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Tuesday, May 31, 2011

The Limits of Autonomy: Should the Mentally Ill Be Forced into Treatment?

The best advice I ever received from a psychoanalyst concerned the son of a friend of mine (let's call him Joe). Joe kind of adopted me, and often came over seeking advice. The young man was unrealistically optimistic. If his boss complimented him on some job he carried out, Joe was sure he soon would receive a promotion. When none of this was forthcoming, far from being crushed, Joe would spin a new tale: he expected to be soon moved to a choice location. And when this move did not materialize, Joe assumed it was just being delayed.

The same with dating: a smile was interpreted as a sure sign of deep interest, and a long deep look meant a potential keeper. And there always was another tomorrow. Joe was never down -- except when I tried to call his attention to his poor reality testing. The therapist warned me not to take away Joe's defenses -- before I provided him with some other foundations on which to base his self-esteem. Sadly, I never found a way to help him find more realistic sources of contentment. Accordingly, I just listened sympathetically but tried not to reinforce his illusions.

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