June 10, 2007


Mental illness and the price of 'free will': Are laws protecting the right to refuse psychiatric treatment doing more harm than good? (Susan Partovi, June 10, 2007, LA times)

THE PHONE RANG at 3 a.m. "Dr. Partovi," the person on the line said, "I'm calling to let you know that William expired this morning."

I'd first met William about six months earlier in May 2006 at the Venice Family Clinic after his release from a hospital where he was treated for congestive heart failure. I still remember his loud, childlike voice: "No, no … I'm not going to the hospital!" he shrieked when I told him that I wanted to refer him to Harbor-UCLA's cardiology clinic.

William — I'm calling him that because medical privacy rules don't allow me to use his real name — was 61. Six feet tall with gray hair, he dressed in T-shirts and pants that were a little too big. He lived alone in an apartment in Brentwood and had a sister in Canada and a niece in New Jersey.

Three years earlier, he'd had a heart attack and a stroke, and he now suffered from dementia, likely as a result of the stroke. It was quickly obvious to me that William could not take care of himself anymore. He spoke like a whining toddler. He was very stubborn, and his judgment was extremely limited. "My memory's not good," he'd huff if he couldn't answer a question.

But one's inability to care for oneself is not a criterion to receive involuntary treatment for the mentally impaired. And for many mentally impaired people without family nearby to rely on for housing, food and help in managing their medical care, the result can be disastrous.

A recent study of adults with serious mental illness who were treated in eight states' public hospitals and clinics found that they died, on average, at age 51 — 25 years younger than the average American. The study's lead author, Dr. Joseph Parks, director of psychiatric services for the Missouri Department of Mental Health, said that about three out of five died of preventable diseases.

William's heart failure was very treatable, but only if he would take his medications appropriately.

Freedom has always been understood to impose obligations. Remove them and freedom is lethal.

Posted by Orrin Judd at June 10, 2007 12:00 AM

We should tread warily here. I have seen these matters corrupted by grasping relatives too often to welcome making it easier to overcome individuals' rights to make decisions over their own lives.

Posted by: Lou Gots at June 10, 2007 4:28 PM

Agreed, but can't allow people to put themselves and those around them at risk. We made a huge mistake when we deinstitutionalized our mentally deficient fellow citizens.

We just went through this with my mother who was delusional and paranoid for many years, but was very good covering it up by pretending that her confusion was caused by hearing loss. Her doctors were no help at all. Neither was the family who only saw her for short periods many months or even years apart.

It was only at the very end when she couldn't keep up the pretense any longer that she finally got help. Had she been diagnosed sooner, she could have lived a less stressful life, not to mention us, by taking the meds.

Posted by: erp at June 10, 2007 5:57 PM