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Hopkins Reader

Mental Health at Its Most Harrowing

The cover image is gripping, stark and unnerving: the outline of two hands pressed imploringly against the glass in a window or door, the barest shadow of the head of the person to whom they belong behind them.

If ever a cover was designed to persuade a reader to open a book, the one adorning Committed: The Battle Over Involuntary Psychiatric Care (Johns Hopkins University Press, 2017) does its job. Although psychiatrists Dinah Miller and Annette Hanson do recount disquieting contemporary tales of appallingly mishandled medical and legal cases involving individuals with serious mental illness, this book is not a horror story.

Instead, it is a compelling, exceptionally well-researched and written analysis of the immensely complicated, multifaceted issues faced by families, physicians, psychiatrists, police, the courts and society when mental illness endangers patients and those around them.

Miller, formerly a consulting psychiatrist for The Johns Hopkins Hospital’s Community Psychiatry Program and still an instructor in psychiatry at Johns Hopkins, and Hanson, a member of the Johns Hopkins psychiatry house staff from 1989 to 1992 and now a clinical assistant professor at the hospital, excel in their efforts to explain their complex, controversy-laden profession to the public.

Through a popular, decade long blog and podcast, “Shrink Rap,” and their identically titled 2011 book (co-authored with Steven Roy Daviss), they have explored such areas as why people seek psychiatric care, how they can get help for mental illness, how psychiatrists work in the mental health system’s different treatment settings, varieties of psychotherapy, psychiatric medications, pediatric psychiatry and what happens “when things go wrong.”

Many things can go wrong when a person with severe mental illness is involuntarily committed, just as terrible things can happen—mass shootings, for example—when such a person is not identified or committed. It’s also possible for involuntary commitment to have a good result, eventually, despite being a dramatic, emotionally harrowing and potentially shattering event.

With Committed, Miller and Hanson prove themselves to be extraordinarily thorough and even-handed reporters who cover an enormous subject from every conceivable angle.

After interviewing and observing dozens of individuals in health care centers, the legal and law enforcement professions, and former patients and their family members, the authors produced an astonishingly comprehensive book.

In 22 chapters that nonetheless are admirably concise—the book is just 285 pages—they address individual cases, the arguments for and against involuntary commitment, civil rights issues, how hospitals deal with such cases, involuntary outpatient commitment and the issue of patients who represent a danger to themselves or society.

They modestly say they “are good at getting people to tell their stories; after all, that’s part of a psychiatrist’s job.”

Miller and Hanson offer balanced, nuanced views on what they deem “a system gone awry,” and examine innovative solutions intended to expand access to care (such as mental health court and crisis intervention training) while diverting those who have serious mental illness out of the cycle of repeated hospitalization and incarceration.

committed book cover
Committed: The Battle Over Involuntary Psychiatric Care
Dinah Miller, M.D., and Annette Hanson, M.D.
Johns Hopkins University Press