Please read and answer the following questions on the attachment files.

Suppose you are hurrying to class one winter morning, slip on some ice, fall, and sprain your ankle. You may not realize that your ankle is sprained, but you know you are injured. Another student offers to help you to the infirmary, and you gladly accept. However, if you were suffering from anosognosia, a condition caused by a brain disease or injury to the parietal lobe, you would not know you were injured. People with this condition may have quite dramatic impairments, such as paralysis and blindness, but are unaware of their problems.

Approximately 50 percent of individuals with schizophrenia, and 40 percent of individuals with bipolar disorder, are unaware of their disorder. However, unlike anosognosia, in which a parietal lobe defect can be seen on a brain scan, there are no objective markers for unawareness of mental disorders. This failure to recognize a disorder is the most common reason that people with these diagnoses do not take their medication, often resulting in worsening of symptoms and increased likelihood of victimization, homelessness, joblessness, incarceration, rehospitalization, and violent acts against others and themselves. In addition, if a person is not treated, the disorder may progress to the point where it is no longer treatable; research has shown, for example, that delaying treatment for schizophrenia causes the disorder to become more severe.

Many family members have been frustrated trying to get help for relatives who are unaware of their own disorders, refuse treatment, and deteriorate. Community members have been frustrated in their inability to help the homeless, who, depending on the state, legally may have the right to refuse treatment. Should people unaware of their own mental disorders be treated even if they do not want to be?

We do not force treatment on people with medical problems, even if their reasoning for rejecting treatment is illogical. Treating mental disorders is even more of an ethical quagmire, mainly because we do not understand many of the disorders completely. As discussed in Chapter 14, the neural underpinnings of depression, bipolar disorder, and schizophrenia are still being studied. Diagnoses are based on behaviors, not on blood tests, and those behaviors may have different origins and be open to various interpretations. In addition, a minority of both psychologists and psychiatrists do not agree that many mental disorders have biological bases; instead, they explain them as emotional reactions to negative life circumstances, stress, or acute trauma. Until research can prove direct causation of mental disorders by biologic processes and can uncover the mechanisms that cause and can treat them, these practitioners believe any involuntary treatments violate an individual’s right of self-determination.

Safety is also an ethical issue. Even if a diagnosis is agreed upon, treatments vary in side effects, costs, and effectiveness. When a person is treated involuntarily, who should determine what treatments to use—the family (if there is one), the physician, the community, the government? The optimal treatment as seen by the community or government may be the most cost-effective one, whereas the optimal treatment for the individual may not be. Ethicists also worry that if individuals are threatened with involuntary treatment, they will less likely seek treatment when they need it or may be reluctant to continue it once they have started.

Studies done from the ethical standpoint of fairness and justice suggest a different treatment modality. A sense of fairness and “being heard” can matter almost as much as treatment pressures. Therefore, any treatment must respect the person with the disorder and treat the person fairly. One such treatment that has proved highly effective and has markedly decreased rehospitalizations involves offering patients a contract in which they receive a small amount of money or gift certificates for treatment compliance. This cognitive-behavioral technique, in which positive or healthy behavior is reliably and clearly rewarded, may be perceived as coercion or as exploitation of poor patients. However, the majority of patients do not consider the practice coercive and understand that, unlike involuntary treatment, they can turn it down.

For this discussion, please answer the following questions.

1. What would you do if your sibling or parent, for example, was experiencing psychotic episodes but was unaware of having a disorder and refused medical evaluation or treatment?

2. Would you consider it ethical to respect your relative’s autonomy and do nothing, or would you force him or her to go for treatment?