Legislatures, professional groups, and mental health consumers across the United States are currently engaged in a debate about the need for change in civil commitment procedures. The authors summarize modifications of legislation and judicial opinion in the history of Oregon's civil commitment procedures from 1853 to the present to show that changes in civil commitment reflect broader shifts in the social and political aspects of the mental health system. Many current issues in civil commitment, such as the question of a patient's competency to make treatment decisions, are not new, and they are likely to continue to be controversial as mental health systems attempt to balance concerns about the liberty interests of mentally ill persons with concerns about providing appropriate treatment for mental illness.