CORRESPONDENCE

Date01 November 1977
DOIhttp://doi.org/10.1111/j.1468-2230.1977.tb02456.x
Published date01 November 1977
CORRESPONDENCE
THE
EDITOR,
THE
MODERN LAW REVIEW.
Dear Sir,
My attention has been called, since
I
am
a
psychiatrist and do not regularly
read your
Review,
to Mr. Joe Jacob’s article1 of above title, and to the fact
that it has not been answered by anyone in my profession up to date.
Incompetent, clearly, to deal with the points of law he raises,
I
must confine
my observations to matters of medical concern and particularly to his general
thesis, which appears to me to show confusion about the nature of psychiatric
treatment. The thesis seems to take the line that, because there is
no
‘‘
express
reference
in the provision of either section
25
or
26
of the Mental Health Act
(1959)
to depriving the compulsorily detained patient of his normal rights to
control the treatment he receives
@.
22),
the patient keeps control of that
right; and he specifically advances the thesis
@.
19)
that
“.
. .
whatever the
cause
(in terms of sections of the Mental Health Act)
of [patients] being in
hospital their right to refuse treatment are the same.”
Mr. Jacob essentially fails to make clear what he means by treatment, though
he seems
(p.
22)
to mean
medical
treatment of the sort warranted by the
nature or degree
of
the patient’s mental disorder. His first reference to any
specified form of medical treatment lies on page
33
when he cites, as an
example, what must today be passing rare in this country: the leucotomisation
of
a
psychopath.
On
the other hand, in relation to severe subnormality only, he finds it
“difficult
60
conceive of
a
hospital being run as a hospital where there is
no
nursing care
and cites here section
147
of the Act, which includes
nurs-
ing
in the definition of medical treatment. But can nursing and nursing care
exist apart from
medical treatment ”-particularly in the case of
a
detained
patient and particularly a restlessly disturbed one in the setting
of
the modern
admission ward of a psychiatric hospital, which will be unlocked and caring
mainly for the
informal
and willing?
The condition which most frequently requires detention in hospital, against
the patient’s wish, on ground of restless disturbance and uncontrollability, is
hypomania, pathological elation, as the result
of
which the patient’s mood is
elevated, his mind racing and his behaviour liable to expansive extravagance
and outrageous
loss
of judgment in behaviour, to a degree which could ruin
him financially or in reputation if let persist; yet
in
a setting of such
loss
of
insight that the patient, far from recognising illness, feels better than ever in
his life.
No
nurse, in the setting outlined, could control, much less care for, such a
patient without the help of drugs medically prescribed-in fact, medical
treatment.
Even merely locking up the patient in
a
room, ward area or ward, in order
to restrict his ambit, could be said to surpass nursing care and be part of
medical
treatment: the two go too much hand-in-hand in practice for
the distinction to be recognised.
But rational therapy of hypomania rarely requires incarceration when
adequate
psychotropic
medication is administered. In most occurrences drugs
rapidly both control the ambit of the patient and settle his illness. Any
experienced nurse would demand their prescription, therefore, in such a
condition. Is it Mr. Jacob’s thesis that such drugs may be properly administered
to detain the patient but not to treat his illness-even
if
such purposes could
748
The
Rights
of
the Mental Patient to
his
Psychosis
1
(1976)
39
M.L.R.
17-42.

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