Psychiatry is the most powerful medical profession in existence. Aside from those doctors who might commit a person because of the fatal health risk they pose to society (i.e., tuberculosis), psychiatrists and their associated mental health professionals are the only medical persons who can legally take away a person’s rights when they have committed no crime. Unlike those doctors who might commit a TB patient, however, psychiatrists can also force their “care” onto another person whether he agrees to it or not. It is a power that is unbelievable in an era where “freedom” is the quintessential goal of humanity.
On the surface, arguments about how some people have benefitted from the time spent in hospital and have had their lives saved by being committed are compelling. Indeed, it has been found that many individuals who have experienced suicidal impulses have been saved by time or blocking access to the means by which one might complete suicide. Most suicides, though, are not impulsive; they are the result of chronic feelings of oppression, helplessness, hopelessness, loneliness, anger, frustration, terror, and victimization. Interestingly, these are the same adjectives many persons who have been through the psychiatric system use to describe the very system that is supposedly “saving” them from that which is being inflicted. Hmmmmm….doesn’t sound like a whole lot of love there.
I have worked in many outpatient and inpatient settings. I have seen the conflicting messages portrayed to mental health professionals from patients, from “I hate you” (guaranteed to lead to a “personality disorder” diagnosis) to “You have saved my life, you are the greatest doctor on Earth.” One can forgive the singular professional from having conflicts on whether or not it is best to hospitalize someone “for their own good.” It is a worthy debate that I, like another commenter recently suggested, would love to see take place center stage at an APA conference.
Studies are also conflicting; there is no way to know what a person who died from suicide might have benefitted from and there is no way to experimentally show the effects of an involuntary hold versus letting the person go off on their own. Additionally, I cannot think of any way to ever measure the vast number of people who fear reaching out to a mental health professional when in distress because they might be punished for doing so (i.e., by being hospitalized). I’m pretty certain there are plenty of individuals who die from suicide precisely because they could not get help for fear of commitment. Science cannot be the only deciding factor. We must listen to those people who have been there.
This is a moral issue. The question as to whether or not any human being in a democratic, free society should have the right to strip another human being of his or her autonomy for any reason other than as the result of a crime having been committed is a question that goes beyond the realms of science. Even giving the benefit of the doubt that any, some, or even most people benefit from involuntary hospitalization, does this make it justifiable? There is a fad in current society to never be extreme, to always find the middle ground, to avoid the demonized “black-and-white-thinking.” This is ridiculous. I stand pretty firm in my extreme positions on believing that there should never be any justification for rape. Or for slavery. Or for discrimination and racism. And, in line with these, for involuntary commitment when no crime has been committed.
Having said that, however, I also understand the dilemma of mental health professionals. I am one. I have been fortunate thus far to not be in a position where I might have to make a decision as to hospitalizing someone. For certain, this luck will be coming to an end in the very near future. What will I do? Will I stand by my principles and risk not only losing my job but also any chance that I will ever graduate, get licensed, and get an opportunity to provide real alternatives to some people? Will I follow the rules and justify it by admitting that I am sacrificing one to possibly help many in the future? Will I even have the chance to find out after this article goes live? I humbly admit, at the risk of much backlash, that I do not know what I would do. What I do know with 100% certainty, however, is that I will not pretend that I am doing something “for someone else’s good” and then pat myself on the back.
Here is an analogy:
I have been a personal trainer for 10 years. My clients come to the gym, sometimes grudgingly, and willingly have me torture them for their own good. I offer advice about things like “maybe broccoli is better for you then a plate of French Fries.” My clients are generally thankful for the help I have provided, even if they also sometimes hate me for it. But, I am pretty certain that the day I take a handful of broccoli and shove it down one of their throats while telling them “this is what’s best for you” is the day that I stop being helpful. The day that I show up at a client’s house, drag them from their bed, throw them into a locked gym and tell them “Work out now or you’ll never get out” is the day that I become a tyrant. Guess what? Working out and eating vegetables IS what is best for my clients, but forcing them to do so is, quite frankly, insanity. Some might argue and say this analogy is irrelevant because the dangers of poor eating and missing workouts are nothing compared to someone who is suicidal. Really? What would you say, then, in regards to my clients who are morbidly obese, with frighteningly high blood pressure and the risk of heart attack looming over every second of their day? Do I justify these behaviors then?
What I find most intriguing are the lengths to which mental health professionals will go to justify their power (or worse, pretend they don’t have power) and to ward off any insinuation of wrong doing or responsibility for harm. This is especially infuriating when no accusation of personal wrongdoing was ever made. There have been a slew of research studies in the field of social psychology that have explored how and why people will almost universally justify the group they belong to, the system in which they reside (political or otherwise), and status (race, wealth, and power). In general, people will justify these things to assuage their own intolerable feelings of guilt and perceived accusations of being a “bad” person. Further, they need to believe that their actions and positions are just and fair… because we all, every single one of us, are driven to believe in the justice of the world. Even those of us who have experienced chronic injustice still believe that if we yell loud enough, if we fight hard enough, if we just keep persisting, justice will be served. The few who lose this belief cease to be motivated for much at all.
In understanding the defensiveness that mental health professionals have when confronted with the harms of their profession, I have to say that I have completely lost all tolerance for the frequent response from those in power that those who have been harmed are “too angry,” “insensitive,” “un-empathic,” or other suggestions that marginalized and oppressed group should consider the feelings of those in power when protesting. Nicki Minaj has provided quite a bit of controversy lately in expressing her outrage over the constant bias and discrimination against black women in the music industry. The only reason this is controversial is because white artists are protesting that their feelings are hurt because the black woman was too angry in her criticism. WHAT?!?! Read some of this:
Even more powerful is this excellent piece by Reni Eddo-Lodge: Why I’m no longer talking to white people about race. All one needs to do is replace the word “white” with “mental health professional,” replace the word “person of colour” with “psychiatric survivor,” and the word “race” with “mental health” and it says everything so clearly. And, if you read this article and still don’t get it then you are part of the problem.
The term “tone-policing” has arisen to describe what is happening when white people tell black people to stop being so “angry” and “rude.” These articles also describe how often those individuals expressing their frustration with discrimination and oppression start off level-headed, polite, even-keeled, and every other synonym for the same; it is when they keep getting ignored and dismissed that the “tone” gets heavier and more insistent, until finally someone notices. But, one doesn’t even need to be “angry” to have their tone policed when expressing that a particular group is responsible for the mistreatment of another. This quote is a pretty polite way of saying what needs to be said: “It is oppressive and unhelpful when people police the way we speak about our struggles.” Precisely. I couldn’t have said it better myself.
The very real dilemma surrounding involuntary commitment is one that cannot be solved by intellectual debates. This is a moral debate about human rights violations, oppression, discrimination, and systemic harm that is being perpetrated in the name of “treatment.” Yes, some people are in fact helped and even “saved.” But, this does not justify tyranny in my humble opinion (and I concede that perhaps my opinion is wrong). A crucial dialogue cannot take place on this subject if those in power are more concerned with their hurt feelings and defending their personal actions than actually hearing and learning from those who have been harmed. Laws must be changed and the moral implications need to be screamed from the mountain tops, no matter how many diagnoses are accrued for doing so. And, I’m tired of walking on egg shells and worrying about ensuring that no one’s feelings are hurt in the process. No matter how polite or nice or empathic I am in my outspoken criticisms of the actions within this field, it fails to matter. My tone is not the problem. Neither is the problem the tone of those who have been traumatized and tortured by their experiences. Can we just get real? I fear the answer to that question.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.