Title: Waukesha County v. J.W.J.

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2017 WI 57 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2016AP46-FT 
COMPLETE TITLE: 
In the matter of the mental commitment of J.W.J: 
 
Waukesha County, 
          Petitioner-Respondent, 
     v. 
J.W.J., 
          Respondent-Appellant-Petitioner. 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at 370 Wis. 2d 262, 881 N.W.2d 359 
(2016 – Unpublished) 
 
 
OPINION FILED: 
June 8, 2017 
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
January 17, 2017 
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit 
 
COUNTY: 
Waukesha 
 
JUDGE: 
William Domina 
 
 
 
JUSTICES: 
 
 
SEPARATE WRITING: 
 
CONCURRED: 
ABRAHAMSON, J. writes separately, joined by A.W. 
BRADLEY, J. 
 
DISSENTED: 
      
 
NOT PARTICIPATING:          
 
 
 
ATTORNEYS: 
 
 
For the respondent-appellant-petitioner, there were briefs 
filed by and an oral argument by Kaitlin A. Lamb, assistant 
state public defender. 
 
For the petitioner-respondent, there was a brief filed by 
and oral argument by Robert J. Mueller, corporation counsel. 
 
 
 
 
2017 WI 57
NOTICE 
This opinion is subject 
to further editing and 
modification.  The final 
version will appear in 
the bound volume of the 
official reports.   
No.  2016AP46-FT 
(L.C. 
No. 
2009ME1158) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In the matter of the mental commitment of 
J.W.J: 
 
 
 
Waukesha County, 
 
          Petitioner-Respondent, 
 
     v. 
 
J.W.J., 
 
          Respondent-Appellant-Petitioner. 
 
 
 
FILED 
 
JUN 8, 2017 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
DANIEL KELLY, J.   The petitioner, J.W.J., is an adult 
suffering from paranoid schizophrenia.  He is currently subject 
to an involuntary commitment order and an order requiring him to 
undergo treatment and take medication prescribed for his 
condition.  Waukesha County seeks to extend those orders for an 
No. 
2016AP46-FT   
 
2 
 
additional year; Mr. J. says further involuntary commitment and 
treatment will not rehabilitate him, so he is not a proper 
subject 
for 
treatment 
within 
the 
meaning 
of 
Wis. 
Stat. 
§ 51.20(1) (2015–16).1  We review the unpublished decision of the 
court of appeals2 affirming the Waukesha County circuit court's 
extension of those orders.3 
I. 
BACKGROUND 
¶2 
Mr. J. is a 55-year-old man who has suffered from 
mental health or substance abuse issues for most of his life.  
He has been subject to commitment orders almost continuously 
from 1990 to 2008, at which time he started an 18-month prison 
term.  Upon release in 2009 he was adjudged so psychotic and 
threatening to others that he was immediately subjected to a new 
set of commitment orders that have been in place since then. 
¶3 
On June 16, 2015, Waukesha County filed a petition to 
extend Mr. J.'s involuntary commitment and treatment orders.  At 
the time of the petition, Mr. J. was attending his appointments, 
receiving medication, and living independently in the community.  
The County's current petition represents the sixth extension of 
Mr. J.'s commitment and treatment orders. 
                                                 
1 All subsequent references to the Wisconsin Statutes are to 
the 2015-16 version unless otherwise indicated. 
2 In 
re 
Mental 
Commitment 
of 
J.W.J., 
No. 
2016AP46, 
unpublished slip op., (Wis. Ct. App. May 4, 2016). 
3 The Honorable William Domina presiding. 
No. 
2016AP46-FT   
 
3 
 
¶4 
Mr. J.'s medical records provide a sense of his 
longstanding, continual struggles from his youth up through 
2014:  
Mr. J[4] has a lengthy history of drug and alcohol 
abuse.  Marijuana, LSD and barbiturates abuse started 
at the age of 15 if not earlier.  In 1979, at the age 
of 17, he experienced an LSD overdose which required 
treatment at the . . . Child and Adolescent Center.  
He was diagnosed with Drug Induced Schizophrenia. 
[I]n-patient 
treatment 
periods 
extend 
from 
1980 
through 
2014 . . . ; 
approximately 
12 
psychiatric 
admissions 
to 
the 
[Mental 
Health 
Center].  
Additionally, 
psychiatric 
treatment 
at 
the . . . Resource Center during his incarceration. 
Mr. J. has a history of criminal behaviors over the 
years including car theft, robberies, two DWI, burning 
down a field as well as a 2008 conviction for selling 
marijuana out of a [store] . . . he ran in [a certain 
municipality].  His prison sentence was 18 months.  
During this period of time he became quite upset and 
wrote a threatening letter to his mother as well as 
[a] sexually explicit letter to the female warden.  
Mr. J was committed in 2009 . . . [and] has been under 
commitment almost consistently since 1990. 
Over the course of mental health treatment Mr. J. has 
shown a significant lack of insight into his mental 
illness and a lengthy history of not cooperating with 
taking 
psychiatric 
medications. 
 
Many 
of 
his 
hospitalizations occurred after a period of refusing 
medications with the expected results that Mr. J. 
became increasingly more paranoid, rambling/pressured 
speech, 
sleep 
problems, 
often 
times 
experiencing 
command-type auditory hallucinations to kill himself 
or others along with depression and/or agitated 
                                                 
4 As submitted to the court, the medical records redact all 
but the first letter of Mr. J.'s last name, a convention we 
follow without noting every instance in which we engage in such 
elision. 
No. 
2016AP46-FT   
 
4 
 
behaviors. 
 
Significant 
alcohol 
usage 
has 
also 
continued over the years.  Mr. J. continues to insist 
that it is the psychotropic medications which causes 
all of his mental health symptoms. 
The 
last 
hospitalization . . . 3/1/14 
to 
3/27/14 
occurred 
after 
he 
was 
taken 
by 
the 
Sheriff's 
Department to get his IM [intramuscular] injection 
which he had previously refused to get.  Mr. J. was 
noted by the attending MD to be rambling and bizarre.  
Patient complained of "the beast" throwing glass 
around his apartment.  He wanted the police to get him 
a tank and bombs so that he could kill the beast.  He 
was then admitted to the [Mental Health Center].5 
¶5 
The Recommitment Report filed along with the County's 
petition to extend Mr. J.'s commitment described Mr. J.'s status 
in 2015:6 
Mr. J. is making his appointments and is receiving his 
IM medication.  He has been [sic] maintained his 
current housing and remains [in] the community.  There 
[have] been no inpatient hospitalizations this past 
year.  Mr. J. is experiencing a number of medical 
problems 
which 
may 
be 
due 
to 
his 
current 
medication. . . . 
 
His 
diagnoses 
are 
Axis 
I 
Schizophrenia, Alcohol Use Disorder and History of 
Cannabis Use Disorder.  He continues to state he is 
allergic to all psychotropic medication.  He at the 
last shot appointment said the medication makes him 
                                                 
5 This material comes from a Report of Examination (dated 
July 1, 2015) prepared by Dr. Richard J. Koch.  Doctor Koch is a 
licensed psychologist and has seen Mr. J. on five occasions 
between 1990 and 2004.  He also performed an assessment of Mr. 
J.'s condition in 2014, although he had to rely on medical 
records and other generally available information because Mr. J. 
refused a personal examination.  Dr. Koch submitted this Report 
in support of the County's petition to extend Mr. J.'s 
involuntary commitment. 
6 This report was submitted by Mr. Robert C. Walker, LCSW, 
on behalf of the Waukesha County Community Human Services 
Department. 
No. 
2016AP46-FT   
 
5 
 
feel like he is being murdered every night.  Given the 
medication changes being made and Mr. J's lack of 
insight into his illness [the advanced practice nurse 
prescriber] is requesting an extension of the current 
commitment. 
¶6 
Doctor Koch tried to personally examine Mr. J. in 2015 
in connection with his involuntary commitment but could not 
because Mr. J. would not allow it:  "Mr. J. contacted this 
examiner by telephone and he quickly stated that he would not 
cooperate in a personal interview and he would not answer 
questions over the telephone.  Mr. J. disconnected the call 
prior to this examiner being able to read him his rights."  
Consequently, Dr. Koch based the Report on Mr. J.'s existing 
medical records and other information he was able to assemble 
without a personal examination. 
¶7 
Dr. Koch's evaluation resulted in this assessment:  
This 
past 
treatment 
year 
Mr. 
J. 
has 
not 
been 
hospitalized.  He has maintained his current housing 
and remains in the community.  Mr. J. has been 
compliant with psychotropic medications but he has 
stated that he is "allergic" to all psychotropic 
medications.  He continues to show lack of insight 
into his illness. 
Dr. Koch checked the boxes in the Report that indicate it was 
his opinion, to a reasonable degree of professional certainty, 
that Mr. J. is mentally ill,7 dangerous,8 is an appropriate 
                                                 
7 The form defines "mentally ill" as "a substantial disorder 
of thought, mood, perception, orientation or memory which 
grossly impairs judgment, behavior, capacity to recognize 
reality, or the ability to meet the ordinary demands of life." 
No. 
2016AP46-FT   
 
6 
 
subject 
for 
outpatient 
treatment, 
and 
that 
psychotropic 
medication would be therapeutically valuable to him.  Dr. Koch 
also wrote that Mr. J.'s mental illness makes him "substantially 
incapable of applying an understanding of the advantages, 
disadvantages and alternatives in order to make an informed 
choice 
as 
to 
whether 
to 
accept 
or 
refuse 
psychotropic 
medication."  Dr. Koch concluded that "[t]here is nothing in 
[Mr. J.'s] record to suggest there has been any significant 
change in his status.  He continues to be a patient who has a 
history of improved behaviors when appropriately medicated and 
deterioration in the ability to function in the community when 
not appropriately medicated." 
¶8 
At the hearing on the County's petition to extend Mr. 
J.'s commitment, Dr. Koch testified consistently with his 
report.  In particular, he said Mr. J.'s schizophrenia is 
treatable 
"to 
the 
extent 
that 
when 
treated 
with 
medications . . . his behavior is improved and he can survive in 
the community."  He explained that this treatment lessens the 
disordering of Mr. J.'s thought, mood, and perception. 
¶9 
Dr. Koch also explained why he believes Mr. J. is 
dangerous.  He testified that Mr. J.'s "history is one of 
inconsistent utilization of psychotropic medications.  When he's 
                                                                                                                                                             
8 Dr. Koch checked the box on the form that expresses his 
belief that Mr. J. is dangerous because 
"[t]here is a 
substantial likelihood, based on this individual's treatment 
record, that this individual would be a proper subject for 
commitment if treatment were withdrawn." 
No. 
2016AP46-FT   
 
7 
 
not appropriately medicated, he becomes increasingly more 
agitated, paranoid, grandiose at times, and he started having 
hallucinations, demand hallucinations to either harm himself or 
others."  However, "[w]hen he's taking medications, while some 
of those experiences and symptoms may still be present, he 
doesn't act on them." 
¶10 Doctor Koch said he does not believe Mr. J. would take 
his medications absent a court order to do so:  "[T]he current 
evidence from the extension report as well as my prior history 
with him and his behaviors indicates that when not ordered to 
take psychotropic medications that he doesn't do it."  And 
without his medications, Dr. Koch said, Mr. J. would require 
confinement for inpatient care. 
¶11 When the hearing concluded, the circuit court granted 
the County's petition.  It found that Mr. J. continues to suffer 
from a mental illness (in the form of paranoid schizophrenia), 
he is a proper subject for treatment and benefits from it, he 
can function in the community in large part because of this 
treatment, and he satisfies the definition of "dangerousness" 
because if treatment were to cease, he would be a proper subject 
for commitment.  The court extended Mr. J.'s involuntary 
commitment order for 12 months.  It also extended the medication 
and treatment order, which requires Mr. J., inter alia, to 
attend his appointments, take his medications as prescribed, not 
engage in any acts or attempts or threats to harm himself or 
others, and not take any non-prescription controlled substances 
or alcoholic beverages. 
No. 
2016AP46-FT   
 
8 
 
¶12 The court of appeals, in a concise opinion, affirmed 
the circuit court in all respects.  The court of appeals applied 
the analytical framework we described in Fond du Lac County v. 
Helen E.F., 2012 WI 50, 340 Wis. 2d 500, 814 N.W.2d 179, and 
found that because Mr. J. has rehabilitative potential, he was a 
"proper subject of treatment." 
¶13 We granted Mr. J's petition for review and now affirm.  
II. STANDARD OF REVIEW 
¶14 This case requires us to interpret provisions of Wis. 
Stat. ch. 51.  While our review of questions of law is 
independent from the circuit court and court of appeals, we 
benefit from their analyses.  State v. Steffes, 2013 WI 53, ¶15, 
347 Wis. 2d 683, 832 N.W.2d 101. 
¶15  We must also review whether the County has met its 
burden of proof to support extension of Mr. J.'s commitment.  
This presents a mixed question of law and fact.  We uphold a 
circuit court's findings of fact unless they are clearly 
erroneous.  K.N.K. v. Buhler, 139 Wis. 2d 190, 198, 407 
N.W.2d 281 (Ct. App. 1987).  Whether the facts satisfy the 
statutory standard is a question of law that we review de novo.  
Id. 
III. ANALYSIS 
¶16 Mr. J. wishes to live his life free of Waukesha 
County's commitment and medication orders because he believes 
they have brought him as much rehabilitation as they are capable 
of bringing.  Waukesha County, however, says that Mr. J.'s 
No. 
2016AP46-FT   
 
9 
 
condition will deteriorate if the orders lapse, making him a 
danger to himself and those around him. 
¶17 There is, of course, an inherent tension between the 
public's interest in involuntarily treating an individual and 
that individual's liberty interest.9  On the treatment side, the 
people of Wisconsin have recognized the challenges that mental 
illness, 
developmental 
disabilities, 
and 
substance 
abuse 
present——both to the public and the individuals suffering from 
such disorders.  So "[i]t is the policy of the state to assure 
the provision of a full range of treatment and rehabilitation 
services . . . for 
all 
mental 
disorders 
and 
developmental 
disabilities and for mental illness, alcoholism and other drug 
abuse."  Wis. Stat. § 51.001(1). 
¶18 However, not all who could benefit from such services 
will partake of them.  And of those who will not, there will be 
a subset whose condition will make them dangerous——either to 
themselves, or to others.  To ward against the danger their 
condition 
presents, 
our 
statutes 
provide 
for 
involuntary 
commitment 
when: 
 
"1. 
The 
individual 
is 
mentally 
ill 
or . . . drug dependent or developmentally disabled and is a 
                                                 
9 See, e.g., Addington v. Texas, 441 U.S. 418, 425 (1979) (A 
"civil commitment for any purpose constitutes a significant 
deprivation of liberty that requires due process protection."); 
In re Melanie L., 2013 WI 67, ¶43, 349 Wis. 2d 148 ("The 
forcible injection of medication into a nonconsenting person's 
body represents a substantial interference with that person's 
liberty." (Quoting Washington v. Harper, 494 U.S. 210, 229 
(1990))). 
No. 
2016AP46-FT   
 
10 
 
proper subject for treatment[; and] 2. The individual is 
dangerous . . . ."  Wis. Stat. § 51.20(1). 
¶19 Because 
of 
the 
liberty 
interests 
affected 
by 
involuntary 
commitment, 
public 
policy 
favors 
outpatient 
treatment whenever possible:  "To protect personal liberties, no 
person who can be treated adequately outside of a hospital, 
institution or other inpatient facility may be involuntarily 
treated in such a facility."  Wis. Stat. § 51.001(2).  Indeed, 
the court must use the least restrictive means of delivering 
effective treatment:  "There shall be a unified system of 
prevention of such conditions and provision of services which 
will assure all people in need of care access to the least 
restrictive 
treatment 
alternative 
appropriate 
to 
their 
needs . . . ." 
 
§ 51.001(1). 
 
Further 
circumscribing 
the 
imposition on an individual's liberty, the initial commitment 
order may not exceed six months.  Wis. Stat. § 51.20(13)(g)1.  
And the order may not issue at all unless the county can 
establish the required elements with clear and convincing 
evidence.  § 51.20(13)(e). 
¶20 Upon each petition to extend a term of commitment, a 
county must establish the same elements with the same quantum of 
proof.  Helen E.F., 340 Wis. 2d 500, ¶20.  However, it may 
satisfy the "dangerousness" prong by showing "a substantial 
likelihood, based on the subject individual's treatment record, 
that the individual would be a proper subject for commitment if 
treatment were withdrawn."  Wis. Stat. § 51.20(1)(am).  An order 
No. 
2016AP46-FT   
 
11 
 
extending involuntary commitment may not exceed one year.  
§ 51.20(g)1. 
A. 
Mr. J.'s challenge 
¶21 Mr. J.'s challenge is a narrow one——he does not 
dispute his mental illness or his dangerousness, only that he is 
a "proper subject of treatment" within the meaning of Wis. Stat. 
§ 51.20(1).10 
 
"Treatment," 
in 
this 
context, 
carries 
a 
specialized 
meaning. 
 
It 
comprises 
"those 
psychological, 
educational, social, chemical, medical or somatic techniques 
designed to bring about rehabilitation of a mentally ill, 
alcoholic, drug dependent or developmentally disabled person."  
Wis. Stat. § 51.01(17) (emphasis added). 
¶22 And so we arrive at the heart of Mr. J.'s argument——he 
does not believe he can be rehabilitated.  If he cannot be 
rehabilitated, he cannot be a proper subject of treatment or an 
involuntary commitment order.  Our focus, therefore, is on the 
meaning of "rehabilitation." 
¶23 As Mr. J. acknowledges, this is not the first time we 
have had to address this statutorily-undefined term.  In Helen 
E.F. we separated treatments into two camps:  Those that bring 
                                                 
10 Mr. J. questions only whether he is a "proper subject for 
treatment."  Because he does not argue he is not mentally ill or 
dangerous within the meaning of Wis. Stat. § 51.20(1), we 
understand he has conceded those issues.  See Racine Steel 
Casings, Div. of Evans Products Co. v. Hardy, 144 Wis. 2d 553, 
557 n.1, 426 N.W.2d 33 (1988) (stating that where an issue "was 
neither briefed nor argued before the court in oral argument, we 
do not address this issue"). 
No. 
2016AP46-FT   
 
12 
 
about rehabilitation, and those that do not.  We said we could 
recognize the former by their ability to control the disorder in 
question: 
If treatment will maximize the individual functioning 
and maintenance of the subject, but not help in 
controlling or improving their disorder, then the 
subject 
individual 
does 
not 
have 
rehabilitative 
potential, and is not a proper subject for treatment.  
However, if treatment will go beyond controlling 
activity and will go to controlling the disorder and 
its 
symptoms, 
then 
the 
subject 
individual 
has 
rehabilitative potential, and is a proper subject for 
treatment. 
Helen E.F., 340 Wis. 2d 500, ¶36 (citing C.J. v. State, 120 
Wis. 2d 355, 362, 354 N.W.2d 219 (Ct. App. 1984) (internal 
alterations, quotations, and citations omitted)). 
¶24 Mr. 
J. 
asserts 
that 
this 
understanding 
of 
"rehabilitation" cannot properly account for some of the unique 
characteristics of paranoid schizophrenia, which deficiency can 
lead to an inaccurate conclusion that the individual is a proper 
subject of treatment. Specifically, he assigns four weaknesses 
to our framework: 
1. When evaluating a patient with paranoid schizophrenia, it 
is difficult to decide whether a treatment is controlling 
"behaviors" as opposed to "symptoms." 
2. Our analysis does not say which, or how many, symptoms 
the treatment must be able to control before we deem the 
patient to have rehabilitative potential.  
3. Picking up on a concern discussed by the concurring 
opinion in Helen E.F., Mr. J. says our analysis is 
No. 
2016AP46-FT   
 
13 
 
sufficiently imprecise that a physician's word choice (as 
opposed to the patient's actual condition) could be the 
deciding factor in concluding a person is a proper 
subject for treatment. 
4. Again referring to a concern raised in the Helen E.F. 
concurring opinion, Mr. J. worries we might determine 
rehabilitative 
potential 
based 
on 
the 
general 
characteristics of a class of disorder, as opposed to 
focusing on the symptoms and condition of the individual 
patient who is the subject of the involuntary commitment 
petition.  
¶25 Based on these perceived deficiencies, Mr. J. asks us 
to 
modify 
our 
Helen 
E.F. 
framework 
for 
understanding 
"rehabilitation" as follows: 
If treatment will maximize the individual functioning 
and maintenance of the subject, but not help in 
controlling or improving their disorder, then the 
subject 
individual 
does 
not 
have 
rehabilitative 
potential, and is not a proper subject for treatment. 
However, if treatment will go beyond controlling 
activity and will go to controlling improving the his 
or her disorder and its symptoms, then the subject 
individual has rehabilitative potential, and is a 
proper subject for treatment.11 
¶26 We revisit Helen E.F. to determine whether its logic 
is 
supple 
enough 
to 
accurately 
evaluate 
whether 
someone 
suffering from a condition like paranoid schizophrenia is 
capable of rehabilitation within the meaning of Wis. Stat. 
                                                 
11 Strikethroughs represent Mr. J.'s proposed deletions, 
while underlined material represents proposed additions. 
No. 
2016AP46-FT   
 
14 
 
§ 51.20(1).  In doing so, we will consider each of Mr. J.'s 
concerns in turn. 
IV. POTENTIAL MODIFICATIONS OF HELEN E.F. FRAMEWORK 
A. 
"Behaviors" versus "Symptoms" 
¶27 Mr. J.'s  first argument that Helen E.F. cannot 
appropriately 
distinguish 
between 
rehabilitative 
and 
non-
rehabilitative 
treatments 
relies 
on 
some 
rhetorical 
prestidigitation.  In Helen E.F., we juxtaposed treatments 
affecting nothing more than an individual's "activities" with 
those that affect "symptoms."  We said only the latter are 
rehabilitative.  Mr. J. responds that "activities" are really no 
different from "behaviors," and so one may just as readily ask 
whether there is any difference between treatments affecting 
"behaviors" and those affecting "symptoms."  If there isn't, he 
says, then Helen E.F.'s explanatory power is an illusion. 
¶28 To turn "activity" (the word we used in Helen E.F.) 
into his preferred term, "behavior," he notes that the American 
Psychiatric Association says "[s]chizophrenia is characterized 
by delusions, hallucinations, disorganized speech and behavior, 
and 
other 
symptoms 
that 
cause 
social 
or 
occupational 
dysfunction."  Referring to an online dictionary, he finds 
"behavior" defined as an "observable activity in a human or 
animal."  From this he concludes that, if schizophrenia 
manifests (at least in part) as a behavior, and a behavior is an 
activity, 
then 
he 
may 
safely 
substitute 
"behavior" 
for 
"activity" in the Helen E.F. framework.  The transitive 
No. 
2016AP46-FT   
 
15 
 
principle, however, functions much more neatly in mathematics 
than it does in semantics. 
¶29 Mr. J. certainly has reason to attempt this dictional 
substitution.  Doctor Koch frequently referred to Mr. J.'s 
behavior when describing the effectiveness of the treatment he 
was receiving under the involuntary commitment order.  By 
melding behaviors and activities, Mr. J. can then challenge us 
to describe how a behavior might differ from a symptom.   
¶30 Assuming we would be unable to rise to this challenge, 
Mr. J. proposes we eliminate any reference to activities or 
symptoms from the assessment of rehabilitative potential.  He 
invites us, instead, to inquire only into whether the treatment 
would improve his disorder.  By the phrase "improve his 
disorder," we take Mr. J. to mean that treatment would need to 
continually improve his condition until he experiences either a 
cure or a plateau beyond which no further improvement is 
possible.12  We decline this invitation. 
¶31 Furthermore, we decline Mr. J.'s challenge to find a 
distinction between "behaviors" and "symptoms" because its 
premise is invalid.  The proper disjunctive categories in Helen 
E.F. are "activities" and "symptoms," and we can tell them 
                                                 
12 We also understand Mr. J.'s position to be that if he 
reaches a plateau beyond which no further improvement is 
possible, 
he 
may 
no 
longer 
be 
subjected 
to 
involuntary 
commitment.  This makes sense when withdrawal of treatment would 
not inevitably result in the deterioration of his condition.  
However, as we discuss in part IV.E., this is not Mr. J.'s 
circumstance. 
No. 
2016AP46-FT   
 
16 
 
apart.  When we developed the framework for determining whether 
someone has rehabilitative potential we leaned heavily on C.J.  
The court of appeals in that case juxtaposed "habilitation" and 
"rehabilitation."  The former relates to the control of 
activities: 
[H]abilitation is more closely related to daily living 
needs and skills than to treatment of a particular 
disorder.  A practical definition of habilitation 
would 
include 
eating, 
dressing, 
hygiene, 
minimum 
social skills and such other things that facilitate 
personal maintenance and functioning.  Habilitation is 
a concept frequently associated with the long-term 
care of the developmentally disabled.  It is possible 
that controlling a person's activities by restricting 
his or her freedom and putting him or her on a 
carefully 
defined 
regimen 
would 
be 
part 
of 
a 
habilitation program. 
 
C.J., 120 Wis. 2d at 359–60. 
¶32 Rehabilitation, on the other hand, addresses the 
control of symptoms.  It comprises "treatment going beyond 
custodial care to affect the disease and symptoms . . . ."  Id. 
at 360.  But rehabilitation is not synonymous with cure.  Id.  
And it "has a broader meaning than returning an individual to a 
previous level of function."  Id.  Thus, "[a]n individual with 
an incurable physical or mental illness or disability may still 
be considered capable of rehabilitation and able to benefit from 
treatment in the sense that symptoms can be controlled and the 
ability to manage the illness ameliorated."  Id. 
¶33 To the extent we need to find a lexical home for 
"behavior," we conclude it most comfortably resides in the 
No. 
2016AP46-FT   
 
17 
 
"symptom" side of our analytical dichotomy.13  The C.J. court 
described "behaviors" as the immediate consequences of C.J.'s 
symptoms.  The psychiatrist said "the primary symptom" of C.J.'s 
paranoid schizophrenia "is recurrent delusions."  Id. at 357.  
He then observed that these delusions "impair his judgment and 
behavior."  Id.  Impaired behavior was the direct consequence of 
C.J.'s primary symptom.  When we addressed Helen E.F.'s 
condition, "behavior" carried the same significance.  She 
suffered from Alzheimer's Disease, the symptoms of which 
included "progressive dementia, memory loss, the inability to 
learn new information, and limited verbal communication."  Helen 
E.F., 340 Wis. 2d 500, ¶3.  Her resulting behavior included 
agitation and aggression.  Id., ¶4. 
¶34 By contrast, "activities" (which the 
C.J. court 
equated to those things addressed by habilitation) relate to 
functional capabilities such as "eating, dressing, hygiene, 
minimum social skills and such other things that facilitate 
personal maintenance and functioning."  C.J., 120 Wis. 2d at 
360.  In Helen E.F. we found that Helen's treatment could not 
                                                 
13 A "symptom" is "any morbid phenomenon or departure from 
the normal in structure, function, or sensation, experienced by 
the patient and indicative of disease."  Symptom, Stedman's 
Medical Dictionary (28th ed. 2006). 
No. 
2016AP46-FT   
 
18 
 
reach her primary symptoms.14  Instead, it could "maximize [only] 
her functioning and maintenance."  Helen E.F., 340 Wis. 2d 500, 
¶37 (internal marks omitted).  The court of appeals maintained 
the same distinction in Milwaukee County Combined Community 
Services Board v. Athans, describing habilitation (control of 
activities) as treatment "which assist[s] an impaired person's 
ability to live in the community," whereas rehabilitation 
(control 
of 
symptoms) 
"ameliorate[s] 
impairments 
and 
facilitate[s] an individual's capability to function."  107 
Wis. 2d 331, 336, 320 N.W.2d 30 (Ct. App. 1982) (quoting U.S. 
Dep't of Health, Ed. and Welfare, Health Planning Taxonomy 4 
(1979)).15 
                                                 
14 We did observe, however, that medication could ameliorate 
Helen E.F.'s anxiety and aggression.  Fond du Lac Cty. v. Helen 
E.F., 2012 WI 50, ¶38, 340 Wis. 2d 500, 814 N.W.2d 179.  But 
these 
behaviors 
were 
incidental 
to 
the 
analysis 
because 
controlling them had no effect on her dementia, memory loss, or 
any of her other primary symptoms.  Thus, controlling these 
incidental 
behaviors 
could 
not 
establish 
a 
basis 
for 
rehabilitative potential. 
15 Athans' reference to an individual's "capability to 
function," at first take, appears to blur the distinction 
between rehabilitative and habilitative treatments.  In context, 
however, the line holds.  Resorting to a Department of Health, 
Education and Welfare document that has nothing to do with our 
statutory structure was perhaps not the most helpful source of 
authority.  But the Athans court was juxtaposing the same 
concepts we are distinguishing here.  So the quote could best be 
understood as recognizing that the amelioration of impairments 
(symptoms) will have the effect of improving the patient's 
capability to function (his activities).  The key is that the 
rehabilitative treatment addresses itself to the symptom, not 
the activities. 
No. 
2016AP46-FT   
 
19 
 
¶35 Ultimately, 
the 
distinction 
we 
draw 
between 
rehabilitation and habilitation depends on whether the focus of 
the treatment is endogenous to the patient (symptoms) or 
exogenous (activities).  A symptom is an expression of the 
disorder at work within the patient.  It is the symptom itself 
that is harmful, and because it manifests from within, it is 
endogenous.  On the other hand, an inability to engage in a 
specific activity, such as feeding oneself, grooming, dressing, 
etc., focuses on the manipulation of something exogenous to the 
patient——food, clothes, washing implements, and so on.  The 
patient suffers harm because he cannot turn those external 
things to his benefit. 
¶36 Habilitation, therefore, refers to interventions that 
help a patient put exogenous things to his benefit (that is, 
activities).  Rehabilitation, to the contrary, refers to 
improving 
the 
patient's 
condition 
through 
ameliorating 
endogenous factors such as symptoms and behaviors.  That is why 
we said in Helen E.F. that "if treatment will go beyond 
controlling activity and will go to controlling the disorder and 
its symptoms, then the subject individual has rehabilitative 
potential, and is a proper subject for treatment."  340 
Wis. 2d 500, ¶36 (internal alterations, quoted source, and 
quotation marks omitted).  Because we are able to distinguish 
between activities and symptoms, this part of Mr. J.'s argument 
does not disclose a need to modify the Helen E.F. analytical 
framework. 
No. 
2016AP46-FT   
 
20 
 
B. 
How Many Symptoms Must a Treatment Control? 
¶37 Mr. J. also says we should modify the Helen E.F. 
framework because we were not especially precise in determining 
which symptoms a treatment must be able to control before we 
conclude a patient has rehabilitative potential.  Specifically, 
he notes we provided no qualifier for the term "symptoms" in the 
test we adopted, did not say whether the controlled symptoms had 
to be the most obvious or disabling ones, and did not quantify 
the number of symptoms a treatment must control.  When we 
referred 
to 
Helen 
E.F.'s 
condition, 
we 
said 
"there 
is 
uncontroverted 
evidence 
that 
Helen's 
underlying 
disorder, 
Alzheimer's Disease, as well as the vast majority of its 
symptoms, do not respond to treatment techniques . . . ."  Id., 
¶38 (emphasis added).  Mr. J. concludes from this that our 
framework requires the treatment to leave less than the "vast 
majority of [the disorder's] symptoms" unimproved, but how much 
less is an open question. 
¶38 This is a fair observation.  We provided no such 
measure, however, because none was necessary.  The expert 
testimony in Helen E.F. demonstrated that Alzheimer's Disease 
"is incurable and untreatable; the only available medical remedy 
is maintenance——not treatment——of the disease as it progresses."  
Id., ¶37.  We concluded that "medical techniques can only 
maximize the functioning and maintenance of an individual" 
suffering from this disorder.  Id. (internal alterations and 
quotations omitted).  So treatment would reach only habilitative 
matters.  The only symptoms/behaviors we were told could be 
No. 
2016AP46-FT   
 
21 
 
affected by medical treatment were her anxiety and aggression.  
These, 
however, 
were 
secondary 
to 
her 
primary 
symptoms:  
progressive dementia, memory loss, the inability to learn new 
information, 
and 
limited 
verbal 
communication. 
 
Medical 
treatment could not reach any of these.  All treatment could do 
was palliate some of the minor aspects of her condition.  So it 
was apparent she did not have rehabilitative potential. 
¶39 There may come a day when we need to quantify and 
qualify the symptoms a treatment must reach before concluding a 
patient has rehabilitative potential.  But this is not that day. 
¶40 The 
uncontroverted 
facts 
show 
that 
Mr. 
J. 
has 
rehabilitative potential.  Doctor Koch said Mr. J.'s paranoid 
schizophrenia was a "substantial disorder of his thought, mood, 
and perception" that "grossly impair[s] his judgment and 
behavior."  Mr. J. expresses these disorders by becoming 
"agitated, 
paranoid, 
grandiose 
at 
times," 
with 
"demand 
hallucinations to either harm himself or others."  The treatment 
he receives lessens the disordering of his thought, mood, and 
perception.  And while some of these experiences and symptoms 
may still be present while under treatment, he does not act on 
them.  In fact, his treatment is so effective at controlling his 
symptoms that he can live in society while taking his treatment 
as an outpatient.  Doctor Koch said that, without treatment, Mr. 
J.'s condition would inevitably decline to the point he would 
have to be confined so he could receive inpatient treatment. 
¶41 The policy of this State is to provide treatment in 
"the least restrictive alternative appropriate to" a patient's 
No. 
2016AP46-FT   
 
22 
 
needs.  Wis. Stat. § 51.001(1).  If a treatment controls 
symptoms to such a degree that withdrawing it would subject the 
patient to a more restrictive treatment alternative, then the 
treatment controls enough symptoms to establish the patient has 
rehabilitative potential.  The court of appeals said in C.J. 
that rehabilitation "has a broader meaning than returning an 
individual to a previous level of function," 120 Wis. 2d at 360, 
so simple logic requires that it means at least that.  If 
treatment is withdrawn, Mr. J.'s symptoms will worsen to the 
point that a more restrictive level of care would be necessary 
(confinement 
for 
inpatient 
treatment); 
reintroduction 
of 
treatment would return him to the previous level (treatment as 
an outpatient).  It is enough that treatment can accomplish this 
to demonstrate the patient has rehabilitative potential.  Thus, 
to resolve this case, there is no need to identify the number or 
significance of the symptoms the treatment controls. 
C. 
Dispositive Word Choices 
¶42 Mr. J. is also concerned that our Helen E.F. framework 
may lead to outcomes that turn not on medical prognosis, but on 
the words a physician may choose to describe his patient's 
condition and prospects.  The concurring opinion in Helen E.F. 
described that very risk: 
The individuals in the two cases [C.J. and Athans] 
suffered from the same condition——chronic paranoid 
schizophrenia——yet the two courts reached opposite 
results on the possibility of "rehabilitation."  The 
results appear driven by the words chosen by expert 
medical 
witnesses 
describing 
the 
impact 
various 
medications would have on the individual. 
No. 
2016AP46-FT   
 
23 
 
Helen E.F., 340 Wis. 2d 500, ¶51 (Abrahamson, J., concurring). 
¶43 This is certainly a legitimate concern.  But it arises 
not 
from 
the 
need 
to 
distinguish 
between 
symptoms 
and 
activities, but from the need to make distinctions based on 
expert medical testimony at all.  If we adopt Mr. J.'s revision 
to our framework, we would not cease making such distinctions.  
We would simply shift to distinguishing between treatments that 
improve a patient's disorder and those that do not.  Expert 
medical testimony, of course, would guide us in that task.  So 
if we are currently at risk of deciding wrongly because of the 
vagaries of an expert's choice of words, Mr. J.'s proposed 
change will do nothing to protect us.  It would just give us an 
opportunity to err in making a different distinction. 
D. 
Group versus Individualized Determinations 
¶44 Finally, Mr. J. believes we need to emphasize that the 
Helen E.F. framework inquires into whether the specific patient 
at issue has rehabilitative potential.  That is to say, he wants 
to ensure we are not developing a taxonomy of ailments, one 
branch of which comprises conditions that have rehabilitative 
potential, while the other branch contains those that do not.  
He again finds expression of his concern in the Helen E.F. 
concurring opinion: 
A tension exists in the texts of the statutes 
[Chapters 51 and 55] (and the application of the 
statutes) between on the one hand lumping together all 
people with a certain condition and on the other hand 
considering 
the 
symptoms 
and 
conduct 
of 
the 
individual.  The tension between the more rigid 
categories of people with a certain condition and the 
No. 
2016AP46-FT   
 
24 
 
more flexible behavioral standards is palpable in the 
majority opinion.  Does this opinion govern all 
Alzheimer's patients or only Helen E.F.? 
340 Wis. 2d 500, ¶47 (Abrahamson, J., concurring). 
¶45 We can see the genesis of Mr. J.'s concern.  In Helen 
E.F. 
we 
described 
Alzheimer's 
Disease 
as 
"incurable 
and 
untreatable; the only available medical remedy is maintenance——
not treatment——of the disease as it progresses."  Id., ¶37.  
This is a categorical statement and strongly suggests that, 
because of the nature of Alzheimer's Disease and the state of 
medical science, no one suffering from that condition has 
rehabilitative potential.  While that may be true as a medical 
matter (emphasis on "may"), it does not mean that our Helen E.F. 
framework countenances the automatic relegation of such patients 
to the non-rehabilitative category. 
¶46 Our analysis explicitly requires an inquiry into each 
individual's condition and potential for rehabilitation.  It is, 
in fact, shot through with references to the individual: 
If treatment will maximize the individual functioning 
and maintenance of the subject, but not help in 
controlling or improving their disorder, then the 
subject 
individual 
does 
not 
have 
rehabilitative 
potential, and is not a proper subject for treatment.  
However, if treatment will go beyond controlling 
activity and will go to controlling the disorder and 
its 
symptoms, 
then 
the 
subject 
individual 
has 
rehabilitative potential, and is a proper subject for 
treatment. 
Id., ¶36 (emphasis added; internal alterations and quotations 
omitted).  There is always hope that seemingly intractable 
conditions 
like 
Alzheimer's 
Disease 
may 
someday 
become 
tractable. 
 
Our 
standard 
for 
determining 
rehabilitative 
No. 
2016AP46-FT   
 
25 
 
potential does not foreclose that possibility.  We evaluate each 
individual individually. 
E. 
Clear and Convincing Evidence 
¶47 Mr. J. says the County did not establish he is a 
proper subject of treatment under either the Helen E.F. rubric 
or his proposed revision.  His objection is largely that his 
disorder is not continuing to improve.  He acknowledges he is 
not 
getting 
worse 
but 
asserts 
that 
unless 
treatment 
is 
continually 
improving 
his 
condition, 
he 
does 
not 
have 
rehabilitative potential.  He does not say why this should be 
so, and no supporting rationale immediately suggests itself. 
¶48 As we discussed at length, supra, Mr. J.'s treatment 
is achieving laudable results.  Currently, he can integrate in 
society while receiving his treatment as an outpatient.  Without 
treatment, his condition will deteriorate to the point that an 
involuntary commitment order will subject him to confinement so 
he can receive treatment as an inpatient.  If we adopted Mr. 
J.'s argument, we would condemn him to a never-ending yo-yo of 
uncontrolled paranoid schizophrenia, followed by involuntary 
confinement for inpatient treatment until his symptoms are 
controlled and his inpatient commitment order is lifted, 
followed by another bout of uncontrolled paranoid schizophrenia, 
and on and on ad mortem.  Nothing in law or logic instructs us 
No. 
2016AP46-FT   
 
26 
 
to ignore this reality, so we will not.16  The County provided 
clear and convincing evidence that treatment controls Mr. J.'s 
symptoms to such an extent that he can integrate into society 
without posing a threat to himself or others and that withdrawal 
of treatment would eventually require his confinement so he 
could receive inpatient treatment.  Consequently, the evidence 
is sufficient to demonstrate Mr. J. is a proper subject of 
treatment within the meaning of Wis. Stat. § 51.20(1). 
V. 
CONCLUSION 
¶49 Mr. J. did not challenge the circuit court's factual 
findings, and both the circuit court and the court of appeals 
properly applied Helen E.F. to conclude Mr. J. is a proper 
subject of treatment because he has rehabilitative potential.  
Consequently, we affirm the court of appeals. 
By the Court.—The decision of the court of appeals is 
affirmed. 
                                                 
16 Mr. J. also asserted he should not be subject to an 
involuntary commitment order because Chapter 51 is meant to be 
used for "short term treatment and rehabilitation intended to 
culminate with re-integration of the committed individual into 
society," and he has already been subject to such orders 
continuously since 2009.  Presumably, Mr. J. meant this 
observation to support his bid to be free of Waukesha County's 
orders.  However, this might instead suggest he would be a 
candidate for involuntary, long-term protective placement under 
Wis. Stat. ch. 55.  But because he did not develop this argument 
and no one has briefed how chapters 51 and 55 complement (or 
don't complement) each other, we will not consider it here.  See 
Clean Wisconsin, Inc. v. Pub. Serv. Comm'n of Wis., 2005 WI 93, 
¶180 n.40, 282 Wis. 2d 250, 700 N.W.2d 768 ("We will not address 
undeveloped arguments."). 
No.  2016AP46-FT.ssa 
 
1 
 
 
¶50 SHIRLEY S. ABRAHAMSON, J.   I renew my concern that 
the Helen E.F. case set forth a confusing and unpredictable test 
to interpret a "proper subject for treatment" under Chapter 51.  
Fond du Lac County v. Helen E.F., 2012 WI 50, 340 Wis. 2d 500, 
814 N.W.2d 179.  The instant opinion continues and possibly 
magnifies the problem. 
¶51 In Helen E.F., this court analyzed and compared 
Chapters 51 and 55 of the Wisconsin Statutes.  Despite the fact 
that Chapters 51 and 55 ostensibly serve different purposes, 
there is substantial overlap and similarity between some aspects 
of the two chapters.  Helen E.F., 340 Wis. 2d 500, ¶45 
(Abrahamson, C.J., concurring).       
¶52 But one important and undisputed distinction between 
Chapters 51 and 55 is the length of the treatment or commitment 
that each chapter provides.  Mr. J. has been under Chapter 51 
for almost a decade.  Although an initial Chapter 51 commitment 
cannot exceed six months and extensions are possible, Wis. Stat. 
§ 51.20(13)(g), Chapter 55 applies to a commitment caused by "a 
disability that is permanent or likely to be permanent." 
§ 55.08(1)(d).  See Helen E.F., 340 Wis. 2d 500, ¶¶29, 44.  The 
majority opinion, ¶48 n.16, slides over this issue. 
¶53 This distinction matters.  Although both provide for 
involuntary commitments, Chapter 55 contains numerous additional 
No.  2016AP46-FT.ssa 
 
2 
 
procedures and protections for an individual subject to a long-
term commitment that Chapter 51 simply doesn't.1   
¶54 Because the court is faced with interpreting and 
applying Chapter 51 to Mr. J., I briefly restate my concerns 
with the Helen E.F. test.   
¶55 Although I agree with the majority opinion that Mr. 
J.'s suggested revisions of the Helen E.F. test are unavailing, 
I remain concerned that the Helen E.F. tests is also unavailing.   
¶56 "Rehabilitation" appears to be the linchpin of this 
statutory definition.  See Milwaukee Cty. Combined Cmty. Servs. 
                                                 
1 See also Wisconsin Coalition for Advocacy, Rights & 
Reality II, An Action Guide to the Rights of People with 
Disabilities in Wisconsin 342 (2001): 
In 
general, 
Chapter 
55 
is 
used 
for 
long-term  
placement or services while Chapter 51 is used for 
more time-limited treatment. 
. . . . 
This is a helpful way to separate the two statutes, 
but there will be many situations where they overlap.  
For example, a person with a permanent disability like 
mental retardation would ordinarily receive services 
under Chapter 55, but could also have a mental health 
crisis which would be handled under Chapter 51 with 
either voluntary or involuntary treatment.  Persons 
with chronic mental illness who are incompetent and 
have a guardian can probably be served under either 
Chapter 51 or 55.  Some younger persons with severe 
mental health needs who live in group homes or in 
their own apartments with intensive services such as 
Community Support Programs (CSP) may be under Chapter 
55 orders.  Others in exactly the same situation are 
under Chapter 51 commitments which are renewed year 
after year.  This varies by county.   
No.  2016AP46-FT.ssa 
 
3 
 
Bd. v. Athans, 107 Wis. 2d 331, 334-36, 320 N.W.2d 30 (Ct. App. 
1982).   
¶57 The 
line 
between 
controlling 
activity 
versus 
controlling the symptoms and the disorder——that is, whether an 
individual is habilitable or rehabilitable——is not any brighter 
or clearer to me in the instant opinion than in Helen E.F..   
¶58 Unfortunately, the court maintains the confusing test 
it adopted in Helen E.F., failing to differentiate Chapter 51 
commitments from Chapter 55 commitments. 
¶59 I renew my suggestion that "it may be time for the 
legislature to reassess the goals and intended scope of the two 
chapters."  Helen E.F., 2012 WI 50, ¶56 (Abrahamson, C.J., 
concurring) (citing Wis. Stat. §§ 13.83(1)(c), 13.92(2)(j)). 
¶60 For these reasons, I write separately. 
¶61 I am authorized to state that Justice ANN WALSH 
BRADLEY joins this opinion. 
 
 
No.  2016AP46-FT.ssa 
 
 
 
1