The ‘lack of insight’ forced treatment excuse

The Catch 22 of the state hospital system used to be the concept of denial. The person who was said to be ‘getting better’ was the person who ‘accepted’ that he or she had a ‘mental illness’. If the person claimed not to have a ‘mental illness’, this was thought to be an indication that the person was in a state of denial as to the seriousness of his or her ‘disease’. This denial was universally seen as grounds for a longer stay.

The fact that human beings were making the diagnostic decisions involved, and the fact that mistaken decisions have been made in the matter, has not fully registered to this very day. The situation has changed somewhat though with the replacement of the concept of denial as a defense mechanism by the notion of ‘lack of insight’ into the nature of the ‘desease’ as an indication of brain dysfunction.

Scarey is scarey, and some folks are scarey. DJ Jaffee, for instance, who just posted to his The Huffington Post blog an argument for adding anosognosia, or ‘lack of insight’, to the growing list of psychiatric maladies in the upcoming 2013 revision of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.

DJ Jaffee is, as his blog will tell you, a co-founder of the Treatment Advocacy Center. What treatment this center advocates for, if you didn’t know already, is more and harsher forced outpatient commitment laws.

Coerced outpatient mental health treatment is about forcing powerful and potentially brain damaging health destroying psychiatric drugs on people. When a person has been court ordered into outpatient treatment, and then this person doesn’t take the drugs that have been prescribed for him or her, this sort of ‘noncompliance’ or ‘nonadherence’ as it is called can get the person reprimanded to a state hospital if knowledge of it gets back to the court.

There is something fundamentally un-American about imprisoning people who haven’t broken any of the laws of the land regardless of whether this imprisonment takes place in a vacation resort, or at a state hospital, or on an island off the coast of South America. The idea that people should be forced to receive unwanted medical treatment stinks of autocracy. This is one example of permitting truly false imprisonment that the Supreme Court of the United States has not gotten around to dealing with in a fair, impartial, and just manner.

Dr. Peter R. Breggin, founder of the International Center for the Study of Psychiatry and Psychology (ICSPP), has come up with another sort of anosognosia, and this is intoxication anosognosia. This anosognosia would explain why people who are under the influence of psychiatric, and other psychoactive drugs, often display little awareness of the adverse effects those drugs are having on themselves and their overall functioning.

The concept of anosognosia came out of the area of brain damage research, an area where it is actually relevant to speak of something of the sort. Psychiatry has taken the notion and twisted it to suit its own less than appropriate purposes. If, as Dr. Jaffee desires, anosognosia were added as a category of disorder to the DSM, then intoxication anosognosia should certainly also be included.

A better course of action would be to leave the matter out of the psychiatrist Bible, the DSM, altogether, and in the realm of afflictions affecting stroke and other victims of brain injury where it belongs.

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