Should paranoid schizophrenics be forcibly committed?

I was watching this show on Court TV this evening, about how this woman with paranoid schizophrenia killed a harmless man because she believed he was a government assassin out to get her. In the course of her trial it became evident that she had been suffering with this mental disease since her twenties, and had always refused help because she thought that everyone else was either clueless about the conspiracies that surrounded her, or out to get her.

If you have someone who’s seriously nuts like this, but has not yet committed any crime, is it moral and/or ethical to enforce therapeutic measures, even if it is against their will, for the safety of society?

I don’t believe so. IIRC, the actual percentage of schizophrenics who do significant harm to others is quite small. So one would be pre-emptively incarcerating hundreds, if not thousands of individuals in order to prevent each serious assault.

Frankly, I think the odds are better in terms of getting risky individuals out of the way if we pre-emptively jail everyone ever arrested more than once for drunk driving.

Agreed. It’s quite probable that the woman in question never showed any behaviour that would have indicated violent tendencies towards others. And schizophrenia only rarely causes such behaviour anyway.

This is the key phrase. They haven’t committed a crime, so they aren’t a criminal, therefore we have no right to lock them up. One might argue about the potential for harm to others, but one would be full of it. Everyone who gets behind the wheel of a car (and I’m not talking drunk driving a la QtM, just every day driving) could potentially kill someone. But we don’t lock up the people who drive because the potential for harm is very small. Same with the potential for harm with mentally ill people.

People are incarcerated in mental hospitals all the time without committing any crimes, aren’t they?

Paranoia/schizophrenia seems like reason enough to legally force psychological treatment on someone to me. In my currently right-thinking mind, I seriously hope that someone will commit me if I suffered from a mental disorder that I was unable to acknowledge as a side effect of the disorder itself.

Has nothing to do with protecting society, though. It has everything to do with helping the people with those disorders.


I’ll be damned I’d I allow the “demons” to take control of my life instead of the state. Certainly some institutions might show up on 60 Minutes, but the record of the “demons” is pretty dismal. I would say “If they kidnap me, please rescue me and put me in protective custody”.

Its a damn shame to see the degree of homelessness out there, with a significant proportion caused by dumping the mentally ill out onto the street.

If they are judged to be an immediate danger to themselves, yes.

Schizophrenia does not often render somebody incapable of understanding and consenting to treatment. Cases such as the OP are very very rare.

I’d be pretty damn hesitant to give over more power to the state to commit “those not in their right mind”. You want to be forcibly held and medicated because you didn’t vote the straight-party ticket? It’s happened in the annals of modern psychiatry.

It’s very difficult (but not impossible) to commit someone these days in the US. And that’s the way it should be. Commit crimes, or be a clear and present danger to self and others, and then there are legitimate grounds for commitment. Fail to manage your life the way others think you should? Not a good reason for commitment to me.

And yes, there’s lots of grey area in between. And yes, there’s big problems with homeless mentally ill people. And more should be done. And perhaps those with mental illness who depend on public assistance should have their assistance tied in some way to compliance with a treatment plan. But lets not go nu… Ahem. Let’s not go overboard here and give the government more power to decide what methods of thinking need “intervention”.

BTW, the institution where I work was originally named “Central Hospital For the Criminally Insane”. :smiley:

This is just one of those situations where it’s hard to come up with the best answer. I read what Qadgop just said, and I can’t argue with any of it. But then I look back at the situation that my cousin was in. He was diagnosed as mentally ill. He heard demons, and they told him that he should kill himself because he was bringing only danger and shame to his family. The freckles on his arm were a sign of the mark of the beast.

He tried to kill himself with carbon monoxide, but failed when the vacuum hose he had rigged to bring the exhaust into the car melted. His father found him and tried to take him inside, but he fought off his father and ran away The family begged the sheriff’s department to take him into custody for his own protection, but they weren’t legally able to. But they were able to help find his body hanging from a tree on the family farm the next day.

I don’t claim to know the answer to this difficult question. But I don’t think the system we have is working.

While I am sure that AHunter will be here shortly* allow me just to chime in -

The burden of proof is that the individual is an imminent risk of danger to him or herself or to others. Without such proof involuntary treatment should not be imposed.

Now having admitted to voices that tell him to kill himself or having made an attempt to do so meets that burden. Just having a different perception of reality than you or I do does not.

*AHunter, for those who have not yet met him online here, is our resident untreated schizophrenic who is quite articulate (and convincing) in his defense of his rights to be as he pleases and to make the decision to avoid treatment that he feels has very significant side effects.

Being mentally ill myself and pretty much indigent, also, I can tell you that the government is lax on providing mental health treatment to people that want it and cannot afford it, now. I’ve known people that reach a point that they can no longer stand the voices and their only option is to go to an emergency room and rant in a corner till someone comes out and gives them a shot of thorazine and locks them in a pink room. I don’t know that the government is prepared to provide treatment to people against their will even though they may need it.

Just so you know right now a month’s supply of Resperidal, a good antipsychotic, costs about $300 to $400. Do I need to remind anyone on the government’s stance on prescription drugs?

Screw medication and treatment, lock us in a deep hole and throw away the key!

Hi, I’m a citizen, diagnosed paranoid schizophrenic, I’m “at large” and untreated, and I view the possibility of involuntary psychiatric incarceration and/or treatment as a grave violation of my civil rights. And yours.

a) Define “paranoid schizophrenic”. You’d better be prepared to do so if you’re going to support locking people up for “being” it. You could, of course, defer to the medical definition thereof, but there’s something you need to know: the working definition of “paranoid schizophrenic” is “person who has been diagnosed paranoid schizophrenic”. There is no “rule-out mechanism”, nothing that anyone can test for to determine that a prior diagnosis was made in error. And the initial diagnosis is made on the basis of reported and observed behavior and self-reported feelings. Do you really want to advocate locking up anyone who, on the basis of opinion derived from interpretations of behavior alone and unsupported by any labs or other rigorously empirical evidence, has been labeled as such?

b) Why lock us up? The conventional standard for locking someone up in our society is “for doing something illegal and being convicted of it”. There are people in America who openly belong to organizations such as the KKK and ascribe to sentiments about the permissibility and appropriateness of violence, and yet we don’t lock them up until they actually do something. Some of us may be really hard to understand (and find other people hard to understand, for that matter); you may be afraid of them and they may be afraid of you. And yet that only occasionally makes some of us violent some of the time (and we’re more likely to be on the receiving end of the violence, picked on for being “nuts”). The psychiatric standard in most of the country is “mentallly ill and dangerous to self and/or others”, not “mentally ill” by itself, and yet the ability of people to predict dangerousness is pretty limited and their accuracy rate is lousy (I’ll dig up a cite on this if requested). So why not just treat us like everyone else and arrest us and charge us if we actually do something?

c) On the other hand, why stop there? I mean, already you’re talking about having us locked up without due process (how could due process exist if we’re being locked up for something we are rather than something we did? how does one defend against that? we can’t even deny being “paranoid schizophrenics”, see (a) above), and unless you had a finite sentence in mind (you’d release us after, say, a year? but we’re still “paranoid schizophrenics” the day we get out, wouldn’t you have us locked up again on the same basis as we were locked up the first time?), that means indefinitely. Having permitted this kind of an approach to public safety and security, why not just have us gassed? I mean, is there a human rights or civil liberties concern that gets invoked at this point, but not prior to this point, that would cause you to have problems with that? Or maybe burning us at the stake would be more the thing, depending I suppose on one’s historical precedence preferences.

I dunno. I’m definitely for forced treatment. I might even be for forced hospitilization on a case by case basis, to get the people who are absolutely out of synch with reality some help. It’s a rather touchy subject, because I am vehemently against locking people up when they only have the potential for harm, but you have to take into consideration that in these cases people may have no real control over that potential.

Yes, you should be. :smiley:

I usually don’t post in Great Debates, but this issue is of great interest to me. My grandfather, a First World War veteran, spent the last 30 years of his life committed to a V.A. Hospital Psych Ward. He was diagnosed with PTSD (“Shell Shock”), which changed over the years to Paranoid Schizophrenia.

It wasn’t easy to have him committed, even back in the 1930s. It took a temporary commitment with psychological testing, a hearing in front a judge with the testimony of three doctors, his family and several witnesses on both sides. Still, once they had him, AHunter3 is right, they had him till his very last day on earth.

Though I understand why my family had him committed, a look into his medical records reveals just a glimpse of one of the saddest, most depressing existences imaginable. An utterly wasted life.

I don’t know what the answer to this is, beyond the hope for more effective, accessible drugs.

Why, in cases where people are no immediate danger (assuming that by hospitalisation when ‘out of synch with reality’ means when shizophrenia does theaten people’s safety)? Or are you in favour of forced treatment on a wider scale, such as blood transfusions for Jehovah’s Witnesses, or animal-derived pharmaceuticals for strict vegans?

Interesting, I am as well. What you said speaks volumes, but I’d like to add some to it.

The kind of thinking, “lock them all up” is falling back centuries in history. We’ve come to a point where we have medications and therapy that are effective. “Locking them up” is a solution that led to centuries of people with mental disorders having their lives RUINED. You may as well just execute us - it would be better than spending life in an institution rotting away. I’ve spent enough time there, thanks.

I don’t have a problem with “forced treatment” - the problem is, how do you fund the treatment? I’d be happy if you want to foot the bill for me. I can’t work, so have no insurance, and holding people in hospitals for long periods of time is very expensive… not to mention the thousands of dollars of meds every month.

On that note, romances cause way more murders than schizophrenics or schizo-effectives. I can think of a hundred things that you could prevent from happening to sanitize society before locking us all up and throwing away the key.

There is no case where a threat is not posed to the public by a paranoid schizophrenic. In mild cases of the disease the symptoms can be recognized and controlled, but in an advanced state the person is unaware of actual events around them and convinced that those around them are trying to do them imminent harm. They are in a state in which they are presented with a situation that would cause a reasonable person to commit acts of violence against others. That situation just isn’t real. It’s unfortunate, even tragic, but their rights do not negate or supersede the rights of those around them.

We regularly commit the insane. We also quarantine those carrying dangerous, communicable disease. When people have conditions that make them a threat to others, they are isolated if necessary and treated where possible.

What does your utter piffle about Jehovah’s Witnesses have to do with mental illness? Or are you just going to plug up your ears and pretend that schizophrenia is merely a difference of opinion?