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March 22, 1995

Almost a Revolution: Mental Health Law and the Limits of Change

Author Affiliations

Oregon Health Sciences University Portland


by Paul S. Appelbaum, 233 pp, $34.95, ISBN 0-19-506880-7, New York, NY, Oxford University Press, 1994.

JAMA. 1995;273(12):969-970. doi:10.1001/jama.1995.03520360083047

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As a prominent commentator and major investigator in the development of forensic psychiatry, Dr Paul Appelbaum has witnessed a profound change in the relationship between mental illness and the law. The civil rights movement of the 1960s not only dealt with racial equality but also extended to the mentally ill, as early optimism about benefits of psychiatric treatment gave way to doubts. Appelbaum, who experienced firsthand the "swirl of events," was a key participant in this "unprecedented epoch of change." Now, in the 1990s, as cries for change have subsided, Appelbaum looks back at a tumultuous era and assesses four important mental health law reforms: (1) changes in civil commitment laws that included strict procedural protections for patients; (2) the imposition of liability on mental health professionals for violent acts committed by their patients; (3) a recognition of the right of psychiatric patients to refuse treatment, particularly with antipsychotic medications;

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