Involuntary Hospitalization - Part 1

At the end of yesterday’s class I mentioned the news article regarding the Italian woman in permanent vegetative state sent to the clinic for euthanasia (news link). In this case we all agree that she is not able to give any form of consent, but what about people who are able to give consent but forced anyway (example, involuntary hospitalization & forced medication)?

Two movies that come to mind related to involuntary hospitalization are the Jack Nicholson "One Flew Over the Cuckoo's Nest" and the other is "Europa'51" starring Ingrid Bergman. For copyright reasons I can't post the article but I will try to provide a zest of the article ("Once the Wheel Are in Motion: Involuntary Hospitalization and Forced Medication" Burton Seitler; Ethical Human Psychology and Psychiatry, Vol.10, No.1, 2008). In the article he mentions two of his patients. Please bear with me as this blog will run long because of the two stories involved but the stories are an interesting.

Background

Terminologies:-

Insanity- This term is a legal invention because there's no such thing as "insanity" in psychology.

Involuntary Hospitalization (Civil Commitment)- Term for the legal procedure to compel an individual (against his/her will) to receive treatment for presumed emotional problem. (Conditions:- too dangerous to themselves or others; from the presumed problem suffer diminished capacity and lack insight to their problem).

IH = involuntary hospitalization IU = intervention unit PTSD = Post traumatic stress disorder

The author mentions that either one of the conditions was sufficient for IH in at least 34 states and in 1998 no less than 51 bills were introduced in 7 states relating to IH. Though most states require "proof of dangerousness" the term dangerousness is a highly ambiguous term (even among clinicians). American Psychiatric Association (APA) in 1993 (from studies done) stated- "......psychiatrists have no special knowledge or ability with which to predict dangerous behavior........even with patients in which there is a history of violent acts, predictions of future violence will be wrong in two out of every three patients".

The Two Cases - Hospitalization

Case1 (Nancy, not real name):-

25yr old, petite (5'1"), employed was seeing the author (Dr.Seitler) for her difficulties with her parents (particularly mother). She was having conflictual feelings regarding leaving home, finding & keeping a boyfriend and fundamental issues involving trust. She went for therapy whenever, she experienced personal anguish or felt depressed and besieged by obsessional thoughts. She was seeing Dr.Seitler for 2yrs during which she was feeling better, she changed her job to a happier position and took up part-time after hours work in her chosen profession. She saved enough money to leave her parents home and find an apartment in a nice neighborhood. She felt she achieved her goals from the therapy and decided to go it alone.

After about 1yr, Dr.Seitler received persistent demanding phone calls from Nancy's mother irately ordering him to commit Nancy because she failed asking the mental health IU. After about 6weeks the local emergency IU (different person in charge) agreed to the mother's demand to commit Nancy and Dr.Seitler received a call from the psychiatric hospital and mentioned that Nancy wanted to speak with him. She requested Dr.Seiteler to visit her.

Dr.Seitler's conversations with the psychiatrist at the hospital informed that Nancy objected hospitalization and they administered antipsychotic injections as a standard protocol. He was also told that Nancy was doing fine and was getting along well with other patients and completely abided the rules and routines. However, they were annoyed that she wore black outfits exclusively even when told not to do so Was it that Nancy was wearing the same clothes and hence soiled and smelled?). On Dr.Seitler's visit he noticed that Nancy was exceptionally clean diligently washing her own clothes. The psychiatrist hinted Dr.Seitler that if Nancy wore a different outfit they could hasten her release.

Dr.Seitler addressed the "black dress" issue to Nancy and asked her how she got here. She recounted that, the local IU along with her parents and 2 policemen came to her workplace asking her to accompany the policemen to the hospital. She agreed thinking it was unreal. But just as she left the workplace and was about to get inside the police car she realized and she got second thoughts. When she began to panicked she was knocked to the pavement, handcuffed and put into the car. She told she was treated so rough she still had marks, bruise and abrasions shown to Dr.Seitler (note she is a petite, 5'1" woman).

After Nancy stopped wearing black clothes, in short order she was released.

Case2 (Ed, not real name):-

40+ yr old man, was suspicious of his wife that she was putting illegally controlled substance in his coffee for over 2 weeks for which she denied. However Ed went to the lab and found traces of the substance in his coffee. Soon after this he filed a restraining order against her and moved out of the house. She immediately countered him with her own. 2 months passed during which they neither saw nor spoke to each other but she left numerous voice mail messages for him at his new living place insisting him to come home with verbal threats of destroying him. Then she filed a
complaint to the local IU stating Ed posed imminent danger to her.

The local IU paid a visit to Ed's new living place asking him to accompany them and when Ed asked if he had any choice they replied no. Ed remained calm and composed (unlike Nancy who demonstrated objections) and was granted the opportunity to make a call upon request. He contacted his attorney.

The author mentions that Ed was now in a mechanized bureaucratic hospitalization process, mechanized because questions such as Ed's wife wanting him to get
hospitalized as an ulterior motive was never raised. Ed was then committed to the psychiatry ward of the county hospital.

Ed's attorney negotiated with the hospital administration on grounds that he would receive psychotherapy. Ed's stay in the hospital was about 5days. His attorney contacted Dr.Seitler for seeing Ed upon release.

The Two Cases - Aftermath

Case1 (Nancy):-

Nancy was receiving antipsychotics in the hospital and was not advisable to stop immediately because of withdrawal effect. After her release the hospital neither gave any medication nor any prescription. When the psychiatrist was informed of this they replied that since she was discharged she no longer fell under her jurisdiction.

At her job, Nancy needed a psychiatric evaluation to return to her job. Dr.Seitler referred her to one of his colleagues for evaluation who reported "she is not mentally ill, is not a danger to herself or anyone else, and can return to work immediately". The employer did not except the report and kept her on payroll till they got a report from psychiatrist of their own choosing. Though the report was still same, it took her 3 months to resume her previous duties at work.

Nancy became distrustful of the system, felt let down, dehumanized and traumatized. The author calls her experience as iatrogenic PTSD. She generalized the failure to everyone including the author himself. Consequently, she began to cancel her appointments with him.

Case2 (Ed):-

It was never established that Ed was previous, currently or even potentially dangerous and the hospital thought Ed was safe enough to be discharged in relatively short period of time. Ed had also expressed his wishes not to receive any medication. However, the hospital continued to medicate him.

Ed felt disgraced and humiliated, and was unable to return to work for nearly 2yr for fear of perception by people around him.