There is usually a negative connotation associated with the term “mental illness.“ Mental illnesses are recognized by the majority as disorders in normal brain functioning. Since people with mental illnesses are in the minority, the majority has decided for them that this abnormal functioning of the brain needs to be treated and fixed. Tancredi takes a stance against the majority in saying, “to whatever extent mental illness is reflective of distortions in thinking and personality, it seems inappropriate for treatments to be directed at correcting this ‘disorder’” (520). Is it a human being’s right to decide if another human being’s state of mind is ill or normal? In the eye of the mentally ill, one’s disorder produces thoughts and feelings that make up their reality. It may go to the extreme that an individual does not know that the “mental illness” they experience every day is not normal, so they may not want to be treated and “fixed.” The majority’s helping hand and mending treatments are not always welcomed with open arms by the mentally ill.
Most citizens in the United States enjoy their Constitutional rights to privacy, freedom of religion, freedom of speech, and due process of law. However, many mentally ill patients in this country have not possessed these same fundamental rights. These rights are presumed to be the rights given to humanity, and by taking rights away from some mentally ill people, society has treated them as lesser humans. The way to improve these illegal and ethically wrong actions is to empower mentally ill patients “by respecting ethical values of autonomy, informed consent, and personal dignity” (Brendel 152).
Mentally ill patients can either be voluntarily or involuntarily admitted to psychiatric facilities. In both methods of admittance, the patients will initially be treated as if they have autonomy, but this has not always been the case. Forty percent of patients involuntarily committed to a facility would never commit another person (Olsen 706). This statistic is probably due largely to the fact that until the late 1970s, “if a patient was involuntarily committed to a mental institution, he/she was deemed incompetent to enter into a host of decisions that other citizens engage in freely” (Tancredi 514). The patient could not vote, enter into marriage or divorce, sign a will, and most significantly, could not refuse treatment. The patient was denied not only the above basic rights, but the right to due process of law to determine if they were actually incompetent or not.
The Rogers v. Okin case in the 1970s was a turning point in regard to the right of involuntarily committed, competent patients to refuse psychiatric treatment. This case decided that if an involuntarily admitted patient refuses treatment, they should go through a competency hearing to follow Constitutional due process rights. A patient’s competency is measured by their ability to make rational decisions regarding their psychiatric treatment by assessing their treatment options, risks and benefits, doctor’s recommendations, and any other viable information in the decision making situation. If the patient is unable to make rational decisions regarding their treatment, they are named incompetent and the court appoints a guardian to make their treatment decisions. The guardian is “expected to ‘stand and act in the place of the patient’ which essentially would mean that his obligation would be to glean the patient’s preference and substitute this perspective for his own view” (Tancredi 517). Once incompetent, a patient is not always deemed so. “Courts recognize that competency is not a constant quality, but that it may fluctuate over time” (Meisel 81).
The Rogers case, along with other similar cases, brought about the idea of informed consent. Informed consent is now a legal condition in which the doctor must disclose all information to the patient regarding any psychological treatment decision and get consent from the patient or legally appointed guardian before initiating treatment. Informed consent is a great right for a patient to have, because it allows patients to “assess benefits and risks in light of their own values” (Force and Gallant 146). With this liberty, a patient can refuse experimental treatments and medications on the basis of unwanted side effects. The only situation that informed consent is not needed from the patient or legal guardian is if the patient is dangerous to self or others.
According to most U.S. state laws, when a mentally ill patient becomes imminently dangerous to self or others, many of their rights are stripped. All mentally ill people that are deemed imminently dangerous are immediately hospitalized. Possible dangers include: “malnutrition, dehydration, neglect of medical conditions, or reckless behavior” and violent behavior (Blass et al. 846). The risk of the laws as stated is that “suicide and homicide have a low probability of occurring in the ‘imminent’ time frame required by most U.S. state statutes” (Olsen 708). Violent events are difficult to predict due to the low probability of occurrences. This means that the state relies on the low probability statistic itself to prevent harm to self or others. With no certain precautions, there is the continuous and ongoing risk that any mentally ill patient could become dangerous at any moment. This risk is practically uncontrollable due to the fact that crime outside of the mentally ill population is of the same unpredictable nature.
Coercion is the most recent concern in psychiatric treatment. Coercion could be in the form of threat of harm or force, the use of force, or the use of manipulation and persuasion. The patient’s care givers may have “strong impulses to render aid, which might lead them toward persuasion and, sometimes, even toward deception and coercion ‘in the best interests of the patient.’ Use of ethically shady means to this ethically noble end” could potentially be lethal to a trustworthy relationship between the patient and the doctor, because the doctor will have feelings of guilt, while the patient feels pressured and manipulated (Force and Gallant 148). Olsen states, “When influence is considered inevitable, neither good or bad in itself, and continuous in the degree of intensity, then the label ‘coercion’ applies to that point at which the use of influence creates moral discomfort” (709). A doctor asking questions to their patient about their opinion on past forced treatment is coercive, because the doctor puts the patient in the position that they feel like they need to supply a sought after answer. In Soliday’s study, the patients expressed, “…the best way to avoid another [solitary confinement] is to acknowledge therapeutic benefit, even if this is not how they really feel” (Olsen 706). Using coercion is a good way for doctors to gain self-satisfaction in their aims, but it in no way supports medical ethics which uphold “beneficence, the obligation of health professionals to act in their patients’ best interest” (Blass et. al. 846).
The use of cruelty, isolation, and restraints for psychiatric treatment are additional ethical concerns in psychiatric treatment. Similar to a young child being punished for disobediently eating a cookie before dinner, mentally ill patients receive punishment for unfavorable behavior like swearing, lying, and tardiness. In a case in the 1970s, “apomophine, a drug which induces violent vomiting, was used as a way to condition such behaviors” (Tancredi 515). This particular punishment is no longer legally used, but isolation and restraints are. Research shows that after seclusion, patients were questioned about their experience, and “only half agreed that seclusion was necessary” (Olsen 706). When deciding the context in which isolation and restrains can be used, Olsen believes, “Even the most restrictive interventions of seclusion and restraint can be applied with little ethical conflict if the patient desires the intervention” (711).
Contrary to Olsen’s beliefs regarding seclusion and restraint, these mechanisms of punishment are unnecessary unless all other methods of treatment have been exhausted. Seclusion and restraint are only needed in severe cases of extremely intense behavior, and should be regarded with much ethical thought. For instance, if a woman told her friend she wanted to die, that does not mean the friend should try to murder the woman. Likewise, even if a patient admits to desiring intervention, it does not mean that they should be treated with less ethical consideration. It is not a doll that is strapped to a bed or locked in an isolated room, it is a human being. All humans should be treated with equal respect and humanity, no matter their mentality or requests.
Each patient should be viewed as “an individual agent with unique characteristics” (Brendel 151). There is not a specific methodology to treat every mentally ill patient. If only methodological treatment is used, “the patient may reap some benefit but may also feel that some meaningful aspects of his or her existence have been overlooked or neglected” (Brendel 151). All aspects of their illness and humanity should be evaluated to treat a patient properly and successfully. In other words, there are no two people exactly alike in the entire world. So, why would we consider generalizing an individual’s personal wellness? We must acknowledge the differences in character and illness. The treatment that follows must be tailored to fit that particular person’s needs.
In the event that a mentally ill individual does not want care or treatment, as long as they are not dangerous to self or others, let them live the way they choose. Every citizen of the U.S. has a Constitutional right to privacy, and cases similar to, and including the Rogers case “have concluded that the constitutional right to privacy must also encompass other important health care decisions, specifically the right to decide about taking neuroleptic medications” (Meisel 76). Some treatments and medications have “the potential to affect and change a patient’s mood, attitude, and capacity to think, thereby implicating first amendment interests, too” (Meisel 76). Forcing a patient to be restrained, confined, or accept treatment for the sake of their mentality is a violation of their Constitutional rights.
What does it mean to be in a natural state of mind? The term “natural,” of and within itself is an abstract idea. An individual’s “natural state of being” is nothing more than the product of one’s own reality. Moreover, if a person has been unstable and not in possession of a sound mind his entire life, then is his state of mind not natural to him? What we must consider is that we have the capacity, by forcibly administering drugs and treatment, to disrupt and perhaps destroy a person’s concept of natural. It is not our right or place to determine and ultimately manipulate someone’s mind through psychiatric treatment.
Works Cited
Blass, David M., et al. “Ethical Issues in Mobile Psychiatric Treatment with Homebound Elderly Patients: The Psychogeriatric Assessment and Treatment in City Housing Experience.” Journal of the American Geriatrics Society 54.5 (May 2006): 843-848. PsycINFO. EBSCO. Torreyson Library, Conway, AR. 17 Nov. 2008 http://0-search.ebscohost.com.ucark.uca.edu/login.aspx?direct=true&db=psyh&AN=2006-05668-009&site=ehost-live.
Brendel, David H. “Healing Psychiatry: A Pragmatic Approach to Bridging the Science/Humanism Divide.” Harvard Review of Psychiatry 12.3 (May 2004): 150-156. Academic Search Elite. EBSCO. Torreyson Library, Conway, AR. 17 Nov. 2008 http://0-search.ebscohost.com.ucark.uca.edu/login.aspx?direct=true&db=afh&AN=14083803&site=ehost-live.
Force, Robert, and Donald M. Gallant., ed. Legal and Ethical Issues in Human Research and Treatment: Psychopharmacologic Considerations. New York: Spectrum Publications, 1978.
Meisel, Alan. “Making Mental Health Care Decisions: Informed Consent and Involuntary Civil Commitment.” Behavioral Sciences & the Law 1.4 (Oct. 1983): 73-88. Academic Search Premier. EBSCO. Torreyson Library, Conway, AR. 18 Nov. 2008 http://0-search.ebscohost.com.ucark.uca.edu/login.aspx?direct=true&db=aph&AN=12149571&site=ehost-live.
Olsen, DP. “Influence and coercion: relational and rights-based ethical approaches to forced psychiatric treatment.” Journal of Psychiatric & Mental Health Nursing 10.6 (Dec. 2003): 705-712. CINAHL. EBSCO. Torreyson Library, Conway, AR. 17 Nov. 2008 http://0-search.ebscohost.com.ucark.uca.edu/login.aspx?direct=true&db=cin20&AN=2004093549&site=ehost-live.
Tancredi, L R. “The right to refuse psychiatric treatment: some legal and ethical considerations.” Journal Of Health Politics, Policy And Law 5.3 (1980 Fall 1980): 514-522. MEDLINE. EBSCO. Torreyson Library, Conway, AR. 16 Nov. 2008 http://0-search.ebscohost.com.ucark.uca.edu/login.aspx?direct=true&db=cmedm&AN=7462583&site=ehost-live.
