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PubMed1988

Schizophrenia, civil liberties, and the law.

During the past 10 years, extensive studies have shown that schizophrenia is a true biological illness. Like diabetes and hypertension, it cannot be cured as yet, but it often can be controlled by medication. Schizophrenia, therefore, is not a hopeless condition, and many sufferers who receive proper treatment can lead productive lives. The stigma attached to schizophrenia will disappear, and the resistance to the proper use of drugs will also cease when a change comes about in the way schizophrenia is perceived in the United States. Meanwhile, the unique tragedy of schizophrenia lies in the fact that victims often cannot recognize their illness, refuse treatment, and throw away their lives. The question becomes: Is court-mandated treatment indicated when persons are severely disabled, lack the capacity to make informed decisions, and will suffer mental and physical deterioration if treatment is not given?

Civil Rights↗
PubMed1976

Determination of grave disability.

There is a historical dilemma concerning the civil rights of psychiatric patients who are believed to need a protected status because of incompetency. California's Lanterman-Petris-Short Act provides a mechanism for putting the patient under the care of a conservator if the patient is unable to provide for his own personal needs of food, clothing, and shelter. If successful, this legislation will likely be the model for the country. Fifty-one patients for whom the clinical staff desired to initiate conservatorship proceedings were given a test consisting of behavioral tasks specifically designed to be appropriate to the legal definition of grave disability. The natural groupings were: chronic organic brain syndrome, chronic schizophrenia, and other. We found that the grave disability of the organic brain syndrome patients was fairly predictable from their mental status examination, while the grave disability of the chronic schizophrenic patients was unpredictable from their mental status examination and required the application of the behavioral test for an appropriate determination of their ability to perform the functions specified in the law: The Lanterman-Petris-Short Act to provide for personal needs of food, clothing, and shelter. When the method or the proceedings were applied to patients of other diagnostic categories, they were found to be inappropriate. At this writing, our method of evaluation is being recognized and requested by public and legal agencies in our area. It has been used as evidence in court. The procedure is clear, relevant, and easily taught to new workers. The results, given in plain English and in essay form, are readily understood by physician, social worker, judge, and jury alike. We began our study with vexation, ambiguous criteria, and a chronic medical and legal problem; we conclude with a practical and relevant answer.

Activities of Daily Living↗
PubMed1995

Civilization, culture and neurotic depression: in view of the Freudian theory.

Our discussion is based on the psychoanalytic theory of Freud. We, however, discuss a case of neurotic depression which is not considered a subtype in Freud's concept of neurosis. We discuss the difference between culture and civilization, referring to what Freud discussed in Totem and Taboo and Moses and Monotheism. We then discuss two matters specific to Japanese culture; the assimilation of foreign cultures, and the sexual differences found in Japanese culture. On the basis of these discussions, we attempt to link these with the problem of structure of the neurotic depression. We conclude with Confucianism which we can consider as relative to the East-Asian world.

Adult↗
PubMed1991

The dilemma of civil rights versus the right to treatment: questionable involuntary admissions to a mental hospital.

Admission to a close ward was analyzed at the Department of Psychiatry, University of Oulu using 888 patients and their 1861 assessment and treatment episodes. Of all referrals for involuntary assessment (n = 237, 12.7% of all episodes) a total of 44 (2.4%) used "questionable" juridical criteria: the final diagnosis was not psychosis. In the follow-up, the admission of the questionable patients was mainly considered a clinical necessity, and at least one third of them were diagnosed as being psychotic and 2 committed suicide. An elevated probability of belonging to the questionable group was seen among patients in their first treatment episode, with minimal professional education, female sex, short treatment time, or residence in a rural area. The result suggests that some inequality existed between women and men, less and more educated and residents of urban and rural areas. The results also reflect conflict between the ethics and clinical practice of involuntary commitment, and the phrasing of the law, especially its diagnostic limitation to psychotic states only.

Adult↗
PubMed1976

Patients' rights or patients' neglect: the impact of the patients' rights movement on delivery systems.

This paper offers a clinician's perspective on the complex and controversial issues related to "patients' rights." It is suggested that such "rights" interpreted and applied literally may contravene the basic right of the individual to receive needed treatment. Related issues are discussed, and a mechanism for exploring resolutions to the conflict between psychiatry and the law is suggested.

Adolescent↗
PubMed1977

The right to treatment and the right to refuse treatment.

This paper examines the legal status of the questions of right to treatment of institutionalized patients and of the need for patients' consent to treatment. The history of judicial involvement in these questions is outlined, and the directions and implications of current litigation are discussed.

Civil Rights↗
PubMed1977

Informal admission of patients to state psychiatric institutions.

Informal hospital admission procedures require no written application by patients and provide that patients must be released upon their demand to leave the hospital. Statistics indicate that informal admission is infrequently used by hospital staff where the more restrictive conditional voluntary procedure is available. Origins of staff reluctance to use informal admission are discussed.

Attitude of Health Personnel↗