ENGLEWOOD CLIFFS, NJ: The Britney Spears recent hospitalization has, once again, opened up the debate on involuntary psychiatric commitment. ?The time is right,? said Dr. Patricia A. Farrell, a well-known licensed psychologist, ?to look at this matter with an eye both toward the past and the future. I think that, if people don?t understand why and when this is done, they live in fear that it could happen to them. The fear is real in many people from whom I?ve heard, but so are the protections we all have.?
The question of involuntary commitment has caused people within and outside the mental health professions to examine it more closely.
?Whenever you are going to deprive someone of their freedom, their ability to make decisions on their own behalf and keep them in a facility against their will,? Dr. Farrell continued, ?you must be absolutely certain that you are doing it to protect either them or the community from harm. We in the mental health professions have a duty in that regard, but we also have a grave responsibility and that is that we insure there is no abuse of this duty. We?ve seen a history where women were committed into psychiatric hospitals by their husbands, families walked up to the gates of the hospital and handed a member over and even courts that have sent people to become unwilling patients. We have to ask ourselves what are the consequences for the person and the community and how can we best protect the rights and safety of those sent to the hospitals.?
The question raised by some is how we make this decision. ?Competency is always the thing about which you hear,? Dr. Farrell continued, ?and it seems to the lay person that there?s some formula for establishing competency. The matter isn?t as simple as that. For one thing, there can be a miscommunication, there may be a language barrier, a cultural problem, even one of experience or bias and all of these factors have a bearing on whether or not someone is committed. Even celebrity gets in the way.
?Usually, if you saw someone who hadn?t slept in three days and was acting in an extreme manner, shopping excessively, refused to accept that they were acting erratically, you might question their competence. But do you have a right to hospitalize them involuntarily? Dr. Thomas Szasz, a well-known psychiatrist and author, would probably say ?no? and he would see it on a par with legalized imprisonment for no crime. Extreme view though it may seem, it has some merit.
?Dr. Szasz believes we live in a world where we are increasing the number of ?consumers? of psychiatric services today. In fact, many mental health professionals now refer to ?patients? as ?consumers? just as department stores do. What?s the difference,? Dr. Farrell asks. ?No one forces anyone to go to a department store or a supermarket or any other place that provides goods or services. Neither do they tell them they can?t leave the store until the manager decides they may go. Perhaps this is too simplistic a view and it won?t please everyone, but we need to look at things with a clear head and fresh eyes.?
The question remains to be one of a need for strong safeguards for mental health consumers just as we need strong safeguards for the community. The problem is that behavior isn?t necessarily pathology if it doesn?t fit within the norm. ?Remember what we?ve always heard about creativity being close to madness? Perhaps we need to keep that thought in mind. Obviously, I?m not against mental health services, but I?m also not for forgetting about someone?s rights.?
Dr. Farrell is the author of ?How to Be Your Own Therapist? (Barnes & Noble, 2007, ISBN: 0-7607-9184-8), a licensed psychologist and medical disability consultant. She has appeared on major TV shows such as The Today Show, The View, Good Morning America, Anderson Cooper 360 and is quoted in national newspapers, magazines and news services.