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Whatever the truth, it's doubtful that even if Yoder is sick, he could heal in such an environment. In 1998, a state commission that investigates complaints for the disabled issued a harsh report on Chester. It said the facility's treatment goals for Yoder--which he must meet in order to leave--were "vague and unobtainable." The commission said it "does not believe that Chester has done all that is necessary to determine if [Yoder] is appropriately placed." Hardy counters that no other hospital in the state is equipped to care for someone so dangerous. He also points out that the national organization that accredits hospitals gave Chester a 91% compliance rating in 2001.
Dr. Thomas Szasz has been the most controversial psychiatrist in the nation for years, so perhaps it's no shock that he has become Yoder's biggest defender. Born in Budapest, Szasz, 82, immigrated to the U.S. in 1938. He has been a psychiatry professor at the State University of New York for nearly 46 years. Szasz's most famous book, The Myth of Mental Illness, was published in 1961. As the Atlantic Monthly said, the book argued "that both our uses of the term 'mental illness' and the activities of the psychiatric profession are often scientifically untenable and morally indefensible." Szasz views mental illness as a metaphor for disturbing and disruptive behaviors, which he says arise from our circumstances and personality--and from our own choices. Until there is incontrovertible proof that, say, paranoid personality disorder is caused by an actual lesion in the brain, Szasz will argue such a label is a mere characterization of bad behavior that shouldn't carry the force of law.
Although he once enjoyed great influence, Szasz is usually dismissed as a crank these days. His foes say he opposes all psychiatry or that he wants to free even incompetent patients who can't feed themselves. Neither is true. But at a time when psychiatry's power has grown dramatically--when it seems normal to grow up taking Ritalin and then graduate to Prozac, when even shyness is treated with pharmaceuticals--his views are worth revisiting. And the Yoder case offers an ideal venue in which to do so.
As academics go, psychiatrists are a lot like economists: their field is presented to the public as pure science, but there's a lot of shouting in the back office. Are drugs overused? Can treatment really work if it's involuntary? Is something like "delusional disorder" a brain disease or a behavioral problem or both? These debates are far from settled. Sometime in the past decade, it became a requirement of polite conversation to say that schizophrenia and other mental illnesses are "no different" from pneumonia. But the latest neurological research has offered only the roughest idea of the precise mechanism by which a disease such as schizophrenia arises. Scientists are decades away from being able to use a brain scan to diagnose something like Yoder's alleged personality disorders.