Two faces of fate

Excerpt from the above post’s comment thread:

I blogged on the same topic today and stumbled onto this blog via tags. Anyway, my views on this subject are quite different from those expressed here. Perhaps you may wish to take a look.

Comment by Abhishek — November 1, 2007 @ 11:28 am

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Hi Abhishek,

I read your post. Interesting. Your viewpoint is not in opposition to mine per se since I have not touched upon Faisals contention.

Nevertheless,it gives me a chance to clarify my stand . You say ” My position is that involuntary custody in such an instance can be justified for only one reason- to prevent the person from harming others.”

I disagree. History of schizophrenic patients normally substantiate two dominant factors 1) If not under medication/supervision/ the disease progresses rapidly and may degenerate into a violent mindset 2) Violence does not constitute an act on another necessarily. It also denotes actions which are unhealthy to oneself. Perhaps this is what Aamir and his mother fear may happen to Faisal.

If one cites the example of Parveen babi since the randomity of her story has intrigued most of us… she willed to live ‘independently as well’ and managed to do so since she had no family to coerce her otherwise. Finally what transpired was pitiful. She died a lonely, sick, destitute woman in her flat at Juhu… too terrified of opening the door to even the domestic help or milkman. She died out of neglect. When the door of her flat was forced open, I believe the scene was ghastly. Gangrene had afflicted her leg, it was putrid and finally led to her death.

She made a decision too. But was it in her best interest? Aamirs family is concerned for him. However he perhaps views it from his perspective. Imbalanced logistics compel him to feel as if’imprisoned’.Presently his moods or thoughts have complete sanction of sanity in his mind..when under medication. One shudders to think of the catastrophy medical neglect may cause

I chanced upon the blog of a schizophrenic patient who understands fully well he is unwell. His notes make for such soulful reading. If you like you may go through to understand the inner turmoil they face.

http://the4thavenueblues.wordpress.com/category/schizophrenia/

Comment by kaveetaakaul — November 1, 2007 @ 11:48 pm

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I guess we differ on that point. Parveen Babi made a choice and in my view such a choice ought to be respected. Yes, her last days were terrible. Yet, for a person with a strong sense of individual freedom, a life in which one has such a freedom is often preferable, whatever the circumstance. If Parveen Babi had been coerced into commitment, put in a hospital against her will, perhaps her death would have been, shall we say, ‘neater’, but would it have been happier?

If a schizophrenic person understands he is unwell, and makes a previous agreement with a loved one (or someone he trusts) that once his condition worsens, the latter will take over the decisions in his best interest, then it is perfectly ok. But some people prefer to have their freedom for as long as they have a sense of what freedom is (and this sense remains much beyond their mind starts deteriorating). I think we have no right to force anything on such a person.

Comment by Abhishek — November 2, 2007 @ 1:03 pm

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However the fact that we know which chemicals are involved in different moods does not mean that it is ok to limit the freedoms of those in whom these chemicals occur in a different proportion than the rest of the population. Indeed, with further advance in medical sciences it will probably possible to give much more refined criteria of various abnormalities. We already have some idea (and it will no doubt become more precise with time) which genes which lead to homosexual dispositions, which virus cause bird flu and what concentration of chemicals lead to schizophrenia. But these are merely refinements of what we already know -differences exist. Indeed, take *any* mental condition that is socially abnormal and I am sure that it will be (one day) possible to give a biochemical desription of it. Does that mean those with these differences have less of a right to freedom? Some people take the craziest risks in life. That makes them happy. I am sure there is a genetic/biochemical way to idenitfy them (at least broadly). That does not mean they deserve to be committed.

You are right that expert testimony is (usually) good in identifying a particular condition, like clinical depression. However in no way does it follow from there that action against such people need to be taken against their will. How much brain ‘malfunction’ deserves involuntary commitment is *not* a scientific question. It would be a scientific question only if the criterion for involuntary commitment is specified. Once the criterion is agreed upon, science can specify means of identifying such
individuals.

In other words I am talking about the ethical basis for involuntary commitment. My fundamental point is that this criterion in the case of involuntary commitment case should be “imminent danger of harming some one else”. I do not agree to coerced medical administration upon someone who is not a danger to others, except for the most extreme cases of impaired mental abilities, e.g. a grown up who is like a four month old baby. So, in my book it is morally abhorent to commit someone who has ‘delusions’ or who is ‘clinically depressed’ but can express himself (and in particular his wishes) coherently, and is of no danger to others. The fact that the dopamine balance in his brain is different from mine or that his judgement with regard to certain things might vary from mine (which reminds me, some of the greatest mathematicians, artists and musicians of the past were identified as either schizophrenic or clinically depressed) does not make his wishes any less sacred.

Similarly, I believe those who decide to commit suicide have the right to do so. They are exercising their right to do what they want with their bodies (in my book, one of the most sacred rights that a person has) There is absolutely no basis for their involuntary commitment, though perhaps there is some basis for a very short-term restrainment if they are ‘caught in the act’ - merely to ensure it is a well thought out decision on their part. I believe I am a rational person and let me say this now - if at any point in my life I decide that its continuance is not worthwhile, I’ll take my life. I’ll be exercising a basic right. And no one should be put in a mental institution for wanting to do so.

Mental illness is not anymore “what society considers abnormal”. By extension, even bird flu could be called just “what society considers abnormal”.

There were days when we didn’t know much about the human brain and psychiatry was more or less a pseudo science. We have left that era way far behind.

Psychiatry is pretty much proper science now. We know that there is a dopamine circuit and a serotonin circuit in the brain and we know that these can be manipulated by SSRI’s. We know that a suicidal person with clinical depression has impaired judgement and so does a severe case of schizophrenia (seen the exorcism of Emily Rose). We know that a person with alziemers disease or retrogade amnesia can’t give consent and we the society have to take their decisions for them. There is a definite case to be made for involuntary commitment.

Of course, there is a question of where the line is to be drawn, but expert testimony and objective criteria sound good enough to me. If it’s implemented badly, improve the implementation but don’t throw the baby out with the bath water.

Szasz had it wrong. Just like science is not the rule of the scientists, pharmacy is no rule of the doctors.

And so we are supposed to decide on behalf of the patient? How can we judge what is “best” for someone else? For instance, if I have a sickness tomorrow and I refuse to see the doctor- does that justify someone else taking over my decisions to prevent my health from deteriorating? What if I go on a spate of outrageous spending that would be considered irrational by the overwhelming majority of the population?

Think about it. Mental illness is essentially what society considers abnormal. It is, in a crucial way, a value judgement. Going a bit back in time, a homosexual was often involuntarily committed with precisely the kind of justification that you offer.

I believe that nothing justifies taking over another person’s freedom (if no crime is involved). Least of all considerations that override his wishes for “his own good”. If I want to hurt myself, or take decisions which (in others’ eyes) are self-harming, I should be allowed to do so. I am fundamentally against involuntary commitment, especially in cases of perceived ‘mental disorder’ where the individual is of no danger to others.

Involuntary commitment is one of the most abused practices in history. It has frequently involved the most inhuman methods - have you watched “One flew over the cuckoo’s nest”? Also you should read up about how it has been an effective tool for political imprisonment , for instance applied frequently in Soviet Russia against writers and artists with dangerous ‘ideas’.

Another rationale behind these kind of legal practices is that the patient’s capacity to judge what is the best way to heal himself might be impaired and might further contribute to the illness. So, it is essential for the health of the patient that he be forced against his will.

This is called involuntary commitment and is practiced all over the world. It is a bit controversial of course.