Psychotic Disorders Do Not Respect Autonomy, Independence, Agency, or Freedom

https://freddiedeboer.substack.com/p/psychotic-disorders-do-not-respect

by paulpauper • 3 years ago

13 13 3 years ago

freddiedeboer.substack.com

thx-2718• 3 years ago

I wanted to like this article.

Unfortunately the author I feel might need to actually interact with the mentally ill more.

A. With respecting choice, healthcare workers are understanding that they can't help everyone. You can't fix their problems for them but you can aid and assist them with them. This is also just happens to be part of the social work profession itself as I understand it.

B. People aren't their illness. In my limitted experiene knowing people with schizophrenia is that's it's one of the worst and saddest illnesses out there. Fundamently they are aware they can't trust their own brain all the time (without medication and management). We don't do enough societally to protect and help the most vulnerable.

throwaway2103• 3 years ago

The author has bipolar disorder and has been involuntarily hospitalized a few times due to mania and psychosis.

He wrote this really different but great piece about his own experience:

https://freddiedeboer.substack.com/p/the-weight

sonjat• 3 years ago

I don't know enough about serious psychiatric disorders to comment on if the author is right or wrong, except that I think our society treats complex issues as if they can be solved with simple answers and I suspect that it is the same here. Involuntary treatment of any sort is problematic and ripe for abuse so it very much should be regarded with suspicion. On the other hand, there are many disorders that make someone a danger to themselves or others, or just unable to live unassisted. The problem is where to draw the line.

If someone has repeatedly shown violent tendencies, then I think some level of forced care is generally agreed on. But what if they have only muttered threats? And what distinguishes their threats from the kind of vague "I'm going to get you" that gets muttered often enough? What about things like hoarding disorder? Should they be forced into treatment? Although they might be endangering their own health, people make choices that are bad for their health all the time. Beyond that, they aren't necessarily posing a danger to anyone. Yet their condition causes, at a minimum, unsafe living conditions and destruction of property. The author mentions bipolar, but I think this is even difficult. Even in a state of mania, I think most bipolar people are still capable of making rational decisions. Do we remove their autonomy simply because we might disagree with their decisions and they have a diagnosis? But if their disease is causing problems making rational decisions, maybe someone stepping in would be appropriate? It is definitely a very tricky issue.

richardjam733• 3 years ago

People suffering from mania DO NOT make rational decisions.

Gunax• 3 years ago

This is hard to write, but I was subjected to involuntary treatment. It ruined my life. And I know I am not the only one.

While Deboer talks about involuntary treatment getting harder, this is right or qrong depending on how you measure it. We are seeing far more interaction with mental services. In Florida, the rate of Baker act has surged 121% [1].

So why the discrepancy? There are really different cohorts. Laws are being created around the psychotic homeless population. But most people interacting with mental health and even most people forced into institutions are not these things. Think anorexics and wrist-cutters, not psychos with knives.

[1] https://www.theledger.com/story/news/regional/2021/11/28/men...

Reubend• 3 years ago

I agree, and while I don't have any real evidence of this, my suspicion is that dangerous drug use is contributing to vastly higher rates of mental illness in our society.

There have been a few articles speculating that new manufacturing methods for methamphetamine are inducing psychoses in a lot of people: https://www.opb.org/article/2022/08/04/oregon-mental-health-...

And I wouldn't be surprised if new drugs like fentanyl cut with traq and other substances are contributing to this situation as well: https://www.sfchronicle.com/sf/article/horrific-new-street-d...

You make the great point that there are several different cohorts involved here, and I think that one of the biggest differentiators there is around illegal drug use.

piperswe2• 3 years ago

I don't necessarily fully agree with what I'm about to say, but it's a logical conclusion I came to while reading this:

If a psychotic person is considered incapable of consent, then it should be especially wrong to commit them, even voluntarily. A lack of ability to consent does not imply consent, which is a doctrine that's critical to concepts like statutory rape. I don't think that the argument that people incapable of rejecting treatment with a sound mind should be treated _because_ of that incapability holds too much water.

Subjectively, I agree with the author that much of this treatment is necessary. But objectively, it's hard to fit it into a (or, at least, my personal) framework of consent.

Don't take this response personally - this is mostly me pointing out an inconsistency in my own personal philosophy.

piperswe2• 3 years ago

Also, in-patient mental healthcare is a crapshoot. Sometimes, you'll have a positively life-changing experience. Some other times though, you'll have the most traumatic experience of your life. We need to fix the image of the treatment itself before the image of involuntary commitment can improve.

whearyou• 3 years ago

I enjoyed his ripping on the activist class, as he’s mostly right there far as I can tell.

Beyond that, wow, this is a complex issue…

Jiro• 3 years ago

A lot of people commented on the article with "I or a relative were involuntarily committed and it was necessary" or "there was a lot of suffering because a relative should have been involuntarily committed and wasn't".

That's like asking about what standards the police should use to arrest criminals, and answering "I was a victim of a crime because the police refused to arrest someone". It's not false, but it doesn't generalize. False positives and false negatives are both problems. Just ignoring false negatives is terrible because people suffer by not being involuntarily committed, but people suffer by being involuntarily committed too, and you need to balance that out, not just say "I know what was needed for me".

richardjam733• 3 years ago

Mental illness can do things to a person that totalitarian police states can only dream of.

richardatlarge• 3 years ago

So can the concept of mental illness, and already has

richardjam733• 3 years ago

How do you know?

Psychotic Disorders Do Not Respect Autonomy, Independence, Agency, or Freedom

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