[ExI] A Small Request [was Re: Impressive book: Farewell toAlms]

[Stathis Papaioannou]

On 08/02/2008, spike <spike66 at att.net> wrote:

> The whole notion of holding people in an asylum against their will on the
> testimony of any quack psychiatrist has always made me squirm.  How can you
> be sure?  There are plenty of people willing to label any libertarian as
> crazy.  There are even more who consider an atheist as a raving looney.
> Signed up for cryonics?  Believe in a coming singularity?  Think that
> mankind can create a bright future through technology?  That we will
> eventually overcome disease and possibly even death?  How do you feel about
> being locked in an asylum for these beliefs?

Mental illness is, well, an illness. Odd ideas are a symptom pointing
to the illness. It's the same as with any other area of medicine. Not
every headache is caused by a brain tumour, and not every odd idea is
caused by mental illness. It's the doctor's job to figure out which
odd ideas are caused by mental illness because those can be treated
with medication, while the other kind of odd ideas can't. If you give
an antipsychotic to someone who has a regular religious belief, it
won't make any difference. If you give an antipsychotic to someone who
has developed what may even be a *less* bizarre belief than the
religious one but as a result of a psychotic illness, the belief is
attenuated.

> So how do we determine if a person can be held against their will?  I would
> recommend doing so only if they commit an actual crime.  That's what the
> courts did.  The fact that a lot of people left those institutions who would
> have been better off staying is beside the point.  There is no way to know
> for sure which are dangerous crazy and which just have crazy ideas.

The Mental Health Act in the Australian state where I work says that
in order to be detained against their will, a person has to be
mentally ill, pose a risk to themselves or others as a result of the
mental illness, require a treatment which can reasonably be expected
to help them, and be refusing to consent or unable to consent to that
treatment on account of that illness. They then have to be admitted to
a psychiatric hospital where they must be reviewed within 24 hrs by a
psychiatrist, who will either uphold the involuntary status or
discharge them. After that, they are reviewed by an independent
tribunal comprising a psychiatrist, a lawyer and a community member
who is neither a psychiatrist nor a lawyer.

"Risk to self" is broadly construed. It applies not only in the cases
where suicide is planned, but also in cases where the patient's mental
illness may for example lead to financial loss or damage
relationships.

The crucial point is that these negative consequences must result from
a *mental illness*. If I decide to give up my job, donate all my money
to charity and take to the road to preach about the Apocalypse because
the voices tell me to do it and I believe that the voices come from
God, I hope that someone will forcibly treat me and return me to my
normal mental state. But if I decide to do that just because it's what
I want to do, I want to be left alone.





-- 
Stathis Papaioannou