Inpatient Hospitalization:
An Inside Perspective

Jonathan Keyes
140
1052

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.

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.

    • 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.

  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

    • 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?

      • 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

        • 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.

          • 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

          • 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.

  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

  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.

    • 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.

    • “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.

    • 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.

  5. 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.

      • 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.

        • 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

        • 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

        • 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.

  6. 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

  7. 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.

  8. 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.

    • 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

  9. 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?

  10. 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.

  11. 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.

  12. 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.

  13. – “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.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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.

    • “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.

  20. 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.

  21. 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.

  22. “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.

  23. 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.

  24. 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

  25. 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.” https://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

  26. 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

    • 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

  27. 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

  28. 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.

    • 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.

      • 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.

  29. 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.