if you knew that the fear of involuntary treatment might dissuade someone
from getting help?
to commonly held misconceptions, many people who have mental illness are
capable of making their own treatment decisions.
In the 2001
Treatment Competence Study, most patients hospitalized with a serious
mental illness were able to make treatment decisions similar to those
of persons without mental illness. The study's researchers assessed and
compared the decision-making abilities of hospitalized patients who had
schizophrenia or major depression, patients who had heart disease, and
nonpatients in the community. While the researchers found some level of
impairment in decision-making abilities among schizophrenic patients who
had more severe psychiatric symptoms, they also concluded that "taken
by itself, mental illness does not invariably impair decision-making capacities."
was forcibly drugged and placed in solitary confinement. I was
so upset, frustrated and frightened. That's when I resolved to
become a psychiatrist. I thought, 'If I ever get out of this,
I'm going to unlock these doors and provide help in a way that
I wish someone had been there for me.'"
Dan Fisher, consumer advocate and commissioner on President Bush's
New Freedom Commission on Mental Health, quoted in the Los
Angeles Times, March 19, 2001
Still, many assume that people with mental illness who choose not to take
certain medications or treatments must be incapable of making sound choices.
Historically, that view resulted in the institutionalization of hundreds
of thousands of people with mental illness. Five-minute commitment hearings
sometimes turned into years-long sentences at psychiatric wards and state
hospitals, where electric shock treatment and inhumane living conditions
were often exposed.
... I arrived in a small section of an upper floor. I would disrobe
and don a hospital gown. A nurse would grease my temples and adjust
the electrodes to either side while I lay on a gurney. Then she
would wheel the black box up to the gurney and plug in, and, together
with the three male attendants hold me down while the doctor,
arriving at the last second, twirled the rheostat. There would
be a painless flash like a bad dream that goes pop. It was more
frightening in contemplation before and after. After a shock I
would come to, groggily struggling over a footrail of one of 20
beds touching sides. An attendant steadied me the first time,
until he was sure I could stand alone, a matter of five seconds."
from Insanity Inside Out, by Kenneth Donaldson, who was
involuntarily committed to a Florida psychiatric ward for 15 years
the 1960s, the Civil Rights movement helped inspire mental health patients
to organize and take back the control over their lives that they felt
they had been robbed of by the medical and psychiatric establishments.
Laws were adopted prohibiting involuntary treatment unless a person posed
a serious danger to himself or others, and thousands of mental health
patients were released from state hospitals.
Today, fear of involuntary treatment is the very thing that continues
to drive underground many people who need help. The Well-Being Project,
a 1989 study of mental health consumers, found that 47 percent of people
interviewed had avoided mental health treatment on one or more occasions
because they feared being involuntarily committed. The figure was even
higher among consumers who had already experienced involuntary commitment.
the State fence in the harmless mentally ill solely to save its
citizens from exposure to those whose ways are different? One might
as well ask if the State, to avoid public unease, could incarcerate
all who are physically unattractive or socially eccentric. Mere
public intolerance or animosity cannot constitutionally justify
the deprivation of a person's physical liberty."
Potter Stewart, U.S. Supreme Court, in the court's opinion of Donaldson