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.
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