Instead of creating a sustainable environment for recovery, mainstream psychiatric practices often create more distress and reluctance.
Editor’s note: First published on Mad in America on March 28th 2026
Recently, multiple blizzards have hit the Northeast, raising urgent questions about how to protect unhoused people exposed to dangerous winter conditions. In New York City, the usual response during extreme weather has often involved forcing people into shelters or hospitals, sometimes by use of police or other forms of coercion. The logic seems straightforward: if someone is vulnerable and refuses help, shouldn’t we step in and decide for them?
This winter, however, the city tried something different. Instead of defaulting to force, officials expanded the number of options available to unhoused people, offering different types of shelter, warming spaces, and services. The mayor, Zohran Mamdani, spoke in a press conference about the impact of this process, suggesting that when they were given choices rather than ultimatums, homeless New Yorkers were more willing to accept support.
For many psychiatric survivors, this shift represents something we have been advocating for years: agency and options. Not being labelled “non-compliant” for saying, “I don’t want to go to the hospital,” and not having distress interpreted as a justification for losing autonomy.
Yet the assumption that people in distress must sometimes be coerced “for their own good” remains deeply embedded in mental health care. We often hear the same argument: wouldn’t someone experiencing suicidal thoughts, hallucinations, or intense distress be better off in a highly surveilled environment? And if they refuse, shouldn’t they be pressured or forced to accept treatment?
But “better off” is a remarkably subjective standard. And despite how normalized it has become, coercion consistently undermines the very recovery it claims to protect.
The recovery myth behind coercion
Often, when I hear fellow psychiatric survivor stories, I hear a subtle questioning in their voices. They wonder whether what was experienced entailed coercion: “I was not forced or anything but I couldn’t get away.” “I wasn’t physically restrained, but I was given ECT without my consent.” We also hear it in instances of “well, I was not directly pressured or threatened, but it was the only option,” or “they told me it was the only thing that would help me.” These instances of what is called hidden coercion appear to eat away at people, washing away their confidence in themselves, little by little, instance by instance.
Psychiatric coercion takes many forms, but it seems that many see it as crucial when dealing with psychiatrized people. The sounds of “it’s for their own good” echo in my head as I type this. The memories of being dismissed and discredited after having a psychiatric label slapped on me, the experience of becoming an invisible human.
This “necessary” tool often has ripple effects, causing more harm directly or perpetuating cycles of harm and compounding distress. The deepening of harm often leads to more distress, which in turn leads to more coercive interventions, which in turn lead to more harm, and so on and on. This is not just something I experienced myself, but something I have witnessed as a psychology trainee. In many instances, it seemed like psychiatric treatment was the last thing a person needed, and it would have been best if they had psychosocial support instead.
Forms of coercion in mental health settings
Researchers have defined two modes of coercion employed in mental health settings: formal and informal coercion. Formal coercion is the most widely recognized: it’s the most visible, including the use of mechanical and chemical restraints, use of force, seclusion, and sometimes, involuntary hospitalization. By contrast, informal coercion takes on a subtle, less visible form, such as muddy consent that lacks transparency, weaponization of psychiatric diagnosis to suppress and contain, and “consent” under threat, including manipulative and paternalistic statements such as “it’s for your own good.” Psychiatric coercion is also used for the clinician to cover themselves from potential liability while knowing it is not a helpful tool for recovery.
These practices are incredibly normalized in our society; it has been more and more ingrained. People seem to think that by normalizing “seeking help” we are destigmatizing mental health problems, but what I observe as a researcher and lived experience expert is exactly the contrary: we are creating more stigma, normalizing oppression and control of highly distressed people, and normalizing potential harm. We are corroding people’s agency and subjectivity slowly.
In psychiatry, recovery is often defined by how productive an individual is in our society. Basically, if you’re not advancing the goals of capitalism, you are not meeting the optimal functioning expectations.
However, if you ask those with lived experiences of the mental health system, recovery is a subjective continuum that depends on an individual’s own experiences, circumstances, desires, and choices. It could range from being able to attain a level of emotional stability to having a good quality of life to being able to regain control over one’s own experience and make decisions for oneself. This is why I often ask in my interviews with psychiatric survivors, “What does recovery mean to you?” Their answers often differ greatly from what mine would be.
For many, recovery is contingent on relationships and safety. An important part of this is self-determination: the recognition that a person is able to make their own choices. The integration of shared decision-making approaches into mental health services attempts to honor this principle, but coercion and force are still prevalent despite these approaches. Coercion and force disempower people, show that their relationships are unsafe and disconnected, and thus prevent recovery. No one can heal in the environment that made them sick.
Many people who come to receive mental health services arrive with a history that includes cumulative experiences of trauma, stress, or general adversity. Placing individuals in an environment that is not trauma-informed, but designed to gaslight, label, subdue, control, and contain at the cost of the individual and for the benefit of the system, will naturally create more adversity in a person’s life. Their needs are not being recognized or centered. This, in turn, will create more resistance towards help-seeking, more disengagement, fear, and distress. It makes people afraid of speaking out due to fear of being isolated, punished, and caged. So instead of creating a sustainable environment for recovery, traditional practices often create more distress and reluctance.
How coercion has remained hidden
In my work, I have interviewed many psychiatric survivors about their experiences. They often describe coercion and force. For instance, one psychiatric survivor described subtle and ambiguous forms of coercion occurring when seeking out services: “It’s the way you’re treated—when you’re seeking help, yet at times you can feel like a prisoner, like a criminal, like someone who is a problem, a burden. At times, they infantilize you or treat you as if you were part of the herd, so to speak—like sheep that need to be kept in line or herded along.”
Listening to the experiences of people who sought out services at their most distressed, and instead found coercion, can be healing and reparative for many; it can help normalize their own experiences, and also help make meaning out of them. It can help people realize why the “care” they received did not feel good or necessarily helpful.
Most people, although marked by their experiences with coercion in the mental health system, only spend a short amount of time in these settings. Therefore, if they achieve recovery and healing, it occurs outside of these settings and not within them. For many, this happens after finding alternatives, building community, leaving abusive households, and gaining housing or employment.
Again, the root of healing is found in our relational and contextual world. That is why it is not rare that recovery occurs outside of these systems, and that these systems many times end up making the problems worse instead. To achieve this much-needed relational healing, however, trust is required, and building trust takes time and effort. People need to be treated with compassion and empathy, to have their needs valued and respected, and not the contrary of being coerced and condescended to.
This has been identified in previous research: the language of having a chronic, lifelong illness leads to disempowerment. “Why try if this ‘disease’ is a part of me?” Psychiatric coercion feeds off that language of chronicity and the catastrophic prognosis without assuming responsibility for their own promotion of the status quo. The relationship has already been defined as one where the provider is the expert—the one who dominates, makes decisions, and serves as a seer, who can determine what someone’s future looks like based on how they act at their most vulnerable.
Intersectional identities, power dynamics, and coercion
These power dynamics extend into the identities of people experiencing psychological distress. The implicit and explicit biases of our mental health system can be unmasked based on how people’s ethno-racial, gender, and sexual identities are pathologized and oppressed within it. I must emphasize that our current mental health system is built upon the legacy of colonialism and genocide, as is our modern society. Consciously or unconsciously, otherness is not seen as beneficial to our society, neither in how people look and identify, nor in how they think.
Minoritized people are often subjected to more restrictive, prescriptive, and violent forms of oppression. Ethno-racially minoritized people are restrained more often and for longer periods of time, and assigned highly stigmatized and personality-oriented psychiatric diagnoses. Meanwhile, LGBTQ+ folks are pathologized at high rates while ignoring factors such as discrimination and anti-LGBTQ+ policies. Women are often pathologized with personality disorders or viewed as delusional, and not believed when recounting their traumatic experiences. Homeless people often cycle in and out of hospitals, accumulating more and more debt, without being connected to psychosocial services in the ways that, when asked, they mention needing support. Moreover, poverty is often viewed through a pathological lens, weaponizing psychiatric labels on people who are in survival mode, trying to make ends meet. These examples make it clearer how coercion is about social control and punishment and not about care.
What is there to lose when coercion in mental health settings is normalized?
Many view psychiatric coercion as a necessary evil to which there is no alternative; this comes from a combination of stigmatizing beliefs, actual care for the person’s well-being, genuinely thinking of coercion as therapeutic, and safety concerns. In many cases, communities are in desperate need of support, but by normalizing coercion, relational ties and trust may be broken, while reluctance to seek out support or admit to distress might take their place.
For many people, taking time to pause and be listened to can oftentimes be enough to reduce distress. In addition, community-based supports, including simple interventions such as “meal trains” where a different person volunteers to bring food to a household each day, may be essential to reducing distress and allowing time for recovery and processing. These sorts of approaches are rooted in dignity and care for the person, and centered around their own needs and choices.
Nurturing communities create environments of care and healing, facilitating recovery and promoting prevention from further psychological distress. Prevention of further harm is crucial and life-saving for many individuals. Creating these types of environments takes time, just as recovering and healing do, but one cannot heal in an environment of manipulation or force. We cannot force or coerce people into recovery, which makes coercion incompatible with recovery.
While mental health systems continue to perpetuate harm by engaging in coercion and utilizing coercive measures, these will not be recovery-oriented or centered around lived experience. There must be a shift in how help and care are defined within mental health. This needs to be accompanied by an ego deconstruction and a willingness to share equal power with people experiencing distress. This includes listening and believing their experiences, and actively working towards a paradigm shift. This shift includes partnering with community-based organizations, communities, and grassroots movements to provide sustainable support for people experiencing psychological distress.
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Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own.
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