(Via Miriam @ feministing 2008-06-18, via Feminist in Pink 2008-06-22.)

Here is the latest proposal from the American Medical Association, to have the government insist that every birth is properly institutionalized, so that they can make sure every birth leads to a fat and healthy hospital bill, with a proper Birth Guild-certified Expert looking over every midwife’s shoulder and between every expectant mother’s legs. And if the expectant mother doesn’t want that kind of a birth, well, she’d better learn to want it—or else.

• Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or lay midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM) recognize; and

• Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film; and

• Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery; therefore be it

• RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers (New HOD Policy); and be it further

• RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, … (Directive to Take Action)

—American Medical Association, Resolution 205: Home Deliveries

Note especially the second Whereas; the AMA has, more or less explicitly, called for government force against home-birthing mothers because recent cultural trends suggest that women might be persuaded to choose otherwise if allowed to choose freely. The birth freedom group The Big Push for Midwives has this to say:

WASHINGTON, D.C. (June 16, 2008) — Just in time for Father’s Day, at its annual meeting last weekend, the American Medical Association (AMA) adopted a resolution to introduce legislation outlawing home birth, and potentially making criminals of the mothers who choose home birth with the help of Certified Professional Midwives (CPMs) for their families.

It’s unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons—or just because they didn’t make it to the hospital in time, said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution.

Until the AMA proposed Resolution 205 on Home Deliveries, no state had considered legislation forcing women to deliver their babies in the hospital or limiting the choice of birth setting. Instead, states have regulated the types of midwives that may legally provide care. Currently, 22 states already license and regulate CPMs, who specialize in out-of-hospital maternity care and have received extensive training to qualify as experts in the types of risk assessment and preventive care necessary for safe and high-quality care for women who choose give birth at home. Certified Nurse Midwives (CNMs), who are trained primarily as hospital-based providers, are licensed in all 50 states and the District of Columbia.

The resolution did not offer any science-based information for the AMA’s anti-midwife or anti-home birth position.

Maternity care is a multi-billion dollar industry in the United States, said Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives. So it’s no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I’m shocked to learn that the AMA is taking this turf battle to the next level by setting the stage for outlawing home birth itself—a direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way.

—Press release, The Big Push for Midwives (2008-06-16): Father Knows Best Meets Big Brother Is Watching: Physician Group Seeks to Outlaw Home Birth—Is Jail for Moms Next?

For what it’s worth, I suppose it’s true that if the emanations and penumbras of the Bill of Rights provide for a right of privacy from government interference in adult women’s decisions to use contraception or abort a first-trimester pregnancy, they probably also provide for a right of privacy from government interference in where a woman chooses to give birth. And if a state should pass any of the AMA’s contemptible model legislation and somebody takes up the issue in federal court, I hope that they’ll win.

But setting aside the politico-legal maneuvering for the moment, should anyone really even care what the Constitution says about it? If the Constitution does authorize this kind of tyrannical state intervention in women’s reproductive choices, then to hell with the Constitution. The important argument here is the moral one, about what simple justice demands. And taken from the standpoint of simple justice for women, it is absurd that I should even have to sit here and type out, in so many words, that a birth experience rightly belongs to the woman who labors on it—not to the AMA, not to a hospital, and not to the State.

Of course it does. Christ. To hell with any know-it-all blowhard busybody, with any association of know-it-all blowhard busybodies, or with any document that says otherwise.

See also:

• GT 2006-04-10: Bureaucratic rationality #4: State Ownership of the Means of Reproduction edition

From nikki @ Give Me Space (To Rock) 2008-06-09: The Medicated Child:

After finding a fast enough Internet connection to pirate, my housemate and I sat in my bedroom and watched The Medicated Child — a documentary about children who are placed on SSRIs, benzodiazapines and mood stabilizers to control various mental diagnoses. As a person who has been permanently altered by medications such as the ones above, it hit me a little bit too close to home to watch this documentary.

You can watch it online on the PBS website: The Medicated Child

My experience in the psychiatric drug system began at age 16. My mother was dying, I was trying to work full time and go to school, and I was sinking in teenage depression. We were on welfare, so my mother decided to find me some sort of mental health care at no cost - this is surprisingly easy in New Jersey.

I was placed on Zoloft, an SSRI, after a brief conversation with a doctor on my first visit to the free clinic. After a few weeks of therapy and more consultations, my doctor raised my Zoloft dose after coming to the conclusion that my depression wasn’t getting better. I was no longer able to fall asleep naturally due to the jitters that Zoloft gave to me, which affected my schoolwork greatly. My doctor then put me on Trazodone to help me sleep at night - this made it very difficult to wake up for school in the morning.

—nikki @ Give Me Space (To Rock) 2008-06-09: The Medicated Child

It goes on from there; every new drug brings a new side effect, and every new side effect brings another new drug to control it. The unending swallow-the-spider-to-catch-the-fly process would be funny, in a macabre sort of way, were it not for the fact that this is a real young woman whose life and brain were being systematically stewed, with permanent effects on her body and her behavior. Not because she wanted it that way, but because the State and its legally privileged medical experts told her do it, bribed her into doing it, and finally used an involuntary commitment procedure to force her to keep doing it, no matter how bad it got.

At age 20, I was on Effexor, Klonopin, Seroquel, Wellbutrin and Neurontin. My social life plummeted, and I was incredibly on edge and anxious. I was suicidal. My skin was a mess. I didn’t feel real — I felt completely detached from my body and was convinced that I was going to die. I became preoccupied with my early death, and started to live as though death was near. I was so tired and had racing thoughts. Seroquel would make me rock back and forth. My doctor said that the Neurontin didn’t seem to be working, so she prescribed me Gabatril in order to strengthen Neurontin’s effects.

I was on 6 different medications for a condition that I didn’t remember anymore. My doctor continued to prescribe me drug after drug to counteract effects of the previous drugs. I didn’t have anywhere else to turn — I trusted and believed her and credited her for keeping me sane. In reality, I was completely insane — and this was from the medication, not from my mental illness.

—nikki @ Give Me Space (To Rock) 2008-06-09: The Medicated Child

This young woman did not have a broken brain. She was not suffering from some congenital mental illness. She was pushed to the brink by emotional crises that were a rational reaction to a terrible situation — her mother’s suffering and death — and then, in the effort to help her by medically suppressing this painful but rational reaction, she was made sick, and made mad, institutionally mad, by the spiraling effects of years of psychiatric cures.

My long-term effects from psychiatric medication: I have painful stomach ulcers that occasionally perforate, my liver has deteorated to the point where I can barely drink liquor, psoriasis on my elbows and knees, some forms of compulsive behavior that started when I began SSRIs, and occasional paranoia that is completely unfounded.

[…]

Before you sign your life away to the psychiatric industry, please pay attention to what goes on. Were you given medication after only speaking to someone for an hour? Were you placed on psychiatric drugs at a young age for ADHD and then put on more drugs for illnesses that seemed to develop after you started those medications? Does your doctor give you a new medication every time you complain about a side effect? Does your doctor ever recommend things like excersize, a change in career, more social time, healthier foods, or naturopathic methods? Does your doctor raise your dose when you have a bad day?

When I think about what was pushed on me in my younger years I feel enraged… and after watching The Medicated Child, I’m outright terrified. There are children as young as 4 years old being diagnosed with Bipolar Disorder and placed on mood stabilizers. There are children who are put on dehabilitating anti-psychotic drugs at age 6 who develop uncontrollable ticks in their necks in their teenage years. These drugs were never tested on children — if you choose to put your children on these drugs, your child is a guinea pig.

—nikki @ Give Me Space (To Rock) 2008-06-09: The Medicated Child

You really must read the whole thing. What was done to her is, quite simply, unforgivable.

Of all the horrible things that institutional psychiatry routinely does, one of the most infuriating for me is its stupidly aggressive lack of anything approaching self-consciousness or critical reflection. In a field where, not half a century ago, patients were routinely locked away in filthy hellholes that would be hard to distinguish from a medieval dungeon, and, once confined, subjected, against their will, to restraints, tortures and mutilations that would have made Torquemada blush — camphor shock torture, repeated massive electric shocks to the brain, and, at the end of the road, an icepick jabbed through the eye socket and rotated so as to mutilate the brain and deliberately destroy centers of personality and higher cognition — in a field, I say, where all this was dignified as brain damaging therapeutics and regarded as best practices for a scientifically-informed helping profession — in a field where current practitioners now more or less universally agree that torture like this was based on little more than pseudoscience and quackery, and where almost no-one in their right mind would propose ever using practices like these on any patient today — in a field, that is to say, where within living memory thousands of people were subjected to the worst kinds of sadism and torture that the human mind can devise, and all of it based on what are now almost universally acknowledged follies, illusions and lies indulged in by the recognized experts of the field — in such a field, you might expect at least a little bit of humility, historical awareness, and decent caution, rather than sanctimonious self-righteousness and aggressive obliviousness to the idea that psychiatric practice itself might perhaps be part of the problem.

In point of fact, there are countless cases like this one, cases where a life crisis becomes the occasion of massive psychiatric intervention, and where the intervention itself spirals into years of institutionally- and chemically-manufactured madness; in which the stereotypical behavior of the psychiatric patient, invariably passed off as part of her disease, can in fact be traced quite directly to the physiological, behavioral and social effects of the forced drugging, the forced confinement in hospital psychoprisons, and other aspects of psychiatric therapy. Psychiatrists then have the gall to use those same symptoms, created by their own therapy, as proof of the need for even more of the same.

Under the present circumstances, there is no reason to believe that individual psychiatrists or psychiatric institutions will ever trouble themselves to acknowledge this possibility or to incorporate it into their practice in any way that matters. It’s not just the financial incentives — although those are certainly there, and those are certainly important. The problem that underlies the financial problem is that psychiatrists have no real reason to care whether they get things right or not. Why should they? They are backed by cultural prejudices in favor of doctors; they can dismiss any complaints by their patients as literally the ravings of lunatics, and almost no-one will bat an eye; they are backed up by the force of the law, which gives them the power to force their latest and greatest therapies on a literally captive market of unwilling patients. Unless and until psychiatrists no longer have the privilege of inflicting nonconsensual treatment, which is to say, unless and until they become directly accountable to the will and desires of the people for whose benefit they claim to be acting, cases just like Nikki’s are going to happen again, and again, and again.

Free Nikki!

Free all psychiatric prisoners!

See also:

• GT 2008-05-05: Texas psychoprisons
• GT 2007-10-29: For her own good

You talk of simplification. But if you can simplify in one point, you can simplify in all. Instead of a million laws, a single law will suffice. What shall this law be? Do not to others what you would not they should do to you: do to others as you would they should do to you. That is the law and the prophets.

But it is evident that this is not a law; it is the elementary formula of justice, the rule of all transactions. Legislative simplification then leads us to the idea of contract, and consequently to the denial of authority. In fact, if there is but a single law, if it solves all the contradictions of society, if it is admitted and acceptedby everybody, it is sufficient for the social contract. In promulgating it you announce the end of government. What prevents you then from making this simplification at once?

—Pierre-Joseph Proudhon (1851), General Idea of the Revolution in the Nineteenth Century, Fourth Study, The Principle of Authority, § 2.2 ¶¶ 9–10.

Over at newsrack, lefty Thomas Nephew kindly took notice of GT 2008-05-16: Women and the Invisible Fist. Nephew wrote:

Via Jim Henley, who seems lately to be about metamorphosing your father’s (and/or mother’s) libertarianism into something more honest, multifaceted, and interesting. See also in this respect Henley’s Art of the Possible post, and the site as a whole: Liberals and libertarians on common ground… and otherwise. Henley says that the challenge is to correct spontaneous malign orders without the tool of state violence. I’m not sure that circle can be squared — some countervailing force is needed against spontaneous malign orders, and that force will need some agreed on norms of justice and enforcement. But I’m interested that libertarians are thinking about the challenge.

—Thomas Nephew (2008-05-24): Worth reading

That lead to some interesting discussion in the comments thread. I replied:

Thomas,

Thank you for the kind mention, and for the thoughtful comments.

You write: “Henley says that the challenge is to ‘correct spontaneous malign orders without the tool of state violence.’ I’m not sure that circle can be squared — some countervailing force is needed against spontaneous malign orders, and that force will need some agreed on norms of justice and enforcement”

There are a couple of different kinds of malign spontaneous orders that need to be differentiated here.

The first are malign undesigned orders that emerge, in part, from diffuse forms of violence — what I called “invisible fist” processes, as with the socio-cultural ripple effects of stranger-rape and other prevalent forms of violence against women.

The second are malign orders that don’t emerge from diffuse forms of violence, but rather from voluntary interactions. Unlike some libertarians, I believe that there are plenty of examples of these, too (for example, certain kinds of widespread credentialism and elitism that have emerged over the past century, and which have a big effect on education and on the workplace). These malign undesigned orders are often intimately connected with social orders that have coercive elements (for example, I’d say that certain pernicious forms of credentialism and managerialism, which contribute to classism and to the exploitation of working folks, have an awful lot to do with consistent government intervention on behalf of the managerial class and against the deskilled proletariat over the past century — cf. for examples my essay Scratching By at http://www.fee.org/publications/the-freeman/article.asp?aid=8204 or Kevin Carson’s Mutualist Blog at http://mutualist.blogspot.com/) — but, while intimately connected, are not identical with them (it’s likely that even without that government intervention they might live on through institutionalized cultural prejudices, unless deliberately confronted and undermined).

Libertarians and anarchists can consistently endorse the use of physical force as part of the response to the former (violent) sort of undesigned order; they can’t consistently endorse the use of physical force as part of the response to the latter (non-violent, but still ugly) sort of undesigned order.

In the second case, though, I ought to stress that not abandoning the use of force doesn’t mean abandoning the use of confrontation or hardball tactics—they just have to be carried out through tactics and institutions outside the political arena, the legal arena, or the regulatory bureaucracy. (On what should be done instead, I’m really an old Leftist at heart: I think people should form fighting unions and community organizations, build counter-institutions and mutual aid societies, use targeted and general strikes, boycotts, work-to-rule, hardball forms of social ostracism, stage sit-ins, etc. etc. etc. Forget about the government; we can do this ourselves.)

In the first case, the use of countervailing physical force in defense of self or others is defense, not aggression, so it need not offend any libertarian or anarchist sensibilities (unless one is a principled pacifist—which I’m not, and which most libertarians and anarchists aren’t either). You worry that that force will need some agreed on norms of justice and enforcement. I’m inclined to agree with that (although we might disagree on what the importance of agreement is here). But supposing that we do agree, I don’t think it tells against Jim’s point. Agreed-upon norms of justice and enforcement aren’t in and of themselves a problem for anarchism or libertarianism. The question is how the agreement on those norms is brought about: whether the agreement comes about by general acquiescence to privileged demands, or whether it comes about by means of a broad consensus among equals.

Government ensures agreement upon these norms by erecting privileged institutions which are legally empowered to force everyone else to acquiesce to the norms they propound and act on.

Anarchy, on the other hand, doesn’t mean chaos or the break-up of any agreed-upon norms of justice or enforcement. (At least, that’s not what anarchy means in the mouths of anarchists who use the term.) What it does mean is that any agreement upon those norms should be brought about through the free interactions among equals and by the emergence of a broad social consensus.

Further, anarchists generally believe that that kind of consensus can rightfully be acted on by any free association that puts reasonable norms for justice and enforcement into practice — rather than being limited to a privileged class of government-approved cops, judges, etc. The idea here being that the justice of judgments and the righteousness of enforcement are things that ought to be assessed on the merits of the conduct itself, not according to the identity or the political status of the judge or the enforcer. That is to say, that it should be considered as a matter to be resolved by appeals to the content of the norms, rather than to the political status and prerogatives of the body propounding them.

So the ideal here is not to abolish any general norms of justice or enforcement, but rather to keep the ideal of consensus on norms while detaching the crafting of the consensus from the imposition of exclusive government-granted prerogatives.

Does that help clarify, or does it muddify?

—Rad Geek (2008-06-01): Comments on Worth reading

Thomas replied with some comments on professionalization and specialization in the law, which are the main thing that I want to focus on today. In part because the issue is interesting and important in itself; in part also because the way that police forces and the legal system operate today is, in many different ways, ideologically dependent on the idea that we need to turn a great deal of our lives and freedom over to a cadre of trained, specialized legal professionals for our own protection and in order to ensure justice and social peace. He wrote:

Thank you very much for your comment — it’s really an excellent post in its own right. I think I understand what you’re driving at; I’m trying to decide what I think about it, and that takes me longer than maybe it should. My thoughts so far:

1. I suppose I have a sneaking agreement that there’s too much that’s privileged and mysterious about judges, lawyers, and law enforcement. But I also think there’s specialization and craft in these pursuits, just as there is in, say, cabinetmaking or watchmaking. Those are pursuits I leave to others; maybe so is law enforcement or judging. Even just a policeman has to master tons of information and training — knowing the law, when to wait, when to intervene, how to gather evidence, how to avoid violating rights while pushing back against spontaneous malign orders.

2. But I also see the difficulty with that analogy: unlike with the cabinet or watchmaking trades, I recognize I have a citizen’s responsibility in understanding my political system and helping point it in the right direction, to the best of my puny abilities.

—Thomas Nephew (2008-06-02): Comments on Worth reading

By way of reply, I argued that the need for specialized expertise and training (1) isn’t an argument for monopoly, and also (2) is itself a function of the expansiveness and authoritarianism of the State:

Thomas,

Thank you for your kind words.

You write: “But I also think there’s specialization and craft in these pursuits, just as there is in, say, cabinetmaking or watchmaking.”

Probably so, although I’m inclined to think that there is, or ought to be, much LESS specialization and craft than the professionalized government enforcers and judges would have you believe. To be sure, the government laws that are on the books today are tremendously complicated and require years of specialized training and practice to even begin to get a good grip on a relatively small specialty. But I think that that’s precisely because the people who make and use the laws have a political and a professional interest in making those laws extremely complicated, and in having them cover an extremely wide and not very well defined scope of human affairs. Libertarians and anarchists believe that regularized enforcement should cover a much more precisely delimited and a much, much smaller field than it currently does, so to some extent the problem vanishes along with the laws that libertarians and anarchists believe ought to be abolished.

For example, labor relations law as it presently exists is extremely complicated — it requires making a lot of very fine distinctions, balancing many different prerogatives granted to and regulatory limitations imposed upon unions, individual employees, and employers, etc. etc. etc. It takes a lot to even understand the basics of the situation, and the tricky details of a concrete case often can’t even be resolved without hashing out the issues in bureaucratic negotiations through the NLRB or in federal court. But the complexity of the legal situation is clearly a function of its being channeled through the federal regulatory bureaucracy. That situation clearly benefits NLRB bureaucrats and professional labor lawyers; it’s much less clear that it benefits the rank-and-file workers for whose benefit this sort of thing was supposedly constructed, but who are substantially deprived of any real control over the process by putting so much of it into the hands of professional legal experts. If agreed-upon norms of justice and enforcement were (as anarchists believe that they should be) limited only to the issue of protecting innocent people from being attacked by physical force, or vindicating their rights after the fact if they should be attacked — with all the rest to be handled by free contracts between the individual parties, unregimented by a government bureaucracy, and by whatever forms of nonviolent leverage and activism that the creativity of organized workers and a fighting union might devise — then it’s much less clear what need for specialization or professionalization there would be. (There might still be a lot of need for impartial arbitrators; but impartiality is distinct from technical expertise, and is something you can get by finding any third party of good will and good sense for the duration of the arbitration; it doesn’t require a distinct class of professional arbitrators.)

Generalizing from that case, I agree with Lysander Spooner that if the realm of enforcement were strictly limited to questions of interpersonal justice, then, quote:

No objection can be made to these voluntary associations upon the ground that they would lack that knowledge of justice, as a science, which would be necessary to enable them to maintain justice, and themselves avoid doing injustice. Honesty, justice, natural law, is usually a very plain and simple matter, easily understood by common minds. Those who desire to know what it is, in any particular case, seldom have to go far to find it. It is true, it must be learned, like any other science. But it is also true that it is very easily learned. Although as illimitable in its applications as the infinite relations and dealings of men with each other, it is, nevertheless, made up of a few simple elementary principles, of the truth and justice of which every ordinary mind has an almost intuitive perception. And almost all men have the same perceptions of what constitutes justice, or of what justice requires, when they understand alike the facts from which their inferences are to be drawn.

Men living in contact with each other, and having intercourse together, CANNOT AVOID learning natural law to a very great extent, even if they would. The dealing of men with men, their separate possessions and their individual wants, and the disposition of every man to demand, and insist upon, whatever he believes to be his due, and to resent and resist all invasions of what he believes to be his rights, are continually forcing upon their minds the questions, Is this act just? or is it unjust? Is this thing mine? or is it his? And these are questions of natural law; questions which, in regard to the great mass of cases, are answered alike by the human mind everywhere.”

—Lysander Spooner (1882), Natural Law, or the Science of Justice, section 4.

And I would follow up your second point by urging that it is dangerous, and to some degree irresponsible, to adopt large-scale systems of law and practice that practically require ordinary citizens to abandon the questions of political and interpersonal justice to a privileged, insular, and easily corrupted class of specialists.

But, secondly, I would also argue, further, that even if the requirements of justice ARE complicated enough in some particular case that it requires some specialized training and expertise to sort them out, or where correctly applying and implementing them requires specialized training and expertise in something else (e.g., for enforcers, training and expertise in de-escalating potentially violent situations may be a form of specialization well worth having), that seems to me like an argument for leaving the field open to many specialists, who can offer their services to anyone who is interested in retaining them (e.g. many private associations for arbitration and/or defense, which people go to on the basis of choice rather than being forced to go to one in particular on the basis of fixed territorial monopolies). Not so much an argument for limiting the field to a single fixed, institutionalized class of specialists (e.g. a government court or a government police force with rigidly and exclusively defined territorial or topical jurisdictions).

The first (non-monopolistic) solution really would make the business of law a skilled trade or profession, much like watchmaking or medicine, where people go to acknowledged experts freely, but aren’t forced to choose one particular expert on the basis of political status, and can choose another, on the basis of their own considered judgment and comfort levels, or for that matter can still choose none at all, if they decide to hazard the risks and trouble of doing it for themselves.

The second, monopolistic solution doesn’t make the business of law so much like skilled trades and professions, but rather like a feudal or command economy, in which people are assigned particular experts and forced to turn matters over to that particular expert rather than another, on the basis of the political status of the experts rather than on the basis of broadly and consensually acknowledged expertise. It’s that which, as an anarchist, I really object to.

Does that help? What do you think?

—Rad Geek (2008-06-02): Comments on Worth reading

In reply, Thomas raised some fairly common counter-objections and worries, especially about the dangers supposedly posed by the devolution of policing from public control to private defense — or, to spin it another way, from government to civil society.

But the complexity of the legal situation is clearly a function of its being channeled through the federal regulatory bureaucracy. That situation clearly benefits NLRB bureaucrats and professional labor lawyers; it’s much less clear that it benefits the rank-and-file workers for whose benefit this sort of thing was supposedly constructed, but who are substantially deprived of any real control over the process by putting so much of it into the hands of professional legal experts.

This seems like blaming the chickens for the fox’s raid on the chicken coop. At least lately, the situation you refer to clearly benefits management in most NLRB disputes. I’d put down most of what’s wrong with NLRB to its being an easily subverted agency, most of the blame for that to corporations achieving via the back door of a compliant board what they couldn’t via the statutes authorizing the NRLB in the first place … and most of what’s wrong with those statutes to earlier corporate influence in making things like unionization far too difficult in the first place. Rightly administered and empowered, NLRB ought to be a counterweight to moneyed and propertied interests that have no interest in worker’s rights. The fact that it isn’t rightly administered and empowered seems to me a measure of the strength of the forces arrayed against it, not of the weakness of the idea of an NLRB itself.

The first (non-monopolistic) solution really would make the business of law a skilled trade or profession, much like watchmaking or medicine, where people go to acknowledged experts freely, but aren’t forced to choose one particular expert on the basis of political status, and can choose another, on the basis of their own considered judgment and comfort levels, or for that matter can still choose none at all, if they decide to hazard the risks and trouble of doing it for themselves.

At least for legal representation, that — in theory — is already the case, isn’t it? The problem is when the innocent can’t afford a Clarence Darrow, a Johnny Cochrane, or an F Lee Bailey to get them off but the guilty can.

I don’t see how to bid out for police functions, though, without that turning into yet another part of society baldly favoring the rich and privileged over the poor and disenfranchised. While that may be too much the case even with a police force as public monopoly, I think it would surely be worse in a “Deadwood“-type services-to-the-highest-bidder world. But maybe I’m misunderstanding you in how police functions ideally ought to work.

—Thomas Nephew (2008-06-02): Comments on Worth reading

To which I made some counter-counter-objections, and raised what I think ought to be some obvious questions:

Thomas,

You write: “This seems like blaming the chickens for the fox’s raid on the chicken coop.”

I’m not sure what you mean. I don’t blame rank-and-file workers for the way the NLRB functions. I blame the politicos, the “Progressive” bosses, and the conservative union bosses who pushed to create the system. (Radical unions, like the I.W.W., rightly opposed the system as an effort to promote conservative unionism and to capture and domesticate unions through a combination of government patronage and government regulation.)

You write: “Rightly administered and empowered, NLRB ought to be a counterweight to moneyed and propertied interests that have no interest in worker’s rights.”

Two things.

First, I have no confidence in anyone’s ability to craft a regulatory agency that successfully resists being substantially captured by the interests that it regulates. I can’t think of any example in the history of American regulatory bodies where this has been pulled off for any length of time, and I don’t think it should be particularly surprising that, since political entities respond to political incentives, they will tend to be administered in a way that systematically benefits the wealthiest and most politically-connected people.

Second, even if the NLRB were ideally administered, the system is designed from the ground up as a means of constraining union demands and restricting unions to the most conservative and least effectual methods. (Thus, the Taft-Hartley bans on secondary strikes, secondary boycotts, union hiring halls, wildcat strikes, etc. etc. etc.; thus the emphasis on a heavily regulated process of collective bargaining, controlled by very elaborate legal requirements that are often next to impossible for rank-and-file workers to understand, in place of extremely effective and very simple to understand tactics, like work-to-rule and other forms of direct action in the workplace.)

You write: “At least for legal representation, that — in theory — is already the case, isn’t it?”

Well, not entirely — you can choose one lawyer rather than another, as long as you can afford their fees, but you can’t choose anyone as your advocate except those who have been officially approved for membership in the government-created and government-regulated lawyer’s guild. But lawyers weren’t the “experts” I was referring to; I was referring to the fact that the government forces people to take legal disputes before specific judges (with jurisdiction fixed by the issue in dispute and by accidents of geography), and excludes other no-less qualified and impartial experts from taking up the dispute simply because the privileged judge has a particular political status and the other would-be arbitrator doesn’t. If we are really talking about a form of specialized expertise here, like that of the watchmaker or of the doctor, then anyone should be able to take the case, not just a judge deemed to have that topic and that location within his bailiwick by the government.

You write: “I don’t see how to bid out for police functions, though, without that turning into yet another part of society baldly favoring the rich and privileged over the poor and disenfranchised.”

Well, I don’t know. Isn’t that already how government policing works?

Tax funding doesn’t prevent government cops from treating poor people pretty shitty, or from acting as an instrument of class power. In fact, the fact that poor neighborhoods have no real control over who provides policing in their neighborhoods, and no way of cutting off their portion of the funding for neglectful or abusive police forces, is part and parcel of the problem.

Anyway, I’m not sure what you mean by bid out for police functions. If you mean the government outsourcing policing to private security corporations (Wackenhut, Blackwater, whatever), I’m not for that, and I don’t consider it an example of free market self-defense. I think that all government involvement in policing (whether in-sourced or out-sourced) should be abolished.

If you mean individual people choosing to cover the costs of policing, and having a choice about who, if anyone, they get police services from, then I don’t think there’s any guarantee that the result will be (even more) plutocratic policing. It’s true that, if all policing were based on free association and not on government monopoly, there might well be some policing that is done by private goon squads for hire, and those might have an incentive to favor the rich over the poor. But (1) again, I’m not convinced that they’d have more of an incentive to do so than government cops already have; and (2) there are lots of other ways of using free association to get self-defense and neighborhood defense done. For example, the Black Panthers and the Young Lords organized historically oppressed people to arm themselves, and to patrol and defend their own neighborhoods (including defending them from the predation of abusive white cops). In any case, where there are many, competing and countervailing associations that serve defensive functions, if one association becomes especially neglectful, or, worse, predatory, against marginalized people, other associations can move in to compete, or new associations can be formed, to check the first. But when policing is monopolized by a single institution, there is no real reason for them to try to please anybody outside of their firmest base of support (in the case of political monopolies, that means the ruling class—as is confirmed by how police departments already operate today). If they don’t please marginalized people, why would they care? They stay paid anyway, and there’s no countervailing force to hold them to account for their abusiveness.

My own view is that the need for any form of professional policing at all would be dramatically less in a free society than it is in the present day. (For example, in a free society there would be no drug laws, vice laws, or border laws, and thus no narcs, no vice cops, and no La Migra. There would also be much less entrenched urban poverty, because — for reasons I discuss in the Freeman article — ghettoized urban poverty as we know it is largely a function of interlocking government interventions against poor people’s survival strategies and attemtps to flourish through creative hustling; hence much less economically motivated crime, and also much less of certain kinds of antisocial behavior. So, again, this is, to a great extent, a problem that vanishes along with the needless government laws and endless government “wars” on consensual behavior, which I already favor abolishing. But, even if the demand for specialized policing were to remain just as high as it is today, I still think that it is far, far better to have a situation in which people are free to withdraw their support from abusive agencies, and where there are many acknowledged experts to keep each other in check, than a situation in which people are forced to pay for their own abuse, and in which cops are never held to account for wrongdoing by any means other than “handling it internally” and issuing the occasional “Oops, our bad”.

—Rad Geek (2008-06-01): Comments on Worth reading

It’s a fairly wide-ranging discussion, and you ought to read the whole thing if you want to follow up on some of the sub-threads about, for example, organizing, class, tactics, immigration, and so on. For now, I want to highlight the discussion about specialization and professionalization in policing. On that note, I want to stress that it’s precisely those ideals in lawyering and law enforcement that lead directly to things like this, and this, and this. And, less directly but very quickly, gets us from those to this and this. And that from there it doesn’t take a very slippery slope to get down to this and this and this.

And the perceived need for specialization, professionalization, and expertise is a need which only exists because of the very system of law and enforcement it is invoked to justify. On a related note, consider this video (thanks to Jeremy at Social Memory Complex 2008-06-04: Don’t talk to the police), which provides both excellent legal advice, from the standpoint of simple self-interest, and some solid analysis of our present predicament how ordinary folks like you and me ought to relate to government cops under these conditions.

Without that system, without its politically-fabricated complexity, and without the tremendous latitude deliberately created by that complexity for government police to exercise arbitrary power in stopping, detaining, fining, and arresting suspect people — the 10,000 or more crimes that government law has fabricated, the crimes so numerous that not even the government itself can count them all anymore, and so potentially ruinous for anyone in trouble with the law that you have little choice but to regard anyone threatening to exercise their specialization and craft in the law as little more than a dangerous soldier in a hostile, occupying force — without all that, I say, there would be no basis, no need, and no call for that complexity or that arbitrary authority, or for the privileged, professionalized retinue of lawyers and enforcers who are expected today to go around navigating that complexity and exercising that arbitrary authority, in order to solve the very problems that the same complexity and arbitrary authority created in the first place.

Further reading:

• GT 2007-11-03: Opinion Columns of the Libertarian Left

Here’s Brent Simmons (2008-05-06):

I was on the ground in Indianapolis…

I love it when TV People — newscasters, analysts, politicians — say they were on the ground somewhere.

It’s a good and welcome reminder that they normally live in the clouds, in heaven, up with the angels. Not on the ground with us, where things are mysterious and messy.

Gosh they’re lucky. Good and lucky.

—Brent Simmons, inessential.com (2008-05-06): On the ground

(Via Stephen Carson 2008-05-06.)

In the past, when I’ve written about violence committed by government police officers or prison guards, I’ve often written something like this:

Please note that if you or I or anyone else without a badge and a gun acted like this, the people around us would more or less universally conclude that we’re belligerent and dangerous lunatics. In fact, if you or I or anyone else without a badge and a gun acted like this, and it was caught on camera, we would soon be in jail for on a charge of assault and battery. When someone with a badge and a gun acts like this, and it’s caught on camera, with a very few exceptions, the worst that ever happens is that they might get fired. The most common response from the powers that be is either to do nothing at all, or else to give the pig a paid vacation and a verbal reprimand.

—GT 2008-02-18: Cops are here to protect you.

That’s a point that I stand by, and that I think is vitally important. But one thing you’ve got to remember when thinking about that point is that the class of government-privileged cops and prison guards is larger than the obvious cases you might first think of when asked. Badges and guns come in a lot of shapes and sizes and prisons can be found in a lot of places. Sometimes the badge is a gold shield and the prison is a penitentiary surrounded by razor-wire and high fences. Sometimes the badge is a white coat, the gun is a syringe, and the prison is the locked mental ward of a hospital. What matters is not the external form, but the underlying relationship of power, and when so-called caretakers have the legal power to restrain, confine, hold down, drug, shock, spy on, and otherwise coerce or violate a so-called patient, to treat her against her will, to force her to remain in a locked room even if she wants to leave, and to chase her down and force her back into that locked room if she tries to slip out without permission, then those so-called caretakers function as a jailers, and their hospital as a prison, no less than the corrections officers and correctional facilities of the official State prison system.

This is, by the way, a basic point that needs to be made, and needs to be accepted, whether or not one accepts presuppositions of institutional psychiatry, and whether or not one accepts the common practices of involuntary civil commitment, the imprisonment of criminals deemed legally insane in State-run psychoprisons, drugging patients through the use of force or deception, etc. etc. etc. If you accept those presuppositions and you support imprisoning and forcibly drugging people who, for example, try to hurt (only) themselves, or who have hallucinations, or who steadfastly cling to beliefs that the majority of people consider irrational, then you should go ahead and defend that. But that is what you need to defend—imprisonment and coercive force—not some sentimentalized helping professions myth in which caretakers are helping willing patients through a disease just like cancer or diabetes. If you have cancer and diabetes, and you decide (for whatever reason) that you’d rather suffer or even die from it than undergo the conventional treatments, nobody has the legal power to force those treatments on you against your will. And therein lies one of the fundamental political differences between real doctor-patient relationships and psychiatry as it is practiced today. If you want to try to defend psychiatry as it’s practiced today, that difference—the fact of psychiatric imprisonment—is something you’ll have to admit, and where you’ll have to start.

And for those of us who have spent some time watching how the official State prisons and their prison guards work, and who know that the pervasive violence and domination that runs through the system, even when it is judged excessive or abusive by the powers that be, should be dismissed as Yet Another Isolated Incident carried out by A Few More Bad Apples, but rather recognized as the natural and inevitable result of the kind of environment fostered by the unaccountable power of government enforcers—well, for those of us, things like the Dallas Morning News’s recent report on intense, pervasive abuse of patients in Texas’s state psychoprisons should be an outrage, but (heart-breakingly) not at all a surprise:

Last year, one [Texas] state mental hospital employee tackled an adolescent patient who was sobbing for his mother, dragging him across the floor by his wrists and hair.

The year before, another brought a female patient into a hospital bathroom and sexually abused her.

And dozens more have participated in brutal beatings at the psychiatric hospitals since 2005, employee disciplinary reports show – using chokeholds, headlocks and threats of violence to restrain the patients under their watch.

In all, 72 employees across Texas’ 10 state mental hospitals have been fired in the last three years for allegations of physical abuse, according to a Dallas Morning News analysis of state personnel records. Hundreds more have been terminated for other violations, the records show, from sleeping on the job to over-medicating mentally ill patients.

[…] Among the allegations of abuse and neglect state hospital workers have been fired for since 2005:

• A worker at the North Texas State Hospital slammed a clipboard on a patient’s head, dragged her by her feet and kicked her in the legs and buttocks.

• An employee at the Big Spring State Hospital failed to notice a patient who knotted her sheet and strung it around her neck. The patient was blue by the time staff found her.

• At the Austin State Hospital, a male employee brought a female patient into a private room for her to carry out a sexual act on him.

• An employee at the Austin hospital tackled a juvenile patient and pinned the patient’s neck and head to the floor, bloodying his lips and face and breaking his glasses.

Other employees were punished for offensive treatment, from using racial slurs on patients to making verbal threats and sexual advances. Some ignored patients’ cries for help while they watched TV, played video games and wrote text messages. Others stole state property and sold tobacco products to patients.

[…]

Jason Evans called 911 in November during a bipolar meltdown and was admitted to the Terrell State Hospital. Days later, the 34-year-old was dead – and his parents still don’t know why.

State officials told the Kaufman couple that their son, who was severely mentally ill but in good physical condition, had been disruptive that evening, and records obtained by the family indicate hospital workers medicated him before sending him to sleep. Mr. Evans was apparently found hours later in his bed, and was no longer breathing.

Lynn Evans, his mother, said psychiatric hospital workers attributed the death to natural causes, and doctors said her son had lost oxygen to the brain. But she and Mr. Evans’ father, a pharmacist, have been unable to get specific details about their son’s death. They believe Jason was effectively overdosed by hospital workers trying to restrain him.

It was a disease. Jason couldn’t help it, said Mrs. Evans, choking back sobs. In my heart, I will go to my grave knowing that hospital killed him.

Mr. McBride said that the agency is prohibited from confirming the identities of anyone in their care – but that any unexpected deaths are investigated by the Department of Family and Protective Services or by local law enforcement.

There were no deaths among Terrell State Hospital patients last fall from anything other than natural causes, he said.

—Emily Ramshaw, Dallas Morning News (2008-05-04): Reports show systemic abuse at Texas’ psychiatric hospitals

And anyone who has followed the official response to past prison abuse scandals (cf. GT 2008-02-21: Mississippi Corrections, GT 2008-02-05: Rapists in uniform, GT 2007-10-28: Corrections officers, etc.) should be outraged, but not at all surprised, by the fact that state Mental Health officials have responded to the threatening, neglecting, assaulting, raping, and torturing of imprisoned patients in the usual way that prison bosses respond. That, when the administrators are forced to admit that abuses have happened, the individual psychoprison guards are usually administratively disciplined, or at worst fired, rather than arrested or sued like the violent criminals that they are. That, when asked, the official mouthpieces of the mental health prison system reply by lying, covering up, whitewashing, isolating, or minimizing the extent of the violence against patients, by making excuses for the perpetrators, and by telling a bunch of sob-stories about the hard luck of supposed trained professionals who are expected to actually do their tough job without hurting people.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

[…]

The state’s juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse.

[…]

Officials with the Department of State Health Services, the agency that runs the psychiatric hospitals, say abuse and neglect are absolutely not pervasive – and verified cases are actually dropping.

In the last two years, they confirmed 15 Class I cases – the most serious abuse. On average, investigators substantiate 5 percent of the more than 2,000 allegations they examine annually. And 90 percent of patient deaths since 2005 were attributed to natural causes, agency spokesman Doug McBride said. Five were suicides, and none were the result of abuse.

Keep in mind there are about 7,400 employees, 18,000 patient admissions and probably hundreds of thousands of staff-patient interactions in a year, Mr. McBride said.

State officials acknowledge that the psychiatric hospitals are stressful environments; there are times, Mr. McBride said, when employees do not handle a situation appropriately. But they say the rules for reporting abuse and neglect are stringent – and confirmed cases of physical and sexual abuse are reported to police.

And they balk at the suggestion that conditions bear a resemblance to the state schools for people with mental disabilities, where the U.S. Justice Department has intervened twice in recent years.

The state psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

It’s a population that’s easy to abuse because they’re not on the radar in any way, said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital.

[…] Mr. Hansen said many employees are conscientious, but conditions vary from hospital to hospital and ward to ward. Some are simply warehouses, where patients are often overmedicated and ignored. In others, patients frequently turn up with unexplained injuries, he said.

—Emily Ramshaw, Dallas Morning News (2008-05-04): Reports show systemic abuse at Texas’ psychiatric hospitals

Besides the fact that it is just a lie to claim that a problem that has involved hundreds of employees in the last three years alone is somehow absolutely not pervasive, one of the most important factors simply goes unmentioned here — that it is really, really easy to get away with far more violence and abuse than crops up in verified official reports, simply because guards tend to stick together against any allegations made by inmates, and because they can act with an incredible amount of impunity when officials will never trust a victim’s testimony, and will happily wave it off, whenever it’s convenient to do so, as the product—literally—of feeble-mindedness or insanity. No wonder that 5% (and dropping) of the 2,000 abuse allegations filed every year end up getting verified by the officials.

And, to cap it all, no matter how bad and how widespread the abuse may get, the administrators can always count on the pro-establishment wing of their supposed critics to go to the public and to the legislature to beg for even more tax money and even more prison guards to be sent into the psychiatric prison system, so that the very people who created these maddening prison-ward hellholes can be rewarded for their institutionalized violence by being allowed to take even more money from taxpayers to go on doing the same old thing:

The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can’t keep up.

[…]

You get what you pay for, said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. When you financially dumb something down, you make services cheap, something’s got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan.

[…]

Aaryce Hayes, a mental health policy specialist with Advocacy Inc., said the Department of State Health Services is working to improve the state hospital system, from incorporating trauma-informed treatment into care regimens to increasing employee empathy training. It is also trying to reduce reliance on restraint and seclusion to keep control of patients.

They get it, she said. They want to see a culture change.

But it’s hard to improve when the state hospital system is so overburdened, Ms. Hayes said. Right now, the state funds just 27 percent of mental health needs in the community – meaning everyone else rotates in and out of crisis care. There are more than 450,000 adult Texans with serious and persistent mental illness, everything from schizophrenia to major depression, Ms. Hayes said.

If we said we were serving just 27 percent of people who had cancer, or diabetes, nobody would be comfortable with that, Ms. Hayes said.

Money is a persistent problem. In 2003, lawmakers stripped $100 million from the state’s mental health budget, Mr. Coleman said – funding that has only partially been replaced.

The Legislature approved $82 million last year to improve community mental health crisis services, said Robin Peyson, executive director of the National Alliance on Mental Illness’ Texas chapter. But Texas ranks 48th in the country in per capita funding for people with mental illness, so that money only begins to address the shortfall.

There are not services at the community level and there are not enough beds in the system, she said. If you have inadequate funding, you’re just supporting this cycle, this revolving wheel.

—Emily Ramshaw, Dallas Morning News (2008-05-04): Reports show systemic abuse at Texas’ psychiatric hospitals

The reality is that what is needed is not more money, or more guards, or better training, or even a culture change. A culture change would be a step forward, but the real solution that is needed is something that goes far deeper: a solution that strikes at the root from which that culture and these conditions grow. What is really needed is a power change, so that psychiatric wards are no longer artificially packed by court order, so that patients can leave and seek help through other means if conditions become unbearable, and so that supposed patients are no longer treated against their will and held down at the mercy of their helper-captors. If you make a hospital into a prison camp, then it should be no surprise when the hospital caregivers start acting like prison camp guards. The only thing to do — the only thing you can do that will not just recreate the same problem in a superficially different form — is to respect the will of patients, to treat violence against them as a real crime worthy of punishment, to repeal the laws that privilege and protect their captors, and to break open the doors and tear off the straitjackets that hold them back from living their lives as human beings, rather than as objects of pity and coercion.

Free the Texas 2,500!

Free all psychiatric prisoners!

Further reading:

• GT 2008-01-06: Shiva on abuse and misdiagnosis
• GT 2007-10-29: For her own good
• GT 2008-02-21: Mississippi Corrections
• GT 2007-11-09: You got served and protected.
• GT 2006-04-14: Over My Shoulder #19: Robert Whitaker (2002), Mad in America on metrazol therapy
• GT 2006-03-18: Over My Shoulder #15: Robert Whitaker (2002), Mad in America