A recent story in Mother Jones highlights the issue of the decrease in psychiatric beds nationwide, reductions in support for the severely mentally ill, and the terrible price paid by both the severely mentally ill and their families. Several times in the article McClelland refers to E. Fuller Torrey’s arguments that in addition to funding services for the severely mentally ill, states also need to change involuntary commitment laws to make committing people against their will depend on things in addition to imminent dangerousness. These issues take on a new salience with the recent mass murders perpetrated by people believed to be psychotic at the time of the murders, and often previously diagnosed with serious mental illness, and with the responses in the media that call for curtailing the rights of the mentally ill.
From a feminist bioethical perspective I find this issue quite perplexing. On the one hand, severely mentally ill women are often left to live on the streets where they are victims of sexual violence and live in deplorable conditions. Yet at least in some cases they choose this over available treatment and other assistance, including assistance from loved ones. Some severely mentally ill women and many severely mentally men end up in prison, which is more and more becoming the primary treatment locus for the severely mentally ill. Also of concern is that some mentally ill people are violent, most often towards family members, and in particular towards their mothers. Yet under the current system family members have no recourse until violence is perpetrated, and that recourse is typically, in the first instance, to involve law enforcement. Mothers and other family members of severely mentally ill adult children still love these adult children and recognize that they will likely end up on the streets without the care of their families. Yet at the same time they are afraid of their sometimes-violent adult children and are left with nowhere to turn for help.
On the other hand, making involuntary commitment easier presents its own troubling possibilities. Historically, women who have rebelled against stifling gender roles have been committed to mental hospitals against their will. Historically various oppressed people, from runaway slaves to gays and lesbians to the politically and socially prophetic, have been subjected to unwanted treatment. It is hard to imagine a change in civil commitment laws that would not present the danger of misuse for enforcement of social norms, regardless of the intention of those advocating for such change. In addition, there are insufficient psychiatric beds for adequate treatment of even those who currently want treatment. On May 21 a judge in Washington State ruled that the practice of ‘parking’ the mentally ill in emergency rooms until a psychiatric bed becomes available violates state and federal law. The practice is common throughout the U.S. due to the lack of psychiatric beds. Lawyers for those facing involuntary commitment argue that it violates their civil rights. However, for those who wish treatment it is yet another hurdle to be dealt with before treatment can be provided.
In his book The Insanity Offense, E. Fuller Torrey, who is cited several times in the Mother Jones article, argues that many severely mentally ill people suffer from anosognosia as part of their illness. That is, a symptom of their illnesses is that they believe that they are not ill and therefore refuse treatment, and in particular refuse medication and hospitalization, though they often refuse other forms of help as well. For this reason he believes that those suffering from such severe illness (he includes schizophrenia, bipolar disorder, and major depression as severe mental illnesses, that is illnesses in which people are sometimes psychotic) should be treated against their will. For him, people with these diagnoses who claim that they are not ill and therefore do not need treatment are displaying a symptom of their illness. Those with these diagnoses who recognize that they need treatment are not as severely ill as those who believe that they are not ill.
There are several clear problems with this argument. First, of course, it would seem that the theory that people who claim that that they are not ill are simply proving that they are ill by making that claim is unfalsifiable. How do we distinguish eccentric behavior from behavior caused by a brain dysfunction? Even if when taking medication people behave in a more socially acceptable way, that may be because of the sedating effects of the medication rather than anything “therapeutic.” Any of us when sedated will be much less likely to engage in a wide range of activities. But for Torrey, there are many mentally ill homeless people who are in the deplorable situation they are in because they refuse treatment due to anosognosia. The prisons are full of such mentally ill people who have refused treatment. And there are families who are terrorized by mentally ill family members who refuse to believe that they are ill and therefore refuse treatment. Finally, of course, there are murders committed by people with untreated psychosis. Most often those murdered are family members, but some widely publicized murders are of strangers. While most mentally ill people present more danger to themselves than to anyone else, there is a subset of mentally ill people who are dangerous to others, but who do not meet the legal standard of “immanent dangerousness” to allow them to be treated against their will.
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How is a feminist bioethicist to deal with the question of involuntary treatment of the mentally ill? This is made all the more troubling by the lack of a scientific basis for the diagnosis of any mental illness. How can we justify forcing people to take medication, especially medication with significant negative side effects? How can we justify incarcerating people who have not broken any laws that would justify incarceration? Wouldn’t this be a gross violation of civil rights and clear discrimination against a class of people whose behavior we find undesirable? On the other hand, how can we leave people to live in the terrible conditions of the mentally ill homeless? How can we leave families, especially mothers, with no recourse when they love but are afraid of mentally ill adult children?
One intriguing possibility suggested by Ellyn Saks (see Forced Care: Forced Treatment and the Rights of the Mentally Ill) is that involuntary hospitalization and medication should be easier for a first psychotic break and that the course of treatment at that time should be more extensive than is currently the case. Once the treatment course has been successfully completed and the person is no longer psychotic, s/he would sign a Ulysses contract outlining how s/he would want to be treated (or not treated) in the event of another psychotic break. The contract would need to be followed unless the person presented an immanent danger to herself or others (which is the current standard for involuntary treatment in most states). Saks’ view is to be taken particularly seriously because in addition to being a professor of law and psychiatry at USC, she is also someone who lives under the diagnosis of schizophrenia and has been treated involuntarily on some occasions (see her memoir The Center Cannot Hold: My Journey Through Madness).
Torrey would find Saks’ proposal inadequate because from his perspective as a psychiatrist who deals with the severely mentally ill, a symptom of their illness is often an inability to recognize that they are ill. This is true even when they are not psychotic. No one who is severely mentally ill could rationally enter into a Ulysses contract that limited treatment in any way in the event of a psychotic break because either (a) s/he is psychotic and thus unable to enter into such a contract or (b) s/he is not psychotic but nonetheless suffering from anosognosia, that is an inability to recognize his/her illness, and thus is unable to participate in decisions about his/her current and future treatment.
In my view, unless and until there is clear scientific evidence for the biological basis of these illnesses outside of their psychotic episodes and for anosognosia as a symptom, Torrey’s objection must be rejected. Saks offers a promising way forward in dealing with this most perplexing problem.
The answer is simple.
NO FORCED TREATMENT!
You don’t lock people up and drug them against their will because of what some expert says they *might* do.
The additional risk of violence to others by people with psychotic illness is negligible and the tools used to estimate risk are poor. We are currently locking up or forcibly sedating around ten harmless mentally ill people just to immobilise one who will commit violence but are still missing about one in five of the violent ones.
The treatments are usually expensive, aren’t much more effective than placebos and have serious side effects.
Diagnosis is fuzzy, subjective, symptom based and only offers predictive prognosis in that it predicts the kinds of therapies the patient will receive and therefore the pathologies of their side effects.
The mentally ill are already at increased risk of violent victimisation. Forcible treatment increases this risk as well as that of reprisals against those inflicting the treatment.
Being a young man who binge drinks and plays contact sports is a much better predictor of violent offending than psychotic illness but you don’t hear the likes of E Fuller Torrey calling for the pre-emptive detention and forced treatment of our football teams.
We don’t force cancer or AIDS patients to accept toxic therapies. We don’t lock ‘sane’ people up for attempting suicide. There is only one reason we accept such major human rights abuses against a substantial proportion of our population without an outcry.
Stigma.
The mentally ill get bad press from Torrey and his Stanley funded Treatment Advocacy Center, from Hollywood and their psychotic axe murderers, from the courts and their hubristic voodoo forensics and from the press themselves who focus on the mostly irrelevant mental health histories of violent offenders or their alleged non-compliance with medication regimes while ignoring their history of violent victimisation or the known violent side effects of the medications they *are* complying with.
Over twenty years ago E. Fuller Torrey inspired Rich Winkel’s rant against abusive, coercive psychiatry. It should be required reading in the field of mental health bioethics.
http://www.davidsmail.info/winkel.htm
This comment is not a criticism of Norah Martin’s blog entry, which was nicely thought-provoking about the limits and justifications for involuntary commitment for mental illness. Rather, I want to add to the discussion a news article in the Daily Mail (yes, I know) that picks up on a photographic project which may further humanize those who are mentally ill. http://www.dailymail.co.uk/news/article-2338714/The-chilling-pictures-suitcases-left-New-York-insane-asylum-patients-locked-away-rest-lives.html
The piece shows some images from this project, which sets out to document something of the lives of people institutionalized in a New York sanitorium in the early 20th century by virtue of looking at the content of suitcases they brought with them. As the intro to the gallery says:
“When patients were committed to the Willard Asylum for the Insane in Upstate New York, they arrived with a suitcase packed with all of the possessions they thought they needed for their time inside. Most never left. The mental hospital had an average stay of nearly 30 years. When patients died, they were buried in nameless graves across the street of the asylum. Their suitcases, with all their worldly possessions, were locked in an attic and forgotten. In 1995, an employee of the mental hospital discovered the suitcases, 400 of them. They date from 1910 to 1960. “
Thank you for tackling the issue, but there is a huge glaring factual error which makes a lot, not all, of what you write different from reality. You stated, “For this reason (anosognosia) he believes that those suffering from such severe illness (he includes schizophrenia, bipolar disorder, and major depression as severe mental illnesses, that is illnesses in which people are sometimes psychotic) should be treated against their will. ” Torrey doesn’t believe that, and I know no one who does. My own sister in law has schiz and is sometimes unaware of her illness, and no one would suggest committing her. She’s never been violent nor prone to violence. Anosognosia is a reason some (a small group of) people with Serious Mental Illness become violent. They don’t think they are ill so why take meds. But Torrey doesn’t even argue for IVCing those folks. You are confusing the “reason” Torrey gives for why some become violent with the criteria used to commit them.
Currently, you can’t commit someone with SMI until after they become danger to self or others. That’s fairly ludicrous. Laws should prevent violence, not require it. I don’t think you would argue that someone with Alzheimer’s who walks away should be required to become dangerous before we get them care. Why do we do that for people with SMI.
The problem with laws is that because inpatient commitment involves a depravation of rights, there is rightfully a high bar to meet before implementing it. But the good news is we would rarely have to use inpatient commitment if we used Assisted Outpatient Treatment (AOT). That is what Torrey (and I) spend our time advocating for. AOT is a court order to stay in treatment as a condition of living in the community. It is less restrictive, more humane, less expensive than the alternatives: incarceration or inpatient commitment.
Because AOT deprives people of fewer liberties, a lower bar can be used to implement it. Basically if a person is SMI, previously been violent or multiply hospitalized, or become gravely disabled as a result of going off treatment, and is likely to do so again, then that person might be a candidate for AOT.
As to your argument that we don’t know what causes mental illness that therefore we shouldn’t treat it, I’m sorry, I’m just not buying it.
Mom’s are the front lines. I would hope you would join in preventing their loved ones from shooting them, and/or being offloaded to jails, shelters prisons and morgues. If you read one article, read this http://mentalillnesspolicy.org/media/bestmedia/uncivilliberties.html
“Laws should prevent violence, not require it.”
No. laws should punish violence, not pretend to anticipate it.
‘Minority Report’ is science fiction and so are psyche tests claiming to reliably predict violence.
“BRAIN DYSFUNCTION, PSYCHOSIS, which Dr. Torrey and others are talking about IS MALADAPTIVE!”
Only according to your circular definition.
I have a different take.
http://neurodrooling.wordpress.com/2013/05/23/psychosis-and-me/
“None of the proponents of involuntary treatment for severe cases are advocating that the checks and balances of the involuntary laws are not necessary”
In fact Dr Fuller Torrey has spent around twenty years at the Treatment Advocacy Center calling for ‘Kendra’s Law’ type reductions in precisely those checks and balances.
“Are you saying the fact of so many thousands and thousands of the severely mentally ill going off their medication at times even when they are stabilized is not evidence? ”
I’m saying that thousands of people refusing to take what passes for psychiatric pharmaceuticals is evidence that the mentally ill are not as crazy as those who presume to know what’s best for them.
Just because it says ‘antipsychotic’ on the pack doesn’t mean it is you know.
Oh, gees. Nobody is advocating that the halucinations from religious experiences or halucinations that don’t make one extremely maladaptive be grounds for involuntary treatment, which is what you are inferring with your link. So let’s put that nonsense aside.
As you well know and try to cloud, Torrey and others are talking about extreme situations where people are unable to take care of themselves, have a history of going off their meds and seriously deteriorating and may in some cases be violent. So your argument makes no sense, nor does the website you linked reflect a sensible conclusion.
Kendra’s law is about Assisted OUTPATIENT Treatment. Don’t cloud the issue with mixing it up with INPATIENT committment and the fact that what Torrey is trying to make easier is OUTPATIENT treatment, as opposed to institutionalization or living on the streets like an animal or in prisons, which is too often the result of what you are proposing, loss of freedom and dignity.
If you knew you had a condition where if you didn’t take your medication you knew that you would likely wind up being so maladapative that you’d be living on the streets, eating out of garbage cans and probably ending up in prison being further abused, would you really expect me or anyone else to believe that it’s a rationale choice reflecting sanity to turn down medicine that may give you side effects, medication that has proven to help many and yet you deny that fact?
No way any person would choose that kind of life-style unless they were somehow in complete denial of the consequences that would happen to them or they didn’t understand they need those meds to stay stable, which is exactly what Torrey is saying and you’re unsucessfully trying to twist.
And then in the most extreme and troubling cases, are you seriously telling me that if you knew that you or a family member would likely become violent (because of history of violence, not a nonspecific red flag as you are trying to infer), that you would advocate that they remain untreated until they seriously harmed themselves or committed suicide or seriously harmed someone else or killed them?
Actually, some may view that enablying someone to do violence by ignoring their medical need would make someone an accomplice in crime, perhaps murder.
Give me a break. Your argument against Torrey’s proposal is not based on fact, makes no sense, twists facts and is irrationale! You haven’t come up with one valid sensible argument against Torrey’s position, nor have you shown one way how a person with seriously mental illness incapable of taking care of themselves would be better off to be given the UNcivil right to choose to be psychotic.
The measure of a society is how it treats its most needy, those who cannot take care of themselves, and ignoring the needs of the severely mentally ill doesn’t say much for America or those who find irrationale excuses not to.
If Torrey’s lot were advocating what you claim they would be calling for greater public funding for *voluntary* outpatient treatment. There are plenty of people who actually want help ( though maybe not the sort Torrey and his Stanley Foundation funded cronies are offering) and can’t get it without shoving it down the throats of people who don’t.
But instead TAC spend all their time and considerable resources lobbying to remove the civil rights of people with a mental illness.
Some people find the meds useful and no-one is proposing taking them away against their will.
But many do *not* find their lives worthwhile on the pills and the side-effects can be *serious*. It is morally unconscionable to force that stuff on people who don’t want it simply because others are embarrassed by their eating habits (maybe we should be drugging people who destroy their health by eating at McDonalds and leave the garbage can grazers alone).
” are you seriously telling me that if you knew that you or a family member would likely become violent (because of history of violence, not a nonspecific red flag as you are trying to infer), that you would advocate that they remain untreated until they seriously harmed themselves or committed suicide or seriously harmed someone else or killed them? ”
Are you seriously telling me that if a non-crazy family member had a history of DV that you would demand intervention when they *aren’t* an immediate threat?
And if they are, what has being crazy got to do with it?
You could neutralise a potential domestic violence threat by keeping him stupefied on olanzapine against his will. Are you advocating laws that would allow that?
The simple fact of statistics is that people with psychotic illness are at only slightly increased risk of committing violence. Alcoholics are a much bigger risk. But people are *scared* of lunatics. They want to drug them to make themselves feel better.
“The measure of a society is how it treats its most needy, those who cannot take care of themselves, and ignoring the needs of the severely mentally ill doesn’t say much for America or those who find irrationale excuses not to.”
And the sort of society that would treat its most needy by increasing their stigmatisations, exaggerating the danger they represent and seeking to take away their civil rights is *sick*.
As far as I know the US is alone among developed countries in heading in this retrograde direction, as they are in so many other social indicators.
@cabrogal
Your viewpoint that you don’t believe that the severely mentally ill EVER need mandatory treatment, regardless of their ability to take care of themselves, regardless of their safety, regardless of the fact that some may be violent, regardless of the cost or safety to anyone else is quite clear.
It’s also quite clear that you haven’t given one valid argument to show how the severely maladaptive severely mentally ill would be better off being left to choose to be untreated. All you have given in argument is innuendos about others, twisted facts, twisting of issues and denial of the inability of some of the severely mentally ill to take care of themselves and denial of the fact that some of them can be violent and have been violent and their violence could be avoided if they were treated and denial of the fact that the vast majority of them have proven to be helped with treatment.
Rather than sounding like someone who is sincerely discussing how to make the lives of the severely mentally ill better, in continuing to do this your words sound more like those of an Internet troll looking to cause chaos rather than add to an intelligent discussion.
“In Internet slang, a troll (/ˈtroʊl/, /ˈtrɒl/) is a person who delights in sowing discord on the Internet by trying to start arguments and upset people.[1]. They may do this by posting deliberately inflammatory,[2] extraneous, or off-topic messages in an online community, such as a forum, chat room, or blog, with the primary intent of provoking readers into an emotional response[3] or of otherwise disrupting normal on-topic discussion.”
So troll away if that’s what turns you on rather than having an intelligent discussion, but don’t expect anymore responses unless and until you chose to discuss this subject intellectually and in a manner that shows that you are sincerely concerned as to what happens to the severely mentally ill and their families.
You might check the timings of the posts on this thread Ms Bodtmann.
I made a rational and human rights based argument against the ongoing forced psychiatric abuse of those with psychotic illness and was met by a series of emotive posters claiming that mothers would be shot if more such abuse wasn’t allowed.
If there is a victim of trolling here it is I.
You constantly return to the alleged threat of violence by the mentally ill when I’m sure that you know as well as I do that any increase in such risk is trivial. You are meeting reasoned argument with hysterical stigmatisation of the mentally ill. The very stigmatisation that leads *them* to become victims of violence at a non-trivial rate.
You argue for the forced administration of treatments that I’m sure you know do not help the majority of sufferers (according to their own evaluation), reduce life expectancy and have a host of unpleasant side effects – including paradoxical violent side effects in some cases.
Treatments that do not help the patients but merely make them more amenable for carers are abusive and a breach of the Hippocratic oath.
My viewpoint is that the severely mentally ill (or anyone else for that matter) might make advanced directives that allow them to be forcibly restrained and/or administered medication under certain circumstances. Or advanced directives that deny it under all circumstances. Unless they actually break the law those directives should be respected.
No-one else should have the right to forcibly restrain or drug someone who has broken no law.
You said: “How can we distinguish between eccentric behavior and brain dysfunction.”
Well, let’s start with common English language definitions:
Eccentric behavior: In popular usage, eccentricity (also called quirkiness or kookiness) refers to unusual or odd behavior on the part of an individual. This behavior would typically be perceived as unusual or unnecessary, without being demonstrably maladaptive.
And then there’s the brain dysfunction that Dr. Torrey and others speak about that manifests itself in the form of psychosis. So let’s define psychosis:
Psychosis (from the Greek ψυχή “psyche”, for mind/soul, and -ωσις “-osis”, for abnormal condition or derangement) refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is the term given to the more severe forms of psychiatric disorder, during which hallucinations and/or delusions, violence and impaired insight may occur
Let’s take one more definition, Maladaptive:
Maladaptive behavior is a type of behavior that is often used to reduce one’s anxiety, but the result is dysfunctional and non-productive.
So eccentric behavior is NOT MALADAPTIVE and is not what Dr. Torrey and others are talking about, but the BRAIN DYSFUNCTION, PSYCHOSIS, which Dr. Torrey and others are talking about IS MALADAPTIVE!
So I don’t buy your argument that these conditions can be confused, nor do I buy your argument that eccentric people and others are at threat of losing their freedom with all the checks and balances that now exist in the involuntary commitment laws when someone is involuntarily committed to confirm the original diagnosis of severe psychosis with multiple experts and needed court approvals for longer term holds.
None of the proponents of involuntary treatment for severe cases are advocating that the checks and balances of the involuntary laws are not necessary, but rather that the severely mentally ill, the psychotic, are being allowed to walk around untreated to their own detriment and the possible detriment of others because of our messed up laws instead of being compassionately treated, nor are they proposing that the eccentric be involuntarily treated.
Your argument sounds more to me like fear-mongering rather than a valid argument.
You also say: “In my view, unless and until there is clear scientific evidence for the biological basis of these illnesses outside of their psychotic episodes and for anosognosia as a symptom, Torrey’s objection must be rejected.”
Let me make sure I understand your above statement. Are you saying that the witness of thousands upon thousands of the severely mentally ill and their families and their medical providers is not evidence? Are you saying the fact of so many thousands and thousands of the severely mentally ill going off their medication at times even when they are stabilized is not evidence?
Are you saying they are all lying or that thousands and thousands of the severely mentally ill, even when they are stabilized, are choosing to be psychotic?
I don’t buy it and I pray that others don’t buy it or enable continued harm to the severely mentally ill!
Of course in the sort of world Dr Torrey and Mr Jaffe advocate for there would be thousands of non-compliant psychotics and prodromal psychotics all living underground trying to avoid variations of Kendra’s law and therefore getting no treatment or support whatsoever.
Presumably mental health police with extensive budgets and powers would be required to detect and apprehend such people.
It’s easy to make involuntary commitment a controversial issue unless you’re a parent or any other person that loves someone who needs it. Someone who is floridly psychotic and unaware that they are psychotic, believing whatever delusions they are having shouldn’t be denied medical care anymore than someone who needs CPR or is having a heart attack. We don’t allow dogs to roam the streets eating out of trash cans but we allow humans to do that because we don’t want to trample on their civil rights? Really?
Why do the people flogging forced psychiatric treatment always resort so quickly to emotional blackmail like “unless you’re a parent or any other person that loves someone who needs it” or “Mom’s are the front lines. I would hope you would join in preventing their loved ones from shooting them” – as if people who don’t approve of the forced psychiatric abuse of people don’t care about them or approve of dead Moms?
Some of us also have loved ones and even personal experience of mental illness that inform our opinions too you know. We just don’t wield them as rhetorical trumps as if it somehow justifies removing their rights and imposing a mental health police state.
“shouldn’t be denied medical care anymore than someone who needs CPR or is having a heart attack.”
And they shouldn’t lose their right to decline medical care anymore than someone with a heart condition either. Especially when the ‘care’ is little more than forced sedation – the chemical adjunct to handcuffs, tasers and nightsticks.
“We don’t allow dogs to roam the streets eating out of trash cans but we allow humans to do that …”
Because, unlike dogs, humans have rights as individuals in our society.
Even crazy ones.
We don’t put them down for straying without a tag either, but there are still some who are happy to treat stray humans like dogs, locking them in pounds and sedating them when they’re too much trouble.
It’s unfortunate that you think the love a mother has for her child is equal to emotional blackmail or that saying we love our children is rhetoric. I love my child and will continue to do anything necessary to make sure she gets the medical care she needs until the day I die, regardless of people who think she shouldn’t have it because I find the argument against her care nothing but cruelty.
I live in a state with a fantastic involuntary treatment law. According to your rhetoric that means we have “forced psychiatric treatment”. Yet, my child was on involuntary treatment for a couple of years before anything was ever forced. Your rhetoric (and I believe this article) leaves out lacking capacity.
At age 17, my child was sick and every legal and ethical argument would say I had to make sure she got medical care, in most states. I know some states allow people as young as 14 to deny medical care, but not where I live. When she’s 18 if I do the same thing, I want her sedated because she’s “too much trouble”? And you accuse me of emotional blackmail?
There are some people who are actually helped by the drugs, though the bulk of these would be helped equally by a placebo if trial data is anything to go by.
There are many others who are not helped by the drugs and still suffer their substantial side effects.
And there are some who experience the drugs as both physical and emotional torture.
Those on long term antipsychotics suffer substantial reductions in health and life expectancy so you need to be quite sure that what you’re getting from them is worth it.
Your daughter is the only person who knows what effect the drugs have on her.
She is also the only measure of what is desirable or not about her own mental state(s).
Nothing you can say about how sick she is gives you a better window into her mind than the one she has herself.
Giving her treatment she wants is medical care.
Giving her treatment she doesn’t want is abuse.
As I said above:
@cabrogal
Your viewpoint that you don’t believe that the severely mentally ill EVER need mandatory treatment, regardless of their ability to take care of themselves, regardless of their safety, regardless of the fact that some may be violent, regardless of the cost or safety to anyone else is quite clear.
If it gives you some sort of satisfaction to keep on pursuing your viewpoint with disregard to all known facts or the consequences, TROLL AWAY!
My daughter is the only one who knows what the meds (that’s what we call them) have on her, huh? Well, that is true. But she does share that information with me & her doctors so we know too. And without a mechanism for involuntary treatment, she wouldn’t know what effects they have because she’d be dead. A substantial reduction in life expectancy is better than no life & so are the side effects. After reclaiming her sanity, my daughter is able to make that decision for herself, no thanks to what you & this author would prefer. My family will keep doing things our way…but thanks anyway.
If your daughter is making an advance directive for treatment while not psychotic and you and the doctors are merely following her instructions at a time she is not capable of giving them – more power to you.
But that sort of thing should be covered by advance treatment directives in the same way that anyone else might make them for the event of, say, falling into a coma.
There is no call whatsoever for Kendra’s Law type forced treatment legislation to achieve this.
cabrogal- I have never heard of someone having to make an advanced treatment directive to receive care if they fall into a coma. It is more common to make an advanced treatment directive if you don’t want care. You are correct though, we shouldn’t need involuntary treatment laws to treat someone who has clearly been rendered incompetent by a brain disorder, but we do. You bring up a good point about following the patient’s instructions….this is why the family voice is so important. You tell me my daughter was being abused by undergoing involuntary care, even though you don’t know her. I, and everyone who loves her, knows that if we were to allow her to live in a delusional state, she would have felt neglected, unloved and would have never forgiven us. So we’ve never needed an advanced directive. Since she regained her sanity, she affirmed that we were correct. If I thought my daughter would have preferred to remain so highly symptomatic, I would have been her biggest supporter in allowing her to do so. I can only assume that even without an advanced directive, your family knows you’d rather stay psychotic and are willing to speak up on your behalf if necessary.
Even in states that have these laws, calling it forced treatment is really disingenuous. There is always a competency issue. Even where I live, again, there is no force until the person repeatedly proves that they are not going to gain competency any other way. The arguments against taking care of people who are seriously mentally ill and lack competency are cruel and don’t make any sense. If you want you or your family members to have to remain psychotic…more power to you. Leave the rest of alone. I won’t be coming back here to make any more comments.
“It would probably be difficult to find any American psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person’s behavior to obtain a judicial order for commitment.” – E. Fuller Torrey, 1997. ‘Out of the Shadows: Confronting America’s Mental Illness Crisis.’