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Comment by ashworth | Hacker News Reader

But who decides who has control over their mental faculties? Who decides who is competent? The state? The family? The physician?

Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.

This isn't a hypothetical for me... like the author of the article we're discussing, I've had close friends suffer from schizophrenia and depression, and seen one of them involuntarily institutionalized. I wish it was so clear cut SpaghettiCat, but I think the majority of mental health cases are not so black and white as the one in the article.

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> But who decides who has control over their mental faculties? Who decides who is competent? The state? The family? The physician?

Who is the most competent to make this decision? The medical professional. Of course government (advised by medical professionals) will set the policy which will constrain the possible decisions.

> Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.

This could apply to absolutely everything: evil police officers taking bribes and releasing criminals, doctors not prescribing expensive medicine to save their hospital money, etc. Does that mean we do away with police protection and hospital services entirely? No, as in this case, we have to accept the risk of the person in authority to make the good decision.

I agree this issue is not black and white.

> Who is the most competent to make this decision? The medical professional. Of course government (advised by medical professionals) will set the policy which will constrain the possible decisions.

This has gone poorly quite often throughout history, which is why it's a tough question. Homosexually was officially considered a mental illness in America until 1974.

Note that countries used to do a lot more forced institutionalization than they do now. There were lots of abuses (even in the West, to say nothing of the way it worked in the Soviet Union: https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_... should be a must-read for anyone arguing for government involvement in institutionalization decisions) and people have backed away from that sort of thing.

It's possible that Europe and the US have swung too much to the other extreme now, of course. But as you say this is very much not black and white.

And there have been at least as many cases of political abuse of the police force, should we also cut down on that just because there is a potential for abuse? Many instutions that are intended to good can be abused or used as political weapons under a totallitarian government, but I think the potential for abuse is much reduced under a more benevolent political system.

Police abuse in a "benevolent political system" generally reads to things like bills of rights and restrictions on when the police can arrest people. Sometimes that means criminals go free.

That's precisely what happened with psychiatric institutionalization: abuses (not just in totalitation regimes) led to restrictions on when it can happen. Sometimes that means that people who maybe should be institutionalized are not.

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