June 26, 2006

Out-patient commitment?

I know this is a controversial subject -- out-patient commitment or whatever name it goes by in your neck of the woods -- and that people are often very passionately for or against it. I want only to write down some thoughts about it, some observations and questions, and ask for opinions...I have not made up my mind about it yet, if indeed I decide there is a hard and fast rule to be made about the subject.

The argument against: Out-patient commitment, by whatever softer eumphemism the powers that be want to use, seems to me to be the last resort of a system that does not want to take care of its mentally it will not provide hospitals and the staff to work there and care for those who need them, so it invents a procedure whereby a person can be legally forced to take medication, be chemically strait-jacketed and kept quiet, just so society is satisfied he or she will be no trouble to it and can safely be ignored. Of course this assumes that the medication chosen and forced upon the person/victim is 1) appropriate (ie that the diagnosis is correct) 2) acceptable (ie without unbearable side effects, and I mean unbearable) and 3) effective (that it helps the person him or herself actually FEEL better as well as do better...not simply behave more calmly or quietly, while feeling. horrible). None of these three things can be assumed, naturally. Doctors make misdiagnoses ALL the time, and in fact most of us have gone through several different diagnoses before getting to the final one, by virtue of having been seen by different doctors with different opinions at different times or stages of our illnesses. Need I add to this the number of medications most of us have tried before arriving at the one or many that finally help without causing intolerable side effects? I can only imagine how horrible it would be to be forced by some visiting goon squad to swallow pills each day that I knew would make me a zombie or cause some other terrible side effect simply to satisfy the requirements of a state-enforced out-patient commitment order, the alternative to which is hospitalization... But of course, what does this mean? Not a helpful hospitalization, no, because those beds are no longer to be had. Only another bed in a locked unit where medication can be forced on you anyway...So you're damned if you do and damned if you don't...And all because the country doesn't give a damn about people it would rather simply throw away. There's another argument too, which is: what if the person doesn't have any illness whatsoever, is simply "different" and doesn't need medication at all? Well, that's a situation I don't even want to think about....though it's one many anti-psychiatry people believe very important.

That's one argument. Now, for those of you who are more likely to be parents of those suffering from these illnesses, though not all of you, an argument for the use of out-patient commitment procedures to ensure that someone takes his or her medications: Say your adult child has schizophrenia and has been homeless and a victim of assaults and abuse, as well as at times abusive and assaultive due to paranoid thinking, and has been repeatedly taken off the streets and hospitalized, whereupon she becomes lucid and quite pleasant, says she wants to turn a corner, stop being homeless, make a change...And is discharged to a halfway house or group home, only to stop taking her medication and end up homeless and paranoid again...and the cycle goes on and on. I'm sure this sort of pattern in multitudinous variations will seem familiar to many people. But if that adult child could be monitored, by virtue of a state or probate court order, so that she had to take her medication even as an outpatient, maybe she would not end up back on the streets, but would in fact turn that corner, get a job and become the productive person she says she wants to be...Would that not be doing her a favor in the end? Forcing her into treatment in order to help her become who she wants to be? Isn't that more humane than allowing her the human rights, so called, to decompensate and live in the gutter?

I do not know how to decide....If I were the person in the second instance, I certainly would think I'd prefer to be medicated. But what if the medication chosen were Haldol? What then? And what if the medication forced on me were Zyprexa??? Would I be so happy to be forced to take medication under those circumstances? So you see, it isn't so easy to simply say: Medicate them! Unfortunately, everyone wwants a blanket policy in this country, something easy to apply in all cases, so we don'[t have to think about individuals and what might be best for each person under consideration. God forbid we spend our taxpayers' money considering them, when we have a war to fight and million-dollar bombs to drop, KABOOM! SMASH! CRASH! There, we just blew up a billion dollars worth of minerals and killed several people and destroyed who knows how much in the process, but it must have been worth more than taking care of the mentally ill, because we did it, right? And we wouldn't do it if it weren't right, right?

Yeah, right. Anyhow, I've laid out two scenarios, and do not claim to have answers...Am still only asking questions. Any comments will be read and welcomed to the discussion.

Posted by pamwagg at June 26, 2006 08:52 PM


I enjoyed your book. My friend Lori gave me the title and I read with great interest. My voices cause me to go to extremes and always taunt me to do something extreme. I have 5 voices 4 male, 1 female. I am on haldol, resperdal, zoloft, cogenitn and ambien. I don't like the haldol because I claim I gained 100 pound on that stuff. My doctor keeps denying it. I am diagnosed with paranoid schizophrenia, because I complained that governement satellites were doing human experimenting with me with sending me voices and trying out mind control. I get voices, muscle twitches, and really intense pain on my body from cramps or sensation of burning on my back. The voices yell and scream when I get something painful. They are faint but I can still hear their mean spirited voices.


Posted by: Andres at September 4, 2006 07:55 AM

At times when I find myself off on a psychotic jag again because of medication noncompliance, I have wished someone could force me to take the damned medications twice a day. So I wouldn't have that agony of deciding whether or not the side effects justify my going off of the meds again. It seems I am miserable either way. I either hate the size of my body which gains more and more weight on Zyprexa, or I hate the psychosis and insomnia and hospitalization that quickly follow noncompliance. I have thought about opting for the depot injections so that I would have to make that decision less often. But for some reason that is too scary to think about. Anything that takes the decision-making out of my own hands is too scary. I can't stand to be controlled by people or medication. In fact, I think I would go back to feeling suicidal if the "goon squad" arrived every day to force the medication down my throat. It is bad enough having friends and family who ask, "Have you taken your meds today?"

Thank you for sharing your thoughts with the rest of us. Your posts are always so personal and thought-provoking.

Posted by: Donna at June 28, 2006 11:13 AM

Dear Pam,

I am the parent of a schizoaffective 23-year-old daughter. Just recently another diagnosis of Borderline Personality Disorder has been tacked on to her diagnosis.

I struggle with the issues you’ve brought up. I do believe my daughter has the right to her own body and her own life-style.

As a parent’s it’s very difficult when to help and when not to.

As for the anti-psychiatric movement, I have nothing but loathing for them. When my daughter was homeless, on the streets and very psychotic they gave me the impression that they thought my daughter has a right to be psychotic. Obviously these people are not parents. I found them to be grossly insensitive people.

The last 8 years of my life I’ve been a caretaker of my daughter and that role can sometimes be described as hell on earth.

Part of me would like nothing better than have my daughter locked up and given the right medication so I don't have to worry about her. Part of me would like to live in fairyland where everything is taken care of. A part of me never wants to worry about my daughter again and part of me wishes I didn’t care or love my daughter so much.

I don’t have any answers, only questions.

The one thing I do understand is that when the chips are down for my daughter, I’m the person who receives her calls for help. I’m the person she turns to so I can pick up the pieces of her life. When she is angry and delusional she doesn’t remember that it is me who wants her to have a content and happy life and it is me who loves her unconditionally (most of the time). When she is ill, I become the target of her anger and rage.

I agree with you regarding our government. Many of our leaders are so arrogant and removed from reality. There seems to be little understanding from our leaders how average people survive, much less the plight and struggles of the seriously mentally ill.

My impression of our current administration is that if there is a mentally ill person in one’s family, that the burden is the family’s responsibility 100%. I sincerely belief that our current top leaders would cut off the miserly stipend my child receives for her survival if they could.

Yaya …..

Posted by: Yaya at June 27, 2006 01:06 PM

Dear Pam,
I like your choice to intersperse factual updates on your book touring experiences with thought provoking dilemmas for your readers to consider. In the former you reveal the strength that inspires so many of your readers, and in the latter,you illustrate that you too are ambivalent about certain issues, just like everyone else.
(I must add a personal note which is sure to make you smile. I could not help but note that the length of some of your sentences in this particular blog came close to reaching Jamesian proportions. This did not deter me in any way from reading the problem you presented from start to finish. Et tu, Brute?)
But I digress. In answer to your invitation for opinions on the pros and cons of out patient commitment, my answer will be surprisingly brief. I am adamently opposed to forcing anyone to take medication of any kind. However, I must insert one caveat here. If a person has illustrated that he/she can be a threat to other people, and has indeed inflicted harm upon an innocent person because of an unmedicated psychiatric condition, then I feel there is no choice but to remove him?her from society, either physically or chemically for the safety of the majority. This is exactly what happens to a criminal, without a psychiactric disorder, who commits a violent crime. With this I have no problem. However, if a person is simply "different", as you mentioned, or does actually have a properly diagnosed mental illness, but is NOT violent or a potential threat to society, the choice to take medication should be left to the discretion of the person, not an impersonal agency.
I realize my stance is full of holes and could be challenged in many ways, but,in essence, if at all possible, I strongly believe that each citizen should be in control of his own destiny.

I welcome you home,my friend of the heart,Paula

Posted by: Paula Kirkpatrick at June 27, 2006 10:59 AM

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