The Psychiatrist’s Power No One Talks About

I have a core memory from my time as a resident in the psychiatric emergency room. I was told, “Get this patient to sign in voluntarily or we will commit them.” It struck me immediately that nothing about this was truly voluntary. It felt like a semantic trick: sign yourself in or face the threat of an involuntary commitment that could follow you for years in background checks and employment screenings. The entire process felt unsettling.

Psychiatrists hold a unique and ethically murky authority among medical professionals—the power to detain someone against their will. When a patient is labeled “incompetent” or “a danger to oneself or others,” the psychiatrist’s judgment can override that person’s autonomy entirely. This creates an uncomfortable dynamic in a relationship that is supposed to be built on trust. For many, it can feel like the ultimate betrayal: the one person entrusted with your secrets, fears, and vulnerabilities is suddenly the person sending you away, taking control of your body, your time, and your choices.

The trauma of involuntary hospitalization is rarely discussed. The sense of betrayal. The abrupt loss of freedom. The shift from everyday life into a locked unit where strangers decide what you can and cannot do. In some cases, this includes forced medication orders. These are life-altering experiences, often carried silently and without validation.

To make matters more complicated, judgments about what constitutes “danger” or “incompetence” are not objective. They shift with culture, training, liability fears, political pressures, and the individual clinician’s biases. What qualifies today may not have qualified ten years ago—and that should concern us.

Any time you enter an emergency room, involuntary commitment is on the table. Sometimes it is absolutely the right choice and keeps someone alive. Other times, the loss of control becomes more traumatic than the original crisis..

After many uncomfortable encounters in these forced situations, my hope is simply to open this conversation long before anyone is being presented with two versions of the same “choice.”

It’s an unsettling topic. It should be. But avoiding it doesn’t protect you — it only keeps you unprepared.

Thinking through where you stand on hospitalization, autonomy, and what safety actually means is an act of self-preservation. These decisions are easiest to explore when you’re calm, grounded, and not already in crisis.

My goal isn’t to tell you what to choose. It’s to make sure you recognize the moment when the system begins narrowing your options — and to help you enter that moment with your eyes open. UnScripted will be exploring these options and provide tools to help with decision making.

Dr. Marissa Witt-Doerring is a board-certified psychiatrist and co-founder of TaperClinic, specializing in psychiatric withdrawal and safe, individualized tapering.