
How can you treat someone who doesn’t accept they are ill? - okket
https://mosaicscience.com/story/anosognosia-assisted-outpatient-treatment-lauras-law/
======
azeirah
> Physicians who cure must abstract person into functions. They threat the
> illness, not the person. And persons willfully present themselves as
> functions. Indeed, what sustains the enormous size and cost of the curing
> professions is the widespread desire to see oneself as a function, or a
> collection of functions. To be ill is to be dysfunctional; to be
> dysfunctional is to be unable to compete in one's prefered contests. It is a
> kind of death, an inability to acquire titles. The ill become invisible.
> Illness always has the smell of death about it: Either it may lead to deat,
> or it leads to the death of a person as competitor. The dread of illness is
> the dread of losing.

> One is never ill in general. One is always ill with relation to some bounded
> activity. It is not cancer that makes me ill. It is because I cannot work,
> or run, or swallow that I am ill with cancer. The loss of function, the
> obstruction of an activity, cannot in itself destroy my health. I am too
> heavy to fly by flapping my arms, but I do not for that reason complain of
> being sick with weight. However, if I desired to be a fashion model, a
> dancer, or a jockey, I would consider excessive weight to be a kind of
> disease and would be likely to consult a doctor, a nutritionist, or another
> specialist to be cured of it.

Finite and infinite games - page 56

~~~
whatshisface
That's a lot of words to define illness as "being worse than normal."

> _The loss of function, the obstruction of an activity, cannot in itself
> destroy my health. I am too heavy to fly by flapping my arms, but I do not
> for that reason complain of being sick with weight._

It wouldn't be a loss unless he had previously been able to fly, otherwise
it's a maintenance of the status-quo.

~~~
grenoire
Then what about the cases with which you were born? What is the definition of
normal then?

If I inherited some form of respiratory condition at birth which persists as
an illness, living with it is maintaining the status-quo; yet it is very much
an _illness_. There is no _loss_ of function per se, it was simply never
there.

~~~
InitialLastName
Status quo applies relative to one's peers as well as oneself. If most humans
could fly, those that couldn't, whether as an acquired or congenital trait,
would have an illness.

------
woodpanel
Anecdotal but: I've experienced this problem first hand and know not one
person with the same experience, that doesn't share the opinion that AOT is a
much needed thing.

In Germany even suggesting a law like this will provoke immediate protest by
some people who claim to fight for civil rights. What I've encountered though
is, that those people who claim to speak for the affected ones don't have a
friend or relative with this condition and have never even met such a person.

Fighting against AOT is for me not a defense of free will, but an act of
denying people having a free will in the first place.

Sure, there should be certain checkboxes to be ticked off first. But e.g. if
the whole family and friends speak out in favor of forced treatment in front
of a judge, it should be regarded as one such checkbox.

In a country like Germany, with generous social services that even provides
housing if your landlord evicts you, the vast majority of non-immigrant
homeless are homeless because of schizophrenia. The friends and relatives I
know affected by it, are only not homeless because we had to pull every legal
string possible, so that social services don't treat them like the rest of
their customers.

~~~
hutzlibu
"What I've encountered though is, that those people who claim to speak for the
affected ones don't have a friend or relative with this condition and have
never even met such a person."

Ok, does meeting here qualifys as meeting? I am very against AOT and I did
experience the problem first hand. A case which ended tragically not because
the lack of, but because of a attempted AOT. As they can also worsen things.
Especially if the patient is very sensitive to force.

~~~
woodpanel
Like I said, anecdotal (indicating I don't assume to have more datapoints to
make it a study). No need for passive aggressiveness, I just shared my
observations, which include multiple cases in which everyone would have
benefitted from AOT.

------
jeffreyrogers
There's a book called _The Myth of Mental Illness_ [0] that deals with this
issue at length. The author argues that many forms of what we call "mental
illness" are not real illnesses at all, but extreme preferences that prevent
people from successfully integrating in society. He's not saying that these
behaviors are healthy or natural, but he makes the argument that because these
behaviors arise from differences in preferences we shouldn't make treatment
compulsory, in part because doing so abridges a person's rights to liberty and
also because it's hard to "cure" someone who doesn't see their behavior as
problematic.

If you're going to disagree with these arguments please realize that they are
not my own. While I agree with much of what's in _The Myth of Mental Illness_
, I don't agree with all of it. The above is obviously a very brief summary
and leaves a lot unaddressed.

[0]:
[https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness](https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness)

~~~
WhompingWindows
You agree with his splitting of the body into distinct mental and physical
spheres? It seems his contention, based on the wiki, would be reliant on the
mind-body duality. This conjecture of his came before numerous neurological
discoveries, I highly doubt it'd pass muster as a scientific argument today.

Further, as a researcher of mental health, I found the stigma associated with
mental health treatment leads to a loss of seeking treatment, which may
contribute to suicide or highly reduced quality of life in those whom
treatment may benefit. Such books as this one do far more damage than good by
perpetuating this harmful stigma.

~~~
jeffreyrogers
In some instances yes, I do. In others no. The book was written in the 60s and
it seems fairly clear now that some mental illnesses have physiological roots.
It also seems clear that many issues such as depression, eating disorders,
anxiety, etc. are often the consequence of environmental or other non-
physiological phenomena.

Have you read the book? He doesn't argue that people should not seek
treatment. He argues that many mental illnesses don't originate in
physiological problems but are instead problems with people reconciling
conflicting desires (I'm simplifying a lot here). He argues against compulsory
treatment, not voluntary treatment.

The author was a psychiatrist and psychoanalyst. He is definitely not
advocating for people to avoid treatment. He is suggesting that the focus on
physiological causes of mental health problems obscures the causes of many
such problems and prevents people from resolving them appropriately.

------
wpietri
Really interesting article. This for me is the crux of it:

> "Being psychotic is not an exercise of free will. It is the inability to
> exercise free will.”

I get why people are nervous about state power. But there are a variety of
conditions, including slavery, addiction, and psychosis, where people may
voluntarily enter them but then cannot leave without help. It's a dilemma with
no simple answers. But if we're serious about freedom, I think it's incumbent
on us to grapple with the complex, inevitably messy issues involved.

~~~
azeirah
I find this a very hard point to deal with as well.

If sickness is defined as a function of your own perception of how it limits
you (analogous to "freedom"), that's fine for all illnesses that don't affect
your perception.

But in some cases like psychosis and schizophrenia, the illness directly
affects your perception... your definiton of freedom; your definition of
illness; it doesn't work anymore.

~~~
amelius
Instead of calling it "curing", one could view it as "self improvement".

As an analogy: most children don't like to go to school, and have no intuitive
feeling of why it is useful, but of course they should have proper education.

~~~
lmm
Does going to school actually help them enough to justify the unpleasantness
of it? What I've read from unschoolers suggests: often not.

------
hutzlibu
If I, speaking with clear will and mind, declare that I never want to be
treated against my will, (fully aware of the consequences) then I want this to
be respected. Otherwise all talks of freedom in our society is not worth the
paper to write it down.

Now why am I so sceptical?

Well, first of all, declaring people mentally ill, was and is a common way to
get rid of dissidents, or to get the money of a rich relative who don't want
to die soon, or even consideres giving the money to a charity or alime Sources
to the last one I don't have at hand, but putting people away who were
annoying, was not only done in soviet russia, but even happened (or happens?)
in germany.

([https://de.wikipedia.org/wiki/Steuerfahnder-
Affäre](https://de.wikipedia.org/wiki/Steuerfahnder-Affäre) or
[https://de.m.wikipedia.org/wiki/Gustl_Mollath](https://de.m.wikipedia.org/wiki/Gustl_Mollath)
German

basically, tax investigators went after some too powerful - which backfired.
So even pro-government people got declared mentally ill and were locked away)

Then secondly, the human brain is not really understood. I have high respect
for psychoanalysis and neurobiology, though, but I am highly sceptical, that
they really understand, what they are doing. As far as I know, also the term
schizophrenia is highly disputed. And I also know, that the common psychatrist
is just bad. At least the quite some cases I knew about. (I know people
working in that area). Standard procedure is calming them down with pills ...
and keeping it that way. No thank you.

If I would see myself getting ill (it does not happen overnight), I would go
seek a good doctor by myself. But if I choose to do what I do, it is my
decision. Even if I would endanger my body - my body, my life.

Only if I would be a danger to other people ... well then society does, what
it ordinary does with dangerous people, locking them away, until they are not
a threat anymore.

~~~
houjo
Well...dangerous or violence doesn't mean just doing physical damage to person
or property, which is what makes the whole issue ambiguous.

There are lot of people out there, who damage the people they deal with
psycologically.

~~~
hutzlibu
"There are lot of people out there, who damage the people they deal with
psycologically."

That totally blures the line. Yes, there are tons of people out there who
attack me psycologically with their stupidy, attempted dominace, insults, etc.
But I don't think a law against stupidity would help.

Sounds a bit sarcarstic? Maybe, but listening to people sometimes (on TV for
example) literally causes me pain.

But more specifically on topic, yes, I know also the situation when a mentally
troubled person hurts the people around them who suffer see him suffering. But
it still is (or was) his life.

------
zaarn
IMO assisted outpatient treatment should be enabled and encouraged under the
right conditions. Of course, it has to be carefully weighed such that you
don't do this in cases where it would make things worse or unwarranted. That
would likely mean that you'd need a history of "leave hospital -> refuses to
take pills -> back into hospital".

The article seems to agree on that though some in this thread seem to conflate
this with "do X first time -> get put into asylum/hospital against your will",
I don't think anyone honestly wants that.

------
pasta
I think in The Netherlands the rule is that when they are a danger to
themselves or others they can be forced to be treaded.

Imho this is a very clear line.

~~~
whatshisface
If you drink soft drinks every meal you are stressing your insulin system,
thereby acting as a danger to yourself. People who practice extreme sports are
also dangers to themselves, along with private pilots and those who take
dangerous jobs.

This is not even to mention that disagreeing with the Party can become _very_
dangerous to yourself... (Not so much in the Netherlands, but elsewhere,
possibly. The soviets used forced institutionalization against their political
enemies.)

~~~
VLM
"along with private pilots"

Which brings up the next problem that what will be enforced is perceived risk,
not actual risk. Per billion-vehicle-miles-traveled, private pilots are as
safe as car drivers around 11 or so deaths, but much more common activities
such as bicycle commuting is vastly more dangerous around 31, and simple
walking commute is even higher around 36. Speaking of bicycle commuting, that
brings up the third dimension which is political, in that aggressive public
support of bicycle commuting is a hipster sacrament not to be interfered with.
Speaking of politics, AOPA is not really a group to be messed with, so even if
private pilot flying were more dangerous, it might not be a fight worth
picking for bureaucrats. And finally the forth dimension is time; its
possible, in fact nearly certain, that private pilot flying was at one time,
perhaps 1925 or 1955, more dangerous than driving in 2018, however influential
or profitable that might be in 2018 it would be bad justification for legal
enforcement in 2018, in a sort of affirmative action sense that my grandfather
was a "very dangerous private pilot" in the WWII era therefore I should be
punished for his actions by making it illegal for me to fly...

~~~
charmides
Seems like "billion-vehicle-miles traveled" is not a good metric; people
travel faster in aircraft and in cars than they do on bicycles and on foot.
Time spent travelling should be a better metric.

~~~
InitialLastName
Time spent traveling isn't necessarily better; by some metrics people going
faster are just traveling more effectively.

It's a question of whether we rate the travelage by utility or by luxury. If
we consider it for utility, vehicle-miles travelled is a perfect metric. If
for enjoyment, time spent traveling is better (but still not perfect).

~~~
scatters
Utility doesn't scale (linearly) with distance. Consider someone walking 0.5
miles to a neighborhood store versus driving 5 miles to a big-box store. The
big-box store may have a larger selection of product lines and slightly lower
prices, but there's certainly not 10x the utility there.

------
FraKtus
My family (in Poland) is in that situation with a member denying, going to
hospital, coming out, avoiding medication and the cycle starts again after a
few months. We feel hopeless and at this time wait a judgement could force
that family member to take a medication once a month...

------
jarmitage
And the corollary: how can you treat someone who doesn't accept that you are
well?

------
tcj_phx
This article repeats several myths with regards to mental health treatment.
While I believe that the treatment providers truly believe they are helping
their patients, any objective evaluation of the current medication-based
standard of care and its alternatives will reveal that the harm perpetrated on
patients by their medications is extensive and severe.

My observation is that conventional psychiatric treatments result in a self-
fulfilling prophecy: mental patients need treatment because the treatments
they receive cause brain damage that necessitates further treatment.

Looking back, I now recognize that my friend made herself psychotic when she
used too much cocaine [0], but I didn't know that was the label for that type
of behavior at the time.

After a few months of my involvement, she realized that she liked me more than
self-medicating with the street pharmacy. But then she ran out of alcohol, was
taken to the hospital, and was assaulted with medications that are NOT FDA-
approved to treat substance-induced psychosis. The medications that they force
upon my friend are actually known to cause stimulant users to use more
stimulants.

[0] [https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Su...](https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Substances) \- "While the vast majority of cases are acute
and resolve fairly quickly upon treatment and/or abstinence, they can
occasionally become chronic and persistent. Alcoholic psychosis is sometimes
misdiagnosed as another mental illness such as schizophrenia."

All my friend really needed was some Naltrexone to help keep her away from
alcohol while she sobered up, and other drugs (thyroid, etc) and nutrients
(B-Vitamins, good proteins, etc) to help support her metabolism (after 2
years, her forced treatment provider did a genetic test and added methylfolate
[Vitamin B9] to her drug cocktail, because she can't use the folic acid used
in fortified flour). But the only treatment she received was haloperidol (used
to torture political dissidents in the Soviet Union [1]) and other palliative
psychiatric drugs.

In my struggles to extract my friend from her misdiagnosis, I have come to
believe that the system is completely hostile to the concept of cause-and-
effect. The professionals believe their patients have chronic conditions that
they will never recover from, and that even if the original cause of the
patient's presenting symptoms is known, the patient's ongoing maintenance
medications are the only thing that matters.

From the article:

> Misty slowly stopped responding to medication. [...] Antipsychotic
> medications led to dramatic weight gain. Misty dyed her hair jet black and
> her eyes lost their sparkle. She eventually started to refuse outpatient
> treatment.

Medications are known to worsen outcomes when used over the long term.
Research has found that first-episode psychosis patients have the best
prognosis if they never receive "anti-psychotics". The next best prognosis are
those that have antipsychotics withdrawn after a short period of time. The
worst prognosis is sustained by those who are maintained on "anti-psychotics".
These "medications" cause "dramatic weight gain" by attacking the body's
metabolism. Refusing outpatient treatment is a completely logical response
when you are being harmed by the treatment.

> With the development of effective antipsychotic medication in the 1950s and
> 1960s, many psychiatric hospitals in the USA and other countries, including
> the UK, began shutting their doors.

Early 20th century "psychiatric hospitals" utilized various forms of abuse to
give their patients brain damage that resulted in the patients being made
docile. Lobotomy [2], electro-shock brain damage, etc. The "anti-psychotic"
drugs were originally known as tranquilizers, and were used to the same
effect: docility without recovery. The transformation of these drugs into
"anti-psychotics" was a triumph of marketing over science.

Resistance to psychiatric abuse is spinning its tires because the system makes
so much money perpetuating itself. But I am certain that eventually the sorts
of palliative treatments forced on patients to perpetuate their mental
conditions will join bloodletting, calomel (mercury poisoning) and the routine
extraction of tonsils in the dustbin of medical history.

[1] I just learned about Soviet use of Haldol for torture from Robert
Whitaker's first book, _Mad in America_. My observations confirm that 'Haldol'
really is a terrible drug.

[2]
[https://en.wikipedia.org/wiki/Lobotomy](https://en.wikipedia.org/wiki/Lobotomy)

Robert Whitaker's foundation is sort-of a clearing house for the Resistance:
[https://www.MadInAmerica.com/](https://www.MadInAmerica.com/)

------
John_KZ
This "I know better than you" disease needs treatment. We need to force AOT on
all those individuals who are unable to understand how their actions are
dangerous to society by enabling forced treatment. We need to enforce
treatment on those individuals to stop the looming danger of forced treatment
as a political control tool.

------
Madmallard
"A bill in California could enforce this, but it had not been passed in
Stanislaus County. Known as Laura’s Law, the bill allows courts to order
what’s known as assisted outpatient treatment (AOT) to people with severe
mental illness if they meet specific criteria, including previous
hospitalisations or arrests, being noncompliant with outpatient treatment, and
becoming dangerous to themselves or others."

Outpatient treatment can cause further harm, worse than what the illness will
do, depending on what it is. In many cases of mental illness the underlying
cause is physical, and if you shove antidepressants or antipsychotics on those
people they just might get worse rather than better.

