Forced psychiatric medication

Great Debates
41

I remember this time last year coming home from work doing about 70 mph and thinking, “I’m tired of it all. All it would take is a quick left into oncoming traffic.” Instead of going home, I went to my therapist and said, “Put me in some place safe and call my wife and explain for me.” In my heart I know that suicide is a permanent solution to a temporary problem but sometimes a momentary lapse in judgement is all it takes.

I’m wary of doctors with crystal balls and I do not believe people should be detained unless they actually do something wrong mentally ill or otherwise. Everyone in America is a couple of drinks away from committing a heinous crime but I do not believe in Prohibiton either.

42

That’s sounds quite reasonable to me. It’s a shame our mental health and legal systems can’t be as enlightened.

43

I don’t know if “good” is the right word. It’s not good to medicate someone against their will, the fact that someone needs medicine or other medical treatment IMO implies that we’re doing what we can in a situation that’s not good. Not so much “good” as mitigation of bad.

Regarding medication of the death row inmate: UGH, that’s an ugly one. I’ll weigh in.

[soapbox]Death row is bad and wrong to begin with, it’s wrong to have anyone there, wrong to put people to death, my opinion, whole other can of worms. The fact that this person has committed a crime for which people want him killed means we’ve failed as a society in providing the culture, social structure, and services necessary to support this person and prevent him from acting the way he did.
Our society not being utopian: The guy should be locked up (although I’m not familiar with the particulars of the case), there’s no reason that we can’t keep him behind bars for life, there’s no reason that we can’t treat him in a humane way (at least not one I’ll agree with). He would likely choose medication for management of his symptoms if it didn’t mean death to do so (just a guess).[/soapbox]

The next best thing: (grimace) execute the person while they’re psychotic. If he was found competent at trial, why does he need to be competent at punishment? I know I’m pretty ignorant here, so bear with me; but this smacks of our own inability to believe that we’re justified in sentencing someone to death. It’s like we know how cruel it is to put someone to death but when they’re psychotic, it’s driven home to the point that we can’t stand it.

That not being an option: (big grimace) medicate him against his will.

44

Well since no one has brought it up, I will. What about the overuse of Ritalin? Is it right for a parent to say, “I can’t control my child, I will put him on drugs”? Or for a social worker or teacher to force it?

45

Hentor,

Don’t sweat TVAA’s smirch of your skill and his false claims unrepented. Your posts do speak for themselves and evince a good amount of clinical knowledge and careful consideration. The most convincing sign of your wisdom is your willingness to admit what you don’t know, unlike others that we have had to deal with who I shall not name. BTW, I don’t deal with the legal side all that often either and am very ignorant to the actual laws too, let alone actual practice (which may not exactly follow the laws). I have my impressions from training, but that was a while ago. That’s why I wish AHunter would stop in to enlighten us.

Now, onto your points. If I may attempt to recap.

Two people tell you that they plan on killing someone because they believe that the individual may kill them first. In the first case it is a man who has been sleeping with another man’s wife and his fears are based in reality because the husband now knows and has told a mutual freind that he is planning on gunning him down, in the other it is the result of delusions. Does it matter? In both cases there is an obligation to protect others, innocent or not.

Now as to less clear threats. Throwing things around the house and make vague threats. Coworkers accusing hlanelee of nonspecific plans of violence. Should “those in authority” consider the individual’s diagnosis as increasing the risk that he might actually carry out the threats (if they had actually been made) or in believing the witnesses?

On the one hand, if the average Joe gets treated badly in a store and says that he’d hopes the clerk meets some grisly death, one tends to dismiss it as venting because no rational person would act on those violent thoughts. But if someone who is known to be schizophrenic states those same things, then one has a more resonable fear that the dis may play into some greater delusion and that he just might actually act on his irrational impulse. No crystal ball, hlanelee, just probabilities, from “very unlikely” to merely “unlikely”. And no intended disrespect to you or implication to your specifics. I am trying to make the general case from the specific. You may not have said it, but what was told to the police by the coeced and lieing witnesses, was possibly similar: he is disgruntled, (proof: your legal action); he has made threats of violence (“proof”: the “witnesses” claiming that you’ve told them of nonspecific plans to commit violent acts or have threatened them with nonspecific harm); he is more likely than the average Joe to act on irrational impulses because he may not be currently rational (proof: diagnosed with bipolar illness … minimally proof that you may be prone to make an irrational choice impulsively at a particular point if inadequately treated) Given that scenerio what are the police to do?

But, OTOH, how akin to racial profiling is this?

And as to the question I see on preview: parents make healthcare decisions for their children with a broad latitude and limited by finding physicians who agree that such is indicated.

46

Thanks, DSeid. I would have thought that after years of licensed practice, I would have known how often my work actually involves interaction with legal matters (apparently with “legal matters” being identical to “compulsory treatment.”) Little did I suspect that I would have to come here to find out what the true nature of my practice and my profession is by a failed graduate student with internet access; one who failed in a different field altogether.

Chalk one more up in the fight against ignorance. I have seen the light! Yet, somehow I still have no cite. Odd, huh?

47

Damn, I feel like I’m late to my own party or something!

DSeid wrote:

a) I totally agree that the standards should be the same. Therefore “mental illness” should have no legal status. Whether or not you, or I, are detained should be dependent on whether or not you, or I, have violated the law or otherwise behaved in a manner for which detention is legal. As with criminal law, the remaining circumstances under which a person can be detained for behavior should be explicitly spelled out and should be as free from arbitrary subjective interpretation as possible. In short, schizophrenics should have as much, but no more, right to behave like a crazy nutcase in public as obnoxious college frat boys, businessmen at conventions, religious fundamentalists bearing tracts, or used car salesmen. If the existing criminal law, in and of itself, is insufficient to establish and maintain public safety and public order, then amend it, but without reference to medical diagnoses, psychiatric or otherwise.

b) If a judge wishes to address a case in which legal punishment is an otherwise appropriate possibility by offering the option of psychiatric therapy to a defendant at the bench, that seems as reasonable as pushing a DWI defendant towards AA meetings. But if the defendant prefers conventional punitive measures, that should be the defendant’s choice, and the punishments so imposed should be commensurate with the offense, in other words no harsher than those imposed on a defendant for whom psychiatric treatment was not offered as an option.

c) I am opposed to the use of psychiatric pharmaceuticals as chemical restraints in prisons or jails. I believe them to be more dangerous, and their use far more invasive, than physical restraints and confinement. If the prisoner chooses to be on psychiatric medication, that is, of course, a different thing. Again, though, there should be institutional safeguards to protect prisoners from undue pressure to see the prison shrink and take psychiatric meds: whatever restraints and confinements are applied should be appropriate to the prisoner’s current behavior and should not be punishment for not taking psych meds that the institution wishes them to take.

48

Welcome to the party!

So,

a) Punishment should be the same? Someone has an acute psychotic episode and does something that they never would have otherwise done, something they are not at risk of doing when treated or not ill, and they should be subject to the same punishment? I have a hard time with that. On the suspicion side my lean remains that the potential harm of “profiling” according to diagnostic label is more than the benfit gained by statsitically increased risk.

b) Someone acutely mentally ill to the point of clear irrationality, no doubt not competent, should be asked to make a decision that they will be held to for the rest of their lives? Should be held to a choice that they never would make when they were their treated selves, that they are only making because they are actively suicidal or delusional? I have a hard time with that too.

c) I think I agree here, if the standard for other medical treatments is the same. But should the choice be made during a period of treatment or while ill?

Finally, how does actual practice differ from the range that we mostly have agreed it should be? I presume it does or you wouldn’t be as much of an activist on this subject as you seem to be.

49

The punishment should be the same! Having actually experienced psychotic episodes and having actually been stinking drunk, I know that either condition can lead you to do what you would not normally do. How you live with your mistakes is a measure of who you are and is vital to growth and improvement. I would rather project competence and capability to the world than ask to be forgiven for a weakness.

50

AHunter3, it’s good to see you again. It’s not often that someone is so pleasant when disagreeing. I hope that you are well.

[quote]
hlanelee: Is it right for a parent to say, “I can’t control my child, I will put him on drugs”? Or for a social worker or teacher to force it?**

No parent, social worker or teacher can prescribe medication. If a doctor prescribes a medication, the parent has the right to force the child to take it. That doesn’t mean that it is always the best thing to do. Parents owe it to their children to make informed decisions.

I do not know what role social workers play. Teachers are not allowed to practice medicine without a license anymore than anyone else. I was a teacher for twenty years and never forced a child to take any medication. I did know children that took ritalin who said that they were glad that they could finally keep still. It was a relief for them. If there were others who didn’t like it, they didn’t mention it to me. (I have been in a situation myself where I couldn’t keep still or in control of myself, and it was a miserable experience.)

Teachers who are concerned about the disruptive behaviors of students are not generally mean-spirited control freaks who have it in for little kids. They must concern themselves with the welfare of the individual student and with the classroom as a whole. I like spirited students.

What I object to is the attitude of some who think that their right not to be medicated trumps the rights of others to work in an environment conducive to learning and productivity.

51

hlanelee,

But when you got drunk you had chosen to get drunk. You made the mistake to lose control. And maybe if you were psychotic because you consciously declined treatment while not psychotic the comparison holds, but many people do not choose to become psychotic. It is against their will. I do not think it is the same.

52

Thank you, Zoe! I have been on Ritalin since I was seven, and trust me, I would never have made it through school without it.

It’s not about the parent controlling the child-it’s about the CHILD not being able to control him or herself!

53

Somehow I doubt that many people claim they have a right to keep their children in school if they’re seriously disruptive.

In all fairness, it should be noted that the right not to be medicated does indeed trump the right of others to work in an environment conducive to learning and productivity.

What it does not trump is the right of others to remove disruptive elements from the system. Since schools possess the ability to expell disruptive students, I suspect your objection is specious. If it isn’t, I await confirmation of your claims with a cite.

I do find it somewhat odd that someone who claims to be a practicing clinician in the field of mental health is also ignorant of one of its elementary aspects: the ramifications of involuntary committment. Perhaps a social worker or novice therapist might not be so aware, but practicing physicians within the field are usually familiar with at least the basic aspects of the subject.

“Failed graduate student” indeed. :rolleyes: Although that designation is inaccurate, I’d rather be a failed graduate student than an incompetent and ignorant clinician.

54

Although it’s doubtful a formerly psychotic person on medication could be said to have normal cognition, many such people decide to stop taking their medication. Such problems make up the bulk of the issue. Giving people those meds. for the first time isn’t nearly as controversial.

So what if a person was manic, or psychotic, and is no longer? If they choose to stop taking their medication, should they be forced to continue?

55

At some point we come crashing into the Philosophy classroom to discuss free will and individual versus societal and other environmental causes, and individual character-nature versus individual neuron-nature and so on.

You are who you are. You either are or are not responsible for your behavior, but we have a lack of consensus on that before we even get to the specific question of “mental illness”, don’t we?

Generally, legally, we hold that if you are adult, you are responsible for your behavior unless you are not, a less than useful construct I suppose, but revolving around questions of capacity. We have capacity standards for whether I would be let off the hook for shooting holes in people and eating them for dinner while cackling should be used in determining whether or not psychiatric meds should be administered to me over my objection, and whether or not I can make a valid will or sign a contract to buy a car down at the Chevy dealership.

Unfortunately, they don’t tend to be the same standards, and the standards for the involuntary psych meds stuff, in practice, totally sucks.

Since I’m not going to argue that everyone should be electrocuted as murderers if they kill someone, or that contracts should be binding on anyone who signs one, it would not make sense for me to argue that no one could ever lack capacity to make decisions with regards to psychiatric meds. But I’d formalize the process like this:

a) Does the individual know what the medication is, and what it is prescribed for? They need not be capable of drawing the carbon chains on a blackboard, nor need they cite the DSM code or recite the full PDR entry on the pharmaceutical in question, but they should be able to say, in effect, “The doctor believes that I am sick in the head and the medicine will make my head work better”.

b) Can the individual express a rational reason for deciding not to take the prescribed medication? The reason need not match the judgment that the doctor, the judge, or even the hypothetical “reasonable person” on the street would give, but it needs to make sense. “I don’t want to take the pills because they make my fingernails pregnant and they bite and you did this to me” would not cut it, but “I do okay without the pills and I don’t like how they make me feel” is certainly sufficient.

And, having made that decision, the individual is responsible for what they do and should be held accountable for it – but, again, according to the same rules as anyone else.

56

Urg. Let me retry that third paragraph:

Generally, legally, we hold that if you are adult, you are responsible for your behavior unless you are not, a less than useful construct I suppose, but revolving around questions of capacity. We have capacity standards for whether I would be let off the hook for shooting holes in people and eating them for dinner while cackling; we have standards for determining whether or not psychiatric meds should be administered to me over my objection; and we have standards for whether or not I can make a valid will or sign a contract to buy a car down at the Chevy dealership.

57

I rather like your point b), AHunter3, but it wouldn’t hold up well in practice. It doesn’t take much for physicians to become convinced that a patient’s refusal of what they see as an necessary and vital treatment is irrational.

58

Could you elaborate on how the standards for the involuntary psych meds stuff, in practice, totally sucks?

Cause despite TVAA’s incredulity, most of us in practice do not do a lot of involutary stuff. ( I know, TVAA knows more about what practice is like than anyone who is actually in practice …) Hentor has dealt with people admitted involuntarily but not with putting them there. Me, not at all. Well once but very peripherially.

Your standards seem fine. Prove that you are not irrational by understanding the basics of why the meds are advised and by giving some rational reason why you decline and then it is a choice that you should be able to make and held accountable to. I’d even go so far to say that if the decision was made and documented while rational, then it should be honored even if later rationality is not maintained. And accountability maintained.

59

Don’t get snippy, DSeid. Psychiatric professionals are generally expected to be familiar with the consequences and procedures followed in involuntary committments, if only because they need to know when a person should and should not be considered for committment.

A pediatrician generally wouldn’t have any reason to know it. Someone practicing in psychology should. You’re not a psychiatric professional, and your basic knowledge base is different.

Mental patients are more protected now than they’ve ever been, but that’s not saying much.

60

I don’t think that psychologists do an awful lot of committing patients TVAA. Tends to be the psychiatrist who is put into the position of making that judgement, usually called in by the Emergency Med doc. I’d expect both of them to know about the law and actual practice but not a psychologist. The psychologist needs to know what I know, that my compact for patient confidentiality ends where I believe that the patient represents a real risk to self or others. And who to call to find out what we do now.

So I really do not know how actual practice operates. We have heard of a few less than perfect experiences (hlanelee’s, zoe’s) and I know that AHunter can tell us more of how the system doesn’t always work the way we think that it should. I am most curious if the problems are avoidable or not. So for example, I can’t see how hlanelee’s situation could’ve gone too much different given the false testimonies. A little better maybe. Would’ve been nice to have some more dignity while awaiting evaluation and to have his regular treating MD part of the evaluation and treatment. And forced treatment with a different course than what he was on seems wrong. Should be that he could be detained while being evaluated but that his doctor should consulted and regular course followed until at least such time that is found guilty of some crime. Other than that should not be allowed. What else goes wrong? And is it that the laws aren’t there or that they are not followed?