Book Reviews -- Forced into Treatment: The Role of Coercion in Clinical Practice (Vol. 137) by the Group for the Advancement of Psychiatry

Article excerpt

Tradition holds that psychiatric treatment to be successful must be voluntary. This book shows that coercion is commonly used to get people into treatment and such treatment can be quite successful. What constitutes coercion? Coercion is defined along a continuum from mandated treatment by a court or parents to someone being told to seek treatment or lose a job to self-actualization. This report explores coercive aspects of psychiatric intervention from a variety of perspectives. It tries to look at the effect of coercion on the initiation of treatment, the process, and outcome.

The first three sections of the book deal with the legitimate role of coercion, power and authority in socializing children and helping internalize controls that lead to freedom and autonomy. Also the use of parental pressure to engage initially resistant children into treatment is discussed. Next, the use of coercive social pressure including the threat of job loss to motivate employees to get treatment for substance abuse that is affecting job performance. Next, court-ordered treatment for sex offenders, child abusers, and others who often avoid treatment until they have trouble with the law is presented.

These three sections are excellent especially the one dealing with child and adolescent psychiatry. Getting the child to treatment is the parents' responsibility, at least at the beginning. Coercion, persuasion, suggestion, and direction are legitimate dimensions of parenting and treatment but they require careful scrutinizing.

In the next two sections the more traditional areas of civil commitment and involuntary hospitalization are reviewed. Most recently the pendulum of commitment has swung toward loosening the laws on commitment. The variation in the criteria for involuntary treatment is evidence that the use of coercion in initiating psychiatric treatment is not a yes/no event but varies on a continuum dictated by society's needs.

The report states that the imposition of the legal system at the gateway to mental health care has fostered an adversarial trend within the mental health system itself--advocates act not to facilitate the patient's cooperation but to encourage an adversarial relationship between patients and staff. The restrictions of the recent past have created too many safeguards to keep patients out of care and too few to get them in. …