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Is there ever any anguish among such groups as Dr. Torrey's Treatment Advocacy Center to zealously promote more forced treatment for people they deem requiring such treatment if other people become caught in the dragnet. In other words there is clearly a vested interest for some hospitals to involuntarily commit people who have lucrative private insurance. Would it bother you that these laws may make it easier to commit people even though they don't fit into the criteria you usually describe as needing "assisted" treatment.

Robert Legge
Etlan, Virginia

Answered by E. Fuller Torrey, M.D.:
Various forms of assisted treatment and involuntary hospitalization are used for some individuals with severe psychiatric disorders who are not aware of their own illness (because the disease has damaged the part of their brain that governs self-awareness) and who are dangerous to others or to themselves. Assisted treatment and involuntary hospitalization are also used for some individuals with other types of brain disorders, such as Alzheimer's disease.

Everybody involved in the use of assisted treatment and involuntary hospitalization should be concerned about potential abuse of this procedure. The involuntary psychiatric hospitalization of political dissidents in the Soviet Union was well documented. And even today in Japan, it is possible for a psychiatrist to involuntarily confine a patient in a private psychiatric hospital that is owned by the psychiatrist. This is why judicial authorities must always be involved in this process and why the person in question must always be provided with legal representation and redress.

During the eight years in which I worked as a psychiatrist at St. Elizabeths Hospital in Washington, D.C., I sought outpatient commitment, a form of assisted treatment, on multiple occasions. The patients were represented by very competent public defenders, and I had to convince a judge that this deprivation of the person's liberty was justified. That is as it should be.

Those who argue that assisted treatment and involuntary hospitalization are never justified because of the possibility of abuse are, knowingly or unknowingly, sentencing thousands of mentally ill people to continuing homelessness, victimization, incarceration for misdemeanor crimes committed because of their mental illness, suicide, and premature death caused by our failure to provide them with medications needed to control their symptoms. The no-involuntary-treatment stance is thus not merely an abstract civil rights issue. I believe that it is possible to provide individuals with assisted treatment, when necessary, and to do it in a way that minimizes any possibility of abuse. Isn't that what we have 900,000 lawyers for in the United States?

E. Fuller Torrey, M.D.

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