Whose Mind is it, Anyway?

A positive, though limited, development in the California Supreme Court, as reported (via Associated Press copy) in today's Los Angeles Times:

Mentally ill inmates cannot be forced to take anti-psychotic drugs, the California Supreme Court ruled Monday, allowing a certain class of prisoners to refuse treatment in limited circumstances.

The justices' 6-1 decision concerns California inmates who have done their time for criminal convictions but have been found to be mentally unfit for release to the community. Those inmates, hundreds in all, are housed at state mental institutions until they are deemed fit for return to the community.

If they refuse anti-psychotics, the court ruled, the state cannot force them to take the medication unless a judge authorizes it. A judge must find that the inmate is incompetent to refuse treatment and is an immediate danger to himself or others.

In other words, in California a judge's approval is now required to force drugs down the throat of people being held in captivity despite the fact that their legally authorized imprisonment has ended. Oh well, at least it's a free country.

Comments

[Russ]

So convicts who have already done their time, and are still being held against their will solely on the say-so of their captors are at least granted the privilege of not being compelled to consume pyschoactive drugs should they object. I guess "Just Say No!" doesn't apply to them.

And somehow the court only ruled 6-1. I'd really like to see the dissenting opinion.

[Anon]

You people should stick to what you know. My brother (schizophrenic) was in and out of jails and hospitals his whole life. He was a constant danger because he would not take his meds. He killed our mother. God forbid if some CRAZY MOTHERFUCKER does not take his meds the state intervene. Maybe we should make sure he kills libertarians.

[thoreau]

I'm probably more sympathetic to compulsory psychiatric treatment than some here.

(commence stoning now)

No, I'm not FOR it, at least not without HUGE qualifications, restrictions, reservations, etc. But I'm probably a lot more sympathetic than most opponents. (It may come as a surprise on Hit and Run to learn that one can sympathize with something but still oppose it.)

I've known a good number of people with mental illness, including a few schizophrenics (via volunteer work, my messed-up family, simply living in a crazy world, etc.). I've heard people complain about the side effects of anti-psychotics, but I've never heard of a person with schizophrenia who recovered from his psychosis and then complained about the recovery itself. i.e. I've heard of people who say "I hate gaining weight and being tired a lot", but I've never heard anybody say "I wish the voices would start talking to me again."

This doesn't mean I support coercion on the grounds of "Oh, you'll thank us later". It's just that while some probably see involuntary psychiatric treatment as simply a way of controlling people, I see it as a compassionate tool that's too ripe for abuse to ever be acceptable. There's a difference.

Oh, I should also add two interesting tidbits about the gov't and mental illness:

1) I know a guy who was misdiagnosed with schizophrenia. I know exactly how the misdiagnosis happened (the doctor was sloppy, but he was also up against some of the most manipulative people you'll ever meet). The misdiagnosed guy is also a heavy pot smoker. A "dual diagnosis" of substance abuse and schizophrenia means automatic disability payments.

Needless to say, the misdiagnosis was at least in part the work of relatives who wanted to wash their hands of a difficult person by getting him on disability. And the doctor, as sloppy as he was, would have caught the mistake had he not been up against a family more Machiavellian than, well, Machiavelli.

2) Atypical anti-psychotics are truly wonder drugs. They suppress a much wider range of symptoms (including the less obvious ones that nonetheless wreak havoc on a patient), and they have far fewer side effects. The only problem is that for a tiny handful of people there are VERY severe side effects. These side effects are usually easy to spot early on, and the medication can be halted.

In Europe, people taking these drugs need blood tests once a month to monitor the side effects. In the US, the law requires them twice a month. That's an extra $500 per year, and people recovering from schizophrenia often have low-paying jobs. To the best of my knowledge, that extra $500 per year per patient hasn't saved any lives.

[Dan]

It gives me the creeps to think of the government drugging me, and my gut instinct is to be strongly against any government attempt to force people to take meds. From an idealistic perspective, it's also a violation of the "victim"'s rights.

However, there's reality, which is that the human mind is not a pure, inviolate entity; it's just a side-effect of how our brain works. It is not uncommon for the human brain to malfunction to a great enough extent that the individual is no longer capable of making the informed, rational choices he WOULD make, if healthy.

Hypothetical scenario: a man suffers a massive stroke. When found, all he does is twitch and say "don't help me" -- and that's ALL he says. So far as we are able to determine, that's all he CAN say, perhaps because (as a CAT scan shows) his speech centers were damaged. Should we assume he doesn't want help, just because that's what he's saying? I don't think we should make such an assumption. I think we should look at what we know(that most people want medical help, and that this person's speech is not reliable) and make an educated guess that the person actually *does* want help.

We "force" unconscious patients to accept medical treatment all the time; we do not consider it true "force", however, since the patient is incapable of giving or withholding consent. A person suffering from severe schizophrenia, or severe depression, may LOOK like he is capable of
giving/withholding consent, because he's capable of speech and we (mostly) understand him -- but he isn't.

Every day, I walk past one or more mentally ill homeless people on my way to or from lunch. I strongly suspect that these people would rather be "forced" to take meds, and be sane and healthy, rather than be living on a sidewalk, defecating in the bushes, and passing the time screaming at invisible demons.

I think the best solution here is a variation of the living will -- let people, while they are mentally healthy, pre-decide how they'd want their medical care to proceed in the event that they're unable to decide for themselves. But the default should be "you get treatment, whether you want it or not". Once you're stable again, you could always draw up the will and stop taking your meds, if that's what you really, rationally, want.

[Russ]

I think that some people are missing the point here. These aren't people who are being released into society... these are people who are remaining in custody.

Saying that they need to be drugged to protect society from their psychotic tendencies doesn't cut it, because that's the rationale for why they're not being released in the first place. As long as they're in custody, they're no danger to society. Once they're out in the street, forcibly medicating them is no longer an option.

Either way, compelling them to take their meds just doesn't stand to reason.

[Will Spencer]

Other points to keep in mind:

1. These court orders are to be issued by judges with no medical training.

2. (If this is like other mental health incarceration law) The prisoner will not be present at the hearing where his case will be decided.

In other words, a judge now has to rubber stamp decisions made by other mindless beauracrats.

[Anonymous]

This is a difficult post.

When I was 17 I was arrested by the police and committed to a private mental hospital and then to a state mental hospital.

I was never given a trial where I was allowed to be present. I was never allowed to be represented by legal counsel. I was incarcerated for approximately one year.

During my imprisonment, I was forced to take drugs. When I refused, I was severely beaten by the "hospital" staff and drugs were injected into me while I was physically restrained by six orderlies.

The drugs I was forced to take had serious negative side effects. When I complained of these side effects, I was called a liar.

Eventually. I was released several months after I was able to force the discovery that I was being held under SOMEONE ELSES MEDICAL RECORDS.

Yes. The top few pages of my "patient binder" were mine, but the next several hundred pages belonged to a person of a significantly different ethnic background.

I was denied access to my medical records for months. As a prisoner in the mental health system, access to your medial records is your legal right, at least in the state where I was incarcerated. However, I was told that I was being denied access to my medical records for... medical reasons.

When I was finally given access to my medical binder, I flipped through it and none of it made sense.

I then folded back the clip that held the paperwork together to reveal -- SOMEONE ELSES NAME.

I have been incarcerated, drugged, beaten, and held in solitary confinement -- under someone elses medical records.

At that point, the state would not admit their obvious mistake, but my treatment did improve. I was quietly released a few months later.

In general, I must remind everyone here that criminals have significantly more rights than mental patients under our current laws.

Readjusting to society after this horrific experience took quite some time. When I went into the system, I was a fairly average boy. By the time I was released, I was emotionally broken. It took years to get back on my feet.

Almost twenty years later I am now a successful business person with a good home and a stable life, but I still have nightmares.

For more information regarding the mental health care system, visit The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility at http://www.szasz.com/

[MJ]

The people we are talking about here are those who have been judged mentally unfit to be in public on their own. Exactly why would anyone assume they are mentally fit to refuse treatment (how and why they were considered "unfit" to return home in the first place is a somewhat separate issue)? While they are not danger to the danger to the general public, presumably they can be a danger to fellow inmates and staff.

If such inmates are being held in custody inappropriately to begin with, I can understand the outrage of having drugs forced upon them, but if they are legimately mentally incompetant, I'm not sure why this is a problem.