The best books for understanding contemporary involuntary commitment and forced psychiatric treatment

Lawyer Michael Perlin was, for decades, lead author of the seminal, annually updated reference volumes on developments in U.S. mental health laws and precedent commitment cases.

The Hidden Prejudice is written for general readers; many pages are still two-thirds reference footnotes, but Perlin allows himself a more personal tone that makes the core text riveting and disturbing.

Dispelling out-of-date notions that people can only be locked up if they’re physically threatening and dangerous, Perlin demonstrates with stark warning how criteria for detaining people have become shockingly broad, most judges have abandoned any requirement that psychiatrists meet even basic standards of science, average commitment hearings function virtually outside the law, and courts grant psychiatric institutions horrifying degrees of immunity for abuses.

You’ll never again hear calls to expand forced psychiatric treatment in the same way.

“That book changed my life”--when interviewing current and former psychiatric patients (and some critical psychiatrists), no book has so often been described to me in this way.

Anatomy of an Epidemic isn’t about forced treatment per se—it’s about the medications used to forcibly treat people today. An award-winning science journalist (and founder of the web magazine Mad in America for which I sometimes write), Whitaker critically examined every existing study of the long-term impacts of common psychiatric medications from antidepressants and ADHD stimulants to lithium and antipsychotics.

He found that, over time, nearly all psychotropics are associated with serious harms to physical health, quality of life, and cognitive capacity. In the precedent Third Circuit case that first established limited rights for people to decline psychotropics, the court found that “even acutely disturbed patients might have good reason to refuse these drugs.”

Whitaker’s research shows, with alternately disturbing, gruesome, and tragic details, why that’s still true today. 

Possibly the 20th century’s most famous book about involuntary commitment, it’s remarkable—and profoundly disturbing—how well Ken Kesey’s masterpiece has stood the test of time.

Kesey was working in a psychiatric hospital as he wrote it, and portrays all-too-vividly the twisted relationships of power, climate of fear, daily routines of institutionalization, insipid group “therapy,” often debilitating medical treatments, and sudden bouts of violence from both sides. Most institutions are simply smaller now.

Readers today might question a white man writing through the eyes of a mute “half-Indian”—but it situates front and center stingingly timely examinations of racism, ableism, and sanism in mental health systems.

And the novel’s central, driving drama also remains consummately contemporary: The more the irascible Randle P. McMurphy rebels against institutional abuses, the more the medical staff diagnose him as "lacking insight" into his mental illness—and prescribe ever-more-aggressive “treatment.”

Forced electroshock or “electroconvulsive therapy” (ECT) is still commonplace, and it caused Linda Andre massive memory loss—but she recovered enough to write one of my favorite of many important books by people who’ve personally experienced forced treatment.

Her commentaries on the science are good, but Andre, once a leading activist, was frequently interviewed by news media and attacked by pro-ECT psychiatrists, and she exposes the behind-the-scenes politics and public relations of psychiatric science, forced treatment, and ECT in fascinating ways.

Her observations on how journalists tend to work, and of the many ways even “responsible” news outlets can misrepresent, manipulate, and get manipulated, are unnerving.

With revealing irony, Doctors of Deception criticized pro-ECT psychiatrists for rarely disclosing their conflicts of interest—and the book was viciously attacked in a prominent review by two pro-ECT psychiatrists who didn’t disclose to readers that they themselves were criticized in the book. 

Hatch did stellar research to expose how coercive psychiatric treatment—especially tranquilization with heavy antipsychotics—is spreading into nursing homes, child foster care and juvenile facilities, immigration centers, and prisons.

Antipsychotics are becoming a ‘go-to’ approach for institutional management of large populations, especially targeting people of color.

Hatch’s work also draws attention to a vital, related issue: Abundant research shows that involuntary treatment is driven by our culture’s dominant prejudices: classism, racism, sexism, sanism, etc. Predictably then, public discussions of involuntary treatment routinely lack, and desperately need, a greater diversity of voices.

So, while highlighting the work of the Black scholar Hatch, I want to also mention several recent anthologies that bring forth a fantastic diversity of voices and perspectives on contempory psychiatric care, forced treatment, and alternatives: Mad Matters: A Critical Reader in Canadian Mad Studies; Disability Incarcerated: Imprisonment and Disability in the United States and Canada, and We've Been Too Patient: An Anthology of Voices from Radical Mental Health.