In a September 19th New York Times article, Benedict Carey writes about the recent death of Dr. Wayne S. Fenton, a psychiatrist who was killed on Sunday, September 3, by a schizophrenic patient. The issue Carey brings up is whether or not severely disturbed patients should be forced to take their medication in order to control potential violence.
Certainly, every doctor who deals with mentally ill patients will have to decide for themselves how much to risk. According to the article, Dr. Fenton was "the therapist of last resort, the one who could settle down and get through to the most severely psychotic, resistant patients, seemingly by sheer force of sympathy and good will . . . he met with patients on weekends, sometimes late at night, at all hours."
Dr. Fenton’s death was a tragedy for him as well as for his 19-year-old patient, whose life is now also ruined. But that doesn’t mean the government should be able to force everyone diagnosed with a particular mental illness to take their medication. Policies favoring coercion would only make it less likely that those struggling with severe illness would try to get help. Instead, they would be more likely to attempt to hide their symptoms.
In California and in my state, New York, laws have been tightened to compel some mental patients to accept treatment against their will. A bipolar friend of mine was worried on one occasion that she might be forced into this position. It’s not necessary to have committed a crime in order for the state to take action, so it is pretty scary from a patient’s point of view.
Why wouldn’t we want to take our medication? The biggest reason for most patients is unendurable side effects, which range from tremendous weight gain to mind-numbing lethargy and lack of ability to focus. Certainly we all know people who stop taking their meds because they miss the highs. But most of them are not going to become violent, and all should not have to pay for a small minority who do.
There is as yet no perfect treatment for mental illness. Each case is unique, and it often takes years of the best efforts by doctor and patient to find a way to make life work. Passing laws that coerce patients into following a doctor’s orders would only set us back in the quest for better solutions and better mental health for all.
Last reviewed by a physician specializing in bipolar disorder on 9/25/06.