Coercion is the power to force compliance with authority using threats of physical punishment, deprivation and/or other undesirable consequences (Geller et. al, 2006). The fact of government coercion is inescapable, as it is the basis of an effective social control model. However, state intervention into the lives of its citizens is not equally distributed across the population. A major point of contention surrounds the ethics and efficacy of using involuntary outpatient commitment to mandate the treatment of mental illness. This post reviews the academic literature to present competing perspectives on this hotly debated topic.
What Is Involuntary Outpatient Commitment?
Involuntary outpatient commitment is a legal mechanism that mandates treatment for individuals with mental illness. As a condition of living in the community, people with psychiatric disorders must comply with court-ordered psychotropic drug and treatment demands. Compulsory measures often include that “a person participate in full-day treatment programs, undergo urine and blood tests, frequently attend meetings of addiction self-help groups, enter psychotherapy with a particular therapist, or reside in a supervised living situation” (Allen & Smith, 2001:342). An additional mechanism entails that a representative (also known as a ‘rep-payee’) control the budget of the person with mental illness. All of this is based on the premise that mental illness, when untreated, will become worse and adversely impact self and/or others.
Types of Involuntary Outpatient Commitment
There are three types of involuntary outpatient commitment:
- Conditional release: Individuals are discharged from an inpatient setting into society. After an improvement of symptoms at the hospital, the person with mental illness is granted the privilege of living in the community. Continuation of this arrangement is contingent upon adherence to a treatment plan that often involves consumption of psychotropic medication (McCaffetery & Dooley, 1990).
- Assisted outpatient treatment: This type of outpatient commitment uses the same standard as inpatient commitment, but gives individuals with mental illness the opportunity to live in the community (Geller et. al 2006). In comparison to inpatient treatment, this is deemed less restrictive.
- Preventive outpatient commitment: Unlike assisted outpatient commitment, preventive outpatient commitment does not require a person meet inpatient standards (Cornwell & Deeney, 2003). Thus, persons with mental illness are coerced into outpatient treatment before they become a danger to self or others. At present, 42 states and the District of Columbia have involuntary commitment laws; with preventive outpatient commitment being legal in nine. In many areas, the time-frame for which treatment is compelled is both vague and expanded without uniformity (Bazelon Center, 1999).
Legal Doctrine & the Power of the State
There are two legal principles that grant the United States government the capacity to compel individuals with mental illness: police power, and parens patriae. These two doctrines have traditionally been applied to justify the interference of government in matters of personal autonomy. First, the state’s police power refers to the ability to prevent harm within the community. In mental health settings, “this justification is utilized when the behavior of a person with mental illness causes them to become a risk or harm to others” (Geller et. al 2006: 552). Ensuring public safety from the potential violence of individuals with mental illness is the main objective. The fulcrum of this legal standard is the idea of dangerousness. In Addington v Texas, the Supreme Court declared that the state has the power “to protect the community from the dangerous tendencies of those who are mentally ill” (emphasis added, 1979: 1). To accomplish this goal, clinical assessments are made about present danger or the likelihood of future harm. More concretely, the police power of the state compels a person with mental illness to submit to treatment because of existing or predicted violence.
The second justification for state intervention into the lives of people with mental illness is parens patriae. A clue into the nature of this principle is the Latin translation of the term, which is ‘parent of the fatherland.’ This legal standard is applied by the state to infringe upon the right to autonomy when the person’s “ability to make autonomous decisions is impaired to the extent that they become a risk to themselves” (Geller et. al 2006: 552). The state’s application of this justification often centers on the notion of competence. While individuals with mental illness are free to refuse treatment, the question is: does the person know they have the illness? In the event that the mentally ill person is unable to acknowledge their illness, the state can act in the ‘best interest’ of the individual by coercing them into treatment.
Are the Mentally Ill More Violent?
A common justification used to support involuntary outpatient commitment is preventing harm to others. Kress (2000) contends that the violence perpetrated by people with mental illness often occurs when they are not being treated. The impulse here is that the physical harm inflicted by individuals with mental illness can be diverted with involuntary outpatient commitment. Interestingly, many preventive outpatient commitment laws have their root in highly publicized crimes committed by people with mental illness. For instance, ‘Kendra’s Law’ and ‘Laura’s Law’ were implemented in New York and North Carolina, respectively, as responses to murders committed by men with untreated delusions. While it is true that people with mental illness are no more likely to commit violence than the general population (Mental Health America, 2014), Torrey (1998) postulates that a subset of individuals with severe mental illness are more dangerous. The high resistance to treatment amongst this group exposes masses of people to tragedies that could have been prevented.
Research has evaluated the relationship between violence and mental illness. Overall, violence amongst persons with mental illness is indeed concentrated to a very small sub-population of the group. Link (1992) found that three symptoms of psychosis were related to violent behavior: the belief that other people wished to do harm to you, that your mind was dominated by forces beyond your control, and that existing thoughts were not your own. These symptoms have been termed threat/control-override. After controlling for sociodemographic factors (i.e. age, gender, etc) these symptoms were not appreciably higher than other social determinants as indicators of violence. Additionally, a study conducted by Stuart & Florez (2001) found that violence was higher among individuals struggling with substance abuse. In the final analysis, people with mental illness are more likely to be victims of violence than perpetrators (Mental Health America, 2014).
Double Maneuver of the State
One of the goals of involuntary outpatient treatment is to ensure public safety. However, Allen & Smith (2001) challenge the conventional belief that outpatient treatment is more advantageous than voluntary treatment in accomplishing this objective. They argue “when compared head-to-head with a program of enhanced and coordinated services, outpatient commitment is no more effective in preventing subsequent acts of violence and arrest” (p. 343). Hence, the usage of coercion to involuntarily commit people with mental illness to treatment may be unwarranted. The unchallenged link between ‘danger to others’ and the need for involuntary outpatient commitment misses two facts: 1). most people are willing to participate in treatment, and 2). there is a lack of resources that prevents people from receiving care. According to Mental Health America (2014), the mental health system has suffered $4.6 billion in budget cuts since 2009, and lacks the capacity to meet current demands. Discourse regarding a danger to others elides the fact that access to treatment is increasingly difficult. The state performs a double maneuver in this regard: it destabilizes the mental health system by withdrawing economically, only to re-insert itself as the provider of protection from the very group it continues to destabilize. Thus, it may be important to question widespread definitions of safety.
Violence Cannot Be Predicted
A premise supporting preventive outpatient treatment is that violence can be predicted. However, research has shown that risk assessments yield results that are similar to chance. Lidz et. al (1993) found that psychiatrists successfully identified 58% of individuals who did not engage in violence and 60% of people who did. These results are not impressive enough to justify preventive treatment. Mental Health America (2014) contends “mental health professionals possess no special knowledge or ability to predict future dangerous behavior” (p. 1). Nonetheless, there are at least four competing ways to frame the effectiveness or ineffectiveness of risk assessments. First, while the aforementioned results are not significantly better than chance, they are the best the system of mental health can offer. This imperfect system will help decrease the number of preventable attacks by screening for dangerous tendencies. Second, since violence assessments will inevitably yield false positives, individuals who truly pose no risk to public safety will be forced to forfeit their autonomy. The problem here is that people will lose their liberty and be unfairly criminalized in a way that does not improve their condition. Third, violence is a complex phenomena, and what ‘counts’ as violence is rooted in political, economic, and social structures. Thus, an individual level of analysis elides the social structures that work in tandem in producing this behavior. Fourth, the wisdom of a risk assessment is ill-advised. The social world changes constantly. However, violence assessments are based on an isolated snapshot of a ever-fluctuating terrain. It is thus impossible to make accurate predictions of violence.
The Failures of Parens Patriae
A subset of the parens patriae principle is the idea that people with severe mental illnesses have impaired insight. The argument from this perspective is that the severity of certain psychiatric disorders leads to anosognosia: lacking awareness of one’s illness. Torrey & Zdanowicz (2001) posit that schizophrenia and bipolar disorder damage the brain and negatively affect decision-making capacities. These neurologically-based incapacitations render people incapable of making informed medical decisions regarding treatment. While this line of reasoning is persuasive on a visceral level, basic research on these claims reveals unconvincing results. Flashman et. al(2000) analyzed physical abnormalities of the brain and the presence of absence of ‘insight,’ and found no definitive evidence.
A fatal flaw with the application of parens patriae is that most states do not require a determination of incompetence. This is asinine – especially when the fact that most people with mental illness are competent is considered (Appelbaum, 1994). This is more than mere paternalism; it is the state’s attempt to present itself as the all-knowing, all-seeing, all-wise Supreme Being. While a doctrine of American jurisprudence is ‘innocent until proven guilty’ – the courts in many states invert this logic. This hostile perspective does more to exacerbate mental illness than improve it. In an attempt to recalibrate this, the first right elucidated on the website of Mental Health America (2014) is:
Presumption of Competence: It is a basic principle of American law that all adults are presumed to be “competent” – that is, they are presumed to be capable of making their own decisions about their own lives and their own medical care, including mental health treatment.
An additional problem with state intervention on the grounds that an individual poses a harm to self is that it reinforces the mind/body schism. The theory and application of parens patriae is the idea that mental illness and physical illness are different. Most notably, mental illness is tethered to a discourse on danger that compels state intervention. People with mental illness are said to be a ‘danger to self’ when they refuse treatment. However, a person who smokes cigarettes and refuses treatment is not said to be a ‘danger to self,’ even though nicotine is clearly a problem for their health. Thus, state intervention is not equally distributed across the population.
By way of conclusion, there are advantages and disadvantages to involuntary outpatient commitment. A benefit of involuntary outpatient commitment is that people with mental illness who otherwise would not consent to treatment are helped while they are – or before they can – become a danger to self or others. However, a disadvantage is that there is little evidence that court-ordered treatment yields better results than community-based approaches. As Wales & Hiday (2006) argue, an alternative to the persuasion, leverage, and coercion exercised by the state is the tender love and care of patient-centered treatment.
References/Further Reading:
Addington v Texas 441 U.S. 418 (1979)
Ahmedani, Brian et al.,2012. Suicide Thoughts and Attempts and Psychiatric Treatment Utilization: Informing Prevention Strategies. Psychiatric Services, 63 (186): 124-129
Allen, Michael & Vicki Smith. 2001. Opening Pandora’s Box: The Practical and Legal Dangers of Involuntary Outpatient Commitment. Psychiatric Services, 52 (3): 342- 346
Appelbaum, Paul. 1994. Almost a Revolution: Mental Health Law and the Limits of Change, Journal of Psychiatry 129: 18-22
Bazelon Center for Mental Health Law, Summary of Statutes on Involuntary Outpatient Commitment (1999). Available at http://www.bazelon.org/iocchart.html
Burns, Tom. Jorun Rugkasa et. al. 2013. Community Treatment Orders for Patients with Psychosis. The Lancet, 381 (9878) 1627-1733
Cornwell, John & Raymond Deeney, Exposing the Myths Surrounding Outpatient Commitment for Individuals with Chronic Mental Illness, Psychology and Public Policy 209: 135-179
Flashman, Laura et al. 2000. Brain Size Associated with Unawareness of Illness in Patients with Schizophrenia. American Journal of Psychiatry, 157 (7) 1167-1169
Geller, Jeffrey., William Fisher., Albert Grudzinskas., Jonathan Clayfield., Ted Lawlor. 2006. Involuntary Outpatient Treatment as ‘Deinstitutionalized Coercion’: The Net- Widening Concerns. International Journal of Law and Psychiatry, 29:551-562
Grob, Gerald. 1994. The Mad Among Us: The History of the Care of America’s Mentally Ill. Free Press: NY
Kress, Ken. 2000. An Argument for Assisted Outpatient Treatment for People with Serious Mental Illness Illustrated with Reference to a Proposed Statute for Iowa. Iowa Law Review. 85 1269-1283
Lidz, Charles et al. 1993. The Accuracy of Predictions of Violence to Others, Journal of American Medical Association, (269) 1007
Link, Bruce et al. 1992. The Violent and Illegal Behavior of Mental Patients Reconsidered. American Sociological Review, 13: 275-278
Markowitz, Fred. 2011. Mental Illness, Crime and Violence: Risk, Context and Social Control. Aggression and Violent Behavior, 16: 36-38
McCafferty, Gerry & Jeanne Dooley. 1990. Involuntary Outpatient Commitment. Mental Health and Physical Disability Law Report, 14 (3):277-287
Mental Health America, 2014. Available at: http://www.nmha.org/positions/involuntary- treatment
Olfson, Mark. 2000. Predicting Medication Noncompliance After Hospital Discharge Among Patients with Schizophrenia, Psychiatric Services, 52 (264): 216-220
Ridgely, M.S.; Borum, Randy; and Petrila, John. 2001. “The effectiveness of involuntary outpatient treatment: Empirical evidence and the experience of eight states”. Mental Health Law & Policy Faculty Publications. Paper 268.
Steadman, Henry., Kostas Gounis., Deborah Dennis., Kim Hopper., Brenda Roche., Marvin Swartz., Pamela Robbins. 2001. Assessing the New York City Involuntary Outpatient Commitment Pilot Program. Psychiatric Services, 52 (3) 330-336
Stuart, Heather & Julio E. Arboleda-Flórez.2001. A Public Health Perspective on Violent Offenses Among Persons with Mental Illness. Psychiatric Services, 52 (5): 654-659
Swartz, Martin., Jeffrey Swanson., Virginia Hiday., H. Ryan Wagner., Barbara Burns., Randy Borum. 2001. A Randomized Controlled Trial of Outpatient Commitment in North Carolina. Psychiatric Services. 52, (3):325-329
Swartz, Marvin et al. 2009. New York State Assisted Outpatient Treatment Program Evaluation. available at http://www.omh.ny.gov
Teplin, Linda et al. 2005. Crime Victimization in Adults with Severe Mental Illness: Comparison with the National Crime Victimization Survey, Archives of General Psychiatry, 62 (8): 911-922
Torrey, E. Fuller. 1994. Violent Behavior by Individuals with Serious Mental Illness. Insight and Psychosis. 45 (7): 653-662
Torrey, E. Fuller & Mary Zdanowicz. 2001. Outpatient Commitment: What, Why and for Whom? Psychiatric Services. 52 (3): 337-341
Wales, Heatcote & Virginia Hiday. 2006. PLC or TLC: Is Outpatient Commitment the/an Answer? International Journal of Law and Psychiatry. 29: 451-468
Zone of Non-being 
February 20, 2017 at 1:27 pm
Man, this is how you come back from your sabbatical, huh? Just killing everything on sight? No warning. Man this was a deadly post brotha. Next year I’m getting you a bullet proof helmet for ya bday. Another fire post.
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February 20, 2017 at 1:32 pm
Lol – thanks! I find it necessary to take some time off to read up on new topics, and recharge my batteries. Glad you liked this one … I find it a bit too dry and academic for my liking, but *shrugs shoulders* I did my best with it lol.
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February 20, 2017 at 2:50 pm
Really enjoyed your post which, incidentally, explores another area where it looks like our interests overlap. I’m writing a little bit on the race-making designations of madness in the late-19th century as a way to evaluate the interaction between white supremacy and the State, which then, as now, acted as the sole arbiter in designations of madness.
So two things right quick before I get back to work:
1) you might enjoy, if you haven’t read it, Thomas Statz, Liberation by Oppression: A Comparative Study of Slavery and Psychiatry (New Brunswick, NJ: Transaction Publishers, 2002). Statz is really weak on the historical knowledge of slavery, but I still found a number of his observations on the carceral power of psychotropic drugs interesting.
2) What do you think (if you’ve read it) of Foucault’s History of Madness? I only ask b/c it looks like you have a strong background in mental health, which I definitely don’t. I get the sense that Foucault’s work, especially as it’s older, is pretty widely dismissed in mental health circles. I’m mostly interested in his notions of madness as produced (even situationally) and as a site where State power works to the benefit of Capital, both of which I find compelling. Still, it would be nice to get some perspective from an external specialist on his work.
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February 20, 2017 at 4:06 pm
Hello Emma! Thank you for reading and commenting. I am glad to hear that this is one of your fields of interest.
If you are working on the connection between white supremacy and the State, if you have not already, please take a moment to check out my article about the dangers of medicalizing racism here: http://www.truth-out.org/opinion/item/37681-the-dangers-of-medicalizing-racism
I have read some of Szasz’s work but not that particular text. I appreciate the reference, I will add that one to the list!
You are right to link Szasz and Foucault – their theories have a lot in common. The History of Madness was fascinating. I find that it is best to read that alongside his Discipline & Punish (published maybe 8 years apart) – because the idea that the mad were “mentally ill” is, at bottom, a disciplinary mechanism. The very concept of mental illness is structured on the idea of a panopticon. The idea of mental illness pretends to be scientifically objective – but it is biased in favor of the bourgeoisie. In the very act of labeling the patient, the labeler is rendered invisible, and the label is upheld as neutral. And this logic is transmitted to institutions beyond that of the psychiatrist: schools, courts, etc – thus becoming a “discourse”.
As you know, the bourgeois family is premised on patriarchy. Early psychiatry pathologized women for being overly emotional or not wanting to engage in intercourse with their husbands. Labeling the deviation (the illness) simultaneously emphasized the “norm” (i.e. whiteness, capitalism, masculinity, heterosexuality, etc) and naturalized it.
A bit about mental illness and capitalism: when the DSM first came out in the 50s, there were only 50 or so diagnoses. Now, there are 300+ mental illnesses. This has nothing to do with improvements in technology – this has to do with greed. The more people that can be diagnosed with something – the more people that will bow to and recognize the authority of the capitalist order, and the more people that can be profited from. I wrote a bit about this in my post titled “How the Pharmaceutical Industry Manipulates Mental Health”.
Here is a prime example. Erectile dysfunction was not even on the radar until a couple of decades ago. A pharmaceutical company was testing a heart medication when they realized that men got erections as a side effect. What did they do? They ran marketing campaigns targeting old men to convince them that their natural impotence was a “problem”. They literally created an illness, cultivated a population, and sold the pills to those who were “diagnosed” with it.
Of interest to you (in light of the State, race, mental illness, and capital) might be Norman O. Brown’s “Love’s Body” (1966). He makes a compelling argument about schizophrenia. I will add at this juncture that over the years, black people are over-represented in schizophrenia diagnoses. In all of our endeavors, with all of our categories, we forget that the world is truly unified. Division is not natural, it is political. Brown said “…in schizophrenia the false boundaries are disintegrating. Schizophrenics are suffering from the truth. Everyone knows the patient’s thoughts: a regression to a stage before the first lie. Schizophrenia testifies to experiences in which the discrimination between the consciousness of self and the consciousness of the object was entirely suspended. Definitions are boundaries; schizophrenics pass beyond the reality-principle into a world of symbolic connections. The insane do not share the normal prejudice in favor of external reality. The normal prejudice in favor of external reality can be sustained only by ejected these dissidents from the human race; keeping them out of sight, in asylums; insulating the so-called reality-principle from all evidence to the contrary”.
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February 20, 2017 at 5:08 pm
Thanks so much for your thoughtful comment, sharing “The Dangers of Medicalizing Racism, and recommending Norman O. Brown’s “Love’s Body,” which I will certainly put near the top of my list. It seems like there’s a good deal of reading I still need to do on the diagnosis side of mental illness, as I had no idea of the racial disparities in schizophrenia diagnoses. Most of my research is on the bad old days before any kind of standardized methodology, where practitioners regularly classified behavior they personally viewed as aberrant as “Stupid,” “Maniac,” “Softening of the Brain,” etc. As you rightly indicate, however, standardization carries its own set of burdens for the diagnosed. Interesting, though I guess sadly not surprising, that the racial disparities continued despite the professional and medical turn in psychology. A strong indicator that a sort of biomedical panopticon is at work there.
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February 20, 2017 at 5:27 pm
Your research sounds interesting! Would love to hear more about it and the conclusions you reach!
If memory serves: I think that during antiquity people with so-called mental illnesses were seen as sources of wisdom, and there are still some cultures that view people with so-called mental illnesses as a message from the gods, symbolizing a connection between two worlds/phenomena.
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February 20, 2017 at 9:00 pm
Thanks Darryl. I’ll have to see if a piece of it works for the blog. Maybe a textual analysis of one of these doctors’ publications would be interesting.
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February 20, 2017 at 2:51 pm
Interesting, and not an area I know much about. Thanks for sharing.
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February 20, 2017 at 4:08 pm
Thanks for stopping by Alice! Mental illness has always been an interest of mine – as it is not what it appears to be at first glance, unfortunately. Whenever something is normalized, I immediately get suspicious lol.
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February 20, 2017 at 4:29 pm
The mental illness aspect I actually think about a good deal, too. Especially the limitations in how our discourse around mental health (or lack of same) get deployed — most specifically, the shift into metaphors of technology [“wired wrong”] and the concomitant rise of psycho-pharmacology as both an exclusive and life-long solution, but also the issue of how “the mentally ill” have become convenient scapegoats for a range of social ills that are at best tangentially related. Your focus on forms of state-mandated OUTPATIENT treatment (as opposed to inpatient, which I am more familiar with), and detailed breakdown of the problematic assumptions inherent in same, provides an interesting bridge between these two areas (the discursive and the public policy) that I haven’t thought about much before.
And yes! to your point about the sketchiness of the normalized! 🙂
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February 20, 2017 at 5:41 pm
Wow, I have never thought about how we are using technology metaphors to describe mental health. That is fascinating! Is that idea a product of your own thought? If so, have you written about it more extensively? (If not, please do!) Or do you have a source you can recommend about that?
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February 20, 2017 at 7:03 pm
Wow Darryl, what an interesting and well researched piece! I have known some individuals with mental illness — both the ‘dangerous’ and the not so dangerous kind. The common denominator I have found in all of them is trauma. Some kind of trauma had occurred (sometimes war, sometimes abusive parents, sometimes just other general societal based problems.) Over the years I have become very interested in PREVENTING the traumas that seem to cause mental illness in the first place. I suspect a more loving and peaceful world would help end mental illness…
In the case of children and young adults, I have seen them put on ‘meds’ only to make them worse, which makes me leery of the medical (government regulated) treatment. When you consider the entire history of mental illness treatments, some have been extremely horrendous! Lobotomies, electro-shock therapy. Even in the 20th century some treatments have been very cruel and unusual.
Nowadays, I am concerned that the labels of mental illness are given out too freely — thus putting stigmas on people and ultimately hurting them. There are about 90 listings of different disorders in the current American Psychiatric Association’s publications!
Anyway great food for thought!
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February 20, 2017 at 8:11 pm
Hey Christine – great point about the link between trauma and mental illness. We cannot give what we never received. If violence was imposed upon us, especially as children, it creates problems within us and becomes a way of relating to others. Like you, I think that a more peaceful world would eliminate mental illness. Of course, there will always be people who think/behave a bit different – but our reaction to them does not have to be labeling them, locking them up, etc.
You are right, we are far too liberal with this “mental illness” label. As of late, I have seen it racialized. Whenever a white male goes on a shooting spree, people are always talking about whether or not he had a “mental illness” – but when an Arab/Muslim person commits a violent act, they were “radicalized by Islam”. There’s no debating about mental states. Arabs/Muslims, in and of themselves, are understood as a kind of mental illness that does not require further explanation; whereas whiteness is understood as “healthy”, and requires an excuse. Smh!
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February 20, 2017 at 8:48 pm
Yes — I would argue it is all caused by separation of self and separation from spirit. Radicalization of Islam (or any religion because they ALL do it!) is probably caused by the initial trauma I spoke of. Very sad situations…
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February 20, 2017 at 8:59 pm
Coming from my anonymous group observations, it seems to me that a number of people who are made to undergo involuntary treatment (therapy, meds, rehab programs) have become visible to the courts because of the problems they themselves have created. The courts see the acts not the person. Coercion becomes the only solution the State has as an entity. Courts are not about love and understanding. And who knows, maybe the system does work so that the courts wind up helping the pharmaceutical industry money-wise. My brother has been diagnosed schizophrenic. He absolutely rejects the idea and was not about to take meds no matter who says so. He has been in SRO housing and ordered to go to meetings which he refused to do. He goes in and out of jail. Every now and then he snaps and someone gets hurt. In the past two years he finally agreed to take meds and he told me he felt much calmer. He has not mellowed out by a long shot but he hasn’t been in a mental lock up lately either. In some instances court intervention can be helpful where a persons autonomy may be detrimental to themselves or society (and yes, it’s too bad), but I will tell you this no matter how much I love my brother, how much my siblings love my brother, no matter that he knows I would move heaven and earth for him, no matter how intelligent he is, how well read, how much he loves his niece, these things did not help him when he became quite comfortable sleeping on Skid Row, getting the crap kicked out of him and kicking the crap out of somebody. It looks like I am for State coercion in some instances. Could have something to do with the Dysfunctional family I grew up in. Hey, thanks for your post.
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February 20, 2017 at 9:54 pm
Hello Elva – thank you for reading and for commenting! I agree with your conclusion that State coercion is necessary in some instances – like matters of public health and public safety. I believe our rights end where another person’s rights begin. Thus, I do not think a person with active tuberculosis should be allowed to take the public subway and cough on everyone – thus infecting them. The State should have the right to intervene in such scenarios.
I would like to bring your comment into conversation with that of another blogger on this thread, Christine Valentor. She stated: “I suspect a more loving and peaceful world would help end mental illness”. I noticed that you said you grew up in a dysfunctional family. Do you think that familial dysfunction is a source of mental illness? Do you think that ameliorating family dysfunction would also ameliorate mental illness?
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February 20, 2017 at 11:02 pm
Yes, in our case inherited mental illness was a source of familial dysfunction. If family members had received counseling the mental illness could have been ameliorated, as in improved, not necessarily eradicated.
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February 20, 2017 at 11:12 pm
Makes sense! Thank you for opening up and helping advance an understanding!
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February 21, 2017 at 8:21 pm
I understand why, in very extreme cases, the State would want to jump in for public safety and the safety of the individual with mental illness. I do wish that the facilities that these individuals go to would be less cold and more warm and healing. It seems like a lot of these places are more so another money maker for pharmaceutical companies. It’s similar to jails that are supposed to “rehabilitate” the folks that go in but the environment doesn’t invite that at all and is more so a means to another money maker – prison industrial complex. So the action sounds like a good cause but the intention seems self-serving and greedy so it lessens the likelihood of the people placed in these systems to actually be in a better place after they leave…. sometimes, it seems to get worse.
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February 23, 2017 at 12:24 am
I agree: it makes sense for the State to interject and force a person into care. Like you, I wish that we had a different societal notion of care, so that prisons are not being used as asylums. You are right that prisons are not inviting. Charles Dickens visited a prison back in his day and he said *paraphrasing* a person, after passing through here will become insane. Prisons are more about revenge and hiding the problems created by capitalism than “rehabilitation”. Our attempt to “solve” the problem perpetuates it; but I personally think that is the point. The system is working exactly as it was designed.
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February 23, 2017 at 8:43 pm
I looked up the quote and it’s a great one. This part is just beautifully written “I hold this slow and daily tampering with the mysteries of the brain, to be immeasurably worse than any torture of the body: and because its ghastly signs and tokens are not so palpable to the eye and sense of touch as scars upon the flesh; because its wounds are not upon the surface, and it extorts few cries that human ears can hear; therefore I the more denounce it, as a secret punishment which slumbering humanity is not roused up to stay.” Sadly, I have to agree with your last point. It is definitely done on purpose and it’s just really cruel.
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February 26, 2017 at 11:46 am
Thank you for sharing this. It’s so important that we come to understand the ways in which those with mental illnesses are treated. I have just published an article about schizophrenia – perhaps you’d like to have a read 🙂
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February 26, 2017 at 12:19 pm
Thank you for referring me to it. I am giving it a peak now!
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February 5, 2019 at 12:47 pm
I’ve read some good stuff here. Certainly worth bookmarking for revisiting. I surprise how much effort you put to create such a great informative website.
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February 5, 2019 at 1:14 pm
Thank you! I am glad my site resonated with you!
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