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History And Moral Development Of Mental Health Treatment And Involuntary Commitment

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History and Moral Development of Mental Health Treatment and Involuntary Commitment

The history of involuntary commitment has been developed and created through the history of mental illness and the constructs of society. Government policy has been created to treat mental illness and this philosophy of mental illness and its treatment goes as far back as Greek Mythology. The belief about mental illness has changed throughout history and at times thought to be due to, possession of demons, reversion to an animalistic level of consciousness, a sinful state of the soul, a chemical imbalance, and as reported recently in the medical journal Nature and Genetics, a defect in chromosome number six (at least as far as schizophrenia is concerned).

The authority of the state to involuntarily commit an individual for care ran the range from the absolute power of the king as sovereign to order incarceration, to the due process of law to protect life and liberty of persons with mental illness under constitutional and state law. In recent years involuntary commitment has become increasingly more difficult, due to many various legal reforms, such as the increased number of professions with the ability to assist with the process, the least restrictive mandate, and the right to refuse treatment mandate. Maine has created amendments to laws that have changed the dynamics of involuntary commitment, including giving persons the ability to refuse treatment, restricting involuntary commitment to persons that are at high risk to themselves or others, and placing limits on time around the number of hours a person can be held for psychiatric evaluation. The moral standards in society raises question of a breach of the constitution are created with this process of involuntary commitment. Thomas Szasz argues that involuntarily committed and involuntary treatment of a mental illness represents a violation of the individual's civil liberties and takes away a person's autonomy, gaining power and control over him or her. The moral conflict within society represents a constant change in the perception of mental illness.

The following is a review of the history of mental illness and the treatments created through various times, including the emergence of mental illness as a diagnosis different from social deviance. Involuntary commitment was established to assist in maintaining safety for individuals as well as society and became a part of treatment for persons with mental illness. The commitment laws were created through history on a federal level and established within the state level. The State of Maine laws and amendments to the commitment laws will be reviewed as well as the impact on society and individuals with mental illness. Also discussed will be a summary of the controversy within society around the morality of forced treatment and the interpretation on constitutional rights by politicians and philosophers.

Ancient History of Involuntary Commitment

Greek philosophy, government, and culture are the ascendants to our own social and legal practices of involuntary commitment today. The creation of the "insanity defense," the definition the "asylum" as a place of rest, peace and recovery for the mentally ill, and definition of the basic principles of "informed consent," were all originally developed in ancient Greece and these fundamentals have changed very little since then. The lack of criminal liability due to the existence of a mental illness, which impairs judgment or behavior, is defined as the "insanity defense." In the extensive myths concerning Hercules, which is stated that later in his life to have killed his wife and three children due to a curse from the goddess Hera. Regardless of this tragic murder being witnessed by the town's people, he was nevertheless excused from this behavior due to the mental confusion caused by the curse. This is precisely the formula of the modern "insanity defense." Accordingly, Hercules was found to be in need of care and treatment by his best friend, Amphitryon, and the townspeople, and he was given counseling to prevent his own successive attempted suicide upon regaining his mental competency and realizing what he had done (E. Hamilton, 1971).

Hippocrates believed that mental illness had a physical and a rational explanation and rejected the views of his time that considered illness to be caused by superstitions and by possession of evil spirits. Additionally, he recommended that the treatment of mental illness should be conducted in an asylum, a secure and safe retreat from the chaos and pressures of the environment, rather than having persons with mental illness whipped in public, or incarcerated in dungeons (Stevens, D. 1997).

Soranus of Ephesus lived in the century 98 A.D. in Rome, and was a physician of women and childbirth. Soranus believed that the human body is composed of atoms constantly in motion. He theorized that disease was caused by a disturbance in these atoms. In light of the recent discovery that schizophrenia might be caused by a defective chromosome number six, Soranus' view coincide with the latest findings on the possible causes of some mental illness (Darton, K. 2000).

Although, Soranus described mental illness as an organic disturbance, he treated it by psychological methods, minimizing the use of drugs and other physical treatments. Treatments included encouraging reading, entertainment, sea voyagers, etc. Soranus thought that the patient should be engaged in intellectual activities not only for therapeutic purposes but to detect the progress of the illness; accordingly, patients should be encouraged to talk to philosophers to "banish their fear and sorrow (Meinsma, R. 1998).

Aristotle defined the legal principle of informed consent, which is essentially unchanged to this day, and underlies the two legal justifications for involuntary commitment of certain persons who are mentally ill. Aristotle, in his work the Nicomachean Ethics, essentially defined informed consent as a person's actions, which are done with knowledge, rationality, and without coercion. It is still a matter of a person's ability to receive and absorb the relevant knowledge, intelligently evaluate the risk and benefits of the decision, and to be free from any coercion. These same three legal elements still form the basis of court decisions, statutes, and they were endorsed by the Report of President's Commission for the Study of Ethical Problems in Medicine and on Biomedical and Behavioral Research (Medical Health Care Decisions, 1982).

In ancient Greece and Rome, care of mentally ill and retarded individuals was largely the responsibility of those persons' families, relatives



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