Involuntary Commitment of the Mentally Ill

Four years ago in Maine a paranoid schizophrenic named William Bruce murdered his mother with an ax.

Bruce was known to be dangerous. He had been committed to a psychiatric hospital involuntarily. But then, he was released.

Elizabeth Bernstein tells why:

Bruce had a long history of mental illness, including attempted suicide and attacks on both his mother and his father. In the year before the murder, he was hospitalized at the Riverview Psychiatric Center in Augusta, Maine, where his doctors noted that he was hostile, paranoid and “dangerous if released to the community without pharmacological treatment.” Yet, Bruce refused medication, saying he didn’t need treatment, the hospital released him when his involuntary commitment term expired,  and two months later he killed his mother.

Not well: “when his involuntary commitment term expired….”

You can only hold an individual for a limited period of time in America.

In France, as noted yesterday, you can hold a dangerous person indefinitely.

Note well: he “refused medication.”

The law grants schizophrenics a moral agency that they lack. Suffering from a brain disease, they do not even know that they are ill.

Bernstein explains:

People who are mentally ill often suffer from agnosia, or a lack of insight into the illness; they don’t believe they are sick. Family members or parents may not comprehend the extent of the illness or may not be able to control their loved one and get him help.

Some schizophrenics hear voices. They believe that the voices are real. There is no way you are going to convince them that the voices are not real.

The law that limits the time you can commit them also grants them the right to refuse medication.

We cringe at the idea of depriving an individual of his free will, but paranoid schizophrenics do not seem to possess the mental competence required to make a judgment.

Since their illness affects their brain, they lack certain basic mental capacity.

Of course, once Bruce murdered his mother, he was confined to a psychiatric facility indefinitely. Since that time, Bruce has been forced to take his medication and has made great progress.

Four years later Bernstein spoke to him on the telephone.

In her words:

When Bruce came to the phone on Tuesday, he was lucid and articulate. “I have never been this good since before I became ill, in my late teens or early 20s,” he says. He credits Abilify and his daily therapeutic treatments with helping to put his mind back together and says he plans never to stop taking the drug. “My mom would be here today if I’d taken the medication and had accepted that I had a mental illness instead of denying it,” he says.

Psychopharmacology has made extraordinary progress in the treatment of psychosis. The legal system has set up roadblocks that make it very difficult for those who need treatment to receive it.