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Letters to the Editor

Revisiting the Past to Chart a New Future
By Dotty Decoster
July 19, 2011
First, I want to thank you for your book, and your ongoing efforts to begin the conversation.  It is a breath of hope for those of us who lost the battle to the medical model in the 1960s and 1970s.
I rather think you may be aware of the following, but if not, here it is:
During the 1960s and 1970s, when many of us were young people exploring alternatives to everything, a part of that exploration was the issue of institutionalization of the “mentally ill.”  While we were reading Marx, Trotsky, Stalin, and Mao, many of us were also debating Skinner, Freud, Bateson, Marcuse, Szasz.  It seemed that the question of “madness” was somehow central to the question of trying to figure out Civilization and It’s Discontents.  Many of us had also grown up with mothers who were using “mothers little helper” and sometimes drove our mothers to such use.  One part of this very robust conversation, revolved around child rearing and the role of women as mothers.  Somehow, a part of the conversation went, mothers were responsible for the “mental health” of their families.  (It has taken me several decades to realize that this attitude was part of the general notion of what women’s roles were defined to be at the time.)  Perhaps the most sensible and reasonable result of this conversation was that people like R. D. Laing (and many others, including small patient groups) were urgently suggesting that we listen to people affected.  Some of us did, in large part because “mental illness” turned out not to affect just those who were institutionalized, but any number of people we knew.  I remember having conversations in a women’s liberation rap group not just about the topic, but with friends who were symptomatic or had been.  The first effort was to reduce the number of people being institutionalized by offering good quality care through community-based clinics (or if necessary, caring for each other).  The Seattle Crisis Clinic grew out of these efforts.
Locally, we were delighted to have a community mental health outpatient clinic appear in our neighborhood.  We thought that at last, deinstitutionalization would lead to appropriate, patient centered care.  Within a year we discovered that the community mental health center was drugging people to the point that we had a neighborhood where zombies walked the streets.  We discovered that inexpensive apartment buildings surrounding the center were being turned into latch-key housing for formerly institutionalized individuals, and the staff were ripping the patients off.  This situation was challenged and eventually resolved.  A new, and more pleasant building was created, and the neighborhood has slowly gentrified since then.  (A part of a gentrification process throughout the central part of our city, not especially this neighborhood.)  To my knowledge (and I have no inside information here), three patients of this facility have committed murders, two immediately adjacent to the facility.  The last one was barely two years ago.  One of the victims was a child.  The most recent victim was a young woman unrelated in any way to the patient or the institution.  While, as the saying goes, shit happens — and while there were a series of “not happenings” which lead to the last murder — the bottom line is that the mental health system failed.  (“He wouldn’t take his meds.”)
It has, of course, been impossible to bring any pressure on the local community health center to provide alternative care to medication.  The medical model turned out to be the support for the movement to deinstitutionalize.  Any changes in care models would have to come from the staff and be negotiated through the politics of the state’s mental health system.  The relationship between the police and courts and community mental health clinic would need to be examined and re-organized.  These are political processes requiring much more than say, sitting on an advisory board.  Moreover, since political history tends to amnesia, it is even possible that pressure brought to bear on the community mental health system  will result in re-establishing and expanding institutions.  (Would this be a bad thing?  It would take the patients out of their context, which might or might not be appropriate?)
In any case,  it did cross my mind, as I was writing to my old friends to read your book, that it is important to note that there was a very robust conversation, internationally, about care for people experiencing mental health “break downs” or “acting out” and not so very long ago.  I suspect that there are a number of people, completely out of the context of the mental health system like me, who would be delighted to have another look at the conversation we carried on in the past and to add to that ongoing debate with new information and new ideas.  In my case, it would not be a romantic “civilization and its discontents” conversation, but it would be a neighborhood-focused issue of what to do with the folks “next door.”
Dottie Decoster



Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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