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Involuntary Psychiatric Commitment in the Era of COVID-19: Systemic Social Oppression and Discourses of Risk in Public Health and Bioethics
Abstract
This paper considers the continuation of involuntary psychiatric hospitalization during the COVID-19 pandemic, with a focus on the United States of America. Situating psychiatric diagnosis and hospitalization within the broader context of decades of social and historical research, as well as emergent fields such as feminist philosophy of disability, critical diversity studies (CDS), and mad studies, I argue that a socially mediated process which is legitimated with appeals to “health” and “safety” should not be maintained during a pandemic of a readily communicable virus that is especially dangerous for individuals clustered in inpatient settings. A CDS approach allows the clear identification of “severe mental illness” as a marked category of social difference which leads to multiple forms of social oppression. In this paper, I show how involuntary psychiatric hospitalization is a social process through which marked individuals are dehumanized and confined. Furthermore, I consider why the maintenance of the status quo, even under pandemic conditions, demonstrates that involuntary treatment is primarily a political, rather than a medical, process. Finally, I outline why the politics of involuntary treatment should concern longstanding disciplines such as public health and bioethics, as well as emergent disciplines like CDS.
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Notes
All current data are taken from The New York Times online feature “Covid in the U.S.: Latest Map and Case Count,” which is updated continuously. All numbers cited correspond to the data presented on November 1, 2020, with page marked as “Updated November 1, 2020, 9:22 A.M. E.T.”
Trenton Psychiatric Hospital, Trenton NJ; Bergen New Bridge Medical Center nursing home, Paramus NJ; New Lisbon Developmental Center, New Lisbon NJ.
Under the 1999 Olmstead United States Supreme Court decision, it was that the unjustified segregation of persons with disabilities constitutes discrimination in violation of Title II of the Americans with Disabilities Act, and that failure to enact timely discharge plans in psychiatric hospitals was an example of this type of discrimination.
I wrote a letter to JAMA in response to this article in February of 2015 outlining the history of abuse and neglect in asylums, and arguing that there is no reason to believe that a new asylum, regardless of how similarly benevolent the current intentions, would evolve differently. The letter was not accepted for publication. There was, on the other hand, a letter published expressing concerns that: “the reintroduction of the asylum system would worsen the plight of persons from ethnic minority backgrounds, based on the discriminatory practices of the health care system in the Western world” (Mfoafo-M'Carthy, 2016, p. 68).