I’m aware that there was once a time when people could be admitted to a mental health facility just on the say-so of another adult (often the husband) and a doctor. Were there ever people who weren’t admitted, because nothing was wrong with them?
Just curious.
Firstly,
just so you khow, the current standard in most states is on the say-so of a doctor and a concurring opinion by a second doctor. I’m not sure what you think the standard is, so apologies if I’m telling you something you’re well aware of.
Secondly,
It’s not like a psychiatric professional is ever in a position to know that “nothing is wrong with them”. I mean, it’s not like they can test your blood for the presence of serum schizophrenerase and it comes back negative and they send you home.
Both now and in the past, it can help if plural numbers of solid well-placed citizens show up at the facility to visit and the patient persistently but politely indicates a wish to leave.
I myself am not sure how the laws worked back in, say, 1910 or 1927, but for a long time (including the era before the shift away from permanent institutionalization) you were entitled to a legal procedure, a commitment hearing, even if the doctor felt you needed to stay incarcerated. The rule I am familiar with is the “72 hour” (aka 3-day) notice rule, where if you indicate that you wish to be discharged the institution has that long to consider committing you involuntarily. It was and is often a bit of a rubber-stamp process, where the judge assumes the doctor knows best and views it as a medical, not a legal, question, but you’re entitled to legal representation and a good attorney will try to get a dissenting psychiatrist to interview you beforehand.
With that in mind, if the psychiatrist is aware that you have the wherewithal to obtain good legal representation, they can shrug and decide not to pursue the matter in the court, rubber stamp or no.
There are many people in the modern and semi-modern era who have attempted to check themselves in, stating that they’re depressed and suicidal, only to be sent home and referred to outpatient treatment. The cynic in me reads it as “if you’re sane enough to know you’re sick and need help, you don’t need to be locked up, but if you think you’re not sick, you’re sick”.
What they’ve always looked at is whether or not you are upsetting other people and hence disrupting the community and whether you can function in the community. If a neighbor, relative, employer, or police officer made a complaint that resulted in you being brought in for observation, you’ve already “upset” someone and they don’t want to err on the side of underestimating how disruptive you might be, but yes they themselves aren’t as much of a rubber stamp as the courtrooms tend to be. They tend to be the type of conservative that views economic and social stability as concurrent with mental stability. (That’s why having supportive friends come visit helps).
I’m talking about the days when, for instance, a wife starts talking about leaving her (often) abusive husband, and especially if he was wealthy, he could grease palms and “have her committed” - or is this largely an urban legend?
I DO know that it was not unusual for men who were even suspected of being gay to be committed, and often subjected to horrific treatments in order to “cure” them.
No. It happens. Doesn’t even require the greasing of palms.
When I was incarcerated in 1980, I met a woman whose husband was an Air Force officer; they’d had a marriage in which he needed his ego propped up a lot and she’d gotten rather tired of it; rather than have an affair behind his back, she decided to tell him up front that marital fidelity was being taken off the table, she was bored and not happy with things as they were, and she understood if he wanted to divorce, but that’s how it was. Telling him was a mistake: he went to a shrink and explained how concerned he was because his wife was behaving so erratically, getting blotto drunk and going home with random guys and being really promiscuous. Then he convinced her to come in with him for “counseling” and they didn’t let her leave.
I also met the widow of a man who owned a shop machine company – one of the name brands, I forget which, something of the ilk of Delta or Rockwell – and her son had gotten mommy committed and now had control of the assets she’d inherited.
As somebody who has been committed to a mental health facility, I’m not seeing errors or exaggeration here. I’d like to think that things have gotten better since then. I wouldn’t risk it.
There was the Rosenhan Experiment.
Rosenhan and seven other perfectly sane subjects went undercover inside various psychiatric hospitals from 1969-1972 and acted insane in order to see if the doctors there could tell that they were faking. The doctors could not.
This predates the move towards de-institutionalising psychiatric care that led to the closure of many mental hospitals and a preference for community based care in the 1980s.
I’m familiar with the study under a different name. IIRC the doctors could not tell the researchers apart from actual schizophrenics BUT the other patients could. They kept saying things like “You don’t belong here. You’re a reporter working on a story or something.”
Of course. Although your question depends on the specific place and year due to the legislation. The usual chain of events is that a person reports their concerns to a justice of the peace, family doctor or primary care provider. The provider decides if the concerns meet the criteria for evaluation by a psychiatrist and how urgent this might be. Very often the concerns do not meet a threshold for an emergency. If they seem to, forms are filled out which give the right to detain the patient for a very short period of time to be evaluated by a psychiatrist. If it is possible to do this in an outpatient setting this is often preferred but again depends on many factors. Historically, rights differed by place and year because the law did. Psychiatric diagnosis can be problematic since different practitioners may disagree, symptoms may change over time, practice varies a lot and so do the ethics of various people.
How long were the women hospitalized, and how did they manage to get out, IF they did?
This is one of the reasons why it’s so hard to get a person committed nowadays when they need it!
I’ve also heard stories like that about people who went into prison as an undercover reporter or other agent.
I don’t know. My own stay came to an end before theirs did, and in neither case had we made arrangements to stay in touch post facto.
I have to dissent with the idea that anyone needs to be committed to a psychiatric institution. I want to make it illegal to impose unwanted psychiatric treatment. Everyone else gets locked up only for something they actually did and not for whatever they think you might do. And if the question is inability to take care of one’s own self, I’m open to some degree of finding someone to be incompetent, but that, too, should be on the basis of established fact about one’s actual observed behavior and demonstration of inability to think clearly and coherently right there in the courtroom — not the alleged presence of a psychiatric ailment, which courts have now rules are not prima facie evidence of lack of decision-making capacity.
Psychiatric diagnosis should not be admissible evidence in a courtroom focused on a competency hearing.
I think this post falls somewhat short. It is within living memory that you could be not only committed against your will, but then sterilized and lobotomized. Hey it wasn’t what just was best for you, but for society too!
Speaking only for myself, I find I function much better on Concerta, Paxil, Vraylar, Mirtazipine and lithium. BUT I don’t think anybody should be forced to take psyciatric medication.
Well, of course.
The researchers were ‘acting crazy’ while they were with the doctors; after that they were sent back to the ward with the other patients, and they didn’t bother ‘acting crazy’ any more. So the other patients saw them when they weren’t acting, and for a lot longer time. And it would be real difficult to keep acting 24 hours a day.
I was going to bring up the Rosenhan Experiment (the “Pseudo-Patient Experiment” perhaps is the name DocCathode remembers). Several posts above have mischaracterized it somewhat, I think.
The pseudo-patients made only minor psychiatric complaints to get themselves put in: They complained of “hearing voices”, and even those voices were claimed to be just sporadic isolated neutral-ish words like “thud”. That sufficed for them to get a diagnosis of schizophrenia, and admitted to the hospital.
Once in, the protocol of the study was for them to immediately cease those complaints, and otherwise just act “normal” – There was no mention of them continuing to act “crazy” in the presence of doctors but not elsewhere. The object of the study was to see how long it would take for the doctors to determine that they were no longer schizophrenic, and for them to be released.
The conclusion was: Never. IIRC, some were allowed to leave “Against Medical Advice”, and some others needed an outside intervention to get them out. (They were at several different institutions.)
The pseudo-patients took notes. One of the things they noted was that, once in, even normal everyday behaviors were seen by staff as being abnormal. One of them caught a glimpse of the comments a nurse had made in their chart: “Patient exhibits writing behavior”.
Another anecdote was this: Patients, having nothing to do and being bored shitless, tended to gather outside the dining hall well before meal-time. It was at a teaching hospital, and a psychiatrist/professor came through with a class of medical students. He pointed out the gathering patients, and told his class that this was an example of “oral-acquisitive behavior”.
More in my next post, more specifically addressing OP’s question . . .
More on Rosenhan:
The point he was making was that psychiatrists couldn’t, or didn’t, distinguish sane from insane: Once one was labeled insane, there was no re-consideration.
Rosenhan did a follow-up: He publicly announced that there would be more studies like this. The result was that hospitals tightened up their diagnostic and admittance criteria, and more people were found to be “pseudo-patients” and turned away.
In fact, Rosenhan never did any such follow-up. The perceived “pseudo-patients” were nothing of the sort. They may well have been genuinely troubled people in need to psychiatric treatment. But Rosenhan’s point was made: Psychiatrists really couldn’t tell the difference.
ETA:
Wikipedia page: (Includes a link to Rosenhan’s actual report, “On Being Sane In Insane Places”):
discarded (redundant info, already posted)
My parents had me locked up for being queer and butch and an embarrassment to them in the early 80s. Every time I tried to leave I was told I would be legally “sectioned” and having that on my record would ruin my life. Eventually a nurse clued me in that they were lying, I would have far more rights if held legally and in fact so long as I did not say certain things it couldn’t happen anyway and I could go.
The experience was horrific and went on for months. It changed me fundamentally but not in the ways hoped for.
Homosexuality was no longer considered a mental illness at that time but the system was run by old men who didn’t agree with the change.
No. The researchers reported hearing voices. They answered all other questions truthfully and did their best to act as they usually did.
BTW I’d often heard of this study as “Being Sane In Insane Places”. This title is mentioned in the link above.
I have many methodology concerns about the Rosenhan study, but it was helpful nonetheless.
I still really haven’t had my question answered, which was if a doctor ever REFUSED to admit someone on another person’s say-so.