Coercion and Influence in Psychiatric Services: Frameworks and Future Directions

This narrative review traces the evolution of the term coercion in psychiatric services. I introduce its use in political theory, then critically review Robert Nozick's analytical framework and subsequent bioethical frameworks, including Szmukler and Appelbaum's spectrum of treatment pressures. Next, I review emerging patient-centered and sociologic accounts of psychiatric coercion in the literature. Through this, I advocate for distinguishing between interpersonal and institutional coercion to broaden and facilitate analyses that consider the structural vulnerability of patients with serious mental illness, ensuring psychiatric ethics addresses both immediate and systemic constraints on autonomy.