paper-cov- has to do with setting the record of W. I was at Washington at that time
ered, spiral-bound copy of a basic straight about one of the latters' cute and through a close acquaintance I
psychology textbook entitled Elemen- and humorous stories about a profes- became privy to the events occurring
tary Principles of Behavior, written by sor who was conditioned by his class, during those two fateful, historic
two fellows named Whaley and Mal- or more exactly, the students in his nights in that summer of '62.
ott. It's very much like the Skinnerian class, using the operant method. As he was known then to the stu-
type of books I remember from years Whaley and Malott's telling must be dents of that night class in introduc-
ago when I was a student at the Uni- about the twentieth time I've heard tory psychology, Mr. Pool was a con-
versity of Washington and took Pro- the story in as many years. It is high scientious, sensitive, and thoughtful
fessor Donald M. Baer's course in time that somebody, for the sake of person, just as he most certainly con-
developmental psychology. The book history and for those who will never tinues to be to this day. Now college