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PubMed2006

[Coercion and active interference in psychiatry].

It is becoming increasingly clear that the autonomy and legal position of psychiatric patients are impediments to their adequate care. There is a strong emphasis on the voluntary cooperation of the patient involved. The patient as a person appears to be more important than his or her health status. There will always be tension between the right to self-determination and the dangers to the patient's health. There is a need for a law addressing the necessity to treat. In addition, a chain of care should be developed encompassing the whole spectrum of care institutions and centred around the individual's needs for food, shelter, care, financial support and medical attention.

Coercion↗
PubMed2006

Lies and coercion: why psychiatrists should not participate in police and intelligence interrogations.

Police interrogators routinely use deceptive techniques to obtain confessions from criminal suspects. The United States Executive Branch has attempted to justify coercive interrogation techniques in which physical or mental pain and suffering may be used during intelligence interrogations of persons labeled unlawful combatants. It may be appropriate for law enforcement, military, or intelligence personnel who are not physicians to use such techniques. However, forensic psychiatry ethical practice requires honesty, striving for objectivity, and respect for persons. Deceptive and coercive interrogation techniques violate these moral values. When a psychiatrist directly uses, works with others who use, or trains others to use deceptive or coercive techniques to obtain information in police, military, or intelligence interrogations, the psychiatrist breaches basic principles of ethics.

Coercion↗
PubMed1990

[Patient advisors and coercion in psychiatry. The situation 3 months after the introduction of the Act on restriction of liberty and other coercive measures in psychiatry].

In a retrospective investigation, we attempted to estimate the effect of introduction of a new law about coercive measures and loss of liberty in psychiatric wards during the first three months after enforcement of the law. By examination of case reports we found that 69 patients, i.e. 14%, were exposed to one or several types of coercive measures. Restraint was the most frequent form of coercive measures. Eight patients lodged complaints about the coercive measures. The decisions of the psychiatrists were all sanctioned. Replies to complaints about treatment with coersion were available within five to 14 days. In an investigation by questionnaire, we found that there was satisfaction with the patient advisors introduced in the wards by the new law. Collaboration with the patient advisors took considerable time for the staff members. Both staff members, doctors and patient advisors suggest that the patient advisors should receive more education in psychiatry. We suggest changes in the law when this is revised.

Coercion↗
PubMed1986

Child behavior, maternal depression, and social coercion as factors in the quality of child care.

Observational and self-report data were obtained in the homes of 33 mother-child dyads. These volunteer, normal subjects were monitored with respect to their affectionate and aversive interactions, and the mothers were asked to provide three categories of self-report data. Mothers made observational judgements of their children, their own feelings of depression, and the valences of their interactions with adults. Multiple regression analyses were then employed to predict the mothers' child care behaviors, which were composed of observed mother responses and mother observational judgements. In addition, conditional probability analyses were conducted to examine the directionality of correlations between observed mother-child interchanges. Results showed child behavior to be the best single predictor of how the mothers responded to their children, followed by maternal depression and mother coercive interactions with adults. Child behavior was shown to be a significant antecedent "cue" for the maternal responses. However, the findings also showed that mother observational judgements about their children had little to do with how the children behaved. Rather, the maternal judgements were best predicted by mother depression, mother coercive interchanges with adults, and the mothers' observed aversive responses to their children. Results were interpreted within a systems framework in which maternal care is viewed as a response that is "triangulated" by adult- and child-produced stimuli.

Child Behavior↗