[D66] When Psychiatric Treatment Isn’t Voluntary

[René Oudeweg]

psychologytoday.com 
<https://www.psychologytoday.com/us/blog/side-effects/202303/when-psychiatric-treatment-isnt-voluntary> 



  When Psychiatric Treatment Isn’t Voluntary

Christopher Lane, Ph.D., is a Professor Emeritus of Medical Humanities 
at Northwestern University.
10–13 minutes
------------------------------------------------------------------------

Source: BenBella Books

Source: BenBella Books


    A timely new book on why the number of involuntary detentions is
    skyrocketing.

Posted March 31, 2023 | Reviewed by Tyler Woods 
<https://www.psychologytoday.com/us/docs/editorial-process>


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“This isn’t a book about mental illness or the mentally ill,” Rob Wipond 
tells me over email about his eye-opening investigation,/Your Consent Is 
Not Required: The Rise in Psychiatric 
<https://www.psychologytoday.com/us/basics/psychiatry> Detentions, 
Forced Treatment, and Abusive Guardianships /(BenBella Books, 2023). 
“It’s a book about the expanding uses of mental health laws throughout 
society on people from all walks of life.”

Though most studies of psychiatry focus on voluntary, outpatient 
treatment to assess impacts on the largest number of patients, the rates 
of North Americans detained involuntarily—including by civil 
commitments, crisis calls, and police “wellness” checks—are more than 
double and triple those in the U.K., Sweden, Finland, Germany, and France.

In Florida, for example, during the years 2001-2016, the number of 
detainees doubled to almost 200,000, outstripping population growth by a 
factor of five. In California, Wipond adds, “per capita rates of 
psychiatric detentions for three-day periods increased about 30 percent 
between 1991 and 2016, surpassing 150,000 annually.” Meanwhile in 
Colorado, as in neighboring states, “emergency psychiatric detentions 
from 2011 to 2016 nearly doubled to 39,000.”

“Every day in Florida,” the /Washington Post /confirmed earlier this 
month 
<https://www.washingtonpost.com/education/2023/03/16/florida-law-child-mental-health/>, 
“children and adolescents are involuntarily committed for psychiatric 
assessments under the Baker Act, a 1971 law. In 2020-21, involuntary 
exams happened more than 38,000 times to children under 18—an average of 
more than 100 a day and a nearly 80 percent increase in the past decade, 
according to the most recent data. The law is so deeply enmeshed into 
the state’s culture that it is widely used as a verb, as in: The 
6-year-old was ‘Baker Acted.’”


    “We help more people than we hurt”

To the question, “Does forced treatment improve mental health?,” in one 
of the 28 chapters in Wipond’s book that takes us from “blindingly 
brisk” courtroom hearings to harrowing “wellness” checks and 
near-inescapable guardianships, he can answer with a clear and decisive 
“no.”

Despite administrators hoping to reassure him that “the system is 
well-intentioned,” that “we help more people than we hurt,” and that 
“from our end, we really are doing our best to help our patients and our 
best to promote good practice and good care,” Wipond’s comprehensive 
study unearths health and social services replete with poor-to-dreadful 
outcomes, lax oversight, and protocols seemingly rigged against those 
most in need: the vulnerable, destitute, and marginalized.

Far from being able to point to improvements in patient outcomes, /Your 
Consent Is Not Required /describes a series of “better-safe-than-sorry” 
decisions and “I-know-it-when-I-see-it” diagnoses and managerialism that 
funnels people into forced treatment, with the consequence that staff 
sometimes begin to “feel they have this right to administer any type of 
intervention,” while those detained are forced to be submissive and 
“compliant”—to consent to treatment, frequently by sedatives, 
antidepressants <https://www.psychologytoday.com/us/basics/ssris>, and 
antipsychotics 
<https://www.psychologytoday.com/us/basics/psychopharmacology>, even 
when unwanted. In the case of Wipond’s father, and over the objections 
of family, the treatment extended to electroshock therapy 
<https://www.psychologytoday.com/us/basics/therapy>, or ECT.

“That’s what bothers me the most, even more than my father’s death,” one 
interviewee tells him of her father’s forced treatment for mild dementia 
<https://www.psychologytoday.com/us/basics/dementia>, on drugs to which 
he had a “severe adverse reaction,” after 11 days in psychiatric 
detention mean her once-functional father is discharged “in diapers on a 
gurney.” “The violation of his agency, his integrity. The more he tried 
to assert his rights, the more he was accused of not making sense.”

“Your normal reaction as a citizen, or a human being, is to get angry,” 
another interviewee affirms of the repeat police visits he endures, “and 
tell them to get the hell out of your apartment. But you’re afraid to 
actually get angry, because you’re sure they’ll use that against you. 
It’s degrading. I felt intimidated, and afraid. It was the fact that 
they could just come like that at any time, bang on your door, charge 
in, and possibly haul you away.”


    “Everything I did was pathologized”

Across multiple health authorities and jurisdictions, Wipond determines 
that the “line between well-intentioned, responsible professionalism and 
potentially harmful abuse” is often hazy and unclear. Among his dozens 
of cautionary examples is Frances Chan, an Asian-American professional 
who “went for a breast-cancer check-up at Yale University’s clinic, then 
had to force-feed herself junk food for weeks because doctors felt her 
natural stature was too slim.”

Facing similar intransigence and discrimination 
<https://www.psychologytoday.com/us/basics/bias> is Kamilah Brock, a 
Black woman who, after “arguing with a New York police officer after her 
impounded vehicle was apparently lost, was committed for nine days. The 
police officer had doubted she actually owned an expensive BMW, and one 
of the jurors in her failed lawsuit later said to media that Brock 
showed too much ‘grandiosity’ in touting her life and career 
<https://www.psychologytoday.com/us/basics/career> accomplishments.”

Under psychiatric detention, Wipond cautions, “you do not have the right 
to remain silent. Refusing to answer a psychiatrist’s questions, even 
about your most intimate inner experiences, can be and often is 
considered evidence of a mental disorder.”

With police questioning added to already stressful 
<https://www.psychologytoday.com/us/basics/stress> situations, events 
can quickly escalate: “If you’re too vocal, if you’re not vocal enough, 
if you cry, if you don’t cry, if you say you’re getting lawyers, if you 
ask to read the paperwork too much—any of it confirms your mental health 
diagnosis. You’re crazy, you’re wrong, you’re misinterpreting, you’re 
overreacting. There’s a lot of room for things to be recontextualized as 
symptoms of mental disorders.”

Wipond’s powers as an investigative journalist frequently collide with, 
but sometimes also overcome, the determined stonewalling of health 
authorities. He tells me, relatedly, that “community-based journalism 
was very helpful for the book, because I think one can only see how much 
of our society is permeated by the mental health system and coercive 
treatment if one is looking into all the nooks and crannies of some 
communities, as I was doing.”

/Your Consent Is Not Required/ opens with a powerful account of the 
forced treatment of Wipond’s father, who says one day he feels like the 
ceiling of the house is “caving in on him.” An attending psychiatrist 
advises that he has “a biochemical imbalance, like diabetes or a broken 
leg but in his brain.” Later, when the drug treatments fail, the family 
is told that ECT is “like a heart defibrillator” that “jolts the 
depressed <https://www.psychologytoday.com/us/basics/depression> brain 
back to life.” “I don’t want it,” Wipond’s father is firm and resolute, 
“his voice barely audible over the telephone. ‘I don’t want it,’ Dad 
said, more feebly. The psychiatrists scheduled the ECT.”

When the new treatment leaves Wipond’s father disoriented, with memory 
<https://www.psychologytoday.com/us/basics/memory> loss, more 
electroshocks are proposed. “We normally do 12 rounds at a time,” the 
physician in charge explains. An attendant nurse reaches for a 
more-routine analogy: “It’s like we’re trying to fill a gas tank, and 
nine rounds didn’t quite fill the tank.”


    “A Massive Curtailment of Liberty”

In 1972, the U.S. Supreme Court recognized psychiatric detention as “a 
massive curtailment of liberty 
<https://supreme.justia.com/cases/federal/us/405/504/>” (/Humphrey/ v. 
/Cady/) and, in 1978, argued that a law-abiding citizen should be able 
“to protect one’s mental processes from governmental interference 
<https://law.justia.com/cases/federal/district-courts/FSupp/462/1131/2142341/>” 
(/Rennie/ v. /Klein/).

Nevertheless, in 1979 the Court voted to lower the standards of evidence 
required for civil commitment, ruling that it is worse for “a mentally 
ill person to ‘go free’ than for a mentally normal person to be 
committed <https://supreme.justia.com/cases/federal/us/441/418/>” 
(/Addington/ v. /Texas/). Yet detention was considered permissible only 
when a person presents an immediate and “serious risk of physical harm”; 
involuntary drugging should also be considered only after other 
therapeutic options have been offered.

That, at least, was the Court’s ruling. The reality, shared by Wipond’s 
traumatized interviewees, appears quite different. “I went looking for 
evidence,” Wipond writes, “that forcibly treating people in psychiatric 
hospitals improves their mental health or has other positive outcomes 
for them, over the short or long term. I found a well-worn trail of 
people who’d gone before me, all coming up empty-handed.”

For instance, a 2007 review of studies of people’s experiences of 
involuntary hospitalization by University of London psychiatrists 
“identified many negative themes: views and voices ignored, feeling 
dominated under strict rules, physical violations, frustration, and 
powerlessness. People often felt the treatment they received was 
meaningless, not appropriate, and more like punishment 
<https://www.psychologytoday.com/us/basics/punishment>.”

A 2016 study in /PLOS One/ summed up the larger issue: “Despite the 
widespread use of coercive measures...there is a remarkable lack of 
empirical evidence as to their association with treatment outcomes.”

“This has ruined our lives,” an adult daughter explains after her mother 
is hounded by intransigent Canadian health authorities acting on 
protocols, to the point of compelling her to live off-grid and 
undercover, to flee their control and jurisdiction. “It’s been a year of 
hell for us. Financially, it’s insane. Just our time, our family, 
everything. It’s been overwhelming.”


    “We think people should be treated better”

Amid the decisions leading to forced treatment, with mounting evidence 
that psychiatric hospitalization can itself be suicidogenic, what 
reforms are possible?

“There are so many ways,” explains Sam Tsemberis, a psychologist tied to 
UCLA and the agency Housing First, “that we can work with people who 
have symptoms to manage their lives much better on their own terms.” 
Adds Kimberly Comer, former director of the National Alliance on Mental 
Illness (NAMI) for Greater Indianapolis: “There are ways to empower 
somebody to get treatment without having to traumatize them.”

Among Wipond’s recommendations for root-and-branch reform: “providing 
stronger, more independent, and transparent oversight, and making 
regulators more arm’s-length from facility operators’ and governments’ 
inherent conflicts of interest.” He adds, as a proposal: “Supported 
decision-making 
<https://www.psychologytoday.com/us/basics/decision-making> alongside 
psychiatric advance directives (PADs) could allow people to outline the 
interventions they’d want in a crisis.” Though he concedes psychiatrists 
will balk at the suggestion, he thinks psychiatry should “simply be an 
offered service,” among others, rather than the diagnostic and treatment 
regimen that determines all others.

Above all, Wipond cautions in extrapolation, “If the line between 
voluntary client and involuntary patient [is] so thin, shouldn’t we be 
more careful about advising people in vulnerable emotional states to 
‘seek help’”—particularly if we knew in advance, from evidence such as 
his, where it is likely to take them?
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