Psychiatric Advance Directives

In Vacco v. Quill, 521 U.S. 793 at 807 (1997), the U.S. Supreme Court said “[t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions … our assumption of a right to refuse treatment was grounded … on well-established, traditional rights to bodily integrity and freedom from unwanted touching.” Unless the Court wishes to make an exception for psychi­atric care (if “care” is the correct term), there is a federal constitutional right to refuse it. Further­more, if this is a federal constitutional right, it prevails over state and federal laws author­izing involuntary psychiatric hospitalization or treatment.

A California Court of Appeals put it this way in Bartling v. Super Ct., 209 Cal.Rptr. 220 at 224-225 (Cal.App. 2 Dist. 1984):

In California, “a person of adult years and in sound mind has the right, in the exercise of control over his own body, to determine whether or not to submit to lawful medical treatment.” … a competent adult patient has the legal right to refuse medical treatment. … The right of a competent adult patient to refuse medical treatment has its origins in the constitutional right of privacy. This right is specifically guaranteed by the California Constitution (art. I, §1) and has been found to exist in the “penumbra” of rights guaranteed by the Fifth and Ninth Amendments to the United States Constitution. [cita­tion omitted] “In short, the law recognizes the individual interest in preserving ‘the inviolability of the person.’” [citation omitted] The constitutional right of privacy guarantees to the individual the freedom to choose to reject, or refuse to consent to, intrusions of his bodily integrity.

One antipsychiatry strategy is making a Psychiatric Advance Directive stating that if you in the future are determined to be “mentally ill” you wish to receive no treatment for your so-called mental illness, includ­ing hospitalization, “medications”, ECT, or psychosurgery, in­clud­ing in “emergency” situations. Involuntary psychiatric hospitalization and treatment is predicated on the assumption that mental illness is a valid concept, that psychiatry has bona-fide therapy for mental illness, that victims of mental illness will benefit from psychiatric treatment, and that they would choose to have psychiatric treatment if they could make a rational decision. As I have shown in these essays, all these assumptions are wrong. By making a psychiatric advance directive refusing psychiatric treatment with a certification by a psychiatrist or psychologist, or both, of your mental competence at that time, this rationale for involuntary psychiatric treatment can be undermined. To prevent your psychiatric advance directive from being disregarded on the ground that you were not mentally competent when you made it, you need to have a psychia­trist or psychol­ogist, or both, certify to your competence at the time of the making of your psychiatric advance directive. If you do not have a certification by a mental health professional of your competence when you made your psychiatric advance directive, it is likely to be disregarded. For example, in 2012 a woman in Minnesota provided me with a copy of her psychiatric advance directive, which had no such certification, just the signatures of witnesses who were not mental health professionals, and a copy of a Minnesota court order dismissing her psychiatric advance directive as a product of her mental illness and authorizing giving her electroconvulsive brain damaging (electro­convulsive “therapy”) against her will.

I disagree with other lawyers I have discussed this with who are of the opinion psychi­atric advance directives are not protection from involuntary “hospitalization”, only from the kind of treatment a person can receive while involuntarily “hospitalized”. These lawyers believe a psychiatric advance directive cannot stop a state from involuntarily “hospitalizing” a person because of the state’s police powers or the states’s right to protect the individuals and the public from (future) harm. I show why these justifications are invalid in The Myth of Psychiatric Diagnosis, Is Involuntary Commitment for “Mental Illness” or “Dangerousness” a Violation of Substantive Due Process?, and Suicide: A Civil Right. I believe the supposedly unalienable right to liberty theoretically enjoyed by all law-abiding Americans may not be abrogated because of predictions of future behavior until such time as it is possible to reliably predict the future. As I have shown, psychiatrists’ and psychologists’ predictions of future violence are wrong approx­imately 90% of the time. The justices constituting the majority in Barefoot v. Estelle, 463 U.S. 880 (1983) may have, and I believe were, influenced by the fact that the State of Texas could have imposed a death penalty on a murderer without the prediction of future conduct required by Texas at that time. I think it unlikely a U.S. Supreme Court majority or a majority at most state or federal appellate courts would allow imprisonment, including when it is called involuntary “hospitalization”, of persons who were always law-abiding because of a psychiatric “diagnosis” or predictions about his or her future behavior if he or she has a psychiatric advance directive declining such supposed care with his or her mental competence when making it certified to by a board-certified psychiatrist or other credible mental health professional. A psychiatric “diagnosis” is dehuman­izing in terms of how other people see a person so “diagnosed” and makes it difficult for judges to think of such persons as citizens with constitutional rights. Nevertheless, I believe a psychiatric advance directive declining treatment including hospitalization for so-called mental illness with a certification to the maker’s mental competence by a psychiatrist or psychologist, and a past that involves no lawbreaking, and evidence such as I’ve summarized in this book about the unreliability of predictions of future behavior, are likely to be a successful defense to unwanted psychiatric “treatment” including involuntary “hospital­ization”, but it may require the intervention of an appellate court, which can take months.

In Hargrave v. Vermont, 340 F3d 27 (2nd Cir 2003), a U.S. Court of Appeals ruled that refusal to follow a person’s psychiatric advance directive while recognizing and abiding by non-psychiatric health care advance directives is discrimination prohibited by the federal Americans With Disabilities Act.

Be leery of Scientology

Any discussion of the future of anti-psychiatry activism is incomplete without mention of the Church of Scientology (scientology.org) and an organization founded by the Church of Scien­tology named the Citizens Commission on Human Rights (CCHR, cchr.org). Scientology and CCHR are the best known antipsychiatry groups in the world, so much so people often wrong­fully assume anyone who criticizes psychiatry must be a Scientologist.

How closely associated CCHR is with the Church of Scientology is
difficult to discern. On October 4, 2009 when I met and talked with Dr. Thomas Szasz for over an hour and a half, knowing Dr. Szasz was one of the founders of CCHR, I asked him about the founding of CCHR and its connection with Scientology. Dr. Szasz told me the relationship between the Church of Scientology and CCHR was a “marriage of convenience” because the Church of Scientology was (and perhaps still is) the only group willing to fund CCHR.

CCHR has created excellent films or videos shining the bright spotlight of truth on psy­chi­atry. I recommend some of them in this book. The criticisms of psychiatry by the Church of Scientology and CCHR that I have seen have been basically accurate.

The association of Scientology with criticism of psychiatry has however been a handicap because Scientology is said by critics to be a for-profit business, not a religion (see “The Prophet and Profits of Scientology”, originally published in the October 17, 1986 Forbes magazine) and because Scientology has been the target of other credible and frightening accusations.

In the 1980s or 1990s I saw a late-night television infomercial on a New York television station advertising a “Dianetics” program for $69.95 or $79.99 or whatever the price was. The infomercial said nothing about Scientology nor the founder of Scientology, L. Ron Hubbard, but I knew Mr. Hubbard had written a book titled Dianetics, The Modern Science of Mental Health and that he founded the Church of Scientology. The infomercial told viewers Dianetics would solve their psychological and emotional problems. The infomercial made me wonder if the people behind Scientology criticize psychiatry because they are in competition with it. During my aforementioned conversation with Dr. Thomas Szasz in 2009, Dr. Szasz told me being in competition with psychiatry is indeed why Scientologists criticize psychiatry. This same observation has been made by John Bush, executive director of the Texas Society of Psychiatric Physicians, who pointed out that “the Church of Scientology competes with psychiatry through it’s Dianetics program, which it calls a ‘modern science of mental health’” (“Opposition to shock therapy diverse…”, Houston Chronicle, January 26, 1997, chron.com, accessed November 26, 2012). In accounts on YouTube.com by former Scientolo­gists I’ve heard claims people recruited into Scientology spend tens of thousands or even hundreds of thousands of dollars on Scien­tology self-improvement courses or training leading to attaining various levels of improvement or recognition within Scientology. In her book Inside Scientology, Janet Reitman says Scientology has a “requirement that believers pay as much as hundreds of thousands of dollars to reach the highest levels of salvation.” (This quote comes from the front flap of the book’s dust cover.) Such allegations make it difficult to avoid the belief that whether it is psychiatry or Scientology, they’re after your money (or in psychiatry’s case, your insurance company’s, Medicare’s, or Medicaid’s money). There are allegations of criminal activity by the Church of Scientology: For example, a Huffington Post report is titled “Belgium To Prosecute Scientology As Criminal Organization; Church Faces Charges of Extortion, Fraud” (huffingtonpost.com, posted 12/28/2012). Before even talking with a Scientologist, do an Internet search so you’ll be familiar with the allegations. I do not know which, if any, of the allegations of criminal or other wrongful activity by the Church of Scientology are true and which, if any, are a misleading counterattack by psychiatry supporters, because I have never been associated with Scientology nor CCHR and have not knowingly talked with nor otherwise communicated with a Scientologist or a CCHR member (other than Dr. Szasz, and more recently psychologist John Breeding of Austin, Texas) for many years, nor have I investi­gated the news reports about criticisms of Scientology. Whatever the truth or falseness of the alle­gations against Scientology may be, know that joining the Church of Scien­tology reduces your credibility in the eyes of many people, not only because of the allegations against it but also because its theology or cosmology seems so much like science fiction like you might expect from a religion founded by a science fiction writer, L. Ron Hubbard, which all agree Scientology is.

Don’t have a family

I began this essay with a quote from Linda Andre’s book Doctors of Deception: “… the injustice of being locked up against our will when we had committed no crime, often on the basis of nothing but a lie by a family member”. The person most likely to start the process of forcing you into harmful psychiatric mistreatment, in­clud­ing incar­cera­tion in a so-called hospital, is someone in your family. The truth of this can be verified by asking almost anyone who has been subjected to involuntary psychiatric treatment or reading the background facts in court opinions about involuntary psychiatric commitments. As regards psychiatric oppression, your family is likely to be your enemy. If you have a family, and members of your family act in ways contrary to your best interest, such as trying to force you into so-called mental health care, your best option may be to divorce or separate yourself from and have no contact with nor communication with your family. In 2009 when I telephoned retired psychiatry professor Thomas S. Szasz and told him I intended to make a psychi­atric advance directive, he asked me about my family. Learning I’m unmarried and without children and have only one elderly parent, my mother, he told me I probably don’t need a psychiatric advance directive because, he said, “You don’t have any family to screw you up.”

Educate your family about psychiatry

However, for most of us not having a family is not an option. Also, for many people, family is one of their most important sources of happiness. Do what you can to make your closest family members, especially the one recognized by law as your “next of kin”, aware of the truth about the complete lack of benefit of psychiatric “treatment” and harm from all of psychiatry’s biological “therapies”. One way to do that is loan them your copy of this book or give them books written by Dr. Szasz, Dr. Breggin, Dr. Moncrieff, Robert Whitaker, and others listed in Recommended Reading in this book.

Don’t expect public outrage

During the writing of this book I met with a long-time friend employed for many years as a hospital administrator. Speaking of health care in the U.S.A., she said, “We’re killing a lot of people” due to “preventable medical errors.” She said it’s “amazing” there isn’t “outrage” about of the number of deaths caused by what is supposed to be health care.

In 2017 in his book Twilight of American Sanity (Harper Collins, p. 31), Allen Frances, M.D., former chairman of the Department of Psychiatry at Duke University School of Medicine, says this:

Excess care has created a pandemic of medical mistakes — errors occur in 30 percent of all hospitalized patients, causing about two hundred fifty thousand deaths each year — the third-leading cause of death in the United States. If you add in fatal outpatient mistakes, you come to the horrible and paradoxical conclusion that medicine itself may cause as much mortality as the biggest killer diseases. It has gotten so bad that my best friend, a very wise neurologist, tells his elderly patients, “If you want to have a long and happy life you must do two things — don’t fall and stay away from doctors.

An article in "The Economist” in 2013 says “Every year nearly 100,000 people die in America alone from pre­vent­able infections acquired in hospitals” (Technology Quarterly innerfold, September 7, 2013, p. 8).

In their book “121 Ways to Live 121 Years and More: Prescriptions for Longevity” (Basic Health Publi­cations 2006, p. 3) Ronald Klatz, M.D., D.O., and Robert Goldman, M.D., Ph.D., D.O., warn —

The U.S. Department of Health and Human Services reported that physicians cause 120,000 or more accidental deaths a year in the United States. Averaging that across the approximate number of physicians in the United States (700,000), the rate of accidental deaths per physician is 0.171. Comparing with a rate of accidental deaths per gun owner of 0.000188, doctors are statistically 9,000 times more dangerous than guns!*

On the front cover of his book Malignant Medical Myths, Joel M. Kauffman, a Ph.D. in organic chemistry from M.I.T. and Professor of Chemistry at the University of Sciences in Philadelphia, who later “turned his attention to exposing fraud in medicine” says “medical treat­ment causes 200,000 deaths in the USA each year”.

Some estimates go still higher. According to Gary Null, Ph.D., Martin Feldman, M.D., Debora Rasio, M.D., and Carolyn Dean, M.D., N.D., in their book Death by Medicine Prak­ti­kos Books 2011, p. 4-5)-

The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is nearly 800,000 per year. It is now evident that the American medical system is the leading cause of death and injury in the US. By contrast, the number of deaths attributable to heart disease in 2005, the most recent year for which final data is available, is 652,091, while the number of deaths attributable to cancer is 559,312.

If the immediately above estimates are even close to correct, mainstream health care in the U.S.A. kills more people than either heart disease or cancer. In his book Do Doctors And Nurses Kill More People Than Cancer? (European Medical Journal 2011, p. xxii), Dr. Vernon Coleman, a British physician, says “I firmly believe that doctors and nurses now kill more people than cancer.” In “An Interview with Dr. Vernon Coleman”, Dr. Coleman says “when doctors go on strike, patient morbidity and mortality levels invariably fall. What an indictment” (vernoncoleman.com, ©2006). Yet there has been no public outrage.

The exonerations of many persons sentenced to death for crimes they did not commit (see The Innocence List) should have sparked outrage about America’s unreliable system of justice but has not.

News reports about the killing in 2011, with a drone strike, of American citizens Anwar al-Awlaki and Samir Khan, far from any battlefield, and without charges or trial, by order of President Barack Obama should have aroused public outrage, even if the victims had Arabic names different from those of most Americans and were in another country at the time, but did not. Attorney General Eric Holder has said President Obama may likewise order the assassin­ation of American citizens while they are within the U.S.A. Do an Internet search for “assassi­nation of U.S. citizens by presidential order” and you’ll find many news reports about this prior to the 2012 election. These news reports were in my opinion not as widely disseminated as they should have been. Rather than being outraged and spreading word of this far and wide, Ameri­cans re-elected the Presi­dent who ordered the killings.

If none of the above caused widespread protest by the American people, it is unlikely a large number of Americans will be outraged by the arbitrary incarceration, torture, and killing of American “mental patients” who because of widespread belief in mental illness are not con­sidered fully human.

Don’t be a witness against yourself

In the words of psychiatrist Allen Frances, “There are no objective laboratory tests in psychiatry, and therefore there is no way for anyone to diagnose your problems [or accuse you of mental illness] without your help. … The key to psychiatric diagnosis is self report” (Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (HarperCollins 2013, p. 229-230). Because judges who rule on questions of constitutional law have for the most part been fooled by the “civil” label attached by legislators to involuntary psychiatric treatment laws and don’t realize involuntary psychiatric treatment is punishment for violating society’s unwritten laws, serving the same function as criminal law, most courts in the U.S.A. have ruled there is no right against self-incrimination in a psychiatric interview unless you are asked if you have violated a criminal statute. However, what can be done to you if you say, “I think I have a right of privacy that gives me a right to keep my thoughts to myself and that my constitutional right to freedom of speech includes the right to refrain from speaking, and I choose to exercise those rights”? You may be accused of “refusing to be examined”, but (in the U.S.A.) your constitutional right of privacy and your First Amendment right to refrain from speaking are, or should be, superior to state or federal laws requiring you to be psychi­atrically “examined”.

Don’t voluntarily make yourself a “patient”

You will see much encouragement to “ask for help”. You’ll be told it’s the “healthy” and “smart” thing to do. Sometimes it is camouflaged as “counselling”. Don’t call attention to yourself by following this misleading advice. If you need someone to talk to, look for someone with experience in his or her own life with the kind of problem that troubles you as I suggest in The Case Against Psychotherapy. Make certain the person you talk with is someone who you can trust to do nothing you consider disloyal to you. Seeing a mental health professional is asking for trouble, because your “therapist” has vicarious liability for your actions should you ever do anything violent or criminal, and courts have ruled this duty of psychotherapists over­rides the “therapist’s” obligation to keep confidential what you say to him or her. This vicarious liability creates a strong incentive for the “therapist” to have you incarcerated or to report you to the police if he or she even vaguely suspects you might do anything that would make him or her liable for failure to predict and prevent your future behavior. The seminal case in this area of law is Tarasoff v. Regents of the University of California, 551 P2d 334 (Supreme Court of California 1976): “In our view, however, once a therapist does in fact determine or under applicable professional standards reasonably should have determined, that a patient poses a serious danger of violence to others, he bears the duty to exercise reasonable care to protect the foreseeable victim of that danger.” In that case the therapist was a psychologist, not a psychia­trist or other type of physician. The Court rejected the argument that psychologists and psychiatrists and other “psychotherapists” are unable to predict clients’ or patients’ future behavior. The Court also rejected the argument that psychotherapy is impossible when a person cannot rely on what he tells his psychotherapist remaining confidential. Confidential conversation or commun­ication with mental health professionals has been essentially outlawed by American courts. An example of what can happen is a woman who consulted me because her “therapist” thought her children sleeping with her was abusive and reported this supposed child abuse to Child Protective Services.

Don’t tell anyone you are thinking about committing suicide

The result of letting it be known you are considering ending your pain by ending your life usually will not be other people helping you achieve the goals dearest to your heart that will, in your opinion, make your life worth living. The result is more likely to be imprison­ment (called hospitalization), and “involuntary medication”, or in other words drug torture. If you resist swallowing or being injected with psychiatry’s torture drugs, you risk being put in 4 or 5 point physical restraints, which may be the worst torture of all and has itself caused many deaths. Electroconvulsive “therapy” is still touted as the best “treatment” for suicidal ideation, and in many if not most states of the U.S.A., the U.K., New Zealand, and probably many other countries, you may be electro­shocked against your will by court order after psychiatrists testify it will “save your life”, even though all it will really do is damage your brain while making money for psychiatrists and those who work with them. What psychiatry is likely to do to you because of your committing the “heinous crime” of freedom of thought (thinking about suicide) not unlikely will be worse than whatever orig­inally caused you to think about ending your life.

Don’t go to a hospital emergency room

Don’t go to a hospital emergency room if you can possibly avoid doing so, especially when you are emotionally trauma­tized. Many if not most hospital emergency departments include either psychia­trists or masters degree level “mental health counsellors” or “consultants” whose job it is to have people forcibly removed from the emergency room to a psychiatric ward or state mental hospital, ensnaring people in the mental health system.

Don’t call the police
Don’t call 911

Calling the police or an emergency telephone number, such as 911 (or in some countries 112) when you are emotionally traumatized is asking for trouble, for similar reasons as going to a hospital emergency room. Laws in probably every state permit police officers to, without a warrant, incarcerate people in psychiatric facilities. For example, Texas Health & Safety Code §573.001, says police officers may “take a person into custody if the officer: (1) has reason to believe and does believe that: (A) the person is mentally ill; and (B) because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained; and (2) believes that there is not sufficient time to obtain a warrant before taking the person into custody.”

Consider moving to a state with more favorable laws

Consider moving to a state where there is no outpatient commit­ment or where the right to jury trial in civil commitment is recognized.

According an article on the Connecticut General Assembly web site, “Involuntary Outpatient Mental Health Treatment Laws”, dated December 21, 2011, “Connecticut is one of six states (also Maryland, Massachusetts, New Mexico, Nevada, and Tennessee) that do not have” involuntary outpatient treatment for supposed mental illness. A 2011 article at the Treatment Advocacy Center web site, “Assisted Outpatient Treatment Laws”, that I accessed on May 15, 2015, says “The five states that do not have AOT [Assisted/Assaultive Outpatient Treatment] are Connecticut, Maryland, Massachusetts, New Mexico and Tennessee.” However, when I contacted the Massachusetts Mental Health Legal Advisor’s Committee (mhlac.org) in August 2013, a lawyer there told me about Massachusetts Rogers Guardianships, which is outpatient commitment by another name (appointing a “guardian” for the purpose of the “guardian” authorizing forced drugging or other treatment objected to by the proposed ward.) On February 7, 2014, a woman working for the Connecticut Legal Rights Project (clrp.org) told me outpatient commitment legislation has been proposed in Connecticut.

A list of states that do and do not permit trial by jury in civil commitment is found at the Antipsychiatry Coalition web site, “Do You Have a Right to Jury Trial in Psychiatric Com­mit­ment?”


Because of the U.S. Court of Appeals for the Second Circuit decision in Hargrave v. Vermont, 340 F3d 27 (2003), the states of Connecticut, New York, and Vermont are required to abide by decisions you make in a psy­chi­atric advance directive. I believe federal consti­tutional law requires all states of the U.S.A. to abide by health care decisions a person makes for himself when he is mentally competent, including (so-called) mental health care. To defeat the argument you were not mentally competent when you made your psychiatric advance directive, it is important to have a certification of your mental competence from a mental health professional at about the same time you made it.

Consider leaving the country

It is regrettable people living in America, a nation that advertises itself as free, would need to leave America to escape psychiatric oppression such as involuntary “hospitalization”, involuntary psych­i­atric drugging, or involuntary electroshock, but this kind of oppression is a reality for many Americans. When considering leaving the U.S.A. to escape psychiatric oppression and psychiatric assault such as forced drugging, keep in mind that without your health you have nothing and that all biological treatment in psychiatry is harmful to your health. If you are court-ordered to remain in the U.S.A. or in a particular state, you may be forced to decide whether it is more impor­tant to obey the law or protect your health. Remember also psychiatric oppression exists in most if not all nations, and to be safe you must avoid the mental health system wherever you go.


  1. Peter R. Breggin, M.D., “Toxic Psychiatry Today,” Empathic Therapy Conference 2013, April 26, 2013, Embassy Suites, Syracuse, New York, available on DVD from EmpathicTherapy.org.

copyright Wayne Ramsay, 2018; permission to reproduce was granted
provided accurate reproduction and proper credit given


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