Coercion in Treatment: Researchers' Perspectives: In Reply

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Back to table of contents Previous article Next article LettersFull AccessCoercion in Treatment: Researchers' Perspectives: In ReplyJanice L. LeBel, Ed.D.Janice L. LeBelSearch for more papers by this author, Ed.D.Published Online:1 Jul 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail I agree with Dr. Roskes: coercion is a complex phenomenon with multiple dimensions. The question that he poses in his letter has three parts, which I address below.Is research conducted by nonconsumers who have not experienced coercion flawed? Yes. Work in the area of emancipatory research has shed more light on the inherent power imbalance between those who conduct social inquiry and those who experience it (1). In addition, measurement bias, instrument bias, and interviewer bias are all basic challenges in conducting research (2). Research design is compromised when the construction of tools does not include the input of consumers with direct experience of coercion. Moreover, the research process itself can have an impact on outcomes. This is confirmed by the Hawthorne effect—or its corollary in physics, the Heisenberg effect—where observation affects the object of study (3). Fundamentally, all research is flawed (4).Is research by nonconsumers of less value? No. Studies by consumers and nonconsumers are both valued.Is research conducted by consumers unbiased? Yes and no. Consumers who have experienced coercion bring an unassailable veracity and credibility to any study. Each person's unique experience cannot be regarded as “bias” when it is first-hand knowledge of coercion. Jonathan Delman, a leading consumer advocate and consultant, recounted, “I would compare my experience of coerciontotorture, with medication changes that have left me in a zombie-like state; coercion causes a sane person to feel insane or akin to a criminal” (personal communication, June 1, 2011). However, consistent with the Rashomon effect (5), individual experience is not uniform, standardized, or universal. Each person's perception is different, which makes the study of coercion challenging.More important than debating who should claim the high ground in coercion research is appreciating the damaging effects of coercion on individuals who receive care. These effects have been well articulated and should be taken as the sentinel call to recognizing that coercive practices thwart the purpose of mental health services—to facilitate recovery by improving a person's mental health condition and functioning—and have no place in a treatment paradigm. It is also important to recognize an inherent flaw in service system design, a flaw based on exploitation of a power imbalance. Tom Lane, a nationally recognized consumer leader who has experienced seclusion and restraint, summed it up well, “To suggest that ‘patients’ who have had coercive experiences are merely ‘unlucky’ or ‘unfortunate’ is a grave misrepresentation of what is, in fact, a gross injustice. It is not a matter of luck or fortune, like winning the lottery or not. It is a further reflection of the lack of understanding of a failed framework of those mental health systems which see coercive practices as treatment or acceptable ‘interventions’” (personal communication, June 5, 2011).References1 Letherby G : Emancipatory research; in Sage Dictionary of Social Research Methods. Edited by , Jupp V . London, Sage, 2006 Google Scholar2 MacCoun RJ : Biases in the interpretation and use of research results. Annual Review of Psychology 49:259–287, 1998 Crossref, Medline, Google Scholar3 Albright Linda , Malloy TE : Experimental validity: Brunswik, Campbell, Cronbach, and enduring issues. Review of General Psychology 4:337–353, 2000 Crossref, Google Scholar4 Ioannidis JPA : Why most published research findings are false. PLoS Med 2(8): e124, 2005. DOI 0.1371/journal.pmed.0020124 Crossref, Medline, Google Scholar5 Chin MH , Muramatus N : What is the quality of quality of medical care measures? Rashomon-like relativism and real-world applications. Perspectives in Biology and Medicine 46:5–20, 2003 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 7 July 2011Pages 806-807 Metrics PDF download History Published online 1 July 2011 Published in print 1 July 2011