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August 18, 1993

Controlling the Tuberculosis Epidemic: The Analogy With Mental Illness-Reply

JAMA. 1993;270(7):832. doi:10.1001/jama.1993.03510070054034

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In Reply.  —I am grateful to Dr Cowen for explaining many of the differences and similarities between TB and mental illness in assessing the need for compulsory detention and treatment. To be sure, the analogy between mental illness and TB control is imperfect. Yet, my proposal for adopting many of the standards and procedures used in mental illness for use in TB control warrants serious consideration.Confinement under civil law of persons who have not committed a criminal offense is highly unusual in our constitutional society. We do so only on the grounds that the individual poses danger to self or others. At present, persons with mental illness or contagious TB are virtually the only populations in society subject to civil commitment.The law, therefore, clearly treats persons with mental illness and TB in comparable ways. The differences between TB and mental illness only reinforce the observation that TB is