McTernan on politics

Mind altering or mind ordering? Two very different ways of
describing anti-psychotic drugs which reflect contrasting views of
personal freedom and medical intervention.

Yet that is the question at the heart of the debate about
whether it is ever justifiable to medicate people with psychiatric
disorders compulsorily. Health secretary Alan Milburn launched a
fierce debate in the UK when he published his draft Mental Health
Bill which proposed that doctors in England and Wales be given new
powers to force people with severe mental illness to receive
treatment.

A case being considered by the US Supreme Court brings this
debate sharply into focus. Charles Sell, a dentist from Louisiana,
was charged in 1997 with mail fraud and money laundering. As his
trial drew near he became paranoid and delusional and his lawyers
argued that he was no longer competent to stand trial as he could
not possibly understand the charges levelled against him or
properly instruct his defence team. Simple, responded the
prosecution, he should take a course of anti-psychotic drugs which
end his paranoia and enable him to participate fully in his own
trial. At this point the accused refused treatment.

The dispute has now reached the Supreme Court. An impressive
array of organisations, ranging from the Association of American
Physicians and Surgeons to the American Civil Liberties Union, back
Sell. They argue that the government’s desire to see Sell treated
in order to face a charge conflicts with his own right to refuse
treatment. Yet, putting aside the details of the specific case,
what freedom is there in psychosis? Is it a right worth protecting?
Anti-psychotic treatment gives people back their lives, reinstating
personal autonomy by ending dangerous and destructive delusion. In
Sell’s case this has led him to believe that he is under siege and
has ended up conspiring to have an FBI agent assassinated. What
humanity is there in leaving Sell trapped inside such a distorted
world? This is not an easy issue to resolve, and even the US
Supreme Court seems to be set on finding a technical way not to
rule on the issue. But Justice Antonin Scalia summed it up well in
asking Sell’s lawyer: “What is your solution to this dilemma? We
can’t try him because his mind isn’t working properly but you say
he’s entitled to refuse the drugs which would make his mind work
properly. It’s just a crazy situation.”

The questions raised are relevant in the UK where we see
homeless people whose lives are in free-fall where their severe
mental health problems are a danger to themselves and any
possibility of an ordered life. Should the standard of care for
them include only shelter, health care and substance abuse
services? Where we can, should we not give them back their selves
as well?

John McTernan is a political analyst.