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<h1 class="reader-title">When Psychiatric Treatment Isn’t
Voluntary</h1>
<div class="credits reader-credits">Christopher Lane, Ph.D., is
a Professor Emeritus of Medical Humanities at Northwestern
University.</div>
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<p><img alt="Source: BenBella Books"
src="https://cdn2.psychologytoday.com/assets/styles/article_inline_half_caption/public/field_blog_entry_images/2023-03/your-consent-is-not-required%20(1300px).jpg?itok=YdEipWyz"
title="Source: BenBella Books"
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height="480"></p>
<p>Source: BenBella Books</p>
<h2 class="blog-entry__subtitle--full"> A timely new
book on why the number of involuntary detentions is
skyrocketing. </h2>
<p class="blog-entry__date--full fine-print"> Posted <span
class="blog_entry--date">March 31, 2023</span> <span
class="blog_entry--full__review-info"> <span
class="blog_entry--full__review-info-bar">|</span>
<a
href="https://www.psychologytoday.com/us/docs/editorial-process"
class="blog_entry--full__review-info-link"> <span
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<span class="blog_entry--full__review-info-text">Reviewed
by Tyler Woods</span> </a> </span> </p>
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<p>“This isn’t a book about mental illness or the mentally
ill,” Rob Wipond tells me over email about his
eye-opening investigation,<em> Your Consent Is Not
Required: The Rise in <a
href="https://www.psychologytoday.com/us/basics/psychiatry"
title="Psychology Today looks at Psychiatric"
hreflang="en-US">Psychiatric</a> Detentions, Forced
Treatment, and Abusive Guardianships </em>(BenBella
Books, 2023). “It’s a book about the expanding uses of
mental health laws throughout society on people from all
walks of life.”</p>
<p>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.</p>
<p>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.”</p>
<p>“Every day in Florida,” the <em>Washington Post </em><a
href="https://www.washingtonpost.com/education/2023/03/16/florida-law-child-mental-health/">confirmed
earlier this month</a>, “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.’”</p>
<h2>“We help more people than we hurt”</h2>
<p>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.”</p>
<p>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.</p>
<p>Far from being able to point to improvements in patient
outcomes, <em>Your Consent Is Not Required </em>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, <a
href="https://www.psychologytoday.com/us/basics/ssris"
title="Psychology Today looks at antidepressants"
hreflang="en-US">antidepressants</a>, and <a
href="https://www.psychologytoday.com/us/basics/psychopharmacology"
title="Psychology Today looks at antipsychotics"
hreflang="en-US">antipsychotics</a>, even when
unwanted. In the case of Wipond’s father, and over the
objections of family, the treatment extended to
electroshock <a
href="https://www.psychologytoday.com/us/basics/therapy"
title="Psychology Today looks at therapy"
hreflang="en-US">therapy</a>, or ECT.</p>
<p>“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 <a
href="https://www.psychologytoday.com/us/basics/dementia"
title="Psychology Today looks at dementia"
hreflang="en-US">dementia</a>, 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.”</p>
<p>“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.”</p>
<h2>“Everything I did was pathologized”</h2>
<p>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.”</p>
<p>Facing similar intransigence and <a
href="https://www.psychologytoday.com/us/basics/bias"
title="Psychology Today looks at discrimination"
hreflang="en-US">discrimination</a> 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 <a
href="https://www.psychologytoday.com/us/basics/career"
title="Psychology Today looks at career"
hreflang="en-US">career</a> accomplishments.”</p>
<p>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.”</p>
<p>With police questioning added to already <a
href="https://www.psychologytoday.com/us/basics/stress"
title="Psychology Today looks at stressful"
hreflang="en-US">stressful</a> 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.”</p>
<p>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.”</p>
<p><em>Your Consent Is Not Required</em> 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 <a
href="https://www.psychologytoday.com/us/basics/depression"
title="Psychology Today looks at depressed"
hreflang="en-US">depressed</a> 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.”</p>
<p>When the new treatment leaves Wipond’s father
disoriented, with <a
href="https://www.psychologytoday.com/us/basics/memory"
title="Psychology Today looks at memory"
hreflang="en-US">memory</a> 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.”</p>
<h2>“A Massive Curtailment of Liberty”</h2>
<p>In 1972, the U.S. Supreme Court recognized psychiatric
detention as “a <a
href="https://supreme.justia.com/cases/federal/us/405/504/">massive
curtailment of liberty</a>” (<em>Humphrey</em> v. <em>Cady</em>)
and, in 1978, argued that a law-abiding citizen should
be able “to <a
href="https://law.justia.com/cases/federal/district-courts/FSupp/462/1131/2142341/">protect
one’s mental processes from governmental interference</a>”
(<em>Rennie</em> v. <em>Klein</em>).</p>
<p>Nevertheless, in 1979 the Court voted to lower the
standards of evidence required for civil commitment,
ruling that it is worse for “<a
href="https://supreme.justia.com/cases/federal/us/441/418/">a
mentally ill person to ‘go free’ than for a mentally
normal person to be committed</a>” (<em>Addington</em>
v. <em>Texas</em>). 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.</p>
<p>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.”</p>
<p>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
<a
href="https://www.psychologytoday.com/us/basics/punishment"
title="Psychology Today looks at punishment"
hreflang="en-US">punishment</a>.”</p>
<p>A 2016 study in <em>PLOS One</em> 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.”</p>
<p>“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.”</p>
<h2>“We think people should be treated better”</h2>
<p>Amid the decisions leading to forced treatment, with
mounting evidence that psychiatric hospitalization can
itself be suicidogenic, what reforms are possible?</p>
<p>“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.”</p>
<p>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 <a
href="https://www.psychologytoday.com/us/basics/decision-making"
title="Psychology Today looks at decision-making"
hreflang="en-US">decision-making</a> 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.</p>
<p>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?</p>
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