The odds of involuntary hospitalization to fit the schizophrenic patient’s needs.

By Elisa Nuñez Acosta

“It is frightening to be put and kept in restraints. It causes feelings of degradation and helplessness, and over, say, ten hours is extremely painful… I had nightmares

about it for years and years,” professor Elyn Saks shared in a TED Talk. She suffers

from schizophrenia, one of the most debilitating mental diseases, and was involuntarily hospitalized. Why is involuntary hospitalization still controversial? What do people with schizophrenia want? How can updated policies help them with their needs?

People with schizophrenia experience psychosis, characterized by losing contact with reality, so that the person might not be conscious of their treatment’s need and refuse it. Thus, caretakers can then put their patients into involuntary hospitalization. This is an incredibly stressful, difficult, and painful decision to make for a loved one. However it is legal, and patients can benefit from it under the right conditions.

Understanding the emotional aspects regarding involuntary hospitalization, as well as the ethical and legal ones, can help to integrate a background to update policies to help people with schizophrenia to enjoy the lives they want to live.

What does a psychotic episode feel like? Professor Elyn Saks, a law professor at the University of Southern California, describes psychosis as having a waking nightmare, in which people have bizarre and confusing thoughts, that ultimately can make them feel “utter terror.”

Involuntary commitment can happen to anyone suffering from schizophrenia, such as John Nash, the Nobel Prize winner in Economic Science 1994, who was involuntarily hospitalized several times.

Sometimes people that suffered a psychotic event are grateful to have been involuntarily hospitalized. However, in the words of Professor Saks, “If someone has a mental illness and is suicidal or a danger to others, there’s no question that intervention is necessary. But […] often times […] people are put away simply because they are acting oddly.”

How does current legislation help people with schizophrenia in terms of involuntary hospitalization? The inpatient civil commitment prevision is a law that asks for evidence of mental illness and danger to self and others before hospitalization. Thus, patients can benefit from this reclusion.

A law that helps avoiding involuntary hospitalization is the preventive outpatient involuntary treatment regulation, so that people comply with treatment without being committed. This law does not require evidence of mental illness or dangerousness. It is still difficult for family’s patient and doctors determine the patient’s need.

Involuntary hospitalization remains controversial. For instance, experts wonder to what extent they can restrain individual liberty because they assume a person could harm himself or others before anything wrong has happened. Ultimately, how does one objectively evaluate the capacity of people with mental disease to make their own decisions regarding their treatments?

There are also ethical considerations to watch. For instance, schizophrenic patients sometimes lose capacity in making decisions in their best interest so that their autonomy is diminished.

Medical practitioners follow the ethical principle to do no harm, so that autonomy is respected. They also observe the beneficence principle and provide patients the necessary service they need to benefit, even if this is involuntary hospitalization.

Weighing those principles is challenging in deciding hospitalizing patients against their will. Ideally these decisions are made based on medical considerations and laws.

However, such laws have room for interpretation. For instance, the criteria of dangerousness must be proven regarding the patient. In most instances, dangerousness means that “physical harm to self (suicide) or physical harm to others (homicide)” is likely to occur, researchers reported on Oct., 2010, in Psychiatry. And still interpretation of dangerousness changes from one state to another in the U.S.

Experts such as Professor Saks believe that by investing more in research and treatment, better care can be offered to people with schizophrenia to prevent the use of force. She also thinks that a first-time forced treatment could be beneficial. After this first experience, patients should be asked in advance to put in writing how they would prefer to be treated during another psychotic episode.

Investment and awareness can help update the treatments and their subsequent regulations for schizophrenia. Ultimately, according to Professor Saks, what people with schizophrenia want is what everyone of us wants “…in the words of Sigmund Freud ‘to work and to love’”.