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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Sometimes Involuntary Hospitalization is Just the Right Prescription

Allan N. Schwartz, LCSW, Ph.D. Updated: Feb 10th 2008

Mia Fontaine, co-author of the book, Comeback: a Mother and Daughter’s Journey through Hell and Back, wrote a compelling editorial in the Op Ed section of the Sunday New York Times the weekend of February 10, 2008. Using Britney Spears as an example of the central issue, Ms. Fontaine discusses the problem of having a loved one committed to psychiatric or drug treatment inpatient hospitalization against the wishes of the patient.

The author correctly points out that involuntary hospitalizations were severely curtailed many years ago in order to protect the civil rights of people from being violated.  Prior to this curtailment, there were abuses whereby people could be involuntarily hospitalized and abused. For example, a vindictive spouse could "drive their husband or wife crazy," make the claim that they were crazy and have them hospitalized in a state or private institution for most of their lives.

In fact, an experiment conducted by David Rosenhan many years ago resulted in a famous article entitled, "On Being Sane in Insane Places." In the experiment, a group of graduate psychology students signed themselves into a mental institution, reporting that they were suffering from psychotic symptoms. Once on the psychiatric wards, they behaved in completely normal ways that betrayed absolutely no psychotic symptoms. The medical staff did not notice that these people were normal and, in fact, made notes about their behavior indicating psychoses.

The results of this experiment was only one of the factors that changed the legal standing of involuntary hospitalizations. Practices such as: 1) the old version of electroshock therapy that used huge amounts of voltage that often harmed patients, 2) lobotomies, in which the a portion of the prefrontal cortex was removed to quiet schizophrenic patients, and other inhumane practices, once brought to the attention of the public, resulted in the modification of laws so as to stop and prevent abuses of the mentally ill.

There is no doubt that it was a good thing that these laws were changed to protect both the mentally ill and the normal population who could be imprisoned in a mental hospital by vindictive family members who had an interest in getting someone out of the way. In addition, the advent of modern medications to treat the mentally ill made long hospitalizations unnecessary and led to the deinstitutionalization movement so that most state hospitals were closed with psychiatric patients referred to outpatient settings while living in the community.

Once again, there is sometimes too much of a good thing with the result that it is now sometimes difficult or impossible to hospitalize someone even though they are in great need of this. At most, a person can be hospitalized for 72 hours, against their will; if it is proven that they may do something harmful to themselves or to others.

For example, Ms. Fontaine points out that even though she was a drug soaked teenager, the law protected her from hospitalization. It was only when she was arrested on felony drug charges that she was forced by the courts to receive intensive drug treatment and rehabilitation.

Ms. Fontaine correctly points out the parents of drug addicted or mentally ill teenagers are prevented by the law from getting the help their children need. What is outrageous is that these ill and addicted young people, as well as those who are well into adulthood, cannot get help unless they have done something criminal or suicidal, at which time it is almost too late.

Unfortunately, I know from personal and professional experience how accurate Ms. Fontaine really is. I have watched tearful parents in my office cry in anger and frustration as their children refuse to stay in treatment facilities. They check themselves out against parental wishes and medical advice and resume their drug abuse. The same holds true for those who are mentally ill.

I fully agree with Ms. Fontaine that in protecting someone from being wrongly committed we have abandoned those who are in desperate need of help. That help, especially with drug addiction, can only be obtained with involuntary hospitalization and treatment.

Your comments about this important issue are welcome and encouraged.

Allan N. Schwartz, PhD

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

Reader Comments
Discuss this issue below or in our forums.

MY HEART GOES OUT to "Forever grief stricken MOM" - - Feb 18th 2015

 I am responding to the woman in the article, Life Triumphs All, "Grief Stricken Mom", Oct.13th 2010, Dear God, why are Hospitals, Professionals, StaTe, Government, ETC so CRUEL!!!! This poor woman was begging and she was RIGHT, just trying to save her daughters life,  she & her daughter were thrown to the gutter, let me guess they would stabilize her & release her , over & over & over & over!!! Horrifying, Wrong! This is NEGLECT, WRONGFUL DEATH, on the part of the Hospital, and anyone else who didn't listen to this womans PLEA for help that was absolutely necessary for her daughter to live. They just didn't care, didn't listen, The Law NEEDS CHANGE FAST! Too many dying as a result of the mental/physical illness of SEVERE Addictions, it needs to be done! No one seems to care except the ones that have went up against this system, but maybe when it comes knocking on the DOORS of more people or more people speak out then something can be changed, yes, sometimes in SEVERE cases INVOLUNTARY TREATMENT is necessary!

Lives thrown to the Gutter!!! - - Feb 18th 2015

In the case of a SEVERE ALCOHOLIC/DRUG ADDICT/or TRIPLE ADDICTED Individual, that has been emergency treated at least once or twice in a months time period, and, has been repetedly taken in for emergency treatment for OD of Alcohol/Drugs and when they are considered to be stabilized and  they are told  repetedly they need to be in an inpatient facility and they refuse time & again to get help & outpatient help did not help, then the family should be able to take legal actions necessary with the State or County to see that this individual, HUMAN BEING gets the treatment necessesary to save their life & the life of others that are affected negatively & sometimes devastatingly. When an individual continually uses alcohol & or drugs or both on a constant basis, they have become severely mentally ill , no doubt that if not voluntarily treated in an in-patient facility, then they need an INVOLUNTARY committment, by hospitals & family members & State or County to get the individual emergency life saving help, not just to STABILIZE & send out again???? That is neglect! That is ignorance! If it can be proved that a person has been taken in for EMERG treatment for an OD of either Alcohol/Drug or Both over 2X's in a one month period or with in a few times in a year then what more proof is needed? This person can not make mentally healthy decisions for self or others  & is therefore a danger to self & others!All Addictions to BRAIN & Body altering substances to this severe DEGREE is the same as a GUN or POISON in the hand of a baby! Any mentally healthy individual would seek the treatment they need, after a certain point!  Addiction can become a true mental illness & if proof can be given to courts that a person just won't or can't mentally make the proper decisions then it needs to be overstepped to save an indivduals life & others around them, hospitals should have responsibilities to report to the Surrounding Counties & States of such EXTREME cases, so that a determination can be properly made for the treatment of individuals that will not & in MOST cases can not make the decision for themselves because they are in the GRIPS of Brain altering substance that has severely altered normal reasoning, even when stabilized they go through horrible Withdrawl that sends their Brain back into a frienzy to use again. Substance addiction is a Body & Mind Disease and needs to be recognized and treated by its SEVERITY and many , too many cases are severe to the point of death and neglected & sent on their way! Lives thrown to the gutter! This is not human Dignity, its the opposite, we reciognize Substance ABUSE as a disease, just like Cancer, diabetise, etc, well sometimes these deseases can be treated out patient & sometimes they are so severe they need inpatient treatments but in the case of metal illness, when it gets so severe the patient just cant make the proper decisions! These are the lives thrown to the Gutter!

No - - May 15th 2014

You are wrong.

I'm still trying to find my soul 9 years after being hospitalized (albeit technically voluntarily since I had no choice).

I don't believe abandoning someone who is somewhat suicidal to a frightening, dignity-destroying institution filled with seriously disturbed people who can and will hurt you is the "right prescription."

You're just wrong. My trust has been destroyed fully since this experience. It was worse than being molested as a child. At least that was done as pure evil and not under the guise of good intentions.

The irony is that the man who molested me could never be prosecuted. I was the one who was punished. 

So you are wrong and insensitive. 

Involuntary hospitalization - MOM - Apr 18th 2013

Thank you for the article.  It is very true what you said. It has to be something terrible to happen before anyone gets involved. I was worried my son, who is 22.

I noticed only two weeks ago, something was odd about his behavior. I could not pin point it. But he was acting differently. Then two days ago he just \\

Guardian/Mom - April - Sep 3rd 2012

I am the Mother and Guardian for a 26 year old man. I found him 8 years ago after he shot himself. He had part of his frontal lobe removed and all of his right temporal lobe removed. He is on SSDI and I am now also his payee. He is also covered under my insurance I work for a large healthcare program. He has a psychiatrist but is not in therapy. He is has been a pot smoker for half of his life but I have many reasons to believe he is using meth!.We live alone and he goes into rages daily. He also threatens me all the time since I control his money. I have to call 9 1 1 weekly but he just leaves and they actually don't want to take him?.I thought being his guardian was enough to have him commited but they tell me no! His psychiatrist stated I would have to have him civily commited?..I did'nt want to do this but I am at the end of my rope and I just hope that the courts will agree!

Need Involuntary programs for Teens in Drug Spiral - John X - Jun 18th 2012

Wife and I are living a nightmare... teen daughter with severe drug addiction problems, which lead to many other problems.  Already have 2 out patient programs under our belt, and 3mo involuntary wilderness program in Utah...  She's in a really bad place again, but there is just nothing short of a $60,000 theraputic boarding school environment for her.  Everything in California is voluntary based, and she refuses to get treatment.  Letting her crash and burn is taking everyone else down as well, not to mention the serious concern of death.  It's incredible really that our laws do not allow a parent to save their child.

Human Dignity Requires Freedom of Thought & Ultimate Self-Determination - Concerned - Mar 9th 2011

I find the practice of involutary hospitalization for expressions of suicidal ideation or intent barbarous, inhumane and medieval -- threat to others' safety is another matter altogether.  In many cultures - including ancient Greece, Rome, India, Japan and Imperial China - suicide, under certain rare circumstances, was (and in certain locales still is) considered an act of honor, duty or moral integrity.  Some Stoic philosophers considered suicide the ethically superior choice over a life that was doomed to ignobility and oppression.

The choice to live or die is human right - in fact, it is THE supreme and most sacred right, as it constitutes the basic will to live, upon which all other acts of will are contingent. Along with Arthur Schopenhauer, I assert that the desire to die is the natural outcome of a distorted, isolated, divided and corrupt social order.  Those who, in the midst of an indifferent and fundamentally cruel society, do NOT feel at times the desire, like Melville's Bartleby, to exit the world of privation, greed, culturelessness, corruption and exploitation, are the insane and mentally disturbed ones, not the healthy people who entertain or express suicidal feelings as a response to such conditions. The USA's consumer economy relies on child slave labor overseas, abuses workers and the environment across the world for the sake of an elite's profit, considers basic treatment for bodily illness and disease a matter of profit and has determined that an enormously overblown defense budget supersedes the need for nutrition & education. Thomas Szasz, Felix Guattari and R.D. Laing were right in positing - in various ways - that much of what passes as psychotherapy today is, in effect, a system of social control -- cultural Fascism if you will -- that has absolutely no basis in emprical scientific inquiry (e.g., the rampant overdiagnosis of children with ADHD or ODD, so as to boost their compliance and performance in an unnatural and stifling environment of controlled, passive, uncritical, institutional rote learning). Many people commit suicide after leaving a hospital, inasmuch as the act of hospitalization reinforces stigma, isolation, inferiority and offers ZERO long or even short-term solution to the reasons which predicated their hospitalization: social isolation, worthlessness and lack of meaningful opportunities for work or creative expression.

Involutary hospitalization for threats of self-injury or suicide should be illegalized for the inane and unjust measure that it is.  I also strongly oppose the administration of drugs against the expressed will of any person for any reason whatsoever.  It is a brutal and unconscionable violation of human liberty to forcefully administer a drug to someone who adamantly opposes it FOR ANY REASON - in particular, for cases in any way related to psychiatric condition, that is - unrelated to pathogens or exogenous diseases.  It is time that more people spoke out against the profitable, ineffective, irrational and inhumane business of hospitalizing, detaining or forcing unwanted therapy on suicidal persons against their their will!

Woes of involuntary hospitalization - JMiller - Feb 17th 2011

My wife was suffering from derpession and need to talk to someone. She reached out to a friend that had the so called 800 numbers and next thing she knew the police showed up and dragged her off to the state hospital where she was kept against her will for 6 days. She had no thought of suicide and was no danger to anyone yet the hospital decided to try and get a court order to keep her locked up.It was a horrible experiance for her and now she is withdrawn from not only public palces but freinds and family as well.I am the only one she feels safe with due to the fact I was the only hope she had of getting out of a place she didnt need to be. The doctors would not speak with me even though she asked them too and from what she tells me they never spoke to her either and if they had I am not sure they would have believed what I had to tell them. They seemed only interested in keeping her locked up medicated and going to art class. Now that I have gotten her out she is seeing a doctor to help get her over the experiance of being held against her will at a very scary place and her civil rights being violated. My dilema now is that the state hospital has seen fit to send me a bill for their so called services at the tune of $623.00 a day. I am of course refusing to pay this and wonder what recourse they will have to collect.

LIFE TRUMPS ALL - Forever grief-stricken Mom - Oct 13th 2010

I lost my only beloved daughter on Jan.29,2010. We suffered through her addiction to oral Oxycontin initially and progressing through to hard-core intravenous morphine addiction for five years prior to her death - due to overdose and wilful neglect by the treating hospital to listen to her parent's frantic, continual pleas to help save this young woman's life. She had made 33 ER visits and 5 hospitalizations at the same hospital over a 4 yr. period. I begged for psychiatric admission and medical detoxification to save her life but was denied time and time again. This was the only thing that could have saved her. She was unable to help herself in any regard. God help us through this grief...

New To This Field - Allan N. Schwartz, PhD - Aug 24th 2010

In my experience and opinion, having worked in and with psychiatric hospitals, (or psychiatric wards within hospitals), as well as working with patients after discharge from the hospital, generally speaking, it is better to call 911 and have a family member assessed by the EMT's and nurses to determine the need for hospitalization than to not call.

The fact is that if someone is threatening suicide and has a plan, the situation is very serious. If someone has a mental illness and is either drunk or on street drugs, the situation is even more serious.

In otherwords, the hospital is a safety net for situations that are dangerous and this includes the patient breaking things and threatening to hit.

I hope this helps.

Dr. Schwartz

New to this field of involuntary hospitalization - - Aug 24th 2010

I have only once tried to involutarily committ my adult child to a hospital because she is bipolar and doing poorly and is talking about suicide. She needs a good psychological evaluation and then to be forced to take her medicine.

I read in your comments section where one of the writers said she was totally freaked out by the experience which only made her worse. Could the author of this article please comment on that person's experience please? I am now losing my resolve out of fear of what that person wrote. As a multicultural person, I have to think these laws are a reflection of the Anglo-saxon culture that thinks we are all individuals with individual rights, and are not members of families that love each other. Help!

Husband is severely mentally ill and in need of help... - Lisa - Aug 17th 2010

Just finished reading everyones comments..each has some very relevant points.  As a estranged spouse of a severely mentally ill man, I can say that it has been more than frustrating to experience this roller coaster ride with my husband.  He is currently hospitalized, he was suicidal and having homicidal thoughts,he acts on impulse as he has ultra rapid cycling bipolar and alcoholism. Even though he asked to go for help that hes tired of all of this he wanted to check himself out AMA...drs were able to keep him there not sure how as Im not on the consent to speak with anyone, as he hasnt signed for anyone to be contacted.  What I dont understand with all of this is my husband became the perfect liar when he had his first psychotic break a year ago he can talk himself out of anywhere only to be back in the same place a short time later.What dont the "professionals" get????  He has been emotionally abusive to myself and his kids,his meds are not working and he is out of work.  I cant seem to get anywhere with anyone ..I am only seen as the enabler and co dependent ... I am the only one that has taken him to the hospital this year all 9 times... he was detained once- the judge let him go... as he knows how to play the game.  When will it end? with him or all of us dead ????  We have three kids together  I fear for all of us.  But no one will listen to my side of the story!  He turns it around.  I am not a vindictive spouse! I am a masters prepared medical social worker who happens to love her husband and knows how ill he is.  I just want him to get as healthy as possible so he can be somewhat happy again, all the other hospitalizations have not helped would involuntary?  Im not sure its not the best scenario but what else is there?

Thanks for reading...and there does need to be some kind of change in the system.  For everyones sake.

Lisa

Unbelievable - Make Involuntary Admission Laws! - Aug 14th 2010

I 100% whole heartedly agree with this article. We need to fight to save our children's and loved ones lives. I understand the crash and burn theory, but easier said than done. My husband had an addiction (cocaine, then crack) for 10 years, he has been clean for the past 2 years, however, it took turning to crime and a court ordered in-patient rehab facility INVOLUNTARILY commiting him to wake him up. Great right? No. Now because of this record, because it came to that, because I couldn't get him into somewhere sooner (He didn't turn to crime until the last 6 months of his addiction, out of 10 years...it just got progressively worse) he has this criminal record, and no one will hire him. He's sunk into a depression, because now he is finally sober and wants to contribute to our family, it's hard. I just hope he doesn't revert back to his old addiction...

I also have a best friend who is an alcoholic, she drives around drunk, and has recently had 2 seizures, we all have talked to her. She doesn't think she has a problem. She is in the hospital as we speak for a double seizure in one day, and almost bit her tongue right off. What do you think she's going to do when she gets out of the hospital? At least if there were some type of involuntary admission law helping her parents (whom she resides with, along with her 2 children) she wouldn't be able to pick up that bottle right from hospital dismissal.

I feel that like anything, there is obviously the potential for those commiting the person to abuse and manipulate the laws, but if there is hard evidence (as in both my cases, physicians knew and documented aspects of the addictions) and a strict process, perhaps this would deter those who are risk to abuse.

I truly believe that involuntary admission into either a treatment facility or phsyciatric facility has the potential to save lives and families.

System needs improvement - Kit Kat - Jul 23rd 2010

I’m relatively new to the psychology field, in an academic sense. But I can’t believe some people get urged to get themselves involuntarily committed because they can not afford therapy or voluntary treatment.So pretty much they voluntarily get involuntarily committed (there are more oxymoronic things to follow).  Then sometimes people get put on medication that makes them worse, which prolongs their stay, and they never get any psychological help while they are there.  The biggest joke of all is that people who are involuntarily committed to a mental health hospital are also permanently considered to be “mentally defective” by the federal government.  Labeling an unhealthy yet healable person as “defective” and the person has no chance of getting that label erased, outrageously contradicts the principals of recuperating from an illness.  Why don’t we go into the leukemia ward at a children’s hospital and tell all the hairless kids that, “the federal government has determined that you are defective they will always think you are defective.  Give me a break.  Who’s the idiot or panel of idiots that came up with that?Probably the same jackass’ that suggests that people get themselves or loved ones involuntarily committed, when the ill person should take another route.

Hospitals - Allan N. Schwartz, PhD - Jun 18th 2010

I fully understand and empathize with all of those who have posted comments protesting involuntary hospitalization.

No one wants to or likes to go to the hospital, whether for regular medical treatment, such as surgery, or for psychiatric reasons. Yet, hospitalization is sometimes necessary whether we want it or not. I prefer to view hospitalization as a necessary evil designed to protect our health, whether its mental or physical health.

It remains difficult to have someone hospitalized or psychiatric reasons and this is largely due to the costs and expenses that it entails. Today, an admitting psychiatrist must prove that a patient: 1. a danger to themself in the form of suicide or, 2. a danger to others in the form of homicide. By far, the largest number of hospitalization are for suicidal intent.

The fact is that thinking suicide does not qualify as a reason for admission. The psychiatrist must prove Intent. Yes, on occasion, a patient can be held for 72 hours for observation in order to determine if there is or is not intent.

Please understand that I am not suggesting that there is anything wonderful about being hospitalized because there is not. Its just that, on occasion, it seems to be the only way to prevent a person from self harming.

Also be aware that there is no more jarring experience as someone not being hospitalized after evaluation, released, goes home and commits suicide. It does not happen often but it does happen. It it incredibly tragic and most psychiatric staff, including nurses and social workers end up feeling terrible anguish for having not been more astute.

Dr. Schwartz 

Involuntary hospitalization is inhumane! - Rat - Jun 18th 2010

I was recently hospitalized against my will. Although I realize that I was extremely delusional I did not pose a threat to anyone. My husband called the police and told them that I was homicidal. He had previously called 911 but they would not commit because I was not homicidal. But the fact was that I was suicidal ( I had not eaten in two weeks). I do not understand why my husband had to lie, and make me out to be something that I am not. I am not some kind of monster that would harm another human being. Actually he is the one that has beaten me on several occasions. Now I have to live in fear that he will commit me again if I say or do anything that appears out of the norm.`I believe he could have handle the situation differently. People that are mentally ill are already made to feel like outcast without being dragged out of their homes in handcuffs by the police.

I am disgusted by this - sarielle - Jun 14th 2010

As one how has been forcibly hospitalized for an actionless THOUGHT of suicide by my former university I would have to disagree with this article. For drug addictions I can understand but where mental health is concerned NO. I am personally in HELL right now because of that experience. I can not stand to look at my parents. I fear to close my eyes afraid I'll wake up in hell. They had to drug me just so i'd sleep in there. Even with Ambien I only sleep a few hours, and it is NOT a peaceful sleep at that. Wise up people! Think this action through or you'll RUIN someone's life. Because of that experience I had to quit my job, pass up another job because it was too near places that brought back memories of that HELL. My school did this to me during finals and I am unable to complete my assignments because I have a panic attack each time I try. I had to move back home were I am on constant alert because I fear that if I don't behave they will send me back there. I can honestly say that I no longer trust or love anyone associated with my involuntary hospitilization. THe worst part is that they made me sign in "voluntarily" because they already had permission to put me in involuntarily. I wish I hadn't signed in, if i hadn't i'd have maintained some control. The funniest thing is now that i'm out I have more serious thoughts of suicide then I did before. Only the fear of going back to that place keeps me tied to this plane of existence. I am dead inside because of BULLSHIT that this article discusses.

recommendation - Ray Smith - Jun 8th 2009

I'd like to recommend: Crazy: A Father's Search Through America's Mental Health Madness by Pete Earley

No help out there - Cassie - Apr 15th 2009

I am so sorry for the family involved in this case.  I am currently hitting all dead-ends with trying to get help for my sister.  She is  a 22 year old mother of 2 that is fighting a losing battle with her heroine addiction.  I have contacted several services including the local rehabs, police, therapists, etc.. and they all say that there is nothing that I or her mother can do to get her help if she is not willing.  We almost lost her to an overdose of heroine just 2 months ago, and still they say there is nothing we can do.  They may be trying to protect the rights of innocent people, but what about protecting the lives of those that can't protect their own?

It is difficult even under the best of circumstances. - - Apr 11th 2009

I'm a chemical dependency involuntary commitment specalist.

I truly sympathize with family and friends of loved ones that are addicted and out of control. Often the addict/alcoholic is the last to realize it. I have two brief comments on this topic. First, there is a fine balance between protecting patient rights and taking away the addicts right to choose. The laws for committing a person to substance abuse treatment involuntarily vary from state to state, but in general there are guidelines outlined to determine whether a person is “committable” or not. These are danger-to-self, danger-to-others, and/or gravely disabled by their substance dependence. So, in my opinion, the addict has to get really bad before the law will intervene. When there are people taking care of the addict, this usually minimizes the chance of commitment. My second comment. Even though there are laws to allow civil commitment in a given state does not mean they have the resources to back it up. For instance, in my state there is authority granted to take an addict into emergency custody, place the addict before a judge to gain authorization for commitment to a treatment program, and then take them directly to a 60-day semi-secured chemical dependency treatment program. However, the reality is, there seldom is a secured place to put someone on emergency custody hold and treatment bed space is at a premium and usually requires a fairly long wait. The bottom line is you can have excellent laws in place, but there need to be funding to back it up.

Involuntary hospitalization for drug abuse - Linda Vendt - Dec 22nd 2008

We have been advised by Drug Counselors and Drug Abuse facilities that our loved one needs to "crash and burn" and voluntarily admit himself into rehab.  We feel helpless and are watching him go deeper and deeper into drug addition.  We feel that if we could intervene and

get him some in-paitent help before it is too late, it would be beneficial.

He is over 18 and claims he is in control - but even his friends know he is in trouble.  There is no help out there for good in-patient treatment under $30,000.   

 

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