He had made some self-destructive statements and a mutual friend reached out to me for help. Several of us scheduled an intervention to try to convince him to go get help and the day before the intervention, he made some more self-destructive statements so that same mutual friend called me and I went to his apartment. He looked like death warmed over. He hadn't been taking care of himself and was extremely thin and pale.
When I asked him to go to a hospital for help, he refused. I told him that I wasn't going to take no for an answer. He had been talking about harming himself and that's all we needed to have him involuntarily committed for 72 hours. He still didn't want to go so I called the police and explained that my friend had been talking about hurting himself and I thought he needed to be committed.
He even threatened that if I followed this course of action, it would mean the end of our friendship. I said that I would prefer to be able to drive past the place where I was no longer welcome than to drive past the place where my friend died because I didn't help him.
The police and paramedics came and the officers explained to me that because of his talk of self-harming, he could be involuntarily committed if he didn't go of his own volition. If he was right and there was "nothing" wrong with him, he could be out of the hospital in the morning.
Their argument persuaded him and he went voluntarily.
He was in the hospital for over a week. Long story short, his problem was caused by the side effect of a medication he was taking for a medical condition. They were able to find a different medicine that helped his condition without producing the side effect of depression. He's doing well today and we're still friends.
Frankly, I find it kind of disturbing that you can have anyone you know committed for several days just by lying to the police.
Yes, I approve of it. Without the ability to compel him to receive medical attention, my friend would have died.
But I don't.
It wasn't a lie.
We can play that game all day.
Even if the cops had heard him, the doctors who treated him wouldn't know if the cops were lying.
The judge, who had the final say about extending his observation beyond three days couldn't have known if I, the other friend, the cops, the paramedics and the doctors were lying.
There is often more nuance to real-life situations than "I contend that I didn't say that. He can't prove that I did say it."
Namely, my friend needed help. It was obvious to everyone, except him.
That's sort of understandable - if you are around people all day who hear Satan, or have obsessive compulsions, complaining that you don't have enough bedclothes or the food is bad is just seen as part of your condition. If you get given the wrong medication, it's assumed you are wrong and you'll be ignored. If you get mad about being ignored, you can't just walk out as they wont let you. In all likelihood you'll be tranquillised to keep you quiet.
How do I know this? Everything except the sedation happened to me!
Where is the difference between this guy and the one who risks their lives and their childrens' lives by being a missionary in some place where their work can be punished by death? If anything, this man is more sane as he isn't risk his life and the lives of those close to him.
P.S. I'm a religious guy myself, but I am seriously asking this. In many ways religion itself can seem to be a mental illness if it weren't so popular.
Look up delusion in the DSM. The definition is more accurate without a special exemption. A close examination of the entire manual will reveal a careful wording to prevent religious people from being diagnosed with any sort of condition.
Simply the fact that this approach is taken says volumes. A rose by any other name...
(If missionary activities were frowned upon in their communities it wouldn't surprise me if the prevalence was close to that of not washing yourself.)
In Oslo, near the university, there used by a "cave dweller". A by all accounts bright student who at 25 decided to stop washing himself. He was soon thrown out of his student accommodation because of the smell. He then decided to take up residence under a tarp in a makeshift "cave" in a hillside next to the university where he stayed for the following two and half decades. In 1987, he was refused the opportunity to take his astrophysics exam because of the smell, and later given a blanket restriction on participating in any exams unless he washed first.
He was repeatedly institutionalised against his will, but in 1988 he won a supreme court decision that made it clear that his unorthodox lifestyle was insufficient grounds for forcing him into mental health institutions. He later sued the University of Oslo over lost income due to the exam ban, but lost.
It may seem obvious that this guy had mental problems. The problem is that in court and during psychological examinations he was fully coherent and defended his choices with references to traditions of asceticism and spiritual beliefs. He understood what he was doing. (EDIT: This does not mean that he necessarily didn't have mental problems, but that he was coherent enough to be able to justify his decisions sufficiently that the court found he was competent to make his own decisions about whether or not he needed treatment)
This poses a challenge, because it can be superficially extremely hard to distinguish actual mental illness from "crazy" lifestyle choices that the person making them are perfectly happy with.
The guy mentioned above was very bright and able to get the resources he needed to protect what he saw as his own best interests in court (all the way to the supreme court 3 times, with one win), but most don't.
Many of these people are mentally ill and need treatment, but we also need to protect those who aren't, and especially those who aren't yet are not resourceful enough to mount vigorous legal campaigns to protect their choices.
At the same time setting the bar high means there are potential high costs and lots of resources involved in helping people that makes it harder to help those who need it out of a concern for e.g. distinguishing resistance and refusals grounded in mental illness from resistance and refusals from people who are mentally competent.
Getting the balance right is hard.