Civil Commitment: Past, Present, and Future

1995:

The history of involuntary civil commitment has been pendular, sometimes in favor as a government policy to treat mental illness, and at other times not in favor. The suspected cause of mental illness has changed throughout history and at various times thought to be due to, among other things, possession of demons, reversion to an animalistic level of consciousness, a sinful state of the soul, a chemical imbalance, and as reported recently in the medical journal Nature and Genetics, a defect in chromosome number six (at least as far as schizophrenia is concerned).

The authority of the state to civilly commit an individual for care, confinement or treatment, also ran the gamut from the absolute and arbitrary power of the king as sovereign to order incarceration, to the contemporary infusion of maximum due process of law to protect life and liberty under constitutional and state law. In the last two decades, civil commitment has become less utilized due to a number of factors, such as the Supreme Court decision in O'Connor v. Donaldson,(1) shrinking public resources, and policy changes in federal and state law. However, in recent years civil commitment appears to be making somewhat of a comeback under various law reforms in many states, such as legislative enactment of the "gravely disabled" standard, outpatient commitment statutes or increased criminal incarceration of persons with mental illness.

As the philosopher George Santayana cautioned, those who ignore history are doomed to repeat the mistakes of the past. The following is a review of the past and a glimpse of the future for this government authority to treat certain individuals with mental illness.

A Brief History of Civil Commitment:

Greek philosophy, government, and culture are the primary precursors to our own social and legal practices of civil commitment today. The formulation of the so-called "insanity defense," the use of the "asylum" as a place of rest, serenity and recuperation for the mentally ill, and definition of the basic principles of "informed consent," democracy, and the essential powers of the state, were all originally formulated in ancient Greece and these fundamentals have changed very little since then. Indeed, many of the Greek concepts and even terminology are still frequently used in court decisions and laws two and a half millennia later.
The insanity defense, i.e., the forgiveness of criminal liability due to presence of a mental illness which impairs judgment or behavior, can be found in ancient Greek mythology. In the extensive myths concerning the demi-god Hercules, he is said later in his life to have killed his wife and three children due to a curse from the goddess Hera. Despite this massacre being witnessed by the town's people, he was nevertheless deemed to be nonculpable due to the mental confusion caused by the curse. That is, he was truly unaware that his acts were wrong and/or he was unable to conform his conduct to the law. This is precisely the formula of the modern "insanity defense." Accordingly, Hercules was found to be in need of care and treatment by his best friend, Amphitryon, and the townspeople, and he was given sympathetic counseling to prevent his own subsequent attempted suicide upon regaining his mental competency and realizing what he had done.(2)

The father of medicine, Hippocrates, thought that mental illness was an organic sickness and not caused by a possession by demons. Moreover, he recommended that the treatment of mental illness should be conducted in an asylum, i.e., a secure and safe retreat from the chaos, pressures and impure environment of crowded urban centers rather than having persons with mental illness whipped in public, or incarcerated in dungeon-like buildings.

..for the rest of the research.. by An Address by Paul F. Stavis at the National Conference of the National Alliance for the Mentally Ill, Washington, D.C. July 21, 1995