The Trauma of Involuntary Treatment

Brief Psychotic Episodes and their Long-Term Consequences

“I had never been suicidal before being locked in a mental hospital.” — Susannah Cahalan, Author, Brain on Fire (2012)

Imagine if everything you saw, heard and believed about your world was false. If only strangers could speak to you, sedated you, watched you all day and all night — offered no information about where your loved ones were, or when you would see them again. You feel isolated, confused and worse, you can’t recall what you did do to deserve this, or when you will return home. This is the typical experience of people with no mental health history, who have been involuntarily committed to a mental facility, held against their will to endure the relentless cycle of screaming roommates, callous staff, and restricted movements for days and even weeks (yes, weeks) in our bureaucratic, profit-driven mental health system.

This year about 3,500 people will experience a situational psychotic episode. For more than half of them, it will result in an involuntary mental health admission. As a result, an improper diagnosis and opioid abuse, not to mention emotional trauma will linger long after someone is released. These are the tragic consequences of the general public’s ignorance of the mental health system, and the laws which protect them with impunity. I can attest to that ignorance, because though I am not a mental health professional, I learned all I know now, only after witnessing the involuntary commitment of a healthy person firsthand.

Left: “My Month of Madness” 2012 memoir by Susanah Calahan. Right: “Brain on Fire” film adaptation of Calahan’s memoir released 2017.

Psychosis is traditionally understood as a symptom of a larger mental health issue such as schizophrenia or bipolar disorder. But a brief psychotic episode, sometimes called a ‘nervous breakdown’, is a single incident causing sudden changes in behavior, unexplained fears and surges of adrenaline; simply our body’s way of reacting to trauma or unyielding stress. In a brief psychotic episode, a person otherwise considered healthy and adaptable, experiences psychotic symptoms even though they have no history of mental illness. Most brief psychotic episodes happen in young people (18–30 and under); young women are at the greatest risk. Frequently cited causes of brief psychotic episodes in people with no mental health history are well-documented and include:

· Marijuana or THC-induced psychosis, up to 2 days after cannabis use

· Anxiety-related psychosis, due to work, finances or recurring stressors

· Postnatal psychosis, during or after childbirth and occasionally at the onset of labor pain

· PTSD, or Situational psychosis, imminent onset of symptoms following a traumatic event, or after exposure to a trigger linked to the traumatic event

· Biology (genes, allergies and/or metabolism), brief psychotic episodes are known to run in families

While research on causes and treatments for mental illnesses such as schizophrenia, bipolar disorder, and borderline personality are evolving, they are an extreme standard by which to treat brief or situational psychotic episodes. In a brief psychotic episode in a healthy person, the behavioral changes are apparent to the person displaying them. As such, involuntary commitments, (or involuntary treatment) of these persons due to can cause or exacerbate trauma. Each state deals with involuntary admission uniquely, but the administration of efficacy of involuntary admission everywhere can leave patients scarred. The experience is too often the catalyst for long-term emotional instability and opioid dependency.

Historically, persons exhibiting psychosis have been combating the centuries-old stereotype that they are not competent enough to make their own decisions. Today we know that not only is this false, but that treatment is only effective when it is embraced by the recipient, not when it is coercive, involuntary and requires the forfeiture of one’s autonomy and liberties.

Credit: Michael W. Flynn,, 2008.

According to Mental Health America (MHA) each state’s rule of law should affirm a Declaration of Incompetency beforeseeking involuntary commitment. States are also advised to conduct a judicial hearing and allow the patient to obtain legal counsel, or appoint legal counsel for them if they cannot afford to. Though according to a 2017 report, only a small percentage of people are involuntarily committed in accordance with these procedures.

Former patients confirm that when they tried to refuse treatment, they were deemed defiant and agitated, even told such behavior is symptomatic of psychosis. Their stories further prove that compliance with involuntary commitment is coerced at every stage of mental health observation. This explains why frightened patients, desperate to regain their liberties, heed the advice of hospital clerks, administrators, and most everyone in authority — often to their detriment.

Patients facing involuntary commitment are routinely asked to sign themselves in for treatment voluntarily, even when they are admitted in the middle of an intense psychotic episode. The process is disturbing: When transported for treatment are often immobilized or strapped down to a gurney. Once they arrive they are disrobed, isolated, and asked to simply ‘sign-in,’ unaware that by doing so they are consenting to voluntary admission. The paradox is alarming. It can’t be rationalized. A person is held involuntarily because they are believed to be incapable of making their own decisions — yet, once held against their will, they are considered competent enough to consent to a surrender of free will.

“(I was told I could not leave) but when I tried to remain calm, it was construed that my ‘eyes were vacuous’. (After a while) I cried out loud, and doctors swiftly appeared with sedatives.” — Amanda Gelender, CEO

In most treatment facilities, a person who has been voluntarily admitted is not free to leave when she or he chooses. According to MHA, it is common for mental health laws to let the facility to detain a person for up to one week after they indicate a desire to leave.

Consider that most involuntary admissions require observation for a period of no more than to 72 (business) hours, yet the average observational period for such stays is double that length of time. Institutional visits are profitable for institutions and funded by patients, insurance companies or sometimes by the state itself. Often overseeing physicians and hospital administrators use their wide latitude to keep patients admitted long after symptoms have subsided.

Of course, there are times when treatment is the only option. MHA does not negate the importance of mental health treatment in advocating that involuntarily treatment should be a last resort. At a minimum, it is important to understand the implications of admitting someone who is more than likely experiencing only a brief psychotic episode.

When someone is admitted for mental health treatment, they forgo their autonomy to be observed by a private or state-regulated facility; they can usually expect at a minimum: Invasive nude examination and restricted movement within a room or wing within the facility, limited contact with friends and family, no access to internet or other means of external communication, constant, close proximity to persons with severe mental illness, sleepless nights due to observation at 15-minute intervals day and night, and perhaps most unfortunately, whimsically prescribed prescription opiods.

Opioids are a class of controlled substances most commonly prescribed in mental health facilities, even in patients with no mental health history. Most often prescriptions are opioids considered antipsychotics, mood stabilizers or antidepressants; sometimes prescriptions are sleep aids, anxiety relief medication. Unfortunately, opioids frequently cite potential side effects that include psychotic symptoms like disorganized speech, memory loss and delusions.

MHA notes most facilities maintain that prescription treatment is optional, but the culture of compliance set by the facility itself, coupled with the involuntary patient’s desperate desire to leave do not lend themselves to the refusal of medications. There is clear evidence that patients who object to treatment procedure are often held even longer than the required observational window. Since the 1980’s over 200 patients with no mental health history filed suit against states because of an institutions citation of a patient’s ‘attitude’ as a reason for involuntary commitment. MHA insists that a person’s failure to comply with procedure should never be the basis of prolonged treatment.

No copyright infrigement intended

It is easy to feel confused, worried and even frightened by a psychotic episode even if you are only a witness to one. However, understand that psychosis of all types is a condition not easily understood, diagnosed or treated by even experienced psychiatric professionals. When mental health treatment is not prohibitively expensive, it is often fundamentally flawed — traumatic, bureaucratic and financially motivated. Because free will is paramount to our well-being, voluntary admission to treatment yields better results. When an individual seeks treatment in their right mind, or at least at the end stages of an episode, they are more often properly diagnosed and receptive to treatment.

If someone you are close to is experiencing a brief psychotic episode, it is important to weigh the potential consequences of mental health treatment. If possible, accompany them to the institution. With loved ones to act as advocates, the chance for abuse of a patient’s rights is minimized. In addition, obtaining (or demanding) legal counsel when faced with an involuntary commitment is critical.

thesimonecherie is a published author and libertarian justice reform activist; she has delivered guest commentary on a variety of cable and online media outlets including CNN’s New Day, NPR, Washington Post and BET News.

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