LETTERS

TO

THE

EDITOR

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on Existence SIR: M.D.

of Dangerousness

The type ofpatient described by Victor R. Adebimpe, in “Physical Violence in the Concept of Dangerousness: A Case Report’ ‘ (February 1977 issue) is familian to all psychiatrists. For those who enjoy categorizing patients, Mr. A certainly fulfills the usual criteria of primary affective disorder, manic type. I have no reason to doubt that ,

the description of Mr. A’s behavior However, I have grave concerns

is accurate. about the attitude

Adebimpe seemed to display, which reflects an lack ofconcern with intraor interpersonal dynamics flicts. The attitude also seems to betray a feeling

doctor

has

prescience, responsibility, and authority than the patient, thejudge, or the Constitution. Dr. Adebimpe apparently feels that the patient’s disagreement with him was a significant indicator of illness. This animosity from

the

arouse through ing

him

more

Dr.

apparent or conthat the

wisdom,

patient toward the within Dr. Adebimpe further confinement, as

doctor urges forced

seems in some way to to protect the patient medication, and label-

dangerous.

Violence is frequently the result of interpersonal The identification of one of the actors as ‘ ‘sick’ forces

the

behaviors

of the

antagonists,

conflicts. ‘ only

reinresulting

frequently

ofthe “sick” person, as this case demonstrates. If we, as a society, insist on the incarceration of individ-

in ostracism

on

uals

would

the

basis

prefer

of

presumed

to see persons

dangerousness,

locked

up for driving

I for

while

one

in-

toxicated physician

or for child abuse. The whole notion that some can invoke a diagnosis as a basis for incarceration is frightening to me, and I think it should be frightening to anyone concerned with human liberty and freedom.

I applaud

the attorney,judge, of the attorney

willingness patient’s rights not, ignore the

and patient in this case. and judge to consider

The this

is refreshing, accusations

even if they did not, or could of the physician. Dr. Adebimpe mentions that a trial was held. I suspect he is referring to a commitment hearing, but his choice of the word ‘ ‘trial’ ‘ is further evidence of the attitude that this patient was ‘ ‘guilty’ ‘ of something. I would rather have seen a trial based on the patient’s assault on his wife than a trial regarding his mania.

I do not blame structions,

for

Mr. A for not following

failing

to make

or keep

low-up, or for ‘ ‘refusing to recognize to have had good reason to suspect

the medication

appointments his illness’ ‘-he

his physician’s

in-

for folseems

giance. Although it may not have been intentional, the psychiatrist in this case gave primary concern to the wife’s fears, not to the patient’s rights. I hope Mr. A will someday encounter a therapist with whom he can feel safe and be safe. Only then will Mr. A be able to recognize his self-dcfeating behavior.

I must cause

have

missed

I could

not

seemed to me that impendingdeath(i.e.,

Mr.

A was apparently tence,

some

follow

major

Dr.

point

A continued his coronary

able

in the article,

Adebimpe’s

final

living disease).

to carry

be-

remarks.

It

with the burden In addition,

of Mr.

out an independent

to move,

to apply for Veterans to refrain from aggression

exis-

Administration

bene-

against the wife who In other words, the patient refused to comthe doctor’s predictions of dangerousness. Although I personally would not enjoy enduring the patient’s posthospitalization existence, I do not see reason to invoke the powers of the state to protect him from that existence. When Dr. Adebimpe states, “The answer is clear,” I do not know what he means. What is the question? If the question is “Should all manics be locked up?” or ‘ ‘Should all mentally disturbed persons be locked up?’ ‘ or ‘ ‘Should a person be locked up because a psychiatrist predicts violence?’ ‘ my answer is a fervent no. However, if the question fits, and abandoned ply with

him.

is “Should yes,

but

dangerous I would

people

need

be

evidence

locked

that

up?”

mortal

I would require confinement not because but because he/she is sick and dangerous previous

behavior.

I would

fensive

acts and penalize

his/her

illness.

into the court

In any

rely

on

the individual case,

proceedings

I would

someone

is “sick,”

as demonstrated legal definitions

for these

acts,

by

of ofnot for

a psychiatrist

until the trier offact

had found

applied. are attempting

not

say

is present.

call

facts and made conclusions of guilt those facts. Ifwe must release “sick” mitted no serious offense, so be sequences for behavior proportional

them be uniformly We in Missouri

I would

danger

the

or innocence based on people who have comit. Let there be conto the offense and let

to remedy

past

abuses

of

citizens’ rights with Senate Bill 275; other states have made such changes already. But providing for due process is only a first step. Ultimately, we need to alter attitudes which hold that mentally disturbed persons should be subject to more,

or more

severe,

sanctions

than

others

who commit

similar

offenses. LAWRENCE

alleAm

J Psychiatry

R. Doss,

M.D.

Columbia,

Mo.

134:7, July 1977

817