COMMITTED: New Book About Involuntary Treatment Is Well Worth Your Time


(11-1-2016) It’s always tricky reviewing a book written by someone who is a friend. Such is the case with Committed: The Battle Over Involuntary Psychiatric Care, which is authored by my pal, Dr. Dinah Miller along with Dr. Annette Hanson. Fortunately, their book is top-notch so I don’t have any qualms about enthusiastically recommending it, especially if you want an accurate picture of the mental health landscape today.

First, a disclosure, Drs. Miller and Hanson, both contributors to the popular blog, ShrinkRap, asked me to write the forward to COMMITTED, which I happily did. That certainly makes my objectivity questionable. But COMMITTED already has received several favorable reviews, including a prominent one in The Washington Post, so I am not the only one saying it is an important book. (The authors also will be appearing on NPR’s Dinah Rhem show Thursday, November 10th.).

What sets this book apart is Drs. Miller and Hanson admirable goal of presenting every possible viewpoint about involuntary commitment.  They begin with those who argue passionately in favor of involuntary treatment, beginning with Dr. E. Fuller Torrey and The Treatment Advocacy Center, who believe many individuals are not capable of making rational decisions about their care when they are psychotic because of anosognosia or a lack of insight, a medical condition. From there, the authors slide down the scale to Ronald Honberg at the National Alliance on Mental Illness, our nation’s largest grass roots mental health organization, that initially favored involuntary commitment but more recently has voiced that it should only be used as a last resort. Then on to Paul Summergrad at the American Psychiatric Association, which takes  a wishy-washy view, refusing to endorse or reject involuntary commitment.

From this center point, the authors enter the anti-commitment realm beginning with Ira Burnim of the Bazelon Center for Mental Health Law, whose original founders opposed all forced treatment but in recent years has talked less about that fight in favor of focusing on demanding better community care. Next up is Daniel Fisher of the National Empowerment Center and then onto MindFreedom International  founded by Harvard graduate David W. Oaks, a champion among “survivors” and the largely anti-medication Mad Pride movement, before reaching the anti-psychiatry Church of Scientology whose representative was extremely suspicious when Psychiatrist Miller knocked on the door.

Having established the playing field, the authors tell the story of  two patients, one who was helped by forced treatment and one who was not.

Interwoven into the narrative is a ride-along with a Crisis Intervention Team trained police officer and visit to a mental ward that proved surprising difficult for Miller and Hanson. Even though both are psychiatrists,  no one wanted to let them in.

While books of this nature often are text book boring, COMMITTED is not. One reviewer credited the “care and consideration” that went into the book for its readability.

“Miller and Hanson…sat across the table from people who think their profession is basically evil and held a civil , thoughtful conversation. If there’s an outrageous factual error they’ll mention it in passing with research to back them up, but otherwise everyone is allowed to say their piece exactly as they’d like in a non-confrontational environment.”

Dr. Miller clearly struggled with her own feelings about involuntary commitment while interviewing each subject and her honesty in presenting their views with respect is refreshing. This is not a one sided proclamation but a fair-minded investigation. There is a purity to this kind of book, one that bestows an honor on the fact-seeing reader. Those who favor involuntary commitment should come away from Committed as unsettled as those who oppose its use.

Unfortunately, John Hopkins University Press did the authors and readers a disservice by choosing a book jacket that is hardly impartial, but rather implies that being committed is much like being shut into a smoky glass tomb.

Buy the book anyway. It is well worth the read.

From my forward:

This book does not sugarcoat what has to be one of the most difficult decisions in modern psychiatry, and we are better because of that. In the final pages, you will find the authors’ conclusions and undoubtedly, you will ask yourself: “What would I do?”

     I’ve always found it interesting that how the involuntary commitment question is framed often elicits much different reactions. Mention involuntary commitment and many Americans will immediately conjure up the imagines of Nurse Ratched, of men in white coats armed with straight jackets, of lobotomies and zombie causing medications, of being locked in a snake pit with no chance of freedom with your fate in the hands of sadistic doctors.

     Because of our strong feelings about liberty, it is natural for Americans to declare that no one should be involuntarily committed as long as they are not hurting themselves or others.

   And if you read the accounts often told by those who were traumatized by being committed, you would readily agree. Can you imagine what it must feel like to be taken from your friends and family, wrestled to the floor, stripped naked, confined in an empty room, injected with powerful medications that knock you unconscious? Can you imagine the torture of being strapped to a hospital bed, unable to move for an hour, four hours, a day? Can you imagine being treated as if you are some mindless child by strangers who claim to know what’s best for you?

   Who would want that?

   But here’s a different image for you to consider. Imagine your child, a loving and brilliant young art student in college. One morning, his friends deposit him at your doorstep and tell you that he is crazy. He is argumentative, refuses to eat or sleep, and is convinced that he needs to go immediately to the White House because God has given him a message for the president that he must deliver. Imagine watching him pacing back-and-forth in front of a television with tin foil wrapped around his head to keep the Central Intelligence Agency from reading his thoughts. Imagine him being arrested because he has broken into a stranger’s house to take a bubble bath. Imagine listening to someone who you love scream at you, call you the enemy, tell you that he hates you. Imagine watching your son hitting his head to clear the voices inside his mind screaming at him, telling him that he will die if he steps out of a car, taunting him to hurt himself, torturing him with thoughts of a girl who he barely knew but who the voices say he impregnated. He must find the girl. Hurry. He has to go. Where? He doesn’t know, but he must leave. Immediately. There’s no time to explain. Quick.

   Picture that and remember that this is your son.

     What would you do?



About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.