Eyewitness to the Ruination of a Public Mental Health System

Dr. Michael Cornwall

March 4, 2012

This blog entry is another chapter in the story of my personal odyssey as a radical therapist and human rights activist with lived experience of madness that I have been sharing on the Mad in America site. I hope it provides a meaningful look at a piece of our reform movement’s history from a ground-level perspective.
Here is my story as a witness from 1980-2007 of the destruction of a large California urban public mental health system by the relentless efforts of bio-psychiatry and big pharma that was supported by NAMI. The joint effort was meant to eliminate psychotherapy and replace it with medication and case management in both the adult and child and adolescent divisions of the county system where I worked full time as a front line licensed psychotherapist.
The ruination of the mental health system at the hands of the powerful alliance I described above was probably more painful for me to witness because I started there in 1980 on a free-standing, unlocked, 20-bed unit where no medications at all were used, no restraints were used, and no diagnoses utilized for early episode young adults who were going through their first madness experience!
Hundreds of young people were diverted in the 8 years of I-Ward’s existence from being stuck in the system for probably the rest of their lives, because their madness processes were allowed to run their course, without their transformative developmental process being aborted by meds. They were supported through it all instead in a loving, empathy filled setting.
It was a sanctuary really.
But all the Bay Area sanctuaries were shut down under the dictates of mental health policy makers and politicians who were intimidated by the ever growing power of bio-psychiatry. Many activists who worked in the county, like my ally Jay Mahler and myself, knew that the push for a direct service, Medicaid/Medi-cal funded monopoly of DSM-defined psychiatric ‘best practices’ was a dream of the psychiatrists in the system, and we knew that dream was being bankrolled by the drug companies.
We knew it was made possible through their brilliant strategy of cynically and tragically using the wounded family members of NAMI as the human face of mental illness to push their agenda.
From the level of local mental health advisory boards to the legislative hearings where laws were passed that locked in bio-psychiatry’s domination, NAMI family members carried their powerful stories of personal heartbreak and accounts of suicides by their loved ones in a compelling message. The message was presented by NAMI and received by decision makers as proof of the reality of the brain disease medical model, and the need for more psychiatrists to manage medications and the accompanying discontinuation of therapy as a primary intervention for madness and depression.
Unfortunately, much of the NAMI testimony was in fact cynically pre-packaged for them. It was and still is mostly bio-psychiatry and big pharma propaganda in my opinion.
I-ward where I worked was one of three SF Bay med-free, first-episode madness system diversion programs that fell victim to the mounting political power of bio-psychiatry.
Like I-Ward, Loren Mosher’s Soteria House and John Weir Perry’s Diabasis House (which I did my doctoral follow-up study on), also were designed to let young mad folks go through their process without meds based on the efficacy results of the NIMH funded, Agnews Project State Hospital study. That gold standard research project, whose results were hugely suppressed by bio-psychiatry, demonstrated, during a three-year followup, a 75% lower re-hospitalization rate for the group of first episode mad young men who got placebo, versus the young men who got Thorazine.
When I-Ward closed I was transferred to an adult clinic as a therapist for about 3 years until the bio-psychiatry, big pharma agenda made possible by NAMI testimony got the statewide Bronzon legislation passed. That law said that so-called severely and persistently mentally ill adults should be given priority for the allocation of adult services that are funded by the state and federal government.
It was supported by bio-psychiatry claims based on their incurable brain disease model that asserted that consumers were best served to be maintained by medication and case management. The law didn’t say therapy had to be eliminated, but the statewide cowardly mental health director’s association saw the handwriting on the wall and decided to announce the wisdom of eliminating therapy ASAP to placate NAMI, and the growing power of Psychiatry in every county system.
When I heard our mental director and his chief psychiatrist announce plans to eliminate therapists and create a medication and case management based system, I knew that several high-risk, suicidal, depressed clients I saw who didn’t have extensive hospitalizations, which was what defined chronicity under the new regime, were going to be left in the lurch and might perish without therapy. Such clients were even characterized as being ‘worried well’ by mental health administrators in a shameful  attempt to justify denying them services.
I guess that is when I remembered the charge I was given at 18 years of age as a new medic in the Army, when a Medical Corps training Officer put the fear of God in me by grilling me: “Private Cornwall, are you fully aware of your responsibility? If your unit goes into combat you, and only you are responsible for the wounded coming home with all their arms and legs and eyes and not in a body bag! Do you understand me soldier!”
“Yes sir,”  I automatically croaked.  But in my guts I understood. I got it.
So, after I heard our mental health director backed by his chief psychiatrist announced their plans to eliminate therapy for the at-risk clients which I served, and to do so in only three months, I wrote and circulated among the 300 county mental health staff a vote of no-confidence petition in our chief psychiatrists and our ambitious director.  The director made sure I got a personal message from him via one of my friends: “Tell Cornwall he is working to lose his job.”
But I didn’t care about that because it was either him going or my clients possibly dying. So I went to the local press with the petition for his removal signed by such a large number of  professional staff that it was big enough news they had to report it.
The local paper carried the front page story of our embattled mental health director which was picked up by the top monthly statewide political journal in Sacramento, and soon he resigned after the plan to cut therapists was officially stopped by the county administrator in a meeting where I testified..
It took 18 months before the political backlash against me and the staff who were tying to preserve therapy was effectively mobilized by the surviving chief psychiatrist under a new director. Then, they finally got rid of therapy in adult services in my county while all the other counties had done it more quickly after the Bronzon legislation passed.
I’d like to think there are some folks above ground because of what we did to save therapy for those 18 months..
The chief psychiatrist made sure we had a moment alone in the hallway after the county board of supervisors voted to pass his plan to eliminate therapists from adult services. He smiled patronizingly as he told me his obviously rehearsed message: “Michael this is really a banner day for me. You must know that as far as I am concerned the last of you therapists to leave the county can turn off the lights on your way out.”
I just laughed and said, “Well Joe, we will see who has the last laugh amigo!”
Of course all of this awful statewide destruction of vitally needed therapy was hugely supported and was happening against the backdrop of the new generation antipsychotics which were being touted by Joe and other psychiatrists across the state as the miracle drugs that proved the brain disease model that the Bronzon legislation had memorialized.
So I got reclassified to be a case manager, but I made sure that every consumer I saw also received therapy from me once the door was closed and we were alone in my office!
During these years as a case manager, I was able to remove a heavy-handed, consumer unfriendly mental health director and blocked her chosen replacement from getting the job by using my role as president of the white collar union mental health workers unit that I was elected as president of for 16 years..
I did an unprecedented manager-performance evaluation on the director and her top managers by union line staff that came back so damning, that the night before I was going to go to the press with it, the big boss of the whole county health services made a deal with me in the hospital parking lot. He told me to “keep your powder dry,” meaning that the current director was leaving because she didn’t want the public disgrace. When I then demanded her equally unacceptable, groomed successor must not get the job either or I would go to the press, the big boss swore loudly but agreed.
I’m sharing all this detail about these grassroots political power struggles because I never felt it was enough to just give from my heart to the consumers we serve, to only act as a therapist.
Policy and destructive practices and real people who do harm to consumers through their wrong actions as administrators and as dogmatically true believers in the medical model must be opposed too. I hope hearing ways to effectively do that inspires others to risk their jobs for the sake of the consumers they serve.
Then, during a fake budget cut move, even more licensed case management staff were rotated from adult services, and so I spent over the next 12 years as a therapist for families, teens and children.
It was during this era that I witnessed the awful progression of less then 10 percent of the hundreds of young folks in the county system being on meds for non-existent ADHD, to the now 90% of teens and kids on multiple meds, almost all with Abilify, or Risperdal prescribed, no matter what their diagnosis.
I also saw the rise from zero kids being diagnosed bi-polar, to the unbelievably huge numbers of kids and teens who started to get diagnosed with bi-polar thanks to big pharma and guys like Dr. Biederman who I believe should be doing hard time in an orange jumpsuit somewhere!
I never have and never will diagnose a child or teen with ADHD or bipolar.
I was there in the late 80′s before Biederman did his more recent dark deeds, when another chief psychiatrist convened an all staff training to announce that the new SSRI’s have proven the chemical imbalance theory of depression.
He said that since Prozac is an SSRI, and it helps dramatically with depression, then of course that proves that the cause of depression is a lack of serotonin in the brain,  and that therapy should now play a minor role since medication is so clearly able to address the underlying cause of depression.
I challenged his statement and he pointed to his diagrams of brain cells and replied that science is saying that depression is best treated at the synaptic level.
I was there at another training when it was announced that the days of folks getting addicted to Valium were over because a totally non-addictive replacement, Xanax, had been developed that was completely safe to use to treat anxiety and panic disorders.
How did that turn out?
I was there when foster child after foster child was drugged into oblivion.
I was in the room with a co-worker psychiatrist, when with his back to the mother and her delusional 17 year old young son I was seeing in therapy,  announced without looking up from typing his chart notes, “Your son has schizophrenia and will need to be on medications for the rest of his life in my opinion. It is similar to having diabetes, a disease that must be managed by medication long term and probably forever.”
The young man started to rock slowly back and forth softly repeating, “Forever, forever, forever, forever…”
I spoke up and said to him:  ”Well, I don’t believe that to be true. I have worked with a lot of young men like you in the past 25 years and I believe you can get through what you need to and not need medications.”
Of course that earned me a look of anger from the MD, but we had bumped heads before and he didn’t want to go there with me again, so he didn’t say anything more.
And finally I was there when a mother and father brought in their 6 year old, 40 lb daughter who was so over-medicated she was slurring her words and could hardly keep her eyes open. They had been referred to me for therapy from a clinic psychiatrist who was starting to get uneasy about diagnosing little girls and boys like this with bipolar and only having them on meds.
So I gladly told the parents that I would report the obvious over medication to the psychiatrist at once, and that I was confident that with family and individual therapy, their daughter would be able to taper off and be off medication as we resolved the issues that were causing her tantrums and crying spells.
The parents knowingly looked at each other, and the mother spoke and said,  ”Thank you doctor Cornwall, but we believe there really aren’t any issues in our family that need addressing. She has bipolar disease like the doctor told us, and we really don’t know why we were sent here to see you. She is so much better now, no tantrums and she sleeps through the night. Thank you but we will stick with the medications.’
They got up and left the office, the little girl shuffling along silently behind them.
I wanted to weep and put my fist through the wall at the same time.
And then it wasn’t long after that that it was announced that many therapists were to be cut from children services. “So at last,” I said to myself, “they have come for the children.”
As the long time leader of both the therapist union and chairperson of the county mental health coalition which included all the diverse mental health stakeholder groups —  NAMI, Consumers, the mandated Mental Health Advisory Board, the local Mental Health Association, non-profit Contractors Alliance, and county mental health union staff — I stood with that assembled group behind me as their spokesperson in the crowded board of supervisor chambers as the vote on cutting children therapists was about to be taken.
I spoke to the 6 supervisors who I had known for many years. None of them could look at me.
I said, “What we are here to tell you with one unwavering voice is that if you take these therapists away from serving these high risk children and teens in need, that those children and teens will surely suffer and some of them who are suicidal may die. What would be worse, that you don’t believe us, your long time advisers on mental health care, and you vote for these young ones to suffer and maybe some to die, or that you do believe us and still vote for them to suffer and some maybe to die? Either way, if you vote for them to suffer and some to maybe die, you will have lost your moral authority to govern.”
They voted unanimously for the children to suffer and for some maybe to die.
This post first appeared in January 2012 in the newsletter of Dr. Peter and Ginger Breggin’s Center for the Study of Empathic Therapy, Education and Living where I serve on the advisory council.
Dr. Michael Cornwall

An Alternative Understanding of The Nature of Madness: I want this blog and the discussion it generates to help deepen our understanding of the mystery of madness and to help us learn ways to lovingly do self care when we are mad, and how to lovingly respond to others when they are mad.

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30 thoughts on “Eyewitness to the Ruination of a Public Mental Health System

  1. Dr. Michael narrative of history reminded me that even during the destruction and wedding of MH to PHARMA, there were passionate and wise souls who argued, manipulated, played politics and endangered their own survival for the health and well being of people who were not healthy enough to do so for themselves at the time. The point that gives me hope and fury at the same time, is Dr. Michael was waging a battle to give those individuals the very chance to be able to stand up and battle for themselves in the midst of the madness of the medical/mental health system in America.

    Even when you leave the services side of this system and move to the outside advocacy side of the problem, the denigration of health and trust continues, as PHARAM owns the funding and growing oversight of advocacy in America today as well as the creation of diagnoses.

        • I think it is also about the huge drug companies using their influence to change policy. As it is the poor and children who are mainly drugged it is a case of the rich pacifying the distressed poor and powerless so as to make profit and mainstream psychiatry is merely the way the drugs are delivered.

          • Thank you again John. I agree that the class issues you raise and the shadow effects of capitalism that prompted pharma to be the largest industry in the US has produced our current crisis where probably the majority of psych drugs are now given by GP’s and pediatricians to people in poverty. This dynamic of entrenched oppression of the economically disadvantaged must be front and center as a human rights issue.

          • I think seeing it as a political issue, where the poor and powerless and oppressed are drugged to benefit multinational drug companies, who suppress the evidence that social support, in all it’s variety, are better, more effective and often cheaper than dangerous medication, may help us find our allies in this struggle.

            In London I talked to someone from the London Poverty Action Group about these issues and they understood the problem straight away. Members of the UK Critical Psychiatry spoke at Occupy London after being invited by the Welfare area, who wanted to politicise their work. I have found what are now called, “Activists,” to be very understanding of this struggle as they see the link to multi-nationals making money at the expense of the people and of greater truths being common to other struggles.

            A friend in London says she is sick of going to mental health conferences where middle class service users talk about collaborative relationships with their psychiatrists because from her perspective it is the poor and ethnic minorities who are forced, under Community Treatment Orders, to have depot injections of major tranquillisers. So there is no collaborative relationship and not a lot of choice for the poor and oppressed, no matter what their opinions of the drugs.

            This is a huge power battle where the drug companies have huge resources to mount successful PR and advertising campaigns. We need allies to have a serious impact on this problem.

          • Thank you again John for your comment below from the UK about the need for gaining allies beyond the consumer/survivor, recovery movement in this international political and human rights struggle. As I noted in my blog here above, organized labor can be a huge ally because of their social justice agendas that address class/economic disparities and discrimination. Some progressive faith communities here in the SF bay area are also very strong natural allies. The Occupy movement as you say is also really taking on the radical mental health care revolution as a cause. The LBGT community is also a very strong natural ally.

  2. I was not aware of this piece of the puzzle, the Bronze legislation that “so-called severely and persistently mentally ill adults should be given priority for the allocation of adult services that are funded by the state and federal government.”

    If you build it, they will come.

    I can see that this legislation enabled families to push to get their relative labelled “severely and persistently mentally ill” in order to get priority services. This is very similar to what accounts for the huge increase in the autism diagnosis. See LA Times “Unraveling an Epidemic.” http://www.latimes.com/news/local/autism/la-me-autism-day-one-html,0,1218038.htmlstory.

    “Of all the advice Laurie Bailey received when she began seeing signs of autism in her son, Benjamin, now 8, one piece proved the most valuable. “If you embrace that word” — autism — “you will get far more services,” a friend told her.”

    Parents are very competitive, especially well-off suburban parents. When your child is enrolled in the public school system, you very quickly observe who has what and who gets what. You talk to other parents and learn how to act to get your child labelled, as the L.A. Times article points out. Unlike the autism diagnosis, for the “bipolar” and “schizophrenia” labels, jurisdictions will only pay for medications.

    Before people push the chronic mental illness label on their adult relative, they should stop and examine what impact this will have on the person’s ability to ever get well.

    • I see this suburban-kid diagnosis stuff at the college level. I have a larger proportion of students who need special services in my current job at a mostly white and wealthy college than I saw in a large university. Gee– I wonder what’s going on there?!

  3. Thank you Rossa for your very insightful comment and link to the autism article. Yes, if you build it they will come. The SPMI designation and the autism spectrum catagory and the hyped up child bi-polar diagnosis have all proven to be magnets that have drawn more people into the system and onto meds. This is the main premise I believe of Whitaker’s Anatomy of an Epidemic. More people are becoming disabled then ever before.

  4. Thank your for this. I was a “client” in an out-patient county clinic for 2 years. I, and just about ALL the other patients I knew were on Seroquel– regardless of our diagnoses. Now, with private services I’m off Seroquel (although I’m ready to be off my SSRI as well). I don’t necessarily feel a lot better– but I’m happier taking trazadone to help with my night-time sleeplessness and anxiety.

    While under the county’s care, I was sickened by the number of pharma reps (I called them drug dealers) that visited the clinic at all times. I understand that county clinics need to rely on free samples– but I felt like there was at least one “drug dealer” on the premises each week. It made me think that I was simply a cog in the machine and I began to resent my treatment. My treatment also included CBT, however, showing that there was some intent to provide non-med treatments.

    What people don’t understand is that having a mental illness is not just about the “brain chemicals” and while some medications can help– they are not necessarily a cure for everyone. Clients need to re-learn the skills that they “missed out on” because of their illnesses. In many cases, even if a person is on meds– they still need social support from a trained therapist.

    • A community worker near me used to work in health care and she said all her staff got taken out to lunch by drug company reps. They flew in, by helicopter, a Dr who was saying how wonderful nicotine replacement therapy is. No expense spared.

      Now it turns out that nicotine replacement therapy is not very effective at all and may even make giving up harder for at least some people.

      So the drug reps have access to health care workers at all levels of the system to push their products which have been tested by the industry using biased tests and written up to show them favourably.

      Understanding how the drug companies achieve the domination of psychiatry and therefore the bias in how psychiatry is delivered is an important part of this struggle.

      • You are so right John! In addition to all the public media news about this practice of drug reps promoting un-needed and harmful psych drugs- every physician prescribing them should be legally required to have a posted list in their waiting room of every drug company rep visit and what drugs they were promoting.

  5. Thank you Jen for both your valuable comments. They add to the much needed eyewitness information about how the incredibly successful business plan of the drug industry and the medical model of psychiatry that supports that plan become operationalized.

  6. It is great that someone opposed biopsychiatry. However, I think that all forms of mental “health care” are more about controlling people. I think that “mental illness” labels are often more about pathologizing non-conformity. However, I would say that the biopsychiatrists who have often received money from drug companies are pretty corrupt and it is good that at least someone is standing up to them.

    • Thank you Laura for your comment. I agree that psychiatry’s DSM is a tool of labelling and pathologizing human emotional suffering and madness. The people I serve as a therapist are never seen through that de-humanizing lens. You might enjoy reading my blog on remembering a medication free sanctuary where no labels were given. Loving compassion was what we offered instead.

  7. Dr. Cornwall,

    I really enjoyed reading your post. Thank you for sharing your important insights.

    The use of social networking through blogging and microblogging (Facebook and Twitter) is becoming an important tool for human rights activists.

    The “Minds on the Edge” project is part of a national initiative that is being supplemented by extensive web-based content with tools for civic engagement, along with active social media on Facebook and Twitter. The creators of the project and the project coordinators have developed an ambitious strategy to engage citizens, professionals in many fields, and policy makers at all levels of government.

    The goal of the project to is to “advance consensus about how to improve the kinds of support and treatment available for people with mental illness.”

    “Prominent promotional placement on nami.org played a significant role in driving traffic to the MINDS website.”

    The project is really a wonderful opportunity for all mental health advocates to engage and collaborate outside traditional organizational boundaries.

    I would encourage anyone who is on Facebook to join the conversation on the Minds on the Edge Fan page. I think it is especially important for those who may have drastically different experiences than the typical NAMI member to share their thougths and experiences to help advance a consensus that will include everyone’s voice.

    As a radical therapist, I hope you will consider submitting a comment to the creators of the Minds on the Edge project.

    http://www.mindsontheedge.org/about/program/

    http://www.mindsontheedge.org/contact/

  8. Thank you Maria for your comment. The minds on the edge project equates human emotional suffering and madness with physical diseases such as cancer. I hope you refer them to my blogs if they wish to understand why I oppose that paradigm.

    • Here in the UK we have an anti-stigma campaign, Time To Talk, with a slogan, Mental Illness, an illness like any other.

      I like the fact that they have lots of money and are trying their best to counter stigma but that slogan is creepy.

      An illness like any other just does not do justice to my friends with mental health diagnosis who have suffered child hood sexual assault, family violence, poverty, racism, homophobia and twisted relationships. If you want people to understand severe mental distress you have to understand the social and psychological causes of it.

      I believe there is epidemiological evidence which says that equating mental illnesses to physical illnesses does not decrease stigma or increase understanding (I can’t quote the evidence but that I what I understand Richard Bentall to have said at a lecture he gave, and he is a master of these sort of statistics. I tend to trust him).

  9. It appears from the context of this fragment that Jesus is the “truth sprouting from the earth”, whereas the spirit that resembled him is “justice looking down from heaven.” The text says: “Truth is the power which issued from thee when thou wast in the lower regions of chaos. For this cause thy power hath said through David, ‘Truth hath sprouted out of the earth’, because thou wert in the lower regions of chaos.” Jesus, accordingly, is conceived as a double personality, part of which rises up from the chaos or hyle, while the other part descends from heaven. [Collected Works vol 9ii, par132].

    What I would like to highlight here for interested readers is the Fact that from all the chaos, “madness” and disarray and disorder –

    GREAT and terrific sense can and will be born.!

    The answers (answerers) and solutions are ALREADY AMONG YOU.

    :)

  10. That was inspiring to read your article and the passion that you have brought to your work and standing up and demanding better services. It broke my heart reading about the 6 year old I don’t know that I could have held back on the parents.

    I just read DJ Jaffes most recent article on his feelings of the failures of prop 63. It is sad to see that there are still a large amount of people out there that don’t see value of early intervention and prevention. The article basically says that prop 63 is failing the “severly mentally ill” in that it proivdes for to much money to early intervention where that money should go to people that are already experiencing serious impairment. He also feels that the system should implement Laura’s Law forcing some people into treatment. (There are some other points in the article, some I have slight agreement with).

    • Thank you Paul. The mindset that Jaffe represents that would deny prevention help for children, teens and adults is very much tied to the fatalitic vision of human emotional suffering and madness as a disease that society should manage and control,not prevent and alleviate.

  11. On Feb.23 I lost my son to suicide after a 32 year diagnosis of Schizophrenia. Cynical psychiatrists,case managers, & pharma- mis-treatment murdered him. True,pharma-dominated psychiatry is manifestation and accessory to Capitalism. This rape of humanity and it’s environment empowered by wealth of the exploiters and their parasites, clings to it’s existence
    at the expense of the most vulnerable.

    The Capitalist edifice is a shaky building but it will not fall until we remove the brick called corruption that holds up that building. Yet, the seeds of it’s destruction are all around us. Honor my son’s life and all the other “disressed” suicide victims who were denied the benefit of beneficial psychotherapy. Become involved and participate in the birth of a healing anti dis-ease social system based on the Way of the Heart, dominated by compassion and empathy.

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