Morton Birnbaum facts for kids

Morton Birnbaum (October 20, 1926 – November 26, 2005) was an American lawyer and physician. He spent his life fighting for the rights of people with mental health conditions. He believed they should receive proper and kind care. Birnbaum also created the term sanism. This word describes unfair treatment against people with mental illness.

In 1960, he wrote a very important paper called "The Right To Treatment." This paper was the first time the word "sanism" was used in print. It explained that people with mental illness, especially those in hospitals against their will, had a legal right to good treatment. Birnbaum even suggested that if they didn't get proper care, they should be allowed to leave. He thought this would make society demand better mental health services. Many publications refused to print his paper at first. At that time, many public mental hospitals kept large numbers of patients without much treatment or enough trained staff.

Early Life and Education

Morton Birnbaum was born in Brooklyn, NY, on October 20, 1926. His parents were Jewish. He went to Erasmus Hall High School and then Columbia University. After serving in the U.S. Navy, he earned his law degree from Columbia Law School in 1951.

He later went back to school and earned his medical degree from New York Medical College in 1957. In 1958, he did advanced training at Harvard University. This training was supported by a grant from the National Institute of Mental Health. He received his final degree, a Doctor of Jurisprudence (a legal doctoral degree), from Columbia University in 1961.

Throughout his life, Birnbaum worked as an internist (a doctor who treats adults) in Bedford-Stuyvesant. He also did legal work for free (called pro bono). Through this free legal work, he first started to fight for better treatment for people with mental illness. He won several important cases that improved their civil rights and helped them get better Medicaid benefits in state hospitals.

Important Ideas and Court Cases

The Right to Treatment Concept

Morton Birnbaum's "right to treatment" idea said that people with mental illness who were held in hospitals against their will had a basic legal right to proper care. After his 1960 article about this idea was published in the New York Times, two psychiatric patients, Edward Stephens and Kenneth Donaldson, contacted him. Birnbaum took on their cases. For the next ten years, he fought similar cases, often using his own money to pay for his expenses.

Birnbaum had success helping Kenneth Donaldson. However, he was not successful with Edward Stephens' case. Stephens, who had schizophrenia, was held in prison for over 30 years without treatment. He was later released, though. Some other lawyers disagreed with Birnbaum's idea. They thought it might still allow patients to be held forever as long as some small amount of "treatment" was given. Instead, they argued for a better system to review these cases.

O'Connor v. Donaldson: A Landmark Case

Ken Donaldson was held for fourteen years at a Florida State Mental Hospital from 1957 to 1971. His parents had him placed there without his permission because they thought he was "incompetent." Birnbaum began working on Donaldson's case in the late 1960s. He had encouraged Donaldson to ask the courts for his release since around 1960. In 1967, Birnbaum asked the 5th Circuit Court of Appeals to help Donaldson, but they said no. So, he decided to take the case to the Supreme Court. Donaldson himself wrote 19 appeals asking for a court hearing.

Birnbaum was key in bringing Donaldson's case to the U.S. Supreme Court. This became the famous case of O'Connor v. Donaldson. This case not only "confirmed the right to treatment" for many mental patients but also suggested "a way to achieve better therapy" in public mental hospitals. Donaldson was released in 1971 when he was 63 years old. The Supreme Court ruled in his favor on June 26, 1975. Judge Potter Stewart famously said that "mentally ill patients cannot be confined in institutions against their will and without treatment if they are dangerous to no one and are capable of surviving on the outside."

Donaldson was awarded £20,000 after his release. During his 14 years in the hospital, doctors had spoken to him for less than 5 hours in total. Donaldson later worked as a night auditor at a hotel and wrote a book about conditions in mental hospitals called Insanity Inside Out.

To Birnbaum's disappointment, the court's ruling in Donaldson was very specific and unclear. This made it hard for many other mentally ill patients to be released from hospitals through state courts. Birnbaum said, "The Donaldson case did nothing to guarantee the right of treatment to all the other patients who are still institutionalized." He noted that the Supreme Court did not directly define "adequate treatment." Instead, the Supreme Court said that "a person could not be held against their will unless they were deemed dangerous to themselves or others." Birnbaum was sad about how hard it was to get treatment. He pointed out that in Florida, there was only one doctor for every thousand patients.

He later remembered with surprise that for 14 years, in every Florida and federal court, and before more than 30 judges, he could not get a basic legal order called a habeas corpus for Mr. Donaldson. This order would have required the state to release Donaldson, at least temporarily, and bring him to court to explain why he was being held.

Rouse v. Cameron, 1966

Another partial victory for the right to treatment idea was the case of Rouse v. Cameron (1966). In this case, U.S. Appeals Court Judge David L. Bazelon became the first appeals judge to state that mental patients held in hospitals had a "right to treatment." Birnbaum's client had been found not guilty of a deadly weapons charge because of insanity and was hospitalized indefinitely. Birnbaum argued that his client should be released if he did not receive proper care.

Thoughts on Treating Offenders with Mental Illness

Around 1966, Birnbaum argued that offenders diagnosed with certain mental conditions should often be sent to mental hospitals instead of prisons. He noted three main things that affected the law and how offenders with mental illness were held:

• The need for a clear line between mental health care and corrections.
• A lack of good psychiatric knowledge about different mental health conditions.
• A serious shortage of staff and facilities to provide even basic care for the nearly 500,000 patients in public mental health facilities at that time.

Wyatt v. Stickney, 1970

Starting in 1970, Birnbaum was involved in a major class-action lawsuit in Alabama called Wyatt v. Stickney. A class-action lawsuit is when a group of people with similar complaints sue together. U.S. District Court Judge Frank Minis Johnson ruled that not giving proper care and treatment to patients held against their will was a violation of their rights under the Fourteenth Amendment to the United States Constitution. This amendment ensures equal protection under the law.

Hearings to define this right continued for decades, making Wyatt v. Stickney the longest mental health case in U.S. history. The case led to the "Wyatt Standards." These standards required a kind and safe environment, enough staff, and personalized treatment plans for mental health patients held against their will. However, as Birnbaum pointed out, there was often little way to make sure these standards were actually followed.

In the mid-1970s case of Woe v. Weinberger, Birnbaum argued that states were separating people with mental illness. He said that poorer and sicker patients went to worse state hospitals, while wealthier and less ill patients went to better private hospitals. Birnbaum also argued that New York's laws for holding people in hospitals were unfair. He said they did not require that patients held against their will receive the active psychiatric care that was the original reason for their being held.

What is Sanism?

Morton Birnbaum is known for creating the term sanism. He felt that sanism was a type of discrimination present in all parts of life and that it stopped justice in courtrooms. He described it as:

... the irrational thinking, feeling and behavior patterns of response by an individual or by a society to the irrational behavior (and too often even the rational behavior) of a mentally ill individual. It is morally reprehensible because it is an unnecessary and disabling burden that is added by our prejudiced society to the very real affliction of severe mental illness … It should be clearly understood that sanists are bigots …

According to Birnbaum's daughter, Rebecca Birnbaum MD, his close friend, the lawyer and civil rights activist Florynce Kennedy, influenced his idea of sanism. They both graduated from Columbia Law School. Kenneth Donaldson used the term sanism in his 1976 book, "Insanity Inside Out." He also thanked Birnbaum as a "dedicated fighter." Later, Michael L. Perlin, a professor at New York Law School, read about sanism in 1980 and began to use and write about it widely.

The Challenges of Deinstitutionalization

During his cases, Birnbaum sometimes disagreed with other advocates. These advocates were mainly focused on civil liberties (individual freedoms) and less on welfare rights (the right to receive help). For example, lawyers from the American Civil Liberties Union often pushed for stricter rules on holding people against their will and more rights to refuse forced treatment. This sometimes meant that patients ended up with neither treatment nor a place to stay.

Birnbaum was very concerned when he saw that deinstitutionalization often happened. This was the process of closing large mental hospitals and trying to move patients to community mental health services. He observed that this often led to many people with mental illness being put in prison or left homeless, instead of getting proper care. He believed there needed to be a clearer standard for good quality care, whether it was in the community or in a hospital.

In the end, Birnbaum's legal approach did not create a constitutional right to treatment for everyone. Many "right to treatment" cases were settled with "consent decrees." These were agreements that often became complicated arguments about rules and paperwork.

Morton Birnbaum passed away from a stroke in Brooklyn in November 2005, at the age of 79. He was survived by his wife, Judith, and his children: Julius, Jacob, Belinda, Rebeca, and David.

See also

• Bazelon Center for Mental Health Law