[pachyderm]

DocJohn on forced treatment:

http://psychcentral.com/blog/archive...ced-treatment/

[Maven]

I left a comment, which is awaiting moderation. I was really surprised that DocJohn feels that way, because it's how I feel. Problem is, anything I say that others disagree with, people will dismiss it because I "don't know what [I'm] talking about" because I'm "mental." Sadly, I don't think it'll change many minds, but I'm glad it's out there. We need to speak louder, us and those on our side.

[pachyderm]

Maybe DocJohn is mental too...

[onionknight]

We are all human. We have hopes and dreams, diginity and the right to decide what happens in our life. A diagnosis doesn't mean we revert to "children" or need someone to come along who "knows better."

If we are in a bad place, it might be in our best interest to recieve treatment until we our stable but after that, when we are feeling better, it should be up to us.

Also, there is a vast different in treatment types: forcing someone on to medication is way worse than forcing someone into talk therapy or community support. Docs who force drugs on people, when there is little evidence to show their long-term helpfulness, might not be acting in a patient's best interest. We can decide what we want out of life. That's my opinon, my humble opinon. I'm firmly on the side of patients' rights.

[venusss]

If we are in a bad place, it might be in our best interest to recieve treatment until we our stable but after that, when we are feeling better, it should be up to us.

Problem here is that once you get crazy stamped on you... you are deemed so forever. Refusing "help" is seen as symptom of crazy. Torrey and his croonies even came up with some sciency term for that. Say it's a symptom, that you are not able see your crazy, when you do not want the wondrous (NOT) treatment.

[venusss]

also, let's not forget psychiatry had been abused as government tool, especially in the Eastern Bloc. Demanding Soviet tank leave your country or demanding human rights was seen as danger to others.

Not saying it is happening today. But it could. And if we allow the thought of "for their own good" and "craziest are to crazy to see what is good for them", it sets a dangerous, dangerous precedent.

[costello]

Thanks for posting this, pachyderm. I too struggle with this issue - but from the point of view of the parent of an adult son with a severe and persistent mental illness. After his first episode, I thought I'd just get him to "help" and if necessary force the medications. Once he was thinking clearly he'd see how helpful the meds were. Or so I thought.

After years of aligning myself with the "professionals" and trying to force my son to do what he didn't want to do, I finally realized that it wasn't going to work. I had to align myself with my son and explore other options.

Other reasons not to force treatment - aside from the civil liberties issues DocJohn discusses:

1. Treatment should be collaborative between the patient and the professional. Forcing unwanted treatment often does more harm than if you'd simply left the person alone. IMO forced treatment does not qualify as treatment at all. It's something else - not treatment.

2. In the case of paranoid people, the tricks you have to play to get around the system reinforce the paranoid world view. If you think people are trying to hurt and poison you, there's nothing like the treatment meted out by the mental health system to confirm that view.

I remember my aunt - who also has a mentally ill son - advising me to call the police and lie, to tell them my son was threatening me and I was in fear for my safety. That's how she got her son involuntarily hospitalized when she felt it was necessary. Seriously? Someone who already thinks you're the enemy, and you do that to them?

3. I guess I have too good of an imagination. I've never been given a psych dx or been forcibly treated, but I can imagine myself in that position. On the one hand, I would hope that if I lost my mind someone would intervene and help me. On the other, I would hope that they would treat me with respect. (I've asked my son what he would do if I started saying odd things and threatening other people. He said he'd just leave me alone. <Sigh!>)

4. Psych meds have serious, serious potential side effects. No one should be forced to assume that risk without being fully informed and allowed to accept or refuse the treatment.

5. I could probably come up with more reasons if I thought about it a while longer.

At this point my son has opted to take an antipsychotic to control his symptoms. Occasionally he hints he'd like to quit them. I've told him I won't allow him to live here if his behavior jepardizes my safety, and I won't retrieve him from jails or hospitals again - if he lands in one of the places due to quitting his meds without medical supervision or abusing drugs or alcohol. Even that feels too coercive to me at times, but at this point IMO he's been wrestling with this monster long enough to avoid behaviors which will make him ill again (I hope!). At any rate I'm a human being who's entitled to some peace too. (Of course, if he becomes ill again despite taking care of himself, I'd help him.)

[costello]

Originally Posted by VenusHalley

also, let's not forget psychiatry had been abused as government tool, especially in the Eastern Bloc. Demanding Soviet tank leave your country or demanding human rights was seen as danger to others.

I often think about that.

Not saying it is happening today. But it could. And if we allow the thought of "for their own good" and "craziest are to crazy to see what is good for them", it sets a dangerous, dangerous precedent.

I think we do something similar. Whenever someone can't or won't fit in and tolerate an environment, we too often hand them a pill. I think of kids with ADD or caregivers wrestling with the care of small children, ill or elderly relatives, and often working fulltime on top of it.

I fall into the latter category. Mentally ill adult son living at home. A mom in the early stages of dementia I think who needs to have someone do something. A job I loathe. A house that's falling apart. A pile of debt and a lack of money. Am I depressed? Yes. Do I have a chemical imbalance in my brain? I doubt it. But I'm sure I could easily - today if I wanted - get a doc to write me a prescription for an antidepressant. In fact, last week, if I'd gone to a pdoc and told him frankly what I was thinking I have no doubt he'd have hospitalized me. Not helpful. (Oh, another reason not to force treatment. How can you ask for help if the result will be forced hospitalization and possibly drugging?)

[Nammu]

What a sticky, sticky area. One right many states now allow is a Psychiatric Advance Directive or Mental Health Advance Directive(PAD or MHAD). The sticky point is of course that you have been "labeled" with a mental illness if you make a PAD. And in many states the PAD legally only need to follow the states own PAD forms which are very limited. Many states like the one I live in now only ask when you have become "unstable" which of three choices of treatment/torment do you wish to have forced on you; Med's(which med's are your first choice), restraint and isolation, some states add ECT as an option. None of the above is my choice, really is there any difference between isolation, restraint and the chemical restraint of some medications?

With my T , Bazelon web site, and legal advise I have my own PAD that is geared toward me and my illness. On it I note that I am not my illness. I explain why I chose not to take certain medications and outline the negative physical reactions I had. I explain that as a human being I respond well to one person talking in a low reassuring voice and no tricks or lies. Two people on my PAD must agree on the treatment for it to be considered. By explaining what physical reactions I have had to medications and how I act to force I have a better chance of any court accepting my PAD than an outline form that simply refuses the standard choices. I've placed copies with my primary care doctor and everyone on the PAD also has a copy.

I've been though the hell of a forced treatment once and do not ever want to repeat it. I was once put on a 72 hour hold where they told me they had called my T (they had not- but said IF she called back and confirmed what I said I could go)and would call my primary doc after the weekend(which doesn't count) but since I was put in on a weds they had no excuse for not calling right away. I contacted my T's office and told them what was going on once she called them they had to let me go.

So there is a bit of protection from forced treatment available if you want to be proactive and are willing to involve others. With so many civil rights at risk in todays times it helps me sleep a bit better. Like many things it is an individual choice and depends on your own circumstances.

[Lauru]

I just posted there. I am awaiting moderation.

[Maven]

I added another comment, which I assume is awaiting moderation. I didn't get a notice saying that, but the comment sent.

[costello]

Originally Posted by Lauru

I just posted there. I am awaiting moderation.

I just read your post there, Lauru, and I wanted to give you a hug.

[eskielover]

Just posted there also.

There are so many sides to this......& the one that personally effected me was my grandmother who had violent alzheimers. Before we were able to get her into the care faclity, she not only beat my grandfather with her cane, she broke almost everything in her house.

In the care facility which was one of the best....with wonderful care givers & the fact that my grandfather was with her every day.....but she would get violent there also & they would end up giving her a shot of Haldol or what ever they needed to calm her down.....that is also forced treatment & if you take away all forced treatment just because.....there will be a lot of negative consequences with that choice also.

I personally believe that there needs to be some serious controls & standards that can be controlled with consequenses otherwise on the forced care that exists now which I do agree in some cases is not ok....while for others, the people who force their treatment do it in a very dignified manor & treat the people with respect....not all forced treatment is equal out there & I'm sure that if you check, there are probably as many positives that come out of it as the negatives & the negatives are usually because of the way it's implemented.

Don't think that either extreme is the right answer since so much is on a case by case basis....but if there were better controls & requirements placed on any forced treatment that does happen to bring it into humane & dignified treatment, there wouldn't be the trauma that seems to go along with it in the negative situations.

[Maven]

I posted again. Awaiting moderation.

[costello]

Originally Posted by eskielover

There are so many sides to this......& the one that personally effected me was my grandmother who had violent alzheimers. Before we were able to get her into the care faclity, she not only beat my grandfather with her cane, she broke almost everything in her house.

To me there's a difference between dementia and mental illness.

[venusss]

Originally Posted by costello

To me there's a difference between dementia and mental illness.

yup. seriously. there was one comment on the article about "losing mind and free will" and meds returning you that free will.... really? How is APs which are mostly given in forced treatment gonna give you... free will? Those things mostly zonk you out. Yeah, you may no longer be willing to harm others... but eh. You are not healed.

and you inject somebody with sense and insight.

[Anika.]

AP"S... ohh the heavy hitting major tranquilizers... free will. Give a horse a tranquilizer, is the horse acting out of free will? I am tired of calling them AP's, neuroleptics, mood stabilizers, AD add on's, sleeping aides.... they are Major Tranquilizers.. and it is no wonder I felt like a wild horse being tied down while on them.

I guess calling them tranquilizers doesn't sound as appealing, or scientifically specific let alone helpful.

I was in the hospital, it was not forced. Did I feel like I had the right to refuse treatment when I was locked inside, not allowed to go outside for 5 minutes, not allowed to have my phone or any other personal belongings, not allowed to shave or shower with privacy, had a camera on my bed, and get in trouble for questioning anything, was dished out meds like crazy. When I was put on three AP's at once at max doses in the hospital, along with benzos and other meds, was I acting on free will? I could not even barely speak or walk, let alone think. I was not a danger to myself or others... I was manic and could not sleep, was not functioning. When the other patients began to express concern to me about why I was being given so many meds, and after passing out three times on the hallway floor.. it does make you wonder..why?

Ok I am obviously still upset about that. It was not exactly voluntary, I was declined for their partial out patient facility, and was taken by the staff to the hospital across the street, and told that it was voluntary but if I choose to not go they would have to have me brought in anyways. Nice choice, I was not on 72 hour hold I was there for almost two weeks.

Luaru, I am soo sorry that happened, I don't even have words to express how wrong that was.

[onionknight]

This might be a somewhat controversial opinion, but our society really needs to find better long-term help for mental illness, besides throwing people on meds, reassuring them they'll get better on them and then unleashing them upon an uncaring world.

I find it hard to believe that with all the knowledge and creativity we possess as humans, we cannot do any better than drugs that cause all kinds of side effects and may make things worse down the line. Yeah, yeah, I know Pharma companies control this stuff, but does it have to be this way?

[Lauru]

I know mine not be a popular opinion. But frankly, I think people should be allowed to commit suicide if they choose. I don't think the government or society as a whole should make that choice for us. I firmly believe that I have a right to end my own life if I choose, Would it be selfish? Yes. Would it be harmful for those left behind? Definitely. Is it a good choice? I think not. Is the idea of government being able to dictate and control my life a good one? Hell no! Why should we give strangers that much control? Why should the government get to decide my fate? This is my life, my body, my choice. Please don't force me into treatment, it won't work. Not anymore. Goddess knows that I know how to lie my way out of a 72 hour hold quite easily. So please, dear government/society, let me live my life or not as I see fit. If I want help I will get it. If I don't I won't.

[Maven]

Lauru, I agree wholeheartedly. I know it sounds crazy at first, but I don't believe people should be able to prevent other people from doing whatever they want to do to their own bodies. If I saw someone who seemed intent on killing themselves, I'd certainly offer help to not feel like they do, and to help the person find treatment, but if your life is so miserable, especially if you've tried treatment, then how can I tell you that you have to stay alive because I'd miss you or I think it's wrong to commit suicide? There are people who cut, and I'm not saying this is good, but I think a person has a right to make this choice. I believe everyone should know there is help, where to get it, and offered options, but the final decision has to be the person's who is suffering. I know most people will think Lauru's and my feelings on this are just signs of mental illness, but I've thought about this long and hard. I grew up hearing and learning about freedom and the rights we have as humans and how rights should only be taken away when someone tries to hurt or step on the rights of another. My body, my choice.

[venusss]

I may be even more controversial here, but I hate we reduced suicide to "s/he is mentally ill". When in many cultures.... it had range of meaning.

I had somebody to talk about Anna Karenina killed herself because of being... unmedicated. I fear the day somebody will start saying that if those Monk in Vietnam gotten their Prozac, they would never kill themself, oh-my-predictable tragedy. Don't forget the Samurais either :/

[Maven]

VenusHalley, you bring up an excellent point! I didn't get to watch the full episode, but on a recent Taboo (on the National Geographic Channel), they featured a country (sorry, I don't remember which one) where it was considered honorable for certain people to starve themselves to death. As they're doing this, they are cared for by others in a loving manner...

Wait, I just found the episode on the National Geographic website, and the episode, "Bizarre Burials," will re-air December 20th: http://channel.nationalgeographic.co...zarre-burials/.

[elliemay]

I agree with Dr. John's position 100%

[lizardlady]

I have mixed feelings about this both professionally and personally.

I did a little on-line research. The "assisted outpatient treatment" that Doc John talks about is NOT enforced hospitalization. It's court ordered outpatient treatment - i.e. - a court order saying someone living in the community must take their meds and comply with treatment.

Ah man, I see both sides of this issue, people who aren't taking their meds who break the law and end up in jail or prison. Something that could have been avoided if they'd been on their meds. Yet, there's a history of governments abusing the power to force people into treatment. Which is a greater infringement on the person's freedom - forcing them to take a medication that will help them stay out of jail or locking them up?

On the flip side, at one point during the early states of Alzheimer's my mother forgot to take her blood pressure medication. It caused a cascade of medical problems that made her act in some bizarre ways. During that time she refused to take her meds. Her primary doc admitted her to the psych unit as a result. I went ballistic and told the doc she had the right to refuse her meds. I ended up having to go to court and be appointed her guardian. She didn't need to be on a psych ward. She needed her blood pressure med.

I'm probably going to take some heat for this, but there's a flaw in Doc John's logic. He compares a mental health diagnosis with terminal cancer. Menatl health disorders are not, in and of themselves, terminal. They can lead to fatal behavior, but they, themselves, do not lead to death. I'm going to fall back on the saying "suicide is a permenant solution to a temporary problem." I've been suicidal in the past due to my mental health problems. My T once asked me if I had a plan. I asked him which one he wanted to know about. At that point in my life I could not see any other way out of the pain I was in. Thankfully, I'm no longer in that place in my head after a lot of hard work in therapy and my meds.

Having said all this, I do believe in a person's right to decide when they've had enough. I have some significant health problems. I want the right to "check out" if I reach a point that I'm going to die a slow, painful death. I want to have that last bit of control of my life. I believe others have the same right. At the same time, it bothers me that someone in a temporary situation might make a very permenant decision how to deal with it. So I guess I'm sitting on the fence.

[Anika.]

Or you get treatment for cancer and live. My sister went through rounds of chemo and radiation. They had to stop because they had given her way to much and they didn't think she would live, deemed it terminal. Months later her cancer was in full remission. She no longer has any cancer at all. Cancer can be cured.

In my case, I have a community order that states that I am to comply with medication and psych appointments. Which is what you are talking about Lizard Lady. The thing is tho, when I signed this I it was under a guise and no one explained it to me, I was not in a good mental state either. It was made part of my disability agreement. The problem is that this is not just the norm, how many people in Canada are on disability with no such agreement? Tons. I was never a threat, I am not violent. I am am not nor was suicidal. I was going through some depression at the time. I have a dx of Bipolar, I am not a criminal, I had never been hospitalized at that point, and that was the very beginning of my treatment. I had just finished college and was doing nothing more than raising my three kids and looking for employment after college. I was stressed and depressed after coming out of an abusive divorce and having to flee with my kids and no belongings besides a suitcase to start a new life.. who wouldn't be stressed and depressed?

Now I am in full breech of that community order. The meds I tried for 7 years and only made my condition worse and worse. So I tried a different route of yoga, mindfulness, cutting out gluten which was an issue for me.. one that does have psychological effects, changing my perspective on life, changing thinking patterns and coping skills. I have not had an episode of depression, mania, or psychosis since. However, apparently doing this can come with serious consequences for myself. Why was I even made to sign that? There is a serious problem there. They are not strictly using these orders for people who are a threat to the public, they are using them on people who never did anything to have these orders placed on them in the first place. I don't do anything for anyone to presume I am a problem to be dealt with. I don't even drink, I don't do drugs. I am working part time, I take care of my children, I take care and am responsible and accountable for my self and my life, there is just nothing there to imply I need this order. Now getting the order reversed is a whole other matter. They are not easy to get reversed once you have one.

I don't have all the answers, but I do know that the majority of us are not a public threat. The fact that my meds did seem to make me worse off also is a bit of a problem in this and I am not the only person who found this, a lot of the meds create the exact symptoms you are taking them for, we just call them side effects. Just because someone take their meds does not mean they will be "better" and not commit crimes.