Sometimes Involuntary Hospitalization is Just the Right Prescription

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Mia Fontaine, co-author of the book, Comeback: a Mother and Daughter’s Journey through Hell and Back, wrote a compelling editorial in the Op Ed section of the Sunday New York Times the weekend of February 10, 2008. Using Britney Spears as an example of the central issue, Ms. Fontaine discusses the problem of having a loved one committed to psychiatric or drug treatment inpatient hospitalization against the wishes of the patient.

The author correctly points out that involuntary hospitalizations were severely curtailed many years ago in order to protect the civil rights of people from being violated.  Prior to this curtailment, there were abuses whereby people could be involuntarily hospitalized and abused. For example, a vindictive spouse could "drive their husband or wife crazy," make the claim that they were crazy and have them hospitalized in a state or private institution for most of their lives.

In fact, an experiment conducted by David Rosenhan many years ago resulted in a famous article entitled, "On Being Sane in Insane Places." In the experiment, a group of graduate psychology students signed themselves into a mental institution, reporting that they were suffering from psychotic symptoms. Once on the psychiatric wards, they behaved in completely normal ways that betrayed absolutely no psychotic symptoms. The medical staff did not notice that these people were normal and, in fact, made notes about their behavior indicating psychoses.

The results of this experiment was only one of the factors that changed the legal standing of involuntary hospitalizations. Practices such as: 1) the old version of electroshock therapy that used huge amounts of voltage that often harmed patients, 2) lobotomies, in which the a portion of the prefrontal cortex was removed to quiet schizophrenic patients, and other inhumane practices, once brought to the attention of the public, resulted in the modification of laws so as to stop and prevent abuses of the mentally ill.

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There is no doubt that it was a good thing that these laws were changed to protect both the mentally ill and the normal population who could be imprisoned in a mental hospital by vindictive family members who had an interest in getting someone out of the way. In addition, the advent of modern medications to treat the mentally ill made long hospitalizations unnecessary and led to the deinstitutionalization movement so that most state hospitals were closed with psychiatric patients referred to outpatient settings while living in the community.

Once again, there is sometimes too much of a good thing with the result that it is now sometimes difficult or impossible to hospitalize someone even though they are in great need of this. At most, a person can be hospitalized for 72 hours, against their will; if it is proven that they may do something harmful to themselves or to others.

For example, Ms. Fontaine points out that even though she was a drug soaked teenager, the law protected her from hospitalization. It was only when she was arrested on felony drug charges that she was forced by the courts to receive intensive drug treatment and rehabilitation.

Ms. Fontaine correctly points out the parents of drug addicted or mentally ill teenagers are prevented by the law from getting the help their children need. What is outrageous is that these ill and addicted young people, as well as those who are well into adulthood, cannot get help unless they have done something criminal or suicidal, at which time it is almost too late.

Unfortunately, I know from personal and professional experience how accurate Ms. Fontaine really is. I have watched tearful parents in my office cry in anger and frustration as their children refuse to stay in treatment facilities. They check themselves out against parental wishes and medical advice and resume their drug abuse. The same holds true for those who are mentally ill.

I fully agree with Ms. Fontaine that in protecting someone from being wrongly committed we have abandoned those who are in desperate need of help. That help, especially with drug addiction, can only be obtained with involuntary hospitalization and treatment.

Your comments about this important issue are welcome and encouraged.

Allan N. Schwartz, PhD

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