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Nancy, thirty-five years old, was undergoing a hearing to decide whether she should be allowed to refuse psychotropic medication. She had been brought to the emergency room by the local police. Some time ago she had lost her job and had subsequently been evicted from her apartment. That night, she was caught trying to break back in. The police did not detain her, but they found her several hours later by the railroad tracks nearby, huddled by a fire she had built to keep herself warm.Nancy's case--a real case--raises many difficult issues. My purpose in describing it is to explore why the typical psychiatrist seeks treatment in cases of this kind and why the typical lawyer seeks a disposition that upholds the patient's right to refuse treatment. That is, I am interested in the fantasies and fears that underlie the psychiatrist's and the lawyer's commitment to their different stances. What stories do they tell themselves to form the basis for their positions? At this point, I must somewhat stereotype the mental health professional's and the lawyer's response to this case; later I will add some depth to this picture.
Nancy's stay in the hospital was difficult. She resisted being there, denied that she was mentally ill, and wanted no part of treatment. Although she had no history of previous psychiatric treatment, her family reported that she had been troubled for a long time. In addition to her bizarre behavior the evening of her confinement and her uncooperative behavior on the ward, Nancy admitted that she heard voices. She was committed to the hospital. She continued to refuse treatment, however, on the grounds that she was not mentally ill, did not need medication, and in any case preferred not to take medication of any kind. Nancy's treating psychiatrists sought to medicate herinvoluntarily via an order of the court.
Excerpted from Refusing Care: Forced Treatment and the Rights of the Mentally Ill by Elyn R. Saks Copyright © 2002 by Elyn R. Saks. Excerpted by permission.
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