On A Person’s Right To Refuse Mental Health Treatment

There has been much ink spilled over some sort of “stigma“ attached to seeking mental health treatment. I think there is some question as to just how much of this mental health treatment is freely sought. Some mental health treatment, after all, is entirely unwanted.

I was an observer at a meeting of a task-force connected with the Virginia Supreme Court commission to reform mental health care in that state. The chair of this taskforce gave an introductory speech stating that a person would have to be “mentally ill” to oppose coercive mental health treatment. I myself was amazed that nobody on this taskforce strenuously objected to that statement. I don’t think opposition to coercive mental health treatment makes people “mentally ill” any more than I believe that support for state sanctioned assault, kidnapping, false imprisonment and torture makes a person “mentally healthy”. I, in fact, believe that the notion of forced treatment runs counter to the ideal of independence fought for so fiercely by our forebears. I would go so far as to call it un-American.

I have heard ex-patients speak about being grateful for the forced treatment they received, but I have also heard ex-patients express much outrage over the forced treatment they endured. Responses vary, as they should, from individual to individual. I don’t think that an ex-patient being grateful for the forced treatment received justifies thinking there is some kind of “stigma” attached to forcing treatment on people that needs to be countered. My feelings are, “stigma” or no “stigma”, forced treatment is wrong.

On the wall of an outpatient facility I once frequented there was a list of what purported to be “mental patient rights”. One of the rights listed on this list was the right to receive treatment. Nowhere on this list was there mentioned a right to refuse treatment. This kind of caving in to tyrannical attitudes and policy I think outrageous. I don’t think a person should have a right to receive treatment who doesn’t also have the right to refuse treatment. I believe mental health treatment, like all other truly medical treatments, should be a matter of choice and not compulsion.

The mass media is such that it is easily manipulated by big money and power interests. The major vehicles within the mass media are often owned by such interests. This ownership often means that our free press is not nearly so free as its rhetoric would have us suppose. That press which is bought and sold, in other words, is not free. This has created a situation where the typical voice of mental health treatment in the media is a voice that has been hand picked by the mental health authorities for its qualities of obsequiousness. There are other voices within the mental health system, and I believe these voices should be listened to as well.

The voice of people critical to force needs to get a hearing, too. Not everybody is happy with having their civil liberties and human rights entirely ignored and disgracefully trampled on. There is certainly a great deal about conventional mental health treatment that needs changing. If the mainstream media won’t carry those voices of dissent that occur forward, then it is up to those critics to make their own media, and to see that those voices get a hearing in the arena of public opinion.

Studies have shown that provoking a disbelief in free will causes many negative effects in subject participants. Among these negative effects are increased lying, cheating and stealing. I think it sad that mental patients, and mental health consumers, are encouraged not to believe in their own self-control as self-control is a matter of free will. I also think that mentioning a right to receive treatment while denying any right to refuse treatment is a matter of trying to cancel any notion of free will.

There is way too much dependency, and way too little interdependency, in the mental health system as it is. Dependency is a one way street. The more powerful look down on the less powerful. Interdependency is a matter of equals working together to achieve goals each holds in common. As it is, the system is often more destructive, for this reason, than it is constructive. It often becomes, given this situation, a crippling matter for some of the people who get stuck in it. Understanding this trend, I think it is often better for some people to work for change in the mental health system outside of that system altogether.

15 Responses

  1. If a controlled study was done I’m certain it would find that the suicide rate amongst self reportedly grateful ex-patients was higher than amongst outraged ex-patients.

    • Suicide is more popular than murder. You’d think that with the survival instinct such wouldn’t be the case, but it’s actually grown in popularity over the years. I could conceive of people saying that they had reason for calling murder “sick” because it was more of a deviation from the norm than suicide.

      I’m not sure there would be much difference between the grateful patients and outraged ones. Outrage, on the other hand, might be an indication of more of a fighting spirit, and so in that case possibly yes. I don’t see anybody conducting research on the matter though.

      One thing we’ve known for a long time is that the suicide rate goes up whenever there is an economic crisis. It went up after the 1929 stock market crash, and it went up after our recent worldwide monetary crisis. I don’t think anythng can demonstrate more clearly than that fact that environmental rather than biological factors underlie suicide as a rule. I think it shows that our national and global objectives (actually big businesses objectives) are not the best objectives to have. Do something about pig-headed materialism, and you do something about the suicide rate.

  2. I agree that environmental issues are factors but I cannot say the same about biological factors until I know more about the research into them. If we can have a biological predisposition towards other kinds of illnesses, it makes sense that we can have a predisposition towards emotional or mental health problems.

    I think the technology explosion is a huge factor. Social networking, cyber-bullying, information overload, the airbrushed culture. We evolve slowly, the technology quickly.

    • A genetic predisposition? Be silly! Why would we look for a genetic predisposition? Oh, yeah, because we don’t have any “disease” in the first place. We have something else besides “disease”. If you stand on your head, it must be because you have a genetic predisposition for doing so. A predisposition would give you a percentage, a percentage you wouldn’t get with any exact science. A genetic predisposion requires an element of self-control. Not everybody who would be so PREdisposed in theory actually goes bonkers. Self-control implies freedom of choice. According to the literature, mental health is not matter a choice. Either you got it or you’re on drugs. Predisposition is biological psychiatry propaganda. How about, You got bad genes, we got drugs, for a advertising campaign.

      Technology is an artificial necessity, and a real luxury. If we have to, we can do without it. It is nature that is under threat.

  3. “Be silly” or “don’t be silly”?!

    Hmm. In my consideration, an illness is something that causes pain and distress. This is where we part company as far as our views on mental illness go. You think it is a matter of self-control; I take into account that there are times when a person has no self-control through no fault of their own. This is not to say that this ought to be wheeled out – on the regular basis that it is – as an excuse for harming others. It is potentially a reason for certain types of behaviour; and I use the word ‘behaviour’ to cover what might be described as a symptom under certain – what I regard as contentious – circumstances.

    A biological or genetic predisposition is just that. It does not mean that an illness will manifest itself in that person. I think that knowing about it would give people the opportunity to initiate strengthening their ability to resist it. I do not equate that with taking drugs. And here is where our views come back together again.

    I do not consider drugs to be the answer. But people want drugs. They do not want the long answer. They do not want to work on themselves and do the things necessary to keep themselves in good health all round. They want a magic pill. So you are not just fighting the drug companies, you are fighting people’s desires. That is a tough one. People take drugs. They always have and may always do so.

    I have strong views about pushing drugs onto children and about not offering viable alternatives to all. What the drug companies do is illegal yet the individuals who run them are not prosecuted for pushing drugs they know to be harmful. That is what needs changing. They should not be above the law.

    Nature has a way of redressing the balance.

    I was standing on my head when I wrote this. What of it?

    • I think biological psychiatry is going to have a difficult, if not impossible, time proving any predisposition. It is my view that these researchers are off on a wild gene chase now precisely because they feel they must prove this predisposition, or perhaps more precisely because they need a lot of hot air to stuff their empty shirts with. Not only that, but most of the research directed at proving this predisposition is just an excuse to peddle psychiatric drugs. Being born homo sapiens is being born with a predisposition to go bonkers. If an ape goes crazy, an ape is just doing what it takes to survive. Ditto a soldier on the battlefield. We’re not looking for the gene that makes a soldier go crazy on the battlefield.

      Sadness, metaphoric pain, unhappiness, and just plain negative emotions don’t spell “mental illness” to me. Some people find a way to make the most of those emotions described as negative. We’re dealing with a larger population than that described as defective by virtue of an inherited defect, even if it isn’t a large population, and it is a growing population. I think the mad gene chase is just as futile as ever a wild goose chase would be. It is just as far fetched as trying to link racial minorities to crime and stupidity by way of genetic propensity. Would you wish to pursue that line of research seriously? I simply don’t think people get labeled because of their genetic inferiority to the rest of the population. I would call the impulse to search for inferior genes to attribute to mad people a matter of prejudice. I, frankly, don’t consider madness a birth defect.

  4. We are not going to come to complete agreement on these things for the time being because I have to take the research under assessment and it is still in progress.

    I share your concerns about drug pushing by the pharmaceutical companies and believe it is necessary to remain vigilant, especially because of their funding much of the research.

    ‘Going crazy’, so to speak, is a survival mechanism. It is an explosion of emotion that people – with their social masks intact for the most part – do not know how to cope with; so they lock people up for it.

    Actually, I think the military is probably looking for the gene that make soldiers go crazy on the battlefield. Once identified, soldiers will be tested for the same disposition and those who show it will be conscripted into an elite, ultimately expendable, fighting force. The scientists will work out how to administer drugs to the carriers in real time thereby giving the generals the ability to activate or suppress the gene in battle circumstances. Whatever you have, the military will find a way to weaponise it.

    What is metaphoric pain?! Pain is pain. Emotional and mental distress are as important as physical distress. The three are bound together and we cannot separate them no matter how well we think we can. To think we can is self-deluding. It is denial – which cannot be known unto the individual until it is recognised as such.

    Just because people can channel their pain into, say, creative activity, it does not mean that their pain is not real or that they might rather be well and happy than brilliant.

    I think crime and stupidity are more likely to do with poverty and lack of education, but I would consider genetic predisposition to negative as well as positive traits like athleticism.

    Why do you refer to “an impulse to search for inferior genes”? Has it been concluded that genes that confer a predisposition towards madness are inferior? Perhaps they should be looking for genes that confer a predisposition towards genius whilst they are at it. They may well find them to be one and the same.

    • Physical pain and mental distress are world’s apart. Mental discomfort is much more manageable. I can argue with the blues, but I can’t argue with a migraine. When I have a headache, it’s time for the aspirin.

      In the DSM-IV there is a Global Assessment of Functioning (GAF) Scale used to judge the severity of what the book calls disorders. The severity of these so called disorders then is determined by the degree of dysfunction seen in them. Dexterity and facility are words that would tend to describe function rather than dysfunction. I don’t know that a high degree of dysfunction, or brokenness, would be a synonym for inferior, but I think it would come awfully close. The lower the functionality rate, the more severe the “illness” is thought to be, and the more inclined biological medical model psychiatrists are to ascribe a genetic basis to it.

  5. Wrong. Mental distress and emotional distress are agonising and it is physically agonising on top of that to experience them. Why do you think people slice themselves open for relief? Why do you think that moment of release, when for a few seconds they can focus on a different physical pain, is so addictive?

    You speak from your own experience of “mental discomfort” alone. The fact that you use the word “discomfort” signifies that whatever you have been through is unlikely to constitute mental illness. Lucky you. Mental illness is when the pain is unmanageable. It is narrow-minded of you to judge everyone by your own experience. There are people who are incapacitated by mental illness; unable to move one way or the other, torn apart with anguish. What of them in your masterplan to overturn the system? You are in danger of pushing for a new system that ignores them.

    I could not be less interested in the DSM-IV’s “Global Assessment of Functioning (GAF) – thank you for the acronym – Scale” and I do not know why you are quoting it as some kind of fact considering your stated views on these books. People function in all kinds of states. Jews functioned in Nazi camps.

    It does not matter whether people’s conditions are genetic or not, they still need addressing. If the study of genetics can ultimately help ease pain and suffering then bring it on.

    Inferior – I don’t think so. People who experience serious mental illness see the world in a different way. They do not play the game or wear the masks. They respect no social constructs. This is the reason why people feel the need to lock them up and control them. They break the rules of society and that is considered as much a crime as murder.

    • P.1. Mental agony is something I can take a vacation from. Physical agony, not so much. That’s why we have chemical concoctions for pain relief. I’m not going to get into an argument over the ease or the difficulty of doing so (i.e. vacating). Self-control can be developed over time. Muscles that are not exercised grow flabby. We have a saying, “With practice comes perfection.”

      P.2. I was responding in my last comment to the end of your previous comment. There is an implicit prejudice behind much of the research being conducted in the field of mental health today. The difference between mental health and “mental illness”, according to what the doctors themselves have put into their psychiatrists’ bible, the DSM, can be summed up in a single word, function. Your lack of interest in the matter doesn’t make this basic fact irrelevent.

  6. Lucky you that you can take a vacation from mental agony. What if you could not? There are “chemical concoctions” for mental pain relief too. Yes, these are handed out for the mental equivalent of a paper cut and that needs to stop but they are not inappropriate for everyone.

    Saying that you do not want to “get into an argument over the ease or difficulty” of vacating, but that “self-control can be developed over time” is putting your side of a debate and then running off with your hands over your ears singing, “La la la la la.” If someone has flabby muscles then they can be toned over time but we do not expect someone with a broken leg to run a marathon every day.

    Whoever has a saying “with practice comes perfection” is placing the bar pretty high for everyone.

    Are you really quoting the DSM to me and calling what it has to say “fact”? Or are you telling me that it is a fact that the DSM says such a thing? Please tell me it is the latter.

    • If you’ve got a broken leg, you wait for it to mend before you tackle any marathon, but you know it will mend.

      I was saying that it is a fact that such a thing is in the DSM. I wasn’t endorsing anything the DSM says. I was suggesting that this scale the DSM has in it is very prejudicial in nature. I think there’s a double standard at work. I see people saying, more or less, that you cannot suggest a racial minority is inferior, but people labeled “mentally ill” are inferior. They have defective genes. I don’t think this has been proven to be true.

      • You go and get your broken leg set properly, take some painkillers if necessary, and rehabilitate it before training for a marathon. You need to give your mind the same care and consideration.

        Oh, 100% regarding the DSM. And even if they do find genes that signal a predisposition, that is not the same as actually having something wrong with you. There is a danger of preemptive treatment. Take a difficult child to the doctor who conducts a blood test and pronounces a positive result for potential development of a disorder that is not a disorder – see Oppositional Defiant Disorder – and you have an excuse for not parenting and you can drug your child into acquiescence with a clear conscience.

        Being hostile and defiant towards authority figures indicates ODD, apparently. Clearly what I thought was independent thinking is a mental illness.

  7. This is so far up your street it is in your driveway:

    http://www.chaada.org/default.asp http://www.chaada.org/OvermedicatingofAmerica.html

    It looks to be a ghost town of a site. They had the right idea, although; maybe they were all carted off to a ‘facility’ in the middle of the night.

    This is appalling and highlights the vulnerability of children in particular again:


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