Why do we protect the "right" of people to avoid medication and remain mentally ill?

Great Debates
1

After reading this post, I can’t help but rant about a related topic.

Isn’t it odd that we are opposed to suicide, and that suicidal talk or actions will get you committed (for a short time), yet, people in the US have been ruled to have a constitutional right to be insane? If you don’t want to take your medication you can stop it. Even if this means you will alienate yourself from those who love you, end up friendless on the street, and live in extremely poor health, being taken advantage of by others who steal from you, and continually disturbing those around you.

As a police officer, I am probably more jaded than most, but I continually deal with people in situations like I described above.

There was the woman whose trailer we went to on a mental-health petition pick-up who had to wade through trash a foot high in her trailer to answer the door. She had lice or fleas. The staff at the County Psych unit said the last time she was in she had been sleeping in bushes and had a lizard living in her hair.

There was the man who the transient kids were scared of and who wandered around town wearing a jacket and wool cap all year (it’s regularly 105 in the summer here) and muttering threats at people. I had found his camp and saw old prescription bottles but, when I was called to arrest him for trespass he denied having any mental condition.

There’s the guy I had to arrest on a public urination warrant (twice now) who had feces-covered toilet paper all down the inside of his pants. I don’t think he’ll live a year but he denies he needs help (and yells at me for bothering him).

There are the people we get called about who are yelling at passing cars. Or threatening the convenience store clerk who won’t sell them beer.

I could go on and on.

It’s sad. And it makes me think that their lives are miserable and pathetic because of activists and judges who trumpet individual “rights” at the expense of human lives.

I served on a United Way committee for several years which evaluated programs for the homeless and made funding recommendations. On a site visit at the largest shelter in downtown Phoenix, someone asked the staff why there were so many shopping cart people in the area. The reply was that most of the shopping cart people were schizophrenic and would not leave their carts in order to come in to stay at the shelter.

Granted, Arizona does not have anything like an adequate mental health care system.

So, go ahead and flame me, but we need a system where people take their medications – regardless of whether they “choose” to or not. Where do the conditions these people face fall under Life, Liberty and the Pursuit of happiness?

Rob

2

I can’t question that many of the people you describe needed help. But it wouldn’t come in a simple little pill-bottle. There’s no “Stop-compulsive-hoarding pill”, nor a “Conform to social norms regarding defecation and urination” vacination. If there was, it’d be easy.

3

In whom would you invest the power to force medication upon those not in custody? What limits or parameters would you set on that power?

4

I’m a diagnosed schizophrenic and I vote.

Why the fuck should you have the right to define my state of mind as a disease if it isn’t bothering me?

If I commit a crime, come get me: you’re a police officer.

If I don’t, guess what? My behavior is absolutely, positively, none of your fucking business!

The rat poison that the pharmaceutical industry and the psychiatric professions push is nasty nasty stuff. YOU take it if you want, but you’ve got no right to try to shove it down my throat.

You ever lived in a shelter for homeless people? I have. I’ve also lived on the streets. In the long run, I decided to use the shelter system because I had enough things going for me that, if lined up just right, would get me out of the situation, but before lifting me up and out it put me through some seriously degrading experiences, and if I hadn’t had the education and the skill-set I had, as many folks on the street do not, I’d have chosen the street over the shelter any day.

I’m now a gainfully employed tax-paying paranoid schizophrenic, making a couple notches better income than the average American and I’m respected in my field. It’s my considered opinion that if I hadn’t been adept at getting myself out of the clutches of the psychiatric system and staying out, and off the meds they tried to put me on, I would not be here. I would be watching TV in some group home, sitting on the sofa, fat from psych drugs and institutional food, with my fingers twitching from tardive dyskenesia, unable to concentrate on anything more formidable than “Survivor”, drawing SSI or SSD and turning most of it over to the group home, that’s where.

You look at the ones with the lizards in their hair and you think “Fuck, how can we let people be in this awful state?”. I know, I know. I acknowledge that there is compassion on your part, not just an urge to force people to do things you think they oughta do. But those needle-weilding pseudomedical folks and their forced-treatment facilities don’t have the answers. The statistics say they don’t, my experiences and those of many others who’ve been there and done that say they don’t, and if you think on it a bit you’ll probably realize your own experiences tell you that you aren’t seeing those same folks running around cured and productive and neatly fixed in the months or years after you escorted them to the psychiatric emergency ward, either.

5

I am having a hard time seeing how the mechanics of this thing would work. Most psychiatric drugs are not available in an injectable form and most also don’t have extended release form.

I am Bipolar and while I am fully treated today, there were times when I was not and I may have been considered eligible for the forced treatment that you describe. I take lithium which is only available in pill form and must be taken twice a day. Extreme Bipolar patients can potentially be the nuttiest of the nutty if they are not medicated. This can range from outrageous manic or depressive behavior to full-blown hallucinations and delusions.

I have a few questions. How would you actually make these people take their medication every day? If I was forced to be in this group, would I have someone come to my house twice a day or would I have to drive to the nearest hospital (17 miles) twice a day to see a nurse? If I had to travel for business or pleasure, would I have a nurse travel with me (make it a pretty one and that might be Ok) or would I just be restricted from going anywhere for the rest of my life?

Who decides who is going to be in this forced treatment program? Some people are already fully compliant with taking their medication.

6

This is why I would not support mandatory medicating, or a principal reason. I’m guessing that there’s some great mental health facilities, I just haven’t had the fortune to interact with one. Since my experience is more along the lines of, “These people are inept bunglers,” I am more fearful about the way my brother would be medicated, than the way my brother is now living. That’s really going some, since I do think in many ways, he’d be better off on some form of medication.

I said principal reason, another one would be the tendency I see of some people wanting to sweep persons with mental problems under the carpet. Medicate them and forget it.

7

Thing is, forcing stuff on people against their will doesn’t make them happier. At least not happier in any meaningful sense that isn’t tainted by the spectre of mind control.

Clearly, they fall under Liberty.

8

actually, there sort of is a “stop-compulsive hoarding pill”, or, at least, a regime.

The drill seems to be cocktailing an ssri (to ease the anxiety from.
throwing stuff out) with methedrine (to prevent the wave of good feeling from the ssri from overcoming and demotivating the sufferer) plus a “coach”, with ruthless disposal dogma

I think the “coach” is normaly known as mom.

9

What happens when a patient is assigned to a psychiatrist who makes an incorrect diagnosis and then medicates the patient into a stupor so that she cannot defend herself in a state hospital committment hearing?

What happens when a patient stays for days in a state hospital without ever talking to a psychiatrist – who later tells her as she is being released that she is “just spoiled”?

What happens when an unethical psychiatrist lies to a patient’s family that she doesn’t want to leave the private hospital and then releases her after 30 days on the day that her insurance runs out?

What can happen to the memory of patients who have been given shock treatment in a private hospital without full knowledge of the possible consequences, without her consent, and even without her knowledge?

All of these things have happened to me before I was 23 years old because some well-ntentioned people thought they knew what was best for me.

Unlike the many people who are diagnosed with schizophrenia, I do have an illness – depression. My depression responds to the right medication with a therapist who knows what he is doing.

Some of the people described in the OP are committing the crime of assault and should be arrested. The State is offering no workable alternatives for the others who may or may not need assistance. And many private hospitals don’t hold the solutions yet either.

BTW, the psychiatrist who misdiagnosed me, over-medicated me, held me against my will and lied to my parents, committed suicide. The doctor who conspired with him to have me committed to a state hospital was himself later committed to that same hospital and died of a drug overdose.

Thanks to a father who trusted me and overruled them both, I was never committed to the hospital except for the few days I was there voluntarily prior to the “hearing.”

10

It’s probably not popular with the public because of the old ghost all the willy-nilly lobotomies that went on for so many years. I mean, the lobotomizers were trying to help people, and they thought what they had going was the best way to treat a lot of mental illnesses…but nowadays, they just end up looking like a bunch of, well, “inept bunglers.” And so today there’s that lingering fear and distrust over the field of mental illness treatment, coupled with the fear that our modern best efforts in psychiatric medicine might just be more “bungling.”

So, I guess it’s probably best for our collective consciences just to leave alone all the badly mentally ill street people. They probably know what they’re doing, anyway.

11

Historically speaking, the pendulum swung in the direction of restored civil liberties for the mentally ill due in large part to the work of Thomas Szasz, M.D., a psychoanalyst, author, critic of patient abuses by the mental health system and libertarian activist. By the mid-'50’s, Dr. Szasz began to question the prevailing praxes in psychiatry. He found a public audience for his ideas with a few “crossover” bestselling critiques of the mental health system in the '60’s and '70’s.

Beginning in the ‘60’s, a burgeoning and vocal mental patient advocacy movement came to challenge public policies concerning involuntary mental health institionalization and the medication, confinement, and surgical/electroshock practices (or abuses) involved. Dr. Szasz’ books and papers were a key early legitimizing authority (and rallying point) in the early years of the mental patients’ rights movement – the foundational texts for the cause, if you will.

A few landmark court cases followed (late '60’s-mid '70’s, IIRC), resulting in new legal protections of diagnosed mentally ill, with new protocols governing involuntary institutionalization – regulating the psychiatric treatment of patients both in terms of treatment/institutionalization term lengths and in clarifying the limits of acceptable procedures and pharmacological regimens. The “Reagan Revolution” – itself shaped in part by libertarian ideas, selectively accepted and quoted, as well as supply-side economics – took care of the rest. The entire public mental health system was gutted and radically downsized in the interest of trimming the federal budget as well as curtailing institutional abuses of the government’s power over the individual. (Having said that, the Reagan Administration’s chief motivation for deinstitutionalization was probably the fiscal one, and not the civil libertarian arguments of the patient’s rights advocates.)

Here’s an internet shrine to Dr. Szasz, with an impressive 34-page bibliography of his writings.

12

Moving this to Great Debates.

13

Y’know, every time I think I’m about to put together an intelligent post for this thread I keep hearing this in my head.

Makes it hard to be serious.

14

I can’t top all the great posts that have been made already, so I’ll just agree. It seems like a no-brainer to me: Does anybody seriously want the government to decide what constitutes sanity, decide who is sane and who is insane, and forcibly administer drugs? That’s just unacceptable, no matter how good the intentions might be. Maybe some people should be getting medication, but rights apply to everyone.

This sort of reminds me of people who say, “Why are we giving rights to criminals?” We aren’t - everyone has rights; whether one is a criminal is a matter to be determined, which can’t be done correctly if you take away the rights in the first place.

(I’m not comparing the mentally ill with criminals in any way - it just reminded me of that argument.)

You sure about that? I’ve been on ssri’s, and they most definitely don’t give you “waves of good feelings”. They’re not happy-pills.

15

I second this. I’ve talked to some people who have experienced a giddiness on their first or second day of taking SSRIs, but in general (and in my experience) they seem more like mood blunters rather than mood elevators. Thus, they help with depression by making it so you don’t get so depressed, but you also don’t get very happy either.

16

Knew I should have started an “ask the guy who was Baker Acted” thread…

I was involuntarily committed for a very short stay a number of years ago. In addition to some of what is above, another thing that must be pointed out is that institutionalization can make things worse.

Step 1: Patient is committed
Step 2: Patient undergoes treatment (meds or otherwise)
Step 3: Patient improves
Step 4: Patient is released
Step 5: Patient is now on the street, and has to go through finding a job, place to live, making new freinds, etc, etc. all very difficult and stressful. If patient is without family and indigent before (as the ones you discuss) he will be so afterwards; in fact moreso. In my own case, if I had been kept in for a day or two more, I’d have lost my job, and subsequently likely have been evicted, etc.

Of course there are halfway houses and the like to ease the transition. But still, at some point, they’re going to be released again, and many will just repeat the cycle.

17

I’m with blowero and chorpler on this one. SSRI’s are usually very slow working. They take anywhere from 2-6 weeks to work. The change is gradual. You just begin to feel like your normal self – not giddy or euphoric.

As I told my shrink, I felt like they allowed me to be who I really am. I have also read that they have no effect on people who do not have a seratonin problem – other than the usual placebo effect.

I wish to point out that my horrible experiences happened almost forty years ago. The treatment of depression has changed greatly since then. SSRI’s are successful with many, many patients and allow you to take control of your life again. Even modern shock treatments have improved – although I would research them carefully before trying them and try everything else first.

Again, I am speaking only of depression as an illness.

Don’t expect to be able to recognize depression when it hits you. The part of your brain which affects your ability to judge your own situation is affected. You may simply see yourself as being a weak person unable to cope with life’s stresses. You may blame yourself. And all along, it’s not your fault at all. It’s not a personality trait or a character weakness. Often it is about your brain chemistry.

18

Psychiatric Treatment of Christians in the U.S.S.R.

Of course, nowadays it’d be easier to just drug them into zombiedom. If you happen to like christians, pick on Liberals, or Libertarians. You can always find some reason to call people you don’t get along with crazy.

19

We draw the line at the point where they represent a danger to themselves or others. Seems perfectly reasonable to me. The only problem I see with mental health in the US is in examples like those in the OP: people get far too caught up in hypotheticals and the perception of even-handedness, they lose the will to actually sit down and evaluate matters on a case by case basis. Committing one insane person does not mean committing them all. It’s the same drivel that gets euthanasiasts prosecuted as rigorously (if not more so) as serial killers.

We finance the judiciary branch for this exact reason, to make situational judgements about the application of broad legal standards.

20

I myself, don’t have a problem with this. Until the other side comes in. The side that says " It’s not my fault I (committed that crime, violated my probation, whatever). It’s all because I have (fill in the diagnosis of the week) Allow me to go to a mental health program instead of jail, and I will comply with the treatment. Just don’t send me to jail". I don’t believe you have or would do this, but I see it every day in my work. The problem you face is not only the people who define your state of mind as a disease, but also the ones who attempt to use their similar states of mind as a “get out of jail free” card