“If you don’t agree with your psychiatrist, make yourself at home.”
We are, more and more, as individuals with “mental health diagnoses,” living in a reality of senselessness, absurdity and and arbitrary outcomes. While I often believe that our movement simply calls itself a movement, but does not really move at all, it is in fact possible today to say that we are part of a post-Justina movement. The attention to her case highlights both the senselessness and the absurdity, but perhaps not the arbitrary nature of how the system functions for those it impacts.
Her story is sympathetic and compelling. It has mobilized some individuals within our movement come together and support an amazing young woman in a way that she sorely needed. That is a good thing. Justina has gone home. But, hers is only one story. Today, I respectfully present you with one more. One more of thousands that could have been mine or, possibly, yours.
John Rorher, my friend and comrade, was found not guilty of assault by reason of insanity. He has been incarcerated in state facilities since 2009, most recently at the Appalachian Behavioral Health facility in Athens, Ohio. While it is apparent that John has been denied his due legal process in the context of this incarceration, I am not an attorney and subsequently will not attempt to discuss legal aspects of his case in this forum. I want to discuss John’s story and experience. I want to discuss my story and experience. I want readers to know that there are many of us. What has happened to John can happen to a pretty teenager like Justina. It can happen to a (former) mental health clinician such as me. My own story has horrific aspects. In meeting with John and others, I realize it could have been so much worse. In this way, the experience of forced mental health treatment is completely arbitrary.
While I feel sympathetic and connected to all survivors as a general state of my being, my visit with John was full of contrasts. I can’t stop thinking about the contrasts. I first became aware of John through a MindFreedom Shield alert that was facilitated by Jim Gottstein. I started to correspond with John, and follow his case. In early May, I visited.
Athens, Ohio is about a three and one half hour trip from my home in Kent. I had a lot of time to think in the car. At the outset, I realized that many of the things that have been concerning me recently would probably soon seem trivial–sleeping on the floor, worrying about money, the status of my organization, my own status within the movement, my lack of professional standing in the mainstream world, my trauma and my memories of my own forced treatment–it could have all turned out so much worse.
Getting into a locked ward at a state facility is not all that easy, that is, if you are someone who retains the freedom to leave at the close of visiting hours. I drove around and around before finally parking in an area that seemed to be an approximation of where the ward might be. I had to ask directions of a couple of staff members before finally happening on the right building and entrance. Going to a locked ward is always a freakish experience for my survivor brain. But nothing like John’s experience. Not for four years. Today, my cell phone, keys and wallet are locked up. None of these are allowed on the ward.
The unit where John is incarcerated has a large yellow sign on the door. HIGH RISK OF ESCAPE it says. I wonder briefly who in their right mind would not try to escape from this place. People in their right minds. Wanting to escape. From a place where they have been put because they are judged to be in their wrong minds. I have been locked up for a few days at a time. Each time I could have lost the thought that escaping was the reasonable choice. The thought could have been taken from me by a longer duration of incarceration, a more intense kind of abuse or even a greater degree of indifference. It could have been so much worse.
Meeting John for the first time is sort of surreal. I don’t know if he agrees with my assessment that he and I are not really very different. I find him to be brilliant in the way that he explains his thought process, and how he has, with practice, become an objective observer of his own thought stream, having the ability to determine for himself what is correct and valuable without application of our culture’s inherent and perverted value system. He explains this also without the artifice of many of our culture’s “alternative recovery” communities. There are no prayers in Sanskrit, no binural beats, no talk of “mindfulness” or related concepts that once seemed so progressive, but have now taken on the same dull, disappointing, ineffectuality of the novice counselor who recommends “exercise” or “deep breathing.”
The one whose every pretentious parroting of his betters in the field confirms how he is merely window dressing for the “team”–a token–that some talk therapy is being implemented along with psychopharmacology. Another billable hour for the agency. Not as billable as the psychiatrist. More billable than the case manager. I was “out” as a mental patient when I became a clinician. In the days before the “peer” was the cheapest and most political kind of labor, I was the ultimate billable token.
John tells me there are a lot of people who are similar to him on the unit. People who have been denied due process, who are forcibly drugged, who are denied the essence of their humanity. I am curious about what “therapies” are available to John. He tells me that recently one of the groups offered a word search about boats. I ask him if he or any of his fellow inmates are planning to sail on their personal yachts soon. “Yes, I will be taking my catamaran out tomorrow,” he replies. Another “therapy” involves a staff member asking “How was your day?”
He feels that there is one group, facilitated by a psychologist, in which he is able to be a little more genuine in his expression. The first time he participated in this group, John explained to the facilitator that he does not agree with his psychiatrist. To this, the facilitator replied, “Then make yourself at home.” We discuss the costs of these treatments, not only in the dollars paid directly to the facility for providing them, but in an overall systemic sense–the amount of dollars collected by universities and state licensing boards to qualify people to provide essentially nothing. The system of forced mental health incarceration has taken on its own life. To question or to step outside of the prescribed legal and billable boundaries is isolation, poverty, death, or worse, for both the mental health worker and the mental health patient.
The inmates at Applacahian Behavioral Health are all on the “levels” system. This is a form of behavioral therapy that has been used for many years in forensic settings, as well as in the “treatment” of individuals having developmental challenges. Simply stated, each level allows or denies different privileges based on the behavior of the person who is “on the program.” Often, the same levels program will be used for every individual enrolled in a given program, meaning that the goals and the reinforcers are all the same for everyone. Clearly, receivers of services are objectified in this context by the assumption that they, like identical objects, will respond identically in identical circumstances. John explains that one possibility to secure his release, should his legal avenues become exhausted, is to “go along with the program.”
Up until this point, John has refused to participate in “the program” any more than is needed to get above level two. At one point, he was put on level one, which resulted in his incarceration on another, more restrictive unit for individuals who are deemed “more severely ill.” This evidently also resulted in the loss of minor privileges like using the snack machine or ordering out to a “specific place” once a week. I think about the politics and the money involved. Who is profiting from writing one levels plan and then billing it to multiple individuals? What does it take to become the “specific” establishment to which a captive audience with $10 each in indigent funds is allowed to order on a weekly basis? Why do John’s forced bi-weekly injections of Risperdal Consta cost $1530, while a 30 day supply of pills costs around $30?
Ultimately, I try to get my mind around what it would be like to be a super-intelligent adult subjected to such demeaning and dehumanizing treatment on a consistent basis for four plus years? John has recently started to refuse the injections. When he refuses, he his held down by as many as three staff members and injected against his wishes. He sometimes has a great deal of trouble thinking and functioning right after an injection. He is defiant, yet somehow also resigned to making the best of his indefinite period of incarceration. I have only snippets of of comparable experience: the time on the “stress reduction” unit at Akron General Medical Center when a nurse asked me to join a group that was making coasters with putty and small tiles. I told her it insulted my intelligence.
Her reply? “I can see how you got yourself locked up in here” − with a sneer that came close to spitting on me. I have nothing as intense as John’s experience. I have nothing as deep as his insight into what the mad brain is capable of when under prolonged and consistent attack. High risk of escape on a big yellow sign? Hell yes. Tattoo it on my forearm.
“I am a real human being, endowed by my Creator with free will, and I have the intellectual capacity to participate in treatment decisions. Receiving permission to hurt someone does not make it in any way ethical to do so. My perspective is valid, my objection are sound, and this institution is rationalizing torture.”
John J. Rohrer, June 26, 2014
Forcibly injected every 2 weeks
Appalachian Behavioral Healthcare, Athens, Ohio
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.