Can The Court Force Treatment on Jared Loughner?
He was found not competent to stand trial. This means his trial is postponed until his mental illness resolves enough for him to: understand the charges against him; participate meaningfully in his own defense; control his behavior in court; etc. See that last "etc?" That's the part that allows courts to do anything they want to you.
Loughner, however is refusing to take antipsychotic medication to get better. A more accurate restating of that sentence would be, "it is extremely likely that Loughner's attorney is refusing to allow him to be medicated, with the hope that trial is postponed forever, or at least until the attorney comes up with a really awesome defense, or people forget who Loughner is."
Let's Michael Foucault this whole discussion and recall that psychiatry is a medical specialty that is also used to set social policy.
Practically, this means that if the court wants to medicate Loughner against his will, they can. There is a legal process to follow, but it is simple and straightforward and completely not in any kind of dispute.
There should be no issue.
II.
So I was surprised to read that the American Psychiatric Association and the American Academy of Psychiatry and the Law, through Paul Appelbaum, filed an amicus curiae brief in support of forced medication. Why? Isn't this a non-issue?
In fact, there are two reasons you can forcibly medicate (only) prisoners. The first is Sell v. US: you can force antipsychotics for the purpose of restoring the defendant to competency to stand trial.
The second reason is Washington V. Harper, which allows forced medication of psychotic prisoners in the situation where they were dangerous to themselves or others.
So, again, I was confused. What's the debate?
The APA's brief had two purposes:
1. "When the courts address issues concerning psychiatric disorders, we want them to have accurate data on the nature and consequences of those illnesses and on appropriate treatments." The reason antipsychotics have traditionally been disallowed is because, as in Sell, there are significant irreversible side effects (tardive dyskinesia) that may outweigh the benefits. So the APA wants to update the court on the real risks, especially of the atypicals.
2. Sit down:
The second key issue the brief addressed was the importance of permitting authorities who have custody of a defendant to make decisions of forcible medication without having to go through a time-consuming judicial hearing on the matter.
The brief pretends that the issue is unscrupulous lawyers keeping their poor psychotic clients psychotic forever, to their great distress, just to avoid trial. Appelbaum would like Harper to be the standard; Sell is too bureaucratic.
In addition, we believe psychiatrists working in correctional facilities need the flexibility to deal with dangerous persons without the delay involved in lengthy court proceedings.The APA assumes that treatment decisions should fall to psychiatrists, but it seems not to appreciate that these are psychiatrists in prisons who work for the government. There is massive, gargantuan pressure on psychiatrists to medicate and commit and diagnose inmates for all kinds of legal reasons. Harper may seem like the more psychiatrist-friendly standard, but it isn't. You want the standard to be Sell, because you want a way to avoid the pressure from the government.
The Loughner case is misleading because he is mentally ill and dangerous, but the APA wants to massage Harper to focus on the dangerousness. Here's a more typical example: the defendant is a violent rapist who has significant personality disorder but no clear psychosis ("no Axis I pathology.") He punched his lawyer. Now what? You commit him to the psychiatric ward because he's incompetent to stand trial and forcibly medicate him because he's dangerous. But he's not psychiatric! "Yes he is, it says it right there on the commitment papers: Psychosis NOS." So you ask how he got that diagnosis, and of course the answer is: we needed it to be able to forcibly medicate him.
I'm not going soft on rapists-- go ahead and sentence him to life. But don't send him to psychiatry because you don't know what else to do with him.
Doctors are given considerable deference to use their judgment; they are given greater latitude to violate a person's rights. The government will use the back door of the doctor's privilege to get what it wants. It is inevitable.
The issue is not whether psychiatrists should medicate people who are obviously psychotic and dangerous-- you don't need an APA amicus curiae brief for that. The issue is whether you want to force all prison psychiatrists to be responsible for the "treatment" of every violent person out there, simply because they are "dangerous."
The APA has always wanted the answer to be yes. And here, again, they do not understand the consequences of this. I can thus say, according to the strictest definition of the term, that the APA is completely insane.
Miscellany:
1. In the Harper case, the American Psychological Association filed an amicus curiae brief in support of Harper, i.e. that forcible medication without a hearing violated the due process and equal protection clauses. You are welcome to explore the disparity between the APAs.
2. Harper does not apply to civilians. You can force hospitalization on a guy for being dangerous and psychiatric, but you cannot force treatment on him without a court order. You can lock him down, but you cannot touch him.
If a psychotic diabetic patient whose sugar is life threateningly high is refusing insulin because aliens tell him to, upon psychiatric review you can force insulin on him, but you still can't force antipsychotics on him because the insulin is necessary to his survival and the antipsychotics are not.
We know that psychosis takes a few days to improve, even if the right dose/drug is hit on immediately. The fact that it takes days to work means you can't argue they are life saving, so you can't get past the need for a court order.
I will point out that even though what I've written is true, psychiatrists still routinely force medication on people, in jails and in hospitals. They're doing it for noble reasons, and I don't fault them, but it's important to know where the line is before you cross it. And, as importantly, it is far preferable that a doctor violate the law in order to do what's best for a patient, then it is for the government to sneak past people's civil rights by hiding inside their doctors' white coats.
--
Competency to be executed
Then I change my mind: Competency to be executed II
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August 25, 2011 2:24 AM | Posted by : | Reply
Look at those eyes.
I never understood how much of a clusterfuck that bureacracy could bring to forensic psychiatry, but wow.
Score: 6 (6 votes cast)
August 25, 2011 6:29 AM | Posted by : | Reply
That particular picture of Loughner is the only one most people recognize, and the only one the media uses. There are plenty of photos of him that look less ridiculously insane, but I guess this one fits the accepted narrative, which is that he went crazy and shot a bunch of people. From what I'm told, that is approximately what happened, but the way the media handled it has always bothered me.
That picture, for one, which can't help but make you think "this man is obviously insane and guilty." The relentless coverage of the event, Giffords's condition, and her family (but not the "18 other people," because they aren't important) also struck a nerve. There was some stuff about the Middle East and the ongoing economic crisis, but for several weeks, most of what I saw on the news was about the shooting.
Maybe I'm just callous, but I got it the first time around. I really didn't want to hear about what happened to Giffords and how tragic it was, over and over. There's a lot of other stuff going on in the world. Plenty of death and violence, too, if that's what it takes to make something potentially newsworthy. Or maybe I just don't like spectacles (the royal wedding comes to mind).
A police officer was shot and killed near my hometown several years ago, and this shooting reminds me of that. Officers from every department in the region launched an extensive motorcade through all the towns in the area (and people turned out, waving flags and so forth), and for the next few weeks, the cops were out in force, issuing tickets, reminding the public that everyone loses when someone kills a cop.
It reminds me of Wikileaks and Assange. While there was initially some support for Assange (more, I think before he used Wikileaks to try to safeguard his wellbeing, by threatening to release information if harmed), the major media outlets gave the event almost universally negative coverage, with politicians from both "sides" throwing in sound bites whenever possible.
The governments of the world decided it would be a good idea to pressure Sweden to extradite him on questionable sexual misconduct charges (which I think may have been translated to "rape" in the public eye), because they didn't like what he was doing and that was a way to get at him. Sweden did what organizations in this kind of situation always seem to do; it caved. The whole affair was completely blatant, and people brought that up, but those in charge didn't care, and it happened anyway.
I don't know that anything will come of the legal proceedings, but they've taken long enough for the Wikileaks spectacle to blow over, and its reputation is cemented in the public mind.
Maybe these aren't the best examples. Something just seems wrong about all of this, particularly the media bias (not that I expect actual and unadulterated news from the major outlets very often).
I guess the message is "Don't rock the boat."
Sorry if this got off-topic. The first two paragraphs refer to Loughner and are the most relevant.
Score: 13 (15 votes cast)
August 25, 2011 4:23 PM | Posted by : | Reply
I'm a bit confused here... the sensible claim is "You can force hospitalization on a guy for being dangerous and psychiatric, but you cannot force treatment on him without a court order. You can lock him down, but you cannot touch him."
But.
If you've locked them down, then how are they still dangerous? What is the definition of "dangerous" in the context of "we want to medicate him to the point where he's competent to stand trial" if they are physically indefinitely restrained? I mean, "dangerous" in terms of "don't stop restraining him because he is dangerous when unrestrained" is obvious (and prejudicial so don't say it near a jury), but it seems to me that being in custody should be synonymous with *not* having "dangerous" as a present-tense descriptor -- that's why we want them to be in custody -- so it's okay to wait for the court order before dosing the defendant up.
Is the push for the Sell standard to be the standing precedent a tacit admission that having psychotic suspects in custody isn't enough to protect society from them? Or am I missing a piece of due process here?
Score: 6 (6 votes cast)
August 25, 2011 6:01 PM | Posted by : | Reply
Good lord, this took long enough.
Score: 0 (0 votes cast)
August 25, 2011 6:30 PM | Posted by : | Reply
I think Jared Loughner is sane.
The day of the shooting he encounter problems and solved them in order to commit the crime.
en.wikipedia.org/wiki/Jared_Lee_Loughner#Tucson_shooting
If someone is insane in my point of view, cause and effect no longer exist. If you are psychotic, you can walk around naked or do whatever idea pops into your head.
They judge should gag him with a physical gag, if Loughner cant be quiet in court. They don't have to chemically gag his brain neurons and call it "medicine".
"Loughner’s crime, like any act, was not senseless at all, provided we are willing to put ourselves in his shoes. Of course, it makes no sense if we are unwilling to do that, denying the personhood of the actor, dismissing a priori his possessing free will, attributing his action to mental disease instead of personal decision." wrote Thomas Szasz in "Senseless
Did the perpetrator of the Tuscon massacre have a reason?"
Score: -1 (7 votes cast)
August 26, 2011 10:05 AM | Posted by : | Reply
Thanks for an excellent review of the issues at hand. I am always amazed at how Alone manages to touch upon so many issues in few paragraphs...
Score: 0 (2 votes cast)
August 26, 2011 11:32 AM | Posted, in reply to , by : | Reply
I'd be forced to agree with you, though not necessarily just because of this case. The guy is insane, and IMO would most likely be haelped by being medicated.
The problem is that mental illness has been defined socially in the past and most likely will be in the future. If something is weird enough to the general population, it's more than likely to be considered "mental illness" and if the government can force treatment for mental illnesses, than it can force a medical intervention for things that aren't medical but are politically incorrect or make other people uncomfortable. This precedent could easily be used in the future to suppress dissedents, enforce religious conformity, and generally medicate anyone that the state determines is unmanagable. It's the way the system works. Given enough time, any of these laws could very quickly be turned against the people who made them for their own protection.
Score: 6 (8 votes cast)
August 26, 2011 6:31 PM | Posted by : | Reply
The good news is, the courts are unlikely to want to give up the power to decide whether a defendant should be forcibly medicated. Judges hate becoming irrelevant.
Score: 0 (0 votes cast)
August 27, 2011 11:50 AM | Posted, in reply to , by : | Reply
RE: "most likely be helped"
WTF? We help criminals? Why are people making an excuse for a criminal? Why do you want to "help" him?
Because he is sick, why is he sick? Because he did something unimaginable. Doing something wrong is the nature of all criminal actions. Thats why we have jails, to protect the people who agree to follow the rules of society and choose not to commit crime.
If instead of shooting people, if he would have robbed a bank (something you could do), would he be a criminal then? Would he be sane if he stole money instead of killing?
In the future , if you decide to do something illegal , you will be "mentally ill"? and forcibly medicated for your illness for the rest of your life...
Score: -2 (8 votes cast)
August 28, 2011 5:54 PM | Posted by : | Reply
I took 1 st home loans when I was a teenager and this aided me very much. However, I require the auto loan as well.
Score: -2 (4 votes cast)
August 29, 2011 3:32 AM | Posted by : | Reply
Central London Counselling
Hi everyone!
It is really very confusing that one can not be treated or medicated without a court order even in the condition that he can not understand the sentence charged to him. The important point is that why we are so ignorant of the significance of mental health. The question is that is it not very necessary for a human being.
Score: 0 (0 votes cast)
August 29, 2011 1:02 PM | Posted by : | Reply
When my stepson was incarcerated in a boys' home, he got his status bumped up to "violent offender" because he bit a staffer's hand when (he says) they were trying to force him to take his Ritalin.
Assuming his version of the story is true, is this kind of forced medication generally allowed? He was never deemed psychotic.
Score: 1 (1 votes cast)
August 29, 2011 1:06 PM | Posted by : | Reply
When my stepson was incarcerated in a boys' home, he got his status bumped up to "violent offender" because he bit a staffer's hand when (he says) they were trying to force him to take his Ritalin.
Assuming his version of the story is true, is this kind of forced medication generally allowed? He was never deemed psychotic.
Score: 2 (2 votes cast)
August 29, 2011 7:56 PM | Posted by : | Reply
Sorry if I missed it, but wasn't the rationale for a right not to be medicated to the effect that the anti-psychotic medication caused "irreversible" damaging effects? That was certainly true a while back (thorazine, et al.) but is it true now with the new anti-psychotics? And if it isn't true with the new anti-psychotics then why can't prison psychiatrists just use them indiscriminately without court intervention? Is there something going on here that I've skipped over or don't understand?
Score: 0 (0 votes cast)
August 30, 2011 1:38 AM | Posted by : | Reply
That man looks like he ODed on a drug called charlie sheen
Score: 3 (3 votes cast)
August 30, 2011 1:46 AM | Posted by : | Reply
@Markps2
There are a lot of ways to go crazy. It doesn't always involve a total breakdown in even basic logic (e.g. cause and effect). Sure, some crazy people sit around throwing out word salads and just banging their head against the wall for 5 hours straight for no reason... but not all crazy people do that. INsanity is basically a breakdown in logical thinking, but logic is not binary. Yes, the rambling word salad schizophrenic is one kind of lack of logic... but another kind of lack of logic involves someone who is paranoid and deluded (therefore illogical), however they still have basic logic abilities which are required to act on their illogical delusions. They can say "if I get a gun, aim and shoot it, I will kill people" which is totally in tact logic, but they can also think "words have no meaning, and there is a grand conspiracy going on to control my thoughts" which is extremely illogical. If the person is asked to reality test their ideas, the more insane they are, the less they can see it.
It's sort of how medical practitioners assess how oriented and lucid a person is by asking the time, the place, and their name. Lucidity is not binary, orientation is not binary. A slightly confused person will not know the time, but they know where they are, and they know their name. A rather confused person does not know the time or where they are, but will know their name. A totally disoriented person doesn't even know their name.
Psychosis is sort of like that. You can understand shooting kills people, yet not understand that there is no conspiracy, no one is controlling your mind, you are just a crazy fuck who needs to settle down and take his risperdal.
Score: 0 (2 votes cast)
August 30, 2011 1:59 AM | Posted by : | Reply
@Solikhoda
MI is no longer defined by "weirdness" or "socially unacceptable". Plenty of things are weird but not MI. Racism is unacceptable but we don't say racists are MI. People who walk around thinking they are vampires are not labeled MI.
Mental illness is now defined by utility - utility to society, and utility to the psychiatry juggernaut. First is utility to the industry of psychiatry. If the person is willing to pay for the services, then they will be labeled ill so a to justify selling them the service. A person who needs to get over it, get a job, stop dwelling on their feelings, and stop being so self indulgent is now called personality disordered or bipolar or some crap, given PRN xanax/seroquel/ativan and a SSRI. They don't need those scripts, they need to grow the hell up and stop acting like a petulant child.
His would NEVER have happened in a world where psychiatrists and pharmaceutical companies are not making $$$ from doing this. It certainly doesn't help this loser to be told they are MI - the loser needs to be told to stop being a loser and to get a grip. They need more harsh reality, and less "yes, your problems really are unique and special, here's a pill to make you more apathetic and tired and unable to remember anything so you have no hope what so ever of changing your situation and learning".
Then, the second utility is to that of society, which is just an off shoot of utility to corporations/industry. No one really cares about the long term good of society anyway, but short term control (which is profitable). So, people are labeled ill if they cause problems, and able to be controlled.
Racists are not MI because they are renegades - They otherwise logical and can't be controlled, so they are outside the spectrum of crazy people. On the other hand, 5 year old boys who throw chairs ARE mentally ill, because they can be controlled and drugged into submission as children are not mature enough to vocalize or understand their rights and wishes.
Psychotic people are mentally ill because they are obviously bat shit, and they are also mentally ill because in their illogical state they lack any means necessary to resist being dominated and vocalizing their noncompliance with the labels, much like an angry 5 year old (but sane) child.
**NOte, if a racist eventually agrees to be medicated, then his racism can be reframed as mental illness. Until then, he is just an evil person.
Score: 1 (5 votes cast)
August 30, 2011 2:10 AM | Posted, in reply to , by : | Reply
I would say a child who bites someone due to medication non-compliance would be showing signs of violence, yes. People usually don't put pills RIGHT IN someone's mouth so I have to assume the biting was pretty unnessary. Speaking as a nurse I would never take a pill, in my hand, and shove it in someone's mouth. There are way better ways to trick a crazy person into taking medication. That is asking for the patient to hit or attack you.
I've never been bit or attacked by a patient who wasn't already crazy and violent. Normal people (and I assume children) are not going to lash out in violence for no reason, just because they are upset. There must be a violent / crazy ass tendency prior to that.
I would wonder why he was in a group home anyway if he was oh so well adjusted and agreeable?
Forced medication for crazy fucks is pretty much par for the course. Sure, sometimes not crazy fucks get mixed in with the crazy ones... but you will never meet a crazy fuck who thinks he needs his medication. Therefore, the caregivers need to give the crazy fuck his medication until he is less crazy, and then can see why he needs it. "Forced medication" is the rule, not the exception. That's why in true inpatient psych facilities you've got your IM shots and they don't even bother with oral drugs for the very crazy ones. Crazy people will not take their pills, will not take anything by mouth.
I have to assume a lot of these group homes for bad ass kids, you have a lot of not very intelligent, very large, very violent boys who need to be controlled long enough to age out (where in which they default to the penal system as adults, being treated like prisoners as opposed to wayward children). The staff is doing what they can with a psychopathic, sociopathic 16 year old boy, who will probably turn into a violent criminal 18 year old man.
I'm sure that normal kids end up there, too, but don't expect the staff to give them different treatment. They see patients, they are at work, and they know the drill. The normal kids will probably end up crying like on Maury Povich and never do that bad thing again which landed them in the facility for bad ass kids.
Score: -3 (7 votes cast)
August 30, 2011 3:09 PM | Posted by : | Reply
this blog really looses the thread whenever it tries to tackle the law.
for alone: the APA isn't concerned with this case at all--they just see this case as a very appealing opportunity to use a very unpopular defendant as a means to an end; i.e. the ability to be able do what they want to any of their patients without court orders. precedence, stare decisis, is both the beauty and the horror of our system of "justice." they get that.
our system has no problem keeping people locked up indefinitely without a trial due to incompetency to stand trial. our jails are full of such people, many of whom refuse medication, but of whom the APA cares not one iota. this isn't about freedom to medicate the recalcitrant in custody. it is the thin end of the wedge for being able to medicate any patient resisting "treatment."
it is also seriously doubtful that the defense counsel has had the defendant declared incompetent to avoid trial for tactical reasons. counsel almost assuredly wants him to plea and move on. so it is far more likely that the defense counsel is at his wits end dealing with this guy and wants an out (for ethical reasons counsel can't just dump an uncooperative, loony-toons client).
it is also very likely, nay probable, that it really is the defendant himself who is refusing the meds, not his crafty lawyer. defense lawyers don't see it as "win" to have thier clients locked up indefinitely, gitmo-style, without a trial, or anything resembling due process-- which is exactly what happens to the thousands of "incompetent to stand trial, medication refusing" defendants every day.
For the blog respondents: incompetent to stand trial != not guilty by reason of insanity
even if this guy is really good at faking psychosis such that he cannot participate in his own defense or refrain from disrupting the trial, this has no bearing on whether or not he was legally sane. legal insanity is almost impossible to achieve these days, and if you don't believe me, consider that jeffrey dahmer, who ate people and kept bits and pieces of them for late night attacks of the munchies in his fridge next to the catsup, was deemed legally SANE (though he clearly, by any rational definition of the word, was not). dahmer was tried. found guilty. sent to good, old, regular prison, where he was promptly murdered--which everyone involved was pretty sure would happen--because psychopaths (who make up the ruling plurality in most prisons) don't hold with cannibals (or child molesters) (prison has a cute sense of morality).
up until the late 1800s, the standard for not guilty by reason of insanity incorporated compulsion, which makes sense. such individuals were not let go, they were held for the rest of their lives in really awful pych hospitals (and i mean way worse than one cookoo's nest horrible, i mean, really, really hills have eyes horrible).
the standard changed with M'Naghten, and since then every garden variety loon has to show that he did not comprehend the rightness or wrongness of his actions at the time. most psychotics fail this test, as i have no doubt this guy has too. even bat-shit crazy, dahmer knew it was wrong to kill and eat people, when he killed and ate them--his knowing so hardly made his having done so knowingly, "sane," but that's the law!
curiously, it is not uncommon that very sane, non-psychotic, garden variety psychopaths are able to pass this test and have themselves declared not guilty by reason of insanity, even though everyone is pretty sure they are neither insane, nor not guilty....which brings us back to alone's favorite topic--"it's the satisfying the narrative, stupid."
ps: it's really amusing (but not really) how randian-anarcho-capitalist-libertarians always talk liberty and fuck-the-bureaucracy, yet are always the first ones to want to use the bureaucracy to force people to do shit they don't want to do, so long as they don't like the person in question of being so forced. every pig is equal, just some pigs are more equal than others, right? sigh...where is snowball when you need him...in the glue factory with boxer i s'pose...
Score: 7 (9 votes cast)
September 10, 2011 6:36 AM | Posted by : | Reply
I spend some time in holly hill previous year. It was difficult, very difficult for me and not at all a pleasurable experience. I was however there for suicidal/homicidal tendencies in a bipolar major depressive episode. I had hearing and visual hallucination. I spent most of the first day in my single bed weeping on watch, and even when I finally came out of that I never really came approximately and socialize.
Score: 0 (0 votes cast)
September 30, 2011 9:38 AM | Posted by : | Reply
Treatments and therapies that are fit for a certain disorder are very helpful to manage psychiatric disorder just like in his case.
Score: 1 (1 votes cast)
October 28, 2011 9:41 AM | Posted, in reply to , by : | Reply
You would be wrong, the insanity standard is not that cause and effect have no meaning. It varies depending on jurisdictions. The federal standard is that the illness caused the person not to be able to appreciate the nature and quality or wrongfulness of one's act. If you are the devil, and I shoot you to save my life, my actions were in fact quite purposeful and I can be quite clear on cause and effect (bang -> you're dead), yet still insane.
Score: 0 (0 votes cast)
January 9, 2012 9:44 PM | Posted by : | Reply
Jared Lee Loughner didn't shoot 18 people. At most he got 2-3. Military snipers on a nearby rooftop got the rest.
He was basically the subject of MKULTRA style brainwashing (cf. "The Program" described at areYouTargeted.com) - not necessarily mentally ill, but definitely deluded. Once he was convinced some group of people connected to Gifford was out to get him, he was ready to blow. Inner voices - seemingly his own thoughts, but actually from the agency running the whole thing (probably CIA) - suggested the only way out was to grab a gun and make a scene at a political event. He was a puppet in the hands of forces he couldn't understand. He probably knew something was very wrong, though. Hence the cry for help on his YouTube page.
The whole thing was totally scripted by the CIA/DoD - Loughner; the strange outbursts from the local yokel Sheriff; who lived and who died; the intentionally botched investigation; the timing and choice of released photos; the media frenzy... and the worst part is, the whole thing was probably a distraction.
Yeah, that's how your government rolls.
Score: 0 (2 votes cast)
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May 11, 2013 8:38 PM | Posted by : | Reply
I'm way late to this, but I think it's swell that a "civilian"--er, that would be "fellow citizen"--who's been convicted of nothing can be immediately apprehended, incarcerated and forcibly drugged by strangers for literally days without any kind of notice or hearing (let alone one involving troublesome judges or lawyers).
A psychiatrist's license, a pen and a dime is pretty much all that's needed, and you can keep the dime.
"They're doing it for noble reasons..." Yeah, like insurance reimbursement for the forced hospital stay, at least until the money runs out. Or for bonuses to the doctors for keeping beds full, or? See http://www.antipsychiatry.org/unjustif.htm
(In California, who finally gets to review these "noble reasons?" Why, another psychiatrist, of course.)
Score: 1 (1 votes cast)
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