Dear Sister, please take your lithium.

The BBQ Pit
41

So who decides when a person should have a competency hearing?

AHunter3, I didn’t mean to imply that a mentally ill person is more likely to carry out a violent threat than a non-mentally-ill person. But I think that the matter is more complicated in the case of the former. Certain kinds of mental illness could lead someone to threaten the people who are most dear to them, whom they would normally never dream of hurting. So I think the actual danger is different - it’s more temporary, for one thing.

Anyway, what happens when a non-mentally-ill person makes this kind of threat?

42

Technically speaking, when the average citizen threatens violence, they are committing a crime, and the threatened person is entitled to an Order of Protection. In practice, based on my experience as an elder abuse social worker, where some of the abusers were non-relatives, criminal court will not issue an OOP unless actual damage has already been done.

In the case of family members, Family Court is an option, and Family Court is far more disposed towards issuing an OOP as a preventative measure when threats have been received.

Chas E could, for example, get an OOP against his abusive sister. It would not get her into any trouble until and unless she violates it, but if she does violate it, she is arrestible long after the fact (e.g., hours after she quits waving sharp knives around or making threats of violence) for having violated the OOP. In most states, as a result of spousal abuse issues, the system takes over at that point, i.e., charges are pressed automatically, but it would still be up to witnesses to testify. Family Court judges rely on their own (often overly lenient) judgment but tend to escalate the penalties rapidly for repetitive violations.

In my opinion, Criminal Court needs to make better provisions for being able to obtain an OOP against one’s abusive neighbors and other non-relatives. I do not mean to claim that the criminal justice provides perfect and universally adequate protection. But, by God, let’s have some equal protection under the law here, and if the laws need fixing, fix them for everyone. If Derleth wants violent people locked up forever unless they agree to being shot up with Prolixin, he should get mandatory sentencing laws for violent crimes enacted, but don’t single us out for having a psychiatric diagnosis.

IANAL, but I believe anyone can make an application regarding anyone else, alleging incompetence; they may also be able to apply to be guardian themselves, or, if there is no connection to the person involved, prompt the state to pursue the possibility itself. Any attorneys visiting this thread, please consider yourself invited to clarify and correct as need be.

The most common targets are folks’ parents or grandparents in situations where the elder person does not wish to turn over control of the finances / keys to the car / ownership of the family business and the younger person either believes the elder is no longer capable of assessing situations and making choices or else thinks when parents get old they oughta at least hand over the goodies and get out of the way, if they going to insist on refraining from dying like old folks should.

The job of the court is to distinguish between these situations and determine whether the allegedly incompetent person is indeed incapable of coping with life’s situations and decision-making opportunities.

43

Thanks, AHunter3, that was very informative.

44

Derleth,
I object to your use of the term “urine-soaked hellhole”, when you could have used the term “pee-pee-soaked heckhole”.

(D&R)

45

AHunter3, let me summarize my points in a painfully clear way: Anyone convicted of a crime, especially a violent crime, who has been adjudged mentally ill by a competent court, shall receive any treatment a competent physician prescribes, by force if necessary. The commission of the crime has reduced that person’s right to self-determination by showing him or her to be a danger to the people around him or her. The right to self defense, the fundamental right from which the government derives its power to punish in the case of criminal law, trumps any right the convicted (not accused, not suspected, convicted) has to refuse treatment. Punishment has been converted into therapy as an act of human kindness. If the convicted does not comply with treatment, the government has the power to place the convicted in a place where compliance can be forced.

Or, to put it more simply: If you do the crime, we, the people, have the right, and our duly appointed representative government has the power, to render you nonthreatening. IT IS THAT SIMPLE. Therapy is a humane alternative to, say, execution. This society likes helping people, as opposed to just lining them up and shooting them. The pump, indeed, the very idea of court-ordered therapy, is an expression of that. But it is the legal consequence of committing a crime, even if it is not punishment. Refusing it is on a level with saying serving prison time is optional.

I have gone back to first principles (self-defense), I have explained the purpose of the pump (a more humane alternative to warehousing the ill in state institutions or prisons), and I have gone to the bedrock of my own thoughts on the issue (Self-defense trumps your right to refuse medicine.). If you cannot understand my postion now, there is no reason to continue this debate.

46

Underlining mine.

I’ve been following this debate since the beginning, and I did not see this point in your previous posts. Now I have a very specific question for you. Suppose a convicted felon has been diagnosed “mentally ill” by a psychiatrist but has not been found legally incompetent. Would you support forced therapy of this person?

47

ultrafilter:
If the therapy would help him, I would advocate it as an alternative to punishment. He should be given the choice of taking the medicine or serving the prison time. You see, as long as he is competent, he has that option: Medication or prison.

You would have a tough time convincing me that someone who is mentally ill and has been convicted of a violent crime is competent, but I’m not medically trained.

And I have been making that point all along, but perhaps not that clearly. For example, I said:

(emphasis added later) right above this post. It would make no sense to give the treatment to someone who is not mentally ill.

(And, of course, that does not preclude its use if the patient wants it, but that point has become tangental to the current thread.)

48

That is reasonable.

If you’ve committed a crime, they don’t have the right to force you to take drugs, but they CAN damn well offer you freedom on their terms (you take the drugs) in lieu of you serving out your full sentence. If you can’t do the time (or the pills) don’t do the crime.

Derleth, is this is what you were saying all along, please accept my apologies as I clamber down from this soapbox.

49

AHunter3, at the risk of taking this thread out to even further lengths, that is not what I meant. I said:

Note the conditional: ‘As long as he is competent’. If the psychologist judges him incompetent to decide his best interests, he obviously cannot choose whether or not to take the medication. Our prisons are already overcrowded. Medication is the humane option in that case, and would be regardless of the state of our penal system. Throwing people in prison simply because they are not capable of deciding that medicine would help them is barbaric. That is the concept behind court-ordered treatment.

50

now, i’m not bipolar, but my best friend in college is.

as in hospitalised last year for 6 weeks, and every autumn for the past 3 years.

as in being deported from the US after a manic episode in JFK airport involving 6 cops having to restrain her.

as in only being diagnosed last year.

as in taking lithium…

as in not having side effects (other than thirst and the odd strange drug interaction with antibiotics)

as in totally normal.

as in she’s completing her medical degree.

as in i spent a month backpacking around europe with her.

lithium doesn’t always work…but when it does…

i also have a team mate who is bipolar.

he is also taking lithium…when he can be bothered.

he is manic about 25% of the time, even on his optimum dose.

and flat the rest of the time.

so when it doesn’t work… it doesn’t work.

so i am sorry about your sister and her problem, i’m sorry she acts like an asshole, and that it affects your niece.
because i know that you find it much nicer to be around her when she is acting normally.

i know it isn’t easy, but pushing her away only compounds the issue.

for what it’s worth

all the best

irishgirl

51

Derleth:

Psychologists don’t determine competency. It isn’t a psychological question, it is a legal question. It is handled in the traditional adversarial courtroom manner, and the person whose incompetency is alleged gets the opportunity to present the case to the contrary. It is ruled upon by an impartial judge.

I am not only not a lawyer, I am also not a criminal justice expert, but I do not believe that any of this changes if one has been convicted of a crime, although of course a person’s rights (competent or not; sane or not) are vastly truncated in prison.

As for what appears to be your premise in this thread: you have assumed that if a person has a psychiatric diagnosis and has also committed a violent crime, the reason that person has committed a violent crime is that they are mentally ill?

I know a guy in the movement. Was once assessed as bipolar and locked up and force-treated for several months. He’s a pushy, arrogant bastard with a short fuse and he was arrested a couple times for beating his wife. He didn’t beat his wife because he’s bipolar and needed his medication. He beat his wife because he’s an eighteen-carat sonofabitch. He should not be forcibly medicated. (I’d be happy to see his teeth knocked out though).

On the flip side, at the risk of inserting spousal abuse as a topic of this thread, I also knew a woman on Long Island who had been abused for years by her husband, but she was the one with the psychiatric diagnosis. She finally went at him, like Farrah Fawcett in The Burning Bed (I think she clobbered him with an ash tray or something, actually) and he called the police and got her incarcerated for “decompensating” (it was not the first time he used her diagnosis as a weapon against her). Again we have a violent person who, again, had a psychiatric diagnosis. You may or may not argue that she did not have the right to clock him with an ashtray under the circumstances, but for our current purposes let’s say we agree that she didn’t. Well, she didn’t hit him with an ash tray due to mental illness or lack of psych meds, she hit him with an ash tray because he was a wife beater and had hurt her and she wanted revenge. She should have been arrested, not incarcerated in a psych ward, and, if she HAD been arrested, charged, convicted, and sentenced for assault, she should NOT have been forced to take psychiatric medication.

Unless she’s determined to be incompetent, which she wasn’t.

52

So a psychologist cannot determine, in our system, if a person can take his own best interests into account in his decision making process? I find that very odd. I do not doubt your word, I just don’t think that determining the psychological characteristics of a person should be up to the legal system, as opposed to the mental health profession.

I also don’t doubt that there are crazy assholes and crazy angels and crazy … well, I guess ‘normal’ isn’t the word I’m after, but you get the picture, right? :slight_smile: All I said was that those people who have committed a violent crime and have a diagnosis should be evaluated to determine if the two are related and, if they are, if medication would help them.

Why not put them in prison anyway? To me, that is simply a very bad solution. Partially, it is because the prisons are already overcrowded. But it’s more about the conditions of prison. It is not a good place to attempt therapy, and it might aggravate pre-existing problems. I know that having a 200 lb. rapist sharing a cell with me would bring out my paranoid side, for example. I’m not a big fan of the state deciding what is in the best interests of someone, but putting someone who cannot decide his own best interests in prison if alternatives exist is barbaric.

Is forced medication also barbaric? Here is the bone of contention, methinks. The best way I can describe my position here is having the state act in loco parentis (Latin, “In the place of parents.”) with regards to the incompetent person. The justice system has assumed guardianship of the person, in my system, just like a parent has guardianship of a child. And just as a parent must administer medications that the child dislikes, so must the state, in my plan. The only way I can justify this, even to myself, is to look at the alternative: A lifetime warehoused in some cell, whether it’s called a prison or a locked ward.

If a person is competent, and that should be decided by psychologists, not a court, IMHO, I’m all for your plan: Prison or pump. But that leaves the incompetent out in the cold, does it not? They cannot decide which would benefit them, they cannot make decisions for themselves, and they are faced with a decision that will affect them for the rest of their lives: A chance at normalcy with initially forced medication, or a lifetime between four solid walls with their madness. Even making them choose is unconscionable, in my view. It seems a cruel trick to play on someone who cannot make their own decisions.

I suppose most people are competent. I suppose I’m just fighting over the fate of a few. But it matters to me. I’m glad we have the Pit: We had a debate going. A very heated debate that might have gotten out of control in Great Debates, with all of the other people weighing in. But here, it was just between us, and I think we’ve come to something of an understanding (it’s sure a lot cooler in here!). I hope Chas didn’t mind the hijack. :slight_smile:

53

Me too.

In a competency hearing, the people alleging incompetence will generally hire their own psychiatrist or psychologist, who is generally given an opportunity to do a clinical evaluation of the person in question, but that individual, if possessing any common sense, will seek out a psychiatrist or psychologist to do an evaluation and testify on the individual’s behalf. The court may appoint some who work for neither side and hear testimony from them as well.
Psychiatrists should not be in charge of competency hearings in general because their practice is not rooted in the legal system’s tradition of rights, equal treatment, due process, etc. More to the point, it would be a spectacularly bad idea to put them in charge of competency hearings that revolved around the right to refuse psychiatric treatment, because they have a conflict of interest. How likely is a psychiatrist to decide that someone choosing to turn down psychiatric services that the psychiatrist believes they need is a person who is making a competent decision?

It’s sort of like if your employer provided the only grievance committee that you could go to if you think they fired you without adequate cause. We, the grievance committee, composed of the same people who just fired you, have considered your situation and after due deliberation have determined that we handled your employment situation correctly. Or your insurance company allowing you to appeal to them if they refused your insurance claim. Well, we reviewed your claim and we find that we were right the first time we said your claim isn’t valid.

54

Why would the psychiatrist have any interest at all in the outcome of the case? Would he stand to gain by saying the person is incompetent? Not in a sane system! The legal system already has precedent for conflicts of interest, and that can carry over into the world of court-appointed mental diagnosis. Put simply, the person who determines if the person is competent will not benefit by giving either opinion. He will be given a flat fee no matter what he says. (Within reason, of course. Calling the person a ‘fat poopy-head’ is not professional. :))

I can see your side, though. The best way to convince someone you’re crazy is to insist you aren’t crazy. So, I really don’t know what to say here, except that we have to trust the professionals (We do already. The courts can sentence a person to receive treatment.) and the case history. (I’m big on using the past to predict the future. I think an incompetent person would have a much different track record than a competent one. Not that that should be the only predictor, just that it should be used.)

55

Derleth, I think the idea of the psychologist being prejudiced is that many of them feel that the “conservative” view is to medicate and/or place patients in therapy. If there might or might not be something wrong with you, let’s treat you just to be sure. And that is rational within the medical system for patients who have freely come to their doctors wanting to be cured. But it’s not necessarily the way to handle it for judging the legal rights of those for whom involuntary treatment is being considered. When we’re talking about the situations in which an adult’s legal rights can be taken away, we leave the final decision to the expert in that area - the judge - who may take into account the opinions of experts in the medical area.

I have not been raped or involuntarily given psychoactive medication. But I believe that I would prefer the former.

Chas, I’m terribly sorry to hear about your sister and your holiday. I hope you will continue your efforts to make a better life for her child.

56

Well, I think psychologists could be instructed on what the court expects of them (only declare the person incompetent if he is truly, fully incompetent) in this case.

Of course, mutiple opinions will be needed. But the psychologists should never work for either side. Having ‘defense psychologists’ and ‘prosecution psychologists’ is simply stupid.

57

I didn’t read all of the posts but I just wanted to give you my sympathies.

I hope your family is trying to do something, anything actually, to get your sister’s child the hell away from her.

58

I would like to come at this from a slightly different side.

My identical twin brother is afflicted with serious bipolar disorder. He was a lineman for a major college football team and has put several people in the hospital during his manic episodes. He beat my father (a lovely man) into a bloody pulp because he thought he had stolen his favorite shirt.

He beat me to a pulp because he thought I was poisoning his hamburger at Bennigan’s. Mind you this was at the Bennigan’s during a Friday happy hour.

He has been forced to take meds more times than I can count, and he has been imprisoned several times. The system, even when it forces meds, refuses to do so for a period of time sufficent for any meaningful recovery. He has left his brief periods of forced detention in a locked ward (72 hours is typical) suffering from a deep depression in which he can barely go to the bathroom let alone take medications on a rigid schedule.

The only successful recoveries I have seen from this height of wackiness come from a conscious decision to take medication, not a forced incarceration following a crisis. Thus, I would argue either for longer periods of detention or abandoning the assinine mini-detentions our system engages in. After 72 he signs himself out and is free to go back to his delusional fantasy land. Anyway not a very well written opinion, but one nonetheless.

59

AHunter says:

You are not a lawyer. I am not a member of a jury. This is not Great Debates. And Derleth has not proven himself to be any danger to me or society as a whole.

Derleth’s logic is simple: Innocent people have the right not to be injured, maimed, or killed by another. The perpetrator’s motive is not highly relevent, be it he thought you poisoned his cupcake, fucked his wife, or stole his heroin stash. The goal of any societal disciplinary action is to prevent an offense from reoccuring–and if an individual is violent when not on psychiatric medication, they must be made to take the meds. Period. Does that mean everyone who is diagnosed with a mental disorder should be forced to take medication? Of course not.

But every one of them who has proven themselves a threat to others sure as hell should be.

Currently here in Southern California, Edward Charles Allaway is trying to become the most prolific murderer in history to be paroled. He killed 7 people in 1976 in an insane episode–but now he’s claiming he’s cured. One victim’s spouse says:

It is truly not about vengeance. It’s about, as Derleth stated, self-preservation. It is far, far too great a risk to let this man go free–regardless of his mental state.

And to reiterate a point Derleth made: Society’s right to self-preservation and protection outweighs an individual’s right to be administered medication–or more accurately, effective therapy–against their will. Whether it’s medication or behavior modification or whatnot is not as much a concern as its effectiveness in removing a threat to society.

60

Ruffian:

By “proven”, do you mean in a court of law?
But we don’t have such a crime on the books! “Ruffian, you are charged with being a threat to others. How do you plead?”

We have crimes with titles such as “reckless endangerment”, “assault”, “aggravated harassment”, even “public nuisance”, but you know what? Every one of them is a charge that is leveled at you for ** something you did **.

Our social system is in large part founded on the notion that actions are punishable, but neither intentions alone nor possible future actions are –

“Ruffian, you are charged with false imprisonment, insofar as you seem capable of and predisposed towards incarcerating the schizophrenic AHunter3, whom you believe to be dangerous, but who hasn’t done anything, how do you plead?”

“What are you talking about, I haven’t locked him up, he’s still right here posting on the board!”

“Yes, but we think you might”
OH, perhaps that isn’t what you meant? Perhaps by “proven”, you meant that a psychiatric evaluation yielded this finding?
“Doctor Ruffian, you are charged with false imprisonment, insofar as you seem capable of and predisposed towards incarcerating the schizophrenic AHunter3, whom you believe to be dangerous, but who hasn’t done anything, how do you plead?”

“What are you talking about, I * still* haven’t locked him up, he’s still right here posting on the board!”

“Yes, but we think you might, and you have a history of having done so in the past, and furthermore you have the wherewithal to do so again, so in our opinion the likelihood of you doing so again makes it necessary for us to consider you a danger to freedom, and we must act with more concern for the public good than for your rights and err on the side of caution.”
SOME INTERESTING FACTOIDS FOR YOUR PERUSAL:

  • Psychiatrists have a dismal track record at predicting violence.
  • A commitment hearing, although technically a legal procedure, does not ensure the right of the patient to testify or secure witnesses to testify on the patient’s behalf; and there IS no “standard of proof” such as preponderance of the evidence or beyond a reasonable doubt.
  • The most common commitment standard, “danger to self or others”, is not defined either, and has, in real life in real hearings with real people, been interpreted to mean:

a) might have sex with too many men (Arlene Sen)

b) has grown a beard and adopted Orthodox Jewish customs instead of looking for a new lucrative stockbroker position after his old firm went under (Leonard Roy Frank)

c) still disagrees with the psychiatrist’s recommendations of appropriate career choice (Janet Gotkin)

d) doesn’t want to take the psychiatric meds that the psychiatrist thinks the patient should take (millions of us)

e) wants to marry again, against the wishes of the adult children (Ms. Helene Rockwell)
I’m sorry, but the opinion of an infinite number of psychiatrists holds no more weight for me than the opinion of an infinite number of Bible-pounding hellfire-and-brimstone preachers, or an infinite number of jihad-declaring mullahs for that matter.