Intended for healthcare professionals

Ward Round

The psychiatric protection order for the “battered mental patient”

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1449
  1. Thomas Szasz, emeritus professor of psychiatry (
  1. 1Department of Psychiatry, Upstate Medical University, State University of New York, Syracuse, NY 13210, USA
  1. Correspondence to: 4739 Limberlost Lane, Manlius, New York, NY 13104, USA

    Psychiatric patients are routinely treated against their will. Legally enforceable psychiatric protection orders would protect patients from coercive psychiatric interventions

    The avowed desires of patients and doctors conflict more often in psychiatry than in any other branch of medicine. People known as “mental patients” are routinely subjected to “diagnostic” and “therapeutic” interventions against their will. Many such people see being committed (sectioned) and treated against their will as a personal violation—a “psychiatric abuse”—and want to protect themselves from future involuntary psychiatric hospitalisation and treatment. At present former psychiatric patients, even when legally competent, have no means to defend themselves from such a contingency.

    Mental health laws—reflecting the point of view of psychiatrists and society—protect (or are said to protect) mentally ill patients from the dangers they pose, because of their illness, to themselves and others. Many mental patients view—and have always viewed—psychiatrists as posing a danger to them. Respect for the self defined interests of such patients requires that the law protect them from further unwanted psychiatric interventions.

    The psychiatric protection order

    Courts recognise the validity of “psychiatric wills” (psychiatric advance directives) only when they prospectively authorise treatment; courts do not recognise them when the “psychiatric testator” rejects psychiatric “help.”1 To remedy this defect, especially when patients are released into the community after a period of involuntary treatment for mental illness, I propose a new legal safeguard: the psychiatric protection order. Such an order, similar to the protection order used in domestic conflicts, would make it a criminal offence to impose involuntary psychiatric interventions on people protected by the order.

    In free societies only psychiatric patients are routinely treated against their will. (Public health laws explicitly serve the interests of the public, not the therapeutic needs of particular persons.) Competent patients with uraemia are not treated against their will and can use a …

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