Involuntary Psychiatric Treatment - Ethical and Legal Issues

[Petros Agapetos]

Community treatment orders are legal orders that prescribe that a patient must receive psychiatric treatment, even if it is against the patient's will, while the patient is to live in the community in "freedom".
Community treatment orders or CTO's are used to inject people with dopamine antagonistic neuroleptic antipsychotic agents for mood and cognition control, essentially acting as a chemical straigtjacked for patients who have to be often hospitalized.

CTO's erode the very idea of an autonomous person. To the self determined person, a CTO can be seen as hostile, which complicates not only patient doctor relationships but the treatment of the patient itself, as it can grow to become a subject matter of unresolving conflict due to the antagonistic stance the psychiatrist has toward a patient on a CTO who refuses to accept the treatment.

CTO's are prescribed to reduce the number of hospitalizations, the time to relapse, and the frequency of hospital visits. However neuroleptics have not been sufficiently well demonstrated to prevent relapse anymore than placebo long term, in fact, there is evidence strongly pointing to the contrary.

[Petros Agapetos]

Psychiatrists seem to lack basic scientific principles in their practice - falsificationism and the regard for evidentiary basis for hypothetical claims about nature.

Is forced drugging of an otherwise healthy individual ethically enforceable?

Often people with no psychotic symptamotology are deemed to lack capacity to refuse medication.

The law must support autonomy for people with mental capacity.

CTO's do not actually reduce hospital readmission rates, nor the time to readmission nor time in hospital for psychosis in patients in the 12 months from discharge.





Often the antipsychotics create a brain condition called supersensitivity psychosis, thus creating the very condition the symptoms of which the antipsychotics are believed to treat.

[Petros Agapetos]

Principles that must govern the interpretation of law in this area:

Best Interest of the Person as the Person regards it, regardless of how much it conflicts with professional opinion.
Best Interest of the Person as the Psychiatrist regards it, regardless of how much it conflicts with the patient's opinion.
First do no harm to the person.
Second do good for the person.
Respect the freedom of choice and the right to self-determination.
The right to develop one's own personality.
Respect person's autonomy
Freedom from force, fraud, violence, exploitation, and abuse
No structural/institutionalized discrimination


Community treatment orders specifically:
1. Important governmental interests are at stake.
2. Will significantly further those state interests substantially unlikely to have side effects that will interfere significantly with achieving state interest.
3. Necessary to further those interest. The court must find that any alternative less intrusive treatments are unlikely to achieve substantially the same results.
4. Treatment is medically appropriate
- In the patient's best interest - as the person is concerned (personal opinion)
- In the patients best interest - as the hospital or the psychiatrist is concerned (professional opinion)
- While personal opinion does not trump professional opinion, the person's request not to receive treatment must be respected.

The proof of dangerousness of the person must be coupled with proof of some additional factor, such as "mental illness" or "mental abnormality" which normally manifests dangerousness.

[Petros Agapetos]

Universal Declaration of Human Rights

1. Right to Life, Liberty, and Security of the Person

2. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment

3. Everyobody has the right to freedom of thought

4. Everybody has the right to freedom of opinion and expression

These are the laws of the Universal Declaration of Human Rights of the United Nations that conflict with Involuntary Psychiatric Treatments and CTO's.

[Petros Agapetos]

My sole social identity is a student. Neuroleptics (Antipsychotic agents) rob me of my scholastic potential and degrade and render null my executive functions ~ planning, organizing, decision making, problem solving. Neuroleptics reduce reward pathway activity thus reducing the high of daily life, music, drugs, and sex. Neuroleptics reduce frontal lobe activity, temporarily chemically lobotomizing people, which can become permanent the higher the dosages are and the longer the treatment. I resent having to call the latter "treatment". Neuroleptics are tremendously toxic to the body, often causing metabolic syndrome, sexual dysfunction, diabetes type II, cardiovascular disorder, high triglycerides and cholesterol, high prolactin levels etc. Neuroleptics cut lifespan by over 25 years, cut the recover rate by at least a half, and increase mental disability rate 6-fold, and causes all kinds of unspeakable unnecessary human toll.

Neuroleptics must be used sparingly and never against the will of the patient. The patient must be given the opportunity to understand why he needs or does not need the treatment.

Under law there must be protections for people who are not mentally disturbed normally (only experience periodic exacerbations), who are competent to make treatment decisions.
Mental capacity is the ability of a person to weight the pros and cons of having and not having treatment for any mental condition to be treated

(i) immediately and acutely, or

(ii) long term maintenance treatment, or

(iii) preventive use

With involuntary treatment orders, psychiatrists are in a position to act as police officers of people's mental life. The autonomy of the patient is not respected under this legal system. There is a parallel legal system governing the rights of people labelled with a mental illness. Mental illness is nothing but a cluster or constellation of abnormal symptoms of the mind.

[Petros Agapetos]

Neuroleptics

~ cause massive amounts of harm
~ substantially responsible for cutting life span by over 25 years
~ substantially responsible for cutting the recovery rate at least in half
~ substantially the cause of the 6-fold increase in mental illness disability rate
~ hugely and unnecessarily expensive to the government
~ inflicting tremendous unnecessary human toll
~ life ruining social death penalty
~ intolerable and ineffective treatment

[Petros Agapetos]

Psychosis is a chaotic process that must be ordered by the counterbalancing forces of reason.
I needed to go through my episode completely and try to recover from it with as little medicine as possible, not as low as possible demonstrated to be necessary to receive a therapeutic outcome.
Unless the patient is floridly psychotic, going through psychosis only equipped by own forces of reason should be the basis for the mainline treatment, CBT, DBT, Dialogue Therapy, Soteria Project, etc (hospitalization without drugs or with minimal drugs). The neuroleptics stop people from going through psychosis by themselves, and thus never gain skills to equip themselves for the symptoms once they arise again in the future (recovery model of mental disorder).

Prosocial approach to treating Psychosis
~ Peer Directed Programs (people who share a common living experience can bond over it better due to the level of trust that it creates)
~ Soteria Project
~ Open Dialogue Therapy
~ Strategic Therapy
~ Cognitive Behavioural Therapy (CBT)
~ Dialectical Behavioural Therapy (DBT)