hospital room with beds and windows

According to the Encyclopedia of Mental Disorders, involuntary hospitalization “is an extremely controversial course of action.” In her 2019 book The Collected Schizophrenias, Esmé Weijun Wang steps into this controversy. She presents arguments from both sides. And she offers a unique perspective on the issue, having been involuntarily hospitalized herself, three times.

On the pro side of the debate, sometimes people who suffer from mental illness are in danger of harming themselves or others. Wang tells stories about people who wish to help a family member with mental illness and prevent negative outcomes, but feel unable to cope with the situation on their own. She points out that being a loved one of someone with mental illness can be challenging and, in some situations, can result in feelings of terror. She also writes of her personal desire to retain the option to put herself in someone else’s care to avoid committing suicide, if it ever came to that.

On the con side of the debate are, as Wang explains, “crucial issues of autonomy and civil liberties.” She clearly considers these issues of vital importance, as she brings them up not just in the essay on the topic of involuntary hospitalization, “Toward a Pathology of the Possessed,” but in many of the other essays throughout the book. She writes about many aspects of the collected schizophrenias; the issues of autonomy and civil liberties arise again and again.

Wang’s personal experiences in being involuntarily hospitalized were far from positive. She explains the intense fear of being in a small, unfamiliar place and not knowing when she will be allowed to leave. She explains the feelings of despair that arise from not being able to make simple decisions like when and what to eat. Further, it is very difficult, she points out, to say or do anything in a mental hospital and be believed and taken seriously. Here are her words about the situation:

“I maintain, years later, that not one of my three involuntary hospitalizations helped me. I believe that being held in a psychiatric ward against my will remains among the most scarring of my traumas.”

And here is what she writes about Julian Plumadore, a speaker and advocate for mental health:

“He’s better now, he tells me, because he was finally told that he himself knows better than anyone else what he needs. For him, that included harm-reduction techniques instead of involuntary rehabilitation, as well as estranging himself from his family.”

This rings true to me. It can be hard to watch someone make their own decisions. You want to reach in and make the decisions yourself, to make sure they are the right ones. The trouble is, your definition of right might not be the same as theirs.

When I was in the worst throes of my bout with physical and mental issues, I did not always know on a conscious level what I needed. I relied on doctors, counselors, family members, and friends to advise me on steps forward. But the advice I received was contradictory and irregular. Much of it did not reliably move me toward recovery. It was only when I began to listen to and trust my gut feelings that I found that I could reliably make decisions that helped, rather than exacerbated, the problems.

I do not claim that I always made the right choices. And I continued to listen to others’ advice, take it seriously, and act on it (if I thought it might help). But if I had not retained the freedom to follow my instincts, I would surely never have found my path to recovery.

It’s admittedly hard to justify letting people make their own decisions when there is reason to believe that they might harm someone (self or others). But it’s also hard to justify taking away someone’s autonomy, without which personal improvement is virtually impossible.

Who makes your decisions?