It’s Not Going To Get Better Soon

Alice Keys, MD
69
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I’ve been thinking a lot about George Saslow since I came south to take a timeout and think. I miss him. A lot. Dr. George Saslow was my guiding light after I moved to Oregon in the middle of residency training and became lost.

I came to his door referred by an old friend of his, my neurology mentor at Tulane. I knocked one afternoon and said, “Dr. Sam Trufant sent me.” These were the magic words. George Saslow smiled and opened his office door. I had found the guide I sought for the remainder of my training years.

Dr. Saslow was an amazing physician. When he was forced to retire at sixty-five by federal mandatory retirement laws, he went off and started a new department of psychiatry in Oregon where there had been none. When the people working on the Manhattan Project started having “stress issues” while developing the atomic bomb, George was the guy they called in to help sort things out. By the time we met, he was professor emeritus and active on the Psychiatric Security Review Board. He provided me an anchor from which to navigate the second half of my psychiatry training.

Sometimes I imagine that George would know what to do if he were still alive today. Then I remember what he thought about the changes that were happening, even back then, in the mid-eighties.

 I talked to him about the changes he and I saw; the replacement of psychiatry education with psychopharmacology training, the infiltration of “prescribing” as a substitute for medical care, the loss of public funding of the state medical school and hospital and subsequent privatization, the closure of state hospitals and the first waves of patients abandoned to live “under the bridge”.

“Things are not going to get any better,” he told me. Back then, I wondered if he might just be a crabby old man. But now, having lived the past 25 years since our regular meetings, I see that he was the voice of experience and history, a skeptical enquirer, a lifelong student of human behavior and a talented visionary. Or maybe I’m just a crabby old woman now.

I often wonder what he would think about it all today, what he would do about the condition of the practice of medicine. More than anything, I long for leadership and guidance. I keep looking around, but see no one who’s in the position to provide this. My colleagues are head-down, occupied in the trenches, bailing the ocean with their teaspoons. They are caught up shoveling pills at patients as fast as they can in an effort to stay ahead of the time choppers nipping at their professional livelihoods. The younger ones have no idea that things were ever any different. The older ones take their marbles and leave.

What would George do? Every day I wonder. Then I remind myself of a favorite saying of mine: “If you ever need a helping hand, there’s one on the end of each of your arms.”

Dr. Saslow was a cognitive and behavioral therapist by inclination, so by professional heredity, I am also one. He believed in the miracle of changing one’s life for the better, one behavior at a time. He understood the power of words to create the world.

So, I take out my laptop and write again.

I’ve been sending my email missives out to a slowly growing group of friends and professional colleagues since I left Portland last fall. I’ve sent travel logs, personal updates, thoughts and feelings and the occasional professional rant. I am certain there are email boxes that have a special spam filter with my name on it by now.

I have had professional rants for years, but usually just talking rants during the slow spells of crisis work and rants when I walk in the mornings with my quiet-natured husband. I’ve always been prone to doing research projects when I’m perplexed, all the way back to medical school. Whenever I’m bothered by the idea of this medical treatment, that nutritional hoax or this social condition, I bury myself in the books. I get excited when I do research. I tell anyone and everyone that will sit still for five minutes what I think this week. I would probably hate someone else for doing this.

Now I’ve been given a great gift, the gift of a wider audience. In the past week I’ve had more different people read me than I’ve ever had in my life. I’m exceedingly grateful for this opportunity. Now, when I sit down to think and write, I know that there are a few more people at the other end of my pipeline.

Even though I still feel lost and leaderless in an overwhelmingly broken medical system, I am reassured when I see that there are others who have noticed that all is not well in our first world paradise of high-profit, “evidence-based” pharmaceutical products.

This endless flood of overpriced pills is poisoning our patients, busting our healthcare budgets and killing the practice of medicine.

And, like George, I fear it’s not going to get better soon.

 

69 COMMENTS

    • I would have to say that right now we are operating not in a capitalist system but a fascist/corporatist system. As for the direction of psychiatry, psychiatry is going to continue to lower the threshold for “mental illness” and subsequent drugging because that is where the money is and that is where the fascist state wants it to go. Just like the absurd oppositional defiant disorder for kids, psychiatry is going to make a similar disorder for adults who don’t bow down to their corporate masters. This is where psychiatry is heading.

  1. “the closure of state hospitals and the first waves of patients abandoned to live “under the bridge”.

    I’ve been subjected to state hospitals, I will take under the bridge please. Not that I am all too used to having my wishes respected.

    And just in case anybody was wondering, forcibly drugging people and forcibly electroshocking them, and forcing psychiatry’s stigmatizing and misleading labels on them, and locking people in solitary confinement, which is what State Hospitals do, cannot be reformed, cannot be made better.

    Under the bridge unmolested, or forced into psychiatry by the government. I’ll take the bridge.

    I was traumatized for life by state hospitals.

    I’ve just seen your biography page on here…

    “But I came home at the end of each day with a smile. It was fun to work on the locked psychiatric unit. “

    • Now I’m really intrigued at a further look at the author’s biography page here…

      This is what Alice Keys says in her bio.

      “But I came home at the end of each day with a smile. It was fun to work on the locked psychiatric unit.”

      https://www.madinamerica.com/author/akeys/

      Many psychiatric survivors read MadInAmerica.com

      Many of these survivors of human rights abuses had anything but ‘fun’ when they were captive and being forcibly drugged and labeled in locked psychiatric units.

      I’d like some context or further depth to this please. I’d like to come to understand what was so ‘fun’ and smile inducing about the locked psychiatric unit you chose to work on.

      I mean, I’m someone who almost loses my lunch at the thought of doing to people the kinds of things psychiatrists are asked by the system to do when they choose to work in these coercive settings. I’ve been on the other side of forced psychiatry, and I wouldn’t wish it on my worst enemy. It’s a completely alien thing to me, to even hear someone describe locked psychiatric units as ‘fun’ places.

  2. Dr. Keys, my feeling is you’re going in the right direction, assembling a group of people who can support your own growth personally and professionally.

    Every doctor who is swimming against the current needs to do this.

    Your example will give your more timid peers courage to question the status quo on their own. And maybe read Bob’s book!

    This all goes toward better and safer care for patients.

  3. There really are other Dr. Saslow’s out there, and they would participate with us if they are made to feel welcome. To over and over focus on what has gone wrong in the past (which of course we should learn from), or to take out of context something which was said that doesn’t sit quite right, won’t help us to progess in a different direction. Let’s talk about how we can make things better together.

    All I can personally do is to apologize if I ever hurt any of my patients or taught others who did, but I am dedicated to making things better.

    • The past, or today April 26, you choose. Today April 26 there are countless Americans being bullied into taking drugs they do not want to take by soft coercion, countless others being overtly brutalized inside locked psychiatric units. Tonight, tomorrow, and the next day, and next year, people are set to be coerced by psychiatry. This is not some “problem of the past” by any means.

      Do you support the right Dr. Moffic, for people to say no to psychiatry? Do you think it okay to force people into psychiatry?

  4. No, of course I don’t think people should be forced to take psychiatric drugs. The only exception, which would be quite rare, is if a life seems to be in real danger. I always give my patients a choice of medication, psychotherapy, excercise, and/or other options, and I tell them what I think might be best for want they want.

    As I’ve said and written, I do know that people are being forced when that is not necessary. There indeed are many, many problems in our health and mental health systems.

    • “The only exception, which would be quite rare, is if a life seems to be in real danger. ”

      I’m sorry sir, psychiatric drugs don’t have a monopoly on the ways to save a life that is in danger. I didn’t know that a life being in danger was a ‘brain disease’.

      If you are referring to someone’s life being in danger because a suspected criminal is about to commit a crime, there is always the police and the criminal justice system to enforce the laws against endangering life.

      If you are referring to self harm, I can only point out that many people would argue they own themselves and have a right do to themselves what they like, and that psychiatry seems rather lax in its efforts to police slow, long term self harm.

      I would further add that in the realm of forced psychiatry, where declarations of dangerousness are made not in a court of law subject to the rules of evidence, but behind closed doors, and are made without any separation of powers, that is, the person who accuses someone of being dangerous is the same person who then strips that person’s rights away.

      I would also point out, that being distressed in a dangerous situation, is no reason for one’s government to force someone into psychiatry of all things. Why psychiatry? why not force people into some other solution?

      You have just told me you support the forced administration of major tranquilizer drugs as a means of rapid behavioral control. What is wrong with other means of self defense? like physical restraint? tasers? handcuffs? If forced psychiatric drugging really is the gold standard for ‘saving lives’, why don’t cops carry around syringes full of haldol? Would you agree that breaching the blood brain barrier seems a little more invasive than cops physically restraining someone on a bridge? Would you agree that using psychiatric drugs to incapacitate a potential criminal seems like overkill? or even that taking away someone’s liberty BEFORE they’ve committed a crime is also overkill?

      Why is it justified for YOUR profession above any other incarnation of ‘help’ to be forced on people?

      Why is it okay for the determination of ‘life being at risk’ to be made by a member of your profession? and without any immediate judicial oversight or the right to an attorney? as is the case with involuntary ‘holds’?

      How can you justify solitary confinement, isolation, the denial of phone calls, attorneys, and the forced drugging of someone labeled ‘dangerous’ by one government psychiatrist?

      Why is your claim of ‘seems to be in real danger’ acceptable? In other areas of government force, it is not what merely ‘seems’ but what ‘is’, and is testable in evidence that is the driver of what happens.

      I don’t agree that forced psychiatry is rare. Unless you feel that the locked psychiatry units are empty ghost towns, with tumbleweeds rolling through them.

      “I do know that people are being forced when that is not necessary. ”

      Do you seriously expect people to feel safe when psychiatrists are pretty much the sole arbiter of what is and when it is necessary? Aren’t we all merely at liberty UNTIL a psychiatrist takes that liberty away?

      I honestly do not see how you can justify forcibly altering the brain of somebody just because you label a situation life threatening? we are not talking about bleeding on the brain here. We are not talking about a life that will surely die if that brain is not intervened upon. We are not even talking about people for whom you can provide evidence of genuine brain disease. Why should they lose the right to own their brains?

      Is that the takeaway? dare become suicidal and automatically forfeit the right to own your brain? I think that is what is happening here. The hubris of biopsychiatry is most on display by its reserving the right to force itself on everyone in a situation labeled an ’emergency’, when in reality there is no logical justification for the government to be responding to situations of ‘dangerousness’ with your particular profession and the current version of the way it practices.

      Why psychiatry? of all the various things to force on someone? all the myriad different solutions and versions of help? what gives biopsychiatry the right to reserve the right to enter the body of any citizen in the land by force?

      To recap, I think your above answer amounts to a kind of ‘no I don’t believe in forced drugging’, (except when a psychiatrist deems it necessary). And the public is just supposed to feel safe and hope they won’t be one of the people forcibly drugged.

      Another serious question for you sir,

      Do you support the concept of a new law whereby adults could sign advance directives that would protect them from involuntary psychiatry in all circumstances? An iron clad living will that could never be overturned by a psychiatrist?

      I hope you answer my final question here, I’d really like to know.

    • People are killed in emergency psychiatry settings not involving police all the time. There are many ways to die on involuntary psychiatric hold. Forced drug overdose, asphyxiation while being physically restrained for the sole purpose of forced drugging and not in response to actual self harm behavior etc…

      Not to mention the people who are made suicidal by the devastating trauma they go through in psych wards at the hands of the things being done to them.

      Psychiatric violence begets more violence. Coercion begets more suicides.

      I’m not suggesting for a moment you’ve killed anybody personally. I note also you’re an academic psychiatrist and not a state hospital psychiatrist who deals in these sort of scenarios regularly.

      Thank you.

      • Anonymous, Sometimes people need drugs. My son was given haloperidol to stop him walking out of A&E traling his drips. He was totally lost in his own world thinking that the police had implanted a microchip in his brain. It took only 15 mn in his case for the medication to work and the voices in his head to stop. This said, it was the psychiatrists’ fault that my son was in this state in the first place but it is a long story. Nevertheless the Haloperidol was a life-saver at the time.

          • There is no set of laws that will fit everyone because we are individuals and our breakdowns are due to different causes. Also, I had to help my son off those meds behind doctors’ backs as soon as he was out of hospital because by then they were not helping anymore they were paralysing him mentally and physically and the doctors couldn’t see it, the blind lot and, of course, they didn’t listen.

          • With all due respect, there are set laws, the commitment laws, and I am very firm in my position that I should not have to lose my rights, just so that it can be made easy for your son to ‘conveniently’ lose his rights at the time desired by you.

            It is one thing to get a guardianship on your son (it would affect only his rights), it is entirely another thing to ask society to have in place a system where my rights are at risk because pesky due process would cause delays in forcibly drugging your son.

            In order for your son to be ensnared in the commitment laws, the snare has to be set wide, others do pay the price for yet others to be rendered some subjective ‘benefit’.

            I’m glad your son is ok. I’m not glad that a system is in place to quickly have a doctor sign a piece of paper and have all his rights removed, the reason for this is because it makes it very easy for my rights to be removed too.

            Please understand I completely understand you didn’t invent forced psychiatry. I am just pointing out, in order for the law to take away the rights of your son, other innocent people inevitably get caught up in those laws.

            I would prefer not to be caught up in those laws, the cost is simply too high to me. I fear I will not survive if I am ever ensnared in these laws again.

            I think it is very important and high time society had a debate about this. Who do we listen to? the people who say they were ‘helped’ by the laws allowing their children to forcibly drugged, or the people destroyed by the laws? what is an acceptable number of lives destroyed, in order to ‘save’ someone else?

            All I want is to feel safe from the actions of my government. I want to feel safe knowing that I haven’t committed a crime, and I will not lose my rights.

            Unfortunately, me having my rights protected, would make it harder for a doctor to take away your son’s rights too. So it is an impasse as I said in the beginning.

          • Anonymous,

            You’ve laid out the fundamental flaw in the “beneficence” justification for coercive medicine brilliantly. Thank you.

      • There are many ways to die on involuntary psychiatric hold, and in psychiatric “care” in general. Not least, there is the obscured way of having one’s life expectancy reduced with 25 years by drugs that cause real physical illness. The thing is, being reactions to life, psychiatric “symptoms” are signs of the psychiatrised person being alive. How do we get rid of these “symptoms”? Well, it’s obvious, isn’t it?…

        When it comes to suicide, Dr. Moffic must have been very, very lucky. In Norway, the suicide rate among psychiatrised people is 100 times that of the general population. Some people off themselves when they’re told they suffer from a chronic brain disease, and won’t have a future other than as a “mental patient”, some off themselves because of the drugs’ “side” effects, which they can’t stand anymore, while no one listens to them, and helps them get off, some off themselves as a direct reaction to the drugs’ “side” effects, namely akathesia, some off themselves because they can’t stand the dehumanisation and torture they experience at the hand of psychiatric staff anymore, and so on, and so on. Lots of very plausible reasons. One thing is for sure, a statistical and empirical truth: psychiatry doesn’t save lives.

  5. Alice,

    It is deeply moving to read your blogs and learn of your inner struggle with the state of psychiatry, health care in general, and our culture’s strong bias for quick fixes. There is no doubt we have some mountains to climb in this paradigm shift so many have come together to create work to usher in.

    The despair you express, ironically, is not unlike the despair of those of us who have struggled (or watched a loved one or friend struggle) with a mental health challenge. Recovery, change, transformation can seem utterly hopeless and out of reach. No pill or provider can light our way out of this dark place. Ultimately, hope and a little faith in the possibility of change must light our way, usually held out to us by friends and family who believe in us before we are capable of doing so. Little progress can be made in recovery until we courageously choose hope.

    This choice is perhaps the hardest choice we can make. And one some of us may have to make daily for the rest of our lives. But it is so worth it.

    There are so many people who have made this choice, who have held the hope for others, and who have worked very hard for many decades to bring recovery and hope to others. Many of them are contributors to this site. And countless others quietly choose hope every day.

    Perhaps your way out of professional angst is not unlike this recovery process?
    Your compassion, wisdom and eloquence could be such a tremendous voice for hope if you turned your lens toward it.

    There is hope. It can and does get better. But it is hard work. That is the task at hand. Bringing hope to our professions, those we serve, and most importantly, to ourselves when we have lost our way.

    So glad you are taking time to breathe and nurture your own transformation.

    Wishing you peace and hope.

  6. We can accelerate the process of changing attitudes towards biopsychiatry and the medical model among the American public if we can find a way to tap into the outrage factor. Anatomy of an Epidemic had that factor, as did Ken Kesey’s One Flew Over the Cuckoo’s Nest decades ago.

    One thing that predictably generates outrage among the American public is the thought that their money and tax dollars have been wasted. We could benefit from a reputable academic study to produce a quantitative estimate of the total economic cost of harmful psychiatric medications and their iatrogenic effects. I think there is enough data out there to draw up reasonable economic estimates.

    A quick Google search shows that in the last few years, between $25 – $29 billion were spent annually on anti-depressant and anti-psychotic classes of prescription drugs. This corresponds to roughly 1% of the $250 trillion in total annual U.S. health care spending. This is small change, but if you start to add up drug expenditures since the early 1990s plus estimates of the cost of side effects, SSDI and lost productivity, and present that in light of the scientific studies questioning drug effectiveness, we could enhance the outrage factor.

    • Mary, this is a good point. However, the counter-argument will be the (highly hypothetical) enormous cost of mental illness, costing the economy jillions in lost work days yadda yadda yadda.

      The argument has to come back to the efficacy of bipsychiatry in reducing those jillions.

      As for the cost of adverse effects, there is some info emerging in public health studies about iatrogenic damage, such as http://www.onmedica.com/newsarticle.aspx?id=a984b136-c486-43ca-983c-d31023f890f9

  7. Dr. Keys,

    For the current mental health situation, the solution is more support networks and holistic treatment centers.

    Support Networks:

    http://discoverandrecover.wordpress.com/category/support-networks/

    Holistic Treatment Centers:

    http://discoverandrecover.wordpress.com/category/holistic-treatment-centers/

    The support networks can be put together for minimal cost, relying on peers, for instance. The holistic treatment centers help people heal, recover, thrive (as opposed to life-long “illness management”)

    Duane

  8. Dr. Keys,

    We seem to see the greatest success in the programs that offer a safe place, along with human contact, without pre-concieved ideas about “mental illness”.

    Unlocked units.
    Inclusive enrironments.
    Listening, caring.
    Hardly “medical”.
    These types of programs seem to be the most “therapeutic”.

    We saw this with Dr. Mosher’s ‘Soteria’, where the staff were not conditioned (beforehand) to understand “schizophrenia”…we see success rates of 85% percent with ‘Open Diaglogue’ in Lapland (as pointed out by Daniel Mackler, CSW and Robert Whitaker; and we will continue to see enormous continued success if truly begin to embrace these very simple, very human concepts.

    People tend to recover when they feel they are loved and accepted, just as they are… And when they begin to understand their own suffering as a very human condition, they can begin to move beyond it, in a spirit of hope.

    We make all of this so much more complicated than it needs to be. We need to stop doing the things that don’t work, and begin doing the things that do work.

    “Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat.” – Mother Teresa of Calcutta.

    Duane