Why Are So Many Psychiatric Patients Forcibly Detained and Treated?

Governments and treatment providers don’t want to publicly expose “the dark heart” of our mental health system, experts say

A photo illustration of the book cover for "Your Consent is Not Required" by Rob Wipond against a blue gradient background.
The Walrus / Penguin Random House and BenBella Books

In 1998, I started working as a freelance investigative journalist based in the metropolitan regions of Victoria and Vancouver. I covered many community and social issues but kept returning to people’s experiences of psychiatric detention and forced treatment. Eventually, I began writing for news outlets with American audiences as well, and my investigations of civil commitment became continent wide.

One of the first people I ever interviewed who’d been involuntarily treated was Gerald McVeigh, a burly, bearded, fifty-eight-year-old. He’d been working as a logger in centuries-old Pacific Northwest rainforests when a dispute developed over a possible clear-cut. Environmentalists and police clashed. Tangled between his own environmental sensitivity and need for more money to meet alimony payments, McVeigh was stressed and barely eating or sleeping when he argued with his boss and got fired.

At home in Victoria and still not sleeping, McVeigh got thrust into a heightened state where his senses, thoughts, and emotions intensified, and events took on mystical symbolism. For hours, he washed himself and his apartment as if cleansing his spirit. “At one point, I was chatting with God!” McVeigh told me. “I was having all sorts of delusions. I guess delusions.”

But the energy also brought fear—what was happening? McVeigh fled into the street seeking reassuring interpersonal connections. When he became afraid of losing eye contact with a friendly woman, she called the police. Even as they interrogated him, McVeigh simply turned away to follow her again. Someone grabbed him. McVeigh panicked.

“A police officer put a choke hold on me,” said McVeigh. “I thought, this was it, I was fighting for my life. I fought so hard I shat myself and pissed myself. It took six of them to get me in the paddy wagon. I had shackles around my ankles, I was handcuffed behind my back.”

He was calmer by the time the police van arrived at the psychiatric hospital. He was briefly interviewed, promptly committed, and forcibly drugged with the tranquilizing antipsychotic haloperidol.

The drug made him mentally numbed and physically exhausted, McVeigh said. He spent hours and days alternately sitting and wandering in a white-walled, window-barred sterile hospital ward with a central television droning constantly. No one spoke with him about what he’d been going through. “If somebody’d given me a hug, I’d have been happy!” he told me.

McVeigh described feeling trapped in a “hell” of humiliating powerlessness. He soon realized that the only way he’d get his freedom back was if he started behaving as “normally” as he could—so he did, despite feeling stranger than before he’d been brought in.

Upon discharge, McVeigh was told that he had bipolar disorder and needed to take antipsychotics for the rest of his life. Instead, he read Toxic Psychiatry, psychiatrist Peter Breggin’s book about the harms of common treatments, and Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison, a psychologist labelled with bipolar disorder who believed the condition fuelled many artists and thinkers. McVeigh stopped taking the drugs, moved to a remote north-coast squatters’ encampment, and decompressed over six months.

In the decades since, McVeigh has usually been settled, occasionally lived out of his car, and gotten briefly involuntarily hospitalized during several other difficult periods. In 2021, passing eighty years of age, he was still speaking out against forced treatment. “They don’t treat you as an intelligent human being.”

Tracy Myers’s story started very differently. A slim, animated woman with shoulder-length dark hair, Myers was thirty when she was sexually assaulted twice while travelling. At a hostel, she became unwilling to get out of bed. “I was lying in the fetal position, shut down and so scared,” she said. “I felt like a small child.” She imagined things that would then manifest before her eyes. She believed she could quickly walk a thousand miles back to a safe place she’d visited.

Myers allowed herself to be taken to a psychiatric hospital, where her experience was strikingly similar to McVeigh’s—right down to the droning television and forced drugging with haloperidol. Nurses behaved professionally enough but mostly stayed behind glass walls, handed out drugs in paper cups, and spoke to patients as if to children. Many of the other patients were slack jawed and shuffling, she said, and there were no therapists asking about her feelings. She recalled pleading in vain to be allowed outside to walk in fresh air.

At one point, Myers had severe neck spasms. “In the middle of the night, my head started to twist to the right further and further, and I couldn’t stop it. It went on for about an hour. It was as if someone was wringing me out.” She was terrified she’d become the possessed girl from The Exorcist. She only learned later from a fellow patient it was an antipsychotic side effect.

Myers got transferred to a hospital closer to home where a doctor was a family friend. The psychiatrist expressed shock at the amount of haloperidol she was on and promptly discontinued the drug and discharged her. A friend invited Myers to help with a log cabin he was building in the wilderness. “For a month I hauled wood up this mountain and physically worked,” said Myers. “It got me back into my body. That was the best kind of therapy I could have.”

Most psychiatrists used to be extensively trained in talk therapy and other techniques. However, after the discovery of “neuroleptic” drugs with anesthetizing effects in the 1950s (later marketed as “tranquilizers” and then “antipsychotics”), political pushes by psychiatric guilds alongside new legislation and policy changes reinforced a trend of hospitals hiring primarily biomedical psychiatrists. By the 1990s, psychoanalysts, psychologists, psychotherapists, and other non-medical mental health specialists had much diminished roles or no presence at all in most psychiatric hospitals. Yet Myers was the first to tell me what I’d soon learn abundant evidence shows—that altered states with spiritual tones like McVeigh’s and traumatized states like Myers’s are common among psychiatric patients, and many would prefer to explore their feelings in hopes of understanding their meaning and finding healing. They often don’t want invasive biomedical treatments like tranquilizers and electroshock therapy and don’t respond well to them. Such people get “coerced, pressured, forced,” said Myers. “Their lives can become unmitigated terror.”

Myers later attended a public reading by Vancouver author Irit Shimrat, who recounted her own experiences with unusual states of consciousness and forced treatment. Myers described it as “revolutionary” for her to see a talented, intelligent woman speaking “without shame” about madness. “I remember just weeping listening to her. I had never talked with anybody about the kind of thoughts I’d had. The most painful thing for me was the isolation and loneliness.” Myers met McVeigh at the event, and they launched a group for people to share their experiences of unusual states and forced treatment.

Myers went on to work at a nonprofit as a counsellor for children who’d been exposed to violence, and she then went into private practice. She did not take psychotropics and was never again psychiatrically hospitalized. When we talked in 2021, I asked if she still felt the same way about involuntary treatment.

“People are suffering,” she said. “The idea that sticking them in a cell and giving them drugs is a solution for this is insanity.”

During that period, I also interviewed Irit Shimrat, the author of Call Me Crazy: Stories from the Mad Movement, a history of modern activism against forced treatment, and sometime editor of various long-running periodicals written by patients and ex-patients. Shimrat educated me about “consumers” who identify as willing clients of mental health services, “survivors” who identify as unwilling victims of those “services,” and the “mad movement” loosely unifying current and former patients from both groups, critical practitioners and academics, lawyers, artists, and others defending the rights of those labelled as mad.

Shimrat and I developed an enduring friendship, and I witnessed how she twice went more than a decade living independently and without any mental health system involvement. Yet in between, shortly after the deaths of people close to her, she behaved in distraught, strange ways that worried or annoyed neighbours and got psychiatrically incarcerated more than a dozen times.

“Here I was this privileged kid with a nice family. Middle class. A good student,” said Shimrat of her first experience of civil commitment at age twenty. Several significant disappointments coincided in her life and she wasn’t sleeping much. She’d always had a quirky personality and rich fantasy life, and after taking the psychedelic LSD one night, she didn’t come down. Over the ensuing weeks, she believed she could control traffic lights, others could read her mind, and she was communing with alien beings. Most of it felt fascinating and enjoyable, Shimrat said, but her worried father took her to a doctor. “All of a sudden, I’m incarcerated and being tortured. It was an appalling shock.”

Promptly labelled with schizophrenia, Shimrat more than once screamed and fought back as groups of men stripped her, restrained her in a gurney, and forcibly injected her. What had she done to deserve this, she asked herself. Had some wacky thoughts and said some wacky things? “I was fully cognizant of the injustice of it right away. The experience of being locked up and then debilitated with antipsychotics is brutal.”

She acknowledged that while some people could eventually find a tolerable dose that quelled their minds but left them still functional, for others—especially when not allowed to participate in dosage decisions—antipsychotics can be disabling. “The whole time that I was ever on antipsychotics, I sort of fluctuated between wanting to die and thinking that I had died and gone to hell,” Shimrat said. “All colour was drained from the world, like everything was grey, and I couldn’t remember where I was from moment to moment. There was just a sort of sense of grinding, endless tedium and pain, physical pain as well as the pain of not being able to think.”

One reason that opinions on involuntary treatment are so polarized, said Shimrat, traces directly to these most obvious effects of antipsychotic tranquilizers, by far the most common class of psychotropics forced on patients. If a person in crisis has been behaving fearfully or disruptively, the instantaneous numbing of emotion and slowing of thought and behaviour can sometimes seem like relief to the person and even more so to others in the person’s life. But for many, antipsychotics feel like a “chemical straitjacket.”

Her experiences in psychiatric hospitals have been “infinitely worse than even the worst moments” of her “so-called mental illness,” Shimrat said. “I’ll never recover completely from the trauma of it.”

Over the years, especially after I began freelancing in 2014 for science journalist Robert Whitaker’s web magazine, Mad in America, I connected with hundreds of people who’d experienced civil commitment in the US and Canada—and gathered perspectives from thousands more via groups, organizations, research papers, and public events. Similar stories kept emerging: frightening police interventions, prison-like stripping under guard, meetings with psychiatrists that lasted only minutes before diagnoses were rendered, uncommunicative staff, heavy tranquilization, seclusion, four-point restraints, resignation to days languishing in bleak wards, unexpectedly long detentions and abrupt discharges, and enduring impacts of fear and trauma more than of healing. And while pro-force psychiatrists, governments, or organizations frequently suggested, without providing evidence, that I was only hearing about “unusual” cases unrepresentative of most people’s experiences, I noticed that, whenever I was able to review sources’ medical records, the treating psychiatrists themselves rarely characterized such cases
as anything but typical.

Very occasionally, I found people who were glad they were detained. But when I delved into their stories, it seemed they’d usually experienced something entirely different. Medical staff had talked with them respectfully. They liked the effects of the drugs. They rapidly developed collaborative relationships with their treatment providers. They weren’t forcibly treated for long, if they ever really had been at all. I never came across anyone who’d exhibited real resistance to treatments and had no criticisms about what happened next.

There’s a clichéd caricaturization of involuntary patients as chronically insane, dangerous madmen, utterly divorced from reality. But the vast majority of the people I was encountering had gone through long periods of their lives—before and after their incarcerations—when they’d shopped for groceries; gone to school or held jobs; developed relationships; walked in nature; experienced hope, ambition, boredom, and love; created art; and basically done most things ordinary people do. Their crises and altered states of mood or consciousness usually emerged amid various combinations of sudden tragedies, major life transitions, escalating anxieties, loss of sleep, homelessness, poor eating, job losses, financial stresses, conflicts with family, and misuse of recreational or prescription substances—basically, circumstances that could potentially drive anyone “over the edge.” Most got hospitalized as a result of behaviours that simply confused, frightened, or annoyed others and had rarely engaged in violence or law breaking any worse than disturbing the peace or appearing threatening. Some agreed that their disruptiveness at the time merited being briefly apprehended—but why, they asked, were they also subjected, against their will, to invasive medical interventions in their brains?

Certainly, some people I spoke with had more difficulties expressing themselves or more enduring inner challenges—sometimes linked to childhood abuse, addictions, or intellectual disabilities—that had led to repeated hospitalizations. But these people tended to describe the impacts of restraints, seclusion, and forced drugging as even more disorienting, humiliating, and frightening.

And virtually everyone spoke of voicelessness. No matter what people’s backgrounds were or how their crises unfolded, they were devastated to suddenly be trapped in a hospital, being treated as if everything they’d been going through and all of their perspectives and wishes were now nothing more than “sickness” that needed to be immediately shut down—by force if necessary. After release, they’d still find the gag hard to remove. Studies have repeatedly found that most mental illness–related stories in news media are about dangerousness and violence, while less than 10 to 20 percent ever quote people labelled with mental disorders, let alone people who’ve been forcibly treated.

This particular kind of stifling oppression stayed with Shimrat forever after. Now sixty-three, a long-lasting effect of forced hospitalizations, she told me, was a crushing of her creative soul: “[Involuntary treatment] left me unable to write fiction, which I had previously done easily. The kind of self-doubt that comes from being punished for imagining things devastates your imagination.”

Shimrat ultimately found some degree of healing and creative revitalization through writing about her experiences and helping create platforms for others. “Forced psychiatry is oppression and silencing,” she said. “If you give voice to people who have been silenced and oppressed and forced to suppress their emotions, they find out that they’re not alone. That can be the beginning of reemerging.”

For two decades, the overriding message from the mental health system has been that a drastic shortage of beds, along with strict civil rights–protecting laws, has made it nearly impossible to hospitalize and involuntarily treat anyone—even the “sickest and most dangerous” often can’t be detained.

For example, in a 60 Minutes episode in 2013, prominent pro-force psychiatrist and author E. Fuller Torrey talked about how few hospital beds there were and was asked, “How difficult is it to get somebody admitted who does not want to be admitted?” Torrey answered, “Almost impossible in most states. The laws will read, ‘You have to be a danger to yourself or others,’ in some states, and judges may interpret this very, very strictly. You know, we kiddingly say, ‘You have to be either trying to kill your psychiatrist or trying to kill yourself in front of your psychiatrist to be able to get hospitalized.’”

But this didn’t square with what I as a journalist was seeing on the ground in communities: relatively ordinary distresses or disruptive activities getting people forced into hospitals from schools, seniors’ facilities, workplaces, subsidized housing, and so on.

It also did not square with the actual numbers—I was investigating those too.

After many of North America’s long-term asylums closed, most civil psychiatric detentions lasted for days, weeks, or months rather than years, so before-and-after comparisons with respect to the 1980s are challenging. Today, good statistics are hard to come by—federal, state, and provincial governments don’t gather them, don’t gather them in full, or don’t share them publicly. Nevertheless, everywhere decent statistics can be found, they show that Americans and Canadians are being forcibly detained at per capita rates that have been rising steadily and dramatically since the 1990s.

In Alberta, between 2008 and 2017, the per capita rate of psychiatric detentions more than doubled. From 2005 to 2016, British Columbia’s population grew by only 6 percent, but its number of involuntary patients doubled annually, to nearly 20,000. Similarly, in Ontario, between 2008 and 2018, the population grew by 10 percent, while the number of involuntary psychiatric hospital patients nearly doubled annually, to 46,000. In some provinces, about half to 75 percent of adult psychiatric hospital patients were involuntary, and overall, it appeared that more than 150,000 Canadians were being detained every year. Most stays were for periods of ten to thirty days at a time—and, apparently, about three to fourteen days in the US.

In Florida, from 2001 to 2016, the number of detainees doubled to nearly 200,000—outstripping population growth by a factor of five. In California, the per capita rates of psychiatric detentions for three-day periods increased about 30 percent annually between 1991 and 2016, surpassing 150,000. In that same time frame, California’s population-adjusted number of thirty-day detentions nearly tripled, and that of child detainees more than doubled. It later became apparent that these numbers were incomplete, and in some large California counties, the rates were now multiple times higher than was being officially reported to the state. In Colorado, emergency psychiatric detentions nearly doubled to 39,000 from 2011 to 2016.

Rudimentary “one-day estimates,” gathered by the US Substance Abuse and Mental Health Services Administration from facility administrators, reported that 34 percent of people in all psychiatric or general hospitals for mental health reasons were detained under civil commitment laws. (Another 19 percent—most in large state hospitals—were involuntary patients under criminal charges, detained in the forensic psychiatric system on grounds of “not guilty by reason of insanity.”)

But even those numbers didn’t tell the whole story. Many experts suggested that, in both countries, potentially 80 to 90 percent or more of psychiatric hospital patients may be there unwillingly. In part, this is because, if people actively seek help, ironically, they’re often refused services and sent home with drugs in hand, to keep beds for forcing people. But it’s also because the legal tool of civil commitment is not unlike a loaded gun—it’s often enough to just wave around the threat while promising that following the doctor’s orders could lead to freedom sooner. Many people I spoke with said they’d indeed been unwilling “voluntary” patients.

The facts about civil commitments are so heavily cloaked from public view, though, it took me much searching and many freedom of information requests just to gather this much reliable data. However, in 2020, Gi Lee, a PhD student at the University of California–Los Angeles, and David Cohen, a social welfare professor, research scholar on psychotropic drug efficacy, and long-time critic of “overmedicalizing” emotional distress, published the results of their own five-year quest, in Psychiatric Services.

Like me, Lee and Cohen found hodgepodges of data with many glaring holes. But in the twenty-four states where they found data, at least 600,000 detentions occurred under mental health laws in 2014—by extrapolation, 1.2 million nationally. In some states, like Nevada and Indiana, the rates had nearly doubled in eight years. In twenty-two states with continuous data between 2012 and 2016, psychiatric detentions had increased every single year and, on the whole, three times faster than the population growth.

And these weren’t just the same patients getting re-hospitalized many times. As I had, Cohen also found that wherever those numbers could be separated out, repeat hospitalizations comprised just 5 to 20 percent, and most of those were only twice.

All told, at more than 300 adults per 100,000, the rates of psychiatric detention in the US and Canada appeared to be more than double and triple the rates in the UK, Sweden, Finland, Germany, France, and most other European countries with comparable mental health systems.

In an accompanying commentary in Psychiatric Services, psychiatrists from several universities pointed to the dangers. “[I]n the absence of consistent data,” they wrote, the public has “no assurance” that these forced psychiatric interventions are being implemented in just and responsible ways. And, they added, psychiatrists cannot answer the “fundamental question” of whether these forced interventions are actually, on the whole, helping people.

“The concern,” Cohen told me in conversation, “is that we’re probably doing exactly what we were doing sixty years ago. My concern is the mental health system is just as coercive as it’s always been—and possibly more.”

Cohen said he had many reasons to doubt the completeness of his numbers, and he suspected that, today, closer to 1.5 million Americans get psychiatrically detained each year—plus large numbers of voluntary patients feeling under threat. I noticed, though, that the numbers tended to be higher wherever the data seemed more detailed and reliable. When I averaged the data for several of those states, the number of Americans getting psychiatrically detained projected closer to 2.3 million annually. Either way, although for comparatively shorter stays, it would appear to be many times the number of people detained at the 1950s’ peak of massive psychiatric asylums.

And even these numbers likely enormously understate the extent of psychiatric coercion going on in our society.

The apparent wide variances in rates between states—up to thirty-three-fold—also raised questions for Cohen. “Why is it that there’s such a difference? Is one of those states doing something right or doing something wrong?” And without decent data, Cohen asked, how can we answer the most important question: “What happens to people who get committed?”

He was frustrated by so many data black holes. We discussed Colorado and Ontario, where governments were collecting good data but, in recent years, without explanation, made the statistics much less accessible. As the COVID-19 pandemic and lockdowns set in, some hospitals seemingly temporarily emptied, while others became death traps—overall, statistics became still more difficult to unearth. I asked Cohen if he believed, in this era of electronic records, the many data holes were intentional. He replied, “Overall, there’s little information available; it’s part of the functioning of the system. In that sense, it’s deliberate. But is it a conscious effort?”

Most governments and treatment providers, Cohen argued, don’t want to publicly expose “the dark heart” of our mental health system—that a core function is to incarcerate and control masses of people. “There’s nothing pleasant about that. There’s nothing beautiful and pretty. It’s just exclusion: ‘Please take them away from me.’ And because we’re saying we’re doing it to help them, there’s a kind of systemic dissonance.”

Did he suspect that civil commitment powers were being used on a growing diversity of people in an expanding array of circumstances?

“Yes, I think we’re going too far,” said Cohen. “But I wish we had more information to be able to say that. I don’t really know who they are.”

Excerpted and adapted with permission from Your Consent Is Not Required, written by Rob Wipond and published by BenBella Books.

Rob Wipond
Rob Wipond is an award-winning investigative journalist who frequently writes about the interfaces between psychiatry, civil rights, policing, community, surveillance and privacy, and social change. He’s the author of Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships (BenBella Books, 2023).