The Perversion of Autonomy, Part II

THE OPEN MIND
Host: Richard D. Heffner
Guest: Willard Gaylin
Title: “The Perversion of Autonomy,” Part II
VTR: 7/9/96

I’m Richard Heffner, your host on The Open Mind, and this is the second of two programs with Dr. Willard Gaylin, Clinical Professor of Psychiatry at Columbia University, and the co-founder and longtime president of the Hastings Center, America’s pioneering institute for the study of society, ethics, and the life sciences. Dr. Gaylin and I have been discussing his new Free Press book, “The Perversion of Autonomy: The Proper Uses of Coercion and Constraints in a Liberal Society,” written with Bruce Jennings, now the executive director of the Hastings Center. We want to go on with our discussion.

And, Dr. Gaylin, talking about autonomy at some length, what about constraints and coercion? Those are words we don’t like to use. How do you use them?

GAYLIN: I used them in an old-fashioned way. I define “coercion” as forcing someone to do something that you will, rather than what they will. That’s as straightforward as possible. I use “constraint” in a different way, to mean preventing someone from doing what they want. You could collapse them both into a definition. But it just makes it a little simpler to keep “constraint” into a holdback position.

HEFFNER: If I were to say, “Don’t fence me in,” I’d be saying both of them, right?

GAYLIN: Yes, you would, indeed.

HEFFNER: Okay.

GAYLIN: Now, I don’t use “coercion” for your thoughts or anything like that; I’m talking about behavior. Behavior and conduct are what we’re dealing with primarily in this book. You’re free to think anything you want. I know there are certain points of view that create negative thoughts. Not me. I’m not a Catholic. I don’t believe that you can have bad or evil thoughts. You can have as many bad or evil thoughts, as long as you behave yourself, and then, Dick, you’re a perfectly good citizen. Now, constraints and coercion are a fundamental part of government. We have laws saying what you can and what you can’t do. Those laws are accompanied by punishments that go along with the laws. Believe me, if there were no punishments, the laws would not be obeyed. You have good examples of that in income tax laws in countries like Argentina or Italy, up until modern time, no one obeyed those laws. We obey income tax laws because they make sure, the government, to institutionalize or convict a couple of prominent middle-class or upper-middle-class people every year so that we know they can send you to jail. So we have all kinds of coercions that we allow. And coercion, we, for instance, demand that children go to school when they’re five years old. We also demand, in most states, that they be inoculated for certain kinds of conditions. When polio vaccine was perfectly voluntary, we found that Black kids in the Harlem ghettos were not getting vaccinated. I was called in at that time by the March of Dimes to help resolve what the problem should be. And I remember at the time there was an optimistic assessment: we don’t have to do anything because polio vaccine has probably disappeared from the North American continent. Within two weeks of that, an outbreak of polio occurred, fortunately not in Harlem, but up in Greenwich, Connecticut (this goes back 15 or 20 years), and where everyone, except for a very few children, had been inoculated. So the question came … Then there was no question. We can’t just let it go by. And the answer was, you gotta coerce them to do it. You gotta demand it. Or you gotta seduce them into it. In other words, you’ve got to pay them for doing it. The point I tried to make was that the future is really a middle-class luxury. The poor don’t know about a future; they’re trying to get through the present. So they’re not going to anticipate. You’ve got to make sure that these kids are protected. You’ll notice that coercion, in our society, has, for the most part, been in the protection of children for one reason or another. And there are certain areas we can’t coerce. But we coerce adults too. I’m using examples of children. What we did then was to use a very simple, minor coercion, and say you couldn’t go to school unless you had your shots for polio or unless you took the oral vaccine. And everyone got it, because everyone wanted their kids to go to school. Also, you had to. So, a certain amount of coercion is essential for people to live together. And since I don’t believe in the isolated individual, that people are only human when they’re sharing with other people, that I firmly believe as a psychologist, it’s a philosophy of mine. You don’t have a human being when he’s isolated from all other human beings. We know that with feral children, the few cases that we’ve had. So I feel that we have legitimacy to coercion. Now, does it mean that I want to go around telling everybody who to vote for? No, it does not mean that. It means that, in certain things that are fundamental for social living, we demand certain behaviors.

HEFFNER: Will, I’m puzzled by that, because we live in a society that is increasingly based upon, well, upon the marketplace model. And if there is anything that is antithetical to the marketplace notion or the marketplace model, it is the concept of coercion. Where, how do you work the notion of coercion into a society that keeps saying – I wasn’t joking before – “Don’t fence me in. Don’t touch me. Don’t interfere with my ability to better my life as I see it being bettered,” meaning “make more dollars?” I mean, we live in a society in which marketplace rules prevail. How do you possibly …

GAYLIN: Well, the marketplace model has often been offered as a much more preferable one. I don’t see a priori preference for one or the other. If it worked in every case, the voluntary … And it does work in some cases. It works at the toll gates. You’ll notice that people go to the toll gates, and everybody is manipulating to get into the shortest line. And that’s almost as good as giving people a number. In many ways, it’s better. So it keeps the line fairly equal. Now, given human nature as it is, everybody is convinced that they’ve gotten into the slowest line …

HEFFNER: Right.

GAYLIN: … whether it’s the cashier’s line … But we use the marketplace. In a sense, that’s the model. But certain things cannot and will not be allowed. Perhaps because they come from bioethics. Medicine was always entrepreneurial here, but we have never, to my knowledge, sold seats in the lifeboats of a sinking ship, as capitalistic as this country has been. So we have never actually sold life. When you get into bioethics, and when you talk about a liver, to whom is it going to go, you can’t use a marketplace model. You simply can’t.

HEFFNER: Oh, you use a model in this book in which you say how appalling that a political figure should get organs that were not easily available to an ordinary person.

GAYLIN: Yes. And I say it with shock and humiliation that we have come to that point. Because I do believe that is a case of politics and market. That’s market too. I don’t believe you can sell life. I don’t believe we can have the futures, the way we have it in porkbellies, in human hearts or lungs or tissue. Now, I think the average American is disgusted by that too. We have come to that. That’s what the whole book is about. Willy-nilly, we’ve let this illusion of freedom drag us into a position of selfishness and instability.

HEFFNER: But, Will, where do you get your notion that … And you do seem to believe that we’ve had enough of this. And I don’t mean that Will Gaylin and Dick Heffner think we’ve had enough of it. You’re working on the assumption that people, we, this nation is appalled by this approach to things. You’re talking about the very people who are wrapped up in the me, me, me, the autonomy business.

GAYLIN: Look, I’ve been a lifelong optimist. And a friend of mine used to say, “Don’t you understand that optimism is an illness?”

HEFFNER: (Laughter)

GAYLIN: Now he says to me, “It’s not only an illness; it’s a malignant illness, and you’re going to die from it.”

HEFFNER: Don’t you understand that?

GAYLIN: I do, but I – and it may be my optimism – I see a change. For instance, in the sixties and seventies, certainly following the Vietnam War, there was the feeling that no one could be trusted in the government. You wanted no paternalism, no beneficence. “I’ll do it myself. I’ll do it my own way.” And you remember those were the days where graffiti, which I took very seriously and still do, because it’s an announced contempt about the public space. You can’t afford to be contemptuous. And I believed that graffiti would lead to urination and defecation in the public streets. And you see that too. And sleeping and living in the public streets. I see a turning away from that. A realization that you cannot allow the homeless to just rot and kill themselves in the midst of the street, or kill us in the streets. There is a sense that there has to be more than just the selfish concern with the I, that there has to be a kind of we. I see it somehow misguided, because it’s still ruled by autonomy. Some of the nicest people I know, some of my best friends, are very active in the homeless movement because their compassion goes out to people living on the street, and because they’re repelled by the way they have to live. Now, they’re still led by autonomy, so they don’t like my suggestion to them that you can build 10,000 dwellings and you’re still going to have the homeless because you’re going to have the dope addict, the alcoholic, unless you get to their fundamental problem, unless you stop thinking about them as homeless and think of them as dumped and littered mentally ill, which is what they are. So I do see …

Now, the problem is, when you’re talking to an optimist, he’s always going to see a light at the end of the tunnel. I see a turning away. I see the communitarian movement. I think it’s a little wrong-headed too, because I don’t like the idea that there’s a difference between a community and an individual. And I remember that Marxism was a communitarian movement, and I sure don’t want any part of that.

HEFFNER: Now, wait a minute, wait a minute. You say you don’t like to see the notion of a difference between community and an individual. I don’t understand that.

GAYLIN: Well, the individual …

HEFFNER: Excuse me. It sounds as though you don’t want to say what you want to say.

GAYLIN: No. What it means is that, as I can’t think of an individual independent of community …

HEFFNER: Yeah …

GAYLIN: … I can’t think of a community independent of individuals. I can, but not one I would like. What I’m trying to say is, all I object to is not that the communitarians want more attention paid to the rights of the community, but in a sense they are setting up a duality which I don’t think exists. There isn’t something called “the individual” and something called “the community.” I feel that if something is good for the individual, truly, biologically good, it must sustain the community.

HEFFNER: Will, when we began our first program (I don’t mean 20 years ago; I mean earlier today, the first program that was on, when people see this, the previous week), you said you’re a very practical person. You said you deal with individuals as a psychiatrist, you deal with them in practical terms, in terms of what problems they experience. I must say – and I’ve listened very carefully – it sounds to me as though you want to, you need to say, ultimately, as you say in the book, all we need to do is balance, balance what has become an imbalanced situation in which rights and privileges and autonomy outweighs social concerns. Isn’t that what you’re saying? Aren’t you beating around the bush a little bit? You want not to be …

GAYLIN: Well, let me see if I can’t tie them together. And I would tie them together on the basis of what makes a human being. I’m very interested in human nature. I do not see a human being as being a smart ape. I do not see a human being as being slightly superior to a slug. I see the human being as different from even its closest relative, the chimpanzee, as the chimpanzee is to that slug. Now, what makes the human being different? What is the nature of the human being, when he does have autonomy to a degree that no other animal does have? He is self-selecting. There’s a wonderful Talmudic quote I use that, if God had meant man to be circumcised, why didn’t he make him that way in the first place? And the answer that the Talmudists give, that, “Alone among creatures, God has given the privilege of sharing in his design with his creator.” So we are autonomous in the sense that we can change things. We fly without wings, we go under the sea without gills, we live in godforsaken places like the desert and Las Vegas and Palm Springs because we have air conditioning and things like that. It is of the nature of the human being also to have a moral conscience, to be a communal animal. If you raise a child with care, certain things emerge which were built in latently into his constitution, things which do not exist in any other animal, even the domestic dog, although people who love dogs will say, “Oh, my dog feels so guilty because he peed on my carpet.” He doesn’t feel guilty; he just doesn’t want to be punished. He’s feeling fear, guilty fear. So human beings have a capacity for shame, they have a capacity for guilt, they have a capacity to anticipate a future. A future that has no relationship to the past. An animal can only anticipate in the future what he’s experienced in the past, the predator. But we can anticipate all sorts of things. And we have control mechanisms built into us. Unfortunately, they are not hardwired, like breathing or the pulsation of the vascular system. In order for them to exist, a child must be cared for in the first couple of years of life, and then a child will behave like a human being. Ninety percent of what’s disgusting in public life that you don’t do or that I don’t do isn’t because the law is going to punish us and we’re afraid to go to jail. There are things that we don’t do because we’re ashamed to do, because we feel guilty about doing it, because they’re alien to our sense of self and pride. That all goes on, even though you don’t know when you’re raising a child, by touching, by handling him, by giving him love, you give him that nurturing environment to emerge as a human being. If he doesn’t emerge, if he isn’t given that caring, if you treat, if you abandon a child, he’s going to grow up to be something less than human, like the psychopaths who run through our streets. And then we’re in deep problem. So that, in the end of I plead, I plead for institutions, and I demand that they be compulsory if parents can’t provide them. Sure, I would prefer an old-fashioned family like William Bennett would prefer, but I’m not sure we’re going to get back there. I still think it was the best device there was, the central family and the larger family. I’m not sure we’re ever going to be able to recover that. If that is not to be recovered, I want some substitute, some caring for the newborn to allow his humanity or her humanity to emerge. Otherwise, you’re going to have the kind of dangerous streets that we have now.

HEFFNER: Yes, but, Will, to me, the problem is, as you come to it in the end of the book, that your descriptions, I think, belie the realities of our lives, the realities that you refer to certainly in your idea mean. It seems to me that you’re saying you want to maintain that there is a proper use of coercion and constraints. You want to say that they can be used appropriately within a society that is essentially autonomous. Why don’t you bite the bullet and say, “That hasn’t worked. It’s not true.” Everything of our century has pushed us further and further in the direction of an emphasis, a singular emphasis upon autonomy. Let’s not talk about limited constraints and coercion. That to have what you embrace as the good life means essentially a limitation upon autonomy. It’s not just a perversion of autonomy. You have to do a hell of a lot more to limit autonomy than you’re willing to say.

GAYLIN: Well, maybe it’s that I see the world we live in, with all my concern and all my passion, in a less jaundiced way than you quietly view it now. I’m not ready to give up. I don’t want a Sparta, nor do I even want a Singapore. I don’t want to whip people into shape. You know, we’re back in the old debate of the Grand Inquisitor from Brothers Karamazov.

HEFFNER: Indeed.

GAYLIN: “Give them food, get order, and take away all freedom.” I don’t believe you have to take away all freedom.

HEFFNER: Why do you make reference to the Grand Inquisitor here? You throw him in, you leave him there. What’s the point? It seems to me that there’s some significance there.

GAYLIN: Well, there is a significance of the Grand Inquisitor, because we don’t have to use his Draco … Because he does, he’s always been given a bum rap, I feel. I’ve always defended the Grand Inquisitor to a certain extent, because he recognizes that freedom without food, I mean, the kind of freedom that you might have in a laissez faire society is freedom without justice. So he places limits on freedom. He goes farther than I want to go. He may go as far as you want, I mean, you may prepare to go, the Grand Inquisitor. I’m not yet. I look at America, even in the 1990s, and, you know what, it isn’t so bad. I’ll take it to America in the 1890s. And, by the way, the roots of this were seen in the 1800s, that wonderful book, “The Radicalism of the American Revolution” points out that by setting people truly free, we were really sewing the seeds of trust for all authority. I think we’re still in the post-Vietnam period, so there’s still an anger with authority. But I think we’re coming back. I wish, I wish we had in the current political campaign one leader who represented integrity, decency, and beneficence even in the old-fashioned way that, let’s say, a FDR did, or Harry Truman did, or Eisenhower, for that matter.

HEFFNER: You know, I know now why you are so wonderfully articulate. To save you from the necessity of facing what you’re really saying. You can express your concerns, your frustrations, your angers, your dissatisfactions with this state of autonomy today, and get it out of your system that way, then when you’re faced with the basic choice that I think you’re really someday going to have to make, you say, “Well, I don’t go that far. I’m not really that unhappy with American life today.”

GAYLIN: No, no, no. Not unhappy. I would still prefer it, let’s say, to a Stalinist regime in the thirties.

HEFFNER: Okay, but that’s …

GAYLIN: Well, but that’s, that’s …

HEFFNER: That’s what?

GAYLIN: That’s the Grand Inquisitor. That is the Grand Inquisitor.

HEFFNER: But you’re the one who really brings the Grand … That’s what intrigued me so.

GAYLIN: Okay. So I’m saying we can go, we can go. We don’t have to give up our liberties. This is always the argument: “Oh, you’re going to take us down to the …” No, this is not the argument. We can still retain a sense of the joy and glory of the individual. But I’m ready to do some very Draconian and drastic things.

HEFFNER: Tell me about them.

GAYLIN: In the end of the book, I finally say, since I am not clear that we can handle the psychopath (they’re always saying set up more psychiatric facilities), I know that once someone is 16 or 17 without a conscience they will not respond by guilt, shame, or psychotherapy. Then you’re forced to the Draconian principle of fear of the punitive law. And if that’s what we must do, we must do it. And we must protect society from those. I do want us to protect ourselves from having a permanent influx of antisocial, psychopathic, young people. Age cures it, by the time they’re 50, if we can all live through that. So that, at the end, I say, if you’re going to have, as we now have, a semi-permanent group of inner-city kids breeding inner-city kids … They talk about the one-parent family. It’s a joke. It’s a non-parent family. Well, I can’t force people to get married, I can’t force them to go back to using prophylaxis, although I could, and I am prepared to do that. Not to force them, but to seduce them, educate them, etcetera. I can say I don’t want these kids neglected. I don’t care if you’re the mother. I represent certain values, as I say to my patients, as the physician, and I would, as we demand education of five-year-olds, demand nursing care … I’m sorry. Demand daycare for those kids. And I mean … And you know what? You don’t need psychologists, and you don’t need psychiatrists. What I’m talking about, care, is not education, is not teaching them to love music, or poetry, or nothing out of the gymnasium or ancient Greece, etcetera; I want someone to touch them, to hold them, to squeeze them. You can use all the unemployed people in the community who have that capacity. And you will get a different kind of child. We are breeding this group. So that, I am prepared to change dramatically the way we take care of children from birth to five years of age. That will not be appealing to most people, but that will satisfy at least, that’s the step I’m prepared to go before I say, “Give up all liberty.”

HEFFNER: Will, you say before you would take this step in which you say, “Give up all liberty.” But you and I know that what you have just described will be characterized by our friends as the equivalent, the moral equivalent, or the legal equivalent of giving up all liberties.

GAYLIN: In the opening of the book (I don’t know if it’s in the first chapter) I say I am prepared to be attacked by right and left. Unless you take a pristine position, you’re in trouble. I was, for years, on the board of Planned Parenthood, National Planned Parenthood. As a board member, I had to protect the right to choice. I find late-term, third-term abortion something that is very questionable. Now, I would want, as an individual … Well, if you’re representing an organization that is the one stalwart of pro-choice movements, you can’t say that there. So I’m saying you never make friends, you never make friends by finding positions away from the two poles. But you muddle through, and indeed, if you look at the entire history of this country, if you don’t just take the period from 1950 to 1990 where the deterioration into a culture of autonomy occurred, it isn’t bad. And I don’t know the roots of your pessimism. You would prefer living here now. If you play that old game, that John Rollsian game, “Richard, you can live anywhere you want, in any time, but you can’t pick whether you’re the worst or the best in society.” You know what? You’d end up with … Maybe you wouldn’t end up with 1990; maybe you’d end up with 1945 America where there was a sense of purpose. But we were at war then. We had just come from a terrible Depression. But you would end up with something close to modern America. We’ve inched our way to progress.

HEFFNER: Will, we have a minute or so left. Tell me what you see as the direction. You say, “Inched our way to progress.” Do you see continuing progress, as you call it?

GAYLIN: I don’t know. I haven’t gotten the response from this book yet; it’s just out. I think I can’t be alone. Usually, when I’ve come to a certain position, I found out … I think there is a general disgust for the let-it-all-hang out, true-to-yourself me generation. I think there is a general turning away and a distaste for it. I think there is a hunger for community. Often it’s dangerous. It comes out in right-wing communities. It comes out in very … There’s a hunger for leadership. Often it’s dangerous. It comes out with Farrakhans. But I think there is a turning away from the rampant individualism and the rights-oriented society to some sense of a shared fate. You know, the ecology movement may force us, if nothing else does, to see ourselves as being part of one community.

HEFFNER: It’s interesting, you talk about turning away from the autonomy shtick, and you say you don’t mean the coercive movement that is gathering speed now. But I don’t think you pose anything very much in opposition to that, and I don’t think you want to make a concession as to how fast that is growing, that movement. You’re talking about movement away from autonomy, but, Will, it is in the direction of coercion.

GAYLIN: Well, I am crying out for some means of moving incrementally, because I fear that ultimately, if we get into a real economic bind, or if we get so the streets truly aren’t safe, etcetera, that the reaction may be so severe that it’ll lead to a fascist state, which is the last thing I want.

HEFFNER: Will Gaylin, get everybody to read “The Perversion of Autonomy.” A damned good book. Thank you for joining me today.

GAYLIN: Thank you, Dick.

HEFFNER: And thanks too, to you in the audience. I hope you join us again next time. And if you’d like to share your thoughts about our program today, please write: The Open Mind, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts, send $4 in check or money order.

Meanwhile, as another old friend used to say, “Good night, and good luck.”