Interference in psychiatric care: a sociological and ethical case history analysis

Marian Verkerk, Louis Polstra and Marlieke de Jonge

in Empirical Ethics in Psychiatry

Published on behalf of Oxford University Press

Published in print February 2008 | ISBN: 9780199297368
Published online February 2013 | e-ISBN: 9780191754586 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Interference in psychiatric care: a sociological and ethical case history analysis

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When, in the early 1970s, initial efforts were made in the Netherlands to modify the old 1884 Lunacy Act (Krankzinningenwet) and establish what was later to become the Psychiatric Hospitals (Compulsory Admissions) Act (BOPZ) a debate arose concerning the morality and legality of coercion and pressure on psychiatric clients (Berghmans 1992). The debate is still ongoing and has been given new impetus by the evaluation of the BOPZ (Berghmans 1997; Raad voor de Volksgezondheid en Zorg 1997). Since the 1970s various studies have been conducted in the Netherlands on aspects of coercion in psychiatric care (Berghmans et al. 2001).

The debate on coercion and pressure is largely based on ethical concerns. In the case of clients who do not constitute a serious danger to themselves or to others but are in a worrisome situation, the BOPZ does not permit any form of coercion. Despite this provision, pressure on such clients – for instance, to take medication – can be an option. The use of various types of coercion with chronic psychiatric clients also requires an ethical assessment, in which preference should be given to the notion of a ‘trajectory’ rather than a single, isolated decision. In other words, the ethical justification for coercion cannot be seen as separate from the care process of which it is part (Verkerk 2001). The decision to apply coercion should be regarded as a situated, moral decision, tailor-made, as it were, depending on the circumstances of those involved in the situation and the possibilities open to them.

It is precisely this social context of coercion that is the subject of this chapter. To that end we make use of the sociologist Giddens’ structuration theory. Giddens states that every action contains within itself the characteristics of the social system. We use a case study to attempt to reveal the influence of the mental health care system on the act of pressure. The data for this case were assembled within the framework of the study ‘Drang als dwangpreventie’ (Pressure as Prevention of Coercion).1 The data sources consist of two interviews with a chronic female psychiatric client, a social psychiatric nurse and a nurse.2 The case analysis starts with a description of the care system as the context within which pressure was applied. This is followed by a reconstruction of two episodes of care and pressure each ending with a short analysis. Our final considerations take us back briefly to the importance of sociological analysis and its relation to ethical judgements. We begin the chapter with a brief definition of ‘coercion’ as we understand it.

Chapter.  4926 words. 

Subjects: Psychiatry

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