Mind the Gap: The Space Between Alternatives & Force

Sera Davidow
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“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive”

-”  C.S.  Lewis

Warning:  Heavy use of ‘’quotes’’ ahead.

Force in ‘‘mental health’ care’ has been a popular topic for decades now, yet it’’s scary how similar the conversation remains.  ( For example, see the ‘‘Declaration of Principles‘’ published in 1982 in Phoenix Rising or the ‘Insane Liberation Front Manifesto‘ as documented by Tom Wittick.)  Jonathan Keyes’’s recent blog certainly generated quite a bit of commentary caught between conflict and assimilation, and the very mention of the infamous Treatment Advocacy Center (no, I will not link to them!) gets many of us boiling over.

Yet, the conversation has also seemingly lost its way.  There’s a vastness between what we think we are demanding and what is actually being conveyed that can sometimes feel impenetrable.  Often, I’’m not sure we’’re really even engaged in the same conversation, as much as we superficially may appear to be.

One perspective that I particularly appreciate originates with Jim Gottstein and the Law Project for Psychiatric Rights.  Jim so often speaks of the ‘Transformation Triangle’ which incorporates multiple points and aspects involved in systems change including creating new choices, changing attitudes and changing laws.  This approach does a great job of recognizing that there can be many parts to the process of transformation.

Perhaps the gaps in our arguments can largely be explained by the fact that often we’’re coming from different (but nonetheless valid) angles of the triangle without fully recognizing and articulating that point.  But, even that is a bit of a leap from where we seem to typically be most stuck.  Prior to diving into how we make the change we want, we need to better define what it is that we’re seeking.

Coming to greater clarity on whether or not we think ‘force’ is okay raises many issues all on its own, and leaves us teetering on the edge of one of the biggest gaps of all:  What happens to all the people who we don’’t want to see forced but for whom the alternatives that exist simply aren’’t a fit or aren’’t accessible?

Our movement (the one with which I most clearly identify, anyway) is well known for its embattled cries for the abolition of all force.  We’’re also known for the promotion of alternatives like Soteria, Open Dialogue (ad nauseum), ‘peer’ respites and the like.  But what happens when someone is in serious distress but seems not quite a fit for one of these highly praised alternatives either for lack of their own interest or inability to participate in the defined process?  What if they aren’’t able or willing to hold the values of a mutually based environment at the local respite or simply have no interest in checking out a Soteria house?  (Never mind that these alternatives are generally either under represented or outright unavailable in most areas.)  Any of us would be fools to pretend that there aren’’t situations where someone is altered in a way that puts them or others in real danger in the absence of any truly satisfying answer as to how to support them through.

Our movement also does itself a great disservice by insisting that the cure all to this particular gap is nothing more than love, being present, talking with, listening to, and so on (as much as all that may be the answer more often than most realize).  We offer ourselves up to be all too easily painted as a naïve group throwing a ‘no force’ tantrum while stubbornly turning away from some of the harshest realities.  In those moments, we also bare our throats to those enemies of the state (of humanity) such as E. Fuller Torrey who are ever poised to dig in their claws with their own battle cries of anosognosia and fear mongering parades of Grimm nightmare tales.

If we are a movement that is ever to fully mature, we need to be willing to answer (or at least talk with) the well-meaning clinician who asks, ‘“But really, what am I supposed to do?  Am I just supposed to walk away?’”  And, we need to come up with much clearer answers to the seemingly unanswerable than we’’ve tended to offer thus far.

While any sort of real, concrete answer to addressing the ‘gap’ has not fully shown itself in the face of the complexities of so many human experiences and competing needs bouncing off one another,  consideration of a series of points seems to have moved many of us toward at least a much less cavernous chasm.

So, are we trying to change the system or disband it entirely?  Or are we trying to disband it by improving it until what was…… simply is no more?  And, are we trying to reduce force to only those times when it is “absolutely needed?”  Or are we fighting to eliminate it altogether?  Or are we trying to reduce it by virtue of aiming to eliminate?  And what about those people with whom we simply cannot connect and who are teetering on an edge of their own?  And where to even begin (again)?

Force is a Force, Of Course, Of Course:…

This conversation gets even more confusing when we don’’t bother to stop and clarify what sort of force we’’re talking about.  In the broadest of senses, I have to imagine that we ALL agree with SOME sort of force….

For example, if someone was to physically assault you, I assume you (whoever ‘you’ are) would be okay with the police (or anyone else in the vicinity) forcing them to stop.  Most would also say that the person who is getting assaulted who then defends themselves using reasonable force is also in the right.

So, for starters, to be clear, when I am writing and talking about ‘force’ here, I am talking specifically about systematized force in the ‘‘mental health’’ system.

Given that, what follows is not a singular answer, but a number of points strung together because they have arisen for me through dialogue on-line and in person.  I offer them because I believe that consideration of each point has the potential to lessen the apparent ‘gap’ and move us toward increasing clarity and change:

A Pig By Any Other Name…

……Is still a pig.  In fact, it could be even more dangerous, because maybe…… just maybe…… that pig will be able to convince you it’’s a swan (or fairy, or whatever treads on the happier end of your fantasy worlds) for long enough to lure you in, leaving you not only trapped but outright lied to as well.   So, let’’s take a quick(ish) look at language.

Some years ago, I visited a so-called ‘‘peer’ respite’ in Arizona that was attached to a crisis services center.  (Mind you, this is not a model that I support for these sorts of respites in the first place.)  A group of us sat with administrators on the crisis services side, and listened while they boasted about having recorded no restraints in the past year.  That sounded good, until we asked more questions and learned that if someone was held down for under 15 minutes in order to be forcibly medicated, the administrators simply didn’’t count it as restraint.

In reality, the dishonesty and lack of transparency that often gets intertwined with so-called ‘’mental health’ services’ feels traumatizing all on its own. After hearing about the re-definition of restraint by the Arizona group, I recall cancelling my evening plans and huddling in my hotel for the night because I felt so disturbed at the idea that these administrators had such power to prettify something so ugly.  Sadly, it’’s nothing new.

However, in order to have a conversation about ‘force’ in any sort of productive way, we need to do away with the prettification.  Somewhere along the way, people got confused about language.  They seem to think that because so many of us argue against diagnostic and systemized language in general, that we’’re into words that are either vacuous or a downright lie.  It’’s quite the opposite, really.

To hell with ‘’Assisted Outpatient Treatment,’” ‘“temporary holds,”’ and the like.  As a friend recently remarked, “’temporary hold’” sounds as if one is simply waiting on the line for the next available customer services representative’ at the power company while, at worst, suffering some particularly bad muzak.  And, few people who have experienced the utter loss of power of being locked somewhere they don’’t want to be for even twenty-four hours would say a three day hold isn’’t force. So, simply put:  Let’’s begin by just naming it.

Lest anyone continue to be confused, a few more clarifications:

  • •    If, as a part of ‘treatment,’ you hold someone down… for any reason… for any length of time…… it’’s still force.
  • •    If you name yourself a ‘’Recovery Center,’’ but people can get involuntarily committed to your definition of ‘‘recovery’…’ it’’s still force.
  • •    If you leave the doors unlocked, but no one is actually allowed to leave without being chased and brought back whether they like it or not… it’’s still force.
  • •    If you say you’’re ‘‘assisting’’ someone, but the direction you’’re assisting them in is the exact opposite of where they want to go… it’’s still force.
  • •    If someone is ‘compliant’ with their psychiatric drug regimen only because you administer it by mandatory order in a syringe once a month… it’’s still force.
  • •    If ‘choosing’ not to follow through with ‘recommended treatments’ results in someone being picked up and incarcerated… it’’s still force.
  • •    If you have someone involuntarily hospitalized because you’’re really, really worried about them and genuinely think they are unable to make decisions that will keep them safe, and it’’s really, really the best, most justified instance of involuntary hospitalization ever…… It’’s. Still. Force.

Calling it what it is is not the same as deeming it right or wrong.  So, please, let’s quit the verbal Febreeze and move on.

Answers Do Not Come to Those Who Wait:

A wise woman (aka Chris Hansen of Intentional Peer Support fame) recently reminded me that when slavery was abolished there was no grand ‘plan’ for all the men, women and children who were abruptly released into freedom.  There was no promise of housing, income or much of anything else.  People suffered.  People died.

And yet, it was the right thing to do.  Lack of alternatives and well-thought-out plans could not be justification for the continued enslavement of human beings.  Perhaps even more importantly, answers are generally born out of necessity, not some far off possibility of change once we figure things out somewhere down the road.

I do not think, for example, it was any sort of coincidence that Soteria Vermont got its funding around the same time that their hospital was washed away in a storm.  We should all bear this in mind as we’ are asked to tread slowly in our demands for an end to human rights violations and incarceration based on projection and subjective assessment.

A Time to Grieve:

So much of this conversation gets lost in anger and defensiveness.  And, it all makes sense.  It makes sense that people who have been hurt or lost loved ones to abuses in the system are angry.  It makes sense that people who were doing what they thought was right out of desperation to help a family member, or via careers that their livelihoods are staked in, feel defensive.  And yet, that continuous loop doesn’t particularly move us toward progress.

We speak often about healing spaces for people who have been hurt.  But what of people in provider roles?  Or family and friends?  Sure many of us have met the cold-hearted provider who seems to hold more wealth in power than compassion, or who has been so beaten down by life that they just don’’t seem to care…… but most want to do what’’s right.  Yes, there are truly terrible family members who have no good intentions…… but most are trying to help.

Thus, it seems critical to find times and places for people to come together -– those hurt and those part of the system (directly or indirectly) that hurt them – – and acknowledge the harm done.  I’’m not particularly attached to a twelve-step approach, but I’’d say that, ‘“the first step is acknowledging there is a problem,’” feels about right here.  Imagine the power of hearing out those who have been hurt without argument or justification, owning at least a piece of the harm that has been done, apologizing and genuinely trying to understand how to move forward to something different.  Imagine how we could all be changed by such a process.

In fact, a woman stood up at the very, very end of this year’’s Alternatives conference, took the microphone in the grand ballroom and – in front of hundreds of people – said that she’d come to realize (as a result of the many voices at the event) that she had done things that hurt people.  (Sandy Steingard’s recent piece in the Washington Post doesn’t go quite so far as this… saying one was ‘wrong’ is different than acknowledging one actually caused ‘harm’ even if the latter is implicit, but it starts to get there and is also worth a read.)  She wanted to say it out loud and own it.  It took courage to say that in front of so many people who are still nursing the many wounds of the ‘treatment’ that was supposed to help them, and I can only hope she’’ll hold onto that courage, take those words home with her and make real change.  However, courage aside, I generally find that those who have been hurt are much more receptive to statements such as that, than to who are simply offering an explanation and asking for a pass.  So, why is that one of the first times I’’ve ever heard those words spoken in such a public setting?

If nothing else, this sort of admission seems a necessary step toward getting to a point where everyone can begin to hear the rest of these arguments.

Unlearning Center: 

When we hire at the Western Mass Recovery Learning Community, the most important questions we ask during the interview are the ones designed to determine just how much someone has to UNlearn.  We offer up scenarios on hearing voices, self-injury, suicide and more not so much looking for  the ‘right’ answer as we are looking to better understand just how ingrained the good ol’’ typical societal beliefs may be in that particular individual.

Why?  We’’re looking for people who know that hearing voices doesn’’t have to be a bad thing; that self-injury is a way of coping and isn’’t the worst thing in the world; that suicidal thoughts are largely an existential issue best addressed by giving someone space to talk things through.  However, we live in a culture that is  (‘Mental Health First’) aid’ing more and more people into believing that these and other understandable human experiences generally require major intervention and panic-button-pushing responses that all too often involve force of some sort or another.

There are many unlearning campaigns (such as Hearing Voices and Alternatives to Suicide) already afoot.  However, strengthening our efforts in that department would provide a rather automatic reduction in the perception of the need for force, and as we all know, perception is incredibly powerful when it comes to something as intangible as ‘mental health.’

Business as Unusual: 

People in provider roles inevitably feel overwhelmed when they are attacked for using force, as it often comes with little to no suggestions as to what to do instead.  We talk about meeting someone who is in distress ‘’where they are at,’’ but we rarely do that for people in provider roles who have been indoctrinated into particular ways of thinking and being, sometimes for decades.  While I agree that we can’’t exactly be patient about demanding change while people are dying, asking providers to jump from A to Z without support just isn’t realistic.

Perhaps one of the smartest things we can do to move people toward change is to ask them to practice ‘business as unusual.’  That is to say:  We know that when people go about their daily routine uninterrupted, it’’s unrealistic to expect change.  However, when we ask them to make even small changes to how they think about or do things, it can have a profound effect.

For example, one organization in Massachusetts has reported a dramatic decrease in the practice of forcibly hospitalizing people simply by requiring that all incidences of such force be tracked.  They record the date, the reason, and so on and have seen such a dramatic reduction that their funder is asking them to identify the details of their process for purposes of replication.

Chris Hansen also suggests that organizations consider making any use of force a critical incident that requires an investigation including an interview with the person who experienced the force.  (This is a protocol we’’d implemented at our respite house, Afiya, before ever hearing Chris’’s recommendations, although we’’ve never had to use it because we’’ve never actually reached the point of calling the police or emergency services at the house.)

Perhaps if such policies were implemented in all ‘‘mental health’’ settings, things would at least begin to shift in the right direction.

Self-DEFEATING Prophecy:

A new law  was recently passed designating assault on a healthcare worker as a felony.  At one point, many people seemed to be advocating that the law be written with an exception for those with psychiatric diagnoses.  I couldn’’t disagree more.  We can’’t argue that people with psychiatric diagnoses are not dangerous whilst at the same time saying, “”but please give us a pass when we hurt you, because we just can’’t help ourselves!””

However, here’’s an argument I could get behind wholeheartedly:  Let’’s put an exception into that law for anyone undergoing any sort of force.

Restraint.  Forced hospitalization.  Forced drugging.  What-have-you.  When you force something on someone’’s personal being, they may quite rightfully deem their actions to be self-defense.  So, when you decide someone’’s dangerous and thusly treat them with force in some manner, ‘’dangerous’’ just became far more likely.

Add to that the fact that the person arriving before you very likely already experienced force, humiliation and/or loss of control in the immediate past with Emergency Responders (never mind a whole world of historical trauma that they may have experienced) and it becomes increasingly difficult to imagine how a person might manage to contain themselves.  Yet, all too often, the provider who feels they have no other choice but to use force is putting the locus of control and responsibility on that person for becoming violent.

If we want people to stop acting violently, perhaps we need to stop treating them violently.  When people who have historically been treated violently act violently, perhaps we need to share in some of the responsibility of how they learned to walk in that way through this world.

So funny how words –- such as ‘violence’ and ‘dangerousness,’ for instance -– ultimately find their definitions in the hands of those who are in power.

AND, MOST IMPORTANTLY…

It Works Until It Doesn’’t Work: 

On October 22nd, 2013, I traveled with many others from the Western Massachusetts Recovery Learning Community (RLC), to testify at a hearing on Forced Outpatient Commitment (aka ‘‘AOT,’’ ‘‘IOC,’’ and whatever other word or acronym you wish to throw at it).  I said many things during my time at the podium, but I concluded with the following statement:  ““If you’’re going to force it, you better make sure that what you’’re forcing works.””

The facts of the matter are (and this doesn’’t get said nearly enough in these sorts of conversations) that forced treatment – –and particularly forced drugging – –simply doesn’’t work.  In actuality, evidence of every kind suggests that it makes the situation worse for most people in the long run (and there’s no way to tell who the minority might be until it’s far too late).  Numerous studies have now demonstrated contrarily pesky sorts of results such as the following:

  • •Psychiatric drugs seem to lead to worsening outcomes (both in that people on them tend to work less and lead less full lives overall, AND in that they appear to experience worsening ‘’symptoms’’ over the long term… INCLUDING those about which the general public expresses the most fear) and potentially permanent damage (e.g., El-Mallakh, R. “‘Tardive dysphoria: The role of long-term antidepressant use in inducing chronic depression.’ Medical Hypotheses 76 (2011): 769-773; Harrow M. “’Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study.”’ Psychological Medicine, (2012):1-11)
  • Forced ‘treatment’ (such as forced outpatient commitment orders) does not appear to reduce difficulties in community (such as those that lead to re-hospitalizations) (e.g., Dawson, J and Rugkasa, R. “’Community Treatment Orders:  Current Evidence and the Implications.’”  British Journal of Psychiatry,(2013) 203: 406-408.)
  • Suicide rates for people just released from hospitals (to prevent suicide attempts) seems to be awfully high (e.g., Crawford, Mike J.  ‘“Suicide Following Discharge from In-Patient Psychiatric Care.”’  Advances in Psychiatric Treatment (2004) 10: 434-438.

Sure, force may prevent someone from doing something undesirable in a singular moment, but then what?  What if stopping them via force actually increases the risk of that undesirable outcome down the road?  If someone’’s most likely to kill themselves after they’’ve been hospitalized for attempting or stating they want to kill themselves, do we just… never let them out?  Quite the quandary, it would seem…… except, not really.  Force begets force begets force begets harm begets force.  Repeat.  The pattern has to end somewhere, and in our conversations about force (particularly with legislative bodies) we need to be much clearer to point this out as we move forward.

An Abolitionist State of Mind:

Last spring, I attended a meeting in the DC area on the topic of ‘’mental health,’’ ‘‘recovery’’ and ‘‘prevention’’ (all quite intentionally in quotes as I am never quite sure what most of us mean by them).   During the introductory remarks, one individual stood before us and declared, “”There will always be forced treatment.””  This remark would have been unacceptable coming from anyone, but was particularly so because the person speaking those words had himself experienced involuntary hospitalization and was now seen as being in a position to represent our movement.

The dichotomy of force/no force is overly simplistic and ultimately false.  However, the truth is that nothing but an abolitionist perspective should be tolerated.  Any protocol that lists force as a viable option (even if only as last resort) will inevitably lead to more frequent justifications.  Any individual who acknowledges the necessity of force in the same breath as saying it is fundamentally wrong, diminishes our values to the point of irrelevancy.  The moment we accept our values in a compromised form and ourselves willingly start portraying them as such, they become something else entirely and are no longer ours to hold.

We Have To Because… We Can:

As much as I would still argue for an ‘abolitionist’ state of mind, many continue to point out the gradations of wrong when it comes to concepts of force, and they are right.  In a conversation on this very topic, one person recently noted to me:  After over 20 seasons of Cops, not a single person that they have apprehended has been sedated with a needle.  Now, granted, the police have other methods that we’’d likely not recommend,– including tasers and guns,– but it’s a thought provoking statement nonetheless.

Truthfully, the most valuable direction to take this conversation is not to a comparison between the merits of the preferred tools of our various systems, but one that explores how people tend to look only within the tool box that they are given and use some tools not necessarily because they absolutely ‘need to,’ but because they can or because it’s all that they know to do.

However we may feel about other methods that are used to subdue people who seem dangerously out of control, the argument that a particular measure was used because there was categorically ‘no other choice’ simply falls flat when we take a look around not just within our own culture, but within all those around us as well as back into our history.  Unless we believe that people in past eras or other cultures where this does not happen (sometimes simply for lack of access to the same tools) are from an alien species, our understanding that there is absolutely ‘no other choice’ than forced drugging continues to disintegrate.

Reality Check:  Forced drugging is several steps more invasive than detainment in a hospital or even restraint.  It is violently invasive and many would aptly compare it to rape.  Just because it looks more peaceful, doesn’’t make it so (though it may mean that the people using the force get to feel better about having done so simply because of said surface appearances).

The same goes for Electroconvulsive ‘therapy (ECT).’  Like forced drugging, it can have permanent physical implications for one’’s body and brain, and can leave one unable to even try to refuse.  In his anti-ECT literature, Peter Breggin makes some interesting statements about ECT never being fully voluntary because one of its primary effects is to render someone substantially more docile and ultimately unable to refuse further ECT.   I would suggest this argument could also be applied to many psychiatric drugs.

Wrong Because It’’s Wrong Because It’s Wrong Which Makes It Wrong.  So, There.:

The truth is that people will be lost, and there’’s nothing we can do to fully control who, when, where or how.  That notion is frightening and it makes sense that people fight against it.  It forces us to stare down our own mortality and that of others around us.

Yes, there may be some instances where force might keep someone alive (in the moment).  There are certainly even people who claim that force has saved their or other people’s’ lives.  However, what of the hundreds of thousands of peoples who have been killed or died decades early because of the ‘‘treatments’’ into which they were forced?  What of the people who have killed themselves specifically because of the demoralization they experienced when hospitalized against their will?  Has anyone done an analysis of all those years lost and lined it up against lives lost in the various well-publicized tragedies we all wish we could prevent?  I’’d be willing to bet big dollars on which tower would stand taller.

But, let’s say for a moment that 99% of people forced suddenly started saying that force helped them.  (And most do NOT say that, no matter what the Treatment Advocacy Center drones would have you believe.)  Would even that justify the continued use of force in the system?

No, people generally are not able to sign away rights just because they think the lack of them might be of some benefit.  Employees cannot agree to work 80 hours without overtime, because of labor laws, even if they would come out ahead financially.  A baby cannot be sold, even if to a much more stable and loving family.  The applicability of rights are not and cannot be based on a cost/benefit analysis.

Hence, the retrospective opinion that forced ‘’mental health treatment’’ was for the best is meaningless and should be considered wholly irrelevant to this conversation.  In actuality, any process that suggests that rights should somehow be curtailed or differently applied to one particular group of people because of some particular label must be seen as incredibly dangerous.

If someone is hurting you, you can use ‘force’ by self defense.  If someone has done something illegal, you can use ‘force’ via the police and the legal system.  But why should force be considered a viable option because you are deemed a risk to do something and also happen to have a psychiatric diagnosis?  Certainly we could take a look around our world and find many people at risk of doing serious harm, but who we’’d never suggest be arrested as a preventative measure, lest we find ourselves in the worst kind of police state imaginable.  A young male with gang associations?  An individual who has been drinking at home and has a history of spousal abuse?  Et cetera.

Although by all statistical indications, these individuals are much more likely to actually do something that will harm someone else, they have rights and the law requires those rights to be respected.  Why should that also not be true for people who have been given psychiatric labels, and what are the full implications of not demanding equality in that way?  (Hint:  The implications are huge, and every time you hear a story of someone losing parental rights, being hospitalized when they maybe weren’’t so obviously dangerous, being forced to continue taking psychiatric drugs that are visibly destroying their body, and so on, please be reminded of that.)

All this said, I hear from desperate parents, friends and other family on a fairly regular basis and it’’s hard to fault them for turning to the system and asking for forceful intervention when desperation looms.  It’s hard for me to imagine that I wouldn’’t lose all objectivity and contradict myself in a matter of seconds if it were my own child.  Or husband.  Or close friend.

We’’re human and we get to have human reactions.  But our human reactions shouldn’t necessarily be called ‘treatment’ and can’’t be used as a justification for force and the violation of human rights of thousands of people.  Our fear and desperation cannot be the reason it’’s okay to force ‘’treatments’’ on people that they do not want (and that research shows tend to make the problem worse in the long run) just so we can feel like we’’re doing something in the moment, future be damned. Recognition that the legal system also has many failings cannot legitimatize power abuses in the ‘’mental health’’ system.  And, when we do ‘go there’ we need to recognize it not as proof that force is necessary, but as proof that we were at a loss and all (not just those working in the system) have far more work to do.

Someone also recently suggested to me that perhaps everyone with the power to initiate, use or legislate force in the ‘‘mental health’’ system should be trained to consider:

  • •    Would you do what you are recommending with your own hands?
  • •    Would you do what you are recommending with that person’’s mother watching?
  • •    And my own addition to that:  Would you do what you are recommending with YOUR mother watching?

Where do we go from here?  I’’m not entirely sure, but, when faced with questions of force, perhaps we should also consider the brilliantly simple words of Duane Sherry:  “”You first.””

79 COMMENTS

    • P.S

      While the definitions vary from state to state, the general rule makes an important distinction between the use of non-deadly and deadly force. A person may use non-deadly force to prevent imminent injury; however, a person may not use deadly force unless that person is in reasonable fear of serious injury or death.

      All psychiatry’s drugs can cause serious injury or death.

  1. Thank you Sera for sharing this fantastically thorough and thoughtful treatise on “the gap” in our approach to alternatives in mental health care. It’s such a gift when articles come out like this with potential to move the whole conversation forward into greater nuance and clarity. I’m looking forward to witnessing your continued leadership on this topic.

  2. On a sad note, most people that experience psychiatric assault were never a danger to them self or others, they usually just drink to much and/or were screwed up by psych meds over some label in the first place and find them selves in the hospital being abused in the name of help.

    Most don’t go on to reading or writing on the MIA website, they just add the horrible experience to a likely long list of terrible things that already happened in there life further convincing them “the world sucks” and stuff like that. No wonder statistics say a person will most likely to kill themselves after they have been hospitalized.

    I still can’t believe they actually wrote “suicidal” on my medical records, just read the way I write, I am a survivor, a fighter, Ya I did show up at the hospital door sick from withdrawals after they turned me into a pill dependent after seeking treatment for insomnia and given F_ing Zyprexa !! Ya , I drank myself sick over some distress the very last time I ever STUPIDLY went to a hospital, my fault, and the so called help ended up being all the abusive stuff described in this article including threats of injection for refusing HALDOL and the other drugs and my reaction to that injection threat ‘rapid speech’ being charted as one more indication I needed more of the same , threats and coercion.

    Also I WOULD NEVER BE STUPID ENOUGH TO TELL A MENTAL HEALTH WORKER ABOUT SUICIDAL THOUGHTS !

    Question: Do you feel like hurting yourself ?

    Question translated: Do you feel like being locked up, your cell phone confiscated, strip searched, forced to share a room with a stranger who likely snores and drugged against your will for an undetermined period of time ????

    No.

    I was out with a friend helping him look at cars this weekend and the small talk with a seller lead to this person sharing “I am a psych nurse”. I could tell this “educated” and professional looking and sounding person could speak fluently in psych clinical words very well but was totally clueless about what and psychiatric “condition” or drug feels like. These are the clueless people that think the what they are doing and the current system is “the right thing to do”, scientific somehow and is helping people. I made a fast comment to this person about how “I saw this thing on T.V” about kids being over medicated and got like no reaction.

    • Hi CopyCat,

      As an FYI, I had to recently caution someone not to tell mental health workers about suicidal thoughts so your points are quite timely. I am so sorry you suffered so much when you simply needed help with withdrawal insomnia.

  3. I think this is a great article in many ways, and I always appreciate Sera’s thoughtfulness. Yet I feel a bit confused. Who are the audience for these ideas? Sharpening our own (movement) thinking is always a good thing. Talking to “mental health” workers/professionals can have some effect on a small number of people. We definitely need these well worked out arguments, but if we really want to change things, I don’t see how much will change if we don’t reach the general public. And for that I think we need ways of showing ordinary people just how out of control and destructive the mental illness system is, and how they, too, are threatened by it.

    So, again, I think this article is full of valuable insights and arguments, and it’s very important, but I don’t think the average person on the street would pay much attention. How can we reach those people? I don’t think much will change until we find a way to accomplish that.

    • I was thinking about that too, reaching the general public. I always write hoping let others know they are not alone if they found “help” and treatment to be an assault and I try to inspire a fight back attitude.

      If the general public was watching CNN last night they would have heard about ‘Adam Lanza day’ coming up and how we ‘need’ more ‘mental health solutions’ and heard them mention the Treatment Advocacy Center.

      Its frustrating cause it all “makes sense” sick people need help… Who can argue with that ?

      Heck I was a sick person who needed help the time I voluntarily went to the hospital all shaking and dehydrated after drowning my sorrows in that hotel room and the time years before when I went in voluntarily sick from the Zyprexa withdrawals from the center of hell.

      Both times I was subjected to the injection threat when I disagreed with the treatment plan, the first time when I was sick with Zyprexa withdrawals I just took the brain disabling “Abilify” so I could go home quicker. I realy resented that threat.

      The second time I heard psychiatry’s injection threat is when I pulled that stupid drink myself sick act in the hotel all alone a few years after I recovered from the almost decade long nightmare of taking psychiatric drugs that included Clonopin dependence, Zyprexa withdrawal hell… several hospitalizations and all that goes with that.

      Ya sure I am a dumb ass drinking myself sick cause maybe I was sad about loosing years in psych med waste land but I sure as hell was not going back into psych med zombie wasteland over a week long drinking slip or being ‘medication complaint’ just to get out, Double F them and there injection chemical rape threats. A bed a few detox pills and send me the bill, that’s what I went hoping for.

      My mother had told them I was once diagnosed ‘bipolar’ like almost everyone who ever used alcohol for insomnia and went anywhere near mental health treatment, so the nightmare began, all of the sudden I’m “manic” and “suicidal”… and ‘need’ assault with there toxic treatments…

      My mother, a member of the general public, had read ‘Wed MD’, Bipolar for dummies… and other selling sickness propaganda after exposure to NAMI bullshit by her ‘helpful’ friend who had a son that drank and was also nothing but screwed up after going to psychiatry.

      The original question “how do we reach the average person?”

      1. My mother knows the truth about psychiatry cause the truth about psychiatry reached me. Target patients.

      2. Keep targeting mental health terms that people search online with web pages that explain the fraud of the medical model and chip away at the psych systems credibility. A person only needs to have the truth explained once and they know the truth forever the view count on those youtube videos explaining psychiatric fraud just keep going up and up !

      Truth About Antidepressants & Chemical Imbalance, Psychology http://www.youtube.com/watch?v=KIjOZq_AUeE
      147,869 views !

      Making a Killing: The Untold Story of Psychotropic Drugging
      http://www.youtube.com/watch?v=UDlH9sV0lHU
      483,975 views !

      Generation Rx psychiatric (kick ass video) http://www.youtube.com/watch?v=7VHf9e39ilI
      2,549 veiws

      Put it back on Netflix !

      5150 Involuntary psychiatric hold abuse
      http://www.youtube.com/watch?v=3QmzCVHzMsY
      1,660 views

    • If someone had the connections certainly the people who blog and comment here at MIA have the lived experience and talent and could conceivably collaborate somewhere and write a hit TV series designed to reveal the truth about the runamuck mental illness system to ordinary people.

  4. A very thoughtful article, yet I have to say that the question Ted is asking about how to engage ordinary people in the efforts to transform the system also crossed my mind as I was reading. I personally am not a psych survivor but I had been harmed by the MH system in a different way (in talk therapy) and I am a big sympathizer and a supporter of your movement. I have to say though that the only reason I follow MIA updates and all the news relevant to psychiatric practices, drug distribution, pharma companies’ lawsuits etc is because I take personal interest in all these issues (the fact that I am an MH professional contributes to that interest). However, if I didn’t take any personal interest in this subject, as an average lay person I wouldn’t care to seek information about it and wouldn’t care much about any MH related issues. Most of the MIA articles and many articles on the subject in other sources are written for the “insiders” of the movement. They don’t even attempt to engage the general public. As wonderful and insightful as many of them are, they are not going to trigger any significant changes in the system unless the activists find ways to engage ordinary people who are normally disinterested in anything they perceive as not related to their everyday lives. They are certainly not interested in musing over, understanding and appreciating all the complexities and subtleties of the internal differences between various visions of different members of the movement, especially when all of it is discussed in a highly intellectual manner. As much as I appreciate the article and many other articles on MIA, they are not going to touch the hearts of ordinary people, sorry if it sounds harsh but it’s true. If the movement is to find force and vitality, it has to go outside its inner circle where activists feel comfortable and start an educational campaign amongst the general population. Otherwise, the talks will never transform into meaningful actions and will remain just talks.

  5. Sera, thank you for writing this and thankyou for broadening the conversation to give a deeper understanding of your perspective. What I am hearing from you is a desire for profound transformation and an abolition of a “mental health” system that has become deeply corrupted and in many ways abusive. Though we have some disagreement I think there are many areas we are in agreement on.

    I think in this conversation on force, there is sincere desire on both our parts for reform. Though you may opt ultimately for abolition of all coercive practices, hopefully we can at least find common ground on implementing some serious improvements to “business as usual.”

    One of the areas where we agree completely is that we need to abolish routine forced medication of patients who are committed. Not only is it incredibly traumatic, can lead to long term deleterious health problems and takes away people’s sense of autonomy and agency, it is also a very poor strategy for improving wellness. In essence, it is not only unethical, it is ineffective and destructive.

    In terms of incremental change, you mentioned two very positive ideas that I think should be instituted broadly. They include both monitoring the use of force as well as interviewing and investigating any use of force by staff. Just as there are formal investigations of the use of force by the police, I believe there should be independent community investigations of the use of force in hospital settings. My hope is that this step alone would make the use of force as rare as possible.

    I also agree that there should be a much larger understanding of the patient’s perspective, especially those who feel they have been seriously damaged by the system. Perhaps staff from all hospitals can be mandated to hear talks by people like yourself who can describe what it feels like to be unheard and traumatized. Raising the overall awareness of all staff to increase sensitivity to the persepctive of those who come to the hospital is key.

    I think where we have ultimately disagreed, is if there is any situation that would warrant the use of force. I don’t know if its even helpful to get into that conversation again. I am willing to talk further about that if you want. But at this time I just want to honor what you have said and to search for meaningful systemic changes.

  6. Most hospital staff just look at the patients as lower life forms. That’s the root of much abuse.

    Below is a response by a staff member to a patients online “ripoff report” .

    ——–

    I feel you are bashing because you had a “bad” experience. If you have spent anytime in there you would have seen what the employees have to deal with. You claim they dont care, well they do. But they cant take any bull from the patients. You have to have a very stern demeanor and a very think skin to put up with that level of crazy. I also feel youre overexagerating your experiences. Everyone has a bad day, and they are no exception. You have no idea what they were dealing with other then your issue. So before you go blasting ppl who perform a VERY important service, I would suggest that you step back and look at your experience with a bit more pity. Im betting you were not the best client they had that day and you did not behave yourself. Im also betting that you were restrained. And Im sure that pissed you off. Your anger is understandable but misplaced.

    Ask yourself this….Do you think you could do THIER job?? I know I couldnt. And I tried. I spent 6 months working in a mental health facility dealing with a super dose of crazy on a daily basis. I wasnt strong enough. Do you really think the ppl that are in there are fit enough to interact with society?

    Point is, before you judge them, try and see it from a position that allows you to clearly understand. YOU CANNOT DEAL WITH THAT LEVEL OF CRAZY AND BE EXPECTED TO BE SUNSHINE AND LIGHT!! They are only human, they are locked up daily for hours and hours dealing with the nutty. How do you think YOU would feel having to deal with that much unreality??

    ——

    If you want to read what the victim reported that’s here.

    http://www.ripoffreport.com/r/stony-brook-hospital-cpep/stony-brook-new-york-11794/stony-brook-hospital-cpep-abuse-neglect-and-poor-living-conditions-stony-brook-new-yor-1053873

    —–

    That’s not my report, I would have attacked psychiatry’s fraud called science as hard as I could since the higher ups consider themselves intellectuals. This guys report is what started me on the Nuerenberg thing I was posting a few weeks back.

  7. “On April 18, 2013 a woman was taken to Restpadd Psychiatric Inc, 2750 Eureka Way Redding, Ca. and admitted. When she arrived she was heavily medicated, disoriented, and tried to leave the facility. Staff tried to subdue her using undue force causing several lacerations, a cracked rib and severe bruising. A witness that had gone with her was standing outside of a locked glass door and saw 3 employees knock the woman to the floor, kicking, punching and scratching her. The woman managed to reach a phone and call for help. When she was taken to the emergency room a police officer from Redding, Ca was called. The officer stated that even tho the woman had a cracked rib, a bruise the shape of a fist in the center of her chest and a bruise in the shape of a boot imprint on her the left side of her stomach that he felt her injuries “were not that serious” The officers supervisor was called by a concerned party and the officer returned to the hospital to take photos of the injuries. There is a video of the attack yet law enforcement says they do not have the legal right to view the video without the facilities consent.
    This was a 5’6″ woman that weighs 125 lb there was no reason for 3 employees to “restrain” her by knocking her to the floor, kicking, punching and scratching her.
    This facility is supposed to be a safe place where mentally ill people go to get help, not abused. Law enforcement is supposed to investigate abuse allegations, not dismiss them as not that serious. How can law enforcement ignore a boot shaped bruise on a persons stomach that can only be caused one of two ways? Either the woman was dropped kicked in the stomach or she was knocked to the ground and stomped on. How can they explain a fist shaped bruise in the center of her chest? The only way for that to happen is for her to be struck with a closed fist with enough force to leave the imprint.”

    http://www.ripoffreport.com/restpadd-inc/hospitals/redding-california-199AB.htm

    There are some good replies.

  8. Sera,

    Oh wow.
    I *loved* this post!

    … Where to start?
    You had so much to say… I’m going to need to read this again… and again…

    This was priceless:

    “If you have someone involuntarily hospitalized because you’’re really, really worried about them and genuinely think they are unable to make decisions that will keep them safe, and it’’s really, really the best, most justified instance of involuntary hospitalization ever…… It’’s. Still. Force.”

    Oh wow!
    It’s great to know that there are people out there who really get this stuff!

    Duane

  9. Nice, Sera.

    I know a large family that recently lost a member after he was brutally murdered by his “problematic” son. I have seen the face of the dead man’s mother, brothers, and sister. I have listened to his family members talk about how senseless it was, how the son should have been locked up years ago, how the father allowed a dangerous situation to go on for too long as the family floundered around looking for a way to address it. They were scared and didn’t know what to do, and now one of them is dead, and the rest are deeply wounded.

    This is the other side. It’s not always just about messed-up authorities playing out power dynamics on eccentric and vulnerable victims. Who are we to oversimplify and imagine that we have some clean answer to the problem?

    I’ve been forcibly, traumatically drugged, restrained, isolated, and hospitalized – and even writing that brings on an echo of intrusive memories. These experiences have destroyed some part of me, and color every aspect of my life. If I had to go back in time, I would absolutely agree that it was unjustified, violent, and far more damaging than any “symptom” or “behavior” I may have had on my own.

    I have also made the decision, twice, to restrain out-of-control children in a “mental health” setting – because it felt like they were spinning out of orbit, terrifying other kids in the process, and I really could not figure out a way to contain their reality for them without using force. It WAS force, and I had a lot of emotions to deal with after doing this, but I don’t think it was a bad decision.

    So I don’t have answers. I don’t have any clean, pithy one-liner, or any clear position on the problem. But yes, yes, yes – it IS a problem. And I hope we can have a little mercy on everyone involved.

  10. I wrote this on another thread but it didn’t seem to post. It occurred to me that there is an interesting comingling of the idea of detaining someone for being violent or threatening, and forcing “treatment” on them. I wonder if there is a way to separate these two issues? For instance, if one of the TAC types points out that some people with “mental illness” labels become violent, we can agree that violent people need to be detained for the protection of others. But why does it follow that they need “treatment?” Can we not agree that force is necessary for protection but does not take away a person’s right to accept or refuse medical treatment? If we can make this distinction, we’re no longer in the place of saying, “Well, force is never justified” and sounding naive. We’re simply saying that enforcing “treatment” is never justified, even if force may be needed for protection. This also leaves more room for entertaining the question of whether “treatment” actually reduces or in fact increases violence, as you documented in your article.

    I am also glad you brought up the point about assaulting “mental health workers.” I agree 100% – I am sick of reading incident reports about how a kid “assaulted staff” after the staff person laid hands on him/her. It’s not assault if someone is trying to grab or force you or physically handle you in some way. It’s self defense.

    Thanks for another great article. I’d be interested to hear if anyone else sees value in separating the issues of using force to protect vs. the use of forced “treatment” in our more public discussions of this issue.

    —- Steve

    • With a history like mine, I don’t have to wonder why I have sat here for nearly 5 years and NOBODY has come banging on my door to force any sort of “treatment” on me.

      I’m not forced into “treatment”. I’m forced into isolation, which is a more sadistic, sinister form of “treatment”.

      I’m hostile and violent, no doubt about that. I’ve made VOWS that nobody will ever put an unwanted, unwelcome finger on me, in this lifetime, ever again. I vow mortal combat. That’s my right and nobody can take it from me.

      For me, this has been real war. It isn’t that I don’t need or want right, good attention, care, support and assistance. It is that IT DOESN’T EXIST or it is forbidden (blacklisted).

      I consider myself VERY VERY judged. Condemned. I boast Hell and I have no reason to deny the hostility and violence (lake of fire) that burns me, daily.

      So. Force? I’m going to tell this world something, right now. Force EXISTS. It cannot and will not ever be transformed. It doesn’t matter if it’s by officers or the orderlies. Force is a permanent part of the equation. It is by FORCE, even though nobody puts a direct finger on my body, it is by FORCE that I’m stuck and trapped here with no way out and no “help” for ANY of the multitude of impossible, intolerable PROBLEMS that I suffer.

      EVERY TIME I TYPE IN CAPS, that is the FORCE of STRESS.

      There’s ALWAYS force, in one form or another.

      It is a sick world and a dangerous world. Mental illness is very real. So is violence. So is force.

      I sincerely doubt that psychiatry and “the system” are ever going to abolish itself. At least, it will never happen universally.

      There will always be quiet rooms. There will always be restraints (in one form or another). There will always be police with guns and doctors and nurses with syringes.

  11. @Sera

    Thankyou for this. I want to comment but may I ask, with regard to this:

    ” Some years ago, I visited a so-called ‘‘peer’ respite’ in Arizona that was attached to a crisis services center. (Mind you, this is not a model that I support for these sorts of respites in the first place.) A group of us sat with administrators on the crisis services side, and listened while they boasted about having recorded no restraints in the past year. That sounded good, until we asked more questions and learned that if someone was held down for under 15 minutes in order to be forcibly medicated, the administrators simply didn’’t count it as restraint.”

    Was this place in Arizona http://www.recoveryinnovations.org/ ?

    I ask because it sounds like it and the CEO of this org has recently been in the UK bragging about how they have reduced restraint in their crisis services to zero. Their model is being held up as a sort of panacea in some very influential places.

    I’m sure you don’t want to slander anyone but if a big part of their success is down to reclassification of what counts as restraint for admin purposes I would really like to know…

    Thanks in advance…

  12. Sera, thanks for articulating this issue that so many of us have struggled with for a long time. I think as abolitionists we have done a pretty good job of envisioning alternatives to the current system. But our struggle is translating this vision into a large scale reality, due to all the obstacles I don’t need to repeat here.

    It seems to me that most people want quick fixes to deep-rooted social issues, which is why the forced treatment argument is so compelling and plays so well with the public and the media. It’s a simplistic “solution” to complex issues, but as we know it often creates more problems that it solves.

    The human rights approach is a powerful one…that force is just wrong because it violates our basic human rights. But then I can see the TAC people saying, “what about the human rights of Kendra Webdale?” Which throws it back on the “violent mentally ill” and puts us right back into the gap of which you speak.

    What so many of us are suggesting (building authentic communities, creating non-coercive supports) is more of a long-term approach. It’s not easily reducible to sound bytes, which makes it more difficult to “sell” to the general public. Part of the issue as I see it, is that we have boxed ourselves into a narrow “mental health” box, which as we know is not at its heart about community, healing mutual relationships, or the like. It’s about “treatment.”

    I know that you all at the RLC have done a great job of cultivating allies in the broader community… perhaps it’s time for us to get out of the “mental health” box and start framing our alternatives as a community development/community organizing approach.

    Anyway, these are just some rambling thoughts…thanks again for getting this important conversation going, Sera.

    • I’m glad Sera has deepened the discussion on how to get to no-force in practice and will be commenting on some aspects from my point of view as a human rights lawyer and activist.

      The human rights of Kendra Webdale are answered in the same way Sera answered the issue of assaults on health care workers.

      There are many people who commit murders – most of them have not been psychiatrically labeled. Why is society targeting only the small subset of those who have been labeled, or whom the media wants to label after the fact, for preventive detention? And why based on the disability (diagnosis/labeling as disability whether the person experiences subjective disability or not) rather than the question of violence alone?

      It is in my view nothing other than discrimination that can account for this.

      – Tina

  13. The issues regarding forced treatment are very complex. But the reality is any time you make it profitable and legal for any group of people to make money by defaming, drugging, and torturing other people, you’ll end up with the unethical, low life’s going into that field.

    And my story is a cut and dry story of abuse of trust and power by sociopathic, paranoid (of a malpractice suit) doctors. I know most doctors are decent, but the wall of silence problem within our current US medical community, that now may boast their “mistakes” are at least the third largest killer of Americans, is a big part of the problem.

    The bad doctors should lose their licenses and be taken out of the hospitals. Instead they’re revered because they’ll commit “medical mistakes” that end up killing the patients the “good” doctors committed malpractice on. The medical community has been given too much power, in general, and absolute power corrupts absolutely. Forgive me, I think a major overhaul of the entire US medical industry is needed.

    I’ve mentioned the violent and top ten in the country egregious miss-medicater who had me shipped long distances to him, forcibly detained me, and had me “snowed,” V R Kuchipudi, by a Humaira Saiyed.

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

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

    I would be grateful if any of the doctors or other medical industry employees who read this would tell me if this man’s prescribing patterns (for an internist) look appropriate. I’m quite certain this man’s been “snowing” lots of patients. I have to wonder how many patients he’s killed between the time he had me medically unnecessarily shipped to him in 2006, when I reported his crimes against me, and when he was arrested this year. And he’s actually practicing medicine still. But at least the Department of Professional Regulations is looking into my case again, since he was arrested by the FBI and his new hospital was shut down.

    The government not monitoring what’s going on in hospitals, and actually making it profitable for doctors to forcibly detain, defame, drug, and torture patients, so they can cover up a “bad fix” by another doctor, is a bad system. There is a need for checks and balances. Because the doctors, collectively at least, are not ethical enough to police themselves. All use of force should be documented and reviewed by people outside the medical industry. Autopsies should be required on every death in every hospital.

    And the mere existence of made up, unscientific, “lacking in validity” disorders makes this type of medical abuse possible. I don’t believe it should be legal to forcibly detain anyone based on a disorder ever. Disorders are not real diseases. Although I do know the drugs given to “cure” these fictional diseases, do cause the symptoms of “violence, suicide, mania” (bipolar) and schizophrenia.

    We need a return of medical ethics. Mandatory survivor talks, and lots of ethics talks at medical schools and hospitals are needed. The government should be looking into all doctors prescribing dangerously, like Kuchipudi. And getting rid of unscientifically valid, and “partially or completely iatrogenic” “disorders” would be a good place to start improving the medical industry.

    But I do appreciate those ethical medical professionals who eventually helped saved me in real life. And those of you who are caring, decent, and ethical enough to read and learn about the massive psychiatric, iatrogenic harm to patients, on this website. I hope and pray for change, and believe it needs to come from outside mainstream medicine. I don’t know why as a society we think the third leading killers of Americans, who don’t repent and confess for their “mistakes,” are going to be ethical enough to change the system themselves. And trust me, forced treatment is “torture,” humiliating, and was hands down the absolute most deplorable experience of my life. Forced psychiatric treatment needs to stop being considered “appropriate medical care” by unconscionable hospitals like Advocate Good Samaritan hospital in Downers Grove, Il.

    • Hi Someone Else,

      I thought of you when I watched this video. Seem familiar? I hope it doesn’t “pull triggers” for you, but this young man is quite angry over a medical error “cover up” situation. I was hoping you might be able to respond to him, a word of support, compassion, guidance, what-have-you. He asked for feedback, and he needs A LOT of feedback, but of all people who could possibly speak to him, for what he’s complaining about, I thought of you.

      http://youtu.be/wkKy10Z2Tuk

      • mjk,

        Yes, that poor young guy is dealing with “the dirty little secret of the two original educated professions,” as my pastor described it, also. Any time a pastor or doctor wants to cover up a sin or malpractice, the psychiatrists apparently have promised they will take away harmed people’s civil rights by defaming, rendering senseless with forced drugging, and torturing the innocent people for the unethical doctors, pastors, bishops, and it does seem the lawyers, judges, and government have all now been corrupted by psychiatry’s promises to defame and torture innocent people so the corrupt and incompetent may rule the world.

        How do we fix such a broken system? I don’t know, but I am now praying for judgement day, because it’s all too grotesque for me. Shame on psychiatry again. Your theories of world domination are as destructive now, as they were in the Nazi era.

  14. Sera,

    Thanks for posting this article and addressing the complexity of issues while holding a clear no-force position.

    It is gratifying to me as one of the originators of the human rights law prohibiting forced treatment, that these discussions are happening.

    A few comments.

    1) I think it’s important to both have the discussions in the mental health context (including alternative services and even peer support) and to take it out of that context entirely. The mental health system, including alternatives, has been the vehicle for social response to a wide variety of situations involving crisis and distress. That is a social policy choice more than it is a choice made by individuals, although individuals’ choices (as people experiencing distress, or as family or community members) contribute to the growing role of the mh system in this regard.

    I’d like to see more analysis from a disability non-discrimination point of view – both in terms of politics (mad/disability pride) and in terms of law. I don’t see much of this on Mad in America website but it is needed – here, in disability studies forums, and in legal communities. The disability non-discrimination analysis, in turn, needs to be informed by a survivor point of view, as we managed to reflect in the Disability Convention; there needs to be work done of this nature, especially by survivor lawyers, looking at the ADA and constitutional equal protection standards.

    2) I’d like to see discussion of the issue of legal capacity in particular. Incapacity is the last refuge of force. Recently in discussions where survivors of forced psychiatry have defended the practice, they have commented that they were incapable of consenting or refusing and therefore force was justified.

    The legal alternative to incapacity is called supported decision-making, and it is what we came up with in the Disability Convention (CRPD). The concept originated independently from users and survivors of psychiatry, and the intellectual/developmental disability community. No one wanted to accept that our legal capacity would be restricted in any situation but we felt there was a value to having support or assistance made available for anything related to the exercise of legal capacity – such as understanding information, coming to a decision, expressing your decision, etc.

    The tension between these two – respecting the person’s own choices while allowing for and even promoting a great deal of involvement by others in decision-making. Some people working on the issue are promoting a highly interventionist version of supported decision-making that allows some forced interventions. Others including myself take a strict view that the person’s decisions must be respected, and and the monitoring committee for the Disability Convention also is indicating that it will take a strict view.

    The tension does exist, and I don’t believe that it is prohibited to use one’s own judgment to question or express concern about what a person wants to do. It depends on what one’s role and relationship is to the person, and other contextual factors, and there has to be the willingness to back off when the person entirely rejects what you are offering. (E.g. in my case, I do not ever want to be harassed by mental health professionals offering their treatments.) I believe that the framework of Intentional Peer Support works as a guide to how to implement supported decision-making. (Chris Hansen has said that she became involved in IPS because it answered these questions that we were being faced with in discussions of the CRPD.)

    Again, thanks for pushing the discussion forward to get us closer to making no psychiatric force a reality.

    In solidarity,

    Tina

  15. Sera,
    As I re-read another one of your brilliantly written posts on MIA, I come back to this paragraph:
    “All this said, I hear from desperate parents, friends and other family on a fairly regular basis and it’’s hard to fault them for turning to the system and asking for forceful intervention when desperation looms. It’s hard for me to imagine that I wouldn’’t lose all objectivity and contradict myself in a matter of seconds if it were my own child. Or husband. Or close friend.”

    Yes, trust me, in Oct, 2009 I was the mom who came face-to- face with this desperate crisis. My 23 y/o son, just two months after marrying his longtime girlfriend ((with 125 family and friends gathered to celebrate this momentous occasion) should have been at the pinnacle of life. imagine as a mom getting a phone call from your dtr-in-law’s mother at 2:00 a.m. from their apt as she had arrived and called the police on my son’s sudden erratic, frightening behavior. What? Imagine, the horror that goes thru your mind as a parent? Before my husband hung up the phone, I had thrown on day clothes and was out the door to find and try to understand the unthinkable about my son, as my husband is shouting that my son’s mother-in- law said our son went peacefully with the police, and not to worry he was in ” safe” hands. Nothing in my life prepared us for the next six hours of hell, finding our boy, who was being released from the county hospital where the police take people in the night. The police had no reason to charge him, as he had always been a law-abiding citizen. I still believe the young psych tech on duty (no p-doc staffing in the night) truly had my son’s best interest, in retrospect, as we found our son outside waiting for a taxi the tech had called. What’? Where would my son have gone? The tech told us he called for a taxi as no one on my son’s list of friends had answered the call back!!! It’s now 4:00 a.m., so I’m triaging in my own out-of-body experience listening to my beautiful son sound like he is some alien from outer space. I run back inside the county hosp holding area and do everything possible – beg, cry that my never before, always healthy, son needs HELP!!! Please, this mom is soooo frightened – where is my fun-loving, functional, charismatic, kind, bigger-than-life son, surely the young man that looks just like my 23 y/o son but sounds out-of- his mind can’t be the same person? How/where/who can help him if this hospital shuts the door in his face?

    And that is the beginning of the horror which began Oct, 2009. Sadly, the two different hospitals who did accept our son over the 18 months between each breakdown( nervous breakdown, the BEST description to me) though each ” episode” was truly delusional, grandiose, paranoid in psych terms, both times his tox report + for cannabis (and after the 1st locked psych hosp my son admitted to using one-time Magic Mushrooms, several wks before he went ” crazy”). Rush to judge, label, force drug with massive psychotropics… but honestly, neither my husband or I knew what to do that first night in 2009 except find another psych hosp that would hear our pleas to help our son. Did I think the next hosp that Oct. night, after hours of driving in the dark, with our son trying to jump out of the car on the 101 fwy, would end up being a step back to One Flew Over The Cuckoo’s Nest? I won’t chronicle, again, what I have blogged too many times on MIA but suffice it to say, our son endured a life-changing nightmare each of the two places, 18 months apart, we believed help would be delivered.

    After the 1st psych locked experience, never did I feel my son would have another ” episode” but when it tragically did happen the second time, 18 months later, I felt absolutely the drug rehab program I contacted would, for sure, honor it’s promise and guarantee that I was given the day before my son ” voluntarily” admitted himself( with his grandfather and uncle alongside for added support). Imagine, being a parent with NO hx of MI, no knowledge how “the MH system” is so tainted and broken. Naive, stupid me believed detailing the drug rehab facility with info on my son’s PPO ins, plus our credit card, and their promise( I gave details on my son’s 1st hosp, dx, psychotropic Rxs he took for 5 months until his psychosis abated) my son would ONLY receive the drug educ this facility prided itself on ” we teach our pts who have been given bipolar or schizophrenic dx that the drugs they’ve used mimic MI”. What parent wouldn’t believe these words? When your now 24 y/o son is back experiencing some severe emotional crisis just where does the family turn? We never found a safe sanctuary as in Mass. Believe me, we had sought guidance from two psychologists, one was even a trusted friend of many decades. Neither therapist believed my son was ” bipolar for life, meds for life”. I was thrilled my son, after his 1st breakdown, 5 months while accepting the medical model of psychiatric care his young wife and her mother believed were gospel, our son found the strength to leave the out-pt p-doc who had brainwashed him insisting though he came out of psychosis he was ” forever mentally ill”. My son weaned himself, slowly, off those toxic meds ( which I never felt helped him at all, especially as my son witnessed the horrific side effects day-by-day).

    But I have NO answers what really happened to him, we all believed he was healthy again so once he opted to move 5 hrs away, near Yosemite, to ” heal and start anew” after all that life had thrown at him( including his wife of 20 months leaving him during the 2nd psych hosp, sadly adding betrayal with her new lover, despite he was slowly coming out of his 2nd psychosis) thought he was going away to seek sanctuary in an area of nature our family has been comforted by for a decade.

    My husband and I will never fully recover from finding our son’s body, five months after he left the community he grew up in. Seven months earlier, our son had overcome the traumatic 2nd hosp, though admitted only for their drug rehab, he was deceptively moved into their locked unit and kept 13 days against his will ( though his medical records I recently obtained show ” voluntary”). I believe my son was hit with the perfect storm and he was too frightened to call any of us, fearing if he honestly shared his feelings, we would find yet a 3rd facility of horrors. Indeed, I found out after my son’s death, he had told the psychologist who was treating him before he moved away ” Doc, I could never end up in one of those places again.”

    Sera, with your lived experiences, and wisdom, you, would know how to help your ” child” if this crisis were to occur. God, I wish I had had something in my life that would have helped me save my son( or the professionals we sought had known about the alternative communities) when we were seeking, desperate direction. But we live in So CA and did not find how or where to get our son the right help. We believed he, though living alone and isolated, would let nature in the wooded community be a source of healing. Of course, intellectually, I was concerned, but it was my son’s choice to start ” anew”, join AA, and because he never touched another substance I truly believed this, alone, would help heal his brain.

    New Years Day, 2012, was the last dy his father and I saw our son, alive. I will never wrap my head around our last visit to our family cabin, where our son moved to, as he was so himself, the laughing, the bantering back-and-forth on Néw Year’s Eve, just like all the yrs we have all our family memories taking our boy’s friends, and family, year after year. How could our son who seemed so healthy, so ” normal”, so himself after all he had overcome be the same body that hung himself, 12 days later??? This is the nightmare my family, his many friends and I live with forever.

    Please keep writing, sharing, reaching out because unsuspecting families are desperate for the answers and support that eluded my beautiful first-born son. I envision, one day, alternative communities will exist in EVERY community when a person suffers some form of emotional crisis. You, Sera, have such vision- and hopefully- influence and persuasion to further this movement along. No mother, no parent, no sibling, no grandparent….no family should experience what we have suffered.

  16. Thank you so, so much for this article!

    I have been deeply wrestling with this issue recently. I’ve participated in a couple discussion comment threads on this topic which, despite the understandable emotional intensity around the issue, have been really helpful to me.

    I’m hoping that your feedback (and that of others) can help me further my own understanding. Forgive me because I am going to provide some lengthy background on my present situation, because I feel like when it comes to a topic like this one, the devil is in the details. So I ask for your patience as I want to ask you some questions after I give this background:

    Actually first, let me state something: I oppose forced “treatment.” I’m not confused as to whether I support or oppose that. But I haves some questions about the implications of that conviction to which I don’t think there are easy answers…

    My background is that one of my two jobs presently is on-call to the local Emergency Room as a “Mental Health Crisis Worker.” My job is to meet with persons who come to the ER and are identified as possibly experiencing non-physical cognitive or emotional distress, determine whether or not they are an immediate danger to themselves or to others in the community, and then recommend to the doctor what the response should be.

    Now, if this was the end of it, I’ll concede to you that I wouldn’t have accepted this job, because I feel it would too often conflict with my own sense of ethical values when it comes to how we treat other people. The description I just gave sounds cold, paternalistic, hierarchical and fought with the potential for abuse. The ER can be a place where people are restrained, secluded, forcibly drugged, sent into longer term involuntary hospitalization, and a sea of other harmful and traumatizing practices. Many if not most members in this community have personal ER horror stories.

    In the interest of full disclosure, I was offered a full-time position working in the same role at a different, larger hospital and at the last minute I turned it down. I was out of work at the time, and I had tried to rationalize away my ability to do that job and not lose my soul in the process because I needed to put food on my table. But in the 11th hour my courage won out – and I accepted that I knew a great deal about how this particular hospital operated, and their predisposition toward force and dehumanization in response to persons experiencing emotional distress was not something I could willingly participate in.

    However, the ER where I work now is different. First, it does NOT hire its own “mental health” workers. Instead, it partners with a local community counseling and “mental health” agency – the only one in this small community, that was built directly from the community started over thirty years ago by a group of volunteers. So I don’t work for the hospital directly. Instead I work for an organization that has a social community mission of proving non-coercive, compassionate support services to the local small town community regardless of anyone’s ability to pay. These services include counseling, case management for persons trying to navigate the complexity of the disability system or the healthcare system or the benefits system, and voluntary psychiatric prescribing services (if requested by the individual) in which the individual makes decisions about what if any supplemental medication support may or may not be right for them.

    Because I work for this agency and not the hospital directly, my role in the Emergency Room is a little different. My mission is to keep people out of involuntary psychiatric hospitals and to avoid hospitalization altogether unless it becomes absolutely clear that an individual is insisting that they want a voluntary admission and convince me that they are fully informed about the risks of such an option. It is the expectation of me in my position that I be an advocate for the person that I see in the ER, and it is my job to hear from then what they feel they might need in terms of support in the face of whatever crisis brought them to the ER and do everything in my power to meet those needs as they define them.

    To this end, my agency takes a financial loss in order to offer any person that I see in the ER up to 10 free visits to our community clinic for any service the individual feels would be of benefit to them. I am also able to schedule them to be able to meet with someone to receive those supports within 24-48 hours of the time they are seen in the ER. Further, with the individuals permission, I am able to offer to contact them in follow-up after they have visited with me in the ER just to check-in and offer a kind and listening ear if they continue to feel they are struggling or just want someone to talk to. If a person gets to the end of 10 free visits and has no ability to pay, then the agency continues to find ways to work with them. One of the core missions of the small community-based agency is “support regardless of ability to pay.” Any person I see in the ER my of course decline any of these options.

    To me this entirely changes the “flavor” of working in an ER. My job is to AVOID forced treatment options and assist someone in connecting to the relational supports that make sense to the individual. There have been many nights I have been called to the ER because the ER doc thinks a person needs to be hospitalized. But after talking to the person I discover that they do not want to be hospitalized and we are successfully able to form a partnership in which I provide a wider array of non-coercive support options and the individual decides what makes sense to them. I then go back to the doctor explain that I don’t support hospitalization and describe the alternative support plan. In every case so far, the doctor has accepted that plan and the person was discharged from the ER freely.

    I feel like I am doing something very positive for both individuals I get to work with who come into the ER often experiencing a lot of suffering. It does not take too long for my heart to break/melt in the face of someone else’s tears of distress and requests to be listened to. I consider it an honor to be able to offer non-coercive options for relational support because I believe that most human beings can benefit from not going through distress alone, and benefit form finding people who genuinely want to listen to them and believe that they can indeed “make it” through even the darkest of spots they find themselves in.

    But I’ve ALSO had the more rare experience of working with someone who adamantly insisted on being admitted to a psychiatric unit of the hospital. Obviously my knowledge of the abuses and shortcomings of psychiatric hospitals mean that I really dislike this option. But after having done my very best to mare certain this person understood that even if s/he went voluntarily, the hospital could turn that into an involuntary stay, that s/he could be medicated by the hospital forcibly, and all the other risks that come with it, this person remained adamant. So, I helped them be hospitalized.

    The one experience I have NOT yet had is the one I am most afraid of: it is the experience where someone comes to the ER because they have severely hurt themselves or because they have hurt someone else, and they express their clear intent to continue hurting themselves or someone else with they leave, and they are not willing to collaborate on any sort of alternative support plan that would decrease their risk of harm to themselves of someone else.

    In those cases, the hospital is REQUIRED to keep the person against their will. If the hospital releases the person who has clearly indicated their intention to immediately (immediately is defined as, “can be reasonably expected to do this within the next 24 hours”) hurt themselves or someone else, and then they make good on that threat, the hospital CAN be held liable, be sued and would lose. Hospitals have lost this suit in the past. Worse still, the ER doctor on duty can also be held personally liable, and sued and lose. Depending on the finding of “negligence” that doctor could be sanctioned or fired or even lose the ability to practice. And I personally could be found liable, and civilly sued. I complaint can also be filed with my licensing board, which would be investigated, and I could potentially be found “negligent” and lose my status as a CSWA (which is like “residency” for social workers, means I’m acquiring clinical hours under supervision toward independent licensure.

    For those reasons, if a person has expressed thoughts to harm themselves or someone else and they then try to leave the ER before a plan has been put together, the ER will prevent them from leaving OR require the police to detain them and bring them back. I’m not saying this is right; I’m saying the reasons it happens are, in part, because of legal liability.

    What I’m trying to do is figure out what I do when I finally have the situation where someone is being detained in the hospital against their wishes and the ER doctor does not consent to any other plan apart from involuntary psychiatric admission? Do I just quit? I have had so many opportunities for deeply positive interactions with people who have come to the ER. In several cases, persons have come to our community office later to seek me out in order to thank me for being willing to listen to them and care enough about them to come up with a plan that made sense. I know that because our people work in this ER, far less people are not hospitalized, and fewer people experience coercive force. I know that I am empowered to disagree with the doctor and advocate for non-coercive alternative plans and I know that in every case so far I’ve been successful with that advocacy…..

    …but there is going to come a time where the doctor refuses to do anything other that hospitalize someone against their will. So do I just stand on principle and quit, losing every opportunity to be a tiny ray of hope for so many other people within a system that is so often oppressive?

    What about when I am faced with a situation like that of my colleague who met with a guy who had cut open his shoulder with a kitchen knife to the point that he severed an artery and was bleeding out. When he stabilized, he told my colleague that he was “doing surgery to remove the microchip” that he believed had been implanted by aliens. He apparently had no understanding that he nearly killed himself and was adamant that the hospital couldn’t be trusted to take it out for him and that one he was released he was going to go right back to finish the job. What do I do then?

    Recently, as I talk with the community at MIA I’ve entertained the idea that the most appropriate thing to do would be to simply let him go and do whatever it is he is going to do. He can then go “die with his rights on.” Certainly he is not presently thinking clearly, and I think its reasonable to say that its possible that if he was able to come to a place of more rational clarity he would likely not want to do something that would kill himself anymore. But hey, at least I didn’t infringe on his rights while he went off and died, right?

    Even if this was truly the best choice, its not an option for hospitals. There is no AMA (Against Medical Advice) procedure for hospitals (that I’m aware of, and not for our hospital) when it comes to “mental health” issues. And maybe that’s the answer – maybe their should be. But would my moral responsibility really be absolved by a piece of paper that says I’m not liable when I can be almost certain that I’m sending someone out the door who is not thinking clearly and is absolutely going to go accidentally kill themselves in the midst of their emotional distress? How am I not morally complicit in not trying to do something to prevent that?

    And then again, I don’t want my other question to get overlooked – what should I do the first time the doctor wants to force someone into treatment over my objection? Am I a reprehensible slug to work there, despite all of the opportunities to do genuine relational non-coercive compassionate work together with persons who are (by their own accounts) deeply suffering? (Not everyone who comes to the ER is “deeply suffering” and I get that. But many are, I know from direct experience of listening to their own statements on the matter.)

    Thoughts?

    • EDIT – I need to correct this because it totally changes the meaning.

      My post above includes a statement that says, “I know that because our people work in this ER, far less people are not hospitalized, and fewer people experience coercive force.”

      That should read, “far less people are hospitalized” NOT more people are hospitalized.

    • “What I’m trying to do is figure out what I do when I finally have the situation where someone is being detained in the hospital against their wishes and the ER doctor does not consent to any other plan apart from involuntary psychiatric admission? Do I just quit?”

      Personally, I don’t think you should quit. I think you should keep on. Things so wrong sometimes, intolerable and unacceptable. But there’s greater value in what you DO do than those instances when things just will NOT work out.

      “What about when I am faced with a situation like that of my colleague who met with a guy who had cut open his shoulder with a kitchen knife to the point that he severed an artery and was bleeding out. When he stabilized, he told my colleague that he was “doing surgery to remove the microchip” that he believed had been implanted by aliens. He apparently had no understanding that he nearly killed himself and was adamant that the hospital couldn’t be trusted to take it out for him and that one he was released he was going to go right back to finish the job. What do I do then?”

      I understand why he didn’t know / didn’t understand / didn’t care about fatality. Something else was more important. So important that it was THE ONLY THING that existed to him. He was suffering from the feeling of invasion (almost regardless if it was imagined or literal. It is still an invasion, either way). If he thought that somebody took it as seriously, and urgent, as he did, THEN he could be reached and “helped”. To IGNORE his complaint, disregard it, make it secondary to everybody else’s OUTSIDE view, that he nearly killed himself, is still ignoring. The only thing to respond to is: his complaint of an “implant” (invasion). If people judge it and dismiss it, they’re in the wrong. The invasion is VERY real to him. A person like that will likely reject anything and everything and be near endlessly fixated on (stuck and trapped in the loop) about their primary complaint, until somebody finally responds correctly. EVERYTHING always has a basis in reality. ALWAYS.

        • Everything has meaning, that is to say no thoughts, feelings, beliefs or perceptions are “empty static” or “gibberish.” Not everything is *literal* however, as I know full well from my own individual experience.

          And without question, as I have written about repeatedly, I am convinced that listening and understanding other human beings’ lived experience is one of the most important things that can be done.

  17. I’m a little embarassed by the mass posting, but I am doing some heavy seeking on this issue right now – I also want to ask for even more discussion about alternatives.

    What are some better ways of doing ER crisis work that I should be advocating? Here are some random thoughts of mine and I would appreciate the thoughts of others….

    — the increasing availability of peer-run voluntary crisis respite programs that follow a relational/social model of offering compassionate support. If there were safe alternatives to a medical hospital, perhaps more people would feel safe in voluntarily accessing those alternatives when experiencing serious distress

    — the total elimination of forced drugging as an option, i.e. making it illegal. I don’t believe I will see this happen in my lifetime, but I imagine that if it did, the system would be forced to come up with more creative alternatives for “support,” and that would mean at least the possibility that those alternatives be more relationally appropriate and morally responsible.

    — the total elimination of “civil commitments” where a judge takes your rights away and hands you over to the state for six months at a time, with the ongoing option to “recommit” after each six months indefinitely. I know this goes beyond the things that happen in the ER (at least in my ER) but I just believe these are utterly abusive. I don’t believe anything I can imagine can justify a six month time period of stripping someone’s rights away. I’ve worked with persons who were civilly committed because they yelled at a cop, and an 18 year old who was civilly committed because he had a “problem with authority.” These are intrinsic tools of systemic abuse and NO ONE should wield that much power over someone else.

    – the replacement of force/restraint response models to dangerous or aggressive situations with non-force/non-restraint models of crisis deescalation. The latter models are focused on safety, avoidance of danger and deescalation rather than behavior control. I have attended trainings for something called PRO-ACT (Professional Assault Crisis Training) which based itself on the triangle of: Safety, Dignity and Respect. It focused on how to get out of assaultive situations, how to avoid conflict, and how to attempt to deescalate critical situations with a combination of calm talking and body language. It also talked about planning ahead on how to evacutate staff from a dangerous situation or areas, how to avoid and escape aggression so that physical force was avoided. In situations where all attempts to avoid physical assault have failed, the principles taught to a person were, “the absolute least amount of force required to escape the situation applied for the absolute least amount of time possible.

    I’ve heard that PRO-ACT includes a whole different section on restraint training, under the idea that sometimes it may be necessary, which I oppose. So I’m not ready to specifically endorse PRO-ACT wholesale, because I don’t know enough about it. But where I had the training, restraint was not acceptable and the training only focused on deescalation and avoidance training. What if ER’s were trained like this?

    Other thoughts?

    • Thinking out loud:

      “step” to “stop”

      In staying with the focus of “the space between”, what can be found in the minimal instances vs the extreme instances where force and restraints (psychiatric violence) is used?

      If somebody could compile some sort of “master list” of unwarranted instances of force and restraints (psychiatric violence) then maybe that could serve to advance awareness and understanding, recognition, of how abusive and destructive it is. How could that not propel change? Rodney King just jumped in my head. Police brutality hasn’t changed one bit, has it? No, I don’t think so but if it has then awareness of that would be good. To the best of my knowledge, police brutality is commonplace.

      I think when people realize and recognize the violence of psychiatry, in the LEAST (instead of the worst examples) then maybe people will see and understand differently and better. And hopefully, in that, the stand will have been taken and a right step, too.

      Other crisis related advocacy… hmm. This is challenging. There have been times when I have had urgent, immediate needs but I am told (by CONTROL) “no” and “it doesn’t work that way”. I honestly think in some (how many, I don’t know) instances of crisis, people should be taken seriously and asked if they have any “demands”. I think people would be very surprised to hear what might blurt out of somebody’s mouth, including the person in crisis.