Hacker News Reader

> So, sometimes it's okay to involuntarily treat, but only if there's a present or soon-to-be present physical danger

If you weren't aware, that is the current standard for involuntary hospitalization, at least in the US. I believe the phrase is "danger to self or others."

Florida's involuntary commitment criteria are probably the loosest in the US[1]:

    CRITERIA.—A person may be taken to a receiving facility for involuntary
      examination if there is reason to believe that the person has a mental
      illness and because of his or her mental illness:
      (a) 1. The person has refused voluntary examination after conscientious
             explanation and disclosure of the purpose of the examination; or
          2. The person is unable to determine for himself or herself whether
             examination is necessary; and
      (b) 1. Without care or treatment, the person is likely to suffer from
             neglect or refuse to care for himself or herself; such neglect or
             refusal poses a real and present threat of substantial harm to his
             or her well-being; and it is not apparent that such harm may be
             avoided through the help of willing family members or friends or
             the provision of other services; or
          2. There is a substantial likelihood that without care or treatment
             the person will cause serious bodily harm to himself or herself or
             others in the near future, as evidenced by recent behavior.

Note that this is only supposed to result in a 72-hour evaluation. It has also been fraught with allegations of abuse by family members, schools, and courts who don't want to properly deal with complex psychological and behavioral issues in more appropriate ways.

[1] Full Baker Act is here: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Displ... The criteria are specifically from 394.463 (1).

It's interesting that Florida's solution is still fraught with abuse because those conditions are about the broadest I'd consider reasonable when removing a person's autonomy.

Sadly, being on the streets and incapable of caring for oneself isn't considered a 'danger to self', at least in the eyes of the hospital that evaluated my former fiancee.

Personally, I think we need to set the bar for involuntary intervention higher than being an active threat. If someone doesn't have the mental wherewithal to not lose their coat in the middle of a cold snap, that seems like a clear indicator to me that they need help and their refusal shouldn't be taken any more seriously than their delusions.

I may be biased and embittered on this subject.

To me, freezing yourself to death seems like a case of 'danger to self' but I'm neither a lawyer nor a doctor.

But in other situations, the question arises just like in the article. At what point do you want to dose the individual with a sense of reality? If their mentally-ill self is content with the life they lead and "curing" them of it will leave them empty, sad, and hollow (in addition to the side effects of medication), is the arguably a better option?

If you factor in the fact that the hospital won't be there to help him rehab back into society, I can see the decision being difficult to make, as the author mentions.

I mean, it could be interpreted as a 'danger to self', but choosing that interpretation loses the hospital money. I'm saddened but not really surprised.

That may be the official standard, but in reality the evaluating psychiatrist commits you if he wants to, and they do sometimes err on the side of caution. So it's somewhat arbitrary depending on where you are and when.

Just a question, but how strictly is that followed? If a mentally disturbed person (who presents no current physical threat) is put in front of a psychiatric professional, how often is that professional going to say "Ah, let him/her be. They aren't going to harm anyone". Especially in today's climate of preemptive responses to threats.

As someone who went to Virginia Tech I've seen how that "eh, he's/she's not bothering anyone" response can go terribly wrong. And when it goes wrong, the first thing people will ask is why that professional didn't do something when they had the chance.

One thing that wasn't addressed in the original article is that there's not a lot of room in psychiatric hospitals and not a lot of funding to keep people there long-term. So that results in a more or less tacit revolving door policy, and certainly affects the decision to involuntarily commit or not.

Generally, professionals will not involuntarily commit patients unless the threat is current and pretty explicit, though there are exceptions. Professionals can involuntarily commit people for short periods of time for observation, to determine if they really are or are not a risk. For instance, if someone shows up in the ER with knife wounds on their wrists, that can warrant an observation period. Interactions with the police can lead to observation if the officer believes you to be mentally ill.

It's a very fine line to walk between individual liberties and providing treatment to those who need it. If you're schizophrenic and you live on the streets, yell at birds all day, and eat from the garbage, you are not considered a danger to yourself, even though you have a pretty abysmal quality of life and are at serious risk of dying from disease, drugs, homicide, exposure, or starvation. It's a complicated conversation with no clear answers.

I am fascinated as to why psychosis so often takes such a religious bend.

Purely speculatively, I would guess that is doesn't, naturally. But religious indoctrination is extremely common. So, it makes sense that if any given person is experiencing a mental break that there's a reasonably high chance they will have a religious background rife with grand concepts to pull from.

The one person I knew personally who broke with reality wasn't religious, and instead seemed to be pulling ideas from her previous goals and highlights of her life. She described a sort of ideal version of her life, the best things she could think of in the moment, regardless of consistency or reality. It makes sense that if one were raised in a religious household, one would talk about being chosen by God or some such instead of how you were getting straight A's in school and getting hired by 5 different places.

Cultures experience mental illness in very very different ways.

http://news.stanford.edu/2014/07/16/voices-culture-luhrmann-...

People tend to think their talking to spiritual things in some sense, but Americans heard God, or angels or demons, Indians tended to hear from ancestors or kin, Ghanaians from various spirits. Indians and Ghanaian found that many voices where helpful and positive. The Americans all found their voices to be violent and negative.

One prophet whom I will not name here initially believed to be possessed by the evil spirits but his wife, which had the monotheistic upbringing, made him believe it was an angel of the God. There's a touching scene where she makes him sit on her one and then another leg, and then she makes him sit on her lap and undresses. As the "images" he saw disappeared at that moment she "proved" him that it's not an evil but the "holy" power that possesses him.

She probably just wanted to calm him down and make him see the world more positive. Eventually it wasn't positive for his opponents and the world. He started to believe he has the direct connection with the God and that therefore anything he does, even the killings and tortures, were directly supported by the God. He turned out to be a "successful" prophet based on the impact he made.

I am by no means a religious expert but it's sad that your very reluctance to name the prophet in question made him easy to guess. And it led me down a bit of a rabbit hole:

https://wikiislam.net/wiki/Muhammad%27s_Just_In_Time_Revelat...

And on and on:

http://quotingislam.blogspot.co.at/2011/06/muhammad-orders-t...

It's worth considering that there are differing opinions on what constitutes danger.

Some would consider religious indoctrination dangerous. Few would agree on the definition of indoctrination.