Yesterday our book, Committed: The Battle Over Involuntary Psychiatric Care was officially released. Our publisher, Johns Hopkins University Press, asked if I'd write a post for their blog, which I was more than happy to do. With permission, I've asked if I could reprint the piece on our other social media venues, including here at Shrink Rap. I hope you enjoy reading about what went into writing this book, and please do visit the JHUP blog over at https://www.press.jhu.edu/news/blog; they have some terrific authors writing about all sorts of topics.
By Dinah Miller, M.D.
2 November 2016
After three years of work, Anne Hanson and I are delighted
that our book, Committed: The Battle Over Involuntary Psychiatric Care was officially released yesterday!
So how did I find myself sitting in court rooms and riding
alongside a police officer? Let me tell you a little about the process of
writing this book, because it was a quite the adventure for me. The title implies that this is another
book by psychiatrists for psychiatrists, but for me, the days I spent working
on this manuscript were days off from psychiatry. Those mornings I woke up a psychiatrist and felt like I walked
into a phone booth (maybe it was just my shower) and emerged as a journalist.
Those days I spent doing research
in a whole new way: I cajoled
people into talking to me, made call after call which sometimes led to dead
ends, trolled message boards, shadowed a variety of psychiatrists, judges and a
crisis intervention police officer, attended legislative hearings, and sat in
on government work groups. I
arranged video meetings with patients, doctors, lawyers, advocates, and adversaries by phone and Skype,
including one with a psychiatrist in New Zealand—quite the challenge with the
18 hour time difference.
I toured psychiatric facilities, and I had meetings and meals with the most interesting of
people, including esteemed psychiatrist/author E. Fuller Torrey of the
Treatment Advocacy Center, the president of the American Psychiatric
Association, a Christian Scientologist whom I sort-of ambushed and who gave me
a video on “Psychiatry as an Industry of Murder,” a mental health court judge
and his team, a former state hospital superintendent, and a medical sociologist
from Duke, to name just a few.
This is not how psychiatrists usually do research.
Patients are involuntarily
hospitalized for one of two reasons: they are acutely psychotic – meaning they
have delusions and often hallucinations and sometimes their thinking is
disorganized to the point of being nonsensical and incomprehensible – or they
are depressed and suicidal. Both
depression and psychosis can be tormenting. Often delusions include paranoia,
the idea that people are trying to harm or kill you. If these patients are presenting a danger to themselves or
others, and they refuse voluntary treatment, they can be held in a hospital
against their will and forced to get treatment. Patients subjected to these treatments get better, and they
often leave the hospital within weeks, if not days.
So what is wrong with that?
Shouldn’t people be happy that someone helped them? Sometimes, patients are grateful
for the help that was forced upon them, but we learned that it wasn’t so
simple, and some people are truly traumatized by the care they get. This care can include the loss of basic
liberty, moments of humiliation, being tied down with restraints or placed in a
seclusion room, and being held down by guards to be injected with sedating
medications. While many involuntary
patients don’t experience this type of physical force, some do. Still, these treatments are often used in dangerous
situations where there may be no good alternatives.
As we heard story after story, we
learned there are large organizations that champion patient’s rights. There are no formal organizations of patients, however, campaigning to make
it easier to commit and force care on people. We decided that if many people leave a treatment setting
feeling injured by the care they received, it is worth more scrutiny.
I didn’t want to write a book full of facts and figures and historical
perspectives, though those are all include. I wanted a book about the human beings and their stories--
who they are and how forced care touched the lives of patients, family members, doctors, the police officers who
brought the patients to the ER and the judges who retained them.
So many people I spoke with had siblings or parents with psychiatric
disorders, or their own histories of illness or loss. So while being a journalist is an entirely different
occupation from being a psychiatrist, the one skill that translated well was
that as psychiatrists, we are good at getting people to talk about themselves,
and this makes for lively and emotional stories.
While the reader might think
I was writing about psychiatry, I felt very much that I was writing about civil
rights for patients and psychiatry’s role in preventing violence, since involuntary
care is now presented by the media and our legislators as a way to prevent gun
violence, suicide, and mass murders, topics we didn’t shy away from.
At times, it was really fascinating,
but there were challenges and many people who did not want to talk to me. Involuntary psychiatric care is a
polarizing topic, not unlike other polarizing topics in our society. It took me months to convince members
of MindFreedom International to speak with me and I never did convince the
leaders of a local chapter of the National Alliance for Mental Illness (NAMI)
to open up. They said the subject was too sensitive, and I ended up driving to
Arlington to meet with one of the national organization’s attorneys. I was determined to look at this
complicated topic with respect to all who came to the table, and to work to
make it something other than a polarized “for” or “against” topic.
And, if hunting down stories wasn’t hard enough, the topic was in
perpetual motion as legislation was proposed, amended, and voted on or not, and
as the number of mass murder victims escalated. We finally realized we had to pick a point and just stop
writing, knowing that it would be impossible to get the book out completely up
to date because the target of involuntary care and it’s related aspects move
Behind the scenes, my co-author, Annette Hanson did the heavy lifting in
a more conventional way. While I
was out meeting with fascinating people, she was hard at work reading the
studies and providing the literature reviews. If that wasn’t enough, she read every word that both of us
wrote, again and again, making sure each chapter was structured in way that
made sense; not an easy task. And
when Anne couldn’t get the structure right, our wonderful editor at Johns
Hopkins University Press, Jackie Wehmueller, had just the knack for figuring
out what was wrong and how to fix it.
Finally, the real credit doesn’t go just to the professionals who, made
themselves a little vulnerable, and trusted me to tag along with them on a
‘take a psychiatrist to work’ day. The real credit goes to the many people I spoke
to who had been involuntarily treated.
“Eleanor” and “Lily” talked and emailed with me repeatedly, let me
access their medical records, their family members, and their psychiatrists. There were many, many others, and while some
of their stories are in the book, I spoke with people whose stories
enriched only me. Every patient selflessly revisited an exquisitely
painful period in their lives and opened up wounds for the sake of helping me
to see what their experiences had been like, and without this, there would have
been no book.
received an education that I never got as a psychiatrist. I hope we wrote Committed in a way that
grabs the reader’s attention so that education can be shared with anyone who is
curious about the process of civil commitment, the rights of psychiatric patients,
or the belief that involuntary care has a role in preventing violence on a
societal level. As you will see,
the issue is not black-and-white and we hope to start a discussion that will
not be so polarized and will allow all voices to be heard at the table.
a start, we do hope you’ll listen next week on Novermber 10, 2016 when we’ll be
guests on NPR’s Diane Rehm Show
to talk about “The Battle Over Involuntary Psychiatric Care.”
And again, thank you to our Shrink Rap readers, your voices were invaluable!