Much has been written about the unethical marketing practices of pharmaceutical companies and the role of psychiatrists and government regulators in marketing psychiatric drugs. Court judgments, research studies and whistleblower accounts have left us in no doubt that dishonesty, fraud, corruption and callous disregard for human suffering underpin the promotion and distribution of these drugs.
In this, however the pharmaceutical industry is not unique. Many potentially harmful products are promoted unethically, improperly regulated and pushed by those in related industries who receive kickbacks for doing so. Gambling, for example causes a range of harms including child abuse, loss of relationships and suicide but is marketed as fun and entertaining (with any harm arising from individual pathology – gambling addiction, poor impulse control – rather than the product), promoted by the tourism industry who receive payment for delivering up customers and is inadequately regulated by government.
What distinguishes the pharmaceutical industry is the fact that, in an outstanding and unique gift to its marketers, governments have passed legislation allowing detention of potential customers and forced administration of its product to consumers who do not wish to purchase it.
Tourists who arrive in New Zealand have a range of options to satisfy their needs for entertainment: bungee jumping, whitewater rafting, snorkeling, sightseeing, shopping, nightclubbing, theatre, and of course gambling at our casinos. The providers of these entertainments compete with each other on their ability to satisfy their customers’ needs on price and on safety. The quality of their product and their customer care determine the market share and profits they receive.
Now imagine if tourists on arrival in New Zealand could be detained by tour guides, forcibly taken to the casino and made to sit in front of a pokie machine or roulette wheel for days or weeks until all their money was gone, their travel companions had left in disgust and their children, unsupervised at the airport, were taken into care. What a windfall for the gambling industry!
Imagine if the government passed legislation allowing for the detention of car buyers and the issuing of court orders that mandated them purchasing and driving a small range of government-approved vehicles because the government decided these vehicles were safe and it was in the best interests of citizens who have been involved in non-fatal crashes (and are therefore a risk to themselves and others) to drive them.
What a furore would ensure from competitors and from the public, from the business community and free market champions.
Isn’t this exactly the situation that exists for pharmaceutical companies? Government has passed legislation that allows those who do not want to purchase their drugs to be detained and injected with their products against their will, while the alternatives to pharmaceuticals are never forcibly administered. No one is forced to attend art therapy, counseling or acupuncture. Children are not forced to undergo play therapy in order to access education despite clinical studies showing these interventions to be more effective than antidepressants or stimulants.
Marketers know that there are certain segments of the population who will never purchase their products. They know that publicity about harm arising from use of their product will seriously affect demand. They leave alone those segments of the market to whom they offer no interest and withdraw defective products or invest in improving their safety profile. They operate in environments where consumers exert control over the market penetration and profitability of their product and where companies who ignore customer perspectives and needs do not survive.
Any marketing executive would kill for legislation mandating use of their product by customers who resist their marketing efforts, legislation that removes consumer control and the impact of market forces. It not only provides a (literally!) captive market but endorsement of their product by the highest powers in the land, across the entire market.
Given governments and the public are so indoctrinated with the view that psychiatry is the cure for mental illness and that pharmacological treatment is safe and effective, I’m wondering if rather than trying to change their views and repeal compulsory treatment laws, we should propose compulsory gambling or vehicle purchasing to our local representatives and when they patiently explain to us that this is not possible in a free market economy, ask innocently why psychiatric drugs are different than other drugs and any other product.
Good analogy, especially if you think that a lot of gambling addicts are prescribed antidepressants. There’s also evidence out there that antidepressants can cause gambling addiction, this would then be treated either by an increase of dosage or a change to another antidepressant type medication.
Either way it’s a win-win situation for pharma… unlike casinos.
I meant unlike the people that frequent casinos
Maria,
The odds may be outrageously horrible, but at least there’s some chance (however small) to win with compulsory gambling.
Psychiatric drugs… not so much.
Duane
I just love your articles, Maria. You make points that should be heard by a much bigger audience than MIA can offer.
I’m wondering what the access to media situation is in New Zealand. You are about the same small population, more or less, as Denmark and Ireland, and I know that the movements in those two countries get the chance to address the public there. What is the situation for that in NZ?
I get quite a lot of tv, radio and print media exposure through CASPER on the issue of suicide and psychiatric drugs but don’t get to air my views on wider issues around psychiatry anywhere except on MIA and in cafes where my friends and I solve the problems of the world. Perhaps its time for MIA TV where we bloggers can preach to the world. Maybe we could pass legislation mandating MIA TV viewing for everyone over the age of 18. People who refuse to rip up their prescriptions could be detained at the pharmacy maybe and forced to watch us for an hour a week.
I just had a thought that I’d like to hear others’ feedback about. The reason always given for involuntary detention is protection of the person or others whom that person might harm. It’s difficult to argue that this should NEVER occur, no matter what, though different arguments exist as to how and why and where such a person might be held. (BTW, I am NOT a proponent of involuntary detention in a “hospital” whose job is not to help you but is more to keep you under control!) But the biggest problem I have with involuntary detention is that it de facto authorizes involuntary DRUGGING of those so detained.
What if we changed the discussion? What if our argument became, “OK, we acknowledge that there may be times when a person needs to be protected by holding him/her against his/her will in some kind of facility, be it jail or a hospital or a halfway house or whatever. But that does NOT give anyone the right to force treatment on that person under any circumstances.” If we could decouple the need for detention (which can be argued separately in a different venue) from what should be the absolute right to refuse treatment in whatever form, we’ve taken away the argument that “well, there are those dangerous people who might hurt someone out there and have to be detained for everyone’s safety” and put the focus back on the enforcement of DRUGS as “treatment” as a separate and critical conversation.
Involuntary detention should not be synonymous with involuntary drugging. Anyone think there is value in talking about them as separate issues?
—- Steve
Steve writes (quite beautifully), “Involuntary detention should not be synonymous with involuntary drugging. Anyone think there is value in talking about them as separate issues?”
Steve,
YES, EXACTLY!
I am in complete and TOTAL agreement with you, on that (and am, in fact, agreeing with every sentiment you’ve expressed in your entire comment)!
What you’re saying here makes perfect sense to me.
And, actually, (I’ll offer this next thought, as humbly as possible): What you are saying here is really what I’ve been attempting to get at, in all my comments, ever since I first began commenting on this website. (That was roughly a year and a half ago.) It’s really the crux of what’s been moving me to keep on contributing to discussions on this site.
(Oh, and lately, too, I’m increasingly charged and feeling strongly, that any and all discussion of advance directives is very important; a full court press and push to construct and defend ‘personal advance directives’ may be key to forwarding the psych-survivor human rights movement, IMHO.)
Steve, thank you for being so much more clear and concise than I could ever be, on this matter, which you’re raising!
What a great comment and query you’ve offered — so simply put.
Yes, exactly as you indicate: the fleshing out, of these two issues should become two different discussions. (That is to say, all talk of some potential legitimacy, at times, of society’s calls for a momentary physical containment, should be viewed in very stark contrast to explorations of society’s (really quite deeply errant) acceptance of compulsory psychiatric ‘treatment’; those two issues should most certainly be raised separately.
Unfortunately, I tend to go on an on, with my words in my comments.
Must. Stop. Writing. Now.
Thank you, again, Steve, for your thoughtful contributions to these discussions. They are always well said…
Respectfully,
Jonah
yep I do Steve but whenever I’ve tried to raise the shade of grey’s, or the idea of limited detention with no forced treatment or only for immediate physical life saving measures (malnutrition/dehydration/sleep deprivation) I get told I’m supporting forced drugging or zero response so I gave up
I think the problem with your argument is this. First, there are many people in society who pose a risk to themselves and others but we apply different standards and protections around detention for those who are labelled mentally ill than those who are not. Under criminal law, the police do not go into someone’s house, ask them a series of risk assessment questions and then lock them up to prevent them committing a crime in the future. Even where there is evidence they may have already committed a crime, the police must have very strong evidence to detain them pending trial and then prove beyond reasonable doubt that they are criminals before detention orders are considered. For those assessed as mentally ill via an entirely subjective assessment process which has been shown to have little validity or reliability can see them detained indefinitely. No proof of mental illness is required and if the test was beyond reasonable doubt, no one would ever be diagnosed.
Second, in practice, compulsory detention is almost invariably combined with compulsory pharmacological treatment. Separating the two ignores the real world experience of involuntary commitment.
Third, Professor Roger Mulder of Otago University has recently published a paper which presents evidence that suicide risk assessment and involuntary commitment are conducted primarily to manage clinician anxiety rather than patient safety.
Fourth, research is very clear that psychiatric hospitalisation is a key risk factor for suicide and violence rather than being a risk prevention measure.
If as a society we are prepared to manage the risk of non-mentally ill people perpetrating harm on themselves and others through means other than preventative detention, I wonder why we would not afford the same rights to those experiencing distress.
In my view, if we provided places of support and safety where those who are sad, scared, worried or angry, those dealing with violent or self destructive feelings as a result of negative life experiences or drug use, places where people were given love and hope and compassion, we wouldn’t need laws detaining them. They would want to go there.
Yes detention and treatment are separate entities but both are harmful and there are alternatives to both which are more humane and manage risk more effectively.
Maria,
I quite appreciate the spirit of everything you’re saying in this response, of yours, to Steve.
At the same time, I continue to see Steve’s suggestion as perfectly good (and, indeed, quite excellent).
As you seem to be stating an objection to something, in Steve’s comment, I wonder if, perhaps, you’ve significantly misread Steve’s comment?
For instance, you write, in your reply to him, that, “If as a society we are prepared to manage the risk of non-mentally ill people perpetrating harm on themselves and others through means other than preventative detention, I wonder why we would not afford the same rights to those experiencing distress.” I don’t know why you feel a need to say that? Certainly, you needn’t argue such a point, in relation to Steve’s suggestion.
After all, please, note prominently: No where does Steve even mention “mental illness.”
From what Steve is saying, I presume that he very well understands, that any designation of “mentally illness” is a ruse, really. [Hopefully, Steve understands that; and, I believe he does understand that (based on previously MIA comment conversations I’ve had with him.)]
“Mental illness” (and, “mentally ill”) is a completely bogus ‘medical’ designation. It’s a proposed delineation, of ‘disease’ that, we all know, cannot be scientifically verified (exactly as you say).
You know that…
We all know it… “Mental illness” is just a term that makes psychiatrists seem more knowing than they actually are.
It’s a mystifying term, and, indeed, as far as I’m concerned, it’s ultimately terribly misleading.
If and when we do not admit that it’s just a very vaguely applied metaphor, “mental illness” is just pure B.S. language and/or, really, languaging that indicates the collective delusion and/or the deliberately propagated fiction, of psychiatrists; it’s mainly nonsense, which a poorly informed society sadly buys into, as though it designates a scientific reality.
At last, Steve’s comment is saying nothing about “mental illness.” It is saying that any arguments regarding a supposed good in forced psychiatric ‘treatments’ should be decoupled from any arguments regarding a potential need for some, occasional societal physical containment, of certain individuals.
The implication is that those individuals may be, at least seemingly, acutely confused and/or emotionally troubled.
(But, NOTE: He’s not even insisting that such containment should necessarily be a responsibility of the government.)
And, of course, I shouldn’t be attempting to speak for Steve!
So, here I will just add, about advance directives…
I, personally, believe, that carefully crafted advance directives can come in handy, to advise family and friends of how an individual may wish to to be cared for — if and when s/he might seemingly need special help.
A well-crafted advance directive can become a social contract (mutually agreeable assurances), amongst oneself and ones family and friends — and, perhaps, one’s therapist/s (if one has therapist/s).
It can include self-described assurances that the individual does not care to be ‘treated’ with a certain class of prescription drugs, ever; and, by the same token, s/he may express agreement to a certain kind of ‘contained’ care under certain circumstances. (That care may include the use of certain prescription drugs, but it needn’t do so. It can be drug-free care.)
S/he can share the content of that advance directive amongst his/her own closest confidants — and receive assurances that those confidants can and will always respect and defend the intents and principles s/he puts forth therein.
In that way, no one in his/her immediate social circle will ever come to insist that s/he be forcibly ‘treated’ in ways s/he doesn’t want to be ‘treated’.
Also, the advance directive can state that s/he never wishes to be ‘treated’ by any psychiatrist.
It can, furthermore, convey a complete disregard for the “mental illness” concept.
It can agree to a certain degree of a certain kind of physical containment, under certain circumstances.
But, you see, the notion of “mental illness” need never enter the conversation — just like it never enters Steve conversation, in his comment, above…
And, it needn’t include resort to government ‘authorized’ provisions.
(Steve says nothing about advance directives, in his comment; that’s just very much on my mind.)
(And, I sure hope Steve will correct me if I’m misrepresenting his message in any way.)
Again, I emphasize that I do appreciate the spirit of your message, Maria; you can, of course (and, surely, anyone who reads this can), please, feel free to offer feedback…
Respectfully,
Jonah
P.S. — Maria, after posting my comment, to you, I’ve realized, I inadvertently failed to acknowledge, that you wrote a fine blog post here. It’s very good. (Though, it leaves me wondering whether gambling is under-regulated, as you suggest it is? I just don’t know if it is. Maybe in your country? Who knows? That point was a very minor sticking point, for me, as I read through it, yet I know it’s really not at all the key point, of what you are saying.) Basically, as a person who, many years ago, had psychiatric drugs forced upon him, I deeply appreciate what you are saying about that terribly abusive ‘medical’ practice. And, no less, I appreciate what Steve is saying, to the extent that he’s suggesting: we might be more effective in our efforts to end such abuse, if/when we become willing to acknowledge that, in some instances, there may well be fair justifications for what might be considered ‘non-criminal containment’ (Steve calls it “detention”). Just think, for instance, of people who are suffering advanced stage Alzheimer’s; if and when they are not, to some extent, ‘contained’ (e.g., kept within the bounds of a ‘nursing’ home), then they may all to easily wind up wandering off and getting lost. Surely, you understand their need for such physical boundaries/limits, as may be created by such facilities? Hopefully, they’ve agreed to those limits; hopefully, they planned ahead and created advanced directives, agreeing; but, what if they didn’t? What if they don’t agree, yet they really are suffering advanced stage Alzheimer’s, which leaves them generally disoriented? I invite your feedback. Respectfully, J.
Hey Jonah
Because I have a very short attention span, I’ve had a lot of career changes and for a period of five years to 2007 was the manager responsible for gambling regulation for the North Island of NZ. Around the world the gambling industry is associated with money laundering, drug dealing and loan sharking, children are left unattended locked in cars while their parents gamble and those who cannot afford it are offered incentives to continue gambling until they lose everything.
In relation to detention, yes I think sometimes people might need to have their freedom restricted for periods of time but just as with a child who needs to be restrained from running out on the road, the appropriate place for this to occur is within families and communities, not institutions which employ the coercive power of the police.
A few weeks after my son died, I was handcuffed by five police officers and involuntarily committed to a psychiatric hospital on the grounds I was a risk to myself. I was put in restraints and had my clothes cut off me in front of two male security guards. As a result of the police action, I was x-rayed for a suspected broken wrist and extensive bruising was photographed. When I asked for a patient advocate, the nurse with the scissors in her hand laughed and said “that’s what nurses are – I’m your patient advocate.” I was not forcibly medicated but that experience has left very deep scars. I needed family and friends to be with me. I needed them to let me talk about the trauma of finding my only, deeply loved child hanging from a noose. I needed to be given hope for the future. I was intensely suicidal and a serious risk to myself but I did not need to be locked up in an institution, I needed to be in my own home, cared for by people who knew and loved me.
Maria, great post. As a hospital therapist, one of the biggest reforms I see is the need to stop forcibly medicating people who are involuntarily committed. It is absolutely untenable to make people take something over a long period of time that has severe side effects and health risks. There must be consent in any form of long term treatment.
The rationale is that the drugs will make them better, stabilize them. And indeed for many, drugs will make a manic person sedate, will dull and muffle the interior world if there is severe psychosis. But we are left with allowing the state and medical system to repeatedly chemically alter patients, at the cost benefit of Big Pharma, an absolutely horrendous situation.
I mentioned this in another post, but hospitals also allow representatives of the pharmaceutical industry to promote their drugs in hospital settings via free lunches where they give away cups, pens, watches, etc. They also promote their medications using evidence that they cherry pick while avoiding talk of the severe complications related to most of the drugs. Untenable.
Jonathan,
Patients are “spellbound.”
And the “benefit” of these drugs is outweighed by their adverse reactions.
Nobody speaks the truth about all of this quite like Dr. Peter Breggin. His work ought to be required reading by the staff at your “hospital” (these places are *not* hospitals). –
http://breggin.com/index.php?option=com_content&task=view&id=187
Duane
Maria,
Thank you so much for your very meaningful reply.
And, thank you, most especially, for sharing your personal experience, of having been so very wrongly treated by the police (and so wrongly treated by that nurse). Of course, you should never have been detained that way.
I had previously been aware, of how you lost your son, but I had not been aware of this other side of your story.
(You are a tremendous survivor, Maria! I am somewhat aware of how you built your great, grass roots organization, in the wake of having lost your son; and, really, I’m in awe of your effectiveness, that way, your courage and your tenacity.)
And, about your now mentioning that previous career of yours, as gambling regulator, in your country: Wow. You certainly do know about gambling regulation!
Wonderful that you do know so much about it. And, thank you for briefly sharing what you did, about that. It certainly does make you an expert in the regulating of huge, corruption prone industries — and also an expert in ‘risk management’ of sorts.
I’m quite sure you were of tremendous service to your country, in that position. Great, that you can and do now serve humanity by applying that knowledge to what you’ve come to learn (unfortunately, the hard way) about the Pharmaceutical/Psychiatric Industrial Complex.
So…
Now, about these matters, having to do with that unholy alliance between Big Pharma and Psychiatry — and about your very genuinely correct/righteous opposition to the ‘medical’ coercion, which it employs for its own gain…
It is, indeed, truly outrageous that the Pharma-Psychiatry industry is forever seeking to co-opts powers of government, to advance its own lust for profit and power. It does that especially by preying on people in emotional distress (and, that means, most particularly, by ‘medicalizing’ people who may demonstrate possibilities of being suicidal).
In many ways, they employ the police to help them in that mission, of theirs; and, that is worse than just wrong. It is a most utterly deplorable and unconscionable, depraved sort of profiteering.
Of course, there are many genuinely well-meaning people who get caught up, in the misguided enthusiasm, which seeks to medicalize people who are suffering emotionally.
I, myself, would never call the police for help with anyone’s emotional distress, of any kind — unless, possibly, if that person seemed truly bent on hurting others.
That is to say, I do not believe that the police should be made responsible for preventing suicides. (That is my opinion.)
Just yesterday, I mentioned that particular position of mine, in comments under Jonathan Keyes’s recent MIA op-ed. (I see he has offered a comment, for you, just moments ago.)
Of course, from what you’re describing, of your experiences, you should never have been apprehended by the police and taken to a “hospital” of any kind.
In fact, I am lately thinking about and speaking of advance directives, in the way that I do, largely in the hope that they can prevent the sort of misery, which you were made to endure, that way.
So, please, understand, I sincerely believe that you and I are actually in full agreement, on this: Police detention is absolutely not appropriate for people who may possibly be threatening to harm themselves.
I fully appreciate what little I know of you and your work, the world is clearly much the better for it! You are surely honoring your son’s life, through your work, in the best possible ways.
Really, I am behind you, cheering you on. (I truly hope you do get this from all that I’m saying here.)
Respectfully,
Jonah
I agree with Maria.
If we take your standard of offering support and never detaining as a preventative measure we might try harder with people who are distressed.
Once people have been violent then there is a reason to wonder if restraint is necessary, but even then trying hard to prevent it by offering understanding before hand is best. That is the same for everyone, diagnosis or not, mental illness or not, politician… Hey Mr President, stop those drone attacks and talk things over.
Maria,
Your latest blog leaves me in tears. I can so empathize with what you’ve so tragically experienced, the suicide of ” your deeply loved child hanging by a noose” . We both lost our beautiful sons, same way. Whether it was from an illicit mind- altering drug (in my son’s case it was cannabis) which is affecting more young susceptible brains or a prescribed psychotropic drug, as with your son- something catastrophically altered their brains.
My heart is with you, Maria. To read what you then experienced a few weeks later in the throes of despair and grief, which every loving parent who experiences this horrific nightmare can only begin to fathom, it is gut-wrenching. I remain lost how society can treat victims, like you, who had just lost your precious boy, so callously. How could you be handcuffed by the police, then dragged and involuntarily committed to a psych hospital? Human suffering seems so acutely misunderstood by society, especially the way ” help” is given.
Please know you have my deepest admiration for the strength you’ve shown in moving through your sorrow. Your writing pieces are so eloquently written. The CASPER organization you spearheaded to wake society up is such a tribute to your beloved son ‘s memory.
Bless you Maria, and just know the love we have for our chilfdren, in the legacy of their significant, but all too brief lives, will sustain us. What we have witnessed and lost now we share with society to bring awareness, and ideally change.
I’m so sorry Iarmac. The cannabis / suicide link is only too clear in the work I do with CASPER and I can only imagine what it must be like to hear people talk about how smoking it is a ‘victimless crime.’ I hate the stuff because I see it inducing younger and younger children to take their lives.
Two weeks out from Christmas I’m sending you much love and wishing you the strength you and I know it takes to get through the holiday season without our childrens’ physical presence.
Mental health court, USA
The use of mental health courts to coerce people into treatment, the requirement in some courts that defendants enter a guilty plea prior to entering the court…
Maria,
I thought of you and your precious Toran tonight at the The Compassionate Friends Worldwide Candle Lighting tonight which is the annual event where persons around the globe light candles for one hour to honor children who have died. The candles are lit at 7 p.m. local time, starting in New Zealand. It reminds each of us about our love for our children, gone far too soon. As candles burn down in each time zone, they are then lit in the next. This creates a virtual 24-hour wave of light as the observance continues around the world. Just hoping you are familiar with this organization and if so, that it brings you the love and support from others who have lost a child.
And thank you for sharing your observations of the environmental link from cannabis to suicide. It amazes me to read the critical blogging from the pro cannabis supporters. We know the factors that took our beloved son’s from us, and as a result of the pain we suffer just want to spare the next son or daughter. This young generation has no awareness how drugs ( illicit or prescription) impact their developing brains.