Coercion and the Critical Psychiatrist

  • Nicolas Badre
  • Shawn S. Barnes
  • David Lehman
  • Sandra Steingard


Psychiatrists play a role in society not only in defining what it means to have a mental illness but also in determining the fate of those so afflicted. This authority can have profound effects on people; psychiatrists have authority to compel hospital admissions, seclusion and restraint within hospital, and administration of psychoactive drugs. Psychiatrists are called upon to offer opinions regarding people’s capacities to make financial and medical decisions and to determine who should be sent to a hospital rather than a jail. The many concerns explored in this book raise urgent questions for critical psychiatrists regarding the underlying justification and wisdom for the assumption of these responsibilities. First, is force ever necessary? Second, if one concludes that force might sometimes be necessary, is there a role for the medical profession in this process? Third, if one accepts that there is a role for physicians, how does one accept this responsibility in an ethical and intellectually coherent manner? This chapter examines these questions in more detail.


Coercion Involuntary treatment Civil commitment Capacity Informed consent Violence and mental illness 


  1. 1.
    Albert M. Coercion breeds coercion: response to Sashidharan and Saraceno. Br Med J. 2017;357:j2904.Google Scholar
  2. 2.
    Barnes SS, Badre N. Is the evidence strong enough to warrant long-term antipsychotic use in compulsory outpatient treatment? Psychiatr Serv. 2016;67:783–5.Google Scholar
  3. 3.
    Bouche T, Rivard L. America’s hidden history: the eugenics movement. Learn science at scitable. [online] 2014. Accessed 05 Aug 2018
  4. 4.
    Copeland ME. Wellness recovery action plan. Brattleboro: Peach Press; 1997.Google Scholar
  5. 5.
    Crossley N. RD Laing and the British anti-psychiatry movement: a socio–historical analysis. Soc Sci Med. 1998;47(7):877–89.CrossRefGoogle Scholar
  6. 6.
    Daily News. Nov. 19, 1999.Google Scholar
  7. 7.
    Davidow S. Suicidal tendencies, part II: The real ‘stigma’ of suicide. 2018a. Accessed 10 Aug 2018.
  8. 8.
    Davidow S. Suicidal tendencies, part III: So when do I get to call the cops? 2018b. Accessed 10 Aug 2018.
  9. 9.
    Durham v. United States, 214 F.2d 862 (D.C. Cir. 1954).Google Scholar
  10. 10.
    Fact sheet. 2016. New executive actions to reduce gun violence and make our communities safer. Obama white house archives. Accessed 05 Aug 2018.
  11. 11.
    Fessenden F. 2000. They threaten, seethe and unhinge, then kill in quantity. New York Times. Available at Accessed 05 Aug 2018.
  12. 12.
    Foucault M. Madness and civilization: a history of insanity in the age of reason. New York: Vintage Books; 1988.Google Scholar
  13. 13.
    Garlow SJ, D’Orio B, Purselle DC. The relationship of restrictions on state hospitalization and suicides among emergency psychiatric patients. Psychiatr Serv. 2002;53(10):1297–300.CrossRefGoogle Scholar
  14. 14.
    Giorgi-Guarnieri D, Janofsky J, Keram E, Lawsky S, Merideth P, Mossman D, Schwart-Watts D, Scott C, Thompson J Jr, Zonona H. AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense. J Am Acad Psychiatry Law. 2002;30(2 Suppl):S3–40.PubMedGoogle Scholar
  15. 15.
    Goff DC, Falkai P, Fleischhacker WW, et al. The long-term effects of antipsychotic medication on clinical course in schizophrenia. Am J Psychiatr. 2017;174(9):840–9.CrossRefGoogle Scholar
  16. 16.
    Hart SD, Michie C, Cooke DJ. Precision of actuarial risk assessment instruments: evaluating the margins of error of group v. individual predictions of violence. Br J Psychiatry. 2007;190(49):s60–5.CrossRefGoogle Scholar
  17. 17.
    Huber CG, Schneeberger AR, Kowalinski E, et al. Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15-year naturalistic observational study. Lancet Psychiatry. 2016;3(9):842–9.CrossRefGoogle Scholar
  18. 18.
    Katsakou C, Priebe S. Outcomes of involuntary hospital admission – a review. Acta Psychiatr Scand. 2006;114(4):232–41.CrossRefGoogle Scholar
  19. 19.
    Konnikova, M. Is there a link between mental health and gun violence? The New Yorker, November 19 2014. Accessed 22 July 2018.
  20. 20.
    Lacan J. De la psychose paranoïaque dans ses rapports avec la personnalité. Paris: Editions du Seuil; 1975. (Original work published 1932)Google Scholar
  21. 21.
    Leucht S, Tardy M, Komossa K, et al. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2012;5:CD008016.Google Scholar
  22. 22.
    Lin Strous RD. Nazi euthanasia of the mentally ill at Hadamar. Am J Psychiatr. 2006;163(1):27–27.CrossRefGoogle Scholar
  23. 23.
    Mind Freedom “Who We Are”. Accessed 04 Aug 2018.
  24. 24.
    M’Naghten’s Case, 10 Cl. & F. 200, 8 Eng. Rep. 718 (H.L. 1843).Google Scholar
  25. 25.
    Ostrow L, Jessell L, Hurd M, Darrow SM, Cohen D. Discontinuing psychiatric medications: a survey of long-term users. Psychiatr Serv. 2017;68(12):1232–8.CrossRefGoogle Scholar
  26. 26.
    Phelan JC, Sinkewicz M, Castille DM, Muenzenmaier K, Link BG. Effectiveness and outcomes of assisted outpatient treatment in New York state. Psychiatr Serv. 2010;61(2):137–43.CrossRefGoogle Scholar
  27. 27.
    Pinals DA, Anacker L. Mental illness and firearms: legal context and clinical approaches. Psychiatr Clin North Am. 2016;39:611–21.CrossRefGoogle Scholar
  28. 28.
    Program Statistics: Length of Time in AOT. Albany, New York State Office of Mental Health. 2016. Available at: Accessed 06 Aug 2018.
  29. 29.
    Rosen DH. Suicide survivors. A follow-up study of persons who survived jumping from the Golden Gate and San Francisco-Oakland Bay bridges. West J Med. 1975;122:289–94.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Sashidharan SP, Saraceno B. Is psychiatry becoming more coercive? Br Med J. 2017;357:j2904.CrossRefGoogle Scholar
  31. 31.
    Singh JP, Grann M, Fazel S. Authorship bias in violence risk assessment? A systematic review and meta-analysis. PLoS One. 2013;8(9):e72484.CrossRefGoogle Scholar
  32. 32.
    Sisti DA. Nonvoluntary psychiatric treatment is distinct from involuntary psychiatric treatment. J Am Med Assoc. 2017;318(11):999–1000.CrossRefGoogle Scholar
  33. 33.
    Sohler N, Adams BG, Barnes DM, et al. Weighing the evidence for harm from long-term treatment with antipsychotic medications: a systematic review. Am J Orthopsychiatry. 2016;86(5):477–85.CrossRefGoogle Scholar
  34. 34.
    Swanson JW, McGinty EE, Fazel S, Mays VM. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol. 2015;25(5):366–76.CrossRefGoogle Scholar
  35. 35.
    Szasz TS. The myth of mental illness: foundations of a theory of personal conduct. New York: Harper Perennial; 1974.CrossRefGoogle Scholar
  36. 36.
    Treatment Advocacy Center. Serious mental illness and Anosognosia. 2016. Accessed 10 Aug 2018.
  37. 37.
    Treatment Advocacy Center. #Anosognosia is a key issue. 2017. Accessed 10 Aug 2018.
  38. 38.
    Wallace ER, Gach J, editors. History of psychiatry and medical psychology: With an epilogue on psychiatry and the mind-body relation. Springer Science & Business Media; 2010.Google Scholar
  39. 39.
    Wharton L, Wharton T. The black stork. New York: Sheriott Pictures Corp; 1917.Google Scholar
  40. 40.
    Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in remitted firstepisode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiat. 2013;70(9):913–20.CrossRefGoogle Scholar
  41. 41.
    Yablon A. The political strategy behind the GOP’s post-shooting ‘Mental health’ playbook. The trace. 2015. Retrieved from: Accessed 05 Aug 2018.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicolas Badre
    • 1
    • 2
  • Shawn S. Barnes
    • 1
  • David Lehman
    • 1
  • Sandra Steingard
    • 3
    • 4
  1. 1.Department of Psychiatry, University of California San Diego School of MedicineLa JollaUSA
  2. 2.Department of Counseling and Therapy, School of Leadership and Education, University of San DiegoSan DiegoUSA
  3. 3.Howard CenterBurlingtonUSA
  4. 4.University of Vermont Larner College of MedicineBurlingtonUSA

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