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We are very good at preparing to live, but not very good at living. We know how to sacrifice ten years for a diploma, and we are willing to work very hard to get a job, a car, a house, and so on. But we have difficulty remembering that we are alive in the present moment, the only moment there is for us to be alive.

Many mental health professionals, especially psychiatrists, see coercion as an essential tool, so it is important to understand why it should be avoided if at all possible. Respect for autonomy – the right to make choices – is, for good reason, a widely recognised principle in medical ethics. Aside from the fact that autonomy is regarded as a virtue in its own right, its denial is usually distressing. Indeed, a compulsory admission to hospital is often experienced as traumatic, sometimes leading to the same kind of post-trauma symptoms experienced by victims of assault or life-threatening events. Of course, many psychiatric patients have previously experienced physical and sexual abuse, bullying and other kinds of victimisation – that is often why they develop psychiatric problems in the first place – so coercion by services adds to a burden of adversity that is already too great to bear. It also damages relationships between patients and services, often leading to greater reluctance to seek psychiatric help during future crises.

Defenders of coercion typically argue that it is a necessary evil, because patients do not know what is in their best interests. This argument, of course, assumes that patients are irrational in rejecting psychiatric care, that psychiatric treatments such as antipsychotic medication are always beneficial, and that patients compelled to receive treatment do better in the long-run.

Each of these propositions is dubious. Studies show that many patients reject drug treatment because it is experienced as ineffective and associated with side-effects (some of which are life threatening – one recent report estimated that psychotic patients, on average, have about 20 years’ reduced life expectancy, some of which is attributable to drug side effects). Recent randomised controlled trials of drug treatments – both antidepressant and antipsychotic – have shown them to be much less effective than previously thought, with many patients showing a minimal response. Finally, the existing controlled trials of CTOs show little evidence of the expected benefits in terms of reduced future hospitalisation – they are not the solution to the “revolving door” patient they were designed to be.

Not everyone is healthy enough to have a front row seat in our lives. There are some people in your life that need to be loved from a distance. It’s amazing what you can accomplish when you let go of or at least minimize your time with draining, negative, incompatible, not-going-anywhere relationships. Observe the relationships around you. Pay attention.

When people walk away from you, let them go. You shouldn’t have to talk them into staying with you, loving you, calling you, caring about you, and coming to see you … because if they really cared about you in the first place, they would not be going anywhere.

‘People think that if you’re depressed, you’re depressed about something., he explains to me. ‘More often than not, I’m not. I just feel… Terrible. And it’s not about record sales or media or family. That’s stuff I can pin it on. The real root of it all is, actually, I suffer with an illness that’s called depression.’