February 10, 2008
Learning From Britney’s Troubles
By MIA FONTAINE
THE involuntary hospitalization of Britney Spears last week brought back memories. Ten years ago, when I was 15, I was a high school dropout and heroin addict, living in the back of a dealer’s van. My mom first noticed red flags at 14: rapid weight loss, self-mutilation, coming home high, irregularly showering. The therapist she had me see, as well as my school counselor, believed that, cutting aside, my actions were typical teenage behavior. The first time I ran away, though, my mother formed her own conclusions, and got a 5150 issued — California code for the involuntary 72-hour psychiatric hold that Ms. Spears was under, before she left the hospital on Wednesday.
I wish I had seen my first, forced hospitalization as the gift it was.
For Ms. Spears, when the 72 hours called for under the 5150 order ended last Sunday, one of three things could have happened: she could have signed herself out or voluntarily committed herself, or doctors at her hospital could have issued another hold, called a 5250, after determining she was “gravely disabled.”
Curiously, the paparazzi — often blamed for contributing to Ms. Spears’s problems — may well helped with the solution this time: they provided ample documentation to support the doctors’ decision to issue a 5250, which can extend a hold as long as 14 days. For patients whose every move isn’t followed and recorded, however, an extension is exceedingly difficult to obtain. Unlike the 5150, which can be issued by any qualified California officer or clinician, the extended hold must be upheld by a court-appointed commissioner.
Involuntary hospitalization becomes still more complicated when you’re dealing with bipolar disease, the very nature of which is cyclical. Being crazy doesn’t make you stupid. As long as you refrain from attempting suicide, homicide or any other documentable action (legally, there needs to be “specific and articulable” evidence of your inability to function normally to continue a hold), you’re free to sign yourself out. Which, 14 days after my admittance, I did, despite my mother’s protests.
As a minor, I would have needed parental consent to get a tattoo, yet when it came to my mental health, the law put me, a drug-addled teenager, in complete control. Only when I landed in a Utah jail with felony drug charges was I finally compelled to receive treatment. By chance, the state I was in at the time of my arrest was one of the few that gave parents the ability to put children in treatment over their objections.
This reality is at odds with the popular conception, abetted by Hollywood movies, of involuntary commitment (sane people being forced into psychiatric hospitals is a horror film staple, after all). Oddly enough, it was a former actor, Ronald Reagan, who did much to restrict its use. As California’s governor in 1967, Mr. Reagan signed a law that set a national precedent of required judicial hearings for extended involuntary commitment (the 5250) and the prohibition of forced medication, among others.
Hamstrung by the new laws, parents of mentally ill and drug-addicted young adults can now do little but stand by helplessly. What’s more, bizarre behavior once limited to adolescents — sudden weight loss, public temper tantrums, gruesome exhibitionism — are enshrined on the covers of Us Weekly and Star. (It’s a sad paradox that Ms. Spears fell prey to the culture she was helping create.)
Ms. Spears’s situation outlines the dangers of blurring the line between socially celebrated behavior and behavior with profound psychological causes. And while her friends and relatives (and a world of transfixed fans) seem to be able to differentiate the two, and recognize that Ms. Spears needs help, now our legal system can’t or doesn’t care to treat someone until he or she has endangered others or themselves, often irreversibly.
Granted, the laws that once allowed us to force adults into treatment could be abused: extreme electroshock therapy, lobotomies, philandering husbands committing their wives, embarrassingly promiscuous daughters being locked up. But in trying to eliminate the possibility that someone could be wrongly committed, we have cast out Britney Spears, and others much less famous, from the havens where they might have been helped.
They need to be brought back.
Mia Fontaine is the co-author of the memoir “Comeback: A Mother and Daughter’s Journey Through Hell and Back.”