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Committed: The Battle over Involuntary Psychiatric Care

by Dinah Miller and Annette Hanson Johns Hopkins University Press
Pub Date:
Pbk 328 pages
AU$48.99 NZ$52.17
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Battle lines have been drawn over involuntary treatment. On one side are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others, regardless of their civil rights. On the other side are groups pushing for increased use of involuntary treatment. These proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them.


In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy'all within the context of civil rights'Miller and Hanson illuminate the personal consequences of these controversial practices through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it.


The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions'mental health court, crisis intervention training, and pretrial diversion'that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public.


Before We Get Started
Part One: The Patients
Chapter 1: Eleanor and the Case against Involuntary Hospitalization
Chapter 2: Lily and the Case for Civil Commitment
Part Two: The Battleground
Chapter 3: Those in Favor of Involuntary Treatments
E. Fuller Torrey and the Treatment Advocacy Center
Ronald Honberg and NAMI
Paul Summergrad and the American Psychiatric Association
Chapter 4: Those against Involuntary Treatments
The Citizens Commission on Human Rights
Cecelia Brown and Janet Foner and MindFreedom International
Daniel Fisher and the National Empowerment Center
Ira Burnim and the Bazelon Center
Part Three: Civil Rights
Chapter 5: Eleanor and Lily and the Process of Civil Commitment
Chapter 6: Christina Schumacher and the History of Civil Commitment Laws
Part Four: Hospitalization
Chapter 7: Officer Scott Davis and Law Enforcement
Chapter 8: Dr. Leonard Skivorski and the Emergency Department
Chapter 9: Eleanor's Hospital Experience
Chapter 10: Dr. Ray DePaulo and Inpatient Psychiatry at a University Hospital
Chapter 11: Dr. Steven Sharfstein and Dr. Bruce Hershfield and Free-standing Psychiatric Hospitals
Chapter 12: Dr. Annette Hanson and the Use of Seclusion and Restraint
Chapter 13: Anthony Kelly and Involuntary Medications
Chapter 14: Jim and Involuntary Electroconvulsive Therapy
Part Five: Involuntary Outpatient Commitment
Chapter 15: Marsha and Involuntary Outpatient Commitment
Chapter 16: Outpatient Commitment by the Books
Chapter 17: The Honorable Jack Lesser and Mental Health Courts
Part Six: A Danger to Self or to Others
Chapter 18: Dan and Guns and Mental Illness
Chapter 19: Bryan Stanley and Violence and Psychiatric Illness
Chapter 20: Amy and Involuntary Treatment for Suicide Prevention
Chapter 21: Will Forcing Treatment on People with Psychiatric Disorders Prevent Mass Murders?
Part Seven: Future Directions
Chapter 22: Transforming the Battleground

"A highly informative and surprisingly balanced book that should be read by anyone with a personal or professional stake in how the mental health system provides care to those with chronic severe illnesses and those in acute crisis... Although Committed explores a complex subject, Miller and Hanson make a great effort to humanize this discussion."

— Washington Post
"Exceptionally intelligent, clear, readable and well researched."

— Psychology Today
"This fact-filled, open-minded, and straightforward survey will interest students of the subject and those serving mentally ill clients."

— Library Journal
"Committed is a very informative and thought-provoking book... Highly recommended. All readers."

— Choice
"A compelling, exceptionally well-researched and written analysis of the immensely complicated, multifaceted issues faced by families, physicians, psychiatrists, police, the courts and society when mental illness endangers patients and those around them."

— Johns Hopkins Medicine
"It is refreshing—indeed therapeutic—to encounter a thoughtful, balanced treatment of this contentious and important topic."

— Psychiatric Times
"This is quite a feat in 265 readable pages. I applaud the authors for their work."

— Mad In America
"I would recommend [Committed] to every clinician."

"A very well-written review of the current state of involuntary treatment for persons with mental illness in the United States."

— Anita Smith Everett, MD, Johns Hopkins University School of Medicine, President-Elect of the American Psychiatric Association
"Reading this book is like attending a seminar, with each chapter representing the best guest speakers from around the country on that particular issue. To have brought together all of these points of view through direct interviews in a single text is a great achievement."

— Bruce J. Cohen, MD, University of Virginia School of Medicine
"While practical information gives Committed its spine, it is the emotions that we feel in reading patients’ firsthand accounts that prick at the conscience."

— Pete Earley, author of Crazy: A Father’s Search through America’s Mental Health Madness
"In Committed, the voices of people with mental illness, family members, and clinicians paint a picture of the ethical complexity of involuntary psychiatric treatment. The authors show that the system for helping individuals with serious mental illness remains broken, and policy makers would be well advised to read this book before offering one-dimensional solutions."

— Dominic A. Sisti, director, Scattergood Program for Applied Ethics of Behavioral Health Care, Perelman School of Medicine, University of Pennsylvania
Dinah Miller, MD, is a psychiatrist in Baltimore, where she is an assistant professor of psychiatry at Johns Hopkins School of Medicine.


Annette Hanson, MD, is an assistant professor of psychiatry at the University of Maryland School of Medicine and Johns Hopkins University School of Medicine. Drs. Miller and Hanson are coauthors of Shrink Rap: Three Psychiatrists Discuss Their Work.