What we’ve said about Involuntary treatment

“in psychiatry, in voluntary psychiatry and also in pediatrics, the patient is not always the agent of the treatment. Sometimes the agent of the treatment is a family member, society at large, the law, anything”

“in almost every country and probably in most developed countries, Psychiatry is a branch of the executive state. Sorry, it's part of the executive branch of the state. Similarly to prosecutors, police officers, et cetera, in a small way or sometimes in a bigger way, we are part of social control and protection of the people”

“think of the three branches. The legislature writes the law, the judicial branch interprets it, and the executive branch executes it. You, the psychiatrist, were part of the executive branch. OK, you were arguing on behalf of the executive branch that someone was dangerous”

“in most places you need to identify a mental illness. OK, not a personality disorder that is different than the person's normal functioning. And you need to connect that that mental illness, its symptoms and impairments have somehow resulted in some kind of likelihood that without the commitment”

“traditionally traditionally mental illnesses did not include things like personality disorders because the personality disorders were thought to be fundamental to the person and not independent mental illness per se okay this is not a clinical reality it's a legal reality right you could call the legal fiction even in some places”

“I think you should ask two things. You should ask, is this a change from the person's baseline? And if so, why? And based on that, is it treatable through psychiatry, the practice of psychiatry as we have it today”

“If somebody is violent and dangerous while they're intoxicated and for about maybe, let's say, a week or two after, let's pretend they have a substance induced psychotic disorder. Then that's treatable, right? You monitor, you keep them in a safe location, you give temporary antipsychotics”

“just because everyone has told you that it's meth, the patient has told you, you have told yourself that it's meth, and the parents have told you that it's meth, doesn't mean that you should automatically assume that's that”

“in the emergency room, the definition of getting inpatient hospitalization involuntarily is acute danger to themselves or others”

“my responsibility here is to really do a thorough assessment of you and what happened. and to figure out whether it's safe for you to leave and there's really no way for me to do that unless we can talk to each other”

“it helps to understand that the law is keeping them hospitalized, the law in society. Right. There is just a system of rules that we've vaguely agreed upon as a system to execute for good reasons”

“With a sufficiently involuntary oppositional patient, you can only make your observations based on that interview. It generally does prolong the time that they have to be involuntarily detained”

“There are patients who will genuinely believe that And it will be true at the time of the interview that they are not dangerous in some fashion. And then they will go kill themselves or hurt somebody else within 24 hours of release”

“the majority of states will punish the doctor Okay, punish the doctor for being more lax rather than being more strict in terms of you will not go wrong for involuntary detainment and allowing a judge or judicial officer to release the patient”

“I think you should be both harder and easier on yourself. I think you should be easier on yourself in the sense that you are not there to please the person in front of you necessarily”