Introduction: Experiences of Psychiatric Hospitalization

This issue of Narrative Inquiry in Bioethics focuses on the experience of psychiatric hospitalization. It contains 13 different first hand accounts of the experience of psychiatric hospitalization as well as commentaries from two ethicists who have different but personal experiences with psychiatric hospitalization.

Except for abortion, it is hard to think of another part of the health care system that is more controversial. Some accounts would lead to the conclusion that psychiatric hospitalization is like imprisonment of the innocent without trial. Several of the narratives contained in this issue report experiences that involved substantial mistreatment by almost any standard. Another perspective sees psychiatric hospitalization as an opportunity to benefit from the skills, technology, and wisdom of highly trained professionals. Although none of the authors of the narratives in this issue would recommend psychiatric hospitalization as an alternative to a vacation in the Hawaii, several of the narratives in this issue do report on the positive sides of hospitalization.

In many ways psychiatric hospitalization reflects the dilemma that the Belmont Report noted in its description of the principle of respect for persons. “Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy.” On one hand, it is hard to see how one can respect the autonomy of individuals and at the same time pressure them to give up their liberty for a period of time with little guarantee that it will ultimately benefit them. On the other hand, people in crisis are hardly in a situation to make the autonomous responsible decisions that the Belmont Report appears to envision.

It is fundamental to the psychiatric approach to the most serious mental illnesses that the individuals so afflicted often have severe impairments to their judgment. Thus there is reason to feel that they have diminished autonomy and they need to be protected from any mistakes in their own judgments. On the other hand, an increasing number of people who have had the experience of mental illness contest that viewpoint. Their perspective is perhaps best captured by the slogan that many would feel is only a slight exaggeration “My diagnosis is your delusion.” How to best respect the autonomy of people with mental illness when they are in crisis is thus a very controversial ethical issue.

There are, however, other basic issues that these narratives raise. One fundamental one is the issue of compassion. Over and over the writers talk about the need to feel that someone understands and cares about their situation. They seek someone who will see another human being in their suffering, someone who will appreciate that however strange their behavior may be, their feelings are ones that others might have in a similar situation. They want to be seen as human beings who are suffering and/or experiencing something unusual and difficult, not as a category.

A few words about how this issue has developed may be helpful at this point. The 13 narratives that are contained here are not a random collection of viewpoints of people with the lived experience of mental illness. Such a collection would be impossible to collect. Rather they reflect the ways in which we went about obtaining them. Requests for drafts went to a wide variety of contacts that the issue editor had in both the community of people with mental illness and in some mental health services. Two groups were particularly helpful. First, Massachusetts has a particularly active community of people who have the experience of mental illness. They have diverse viewpoints on mental illness and current mental health care but they are united in wanting a more effective system. Several individuals in that community took it on themselves to spread the word to a national population of potential authors. A second source was the “clubhouse” community. Under the overall direction of the International Center for Clubhouse Development (ICCD), these member-directed services are focused...