Inpatient Hospitalization:
An Inside Perspective

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When someone is in severe crisis due to feeling emotionally overwhelmed, one of the main access points for receiving care is an inpatient hospital setting.  People come for mental health care in a hospital when they are feeling suicidal, have attempted suicide, or are becoming increasingly confused, have strange distorted thoughts or are hearing malicious and scary voices.

In the best of worlds, the hospital setting would be a sanctuary, a place for respite and nourishment, where the mind and body can find a place of ease and stillness before returning to the outside world.  People who have experienced severe emotional trauma and cannot think clearly need a place to rest and get support.

For the past eight years I have worked as a therapist in psychiatric units of a hospital.  As a therapist my main job is to listen to patients, help them navigate the maze of inpatient hospitalization, and offer them support and comfort measures.  I also help patients if they become severely agitated.  I spend time trying to hear their concerns, sometimes helping them find a comfortable and safe space to vent.  And yes, I have taken part in restraining individuals and delivering injections of medications to patients who become severely hostile, threatening or self-destructive.

When someone becomes severely confused, psychotic, or suicidally depressed, one of the main options for helping an individual is to bring them to a hospital.  Though many disparage the hospital setting, there are few alternatives to this setting during an acute mental and emotional crisis.  The positive aspect of a hospital setting is it provides the space and time for an individual to go through severe crisis before returning home or to a step down facility.  At the same time, there are also a number of barriers to individuals getting optimal care, and there are numerous stories of individuals being treated harshly, restrained with excessive force, forcibly medicated, “treated like a child,” and treated with condescension by doctors.

I will try to examine some of these barriers and some of the main critiques of hospitalization.

Critique 1:  “They over medicated me.”

One of the main critiques of hospitalization is that the fundamental way of treating individuals is prescribing them strong medications with side effects that can cause long-term adverse health problems.  Not too long ago, doctors would sit and do “therapy” with a patient.  The doctor would help explore and navigate the myriad social, family and individual barriers to greater health and well being.  Since the 80’s that has really shifted towards a medical model of managing mental illness as a disease.  The underlying philosophy is that mental illness is a permanent condition based on organic and chemical imbalances that can be fixed, or at least managed, with pharmaceutical medications.  As Robert Whitaker, and many others have pointed out, the idea that medications fix chemical imbalances is simply erroneous.

Medications such as atypical antipsychotics and mood stabilizers do indeed exert a profound effect on the brain’s chemistry and often act to sedate patients so that the extreme symptoms of their illness – such as loud intrusive voices and manic behavior – is quelled.  These medications do not actually “fix” the underlying brain chemistry that lead to altered states of mind, but for someone who is overwhelmed, agitated, not sleeping, confused and plagued by delusions, a sedative drug can be a very helpful short-term measure.  It allows the body to rest, get some sleep, reset, and try to find some balance.

However, the long-term use of these potent medications can also bring a host of complications.  Psychiatric medications often come with a side-effect profile, and withdrawal can be extremely challenging.  Worst of all, though they can sometimes  be effective in the short term, they tend to lead to the need for an escalating level of medication; a cocktail of anti-depressants, mood stabilizers and anti-psychotics.  For some, these medications can have a cumulative effect that leads to a variety of health complications.  I have seen patients started on a commonly prescribed anti-psychotic come back in 6 months having gained over 50 pounds.  Others develop tardive-like twitches, and akathisia, severe lethargy, foggy brain, high blood pressure, dizziness and diabetes.

When doctors have conversations with patients, there is rarely any talk of side effects, long term health concerns or potential problems with withdrawing.  In a hospital setting, a doctor/patient conversation is often quite short, and in that brief assessment, medication is prescribed that can change the whole course of a person’s life, especially if they are going through their first psychotic episode. Each individual needs to weigh the pros and cons of taking medications and, for some, medications and their associated risks and side-effects will seem a better choice than being plagued by delusions, confusion and roller coaster ups and downs.  However, I believe the choice to take medications needs to be a much more informed one.

Critique 2:  “They restrained me and shot me up.”

When someone has come to the hospital because they are extremely psychotic, agitated and acting in a threatening or self-destructive way, there is a strong chance they will receive forced medications and sometimes restraints if they don’t willingly take medication orally.  The first point of contact is the emergency room of a hospital and if a patient becomes severely agitated, there are few options for staff.  Generally, staff take the time to try and talk to the patient, offer comfort measures and help divert them, but if a patient escalates to a point of being threatening, staff will call a “code” and restrain and give a patient a forced medication.

The tip-over point of when a code is called is a subjective one that depends on the specific staff.  There are staff that are better or worse at helping calm patients, and some that are way too hair-trigger in their move to force such as chemical and physical restraint.

In my hospital, I have seen a lot of movement away from restraints and a lot more attention placed on trying to gain an alliance with a patient, offer them a safe and supportive environment to vent and be intense and angry without moving towards a “code”.  At least in my hospital setting, the prison guard mentality has largely disappeared though I am sure that it still exists in many hospitals around the country.

Though restraints are very uncommon on the unit at this point, they are still used, and mainly because the patient has become so violent that they are attacking staff or other patients.  Some good questions to ask are, “Why has the patient become so violent?” and “Could the patient have de-escalated if he had been listened to and offered support before he became violent?”  As staff become trained and supported in a culture that promotes listening and de-escalation, restraints become increasingly rare.

In terms of forced medication, it is generally given only in two situations.  The first is when a patient has become extremely self-destructive, threatening or violent.  If the person doesn’t de-escalate after prolonged staff interaction, or will not take oral  sedative medications, I support the limited use of injectable medications to help stop violence.

I know this is a highly controversial subject for many members of this community who have been horribly abused by overzealous and harsh hospital staff trying to exert control and force in a humiliating way.  At the same time, when an individual has shifted towards being actively violent towards staff and patients, there comes a point when it is essential to protect these people.  There is no easy answer to this.  Forced injections are by nature traumatic.  But staff and patients being violently attacked by a psychotic patient is also traumatic.  I think many “codes” can be dramatically reduced by making effective non-hierarchal alliances with patients and supporting them before they become violent.  At the same time, if all other measures have been tried and a patient continues to be violent, there are sadly few options left to protect other staff and patients.

The other situation for forced medications is for patients who have been involuntarily committed by a judge and continue to choose not to take medications.  In this case, a doctor (and a second opinion doctor) decide to administer medications involuntarily to a patient in order to “help them stabilize.”  I don’t support this form of forced medication for a few reasons.  For one, the long term use of medications can have serious health implications and I believe an individual needs to partner in that decision.  Secondly, a patient who is forced to take medications in a hospital setting is very unlikely to voluntarily take those meds once he returns to a less secure setting.  Once he goes off the meds, he is likely to experience the myriad withdrawal effects from a very quick taper off a neuroleptic.  The withdrawal effect from quickly going off the drugs often can spike psychotic symptoms and lead to being hospitalized again.  Finally, the notion of forcefully administering a very potent drug to an individual that doesn’t present an imminent danger to self or others seems unethical to me, personally.
Critique 3:  “They don’t listen to me”

A hospital setting is by its nature very hierarchical.  When an individual comes to a hospital seeking care for mental health concerns, they are treated primarily by a doctor.  That doctor gives orders for medications and other treatments that the nurses, therapists and line staff follow.  As I have said before, conversations with doctors are usually very short and for some patients, they feel that they are not getting their needs met, are being prescribed meds that are too potent, ineffective or that are causing side effects.

Instead of a therapeutic alliance, for some people the relationship to the doctor can feel paternalistic and lacking in any  meaningful connection.  The doctor is placed in the impossible role of trying to solve mental health issues and complex myriad social and family of origin issues with short 5-minute conversations and prescribed psychiatric medications.

One of the main reasons for “not listening” is that insurance companies have moved towards managing mental health with medications and do not effectively reimburse any long conversation with a doctor.  In essence, it doesn’t pay to talk.

The other main reason for not listening is that doctors have been trained in managing illness with medications and are not trained in integrating psychological methods or more holistic ways of managing mental health such as mindfulness training, nutrition, or healthy coping strategies.  Sadly, those ideas are often left to therapists as an after-thought while the emphasis is on medication.

The other aspect of hospitalization is that the process has become quicker with patients cycling in and out at a much faster rate.  Insurance companies don’t want to pay for long hospitalizations so they push for rapid stabilization and then try to get them moved out as soon as possible. This has changed the face of hospitalization dramatically.  In the 70’s, patients stayed for quite a long period of time and now many of them leave within a few days.

Patients are admitted, prescribed medications and then a quick plan for outpatient care is provided.  Nurses and therapists are often busy with the process of admitting and discharging patients, and less time is available for one-to-one contact.  They are also busy at computers monitoring the thousand tasks they are assigned and have much less time to interact with patients.  This can also lead to a feeling of being isolated and “not listened to”.

Hospitalization: New Models of Care

In this framework, is there any way for hospitalization to work more effectively and provide a greater degree of care and support for those experiencing a mental and emotional crisis?

The main good thing I see is a strong movement away from using coercive tactics such as restraints and injectable medications for “managing” agitated patients.  My hope is that this trajectory can continue and a strong emphasis can be placed on developing therapeutic alliances and utilizing de-escalation skills, such as offering a safe space and comfort measures, as an alternative to the traumatic practice of restraining and forcibly medicating people.

However, even in the context of a less coercive environment, the disease model of mental health care underlies much of the care that people receive in this setting.  Long-term care with potent medication is the main course of treatment one receives in a hospital setting.  Alternative treatment models may have to come from outside of the framework of a hospital setting.

In a perfect world, those experiencing severe emotional crisis would be able to find true sanctuary; a place for rest and healing.  The primary goal would be to allow them to cycle through their altered state with the support of compassionate and caring staff.  Instead of incorporating a disease model of mental illness, these facilities would present a recovery-model based on the belief that with enough time, nourishment and self-care, people experiencing severe emotional distress can and do get better.

Perhaps alternatives to hospitalization can be developed that are not as costly.  The average stay in a psychiatric unit of a hospital is over $1200 a day.  I believe a “sanctuary” model of respite homes for mental health crises could be created that would be much cheaper if the staffing were weighted more towards peer counselors, and less dependent on highly paid medical staff.  If they were much cheaper, perhaps insurance companies and state and federal agencies would agree to pay.

This model of treatment has already been developed and implemented with good success. Loren Mosher’s Soteria houses in the 70’s and 80’s, for example.  In these settings, patients received care from staff who treated the patients as peers and worked with them in running the home and doing the chores.  Psychotropic medications were administered occasionally, but usually in low doses and with no coercion.

In these calm and quiet facilities, people who were experiencing severe altered states and emotional distress were able to return to a greater state of health and well-being over time.  Soteria Houses have been duplicated in Scandanavian countries and in Germany with much success.  I believe there is no reason we can’t develop new “Soterias” in the US; respite houses for those experiencing severe emotional distress to come and find rest and healing.

In the coming years, I hope that the work of this community will propel a movement that creates viable alternative structures for the care of those who are experiencing severe mental and emotional distress.  Perhaps the model of care we develop for those in crisis will be one of sanctuary; a true place of rest and healing.

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140 COMMENTS

  1. From the editor: We understand that the topic of force and forced medication, in any situation, is upsetting for many of our readers. But it is a reality, and Mad in America needs to be a place where such difficult topics can be raised raised and discussed, and that the resulting dialogue can be a productive one.

    Jonathan, who is not a prescriber of meds, presents here that though he is opposed to force of any kind, and aspires to be part of a system in which it is not used or needed, he nevertheless works in a system which must respond to individuals who are agitated and potentially violent. So what is to be done? If the argument is that there shouldn’t ever be forced use of antipsychotics, then what alternative can be developed for instances where a person is acting in a violent or threatening manner?

    We hope that readers, in their comments to this post, will speak to this question, and to this dilemma. As such, we would hope that people who are in a similar position as Jonathan will weigh in with their thoughts, and we hope too that those who have been forcibly treated will tell of what that experience was like for them, and how it affected their future interactions with the psychiatric system. We would ask everyone to speak about what alternatives to forced treatment could be developed. And finally, we ask everyone who comments to do so in a way that promotes a real dialogue on this matter, where people can hear each other.

    We thank Jonathan for telling of his experience, and giving us this opportunity on Mad in America to explore this difficult issue.

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    • Then what alternative can be developed for instances where a person is acting in a violent or threatening manner?

      An ounce of prevention…

      I saw quite a few people act out in a in a violent or threatening manner because all they wanted was to smoke a cigarette to get back in control.

      I can’t understand the logic of a forced wake up for sleeping manic patients under the cover of a “blood pressure check”. The psychosis that comes with mania is usually the result of the lack of sleep that mania causes, why interrupt the psychosis healing sleep and also piss them off ?

      The severely depressed patient who can’t have a cup of coffee in the morning, that makes no sense at all adding caffeine withdrawal to there misery !!!

      It is also well documented that many suicidal people are struggling with complex personal histories of trauma. For these people, involuntary psychiatric treatment further traumatizes them, often worsening or indeed sometimes triggering suicidal feelings.

      And the great big fat # 1 on this list,

      Cameras pointed at the paranoid patients 24/7 !! its STUPIDITY, that was my fist post below. Its inhumane.

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      • I totally agree with the “ounce of prevention” strategy. Listening, getting food when people are hungry, giving people support, not waking up manic people who haven’t slept for days just to take their blood pressure, etc.

        And yes, hospitalization by itself is traumatic for many…so you are compounding trauma on top of the trauma they have already experienced. That is why I hope for a much better model for helping people who are in severe mental and emotional crisis.

        Cameras. I get it. It adds to the level of trauma and can easily heighten paranoid states. The justification is to make sure people aren’t hurting themselves but it does seem excessively intrusive.

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        • It is hard for me to understand being put into seclusion for being unable to sleep. That was my problem and I spend many nights in seclusion because of it. The only thing I can understand was that it made it easy for the workers. As soon as I would come out of my room I would either be threatened to be locked up or locked up and restrained, just for going out of my room. I could not control this behavior. At only one hospital of several, they did have someone to talk to and help people to go back to bed. There does need to a staff person available to the patients just to talk to, especially in the evenings. I was ignored whenever I tried to talk to staff. Also, it was inhumane to be denied access to visitors and personal medication for at least the first 24 hours of lock up.

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  2. Kermit,

    For right or wrong, Jonathan does *not* say here that he is opposed to all force. In fact, here, he quite clearly acknowledges at least one instance when he approves of force: “If the person doesn’t de-escalate after prolonged staff interaction, or will not take oral sedative medications, I support the limited use of injectable medications to help stop violence.”

    Jonathan,

    For me, the statement I quote above is of concern… Not because I disagree with some parts of it. I, too, would acknowledge that – based on the current system, the tools afforded to people working in it, our culture, and so many other points – there are situations where people feel incredibly stuck and at a loss as to what to do to prevent violence, and resort to force… which is what I at least *think* you’re essentially saying.

    However, that statement as you’ve currently worded it is a problem for me because the moment we start saying, “I agree with force in the mental health system in x, y or z situation,” then you are saying you agree with force as an option. Period.

    Fundamentally, there is a difference between saying “I agree with force as an option on the menu,” and saying, “I agree there are times when the options on our menu fail and we get stuck, and we have much more work to do as a community to continue toward eradication of those times.”

    For me, the latter is understandable and a reality, but the former is an unacceptable statement that leads – in most settings – to the increase in use of force as once it’s on the menu, it’s… well, on the menu, and people tend to find more reasons to use what’s on the menu than what’s not.

    Since it opened, our respite house has stated that force of any kind (calling emergency services, police, etc, on someone) is not on the standard menu, and if it were to happen that we’d have to regard it as a critical incident and investigate why it got there, take responsibility for what we find that was in our control, and do everything we can to learn from it and make things as right as we can. Fortunately, we’ve never gotten stuck and ‘gone there’ in our 16 months of existences, but that policy still stands.

    I wish it stood everywhere.

    On another note: We (the Western Mass Recovery Learning Community) currently have a survey running on language (see here if anyone is interested in filling it out: https://www.surveymonkey.com/s/language_survey99), and one of the most interesting responses I’ve received so far is one from a person who questions the line, “Danger to self or others,” which I hear you using in varying forms throughout this blog.

    The person’s main point of concern is in regards to the implications of equating hurting one’s self and hurting someone else – something the mental health system generally does as force of habit.

    Do you – do others – truly see those two points as equal? I realize that this is a whole conversation topic on its own, and yet it seems a critical part of the ‘force’ conversation. Are suicidal thoughts and actions ones that we are all necessarily and systemically responsible for stamping out? Are they ‘health’ issues? Or are they existential issues? Deeply personal issues? Choices? Is chemically restraining someone to stop them from hurting themselves equivalent to stopping them from hurting someone else? If so, why and when?

    Anyway, these are the first two thoughts that pop up for me when I read your blog.

    Thanks,

    -Sera

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    • I think it would be interesting to ask here:

      In what ways is your respite house like, and unlike, a hospital? What are the conditions under which you will or will not accept someone? Are these conditions a form of force, if it is understood that the person may not have a choice but to accept your conditions? What are your responsibilities to a person once they are accepted? Are you responsible to or for them until the crisis that brought them there is somehow ameliorated, or would you, upon reaching the limit of your resources or your the pre-defined limit of your obligation, ask them to leave? If so, could that be considered a form of force?

      Is the inpatient setting different in its responsibility; to somehow find a resolution for any situation it is faced with? What is its option when no resolution can be found, and yet clear and present danger remains? What is the implied responsibility of an inpatient setting, and how can that responsibility be fulfilled while honoring the both the rights and safety of all individuals to whom the hospital is understood to be responsible? Under what conditions can of should a hospital refuse its services?

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      • Except that none of those questions have anything to do with the questions I raised.

        While a valid conversation, what you bring up is a completely different conversation, and while I recognize that it is a question related to your initial post, it’s not the one I want to have at the moment.

        Perhaps once there’s been an answer to my questions, I’ll come back to these ones… In the interim, I’m going to let them sit as I feel they will only distract and/or add to the impression that what underlies my questions was something completely different than what was actually there.

        -S

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        • Yes, my questions were prompted by your statement “Since it opened, our respite house has stated that force of any kind (calling emergency services, police, etc, on someone) is not on the standard menu.” The questions you raise after are pertinent to both the respite context and the inpatient context; in some ways they are equivalent in both contexts, and in some ways they are different. What I was alert to was delineating the ways the contexts are alike and different, as I felt that addressing your very important questions warrants that. I did not mean to derail the conversation, but rather I think that this conversation often – perhaps always – reaches a dead end because of a lack of these distinctions. Perhaps an argument could be made that inpatient settings should not exist, or that the medications should never be used. Certainly the argument can be made that preferable options exist. But I don’t think that that those arguments can be made effectively without acknowledging the differences in the context.

          Nobody is obligated to follow my lead on this, and your questions are extremely important independent of mine. It was simply a hope of seeing as fully elaborated a conversation as possible that motivated me to add my questions to the mix.

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          • Kermit,

            The questions I am asking are this:

            1. Is it reasonable/advisable to ever say – regardless of location – that “I support force” within the mental health system and, if so, what are the implications to stating and integrating that belief into said structure? This is a question that I am asking regardless of settings, and I don’t think that any delineating needs to be made.

            2. Should ‘danger to self’ and ‘danger to others’ be so readily equated and used to justify force? If so, why? If so, when? And, perhaps, if we are to do that, shouldn’t we at least be more conscious and intentional of the philosophical and actionable consequences and implications? Again, this is regardless of context and is more a cultural/systemic question.

            What *you* are asking speaks more to the issues I was raising in a separate conversation a few weeks back… What do we do about the ‘gap’ between forced options and alternative options, etc. (I’ve got a blog post brewing on that topic, myself.) etc. Again, a valid conversation, but it feels like a very different one to me right now.

            -S

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          • Sera,

            I will attempt to reply to your question from my perspective.

            You ask whether force should be on the menu of options. I hope that you do not mean “menu of ‘treatment’ options. The propaganda that sells the assault of forced-drugging as ‘treatment’ is sick.

            IMHO, there is a great deal of bigotry driving the discussion of this topic. In a legal sense, the use of force (by an individual), should be and always will be “on the menu of options” in extreme situations, even if we outlaw forced treatment. Why? Because self-defense can applicable, even if forced treatment is illegal.

            I am anti-forced-treatment, pro-choice on the issue of suicide, and in favor of self-defense (with the caveat that it is always better to involve the authorities). I am totally against the misuse of self-defense for discrimination, as we saw in Florida. But self-defense exists, precisely because humans instinctively protect themselves from assault.

            How do I see a hospital/retreat properly implementing self-defense? The notion of ‘danger’ must go. The ONLY appropriate use of force in a treatment setting is when someone is protecting themselves from a physical assault that was instigated by another person. This must apply equally to staff and patients, and this means that forced-drugging is viewed as instigating an assault. In this view, it is natural and legal for a patient to resist forced drugging.

            Again, I must emphasize the difference between ‘danger’ and ‘assault’. The former cannot be substantiated since it is hypothetical. The latter can be substantiated by record of physical action.

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    • Thanks Sera for your comment. Let me try and respond as best I can. To start out with, my piece is a critique of hospitalization as a process rooted in the disease model of mental illness. I have strong concerns about pharmaceutical drugging as a primary tool of treatment. I have strong concern with the power imbalance and hierarchal nature of hospitalization. I have strong issue with coercive treatment without full understanding of the side effects and long term adverse health effects of psych meds. I don’t support long term involuntary medication.

      But let me try and address your two main concerns with my piece.
      1- the support of very limited use of medications/sedative drugs in the face of violence.

      If, as you say, it is part of the “menu”, then it becomes easier to use this method of interaction. And I certainly believe that is happening in many hospital environments. Harsh, hair trigger staff exist in many places and there are many stories of people who can attest to that. It is simply untenable to use force to control a patient unless under extreme circumstances. So what are these circumstances? Severe violence towards staff or other patients.

      I completely agree with your statement that I could change my wording to ….”sometimes the options on our menu fail and we get stuck. ” But the reality is that we have to be prepared for the possibility of violence, respond to it as best we can…but above all we need to make sure both staff and patients are protected from violence. How can we do that?

      The best way I know is to spend time making alliances with everyone in that setting, offer them support in a way that reduces the potential for anything like this happening. And if someone does become angry and aggressive, use all the skills possible to try and help that person and meet their needs. Perhaps they need space. Perhaps they need food, or they need to vent, or they need to pace. Whatever it is, allowing a space for them to be “intense” without reacting poorly is key.

      However, there is a time when the situation tips over and a patient becomes severely aggressive and violent. I cannot abdicate the rights of other patients and staff to feel protected as well. How to solve an unsolvable situation?

      It really is a no win situation. I know there are many many people who have been treated abysmally with unnecessary force in harsh and cruel ways in a hospital setting. Perhaps for many, it is just too much to ask to allow for some very limited use of force. I get that. But I would hope you see my perspective as well.

      My question to you is, what would you do if someone became extremely violent towards you or other patients in your setting?

      And hey, I will try and answer the suicidal question in another post….this one got a little lengthy.

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      • Johnathan,

        It would be silly of me – of anyone – to say, “Hey, Sally just started attacking everyone in the rec room with broken chair legs, but since we’re anti-force, we’ll just have to stand on the sidelines and hope she stops.”

        I can’t imagine *anyone* would advocate that – in the face of serious violence – there is no right to self defense or defense of others in your environment.

        *HOWEVER,* there’s a serious difference between saying ‘I practice self-defense’ and ‘force is a rare but acceptable part of treatment.’

        I was essentially already saying this in my first post, but by your response, I’m not sure I was clear enough.

        There’s a serious price to pay when force or violence of any kind becomes a written in (and thus, a normal) part of a system (even if it’s written in a way that says it’s rare and ‘we really try to avoid this’).

        Is it necessary for it to be written in to the system as acceptable in order for people to be able to defend themselves or take some sort of action when the situation calls for it? I don’t think so, and I guess that’s my point.

        What would we do at the respite house, one of our resource centers, etc, if the setting itself, the culture we’ve created, and a willingness to talk through and sit through very difficult situations didn’t work and someone was actually being violent toward us or someone else in the space?

        We would support someone to defend themselves (but we wouldn’t call it treatment or see it as a programmatic intervention of any kind). We might call the police or for other assistance (just like we might if someone did that to us in our personal home). And, as aforementioned, we would go through a critical incident process that wouldn’t necessarily blame the team members directly involved, but would explore – as best we could – the responsibilities held by all (including the person who was violent), the things that were in our control and could have been done differently, the things that may have been out of our control (but of which we should still nonetheless be aware), and what reparations should be made or steps should be taken moving forward.

        -S

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        • Ok, yes we will just have to disagree. But let me explain a little more. In our setting, we do see it as a very rare but acceptable only in extreme circumstances. I don’t see it as “part of treatment.” We do prepare for it by going through extensive training on how best to physically interact with a violent person. The most immediate training is how to use interpersonal skills to deescalate the situation. But, there is also training on how to protect yourself and the individual without inflicting pain or injury.

          The alternative, unfortunately, is to call the police. And the tools they use to interact with violent people is the use of tazers, bean bag guns and lethal force. I would much prefer our staff to interact with a violent person than the police.

          So yes, unfortunately, the process of interacting with violent people is part of the system. It requires attention and training.

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          • Jonathan,

            I appreciate your post and the empathy that you have for people experiencing distress.

            Wikipedia “Violence”: anything that is turbulent or excited in an injurious, damaging or destructive way, or presenting risk accordingly, may be described as violent or occurring violently, even if not signifying violence (by a person and against a person).

            So, you are saying that the staff can respond with force to anything that they judge to be violence. As this notion is highly subjective and encompasses a range of behaviors, I believe it is not necessarily rare. What if a person raises their voice? What if they verbally threaten someone? What if they take out their anger on an object such as a punching bag? Do you intervene? Would you go into a boxing gym and restrain everyone in sight for being violent? Or do you treat people in your facility with a different standard than the rest of the world enjoys?

            A justifiable standard for use of force is a physical _assault_ and the person with a right to defend themselves is the person who is being assaulted provided that they did not instigate the assault. Since there are cameras in your facilities, this standard can be enforced and justified in a court of law.

            Other standards would seem to provide a slippery slope of subjectivity. If you disagree, can you please explain how the standard of responding to ‘violence’ can be consistently enforced such that abuses like those described by “Someone Else” do not occur?

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          • @Tom. Yes this is the core of the issue…what justifies the use of force. And I think in many cases still today in many hospitals, the use of force comes too quickly, and without enough time to allow for deescalation. For me the decision to use force should only come as a means to stop someone from being truly violent. By that I mean physically attacking patients and staff. It does not mean yelling, cursing, being verbally abusive, etc.

            But these are warning signs…times to intervene and talk with the individual. Perhaps they aren’t getting this needs met. Perhaps they are frustrated with their care, or perhaps they just need to express a lot of rage and anger. That does not require any physical intervention. But it does require close attention, especially if it looks like it could rise to the level of violence.

            Unfortunately as we all know, there have been and continue to be horrendous abuses. And because of this, we need a much higher level of scrutiny for how we interact with patients. The decision of when to act and how to act in the face of intense emotion and violence is key.

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  3. Good morning folks. Well, this is the first read of my Saturday morning; and, I have to admit to feeling a little stumped about what to think of it. Those familiar with my thoughts on the movement know that I believe the current, mainstream mental health system needs to be completely dismantled, and that those who work in any capacity to keep these cogs turning should not be a part of the c/s/x movement. So, I guess I will address this aspect. On the surface of it, Jonathan Keyes makes a pretty good and not terribly complicated case for my position: too much coercion in hospitals, forced treatment=bad, Soteria model=good. He also makes the case, however, that SOME of the former can be good, if only it were better delivered and policed. Here is where we diverge. Here is where we diverge.

    I will be having my 45th birthday shortly, and have spent most of my life as a mental patient. I also spent twenty plus years of my life as a therapist/social worker, so I am not unsympathetic to Jonahan in his clinical role. I was radicalized in the year 2003, during a particularly brutal inpatient hospitalization. In the year 2003, I was raped and beaten on the psychiatric ward at Akron General Hospital in Akron, Ohio. The “perpetrator” (and I use this term loosely because I actually consider the hospital the perpetrator) was someone who was under my care at an outpatient facility where I was working at the time. The attack happened (I believe) in the small hours of the morning, after I had been given a heavy dose of what I believe to have been atypical antipsychotics, or possibly Haldol. I could not find a staff person for the longest time. When I finally located “nurse Cathy”, she told me that “people get hurt when they throw themselves out of bed because they aren’t getting the meds they want”.

    I know my story is not unique. I know it is not as horrific. I simply offer it here in response to Kermit’s request for personal experiences. One more story from the other side of the desk, and I will leave you all to your Saturday coffee and post-black Friday shopping.

    One of my last contracts in my private practice was a smallish behavioral health nursing home type facility. Once I got in and started looking at the charts, I noticed that every single person there carried the diagnosis Schizoaffective Disorder. I started writing diagnostic updates because it was clear to me this diagnosis was incorrect in many cases. This was when I drew the wrath of the contracting Psychiatrist. Well, being that I am a little bit smart, I asked myself why he was so upset. It did not take too long for me to figure out that Schizo cover his Psychiatrist butt for any antipsychotics he wants to prescribe and Affective covers the full range of mood drugs: uppers, downers, so-called stabilizers, etc. So, basically, he could medicate the individuals however he chose from one day to the next without even doing the paperwork to change a diagnosis in support of the change. I later learned this doc had over 3,000 of these type of individuals on his caseload.

    So, in closing, abolish psychiatry and return the power to the people. Anarchy. Pride. Civil Disobedience. Now.

    Best Regards to all,

    Sharon Cretsinger, ICON, Founder and Director, Kent Empowerment Center, Kent, Ohio

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    • Sharon, thanks for your direct honesty of your personal experience. I fully agree with you that there have been and continue to be, extremely over zealous, harsh and cruel ways of “managing behavior” in hospital settings. And because of this, the entire system of care is deeply flawed. And I also agree that I would prefer an entirely new philosophy for helping people in emotional distress and crisis who need support.

      When you say I say some of the hospitalization process “can be good”, and you diverge…I just have to say I disagree. I believe the process of care for people under intense emotional distress needs to be radically overhauled. At he same time I do acknowledge the need for respites of care, sanctuaries for people to come to. And in this setting, sometimes violence happens. How do we prevent it? How do we care for those who are extremely aggressive and are hurting other patients?

      If all other measures have been tried, such as listening, offering food, comfort measures, offering space…and the person still is deeply aggressive and violent, how would you respond?

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      • Hi Jonathan. I would respond as I have responded in the past–individually to each distinct case–by sitting quietly with the person, asking questions, reaching out to them energetically or letting the voices in my head talk to the voices in their head. It is hard to know what to do in any given situation without feeling the vibration of that specific situation.

        Now may I ask you, when you say that you believe the process needs to be radically overhauled, do you believe that such an overhaul can take place while titles and letters professional roles continue to define who is the expert and who has power?

        Best, Sharon

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        • A very good question Sharon. Within the context of a hierarchal framework, is it possible to see fully realized reform. Very doubtful. I think its likely we need to develop completely different models of care for crisis. But at the same time, I would like to see incremental reform within the system that we have.

          But you are right, power imbalance is at the root of much of the problem.

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    • Go to MIA’s main page, click on My Account (top right). That will bring you to the user-info page.

      Click the link in the paragraph:

      Want an avatar on our site? Simply sign up for a free Gravatar with the same email address.

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  4. Excellent post, if only psychiatrists and other staff would take heed! My son definitely needed medication to settle him when he arrived in A&E and to help him sleep. But medication is all he got-no emotional support whatsoever. All staff did was twiddling their thumbs, filling in forms and dishing out tablets. Even when he recovered his senses, he wasn’t allowed a say in his medication. If he reported side-effects, he was laughed at and once out of hospital, doctors refused to help him off the medication. He had to do it himself behind doctors backs. Nobody ever inquired what caused his breakdown. It was a mental illness, no need to look any further. That’s what the young psychiatrists had been taught at medical school it didn’t occur to them that they should question what they had been taught. I was labelled an EE mother and a pain in the neck.

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  5. In the spirit of accuracy, I have a couple of questions:

    Can we please stop calling these places ‘hospitals’?
    The drugs used there ‘medications’?

    IMO, a debate with someone who agrees with forced treatment can be addressed in two words: “You first.”

    We make this stuff too complicated.

    Duane

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    • Totally agree Duane about calling those places hospitals.

      By the way, when I felt the director of CooperRiis on Pete Early’s blog was unfairly implying I was a radical zealot because I expressed a concern about forced treatment, I wish I had thought of your response. Sorry, I forgot his name.

      At least Johnathan didn’t state that in hindsight, people like were grateful for their forced treatment like this guy did regarding a particular person.

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    • “you first” :D. Duane, you have a great ability of putting things that the defenders of psychiatric abuse usually call “complex, difficult, no easy answers” in simple terms. Sure there is an easy answer to the so called “dilemma” brought here: “you first”.

      Up until I was restrained and forcibly drugged, I would have probably empathized with the “complex, difficult, no easy answer” crowd. After my own experience, I do do have a simple answer to the issue of civil commitment and forced drugging: it should be banned in all circumstances, period, no exceptions.

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    • Agreed. The places are not “hospitals” nor are the toxic drugs “medications!” In the “hospital” where I work there is almost no talk therapy of any kind. Any that gets done is done by a few psychologists. The only treatment is the toxic drugs, no matter what. And there is no true informed consent being practiced in any form.

      It’s not a place of sanctuary not healing; it’s a place to warehouse people.

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  6. This is a good chance for me to point out the huge amount of distress that security cameras inpatient cause on the patients suffering from paranoia. The harm is far outweighing any good, paranoia is not my thing but I saw alot of people going through pure hell cause of those camera.

    As for me the only time I got agitated in the was when I was told if I didn’t take the huge amount of drugs prescribed I would get an injection to which I responded “If you do that chemical rape to me I will get even with you outside this hospital someday” I guess the doctor didn’t want to risk it cause I continued to refuse and the injection never came. That ordeal is the main reason I write here.

    But back to the cameras, does no one else see the illogic of subjecting people suffering from paranoia to living in an environment with a camera pointed at them 24/7 ???

    That is inhumane !!! Someone do something.

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      • I can totally see the cameras being a problem for people. But I wonder: is the severity of the problem more reflective of the power dynamics involved in how the cameras are used? What if patients had control of the footage? Would that remove some of the threat? What if patients could use the footage to substantiate claims of mistreatment by the staff?

        When I get worried about data collection, I just remember that post entities doing the collecting are drowning in data that they cannot analyze. Take video footage for example, a human is required to review the footage, and if they are looking at multiple monitors, they miss a lot.

        The key for patients is to not attract extra scrutiny and let the massive amounts be a shield.

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        • Behavioral Health Ward, Security Cameras, and Fear of spies

          Postby Cloud09 » Tue Feb 12, 2013 4:59 am
          Hey everyone. I was in the behavioral health ward last week. Well, I chose a different place to go since my mental health clinic closed my chart. Anyway, I have this severe paranoia of being spied upon. I got into the mental health ward and there were security cameras in the rooms and such. I understand that these are for the safety of patients and staff but it was very difficult for me to sleep because of those cameras.

          Anyway, considering the fact that I am certain I am not the only one with such a paranoia, why do behavioral health wards employ such cameras when it is only going to exacerbate the symptoms of people like me? I mean, I was there to get better, not to be spied upon.

          http://www.psychforums.com/anti- psych/topic106929.html

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        • What if patients had control of the footage?

          True,

          “Restpadd is a Psychiatric Health Facility licensed by the state of California. Patients are on 5150, 72 hour holds done at the ER or by police. Patients can be assaultive and unpredictable. We have a team of professional nurses, mental health technicians, doctors and a PA. We would never hit or assault a patient for any reason. A copy of the video surveillance exists and was turned over to the police several months ago.”

          http://www.ripoffreport.com/r/restpadd-inc/redding-california-96001/restpadd-inc-woman-was-beaten-by-staff-redding-california-1046550

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        • Actually, the cameras are often used to catch staff that are not doing their jobs properly or are actually harming or being disrespectful to the “patients.” I hate them too and understand the anguish that they can cause for many people.

          Anytime that a “patient” makes a claim against a staff person the tapes are watched and more often than not, the “patient” is vindicated and proven to be truthful. That staff person is shown the door or is prosecuted by the law.

          It also works in the opposite direction. Sometimes “patients” claim that a staff person did something to them just to cause trouble and problems for that staff person. The tape doesn’t lie and the action is caught from numerous directions. Patients who are lying cannot bring a lawsuit when the tape shows that what they claim didn’t happen.

          Cameras are a blessing and a curse. Also, there is audio and it catches every little word that is uttered or even whispered. Staff can’t get away with anything anywhere. There are no blindspots where things can be done to people without it being noticed.

          For the patients’ sakes cameras are one of the few things that I wouldn’t get rid of where I work.

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  7. Those who defend hospitals always seem to have some investment in them (like a paycheck). I’ve seen studies where people do better without going to the hospital (Texas Crisis Alternatives Project: Cost-Effectiveness of 9 Crisis Residential Modalities, May, 1996; SAMHSA Grant #SM47634-0351). Providing up front screening by peers who can also provide peer support would eliminate the need for psychiatric inpatient units.

    I’ve also seen many places that have eliminated the use of seclusion or restraints entirely. If these places can do it, so can this unit. It only takes the will to change.

    I started back in the 1960’s by volunteering at a free clinic. I was a good listener and I find that the same thing works today in the mental health realm. I have never needed force or coercion (a locked door, formal structure, medication, etc.). Back in 1970 in Portland, Oregon where our modern mental patient movement started, they issued a manifesto. Item 3 on the list was, “We demand the establishment of neighborhood freak-out centers, entirely controlled by the people who use them. A freak-out center is a place where people, if they feel they need help, can get it in a totally open atmosphere from people who are undergoing or have undergone similar experiences.
    “I see the freak-out center as a place where there will be people who know where people freaking out are at because they have been there and they won’t cut them off because they know how devastating that can be. The people that live and work there see themselves as no more sane than anyone that will come there. Everyone is insane and everyone freaks out.” (Insane Liberation, Portland, Oregon.)

    That sounds an awful lot like what I used to do in the free clinics. Modern peer support can provide this function without the rigid structure of an inpatient hospital.

    Inpatient hospitalization is traumatic. Jonathan might be kind and benevolent but, he’s a single individual. The entire staff are likely more grounded in the medical model. We’ve become a pharmacracy and hospitals are the worst. (http://dxsummit.org/archives/1244) We have words to describe medical conditions but not an adequate vocabulary to describe the sorts of abuse, neglect and trauma from which people suffer. That doesn’t stop medicine from trying to medicalize these human feelings.

    Psych hospitals are not places of healing. They are confinement and containment at best. Healing comes from self-determination and in the context of community. The artificial nature of hospitals are not conducive to healing.

    Besides, hospitals are supposed to be those places where medicine is practiced; with things on the walls where oxygen and stuff comes out and fancy beds where the feet and head can be raised and lowered and where they bring you food and let you sleep or watch TV. They hand deliver medicine and let you refuse. If you spend too much time in bed, they’ll rub your back and help you with kindness and gentleness. None of that sounds like a psych unit. There you must line up for medicine like a cattle call. If you refuse, greater force is used.

    Yeah, defend them all you want but in my experience, psych hospitals are all hell holes. Some are nicely gilded with better beds, food and color on the walls but underneath, they’re all designed to force compliance with medication that kills us 25 years too soon. Somehow that’s not my idea of a place that’s very healthful.

    Pat Risser

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  8. To the risk of sounding like a broken record, my position is the same: all forms of coercive psychiatry should be banned, period, no exceptions.

    Or, for those who don’t like statements with a negative proposition, nobody should be forced into any kind of psychiatric so called “treatment”, be it drugging, civil commitment or whatever, period, no exceptions.

    Now, with respect to those who misbehave, there is the criminal justice system to deal with them, period, no exceptions. The notion that somebody is doing somebody else who has not committed a crime a “favor” by labeling that person with a DSM label that will follow the person during the rest of his/her life is preposterous.

    To Jonathan: does any of those whose human rights are regularly violated at your facility, by your own admission, committed a crime? If the answer is no, freedom or voluntary forms of so called “treatment” is the appropriate course of action. If they have committed a crime, then jail is a perfectly acceptable option.

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    • I agree with your view that there should be no coercive psychiatry. When a person first comes to a hospital due to a hold, they have the right to refuse medications. Only a small portion, perhaps 5-10 percent go through a court commitment process. Only after they have been court committed can they be made to take medications. I have serious ethical problems with doing this. I agree.

      But as to those who “misbehave”, I have to disagree. If someone in the throes of severe psychosis and paranoia has become assault ive and violent, he last people I want to see are the police. They tend to not be trained in how to work with this population and generally use tazers or lethal force in the face of violence. I would prefer to help them move through the state they are in until they have become calmer. I just dont believe that folks who are violent while psychotic should not have to go to jail.

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      • The following statement (by Jonathan Keyes) should be amended (because it is wrong):

        “When a person first comes to a hospital due to a hold, they have the right to refuse medications. Only a small portion, perhaps 5-10 percent go through a court commitment process. Only after they have been court committed can they be made to take medications.”

        [P.S. — note: Here, I address what follows, in my comment, to Jonathan Keyes, even as he has commented (below) that he’s taking a break from replying to me. I will address myself to him, in order to avoid seeming impersonal — even though he tells me that he believes I’m getting too personal; after all, for some reason (I’m not sure why), to me, it seems wrong to be completely impersonal in my MIA comments.
        (Maybe I have become convinced that this is truly a community, and I am a part of it? Yes, I think that may be true.)]

        So, here I’m attempting to walk a middle-way; being community-minded, I am speaking somewhat personally to you, Jonathan, even as you’ve expressed that you’re done dialoguing with me (or, maybe, just taking a break).

        As you have no intention of responding (or, at least, have taken a break from responding) to me, I will surely welcome replies from any MIA reader/s who care to offer feedback…

        OK, so…

        Jonathan Keyes,

        I believe you are actually quite sincere in what you say, throughout you op-ed and comments.

        Nothing you’re saying in these discussions is deliberately misleading; I say that with full assurance, that I’m right, in this sense; having carefully studied your op-ed and your comments, I take you to be doing your best to just ‘tell it like it is’ in all ways.

        Nonetheless, as someone who cares a great deal about the issues you raise in your op-ed, I have come to feel a certain ‘duty’ to point out some really serious factual problems, in your writings, that have caught my attention…

        On another recent MIA thread, you and I have already ironed out the reality, that people are, in fact, frequently put on nueroleptic ‘medications’ without a prior physical screen for ‘recreational’ drugs. (You had first indicated that all “patients” in psychiatric “hospitals” are tested for ‘recreational drugs,’ but, I pointed out, that’s not the case, and you kindly agreed.)

        That was a truly minor point in comparison to the issue I will raise in this comment.

        This comment shall, hopefully, shed light on a major blind spot you have…

        As I’ve said elsewhere (in my comments, on this thread and on another MIA thread): I believe you are prone to painting “inpatient hospitalization” as being a far more potentially benign/safe experience than it actually is for most who experience it.

        You speak confidently of what you see as a broad movement that’s effectively putting an end to psychiatric abuse within “hospital” settings.

        (I’ve told you, in various ways, on this page and on another MIA thread, that I see no evidence of this.)

        You write with broad strokes, from your point of view, at work, in a “hospital” that’s apparently been regulated by what are, actually, quite unusual psych-rights protections (and, perhaps, your “hospital” has an unusually good-intentioned staff as well); my sense is that your observations of “inpatient hospitalization” are, thus, limited; in deed, I believe you bit off more than you can chew, attempting to describe what “inpatient hospitalization” is all about…

        In this instance, we find a comment (directly above) wherein you offers your view that,

        “When a person first comes to a hospital due to a hold, they have the right to refuse medications. Only a small portion, perhaps 5-10 percent go through a court commitment process. Only after they have been court committed can they be made to take medications.”

        Jonathan, that’s a major factual blunder; as you’re an author replying to comments on his article titled, “Inpatient Hospitalization: An Inside Perspective,” I believe you owe it to your readers to correct yourself, here.

        I do trust that believe what you’re saying, and I fully presume that what you’re saying truly describes how “inpatient hospitalization” works in your neck of the woods.

        (Note: I get the sense from exchanging comments with him, that he is quite well-intentioned, and he has no desire to be deceptive. He does a bit of inadvertent misjudging of what he reads, in the comments directed to him; but, so do most writers who field comments on controversial topics. So, I do not take his begging out of a comment-exchange personally, and I very deliberately assume that he’s well describing what’s happening in his own “hospital”.)

        However, what he’s saying here about a supposed “right to refuse medications” for people on “holds” is absolutely not true of how psychiatric “hospitalization” works throughout most of the United States.

        This is to say, his comment, above (on December 1, 2013 at 10:21 am) is providing information that’s terribly mistaken.

        Throughout most of the U.S., when people are put on a psychiatric “hold” (i.e., a relatively brief psychiatric “hospital” ‘commitment’ — be it for a few days or a number of weeks), it is for the expressed purpose of what’s usually called “observation and treatment”; that ‘treatment’ can and does include unwanted ‘medications’ — frequently.

        In deed, many (countless) people are put on “holds” and instantly, forcibly drugged.

        (That happened to me, despite my screaming “No!”)

        Many (countless) people on “holds” are forcibly drugged after refusing to swallow drugs orally.

        In the first instance of my being put on “hold,” I was instantly forcibly drugged (and screamed “No!”) — never having even been given any option to take a drug orally.

        (Probably, they well sensed that I would not be up for taking any drugs, so they didn’t even talk to me about ‘medications’ at all.)

        They just walked me from the room where the psych-evaluation was finally completely, to another room, where there was a gurney; in that small room, with a “hospital” chaplain beside me, I was instructed to just lay down and relax.

        A few minutes later, in came the men who’d strap me down and inject me with neuroleptic drugs, as I screamed “No!”

        Throughout most of the United States, no court order is required to initiate such a forced drugging.

        Simply, a psychiatrist or similarly ‘authorized’ professional in the ‘mental health’ field, who works for the “hospital,” orders the members of a psychiatric staff, who are trained to forcibly drug people: Go drug that person who is now on “hold”.

        So far as I know, there needn’t even be any particular reason given for such forced drugging.

        (No one ever explained to me why I was being forcibly drugged, in that above-mentioned instance, nor would I receive any explanation for yet another experience, of being forcibly drugged, later that same day. Quite honestly, neither time was I demonstrating even the least bit of a threat, to anyone. I was never a threat to myself nor to anyone else. But, I was accused of being a threat to myself, and that ‘justified’ all kinds of unwanted ‘treatment’.)

        So, does th law that allows for such druggings differ greatly from state to state?

        It’s my understanding that only a very small percentage of States have any protections against forced drugging for people on “holds”.

        According the law, throughout most of the United States, any person placed on “hold” has already been declared “a danger to himself/herself” and/or “a danger to others” …ostensibly “as the result of mental disorder”; the law (in most states) stipulates that such people can be “held” for “observation and treatment”; no protections against forcible ‘treatment’ in the form of ‘medication’ ever enters the legal equation.

        Though, emphatically, I readily admit that I’m no expert on the law; simply, I do believe that, generally speaking, such is the essence of the law, in most of the United States, as it applies to psychiatric “holds.”

        And, note: My understanding is that, even in states which do provide some legal protection against unwanted ‘medications’ for people on “holds,” there are also many exceptions — as stipulations, in those laws provide that events deemed “emergencies” can warrant forced drugging.

        So, in reality…

        Forced drugging is an all too common experience of those who endure “inpatient hospitalization” in the form of psychiatric “holds”; throughout most of the United States, it happens quite frequently; that is a basic factual truth…

        Respectfully,

        Jonah

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        • P.S. — Jonathan, perhaps, you noticed that, half-way through my comment, I offered a parenthetical phrase, in which I was speaking of you in the third person. Then, I continued speaking in of you in the third person, even without parentheses. That was not planned; it just happened. It was a ‘slip’ into the third person. I guess part of me feels that, because you say I was getting too personal, I should not address you directly anymore. (Yet, here I am addressing you directly, as another part of me feels I should address you directly.)

          Note to MIA readers: Though I may be confused as to whether or not I should be addressing Jonathan directly, in these comments, of mine, I believe I’ve been factually accurate, when it comes to the substance of what I’ve been saying.

          And, about the substance of what I’ve been saying, I’ll be happy to receive feedback, from any MIA reader.

          Respectfully,

          J.

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  9. Thanks Pat, I agree with all you say here….and the question still remains in an open, self referred, voluntary peer support settings, “freak out centers”, that sometimes (fortunately it’s rare) the peer staff are faced with threats of violence while someone is in the midst of their personal journey. This creates a “gap”, in our values and thinking when you are in the midst of someone yelling in your face and threatening to harm you….How does one hold true to the value of no force , “being with” and not run the risk of being assaulted, injured and traumatized? Assume you’ve taken the path of least resistance already, and of course have tried to deescalate the situation, meaning, stepped out of the energy force, opened the door and asked the person to go outside, etc… leave…walk away, take a break, they continue to escalate. Do you wait to be hit? or call the police? These are some of the real life situations that respites may or are actually facing today. Often drug induced states of violence =Methamphetamine’s, alcohol etc….Calling the police is force, trauma for everyone in the setting to witness etc.
    At this point we call police (in our Respite) While these occurrences are quite rare, they have happened. Sera says in RLC-MASS…they would have a “critical incident review”….I’m surprised they have never had to actually exercise this at their respite, we’ve been open three plus years and have had to do this and it’s awful, but at some point I think we all have to accept consequences for our own behavior and intent to harm another is not acceptable in any environment, home, streets etc. no one is employed to be assaulted and harmed so that another can work through their internal struggles. Being faced with calling the police doesn’t feel like an acceptable outcome either….we are still looking for answers to this question.

    Sera, your question re: Danger to Self (DTS) =suicidal thoughts, feelings, intent….to me is existential on a deeply individual and personal level and does not belong on the menu of health care per se. That said, I find it ridiculous that people are put in locked care for DTS. And to add insult to injury, they are “treated” for “depression” which of course is how the issue of health is pulled in and then you go down the path of the medical model which of course justifies the use of anti-depressants to force the person to treatment….it’s all insane, and shows complete disregard for individual states of being, the human experience of moods and ups and downs…. This of course gets complicated when states of self harm are possibly being influenced/induced by substances, illicit and/or prescribed…then the “health care” issue veers it’s ugly head again…

    I think the question of drug induced states, lets just limit the question for a moment to drugs like Meth, which are a real issue in our community and often present with extreme states of violence and may last for days or even weeks…these drug induced states are huge challenges when faced with criminal charges, police interventions OR “health care:”=lockem up in psych hospitals…..I keep coming back to this as I have found that these are the circumstances that we haven’t been able to resolve without police intervention which equals force and causes great trauma to all involved.

    Thoughts, suggestions are welcome.

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    • Yana,

      We haven’t – for whatever reason – had the experience that you describe that would have led us to call the police… we’ve had plenty of intense situations – including issues with drugs – but not that as of yet. Do you do a critical incident review when you do?

      -S

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    • Very challenging to be respectful and compassionate if someone is directly assaultive. I much prefer working with hospital staff and we simply do not allow police to come in to the picture. The tool bag for police officers is very narrow and they tend to have much less training in how to help someone who is experiencing psychosis and is aggressive.

      While meth and drug induced aggressive states from meth and alcohol are not uncommon, I am often more concerned when we receive people from jail or who have an extensive criminal history. It becomes that more important that staff develop good skills in interpersonal communication and deescalation.

      As for suicidality, this is a tough one for me. We get many patients who have been suicidal or have made a suicide attempt. They are placed on a hold for a short period- meaning they have to stay in a locked facility. Often within a day or two, most of these folks leave as they are no longer suicidal. I think it makes sense to have a place that can act as a sanctuary for people who are in extreme distress and are not thinking clearly. By taking a day or two to reflect, they often change their minds. Is that a service, or a harm to someone who is contemplating suicide?

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      • “I think it makes sense to have a place that can act as a sanctuary for people who are in extreme distress and are not thinking clearly. By taking a day or two to reflect, they often change their minds. Is that a service, or a harm to someone who is contemplating suicide?”

        Two problems with this argument. First, there is evidence that the humiliation that comes with being involuntarily committed and drugged can be more traumatic than whatever experience incited somebody to becoming suicidal. Speaking of my own experience, my civil commitment happened under a European “need for treatment” standard which is way more abusive than anything that is possible today in the US -ie, I was not dangerous to anybody. I have from time to time nightmares about being civilly committed even though it has been several years since that happened and the possibility of being civilly committed in the US under the circumstances that resulted in my commitment are zero. The last time I experienced one of these vivid nightmares was a few days ago. The trauma doesn’t go away with time. It stays with you. Being civilly committed has altered the course of my life in so many negative ways that I would need an entire book to elaborate each of them.

        But my most important argument is the second one. It all comes down to whether one respects individual rights. You are defending government imposed paternalism, which has caused more suffering to more innocent people than we can count. Even if 100 out of 100 people surveyed said that they were “grateful” to have been civilly committed, that should have absolutely no bearing in my decision to reject any such intervention. That is what an individual right is.

        And yes, I do believe that somebody who behaves violently is better served by calling the police than by leaving that somebody in the hands of psychiatrists. As a criminal defendant he/she will have rights that are routinely denied to those are civilly committed in the name of paternalism.

        In a different context, CS Lewis said “the greatest evil is not now done in those sordid “dens of crime” that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed, and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voice.”

        That is how I see the work of the APA and all those who defend in some form or another coercive psychiatry.

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        • @cannotsay: in my entire time as a part time therapist in a hospital setting, I have only seen one person civilly committed for being depressed. For the vast majority of folks who come to us depressed and suicidal, they leave within a few days. There is no forced drugging.

          The bigger issue for me is that here folks often are prescribed strong anti-depressants without a full ne’er standing of their scope of efficacy, side effects, long term health issues and challenges around withdrawal. To me it is more an issue of informed consent. He consent part is often their, but not the informed part.

          As to supporting government imposed paternalism, I hear that critique, and I am in no way defending the current state of mental health care. We need an overhaul.

          But right now, if a friend was drunk and started slashing their wrists, I would want them to get to a hospital. After getting sober, most of the people I meet do not want to kill themselves. Is it paternalistic to put them in a locked ward? Yes. And I would like to see alternatives. But that day or two can help many people change their minds and is worth it to me.

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          • Jonathan,

            You are resorting to the old trick of “retrospective validation” to justify paternalistic and abusive interventions. Again, I don’t buy it. As I said, even if 100 of every 100 people surveyed were to be happy with their commitments, that should have no bearing in my decision to deny one such intervention.

            Potential “retrospective validation” could be used to justify all kinds of paternalistic government interventions,

            – “Fat camps”: the government could kidnap all obese people and put them in a strict dietary regime. I am sure that many formerly obese people would be thankful for having been kidnapped. In addition, many of the 600,000 annual deaths in the US due to heart disease will probably be avoided, not to mention many billions of dollars caused by obese people.

            – Banning gay sex among men and/or quarantining HIV positive gay males in high risk urban areas. The New York Times had an article this week about how unprotected sex has become very popular among these gays (with ~ 70% of surveyed gay males reporting that they had one such encounter in the last year). The vast majority of new HIV infections come from unprotected sex among gay males. The US government alone spends 14 billion dollars a year on HIV programs, most of them on gay males. ~ 15,000 people die each year of preventable HIV infection, most of them gay males. I am sure that many of these gay males would appreciate that somebody would have stopped them before engaging in a sexual act that gave them AIDS.

            Note that even the alarmist TAC is unable to put the number of violent deaths caused by so called “untreated serious mental illness” beyond 1,000 a year, which is very little compared to the number of lives that could be saved by kidnapping obese people into “fat camps” or quarantining “gay males” in high risk urban settings.

            At the end of the day, it’s the same empty, exaggerated defense of abusing people human rights for “their own good”.

            What we in the survivor movement lack is the political influence that prevents government from kidnapping obese people and quarantining gay males in high risk urban areas. And the reason we lack that political influence is the stigma that the APA and people like you create with these fairy tales of “danger” and “how good” it is to so called “treat” people who would “otherwise end up in jail”.

            I have also said several times that the only issue I care about in the context of psychiatry is the abolition of coercive psychiatry. That conviction is reaffirmed every time that I debate the issue with somebody who uses your line of argument to defend coercive psychiatry.

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          • @cannotsay…sorry I missed your comment. Let me try and respond. You lay out some really goods points and I will take some time to reflect on them.

            One thing though, just to delineate the difference between a hospital hold and a court commitment. The first one last a matter of days while the other tends to last up to 180 days. When I was talking about holding someone who was drunk and suicidal, it referred to a hospital hold, not a commitment. Ad again, as soon as the person clears from the alcohol, they are usually no longer suicidal and usually the hold is dropped and they leave.

            But you bring up a really valid point. Is it the governments job to intervene when people make poor choices such as getting high and then making an impulsive choice to hurt themself (or worse, what they deem are bad choices like the examples you bring up)? I will have to reflect on that one.

            On an emotional level, I can imagine a friend having a really bad night, getting high and then trying to hurt themself. On an instinctual level I would want to protect them by getting them to a hospital where they would have to stay until the drugs wore off.

            But by allowing the government to intervene in this manner, am I condoning the government to take away a person’s inherent right for self-determination. Really hard question. I’ll mull that one.

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          • Jonathan,

            Thanks for your reply. For a lengthy, but very worthy debate, on these matters you can take a look at this conversation organized by the CATO institute last year http://www.cato-unbound.org/issues/august-2012/mental-health-law . My “fat camp” example is taken from one of the essays by Jacob Sullum. The HIV example is my own. I can come up with many others like banning smoking, banning high risk sports, etc.

            After listening to arguments from both sides, it all comes down to the question that you ask at the end: does government has a universal right to protect people who have committed no crimes from their own self inflicted harmful behavior? Those who adopt my position say, unconditionally NO: there is already the criminal justice system to take care of harmful individuals.

            Those who answer in the positive have to address what is “harmful behavior” for the purpose of a paternalistic intervention. Why is it “acceptable” to prevent somebody from taking his/her own life via a drug overdose but it is perfectly acceptable to have somebody kill himself/herself via consumption of calories or having unprotected sex that would expose the person to HIV. What makes a death via drug overdose less acceptable than a death caused by a heart attack or an AIDS related disease? Aren’t all preventable deaths equal?

            Those who adopt my position, at least I, give you that if paternalistic policies were to be widely adopted many lives would be potentially saved. However, we also take the position that by letting paternalism kick in a greater evil is inflicted on the individual affected by the application of the policy as well as on society at large: government denying non criminals their right to self determination, as you put it. For government to “terrorize” its citizens, all it needs is the threat of its ability to impose paternalistic policies on them. So, on balance, the only acceptable option for those like me who believe that individual freedom trumps the “alleged benefits” is to ban all forms of psychiatric coercion. And all forms of Bloomberg-like soda sizes as well, BTW :D.

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          • Cannotsay…after this conversation, all I can say is that you have given me more to think about. The question of how society intervenes in terms of suicidality is very complex. And as you say, we willingly condone oth forms of very self-destructive behavior that will likely lead to early death (smoking, drinking, obesity). Yet we allow the government to intervene during someone’s very private choice to take their life.

            I think the notion of when and when not to intervene is complex. I think most interventions happen because the situation is so immediate that police have been called. Someone is about to jump off a bridge or someone has slashed their wrists and a family member called for help. On a visceral level it seems heartless to ignore a bridge jumper because I am honoring their “right to self-determination.” A the same time we allow people in my state to kill themselves if they are facing a serious disease.

            No easy answers and its a very grey area for me. The funny thing is there is an argument on the other side that we release suicidal people way too quickly in a hospital setting. Most folks who are suicidal leave the hospital within a few days. Many times its the next day. There is an immense push to get these people out the door. Most of them are in a fragile emotional condition and we give cursory advice to follow up with a provider/case manager/therapist.

            On a deeper level, I have encountered people who are so tortured by their experiences, so traumatized by their extreme emotional states or their poverty and homelessness that they regularly contemplate suicide. One of my main jobs is to talk to people in that state and explore the notion of suicide and reasons for living. Often times I completely understand the reasons why people are suicidal. Yet I work toward finding some sense of purpose, some sense of meaning, even in the face of feeling tortured and constantly miserable.

            A very muddy grey area. Thanks for the conversation and your insight.

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          • Jonathan,

            I am happy to hear that you concede that our disagreement here lies in competing visions about the ability of government to impose behavioral control on non criminal citizens. Nothing bothers me more than when I am accused of being “heartless” when I defend my position. I am not heartless, I do however think that a greater evil is caused in the “forest” under the excuse of “helping” a few “trees” by those who defend your position.

            I do not buy the “these are complex issues” line of reasoning either. This is very simple, I believe that no behavioral control is warranted on non criminals under any circumstances, period. It cannot be simpler than that.

            Note that to defend your position you have had to resort to contradictions, like on one side defending forced so called “hospitalizations” to prevent suicides while on the other not opposing euthanasia. I do not buy your argument “on a visceral level it seems heartless to ignore a bridge jumper because I am honoring their “right to self-determination.” “. Well, that is what we do when we let gay men engage in unprotected anal sex with other gay men or when we let an obese person consume a 1000 calories hamburger. We do not demand in either case a psychological evaluation of “being in their right mind” or that they sign a release form that they know that what they are about to do exposes them to a high risk of death (around 7500 gay men die each year of preventable AIDS transmission in the US alone). Note, that if we were to do so, by forcing these people to think before acting, many gay men would be spared of AIDS and probably many obese people would be also spared of a heart attack. I don’t see you supporting such procedures to prevent the spread of AIDS or to prevent deaths by heart attacks -even though both types of deaths cost more money to society than suicides because they require expensive medical treatments all the way until the end- and yet I see you are still defending your work, despite all your qualifications.

            At core, this is the problem with the “positive liberties” approach, that contradictions are inevitable. If you are happy with your contradictions, I have nothing to object. At the same time, on matters such as these that affect so negatively people’s lives, I believe that a “negative liberties” approach is more warranted.

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  10. Thanks for this post, Johnathan. It reminds me that while I observed a great deal of psychiatric abuses when I worked inpatient in the 80’s – I also saw great compassion exhibited on occasion towards people acting out violently when in the midst of a severe crisis. A slippery slope, I know – but I can’t rule out restraint absolutely when witnessing people trying to hurt others and themselves.
    I appreciate Yana’s comment about the “gap”, acknowledging the struggle between our values and practices.
    To widen the context a bit – many people get incarcerated for acting dangerously while in an emotional crisis. How can we act most compassionately when people are in these extreme states? Certainly we can do better than jail?

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    • Thanks Wayne. It is a slippery slope, and one that needs to be monitored very carefully. It is interesting the fine line between incarceration and psychiatric care for those who are emotionally distressed and acting dangerously. I agree in many circumstances we should do better than jail. We have enormously high and excessive incarceration rates.

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      • Jonathan,

        “Fine line between incarceration and psychiatric care?”

        Really
        What “fine line?”

        If someone is being locked up against their will, they are being incarcerated. And if they are being drugged and/or restrained against their will they are undergoing force.

        The only question is whether their civil rights are being violated; not whether you or your staff feel you are doing the right thing.

        Feelings are important, yours included. But not when it comes to this subject. Your feelings, and those of your fellow staff are trumped by the constitutional rights of the people your “hospital” incarcerates.

        Agitated.
        I bet there are a bunch of agitated patients on the “hospital” floor. What sane and/or mad person wouldn’t be?

        Duane

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          • From the piece cited above:

            The United States Supreme Court has unequivocally declared involuntary commitment a “massive curtailment of liberty” requiring due process protection.94 While the government does not have to prove its case beyond a reasonable doubt, it does have to prove it with more than a preponderance of the evidence.95 Further, involuntary commitments are constitutional only when: “(1) ‘the confinement takes place pursuant to proper procedures and evidentiary standards;’ (2) there is a finding of ‘dangerousness either to one’s self or to others;’ and (3) proof of dangerousness is ‘coupled . . . with the proof of some additional factor, such as a “mental illness” or “mental abnormality.’’”96 The Court has suggested that the inability to take care of oneself cannot be considered a sufficient finding of dangerousness, unless survival is at
            stake: “a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”97 In addition, “although never specifically endorsed by the[United States] Supreme Court in a case involving persons with mental disabilities,” it also seems people may not constitutionally be involuntarily committed if there is a less restrictive alternative.98

            94. Humphrey v. Cady, 405 U.S. 504, 509 (1972).
            95. Addington v. Texas, 441 U.S. 418, 432–33 (1979).
            96. Kansas v. Crane, 534 U.S. 407, 409–10 (2002) (quoting Kansas v. Hendricks,
            521 U.S. 346, 357–58 (2002)).
            97. O’Connor v. Donaldson, 422 U.S. 563, 575–76 (1975).
            98. PERLIN & CUCOLO, supra note 27, at § 2C–5.3.

            So, my question for you, Jonathan is this:

            Is your “hospital” operating within the law, or outside the law? This, IMO, is the *only* question that needs to be addressed.

            Duane

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          • If I might go out on a limb a bit, it seems to me that Jonathan is advocating for de-escalation over criminal punishment in event of assault.

            Assault, if established at a trial, is a crime. I’m all for de-escalation in tense situations. I believe that Jonathan is saying he believes that hospital staff are more prepared for these situations than police.

            However, what concerns me is the lack of trial or any independent review. Do hospitals have an independent party review all the video footage of these incidents? Is it ever established whether they were acting in self-defense to a system that threw the first stone and instigated the use of force? The standard of self-defense must be applied equally to all parties involved, or application of the law is discriminatory.

            Instead, these ‘assaultive’ patients, instead of having a trial or any kind of independent incident review, are punished with increased doses of drugs regardless of who started the fight. Whether these people initially consented to take drugs at some dose, is irrelevant. If the dose is increased without explanation or consent it constitutes force and is punitive.

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          • It is *not* Jonathan’s right to “advocate” for anyone, at least not in the sense of a legal advocate.

            We have a legal system for that, where advocates are licensed to practice *law*; to represent their clients as *lawyers*.

            Unless I’m mistaken, Jonathan is a therapist, not a lawyer. A person whose freedom hangs in the balance needs a good lawyer, not a mental health professional.

            Duane

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      • “It is interesting the fine line between incarceration and psychiatric care”

        I would never, ever call psychiatry “care”. In my eyes, there is no fine line: there are TWO jail / prison systems in America.

        Psychiatry is one of them.

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  11. I’d like to address Kermit’s queries. I don’t believe there is a one size fits all solution to dealing with people who are agitated or potentially violent. But I know the psychiatric / medical industry has historically, and still is, abusing their power. I believe this is the real problem – absolute power corrupts absolutely. And my experience with forced psychiatric treatment is an example of such abuse of power.

    I was dragged out of my bed in the middle of the night in September of 2006 due to a sleep walking and talking problem, likely due to lithium withdrawal induced issues. Five paramedics dragged me out of my bed, while the sixth paramedic told them, and me, that what they were doing was illegal because I was neither a danger to myself nor anyone else, since I had agreed to just go back to sleep.

    This is true, I would never even hurt a fly (unless it was really bugging me). The only people in the entire world who, I understand now from reading all my medical records, considered me a potential threat were those who had chosen to try to cover up a prior “bad fix” on a broken bone, with a bad drug cocktail. Then misdiagnosed the resulting ADRs and withdrawal symptoms. Then mistreated these with Risperdal, which resulted in a confessed “Foul up.” Then this resulted in a further cover up of my egregiously adverse effect to the psychiatric industry’s precious new “wonder drug.” Plus, those covering up medical evidence of the abuse of my child.

    And these paramedics took me to the hospital these doctors work out of, despite the fact I’d switched doctors and medical insurance groups upon the advice of a subsequent doctor, thus this hospital was no longer covered by my new insurance group. This hospital inexplicably put me on a hypnotic drug, and shipped me unnecessarily over an hour from my home to another hospital, to a Dr. V R Kuchipudi. Kuchipudi was arrested in April of 2013 for having patients who did not require medical care shipped long distances to him, egregiously miss-medicating (“snowing”) them, and ordering unneeded surgeries for profit. Please read about his abuse of other patients:

    http://www.justice.gov/usao/iln/pr/chicago/2013/pr0416_01a.pdf

    http://projects.propublica.org/checkup/providers/1345809

    I think the authorities should be looking into all doctors with prescribing patterns like Kuchipudi’s, personally. By the way, Kuchipudi’s “snowing” partner at Advocate Good Samaritan hospital was a Dr. Humaira Saiyed.

    Nonetheless, I was terrified of rape as six giant men almost immediately strapped this 135 lb pacifist to a bed and pumped me full of the following drugs:

    Benzotropine, Depakote, Haloperidol, Lorazepam, Ziprasidone, Alum-mag hydrox-simeth, Divalproex ER, Quetiapine, Acetaminophen-isometh-dicloral, Seroquel, Geodon, Midrin, Tylenol, Mi-Acid II, and Milk of Magnesia.

    I’ve taken my name off the organ donor list now. Apparently being on that list is “too tempting for some doctors.” The reality is that giving doctors the power to hold people against their will and force medicate patients results in abuse of that power, like I and no doubt many, have dealt with by doctors like Kuchipudi and Saiyed. Power corrupts, and absolute power corrupts absolutely. The doctors have too much unmonitored power currently.

    How did this most terrifying and appalling experience of my life, bar none, effect my future dealings with the psychiatric system? I did follow up care with a Dr. Gregory Teas, whose medical records state he believes my concerns of maltreatment by my former doctors were “odd delusions.” I guess he thinks the FBI has “odd delusions” now also. But Teas did eventually wean me off the drugs because he became embarrassed when I quoted my oral surgeon who thankfully stated the blatantly obvious, “concerns of child abuse are not cured with antipsychotics.” (I had been handed over medical records with proof I was originally misdiagnosed based on a list of lies and gossip from the people who allegedly abused my child, who unbeknownst to me at the time, were friends with the original misdiagnosing therapist.)

    I have been researching the psycho / pharmaceutical industries’ similar iatrogenic crimes against millions of others since, and want nothing to do with the psychiatric system ever again. I have no respect for an industry that is covering up medical mistakes and child abuse by defaming people with made up diseases and force medicating people with drugs that cause their made up diseases. I’m utterly disgusted they’ve turned over a million little children into bipolar / schizophrenics for life completely with drugs, in the exact manner paranoid doctors proactively prevented a non-existent malpractice suit due to a “bad fix” in me, and kept the alleged molesters of my child on the streets.

    A complete overhaul of the mental health (and mainstream medical) industry is needed. It is completely corrupt, at least based on my experience, and the fact Advocate Good Samaritan hospital is still claiming Kuchipudi’s and Saiyed’s crimes against me and others are “appropriate medical care,” due to their greed. And the fact all my former unethical doctors are still practicing due to the medical “wall of silence” problem and a completely unchecked medical industry. Medical “mistakes” are killing too many Americans now, because the government is not holding doctors accountable.

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  12. People who work in “hospitals” routinely use the word violent when what they are really faced with is unpredictability. Routine use of the word violence is part of the mentalism inherent in mainstream services.

    By using the word violent they brush the complexity of what they call difficult situations under the carpet along with their own complicity with generating what becomes violence.

    The mental health system is inherently violent, abusive and degrading from start to finish. The policies, processes, procedures and language used in psychiatric detention centres make them motors of violence. Professional legalized assaults by staff on involuntary inmates are only the tip of the ice burg.

    That the “medications” that are doled out often cause akethesia, which in turn results in irritability in an already extremely irritating environment is always discounted. This is just one example.

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    • My hope is that we could overhaul the system to provide alternatives to hospitalization. However, at this point, we are left with few options in the community when people are under severe emotional stress. I believe there should be an alternative to jail when someone is confused, becoming aggressive with disorganized thoughts. Respite houses will not take people unless they feel they are mostly “stable”. How do we bridge the gap and create sanctuaries for people to cycle through disorganized states in the most humane manner possible?

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  13. How about no locked doors for voluntary patients ?

    My thing was voluntarily going to the hospital with overwhelming anxiety and panic attacks (as a result of psych drugs) but that’s not the point.

    Why did I have to be subjected to crap like locked doors, strip searches and those degrading suicide precautions ???????

    Because doctors are stupid and misdiagnose anxiety as “mania” and coerce drugs with injection (chemical rape) threats is not a valid answer.

    After what happened to me I refuse contact with and treatment by any psychiatrist, psychologist or other mental health practitioner as these practices, according to my philosophic and/or religious convictions, do not adequately or properly diagnose and such diagnoses can constitute a false accusation about my behavior and/or beliefs and practices, and are stigmatizing and therefore a threat to my reputation and physical and mental well-being. Any of their treatments, given against my expressed wish, are an intrusion upon and thus an assault on my body and constitute, in my view, criminal assault. Any involuntary hospitalization or commitment is a violation of my right to liberty and would therefore constitute a false imprisonment by all those advocating and authorizing such action, against my consent and wishes. If in the future, I am accused of a crime, then I direct that I be subject to due process accorded to the criminally accused and not subjected to psychiatric or psychological assessment, processing, profile, confinement or treatments.

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  14. – “VPD data show that in the instances of violent crime, persons suffering from mental illnesses are 23 times more likely to be victims than the general public.” (Vancouver Police Department, “Vancouver’s Mental Health Crisis …” Sept. 2013)

    – I was told by a counselor at a particularly respectful recovery house for people labeled with addictions and emotional distress that she has never experienced a violent incident working with the very people predicted to be the most inclined to violence. She said that around the corner from this residence there are violent incidents daily in the hospital’s psych ward.

    – I keep waiting for Michael Cornwall to join the discussion with his stories of working in the I Ward in the 70s. His descriptions of holding people who needed to be contained so as not to hurt themselves make so much sense. Sometimes it took several people to hold someone and the outcome was that people found comfort in this embrace and would relax and often cry out their distress in the embrace of others. That happened in a hospital ward, didn’t it?

    Are we so averse to holding each other when it is needed? Perhaps the way school teachers are no longer permitted to give a young student a reassuring pat on the shoulder.

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    • Really interesting reply Diana- We also practice “holding” someone and waiting for a time for severe and violent emotions to pass. I have seen it work many times. More often I have seen the power of staff taking the time to listen to someone who is deeply angry, even if they are throwing furniture and smashing up a room. The key to the process is just being with the emotion without becoming triggered, fearful or reactive. There’s a lot of power in these ways of interacting with people in severe distress.

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  15. I’ve known people become violent on withdrawing from psychiatric drugs. Now there’s a can of worms.

    And as for comparing prison to psychiatry, there’s another can of worms. USA prisons have a certain reputation. Both psychiatry and the penal system need reform – or ending.

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  16. How about even more than an ounce of prevention ? Lets stop the coercion earlier ? Agree to mutually guaranteed survival. Lets have education on how to not abuse or molest or otherwise harm each other .Not within our families or outside . Stop the without informed consent , including what kind of delayed action poison is in this , wholesale injecting of vaccines into our bloodstreams right from birth and onwards.Obama’s kids don’t get injected. Homeopathy works better and is warpspeed safer.It was the first choice of the Queen Mother of England and she lived 102 years. Try Traditional Naturopathy and Yuen Method energy healing system and other natural systems and modalities that really first do no harm. Use a Hal Huggins protocol trained dentist instead of ADA primitive dentistry.Organic food and agricultural practices.All the above have everything to do with peace of mind and wellbeing, As for Psychiatry and Psychiatrists I agree with Pat Riser and the others above that don’t agree with Jonathan Keyes.Not an overhaul but an abandoning . Not a milking us for info to be filed and business as usual, but the revolution David Oaks envisioned . Fund and put the peers with lived experience in charge.That will save the most lives and facilitate the most healing.One more thing, don’t ask a survivor to sum up what sometimes has been a roller coaster lifetime of torture and how they escaped it in only 500 or 1000 words or less.Its insulting,to me it is anyways. And don’t assume your reflections on their experience will be more important to helping others than their own.

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  17. As requested, the complete Insane Liberation Front Manifesto:

    In 1969, in Portland, Oregon, our modern human rights movement was founded. Dorothy Weiner, a union activist and labor organizer put an ad in a local underground newspaper. Tom Wittick, a socialist political activist and organizer answered the ad. A shy young man who had just gotten out of Western State Hospital in Washington and was living in a half-way house was driven down to the meeting by his sister, Helen. That was Howie The Harp (Howard Geld), a homeless organizer. These three laid the groundwork for all that was to become our modern movement.
    Howie The Harp is the name to which Howard Geld had his name legally changed so that he’d have the same middle name as “Winnie the Pooh” and “Ivan the Terrible.” He learned to play harmonica from a fellow inmate once while locked up and found it to be a useful organizing tool and at times used it to support himself on the streets. In 1965, Howard Geld was a 13-year old patient in a psychiatric hospital. Often he could not sleep, and a night attendant taught him to play the harmonica. “When you cry out loud in a mental hospital you get medicated” – “When I was sad, I could cry through the harmonica.” He was given the name Howie the Harp on the streets of Greenwich Village, New York.
    They met regularly on Friday nights with a business meeting followed by social time. Sometimes they met in each others’ living rooms and sometimes they’d meet at a pizza house, the library or other gathering places. They’d have anywhere from 8 to 80 people show up for the meetings. They named themselves the “Insane Liberation Front.” At one point they were offered support by “Radical Therapists” who were a group of psychologists from the Air Force who had served in Viet Nam. The “Radical Therapists” published a collection of papers from the time and this is the chapter written by the Insane Liberation Front in 1971. The Manifesto is modeled after the “Ten Point Program” of the Black Panther party written in 1966.
    Insane Liberation Front
    We, of Insane Liberation Front, are former mental patients and people whom society labels as insane. We are beginning to get together – beginning to see that our problems are not individual, not due to personal inadequacies but are a result of living in an oppressive society. And we’re beginning to see that our so-called “sickness” is a personal rebellion or an internal revolt against this inhumane system. Insane Liberation will actively fight mental institutions and the brutalization they represent (e.g., involuntary confinement, electric shock, use of drugs, forced labor, beatings, and the constant affronts to our self-identity). Even in so-called “progressive hospitals” where many of the physical abuses do not occur, we’re still made to feel so low that our concepts of who we are, and our beliefs, are pushed down so far that we often end up accepting our jailer’s society. We will fight to free all people imprisoned in mental institutions.
    Insane Liberation plans to establish neighborhood freak-out centers where people can get help from people who are undergoing or have undergone similar experiences. We believe that the only way people can be helped is through people helping each other – people with hang-ups being totally open and sincere to each other. The majority of shrinks, on the other hand, set themselves up as all-knowing authorities and from their positions of power automatically assume that the so-called patient is sick and not the society.
    We demand, with other liberation groups, an end to the capitalistic system with its racist, sexist oppression and with its competitive, antihuman standards. We believe in a socialist society based on cooperation.
    Demands from Insane Manifesto
    1. We demand an end to the existence of mental institutions and all the oppression they represent (e.g., involuntary servitude, electroshock, use of drugs, and restrictions on freedom to communicate with the outside).
    2. We demand that all people imprisoned in mental hospitals be immediately freed.
    3. We demand the establishment of neighborhood freak-out centers, entirely controlled by the people who use them. A freak-out center is a place where people, if they feel they need help, can get it in a totally open atmosphere from people who are undergoing or have undergone similar experiences.
    “I see the freak-out center as a place where there will be people who know where people freaking out are at because they have been there and they won’t cut them off because they know how devastating that can be. The people that live and work there see themselves as no more sane than anyone that will come there. Everyone is insane and everyone freaks out.” (Insane Liberation, Portland, Oregon.)
    Insane Liberation plans to form freak-out centers immediately.
    4. We demand an end to mental commitments.
    5. We want an end to the practice of psychiatry. The whole “science” of psychiatry is based on the assumption that there is something wrong with the individual rather than with society. We see psychiatry as a tool to maintain the present system. Rebelling often means being immediately sent to a shrink because of “emotional disturbance.” We see that the majority of shrinks a) make money off our problems; b) see us as categories and objects. To them we are an “anxiety neurosis” or a “paranoid reaction” instead of a human being; c) foster dependency instead of independency by making us distrust ourselves and consequently look for answers in the all-knowing God, the psychiatrist.
    Many psychiatrists have already used their influences to discredit the revolutionary movement by calling it sick. We see that this will continue and get worse.
    6. We demand an end to economic discrimination against people who have undergone psychiatric treatment and we demand that all their records be destroyed.
    7. We want an end to sane chauvinism (intolerance toward people who appear strange and act differently) and that people be educated to fight against it.
    8. We demand with other liberation groups an end to the capitalistic system with its racist, sexist oppression and with its competitive, antihuman standards. We believe in a socialist society based on cooperation.
    9. “We demand the right to the integrity of our bodies in all their functions, including the extremist of situations, suicide. We demand that all antisuicide laws be wiped

    From “The Radical Therapist; therapy means CHANGE not adjustment”, The Radical Therapist Collective Produced by Jerome Agel, Ballantine Books, Inc., NY, September 1971, SBN# 345-02383-8-125

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  18. When I worked on a locked psych unit, I was the only one never assaulted because they all knew I was one of them. I didn’t hang out in the nurses station talking about who’s doing whom on Saturday night. Instead, I hung out with the folks and played pool or otherwise sat and chatted.

    When I worked as an Intensive Case Manager on the streets of Denver in the mid-80’s we met with police at every shift change and made sure they had our number. If they even suspected something amiss might be one of our folks, they’d call us. They never left the squad car. We’d respond immediately. We’d talk with the person and deescalate the situation. We also saved the system much money because we were empowered to release the officers back to patrol where they could go get real criminals. They didn’t have to do paperwork or transport anyone. The only time we ever needed the police assistance was one time when someone was obviously high on PCP. Angel dust gives super human strength (or at least the appearance because there’s no pain). But, we didn’t abandon care of one of ours to the police. We went with the person and we’d sit with them all night if necessary. Then we’d talk about what the person would like to have happen if there was a next time.

    I guess that’s the difference. Perhaps we had police backup for dangerous folks but we didn’t just turn it over to the police and wash our hands of it.

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  19. The labeled manic depressive do it at home ,don’t wana go into the loony bin but I’m freakin out, got to go to work on the nite shift loading trucks, haven’t slept in 2 days ,hearing voices ,got a wife and baby to support , don’t wana lose my job, emergency over the counter,necessity is the mother of invention,strategy to cycle through disorganized states. I took 1200 mg. of flushing niacin.When my body turned to itching red blotches, I laid down into a hot bathtub of water filled with 6 handfuls of Batherapy the kind loaded with mineral compounds ,green in color ,not the original. I had a I foot long loofa sponge ready to quickly rub down and soothe my itching body.I Even put my head under water.I laid back in the tub. Next thing I know I had woken from a deep sleep feeling I had taken the most rejuvenating nap ever.I actually slept for 2 hours.And I wasn’t hearing voices.Later slept some more in bed and was able to go to work.I weighed 180 lbs. was 32 years old on a vegetarian diet.That much niacin may be not ok for someone with a heart problem. I’d always, since the age of 17 when I was terrified by 15 electro- shock “treatments” one every other day,I wanted to invent some safe substitute so that other people wouldn’t have to go through that horrific ordeal.I figured with this niacin Batherapy combo I had reached my goal. I tried to notify the NIMH and NAMI and some Psychiatrist. What a naive dummy I was to think they even cared.I didn’t know of any activist community.I think this combo could be a possible voluntary option for the tool box in a respite setting.I’d wear a air filled collar as a precaution to prevent any chance of drowning or have someone else there watching and adjust the nacin for body weight.

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  20. Just want to add my one lone voice of reason. I have read a lot of awfully hostile comments directed at Jonathan who had the guts to write a piece that in my experience( witnessing the two horrific psych hospitalizations with my son in ’09 and ’11 as he was going further into some state of psychosis) is as accurate as he writes about. My son’s severe emotional crisis (twice) was IMO the result of the super strength THC he was using and tested positive for but many bloggers still question this association. And I respect everyone’s right to their opinion. I don’t think either hospitalizations ever gave my son any help, no compassion for sure. It was just rush to judge, dx, forcibly treat with massive drugs and warehouse while until my son’s PPO insurance (and let’s not forget the $15K we, his parents, ponied up the day before admission to be sure our son got the drug rehab we now believed he needed despite the first hospitalization ’09 telling us “he’s just a recreational cannabis user”). I would have loved to have had Jonathan’s help as I never met anyone, either of my son’s two hospitalizations that had knowledge, clarity, or compassion. Basically, in the 21st century of MH, there are no therapists from what I witnessed (and this is in two supposedly first rate psych centers/drug rehab in So CA) that care or offer support. The young social worker in’11 was terrified of the patients so hung on my sleeve to get the necessary paper work completed. No one asked my son “what happened to you?” or tried to understand the sea of stressors that led him to substance use. No one bothered to do the research that I have to done myself that yes, some susceptible brains especially <25 yrs can and are experiencing psychosis from cannabis.

    But I want to ask my fellow MIA bloggers- why are we shooting the messenger? Trust me, I did everything from taking my son to see his psychologist who recognized the start of mania, as sleep deprivation was huge. The therapist my son was seeing rec'd some idiot addiction specialist who ignored my son's pleas to help him get to sleep. (Apparently, this doc forgot basic Psych 101 that sleep itself can slow or abate psychosis). This doc preferred to push the toxic drugs again and recite to my son what the hospital in '09 had told him "once bipolar, always bipolar, MI for life, meds for life". But guess what? No, med for sleep!!!! So my son's psychosis worsened and despite the love we had for our then 24 y/o son we were frightened as his behavior became more bizarre, the delusions terrified us. My son was 6'5" and 230 lbs, his younger brother was just home from college and at 6'4" but leaner he, too, was overwhelmed with seeing his big brother whose brain was spinning out of orbit. After seeking help for a panic attack he had (again think cannabis drug related) in ER, no one offered any true support. In desperation, I contacted this drug rehab program who sold me a load of lies once I gave over the credit card. My son was terrified to go anywhere near another psych hospital after his experience in '09 but we promised, guaranteed he was only there for drug rehab as the hospital promised me. Lies, lies and more lies…. my son was not saying he was a danger to self or others (had NO history either) but was psychotic as I honestly shared before he was admitted. Please people, we are living in the 21st century of pathetic MH care, just how do you treat someone who is in such a frightening state of emotional crisis? My son was with us during the day, his young wife at night, but no matter we couldn't find a way to help his brain reset on our own!!!!!!!!!!!! My goal was to find a way to shut his brain off with sleep so putting him in for drug rehab was the only solution I could triage from my limited understanding. Of course, I regret ever taking my son to this disgusting facility but hindsight is 20/20. (And yes, it's imperative we find alternatives to these dastardly facilities so where the hell are they??????????)

    And truth be known, where does a person in this state seek appropriate, compassionate help? It's lovely we hear talk about resurrecting the Soteria Houses again but right now when someone is in this state, how do they get the right humane help? I'm not leaving this arena which I sadly stumbled into in Oct '09 when my then 23 y/o out of nowhere, after getting married, went into this state of psychosis. I have yet to hear in CA where I should have taken my kid where the outcome could have been different? I would love to know!!!!!!!!!! And I am not a strong believer in meds, especially psych meds, but my son weaned himself off the psychotropic meds after his brain re-emerged to normal (10 wks after hospitalization) and actually went to AA and got support to stop any recreational drug use, but he took his life 6 months after his locked psych discharge. What's wrong with this outcome? EVERYTHING!!!!!

    I'm also asking everyone to please put civility first when an MIA author writes a piece, especially an Op-Ed piece. I'm in Jonathan's court. I have seen psychosis in my face and nothing has terrified me in 55 years of life. And yet's not forget the tragic outcome of the recent news report about the VA State Senator, Creigh Deeds, and his 24 y/o "precious son" (Deeds' words) who according to report had been treated for "bipolar" but was experiencing some episode enough to warrant the son be admitted but a psych bed was not available. That poor father took home his son in a state I have seen with my son, twice, but whatever happened his son destabilized further and the next morning attempted to harm, perhaps even kill his father, who narrowly escaped critically wounded. And then every parents' nightmare, to learn his beautiful talented, gifted son got a rifle and took his own life.

    This is happening in every town across America. I still blame rampant drug "recreational" use but that is just my opinion. Whatever the reasons, we need help for our adult children and their families. Jonathan wrote an excellent, factual piece about what goes on in the psych centers of America. Instead of criticize him, we should thank him for bringing this subject to the forefront.

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    • “Just want to add my one lone voice of reason”

      This reads in a way you probably didn’t intend…however, no one has a monopoly on reason and for what it’s worth rationality and reason are over rated. imo

      The age of reason and rationality reached their inevitable conclusion with industrialized killing in two world wars. Like I say, reason and rationality are over rated.

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  21. Larmac, that’s a heartbreaking story. I’m really sorry for the loss of your son. Terrible.

    To start with, I get why there is a lot of angry and hostile comments here. I expected that and I get why there is so much anger in this community. The system has been so abusive and destructive that many people want to see the entire edifice of modern mental health “care” collapse. And if I in some way represent that edifice, then that anger will be directed at me. So be it. The anger is valid.

    However, we sadly don’t live in a world of Soterias, holistic management of emotional distress and non-hierarchal crisis centers designed to allow people to cycle through episodes with humane care.

    Your situation illustrates that problem completely.

    My hope is that new models of care develop but in that time what can a family member do in this broken system? It sounds like you did your best and still it was not enough.

    Again I am really sorry for your loss.

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    • “To start with, I get why there is a lot of angry and hostile comments here.”

      Jonathan Keyes,

      A lot of angry and hostile comments? Really?

      I have read through this entire Web page (more than once); there are currently 91 comments on it, and I do not see anything but highly civil commenting, from one and all.

      (Commenter larmac has written, to you, “I have read a lot of awfully hostile comments directed at Jonathan.” Much as I sincerely feel for that commenter’s grief, at having lost a son to the classic incompetence and corruption of the ‘mental health’ system, I do not see any hostility on this page, certainly not any being directed at you — none whatsoever. Is there even any anger being expressed on this page, really? I don’t know.)

      Perhaps, you could do me a favor and point out even one comment, which you consider hostile, toward you? Your doing so might be helpful (not just for me but for all readers, such as I, who have given up any hope that the ‘mental heath’ system can be positively reformed), as I think your accusation, that there’s supposedly a lot of hostility being directed at you, is highly germane, to the topic at hand.

      In my recollections, of being locked up in “hospitals,” one thing I cannot forget, is that there was always zero tolerance, by staff, for anger and hostility from “patients”.

      Expressions of anger and/or hostility from “patients” were, in fact, extremely rare; most “patients” were “medicated” in such a way, that they could not possibly have become visibly angry. And, even the most mildly hostile gestures from them, were were interpreted, by staff, as precursors to violence — and were, thus, ‘treated’ with restraints and hypodermic needles.

      Much as I truly believe you are, in your field, a genuinely well meaning professional, from your expressions here, at last, I can’t help but wonder whether anyone’s freedom and/or anyone’s right to a life free from ‘medical’ brain-tampering should be sacrificed, on behalf of your personal judgments, of what is or is not supposedly ‘hostility and anger.’

      Respectfully,

      Jonah

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      • Jonah,

        By and large most all the comments have been very respectful. The anger I see from comments here and elsewhere is mostly directed towards the system. I will acknowledge though, that some of the comments accuse me of being complicit with a system that perpetrates violence and that people like me who work in hospitals do it mainly for the paycheck. I would much rather have a dialogue about the issues going on in hospitalization then what a poster said about me though.

        I hear you that in a hospital setting, there is a high degree of alertness for anger and hostility. The reason is that is it can become the precursor to violence, usually directed at other patients. That is where staff at my hospital intervene to try and create a safe haven for all the patients. Sometimes that means offering a separate place to vent, separating individuals who are trigerring each other, offering a place to talk, etc. I believe you that there are hospitals where staff react to even the slightest pretext of hostility with drugs and restraints. That has to change. It is one of the main reforms that has to happen.

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        • “…some of the comments accuse me of being complicit with a system that perpetrates violence and that people like me who work in hospitals do it mainly for the paycheck.”

          Jonathan Keyes,

          From everything you say, in your op-ed, I see you as someone who is, by this point, complicit with a system that perpetrates violence (the ‘mental heath’ system). Most certainly, you are.
          How can I (or anyone else who reads you, who has likewise endured forced psychiatric drugging) possibly avoid coming to such a conclusion?

          You are someone who admits to forcibly drugging people.

          Are you unwilling to admit, that forcing psychiatric drugs on people is indeed a form of violence? (How can anyone fail to admit this, who has witnessed such violence going down?)

          All things considered, you are definitely complicit with a system that perpetrates violence, in my humble opinion (based on all that you say).

          Maybe, sometimes, it’s a kind of violence which prevents another kind of violence — which could, possibly, have become a worse form of violence. Maybe. Sometimes. Just maybe.

          From that point of view, you may possibly be doing more good than harm in that (truly violent) ‘mental health’ system overall. (I’m not sure, but, to me, it seems, this might well be the case.) And, in any event, I can’t be the ultimate judge of you, as I know that, I myself have been complicit with a system that perpetrates violence — and, who knows, perhaps, more than one such system. (E.g., whenever I’ve paid Federal taxes, some significant portion of that money has gone toward feeding this country’s military industrial complex — which perpetrates all sorts of violence, in order to supposedly prevent worse violence. Also, I pay local taxes, which support a police force…)

          Many people work in ways that are more or less complicit with violent systems.

          Some of those violent systems may, at times, do more good than harm.

          As you may be doing more good than harm, in the ‘mental health’ system for which you work, I can’t reasonably judge your work there, as ‘bad’ overall. I don’t know you or your work well enough to be the judge.

          But, I can be critical of your words…

          As to questions, of what motivates you to work in a psychiatric “hospital,” only you assuredly know the answers to such, and it seems that maybe, as you raise that issue, in your comment to me, you are referring to MIA author and commenter, Pat Risser’s, regarding his first comment (November 30, 2013 at 11:39 am)?

          He began that comment, of his, with this line: “Those who defend hospitals always seem to have some investment in them (like a paycheck).”

          It’s my impression, that, he was not necessarily referring to you, there; though, he may have been referring to you. Who knows? (I suppose he does.)

          Frankly, even if he was referring to you, I don’t read him as being particularly critical of you, generally speaking. (I see, for instance, how he went on, to explain, “Jonathan might be kind and benevolent but, he’s a single individual”). And, please note, even if Pat Risser’s first line was referring directly to you, he was not saying that people “who work in hospitals do it mainly for the paycheck.” (Those were your words, not his, and those words of yours are truly an exaggeration of what he was saying.)

          You were misreading him, I think.

          My ultimate point, then, follows from my first comment, above; and, it is this: From your response to larmac and now, from your response to me, I view you as being only human — and, thus, highly fallible, most particularly in how you interpret people’s responses to you.

          Your assessments of what is happening on this page are highly questionable, in ways.

          Having taken at least one commenter’s critical words way too personally — and exaggerating their meaning, you then, also, misinterpreted him.

          You made a broad, affirmative reference to the notion (suggested by larmac) that you’re receiving much hostility from readers.

          Of course, all that’s entirely forgivable; you’re only human, as I say, and these things happen — particularly in the midst of debating issues, such as these, which involve matters of life and death for millions of people.

          Meanwhile, what most troubles me about your op-ed and about your subsequent comments, is my sense that you are not accurately portraying life in the ‘mental health’ system, generally speaking.

          From all that you say, I gather that you are (apparently) working in highly unusual psychiatric “hospital” setting; in it, virtually all of the “patients” are (if we are to take your reports as accurate) being ‘treated’ quite fairly, as compared to most other psychiatric “hospital” settings.

          (Indeed, from what you write, it seems you may feel that literally all of the “patients” in your “hospital” are ‘treated’ fairly, period; and, yet, knowing that many of those “patients” are there against their will, I can’t reasonably judge their ‘treatment’ as being anything better than, ‘fair, as compared to most other psychiatric “hospital” settings.’)

          From all that you say, readers may figure that your psychiatric “hospital” is considerably less abusive than are most (maybe even imagining that it is not at all abusive).

          But, what happens to “patients” who have no desire to be there? What happens to them in the long run? Do you know, really? Truly?

          I mean to ask, in particular (of anyone who defends the supposed ‘good’ of his/her psychiatric “hospital”): what happens to those who have unspoken, deeply aversive reactions to being there?

          While you paint a picture of a setting that is, in the main, highly conducive to dialogue, surely, as an intelligent person, you cannot possibly believe that most “patients” on psychiatric drugs are fully capable of articulating their feelings?

          And, certainly, being intelligent, you must be aware, that: many (or most) “patients” on a lock ward shall never be fully willing to air all their difficulties concerning the ‘treatment’ they’re receiving?

          Or, do you actually figure that your “hospital” staff is so highly compassionate and attuned and receptive to all “patients,” that all “patients” wind up clearly conveying their complaints, in all instances?

          You describe your “hospital” as lending “patients” (in particular, lending those “patients” who are on relatively brief ‘holds’) certain therapeutic experiences.

          After a few days, the alcohol wears off, and ‘suicidal’ people are no longer suicidal?

          Meanwhile, my experience and observation of psychiatric “patients,” on locked wards, is that, most of them do not ever truly reveal their inner world to staff.

          Most don’t even begin to do that; however, most do wind up saying whatever seems most agreeable to staff, because staff hold the keys to their ultimate freedom from that setting.

          E.g., people who were never suicidal, to begin, may indeed wind up claiming to be suicidal — only because they’ve been accused of being a ‘danger to themselves.’

          By all appearances, they end up adopting the implications, of that ‘danger to himself or herself’ accusation.

          This is not to suggest that you’re doing no good, at work. E.g., I get that you truly don’t believe in that most common (utterly fallacious) psychiatric medical model, which suggests a supposed ‘need’ for long-term use of psychiatric drugs. Wonderful, really, that you refute that model.

          But, do you not suspect that you may be, in many instances, failing to realize what’s really going on, with at least some of thy “patients” who cycle through your locked wards?

          And, what about this fact, that, apparently, you do believe, quite strongly, in the supposed ultimate benefits of short-term psychiatric ‘medication’ use, in many instances. (Note: I am not wholly against such ‘treatment,’ except when it is forced on people.)

          You write, “These medications do not actually “fix” the underlying brain chemistry that lead to altered states of mind, but for someone who is overwhelmed, agitated, not sleeping, confused and plagued by delusions, a sedative drug can be a very helpful short-term measure. It allows the body to rest, get some sleep, reset, and try to find some balance.”

          Simply put, I insist, at last: what you describe there is completely foreign to my own, personal experiences with psychiatry…

          No psychiatric drug that I ever experienced, on any ‘short hold,’ ever did me even the least bit of good. (I say that with absolutely firm conviction.)

          Moreover, your description of brief ‘holds’ (as being quite benign and/or helpful) is nothing at all like the brief ‘holds’ that I experienced. (Please, understand, my saying this does not mean that I endorse long ‘commitments’.)

          All I know, at most, for sure, is how I experienced psychiatry.

          From the start, I never wanted its drugs.

          Yet, after a couple of hours of interrogation, in the Emergency Room, they were forced upon me, as I screamed “No!” (I had not been screaming, at all, prior to that moment; I had not behaved in any way threatening, in that E.R..)

          My experience of those psychiatric drugs was pure torture, from day one. (And, in fact, twice that day, I would be restrained and forcibly shot up, with drugs; though, I’d been threatening no one.)

          Naturally, those experiences were terrifying and infuriating.

          Therefore, as soon as I got out of the “hospital,” I would indeed wind up raging like a ‘madman’ (never before in my life had I done that); and, naturally, my doing that was horrifying for my family and friends.

          As a result, quite soon thereafter, I was “re-hospitalized” and, therein, received a psychiatric label, which suggests to ‘mental health’ professionals, that I’d supposedly always and evermore need psychiatric drugs coursing through my veins.

          I got away from psychiatry after a few years. I de-toxed from the psychiatric drugs.

          I never received therapy (because, considering the psychiatric labels that were tagged upon me, I couldn’t trust any therapist to protect me against psychiatric intrusions).

          I have been, gratefully, free of psychiatry and its drugs for nearly a quarter of a century.

          But, to some small extent, I still live in fear of psychiatry.

          And, I can only imagine how much more opportunity I would have had, to achieve real/tangible successes, in my life, had I never been put on that first, brief psychiatic ‘hold,’ in which I was forcibly ‘treated’ with what you call, “sedatives.”

          You write,

          “The main good thing I see is a strong movement away from using coercive tactics such as restraints and injectable medications for “managing” agitated patients. My hope is that this trajectory can continue and a strong emphasis can be placed on developing therapeutic alliances and utilizing de-escalation skills, such as offering a safe space and comfort measures, as an alternative to the traumatic practice of restraining and forcibly medicating people.”

          What you see is what’s directly in front of your nose. Likewise, we all see what’s directly in front of our noses.

          That is to suggest, I highly doubt that any real (scientifically verifiable) evidence suggests that, globally, in psychiatry, there’s a strong movement away from using coercive tactics such as restraints and injectable “medications” for “managing” agitated “patients.”

          (If there is such evidence, of course, I’ll be happy to study it — but with all due skepticism. After all, I am entirely doubtful that psychiatry can be reformed, in any significant ways, globally. And, I have no use, myself, for any government’s ‘mental health’ system; but, I’d gladly welcome trends which clearly and undeniably suggest that the severity of abuse being perpetrated by such systems is being effectively reduced.)

          Respectfully,

          Jonah

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          • Maybe there are a small amount of institutions like where Jonathan works that are allowed to exist to attempt to give a more positive spin on coercion, that are encouraged to play the role of some kind of More Benevolent Psychiatric Theresienstadt in order to keep the general population asleep while business goes on as usual most everywhere else. Considering the increasing danger of the cocktails of poisons called meds, the new more dangerous ect ,the ever increasing number of coerced patients some as young as a year and a half old. IMO

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        • Okay Jonah, ill try and address your post after taking some time to read it. There’s a number of issues you address in there so I’ll try to look at each one.

          The first one has to do with my perceptions of the reception to my piece here. I again want to state that I really don’t want to talk about individual perceptions of my character. I would much rather have a broader conversation about the topic of hospitalization.

          You bring up some really important issues that I would like to address though. You say that I make it sound like there s less “abuse” in the hospital I work in. I can’t address my specific hospital but I can say that in general there is a strong similarity to all psychiatric hospitals, the desire to prescribe drugs as the fundamental way of treating emotional distress. I have serious problem with this. It is systemic and it happens at all hospitals. Prescribing drugs with long term health consequences without fully informing patients of these consequences is a serious problem. It needs to be addressed systemically at all hospitals.

          Th piece about supporting short term medication? Only if a patient who is fully informed about the medication makes a choice to take it. Or only by force if a patient has become violent towards other vulnerable patients or staff. It is an opinion that I understand is very unpopular here. I think I addressed that mostly in above comments.

          The suicide discussion is ongoing below so I will leave that for now.

          As to whether my hospital and its staff represents some alternate Pollyanna place? No. Like everyone else, they are human. But by and large I see staff trying to interact in a way that is respectful, does not move hair trigger towards applying force and are generally interested in the well being of the patients. In essence, I work with a lot of compassionate people. Still, I will agree that we are working within a system with a core philosophy of prescribing psychotropics that is bankrupt.

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          • Jonathan Keyes,

            Very, very good (I think), how you admit you “are working within a system with a core philosophy of prescribing psychotropics that is bankrupt.”

            Perhaps, then, it’s only a brief matter of time, before you awaken, to realize the bankruptcy, in your forcing those psychotropic drugs on “patients” (e.g., as a proposed ‘necessary’ precaution against violence).

            I trust you’ll awaken sooner rather than later, your blind-spot cured, so you then fathom the deeply immoral nature of forced psych-drugging — how surely it is entirely immoral, in and of itself… and how it effectively serves to prop up that very system, which you so rightly define as bankrupt.

            Such is what you will hopefully recognize, in a flash of insight… sooner rather than later.

            No need to reply. I explain why, at the bottom of my earlier response, below (at 7:47 a.m.).

            Respectfully,

            Jonah

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  22. larmac, I have heard your heartbreaking story before. I think you and I even had a brief conversation about it. And yes, it is true that right now, there is almost no helpful place available for ANYONE who is in emotional distress.

    After my own childhood spent in a state hospital, many years later I found myself in a Soteria-like place in Canada where I was allowed to go through my emotional crisis without drugs or any kind of coercion. It helped me tremendously, so I know first hand how much places like Soteria are needed.

    I really want to encourage you to get involved, if you aren’t already, with the people who are fighting for places like Soteria and respite centers to be established. And this will sound strange to people who know me, but have you considered getting involved with NAMI? I am one of their strongest critics, but it is also true that lately there has been ferment within NAMI’s ranks, as its members start to realize they have been lied to about the drugs and other standard “treatments.” You have seen first hand what the standard treatments are like, and you can raise the issue well. Surely someone like you, who lost your son because of psychiatry, has to be listened to respectfully within NAMI’s ranks.

    I don’t know what state you live in, but I hope our paths cross in the future, because definitely we are trying to go in the same direction.

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  23. I came upon this article and this website just by chance and it’s as if you were looking through my eyes. I have been hospitalized 3 times in the past 4 years. I got into a complicated discussion with my therapist last week. I was trying to explain to him my experience of being a psych patient. I recently realized I am slipping away from my life and I feel lost in a sea of psych medication. I could not put a sentence together. I could not string two cohesive thoughts that made any sense, but I wanted him to know of my experience as a patient. Thank you for your article. Thank you for telling it like it is and seeing it from my eyes. I was able to share your article with him. It helped me tell my story.

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  24. “As for suicidality, this is a tough one for me. We get many patients who have been suicidal or have made a suicide attempt. They are placed on a hold for a short period- meaning they have to stay in a locked facility. Often within a day or two, most of these folks leave as they are no longer suicidal. I think it makes sense to have a place that can act as a sanctuary for people who are in extreme distress and are not thinking clearly. By taking a day or two to reflect, they often change their minds. Is that a service, or a harm to someone who is contemplating suicide?”

    I’ve come a bit late to this discussion but I want to respond to the points that you raise because I myself was harmed by people making these same arguments.

    First of all, what you call a ‘hold’ I experienced as a kidnapping under threat of violence. The loss of autonomy was traumatic in and of itself. By all means, let the hospital be a sanctuary for those who seek it out in a time of crisis. It was not a sanctuary for me because I felt violated and threatened by virtue of being held there.

    Point #2. The vast majority of people who consider suicide do not end up killing themselves. Three months before I was committed, I had a plan to commit suicide. If I had been put on a locked ward at that particular time, I might have honestly believed that the forced intervention saved my life. Maybe today I would even be out there making speeches about how involuntary commitment can prevent suicide. But that’s not what happened. No one knew about my plan, no one stopped me, and I had all the means, motive and opportunity that I needed. And yet I’m alive to write this comment. Because I realized on my own that I couldn’t go through with it. And that was a powerful and important piece of self-knowledge that I gained from the experience. In hindsight, I can tell you with 100% certainty that a forced commitment at that time would not have saved my life and would have denied me an important avenue of personal growth. Yes, in the period before I made the decision there was a risk to my life. This is what is sometimes referred to as the dignity of risk.

    Point #3: If you are suicidal when committed and you change your mind, you will tell the doctors that you are no longer suicidal so that they will release you. If you are suicidal when committed and you do not change your mind, you will tell the doctors that you are no longer suicidal so that they will release you. If you are ambivalent about suicide when you are committed and the experience is so traumatic that you deeply regret not having taken your life when you had the chance, you will tell the doctors that you are no longer suicidal so that they will release you.

    I was the third case. I will always remember the young doctor who met me after my intake and informed me in no uncertain terms “we are saving your life”. It was the moment I realized there was no one to protect me in that hospital and my only option was submission. Later on her words echoed in my head as I attempted to commit suicide. If this doctor remembers meeting me at all, she probably still believes she helped save my life. There was no visible violence in our encounter, and an outside observer might even have concluded that she had helped me. But the fundamental psychological damage from being so totally powerless and invalidated was deep and destructive.

    Using coercion is a dangerous strategy. The power imbalance inherent in the system forces those who have been harmed by it to hide the damage. I am not the only one.

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    • Good points and good perspective to add to the conversation. The manner in which people are brought to a hospital due to feeling suicidal and if it should happen at all is something we all should be examining closely. When police interact with someone in the community who has made a suicide attempt or is actively saying they will kill themselves and describe a plan, there are only a few options right now.

      One is to talk to them, but allow them to continue their plan if they choose to, and the other is for police to take them into custody and bring them to a hospital, or what you have called kidnapping in your case. I have said in a previous post that this is very challenging for me. On one hand I want to defend the right of self-determination as well as privacy for anyone to make the choice they want to make as long as it does not harm others.

      But at the same time I come back to the idea if it was my friend who was making a choice to kill herself in my presence and I couldn’t talk her out of it. My instinctual emotional response is to try and do anything to stop her, including calling the police.

      As to your second point, I also see that holding someone and intervening in this way does not allow for a person to unfold their own process and retain the “dignity of risk” as you so eloquently put it. So yes, it is a further challenge to the instinctual desire of many in the community to intervene.

      And as to point 3. Yes indeed. Many folks will simply say they are not suicidal in order to leave. A very valid point.

      My question about this process is this. How would you prefer the community respond to someone who is about to jump off a bridge? Or who has seriously injured themselves? Or who are drunk and threatening to shoot themselves? Is there a place for intervention?

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      • How would you prefer the community respond to someone who is about to jump off a bridge? Or who has seriously injured themselves? Or who are drunk and threatening to shoot themselves? Is there a place for intervention?

        I don’t see how the part of the standard intervention where you walk around in that zombie daze full of drugs like Haldol at the hospital helps anyone recover from suicidal thinking. Its like cutting the power to the check engine light cause a car is running poorly.

        You are better off having an episode of suicidal thinking in outer Mongolia cause in countries like the US you will almost always be given a bogus label that implies a permanent condition that also comes with a lifetime commitment to psychiatric drugs.

        I can’t stand when “suicide risk” (a marketing favorite) is used to sell drug treatment. Here is my favorite link on the subject.

        “The selling of bipolar disorder stresses that the disorder takes a fearsome toll of suicides…

        Yet, the best available evidence shows that unmedicated patients with bipolar disorder do not have a higher risk of suicide…”

        The Latest Mania: Selling Bipolar Disorder http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030185

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  25. I entirely agree that the approach of being brought to a hospital and being prescribed psychotropics as a primary approach for helping someone who is suicidal needs to be completely reformed. If a person does decide they want to take psychotropics, the decision should be deeply informed. But before that happens, in my opinion, a host of other support mechanisms and alternatives should be offered.

    But again, that still leaves me with the question…what would I do for someone who is trying to commit suicide?

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    • To which I ask,

      – What should be do with a gay man who insists in having unprotected anal sex with another gay man despite the highly likelihood that it will lead to a transmission of a mortal disease (manageable, but mortal nonetheless).

      – What should be do with a 350 pounds person who insists in eating 1000 calories hamburgers both for lunch and dinner (plus an equally caloric desert afterwards, for a total of a minimum consumption of 4000 calories per day) despite the fact that the probability of the person dying of a heart attack is all but guaranteed.

      The answer in the three cases, from my point of view, is clear: if no crime is committed, absolutely nothing. Let everybody accept their destiny!

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      • In those cases I absolutely agree. In the case of someone in the community trying to kill themselves? I just cannot agree that I should let that person accept their destiny. My instinctual response is to intervene.

        However, I would love to see a much more thoughtful way of intervening. How we do it now is traumatic…police cars, sometime fire engines show up. Someone is whisked away to a sterile hospital environment, etc. I would love to see a vastly improved model that creates alternate sanctuaries where people can go when suicidal.

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        • Jonathan,

          We have courts.

          The States have laws against attempted suicide. If a person is charged with attempted suicide, they have a right to a trial with a jury if preferred.

          Before and during the hearing, they can receive counsel and representation by an attorney, who represent their best interests – not the interests of the psychiatric hospital!

          The attorney may be able to show that psychiatric drugs were behind the event; or the memories of trauma, including being formerly locked up in a “hospital”…

          The attorney may be able to mitigate the case – persuading a judge or jury that the individual would be best served by less restrictive, more supportive environment, and staying the hell *away* from a psychiatric “hospital”!

          Duane

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        • Before I continue with a reply along the Duane line of reasoning, I want to make it clear that when it comes to the strategies that would result in a lower number of AIDS transmissions, I have nothing against gay males. Only, as the CDC points out, http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html

          “Gay, bisexual, and other men who have sex with men (MSM))a represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young MSM (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were MSM or MSM-IDU.”

          A policy that would target primarily, although not exclusively, urban gay males would accomplish great results in terms of decreasing both the overall rate of HIV transmissions and the number of annual deaths due to AIDS because these gay males are easy to find, while the people responsible for the remaining 30% transmission is scattered around the US. If we are going to use science to implement effective strategies in HIV reduction, setting a “coercive shop” at the gay districts of America’s largest cities makes more sense than any of the current strategies in HIV prevention. By focusing resources in such a coercive HIV strategy, this measure alone would, in all likelihood, prevent the majority of new HIV transmissions. This is what is called the “Pareto principle”, which is widely applied when it comes to prioritization of limited resources in many areas of public policy but also, and probably even more, in the private sector.

          What’s more, we do have evidence that a policy that would target all persons “reasonably believed to be at risk of transmitting HIV” would be tremendously effective based on the Cuban experience: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688320/ . Cuba, despite being a well known destination for sexual tourism has a HIV prevalence rate which is one of the lowest in the world, around half of that of the United States.

          And yet, because we value civil liberties over “saving lives”, in the case of HIV we, and rightly so, repudiate coercive HIV prevention even though the scientific case for coercive HIV prevention is much stronger than the coercive case for “suicide prevention”. Why? Because we can quantify with numbers who is more likely to be HIV positive based on lifestyle choices alone than we can quantify suicide idealization based on any factor. We can also quantify as well more accurately the probability of death by AIDS once HIV transmission happens than the probability that somebody who has suicide thoughts goes on to commit suicide (there is something called “free will” that gets in the way, you know).

          Now, following up on what Duane said. I see a huge, huge difference between laws that make it a criminal offense suicide attempts (I personally believe that such laws should be repealed) and “preemptive locking up of suicidal people”. If you go to court charged with an attempted suicide, in jurisdictions that have such thing as a crime, you cannot be arrested unless there is “probable cause” and you cannot be convicted unless there is evidence beyond “reasonable doubt” that the crime has been committed. In other words, it is an “after the fact” approach vs a “minority report style” type of intervention that you seem to be defending.

          One of the first measures that countries that open up from a totalitarian form of government is to change their censorship policies from “preemptive censorship”, by which all publications need to be cleared by a censorship office, to “after the fact censorship”, by which censorship still exists but it is enforced only after the fact. That little change, makes usually a great difference in improving the lives of those who are targeted by the thought police.

          In the case of suicide, even it society thought that it is a good idea to fight suicide by way of criminalization of suicide attempts, we are better served if no intervention whatsoever is done until “after the fact”, and that would include attempts at saving the suicidal individual life if after attempting a suicide, he or she changes his/her mind.

          As I said above, for governments to terrorize their citizens by way of psychiatric coercion, the “threat of coercion” is good enough.

          So yes, I do think that you are mistaken or that, at the very minimum, you have a double standard when it comes to valuing preventable deaths. I interpret what you are saying as: you don’t have a problem that people die of preventable AIDS or heart attacks but you have a problem with people dying of a preventable suicide even though the type of intervention to prevent suicide that you defend has very little science to back it up, only the “subjective” appreciation of he/she who orders a psychiatric hold.

          As somebody who uses reason mostly when it comes to thinking about matters of public policy, I surely do not understand your point of view, other than it is contradictory.

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    • Jonathan Keyes,

      Regarding your brief reply to me, yesterday (on December 4, 2013 at 10:56, explaining “There’s a whole lot to digest there. Let me take a day or two to think about it and get back to you…”), no worries at all and no hurry.

      My comment was rather long and meandering, so I encourage you: Do take as long as you need, mulling it over.

      And, RE your response (directly above) to Copy_cat, “But again, that still leaves me with the question…what would I do for someone who is trying to commit suicide?” May I suggest, when you may have a moment, you might check out the MIA blog post “Man Jumps, News at…?,” by Jennifer Maurer. It generated some very thoughtful comments — especially, from Jennifer herself.

      [Note: If/when you do check out that blog, you may see I posted a few comments there; just take them or leave them, it’s really not my intent to draw your attention to more of my words. You’ve already got enough of those on your plate. And, to be perfectly honest, I am directing you to that blog, as I am most impressed by Jennifer’s writing, her personal story and her unique ability to thoughtfully moderate discussion…]

      Here’s the link to that post of hers (May 14, 2013):

      http://www.madinamerica.com/2013/05/man-jumps-news-at/

      Respectfully,

      Jonah

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      • @jonah. Thanks for the link. I had the time to read the article and the comments afterwards. Good discussion.

        In my practice as a therapist in a hospital setting, I often have long talks with folks about the desire to die. For many folks, they have experienced so much trauma, pain and suffering for so long that the urge to commit suicide seems pretty rational. Here in Oregon we have passed laws to allow very physically ill people to end their lives.

        As a side note, my own grandmother took her own life after years of experiencing extreme pain. My uncle assisted her and because of this was actually arrested and had to stand trial. This helped in sparking a death with dignity movement in Australia.

        There are layers of complications around this subject. Poverty, homelessness, racism and oppression also add to the injustice that can make some people feel more depressed. As a society, we try to apply band aids like psychiatric drugs that often compound despair.

        In a perfect world we would address these deep societal issues. We would create sanctuaries where people who are suicidal could go without having drugs pushed as some sort of solution.

        But in the end, I also acknowledge where we don’t achieve those goals and we are left in a world with few options in the face of someone wanting to end their life. Do we as a community intervene? How do we intervene if we do?

        In my work at the hospital I often listen to people who are suicidal. I have no answers but I try to hear them fully. Sometimes that is all we can do.

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        • “How do we intervene if we do?” […] In my work at the hospital I often listen to people who are suicidal. I have no answers but I try to hear them fully. Sometimes that is all we can do.”

          Jonathan Keyes,

          You wound up answering your own query, and it’s a good answer; I suspect you’ve probably done much good for the ‘suicidal’ people, in your “hospital”; with that listening practice, of yours, you’ve done good, I bet — and much better than had you wound up calling the police, I think.

          Of course, many of those people were probably brought in, by the police, but had you been the one to call the police, you wouldn’t be the listener.

          And, really, I have no idea why you’d ever be tempted to call the police, hoping to prevent a suicide. (You mentioned that temptation, of yours, in an earlier comment, and it struck me as unfathomable, as I read it.)

          On the other hand, that you’re so wholly opposed to involving the police when a “patient” is threatening violence against others in your “hospital,” is highly problematic; I don’t understand that reticence, of yours, in light of the fact that you’re tempted to call the police when someone threatens himself/herself. (Really, I don’t get your line of thinking, about the police; in fact, it seems a bit ‘crazy’ to me.)

          I’ve met people who were apprehended by the police after threatening to commit suicide, who describe the ordeal as having been entirely traumatizing.

          And, psychiatric “hospitals” are terribly traumatizing, in my experience and observation.

          Never, did I meet any careful listener, on any staff, of any such hospital.

          I know you think your “hospital” is like most others, but I think you’re highly unusual, being a careful listener, working in such a place.

          Though, yes, you are quite illogical about what the police are for; at best, you are illogical about that…

          Yet, you become uniquely qualified to prevent suicides — just by learning to listen. I suggest you’d do well to fully trust yourself that way, and know that, eventually you’ll realize, the “hospital” is unnecessary.

          Meanwhile, about “patients” in your “hospital” who may seem threatening, I doubt anything I can say will cause the change in your outlook, which I think you need.

          But, I say this anyway: I think you need to understand, that those people need to be listened to, also; however, if they are actually assaultive, they should be put in the hands of the law — and not be “medicated” into submission.

          Drugging them does not help them, really; it robs them of the opportunity to learn from what is happening, at that moment; it teaches them nothing helpful about themselves; it will only confuse matters, by suggesting to one and all that they are ‘sick’ and thus require further ‘medication’; e.g., the violence they’re experiencing, from the take-down and the drugging that you and your staff impose, will not be felt as helpful, nor will it be therapeutic or caring.

          Simply, I suggest that you reconsider your embrace of all such psychiatric violence.

          Forcibly drugging people (even those who seem threatening) is purely an abomination — having nothing to do with listening.

          Forcible psychiatric drugging for any reason is wrong; but, furthermore, calling those forced drugs “medication,” can only demonstrate, to the would be, seemingly threatening persons, that you (and the other perpetrators of such drugging) have been deeply corrupted, by the world of psychiatric quackery.

          Most often, when people truly seem threatening, in psychiatric “hospitals,” it’s because they have been ignored by the law, or they’ve side-stepped the law, by way of becoming involved in psychiatry; they have received no real justice… and/or, they are just plain rebelling against that most supreme injustice, which is forced psychiatric ‘treatment’.

          I won’t go on, as I find my words become redundant.

          I am tiring of my own words, so I can’t write any further; and, since there are other commenters on this page, whom you’re failing to address, I think it would be great if you’d address them, not me — even though I thank you for your replies. I hope you will not feel a need to respond to me this time.

          Just, please, consider: ‘Treating’ perceived violence and/or threats of violence with forced drugging is meeting violence with violence; it is cruel and unusual punishment — much worse for the soul than a possible jail sentence, especially as it tends to lead to indelible psychiatric labels, which suggest a lifetime of psych-drugs are needed.

          The only real problem with jail time for a truly assaultive person would be, if the individual was so deeply confused that s/he couldn’t understand why s/he was being jailed.

          In that case, s/he need special help — not medical-coercive psychiatry.

          Medical-coercive psychiatry (i.e., any and all forms of brain-tampering, forced and coerced psychiatric ‘treatment’) is barbaric, unnecessary, and just plain evil.

          I trust you’ll understand that sooner rather later.

          Meanwhile, keep up that practice, of carefully listening — most especially, to psychiatric survivors.

          Thanks again for the replies…

          Respectfully,

          Jonah

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          • Thank you, Jonah, for pointing out Jonathon is not responding to some of us. Jonathon, I don’t think you responded to me. And for obvious reasons, as I point out what’s been confessed to me as the “dirty little secret of the two original educated professions,” is actually a common psychiatric industry crime against patients.

            I’ve been told by a subsequent pastor, who was kind enough to read my chronologically written up medical records and medical research, that historically any time a pastor or doctor wants to cover up a sin or medical malpractice they have historically shipped the patient off to the psychiatric industry, defamed the person with the symptoms of one of the made up DSM disorders, and created the disorder with the meds.

            And in my case, I was made sick in exactly the way Whitaker has concerns that over a million children were turned into bipolar / schizophrenics, completely with drugs. It has been known within the medical and religious industries for a long time that this is a viable and easy way for doctors and pastors cover up sins and “easily recognized iatrogenic artifacts,” like a “bad fix” on a broken bone, by my PCP’s husband.

            Jonathon, would you mind addressing the apparent reality that the psychiatric industry bought it’s power, by bribing mainstream medicine and the religions who own hospitals, with your ability to defame, discredit, and turn healthy people into mental patients to cover up pastoral sins and medical malpractice, for profit, please?

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          • @Someone Else, Yes I haven’t addressed every comment here, partially because the have been many to respond to and also I don’t want to hit the mike here.

            As to our question about how the psychiatric industry bought its power and bribed mainstream medicine in your last paragraph.

            I think Whitaker, Breggin and many others have described many of the abuses of power inherent in the system, including what you describe. You will find no disagreement from me there.

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      • “Here in Oregon we have passed laws to allow very physically ill people to end their lives.”

        I wonder if I made the journey to Oregon if it would EASY or HELL TORTURE for me to have the assistance I need to pass away SUCCESSFULLY.

        I wonder if I’d be met with all sorts of obstructions and interference.

        Any idea how agonizing it would be for me to move myself all the way to Oregon, just to pass away. When I so desperately need to.

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  26. Involuntary psychiatric treatment also fails a fundamental principle of medical ethics, though the rest of the medical profession chooses to turn a blind eye to this. Although some people might receive some benefit from involuntary psychiatric treatment (but see also below), it also clearly pushes some people over the edge. To say it crudely, while it may save lives, it almost certainly contributes to the death of others.

    Unfortunately, the answer to this question is not known for the simple reason that there is virtually no research into it 9.
    Although complicated by the fact that we cannot hear testimony
    from the dead,there is significant circumstantial and anecdotal evidence to know that it does occur. There are many first person testimonials of those who have experienced involuntary psychiatric treatment as an assault, along with many others who describe how they survived despite rather than because of psychiatric treatment. One particular telling report I have heard is of people who say that they had never even contemplated suicide until they found themselves on the psych ward.
    The crucial point here is that at the very least there is a
    significant question mark over the claim that involuntary psychiatric treatment saves lives.

    http://www.communitylaw.org.au/mhlc/cb_pages/images/MHLC-Forum-Paper%20David%20Webb.pdf

    That’s a link to an excellent paper on this subject. I can’t copy the whole thing here.

    Read this story,

    “Man Tased By Suffolk Police Dies Following Altercation”

    But when they told Simmons they were taking him to a hospital for a psychiatric evaluation, he began kicking and punching them, Fitzpatrick said.

    All three officers wrestled with the 240-pound Simmons on the floor while trying to handcuff him. Two of them used a Taser on the resident; he also was hit with pepper spray.

    http://newyork.cbslocal.com/2013/07/25/man-tased-by-suffolk-police-dies-following-altercation/

    MadinAmerica readers can see what really happened, It was ONLY AFTER this man heard he was going to be taken in for psychiatric mistreatment he decided to fight police and get himself killed. He had obviously experienced the nightmare of involuntary treatment before and reacted in self defense.

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  27. Jonathan Keyes,

    What’s been in the back of my mind, ever since I first read your op-ed, is that you’re doing an huge disservice to your readers, quite inadvertently.

    To some extent, I’ve been attempting to convey my sense of this; but, I have not yet been entirely clear, as many issues are raised, in the process of reading your op-ed and comments.

    Here I will be as clear as possible…

    You are failing to realize the extent to which your psychiatric “hospital” is unlike other psychiatric “hospitals” — how it is, indeed, functioning in some ways (for many or most of its “patients”) quite a bit more ‘fair’ than most psychiatric “hospitals”.

    (“Fair” — I use it, in regards to describing various facets of medical-coercive psychiatry – is a term of relativity.)

    Specifically, I gather from what you say, that: the setting in which you work provides certain, basic, minimal safeguards against extreme psychiatric abuse, for people “hospitalized” on brief “holds” — protections which most “hospitals” do not provide (because they are not required to do so).

    I don’t know the detailed history of this, but surely it has to do with the way psych-rights people have been better organized in some states and/or have met more resistance in some states, such that they are just plain more successful, in their promoting of protective legislation, in some states, across the U.S., than they are in other states.

    Thus, the bottom line (what you seem more or less unaware of), that I’m getting at, here, is the extent to which different states regulate psychiatric “hospitals” differently, especially in terms of how psychiatric “hold” work.

    Apparently, you don’t even think of a “hold” as “commitment”; and, I believe that’s because you don’t realize the added protections, which people on “holds” have, in your “hospital” (because your “hospital” happens to be in one of the rare states, that has protections against unwanted ‘treatment’ for people on “holds”).

    To me, it seems that this blind spot of yours has seriously impeded your ability to fathom the extent to which you’re failing to understand what life in most psychiatric “hospitals” is actually like (i.e., throughout most of the U.S. and elsewhere).

    Now, mind you, I am surely no expert on the law (and, least of all, do I know about the laws outside my own state); so, regarding the different regulations for operating psychiatric facilities, from state to state, I am no real authority; but, from what you describe, of life in your “hospital,” I believe you’re working in a state that has much better psych-rights than most.

    You don’t realize the truth of that, apparently.

    And, so, unfortunately, you’ve taken what you know of your psychiatric “hospital,” and how it works, and you’ve generalized, as though all such “hospital” must operate under those same legal parameters.

    Thus, you’ve been led to believe (and, you may lead unsuspecting readers to believe, likewise) that “patients” on brief psychiatric “holds” cannot be forcibly “treated” with neuroleptics.

    Indeed, you seem to believe that “patients” are not forcibly “medicated” without court orders.

    (Actually, I presume that, almost certainly, you must well understand: any and all such limits, as that, on the application of forced drugging, in “hospitals,” are not iron-clad; they are not protections against forced drugging in situations deemed “emergencies”; exceptions are made, when forced drugging seems ‘necessary’ to quell violence in “hospitals”.)

    That, generally speaking, “patients” who are on brief “holds” in your “hospital” are not forcibly drugged, must be true for “patients” where you work (because you say that’s so, I accept it is so); but, I assure you, that is absolutely not universally true.

    It’s not at all universally true.

    My understanding is that such protections exist only in a few, relatively small states (in terms of population); i.e., the existing protections, against unwanted ‘treatment,’ for people on brief “holds,” covers only a very, very tiny minority of Americans; for, in the vast majority states, there has never been legislation passed, which would offer such protections.

    In fact, where such legislated protections do exist, they shall not necessarily exist for long; currently, many legislators are calling for their repeal. (I know that’s true in Vermont.)

    Are you not at all aware of these different legal regulations and operating procedures, from state to state, I wonder?

    Can you even begin to imagine the extent to which life for yourself and the “patients” in your “hospital” would change, if all those people on “holds” could be ‘medically treated’ in any way that the psychiatrists wished to ‘treat’ them?

    Frankly, I think, it would be difficult (if not impossible) for people to know what life in most psychiatric “hospitals” is like, if they haven’t been “patients” there; but, in any case, if you can’t well imagine what it would be like to see all those people on ‘holds’ being treated against their will, then you really have no idea whatsoever what life was like the “hospitals” that I was in, years ago; nor, would you know what life is like in most psychiatric “inpatient” settings today.

    Respectfully,

    Jonah

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  28. Jonathan Keyes,

    I’m offering you one more comment here..

    I will tell you, in advance (so you needn’t wade through it, to understand what I’m getting at), I am basically aiming, in this comment, to figure out: Will you forever reserve your supposed right to forcibly drug “patients” in the “hospital” where you work?

    [ Note: As I pose that question, I’m most focused upon your recent statement, on another MIA comment thread, wherein you explain: “By the way, I don’t support forced drugging, except in cases of responding to severe violence.” http://www.madinamerica.com/2013/12/canadian-study-links-cannabis-psychosis/#comment-34272 ]

    To begin this line of query, here, I will tell you, there’s one more thing, that’s been in the back of my mind, ever since my first read-through, of your op-ed.

    It’s one sentence of yours, which, as soon as I initially read it, was seemingly jumping off the screen, screaming at me.

    (Of course, I don’t mean to say that I felt it was literally jumping off the screen and screaming.)

    It was immediately begging for attention.

    And, still, I cannot get it out of my mind.

    Here’s exactly what that was (and is).

    You wrote,

    “Medications such as atypical antipsychotics and mood stabilizers do indeed exert a profound effect on the brain’s chemistry and often act to sedate patients so that the extreme symptoms of their illness – such as loud intrusive voices and manic behavior – is quelled.” [emphasis added]

    Well, in our recent comment-exchange, on another MIA thread, I’ve touched upon my view of neuroleptic drugs, my sense that calling them “antipsychotics” is just playing into the hand of Big Pharma; and, so I see your using the “neuroleptic” term, there, as refreshing; if we can continue to agree upon using that more realistic language, that’s quite helpful, I feel; it’s clarifying; and, so, here I won’t harp on that issue, at all.

    Yet, the last half of that sentence, of yours, which I’ve offered in italics, above (especially, that word I’ve highlighted with bold print: “illness”), keeps coming to mind, as I read your words, in MIA comments on this page and elsewhere on this site; it’s been nagging me in recent days.

    I’ve not been able to reconcile that one-sentence statement, of yours, in your op-ed, with what you otherwise seem to express, as a general rejection of psychiatry’s “disease model.”

    To me, it seems these words of yours are suggesting that you believe you address effects of “illness,” via your “inpatients'” reported experiences (of ‘intrusive voices’) and via observation of their behaviors (deemed ‘manic’).

    When I encounter individuals who report ‘intrusive voices’ and/or who seem to demonstrate ‘manic’ behavior, I don’t take them to be ill.

    When you encounter “patients” who report “loud intrusive voices” and/or who exhibit so-called “manic behavior,” such reports and/or observations represent, to your mind, not only signs of supposed “illness” but, furthermore, “extreme symptoms of their illness.”

    Most people who claim to be able to identify “extreme symptoms of … illness” of any kind, are, most likely, going to be perfectly willing to presume that “medications” are called for.

    You believe you are working with “patients” who exhibit considerable degrees of “illness,” which is yet not identifiable as physical ‘disease’.

    There are no biological marker proving any psychiatric “disorder” exists, in the physical sense; yet, it is “illness” which you observe, in these people.

    To you, such “illness” is what plagues these people (called “patients”), yes?

    Is that why you are perfectly willing to force “medications” into those “patient’s” veins, when they may seem to exhibit “severe violence,” I wonder?

    You presume that “severe violence” is necessarily an effect of their “illness”?

    Or, am I presuming to know too much, of what you believe?

    (I really don’t know. I’m just not at all sure of what you do believe, in these respects — especially, as you indicate, that, in your view, forcing drugs on “patients” should not be considered ‘treatment’. I think it’s possible that you just find it expedient to forcibly drug certain people, because they represent a seeming threat.)

    Well, in any case, I am led to wondering: Is it possible that what you see as “severe violence” is not necessarily what others (such as I) would judge to be “severe violence”?

    And/or, might it be possible that, in some instances (or many), the seemingly “severe violence” that a given “patient” exhibits, in a “hospital,” is actually a product of his/her failing to find any real justice, in that setting?

    [ Note: When you have a spare moment, you might be interested in reviewing the article, that can be found via the following link. (In it, one can read these lines: “…it is the ward staff, and not the patients, who play the key role in influencing how much conflict and containment occurs on psychiatric wards,’ says Dr. Papadopoulos.”) http://www.mentalhealthy.co.uk/news/1551-new-insight-into-acute-inpatient-psychiatric-care.html ]

    Isn’t your word “severe” mainly an emotional appeal, as opposed to a clear description of something? Will it not require clarification?

    I.e., an existence of what’s called “severe violence,” in a psychiatric “hospital” represents whose views of what is or is not requiring forced drugging? Of course, it’s the staff’s view? And, it is a subjective judgement.

    So…

    With all due respect, I wonder: What makes you (or any other “hospital” worker) the ultimate judge of what is or is not “severe violence”?

    (Surely, yours attempts to justify forced drugging, based on the accusation of a “patient’s” committing “severe violence,” is going to convince a lot of people, that forced drugging is ‘necessary’; but, is it really necessary? I mean, in what instances is it truly necessary, if it is ever truly necessary? These are important questions, yes?)

    Really, I wonder what you view as “severe violence”? And, I wonder, of any instance, wherein you’ve participated in forcibly drugging a “patient,” what measures were first taken, to avoid that forced-drugging scenario?

    (Typically, in psychiatric “hospitals,” a forced-drugging comes as the direct result of a “patient” refusing to take “medications” orally. When I observed such scenarios, years ago, it always seemed that, had the “patient” been allowed to refuse the “medications,” s/he would have calmed down. Is it not possible that you have participated in a forced drugging that was avoidable?)

    Certainly, by this point, you don’t agree with me, as I say that, the forcing of neuroleptics into people’s veins, is a form of very severe violence (I say it is, most definitely).

    But, you say that you care to develop sanctuaries, wherein people can experience their emotions without being medicalized. (There, I am paraphrasing you there.) That’s a noble intent.

    So, I wonder, is it possible that you could help to make your “hospital” a setting that’s somewhat more like that kind of sanctuary place, which you describe?

    (Frankly, I’ll not ever choose to go to any “hospital” for any emotional issues; I will not seek sanctuary in a hospital of any kind; I find all hospitals to be antithetical to my inner peace, ever since first being introduced to a psych “hospital.” I do not recommend that anyone choose that sort of “hospital” for help; and, IMO, emotional issues should not be medicalized; however, I do not aim to outlaw the medicalization of emotional issues; and, I am in favor of policies that improve circumstances for individuals who wind up, in such places. So, I offer you the following questions…)

    Jonathan, what if a “patient” who was placed on a “hold” in your “hospital” had a carefully written advance directive, in which s/he made it plainly clear, that his/her desire was to altogether avoid being ‘medicated’ with mind-altering drugs?

    And, what if s/he also made clear that, s/he was dedicated to non-violence but that, in the event of his/her displaying some seeming “violence,” s/he’d much prefer to be turned over to the police, as opposed to being drugged by you and your associates?

    Would you, nonetheless, still insist upon keeping the police away and dealing with “severe violence” through forced drugging,
    I wonder?

    Please, take all the time you like considering…

    Respectfully,

    Jonah

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  29. Jonathan,

    Thank you for your very thoughtful article on a very difficult and emotionally charged subject. More important than agreeing on every point is someone making clear effort to wrestle with the extremely complicated questions of how we interact and relate socially to other human beings without lapsing into either sweeping generalizations or dismissive dogmas that end up not serving any person well.

    I work in a hospital too. Well, that’s one of my two jobs – working as a ER mental health crisis worker. Before this I also worked as something called a “Treatment Team Coordinator” in a secure psychiatric facility. I hope that background will provide some context to what I’m going to say next.

    It’s difficult to talk about these issues when many in the community have such direct and extreme trauma histories related to hospitals, doctors, psychiatrists and the like. Myself I managed to avoid what I’m sure would have been involuntary hospitalization during my own “darkest night” because I happened to be lucking enough to have friends with resources who chose to offer me 24-7 private care in their own home for about 36 hours instead of taking me to a hospital. But beyond this, I attribute some of the responsibility for my own fathers traumatic and early death to a mental health system that utterly failed him, loaded him up on medications and sent him out the door without any kind of actual human care.

    While everyone’s individual experience is different, one thing many if not most of us bring to the discussion is a lot of emotion and not a small amount of pain around the topics. This is always a tricky environment in which to maintain respectful discussion without becoming overwrought with emotion. I appreciate the tone and thoughtfulness in which you give your perspective.

    Generally I find myself in broad-based agreement with your perspectives. But the discussion thread has helped me clarify my points of disagreement.

    The person who made the distinction between “force” as treatment tool and “force” as a matter of self-defense really hit the nail on the head. I don’t think “force” is ever therapeutic in any way, and really has not business being talked about as part of treatment even in “extreme cases.” Once you’ve gotten to a situation where you are doing things to another person against their consent, you’ve left the domain of “treatment” and gone somewhere else. That might be a place you have no choice to go, but its not treatment anymore, or therapeutic. “Treatment” can resume when the people involve can find their way back to a collaborative space.

    Having said that, if someone is violent I believe that I not only have the right to protect myself by whatever means required but I also believe I have the moral responsibility to attempt to protect other innocent people who are the target of violence even if I am not directly targeted myself. If I have the ability and capability to intervene to prevent violence and protect innocent people from violence, its my moral obligation to do so. That’s what I believe, and I won’t be budging in that belief any time soon.

    In those situations I believe in the application of the absolute minimum force necessary for the absolute minimum amount of time possible to prevent immanent violence. This isn’t an issue of treatment, as there is nothing therapeutic about the situation at all. It is simply a matter of the response to immanent violence I believe to be necessary in order to live with myself morally.

    Here’s the real rub: How do we define immanent violence? I believe that it includes the threat of immanent violence. I don’t believe that we should first let someone be violently assaulted before we intervene.

    Verbal threats ARE a form of violence. So if a patient in the emergency room says to the staff, “the first opportunity I get I am going to kill you tonight” I don’t really care how quietly and calmly that violent statement is made, I fully support taking appropriate measures to PROTECT innocent people from the treat of immanent violence.

    What would that mean? It would mean that, if that patient was unwilling to collaborate in a non-violent way, we utilize the minimum amount of force required to protect innocent people from the immanent threat of violence for the minimum amount of time required to alleviate that threat. That means I can’t say that restraint is ALWAYS wrong, or that chemical sedation is ALWAYS wrong, or that being held in a hospital involuntarily is ALWAYS wrong. Sometimes, those things may be part of my moral responsibility to defend myself from immanent violence and to defend other innocent people from immanent violence when it is within my power to do so.

    Some people I have talked with have suggested that individuals would be better served if persons who make violent threats in the ER were not restrained or involuntarily hospitalized rather than released to the community but were instead simply arrested and sent to jail. The argument being that immanent threats of violence toward others are a criminal matter and that’s the appropriate mechanism for responding.

    I must admit that to me, this seems like an infinitely worse option as in my opinion, the only institution more broken than the mental health institution is the institution of “law enforcement.” But obviously different people have different viewpoints.

    At the end of the day, the main issue boils down to this: some people believe that there is absolutely no situation whatsoever in which it is morally appropriate to intervene on another person’s behalf against their will. I disagree. In fact, I believe that if I really adheared to that idea, I’d end up being more guilty of morally abhorrent behavior more frequently, as I refused to act to defend innocent people against the threat of immanent violence.

    The way our system fails right now is that by and large it:

    (a) does not accept that any sort of “forced” action is not, by responsible definition, “treatment” or “theraputic.” It may be necessary to prevent violence, but its not a treatment tool.

    (b) does not believe that force is a last resort used only in cases of credible threat of impending violence. Instead it is often used casually and as a mechanism of power and control.

    (c) does not believe that one should use the absolute minimum amount of force necessary. Instead, often disproportionately applying force far beyond anything appropriate to the level of threat.

    (d) does not believe in the the absolute minimum amount of time required. Instead, the system believes in involuntary “treatments” that can last up to six months or longer depending on the civil commitment process. That sort of thing is not any kind of response to an immanent threat. And I don’t support that.

    Again, thank you for your article and I want to reiterate that I appreciate the tone in which you right and broadly agree with much of your perspective.

    Cheers,
    Andrew

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    • Hey, thanks for responding Andrew. These are by very tricky and hard things to talk about as they trigger a tremendous amount of emotion, especially in people who have been abused by the system. At the same time, I think it’s key we try to have these discussions as a way of exploring ways to both reform hospitalization as well as creating alternatives to hospitalization.

      I would especially like to see something like you experienced, a place to go for a short period of time, perhaps up to a few days, where people would stay with you round the clock in a non-medical establishment.

      Ok, to address the force issue. I think you are absolutely right, and maybe I didn’t
      make myself clear, that force of any type is not “treatment”, including forced drugging. But here I differentiate between a doctors order to mandate forced drugging for committed patients and the use of force in a violent, or potentially violent, situation. In the first case, I am totally opposed for many reasons that I stated in the op-Ed.

      As to the latter, this is a really really hard issue. I see you were conflicted and in many ways I am too. I think it needs much more exploration and I love that you outlined four large issues surrounding the use of force in your a-b-c-d. Let me try and look at each one.

      A- couldn’t agree more. It is not a therapeutic tool. And I believe it should be abolished as “therapeutic” for court committed patients. Without consent, the state is allowing drugs that have knon serious side effects and long term deleterious health effects to be administered routinely against the will of the patient. This absolutely needs to stop.

      Furthermore, forcing drugs on someone who doesn’t like them will lead to them stopping them as soon as they possibly can after being released from commitment. Stopping taking powerful neuroleptics cold turkey often leads to severe rebound psychosis, essentially dooming someone to heavy sedation and then torturous withdrawal effects.

      Finally, allowing the state to suppress and sedate someone on a long term basis is abhorrent. The state, and certainly modern medicine, should not have that right. It needs to be constitutionally challenged.

      B- another big problem. How and when to use force is a subjective decision made by nurses, security officers and therapists. The decision making process can be quick, at times arbitrary and with control in mind instead of as a protective measure of last resort.

      Imagine a situation in which someone who is drunk comes out of their ER room and starts challenging staff to fight. Sme staff may immediately see the need for restraining and sedating the patient. Anoth staff may see an opportunity for dialogue, trying to listen to the patient, offer comfort measures like food and drink. Ways to deescalate the situation. Essentially, there can be a wide variance in staff approaches to potential violence.

      C- disproportionate force. Indeed. Both B and C are what many people who feel abused rightly complain about. An overezealous security officer who handles a patient roughly. Someone who has been punched or kicked in a hospital setting. It is absolutely untenable and must be reformed.

      D- use of force in a regular basis up to a 6 month commitment process. I already addressed this but it is simply unacceptable.

      I’ll respond to the actual issue of forced drugging in your next comment but thanks for taking the time to respond.

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    • Andrew,

      I am posting this message primarily for the sake of MIA readers who may fail to realize, that you have posted a 2nd comment below.

      I am urging readers to know, your 2nd comment should be read after reading this comment of yours (above).

      It’s very important that you did offer that 2nd comment, I feel; for, this 1st comment of yours (directly above, on December 11, 2013 at 6:30 am) left me feeling immediately concerned, that, apparently, you don’t get what’s going on, in your own psychiatric “hospital” work environment — nor, then, either in these comment conversations, on this web page.

      Reading through this 1st comment of yours, I felt you really aren’t getting what’s gone on in the life of those many (countless) psychiatric survivors (such as myself) who have been forcibly drugged; also, I thought, as read through this 1st comment, of yours, to its end: ‘…nor, then, either does he do any service to the memory of terminal psychiatric victims, such as his dad.’

      Note prominently: You actually do great service to your dad, in your 2nd comment (below) by very significantly clarifying your position.

      That is actually why I am posting this comment; I am directing readers to your 2nd comment (below); it makes the first part of this 1st comment of yours, make sense.

      The first part of this 1st comment of yours is very meaningful (especially, to the extent that you’ve included vital information about your personal experiences working in the field of medical-coercive psychiatry and concerning your personal experiences having avoided ‘treatment’ by medical-coercive psychiatry and your personal experiences, of have seen your dad destroyed by medical-coercive psychiatry); all things considered, you have a fascinating personal story; but, it is, ultimately, confusing, confused and poorly conceived — especially, as you come to write, that,

      “At the end of the day, the main issue boils down to this: some people believe that there is absolutely no situation whatsoever in which it is morally appropriate to intervene on another person’s behalf against their will. I disagree.”

      Surely, that is not the main issue.

      Though that may be the main issue for some few people, somewhere, actually, the main issue that (in my opinion) is most necessary to consider here, is the question of, ‘Does any person naturally have a right to forcibly drug another person, injecting that person with a terribly potent concoction of pharmaceutical lab-chemicals, which are, in truth, severely mind-altering substances?’

      Does anyone have the right to ‘treat’ another person that way?

      Of course, there are some folk (such as Jonathan Keyes, currently) who do feel they have such a right, in certain circumstances; and, yet, they shudder at the thought of calling for police help, instead, because they dread the possibility of witnessing such force, as the police could apply, to quell “severe violence”; Jonathan, e.g., fears tasers may be used.

      But, as compared to hypodermic needles containing ‘heavy tranquilizers,’ I wonder: what is so much worse about tasers, really?

      Is it not that shooting tasers lends the appearance of a police operation, and shooting hypodermic needles lends the appearance of a ‘medical’ procedure?

      I believe that a strong argument could be made, that, generally speaking, tasers are safer than forced drugging.

      (Yes, of course, there are reports of the terrible misuse of tasers — of people being repeatedly tasered; and, I am not favoring any use of tasers — not in “hospitals” nor anywhere else; I believe that police should be trained in a form of martial arts, which allows them to immobilize individuals without harming them.)

      Police are not ideally suited to quell the sort of seeming threats, which tend to arise in psychiatric “hospital” settings.

      But, I would certainly consider calling the police to take away anyone who was being “severely violent” in such a setting. (According to my reading of Jonathan Keyes, he would not do that under any circumstance.)

      most people who work in your field automatically answer “yes” to that question, which I’ve posed (‘Does any person naturally have a right to forcibly drug another person, injecting that person with lab-chemicals, chemicals which are very severely mind-altering substances?’); they believe that the answer to that question is naturally, “yes.”

      Most people working in your field believe the answer to that is naturally “yes,” because they are conditioned, by their training, to believe such practices are a perfectly acceptable and the ‘necessary’ extension of those ‘medical treatments’ that “patients” receive, in psychiatric “hospitals”. (Never mind the fact that such ‘medical treatment’ is, more often than not, wholly unwanted, by the “patient,” and the “patient” who appears to ‘need’ such an injection may be doing nothing more or less than expressing, through a seemingly ‘scary’ catharsis, his/her very, very, very natural, deeply felt aversion to such ‘treatment’; this is to say, most people who wind up forcibly drugged in psychiatric “hospitals” are not truly violent, nor are they truly threatening violence, they are just fed up with being coerced into ‘taking their meds.’)

      Well, considering all this, I am very gratified to have gone on to read your 2nd comment (directly below — on December 11, 2013 at 7:57 am).

      (Really, I nearly stopped reading your 1st comment, halfway through — but didn’t do that, after all.)

      I went on and found, that, in your 2nd comment (below), you’re vastly clarifying your position.

      In that comment, you state, clearly and unequivocally,

      “Forced drugging is wrong. I want to START there, and then discuss the complexities from that starting point.”

      As I read that, Andrew, I feel very gratified and grateful to you (to say the least); I am more than happy to think that any MIA author (such as you) who works in the field of medical-coercive psychiatry is taking such a stand.

      For that stand which you’re taking, I salute you, in all sincerity.

      Likewise, I salute you for posing the question,

      Is it possible that there is usually (or always?) a viable, accessible alternative that can effective protect others from violence and be less coercive?

      Those questions can be answered in the affirmative, I believe — but are not likely to be answered in the affirmative as long as neuroleptics are thought of as mere “sedatives” (such as they’re described by Jonathan Keyes).

      Frankly, I wonder what has brought you to such a wise understanding — considering…

      Only people who have had such drugs forcibly shot into our veins really know, how utterly violating is that process of being shot up, is.

      Truly, it is every bit a form of rape.

      Those who administer such injections routinely, of course, numb themselves to this reality; hence, any currently existing psychiatric “hospital” staff will need to be completely re-trained, if it is to understand the full sense, in which most psychiatric survivors shall, even many years later, remain deeply affected, traumatized by such ‘medical’ procedures.

      We all too well recall being forcibly drugged (even decades later), as though it was just was just yesterday.

      “Hospital” staffs should be prepared to realize, that the forced ‘take downs’ (as well as the being strapped to a gurney) that typically precedes a forced drugging, are nothing but the pure, unadulterated brutalization of their fellow human beings.

      And, the subsequent, forced injecting of “tranquilizer” drugs, via needles, is nothing short of rape.

      I strongly suggest that all genuinely well-meaning psychiatric “hospital” staffs elect to be re-programmed, to understand that no one need ever needs be forcibly drugged; they should come to realize that most violence in psychiatric “hospitals” is precipitated by the provocations of staff; most of it is just a rebellion against coerced ‘medication’; and, if they sincerely care to do their best, to avoid bringing the police into the equation, when a “patient” seems to be threatening violence, they should always be well-prepared to isolate an individual from the general population, on any ward.

      Toward that end, they should be taught the principles of Aikido. (Quite seriously, I believe that would help tremendously. See: http://en.wikipedia.org/wiki/Aikido )

      Thank you for offering that 2nd comment of yours (below).

      Respectfully,

      Jonah

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      • Jonah, covering human history for how we treat violent people who are suffering emotional distress is a pretty broad topic. There have been, and continue to be, horrendous abuses before neuroleptics and in countries that don’t use neuroleptics. At the same time, I agree we could look at some traditional cultures such as within a tribal framework to examine alternative ways of managing violence.

        IN terms of Ai Ki Do, I agree there are a lot of ways to disable someone who is violent without inflicting violence. We practice techniques for interacting with someone who is violent quite a bit and they involve non-harmful ways to hold someone. At the same time, the question is what do you do after you have held someone? We do practice waiting, but that is not always effective.

        Physically holding someone is traumatic. Holding someone in seclusion is traumatic. Restraining someone is traumatic. Drugging someone is traumatic. Calling police is extremely traumatic. This is a choice of wrongs. But I entirely agree with Andrew that I cannot abdicate my responsibility of protecting people when someone has become violent.

        IN terms of the previous comments, hopefully some of the things I wrote and what Andrew was saying also addresses some of what you said.

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        • “Physically holding someone is traumatic. Holding someone in seclusion is traumatic. Restraining someone is traumatic. Drugging someone is traumatic. Calling police is extremely traumatic. This is a choice of wrongs. But I entirely agree with Andrew that I cannot abdicate my responsibility of protecting people when someone has become violent.”

          Jonathan,

          Wow. That’s a really amazing statement.

          In my humble opinion, that is a very revealing statement. It leads me to wonder whether or not you have yet studied my comment, above (on December 10, 2013 at 5:54 pm); I asked you, at last, in that comment, how would you react to a “patient” who comes to you, with an advance directive, which stipulates, that: calling the police, to address any seeming violence and/or threat of violence s/he may be accused of would be (to her/him) preferable to forced drugging.

          There is a fascinating aspect, of your statement, which I’ve now highlighted, in italics, and I would just love for you to address this matter.

          You describe only one of the ‘wrongs’ as “extremely traumatic”; it’s the ‘wrong’ of calling the police.

          If all those other ‘wrongs’ (which you list) are just traumatic, but that one is “extremely traumatic,” then, of course your “extremely traumatic” wrong must take the cake, as the most wrong of all, eh?

          Jonathan, I must conclude from what you’re saying, that, if I am (hypothetically speaking) to become a “patient” in your “hospital,” then you are bound to be, there, defending yourself against being traumatized; you find it “extremely traumatic” to see the police in your work environment; meanwhile, you are not defending me against being traumatized, in what I feel to be the most extremely traumatic way of all.

          You find a police presence “extremely traumatic,” OK. But, I don’t.

          You, as “hospital” staff, are in on making the choices, of what to do with seeming violence, in your midst.

          What choice (if any) would I have, as (hypothetically speaking) a “patient” in that environment?

          We may have very little, of substance, to discuss, from this point, forward. (I mean to say, that: if you and I were to agree that all the ‘wrongs’ you identify, as such, are equally wrong, except calling the police is most wrong, then, perhaps, I’d say, well, we’ve come to a wonderful understanding.)

          I would actually find more reassurance if we just let each one of your ‘wrongs’ be scribbled on its own piece of scratch paper, and take those pieces of scrap paper and pin them to a dart board; then, we could take turns throwing darts, to decide how to deal with seeming violence and/or seeming threats of violence, in that “hospital” of yours, where we find ourselves meeting (hypothetically speaking), you being ‘counselor’ me being ‘patient’.

          I’d say let’s play darts, in order to hopefully get beyond your (apparently quite real) fear of the police.

          I won’t begrudge you, your fear of the police.

          I won’t mock it.

          But, can we not agree that different forms of applied force will have differing degrees of traumatic impact, on different individuals.

          As far as choice goes (i.e., as far as your mentioning its significance goes), to me it seems very obvious that “patients” should be allowed choice in how they shall be ‘medicated’ or not ‘medicated’.

          Have you no real interest in that aspect of your “patient’s” lives, have you no real interest in offering them informed choices, when it comes to the drugs that shall go in their bodies, as compared to your hope that you can ‘protect’ them, against the police.

          I encourage you to, please, consider my last questions which I offered you, in my comment concerning advance directives (on December 10, 2013 at 5:54 pm).

          And, meanwhile, pPlease know, my suggestion for psychiatric “hospital” staffs, that they should be trained in Aikido, is just a beginning; but, it is a serious suggestion. I believe such training, in and of itself, could (at least, gradually) very well shift the culture of psychiatric “hospitals” away from medical-coercion, which, first and foremost, relies upon threats of forced drugging; actually, I suspect it could be an huge step toward eliminating the ‘medical’ violence that you now condone.

          (And, let’s not ignore this: You do, in deed, by this point, condone what I consider very severe violence — that is the forcing of neuroleptic drugs, into “patient’s” veins.)

          The violence you condone is only necessary to the extent that you and your staff say that it is.

          I deeply believe that you (being a well-meaning person, who has no inherent grudges against the “patient” population, in your “hospital”) would, in deed, realize that, forced drugging is unneeded; the resort to forced drugging represents an existing incompetence, on your part and on the part of your “hospital” staff; it is ignorance and incompetence, which leads one person to completely overwhelm another person.

          (Forced drugging is sometimes called ‘overwhelm psychiatry’; and, that, IMO, is a good, objective word for it. So, really, you needn’t necessarily be convinced of the immorality of forcibly drugging people, with neuroleptics — if only you can realize, it is the practice of totally overwhelming a person, with force and with chemicals; hence, it is not conducive to any sort of healing. It lends that person nothing but a sense that s/he’s met up with, at best, morally blind perpetrators of evil.)

          What I am going to say next may seem like pie-in-the-sky dreaming, but I say it anyway…

          Were you (and your staff) to become immersed in Aikido training, eventually, such training could lead to an abolition of forced drugging — at least, in your “hospital” setting.

          I genuinely believe that, where such training would take place and become deeply valued by particularly influential staff members (and/or be taken to heart, by any significant number of staff members) in virtually any psychiatric “hospital,” the coercion and forced drugging would end.

          Also, there could be personnel on hand — e.g., counselors — who are specially trained, in mediation (not ‘medication’ and not mere ‘de-escalation’).

          They could be people who have no responsibility for (nor either any personal interest nor stake in the ‘medical’ aspect of) the ‘treatment’ of any psychiatric “patient’s” supposed “mental illness” — thus, no reason to agree there’s ‘need’ for psychiatric drugs.

          These could be people who fully believe in a ‘behavioral’ approach to counseling; I would suggest Dr. William Glasser’s training in ‘Choice Therapy’; but, in any event, they’d be individuals who feel confident that mediation (not ‘medication’) resolves conflicts.

          In fact, as long as there remains no abolition of forced drugging, there could, at least, hopefully, be a mediator or mediators on hand, in psychiatric “hospitals” (IMHO, this could be mandated by psych-rights driven legislation); such individuals would, ideally, be skilled in de-escalating tensions between “hospital” staff and “patients”; this is quite different than just knowing about techniques for ‘de-escalating’ so-called “patients”.

          After all, the worst tension that arises, most typically, in psychiatric “hospitals,” is not coming from the “patients,” nor is it between “patients” themselves. You seem to suggest that it is, yet that’s not what I’ve observed, nor is it what careful research suggests. (Hopefully, you followed that link, which I offered, in my comment, above — the one which mentions the conclusions of a Dr. Papadopoulos.)

          Finally, as you’re speaking of what’s ‘wrong,’ I must admit, that: Frankly, to me, it seems quite wrong, that a “hospital” would hire a therapist/counselor who’d be required to forcibly drug people, in any instance.

          That seems an utterly inane hiring policy, IMHO.

          I, myself, am a certified, unlicensed counselor.

          (I formally studied hypnotherapy, in an accredited vocational school of hypnotherapy, and, as a result, am, technically speaking, qualified to work as an avocational and vocational counselor.)

          Counseling requires trust, based on mutual respect, between counselor and client. (It is, in deed, considered a sacred trust, which requires full presence of mind, on the part of the counselor; s/he should, ideally, put his/her own life aside, and consider only the best interest of the client, when counseling. One must forget about ones own fears, to counsel others — represent an open mind and presenting oneself not as ‘knowing what’s best for that client,’ but, rather, guiding the client back to his/her own best ‘knowing’ of what is right for himself/herself.

          When one merely presents ones credentials, that is an huge responsibility, as such.

          There should be no threat of physical force, from a counselor — and really, it should go without saying: Most certainly, there should not be threats of overwhelming force (such as that forced drugging, which you have delivered).

          You are a perpetrator of overwhelming force, capped off by the most invasive sort of attack (that neuroleptic filled needle/jab).

          Unless or until you realize how contrary that is, to the sacred trust required of a counselor, I would not recommend you as a counselor, to anyone (and, certainly not to any psych-survivor).

          I hope that does not seem a personal affront; it is not meant to be; I would very gladly reconsider, were you to renounce that forced-drugging practice, at the very least, yourself.

          But, really, your “hospital” should not even allow you or any other ‘counselor’ to get involved in that practice.

          After all, who can the “patients” turn to, to convey their sense (their very justifiably righteous sense) that it is patently unfair (and, really terribly unjust) that a psychiatric “hospital” administration is left to do as it sees fit, without oversight — even training and enlisting their ‘counselors’ to their dirty work, of forcibly drugging “patients”.

          What more can I say?

          Well, I guess it’s to your credit, that you honestly admit you are a party to such violence; but, you do not admit that is violence (as far as I can tell, you don’t).

          How you or any other ‘counselor’ can come to support forced drugging, calling it a ‘necessary’ part of psychiatric “hospital” protocols, is almost beyond fathoming, except I see, from your references to “illness” and “extreme symptoms,” you think what you’re doing is ‘medically’ justifiable.

          [Again, as you have not yet addressed my comment, in which I mention this, I repeat: I do see (from your writing) that you believe people in your “hospital” are afflicted with “extreme” symptoms of “illness,” so I think you must presume that such “illness” sometimes precipitates “severe violence,” ostensibly requiring forced drugging.]

          Were I you, even if I believed I was dealing with “patients” who were “ill,” I would not be a party to such violence.

          I couldn’t be a party to it, under any circumstances.

          I guess you just believe in its ‘necessity’ so much, that it doesn’t bother you to take the training for those who are to perpetrate it; you allow yourself to get involved, perhaps, feeling that it may even be a proud duty, as you are so wholly opposed to calling the police.

          [P.S. — note: In your op-ed, you made a point of mentioning the hierarchical nature of “hospital” settings; surely, you know you have a duty to ‘perform’ in ways that you’re told to… Well, it has recently been suggested to me (by one very insightful psychiatric survivor), that this bringing in ‘counselors’ who shall participate in the forced-drugging is all about bluttkit. I did not know that word, so I Googled it. If you do not know it, I highly encourage you to Google it… and/or, simply click on the following link, and read about it, in a historical context:

          http://books.google.com/books?id=cGHGPgj1_tIC&pg=PA263&lpg=PA263&dq=bluttkit&source=bl&ots=OGE-oUcjix&sig=l6WdLNCeeRCn51y1Tbd_zp1_MCA&hl=en&sa=X&ei=mPOjUsfeBMfmoASPxYLgBA&ved=0CC0Q6AEwAA#v=onepage&q=bluttkit&f=false ]

          Finally, about your mentioning, in your op-ed, that the standard procedure in “hospitals” is to call a “code” when a “patient” seems threatening:

          It seems to me wise and necessary to capture those incidents on video. (Other commenters have already mentioned their opinions on the fact that video cameras are present in “hospital” settings, so here I offer my brief take on that… which is quite akin to the view offered by commenter Tom Jones.)

          As long as no abolition against forced drugging exists, let there at least be some considerable amount of video proof, of what’s going on, when forced drugging occurs. Let there be some proof, documented on video, that no de-escalation techniques are working.

          There should be, on video camera, the collection of enough footage to offer a clear sense, that forced drugging is not applied merely as form of ‘medicating’ those “patients” who are really doing little more or less than being obstinate, by refusing/rejecting the psychopharmacology (pills) that they’ve been coerced into swallowing.

          Put the video in the hands of a “patient” advocate, preferably one who is a psychiatric survivor, who has been released from captivity.

          Make it mandatory that the “patient” who has been forcibly drugged, afterward, receive free defense and a the opportunity to appear at proper trial, to establish whether or not the supposed reasons for his/her forced drugging (the claimed ‘necessity’ of such) has any real merit, in the eyes of a true court of law.

          I say don’t let it be easy for forced-drugging to go on.

          After all, I never saw any practice of careful listening happen (e.g., no thoughtful ‘de-escalations’) in any “hospital” where I was a captive, years ago. (Simply, a code would be called, and a handful of staff would come running down the halls, to tackle a “patient” and forcibly drug him/her. Usually, there would be no clear reason for why that “code” was called. Again, I feel it necessary to emphasize: My understanding is that most forced druggings have nothing to do with threats of violence, on the part of the “patient”; rather, they represent the “staff” being violent, after they find a “patient” is not going along with the program — typically, meaning s/he is showing signs of resistance to swallowing pills.)

          If and when any ‘de-escalation’ efforts fail in “hospitals,” I’m willing to bet, that at least nine times out of ten, it’s because there was never any real interest in de-escalating the conflict.

          [Note: I recall overhearing one new hire in a psychiatric “hospital” cafeteria (he was a man in a suit, so I believe he was fledgling hospital administrator) assure the hospital bigwig, who had just hired him, “I love the riot.” (I overheard the whole conversation, including that line, which I recall exactly, as it was uttered; it was, of course, not meant to be overheard. Looking back, I figure I was just ‘medicated’ in a way, then, that those two guys presumed I was totally out of it; and, being typically very far removed from the “patients,” they wouldn’t have imagined that a “patient” at another table, who appeared so out of it, could be listening to their conversation.)]

          Finally and emphatically, this…

          I pray for the abolition of forced drugging in all psychiatric “hospitals”; and, as long as there remains no such abolition, I strongly believe that every psych “hospital” setting should always have a number of anti-forced-drugging advocates, on hand (not just to record the forced druggings on video).

          I believe it’s possible that, not only psych-survivors, but, also, good/excellent therapists and counselors (who may or may not be psych-survivors) could, ideally, become such advocates.

          I pray such therapists and counselors make themselves known, as being opposed to forced-drugging; I don’t know how that shall play out, with the rest of the staff; but, I figure they could be accepted.

          And, such professionals are sorely needed.

          Many psychiatric “hospital” captives shall simply know better, about the evils of forced drugging, than the staff; i.e., they will know better about what’s truly most wrong, in a “hospital” setting; but, they need back-up; for, they have little or no real power in those settings.

          Staff members who are increasingly opposed to forced drugging should step up, become the true guiding lights, amongst their fellow “hospital” workers…

          And, drop the baloney about how, supposedly, ‘sometimes it’s necessary’ to forcibly drug.

          I assure you, Jonathan, there are a lot of people who would much prefer being locked in a padded room, to being forcibly drugged. (Mind you, I wouldn’t lock anyone for long, in such a room; nore would I lock anyone in such a room who had not clearly stipulated a preference for that, as opposed to being drugged.)

          That sort of ‘treatment’ might seem entirely ‘wrong’ to you (and to many psych-survivors, as well); but, to me, it would be very much preferable to being forcibly drugged.

          That’s my view anyway.

          Respectfully,

          Jonah

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          • Jonah, just to add to what you are saying…I think the idea of a formal declaration, or advanced directive to describe how a person wishes to be treated in the event of them becoming violent is a great idea. Some may prefer that we call the police. Some may prefer to be secluded “in a padded room” as you have said. Some may prefer restraints and some may prefer forced drugs. All are going to be traumatic but I think the idea of stating a choice is a good idea.

            Obviously this can be very challenging if someone comes into an ER and is already violent towards staff. Ai Ki Do or other forms of non-harmful physical interaction can only go so far. Eventually some sort of decision about how to interact with someone who is trying to hurt people must be made. Though you perceive forced drugging to be the most horrendous assault, others consider restraints to be worse. And certainly some consider being locked in an isolated room to be very traumatic. But I agree with you that individual choice would be a very good reform.

            On a deeper note, a lot of how you are responding to me is becoming more personal and I am going to take a break from responding. At the heart though, I truly appreciate your passion and how much you care about these issues. Thanks for the conversation,

            Jon

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          • Jonathan Keyes writes, “if someone comes into an ER and is already violent towards staff. Ai Ki Do or other forms of non-harmful physical interaction can only go so far. Eventually some sort of decision about how to interact with someone who is trying to hurt people must be made. Though you perceive forced drugging to be the most horrendous assault, others consider restraints to be worse. And certainly some consider being locked in an isolated room to be very traumatic. But I agree with you that individual choice would be a very good reform.”

            Jonathan,

            Yes, individual choice would be a very good reform; that’s why so many psychiatric survivors tend to agree, that the value of providing ‘informed choice’ is absolutely paramount, in the provision of genuine medical care.

            Were psychiatrists to offer informed choices, as a rule, that would be key to ending psychiatric abuse.

            But, of course, offering informed choices cannot become a high priority for psychiatrists, as long as they reserve a ‘right’ to force ‘medications’ on their “patients”.

            For example, consider the choice of coming and going, as one pleases, from a medical facility.

            Here you offer a scenario in which someone comes into an Emergency Room who is, as you say, “already violent to staff.”

            Well I don’t presume to know what you mean by “already violent to staff” (and, I don’t expect to find out what you mean, because, in this latest comment of yours, you indicate that you are are now begging out of the conversation).

            I don’t presume to know what you mean by
            “violent to staff,” but here I will speculate briefly:

            Maybe that person is just being verbally abusive, toward staff, because, upon voluntarily entering the ER, s/he immediately finds it’s a trap laid by Psychiatry?

            As soon as s/he gets into the ER, s/he finds s/he’s not free to go.

            S/he finds that the psychiatric Inquisitor is there, to ask a battery of questions that have been very deliberately designed to make a would be “patient” appear appear as though “mentally disordered” and as “a danger to himself/herself or others.”

            (Those who have never experienced such a trap, in an ER, may read those words, of my last sentence, above, and doubt that such traps exists; but, I know what I’m talking about; they do exist, most definitely.)

            Perhaps, that person becomes verbally abusive, as s/he’s been trapped, in the ER, and you think of that verbal abuse as violence?

            On the other hand, that person might be, seemingly, physically threatening — as s/he’s experiencing a ‘fight or flight’ reaction and is not being allowed to exercise a flight response.

            E.g., maybe s/he is wrestling with the ‘security’ guard, who’s been ordered to keep all prospective psychiatric “patients” from leaving the facility.

            The guard is working in the service of Psychiatry, and the prospective “patient” is feeling quite shocked to find that this is the case.

            Perhaps, s/he scuffles with the ‘security’ guard, behaving in a way that seems ‘violent’ to you, but s/he is really just attempting to get out of an environment where s/he’s being kidnapped.

            (And, s/he is being kidnapped, truly; after all, s/he walked in voluntarily and has never been charged with a crime.)

            So, perhaps, s/he is just attempting to get away and/or — in sensing what shall come next — is simply attempting to put up a defense against being forcibly drugged.

            Who knows if that is not the case? I don’t know — because you are begging out of the conversation.

            That’s certainly your prerogative.

            I won’t begrudge you that choice, you are making.

            I honor it.

            It’s great that you can exercise your ability to come and go, as you please — here and in the “hospital” where you work.

            Really, it’s wonderful that you are modeling that ability to come and go so well.

            Though, honestly, I wish you had not begged out of dialoguing.

            And, note: As I recall, that was always the problem with psychiatric “hospital” staff; they would not dialogue for long; and, most certainly, they would not allow any “patient” to get to the point of questioning their authority. They would just keep to themselves, mainly, as they did their ‘medical’ duties and exercised their right to come and go, through doors that were locked against the passage of “involuntary patients” (such I was).

            Thank you for your replies and your “Inpatient Hospitalization: An Inside Perspective.”

            Respectfully,

            Jonah

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          • P.S. — I forgot to address this…

            Jonathan, you began your final reply with a passage that suggests to me, you’ve not read my comments carefully, as you are apparently misunderstanding my main point, regarding advance directives.

            You state, “a formal declaration, or advanced directive to describe how a person wishes to be treated in the event of them becoming violent is a great idea.”

            Actually, that was not my suggestion.

            And, frankly, I would not be one to promote such an idea.

            The idea which you are praising, there, is not mine at all.

            In fact, what you are saying is suggesting that I believe “patients” should write provisions for when they become violent; but, I don’t believe “patients” need to write any such provisions — as I don’t believe “patients” are prone to becoming violent.

            I do believe that falsely imprisoned people, who are being tortured with severely mind-altering drugs (called “medications”), may, at times, become somewhat rebellious, quite naturally.

            Their expressions of rebellion (no matter how slight) are very often interpreted, by “hospital” staff, as threats of violence.

            (Have I not explained that, in so many ways? I think I have, but you must be skimming my words or something. I don’t know, but, anyway, you have gleaned a message from my comments, that isn’t there; you’ve got your own mistaken way of reading me, apparently…)

            So, here, to clarify:

            Please know, I was questioning how you might respond (hypothetically speaking) to a “patient” in your “hospital” who had written a clear advance direction, which stated how s/he’d wish to be ‘treated’ in any event of being accused of seeming violence.

            Here’s exactly what I wrote, verbatim,

            “what if s/he also made clear that, s/he was dedicated to non-violence but that, in the event of his/her displaying some seeming “violence,” s/he’d much prefer to be turned over to the police, as opposed to being drugged by you and your associates?”

            Do you not see the difference between what I wrote and what you say is a “great idea,” I wonder?

            Perhaps, I should have put the word “seeming” in bold print, to be more clear?

            Anyway, frankly, I think it’s fascinating, how you misunderstood me.

            For, in so many ways, in my comments to you, I have been attempting to point out, that “patients” in psychiatric “hospitals” are frequently the victims of false accusations, made by staff, in order to ‘justify’ forcibly drugging them.

            Hence, in my questions, to you, regarding advance directives, I was, again, making that point and aiming to see if there was any circumstance, in which you would respect a “patient’s” preference to be taken away by the police, as opposed to being forcibly drugged.

            I know I would have very much appreciated such an alternative; I would have loved to go to jail, instead of being incarcerated in the “inpatient hospital,” for the “inpatient hospital” experiences I had were far worse than almost any jail experience I have ever heard of.

            People fear getting raped in jail, but I think that happens in prison more than jail, and I suspect that happens relatively infrequently, even in prison, as compared to all the brain-raping that goes on, in “hospitals” of the psychiatric variety; I was repeatedly brain-raped by “hospital” staff.

            I would have much preferred dealing with the police.

            If faced with an option between being, on the one hand, brain-raped, and, on the other hand, getting taken away by the police, to be booked into jail, I would choose the latter option every time.

            I would much prefer to face the jail, with its legal process, of being accused of a crime and having my day in court (preferably, a real court, not some phoney baloney ‘mental health court’).

            Even if I had been offered the choice of facing a ‘mental health court,’ that would have been far preferable to being forcibly drugged.

            (As mentioned, in one of my preceding comments, which you did not respond to, here I remind you: You do an huge disservice to your readers, by telling them that forced drugging requires court orders. That’s simply wrong.)

            That’s all.

            Respectfully,

            Jonah

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  30. It’s 4:15am here, but I had to get back up because I couldn’t sleep while still thinking about this. In my previous comment, I said at one point that, because of my sense of right to protect myself from the threat of immanent violence and my belief in a moral obligation to protect others from the threat of immanent violence that I could not say that I can’t say that restaint, forced drugging, or involuntary hospitalization is always wrong.

    Then I couldn’t sleep…

    Look I don’t know what the answers are to all of this. But I can’t go to sleep tonight and leave that the way I stated it.

    Forced drugging is wrong. I want to START there, and then discuss the complexities from that starting point. When I said earlier that when responding to the threat of immanent violence I believe in the principle of the least amount of force required (so, if none is required because there are real alternatives then none should be applied) for the least amount of time required I’m not sure that forced drugging *ever* meets those standards.

    Is it possible that there is usually (or always?) a viable, accessible alternative that can effective protect others from violence and be less coercive?

    I get into these comment thread discussions because this is one way through which I learn. I try not to write articles that seek out the most controversial sub-topic because I don’t think that’s helpful, or its at least not where I want to spend my writing energy. But in these discussion threads, I do sometimes try to grapple with the complexities of the particulars.

    My posts my not always be perfectly consistent because I am learning, struggling, questioning, thinking. But tonight, so that I can sleep, I want to take a step back and revisit some core principles that I do feel clear about.

    (1) The use of coercion, in all its forms, should be understood as both a relational evil as well as a “treatment” failure. I put the words “treatment” in quotes, because I don’t like the word at all. I think its demeaning and hierarchical and comes from a medical disease model that is evidence-lacking. But what I mean is that, there is nothing at all positive about coercive actions toward other human beings.

    Is there even a situation in which coercion of another human being might be necessary and justified? I don’t know (honest, yes?) But maybe.

    To me, self-defense in response to an immediate (“immediate” means right then and there) danger of violence may be a time where coercive force to prevent violent assault may be justified. I stand by what I said earlier when I said that I feel a sense of obligation to attempt to intervene to protect an innocent person from violent harm. That might mean that I tackle and “restrain” a person who is trying to attack an innocent person – something I might chose to do anywhere in my community and having nothing to do with “mental health,” hospitals or anything else.

    One of the major problems with our system right now is that if a person comes to a hospital ER and states their intention to hurt themselves or someone else, and then the ER allows that person to leave the ER when they ask to leave, if that person then kills themselves or someone else the hospital can be successfully sued, and the Doctor on call can be successfully individually sued for failing to “appropriately” respond. Additionally, the Doctor can be found to have been “negligent” and even lose the ability to practice.

    Please understand I did not write the above paragraph as a DEFENSE of coercive practices. But I do believe we need to be honest about the barriers created by a system to non-coercive practice. ER Docs do not feel able to make a decision to let a person leave the ER whenever they wish because if they do and that person goes out and hurts someone they can and will be held directly responsible in many cases. That is just as wrong as coercive practices are.

    This conversation thread has also conflated the subject of long term involuntary psychiatric incarceration, and acute emergency care lasting no more than 48 hours. For some that is because there is absolutely no difference and context does not matter in this case, because coercive interventions are never acceptable not matter what the situation. For others though, it seems to be more an accidental conflation of two very different situations.

    What I am confident tonight that I oppose are long term involuntary actions – long term involuntary psychiatric hospitalizations, and involuntary civil commitments (which are long term by definition, usually for six months with too many options available to the system to recommit someone over and over again against their will.)

    As I keep reflecting on things, I also think that I might just oppose forced medications in every circumstance, including the emergency room or any other circumstance. And the reason I think this might be true is because I think its possible that there may always be a less invasive, less “force” alternative available. That’s not the same thing as saying I don’t believe medications can sometimes be helpful. I do believe, and speak from personal experience with psych meds, that in some cases, medications chosen voluntarily and used carefully and selectively MAY be helpful to some people some times….

    …but I’m not sure I think forced drugging is ever ok.

    I am more confused about letting someone who is expressing immanent threat of violence toward other people leave the Emergency Room the moment they state they want to leave. I worry that this might be recklessly irresponsible to other innocent people. So then the question of law enforcement comes up. Again, many people here have made it quite clear they think that is the appropriate mechanism when coercive force becomes a necessity for the protection of others. Maybe that’s true, but I have grave, grave concerns about just saying “call the cops.”

    My experiences with police are worse than my experiences with the mental health system. Much worse. I agree with those who have pointed out that the police are much more likely to escalate bad situations and utilize violence. So is keeping someone in a hospital ER room for 24 hours while crisis workers like myself talk with them and try to offer relational support a worse choice than calling in the police, having them taszed to the ground and carted off to prison? How is that not the more disproportional application of force?

    To me there is a big difference between talking about psychiatric hospitals and long term involuntary hospitalization and talking about dealing with an acute and dangerous crisis in the Emergency Room. The questions are still complicated in either case, but I do believe those cases are SO different that the really need to be talked about separately.

    I don’t agree with long term psychiatric hospitalization, which is why I left my former job. And I’ve written about why and know that there’s very little disagreement within the community with my perspective when it comes to that. The issue of emergency response to acute crisis when other people are at risk is a different issue altogether for which I don’t have perfect answers tonight.

    Goodnight!
    Andrew

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    • Andrew, I’m sorry you had to make this post at 4 in the morning but as an intermittent insomniac I understand waking up in the middle of the night to mull things over. Hope you are sleeping in this morning.

      Forced drugging. A very very challenging topic. I think we have both agreed that long term involuntary drugging for “treatment” is simply not tenable and needs to be ended as a practice. But lets look again at doing this in reaction to violence. I agree that we are dipping into murky waters here and there is very good reason for some people to say the practice should end.

      The reasons for ending the practice include that it has been highly abused (as we talked about in the previous posts) and that perhaps there are better tools for dealing with violence.

      We both agree that anything and everything should be tried before resorting to engaging physically with someone who comes to a hospital setting.

      So what options do we have in the face of violence or potential violence? One of the techniques that we have used in our hospital is the practice of simply holding a person and essentially waiting them out…Waiting until they have calmed down enough so that they stop attacking staff and patients. Is it still coercive? Yes. Is it traumatic? Yes. But hopefully less so. Does it always work? No. It can be dangerous to staff because as soon as the patient is released from the physical hold they may decide to attack staff or other patients quickly. In essence it is more risky to staff members but can be a way of reducing trauma.

      So I would be interested in what ways you think we could interact with violent people in a way that less force can be utilized (again with the caveat that all other measures have been tried) than restraints or forced drugging.

      At this point I think we are on the continuum of “wrong”. Forced drugging is wrong. Restraints are wrong. Tazers are wrong. Bean bag guns are wrong. Lethal force is undoubtedly wrong. And yet we are left with tough decisions as you well know. I am very open to exploring how to make this better, but I agree with you that involving police or taking people in the midst of psychosis who are violent to jail is not a solution.

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      • “So I would be interested in what ways you think we could interact with violent people in a way that less force can be utilized (again with the caveat that all other measures have been tried) than restraints or forced drugging.”

        Jonathan,

        What do you think people did before injectable neuroleptics were developed???

        Do you believe there was nothing but ‘mad’ violence running amok, prior to that time?

        Have you no sense that, there have been societies and cultures with deep respect for human dignity, thus strong traditions of non-violence — wherein great masters developed harmless means of ending personal conflicts?

        Your persistent suggestions, that forced drugging is, at times, is supposedly ‘necessary,’ does not make any sense, in light of the fact that, throughout most of the course of humanity’s existence, no such means for incapacitating people existed.

        Truly, I suggest you look into the world of Aikido.

        Surely, there, you’ll find that, forced drugging can very well be supplanted with non-violent, non-invasive means of immobilizing individuals who seem threatening.

        Looking forward to finding your responses to my preceding comments (but I’m in no hurry to receive them, truly).

        Respectfully,

        Jonah

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  31. There is no reforming a system which is based on the belief that some people know what’s best for others. This is inherently classist and divisive, and is also what leads to oppressive and debilitating abuse of power–largely through fear-mongering and intimidation, including subtle, implicit language. Personally, I believe these dynamics to be the #1 cause of profound and overwhelming mental and physical distress, such as what we discuss here.

    From what I’ve seen and experienced myself in that world, this is a snowball of utter confusion and malaise that has permeated the academically-oriented ‘mental health’ culture. At this point, I can only see it caving in on itself, which will force us all, as a society, to redirect entirely how we address these issues, and most importantly, how we experience them first-hand.

    Just my perspective, but it’s what I very strongly feel.

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    • Of course, which is why my only beef is with “coercive” psychiatry outside the criminal justice system. I have repeated many times this: if psychiatry were to be deprived of its coercion on non criminals, psychiatry would be no more dangerous than astrology or homeopathy. There would always be somebody finding the chimera of the “chemical imbalance”/”psychotropic drugging” appealing, just as there are people who believe in planets influencing human behavior or the healing power of infinitesimal dilutions. The only reason psychiatry has destroyed so many lives is because it has the legal right to impose its pseudoscience on the rest of society. This power imbalance cannot be dismissed in any serious conversation about why so many people claim to have been harmed by psychiatry compared to other areas of medicine or CAM.

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      • Excellent point, the law does support current psychiatric trends, vehemently, which basically means that it allows these social ills to occur against those already being harmed by ‘mental health treatment.’ I don’t limit that to the issue of forced drugging, though. I feel it’s the same toxic culture, believing the same myths and illusions–along with operating in the same social/professional hierarchy–that created this mess to begin with, so it just goes on and on and on…

        And for the record, I’d much sooner trust and astrologer’s information, which I find can be reliable, over a psychiatric projection, which I’d never at all found to be in any way helpful, but more something to strengthen my boundaries and personal convictions around. Again, my personal experience, not everyone’s reality.

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  32. Even “voluntary” patients are not truly voluntary. As long as the threat exists that their voluntary stay could become involuntary, it’s like having a sword hanging over your head. That comes through in attitude both on the part of the staff and the recipients. Everyone knows that there’s this little pretend dance going on and yet if someone even seems as if they might become upset, things can switch to involuntary almost instantly. I tried to sign out from a voluntary stay AMA and a quick call to the doctor kept me in but switched to involuntary before the door could be unlocked.

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