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Should The Mentally Ill Be Forced To Medicate?

Posted Dec 13 2011 5:45pm

I owe this one to a google search that led to my site. And I think that it’s an important question that delves deep into the philosophy of medication.

I’ll tackle the Pro side of this first.

One of the best arguments that I’m looking at is economical. According to Times Magazine, those with serious mental illness (SMI) like bipolar disorder, major depressive disorder, and schizophrenia, cost society $193.2 billion dollars in lost productivity. What’s more, that is a conservative number. To put this into perspective, the GDP is $14.58 trillion, meaning that the 6% with a SMI cost the the USA 1% of its GDP. If we then follow National Institute of Mental Health’s statistics on minimally adequate treatment, only 12% of those who are mentally ill are receiving minimal treatment. So a point can be made for giving treatment to those who are unmedicated and try to lower the societal impact.

But there’s another, which is that an initiative to force everyone with an SMI into treatment would be an undertaking that would make the number of those receiving minimally adequate care jump from 12% to 100%. That’s a mammoth undertaking, but part of me (and this is the pill popper side of me) sees this as a potentially good thing. Especially if medication is expanded to treatment. The devil is in the details, if the government is supplying, then it might not be the most horrible thing ever. But then there is the con to this. To force expensive medications onto people and make them pay for it, that’s grotesque. Multiple medications might be required to treat, and that can run up the bills very quickly. So depending on what people mean by forcing medication on people, it could be a good thing or a horrible burden to people.

On the con side there is the fact that the cure can be worse than the disease. Medication is not a one size fits all approach to mental illness. Sometimes interpersonal rhythm therapy with cognitive behavioral therapy is enough.

But there is a deeper philosophical point to make here, I’ll borrow it from John Rawls’ approach to justice in a society. Imagine that you are creating a society without knowing anything about yourself and where you would be. Now, would you create a society such that your personal autonomy could be violated and forced to adopt dangerous medications at the behest of the rest of society? My vote would be no. Furthermore, I would not subject people to medications where the side effects can be intolerable.

Finally, since when does being mentally ill make us second class citizens that can be forced to do anything? Having an SMI does not impact our citizenship, nor should it. To see why, just return to the thought experiment above to determine whether or not one would design a society where they could be second class citizens by luck and genetics. I believe that most people would not. I at least wouldn’t.

I would also like to touch on a point that is rarely explained, what does it mean to be medicated? Does it just mean slap everyone with a mental illness on some lithium and antipsychotics? Does it mean remission or just band aids? Being “medicated” makes it sound like there is a cure for it, like it’s a broken leg. It’s easy to throw a term out there, but what really goes on in terms of “medicated” is so vague that it’s hardly even a useful term. So for this question to even make sense there needs some clarification to be done. First of which is what it means to be medicated. Secondly, what does it mean to be forced? Is there a prison sentence involved in noncompliance, or is it a forced stay at a mental hospital? Finally, the should needs to be qualified. Is it a moral should, a justice should, or a pragmatic should? Terms can be tossed out, but do they have substance, and I find these lacking any real substance at all.

Finally we should look at should, if it is a moral should, then I’d like to see your morality, because it sucks. If it is a justice should, then what type of justice are you looking up to. One might use Rawl’s theory of justice, but part of what I did above is show that at least for me, I’d not live in a society that putatively medicates people. I’d be for a society that gave free access to mental health care, but that’s a different story. The only should that I see happening here is a pragmatic one. Where providing medication to those with serious mental illness would offset the economic toll that these diseases ravage. I mean seriously, 1% of the GDP is lost, some money could be thrown at the problem to help with that.

As a side note, and I’m not going to get into it here. It’s that what usually fuels this fire is the idea that those with mental illness are dangerous and need to be medicated. I’m not going to go into this here, that’s for a whole other post.,8599,1738804,00.html

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Student of philosophy and mathematics at UW Madison diagnosed with Bipolar 1. I'm particularly interested in philosophy of science as of this moment as well as the intersection of academic life and mental illness.
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