Treating the Troublesome

• Published date: 01 January 1982
• DOI: 10.1177/0306624X8202600111
• Date: 01 January 1982
• Author: M. Schmideberg,Betty Tahourdin
• Subject Matter: Articles

72

Treating

the

Troublesome*

M.

Schmideberg

and

Betty

Tahourdin

IN

all

societies

there

are

mentally

or

emotionally

disturbed

individuals

whose

behaviour

is

so

unacceptable

that

they

have

to

be

compulsorily

detained.

This

Report

looks

at

the

medical

and

psychological

techniques

currently

used

for

modifying

behaviour

and

examines

the

ethical

and

other

issues

involved

in

the

giving

of

such

treatments

and

in

the

obtaining

of

&dquo;informed

consent&dquo;.

The

report

details

the

various

treatments,

both

physical

and

psychological,

at

present

available,

their

benefits

and

their

side

effects.

All

the

physical

treatments,

with

the

possible

exception

of

psychosurgery,

have

produced

beneficial

effects

for

the

treatment

of

certain

mental

conditions;

all

have

possible

side

effects

of

varying

degrees

of

seriousness.

The

behavioural

treatments

have

some

value,

but

their

proven

efficacy

varies

very

greatly

with

the

individual:

the

psychotherapeutic

treatments

based

on

psychoanalysis

have

serious

disadvantages,

in

that

they

are

very

long

term,

their

efficacy

is

unproven,

they

may

prove

too

stressful

and

may

even

have

dele-

terious

effects.

Many

of

the

patients

who

receive these

treatments

are

confined

in

mental

hospitals

or

in

prison,

and

the

question

of

their

treatment

sets

a

considerable

ethical

problem

for

those

dealing

with

them.

For

example,

the

manic

depressive

may

gain

very

greatly

from

lithium

carbonate,

but

it

has

short

term

effects

on

the

brain,

heart

and

kidneys,

and

long

term

may

produce

irreparable

kidney

damage;

the

schizophrenic

may

benefit

greatly

from

the

antipsychotic

drugs,

but

even

if

he

does

not

suffer

from

the

short

term

effects,

he

may

suffer

a

long

term

effect

which

is

in

its

severe

form

extremely

un-

pleasant,

and

irreversible.

Electro-convulsive

therapy

is

found

very

beneficial

to

some

severe

depressives,

but

is

frequently

used

indis-

criminately,

when

it

can

cause

impairment

of

memory

(a

course

of

treatment

should

not

exceed

12

applications)

and

may

succeed

with

far

fewer.

Anyone

who

has

witnessed

the

almost

miraculous

improvement

in

a

patient

on

one

of

these

treatments

can

understand

the

problem

with

which

a

doctor

is

faced;

if

he

considers

the

patient

is

suffering

severely,

he

may

well

feel

that

the

risks

involved

are

worth

taking,

but

it

is

his

duty

to

explain

this

to

the

patient

as

he

would

in

any

*Treating

the

Troublesome-The

Ethical

Problems

of

Compulsory

Medical

TrPPtment

for

Socially

Unacceptable

Behaviour.

A

Report

by

a

Working

Party

for

the

Council

for

Science

and

Society,

3/4

St.

Andrews

Hill,

London;

EC4V

5BY,

0

906503

08

6

(hb),

£7.50 ;

0906503

07 8

(pb),

f2.50.