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Controlling the Tuberculosis Epidemic: The Analogy With Mental Illness

Joseph R. Cowen, MD
JAMA. 1993;270(7):832. doi:10.1001/jama.1993.03510070054033.
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To the Editor.  —Mr Gostin1 proposes that "Constitutional adjudication in the field of civil commitment of persons with mental illness provides an apt model for tuberculosis [TB] [control] statutes."In failing to recognize the differences, as well as the similarities between TB and mental illness, he risks making the same errors that have resulted in civil procedures that now plague care of mental illness.The issue of "imminent danger" to self and others, in mental illness, has poor definition and unreliable predictability. In TB, "imminent danger" is definable and reliably predictable. The similarity is that ill persons may not know that they are ill. This ignorance poses danger to self for both TB and mental illness sufferers, although not with the same degree of certainty for morbidity and mortality. They differ in that TB can be casually transmitted to others by ordinary behavior (cough). Mental illness poses a danger


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