Dinah Miller - Committed: The Battle Over Involuntary Psychiatric Care

Committed

THE BATTLE OVER INVOLUNTARY PSYCHIATRIC CARE

DINAH MILLER, MD & ANNETTE HANSON, MD

FOREWORD BY PETE EARLEY

Note to the reader: This book is not meant to substitute for medical care of people with mental disorders, and treatment should not be based solely on its contents. Nor does it provide legal advice regarding treatment of people with mental disorders. Instead, treatment must be developed in a dialogue between the individual and his or her physician, and legal advice must be obtained from a qualified attorney.

2016 Dinah Miller and Annette Hanson
All rights reserved. Published 2016
Printed in the United States of America on acid-free paper
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Johns Hopkins University Press
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Baltimore, Maryland 21218-4363
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Library of Congress Cataloging-in-Publication Data

Names: Miller, Dinah, author. | Hanson, Annette, author.

Title: Committed : the battle over involuntary psychiatric care / Dinah Miller, MD, Annette Hanson, MD.

Description: Baltimore : John Hopkins University Press, [2016] | Includes bibliographical references and index.

Identifiers: LCCN 2016002161| ISBN 9781421420783 (hardback : acid-free paper) | ISBN 1421420783 (hardback : acid-free paper) | ISBN 9781421420790 (electronic) | ISBN 1421420791 (electronic)

Subjects: LCSH: Mentally illCareMoral and ethical aspects. | Mental health servicesMoral and ethical aspects. | Involuntary treatment. | Psychiatric ethics. | BISAC: HEALTH & FITNESS / General. | MEDICAL / Psychiatry / General. | PSYCHOLOGY / Mental Illness.

Classification: LCC RC455.2.E8 M55 2016 | DDC 362.2dc23 LC record available at https://lccn.loc.gov/2016002161

A catalog record for this book is available from the British Library.

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Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible.

To the memory of my brother, Ross Miller.

Dinah Miller

To my sister, for her undivided love and support, and to my brother, who showed me through his photography just how beautiful the world can be. And finally, to my parents, whose life lessons cannot be captured in words. I couldnt have asked for a better family.

Annette Hanson

by Pete Earley

When should an individual be involuntarily committed?

For too many of us, this is not an abstract question. It is a painful and often horrific one for those who are committed against their will and for those who are responsible for involuntarily committing them.

In the pages that follow, Doctors Dinah Miller and Annette Hanson set out to examine involuntary commitment from every possible angle. This is a herculean task, not only because of the patchwork of differing statutes and procedures across the United States, but because of the strong opinions and emotions that always accompany forcing someone to accept psychiatric care.

This is not the first time these two Baltimore-based psychiatrists have collaborated, and it shows in the ease of their combined writing as they present research, profile patients, interview experts, and slip their personal observations seamlessly into this thought-provoking narrative. I first learned of the authors when I read Shrink Rap: Three Psychiatrists Explain Their Work (2011), which they penned with another colleague, Dr. Steven Roy Daviss. Soon I became an avid reader of the trios blog, which bears the same title as their book and bills itself as psychiatrists writing for psychiatrists, although it attracts a much broader audience.

Dr. Miller and I exchanged emails, and I came to admire her insatiable curiosity and her willingness to listen to other points of view. These traits are apparent throughout this book, especially in , we hear a different chorus. Miller startled members of the Church of Scientology by asking them to explain their antipsychiatry views and spent time listening to complaints from self-described mental health survivors who belong to MindFreedom, which opposes all forced psychiatric care. She interviewed Dr. Daniel Fisher, the psychiatrist and patient behind the National Empowerment Center, which advocates recovery with or without medication, and she talked with Ira Burnim at the Bazelon Center for Mental Health Law, whose founders questioned whether involuntary commitment could ever be justified. This willingness by Miller and Hanson to include the voices of critics hostile to their own profession gives readers a panoramic view that is vital in any serious discussion about the pros and cons of forced treatment.

Having introduced us to the major players in the debate, the authors zero in on what actually happens when someone is committed, explaining the hodgepodge of state laws and the use of restraints, electroconvulsive therapy, and medications. Because the US criminal justice system has come to play a major role in community mental health, there are chapters that focus on crisis intervention team training for the police (who may interact with more mentally ill Americans in a given day than psychiatrists do) and on mental health courts, guns, violence, and mass shootings.

Thats a plateful for any book, but Miller and Hanson do a masterful job of illuminating each issue and giving it context. They dont skimp or oversimplify. There is more meat on the plate than salad.

While practical information gives Committed its spine, it is the emotions that we feel in reading patients firsthand accounts that prick at the conscience and ultimately distinguish this book from some impersonal, analytical tome. That is one of the many reasons that this book should be readbecause emotions lie at the heart of the involuntary commitment process, whether they are expressed in the angry voice of an unwilling patient or the anguished voice of a parent, spouse, sibling, friend, child, or professional caregiver.

These issues became real to me when I involuntarily committed one of my sons into a mental hospital. In my book, Crazy: A Fathers Search through Americas Mental Health Madness, he is identified by his middle name, Michael. He was an art student in Brooklyn when he began having a difficult time discerning reality from fantasy. A psychiatrist diagnosed him as having bipolar disorder with psychotic features and prescribed medication, but after several months Michael stopped taking his pills.

I was at work when I received a panicked call from my eldest son, who lived in Manhattan, telling me that Michael was crazy. Hed been roaming the streets of New York City for five days with little sleep and hadnt bothered to eat because he believed God had ordered him to undertake a divine mission.

I rushed to Manhattan and persuaded Michael to return home with me to the northern Virginia suburb where I live. During that frantic ride, I pleaded with him to take his medication, but he screamed, Pills are poison! Leave me alone! His moods were herky-jerky. One moment, he would be laughing. Seconds later, he would break into gut-wrenching sobs.

Dad, how would you feel if someone you loved killed himself? he asked me.

I drove him to a hospital emergency room only to be told that there was nothing a doctor could do. At the time, state law in Virginia required a threat of imminent danger before a patient could be forcibly medicated, and the fact that my clearly psychotic son had not harmed either himself or me during our four-hour wait in an exam room showed there was no immediate threat. I was told to bring him back after he hurt himself or someone else.