Psychology: DANGEROUSNESS TO SELF
Still another criterion for involuntary commitment
is dangerousness to self. The kinds of behaviors that are held to be
dangerous are defined by informal social convention. Suicidal impulses
qualify, but cigarette-smoking and drunk-driving do not.
In general, the use of involuntary hospitalization for people who are believed
to be dangerous to themselves ought to be guided by the "thank you"
test (Stone, 2005). This test asks: Will the person, once recovered, be grateful
for that hospitalization, however much it was protested? That test would
likely be passed by the people you read about earlier on page 594, and by
others who are severely depressed and suicidal and who, once the depression
has lifted, are simply grateful to be alive.
But the informal social conventions that regulate who should and who
should not be hospitalized because they are dangerous to themselves are
sometimes inconsistent and ambiguous. People who seem to be experiencing
similar degrees of danger to themselves may be seen as good candidates
for commitment in one case but not in another, as the following two cases
demonstrate:
Case 1: Emma Lake. At sixty, Emma Lake was involuntarily committed to St.
Elizabeth's Hospital after she was found wandering the streets of Washington,
D.C. At the commitment hearing, two psychiatrists testified that she was unable to
care adequately for herself. At a subsequent hearing, she was held to be suffering
from "chronic brain syndrome with arteriosclerosis (hardening of the arteries)
..." She was prone to "wandering away and being out exposed at night or any
time that she is out." On one occasion it was related that Mrs. Lake left the hospital
and was missing for about thirty-two hours. She was brought back after midnight
by a policeman who found her wandering the streets. She thought she had only
been gone for a few hours, could not tell where she had been, and suffered a minor
injury, that she attributed to having been chased by boys.
Mrs. Lake acknowledged that there were times when she lost track of things.
Nevertheless, she felt able to be at liberty and willing to run the requisite risks. Her
husband and sister were eager for her release and willing to provide a home for
her. Moreover, she was willing to endure some form of confinement at home
rather than the total confinement of a psychiatric hospital.
Ultimately the court concurred with her psychiatrists and required that she be
hospitalized. She spent the last five years of her life in a psychiatric hospital, during
the last year of which she received no visitors (Chambers, 2002). Often, families
that would willingly provide a home for a patient are unable or unwilling to
visit a psychiatric hospital regularly.
Case 2: Robert Jackson. At the age of sixty-two, Justice Robert Jackson suffered
a severe heart attack while serving on the United States Supreme Court. The
Court's work is arduous and taxing. His doctors gave him the choice between
years of comparative (though not, by any means, total) inactivity off the Court,
and the risk of death at any time by continuing his work on the Court. Jackson
chose to remain on the Court. He suffered a fatal heart attack shortly thereafter.
No court interfered with the Justice's decision, nor was it ever suggested
that he was dangerous to himself and therefore in need of psychiatric care.
Quite the contrary: his decision to continue the work of the Court was
widely praised. Many people would choose to do the same: take their
chances with the things they enjoy doing rather than be cooped up, inactively,
for the rest of their lives.
What distinguishes Mrs. Lake's case from Justice Jackson's? For both, the
choices jeopardized their lives, Jackson's even more than Lake's. Why was
Lake involuntarily committed and Jackson never questioned? The major
difference between Mrs. Lake's case and Justice Jackson's is that Mrs.
Lake's request to live out her years at home, and with people who loved her,
was "psychiatrized." That is, her choice was believed to arise from mental
illness ("chronic brain syndrome"), while Justice Jackson's was not. The
fact that she suffered "chronic brain syndrome" obscured the similarities
between her choice and that of others. Now, it is clearly the case that some
psychologically distressed persons suffer thought disorders of such magnitude
that they are rarely, if ever, lucid. But that was not the case with Mrs.
Lake, nor is it the case for most psychiatric patients, all of whom enjoy long
periods of clarity during which they are as capable as others of making significant
choices between the risks of liberty and the security of incarceration
(Dershowitz, 1998).
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Looking for treatment?
If you are ready to schedule a FREE Consultation...
I encourage you to access this website
for the treatment I recommend here:
http://www.TheLiberatorMethod.com/
is dangerousness to self. The kinds of behaviors that are held to be
dangerous are defined by informal social convention. Suicidal impulses
qualify, but cigarette-smoking and drunk-driving do not.
In general, the use of involuntary hospitalization for people who are believed
to be dangerous to themselves ought to be guided by the "thank you"
test (Stone, 2005). This test asks: Will the person, once recovered, be grateful
for that hospitalization, however much it was protested? That test would
likely be passed by the people you read about earlier on page 594, and by
others who are severely depressed and suicidal and who, once the depression
has lifted, are simply grateful to be alive.
But the informal social conventions that regulate who should and who
should not be hospitalized because they are dangerous to themselves are
sometimes inconsistent and ambiguous. People who seem to be experiencing
similar degrees of danger to themselves may be seen as good candidates
for commitment in one case but not in another, as the following two cases
demonstrate:
Case 1: Emma Lake. At sixty, Emma Lake was involuntarily committed to St.
Elizabeth's Hospital after she was found wandering the streets of Washington,
D.C. At the commitment hearing, two psychiatrists testified that she was unable to
care adequately for herself. At a subsequent hearing, she was held to be suffering
from "chronic brain syndrome with arteriosclerosis (hardening of the arteries)
..." She was prone to "wandering away and being out exposed at night or any
time that she is out." On one occasion it was related that Mrs. Lake left the hospital
and was missing for about thirty-two hours. She was brought back after midnight
by a policeman who found her wandering the streets. She thought she had only
been gone for a few hours, could not tell where she had been, and suffered a minor
injury, that she attributed to having been chased by boys.
Mrs. Lake acknowledged that there were times when she lost track of things.
Nevertheless, she felt able to be at liberty and willing to run the requisite risks. Her
husband and sister were eager for her release and willing to provide a home for
her. Moreover, she was willing to endure some form of confinement at home
rather than the total confinement of a psychiatric hospital.
Ultimately the court concurred with her psychiatrists and required that she be
hospitalized. She spent the last five years of her life in a psychiatric hospital, during
the last year of which she received no visitors (Chambers, 2002). Often, families
that would willingly provide a home for a patient are unable or unwilling to
visit a psychiatric hospital regularly.
Case 2: Robert Jackson. At the age of sixty-two, Justice Robert Jackson suffered
a severe heart attack while serving on the United States Supreme Court. The
Court's work is arduous and taxing. His doctors gave him the choice between
years of comparative (though not, by any means, total) inactivity off the Court,
and the risk of death at any time by continuing his work on the Court. Jackson
chose to remain on the Court. He suffered a fatal heart attack shortly thereafter.
No court interfered with the Justice's decision, nor was it ever suggested
that he was dangerous to himself and therefore in need of psychiatric care.
Quite the contrary: his decision to continue the work of the Court was
widely praised. Many people would choose to do the same: take their
chances with the things they enjoy doing rather than be cooped up, inactively,
for the rest of their lives.
What distinguishes Mrs. Lake's case from Justice Jackson's? For both, the
choices jeopardized their lives, Jackson's even more than Lake's. Why was
Lake involuntarily committed and Jackson never questioned? The major
difference between Mrs. Lake's case and Justice Jackson's is that Mrs.
Lake's request to live out her years at home, and with people who loved her,
was "psychiatrized." That is, her choice was believed to arise from mental
illness ("chronic brain syndrome"), while Justice Jackson's was not. The
fact that she suffered "chronic brain syndrome" obscured the similarities
between her choice and that of others. Now, it is clearly the case that some
psychologically distressed persons suffer thought disorders of such magnitude
that they are rarely, if ever, lucid. But that was not the case with Mrs.
Lake, nor is it the case for most psychiatric patients, all of whom enjoy long
periods of clarity during which they are as capable as others of making significant
choices between the risks of liberty and the security of incarceration
(Dershowitz, 1998).
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Looking for treatment?
If you are ready to schedule a FREE Consultation...
I encourage you to access this website
for the treatment I recommend here:
http://www.TheLiberatorMethod.com/