A brief history of medicine's war on responsibility

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J Clin Epidemiol Vol. 49, No. 6, pp. 609-613, 1996 Copyright 0 1996 Elsevier Science Inc. ELSEVIER

A Brief History of Medicine’s War on Responsibility SUNY

HEALTH

SCIENCE

CENTER,

SYRACUSE,

Ninety-nine years ago, Andrew Dixon White-a noted historian and the first president of Cornell University-published his nowforgotten classic, A History of the Warfare of Science with Theology in Christendom [l]. As the title suggests, White’s book is a contribution to what Herbert Butterfield called the “Whip interpretation of history,” that is, a tale of relentless human progress from darkness to light [2]. Alas, today we know better. But we have not learned the lesson that modem history-from the French Revolution to our bloody century-should have taught us, namely, that today’s liberator is bursting at the seams with impatience to become tomorrow’s oppressor, this time truly for our own good. The Argentinean novelist and poet Adolf0 Bioy Casares put it thus [3]: Well then, maybe it would be worth mentioning the three periods of history. When man believed that happiness was dependent upon God, he killed for religious reasons. When man believed that happiness was dependent upon the form of government, he killed for political reasons. After dreams that were too long, true nightmares . . . we arrived at the present period of history. Man woke up, discovered that which he always knew, that happiness is dependent upon health, and began to kill for therapeutic reasons. . . It is medicine that has come to replace both religion and politics in our time. Science commences when people begin to pay attention to certain regularities in their environment. The most elementary regularities in nature are sunrise and sunset, which is why astronomy-the study of the planets-is the oldest science. The most elementary regularities in human nature are our experiences of willing and being responsible, which is why religion-the regulation of intentionality and culpability-is the oldest social institution. For millennia, man lived in a technologically undeveloped world over which he had scant control. His experience of pervasive helplessness contradicted his intense sense of willing, which he projected onto imaginary spirits. He thus saw natural events through intention-colored lenses, attributing them to quasi-human agents (gods). In such an animistic view of the world, nothing happens “naturally”; instead, everything is willed, by human or, more often, suprahuman, agents. Animism-attributing, for example, earthquakes and plagues to human acts that cause spirits to harm people-thus magnifies intentionality and culpability. In contrast, modem man lives in a technologically sophisticated world over which he-and others, possessing specialized knowledged and technics-has far-reaching control. Yet, our experience of technological control over nature is contradicted by our intense sense of personal helplessness in an increasingly crowded and comAddress for correspondence: Thomas Szasz, SUNY Health Science Center, 750 East Adams Street, Syracuse, New York 13210.

NEW

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plex world. As a result, we deny free will and responsibility and replace it with the (pseudo)scientific notion of “psychological determinism” (as Freud called it). In such a scientistic view of the world, virtually no (bad) human conduct is the result of human choice; instead, human behavior is due to causes, most of which remain to be identified by a better understanding of the neurobiology of the brain. “The hypothesis that man is not free,” B. F. Skinner explained in Science and Human Behavior, “is essential to the application of the scientific method to the study of human behavior. The free inner man who is held responsible . . . is only a prescientific substitute for the kinds of causes which are discovered in the course of scientific analysis” [4]. Scientism-attributing, for example, crime and unhappiness to genes and neurotransmitters-thus reduces (or annuls) intentionality and culpability. Happily, there is a middle ground between animism and scientism. We can distinguish events that require a causal account or scientific explanation, such as the fall of an apple, from acts that require a motivational account and moral judgment, such as the Fall of Man. While the physicist’s choice between complementary explanations of nature is morally unproblematic, our choice between complementary explanations of human nature is ethically onerous. When should we attribute “mentality” to a person, treat his behavior as an intentional act, and hold him responsible for it? And when should we attribute “materiality” to him, treat his behavior as a manifestation of physical processes in his body, and hold him not responsible for it? The word “responsible” comes from the Latin respondere, which means to respond or answer. Although we often say that a person “has” responsibility, that locution is deceptive: responsibility is not something that a person “has”; it is something that he “is” or is “said to be.” Like, say, loyalty, responsibility is a moral and psychological trait with which a person may or may not be accredited. Thus, a physician can examine a person’s body to determine whether his kidney function is diminished or absent, because of renal disease; but he cannot examine a person’s mind to determine whether “its” responsibility is diminished or annulled, because of mental disease (although that is precisely what he pretends to do). We must also keep in mind that the word “responsible” can refer to three quite different things: a (physical) cause, (moral) blameworthiness, or (legal) culpability. For example, we say that lightning was responsible for setting a forest on fire; that Jones was responsible for (unintentionally) burning down his house, because he fell asleep while smoking; and that Smith was responsible for (intentionally) burning down his warehouse, because he wanted to collect the insurance on it. I shall be concerned with the moral and legal uses of the term only. Finally, we often use the term “mind” in lieu of the word “person,” and attribute responsibility or its absence to “it.” In religion, ethics, and law, a person is regarded as a moral agent only if he is answerable for his conduct, here and in the hereafter,

T. Szasz

610 to God, Pope, King, the law, and his fellow man. Being responsible is thus a type of minding, like thinking and remembering. Because an unconscious or demented person does not mind-cannot “answer”-we regard him as not responsible. The answerability of the person as moral agent is not limited to interrogation by external authorities. The sternest and most inescapable judge of a person’s behavior is often his own self, monitoring not only his publicly observable actions, but his private thoughts or self-conversations as well. We call this personal judge the conscience. Minus the prefix con, we have science. Conscience, then, is that part of the mind that “knows.” In contrast to the knowledge we call “information” or “memory,” we call the knowledge of the conscience “moral judgement” or “knowing the difference between right and wrong.” Moreover, the conscience does not merely comprehend, it also controls: it is the Voice that prompts us to do right and protects us from doing wrong.’ How does “it” know-that is, how do we know-how to do these things? The same way we know everything else, namely, by learning it. Newborn infants are human beings, but are not moral agents. Soon after birth, however, parents begin to attribute a measure of responsibility to the child, for tolerating progressively less frequent feedings or sleeping through the night. They do so not because the child is responsible for his behavior, but because they want him to become responsible, that is, to acquire certain habits. In other words, responsibility is not only a characteristic an actor may be said to possess or lack, but also a trait that we expect him to possess. Philosopher Arnold S. Kaufman put it this way: “One may be justified in blaming or praising an infant in order to influence his future behavior, but there would be no justice in it” (p. 188 of Ref. 5). Economist Friedrich von Hayek phrased the same principle thus: “[Tlhe statement that a person is responsible for what he does aims at making his actions different from what they would be if he did not believe it to be true. We assign responsibility to a man, not in order to say that as he was he might have acted differently, but in order to make him different” [6]. Finally, C. S. Lewis put the matter the most eloquently: “Christ died for men precisely because men are not worth dying for; to make them worth it . . .” [7]. Curiously, it is in death-even more than in life-that medicine and morality meet, often as adversaries. As a passive, biological event-as the result of illness or injury-death is a medical matter. However, as an active, personal deed-as the taking of a life, one’s own or that of another-death is a quintessentially moral and legal matter. Not by coincidence, the story of modern medicine’s war on responsibility begins in this vexatious domain. Judaism and Christianity prohibit suicide as self-murder. Indeed, both regard it as an especially heinous type of felonious homicide, felo de se. In the fifteenth century, the criminal laws of England combined the ecclesiastical and secular penalties for killing oneself, a development which William Blackstone, the great eighteenthcentury English jurist, approvingly summarized as follows [8]: The law of England wisely and religiously considers that no man has the power to destroy life, but by commission from God, the author of it; and as the suicide is guilty of a double offense, one spiritual, in evading the prerogative of the Almighty, and rushing into His immediate presence uncalled for, the other temporal, against the sovereign,

II am couching this description in metaphoric language. The reifications and personifications implied are verbal devices, not the names of actual somatic entities.

who has an interest in the preservation of all his subjects, the law has therefore ranked this among the highest crimes, making it a peculiar species of felony committed on one’s self. Because suicide was regarded as a double offense, against both God and King, the self-killer was punished doubly, by denying his corpse burial in consecrated ground’ and by confiscating his wordly goods and bestowing them on the sovereign’s Almoner. This savage retribution gradually led English juries-which bore the duty of having to determine the causes of so-called unnatural deaths-to find a way to show mercy to the victims, both dead and alive. They did not have far to look. The method had already been identified by Shakespeare. Hamlet: “Make mad the guilty, and appall the free, / Confound the ignorant, and amaze indeed, / The very faculties of eyes and ears” [9]. Eighteenth-century England was the most technologically advanced, most prosperous, and most powerful nation in the world. Not by coincidence, Englishmen enjoyed more personal liberty, and killed themselves in greater numbers, than any other people on earth. Under the entry for “self-murder,” the Oxford English Dictionary offers this example of the use of the word: “1741 . . ‘In such a gloomy, saturnine nation as ours, where Self-murders are more frequent than in all the other Christian World besides.“’ What was new in England in the eighteenth century, however, was not melancholy but liberty. For the first time in history, the English people began to take seriously the twin ideas of personal freedom and the right to property. In this connection, let us recall that, in 1726, after being imprisoned in the Bastille on the basis of a kttre de cachet, Voltaire was permitted to go into exile in England. One of his biog raphers describes Voltaire looking out over the Thames “swarming with rich merchant ships . . . surrounded by other barges rowed by men in silk and gold. One glance told him that the rowers were ‘free citizens’: the joy of liberty and plenty leaped to the eye” [lo]. This picture is, of course, too rosy. Still, it illustrates the cultural climate in which Englishmen sitting on coroners’ juries found the duty of imposing the penalties prescribed by law for suicide increas, ingly more troubling. However, abolishing the laws against selfmurder was unthinkable. Rulers and ruled alike believed that legaliz, ing suicide would be tantamount to sanctioning self-murder, exactly as people now believe that legalized drugs would be tantamount to sanctioning drug abuse. [l 11. suicide, treating Making mad the guilty-that is, “insanitizing” persons guilty of this crime as if they were lunatics-was the perfect solution. It allowed English men and women to maintain the religious and legal sanctions against the act and, at the same time, provided a compassionate and seemingly scientific and enlightened mechanism for sparing the suicide’s family the indignity and economic loss entailed in punishing the deed. S. E. Sprott, a historian of English suicide, summarized this development as follows [12]: In the eighteenth century, juries increasingly brought in findings of insanity in order to save the family from the consequences of a verdict of felony; the number of deaths recorded as “lunatic” grew startlingly in relation to the number recorded as self-murder . . [B]y the 1760s confiscation of goods seems to have become rare.

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It must have been clear to anyone who gave thought to the matter that finding the suicide’s “mind” non compos-posthumously, exactly at the moment when he was executing his felonious deedwas a legal tactic for circumventing the penalty the law prescribed for this crime. Blackstone recognized the subterfuge and warned against it: “But this excuse [of finding the offender to be non combos men&] ought not to be strained to the length to which our coroner’s juries are apt to carry it, viz., that every act of suicide is an evidence of insanity; as if every man who acts contrary to reason had no reason at all; for the same argument would prove every other criminal non compos, as well as the self-murderer” [13]. The warning was futile and Blackstone probably knew it. The law defined the jury’s posthumous judgment as a genuine finding of fact about the human mind. People need no encouragement to evade responsibility. Yet, here the Law, the Great Teacher, encouraged just such an evasion. Declaring that suicides were non compos, the Law had crafted a mechanism for rejecting responsibility and, aided by the medical profession, wrapped this evasion in the mantle of healing and science. Perhaps this was inevitable. In delicate situations, the white lie is often considered preferable to the black truth. Such was the case with declaring suicides insane, a policy whose tactical character was not officially acknowledged in the eighteenth century, and has remained officially unacknowledged to this day. Contemporary American society has embraced deploying this legalpsychiatric tactic-of impaired mental state as an excuse-on a scale that Blackstone could never have imagined.’ The posthumous use of an insanity defense signals the beginning of medicalidng mercy. Medic&ng cruelty did not lag far behind [ 141. It has been said that nothing in the world is so powerful as an idea whose time has come. In the nineteenth century, the idea of insanity as a disease that annuls the actor’s responsibility for his behavior was such an idea [15]. “The insane action or idea,” declared the editor of the British Medical Journal in 1875, “as surely springs from a morbid derangement in the brain structure, as a bilious attack springs from a morbid condition of the liver. There is no mystery about it; it is a mental manifestation arising from a physical cause” (quoted in Ref. 16). How did the medical profession reach this remarkable conclusion? Largely through the work of Henry Maudsley (1835-1918), the acknowledged father of British psychiatry. What made Maudsley so famed and revered? He discovered neither any new diseases nor any new treatments. He did something far more socially useful: by the force of his personality, he established medicine’s legitimacy as an arbiter of morality, masquerading as psychiatric science. In one of his most influential books, revealingly titled Responsibility in Mental Disease, Maudsley argues that insane persons are not responsible for their actions and that only psychiatrists possess the medical expertise to diagnose insanity. The view that psychiatrists are indispensable for the proper functioning of a modern-medically enlightened-society follows inexorably from these premises. I shall cite a passage from Maudsley’s work to illustrate how the new science of psychiatric medicine went about destroying the old superstition of moral agency and personal responsibility [17]. To hold an insane person responsible for not controlling an insane impulse . . . is in some cases just as false in doc‘This result is due in part to the fact that, today, the law, psychiatry, and the media all obscure or ignore the distinctions between the notion of non compos mentis as mental incompetence, which perforce is a legal determination, and the idea of mental illness, which by definition is a medical diagnosis.

trine and just as cruel in practice as it would be to hold a man convulsed by strychnia responsible for not stopping the convulsions . . . [IJt is a fact that in certain mental diseases a morbid impulse may take such despotic possession of the patient as to drive him, in spite of reason and against his will, to a desperate act of suicide or homicide; like the demoniac of old into whom the unclean spirit entered, he is possessed by a power which forces him to a deed of which he has the utmost dread and horror. This passage presents us with nearly all the moral, medical, linguistic, and legal metaphors and misapprehensions that form the foundations of modem psychiatry. By medicalizing (mis)behavior, psychiatry replaces the otherworldly superstitions of religion with the worldly superstitions of scientism. Examples of psychiatric magic masquerading as medical science abound. As I write this, the New York Times reports the case of a 25-year-old man in Ohio “acquitted of aggravated burglary and assault,” on the ground that he had suffered from sleepwalking and “had no memory of the attack” [18]. A few days later, the Times reports the case of a white man in Boston who, shouting racial epithets, attacked and injured a black man, and who was acquitted on the ground that he suffered from “manic depression . . . [and] neglected to take medication to help him control aggressive behavior” [19]. I will spare you from further comments along this line. Instead, let me call your attention to an important aspect of medicine’s war on responsibility that is, at least on the face of it, far removed from psychiatry-namely, the systematic disjoining of rights and responsibilities, exemplified by holding the sellers, but not the buyers, of certain goods and services, responsible for their conduct [20]. “We’re just saying”-explained a Colombian judge, apropos of the decriminalization of the use of cocaine in that country in 1994“that the person who consumes drugs is a victim and that the person who traffics in drugs is still a criminal (quoted on p. 21 of Ref. 21). To this judge, and to the American public whom he was addressing, it is self-evident that the drug seller (“trafficker”) is a responsible adult, whereas the drug user (“patient”) is (like) a nonresponsible child. With the naivest of conceits, we regard this disjunctive attribution of responsibility as both natural and just; actually, it is only a pathetic rationalization of our confusion about how best to cope with the complex risks inherent in modern life. It would be difficult to exaggerate the extent to which America’s War on Drugs has undermined people’s sense of personal responsibility. Countless individuals now view themselves as if they were like undisciplined children, unable to resist temptation. Such persons actually believe that their yielding to the enticements of alcohol, cigarettes, food, or gambling is a symptom of a bonajide medical illness [22]. Blind to the implications of defining intemperance as illness, the drug prohibitionists then complain that “drug addicts and alcoholics can qualify as disabled. . . Today the federal govemment is paying some $1.4 billion annually to 250,000 substance abusers-who often spend the money on the substance, not on treatment [23]. Drug prohibitionists love to justify their policies by claiming that the drug abuser’s habit spreads from a “gateway drug” such as marijuana, to a “hard drug” such as heroin. I doubt it. There is evidence, however, that the drug law-abuser’s habit spreads from prohibiting recreational drugs to prohibiting recreational foods. Kelly D. Brownell, a professor of psychology at Yale, proposed putting “a surcharge on foods with high fat and low nutritional value . . the true

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battle must be waged against an increasingly seductive environment” [24]. Note that Brownell blames the choice to ingest more calories than one burns, not on the failure of a particular actor to resist the temptation to overeat (or on his other personal reasons for behaving as he does), but on the “seductive environment” in which he is forced to live-in other words, on his being blessed with an abundance of affordable good food. Rationalized as health promotion, this type of political infantilization and tyrannization is not limited to the United States. Britain’s Independent Television Commission (ITC), which has authority to regulate advertising on Britain’s commercial channels, has ruled that “the nation’s health would be threatened by an ad in which a popular comedian fills his supermarket cart with chocolate bars. . . The ad would be acceptable only if ‘it was clearly established thar the [bulk] purchase was not for individual use.’ . . health lobbyists want the ITC to go further and forbid all commercials for fatty and sugary foods when children are likely to be watching television” [25]. By transforming the all too human desire to yield to temptation into a pathologically irresistible impulse, modern psychiatry has inverted traditional morality. The distinguished psychiatrist G. Brock Chisholm, the highest-ranking medical officer in the Canadian Armed Forces during World War II, proudly declared: “The reinterpretation and eventual eradication of the Concepts of right and wrong. . are the belated objectives of pratically all effective psychotherapy. . . If the race is to be freed of its crippling burden of good and evil it must be psychiatrists who take the original responsibility” (p. 9 of Ref. 26). This attitude exemplifies the hubris Wystan Auden called “the conceit of the social worker: ‘We are all here on earth to help others; what on earth the others are here for, I don’t know’ ” [27]. To help us resist this conceit-a task to which I have devoted much of my labors-1 offer some reflections on the parable of the Fall. The drama of life begins when Satan challenges Eve to eat the Forbidden Fruit. Eve hesitates, fearing God’s punishment: “God hath said, Ye shall not eat of it, neither shall ye touch it, lest ye die” (Genesis, 3:3). Satan reassures her that God will welsh on his threat: “And the serpent said unto the woman, Ye shall not surely die” (Genesis, 3:4). The rest, as they say, is history. We could interpret this grand parable in several ways, for example as the first historical case of: Child abuse Lured to disobey their Father’s warning, two children yield KO the seducer and suffer the consequences. Advertising Persuaded to give in to their CUtiOSiKy, two consumers throw caution to the wind and get more than they bargained for. Research Deciding to participate in a risky experiment, two investigators test their hypotheses, which produce significant results in advancing their understanding of their environment. “Diminished mental capacity” as an extenuating circumstance in law. Guilty of a capital crime, the Judge “excuses” two criminals by reducing their sentence from death to “imprisonment in life.‘14 The view that man is a priori responsible for his actions is intrinsic to the Jewish and Christian religions. John Milton (16081678) was emphatic on this point [28]: I formed them free, and free they must remain, Till they enthrall themselves: I else must change Their nature, and revoke the high Decree 4As Same put it, man is “condemned to freedom.”

Unchangeable, Eternal, which ordaind Thir freedom; they themselves ordaind thir fall. Indeed, God’s unrelenting punishments of His own creationsthe expulsion from the Garden, the Flood, the Confusion of Tongues-make sense only if human beings are moral agents responsible for their actions. Punishment and forgiveness alike imply and presume personal responsibility. In proportion as we diminish or abolish responsibility, we transform our grand religious dramas of retribution and redemption from morality plays into incoherent acts of savage retribution and capricious clemency. Having made responsibility contingent on sanity, that is precisely the moral chaos we have created. No longer do we regard responsibility as intrinsic to the human actor and his mind. Instead, we regard the human actor as intrinsically morally enfeebled, a “biological machine” equipped with a mind that belongs not to him, but to his brain. In closing, I want to pay tribute to Petr Skrabanek. Petr was a good man. To know him was to love him. His death was tragically premature, a melancholy circumstance no words or deeds can alter. Inasmuch as we are gathered here, at Trinity College in Dublin, it seems to me fitting to honor Petr Skrabanek by drawing a parallel between his life work and that of Ireland’s greatest son, Edmund Burke. Burke devoted his powers to protesting against the abuse and arrogance of political power; thus, he opposed the official champions of Reason and Virtue who regarded tolerance of theologically disapproved life SKykS as a sin. Skrabanek devoted his powers to protesting against the abuse and arrogance of medical power; thus, he opposed the official champions of Health and Medical Ethics who regarded tolerance of medically disapproved life styles as a sickness. Seething with indignation against the Jacobins, Burke wrote [29]: Benevolence to the whole species, and want of feeling for every individual with whom the professors come in contact, form the character of the new philosophy. . . The bear loves, licks, and forms her young; but bears are nOK philosophers. Vanity, however, finds its account in reversing the train of our natural feelings. Thousands admire the sentimental writer; the affectionate father is hardly known in his parish. Mutatis mumndis, Petr Skrabanek could have written these lines, denouncing the doctors who place the glory of medicine above the welfare of the patient. Moreover, like Burke, Skrabanek succeeded in the difficult task of reconciling two basic, but mutually contradictory, human aspirations-for attachments and for achievements. Petr was a devoted father, a loving husband, and a loyal friend-as well as a physician committed to medicine’s oldest and most serviceable precept: Primum non nocere (First, do no harm). He was much loved and keenly appreciated in his own parish and far beyond. In any case, I am sure he would have agreed with Sir Thomas Browne’s (1605-1682) wise counsel: Ipsa sui pretium virtus sibi (Virtue is its own reward).

1. White AD. A History of the Warfare of Science with Theology in Christendom (Mazlish B, abridger). Free Press, New York, 1965. [Reprint of the 1896 edition.] 2. Butterfield H. The Whig Interpretation of History. Norton, New York, 1965. [Reprint of 1931 edition.] 3. Bioy Casares A. “Plans for an Escape to Carmelo.” New York Review of Books, April 10, 1986, 7.

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4. Skinner BF. Science and Human Behavior. Free Press. New York. 1953. p. 447. 5. Kaufman AS. “Responsibility, moral and legal. In: The Encyclopedia of Philosouhv (Edwards P. ed.). Vol. 7. Collier Macmillan. New York. 1967, pp. 183-188. 6. von Hayek FA. The Constitution of Liberty. University of Chicago Press, Chicago, 1960, p. 75. 7. Lewis CS. The Business of Heaven: Daily Readings from C.S Lewis (Hooper W, ed.). Harcourt Brace Jovanovich, New York, 1984, p. 52. [Emphasis in the original.] 8. Blackstone W. Commentaries on the Laws of England, of Public Wrongs. Beacon Press, Boston, 1962, pp. 211-212. [Reprint of 17521765 editions.] 9. Hamlet, act 2, scene 2, lines 547-549. [Emphasis added]. 10. Orieux 1. Voltaire (Brav B. Lane NR. transl.). Doubledav. Garden Citv. New York, 1979, p. 84. 11. Szasz TS. Our Rights to Drugs: The Case for a Free Market. Praeger, New York, 1992. [Paperback available from Svracuse Universitv Press, Syracuse, New Yo&l996.] 12. Snrott SE. The Enelish Debate on Suicide: From Donne to Hume. Ooen Court, LaSalle, Ilhnois, 1961, p. 112. [Emphasis added.] 13. Blackstone W. Commentaries on the Laws of England, of Public Wrongs. Beacon Press, Boston, 1962, p. 212. [Reprint of 1752-1765 editions.] Press, Syra14. Szasz TS. Law, Liberty, and Psychiatry. Syracuse University cuse, New York, 1989. [Renrint of 1963 edition.1 15. Szasz TS. Insanity: The Idea and Its Consequences. John Wiley & Sons, New York, 1987. 16. Skultans V. Madness and Morals: Ideas on Insanity in the Nineteenth Century. Routledge and Kegan Paul, London, 1975, p. 129.

613 17. Maudsley H. Responsibility in Mental Disease, 4th Ed. Kegan Paul, Trench & Co., London, 1885, pp. viii and 133. 18. “‘Sleepwalk’ Defense Results in Acquittal.” New York Times, March 1, 1995, A14. 19. “Uncontrolled Rage is Ground for Acquittal.” New York Times, March 17, 1995, A22. 20. Szasz TS. Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers. Doubleday, Garden City, New York, 1974; Our Rights to Drugs: The Case for a Free Market. Praeger, New York, 1992. 21. “Losing Their Minds in Bogota.” World Press Review, October 1994, 20-21. 22. Poll shows Americans want more drug treatment. Newsbriefs (National Drug Stratew Network) 1994; 6(November): 17. 23. Zuckerman MB “Welfate’s Scandalous Cousin” [Editorial]. U.S. News & World Report, February 6, 1995, 102; Zuckerman MB. “Fighting the Right Drug War” [Editorial]. U.S. News & World Report, April 26, 1993, 74. [In this connection, see also Szasz TS. Cruel Compassion: Psychiatric Control of Society’s Unwanted. John Wiley&Sons, 1994, New York, p. 165.1 24. Brownell KD “Get Slim with Higher Taxes.” New York Times, December 15, 1994, A29. 25. The Week. National Review, March 6, 1995, 18. 26. Chisholm GB. The psychiatry of enduring peace and social progress. Psychiatry 1946; 9: 3-9. 27. Auden WH. The Dyer’s Hand, and Other Essays. Vintage, New York, p. 14. [Reprint of 1962 edition.] 28. Paradise Lost, book III, lines 124-128. 29. Burke E. Writings and Speeches, quoted in O’Brien CC. The Great Melody: A Thematic Biography of Edmund Burke. University of Chicago Press, Chicago, 1992, pp. 435-436.