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In March or 2007, after subsisting for five years with untreated schizophrenia, which manifested as severe psychosis, delusions, homelessness, and incarceration, I was taken to a psychiatric hospital for an involuntary commitment. It would last two weeks. While there, I would be mandated to take antipsychotic medication. I hated being in the hospital, strongly preferring my homeless life living outside in the Los Angeles area. I thought my medication did nothing and I certainly did not need it. In my mind, the doctors and staff were wrong about me and simply did not really know me well enough.
Following my discharge, due to side effects of my medication, I discontinued it, which quickly led to another hospitalization. Fortunately, this hospitalization was one of the biggest milestones of my life. I recognized and accepted my diagnosis of schizophrenia and my need for a lifetime of commitment to treatment.
Involuntary commitment
Whether or not to take away a person’s freedom and liberty through an involuntary hospitalization is a difficult question to consider. Ideally, no one should have to be confined to a facility against their will, or prevented from making their own choices regarding their personal life or their medical treatments.
But people are involuntarily hospitalized every day. The idea is that, through involuntary treatment and mandated care, they will come to a point where they will develop insight, decide on their own to continue treatment, and even eventually become grateful for the involuntary hospitalization. I came to that point a few weeks after my second hospitalization. I was even grateful. But every story is different, and when I look back, I realize there is no easy answer.
Criteria for hospitalization
Today, fully recovered on medication and enjoying a healthy, productive life, I ponder my personal journey and still try to make sense of it. My thoughts turn to others who struggle with untreated mental illness and wish there was a solid path to recovery that would work for every person, but I know there is not. There are so many factors in the recovery process, so many variables, that it is hard to make sense of it all.
The general criteria in America today for committing someone to a hospital are simple: they must be a danger to self, a danger to others, or “gravely disabled,” which might mean they smell bad from five feet away. But isn’t anyone in an acute state of psychosis, who cannot tell the difference between reality and hallucinations and delusions, in need of involuntary commitment?
Unfortunately, there is no definitive test to measure psychosis, while there are definitive tests for most medical illnesses. Doctors must do their best to analyze a person’s mental state using their medical judgment. Does the fact that there is no quantitative test mean that physicians are unable to make an accurate assessment and offer a solid path toward recovery?
Looking back, we did not always have breathalyzers for those suspected of driving drunk. Police did their best to evaluate the person, asking them to close their eyes and touch their nose, or walk in a straight line. Though these tests were not definitive or could not be measured with numbers, they were accepted as adequate and necessary.
Taking away the car keys
When a person goes to a bar and drinks heavily, sometimes the bartender will take away her keys. She will have to make it home with friends, a taxi, or possibly walk. The bartender does not take away the keys readily or deliberately intend to take away her freedom. In her best interest, she simply should not drive until the effects of the alcohol have worn off. The elderly also sometimes come to a point in life where they are no longer fit to drive.
Psychosis Essential Reads
When dealing with a person in an acute state of psychosis, who does not know if what he is hearing is real or a hallucination in his mind, through “taking away the car keys” of his or her life, and mandating treatment, can we address needs and protect the person from making choices that they probably will deeply regret?
Feelings of betrayal
Sometimes it can take time for a person who is involuntarily hospitalized to come to a point where they understand they needed it. People sometimes feel confused, certain there is nothing wrong with them, and angry about being confined to a ward, or they simply do not understand. It is important for any family involved in their involuntary commitment to offer support.
My parents played a significant role in my involuntary commitment, as my mom called and told the hospital staff about my severely disjointed history over the previous five years. Fortunately, I never blamed them for this and would soon understand my need for treatment. Later, I would be thankful for their intervention.
When I was hospitalized, my parents immediately flew from Cincinnati to Los Angeles to see me. They visited often. I greatly appreciated special food they brought me, as well as clothing, books, and music (a CD player). For persons who do blame their family and do not understand, support from loved ones is critical in the healing process.
Looking back
I wish I had never become sick enough to be involuntarily hospitalized, but looking back, I am grateful for it. It made me realize I needed help. I had come to a point where I did not know if what I was hearing and seeing was in my reality or a trick of my mind.
If one thing had been done differently, I wish that the hospital staff had educated me about how my illness was affecting my life and the improvements they saw on medication.
I often am contacted by families with a loved one who they believe badly needs help and who hope to get their loved one involuntarily committed. Sometimes I tell them, if need be, to consider “taking away the car keys.”
Thanks to Darrell Herrmann for helpful contributions to this post.
