In our current system, someone having a psychotic episode has a legal right to be psychotic. In other words, they can have lost touch with reality and yet be treated as if they haven’t. Is this a case of civil rights taken too far?
First, lets define psychosis. The National Institute of Mental Health (NIMH) says it’s a mental health break that includes “delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear)”.
How did we get to this absolute autonomy for a seriously ill person?
Before the 1960s and the advent of anti-psychotic medication, there was no distinction between voluntary and involuntary admissions to psychiatric hospitals; all admissions were involuntary. In Madness In America: Cultural and Medical Perceptions of Mental Illness Before 1914, Gamwell and Tomes describe the problematic case of Mrs. Elizabeth Packard. Mrs. Packard was committed to a Jacksonville, Illinois, asylum in 1860 at the behest of her husband who was a clergyman. Mr. Packard initiated the hospitalization of his wife to punish her for having an unclean spirit, a decision that he based on her exploration of spiritual traditions outside the Presbyterian faith. Mrs. Packard was diagnosed with “moral insanity” and held involuntarily in the hospital for three years before ultimately being declared sane. Once released, Mrs. Packard learned that she had lost custody of her children and ownership of her property. She filed a lawsuit for wrongful confinement and won.
Cases like that send shivers down my spine. But the pendulum has swung too far in the other direction, and the safety of our communities and the ill are at tremendous risk. In fact, imminent risk is the singular criteria for hospitalization.
I have experienced a psychotic break firsthand in a loved one. I can tell you that she wasn’t rational enough to calmly seek out the treatment she needed. We helplessly watched as the psychotic break reached full fruition, a fruition that required a 911 call. There was nowhere to turn for help until we’d arrived at the life or death stage. We were extremely fortunate to get the officers we did; they managed a delicate negotiation with someone who was completely unmoored. They saved her life. But we shouldn’t have to rely on luck.
Let’s consider a safer, saner scenario.
We’re watching a loved one losing control over a number of hours, days or weeks. Maybe they have moments of lucidity and maybe those moments of lucidity allow them to behave rationally in front of a therapist or emergency response team.
In this scenario, a therapist is called in to work collaboratively with the family, neighbor, teacher etc. to consider the need for hospitalization. This same mental health professional observes the individual over a longer period of time than a 45 minute therapy session or quick emergency response. So you have ONE point person who is well qualified to undertake a diagnosis of the situation.
The next step would be to get the psychotic patient to a hospital for an even more thorough examination/observation because behavior is erratic enough to warrant a closer look. And probably some much needed medication. We let the professionals decide, again, over enough time to make an accurate assessment possible.
Maybe the patient can be quickly stabilized with some meds and a prescription to fill. Excellent!
Maybe that isn’t even necessary and the patient can resume daily life in a relatively quick span of time. Excellent!
Maybe a hospital stay is in the best interest of the patient and the public. Tragedy averted!
If hospital treatment is humane and well informed, what’s the great harm, no matter the determination?
It’s time for an early intervention framework to be put in place by our legislators. And those who have a loved one at risk can’t wait another day.