Voluntarily locked up?

[Guest guest]

http://www.world-science.net/exclusives/050411_coercionfrm.htm

 

Voluntarily locked up?

 

Many mental patients who are supposedly hospitalized by choice

describe their own situations as far from voluntary.

 

Posted April 11, 2005

 

 

Officially, most people who are hospitalized or under therapy for

mental illness are in that treatment by choice.

 

But you might well not know that if you asked them.

 

Some recent studies have found that many patients hospitalized for

mental disorders feel they were coerced into getting treatment, even

when there was no legal order requiring the treatment.

 

Coercion is far from a new phenomenon in the treatment of the mentally

ill. In Western countries it started as early as the Middle Ages, at

least if you count stuffing someone naked into a dark cage as

" treatment. "

 

The centuries since then have brought more rational, humane therapies

and a drop in the use of laws to force treatment on people, though

most agree this must remain a last resort for some cases.

 

Yet in the past dozen years or so, research has shed light on a

different phenomenon: the way patients who are supposedly voluntary,

not subject to any legal orders, experience coercion. Such patients

sometimes perceive coercion not from the law, as before, but from

family, doctors or others, researchers have found.

 

One survey of such patients found that when hospitalized, two-thirds

of them either weren't sure they were free to leave, or positively

believed they weren't allowed to. Another survey found that one third

of studied recipients of " electroshock " therapy—a treatment used for

some difficult mental illness cases—didn't feel they had freely agreed

to it, despite having signed consent forms.

 

Both these surveys, conducted in Britain, add to growing number of

studies in other countries documenting feelings of coercion among

ostensibly voluntary mental patients. The studies come from nations

generally seen as advanced, such as Norway and the United States.

 

" Perceptions of coercion will vary according to culture " and laws in

every place, wrote Jonathan Bindman of the Institute of Psychiatry,

London, an author of both the studies, in an email to World Science.

Yet several studies have turned up similar statistics across countries

in terms of how many psychiatric patients feel coerced.

 

For instance, Bindman's study on hospitalized patients, published in

the February issue of the journal Social Psychiatry and Psychiatric

Epidemiology, found that a third of them feel " highly coerced, " with a

few reporting threats or force. A similar study on Norwegian patients

published in the November 1, 2002 Nordic Journal of Psychiatry found

that 32 percent perceived " high levels " of coercion.

 

In the United States, the Chicago-based MacArthur foundation reported

in February 2001, based on a series of studies, that " a significant

minority of legally `voluntary' patients experience coercion. " The

opposite also occurs, the studies found: some patients who are in

treatment under orders think they are there only by free choice.

 

One reason it has taken some time to bring these issues to light is

that coercion is hard to measure, researchers say.

 

" For many years coercion was equated with legal compulsion, which had

the advantage of being clearly defined and straightforwardly

measurable, " Bindman and colleagues wrote in a February, 2001 report

commissioned by the U.K. Department of Health.

 

But " the relationship between legal restraint and coercion is not a

direct one, some patients accepting voluntary admission only after a

process of persuasion (by professionals, family, or others) in which

coercive elements are clearly present. "

 

The problem may ironically have come to the forefront because in

recent years, industrialized countries have changed laws to sharply

reduce the open, legal use of forced treatment. The trend, called

deinstitutionalization, was part of a shift in societal attitudes

towards greater tolerance and respect for civil liberties. But critics

argue that the process created a wave of untreated, sick patients who

pose a danger to themselves and others.

 

One treatment that stirred controversy both before and after

deinstitutionalization is electroconvulsive therapy, also known as

electroshock therapy. In this treatment, a strong electric current is

passed through the brain. It is widely considered effective for

difficult cases of depression and some other illnesses, but some

advocates for the mentally ill have also decried it as dehumanizing.

 

One new study found that despite the dramatic rollback of laws

allowing forced treatment, electroshock therapy is still often

associated with coercion—official or not—at least in the United Kingdom.

 

In a paper published in the January 2005 British Journal of

Psychiatry, Bindman and colleagues found that about one-third of

electroshock patients who had participated in studies didn't feel they

had freely consented to the therapy, despite having signed a consent

form. Around half of them also didn't feel they had gotten enough

information on the procedure and its side effects, added the

researchers, who based their findings on a review of previously

published medical literature.

 

" Neither current nor proposed safeguards for patients are sufficient

to ensure informed consent, " the researchers wrote.

 

Apart from the electroshock cases specifically, information could also

be a useful antidote to the feelings of coercion among patients more

generally, Bindman and colleagues wrote in their Social Psychiatry and

Psychiatric Epidemiology paper. The medical community should consider

informing all psychiatric patients " of the powers of detention which

may be used once they are admitted, and of the circumstances in which

they might be used, " the researchers wrote.

 

Moreover, Bindman and colleagues wrote in the 2001 report, for

patients not under legal orders, mental health professionals may have

to make up their minds between two sometimes tough choices. One is to

eliminate the coercion. The other: reopen a page from the old

rulebook—make the coercion official.

 

* * *