Should The Mentally Ill Be Forced To Medicate?
I owe this one to a google search that led to my site. And I think that it’s an important question that delves deep into the philosophy of medication.
I’ll tackle the Pro side of this first.
One of the best arguments that I’m looking at is economical. According to Times Magazine, those with serious mental illness (SMI) like bipolar disorder, major depressive disorder, and schizophrenia, cost society $193.2 billion dollars in lost productivity. What’s more, that is a conservative number. To put this into perspective, the GDP is $14.58 trillion, meaning that the 6% with a SMI cost the the USA 1% of its GDP. If we then follow National Institute of Mental Health’s statistics on minimally adequate treatment, only 12% of those who are mentally ill are receiving minimal treatment. So a point can be made for giving treatment to those who are unmedicated and try to lower the societal impact.
But there’s another, which is that an initiative to force everyone with an SMI into treatment would be an undertaking that would make the number of those receiving minimally adequate care jump from 12% to 100%. That’s a mammoth undertaking, but part of me (and this is the pill popper side of me) sees this as a potentially good thing. Especially if medication is expanded to treatment. The devil is in the details, if the government is supplying, then it might not be the most horrible thing ever. But then there is the con to this. To force expensive medications onto people and make them pay for it, that’s grotesque. Multiple medications might be required to treat, and that can run up the bills very quickly. So depending on what people mean by forcing medication on people, it could be a good thing or a horrible burden to people.
On the con side there is the fact that the cure can be worse than the disease. Medication is not a one size fits all approach to mental illness. Sometimes interpersonal rhythm therapy with cognitive behavioral therapy is enough.
But there is a deeper philosophical point to make here, I’ll borrow it from John Rawls’ approach to justice in a society. Imagine that you are creating a society without knowing anything about yourself and where you would be. Now, would you create a society such that your personal autonomy could be violated and forced to adopt dangerous medications at the behest of the rest of society? My vote would be no. Furthermore, I would not subject people to medications where the side effects can be intolerable.
Finally, since when does being mentally ill make us second class citizens that can be forced to do anything? Having an SMI does not impact our citizenship, nor should it. To see why, just return to the thought experiment above to determine whether or not one would design a society where they could be second class citizens by luck and genetics. I believe that most people would not. I at least wouldn’t.
I would also like to touch on a point that is rarely explained, what does it mean to be medicated? Does it just mean slap everyone with a mental illness on some lithium and antipsychotics? Does it mean remission or just band aids? Being “medicated” makes it sound like there is a cure for it, like it’s a broken leg. It’s easy to throw a term out there, but what really goes on in terms of “medicated” is so vague that it’s hardly even a useful term. So for this question to even make sense there needs some clarification to be done. First of which is what it means to be medicated. Secondly, what does it mean to be forced? Is there a prison sentence involved in noncompliance, or is it a forced stay at a mental hospital? Finally, the should needs to be qualified. Is it a moral should, a justice should, or a pragmatic should? Terms can be tossed out, but do they have substance, and I find these lacking any real substance at all.
Finally we should look at should, if it is a moral should, then I’d like to see your morality, because it sucks. If it is a justice should, then what type of justice are you looking up to. One might use Rawl’s theory of justice, but part of what I did above is show that at least for me, I’d not live in a society that putatively medicates people. I’d be for a society that gave free access to mental health care, but that’s a different story. The only should that I see happening here is a pragmatic one. Where providing medication to those with serious mental illness would offset the economic toll that these diseases ravage. I mean seriously, 1% of the GDP is lost, some money could be thrown at the problem to help with that.
As a side note, and I’m not going to get into it here. It’s that what usually fuels this fire is the idea that those with mental illness are dangerous and need to be medicated. I’m not going to go into this here, that’s for a whole other post.
http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml
http://www.time.com/time/health/article/0,8599,1738804,00.html
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Posted on December 13, 2011, in General Philosophy and tagged bipolar, bipolar disorder, depression, health, mental health, mental illness, philosophy, schizophrenia. Bookmark the permalink. 8 Comments.
Your post about made me climb out of my skin! I have finals this week and I have to study so I will make this short. Healing depression and bipolar disorder does not come from medication! Healing comes from somewhere deep inside of a human. Medication only carries a person through (keeps them alive and stable) long enough to get true healing. Psych meds were never intended for long term use.
A person with depression or bipolar disorder can live a beautiful life if they are willing to do the work necessary to heal without medication. I know, I am one of those very humans. I have been medication free for about 8 years now.
It breaks my heart that the medical profession is in bed so deep with the pharmacy companies that they will push meds instead of true healing! My ex-psych refused to take me off medication. I bet he would be shocked to see me now!
A better way to spend that 1% – get people into real therapy and work toward real healing!
hi i have a question my husbend was 302 by a doctor he over dosed on pills do u no by law if they are allowed to medicate him and how long by law are they allowed to keep him thanks so much
I think this is a really interesting topic to think about and debate.
A key question for me is: who’s best interests are we working for? Are we working for the best interest of society, for the patients, or for the patients family?
From here, we need to conceptualise what someones best interests actually are. What is best for society, for the patient, and for the family members? It’s important to take into account the fact that each party’s best interests will probably differ. What society, an individual and a family want are different. Is it possible to find a happy medium?
Personally, I do not trust the medical profession (in general – I must stress this point) to work in my best interests. I appreciate the necessity of the Mental Health Act, and the fact that I can be sectioned and medicated forcibly if the situation warrants it. However, this frightens me because what I see as my best interests when I am well are probably not what the doctors who treat me will see. After all, they won’t know me for who I am, so how can they make a judgment about what is right for me? It is for this reason I am creating a living will.
I believe it is not in my best interests to be given large dosages of powerful drugs. Most doctors would believe it is. Who is right? Science, group differences and the average are helpful for making decisions, but how does any one person fit within the mean?
Another issue I think it’s important to address when it comes to medication is: if someone is non-adherent to their prescribed medication regime, and they take it irregularly and in varying dosages, is it best for this person to be on drugs at all? These are powerful substances that create huge changes in the brain, if they are not taken as prescribed, are they causing more harm than good? I don’t know the answer to this question.
Yet another issue is that of free choice. Should we be able to choose what we do with our health care? If we do not want to take medication, then should we not be allowed that choice? And, if we are unwell, say manic or depressed or psychotic, are our choices the choices of an illness, or are they the choices of us? And under what circumstances should free choice be respected?
All great ideas. I could only skim over a few of them in my current state of blahness, but you really highlight some major issues. There is a tension between what society would want and what is in the best interest of the individual. This tension even exists in the role of the individual in a society, to some extent we should be afforded every right that a healthy individual has, but on the other hand, sometimes we do need to be forcibly medicated. Personally, I don’t want random people making decisions for me and I’m going to draft a power of attorney with my parents in charge. That way, if it ever comes down to me needing medication and not wanting it, they can make the decision that is in my best interest. It’s especially important if I ever go psychotic again.
In my opinion medication should never be forced on a person. People have developed a million different coping mechanisms. They may not necessarily be the right ways of doing things, and may lead to further hurt or anguish but if it works, if only for a short time then what’s wrong. Taking medication can just be as harmful as not medicating. I speak from experience when I say that. I don’t feel that medication should be the only resort. It should be the last resort.
I am a schizophrenic. I have been living with it for a few years now. I have tried many forms of treatment. I have found medication does not work well with me.I find I function better off than when I was on.
Not only do I function better now, but I developed other problems from the medication. I now have to deal with psych issues that I never had before. These were side effects of the medication. Medication should NEVER be forced.
Some people really do need it, but some it makes things worse. I really think that this is something that should be worked out between someone and their doctor.
I know this from my own first hand experience. I would rather die than be forced to take meds again. Most states offer free mental health care. These places also cover the cost of meds. If someone really needs/wants help it is out there.
I think that there is a lot to be said for the use of Advance Directives where you can nominate your medication of choice ahead of time should there be a need to commence medication when you are not in a situation where you are able to decide for yourself. I like a lot of the principles that Mary Ellen Copeland puts forward in the WRAP to do with crisis planning so that you can have a say in what happens and so that there are instructions and agreements made ahead of time. I also carry a list of my medications in my wallet along with a contact number for my doctor in case there is a need for me to be in hospital so that noone else stuffs up my treatment.
This is a super hot subject, and I’m sorry to say I wasn’t able to get to it until now.
It’s not the American way. We can’t force anyone to do anything in this country except live and pay taxes. (I never understood the “live” part. But, euthanasia is another topic for another day). The government attempts to force us to do all kinds of things. Look at flu shots and birth control. I have had those things attempted to be forced on me for a long time. No, I don’t want the flu shot that’s got worse junk in it than the flu. And no, I don’t want to lose my option of having as many children as I want, as my god-given right, because I had this birth control forced on me. And by force, I’m using the more creative definition that includes coercion, deception, and blackmail. I refused to vaccinate my child. I don’t feel like these new vaccinations are safe. Every year, they reveal something new and horrible from longitudinal studies. I got him the ones for the worst of them, DTaP, Hepatitis, etc. But, if it’s less than five years old and has questionable benefits, like the Chickenpox vaccine, forget it.
That would also give Big Pharma waaaay too much incentive. Medicate SMI? Then, they’ll start broadening their definition of SMI, just like they’ve broadened the parameters on most childhood Dxs. Every kid seems to have some kind of problem where medication is the answer. I don’t like that. I don’t like the fact that I have to question my kid’s Dx, because I have to wonder if they’re scamming me. Yeah, my kid has a developmental delay, but is it really ASD? Another topic for another day, I suppose.
And then where does it stop? Over-medication, to the point of near overdose, right? And if someone overdoses, that means they get an expensive stay in the hospital! Do it! Do it! I can hear the enticing cha-ching now. And then, they’ll have a whole population of people to experiment their unsafe medications on. Sure, they’re considered safe now. But, 20 years down the line, we’ll start seeing people with severe brain damage. But, these people won’t have any recourse, because they signed a waiver with the belief that there was no other option for successful treatment. Why don’t we save ourselves the trouble and bring back the lobotomy now?
I see the merits to this. There are a lot of people who refuse treatment that are in dire need, or will become in dire need. Lost time, lost wages, lost productivity, increase in debt due to heavy medical expense, etc. Then, what about the fraction of the population that completely loses touch with reality and does something to harm themselves and / or others? We’ve had a number of shootings here in Pittsburgh within the last five years that are a testament to what mental health services could do for people. No one wants to see anyone else get hurt.
Honestly, I don’t think I want the additional stigma attached. What if I decide that I don’t want to be medication compliant anymore? Then, I’ll have it forced on me, and that will always live in my medical history. Dangerous and defiant. One step closer to Big Brother. What if an employer finds that relevant to a job situation? I could see my whole world collapse around me. It’s bad enough that I have to tred carefully as it is. There’s already a such thing as a 302 here in PA, where someone, official or not, commits you. And if it’s in a record, someone can find it. How does a person explain that to their employer? “Oh, I was acting funny, so someone took it upon themselves to ‘get me treatment’.” Yeah, that will work out. I’m just glad that the hospitals around here are so packed that they won’t take anyone that isn’t an immediate threat.
It would probably be a better idea to offer more anonymous mental health screenings at community health fairs. I’ve been to a few at my place of work. They have one tiny table, tucked in the back corner. The people working the table never approach anyone, and seem to be hesitant when someone else approaches them. They only screen for depression. Why is it still so taboo to talk about serious mental illness, like schizophrenia and bipolar disorder?
Education in the community, from the community. Someone eventually needs to step out there and tell the world, “It is okay to have a mental illness, and it’s okay to be treated for it.”