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I am concerned that many psychiatric patients are being treated as guinea pigs. I have read news stories indicating forced medication may be the next thing on the horizon and already is being used in some states through "involuntary outpatient commitment." How do members of your panel feel about forcing someone to be drugged against their will?

Ryan Dans
Chicago, Illinois

Answered by Robert Whitaker:
Forced treatment has basically always been a part of involuntary commitment to a mental hospital. However, many states are now passing "involuntary outpatient commitment" laws, which, in essence, are designed to make certain that people so committed continue to take their meds. Personally, I think this extension of state authority over the "mentally ill" is misguided, and a big step backward in our country's treatment of the mentally ill.

First, most consumer groups are against this legislation. They see such laws as a violation of their civil rights and counterproductive (in that such legislation will drive people away from voluntary treatment). These are the people who have been through the mental health system, and who may know what it is like to be forcefully treated, and I would think that gives their opinion a moral authority that we, as a society, should listen to.

Second, the drugs used to treat severe mental illness are designed to change how the brain works, so to speak, which means forced treatment is a profound intervention. If a person is living in the community and hasn't been charged with any crime, then how does the state have the moral right to force this change on them? If the goal is to get certain people to take antipsychotic medications, then programs that seek to achieve this in a cooperative manner should be pursued.

Third, the diagnosis of schizophrenia is known to be affected by class and racial status -- it is a diagnosis more quickly given to the poor and to African Americans. So you can see how such outpatient commitment laws can lead to forced drugging of certain groups in society, which has its obvious ethical problems.

Finally, the understood premise behind outpatient commitment laws is that antipsychotic drugs are helpful, as a matter of course, for the mentally ill. The problem with this premise is that the drugs may cause a lot of problematic side effects, and, as many patients have complained, may diminish their capacity to experience the world around them. Indeed there is a notable absence of studies in the medical literature showing that the drugs lead to an improved quality of life over the long term. In fact, Harvard researchers reported in 1994 that outcomes for schizophrenia patients in the U.S. had declined over the past 20 years, and were now no better than they had been in the first decades of the 20th century, when wrapping the insane in wet sheets was the therapy of the day. Outcomes studies like this one undermine even the medical premise behind forced treatment.

Forced treatment has historically driven a wedge between society and the "mentally ill," and extending forced treatment into the community, I think, achieves that very result.

Robert Whitaker

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