Constanze Wilkes explores the question of under what legal and diagnostic conditions the right to self-determination of mentally ill adults is restricted in the general psychiatric context and how the parties involved deal with this in practice. The legal foundations of involuntary guardianships, admissions, treatments, and restraints are discussed with reference to the Civil Code and the Mental Health Act of North Rhine-Westphalia. Additionally, qualitative research is presented, which investigates the subjective perspectives of five professionals, one affected individual, and a representative of the anti-psychiatry movement.