Dr. Paul Appelbaum, M.D., a psychiatrist from Columbia University and a past President of the APA, was one panelist in the symposium I attended today in San Diego, entitled "The Battle Over Involuntary Psychiatric Care". This was Dr. Appelbaum's seventh presentation during the week of APAAM 2017. Clearly, he is an APA star.
Dr. Appelbaum did not "battle" at all, however. He gave a fairly boring synopsis of the history of involuntary psychiatry, the main point of which was that it was only beginning in very recent times when voluntary hospitalization even became a concept. Historically, everything was involuntary. He believes now that society will not relinquish its dangerousness-only-based justification for forced treatment, despite the fact that there may be better justifications. In particular, he considers that the possibility of successful treatment should be a basis.
In other words, whether or not a person is truly dangerous to themselves or others, it might make sense to force them into "treatment" that will work and actually help them live better. It seems illogical (to Dr. Appelbaum) that a person can meet legal criteria for involuntary hospitalization and yet be allowed to refuse "treatment". These issues should suggest a new look at the laws, which were more or less all created in the 1970's. The doctor's opinions were communicated in a very calm, conservative way that could be interpreted as banal arrogance. No need for any "battle" in any event.
What Dr. Appelbaum fails or refuses to consider is that his own concept of "treatment" (that would be drugs, drugs, drugs, and nothing but drugs) is something that many people do not want and go to enormous trouble to escape from. It is damaging. It causes disability, dehumanization and loss of life.
This reality is something that Dr. Appelbaum seems to completely deny, or to be completely ignorant of. In fact when one member of the audience brought up the recently less controversial position that long term "maintenance" on antipsychotic drugs is bad for recovery from psychosis, he threw out a citation of the new article by Jeffrey Lieberman saying neuroleptics aren't bad for people at all! That article, of course, was meticulously criticized and decisively refuted by Robert Whitaker in a MadInAmerica blog. (What a surprise, Dr. Appelbaum didn't mention Whitaker's criticism.)
Drs. Appelbaum, Lieberman and their ilk are exactly what Whitaker refers to as "a case study of institutional corruption". If they are American psychiatry, then American psychiatry has little or no future.
I asked Dr. Annette Hanson, M.D., about the future of psychiatry. Dr. Hanson is one of the authors of the book, Committed: The Battle Over Involuntary Psychiatric Care, from which the symposium's name was derived. She graciously signed my copy of her book, and got her co-author Dinah Miller, M.D. to do the same.
My question was, "Given a presumed, hypothetical continuation or acceleration of two trends, how do you see the future of psychiatry and the law? The two trends have been repeatedly suggested and evidenced during the week of the APA conference. They are: 1) the substantial loss of faith in a pure medical/brain-pathology model of psychosis; and 2) the loss of public will to force people into treatment for mental illness."
Dr. Hanson liked my question, and we had a short conversation. She practices in the field of correctional (i.e., prison) psychiatry. Her experience has much in common with my own. People have to be "treated" by alert human beings who understand them and care, and take time to predict what they think and what they will do as people. It may take years, patience, much trial and error, many steps back for many steps forward, much negotiation, etc., before a violent criminal said to be "mentally ill" becomes well and civil. This is a teaching project far more than any procedure for medical cure. In short, the psychiatrist must talk the "patient" into changing his attitudes and his behavior.
Obviously this is a far cry from the Appelbaum-Lieberman vision of psychiatric power based on medical technology and access to legal force. Those guys are on their way out.
I also told Dr. Hanson to let her co-author know I am a member of the group she claims she had to "ambush" to get a statement for her book. (See pages 34-36 of Committed.) More conversation, please!