# Questions on Institutionalization **URL:** \ **Category:** Great Debates\ **Created:** [September 22, 2009, 5:55pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108 "2009-09-22T17:55:22Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 2:43am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/81 "2009-09-27T02:43:28Z")
> [@Jodi](#): > > The person HAS safeguards. That’s the whole point of the involuntary commitment hearing; that’s that it is: A procedural safeguard against wrongful commitment. No, the deck is stacked against the patient. The psychiatrist has a vested interest in incarcerating him and the other participants defer to the shrink’s “expertise.” It’s up to the patient to prove he doesn’t suffer from a mental illness and it’s pretty hard to prove a negative. The only way the hearing could be an actual safeguard would be if it involved an unbiased panel of observers, say a psychiatrist (if you insist), social worker/case manager, the patient, and the patient’s advocate. The hearing would have to involve only the patient’s state _right now._ It would be up to the shrink to demonstrate to the judge that the patient _right now_ is mentally incompetent. This means past observations would not be admissible. It also means conjecture about future events would not be admissible either. The state of mental health policy now is that you can be entirely competent and still committed because you choose, say, to decline drugs. Or you might choose not to have the treatment team intrude upon your home. Or you might choose not to attend day hospital. Many other very benign decisions can land your ass back in the psych ward if you’re unlucky enough to have a history of noncompliance noted on your chart. In some ways even more sinister, however, is that horrible murky grey swamp where patients are ostensibly “voluntary” but are only compliant for fear that they’ll be downgraded to involuntary. You might find yourself agreeing to all number of preposterous conditions just to avoid involuntary status or the dreaded “borderline personality disorder” label that gets attached to those who don’t play the passive, compliant, “doctor knows best” game. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 3:29am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/82 "2009-09-27T03:29:01Z")
> [@Jodi](#): > > “Paranoid schizophrenic” may “mean nothing” to you, but for most it is a generally-understood way to convey a significant amount of information with a few words. It is a label – using the word not in a pejorative sense, but in a literal sense – and it serves the same purpose a label does in any other situation. You may refuse to accept any of the information intended to be conveyed because to you the label “means nothing,” but to me that’s nothing more than willful obtuseness on your part. I don’t feel constrained to refrain from using useful labels or shorthand because you declare that IYO they are meaningless. “Schizophrenic,” “bipolar,” whatever, they’re all just a bunch of labels which have no objective basis. If these were neurological disorders, they’d be treated by real doctors, not these pill pushers we call psychiatrists. These aren’t disorders; they’re merely lists of troublesome and unwanted behaviours. Calling someone a “paranoid schizophrenic” damns them. The only worse label you can apply to a person is pedophile. > [@](#): > > Why would you assume that criminal behavior meant the police were automatically involved? Only because in my experience that’s what happens. And, often, interaction with the criminal justice system is a wake up call. > [@](#): > > He make people feel unsafe by screaming at them and approaching them in an apparently aggressive matter. I suppose it would have been technically possible to wait until he actually assaulted someone, or was beaten up again, but I fail to see how that would have improved his situation any. Because if you’re treating him like a criminal _before_ he commits a crime, you’ve got a big problem with civil liberties. I am just not comfortable incarcerating someone on the basis of what he _might_ do. > [@](#): > > He was too ill for community placement, even closely supervised – believe me, they tried that, repeatedly. Isn’t it odd that in over a decade of interactions with the mental health system, that I never ran across somebody like this? > [@](#): > > And if you think the mental health services offered in local jails is better than that offered in hospitals through involuntary civil commitments, allow me to bitterly laugh. Actually, I wasn’t aware that mental health services even existed in jails. I’d much rather be in jail than on a psych ward. > [@](#): > > His mother had his SSDI and used it on his behalf, which only led to more fights and physical threats to her when he demanded she give him “his” check. Interesting quotation marks. It _was_ his check. Why wouldn’t he demand it? > [@](#): > > What is the distinction you are drawing between a “psychiatric group home” and an institution? Assuming the “group home” is for persons who are severely disabled enough to require locking them in so they don’t escape – what meaningful distinction between that and an institution are you drawing? Group homes shouldn’t be locking people in. They’re just assisted housing, for people who can’t manage independently. > [@](#): > > And what does that have to do with involuntary commitment? Even if you are committed to a “psychiatric group home” instead of a hospital, you’ve still be involuntarily committed, right? In our system, you’d be on extended leave which is a vast improvement over being involuntarily committed. > [@](#): > > He could not or would not meet the minimal requirements to live in a group home. Fair enough. So why couldn’t his case manager arrange to pay his rent directly from his SSDI and provide him with a weekly allowance for food, etc.? > [@](#): > > If you want to stay out of the hospital, you have to be complaint. If you are not, you go back to the hospital, where the process of making you stay there is _involuntary commitment_. _That_ was this guy’s situation. So was hospitalizing him appropriate, or not? Probably not. The test to staying free shouldn’t be being compliant. The test should be not breaking the law. > [@](#): > > Any such hospitalization would be involuntary, because he lacked the mental capacity to make such decisions. As proven by his unwillingless to conform to his psychiatrist’s direction. Do you really need mental capacity in order to determine that you don’t want to be subjected to forced drugging? Should the fact that you aren’t willing be enough to enable the state to force you? > [@](#): > > You can hardly expect me or anyone else to agree with you that it better to be homeless and at risk for victimization than it is to be hospitalized and receive treatment. You are entitled to your opinion, of course, but the value of it is to me pretty self-evident. Well, you might want to consider the fact that the homeless, even with the promise of food, showers and a clean bed, still prefer to live in the park. You also might want to remember that you’re speaking from a viewpoint of privilege. I don’t think _you_ have ever experienced four-point restraints. I don’t think _you_ have ever been dragged kicking and screaming down to the electroshock room. I don’t think _you_ have ever been dumped into an isolation cell. I don’t think _you_ have ever been held down and injected with powerful, mind-altering drugs. So maybe the reason your choice is self-evident is that you don’t comprehend the choice. > [@](#): > > Did you have a substantive response to my point, which is that they have no more ability to care for themselves than a baby does, or would you prefer to simply take issue with the word choice by inferring a “comparison” where one wasn’t made? It was an unpleasant analogy. I can’t answer your question because I have just never met a person that was so far gone. I don’t believe they exist. I’ve met all sorts of mental patients and I’ve never met one that _some_ reasonably living situation couldn’t have been carved out for. > [@](#): > > I’m not really interestesd in arguing with your opinion beyond reiterating that it doesn’t tally with my experience in any way. Yes, that’s the responsible thing to do. When someone is demonstrating that your system contains dangerous pitfalls, by all means, just ignore them. > [@](#): > > Sure, I pardon you. You are generalizing from your experience, which is fair. Not just my own experience. I’ve also observed how the system unfolded for many, many others. > [@](#): > > The difference between us is that I am not insisting that your experience must have been wrong just because it happens to be different from mine. But you basically said that it didn’t matter, that the important thing was that the people you know had been helped. So, basically, the take away message is that it doesn’t matter that I was screwed over. > [@](#): > > The system didnn’t work for you. That doesn’t mean it never works; in my experience, it did. Nothing you can say will change the reality of that. I didn’t say that it _never_ works. What I’m saying is that it screws up. Unfortunately, the only people it screws over are so marginalized (thanks to their labels like “paranoid schizophrenia”) that society really doesn’t care. Anyway, this whole argument has been about the justness of forced treatment. We’ve completely been ignoring the effectiveness of said treatment. What do you make of the Soteria House successes? What do you make of the WHO studies? Did you read Whitaker’s article? How is it that with the advent of these miraculous wonder drugs, outcomes for the mentally ill have not improved? Why is the proportion of people disabled by mental illness now greater than ever? ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 3:39am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/83 "2009-09-27T03:39:33Z")
> [@fuzzypickles](#): > > Bullshit. Your schizophrenia is _not_ based on any doctor’s opinion, it is a diagnosis based on very specific criteria. It’s diagnosis by checklist. As Thomas Szasz says: If you talk to God, you’re praying; if God talks to you, you’re schizophrenic. > [@](#): > > Keep in mind, if you really ARE receiving secret messages from the government beamed directly into your brain, then the burden of proof lies on you to demonstrate that it’s really happening, and not a symptom of brain malfunction. Why should you have to prove anything? Do we ask the religious to prove the existence of God? Who really gives a shit if I think I’m picking up messages through my fillings? Why is that worse than any other conspiracy theory? > [@](#): > > Isn’t that the point, though? The exact neurochemical effect is irrelevant to whether or not the medication is successful at alleviating symptoms. It’s only relevant if you are concerned about the health of your patient. It’s only relevant if you consider brain damage, diabetes and irreversible tics, among many other side effects, an unworthy trade off. It’s only relevant if it concerns you that outcomes are worse with conventional treatment. > [@](#): > > But the whole point of involuntary institutionalization is to aid people who no longer possess the ability to help themselves. I disagree. The point of forced hospitalization and/or forced drugging is to make the troublesome conform. It’s to label and punish our undesireables. ---
**Author:** ![fuzzypickles](https://avatars.discourse-cdn.com/v4/letter/f/9d8465/32.png) [@fuzzypickles](https://boards.straightdope.com/u/fuzzypickles)\ **Post date:** [September 27, 2009, 4:19am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/84 "2009-09-27T04:19:50Z")
> [@G.Pie](#): > > “Schizophrenic,” “bipolar,” whatever, they’re all just a bunch of labels which have no objective basis. If these were neurological disorders, they’d be treated by real doctors, not these pill pushers we call psychiatrists. These aren’t disorders; they’re merely lists of troublesome and unwanted behaviours. First of all, psychiatrists ARE medical doctors. You MUST have an M.D. in order to prescribe medication. Secondly, there IS an objective standard for diagnosing mental disorders, albeit not a perfect one. It’s unfortunate that mental disorders can’t be diagnosed with the same precision as viruses or cancer biopsies, but someday that may change. Until then, obtaining a diagnosis via a checklist of symptoms is the best procedure we have available, and it sure as hell is better than nothing. > [@G.Pie](#): > > I don’t think _you_ have ever experienced four-point restraints. I don’t think _you_ have ever been dragged kicking and screaming down to the electroshock room. I don’t think _you_ have ever been dumped into an isolation cell. I don’t think _you_ have ever been held down and injected with powerful, mind-altering drugs. No, I haven’t. Have you? :dubious: > [@G.Pie](#): > > Anyway, this whole argument has been about the justness of forced treatment. We’ve completely been ignoring the effectiveness of said treatment. Yeah, let’s talk about that. Why _don’t_ we “force” treatment on anyone? 72 hour holds are useful for emergency situations only; but if someone has a chronic condition, that 3-day hold won’t do them a lot of good in the long run. However, we live in a free society, and that’s what the Patient Bill of Rights is all about. NOBODY is forcing you to seek treatment, to take your meds, to attend therapy sessions; it’s your choice. That’s how our current system works. But you should keep in mind that you are not the only one your illness affects – think about friends, family, co-workers etc. who have to put up with your behavior. What about them? Do you care? ---
**Author:** ![fuzzypickles](https://avatars.discourse-cdn.com/v4/letter/f/9d8465/32.png) [@fuzzypickles](https://boards.straightdope.com/u/fuzzypickles)\ **Post date:** [September 27, 2009, 4:36am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/85 "2009-09-27T04:36:04Z")
> [@G.Pie](#): > > If you talk to God, you’re praying; if God talks to you, you’re schizophrenic. Oh, I’m certain many religious people could benefit from psychiatric treatment. However, the difference is that religious people, esp. charismatic Christians, CHOOSE to be delusional. They can always break away from the church and join the rest of reality, if they so desire. The genuine schizophrenic has no such choice – his brain is malfunctioning, and changing belief systems won’t fix that. > [@G.Pie](#): > > Who really gives a shit if I think I’m picking up messages through my fillings? No problem at all, if it doesn’t affect your ability to function in society. But I certainly wouldn’t go around telling people about it. (Unless you’re Lucille Ball…) > [@G.Pie](#): > > It’s only relevant if you are concerned about the health of your patient. It’s only relevant if you consider brain damage, diabetes and irreversible tics, among many other side effects, an unworthy trade off. In order to make an omelette, you have to break a few eggs. It’s no different from side effects you get with “regular” medications, which can be annoying or even dangerous – it’s a trade-off, and it really boils down to whether the benefits outweight the risks. And nobody is ever forcing you to take meds, _even during a 72-hour hold._ The patient _always_ has the right to refuse treatment, whether it’s deleterious to their health or not – for all your bluster, you should be thankful that our medical system allows you such personal freedom. Look, I’m sympathetic to people with mental illness. It sucks, and it’s not their fault. But my sympathy ends with patients who refuse treatment based on some voice in their head telling them that we’re all equally sane, or that doctors and nurses and social workers are all members of some grand conspiracy. Like I said before, mental illness doesn’t just affect the patient, it affects everyone that patient knows, including his or her family. ESPECIALLY the family. Why don’t you think about their feelings, what it’s like to watch someone sink further and further into their selfish delusions, and being powerless to stop them? ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:14am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/86 "2009-09-27T05:14:48Z")
> [@fuzzypickles](#): > > First of all, psychiatrists ARE medical doctors. You MUST have an M.D. in order to prescribe medication. Yes, I know they have medical degrees. What they practice isn’t science, however. > [@](#): > > Secondly, there IS an objective standard for diagnosing mental disorders, albeit not a perfect one. It’s unfortunate that mental disorders can’t be diagnosed with the same precision as viruses or cancer biopsies, but someday that may change. Until then, obtaining a diagnosis via a checklist of symptoms is the best procedure we have available, and it sure as hell is better than nothing. No, it’s not “better than nothing.” It’s considerably worse than nothing. > [@](#): > > No, I haven’t. Have you? :dubious: Indeed I have. > [@](#): > > Yeah, let’s talk about that. Why _don’t_ we “force” treatment on anyone? 72 hour holds are useful for emergency situations only; but if someone has a chronic condition, that 3-day hold won’t do them a lot of good in the long run. However, we live in a free society, and that’s what the Patient Bill of Rights is all about. NOBODY is forcing you to seek treatment, to take your meds, to attend therapy sessions; it’s your choice. That’s how our current system works. What are you talking about? The whole reason we have mental health legislation is to enable forced treatment. This is not a free society for anybody who carries a psychiatric label. > [@](#): > > But you should keep in mind that you are not the only one your illness affects – think about friends, family, co-workers etc. who have to put up with your behavior. What about them? Do you care? And what is it exactly that they have to “put up with”? Which behaviour of mine troubles you? ---
**Author:** ![Pray\_for\_peace](https://avatars.discourse-cdn.com/v4/letter/p/5f9b8f/32.png) [@Pray\_for\_peace](https://boards.straightdope.com/u/Pray_for_peace)\ **Post date:** [September 27, 2009, 5:23am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/87 "2009-09-27T05:23:16Z")
> [@G.Pie](#): > > It’s diagnosis by checklist. As Thomas Szasz says: If you talk to God, you’re praying; if God talks to you, you’re schizophrenic. > > Why should you have to prove anything? Do we ask the religious to prove the existence of God? Who really gives a shit if I think I’m picking up messages through my fillings? Why is that worse than any other conspiracy theory? If you are telling your neighbors or your employer that you’re picking up messages through your fillings or hear God talking to you, I think they are right to be concerned about your state of mind. If you’re not delusional, you would realize that (1) what you’re saying is outside of the bounds of what most people consider to be physically possible, and (2) these kinds of thoughts are not just odd, but are consistent with stereotypical types of delusions that are experienced by people who are psychotic (not necessarily dangerous, but not fully in touch with reality). If someone is in fact not in touch with reality, there are reasons to be concerned that the person may not be able to take care of themselves (e..g, did they remember to eat and sleep, are they drinking too much, are they wandering around the neighborhood). If you’re not delusional, you should realize why these thoughts would raise a red flag for the listener, and you should know to save discussion of these thoughts for the right audience (e.g., talk to a clergy person about what God is telling you; talk to your family or a trusted friend about your fillings.) If you’re not delusional and you decide to risk talking to your neighbor or employer about these experiences, you should be prepared to calmly respond to questions about what you are experiencing, how you interpret it, and what you’re going to do about it. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:23am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/88 "2009-09-27T05:23:56Z")
> [@fuzzypickles](#): > > Oh, I’m certain many religious people could benefit from psychiatric treatment. However, the difference is that religious people, esp. charismatic Christians, CHOOSE to be delusional. They can always break away from the church and join the rest of reality, if they so desire. The genuine schizophrenic has no such choice – his brain is malfunctioning, and changing belief systems won’t fix that. Many people have successfully recovered from schizophrenia and other mental illnesses without drugs. That shouldn’t be possible (what with their malfunctioning brains and all) but it’s the reality. It’s also clear that some schizophrenics do choose to be delusional. Delusions can be a respite from an appalling reality. > [@](#): > > No problem at all, if it doesn’t affect your ability to function in society. Functioning to be assessed by whom? There’s plenty of people out there who I don’t consider to be functioning well yet they’re not subject to discriminatory legislation like the crazies are. > [@](#): > > In order to make an omelette, you have to break a few eggs. It’s no different from side effects you get with “regular” medications, which can be annoying or even dangerous – it’s a trade-off, and it really boils down to whether the benefits outweight the risks. That’s right, it’s benefits versus risks. Unfortunately, with antipsychotics, the risks far outweigh the benefits. > [@](#): > > And nobody is ever forcing you to take meds, _even during a 72-hour hold._ The patient _always_ has the right to refuse treatment, whether it’s deleterious to their health or not – for all your bluster, you should be thankful that our medical system allows you such personal freedom. Why would I be thankful for a freedom that doesn’t exist? People are forced to take psychiatric medication. It would be good if you understood even the most basic facts before you try to argue your case. > [@](#): > > Look, I’m sympathetic to people with mental illness. It sucks, and it’s not their fault. But my sympathy ends with patients who refuse treatment based on some voice in their head telling them that we’re all equally sane, or that doctors and nurses and social workers are all members of some grand conspiracy. Uh huh. And what about the people who reject their psychiatric labels and refuse treatment based on the fact that they do better without it? > [@](#): > > Like I said before, mental illness doesn’t just affect the patient, it affects everyone that patient knows, including his or her family. ESPECIALLY the family. Why don’t you think about their feelings, what it’s like to watch someone sink further and further into their selfish delusions, and being powerless to stop them? Mostly because in many cases it’s family dysfunction that caused the alleged mental disorder. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:31am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/89 "2009-09-27T05:31:28Z")
> [@Sidney Evgeni Jordan](#): > > If you are telling your neighbors or your employer that you’re picking up messages through your fillings or hear God talking to you, I think they are right to be concerned about your state of mind. If you’re not delusional, you would realize that (1) what you’re saying is outside of the bounds of what most people consider to be physically possible So God can hear you (or else why bother praying?) but it’s crazy for you to hear God. They’re both impossible but society deems the former acceptable. That’s a value judgement and has nothing to do with the practice of medicine. > [@](#): > > If you’re not delusional and you decide to risk talking to your neighbor or employer about these experiences, you should be prepared to calmly respond to questions about what you are experiencing, how you interpret it, and what you’re going to do about it. No, I don’t think so. I have freedom of speech. I also have freedom not to speak. I am not obligated to respond, calmly or otherwise. It is not my duty to allay anybody’s fears. ---
**Author:** ![Pray\_for\_peace](https://avatars.discourse-cdn.com/v4/letter/p/5f9b8f/32.png) [@Pray\_for\_peace](https://boards.straightdope.com/u/Pray_for_peace)\ **Post date:** [September 27, 2009, 6:22am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/90 "2009-09-27T06:22:37Z")
> [@G.Pie](#): > > So God can hear you (or else why bother praying?) but it’s crazy for you to hear God. They’re both impossible but society deems the former acceptable. That’s a value judgement and has nothing to do with the practice of medicine. > No, I don’t think so. I have freedom of speech. I also have freedom not to speak. I am not obligated to respond, calmly or otherwise. It is not my duty to allay anybody’s fears. They’re both impossible? Personally, I don’t think it’s crazy to hear God. It’s not something I would discuss at work or with a casual acquaintance, though. Yeah, society is making a value judgement about what religious behaviors are acceptable, and I don’t necessarily agree with that judgement. But I don’t have a problem with that. I can choose to conform when it benefits me to do so, and I can find the right forum to discuss ideas and feelings that society deems controversial. Or I can choose not to talk about those ideas at all. If I understand you correctly, you’ve been treated poorly by mental health professionals. I’m sorry that happened to you. Take care. ---
**Author:** ![muttrox](https://avatars.discourse-cdn.com/v4/letter/m/a8b319/32.png) [@muttrox](https://boards.straightdope.com/u/muttrox)\ **Post date:** [September 27, 2009, 11:16am UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/91 "2009-09-27T11:16:27Z")
> [@G.Pie](#): > > No, the deck is stacked against the patient. The psychiatrist has a vested interest in incarcerating him. How so? (I’m genuinely curious, this is a fascinating thread.) ---
**Author:** ![Orr\_G](https://avatars.discourse-cdn.com/v4/letter/o/ee59a6/32.png) [@Orr\_G](https://boards.straightdope.com/u/Orr_G)\ **Post date:** [September 27, 2009, 2:06pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/92 "2009-09-27T14:06:13Z")
> [@fuzzypickles](#): > > And nobody is ever forcing you to take meds, _even during a 72-hour hold._ The patient _always_ has the right to refuse treatment, whether it’s deleterious to their health or not – for all your bluster, you should be thankful that our medical system allows you such personal freedom. Since when is this true? At what point in history did we stop restraining even the most violently out-of-control resistive patients? When did we stop giving sedatives and/or antipsychotics to such patients? Does this new rule apply for the whole country, or is it determined by each state? What processes have been installed to ensure compliance with this new law, so that instances such as experienced by **G. Pie** and **AHunter3** can no longer happen? The character in **Jodi** ’s hypothetical is, by law, free to go? ---
**Author:** ![Zeke\_N.Destroi](https://avatars.discourse-cdn.com/v4/letter/z/4af34b/32.png) [@Zeke\_N.Destroi](https://boards.straightdope.com/u/Zeke_N.Destroi)\ **Post date:** [September 27, 2009, 4:10pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/93 "2009-09-27T16:10:37Z")
This is a really interesting thread! I’ve no interest in picking a fight with anyone. We all have our own experiences and, for the most part, any discussion of this type of thing will fall more into the anecdotal than the empirical. In keeping with that I’ll share a few anecdotal experiences of my own: Girlfriend #1) Was in university and holding down a pretty good GPA. She was also actively bulemic. I asked her to seek counselling but she wouldn’t. One day she crashed and was taken to ER and hospitalized. After a few days of IV electrolytes and nutrients she was released and told to go - on her own - to the mental hospital. I accompanied her at her request. She was interviewed by a psychiatrist with a psych nurse in attendance. She answered questions rationally and coherently and repeatedly said she was willing to get therapy but did not want to be admitted. The psychiatrist pushed some papers over to her and, in a round about way, told her they were commitment papers. She was about to sign them when I asked for a minute alone to talk to her. The Dr and nurse left and I said, “Debbie, you know that these are commitment papers right? If you sign them you’re staying here for awhile.” She hadn’t understood what the papers meant and the DR had made no effort to determine whether she did before asking her to sign them. Commitment would have screwed up her semester at university and humiliated her. She didn’t sign, she did seek therapy and she graduated and has a good and productive life with no recurrence of bumelia. But she almost ACCIDENTALY committed herself. Girlfriend#2) Was in a technical college and under the care of a psychiatrist owing to very real mental health problems. Gradually he prescribed more and heavier drugs in larger doses (at one point she was on 6 different meds simultaneously including Diazapam, Clorazapam, an antipsychotic that can cause permanent tics and twitches, Paxil and I can’t remember the rest). She got to the point where she couldn’t get out of bed, couldn’t care for her child, couldn’t convince herself to make meals etc and had to drop school because she could only force herself to make it there once or twice a week at best. She voluntarily committed herself to adult in-patient treatment a number of times - sometimes at the behest of her care worker - when she felt her illness had progressed to far. She gradually started to wonder if the meds were part of the problem and asked her pychiatrist to wean her off the two heaviest. The pychiatrist basicaly said, “Okay, if you don’t trust my judgement we’ll see how you do without them.” Rather than weanning her off of them he refused to write a prescription for them and cut her off cold turkey. Within 5 days she was so batshit nuts that she begged to be put back on them. The pychiatrist lectured her about how she wasn’t qualified make decisions about medication and he hoped that this experience showed her that. After her 5th voluntary commitment in under a year I suggested that she maybe consider seeing another pychiatrist. She, over massive protests from her current psychiatrist, changed psychaitrists to one that didn’t rely so heavily on medication. The new pychiatrist weanned her off of the three heaviest drugs and gradually cut down the doses of the other three. She now has full custody of her child and is working as teacher’s aid and has been for about 4 years. **Jodi** said that there is no assumption of imcompetence (I hope that is a close enough summation of what you said in an earlier post if not please correct me) and I agree that there is no such codified or overt assumption. There does seem to be, in my experience, an underlying one. I call it the wing-nut test \<— not meant to be offensive and if it is I apologize sincerely - it goes like this: Are rational people generally in psch wards? No. Is [insert name here] in a psychward? Yes. Therefore [insert name] musn’t be rational and any statement made by [insert name] must take that into consideration. If [name] were rational then he/she wouldn’t be here; ipso facto they are not rational. Remeber that Doctor’s are often accused (sometimes fairly sometimes not) of having a God complex. Specialists (like psychiatrists) are more prone to this than GP’s owing to greater education and expertise. The lawyer arguing for commitment is also highly educated and is likely to defer to the judgement of what they percieve to be another professional’s greater expertise. The Judge is likely to do the same. The patient however is likely not possesed of advanced education and has already failed the wing-nut test (if they had passed the test then this hearing would not be taking place). The system is weighted against the patient. Not, in my opinion, because of malice on the part of any party (although sometimes that does exist) but because of a natural human tendency to “trust the expert.” And I have known people (girlfriend #2 for instance) who asked to be released from voluntary commitment and was greeted with a refusal until the psychiatrist could talk to her - sometimes over a day later - and intense pressure from the psychiatrist to remain. Insistence upon release resulted in forced commitment for non-compliance / combative attitude. I’ve no doubt that **Jodi** and others like her honestly believe in what the7y are doing but they have little or no 1st hand experience with the patient side of mental health care outside of files/charts and hearings. Zeke ---
**Author:** ![fuzzypickles](https://avatars.discourse-cdn.com/v4/letter/f/9d8465/32.png) [@fuzzypickles](https://boards.straightdope.com/u/fuzzypickles)\ **Post date:** [September 27, 2009, 5:24pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/94 "2009-09-27T17:24:19Z")
> [@sidney evgeni jordan](#): > > if you’re not delusional, you would realize that (1) what you’re saying is outside of the bounds of what most people consider to be physically possible, and (2) these kinds of thoughts are not just odd, but are consistent with stereotypical types of delusions that are experienced by people who are psychotic (not necessarily dangerous, but not fully in touch with reality). If someone is in fact not in touch with reality, there are reasons to be concerned that the person may not be able to take care of themselves (e..g, did they remember to eat and sleep, are they drinking too much, are they wandering around the neighborhood). > > If you’re not delusional, you should realize why these thoughts would raise a red flag for the listener, and you should know to save discussion of these thoughts for the right audience (e.g., talk to a clergy person about what god is telling you; talk to your family or a trusted friend about your fillings.) if you’re not delusional and you decide to risk talking to your neighbor or employer about these experiences, you should be prepared to calmly respond to questions about what you are experiencing, how you interpret it, and what you’re going to do about it. This is a critical point. One hallmark of “sanity” is the ability to recognize other people’s point of view, and to respect that point of view, even if you yourself don’t understand it. To demand that everyone believe your words without any external proof is, at the very least, a sign of immaturity. So if you really think you’re being stalked by FBI agents, or the victim of some grand conspiracy, the onus is on YOU to restrict your conversations to people who are willing to give you the benefit of the doubt, and to communicate your reasoning process in a manner that can be followed and understood by others. > [@G.Pie](#): > > Actually, I wasn’t aware that mental health services even existed in jails. I’d much rather be in jail than on a psych ward. Hate to tell you this, but due to lack of government funding for mental health care, most jails have become _de facto_ psych wards for the criminally insane. Trust me, you do not want to be in jail, _especially_ if you are insane. If you think regular psych wards are abusive and dehumanizing, you ain’t seen nothin’. > [@G.Pie](#): > > Many people have successfully recovered from schizophrenia and other mental illnesses without drugs. No, they haven’t. It is true, that schizophrenic symptoms typically become reduced as the patient ages, but that’s commonly a result of the patient learning to live with them, as opposed to overcoming them. And I think you’ll be hard pressed to point out any individual who overcame mental illness _without_ the use of therapy or drugs, unless that individual received an incorrect diagnosis in the first place. > [@G.Pie](#): > > Mostly because in many cases it’s family dysfunction that caused the alleged mental disorder. Cite? > [@Orr\_G](#): > > Does this new rule apply for the whole country, or is it determined by each state? The [U.S. Patient’s Bill of Rights](http://en.wikipedia.org/wiki/U.S._Patients%27_Bill_of_Rights) is a federal mandate, which was set in place _specifically_ to prevent the very abuses alleged by **AHunter3** and **G. Pie**. In particular, it contains the _right to appeal_ if any alleged offenses take place. No system is perfect, there will always be a small percentage who fall through the cracks, which is tragic but unavoidable. But I suspect that when a patient claims he’s been robbed of his rights, or forced treatment against his will, it’s far more likely to be a symptom of his/her ongoing paranoid illness. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:43pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/95 "2009-09-27T17:43:55Z")
I can’t seem to use the quote function today. Anyway, **fuzzypickles** said: > [@](#): > > To demand that everyone believe your words without any external proof is, at the very least, a sign of immaturity. It’s ironic that this is _exactly_ what psychiatrists do. They continue to promote the biochemical theory of mental illness and they insist that they’re in the right even though they do so without proof. They ignore the vast amount of research demonstrating that outcomes are better without psychiatric intervention. > [@](#): > > Originally Posted by **G. Pie** : Many people have successfully recovered from schizophrenia and other mental illnesses without drugs. > [@](#): > > **fuzzypickles** responds: No, they haven’t. Sure they have. I’m one of them. > [@](#): > > And I think you’ll be hard pressed to point out any individual who overcame mental illness without the use of therapy or drugs, unless that individual received an incorrect diagnosis in the first place. That’s a bit circular, isn’t it? If you’re ill but you recover without us then you weren’t really ill. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:46pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/96 "2009-09-27T17:46:54Z")
> [@fuzzypickles](#): > > The [U.S. Patient’s Bill of Rights](http://en.wikipedia.org/wiki/U.S._Patients%27_Bill_of_Rights) is a federal mandate, which was set in place _specifically_ to prevent the very abuses alleged by **AHunter3** and **G. Pie**. In particular, it contains the _right to appeal_ if any alleged offenses take place. No system is perfect, there will always be a small percentage who fall through the cracks, which is tragic but unavoidable. But I suspect that when a patient claims he’s been robbed of his rights, or forced treatment against his will, it’s far more likely to be a symptom of his/her ongoing paranoid illness. Of course you do. If somebody claims to have experienced “forced treatment against his will” then he must be paranoid. Wanting to be free of the system is just a symptom proving you should be in it. It’s a hopeless catch 22. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 5:49pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/97 "2009-09-27T17:49:58Z")
> [@fuzzypickles](#): > > Cite? You could start here: [Google Search](http://www.google.ca/search?hl=en&source=hp&q=childhood+abuse+and+mental+illness&meta=&aq=5&oq=childhood+abuse+) ---
**Author:** ![fuzzypickles](https://avatars.discourse-cdn.com/v4/letter/f/9d8465/32.png) [@fuzzypickles](https://boards.straightdope.com/u/fuzzypickles)\ **Post date:** [September 27, 2009, 6:11pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/98 "2009-09-27T18:11:19Z")
> [@G.Pie](#): > > Wanting to be free of the system is just a symptom proving you should be in it. It’s a hopeless catch 22. What’s preventing you from being free of the system? What’s keeping you from getting a job, finding new friends, acquiring hobbies and pastimes which nurture your soul, joining a health spa, stuff like that? If you genuinely think you’re able to experience rebirth, there are options available to you – but your first step is to take responsibility for _yourself_, and quit blaming other people for the hand that you’ve been dealt. Spouting vitriol and hatred on an anonymous message board about how people should feel sorry for your problems isn’t going to help you achieve your goals, in fact it’s keeping you trapped in the system. Your juvenile attitude is only teaching others to believe that you’ve brought all these problems on yourself, and are continuing to do so. ---
**Author:** ![G.Pie](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@G.Pie](https://boards.straightdope.com/u/G.Pie)\ **Post date:** [September 27, 2009, 6:21pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/99 "2009-09-27T18:21:24Z")
> [@fuzzypickles](#): > > What’s preventing you from being free of the system? Nothing. I am free of the system. > [@](#): > > What’s keeping you from getting a job I don’t need a job. I have a job. > [@](#): > > finding new friends, acquiring hobbies and pastimes I also have all these. > [@](#): > > If you genuinely think you’re able to experience rebirth, there are options available to you – but your first step is to take responsibility for _yourself_, and quit blaming other people for the hand that you’ve been dealt. Why should I quit blaming the psychiatric system for stealing years of my life? Do you think the wrongfully convicted should just buck up and quit complaining? > [@](#): > > Spouting vitriol and hatred Such as …? My contention that the mental health system is seriously flawed is “vitriol and hatred”? > [@](#): > > on an anonymous message board about how people should feel sorry for your problems What??? The purpose of my posts was solely to point to Jodi and others that the system isn’t the fair and reasonable one that’s described. > [@](#): > > Your juvenile attitude is only teaching others to believe that you’ve brought all these problems on yourself, and are continuing to do so. Don’t really know what this is supposed to mean but I think it’s pretty clear that it is you who is spouting hatred. ---
**Author:** ![Jodi](https://avatars.discourse-cdn.com/v4/letter/j/7feea3/32.png) [@Jodi](https://boards.straightdope.com/u/Jodi)\ **Post date:** [September 27, 2009, 7:05pm UTC](https://boards.straightdope.com/t/questions-on-institutionalization/511108/100 "2009-09-27T19:05:31Z")
> [@G.Pie](#): > > So what I’m hearing here is that if 999 people are helped by involuntary treatment, then it’s just too damn bad if 1 person’s life is destroyed. How about 99 to 1? Still okay? What about 9 to 1? At what point would it concern you? It concerns me at any level, but I don’t see anyone coming up with a better system. Certainly you aren’t theorizing one. > [@](#): > > How many harmless people are you willing to persecute in order that one dangerous crazy person gets forcibly drugged? Oh, I don’t know. How many crazy people are you going to allow to be homeless, incarcerated, injured or killed to make sure that no non-crazy person ever spends 3 days on a psych ward? [Previous page](https://boards.straightdope.com/t/questions-on-institutionalization/511108.md?page=4) [Next page](https://boards.straightdope.com/t/questions-on-institutionalization/511108.md?page=6)