NetNews Usenet Archive 1992 #31/NN_1992_31.iso/spool/sci/med/23066

Internet Message Format | 1992-12-24 | 2.9 KB

Path: sparky!uunet!usc!howland.reston.ans.net!paladin.american.edu!gatech!pitt!ky3b!ky3b.pgh.pa.us!km
From: [e-mail] (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Message-ID: <[e-mail]>
Date: 24 Dec 92 22:55:00 GMT
References: <[e-mail]> <[e-mail]>
Sender: [e-mail]
Organization: KY3B - Vax Pittsburgh, PA
Lines: 41

In article <[e-mail]>, [e-mail] (Gary Merrill) writes:

|> If I decide to terminate my chemotherapy for cancer, I can simply
|> do so and walk away from the hospital (suffering whatever consequences
|> there may be).  If I am committed to a state psychiatric institute,
|> am I free to leave when I decide (for whatever reason) to terminate
|> my treatment?  (Notice that the very concept of "committed" seems
|> to imply a certain degree of coercion.)  If you will assure me that I
|> can terminate my psychiatric treatment under the same conditions and
|> with the same freedoms that I can terminate my cancer treatment,
|> I withdraw any complaint.

Of course committing a person involves coercion. The person who is committed gives
up some rights while treatment is initiated. Reasons to commit a person vary from
state to state (and are scary in some places!) but the basic idea is that the
person is considered a threat to him/herself or others. This includes people with
severe depression who are suicidal, who may not fit your (or anyone's) definition
of "crazy" or psychotic. Indeed, a psychotic person who is not a danger to someone
is not commitable.

The rationale for committing a person has nothing to do with therapy per se, but
is rooted in the idea of preventing harm to people. The criterion for ending the
committment is not whether the person is "treated" or "cured" but whether he/she
is no longer a threat. This is the reason that many patients routinely get released
from the hospital "prematurely". Patients are committed, forcibly treated, and
become normal enough to end the committment and leave, even though the staff know
they will not take medication on the outside, and will be brought in again in a few
days or weeks. It is not unusual to see such patients have a hundred or more
hospital admissions in the course of a few years. These patients are not common,
however, as most psychiatric patients have enough insight to realize they have
a problem, and the come to the hospital voluntarily.

There are actually a few "non-psychiatric" reasons to commit patients. Tuberculosis
is a common one, and there should be others: several years ago I had a patient with
Salmonella sepsis, who also was growing it from an open wound and from the stool
(of course). I tried to commit the patient for a course of IV antibiotic therapy
on the grounds that he was a public health menace. The judge laughed, then yelled
at me for wasting his time, and let the man go spread his Salmonella all over
creation.

-km