The Bitterest Pills: The Troubling Story of Antipsychotic Drugs by J. Moncrieff

Author:J. Moncrieff
Language: eng
Format: mobi
Publisher: Palgrave Macmillan UK
Published: 2013-09-14T21:00:00+00:00

Long-Term Behaviour Control

Although the claim that the forcible administration of drugs in emergency situations is a therapeutic activity that is hard to sustain, there is a more legitimate debate about the nature of antipsychotic treatment when it is given to someone against their wishes on a continuing basis. Psychiatric critics like Thomas Szasz have argued that all non-consensual drug ‘treatment’ should be considered a form of social control and that it consists of the drug-induced modification of behaviour that others find unacceptable. Mainstream opinion, however, regards such activity as medical treatment that is given to improve the patient’s ‘health’, and this is the view that is enshrined in mental health law.

We saw in Chapter 7 how antipsychotic drugs can help to suppress otherwise irresistible psychotic experiences and by doing so can sometimes unlock people from the internal world that had engulfed them. Although some people ultimately welcome these effects, many people find they do not compensate for the state of demotivation and loss of interest the drugs produce. Like Peter Wescott, people sometimes talk of undergoing a personality change while taking the drugs, of becoming someone less interesting and less distinctive than they were before. Moreover, people who are deemed to have severe mental disorders often do not agree that there is anything wrong with their actions, even when their psychotic symptoms have subsided. Where people dislike the effects of the drug more than their symptoms, and where people do not wish to change their behaviour, it is difficult to see how it can be argued that ‘treatment’ is being imposed in their own interests.

Up until recent times, drugs could only be forced on people against their will while they were in a psychiatric institution or hospital. Once someone had recovered sufficiently to be discharged, they were free agents again and could stop taking their medication if they wished to do so, at least in theory. Research led by Manchester sociologist Anne Rogers showed that even in these circumstances, however, many people felt compelled to continue with their drug treatment when they wished to stop it, even though they were under no legal obligation to do so. The patients who were interviewed revealed that they were cajoled and pestered to take medication by mental health staff, and that they feared they would be taken back to hospital if they refused it. The researchers concluded that some patients had internalised the control that can be exercised through the Mental Health Act, and effectively policed their own medication intake, no longer believing they had any real choice in the matter (Rogers et al., 1998).

Many countries have now introduced legislation that enables people with mental health problems to be legally forced to continue treatment—usually drug treatment—after they are formally discharged from hospital. Community treatment orders were introduced into England and Wales in 2008, and, at first, the government anticipated they would only be applied to only a small fraction of patients. The orders were intended to be applied to the sort of people

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