Treatment without Consent: Law, Psychiatry, and the Treatment of Mentally Disordered People since 1845

Treatment without Consent: Law, Psychiatry, and the Treatment of Mentally Disordered People since 1845

Treatment without Consent: Law, Psychiatry, and the Treatment of Mentally Disordered People since 1845

Treatment without Consent: Law, Psychiatry, and the Treatment of Mentally Disordered People since 1845

Synopsis

Phil Fennell's tightly argued study traces the history of treatment of mental disorder in Britain over the last 150 years. He focuses specifically on treatment of mental disorder without consent within psychiatric practice, and on the legal position which has allowed it. Treatment Without Consent examines many controversial areas: the use of high-strength drugs and Electro Convulsive Therapy, physical restraint and the vexed issue of the sterilisation of people with learning disabilities. Changing notions of consent are discussed, from the common perception that relatives are able to consent on behalf of the patient, to present-day statutory and common law rules, and recent Law Commission recommendations.This work brings a complex and intriguing area to life; it includes a table of legal sources and an extensive bibliography. It is essential reading for historians, lawyers and all those who are interested in the treatment of mental disorder.

Excerpt

In the 1870s and 1880s the use of drugs to restrain patients was extensively debated. There was evidence that heavy doses of medicines with unpleasant effects were used to deter patients from misbehaviour and that many patients were kept in a permanent state of over-sedation. Motivation was all important. Administration of strong sedatives was acceptable if given with the intention to quieten a disturbed and potentially violent patient, but not as a form of punishment. Nor was routine sedation permissible simply to make life easier for the attendants. Although doctors were required to enter the drugs given to each patient in the case book, chemical restraint was clearly viewed by the Commission as medical treatment, and a matter of medical judgment, unless there was clear evidence of punitive intent. Nevertheless, the debates of the 1880s and 1890s clearly reveal the importance of drugs as a vehicle of disciplinary power in institutional psychiatry.

Although other hypnotics were widely used, opium was the traditional standby for the mad doctor, described by Bucknill and Tuke in the 1858 edition of their Manual of Psychological Medicine as the ‘sheet anchor’ of the alienist physician. ‘It was the right hand of the physician in the treatment of insanity,’ waxed Bucknill, ‘a true balm to the wounded spirit, a sedative in mania, and a restorative in melancholia.’ By the late 1850s the addictive properties of the drug were well known. The annual report of Lincoln asylum for 1858 remarked upon the high number of admissions of melancholic opium addicts due to the prevalence of opium eating amongst the people, and it pleaded for philanthropic endeavour to eradicate the addiction. Although opium was used initially as a remedy against ague (malaria), the disease had now

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