Last Sunday I reviewed the book Committed: The Battle Over Involuntary Psychiatric Care by Dinah Miller, MD and Annette Hanson, MD.  If you have not read that you may want to before reading this, as I will refer to the book.

I first heard of Committed in an emailed newsletter from my local NAMI Chapter.  They were going to be co-hosting an Author’s Live event with the Enoch Pratt Public Library.  I read the description of the book, and thought it looked interesting.  I also thought it would be a good “together” activity with my husband because it combines my interest in mental illness and his interest in the law.

I ordered the book from Amazon, and when it came in I eagerly sat down with it and a calendar and worked out a reading schedule to finish the book in time for the event.  It didn’t turn out quite how I planned, turns out two people reading the same book, but with very different reading habits doesn’t lend itself to such a structured format.

On the day of the event I had around 40 pages left until the end of the book.  I was able to finish the book just in time.  At the event I learned that a lot of people had not read the book, and some didn’t even have a copy until they bought it at the event.  My having finished the book seemed to level the playing field, since most of the crowd was psychiatrists and other mental health professionals.

The talk started with Dr. Miller discussing what she called the “battlefield”.  She had a great visual for this and showed where different organizations fell on the “battlefield”, depending on how they felt about involuntary civil commitment, while taking personal and public safety and individual liberties into consideration.

Representing the furthest extreme on the pro-commitment side of the “battlefield” is E. Fuller Torrey and the Treatment Advocacy Center, which works towards, as their website states: “Eliminating Barriers in Mental Health Treatment”.  This sounds great on the surface, but once I learned more about Torrey’s opinions by reading the book and during the discussion at this event, I decided that I was in strong disagreement.

Torrey is very pro civil commitment, but only in certain circumstances.  He feels that if someone is psychotic and/or has been diagnosed as schizophrenic, then they should be involuntarily committed, period.  He does not take into consideration their level of safety or their own wants when it comes to treatment.  Torrey also talked to Dr. Miller about suicidal patients during their interview: “Suicide can be, and often is, a fully rational decision.  I won’t say I would never involuntarily hospitalize such a person, but it would take a very unusual set of circumstances.” (Page 244)

To me, Torrey’s statement is very troubling.  To say that suicide is a rational decision is not only antidotally wrong, but is also contradictory to what most suicide prevention educators express.  There are tall fences around bridges because if someone who is suicidal has a barrier to quickly and easily jump, they often will walk away.  Stopping a suicidal person from acting can prevent their suicide, if, as Torrey asserts, suicide is rational, then it wouldn’t matter what small preventative measures were taken, people would follow through with their “rational” plan.

On the other extreme lay Daniel Fisher and the National Empowerment Center, whose mission according to their website is: “To carry a message of recovery, empowerment, hope and health to people with lived experience with mental health issues, trauma, and/or extreme states.”  Once again, sounds good, but their mission statement is somewhat misleading.

The National Empowerment Center asserts that psychiatric medications actually cause the symptoms of mental illness and that those who are no longer taking their psychiatric medications are survivors of a system trying to make them ill.  For this reason, the Center is obviously against not only involuntary treatment, but voluntary as well.  I feel that this is a very dangerous stance to take, because to stop your medication and all other treatments can result in not only withdrawal, but also a flair up of your original symptoms.

Also on the anti-involuntary treatment side is the church of Scientology which has a museum called: “Psychiatry, and Industry of Death.”  If you want to hear about this museum, there is an episode of the podcast “Oh No Ross and Carey” in which they visit the museum.

The “battlefield” was discussed in detail by Dr. Miller, and then Dr. Hanson spoke about the history of treatment.  We were shown a clip of Alberta Lessard whose case caused the standard of “least restrictive” treatment.

After both authors had their opportunity to talk about their main topic, they turned the discussion over to the audience.  Despite my fear of speaking in groups, I made it a point to participate.  I asked the first question during the question/answer/discussion period of the evening.  I wanted to make sure that I had understood Torrey’s standpoint because it seemed so ludicrous to me.

There were several people after me who spoke up, some applauding the authors for approaching such a difficult topic, and some sharing how the issue affects their practice.  The last audience participant talked about her experience as both a patient and a psychiatric social worker.

Overall, I highly enjoyed my evening.  It was a great experience to be able to meet the authors of a book that I had enjoyed and learned so much from.  I also saw some people from NAMI that I had met previously during advocacy day.

You can listen to this Writers Live event on the Enoch Pratt Website.

Once again, I want to urge you to purchase a copy of Committed: The Battle Over Involuntary Psychiatric Care.

authors hanson and miller
Left Dr. Annette Hanson; Right Dr. Dinah Miller

 

My Opinion on Involuntary Psychiatric Care:

I feel, much like the authors, that at times involuntary treatment is necessary, however, it should be used only in the most extreme circumstances, with the understanding that it can be traumatic for the patient.