I will admit to being frustrated with you marching into a factual GQ thread about “how do people get committed?” to announce that mental illness isn’t really illness, as I personally considered that so much of a hijack of the topic as to be borderline thread-shitting. But even in that regard, I certainly didn’t intend to come across as “fairly hostile” or as “lashing out.” I make no apologies, however, I believe I have taken no worse tone with you and AHunter than the two of you have taken with me. And if you think your personal and difficult experiences mean I’m going to let you tell me my experience was invalid or let you effectively call me a liar, you’ve got another thing coming.
You are misunderstanding the argument. The point is that it is up to the party that seeks to deprive another party of liberty to demonstrate why this should be so. The burden is on the system to show why someone should be locked up, not on the alleged incompetent to prove why he should be free.
Yes, thank you, I am aware of what “incarceration” means. My point is that in the context of discussing the confinement of the mentally ill, it is helpful to distinguish between “incarceration” (criminal system and jail) and “commitment” (civil system and hospital). Using “incarceration” to describe both just imports uncertainty as to what you’re talking about. The distinction is not one of “euphamisms” such as “assisted treatment,” it is a valid distinction and useful distinction between different types of confinement.
Then please correct me and demonstrate how it’s an illness like diabetes. What pathology drives bipolar disorder or schizophrenia? How do people recover from this neurologically based brain disorder without drugs? Why don’t neurologists treat this supposed neurological disorder?
I don’t think your experience was invalid. I’m sure some of those people were better off in the short term. What I think is invalid is your apparent belief that the system doesn’t fail a frightening amount of the time.
And I will ask you again: What do you think of the World Health Organization findings that demonstrate that the mentally ill do better without psychiatric intervention? Does that cool your heels even a little?
No, I think I’m pretty good on the argument, though if you want me to try to be less of what you perceive to be hostile, you’re going to have to try to be less condescending, especially where it isn’t warranted.
You are conflating the standard of proof with where the burden of proof lies. Only in criminal cases is the innocence or guilt of the defendant at issue. That is as it should be, since “innocence/guilt” necessarily implies volitional conduct, which is obviously NOT the appropriate inquiry in a hearing about a person’s mental status. But the State bears the burden of proof in both criminal matters and civil commitment matters. No one except you has said anything about “the alleged incompetent proving why he should be free.” The burden is clearly on the State to prove that the standards for commtment have been met. IIRC, the standard of proof in the jurisdiction in which I then practiced was “clearn and convincing evidence.” This is a higher standard that the usual civil standard of “preponderance of the evidence” but a lower standard than the criminal standard of “beyond a reasonable doubt.”
A better system would involve every patient being assigned a psychiatric advocate whose job it would be to ensure that the law is being upheld. That means patients would have to be demonstrably suffering from a mental disorder and be a danger to themselves or others. Expressing your intention not to take drugs, for instance, would not qualify.
It’s not always a matter of a three day holiday on a psych ward. It can take weeks or months to get released. If the potential downside was merely a three day incarceration on a psych ward (with no coerced or forced drugging), then I’d be more cavalier about the possibility of the sane being accidently deemed insane.
I said I considered your attempt to derail the threat into that issue to be near thread-shitting. I haven’t changed my opinion on that. If you want to start a GD thread about whether mental illness is truly illness, go right ahead. I’m sure you’d get lots of lively debate, though I’m not sure you wouldn’t find some of the responses to be hostile.
If by “fail” you mean people were committed who didn’t really need to be, I can only reiterate that in my experience it didn’t. You’re the one claiming that must be wrong, though I’m not real clear on what basis. I get that you think it failed you, and AHunter thinks it failed him. I’m even willing to assume that’s true, becaue I never said the system was perfect, contrary to what you seem to want to assert. It is flawed. However, IMO it is better than no system, and I don’t see you or anyone else coming up with a better one that is in any way realistic.
You’re going to have to re-post a cite; I can’t trawl through for it. I will respond, though.
No, I’m fine with you being hostile.
No, other posters have also commented on the underlying prejudice against the patient. Only a crazy person would be caught in the net.
Right, that’s how it works in theory. Unfortunately, what it really comes down to in practice is that it’s the psychiatrist’s call.
And I’d be thrilled with “clear and convincing evidence” as a standard. But the fact is that many of us have been incarcerated on a psych ward with much less than that.
What if I found you bleeding on the sidewalk, or clutching your chest in great pain, or having a grand mal seizure – would you allow those people to suffer and die just in case they weren’t actually bleeding to death?
I’ve been in large rooms of people who claimed they were abducted by aliens, or that 9/11 was a government-led conspiracy, or that the spirit of Jesus Christ enabled them to speak in tongues. What’s your point?
I’m not sure what you mean by a “psychiatric advocate” as opposed to the MHP who is treating the patient, but I can tell you there’s no money for whatever it’s intended to mean. And the patients ALREADY have to be demonstrably suffering from a mental disorder and be a danger to themselves or others, or gravely disabled. And a refusal to take psychiatric drugs is NOT considered. I feel like we’re back at the beginning of the thread.
I never said it was. I can only speak from my experience, but what I have said GENERALLY happens, which I stand by, I have never said ALWAYS happens.
I’m pretty much done with arguing with you about what happens “in practice” or what happens “in fact.” Your experience was not mine. You were one patient, but you had a thorough experience of every aspect of being a patient. I dealt with dozens of patients with dozens of illnesses and societal problems, but I only dealth with them in one narrow regard. But only one of us is insisting the other one must be wrong, and it isn’t me. Your experience was not the universal experience, despite your insistence that it must have been. You bring nothing beyond your own anecdotes to back up your assertions for what happens “in fact” or “in practice.” I really have nothing to say to that, that I haven’t already said multiple times.
You know, your language gives you away. You reiterate your experience that the system didn’t fail while *AHunter and I * “think” it failed us. All is not lost, though, because you’re “even” willing to assume that we speak the truth.
Anyway, I’m not clear on how you would be aware if your system failed. You approached each case, believed each person was crazy, and won your hearing every time. If you were wrong and one of those people actually wasn’t crazy how would you know?
I’m not insisting that my experience was the universal one. Where do you get that? My own “anecdotes,” as you quaintly put it, do back up my assertion that the system can fail. If you choose to disregard that possibility, that’s your choice.
A psychiatric advocate might be a peer or a friend, knowledgeable about the mental health system, someone who the patient could approach with their concerns. Someone to liaise between the patient and the system. When someone’s being forced to take drugs, the forcer is hardly their advocate.
I think there’s enough will in the psychiatric survivor community to create this position on a volunteer basis.
Well, I suppose it could be that the system in your area is vastly superior to where I am. I was kind of under the impression though that the standard across North America didn’t vary much. Maybe that’s not true. Anyway, here, being alleged to suffer from a mental disorder and not be willing to take drugs will do it.
In British Columbia, the standard is having a mental disorder and being capable of mental or physical deterioration. It’s a handy standard, and the psychiatrists love it, because it can be applied to absolutely anybody. It’s meaningless.
You can parse my postings as carefully as you like, but when you are obviously spending more time dissecting my word choices than I put into considering them, I don’t feel constrained to respond.
I didn’t “believe each person was crazy.” It wasn’t my role to make a determination as to whether they were crazy or not, and it didn’t make any difference to me in terms of the job I was there to do. I evaluated whether I thought legal grounds existed to pursue commitment, relying (as I have freely admitted) very heavily on the opinion of the MHP and the doctor. If there were such grounds, I presented the state’s case at the hearing, the PD presented the defense (both of us relying on the same evidence), and the judge made a decision. Although frankly I think a good indicator of a person not being crazy, is not acting completely crazy.
I’ve never said failure was not even a possibility, and I challenge you to find where I ever did. YOU are the one insisting the system is fatally flawed and that the patients I am describing “don’t exist.” So you sure as hell have implied that your position is universal, by citing it repeatedly for the premise that I must be wrong.
That sounds like a great program and I wish you the best with setting it up. I have dealt with a number of involved family members, but very few other people who have any interest in wading into the quagmire that exists at the intersection of mental illness and public health.
You’ve taken awfully sharp issue with my description of “the system” to be admitting at this late point that you don’t even really know what system I was even talking about. Which it ends up you don’t; BC law is fundamentally different from American law, as a quick review of the relevant BC enactments reveals. Didn’t all the talk of “72 hour holds” and “14 day holds” indicate as much to you? Neither is a feature of Canadian law, apparently.
Yeah, I’ll give that some thought.
They’re pretty similar actually. Our relevant timing is 48 hours and then 30 days and then 6 months. The ball gets rolling with one psychiatrist’s certificate and there has to be a second to proceed past 48 hours. Once you’re an in-patient (I think for 14 days), you’re allowed to apply for a Review Panel which is analogous to your commitment hearing. Patients win Review Panels about 25% of the time.
Sorry for being such a hothead. This is a difficult issue for me. I probably shouldn’t discuss it.
No prob. The laws are similar but, having zero experience with Canadian law, I think there are important differences. For example, a “Review Panel” seems to indicate some sort of appeals process from the initial hearing, where perhaps the initial finding might be overturned if it was found to be wrong? (WAG, WAG, WAG) In the system I was familiar with, the hearings were to be de novo, meaning the State always bore the burden of showing a need for continued commitment right then, at that hearing, with no assumption made due to whatever hearing had gone before. You had to prove the whole thing from the beginning, again. But again we venture into the area of unconscious bias, since of course everyone at, say, a 14 day hearing knew the patient had already been committed at a 3 day hearing, so it would be a valid question whether that knowledge could ever be completely disregarded.
We don’t have an initial hearing. All it takes is two psychiatrists’ certificates. I have read some where the second doc just copied verbatim what the first doc said. In no sense is this truly an independent second opinion. And 30 days is a long, long time to wait for a shot at the Review Panel.
In general, I have found it’s a better strategy to just ignore the legalities and try to convince them to let you go. You have to pretty much agree that your brain is diseased and that you can’t function without chemical intervention. Be compliant, cooperative and pleasant and you’ll be out the door before you know it. And, once you’re out, just don’t do anything to bring attention to yourself. No one gives a shit if you actually *are *crazy; the thing is to avoid acting crazy.
What would happen at a 14 day hearing if a patient was stabilized and lucid but intended not to take meds upon release? Wouldn’t the psychiatrist testify that it would be impossible for the patient to maintain stability?