Letters

Editor:

I am writing in response to the article on covert medication published by Hung et al.¹ in the April 2012 issue of The Journal. While the authors raise critically important questions regarding this practice and note some of the ethics pertaining to its use and potential aftermath, I am writing to address what I feel is an important psychodynamic consideration that attends this situation.

Given our particular culture's admiration of independence and autonomy, my perception is that people are often placed in a no-win position when confronted with the choice of taking unwanted medication and of having to refuse it in the interests of appearing autonomous and being the master of their own fate. Unfortunately, this cultural given can run aground when the individual has impaired judgment, as happens in the face of psychosis or many other psychiatric illnesses.

My belief is that covert medication can often allow the individual to save face when apprised of its use later, at a time when he is more psychiatrically stable. It is then possible for the person to say that he was medicated without his awareness, and therefore, he is absolved from having caved in to the demands of others at a time when the illness was at the helm.

While I do not condone covertly medicating people as a routine procedure, I do believe the dynamic account by Hung et al. explains why many people, upon learning of the incident, are only momentarily angry or actually may be grateful and receive the news calmly. I would like to hear what others think on this topic.