psychosis, insight, self-image and reality in the new yorker

“In 1886, the hospital’s superintendent described psychosis as "a waking dream, which, if not broken in upon, works mischief to the brain,” and wrote that the goal of treatment was to “interfere with this world of self – scatter its creations and fancies and people it with objects and thoughts foreign to its own.””

“In her book "Refusing Care,” [Elyn] Saks calls the method “self-paternalism,” and argues that there are few other scenarios in which psychiatrists should forcibly impose treatment that intrudes on the privacy of people’s own minds. A widely cited justification for compulsory treatment is the “thank-you theory,” which assumes that patients will retroactively agree that intervention was in thier best interests. But only about half of patients who have been involuntarily hospitalized subsequently say that they needed treatment.  “We should not be in the business of choosing selves,” Saks writes. It’s impossible to determine whether a mental illness has altered someone’s preferences, or whether that person has simply changed.“