“Those who cannot remember the past are condemned to repeat it” is a quote by George Santayana.

It rings true in so many facets of life and medicine. In my career in psychiatry, I have held fast to this treatise.

Psychiatry, as a practice, has changed over the years. We operate with the knowledge that we must always remember our past, especially since our past has been quite sordid.  The treatment of mentally ill people has been fraught with human rights violations and at the center is the misuse of psychiatry to violate civil liberties. The institution of mental health laws ushered in a new era of psychiatry. These laws can be very frustrating and can be confusing at the very least.

When you consider that they vary by state, the misunderstanding and consternation of laypeople and nonmental health practitioners can be felt quite acutely.  My role as a psychiatrist is to engage my patients’ autonomy and protect their rights to make decisions for and about their health care.  When it becomes evident that they are unable to make those decisions requiring the use of involuntary hospitalizations or even more complicated the guardianship laws; the protection of the individual’s autonomy must be considered as the clinician proceeds in ensuring proper care.

Paternalism and autonomy are at separate ends of a fluid spectrum. While paternalism seems to take responsibility for the care of the individual, it does so in some instances at the cost of an individual’s rights. While this is necessary for certain circumstances, it should be done with careful and thoughtful consideration. I have often come up against differing opinions about these principles in my career and have held it very important to remain vigilant in protecting the civil liberties of patients who have mental illness. The right to place patients involuntarily in treatment is given to different disciplines based on state law. Individuals tasked with these decisions must continue to be ever mindful of our field’s past.

Courtney Markham-Abedi is a psychiatrist.

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