Chapter 2
The Baker Act
All the greatest things we know have come to us from neurotics. It is they and they only who have founded religions and created great works of art. Never will the world be conscious of how much they owe to them, nor above all of what they have suffered in order to bestow their gifts on it.
Marcel Proust,
Remembrance of Things Past: The Guermantes Way
The Florida Legislature passed the Florida Mental Health Act in 1971. It was an improvement over past laws regarding the care and rights of those charged with being mentally ill. The act was named after Democratic State Representative Maxine Baker of Miami, who spearheaded the campaign to reform the culture of institutionalization: “In the name of mental health,”Representative Baker said of the ill, “we deprive them of their most precious possession-liberty.”
Consider the 1975 case of O’Connor vs. Donaldson, 422 U.S. 563, in which the United States Supreme Court held unanimously (9-0) with Justice Stewart, who wrote the opinion that:
A State cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends, and since the jury found, upon ample evidence, that petitioner did so confine respondent, it properly concluded that petitioner had violated respondent’s right to liberty.
The case involved Kenneth Donaldson, who in January, 1957, in a courtroom in Pinellas County, Florida, was wrongly declared to be suffering from paranoid schizophrenia. He was forty-eight years old when he was committed for “care, maintenance, and treatment” to the infamous Florida State Hospital in Chattahoochee, Florida.
His father had initiated the commitment because his son was suffering from “delusions.” Donaldson was a Christian Scientist, who, in keeping with his religious practice, sometimes refused his medication. He repeatedly requested his release, claiming he was neither mentally ill nor a threat to himself or others. The doctors in charge refused him. He suffered the loss of his freedom, human rights, and dignity for nearly fifteen years. Once released, Donaldson authored, Insanity Inside Out, published in 1976, and became gainfully employed again.
Without the aid of an attorney, and against all American and human odds, Donaldson won his own freedom when he initiated what in legal circles was known as a 1983 action. At the time, fewer than 5 percent of all individuals ever won their freedom by such an appeal. A 1983 action refers to Section 1983 of Title 42, of the U.S Code. It provides that every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress.
Mr. Donaldson filed his case with the United States District Court for the Northern District of Florida in Tallahassee, Florida, which covered Gadsden County, where Chattahoochee State Hospital was located. He alleged that Dr. J.B. O’Connor, the administrator of Chattahoochee during most of Donaldson’s confinement, along with other hospital personnel, had intentionally and maliciously deprived him of his constitutional right to liberty. My dear gentle readers, without liberty, life is barely precious, except to the ignorant.
Fortunately, the United States Supreme Court agreed unanimously with Mr. Donaldson. Justice in America was slow; justice in America was sometimes unjust, but with enough evidence and enough persistence, justice did usually prevail. By the beginning of the twenty-first century, the American system of justice, warts and all, was one of the best systems in the world.
From the O’Connor vs. Donaldson United States Supreme Court opinion of 1975:
The testimony at the trial demonstrated, without contradiction, that Donaldson had posed no danger to others during his long confinement, or indeed at any point in his life. O’Connor himself conceded that he had no personal or second-hand knowledge that Donaldson had ever committed a dangerous act. There was no evidence that Donaldson had ever been suicidal or been thought likely to inflict injury upon himself. One of O’Connor’s codefendants acknowledged that Donaldson could have earned his own living outside the hospital. He had done so for fourteen years before his commitment, and, immediately upon his release, he secured a job in hotel administration.
Furthermore, Donaldson’s frequent request for release had been supported by responsible persons willing to provide him any care he might need on release. In 1963, for example, a representative of Helping Hands, Inc., a halfway house for mental patients, wrote O’Connor asking him to release Donaldson to its care. The request was accompanied by a supporting letter from the Minneapolis Clinic of Psychiatry and Neurology, which a codefendant conceded was a ‘good clinic.’ O’Connor rejected the offer, replying that Donaldson could be released only to his parents.
That rule was apparently of O’Connor’s own making. At the time,Donaldson was 55 years old, and, as O’Connor knew, Donaldson’s parents were too elderly and infirm(ed) to take responsibility for him. Moreover, in his continuing correspondence with Donaldson’s parents, O’Connor never informed them of Helping Hands offer. In addition, on four separate occasions between 1964 and 1968, John Lembeke, a college classmate of Donaldson’s and a longtime family friend, asked O’Connor to release Donaldson to his care. On each occasion, O’Connor refused. The record shows Lembeke was a serious and responsible person, who was willing and able to assume responsibility for Donaldson’s welfare.
The evidence showed that Donaldson’s confinement was a simple regime of enforced custodial care, not a program designed to alleviate or cure his supposed illness. Numerous witnesses, including one of O’Connor’s codefendants, testified that Donaldson had received nothing but custodial care while at the hospital. O’Connor described Donaldson’s treatment as ‘milieu therapy.’ But witnesses from the hospital staff conceded that, in the context of this case, ‘milieu therapy’ was a euphemism for confinement in the ‘milieu’ of a mental hospital.
For substantial periods, Donaldson was simply kept in a large room that housed 60 patients, many of whom were under criminal commitment. Donaldson’s request for ground privileges, occupational training, and an opportunity to discuss his case with O’Connor or other staff members were repeatedly denied…
May the State fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different? One might as well ask if the State, to avoid public unease, could incarcerate all who are physically unattractive or socially eccentric. Mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty.
In short, a State cannot constitutionally confine, without more, a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends. Since the jury found, upon ample evidence, that O’Connor, as an agent of the State, knowingly did so confine Donaldson, it properly concluded that O’Connor violated Donaldson’s constitutional right to freedom.
In footnote ten of this case, you find what the modus operandi within my walls was always, and that was the institutional wisdom that the doctor knows best, and what the doctor knows may be neither questioned nor challenged.
Footnote ten: O’Connor argues that, despite the jury’s verdict, the Court must assume that Donaldson was receiving treatment sufficient to justify his confinement, because the adequacy of treatment is a ‘nonjusticiable’ question that must be left to the discretion of the psychiatric profession…
Chief Justice Burger wrote a concurring opinion, and pointed out that: The Court appropriately takes notice of the uncertainties of psychiatric diagnosis and therapy, and the reported cases are replete with evidence of the divergence of medical opinion in this vexing area…To deprive any citizen of his or her liberty upon the altruistic theory that the confinement is for humane therapeutic reasons and then fail to provide the adequate treatment violates the very fundamentals of due process…
The Court’s reference to ‘milieu therapy’ may be construed as disparaging that concept. True, it is capable of being used simply to cloak official indifference, but the reality is that some mental abnormalities respond to no known treatment. Also, some mental patients respond, as do persons suffering from a variety of physiological ailments, to what is loosely called ‘milieu therapy,’ i.e., keeping them comfortable, well nourished, and in a protected environment. It is not for us to say in the baffling field of psychiatry that ‘milieu therapy’ is always a pretense…
‘Indeed, there is considerable debate concerning the threshold question of what constitutes ‘mental disease’ and ‘treatment.’ See Szasz, The Right to Health, 57 Geo.L.J. 734 (1969).
Donaldson’s initial situation happened before the Baker Act passed. Prior to Baker, to commit a person to a state hospital required only three signatures on an affidavit and the agreement of a county judge.
Opened in 1876 in a former civil war arsenal, Florida’s first psychiatric hospital was the Florida State Hospital in Chattahoochee. The second was opened in Arcadia in 1947. Some three hundred and fifty more would open in the 1950s, the decade that also saw the first boom in psychiatric pharmaceuticals in America.
The primary purpose of the Baker Act was to restrict involuntarily institutionalization to only those who were a threat to themselves or others. As Representative Baker said at the time, “only 9 percent of our patients are dangerous to themselves or others, yet 91 percent are under lock and key.” She continued, “For the 58 percent of our patients who are committed involuntarily, they lose all their civil rights and leave with an indelible stigma.”
Prior to Baker, the committed could only correspond with one person; after Baker they could correspond with whomever they wanted; they could vote, exercise the right to an attorney, and enjoy other basic human rights. For all of its reform and progressive statutes, however, neither the Baker Act nor O’Connor vs. Donaldson could stop the profiteers in my building from continuing their campaign of organized crime and abuse of patients.
The only thing necessary for the triumph of evil is for good men to do nothing.
Edmund Burke
