More On the “Civil War” Between Mental Health Advocates

“A house divided against itself cannot stand.” I believe this government cannot endure, permanently half slave and half free. It will become all one thing or all the other. Either the opponents of slavery, will arrest the further spread of it, and place it where the public mind shall rest in the belief that it is in the course of ultimate extinction; or its advocates will push it forward, till it shall become alike lawful in all the States, old as well as new — North as well as South.

Of course, it was Lincoln — not Clay — who became President and abolished slavery.

Today we are offered a Great Compromise that would free a million people from prison so long as the institutional-industrial complex does not lose them altogether. Allen Frances sincerely believes that all sides — except a few extremists — will join together to support this compromise. History suggests he may be mistaken. An alternative view is that the institutional-industrial complex is a great leviathan capable of taking many forms. It faces the loss of billions of dollars in revenue as the so-called War on Drugs is declared a failure, but it will not give up so easily.

Rep Murphy’s call to increase short-term psychiatric beds and replace the outdated state hospital beds with modern technology — to enforce court-ordered psychiatric compliance — may gain far wider acceptance than Allen Frances believes. With modern psychopharmacological restraints, ankle bracelets with GPS tracking, and plenty of new surveillance technology, it’s a brave new world. With about $30,000 a year per person to invest in latest and greatest surveillance and restraint technology, there is no need for the old bricks and mortar approach. Murphy’s paper tiger may have teeth after all!

When Murphy, the only psychologist in Congress, introduced legislation on December 12, 2013 that would institute what he euphemistically calls “Assisted Outpatient Treatment,” many of us expressed alarm. The bill was introduced two days before the one year anniversary of the shooting of 20 school children in Newtown, Connecticut and it was apparent that all efforts to pass gun control legislation had failed. Murphy’s bill shifted the conversation away from guns toward mental illness. It offered a solution that Murphy hoped would be attractive to many Americans: increase the number of acute short-term psychiatric beds funded by Medicaid and instead of sending patients to long-term state hospitals refer them to court-ordered outpatient psychiatry.

Murphy’s bill had another troubling component: a frontal attack on the Federal Substance Abuse and Mental Health Services Administration (SAMHSA). In the Dec 12, 2014 press release announcing his legislation, Murphy attacked: “Unauthorized in the last decade, the Substance Abuse and Mental Health Services Administration has lacked mission focus. Grant programs are not evidence-based or guided by the best available medical science.” Murphy’s goal was to discredit SAMHSA’s recovery-oriented approach and defund programs with a recovery focus because he believes there is no evidence that recovery is real. Instead of believing in the evidence the so many of us in the recovery movement offer in support of SAMHSA’s ten principles of recovery, Murphy offers his belief — without supporting evidence — that: “Approximately forty percent of individuals with schizophrenia do not recognize they have a mental illness, making it exceedingly difficult for them to follow through on a treatment regimen.”

Murphy hopes that the image of these dangerous people unable to recognize their own illness will shift the nation’s attention away from SAMHSA’s Ten Principles of Recovery:

1. Recovery emerges from hope.
2. Recovery is person-driven.
3. Recovery occurs via many pathways.
4. Recovery is holistic.
5. Recovery is supported by peers and allies.
6. Recovery is supported through relationships and social networks.
7. Recovery is culturally-based and influenced.
8. Recovery is supported by addressing trauma.
9. Recovery involves individual, family and community strengths and responsibility.
10. Recovery is based on respect.

These are the principles that Murphy says are “not evidence-based or guided by the best available medical science.”

I believe Murphy’s advocacy for forced psychiatric compliance and his assault on SAMHSA’s ten principles of recovery — taken together — mark the beginning of what Allen Frances would now like to us to believe is a “longstanding civil war” among various advocacy groups. In his October 20, 2014 Huffington Post blog — following his appearance at the Mad in America Film Festival — Frances claimed: “I have spent a good deal of frustrating time trying to open the minds of extremists at both ends — rarely making much headway”?

Really? We should take a step back to August 28, 2014 — not really so long ago — when Frances teamed up with DJ Jaffe — a true warrior in the battle against SAMHSA — to write a Huffington Post Blog entitled “Hall of Shame.” Frances described Jaffe as “one of a small group of stalwart defenders of the 5 percent who otherwise lack voice and influence.” The 5 percent is a reference to Rep Murphy’s Dec 12, 2014 assertion that “More than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression… Tragically, undertreated mental illness has been linked to homicides, assaults, and suicides.” This not-so-subtle attempt to link his legislation to the anniversary of the Newtown Connecticut shootings gave Rep Murphy the ammunition he would need for his assault on SAMHSA.

Jaffe fills out the details in the August 28, 2014 Huffington Post blog that he wrote with Frances:

Substance Abuse and Mental Health Services Administration: SAMHSA distributes over $400 million in mental health block grants to states and tells them how to spend it. But as Representative Tim Murphy noted, “SAMHSA has not made the treatment of the seriously mentally ill a priority… It’s as if SAMHSA doesn’t believe serious mental illness exists.” SAMHSA encourages states to spend block grants on the highest functioning. It wants to replace the scientific medical model with their internally invented recovery model, and creates it’s own “illnesses” — bullying and trauma being the most recent.

Consumer Groups: The National Coalition for Mental Health Recovery (NCMHR) is the umbrella organization for SAMHSA-funded consumer groups like the National Empowerment Center and National Mental Health Consumers Self Help Clearinghouse. Rather than advocating for the seriously ill, they advocate for anyone with “lived experience.” They believe everyone should self-direct their own care, thereby ignoring those too sick to do so.

SAMSHA and Consumer Groups are not the only targets of Jaffe’s pen. He goes on to attack the American Psychiatric Association, the American Psychological Association, Mental Health Lawyers — such as the Bazelon Law Center, ACLU, the National Disability Rights Network (NDRN) — Mental Health America, the National Council for Community Behavioral Health and what Jaffe calls “Celebrity Centric Advocacy Organizations” such as the Rosalynn Carter Symposium on Mental Health Policy. Apparently these are the extremist groups that Allen Francis has had such a difficult time with — “rarely making much headway” — because it is clear that these are the groups against which Jaffe has declared war.

One surprising and extraordinary addition to Jaffe’s enemies list — his so-called “Hall of Shame” — is the National Alliance on Mental Illness. Jaffe writes:

Historically, NAMI did focus on serious mental illness because it was founded by families of the very seriously ill. In 1993, NAMI argued for parity for people with severe mental illness. In 1995, NAMI endorsed various forms of involuntary treatment when needed. Cut to today. Instead of the 14 million who are most seriously ill, NAMI National now claims to represent 60 million people with any mental health issue. Some brave state and local chapters like NAMI/NYS have refused to follow their lead and they still focus on helping people with serious mental illness

For Jaffe, “helping people with serious mental illness” is equivalent to those “various forms of involuntary treatment” that NAMI once endorsed and now has so scandalously abandoned… except for a small band of true believers.

In the Aug 28, 2014 Allen Frances endorsed this enemies list — “Thanks DJ. A sorry Hall of Shame indeed.” — and then adds an enemy of his own: the National Institute of Mental Health (NIMH). This is another surprise because when Rep Murphy introduced his legislation he singled out the “evidence- based” NIMH for praise, as a clear alternative to the recovery-oriented SAMHSA: “The National Institute of Mental Health measures public health outcomes to develop medical models of care. The NIMH also excels at basic medical research, but lacks the financial resources.” Murphy’s Dec 12, 2014 goal was to take funds from SAMHSA that could be given to NIMH so that it could “undertake additional research projects on serious mental illness and self- or other-directed violence.”

Having established the enemy lines, Allen Frances ends the Aug 28 2014 blog with a battle cry: “DJ Jaffe has provided a jolting ‘j’accuse’ — a much-needed wake up call. The question now is whether those sleeping on their watch are capable of being shamed into action.” I hope that some of you understand — because I certainly don’t — how Frances then transitions to his Oct 20, 2014 blog: “With open-mindedness as a starting point, common ground can usually be found; seemingly divergent abstract opinions are not so divergent when you discuss how to deal with practical problems. And finding common ground has never been more important.”

Apparently Frances is counting on those of us in what he calls the “anti-psychiatry” movement to feel that same disgust toward the mental health establishment that DJ Jaffe feels. He tries to tap into our anger while playing the peacemaker in his Oct 20, 2014 blog:

Mental-health services in the U.S. are a failed mess: underfunded, disorganized, inaccessible, misallocated, dispirited, and driven by commercial interest. The current nonsystem is a shameful disgrace that won’t change unless the various voices who care about the mentally ill can achieve greater harmony.

Rome is burning, and no one seems to be doing much about it. The ivory-tower institutions (like the professional associations and the National Institute of Mental Health) and the more grassroots organizations need to put aside differences and focus common advocacy on two goals that all can share: helping our most disadvantaged regain freedom and dignity, and taming the rampant and careless overuse of medication.

This is a shrewd strategy. Fan the flames of a long simmering conflict; step back and watch the war begin; and then step forward to broker the peace.

The paltry $400 million that Rep Murphy wants to take away from SAMHSA to fund his pet NIMH project — designed to find evidence for the non-existent relationship between mental illness and violence — is just pennies compared to the real money that could be freed up through prison reform. After all, Rep Murphy’s goal is primarily ideological — to scapegoat the “mentally ill” and discredit SAMHSA’s ten principles of recovery — while Allen Frances is much more pragmatic.

When, more than 50 years ago, Tom Szasz began to fight for patient empowerment, freedom, and dignity, the main threat to these was a snake-pit state hospital system that warehoused more than 600,000 patients, usually involuntarily and often inappropriately. That system no longer exists. There are now only about 65,000 psychiatric beds in the entire country, and the problem is finding a way into the hospital, not finding a way out.

In fact, the system that warehoused more than 600,000 of us still exists; it just changed its name. Many of the building that are penal institutions today were once psychiatric institutions. Many new institutions have been built. The names have changed but the institutional-industrial complex remains. Frances acknowledges that at least a million are imprisoned inappropriately, but the injustice is much deeper than that. Those who are targeted are disproportionately African American or Latino, young, poor and male.

The mantra of the Murphy Bills backers is that mental illness does not discriminate; it affects all races, classes and sexes equally. This helps sell their plan as something other than a liberal charity for the underprivileged. However, everything we know about the institutional-industrial complex is that it does discriminate. It targets the most vulnerable. Non-white poor young males make especially easy targets for the War on Drugs. We can expect they will continue to be easy targets in the new War on Mental Illness.

If we who have been psychiatrically labeled refuse to live “half slave and half free;” if we reject Allen Frances’ Great Compromise that would save $400 million in SAMHSA funding in order to procure many billions more for the institutional-industrial complex, what alternatives do we have? Are we bound to accept court-ordered outpatient psychiatry as the price of keeping SAMHSA’s Ten Principles of Recovery off the Congressional chopping block?

One alternative to the institutional-industrial complex is the Transformative Justice Movement. Generation Five — an organization which aims to end childhood sexual abuse in five generations through non-violent intervention — has taken the lead in defining the movement’s goals. In their widely distributed 2007 document “Toward Transformative Justice: A Liberatory Approach to Child Sexual Abuse and other forms of Intimate and Community Violence,” Generation Five explains:

Generation FIVE’s commitment to the prevention of child sexual abuse has always been rooted in the understanding that violence prevention requires us to challenge the very conditions that allow violence to occur. Central to this work was the premise that Transformative Justice must respond to the need to transform the violent conditions and dynamics of our lives—such as racism, colonization, patriarchy, and heterosexism — in order to achieve justice at every level. Ultimately, we will not be successful in mobilizing masses of people to transform current political, economic, and social apparatuses if we do not have a concrete vision for the future. The goal of dismantling oppressive structures is shortsighted, and perhaps impossible, if we are not also prepared to build alternatives. This is not merely a rhetorical failure or a failure of analysis; it is a failure of practice.

Differences in philosophies, goals and priorities often create barriers to cross-sector, cross-movement relationships. There is not enough cohesion in our movements and organizing for personal or political liberation… Yet, even with relationships and willingness, we all face a real lack of options. This lack of options reflects the current economic environment, the erosion of protective factors within communities, the devastation, targeting, and dismantling of communities by the prison-industrial complex and the child welfare system. Without liberatory options, people are forced to rely on State mechanisms in which they have little faith.

Understanding trauma and supporting resilience are critical not only to addressing child sexual abuse and other forms of violence but to increasing our effectiveness as healers, organizers and activists. Our experiences of violence and trauma become barriers to being in and building relationship with each other, and to building community as we build social movement. We use the word “trauma” to describe harmful experiences that persist long after an immediate threat or abusive experience is over. The impact of trauma can live on in the individual, group, or culture for years and even generations. For individuals, trauma is an experience that affects body, mind, emotions, spirit, and our relationships.

Resilience is the ability to holistically (mind, body, spirit and relationship) respond to and renew ourselves during and after trauma. It is the ability to shift ourselves from automatic survival responses – some of which may be useful, some of which may have undesired consequences – to a more calm, connected and cohesive place. For example, the ability to engage in intense conflict may be a survival response that comes out of a history of trauma or violence. This can be very useful for self-protection as well as for challenging those who are abusive, oppressive or acting out of privilege. Such abilities can be put to good use in our activism and organizing.

However, when our ability to contain this response is limited by past traumatic experiences, this response can play out within our organizations, networks, or communities rather than be used strategically in struggles against those or that which is creating the conditions from which we are seeking justice. In contrast, resilience would offer the choice to engage in conflict when necessary and avoid it when it may be destructive to relationships or counterproductive to meeting the goals of our community organizing or activism.

Generation FIVE believes we are all fundamentally resilient and creative beings. We seek to organize and participate in movement-building that supports and builds the resilience of individuals and communities. We seek to help create the resources and practices necessary to transform the harmful behavior that undermines our liberation work and our power.

Many of us have experienced gross injustices that have deepened our commitment to understanding the world as it is and to creating new visions. This trauma can produce incredible forms of creativity and resilience, as well as limitations that keep us from actualizing those possibilities to our fullest potential. In dealing with our own experiences of oppression and violence and how they play out among us, we become increasingly more able to transform the conditions that allow that violence and oppression to occur, and to create the just world we seek and deserve.

The work of Transformative Justice is not simply a task of changing others. Those of us who are engaging in this work, too, will be changed by the kind of deep community- based practice that Transformative Justice requires. Through this deep engagement with expanding circles of community, our visions of change will continue to evolve, as will our ability to apply the work to our organizations and movements more broadly. We will therefore be more able to create spaces that allow us to explore our own collusion with the oppression we fight. It is the combination of accountability and compassion within a Transformative Justice approach that makes this possible.

The Transformative Justice approach begins with creating expanding circles of community, accountability and compassion that allow us to grow our resilience both as individuals and as a non-violent collective movement. Without such healing circles, our opposition to the institutional-industrial complex lacks concrete, practical — and not just ideological — alternatives to Rep Tim Murphy’s Orwellian vision of coerced psychiatric care. The Generation Five document is 78 pages long, but I believe each of us should invest the time needed to digest in this vision of Transformative Justice.

If we want to rant against the oppression of the institutional-industrial complex, we need to back up our beliefs with specific political and personal actions that offer a practical alternative. Allen Frances has offered his practical proposal for a Great Compromise. It offers mental health advocates access to billions of dollars through a new War on Mental Illness that would replace the failed War on Drugs. In fact, this new war has already begun. Standing on the side lines is no longer an option. Rep Tim Murphy already has us in his sights — and he is no paper tiger! If we don’t respond, we will soon enter a brave new world of high tech coercive psychiatry.

So what practical steps can we take to defeat the Murphy Bill and oppose Allen Frances’s Great Compromise? Mia Mingus recently received the Champion on Change award from the White House. She works for the Bay Area Transformative Justice Collaborative (batjc.wordpress.com) and identifies as a “queer physically disabled woman of color transracial/transnational adoptee.” On May 27, 2013, Mingus was interviewed by Oakland Local, a publication of the Center for Media Change. Here is a portion of that interview:

Oakland Local: It seems like there are a lot of questions — like what does community mean, where does community begin and end? What about the individual causes of why someone might harm another person or perpetuate violence, not just within a community or society that allows it to happen, but also what happened in an individual’s own history?

Mia Mingus: Yeah, definitely. I feel that transformative justice is about connecting those two things, that it’s not about excusing violence at all, but connecting individual responsibility and accountability with communal responsibility. We all contribute to the culture that we live in. We all help to perpetuate a rape culture — according to estimated statistics, 1 in 4 girls and 1 in 6 boys will be survivors of child sexual abuse. So it’s not about just finding a couple of “bad eggs” and locking them up, because given the prevalence of child sexual abuse — not to mention battery, domestic violence, rape, assault — given the rates, we would be locking up most people, our sisters, our brothers, our uncles, our grandfathers, it would be so many people from our communities.

Oakland Local: It sounds like you’re literally building a movement from the ground up, in terms of language and framework and the basic ways we interact with each other.

Mia Mingus: Exactly. We’re not going to end violence with a campaign or even necessarily in our lifetimes, so how can we take the chunk of work that we have to do in our lifetimes and do it well enough that we can pass it on to other people? One of the things I’ve learned really deeply in the time I’ve spent organizing is that we need both systemic policy change and broader institutional change like abolishing prisons, AND we need to be able to respond to violence in our own communities. Even if prisons were abolished tomorrow, we still need some way of confronting violence or harm when it happens. And I think we can all agree that prisons were not set up for rehabilitation. The work of resisting existing systems has to be coupled with the work to build alternatives. Some of the most powerful work I see is the work that’s connecting those two together.

What I’ve been most inspired by is seeing people create what they need from what they have — people who aren’t in formal movements or involved in nonprofits, who are doing frickin’ amazing work. I think a lot of people feel intimidated by the kind of elitism and professionalization in our movements that creates “celebrities” or “experts” who go to fancy trainings. A lot of the most groundbreaking and grounded work is done by people who didn’t go to school for organizing, they’re just people figuring out the crux of how we take care of each other better.

I keep trying to remind people that we have everything that we need to get free. And most of us, if we would just believe that and tap into that, we would be in such a different place.

When I was coming up, there was no such thing as disability justice. Many of us are creating it, just from our own lived experiences. We’re creating it in the ways that we, as disabled people, have figured out how to live in a world that’s ableist. It’s a movement that comes out of something like four disabled friends figuring out, “How are we gonna go to the movies together when one of us can’t take mass transit because it’s not accessible, when one of us needs a PA [personal assistant], one of us has a service dog and one of us has severe depression or chronic fatigue?” That’s where it started.

I don’t want it to lose those roots. My work is trying to cultivate an environment where we believe in ourselves and each other enough to start doing that work.

Let us join Mia Mingus in believing in ourselves and each other enough to reject Allen Frances’ Great Compromise and carry forth with our “civil war” — a non-violent struggle to build a true alternative to the institutional-industrial complex. We may not win the war in our lifetimes, but history is on our side. No people can long endure half slave and half free. As Lincoln — who undoubtedly would be given a psychiatric diagnosis if he were alive today — concluded in his House Divided Speech:

“The result is not doubtful. We shall not fail —
If we stand firm, we shall not fail.
Wise councils may accelerate or mistakes delay it,
But, sooner or later the victory is sure to come.”