9 ms·

How can you treat someone who doesn’t accept they are ill?

47 points by okket 8y ago

azeirah 8y ago
> Physicians who cure must abstract person into functions. They threat the illness, not the person. And persons willfully present themselves as functions. Indeed, what sustains the enormous size and cost of the curing professions is the widespread desire to see oneself as a function, or a collection of functions. To be ill is to be dysfunctional; to be dysfunctional is to be unable to compete in one's prefered contests. It is a kind of death, an inability to acquire titles. The ill become invisible. Illness always has the smell of death about it: Either it may lead to deat, or it leads to the death of a person as competitor. The dread of illness is the dread of losing. > One is never ill in general. One is always ill with relation to some bounded activity. It is not cancer that makes me ill. It is because I cannot work, or run, or swallow that I am ill with cancer. The loss of function, the obstruction of an activity, cannot in itself destroy my health. I am too heavy to fly by flapping my arms, but I do not for that reason complain of being sick with weight. However, if I desired to be a fashion model, a dancer, or a jockey, I would consider excessive weight to be a kind of disease and would be likely to consult a doctor, a nutritionist, or another specialist to be cured of it. Finite and infinite games - page 56
- whatshisface 8y ago
  That's a lot of words to define illness as "being worse than normal." >The loss of function, the obstruction of an activity, cannot in itself destroy my health. I am too heavy to fly by flapping my arms, but I do not for that reason complain of being sick with weight. It wouldn't be a loss unless he had previously been able to fly, otherwise it's a maintenance of the status-quo.
  - grenoire 8y ago
    Then what about the cases with which you were born? What is the definition of normal then? If I inherited some form of respiratory condition at birth which persists as an illness, living with it is maintaining the status-quo; yet it is very much an illness. There is no loss of function per se, it was simply never there.
    - InitialLastName 8y ago
      Status quo applies relative to one's peers as well as oneself. If most humans could fly, those that couldn't, whether as an acquired or congenital trait, would have an illness.
  - deleted 8y ago
    [deleted]
wpietri 8y ago
Really interesting article. This for me is the crux of it: > "Being psychotic is not an exercise of free will. It is the inability to exercise free will.” I get why people are nervous about state power. But there are a variety of conditions, including slavery, addiction, and psychosis, where people may voluntarily enter them but then cannot leave without help. It's a dilemma with no simple answers. But if we're serious about freedom, I think it's incumbent on us to grapple with the complex, inevitably messy issues involved.
- amadeuspagel 8y ago
  > But there are a variety of conditions, including slavery, addiction, and psychosis, where people may voluntarily enter them but then cannot leave without help. In the case of slavery, the slave doesn't want to do something, but is forced to. In the case of addiction and psychosis, you don't want someone to do something, but he's allowed to.
  - wpietri 8y ago
    In the case of all three, it's a condition people can enter into nominally through their own choice. Sex slavery, for example, often starts with women taking misleading distant jobs. And a lot of what was effectively slavery has been justified through a gloss of choice: http://www.pbs.org/tpt/slavery-by-another-name/home/ http://www.pbs.org/tpt/slavery-by-another-name/home/
    - amadeuspagel 8y ago
      I don't deny that people sometimes make bad choices, and sometimes need help because of that. I'm just pointing out that there's a difference between involuntarily committing someone to a psychiatric hospital, forcing him to take drugs, electroshocking him, etc. and freeing him from slavery and I question whether the word help is appropriate for the former.
      - wpietri 8y ago
        The US had 4m+ slaves. If you asked every one of those about emancipation, I doubt all of them would have said yes. Given the failure to give them all sufficient resources to survive independently (e.g., 40 acres and a mule), and given how many struggled after emancipation [1], it's not clear that the word help is appropriate there either. And for the people trapped in things that are like slavery but have a gloss of voluntary acceptance, I'm sure that even more of those people would say they don't want outside help. Learned helplessness is a real phenomenon. If you're saying these issues are complex, sure, all of them are complex. But I don't think economics and primate power dynamics are any less complex than addiction and mental illness. [1] https://www.theguardian.com/world/2012/jun/16/slavery-starvation-civil-war https://www.theguardian.com/world/2012/jun/16/slavery-starva...
woodpanel 8y ago
Anecdotal but: I've experienced this problem first hand and know not one person with the same experience, that doesn't share the opinion that AOT is a much needed thing. In Germany even suggesting a law like this will provoke immediate protest by some people who claim to fight for civil rights. What I've encountered though is, that those people who claim to speak for the affected ones don't have a friend or relative with this condition and have never even met such a person. Fighting against AOT is for me not a defense of free will, but an act of denying people having a free will in the first place. Sure, there should be certain checkboxes to be ticked off first. But e.g. if the whole family and friends speak out in favor of forced treatment in front of a judge, it should be regarded as one such checkbox. In a country like Germany, with generous social services that even provides housing if your landlord evicts you, the vast majority of non-immigrant homeless are homeless because of schizophrenia. The friends and relatives I know affected by it, are only not homeless because we had to pull every legal string possible, so that social services don't treat them like the rest of their customers.
- hutzlibu 8y ago
  "What I've encountered though is, that those people who claim to speak for the affected ones don't have a friend or relative with this condition and have never even met such a person." Ok, does meeting here qualifys as meeting? I am very against AOT and I did experience the problem first hand. A case which ended tragically not because the lack of, but because of a attempted AOT. As they can also worsen things. Especially if the patient is very sensitive to force.
  - woodpanel 8y ago
    Like I said, anecdotal (indicating I don't assume to have more datapoints to make it a study). No need for passive aggressiveness, I just shared my observations, which include multiple cases in which everyone would have benefitted from AOT.
- tremon 8y ago
  Two words: legal guardianship. We already have constructs in society for people that do not have the ability to care for themselves (temporarily or permanently). I would not be in favor of any law that tries to deliver care through the judicial system. Instead, I would much rather support a law that allows people close to the patient (like the mother in this story) to be officially designated as health proxy, so they can force treatment if the patient is unwilling/unable. Only in cases where no such guardian is available (or is willing -- it is not an easy burden I presume) would I want the state to get involved, and even then much rather a health official than a judge.
pasta 8y ago
I think in The Netherlands the rule is that when they are a danger to themselves or others they can be forced to be treaded. Imho this is a very clear line.
- deleted 8y ago
  [deleted]
- dsego 8y ago
  How do they make sure someone is taking their medication? Is it by monthly injections?
  - pasta 8y ago
    If you are forced to do something someone else is making sure you will do it...
    - dsego 8y ago
      So far the only way to control my brother is to have him take an intramuscular injection every few weeks. Pills usually need to be taken 2 to 3 times daily. No one can control that (unless hospitalized), it's hard even for family members.
  - robbiep 8y ago
    In Australia a treatment order is enforced by 3 monthly depo injections, usually of respiradone
- whatshisface 8y ago
  If you drink soft drinks every meal you are stressing your insulin system, thereby acting as a danger to yourself. People who practice extreme sports are also dangers to themselves, along with private pilots and those who take dangerous jobs. This is not even to mention that disagreeing with the Party can become very dangerous to yourself... (Not so much in the Netherlands, but elsewhere, possibly. The soviets used forced institutionalization against their political enemies.)
John_KZ 8y ago
This "I know better than you" disease needs treatment. We need to force AOT on all those individuals who are unable to understand how their actions are dangerous to society by enabling forced treatment. We need to enforce treatment on those individuals to stop the looming danger of forced treatment as a political control tool.
- VLM 8y ago
  "forced treatment as a political control tool" Its called affirmative action, quotas, diversity hires, all heavy handed ways to "fix" things, or maybe more importantly a way to perpetuate "divide and conqueror" strategy. We already have it in all areas of society other than medical, only seems fair.
Madmallard 8y ago
"A bill in California could enforce this, but it had not been passed in Stanislaus County. Known as Laura’s Law, the bill allows courts to order what’s known as assisted outpatient treatment (AOT) to people with severe mental illness if they meet specific criteria, including previous hospitalisations or arrests, being noncompliant with outpatient treatment, and becoming dangerous to themselves or others." Outpatient treatment can cause further harm, worse than what the illness will do, depending on what it is. In many cases of mental illness the underlying cause is physical, and if you shove antidepressants or antipsychotics on those people they just might get worse rather than better.
hutzlibu 8y ago
If I, speaking with clear will and mind, declare that I never want to be treated against my will, (fully aware of the consequences) then I want this to be respected. Otherwise all talks of freedom in our society is not worth the paper to write it down. Now why am I so sceptical? Well, first of all, declaring people mentally ill, was and is a common way to get rid of dissidents, or to get the money of a rich relative who don't want to die soon, or even consideres giving the money to a charity or alime Sources to the last one I don't have at hand, but putting people away who were annoying, was not only done in soviet russia, but even happened (or happens?) in germany. (https://de.wikipedia.org/wiki/Steuerfahnder-Affäre https://de.wikipedia.org/wiki/Steuerfahnder-Affäre or https://de.m.wikipedia.org/wiki/Gustl_Mollath https://de.m.wikipedia.org/wiki/Gustl_Mollath German basically, tax investigators went after some too powerful - which backfired. So even pro-government people got declared mentally ill and were locked away) Then secondly, the human brain is not really understood. I have high respect for psychoanalysis and neurobiology, though, but I am highly sceptical, that they really understand, what they are doing. As far as I know, also the term schizophrenia is highly disputed. And I also know, that the common psychatrist is just bad. At least the quite some cases I knew about. (I know people working in that area). Standard procedure is calming them down with pills ... and keeping it that way. No thank you. If I would see myself getting ill (it does not happen overnight), I would go seek a good doctor by myself. But if I choose to do what I do, it is my decision. Even if I would endanger my body - my body, my life. Only if I would be a danger to other people ... well then society does, what it ordinary does with dangerous people, locking them away, until they are not a threat anymore.
- houjo 8y ago
  Well...dangerous or violence doesn't mean just doing physical damage to person or property, which is what makes the whole issue ambiguous. There are lot of people out there, who damage the people they deal with psycologically.
  - hutzlibu 8y ago
    "There are lot of people out there, who damage the people they deal with psycologically." That totally blures the line. Yes, there are tons of people out there who attack me psycologically with their stupidy, attempted dominace, insults, etc. But I don't think a law against stupidity would help. Sounds a bit sarcarstic? Maybe, but listening to people sometimes (on TV for example) literally causes me pain. But more specifically on topic, yes, I know also the situation when a mentally troubled person hurts the people around them who suffer see him suffering. But it still is (or was) his life.
hanselot 8y ago
Not long ago homosexuality was considered a mental illness. I suspect in time we will come to understand that everything anyone does is simply as a result of the input we are given and has very little to do with the conditions we use to validate those inputs.
zaarn 8y ago
IMO assisted outpatient treatment should be enabled and encouraged under the right conditions. Of course, it has to be carefully weighed such that you don't do this in cases where it would make things worse or unwarranted. That would likely mean that you'd need a history of "leave hospital -> refuses to take pills -> back into hospital". The article seems to agree on that though some in this thread seem to conflate this with "do X first time -> get put into asylum/hospital against your will", I don't think anyone honestly wants that.
FraKtus 8y ago
My family (in Poland) is in that situation with a member denying, going to hospital, coming out, avoiding medication and the cycle starts again after a few months. We feel hopeless and at this time wait a judgement could force that family member to take a medication once a month...
jeffreyrogers 8y ago
There's a book called The Myth of Mental Illness[0] that deals with this issue at length. The author argues that many forms of what we call "mental illness" are not real illnesses at all, but extreme preferences that prevent people from successfully integrating in society. He's not saying that these behaviors are healthy or natural, but he makes the argument that because these behaviors arise from differences in preferences we shouldn't make treatment compulsory, in part because doing so abridges a person's rights to liberty and also because it's hard to "cure" someone who doesn't see their behavior as problematic. If you're going to disagree with these arguments please realize that they are not my own. While I agree with much of what's in The Myth of Mental Illness, I don't agree with all of it. The above is obviously a very brief summary and leaves a lot unaddressed. [0]: https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness
- WhompingWindows 8y ago
  You agree with his splitting of the body into distinct mental and physical spheres? It seems his contention, based on the wiki, would be reliant on the mind-body duality. This conjecture of his came before numerous neurological discoveries, I highly doubt it'd pass muster as a scientific argument today. Further, as a researcher of mental health, I found the stigma associated with mental health treatment leads to a loss of seeking treatment, which may contribute to suicide or highly reduced quality of life in those whom treatment may benefit. Such books as this one do far more damage than good by perpetuating this harmful stigma.
  - jeffreyrogers 8y ago
    In some instances yes, I do. In others no. The book was written in the 60s and it seems fairly clear now that some mental illnesses have physiological roots. It also seems clear that many issues such as depression, eating disorders, anxiety, etc. are often the consequence of environmental or other non-physiological phenomena. Have you read the book? He doesn't argue that people should not seek treatment. He argues that many mental illnesses don't originate in physiological problems but are instead problems with people reconciling conflicting desires (I'm simplifying a lot here). He argues against compulsory treatment, not voluntary treatment. The author was a psychiatrist and psychoanalyst. He is definitely not advocating for people to avoid treatment. He is suggesting that the focus on physiological causes of mental health problems obscures the causes of many such problems and prevents people from resolving them appropriately.
jarmitage 8y ago
And the corollary: how can you treat someone who doesn't accept that you are well?
tcj_phx 8y ago
This article repeats several myths with regards to mental health treatment. While I believe that the treatment providers truly believe they are helping their patients, any objective evaluation of the current medication-based standard of care and its alternatives will reveal that the harm perpetrated on patients by their medications is extensive and severe. My observation is that conventional psychiatric treatments result in a self-fulfilling prophecy: mental patients need treatment because the treatments they receive cause brain damage that necessitates further treatment. Looking back, I now recognize that my friend made herself psychotic when she used too much cocaine [0], but I didn't know that was the label for that type of behavior at the time. After a few months of my involvement, she realized that she liked me more than self-medicating with the street pharmacy. But then she ran out of alcohol, was taken to the hospital, and was assaulted with medications that are NOT FDA-approved to treat substance-induced psychosis. The medications that they force upon my friend are actually known to cause stimulant users to use more stimulants. [0] https://en.wikipedia.org/wiki/Substance-induced_psychosis#Substances https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su... - "While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia." All my friend really needed was some Naltrexone to help keep her away from alcohol while she sobered up, and other drugs (thyroid, etc) and nutrients (B-Vitamins, good proteins, etc) to help support her metabolism (after 2 years, her forced treatment provider did a genetic test and added methylfolate [Vitamin B9] to her drug cocktail, because she can't use the folic acid used in fortified flour). But the only treatment she received was haloperidol (used to torture political dissidents in the Soviet Union [1]) and other palliative psychiatric drugs. In my struggles to extract my friend from her misdiagnosis, I have come to believe that the system is completely hostile to the concept of cause-and-effect. The professionals believe their patients have chronic conditions that they will never recover from, and that even if the original cause of the patient's presenting symptoms is known, the patient's ongoing maintenance medications are the only thing that matters. From the article: > Misty slowly stopped responding to medication. [...] Antipsychotic medications led to dramatic weight gain. Misty dyed her hair jet black and her eyes lost their sparkle. She eventually started to refuse outpatient treatment. Medications are known to worsen outcomes when used over the long term. Research has found that first-episode psychosis patients have the best prognosis if they never receive "anti-psychotics". The next best prognosis are those that have antipsychotics withdrawn after a short period of time. The worst prognosis is sustained by those who are maintained on "anti-psychotics". These "medications" cause "dramatic weight gain" by attacking the body's metabolism. Refusing outpatient treatment is a completely logical response when you are being harmed by the treatment. > With the development of effective antipsychotic medication in the 1950s and 1960s, many psychiatric hospitals in the USA and other countries, including the UK, began shutting their doors. Early 20th century "psychiatric hospitals" utilized various forms of abuse to give their patients brain damage that resulted in the patients being made docile. Lobotomy [2], electro-shock brain damage, etc. The "anti-psychotic" drugs were originally known as tranquilizers, and were used to the same effect: docility without recovery. The transformation of these drugs into "anti-psychotics" was a triumph of marketing over science. Resistance to psychiatric abuse is spinning its tires because the system makes so much money perpetuating itself. But I am certain that eventually the sorts of palliative treatments forced on patients to perpetuate their mental conditions will join bloodletting, calomel (mercury poisoning) and the routine extraction of tonsils in the dustbin of medical history. [1] I just learned about Soviet use of Haldol for torture from Robert Whitaker's first book, Mad in America. My observations confirm that 'Haldol' really is a terrible drug. [2] https://en.wikipedia.org/wiki/Lobotomy https://en.wikipedia.org/wiki/Lobotomy Robert Whitaker's foundation is sort-of a clearing house for the Resistance: https://www.MadInAmerica.com/ https://www.MadInAmerica.com/

47 points by okket 8y ago

> Physicians who cure must abstract person into functions. They threat the illness, not the person. And persons willfully present themselves as functions. Indeed, what sustains the enormous size and cost of the curing professions is the widespread desire to see oneself as a function, or a collection of functions. To be ill is to be dysfunctional; to be dysfunctional is to be unable to compete in one's prefered contests. It is a kind of death, an inability to acquire titles. The ill become invisible. Illness always has the smell of death about it: Either it may lead to deat, or it leads to the death of a person as competitor. The dread of illness is the dread of losing. > One is never ill in general. One is always ill with relation to some bounded activity. It is not cancer that makes me ill. It is because I cannot work, or run, or swallow that I am ill with cancer. The loss of function, the obstruction of an activity, cannot in itself destroy my health. I am too heavy to fly by flapping my arms, but I do not for that reason complain of being sick with weight. However, if I desired to be a fashion model, a dancer, or a jockey, I would consider excessive weight to be a kind of disease and would be likely to consult a doctor, a nutritionist, or another specialist to be cured of it. Finite and infinite games - page 56

whatshisface 8y ago
That's a lot of words to define illness as "being worse than normal." >The loss of function, the obstruction of an activity, cannot in itself destroy my health. I am too heavy to fly by flapping my arms, but I do not for that reason complain of being sick with weight. It wouldn't be a loss unless he had previously been able to fly, otherwise it's a maintenance of the status-quo.
- grenoire 8y ago
  Then what about the cases with which you were born? What is the definition of normal then? If I inherited some form of respiratory condition at birth which persists as an illness, living with it is maintaining the status-quo; yet it is very much an illness. There is no loss of function per se, it was simply never there.
  - InitialLastName 8y ago
    Status quo applies relative to one's peers as well as oneself. If most humans could fly, those that couldn't, whether as an acquired or congenital trait, would have an illness.
- deleted 8y ago
  [deleted]

wpietri 8y ago

Really interesting article. This for me is the crux of it: > "Being psychotic is not an exercise of free will. It is the inability to exercise free will.” I get why people are nervous about state power. But there are a variety of conditions, including slavery, addiction, and psychosis, where people may voluntarily enter them but then cannot leave without help. It's a dilemma with no simple answers. But if we're serious about freedom, I think it's incumbent on us to grapple with the complex, inevitably messy issues involved.

amadeuspagel 8y ago
> But there are a variety of conditions, including slavery, addiction, and psychosis, where people may voluntarily enter them but then cannot leave without help. In the case of slavery, the slave doesn't want to do something, but is forced to. In the case of addiction and psychosis, you don't want someone to do something, but he's allowed to.
- wpietri 8y ago
  In the case of all three, it's a condition people can enter into nominally through their own choice. Sex slavery, for example, often starts with women taking misleading distant jobs. And a lot of what was effectively slavery has been justified through a gloss of choice: http://www.pbs.org/tpt/slavery-by-another-name/home/ http://www.pbs.org/tpt/slavery-by-another-name/home/
  - amadeuspagel 8y ago
    I don't deny that people sometimes make bad choices, and sometimes need help because of that. I'm just pointing out that there's a difference between involuntarily committing someone to a psychiatric hospital, forcing him to take drugs, electroshocking him, etc. and freeing him from slavery and I question whether the word help is appropriate for the former.
    - wpietri 8y ago
      The US had 4m+ slaves. If you asked every one of those about emancipation, I doubt all of them would have said yes. Given the failure to give them all sufficient resources to survive independently (e.g., 40 acres and a mule), and given how many struggled after emancipation [1], it's not clear that the word help is appropriate there either. And for the people trapped in things that are like slavery but have a gloss of voluntary acceptance, I'm sure that even more of those people would say they don't want outside help. Learned helplessness is a real phenomenon. If you're saying these issues are complex, sure, all of them are complex. But I don't think economics and primate power dynamics are any less complex than addiction and mental illness. [1] https://www.theguardian.com/world/2012/jun/16/slavery-starvation-civil-war https://www.theguardian.com/world/2012/jun/16/slavery-starva...

woodpanel 8y ago

Anecdotal but: I've experienced this problem first hand and know not one person with the same experience, that doesn't share the opinion that AOT is a much needed thing. In Germany even suggesting a law like this will provoke immediate protest by some people who claim to fight for civil rights. What I've encountered though is, that those people who claim to speak for the affected ones don't have a friend or relative with this condition and have never even met such a person. Fighting against AOT is for me not a defense of free will, but an act of denying people having a free will in the first place. Sure, there should be certain checkboxes to be ticked off first. But e.g. if the whole family and friends speak out in favor of forced treatment in front of a judge, it should be regarded as one such checkbox. In a country like Germany, with generous social services that even provides housing if your landlord evicts you, the vast majority of non-immigrant homeless are homeless because of schizophrenia. The friends and relatives I know affected by it, are only not homeless because we had to pull every legal string possible, so that social services don't treat them like the rest of their customers.

hutzlibu 8y ago
"What I've encountered though is, that those people who claim to speak for the affected ones don't have a friend or relative with this condition and have never even met such a person." Ok, does meeting here qualifys as meeting? I am very against AOT and I did experience the problem first hand. A case which ended tragically not because the lack of, but because of a attempted AOT. As they can also worsen things. Especially if the patient is very sensitive to force.
- woodpanel 8y ago
  Like I said, anecdotal (indicating I don't assume to have more datapoints to make it a study). No need for passive aggressiveness, I just shared my observations, which include multiple cases in which everyone would have benefitted from AOT.
tremon 8y ago
Two words: legal guardianship. We already have constructs in society for people that do not have the ability to care for themselves (temporarily or permanently). I would not be in favor of any law that tries to deliver care through the judicial system. Instead, I would much rather support a law that allows people close to the patient (like the mother in this story) to be officially designated as health proxy, so they can force treatment if the patient is unwilling/unable. Only in cases where no such guardian is available (or is willing -- it is not an easy burden I presume) would I want the state to get involved, and even then much rather a health official than a judge.

pasta 8y ago

I think in The Netherlands the rule is that when they are a danger to themselves or others they can be forced to be treaded. Imho this is a very clear line.

deleted 8y ago
[deleted]
dsego 8y ago
How do they make sure someone is taking their medication? Is it by monthly injections?
- pasta 8y ago
  If you are forced to do something someone else is making sure you will do it...
  - dsego 8y ago
    So far the only way to control my brother is to have him take an intramuscular injection every few weeks. Pills usually need to be taken 2 to 3 times daily. No one can control that (unless hospitalized), it's hard even for family members.
- robbiep 8y ago
  In Australia a treatment order is enforced by 3 monthly depo injections, usually of respiradone
whatshisface 8y ago
If you drink soft drinks every meal you are stressing your insulin system, thereby acting as a danger to yourself. People who practice extreme sports are also dangers to themselves, along with private pilots and those who take dangerous jobs. This is not even to mention that disagreeing with the Party can become very dangerous to yourself... (Not so much in the Netherlands, but elsewhere, possibly. The soviets used forced institutionalization against their political enemies.)

John_KZ 8y ago

This "I know better than you" disease needs treatment. We need to force AOT on all those individuals who are unable to understand how their actions are dangerous to society by enabling forced treatment. We need to enforce treatment on those individuals to stop the looming danger of forced treatment as a political control tool.

VLM 8y ago
"forced treatment as a political control tool" Its called affirmative action, quotas, diversity hires, all heavy handed ways to "fix" things, or maybe more importantly a way to perpetuate "divide and conqueror" strategy. We already have it in all areas of society other than medical, only seems fair.

Madmallard 8y ago

"A bill in California could enforce this, but it had not been passed in Stanislaus County. Known as Laura’s Law, the bill allows courts to order what’s known as assisted outpatient treatment (AOT) to people with severe mental illness if they meet specific criteria, including previous hospitalisations or arrests, being noncompliant with outpatient treatment, and becoming dangerous to themselves or others." Outpatient treatment can cause further harm, worse than what the illness will do, depending on what it is. In many cases of mental illness the underlying cause is physical, and if you shove antidepressants or antipsychotics on those people they just might get worse rather than better.

hutzlibu 8y ago

If I, speaking with clear will and mind, declare that I never want to be treated against my will, (fully aware of the consequences) then I want this to be respected. Otherwise all talks of freedom in our society is not worth the paper to write it down. Now why am I so sceptical? Well, first of all, declaring people mentally ill, was and is a common way to get rid of dissidents, or to get the money of a rich relative who don't want to die soon, or even consideres giving the money to a charity or alime Sources to the last one I don't have at hand, but putting people away who were annoying, was not only done in soviet russia, but even happened (or happens?) in germany. (https://de.wikipedia.org/wiki/Steuerfahnder-Affäre https://de.wikipedia.org/wiki/Steuerfahnder-Affäre or https://de.m.wikipedia.org/wiki/Gustl_Mollath https://de.m.wikipedia.org/wiki/Gustl_Mollath German basically, tax investigators went after some too powerful - which backfired. So even pro-government people got declared mentally ill and were locked away) Then secondly, the human brain is not really understood. I have high respect for psychoanalysis and neurobiology, though, but I am highly sceptical, that they really understand, what they are doing. As far as I know, also the term schizophrenia is highly disputed. And I also know, that the common psychatrist is just bad. At least the quite some cases I knew about. (I know people working in that area). Standard procedure is calming them down with pills ... and keeping it that way. No thank you. If I would see myself getting ill (it does not happen overnight), I would go seek a good doctor by myself. But if I choose to do what I do, it is my decision. Even if I would endanger my body - my body, my life. Only if I would be a danger to other people ... well then society does, what it ordinary does with dangerous people, locking them away, until they are not a threat anymore.

houjo 8y ago
Well...dangerous or violence doesn't mean just doing physical damage to person or property, which is what makes the whole issue ambiguous. There are lot of people out there, who damage the people they deal with psycologically.
- hutzlibu 8y ago
  "There are lot of people out there, who damage the people they deal with psycologically." That totally blures the line. Yes, there are tons of people out there who attack me psycologically with their stupidy, attempted dominace, insults, etc. But I don't think a law against stupidity would help. Sounds a bit sarcarstic? Maybe, but listening to people sometimes (on TV for example) literally causes me pain. But more specifically on topic, yes, I know also the situation when a mentally troubled person hurts the people around them who suffer see him suffering. But it still is (or was) his life.

hanselot 8y ago

Not long ago homosexuality was considered a mental illness. I suspect in time we will come to understand that everything anyone does is simply as a result of the input we are given and has very little to do with the conditions we use to validate those inputs.

zaarn 8y ago

IMO assisted outpatient treatment should be enabled and encouraged under the right conditions. Of course, it has to be carefully weighed such that you don't do this in cases where it would make things worse or unwarranted. That would likely mean that you'd need a history of "leave hospital -> refuses to take pills -> back into hospital". The article seems to agree on that though some in this thread seem to conflate this with "do X first time -> get put into asylum/hospital against your will", I don't think anyone honestly wants that.

FraKtus 8y ago

My family (in Poland) is in that situation with a member denying, going to hospital, coming out, avoiding medication and the cycle starts again after a few months. We feel hopeless and at this time wait a judgement could force that family member to take a medication once a month...

jeffreyrogers 8y ago

There's a book called The Myth of Mental Illness[0] that deals with this issue at length. The author argues that many forms of what we call "mental illness" are not real illnesses at all, but extreme preferences that prevent people from successfully integrating in society. He's not saying that these behaviors are healthy or natural, but he makes the argument that because these behaviors arise from differences in preferences we shouldn't make treatment compulsory, in part because doing so abridges a person's rights to liberty and also because it's hard to "cure" someone who doesn't see their behavior as problematic. If you're going to disagree with these arguments please realize that they are not my own. While I agree with much of what's in The Myth of Mental Illness, I don't agree with all of it. The above is obviously a very brief summary and leaves a lot unaddressed. [0]: https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness

WhompingWindows 8y ago
You agree with his splitting of the body into distinct mental and physical spheres? It seems his contention, based on the wiki, would be reliant on the mind-body duality. This conjecture of his came before numerous neurological discoveries, I highly doubt it'd pass muster as a scientific argument today. Further, as a researcher of mental health, I found the stigma associated with mental health treatment leads to a loss of seeking treatment, which may contribute to suicide or highly reduced quality of life in those whom treatment may benefit. Such books as this one do far more damage than good by perpetuating this harmful stigma.
- jeffreyrogers 8y ago
  In some instances yes, I do. In others no. The book was written in the 60s and it seems fairly clear now that some mental illnesses have physiological roots. It also seems clear that many issues such as depression, eating disorders, anxiety, etc. are often the consequence of environmental or other non-physiological phenomena. Have you read the book? He doesn't argue that people should not seek treatment. He argues that many mental illnesses don't originate in physiological problems but are instead problems with people reconciling conflicting desires (I'm simplifying a lot here). He argues against compulsory treatment, not voluntary treatment. The author was a psychiatrist and psychoanalyst. He is definitely not advocating for people to avoid treatment. He is suggesting that the focus on physiological causes of mental health problems obscures the causes of many such problems and prevents people from resolving them appropriately.

jarmitage 8y ago

And the corollary: how can you treat someone who doesn't accept that you are well?

tcj_phx 8y ago

This article repeats several myths with regards to mental health treatment. While I believe that the treatment providers truly believe they are helping their patients, any objective evaluation of the current medication-based standard of care and its alternatives will reveal that the harm perpetrated on patients by their medications is extensive and severe. My observation is that conventional psychiatric treatments result in a self-fulfilling prophecy: mental patients need treatment because the treatments they receive cause brain damage that necessitates further treatment. Looking back, I now recognize that my friend made herself psychotic when she used too much cocaine [0], but I didn't know that was the label for that type of behavior at the time. After a few months of my involvement, she realized that she liked me more than self-medicating with the street pharmacy. But then she ran out of alcohol, was taken to the hospital, and was assaulted with medications that are NOT FDA-approved to treat substance-induced psychosis. The medications that they force upon my friend are actually known to cause stimulant users to use more stimulants. [0] https://en.wikipedia.org/wiki/Substance-induced_psychosis#Substances https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su... - "While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia." All my friend really needed was some Naltrexone to help keep her away from alcohol while she sobered up, and other drugs (thyroid, etc) and nutrients (B-Vitamins, good proteins, etc) to help support her metabolism (after 2 years, her forced treatment provider did a genetic test and added methylfolate [Vitamin B9] to her drug cocktail, because she can't use the folic acid used in fortified flour). But the only treatment she received was haloperidol (used to torture political dissidents in the Soviet Union [1]) and other palliative psychiatric drugs. In my struggles to extract my friend from her misdiagnosis, I have come to believe that the system is completely hostile to the concept of cause-and-effect. The professionals believe their patients have chronic conditions that they will never recover from, and that even if the original cause of the patient's presenting symptoms is known, the patient's ongoing maintenance medications are the only thing that matters. From the article: > Misty slowly stopped responding to medication. [...] Antipsychotic medications led to dramatic weight gain. Misty dyed her hair jet black and her eyes lost their sparkle. She eventually started to refuse outpatient treatment. Medications are known to worsen outcomes when used over the long term. Research has found that first-episode psychosis patients have the best prognosis if they never receive "anti-psychotics". The next best prognosis are those that have antipsychotics withdrawn after a short period of time. The worst prognosis is sustained by those who are maintained on "anti-psychotics". These "medications" cause "dramatic weight gain" by attacking the body's metabolism. Refusing outpatient treatment is a completely logical response when you are being harmed by the treatment. > With the development of effective antipsychotic medication in the 1950s and 1960s, many psychiatric hospitals in the USA and other countries, including the UK, began shutting their doors. Early 20th century "psychiatric hospitals" utilized various forms of abuse to give their patients brain damage that resulted in the patients being made docile. Lobotomy [2], electro-shock brain damage, etc. The "anti-psychotic" drugs were originally known as tranquilizers, and were used to the same effect: docility without recovery. The transformation of these drugs into "anti-psychotics" was a triumph of marketing over science. Resistance to psychiatric abuse is spinning its tires because the system makes so much money perpetuating itself. But I am certain that eventually the sorts of palliative treatments forced on patients to perpetuate their mental conditions will join bloodletting, calomel (mercury poisoning) and the routine extraction of tonsils in the dustbin of medical history. [1] I just learned about Soviet use of Haldol for torture from Robert Whitaker's first book, Mad in America. My observations confirm that 'Haldol' really is a terrible drug. [2] https://en.wikipedia.org/wiki/Lobotomy https://en.wikipedia.org/wiki/Lobotomy Robert Whitaker's foundation is sort-of a clearing house for the Resistance: https://www.MadInAmerica.com/ https://www.MadInAmerica.com/