One thing I gather from these kind of conversations is that all of us have anecdotal experiences that bias our thinking. It is even a problem in academia where biologists, psychologists, sociologists, criminologists, and social workers with terminal degrees hold perspectives that are often somewhat characteristic of their academic disciplines. We have to be constantly on guard to avoid concluding that our experiences are the experiences of others, or that our thinking is correct. I recognize that my education in biology and statistics biases me toward the more biological perspectives. But I try to avoid confirmation bias by reading and considering the perspectives of others. I do not think Wipond tries very hard to balance his point of view with conflicting perspectives.
I know other parents who have hospitalized their adult children dozens of times and I wonder if that is doing the same thing and hoping for a different result. It is not something I would choose for my daughter. On the other hand, a friend of mine has a son who had a psychotic break in college and was diagnosed with schizophrenia. He has experienced a near awakening on medication and is doing great, having now graduated from college.
If Wipond read memoirs written by Dr. Elyn Saks and Dr. Kay Redfield Jamison, he would know of two highly-education and successful individuals with schizophrenia and bipolar disorder who concluded after many relapses that medication is crucial to their stability. Their decisions and the decisions of parent caregivers are medically and morally difficult ones. Although I am unsure of Jamison's thinking about the issue, I do know that Saks recognizes the importance of respecting civil liberties and that she has worked to promote the civil liberties of patients. As demonstrated by my decision to not even attempt to involuntarily hospitalize my daughter, I fully agree that civil liberties are an important but not the only consideration. I agree with Dr. Aftab that developing psychiatric care that patients want to seek is a way to minimize the need for involuntary care. Dental and maternity care are examples of medical fields that have become more comfortable for their patients in recent decades. Psychiatry should do the same. But if the mind and the ability to make rational choices is a product of a healthy brain, there is a continuing role for involuntary care in rare cases.
As founder of Inner Compass Initiative and its association with The Withdrawal Project, my guess is that Wipond probably believes my daughter would be better off without medication. My daughter is able to function in society despite her persistent delusional beliefs, which have not resolved despite medication. And, she has tried many medications with limited efficacy. That has made me question if she should try discontinuing medication. I have even raised the question with her psychiatrist. But that decision is between her and her doctor. And the possibility that her symptoms could become worse without medication, perhaps permanently, gives me pause. A successful acquaintance of mine, who was a certified peer support specialist, decided to discontinue medication and soon became entangled in the criminal justice system with felony convictions that led to a lengthy jail stay. He still is not doing well and may never regain his previous level of recovery. Wipond's statement that persons without mental illness engage in criminal behavior is offensive in its attempt to dispense with consideration of a real risk, which solid studies have found elevated by several fold in the population of those with untreated serious mental illnesses. Such coldhearted and disingenuous reasoning is used in the U.S. to continue jailing and even executing persons with profound psychiatric illnesses, just like everyone else, rather than finding a more humane and intelligent way of responding to illnesses that have behavioral symptoms.
I'm very glad you two had this conversation, with so many important points about involuntary treatment debated. I'm left thinking about how competent, caring psychiatrists (and other mental health clinicians) make such a difference while incompetent, inflexible ones reinforce bad treatment experiences or inflict more of them. Even in the worst inpatient situations, I've found one or two staff who respected me enough, were honest enough, to help me through, maybe even inspiring some hope. I have faith in the newer generation of clinicians I've seen, the ones I've been lucky to come across.
I've been through years of "bad treatment" that included sometimes nonsensical and unhelpful medicating and many, many involuntary hospitalizations. When a psychiatrist stopped 5 meds without tapering, leading to a dangerous and lengthy withdrawal period, I was disillusioned, angry at all of psychiatry and constantly spouting criticism. My process in recovering ultimately led me back to medication because bipolar didn't just go away. I found a psychiatrist of my choice this time, who gives me his full attention and is transparent about what meds can do. Thankfully, the ONE medication this time around is making a big difference in leveling moods and giving me confidence to connect with people in the outside world. Staying stuck in hating psychiatry would've left me in a sort of limbo, a resignation that my life would get no better, constantly hoping I'd pass in my sleep, and isolated in my suffering.
Wouldn't it be great to have unlocked psych facilities, community counselors with unlimited and paid time to know and assist people in crisis, care (even when involuntary) that's warm and inviting, elimination of the dehumanizing process when being taken into a hospital, a decrease in mental health professionals' liability concerns, a slowing of society, at least enough that quick solutions would become less appealing, and general views that everyone is equal in value and insight?
I believe that in the here and now we can call out cruel patient treatment, protect patients' rights more effectively, and discourage arrogance that some psychiatrists carry as if they know better and are not to be challenged (which is likely just covering up their own insecurities anyway). Perhaps we might collectively reject old style and unenlightened practices as they are occurring, stomping on them as relentlessly as many patients are under psychiatric detention.
And now I just talked to a person I know who said that they've been so, so, SO traumatized from repeated involuntary hospitalizations. And what makes matters worse, they say, is that no one believes that you're traumatized. If you've been raped or assaulted in the street, people get that it's traumatizing. But it's just too hard for people to believe that CARE can be traumatizing, what do you mean, CARE is by its very nature the opposite of assault and trauma, CARE is for your own GOOD, so how could you possibly be traumatized from it?
This is the kinda thing that makes the stark antipsychiatric position understandable to me. I think it's wrong and I argue against it, but it's not hard to see that there are very real phenomena feeding into it.
Hi Dr. Aftab, I just wanted to let you know how grateful I am to you! What happened to me as a teen wasn’t ok. The facility ended up getting shut down for abuses against foster kids. I am so appreciative of people in the field who are willing to foster these kinds of convos, afterall if the goal of psychiatry is “wellness” then it doesnt do good to traumtize patients more.
They've talked about how they do need hospital care sometimes, but they wish there existed some hospital where staff talked to you like a human being even when you're in a weird state, and respected if you don't wanna be injected with meds instead of wrestling you down by force and tearing your clothes off and jabbing you anyway... Where you could be in a calm environment and gradually calm down among compassionate staff, even if the calming-down part takes time.
I'm like yeah, why is this somehow too much to ask for?
Another thing: It's so, so common with mistreatment and abuse in all kinds of coercive care. I think there need to be a general acknowledgement that coercive care is an environment that is "abusogenic", and it's HARD to create a good environment. I think way too many people believe that the environment will naturally be good and respectful unless the institution by sheer bad luck happens to hire an unusual kind of psychopath or two.
Of course everyone agrees with the statement "coercive care should only be used when absolutely necessary". But if you try to define necessary and elaborate on it, there are VAST disagreements. Some (like Awais) will say that you can bring down the numbers A LOT by
a) creating a better society with less stress, poverty, homelessness, discrimination etc, and
b) creating a better mental health system where people feel safe and trusted (believe me, even when you're pretty out of your mind you may trust some people and distrust others, and this may have a lot to do with how they actually treat you and listen to you)
So it's not some empty statement that everyone agrees on.
Moreover, on antipsychiatry vs mainstream views:
I think sane people SERIOUSLY underestimate how bad it can be not to be listened to, and how bad it can be if people don't even try to understand you because you're crazy anyway. Sane people may think it doesn't really matter how madpeople in a state of accute psychosis are treated, because they think we're oblivious to everything in that state. Often, sane people SERIOUSLY underestimate how horrible it is to suffer medication side effects (even comparatively mild ones like the ones I have had). They think staying on medication always means erring on the side of caution and getting off to try alternative approaches is always reckless, and so on. (As I've talked about before in comments, and as I've published plenty about, I've been off antipsychotics for five years now - and NOT because I've become sane and normal! It's just better all things considered, and I've learnt to function quite well without them.)
HOWEVER. Lots of antipsychiatrists I've talked to have pretty weird ideas about what mental health care is like, and what psychosis is like. In response to a question I recently got after a conference talk, I went pretty sarcastic ... I first painted this picture of how I entered academia as a fish out of water. I came from a rural working-class background and just didn't fit in. I was too much of a rebel for THE MAN, so THE MAN slapped a schizo-something-label on me and gave me psych meds because they weren't ready to hear me speaking truth to power and blabla... I then went "though this was really NOT what happened. Sure, you don't fit in when you're just sitting in a corner shaking with fear, but you're also not much of a rebel or much of anything in that state".
The section on the actuality of manic/psychotic/acutely suicidal presentations is the best point that speaks to the actuality of involuntary commitment- that he then rationalizes it by saying psychiatrists with years of training, which cannot be distilled into a paragraph, are only seeing something so easily rationalized away, and can't differentiate true delusions with extension (often reorganizing into the inpt environment)/pressure/bizareness/conviction from real environmental toxins or differentiate delusions from simple trauma induced anxiety shows such disregard for the field. Not to mention collateral, wherever possible, is used to substantiate the diagnosis and the people who care most about these people are the ones bringing them in, helping give context and are horrified and terrified by what is happening.
The problem is involuntary commitment and its true impact can only be seen if we could study alternate histories that would occur if it did not happen. Or study equally ill and seemingly dangerous patients where half are released and half committed- which no IRB would approve and it would be far to dangerous and unethical to study. Nothing in his argument really rings true to clinical realities, sounds like antipsychiatry at its core, and if he spent one day in a psych ER I doubt he would disagree with any of the decisions being made were they explained in detail to him. It's not some vague thing, it's real decisions being made in real time with people who are experiencing real and severe problems and are in real danger. It's not "that guy has social anxiety disorder, commit him!"
When critics rationalize away states of acute psychosis, they immediately lose credibility with clinicians and patients/families with direct experience of these issues, as your comment illustrates as well.
I actually have a clinical question, what's the current consensus in psychiatry on something like schizophrenia? Is it a mental illness that's amenable to remission and recovery back to a state of prior health, or is it a neurodevelopmental disorder that lies latent until puberty? If it's a neurodevelopmental disorder like autism which is incurable and at best simply just the way the person is and alwayshas been, are medications really the best approach?? I know there are a lot of modalities used today for high functioning autism like occupational therapy, or social skills training to improve their overall social functioning, even acknowledging that the overall functioning may never be the same as a "neurotypical" person, but it's unclear to me how schizophrenia should be conceptualized.
A number of different conditions have likely been lumped in the category of "schizophrenia" because of similar symptoms, so that makes it difficult to generalize. There is a neurodevelopmental aspect to schizophrenia in general, such that patients *on average* show lower IQ (but within "normal" range) and various subtle neurological differences even before they have experienced an episode of psychosis, but there is considerable variation (not everyone shows this pattern). The neurodevelopmental aspect, when its present, is generally stable, and influences how well the person with schizophrenia functions intellectually and socially. The psychosis part of schizophrenia - hallucinations, delusions, thought problems, etc. - is more dynamic. More people experience episodes of psychosis, although some people do experience psychosis chronically, all/most of the time. Around 20% of people with schizophrenia recover and don't have another episode again. The rest have multiple episodes, but can do well with treatment or have a chronic course of psychosis.
So, with the chronic course of schizophrenia, what's the best available guess or hypothesis as to why these changes become permanent?? Why is prior functioning difficult to achieve for these patients?? A condition like CTE found by Dr Bennett Omalu in retired football players like Mike Webster or boxers, can also cause hallucinations, delusions, depression, but it's clear that it's caused by repeated head trauma. Since the hereditary factors can't be changed, what are the environmental influences that could be changed?
the response about the poisons in the house that need to be checked is all you need to read to understand this man has no idea what psychiatrists deal with.
I'm sorry, I can't take this person remotely seriously. He can't even express minimally realistic images of how horrible mental illness can be; his entire conception of the issue reflects a totally idealized and theoretical vision of mental illness. I wish you had asked him much more frank and direct and impolite questions. It's the only way his bullshit ever gets challenged. Mental illness is a guy shitting his pants on the subway while he slowly dies from sepsis he's too sick to treat. If you can't understand it in those terms, you don't really care about the mental ill
In general, no. We don’t hospitalize people on a whim or without safeguards. That said, like any other mechanism, the process for involuntary admission can be misused and misapplied. And because of a variety of systemic factors (underfunding, staffing issues, legal liabilities), even when involuntary care is justified, the experience can end up being quite traumatic for some people. Couple this with lack of pathways for voluntary inpatient care and lack of community resources, and there is increased pressure on inpatient services to handle issues that could’ve been handled elsewhere if we had a better system of crisis care. For people who have these really negative experiences with inpatient care, it is small comfort that inpatient care is very difficult to access for most people. I am a practicing psychiatrist. I admit many people involuntarily, I treat many involuntarily. I am super-aware that there is often no way around it, but I am also super-aware of the ways in which the process can go wrong and I’m aware that for a subset of people, it could either have been avoided or care could’ve been provided in a more therapeutic and humanistic manner, if we had the resources to do so.
One thing I gather from these kind of conversations is that all of us have anecdotal experiences that bias our thinking. It is even a problem in academia where biologists, psychologists, sociologists, criminologists, and social workers with terminal degrees hold perspectives that are often somewhat characteristic of their academic disciplines. We have to be constantly on guard to avoid concluding that our experiences are the experiences of others, or that our thinking is correct. I recognize that my education in biology and statistics biases me toward the more biological perspectives. But I try to avoid confirmation bias by reading and considering the perspectives of others. I do not think Wipond tries very hard to balance his point of view with conflicting perspectives.
I know other parents who have hospitalized their adult children dozens of times and I wonder if that is doing the same thing and hoping for a different result. It is not something I would choose for my daughter. On the other hand, a friend of mine has a son who had a psychotic break in college and was diagnosed with schizophrenia. He has experienced a near awakening on medication and is doing great, having now graduated from college.
If Wipond read memoirs written by Dr. Elyn Saks and Dr. Kay Redfield Jamison, he would know of two highly-education and successful individuals with schizophrenia and bipolar disorder who concluded after many relapses that medication is crucial to their stability. Their decisions and the decisions of parent caregivers are medically and morally difficult ones. Although I am unsure of Jamison's thinking about the issue, I do know that Saks recognizes the importance of respecting civil liberties and that she has worked to promote the civil liberties of patients. As demonstrated by my decision to not even attempt to involuntarily hospitalize my daughter, I fully agree that civil liberties are an important but not the only consideration. I agree with Dr. Aftab that developing psychiatric care that patients want to seek is a way to minimize the need for involuntary care. Dental and maternity care are examples of medical fields that have become more comfortable for their patients in recent decades. Psychiatry should do the same. But if the mind and the ability to make rational choices is a product of a healthy brain, there is a continuing role for involuntary care in rare cases.
As founder of Inner Compass Initiative and its association with The Withdrawal Project, my guess is that Wipond probably believes my daughter would be better off without medication. My daughter is able to function in society despite her persistent delusional beliefs, which have not resolved despite medication. And, she has tried many medications with limited efficacy. That has made me question if she should try discontinuing medication. I have even raised the question with her psychiatrist. But that decision is between her and her doctor. And the possibility that her symptoms could become worse without medication, perhaps permanently, gives me pause. A successful acquaintance of mine, who was a certified peer support specialist, decided to discontinue medication and soon became entangled in the criminal justice system with felony convictions that led to a lengthy jail stay. He still is not doing well and may never regain his previous level of recovery. Wipond's statement that persons without mental illness engage in criminal behavior is offensive in its attempt to dispense with consideration of a real risk, which solid studies have found elevated by several fold in the population of those with untreated serious mental illnesses. Such coldhearted and disingenuous reasoning is used in the U.S. to continue jailing and even executing persons with profound psychiatric illnesses, just like everyone else, rather than finding a more humane and intelligent way of responding to illnesses that have behavioral symptoms.
I'm very glad you two had this conversation, with so many important points about involuntary treatment debated. I'm left thinking about how competent, caring psychiatrists (and other mental health clinicians) make such a difference while incompetent, inflexible ones reinforce bad treatment experiences or inflict more of them. Even in the worst inpatient situations, I've found one or two staff who respected me enough, were honest enough, to help me through, maybe even inspiring some hope. I have faith in the newer generation of clinicians I've seen, the ones I've been lucky to come across.
I've been through years of "bad treatment" that included sometimes nonsensical and unhelpful medicating and many, many involuntary hospitalizations. When a psychiatrist stopped 5 meds without tapering, leading to a dangerous and lengthy withdrawal period, I was disillusioned, angry at all of psychiatry and constantly spouting criticism. My process in recovering ultimately led me back to medication because bipolar didn't just go away. I found a psychiatrist of my choice this time, who gives me his full attention and is transparent about what meds can do. Thankfully, the ONE medication this time around is making a big difference in leveling moods and giving me confidence to connect with people in the outside world. Staying stuck in hating psychiatry would've left me in a sort of limbo, a resignation that my life would get no better, constantly hoping I'd pass in my sleep, and isolated in my suffering.
Wouldn't it be great to have unlocked psych facilities, community counselors with unlimited and paid time to know and assist people in crisis, care (even when involuntary) that's warm and inviting, elimination of the dehumanizing process when being taken into a hospital, a decrease in mental health professionals' liability concerns, a slowing of society, at least enough that quick solutions would become less appealing, and general views that everyone is equal in value and insight?
I believe that in the here and now we can call out cruel patient treatment, protect patients' rights more effectively, and discourage arrogance that some psychiatrists carry as if they know better and are not to be challenged (which is likely just covering up their own insecurities anyway). Perhaps we might collectively reject old style and unenlightened practices as they are occurring, stomping on them as relentlessly as many patients are under psychiatric detention.
And now I just talked to a person I know who said that they've been so, so, SO traumatized from repeated involuntary hospitalizations. And what makes matters worse, they say, is that no one believes that you're traumatized. If you've been raped or assaulted in the street, people get that it's traumatizing. But it's just too hard for people to believe that CARE can be traumatizing, what do you mean, CARE is by its very nature the opposite of assault and trauma, CARE is for your own GOOD, so how could you possibly be traumatized from it?
This is the kinda thing that makes the stark antipsychiatric position understandable to me. I think it's wrong and I argue against it, but it's not hard to see that there are very real phenomena feeding into it.
Yes! This!!!! Thank you for speaking out!
Hi Dr. Aftab, I just wanted to let you know how grateful I am to you! What happened to me as a teen wasn’t ok. The facility ended up getting shut down for abuses against foster kids. I am so appreciative of people in the field who are willing to foster these kinds of convos, afterall if the goal of psychiatry is “wellness” then it doesnt do good to traumtize patients more.
They've talked about how they do need hospital care sometimes, but they wish there existed some hospital where staff talked to you like a human being even when you're in a weird state, and respected if you don't wanna be injected with meds instead of wrestling you down by force and tearing your clothes off and jabbing you anyway... Where you could be in a calm environment and gradually calm down among compassionate staff, even if the calming-down part takes time.
I'm like yeah, why is this somehow too much to ask for?
Another thing: It's so, so common with mistreatment and abuse in all kinds of coercive care. I think there need to be a general acknowledgement that coercive care is an environment that is "abusogenic", and it's HARD to create a good environment. I think way too many people believe that the environment will naturally be good and respectful unless the institution by sheer bad luck happens to hire an unusual kind of psychopath or two.
Of course everyone agrees with the statement "coercive care should only be used when absolutely necessary". But if you try to define necessary and elaborate on it, there are VAST disagreements. Some (like Awais) will say that you can bring down the numbers A LOT by
a) creating a better society with less stress, poverty, homelessness, discrimination etc, and
b) creating a better mental health system where people feel safe and trusted (believe me, even when you're pretty out of your mind you may trust some people and distrust others, and this may have a lot to do with how they actually treat you and listen to you)
So it's not some empty statement that everyone agrees on.
Moreover, on antipsychiatry vs mainstream views:
I think sane people SERIOUSLY underestimate how bad it can be not to be listened to, and how bad it can be if people don't even try to understand you because you're crazy anyway. Sane people may think it doesn't really matter how madpeople in a state of accute psychosis are treated, because they think we're oblivious to everything in that state. Often, sane people SERIOUSLY underestimate how horrible it is to suffer medication side effects (even comparatively mild ones like the ones I have had). They think staying on medication always means erring on the side of caution and getting off to try alternative approaches is always reckless, and so on. (As I've talked about before in comments, and as I've published plenty about, I've been off antipsychotics for five years now - and NOT because I've become sane and normal! It's just better all things considered, and I've learnt to function quite well without them.)
HOWEVER. Lots of antipsychiatrists I've talked to have pretty weird ideas about what mental health care is like, and what psychosis is like. In response to a question I recently got after a conference talk, I went pretty sarcastic ... I first painted this picture of how I entered academia as a fish out of water. I came from a rural working-class background and just didn't fit in. I was too much of a rebel for THE MAN, so THE MAN slapped a schizo-something-label on me and gave me psych meds because they weren't ready to hear me speaking truth to power and blabla... I then went "though this was really NOT what happened. Sure, you don't fit in when you're just sitting in a corner shaking with fear, but you're also not much of a rebel or much of anything in that state".
The section on the actuality of manic/psychotic/acutely suicidal presentations is the best point that speaks to the actuality of involuntary commitment- that he then rationalizes it by saying psychiatrists with years of training, which cannot be distilled into a paragraph, are only seeing something so easily rationalized away, and can't differentiate true delusions with extension (often reorganizing into the inpt environment)/pressure/bizareness/conviction from real environmental toxins or differentiate delusions from simple trauma induced anxiety shows such disregard for the field. Not to mention collateral, wherever possible, is used to substantiate the diagnosis and the people who care most about these people are the ones bringing them in, helping give context and are horrified and terrified by what is happening.
The problem is involuntary commitment and its true impact can only be seen if we could study alternate histories that would occur if it did not happen. Or study equally ill and seemingly dangerous patients where half are released and half committed- which no IRB would approve and it would be far to dangerous and unethical to study. Nothing in his argument really rings true to clinical realities, sounds like antipsychiatry at its core, and if he spent one day in a psych ER I doubt he would disagree with any of the decisions being made were they explained in detail to him. It's not some vague thing, it's real decisions being made in real time with people who are experiencing real and severe problems and are in real danger. It's not "that guy has social anxiety disorder, commit him!"
When critics rationalize away states of acute psychosis, they immediately lose credibility with clinicians and patients/families with direct experience of these issues, as your comment illustrates as well.
I actually have a clinical question, what's the current consensus in psychiatry on something like schizophrenia? Is it a mental illness that's amenable to remission and recovery back to a state of prior health, or is it a neurodevelopmental disorder that lies latent until puberty? If it's a neurodevelopmental disorder like autism which is incurable and at best simply just the way the person is and alwayshas been, are medications really the best approach?? I know there are a lot of modalities used today for high functioning autism like occupational therapy, or social skills training to improve their overall social functioning, even acknowledging that the overall functioning may never be the same as a "neurotypical" person, but it's unclear to me how schizophrenia should be conceptualized.
A number of different conditions have likely been lumped in the category of "schizophrenia" because of similar symptoms, so that makes it difficult to generalize. There is a neurodevelopmental aspect to schizophrenia in general, such that patients *on average* show lower IQ (but within "normal" range) and various subtle neurological differences even before they have experienced an episode of psychosis, but there is considerable variation (not everyone shows this pattern). The neurodevelopmental aspect, when its present, is generally stable, and influences how well the person with schizophrenia functions intellectually and socially. The psychosis part of schizophrenia - hallucinations, delusions, thought problems, etc. - is more dynamic. More people experience episodes of psychosis, although some people do experience psychosis chronically, all/most of the time. Around 20% of people with schizophrenia recover and don't have another episode again. The rest have multiple episodes, but can do well with treatment or have a chronic course of psychosis.
So, with the chronic course of schizophrenia, what's the best available guess or hypothesis as to why these changes become permanent?? Why is prior functioning difficult to achieve for these patients?? A condition like CTE found by Dr Bennett Omalu in retired football players like Mike Webster or boxers, can also cause hallucinations, delusions, depression, but it's clear that it's caused by repeated head trauma. Since the hereditary factors can't be changed, what are the environmental influences that could be changed?
the response about the poisons in the house that need to be checked is all you need to read to understand this man has no idea what psychiatrists deal with.
I'm sorry, I can't take this person remotely seriously. He can't even express minimally realistic images of how horrible mental illness can be; his entire conception of the issue reflects a totally idealized and theoretical vision of mental illness. I wish you had asked him much more frank and direct and impolite questions. It's the only way his bullshit ever gets challenged. Mental illness is a guy shitting his pants on the subway while he slowly dies from sepsis he's too sick to treat. If you can't understand it in those terms, you don't really care about the mental ill
I mean, does this look anything like a society in which people are constantly thrown into involuntary care too quickly or without deliberate process?
In general, no. We don’t hospitalize people on a whim or without safeguards. That said, like any other mechanism, the process for involuntary admission can be misused and misapplied. And because of a variety of systemic factors (underfunding, staffing issues, legal liabilities), even when involuntary care is justified, the experience can end up being quite traumatic for some people. Couple this with lack of pathways for voluntary inpatient care and lack of community resources, and there is increased pressure on inpatient services to handle issues that could’ve been handled elsewhere if we had a better system of crisis care. For people who have these really negative experiences with inpatient care, it is small comfort that inpatient care is very difficult to access for most people. I am a practicing psychiatrist. I admit many people involuntarily, I treat many involuntarily. I am super-aware that there is often no way around it, but I am also super-aware of the ways in which the process can go wrong and I’m aware that for a subset of people, it could either have been avoided or care could’ve been provided in a more therapeutic and humanistic manner, if we had the resources to do so.
I have been thinking alot about involuntary care, specially in 2 situations: when someone represents a danger to himself or others