When Mental Health Care Becomes Control

What happens when the places meant to heal the mind and body become tools for control? That is the question that recent news reports have investigated – particularly, how patients may have been hospitalized in mental health facilities longer than medically necessary. Such stories echo critiques from the past around the ethics of involuntary hospitalization and which formed part of the antipsychiatry movement of the 1960s and 1970s.

This post will provide context about these types of critiques in the past to better inform the present. Involuntary hospitalization, the practice of confining individuals to mental health institutions without their consent, has long been a subject of intense debate. While considered a measure for protecting both individuals and society, it has also faced criticism for infringing on personal freedoms and serving as a tool of social control. Hollywood has even depicted such practices in films like One Flew Over the Cuckoo’s Nest (1975), Girl, Interrupted (1999), and Changeling (2008).

The Roots of Involuntary Hospitalization

Over the past 200 years, involuntary hospitalization has been linked to the establishment of asylums and their confinement of those deemed "insane." These institutions were intended to provide care; however, as I wrote in Break on Through, they also served as places where individuals faced harsh and inhumane treatment. The rationale for involuntary hospitalization was rooted in the belief that mental illness was a threat to both the individual and society, making forcible confinement necessary at times.

As psychiatry developed in the 18th and 19th centuries, the medicalization of mental illness led to psychiatric institutions being viewed as places of healing. Yet, methods like leather restraints, electroconvulsive therapy (ECT), and lobotomies often blurred the line between care and control. These treatments were critiqued as being more about managing patients than curing them, reflecting society’s desire to maintain order rather than genuinely address the needs of the mentally ill.

A Landmark Case

A pivotal moment in the history of involuntary hospitalization was the Supreme Court decision in O'Connor v. Donaldson (1975). The Court held that a state cannot constitutionally confine a non-dangerous individual who can survive safely in freedom, either alone or with help. This decision underscored the importance of individual rights and set a legal precedent that emphasized justifying involuntary hospitalization with clear evidence of danger to oneself or others.

The O'Connor v. Donaldson case significantly impacted psychiatric and mental health practices by reinforcing the principle that involuntary hospitalization must be based on objective criteria and that the rights of individuals with mental illness must be respected.

The Antipsychiatry Movement and Critiques of the 1960s and 1970s

By the mid-20th century, the antipsychiatry movement brought significant attention to ethical and human rights issues surrounding involuntary hospitalization. Figures like Thomas Szasz, R.D. Laing, and feminist mental health activists like Phyllis Chesler challenged the psychiatric establishment. Szasz argued that mental illness was a social construct used to justify the control and suppression of individuals who did not conform to societal norms.

Phyllis Chesler, in her groundbreaking book Women and Madness (1972), critiqued how psychiatry disproportionately targeted women, using involuntary hospitalization to enforce traditional gender roles. Chesler’s work exposed how psychiatric practices were often less about treatment and more about maintaining social order, especially amid the women’s liberation and other social movements of the time.

These critiques were part of a broader movement questioning mental health practices that seemed to prioritize control over proper care.

Connecting Past and Present

Contemporary examples of forced hospitalization by for-profit health companies highlight the dangers of allowing financial incentives to dictate the care provided in mental health facilities. It serves as a reminder that the issues raised by the antipsychiatry movement in the 1960s and 1970s are far from resolved.

Psychiatry Essential Reads

Public Health and Psychiatry: Two Ways to Treat Mental Illness

It’s Time for Social Psychiatry’s Comeback

Modern controversies also underscore the importance of continued vigilance and advocacy in mental health care. The lessons of the past, as articulated by figures like Phyllis Chesler, remain relevant today. The need for informed consent, patient autonomy, and a focus on genuine care rather than control or profit must remain central to any discussion of psychiatric treatment.

By reflecting on the critiques of the past and examining the practices of today’s mental health care providers, we can better understand the challenges that persist and work toward a mental health care system that truly prioritizes the rights and well-being of patients.