To the Editor: William Anthony has done superb work in psychiatric rehabilitation, and I have always admired him. I do not, however, agree with this comparison of treating multiple sclerosis (MS) and serious mental illnesses. It is like comparing apples and oranges.
It is our brains that make us uniquely human. No other mammal has such a highly developed brain. MS does not damage the brain; serious mental illnesses do. That is an essential difference. We do not let seven-year-old children determine their treatment when they are seriously ill, because their brains are not yet fully developed. In a similar vein, people in severe psychotic states have brains that are not functioning well enough to make decisions about treatment.
I have worked in jails and in shelters for homeless people, where there are large numbers of people with serious mental illnesses who have refused treatment. I fail to see the advantage of jail over involuntary treatment. The psychiatrist Daryl Treffert (1) said it all very well in "Dying With One's Rights On," which he wrote more than 30 years ago.
Why must we keep swinging from one extreme to another in our treatment ideologies? There is a time and place for involuntary treatment. Such treatment should be given in the kindest, most respectful, and gentle way possible, of course. Then as soon as a person has responded well enough to be functioning on a rational level, he or she should be involved in making a treatment plan.
We have all seen families deplete their resources, both emotionally and financially in an effort to save one family member who is actively psychotic and refusing treatment. Sometimes it may be better to save four members of a family by permitting the forced treatment of one. Sometimes is may even be necessary for the family to give up and hope that the mental health and welfare systems will find a way to intervene.
Dr. Anthony, I am sincerely sorry to hear of your MS. But I strongly disagree with what it has taught you about serious mental illnesses.
Ms. Wasow is professor of social work, emerita, at the University of Wisconsin, Madison.
Treffert DA: Dying with one's rights on. JAMA 224:1649, 1973