The Issue of Coercion

None of the studies reviewed in this chapter considered whether the patients wanted to be in treatment or whether they were being coerced. None mentioned whether the patients were legally voluntary or involuntary, let alone whether ostensibly voluntary patients were undergoing treatment under duress, as frequently happens. The absence of such considerations 

Publishing more than four decades ago, my 1964 study Coercion of Voluntary Patients in an Open Hospital remains the only peer-reviewed scientific article that systematically investigated the various threats and outright forms of coercion used to control mental patients, including drugs, electroshock, and commitment. 

Unfortunately, some of these painful and mentally disabling neurological reactions, including dystonia and akathisia, can also be caused by the newer antidepressants such as Paxil, Prozac, Zoloft, and Celexa. These distressing adverse drug reactions sometimes contribute to or cause violent and suicidal behavior (chapters 6 and 7). 

Severe and Potentially Irreversible Neurological Syndromes (Tardive Dyskinesia and Neuroleptic Malignant Syndrome) Caused by Neuroleptics 

The so-called clinical effect of neuroleptics, their chemical loboto-mizing impact, is primarily caused by the blockade of dopaminergic nerves, especially the D2 receptors, in the ventral striatum, with their connections to the limbic system and frontal lobes (chapters 1 and 2). However, blockade of the same D2 receptors in the dorsal striatum is the probable cause of extrapyramidal reactions, including TD (Ethier et al., 2004 Seeman, 1995). Hence, as described in chapter 1, the so-called therapeutic effect is inextricably entwined with some of the worst adverse effects. 

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