The following is a weekly response paper written for the 10th week of my Abnormal Psychology class; papers are based on questions asked at the end of lecture every week.
Question: The issue of individual civil rights for the seriously mentally ill is a major controversy today. Do you feel that schizophrenic patients should ever be institutionalized against their will? Do you feel they should be medicated against their will? If you answer yes, under what conditions should the decision be made and who should have the authority to make this decision?
Schizophrenia (SCZ) is a devastating psychotic disorder characterized by delusions, hallucinations, and disorganized behavior. People diagnosed with SCZ are often severely impaired by these symptoms, lacking the ability to judge reality correctly, and even the ability to care for themselves at the very basic level. Treatment is an intensive combination of medication, psychosocial, and social therapies, all of which more than likely will have to be continued for the remainder of a person’s life. Given the very nature of SCZ, obtaining consent for such interventions becomes a complicated issue. Though a person’s treaters, or family and friends may believe receiving care for such a serious psychiatric illness is a healthy and positive choice, the only one capable and responsible for making that decision is the patient him/herself. What happens when that person becomes incapable of making responsible decisions in regards to their psychiatric care? Should this point exist?
When a person diagnosed with SCZ is found to be a danger to themselves and/or others it means that the presentation of the disorder is such that it would be irresponsible for professionals to allow that individual to continue living in the general population in their current state without some sort of intervention. This intervention could manifest via medication and/or institutionalization, and may occur against the individual’s will. Examples of “irresponsible” situations include making threats, violent behavior, and criminal acts. “Professionals” include anyone capable of adequately assessing the mental status of a person with SCZ, a psychologist, psychiatrist, MD, etc, as well as those who would be involved with the legal process, such as police and lawyers. The difference between a person with SCZ and a criminal being “locked up” is sanity, both at the time of the crime as well as at trial; sanity being the legal term referring to the ability to judge right from wrong. Oftentimes a person with SCZ is not sane, and unless medicated cannot accurately judge if their actions are safe for the situation and based in reality.
Once medicated, however, a person with SCZ can become lucid and able to distinguish the meaning of their actions. At this time a person may decide that being medicated is something they genuinely wish not to be, and may even sign a legal document to that effect. This poses an interesting avenue of civil rights for the mentally ill: choosing to remain ill; rather, choosing to abstain from intervention/relief from symptoms. A person of sound mind certainly has the right to decide whether or not they want to be on medication or not, but if a person with a life-long mental illness chooses not to be medicated for said illness is this a decision the person made, or is the decision a symptom of the illness?
The ultimate question becomes whether or not to trust someone with SCZ to have a sound mind if a medication-free lifestyle is something they value. I do think there are times at which a person with SCZ should be medicated or institutionalized against their will, such as the instances highlighted above. If a person is too sick to understand the dangerous effect they are having on themselves and/or others, I believe it is the responsibility of others to keep that individual and others safe. It is necessary to deprive this individual of some freedoms, especially if their right to remain medication free encroaches on the rights of others. This freedom deprivation should only last until such a time until the individual is able to understand the consequences of their actions; at which point safety and sanity should be reassessed, and further, less invasive treatment options should be presented. Important considerations include repeat offenders and severity of actions committed when not of sound mind.