Thomas W. Kallert & Juan E. Mezzich 
Coercive Treatment in Psychiatry 
Clinical, Legal and Ethical Aspects

Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge. This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment.

Coercive Treatment in Psychiatry is a much needed contribution to the literature. The first three sections deal with the conceptual and clinical aspects of coercive treatment, the legal aspects and the ethical aspects of coercive treatment. In detail, these sections cover a broad spectrum of issues: coercion in institutions and in the community, coercive treatment and stigma, the definition of best practice standards for coercive treatment, de-escalation of risk situations, recent developments in mental health legislation, mental health care and patients’ rights, cross-cultural perspectives on coercive treatment, historical injustice in psychiatry, and paternalism in mental health. The fourth section features users’ views on coercive treatment: giving voice to an often-unheeded population. Finally, the book addresses the original topic of coercion and undue influence in decisions to participate in psychiatric research.

This book presents the first comprehensive review of the issue of coercion in psychiatry. With chapters written by the leading experts in the field, many of whom are renowned as clear thinkers and experienced clinicians, it may be seen as a starting point for international discussions and initiatives in this field aiming to minimize coercion.

Highly Commended in the Psychiatry section of the 2012 BMA Book Awards.

قائمة المحتويات

List of Contributors vii

Introduction xi

Thomas W. Kallert, Juan E. Mezzich and John Monahan

SECTION 1 Conceptual and clinical aspects of coercive
treatment 1

1. Person-centred psychiatry perspectives on coercion and
cooperation 3

Juan E. Mezzich

2. Coercive treatment and stigma – is there a link?
13

Wolfgang Gaebel and Harald Zaske

3. Mandated psychiatric treatment in the community –
forms, prevalence, outcomes and controversies 33

John Monahan

4. Is it possible to define a best practice standard for
coercive treatment in psychiatry? 49

Tilman Steinert and Peter Lepping

5. How to de-escalate a risk situation to avoid the use of
coercion 57

Dirk Richter

SECTION 2 Legal aspects of coercive treatment 81

6. Psychiatry and the law – do the fields agree in their
views on coercive treatment? 83

Julio Arboleda-Florez

7. Reducing discrimination in mental health law – the
‘fusion’ of incapacity and mental health legislation 97

George Szmukler and John Dawson

8. Mental health care and patients’ rights – are these two
fields currently compatible? 121

Thomas W. Kallert

SECTION 3 Ethical aspects of coercive treatment 151

9. Cross-cultural perspectives on coercive treatment in
psychiatry 153

Ahmed Okasha and Tarek Okasha

10. Historical injustice in psychiatry with examples from Nazi
Germany and others – ethical

lessons for the modern professional 161

Rael Strous

11. Paternalism in mental health – when boots are superior
to Pushkin 175

Tom Burns

SECTION 4 Users’ views on coercive treatment 185

12. The moral imperative for dialogue with organizations of
survivors of coerced psychiatric human rights violations 187

David W. Oaks

13. Resisting variables – service user/survivor
perspectives on researching coercion 213

Jasna Russo and Jan Wallcraft

14. Seventy years of coercion in psychiatric institutions,
experienced and witnessed 235

Dorothea S. Buck-Zerchin

15. Coercion – point, perception, process 245

Dorothy M. Castille, Kristina H. Muenzenmaier and Bruce G.
Link

SECTION 5 Coercion and undue influence in decisions to
participate in psychiatric research 269

16. Ethical issues of participating in psychiatric research on
coercion 271

Lars Kjellin

17. Coercion and undue influence in decisions to participate in
psychiatric research 293

Paul S. Appelbaum, Charles W. Lidz and Robert Klitzman

Index 315

عن المؤلف

Professor Kallert has been active in the field of mental
health services research for many years. He was co-ordinator
of the EC-funded research project, European evaluation of coercion
in psychiatry and harmonisation of best clinical practice
(EUNOMIA). He has published 6 books, more than 35 chapters in
books, and more than 125 articles in peer-reviewed journals. He has
received the Hermann-Simon-Prize for Social Psychiatry, and the
Hans-Heimann-Prize of the German Society of Psychiatry,
Psychotherapy and Neurosciences. He is an Honorary Member of
the World Psychiatric Association.

Dr. Mezzich was Chair of the World Psychiatric
Association (WPA) Section on Classification and Diagnostic
Assessment, and a member of the ICD-10 Mental Disorders Workgroup
and the DSM-IV Task Force. He has authored over 200 scientific
journal articles and book chapters and 25 books and monographs
primarily on psychiatric diagnosis and epidemiology from clinical,
philosophical, statistical, and cultural perspectives and more
recently on person-centered psychiatry and medicine. He has
received six Honorary Doctorates from universities in the Americas
and Europe as well as the Simon Bolivar Award of the American
Psychiatric Association, the Medal for Extraordinary Merit of the
Medical Council of Peru, and the Linneaus Medal of Uppsala
University in Sweden. He is President of the International Network
for Person-centered Medicine.

Professor Monahan is well known internationally for his
numerous publications and presentations in mental health law, for
his leadership of the Mac Arthur Research Network on Violence,
Coercion and Competence and of the current Mac Arthur Research
Network on Mandated Treatment in the Community, and for his
generous support and encouragement of scholars in coercion and in
all areas of mental health law.