e-book Coercive Treatment in Psychiatry: Clinical, legal and ethical aspects

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Professor Monahan is well known internationally for his numerous publications and presentations in mental health law, for his leadership of the MacArthur Research Network on Violence, Coercion and Competence and of the current MacArthur Research Network on Mandated Treatment in the Community, and for his generous support and encouragement of scholars in coercion and in all areas of mental health law.

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Skip to Main Content. Kallert Juan E. Mezzich John Monahan. First published: 31 March About this book Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge.

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This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment. Author Bios Professor Kallert has been active in the field of mental health services research for many years. He has published 6 books, more than 35 chapters in books, and more than articles in peer-reviewed journals. Free Access. Tools Get online access For authors. Email or Customer ID. Forgot password? One of these essays is Dorothea Buck-Zerchin's "Seventy years of coercion in psychiatric institutions, experienced and witnessed" — a ninety something woman who's forced treatment and sterilization began before she was twenty, and went on intermittently for the rest of her life.

The personal detail, breadth of historical knowledge and sheer sanity of Ms Buck-Zerchin's chapter are a shameful reminder of how unwarranted and mistaken coercive treatment has often been. Other chapters by users introduce helpful examples and analyses that provide detail and depth, and show a sophisticated assessment of research methodology and an encouraging emphasis not only on how treatment has been in the past and what was wrong with it, but on how the situation might be realistically improved.

Much here is familiar. Central questions about coercive treatment find there way into one or several of these discussions: how to define coercion; what circumstance may make it at times unavoidable in the psychiatry setting; whether in our embrace of autonomy we have lost sight of more paternalistic principles that might serve to justify such treatment; the ingredients of true informed consent; the cultural ideas linking coercion to stigma and other negative consequences, and the possibility that a person-centered approach stressing partnership and trust can reduce the need for, and baleful effects of, coercive treatment.

The unfortunate history of the worst abuses to which enforced treatment has led is also rehearsed. Less familiar ideas raised in these chapters include a practice-oriented preventive strategy for avoiding the escalating situations where coercion is a response of last resort, and a review of the forms of leverage employed in the community treatment setting that bring their own, new coerciveness in this post-asylum era.

In a far-reaching policy proposal Szmukler and Dawson take on the relationship between dangerousness and capacity, traits often wrongly and misleadingly linked, as they point out. These authors' elaborate new legal structures that would eliminate the in their view discriminatory difference of treatment for mental and physical conditions found in current law and policy — what they entitle mental disorder exceptionalism. Instead, they favor fusing civil commitment statutes with capacity tests in comprehensively revised legislation based on decision-making capacity that would cover everyone with reduced capacity, regardless of cause.

A person without deficits of capacity cannot be detained, according to this revision, even if he has been given a diagnosis of mental disorder. Addressing as it does the time honored and hard-fought protections traditionally accorded the mentally ill in law, this discussion shows the privileging of the principle of autonomy over that of beneficence at its most extreme, and illustrates the depth and importance of the philosophical issues at stake in this arena.

The person who binds himself in advance to accept some treatment is acting as an autonomous and free agent, and another important set of ideas raised in several of these discussions points to advance care directives as a preferable alternative to coercive treatment — as they are. Despite their obvious ethical appeal, their widespread and for the most part effective use in general medicine, and the fact that in the small body of empirical research undertaken they have been shown to reduce the use of coercive interventions, psychiatric advance care directives seem thus far to have provided more problems than solutions.

Research on attitudes towards them, for instance, show practitioners reluctant to follow those directives permitting the patient to refuse treatment; concern is also expressed over their usefulness in crisis situations to which must be added the obvious point that they will not help with unanticipated first episodes of disorder. Issues of personal identity may complicate the use of such directives with disorders that result in deep personal change, or reoccurring personalities.


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But even before we get to these, the difficulties expressed by authors in this book seem to doom psychiatric advance care directives. Unfortunately, as in almost all the other areas around coercive treatment and its effects, there is a dearth of adequate research or empirical data.

Yet, to the extent that coercive treatment is increasingly recognized to jeopardize human rights, improvements and innovations such as these must be given a chance and subject to more thorough, empirical study.

New book on coercion in mental health includes chapter by former MindFreedom director, David Oaks

Summing up then, this is a rich and valuable collection. It comes at a time when ideas about both coercion and treatment are being revised, and in addition to raising more practical and policy-related challenges, it demonstrates important philosophical issues requiring further attention. Jennifer Radden, University of Massachusetts, Boston. Welcome to Metapsychology. We feature over in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives.

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Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

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