Primum Non Coercere: Private Personal Services and Public Social Services

Relations between doctors of the body (physicians) and their patients are governed by contract and the principle of "primum non nocere" (first, do no harm). Relations between doctors of the mind (psychiatrists) have never been so governed: relations between these two parties have always rested on domination and coercion, authorized by the state. This is still the case. Once doctors and patients disagree about what counts as harm and what counts as help, it becomes necessary-for the protection of the patient's liberty interests-to restrain the psychiatrist by the principle of "primum non coercere" (first, do not coerce) and by extending the legal rule of treating unauthorized or coerced therapy as assault and battery. Because of the absence of such a rule, the history of psychiatry has been a tale of an unending series of tragedies-medical, legal, economic, and social.