Forced treatment for people with mental illness has had a long and abusive history, both here in the United States and throughout the world. No other medical specialty has the rights psychiatry and psychology do to take away a person’s freedom in order to help “treat” that person.
Historically, the profession has suffered from abusing this right — so much so that reform laws in the 1970s and 1980s took the profession’s right away from them to confine people against their will. Such forced treatment now requires a judge’s signature.
But over time, that judicial oversight — which is supposed to be the check in our checks-and-balance system — has largely become a rubber stamp to whatever the doctor thinks is best. The patient’s voice once again threatens to become silenced, now under the guise of “assisted outpatient treatment” (just a modern, different term for forced treatment).
This double standard needs to end. If we don’t require forced treatment for cancer patients who could be cured by chemotherapy, there’s little justification for keeping it around for mental illness.
Charles H. Kellner, MD unintentionally provides a perfect example of this double-standard in this article about why he believes electroconvulsive therapy (ECT, also known as shock therapy) shouldn’t be held to the same standards as FDA-approved drugs or other medical devices:
Yes, ECT has adverse effects, including memory loss for some recent events, but all medical procedures for life-threatening diseases have adverse effects and risks. Severe depression is every bit as lethal as cancer or heart disease. It is inappropriate to allow public opinion to determine medical practice for a psychiatric illness; this would never happen for an equally serious nonpsychiatric illness.
And yet, strangely enough, if someone were dying from cancer or heart disease, they have an absolute right to refuse medical treatment for their ailment. So why is it that people with mental disorders can have that similar right taken away from them?
People who’ve just been told they have cancer are often not in their “right” minds. Many people never recover from that information. Some rally, undergo treatment, and live a long and happy life. Others feel like they’ve been given a death sentence, resign themselves to the disease, and refuse medical treatment.
As long as they do it in the quiet of their home, nobody seems to much care.
Not so with mental disorders. No matter what the concern — depression, schizophrenia, bipolar disorder, heck, even ADHD — you could be forced into treatment against your will if a doctor thinks it may help you. Technically, he or she must also be concerned about your willingness to live, but isn’t an oncologist also concerned about their patient’s will to live?
I’ve wrestled with this double standard all my professional life. Early in my career, I believed professionals had the right to force a person to undergo treatment. I rationalized this position — as most psychiatrists and psychologists do — arguing to myself that since many mental disorders can cloud our judgment, it seems like something that may be appropriate from time to time.
I was never fully comfortable with this idea, though, because it seemed completely antithetical to the basic human right of freedom. Shouldn’t freedom override the right to treat someone, especially against their will?
After talking with hundreds of people over the years — patients, clients, survivors, people in recovery, advocates, and even colleagues who voluntarily underwent psychiatric treatment procedures such as ECT — I’ve come to a different point of view. (Luckily, it appears ECT treatment is in decline and may someday go the way of the dodo bird.)
Forced treatment is wrong. Just as no doctor would ever force someone to undergo cancer treatment against their will, I can no longer back the rationalizations that justify forcing a fellow human being to undergo treatment for their mental health concern without their consent.
As a society, we’ve shown time and time again that we cannot devise a system that won’t be abused or used in ways that it was never intended. Judges simply don’t work as check for forced treatment, because they don’t have any reasonable basis on which to actually rest their judgment in the short time they’re given to make a determination.
The power to force treatment — whether through the old-style commitment laws or the new-style “assisted outpatient treatment” laws — cannot be trusted to others to wield compassionately or as an option of last resort.
What should be good enough for the rest of medicine should be good enough for mental health concerns. If an oncologist can’t force a cancer patient to undergo life-saving chemotherapy, there’s little that can justify our use of this type of power in psychiatry and mental health.
It’s a double-standard in medicine that has gone on long enough, and in modern times, has outlived its purpose — if it ever even had one.