Committed

Part 3

by Clea Simon

Chrissie's tale sounds like a nightmare. Locked up, drugged, perhaps beaten, for reasons you don't know or understand. For some, this bad dream comes horribly true: a Boston Globe Spotlight Team last May discovered several disturbing stories in which involuntary hospitalization was, at best, an iffy call. A despondent woman went to a support group and found herself hospitalized. Another, depressed, sought to end counseling and was committed. Perhaps most tragic, a 64-year-old Holocaust survivor -- who did have a history of mental illness -- died as she was being taken into custody. Thousands of orders for involuntary hospitalization or treatment are taken out in this state (approximately 9000 annually, according to Stan Goldman, director of mental health law at Boston's Committee of Public Counsel Services); as these stories make clear, many may be misguided, some perhaps tragically so.

But the consequences are equally nightmarish when treatment comes too late, or not at all. Think of the recent New Jersey case in which a 15-year-old was charged with the sexual abuse and murder of a younger boy. The accused murderer's parents had tried to have the teen, also a victim of abuse, hospitalized several weeks before he allegedly sodomized and killed his 11-year-old victim. They believed he needed professional assistance, the state prosecutor told the New York Times. "We took him to a hospital and he refused to enter. He refused counseling. . . . I can't conceive of anything more we could have done in a democratic society to restrain this boy."

These cases are, of course, extreme. And in each, the question of whether to impose involuntary treatment or hospitalization seems simple: of course, the 64-year-old Holocaust survivor should have been treated more gently and not taken against her will. And obviously, the abused teen was dangerous, even if some judge at a commitment hearing missed the signs. But if these examples illustrate how much responsibility falls on those who make the decisions, they barely begin to show how difficult most such cases are.

Consider the scene one frigid winter night, not long ago. The police pick up a woman who seems to be acting irrationally. She's been getting in people's faces, demanding coffee, crossing carelessly into the street. The cops bundle her into their car and ask if she wants to go to a shelter. No, no, no, no, she's adamant about that. Taking cues from her behavior, from her somewhat garbled speech, they bring her to the Massachusetts Mental Health Center instead. It's 16 degrees out, and they'd like to find a place for her to spend the night. The doctor on duty meets with her and asks if she'd like to check herself in. No, no, no, no. She sure doesn't want to do that. All she wants, she keeps repeating, is coffee. The doctor weighs the evidence. The police didn't say she was actually in traffic, just that she was darting into the streets and being a little too aggressive in chatting people up. She seems to know the shelter system well, and she promises to come back for treatment the next day. He gives her coffee and lets her walk back out into the cold.

That's just how it has to work sometimes, says Dr. Ken Duckworth, medical director of continuing care service at the center, who was the clinician on duty that night. "There are definitely times when it's the right thing to say `I respect your right to refuse treatment, even though I think you're going to run into problems because of your decision.' "

But if a distraught family member had been on the phone when the coffee lady came in, begging him to admit this mother/daughter/sister, Duckworth says now that he does not know what he would have done. He brings up a similar situation, when he spoke at a hearing to have a man declared incompetent. The man won the right to make his own treatment decisions, and he walked out into the winter. A year later, he wandered into Duckworth's clinic again. He had lost all his fingers and toes to frostbite.

Back to part 2 - On to part 4

Clea Simon's Mad House: Growing Up in the Shadow of Mentally Ill Siblings (Doubleday) was named Book of the Year by the Alliance for the Mentally Ill (Mass.)