Editor’s Note: At the Mad in America film festival, Allen Frances, M.D., who was the chairman of the DSM IV task force, participated on a panel of psychiatrists who were asked to respond to the themes explored at the festival and to offer their own critiques of psychiatry. After the festival, he wrote a blog for the Huffington Post, which was partially inspired by his participation at the festival, and he then offered to re-publish it on MIA. It appears below. Also at the festival, Justin Brown sought to hand out a leaflet criticizing Dr. Frances’ writings, as well as his critique of those who criticize psychiatry. We asked him to submit a post for MIA instead, which is published below.
Finding a Middle Ground Between Psychiatry and Anti-Psychiatry
by Allen Frances, M.D.
There will never be any compromise acceptable to the die-hard defenders of psychiatry or to its most fanatic critics.
Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem.
Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental-health treatment, not its necessity or any of its benefits.
I have spent a good deal of frustrating time trying to open the minds of extremists at both ends — rarely making much headway.
Fortunately, though, there are many reasonable people in both camps who may differ markedly in their overall assessment of psychiatry but still can agree that it is certainly not all good or all bad. With open-mindedness as a starting point, common ground can usually be found; seemingly divergent abstract opinions are not so divergent when you discuss how to deal with practical problems.
And finding common ground has never been more important. We simply can’t afford a civil war among the various advocates of the mentally ill at a time when strong and united advocacy is so desperately needed.
Mental-health services in the U.S. are a failed mess: underfunded, disorganized, inaccessible, misallocated, dispirited, and driven by commercial interest. The current nonsystem is a shameful disgrace that won’t change unless the various voices who care about the mentally ill can achieve greater harmony.
Here is the cruel paradox: Those who need help can’t get it. We have half a million severely ill patients in prison for nuisance crimes that easily could have been avoided had they received adequate treatment and housing. Sleeping on a stoop, stealing a Coke, or shouting on a street can get the person arrested. Once arrested, not being able to make bail and/or not fitting in well with jail routine leads to prolonged incarceration and, too frequently, crazy-making solitary confinement. The U.S. today is probably the worst place and worst time ever to suffer from a severe mental illness.
Meanwhile, those who don’t need psychiatric medicine get far too much: We spend $50 billion a year on often-unnecessary and potentially dangerous pills peddled by Big Pharma drug pushers, prescribed by careless doctors, and sought by patients brainwashed by advertising. There are now more deaths in the U.S. from drug overdoses than from car accidents, and most of these come from prescription pills, not street drugs.
The mess is deeply entrenched because 1) there are few and fairly powerless advocates for the most disadvantaged; 2) the commercial interests are rich and powerful, control the airwaves and the politicians, and profit from the status quo; and 3) the mental-health community is riven by a longstanding civil war that distracts from a unified advocacy for the severely ill.
The first two factors won’t change easily. Leverage in this David-vs.-Goliath struggle is possible only if we can find a middle ground for unified advocacy.
I think reasonable people can readily agree on four fairly obvious common goals:
- We need to work for the freedom of those who have been inappropriately imprisoned.
- We need to provide adequate housing to reduce the risks and indignities of homelessness.
- We need to provide medication for those who really need it and avoid medicating those who don’t.
- We need to provide adequate and easily accessible psychosocial support and treatment in the community.
The arguments occur over the extent to which medication and coercion are necessary, and over who should get how much funding to provide what type of psychosocial support to which people.
We can all agree that too much medicine is being prescribed by the wrong people to the wrong people and for the wrong indications. Eighty percent of all psychiatric medicine is prescribed by primary-care doctors after very brief visits that are primed for overprescribing by misleading drug-company advertising. Many psychiatrists also tend to err by being too quick to write prescriptions. Anti-psychiatrists err in the other direction, thinking that because they have personally done better without meds, no one needs them.
I think reasonable people can agree that we need to reeducate doctors and the public that medications have harms, not just benefits, and should be reserved only for narrow indications when they are really necessary. It is ludicrous that 20 percent of our population takes a psychoactive pill every day, and it is equally ludicrous that anyone should be sent to jail for symptoms that would have responded to medication if the waiting time for an appointment had been one day, not two months.
Coercion is an even more contentious topic, but one that also has a common-sense common ground. When, more than 50 years ago, Tom Szasz began to fight for patient empowerment, freedom, and dignity, the main threat to these was a snake-pit state hospital system that warehoused more than 600,000 patients, usually involuntarily and often inappropriately. That system no longer exists. There are now only about 65,000 psychiatric beds in the entire country, and the problem is finding a way into the hospital, not finding a way out.
Anti-psychiatrists are fighting the last war. Psychiatric coercion has become largely a paper tiger: rare, short-term, and usually a well-meaning attempt to help the person avoid the real modern-day coercive threat of imprisonment. Decriminalizing mental illness and deprisoning the mentally ill should be an appealing common banner. And when you discuss specific situations, there is much more common-sense, common-ground agreement about when psychiatric coercion makes sense than when you discuss this hot-button issue in the abstract.
Finally, there is the inevitable competition for scarce resources that causes conflict between professionally run mental-health programs and those based on recovery. The fight for slices of the pie gets particularly fierce when the pie is far too small to start with and is forever shrinking.
The common ground here is recognition of the fact that one size does not fit all. We need all sorts of different psychosocial support systems, because different people have different needs and tastes. We should be joining together to grow a bigger pie, not fighting for slightly bigger slices of a shrinking one.
Rome is burning, and no one seems to be doing much about it. The ivory-tower institutions (like the professional associations and the National Institute of Mental Health) and the more grassroots organizations need to put aside differences and focus common advocacy on two goals that all can share: helping our most disadvantaged regain freedom and dignity, and taming the rampant and careless overuse of medication.
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Are We A Silent Minority?
A Response to Allen Frances’ Remarks at the Mad In America Film Festival
by Justin Brown
Some two hundred people sat in silence as prominent psychiatrist Allen Frances concluded his remarks at the Mad in America Film Festival. Unlike other Film Festival presenters — who were uniformly granted a warm round of applause — Frances’ remarks concluded in silence. Ringing in my mind were the words Frances hadn’t spoken. Frances said nothing at the Film Festival about his August 28, 2014 Huffington Post Blog entitled “Hall of Shame” in which he claimed to speak for “the 5 percent who otherwise lack voice or influence.” In the Huffington Post, Frances asserted that five percent of Americans — that’s approximately 16 million of us — who have what he calls “really severe and incapacitating illness” are “a small, very easily ignored, relatively unattractive, silent minority.”
Are we truly a silent minority? In fact, our voices — those of us with lived experience of extreme states and emotional distress — could be heard loud and clear throughout the MIA Film Festival. Later that night at the Gala Dinner, Mad in America blogger and psychiatric survivor Leah Harris spoke eloquently about her opposition to Representative Tim Murphy’s bill that would compel psychiatric compliance through so-called “outpatient commitment.” Harris echoed her April 21, 2014 MIA blog, entitled “Defeating Goliath: Mental Health is a Social Justice Issue, and People with Lived experience and Their Allies are Rising Up” she wrote: “Unity in action comes when people with diverse views and life experiences can focus on what they have in common, instead of on their differences. The Murphy Bill is our opportunity to organize stronger and better than we ever have, as persons with lived experience, people with disabilities, and allies who believe in our values.”
Allen Frances also had asserted that we should focus on what we have in common, instead of our differences. It is tempting to believe that Frances — who urged the Film Festival audience to join in what he described as a “Rainbow Coalition” advocating for the needs of the most vulnerable — has reversed his earlier support for the Murphy bill and has become one of our political allies. In fact, Frances and his ally DJ Jaffe of Mental Illness Policy Org — an internet site advocating forced psychiatric compliance—have a very different political agenda.
In their Huffington Post blog, Frances and Jaffe aim to separate off “the 5 percent of the population with the most serious mental illnesses” from the 20 to 25 percent of Americans who the Federal Substance Abuse and Mental Health Service Administration (SAMHSA) says experience “a mental health problem in a given year.” Jaffe asserts:
[A]s as Representative Tim Murphy noted, “SAMHSA has not made the treatment of the seriously mentally ill a priority… It’s as if SAMHSA doesn’t believe serious mental illness exists.” [SAMHSA] wants to replace the scientific medical model with their internally invented recovery model, and creates its own “illnesses” — bullying and trauma being the most recent. They advocate for anyone with “lived experience.” They believe everyone should self-direct their own care, thereby ignoring those too sick to do so.
Maddeningly, Frances and Jaffe claim to speak for “the 5 percent who otherwise lack voice or influence.” Now, let’s do that math. Five percent of 317,297,938 Americans — according to the US Census as on January 1, 2014 — is 15,864,896 human beings potentially forced into involuntary psychiatric compliance, both inpatient and outpatient. How are we to put that number into proper perspective? How are we to engage in a civil conversation with Frances, Jaffe and other proponents of the Murphy Bill?
Prior to Allen Frances’ appearance at the MIA Film Festival, I distributed a letter to those attending the festival in which I wrote: “Please join me in being silent no longer! We may be unattractive to Allen Frances, but sixteen million Americans (five percent of the US population) is not a small number, nor should we be easily ignored. It’s time we awaken to a new reality. Our civil rights are threatened more today than they have been at any time since the 1950s.”
Robert Whitaker approached me outside the Regent Theater and asked that I stop distributing this letter because he was concerned that the letter could disrupt the panel he had invited to discuss important issues facing psychiatry. Whitaker explained that, as the host of the Film Festival, he was concerned that we “treat an invited guest in a proper way.” He explained that “given how poorly I have been treated at times by my ‘hosts,’ I want to make sure that nobody could say that about us.” I agreed to stop distributing the letter out of respect for all the effort that Whitaker and so many others had put into making the MIA Film Festival such a positive and inspiring event focused on healing alternatives to the Pharmaceutical Industry.
Whitaker is absolutely right that we need to have civil conversations about psychiatry. Gandhi cautioned: “We must resolutely refuse to consider our opponents as enemies.” In fact, Gandhi pushes us even further along the path of non-violent activism by asserting that the person “who is truthful and does not mean ill even to his adversary will be slow to believe charges even against his foes. He will, however, try to understand the viewpoints of his opponents and will always keep an open mind.” We do well to adopt this non-violent approach in our opposition to the Murphy Bill.
At the MIA Film Festival, Allen Frances spoke — as he did in the Huffington Post blog — of one million Americans in “inappropriate prison bondage.” He said we should be funding model programs to get these people back into the community. For Frances, these model programs include involuntary outpatient commitment such as a $250,000 pilot program Massachusetts Governor Deval Patrick quietly signed into law on July 11, 2014 and the approximately $60,000,000 of Federal funding currently slated for similar pilot programs across America. At least for now, advocates of forced psychiatric compliance gain almost as much from such “pilot” projects — which they claim provide empirical support for their agenda — as they would from actually forcing 16 million Americans into psychiatric compliance. The empirical reality is that forced treatment on this scale would prove ineffective and would almost certainly create a political backlash against their agenda. The cultural reality is that these pilot projects already are extremely effective in achieving one simple goal: to deflect a much needed national conversation about guns and violence onto a convenient scapegoat — those of us with lived experience of extreme states and emotional distress.
Our goal should be to redirect the national conversation back to where it belongs. Our goal should be to articulate a vision of the future where confronting guns and violence is a collective responsibility, not merely “outsourced” to psychiatry. In her April 21 MIA blog Leah Harris asserts “We have a vision that would take us forward, not backwards, as proponents of [the Murphy] legislation would do.” In her remarks at the closing of the MIA Film Festival, Harris called upon us to take an “intersectional” approach which emphasizes the ways that distinct forms of oppression—such as racism, classism, sexism, heterosexism, ableism, and mentalism—intersect.
Liat Ben-Moshe, in a December 20, 2011 article in Critical Sociology entitled “Disabling Incarceration,” looks at “the phenomenon of mass incarceration through an intersectional lens.” Ben-Moshe observes:
For the first time in US history, in 2008, more than one in 100 American adults was behind bars. In 2009 the adult incarcerated population in prisons and jails in the USA had reached 2,284,900 according to the Bureau of Justice Statistics (BJS, 2010). The USA incarcerates a greater share of its population, 737 per 100,000 residents, than any other country on the planet (Pew Center, 2008). Another whopping 5,018,900 people are under ‘community corrections,’ which include parole and probation (BJS, 2010). Race, gender and disability play a significant role in incarceration rates. In 2006, Caucasians/whites were imprisoned at a rate of 409 per 100,000 residents; Latinos at 1038 per 100,000 and African-Americans at 2468 per 100,000. The rate for women was 134 per 100,000 residents and for men, 1384 per 100,000. In 2005 more than half of all prison and jail inmates were reported as having a mental health problem.
While we may oppose the “outpatient commitment” programs Allen Frances advocates as an alternative to prison, he is right to bring our attention to the many millions of Americans in prison today (and not just to the 350,000 prisoners that he claims fit his diagnostic criteria for forced psychiatric care). Liat Ben-Moshe’s continues her intersectional approach to mass incarceration:
In social science research, including criminology, the convention is to think of confinement in terms of placement in jails and prisons, therefore reinforcing a skewed interpretation of ‘the rise in incarceration’ in the USA. Under this interpretation, the first half of the 20th century is conceived as an era of relative stability in terms of incarceration, with an explosion in this area in the 1980s onward, in the form of immense growth in the capacity of prisons and jails. However, if the data on mental hospitalization and institutionalization were also covered in such studies under the prism of incarceration, then the ‘rise in incarceration’ would have reached its peak in 1955, when mental hospitals reached their highest capacity. Put differently, the incarceration rates in prisons and jails today (although appallingly high by any standards) barely scrape the levels of incarceration during the early part of the 20th century because of the then massive confinement in hospitals.
Ben-Moshe urges us to “reconceptualize institutionalization and imprisonment as not merely analogues but as in fact interconnected, in their logic, historical enactment and social effects.” She asserts that “disablement” has become big business:
Class based analysis of disability urges us to shift our understanding of disability oppression from discussions of stigma and deviance to that of systematic economic exclusion of people with disabilities. In post-industrial times, disablement has become big business. A single impaired body generates tens of thousands of dollars in annual revenues in an institution. From the point of view of the institution-industrial complex, disabled people are worth more to the gross domestic product when occupying institutional ‘beds’ than they are in their own homes. Capitalism has found a solution to the ‘problem’ of unproductiveness, for those who are not perceived as laborers. Their bodies generate revenues when placed in institutional beds, such as large institutions, nursing homes, prisons and (some) group homes.
Even as the soaring number of prisoners provides a growing revenue stream for the institutional-industrial complex, increasing psychiatric beds could increase this revenue further, but at what cost? A Pew Charitable Trust 2010 Report entitled “Collateral Costs: Incarceration’s Effect on Economic Mobility” explains that “the collateral costs of locking up 2.3 million people are piling higher and higher.” According to a September 28, 2010 Pew press release, the collateral costs of imprisonment fall disproportionately on non-white men and their children:
Incarceration reduces former inmates’ earnings by 40 percent and limits their future economic mobility. Before being incarcerated, two-thirds of male inmates were employed and more than half were the primary source of financial support for their children.
Collateral Costs details the concentration of incarceration among men, the young, the uneducated and African Americans. One is 87 working-aged white men is in prison or jail compared with 1 in 36 Hispanic men and 1 in 12 African American men. Today, more African American men aged 20 to 34 without a high school diploma or GED are behind bars (37 percent) than are employed (26 percent).
The report also shows more than 2.7 million minor children now have a parent behind bars, or 1 in every 28. For African American children the number is 1 in 9.
We can only imagine what the economic impact of forced psychiatric compliance for 16 million Americans might be. While it could fuel the institutional-industrial complex, what would be the collateral costs?
For now, our most immediate challenge is not the forced-treatment legislation itself — Representative Tim Murphy’s bill — but a pervasive cultural attack on our identity embedded in this legislation. Liat Ben-Moshe explains that we who have lived experience fall under the logic of “handicapitalism” whether we want to or not. She asserts:
People who are psychiatrized and those who are labeled as intellectually or physically disabled all share a common label in administrative categorization, the gathering of statistics and bureaucratic definitions – the label of ‘disability.’ This is done despite the resistance of some of these groups seeking to escape from the label of disability, as an administrative label or self-definition. For instance, many with psychiatric labels do not identify as disabled and see their life circumstances as significantly different from those of people with disabilities. But even if certain groups or individuals resist the impetus to collide all these categories, often in social policy, legislation and service provision they are lumped together nonetheless.
Ben-Moshe asserts that “disabled people mark, with their different bodies and minds, the boundaries of normalcy.”
In fact, the boundaries of normalcy stand at the heart of our current predicament. I began to recognize the tremendous cultural impact of what might be described as the “Myth of Normal” as I listened to WBUR Radio in Boston on May 30, 2014. The commentary focused on Isla Vista, California where, a few days earlier, 22-year-old Elliot Rodger had killed 6 people and injured 13 others. WBUR Radio played tape of Richard Martinez—whose son Chris was one of one of six people killed—pleading for stricter gun laws: “Chris died because of craven irresponsible politicians and the NRA. They talk about gun rights. What about Chris’s right to live. When will this insanity stop?” The insanity this grieving father spoke about was not only Elliot Rodger’s horrific actions but the broader cultural context of these actions: a cultural insanity that worships guns and violence.
Asked whether this event will make any difference in the gun control debate, commentator Jack Beatty responded “Probably not, the NRA rules because Congressional fear — ‘cravenness’ as Mr. Martinez said — is a bottomless commodity.” Then, without further analysis Beatty switched the focus:
I do think there is something hopeful here and that’s a piece of legislation proposed by Congressman Tim Murphy of Pennsylvania, the only clinical psychologist in Congress… He wants to lower the threshold for institutionalizing people… As it is now, it’s an extremely high bar. He wants to lower that and he wants it to apply much more quickly… It is a bi-partisan bill. It has, I think, over 30 Democratic sponsors. It’s rare that you can look at one of these things and say ‘if only…’ Well, here we have it!
Here, in a matter of a few seconds, we see how the Murphy bill—even without the votes needed to clear committee—had already been successful in shifting the national conversation away from our collective hopelessness about passing meaningful gun control legislation onto a new scapegoat—those who Allen Frances calls “the 5 percent.” All the Isla Vista Sheriff’s Department needed to say about Elliot Rodger was: “It was apparent he was very mentally disturbed.” Here is a message that everyone could understand: The shooter is not like the rest of us; he is one those who does not belong among us, one of those who must be forced into psychiatric compliance, one of those who is not normal!
Sixteen million Americans forced into psychiatric compliance is an astounding goal, but perhaps it is easier to achieve than removing somewhere between 270 and 310 million guns held in 37% of American households. Forced outpatient commitment makes the unthinkable, thinkable and psychotropic medications make the impractical, practical. Only in the context of the widely-held cultural belief in a magic pill that can cure all woes does forced treatment of 16 million Americans become an imaginable goal. In fact, Americans have embraced psychotropic medications on a scale that makes the 5 percent goal seem entirely practical. According to the US Centers for Disease Control and Prevention, 11 percent of Americans over the age of 12 already use antidepressant medications, with 60% of these taking their pills for 2 years or longer (NCHS Data Brief Number 76, October 2011).
How appealing it must be is to believe that countless lives could have been saved if only Elliot Rodger in Isla Vista, California or Adam Lanza in Newtown, Connecticut or James Holmes in Aurora, Colorado or other senseless shooters had been forced to swallow a magic pill. It is so much simpler and easier than looking at the “intersectional” forces that motivated these shooters such as racism, classism, sexism, homophobia, ableism, mentalism and a pervasive cultural infatuation with guns and violence. What might Jack Beatty’s commentary have been if he had not so readily swallowed the “if only…” pills hawked by the advocates of forced psychiatric treatment?
A few days before Beatty’s “if only…“ comment, the New Republic published an article entitled “Not Just a White Guy Killer: Elliot Rodger’s perverse sense of racial hierarchy — and his uncertain place in it.” The author, Hua Hsu, observed that Elliot Rodger described himself as a half white, half Asian kid who felt different from the “normal fully-white” kids with whom he grew up. This equation of “normal” with “fully-white” stands at the heart of Hsu’s decoding of the cultural context that motivated Rodger’s madness.
After observing that Rodger “expressed an open hatred of women, the rich and the poor, anyone with a girlfriend, African Americans, Mexicans, Asians, members of his own family, childhood friends, his roommates,” Hsu observed that Rodger “also appeared to hate himself.” Hsu continued:
I currently have a dozen browser tabs open, each page shading in a different aspect of Rodger’s madness. Many of these analyses echo the initial accounts that mistakenly identified Rodger as a white male, slotting him within the larger phenomenon of white, male mass murderers… Does it actually matter that he was half-Asian?
Rodger drew on his identity selectively, much as we do in our search for answers. Sometimes he embraced his [white male] privilege, other times it haunted and gnawed at him. One can imagine a situation where Rodger couldn’t make sense of his mixed race heritage—“I am half White, half Asian, and this made me different from the normal fully-white kids that I was trying to fit in with,” he wrote. With the comfort of distance, we might suppose that he felt scorned by some abstract sense of the “normal” rather than realizing that the word describes nothing. [Emphasis added]
At the heart of Elliot Rodger’s violence is the pathology of normal. Unlike Rodger, Hsu recognizes “normal” as a word that describes nothing at all. The Myth of Normal — a myth that equates being fully-American with being fully-white and fully-male and fully-straight and fully-rich and fully-able and fully-sane and fully-armed with guns and ammunition — is at the root of Rodger’s pathology. We — as persons with lived experience of extreme states and emotional distress — can ask ourselves: How often have we too felt scorned by some abstract sense of “normal” that does not include us? How often have we too failed to recognize that the word “normal” describes nothing at all?
One thing is certain: No pill will ever cure the disease of wanting to be normal! We have a rich history of consciousness raising and activism around what Judi Chamberlin called “Mentalism.” Like racism, classism, sexism, heterosexism and ableism, mentalism is a set of cultural assumptions that Chamberlin asserts most people hold about mental patients including that we are “constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational, and so forth.” I would assert that racism, classism, sexism, heterosexism, ableism and mentalism all share a common foundation in the Myth of Normal that cuts across all these forms of oppression.
Leah Harris, in a June 16, 2014 MIA blog entitled “From Self Care to Collective Caring,” points the way for us to begin cutting through the Myth of Normal:
In this society, we have a dichotomized response to distress. Suck it up and adjust to what is, or be put somewhere where you will be made to adjust. It is possible to be so focused on individual illness and wellness that we forget the equally important need to work for collective wellness and social justice. In an ideal world, we are taking care of one other, and working together to change the way things are.
A liberating notion of care would follow from the understanding that most of us need other people. We need truly safe relationships in our everyday lives where we can be vulnerable and real, and let the masks of “keeping it together” fall away. A redefined notion of care would presuppose that we as individuals are all deeply interconnected. The “burden of healing” would be spread around, rather than placed squarely on each of our individual shoulders. Together, we are stronger than alone.
For too long we as a society have outsourced emotional and social care, and it has largely been a disaster. Everyone admits the systems are broken. Our current way of life is not sustainable. It’s time to seriously re-imagine what care means. The future is in our hands.
Yes, the future is in our hands! Many thanks to Robert Whitaker for insisting that we engage our opponents not as villains but with an open mind that allows us to look more deeply into what Allen Frances describes as “prison bondage.” Many thanks to Leah Harris for introducing the intersectional approach to oppression that helps us see forced psychiatric compliance in the larger context of what Liat Ben-Moshe describes as the “institutional- industrial complex.” Many thanks to Hua Hsu for recognizing “normal” as a word that describes nothing at all. Together, we can build a deeply interconnected community where emotional and social care is no longer outsourced to psychiatry but becomes our shared responsibility. Together, we can step beyond the Myth of Normal to embrace the collective power of our diversity. Not one of us is fully-white, fully-rich, fully-male, fully-straight, fully-able and fully-sane. Not one of us is normal! The prospect of sixteen million Americans forced into psychiatric compliance is a symptom of a much deeper cultural despair about our capacity to confront violence with non- violence. After suggesting a variety of steps that we can take to defeat the Murphy Bill in Congress, Leah Harris writes:
Nonviolent direct action is also very much necessary at this time. We need marches and rallies and events and teach-ins to be happening everywhere in opposition to this frightening legislation and all that it represents.
We also can be right now creating the world we want to see. We do not need to wait for social change to be funded or legislated. Isolated and seeking support in your area? Build community. Start a cooperative to provide peer-to-peer support and support for struggling families in your community. Start a local dialogue on trauma, social inequality, and the real causes of violence and suicide.
Frustrated at the lack of real community-based alternatives for people in crisis in your area? Find out who else in your local networks might also care about creating viable alternatives, and get the conversation started as to how to make it happen.
The idea is to dream up how we can take back our power, as individuals and communities. In this way, we attain power together—control over how we determine our own lives, and the collective will to solve our collective problems.
Together, we can overcome a collective sense of hopelessness in the face of guns and violence and achieve what Martin Luther King called the “beloved community.” In his 1959 Sermon on Gandhi, King said: “The aftermath of nonviolence is the creation of the beloved community, so that when the battle’s over, a new relationship comes into being between the oppressed and the oppressor. The way of acquiescence leads to moral and spiritual suicide. The way of violence leads to bitterness in the survivors and brutality in the destroyers. But, the way of non-violence leads to redemption and the creation of the beloved community.”
Through non-violent direct action — and the many other forms of community engagement recommended by Leah Harris — I believe we can defy Allen Frances description of us as “a small, very easily ignored, relatively unattractive, silent minority” and become a much broader community — a truly diverse and outspoken community that cuts across race, class, sex, sexual orientation, ability and sanity in the common recognition that not one of us is normal. I believe that together we can defeat the Myth of Normal and create the beloved community.
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.
“We have half a million severely ill patients in prison for nuisance crimes that easily could have been avoided had they received adequate treatment and housing. Sleeping on a stoop, stealing a Coke, or shouting on a street can get the person arrested. Once arrested, not being able to make bail and/or not fitting in well with jail routine leads to prolonged incarceration and, too frequently, crazy-making solitary confinement. The U.S. today is probably the worst place and worst time ever to suffer from a severe mental illness.” [emphasis added]
Where do you get that statistic? (I seriously wonder.) Please, do tell.
And, please, consider this: Surely, the U.S. today cannot reasonably be called “the worst place and worst time ever to suffer from a [presumed] severe mental illness.”
(Frankly, I consider the concept of “severe mental illness” to be nothing more or less than a socio-political construct, which serves no one — except for those who wish to force psychiatric “treatment” on ‘others’ who’s behaviors they find ‘abnormal’ thus unacceptable; oh, and it serves to gain and sustain government so-called “assistance” for such individuals, once they’ve been permanently dis-abled by such psychiatric “treatment”.)
But, clearly, the worst place and time was Germany, leading up to and during the 2nd World War — as individuals identified that way were being euthanized there, then; and, in the U.S., in the 1940’s and 1950’s, at least 40,000 individuals (supposedly ‘severely mentally ill’) were lobotomized. Hence, that seems like a worse time, than now, to be viewed and ‘treated’ as ‘severely mentally ill’ in this country (the U.S.).
In fact, as you’re now enthusiastically promoting increased reliance on court-ordered, so-called “assisted outpatient treatment,” you should take a look at Australia. From all that I hear of current Australian psychiatry (as there is no Bill of Rights in Australia nor any rough equivalent of such), court-ordered “outpatient treatment” is proving to be quite the rage, Down Under. Far more Aussie citizens, per capita, than here in the U.S., are now are being, as “outpatients,” forcibly ‘treated’ with I.V. psychiatric drugs (neuroleptics, a.k.a., so-called “antipsychotics”); they’re being forcibly drugged, in their homes… (that is, when they are not ‘just’ allowing themselves to be dutifully coerced into swallowing the pill form of such chemicals — which we all know now for a fact are literally shrinking “patients'” brains, at least 1% every year that they’re used… and which we know are creating, moreover, obesity, diabetes, deadly metabolic disease… when administered continually for any considerable amount of time).
But, back to my first question: Where did you come up with that statistic, that I’ve emphasized, by adding bold print, above?
Pray, do tell. Answer me just that one question, in response to my comment, and I will be be very grateful…
P.S. — To whoever may be interested (as I highly doubt that Allen Frances will be responding to my comments):
First of all, I suggest, check out: “Community Treatment Orders Don’t Work” http://www.madinamerica.com/2013/04/community-treatment-orders-forced-treatment-dont-work/
For those who may not know, court-ordered “AOT” (“assisted outpatient treatment”) in the U.S. is roughly the equivalent of what’s called “CTO” (“community treatment orders”) in the U.K..
…Over a year ago (maybe it was nearly two years back), on Twitter, to Dr. Allen Frances (@AllenFrancesMD) I ‘tweeted’ a necessarily brief — and perfectly courteous message — that included my recommendation, to, please, take a moment and look into the following Youtube link (It’s a 17 minute Youtube video, in which a woman from the U.K. — now, tragically, deceased — speaks of the effects of the depot injections she was getting, as a result of her “CTO”):
“Depot injection robs artist of her creativity”
I encouraged him to “See the ‘uploader’ notes after watching the video.”
Not surprisingly, I received no response from Dr. Frances…
Here, as follows, are those Youtube uploader notes (copied and pasted):
And, here is a copy and paste of a recent comment from the Youtuber (Sian whitehead) who uploaded the video:
I wish everyone who committed suicide because of the abuse by psychiatry has left a letter stating his/her reasons. This way every suicide is only used to justify torture of even more people. Sick.
So Allan Frances claims to speak for, “the 5 percent who otherwise lack voice or influence.”
But Justin Brown writes, “In fact, our voices — those of us with lived experience of extreme states and emotional distress — could be heard loud and clear.”
A book I was reading compared psychiatry to colonialism. The great white psychiatrist is taking care of those poor, ignorant, patients (natives). This post makes that relatinship clear.
Justin says, “identifies as a person in recovery who voluntarily takes psychotropic medication thereby disqualifying him from the so – called “anti-psychiatry” movement.” But according to Bonnie Burstow’s blog, just below this one, he may well be able to call himself anti-psychiatry if he so wishes. Taking psychiatric drugs does not, in her opinion mean that one is not anti-psychiatry.
Allen Francis talks of prison. But anyone who talks of prison in the USA without reference to the fact that the USA has one of the highest, and most brutalised, prison populations in the world, is talking in a very select fashion. The answer to mentally distressed people in prison is to not lock them up and to provide decent housing, benefits, jobs etc etc, not to force psychiatry on them.
“The answer to mentally distressed people in prison is to not lock them up and to provide decent housing, benefits, jobs etc etc, not to force psychiatry on them.”
In that last line of yours, you’re making no sense, imo, and (because I know from reading many 0f your MIA comments, that you are an intelligent person) I can’t help but wonder: Do you mean to say what I think you are saying there? Or, am I misunderstanding you? Do you believe that anyone who is arguably “mentally distressed” should not be locked up in prison?
Personally, I think prison should be reserved mainly for violent criminals.
With few exceptions, I oppose, in principle, the imprisonment of those who’ve not been convicted of considerably violent crimes. (Among the exceptions: I will not oppose the imprisonment of those who’ve ‘just’ been found guilty of a conspiracy to commit or incite such violence.)
Imo, violent criminals may need to be imprisoned.
Any policy to remove such persons from prison, only because they seem “mentally distressed” there, would be a certain mistake, imo.
Along those lines, I can’t help but strongly object to Allen Frances’s expressed call (in his blog post, above) to begin “deprisoning the mentally ill.”
That call of his is 100% propaganda (inspired by NAMI and E Fuller Torrey’s TAC) designed to encourage the transfer of as many as 1,000,000 prisoners into the so-called “care” of psychiatry… via ‘mental health courts’ and mandatory (court-ordered) “AOT”.
(I’m sure a significant proportion of those prisoners should not be in prison, because they were not convicted of violent crimes; but, Frances refers to “half a million severely ill patients in prison for nuisance crimes.” I do not think that stat reflects reality, at all, and I do not believe anyone should get a ‘pass’ out of prison, nor either should anyone receive a ‘Do Not Go to Prison’ ticket, merely because s/he’s been ‘diagnosed’ as supposedly “mentally ill.”)
To reverse the rampant imprisonment of people in the U.S. who should not be in prison will require decriminalization of ‘illicit’ drug use.
That other sort of policy (ostensibly “deprisoning the mentally ill”) is just a ruse, of psychiatry, that’s benefits no one, except psychiatrists and Big Pharma.
P.S. — John Hoggett, of course, I most certainly do quite appreciate the very last words, of your last lines, recommending “not to force psychiatry on them.”
Personally, I would appreciate it if you stopped speaking for us at all. I’m not even sure you know who it is you claim to represent. Your description is insulting and demeaning, but more so, it shows more of an interest in selling a generalization than in the people you have thoughtlessly described as disposable. In all this talk about the moral obligations to the mentally ill and the medical treatment we deserve and the the bills that need to be written for our well being, I find it interesting that no one seems to have talked to use about how we see our well being. What is the point of deprisoning the mentally ill if you only plan to lock them back up again? I also wonder who it really benefits because, as convicted criminals, those people have rights and courses of action to consider if their rights are trampled. However, there’s nothing like a civil commitment to strip a person of any rights or protection. Isn’t that how the Adam Walsh Act works? Even though treatment is a requirement for them to be released as there is no real mental illness there is also no treatment. They can be held indefinitely. The problem in the US isn’t that we are “a small, very easily ignored, relatively unattractive, silent minority.” The problem is that people in your position have already classified us as less than human, a necessary sacrifice for the good of the many (or the profit of the few or the political podium of the couple).
There was a recent study in Austria, which shows that people who end up in mental institutions serve more time (sometimes many fold more) for the same offenses as people in regular prisons. Simply because they are kept there until psychiatrists deem them “stabilized” which we all know is a vague standard to say the least why people who go to prison have a release date that can’t be breached.
I’ll take prison over psych ward any time.
This is such a no-brainer.
Frances sees his own beloved profession biting off more than it can chew; so he issues a warning, in hopes psychiatry doesn’t choke to death, due to its own insatiable appetite to label, drug and control others.
The DSM-V posed a threat to its survival.
So Frances spoke up, so psychiatry could continue being able to exercise its monopoly on the 5% of the population, who have historically had little or *no* say in the “treatment” they get (namely, those labeled as ‘bipolar’ or ‘schizophrenic’); along with a few other groups, ie ‘major depressive disorder’ – people conventional docs are hesitant to treat.
Biting off too much (insisting that 20-25% of the population has a ‘mental illness’) threatens to expose psychiatry as the *myth* that it is…. Frances knows this…
I could go on and on… but so could *anyone* paying attention, so I won’t.
What I will say is this:
If psychiatrists truly want to help, the could begin by getting well-versed on how to assist people in getting *off* psychiatric drugs (the very ones they routinely prescribe).
From Dr. Peter Breggin –
“Nothing in the field of mental health will do more good and reduce more harm than encouraging withdrawal from psychiatric drugs. The time is past when the focus in mental health was on what drugs to take for what disorders. Now we need to focus on how to stop taking psychiatric drugs and to replace them with more person-centered, empathic approaches. The goal is no longer drug maintenance and stagnation; the goal is recovery and achieving well-being…”
“… It’s time for therapists—psychologists, nurses, social workers, family therapists, and counselors—to stop pushing their clients and patients to take psychiatric drugs that cause brain damage, harm the body, and shorten their patients’ lives. In Psychiatric Drug Withdrawal, therapists will learn about psychiatric drugs to actively participate with patients and families in the medication decision-making process.” – From Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Families by Peter Breggin, MD
From the International Society of Ethical Psychology and Psychiatry –
“If you chose to take psychiatric drugs you are at risk of becoming dependent on them. You can also experience very distressing withdrawal symptoms when you stop taking them. This can make you feel trapped into taking then indefinitely. But you can stop. Tell the physician who prescribed them that you want to stop and ask for instructions on how to slowly reduce the dosage over time so your body can regain its natural functioning.
This site has some good resources as well:
Any shrink who is *serious* about helping should get serious about helping people get off these drugs. Otherwise, get out of the way.
Duane – Awesome, informative sounding of the issues in your comment and its citations.
Allen Frances calls for “deprisoning the mentally ill.”
It’s an outrageous proposal — for many reasons — not least of all this one: It gives psychiatrists all the power in the world, to determine which prisoners supposedly should be in prison as opposed to which prisoners supposedly shouldn’t be…
“Mentally ill” is a label that can only be applied by psychiatry (as the supposed existence of ‘mental illness’ can only be confirmed by psychiatrists).
And, what does “mentally ill” even mean?
Here’s the concluding paragraph (and link) from an article that I’ve recommended previously, in MIA comments (I do so again now, as it’s quite good, imo, and perfectly apropos):
I find “the mentally ill” a very insulting expression. In fact, it’s way up there with “the easily ignored, relatively unattractive” (if not down right ugly) in Frances Allen’s glamorously handsome opinion, and “silent minority”, but please don’t censor me, again, for saying so.
What’s more, I confess to being part of the 5 %, at least, I confess to having previously been part of the 5 %, unless I lack insight, in which case I confess nothing, and I still wouldn’t have Frances Allen, nor Bob Whitaker, for that matter, speak for me. I am perfectly capable of speaking for myself, when I am not being censored, and having Allen Frances speak for me.
If a little “extremism” a day will keep the psychiatrist away, by golly, I’m good with it, and apparently many more people should try a little “extremism” more often. Of course, it’s not that sort of extremism that will give you a convulsion by sending electricity through your organ of thought. Nor is it that kind of extremism that will give you a chemical lobotomy. Nor it is that kind of extremism that will imprison you in the name of “normality”.
Censored censored censored censored etc.
Dr. Frances, you are suggesting that what is reasonable is something midway between psychiatry and antipsychiatry. Your proof? You don’t offer any. Yet people who are antipsychiatry have demonstrated again and again that psychiatric tenets lack foundation and that the so-called “treatments” inherently harm people. An implicit contradiction. Beyond that, what I would like to suggest it that you are drawing on is a common misconception that the midpoint between two positions is reasonable, while everyone else is what you call “an ideologue”. By this kind of reasoning, however, we would been badly served again and again throughout history. For example, we would not have gotten rid of slavery in the various places that we have (we would have argued, that it does some good and some harm and accepted it for “some people”, much as you would accept psychiatric intervention for some people). The point is here the golden mean, which you seem to assume is both good and the “non-ideological” way to go is simply not uniformly applicable. I would invite you in this regard to question your own starting point. I would likewise ask you to honestly ponder why you are so intent on saving psychiatry, why psychiatry remains at the centre of your vision. I would also like to suggest that you too have an ideology–and it is the common ideology of those who think they have none–liberalism. Now, liberalism has its place. And indeed, liberalism often serves people well. However, it will never get at the roots of issues.
yes, his article does not really have any argument. It just says, “Please do not be nasty to psychiatrists, we’re only trying to help and a lot of nutters are so far gone we need to treat them for their own good.” But he has no evidence or reasoned argument, unlike just about all of the posts on MIA
Very well said Bonnie. There is no saving something as thoroughly and universally destructive as modern day psychiatry. There is a time to be decisive and dogmatic. The appeal to be moderate doesn’t fit in this situation. While it can be appropriate at times, and issues are often more complex than first meets the eye, a thorough and thoughtful critique of psychiatry leaves essentially nothing to salvage, at least in its current biologicaly/ pharmaceutically ravaged state.
I like to think of myself as a reasonable person. I can see extremes on both sides. But, I can’t get my head around several things that Dr. Frances has written. The first one is that he refers to Eleanor Longden’s self-help solution to grappling with voices as non-controversial, something that just about anybody on both sides can agree with. Actually, there are many people out there who insist that working with their own voices is too controversial for their relatives to indulge in. (Scared relatives who like drugs is my reading of it.) Here’s what one HuffPo blogger has to say about this: “Many perfectly healthy people have auditory hallucinations. However, auditory hallucinations can also often be part of the chaos of a psychotic illness. In recent years, numerous groups have developed to assist “voice hearers,” as some wish to be called. Unfortunately, most of these groups don’t want to recognize the very different needs of people with severe mental illnesses.” Here’s what another blogger has to say: “My son, however, would be harmed by this “hearing voices” movement – or, in the US, something called Mad In America. I’m glad it has worked for some – but it is not for everyone.” I am very surprised that Dr. Frances thinks that the Hearing Voices movement is non-controversial. All well and good as long as his own patients don’t attempt something like this? Does he not consider Eleanor Longden part of the 5%? Dr. Frances also seems to be saying although he acknowledges the inappropriate laws, that it is inappropriate people, not inappropriate laws that need fixing. The laws are particularly unreasonable if sleeping on a stoop gets you jail time. I heard a story last week about the Canadian War Memorial in Ottawa that illustrates how policing of inappropriate behavior leads to bad social outcomes. Since when, I asked a friend, does the War Memorial need a soldier standing guard in front of it? Since someone was caught urinating on it several years ago, was her understanding. If this is true, and it sounds plausible, a young soldier died because someone decided that public urination on a handy vertical object was too great an affront to Canadian values.
Agree with most points you brought up.
I see the anti-treatment groups as promoting a death sentence for the severely mentally ill.
There is no ‘dialogue’ with Mad In America. None. To even SUGGEST there is any dialogue anywhere NEAR Mad in America is ridiculous. It is all about one view, and that is NO treatment. And that is a death sentence for the severely mentally ill.
All I can say is that while Mad in America’s approach may work for the ‘worried well’, it is the worst possible approach for the severely mentally ill.
“I see the anti-treatment groups as promoting a death sentence for the severely mentally ill.”
I don’t see “anti-treatment groups” anywhere on this website.
But, maybe I misunderstand your meaning, as you’re applying that label?
“Anti-treatment” suggests, to my mind, a movement that would strive to prevent people from receiving treatment. (I’ve never seen anyone — let alone any group — express such sentiments on this MIA website.)
Perhaps, you have an idea of what “anti-treatment groups” means, that I don’t understand. Can you please explain what you mean when you use that term.
Thanks in advance.
P.S. — As you say, “There is no ‘dialogue’ with Mad In America. None. To even SUGGEST there is any dialogue anywhere NEAR Mad in America is ridiculous. It is all about one view, and that is NO treatment,” I think maybe you are failing to realize, that: of the two persons whose views are being featured in the ‘dialogue’ above, one is a psychiatrist who is actually promoting ‘treatment’ in a very big way (indeed, he’s stumping for more “AOT” — court-0rdered ‘assisted outpatient treatment’), and the other person is someone who describes himself as accustomed to taking psychiatric ‘meds’ (‘treatment’) and benefiting from doing so…
Maybe as you say “anti-treatment,” what you are really meaning to say, is “anti-forced-treatment.”
Of course, you can tell me if that’s putting words in your mouth; maybe that’s not what you’re meaning to say…
I hope you can clarify…
I actually think tusu has something of a point when he accuses Mad In America of lacking dialogue. Obviously there is dialogue here, but largely it’s discussions between people who are generally like-minded but disagree in the particulars. There are few commenters, for example, who speak in favor of the medical model, or who speak of their recovery from depression using antidepressant medications.
While I generally doubt the efficacy of mainstream psychiatry and medical model based treatments, I would still like to see more contrary voices around these parts. Perhaps MIA is seen too much as espousing just one side of the debate?
I, for one, appreciate the fact that I feel ‘heard’ here on MIA…because I sure don’t anywhere else out there in the wide world.
Well, would you be surprised if a forum for African American activists didn’t have much dialogue with Ku Klux Klan? I mean instead of discussing the particulars like police brutality against the young blacks or systemic discrimination they should broaden the dialogue to include things like genetic racial propensity for violence…
@tusu Regarding “severely mentally ill”.
No one wakes up one day “severely mentally ill”.
“you first make thieves and then punish them” Sir Thomas More
Au Contraire, tusu, I hear a great deal of dialogue on the MIA boards. There is such a range of opinions here that threads sometimes degenerate into attacking one another’s conflicting views on a particular subject.
And I definitely don’t see an “anti-treatment” bias here, unless you mean to define medication as the only “treatment” and try to force it on people. There are extensive discussions of alternative forms of treatment, including for psychosis and “bipolar disorder,” as well as frequent comments reminding us all that some people find medication helpful and that we need to respect their individual experiences. The main difference is that we also respect the individual experiences of people who DON’T find medical treatment helpful, regardless of their “diagnosis,” which is a viewpoint Dr. Frances (and I gather you agree with him) does not appear to support.
Where I don’t hear dialog is on the NAMI or the CHADD sites or in most mainstream discussions about psychiatry. Everyone is supposed to sing the “mental illnesses are brain diseases” song, and anyone who is off-key is shouted down very quickly.
As to death sentences, please recall that the average life expectancy for those receiving “medical treatment” for these “severe mental illnesses” is 25 YEARS LESS than the general population. So it does not appear that not receiving this treatment is likely to lead to loss of life in the collective, though there may be individuals who may want or benefit from medical interventions and decide the risk of a shorter life is worth the reduction in symptoms they experience. And they won’t get any argument from me or the vast majority of our community members. What will get an argument is if you pretend that the shortening of lifespan is not an issue, or that everyone who doesn’t embrace this form of “treatment” is a moron or a dangerous extremist.
Aside from which, I think you totally missed Rossa’s point if you claim to agree with her. I believe she’d agree with almost everything I just said, though of course, she’s welcome to correct me if I’m wrong.
All I know is this. As I sit at my desk in my office of the hospital that I was once a patient, I can look out my window into the cement courtyard of two of the adult acute units. I work in Admissions as a peer worker. I meet vibrant, very alive people who are articulate and verbal. These people are usually saying things that the “normals” don’t want or like to hear and so the “normals” label these people as “patients” and they are sent from Admissions to the two units connected to the cement courtyard that I can see. And from there on I get to watch the downward spiral that these people make as they are pumped full of the toxic drugs. I must watch them go from being vibrant and alive and verbal to people who become silent and extremely obese. They shamble along looking at the ground, drooling on themselves. And the psychiatrists of these units pat themselves on the back and congratulate themselves on what “good treatment” they’ve given these poor people who were “severely mentally ill” before they got their hands on them. These “patients” can’t put two words together to express a thought and if they do nothing is coherent. It seems to me that they became “severely mentally ill” after falling into the hands of the psychiatrists and the system.
Nothing is as simple as you seem to be trying to make it.
My concern is what to do when wrongly diagnosed and having this stigma follow us around? Years of wrongly prescribed psychiatrist drugs and how they caused us to change to change into another person, confused and rambling. That is why I come here and read MIA articles. What happened to me is becoming common place. I had gone to a psychiatrist because I was having trouble sleeping for God’s sake. Worst mistake in my life. Yes, I’m drug free now and no longer have toxic psych drug issues. Geez.
Am I anti-psychiatry?? Yes, because of how dangerous psychiatry is handing out diagnoses based on assumptions. I had my prescribing pdoc apologize for wrongly drugging me but it didn’t help. Hind sight apology after this level of heinous magnitude, no way. How often does it happen someone is treated with chemo and radiation for a cancer diagnosis they did not have?
I’m not sure there is a Mad in America approach.
I think there are a lot of articles that critique the science of mainstream psychiatry and a fair number of articles on a variety of non-medical ways of helping severely distressed people.
There are some personal stories of how severely distressed people got better without drugs and also of people withdrawing from drugs and improving thier lives.
Some things are implied in all this but it does not constitute an approach. MIA mainly seems to be about debate and science, which is about looking for evidence and using evidence to test ideas. These ideas then change as evidence for is accrued and new ideas forumlated.
Also, MIA is an editorial board that commissions articles, and now a film programme for a film festival. Then poeple comment on the articles. Different writers and commentators engage in different styles and ammounts of dialogue, from no comments from some authors, to lots from otheres, from commentators that try to understand other commentators points of view to those who are dog in a manger about thier ideas and who will attack others who dissagree until the moderators intervene.
Robert Whittiker however, is keen to debate with a wide range of people. I guess that is why Allen Francis was invited to talk at the film festival.
“I see the anti-treatment groups as promoting a death sentence for the severely mentally ill.”
There are people who need help but I think in the current system no treatment at all is better than this nonesense. If I have listened to psychiatrists I’d be dead now.
Rossa, it isn’t just Huff Post commentators who decrie the hearing voices groups approach. I have a friend who hears voices. He told his psychiatrist he had learnt to deal with them by accepting them and offering them compassion. They siad they had never heard of that approach, put him on clozapine, a nasty drug, and made sure his sister gave it to him everyday as they did not trust him to take it.
He is one of the sanest people I know.
He cannot get a life together as he is asleep 12 hours a day due to the drug.
He was recently told by a psychiatric nurse that he needs to stay on the drugs for the rest of his life or he will have another breakdown.
This is wrong, nasty and dangerous.
So Allen Francis is either ill informed or trying to sugar coat his message that psychaitry is not that bad really and we should all have sympathy for what he sees as his wrongly put upon proffession
Hi Rossa – You get the immediate relevance of the discussion with “Al” in short order, where it goes and might ought to and how it could. Since you keep it interesting for me the second time through, that makes me think that your writing is top of the line for anyone who gets here from nowhere special or Googles this or is looking without much experience, whatever they’re looking for. Nicely done–
I see (at least) two distinct groups here: one craves power and the other craves truth. My feeling is that everyone craves freedom.
“Freedom’s just another word for nothing left to lose.” Kris Kristofferson
Huge appreciation of Justin Brown’s politically, socially, legal-wise and existencially concise, and critically enlightening presentation!
Wonder why people respond mostly to Dr Frances political beauty talk. Frances offers no considerations of the procedures and diagnostic inventions as well as de-personalizing interventions done by psychiatry, on no scientific nor humanistic foundations.
Frances – softened and positionless mater discvourse – silences the voices of people in distress (de-personalization) and blames critical deconstruction of the apparatus of psychiatry as mere ideology. Were it exposure of an ideology in the sense of philosophical and political social sciences! But that kind of knowledge seems not available to post-positivists. So much about the flatness of critical social and scientific exploration by a leader of his/ a historically situated disciplin/ary. A disciplin/ary in crisis and state of exposure – as clearly and dialectically criticized by Justin Brown and others, from survivor activists to critical of Zeitgeist scholars.
What would Eisenhower think? What he said in 1961 was:
‘In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. …
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present – and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientifictechnological elite.’
… and of the military-industrial complex, as known.’
There is no middle ground between psychiatry and anti-psychiatry unless you are talking about non-psychiatry, and it really doesn’t qualify as psychiatry. Psychiatry itself goes from the most fervently biological of believers to the most skeptical of dissident agnostics. There’s your continuum, but there the continuum breaks off. Next you’ve got people who are mostly indifferent to psychiatry, not needing it, although some might be sympathetic. Then, and only then, do you come to the people who actually actively oppose psychiatry, and when the psychiatrized constitute 1/4th of the population of the nation, obviously, they’ve got plenty of reason for doing so. The mental health movement never was a movement for mental health, it was always a movement to get the government to pay for “mental illness”, that is, mental health treatment. Mental health treatment itself is an industry, the “mental illness” industry, and this is what we call expansion of that industry, the mental health movement. What is the result of this movement? The mental health ghetto, and the hospital without walls. 1 in 4 people, human beings, are rumored to have it. Children, when they are growing up, sometimes play nurse and patient. Some children never grow out of this game playing. Anybody has got something better they could be doing. The main claim of anti-psychiatry is that the treatment is worse than the disease. (Elaborating. The “disease” is an illusion, and the “cure” to this illusion is seen as actual injury to the patient (i.e. trauma.) The main claim of the psychiatrist is that a reduction of brain tissue is somehow therapeutic, and a medically sound procedure, whether achieved through electrically induced fits, or surgically through mutilation, or chemically through long term and persistent drugging. I guess theory has it that “mental illness” is a matter of too much gray matter. You’ve got, therefore, three methods of arriving at brain pudding. 1 in 4 people.
I think I would qualify as being in the group that Allen Frances wants to speak for and I totally reject the notion. He should admit that he can only speak for himself and maybe for his profession but never for us. I would like him to see his main task as breaking down the barriers in the psychiatric system that prevent us from speaking and acting for ourselves. He could possibly, after rigorous soul searching, become an ally to those of us who currently identify as people with psychiatric disabilities or “serious mental illness” or whatever other nomenclature which might be used.
As far as speaking in his role as a psychiatrist who was heavily involved in the development of the DSM IV and the perpetuation of the myth that the DSM contains scientifically based medical diagnoses, he has a lot to answer for. Countless people have been harmed, further disabled, rejected, dismissed, drugged, marginalized, being held down and subjected to forced injections, locked up, handcuffed, segregated, denied medical treatment, fired from jobs, denied professional licenses, added to federal government databases, bullied, beaten up, ended up in solitary confinement, tortured and even lost their lives because of being categorized as a person with a DSM diagnosis.
If by some true change of heart and mind, he, or any other mental health professional who has decided that s/he really cares about us and our suffering, should be willing to engage in a process similar to the Truth and Reconciliation Commission in South Africa that was co-ordinated by Desmond Tutu. He needs to emotionally and intellectually listen to the stories of great suffering, persistence, courage, and survival of the oppression of people who have been harmed and take responsibility for his part in it.
He would then have to ask for forgiveness and agree to fight against the oppression of the current psychiatric structure. He would have to be willing to flatten the psychiatric hierarchy. He would have to admit that psychiatry has very little to offer in terms of scientific evidence for what it does. He would have to admit that psychiatry knows very little about what causes people with or without diagnoses to become violent. He would have to admit that what is proposed by something like the Murphy bill would have little impact in terms of stopping mass shootings. He would have to admit that psychiatrists do not have any special expertise to accurately predict whether certain individuals will become violent.
Next, he and others who want to ally themselves with us need to spend a lot of time listening to what we want in terms of alleviating the suffering we might be experiencing. Some of us don’t feel that we are suffering at all except from oppression and basically want to be left alone or given opportunities to get out of poverty and live lives that we find meaningful where our civil and human rights are respected and enforced.
He also needs to listen to others of us who might want to use services and supports and agree to work with us to promote the supports that we need and want. It sounds to me like he doesn’t have a clue who we even are if he thinks that we all need forced interventions and that all of us have either been in jail or prison and other environments which are controlled by mental health professionals.
There are millions of us who live our lives peaceably in the community and struggle because we don’t have access to much of anything that we feel is helpful enough to recover the lives we wanted to have prior to receiving diagnoses. Millions are begging for those kinds of voluntary services and get next to nothing. Why not work with us to pass laws that would give us a right to safe and effective voluntary treatment, support, and services of our choosing, including housing that would enable us to fully participate as members of our local neighborhoods and communities.
Such supports would be based on a flexible interdisciplinary consumer-directed process that would facilitate rather than control our participation and integration into our community, our family, and our friends. They would have to lift all of us out the current system of poverty. Non-violent human connections and civil and human rights would be paramount.
As one who would welcome such supports, I truly believe that much of what I need and would choose would have little to do with traditional psychiatry. I never really identified with the term “anti-psychiatry” a la Szasz or Foucoalt or anyone else. Maybe its because I hoped for such a long time that psychiatry would eventually, within my lifetime, discover the silver bullet. Well, forget that, even for a “compliant patient”.
If I do use the term its not because of academic or professional theory and/or writings. Its because I have seen how psychiatry continues to destroy and shorten the lives of people I care deeply about. I’ve seen how it has wasted their lives by focusing on compliance, coercing them into expressing acceptable behavior and punishing or ridiculing anything deemed “inappropriate” or is against the many program rules or philosophy. Since I’ve been a witness to this injustice for a long time, I’ve seen how it has wasted people’s lifetimes by blaming the oppressed. I’ve seen how ineffective the pills and locked wards have been at preventing the suicides of my close friends. I’ve seen way too many premature deaths from related conditions.
Truth be told, I think that the way psychiatry has been practiced in the previous two centuries would become irrelevant if we could provide access to non-violent trauma-reducing egalitarian and democratic supports within a community of people and institutions who value us. We need to be embraced no matter what our struggles or strengths are. We need to be able to develop our skills and have them be used. We need to provide access to a wide range of options so that we can find what heals our own soul and gives us meaning and purpose.
Well put, Dengster.
I agree with Bonnie (and then some), as she says “Well put.”
You’ve written a truly beautiful comment.
Frankly, I am someone who has no interest in seeking ‘services’ from the ‘mh’ system, nor do I recommend to anyone that s/he seek ‘services’ from it (simply, my experiences as a “patient” within the ‘mh’ system were so averse, that, as soon as I got away from it, over 25 years ago, I knew I’d never go back).
However, I can empathize with many people who are seeking help within the ‘mh’ system and can sympathize with many who are seeking a ‘next step’ beyond it.
Your comment is so very well-stated, I wound up looking at your ‘comment history’ and happened to find this from you (in a comment you posted under Corinna West’s blog post titled “Are You Committed to Eliminating Labels and Medications With Emotional Distress?”):
‘I have searched high and low for an alternative doc who takes Medicare with no luck. I have also searched high and low for a therapist who takes Medicare or my secondary insurance who incorporate mindfulness Buddhist practices into therapy with no luck. There are no people who I know of who have learned and practiced intentional peer support in the Northern Virginia area or in Sarasota, FL. All of the people who have been trained in peer support in Northern Virginia have been trained and work within the traditional mental health system. Almost all peer specialists who I know of are not very active in pursuing the rights of their peers within the m h system because they are so low on the totem pole in the system and have so little systemic power that they are afraid to rock the boat. As far as using a “business model” to provide viable and effective alternatives, I’m not too excited.’
Apparently, you are on the East Coast (I am on the West Coast), and I am not a trained ‘peer specialist’ (nor would I ever become one), but, as a long-time practitioner of Buddhism (and self-described “Buddhist”), my aim is increasingly to reach out to psychiatric survivors — as a friend online; and, in that way, maybe I could be of some assistance to you (and you might be able to help me, no less, through simply being an online friend).
I have occasionally mentioned that I am a Buddhist, in my MIA comments. Something I’ve not (until now) mentioned in comments, is that my connection to Buddhist ‘community’ has long been limited to communications online…
That is because, there was a local Buddhist lay community to which I had belonged (for roughly seven years), but I was, one day, suddenly ‘outed’ as someone who is “supposed to be on medications” by a ‘leader’ to whom I’d confided about my ‘history’ as a ‘patient’ of psychiatry. (I had done nothing to prompt his ‘outing’ me; on the contrary, when I’d met him he was a psychiatrically ‘diagnosed’ person who was eschewing psychiatry, so I confided to him, about my psychiatric ‘history’; six years later, he went back to psychiatry and, I guess, felt compelled to to try to drag me back into it…)
I felt so unsettled by that experience, I left that group.
(Note: I was ‘outed’ by that ‘leader’ only seven years after I’d eschewed psychiatry. It was 1996, the Internet was just in its infancy, so it could have become an extremely difficult/isolating experience; however, I wound up meeting my wife-to-be — who is now my ‘ex’ — at exactly that same time; she’d not been a part of that community; so, I simply maintained my Buddhist practice, on my own, and moved on with my life, with her…)
I am (many years later), a single dad, raising his teenage daughter — and, now more than ever, interested in studying and practicing Buddhism.
And, I believe it could be helpful (really, mutually helpful) to simply exchange email with other psychiatric survivors who share that interest, in Buddhism, in common.
Please, if you are at all interested in discussing Buddhism (and, really, I put this out to anyone else who may, likewise, fit the bill of ‘psychiatric survivor interested in Buddhism’), do feel free to contact me via email: [email protected]
Again, great comment…
Dear Dr. Frances,
I am a family member of a severely ill person and before this illness, did not have negative feelings towards the mental health system. I also have no other agenda then trying to get my family member well.
Hospitalization and medication preceded the change of our family member from being ill to becoming severely ill. Pyschiatrists will tell you that is due to the underlying nature of the illness. But they can not KNOW that that is the case. We have learned over the course of time, that psychiatry -even at the most specialized level – is very defensive and does not look at any factors that are critical of their approach or their members. When people become more ill under their care, they are also quite ready to blame family or anything other than their treatment approach.
My argument with your opinions are two fold. First of all, psychiatry does not yet know how to determine who are the people who benefit form medication as compared to who are the people it harms. Thomas Insell talks about the need of psychiatrists to be humble, as the entire assessment and treatment paradigm for psychiatric illnesses is undergoing a complete overhaul.
Thomas Insell also says , as I am sure you know, that psychosis has many trajectories and for some people, antipsychotic medication prevents them from becoming well although for others, he believes, stopping antipsychotic medication can be disastrous. I have noticed that people who blog about mental illness from a more mainstream perspective interpret Insell’s comments to mean that it is the severely ill who benefit from antipsychotic medication. This is not what Insell says, and I have the very scary impression that antinpsychotic medication can in fact make and keep some of the severely ill in their severely ill condition. A very careful read through Robert Whittaker’s post and blogs lends a lot of support to this devastating possibility, and providesytheories as to why it might be true.
My discussion this far probably makes my second difficulty with your opinions somewhat obvious. This is your dismissal about the seriousness of coersion for the severely mentally ill. Since the long term effects of antipsychotic medication is at best unknown in terms of its helpfulness versus harmfulness, forced drugging is likely causing harm for at least some of the severely mentally ill. Indeed many of the recovery stories of people who were severely mentally ill come from people who either didn’t take, or stopped taking antipsychotic medication. Remember, I am pretty mainstream and a family member of an ill person , so forced temporary `safety’ is not repugnant to me – forcing a drug treatment which may ruin the chance of long term recovery is quite another thing.
I think we already have a `middle ground’. I believe Robert Whittaker is the `middle’. He says that he believes there are biological markers as well as emotional distresses that underlie psychiatric illness, but he believes that the science underlying treatment with psychiatric drugs is flawed. I believe Sandra Steingard is the `middle ground’. She painstakingly reports what she has experienced, regardless of a `position’ . In light of Whittaker’s research, she avoids the initial use of antipsychotic medication if the person can be kept safe without it. I believe Ron Unger is the middle ground. With his ever present messages of hope, he acknowledges that once medication is involved, it can be impossible to tell whether the ups and downs of mental distress is due to medication or illness. And I believe Eleanor Langdon is the `middle ground’. She has written that is only by `chance’ that she recovered despite the fact that her previous interventions were from other psychiatric teams, not from primary care doctors, as is the case with my family member.
My plea to you Dr. Frances, is to join the middle. You could have an enormous impact on appropriate care. You have shown your willingness to enter into dialogue and are at the same time a respected member of the psychiatric community.
To me the middle includes :
-taking very seriously the potential devastating consequences of forced drugging especially for the severely mentally ill
-advocating for alternative `Soteria’ type places or healing homes where people in extreme states can be kept safe without forced drugging
-recognition than neither the assessment nor treatment of psychiatric illnesses with drugs has been proven to do better than treatment without drugs, and that successful treatment without drugs can takes years -therefore people need to have the option of allowing their brain to right itself in this slow manner without forced drug intervention
-people who are certified for their safety should be allowed to have a support person staying with them. For example I know that the `poster boy’ for a mainstream Early Intervention program told me that when he feels a relapse coming on, the last place he wants to be is at the hospital – he wants to be with his supportive people
-recognition that some people do want to have forced treatment because the drugs have worked for them, and devising some kind of contract system that allows them to get the treatment they need – here I am thinking of that amazing law professor who did a Ted talk, and some parent advocates for forced treatment
-careful ongoing examination of research to try and determine if and when medications are effective
-not letting short term gains interfere with long term recovery
-not using long term medication to control behaviour – only for promoting real recovery
-thinking honestly about severely ill who are on long term medicaton – If they are not getting better shouldn’t they be taken off the medications so that we are `doing no harm’ and giving their brain at least a chance to right itself like the story of Mary Copeland’s mother on Beyond meds.
-listening and respecting the rights and information of patients and their loved ones
Wow. Great post. Why isn’t Francis responding? Does he not want to dialogue with the people on this site?
Dear Dr Frances
I think you’re right about decent Housing being one of the main ways of of helping people. But who should be medicated? And who should decide? And at what volume?
I have been described as suffering from the ‘severe’ diagnoses and chronically, but I made complete recovery 30 years ago as a result of not taking my medication. I got my help from what was available outside of medicine (for free) and in the community.
You’re right about the white collar fraud as well:
In 2012 I caught my GP practice in the UK claiming for me as an invalid – but without telling me (I’m a subcontractor in the building industry). I complained to the UK Ombudsman, and the Practice got a slap on the wrist.
Oh my. Justin, such amazing effort and erudition but…for what? Do we really want to “dialogue” with these people, or should our limited energies be put into organizing to take their power away?
I of course choose the latter, no surprise. And I give you maximum kudos for your efforts nonetheless.
Btw I disagree that since you are currently “voluntarily” taking their drugs you can’t be anti-psychiatry. If I were in that predicament I would probably be more anti-psychiatry and more eager to escape my dependency on it, plus even more eager to replace the system that tells us our best way to deal with our oppression is to distort our consciousness with chemicals to ease the burden.
I don’t need psychiatrists, nor psychiatry. I stay out of the hospital by not dialoguing with them. Their dialogue is all about (mis)treating people, and I, for one, don’t need (mis)treatment. I’m perfectly, accent on the perfect, content without a mental health system, and near the top of the food chain in that mental health system are psychiatrists. Let them lord it over anybody else. Frankly, I prefer life, liberty, and the pursuit of happiness. BTW, it is precisely life, liberty, and the pursuit of happiness that psychiatry jeopardizes. I wasn’t born to fit their diagnostic label box, and I’m glad to be well outside of it. I’m also not a person to languish for a lifetime “in recovery”, but if I was, would I really be talking this way? If more people didn’t need psychiatry, the profession wouldn’t exist. I would call it bad faith in practice. Besides it’s a profession based on thoroughly false terms, that is, fraud by any other name. All the pseudo-science in the world has yet to make “mental illness” anything but a confusion of terms, and ditto “mental health”. It may serve the existing order, okay, if so, all the more reason to get rid of it.
Psychiatrists shouldn’t be doping people up (killing people) in the first place, but now that 3 states have voted psychologists what they are calling “prescription privileges”, and others are expected to follow eventually like dominoes, there’s your proof, you don’t need a medical doctor to administer drugs. This power struggle between professions renders one completely redundant, and the other in desperate need of critical scrutiny. When you’ve got an industry gobbling up the country, as is the pharmaceutical trade, one puppet is as good as another for pushing pills. Maybe psychiatrists should be doing something else, but, uh, last time I heard they had handed that something else over to psychologists and social workers. Oops.
How is this a dialogue?
I just see Allen Frances promoting his theory, exactly the same it is was a week ago without any revision at all from the multiple responses he’s gotten over the last week.
And our people are responding again to his now outdated theory, but no one is responding back to our people.
When you’ve got no defense to your position Corrina, your only option is the boycott.
Loved you article about this topic btw.
a few more comments from people on AF’s huff post article would be good too
They have a comments section? Go for it, folks!
Hmmm…don’t see any comments at all. Do you have to sign in or something?
I so agree with you Corinna, and also wish to add that as far as I could see Allen Frances did not attend the whole festival. As is far too often the case, when so called “prominent” people attend they tend to stay while they present themselves and then leave. I also noticed that during the panel with invited doctors all of a sudden people started to use titles, in a way that had not been done before.
Dear Dr. Frances,
I wrote you an earlier post about this article and now here I am replying instead about your most recent Huffington Post `We should all be ashamed’ article in the hopes that you will see and read it. I haven’t figured out how to post anonymously on Huffington post and am too fearful for my son to draw attention to our terrifying fear of forced medication.
You say in your post
‘The most contentious issues are the value of antipsychotic medication and the occasional necessity of enforced treatment. Dr. Torrey’s research and clinical experience has convinced him (as has mine, me) that proper use of medication for acutely psychotic and for recently stabilized individuals is absolutely essential in resolving symptoms and reducing the appreciable risk of relapse. ‘
This comment siims to disregard the research discovered and presented by Whittaker. This body of research indicates that in the long term, more frequent relapse is not the picture. – Could you please post any additional research aside from the article from China that is discussed by Whittaker, that shows less relapse in the LONG term?- In addition, although psychotic symptoms can be solved for some or many people in the short term by psychotropic medication, it has not been proven to benefit the long term full recovery of people – and that is what people in the recovery movement are most concerned about. I mentioned in a previous post, a careful read through WHITTAKERS analyses such as ‘THE FAT LADY HAS SUNG’, his responses to critics and his queries –e.g. such as his questions as to whether or not the difference between the 80 per cent success rate in the open dialogue results as compared to the 40 per cent success of the Wunderrink study could be due to the initial use of psychotropic medication? –outline the concerns of many of the people who have a severely ill loved one.
YOU SAY. .
‘ But that doesn’t mean it is safe or optimal for others who have more acute, severe, endangering, pervasive, and impairing symptoms which puts them at risk for prison, homelessness, chronicity and a terrible outcome if treatment is not promptly offered.
Of course psychosis – what you refer to as `untamed psychosis’ can lead to prison and homelessness if a person is not kept safe. That is why people who are justifIbly concerned about the damaging effects of medication on their loved one, need viable alternatives – such as Soteria type houses and healing homes, or out patient programs such as are done in open dialogue approaches, or for goodness sakes, HOSPiTALS settings that don’t FORCE MEDICATION- to keep their loved ones safe while they go through the extreme part of their illness. In terms of chronicity and terrible outcomes, the jury is really out as to how much current treatment could be contributing to that problem.
‘It is crucial to find a middle ground that will allow joint advocacy and caring for those most in need. This has been possible with Eleanor Longden of Hearing Voices ‘
I had mentioned Eleanor Longden in a previous reply to you as an example of someone who represents a very reasonable approach because I knew from your articles how much you respect her. I believe, however, from your own article about her opinions, and from her book, that she believes medication should be a choice. Perhaps before using her in your argument about what the `middle ground’ is, you should clarify with her whether or not she believes in assisted outpatient treatment with forced medication, or if she would believe more in a system that also allows for other viable choices that don’t include forced medication.
On the Treatment Advocacy center website, there is listed research showing the following effects of AOT programs;
ASSISTED OUTPATIENT TREATMENT REDUCES HOMELESSNESS.
ASSISTED OUTPATIENT TREATMENT REDUCES ARRESTS AND INCARCERATION.
ASSISTED OUTPATIENT TREATMENT REDUCES VIOLENCE, CRIME AND VICTIMIZATION.
ASSISTED OUTPATIENT TREATMENT IMPROVES TREATMENT COMPLIANCE.
ASSISTED OUTPATIENT TREATMENT REDUCES CAREGIVER STRESS.
However, as there are not other viable choices than AOT for many people in extreme states, it is basically saying that people in psychosis need help and support from others to stay safe, and that it is extremely stressful for others to keep them safe without support. What is eerily missing from this list of reductions and improvements in this above list, is any research about whether AOT results in improvement of function or independence or cognition of the severely ill. It is inhumane. In my opinion, to use treatment as a way to control behaviours, if it is harming people’s recovery.
Right Sa, and whew what a lot of work to keep the point visible amidst this doubletalk of his and his kind. Attaching to that point is another. Here, rite-ch’eer, we still aren’t seeing people who could make the most of their uniqueness as licensed to offer services by pointing out that they are for patient advocacy ahead of non-patient advocacy in all cases. The going default position is non-patient advocacy and no one brings this up. That is because it is the simplest approach for keeping the doctor empowered to take over and explain away the patient’s concerns with their label(s) and the drugs. One source of the misery of all is neatly determined, Again.
I’m newly out from mental health and in the 20+ years of being degraded via medicaments I can say, “Medication should be self adjusted”.
What I find with medicaments is that saturation points cause a person to, “Sleepwalk”. Here these people are seen as, “Abnormal to be Normal” simply by facial look interpretations and what I interpret as the scent of magnolia signalling a sleepy or person that is in thought. The physical opposition is muscle spasms, panic attacks (nervous system and the Medulla Oblongata) and physical stress types, etc.
If you look at side effects of muscle spasms I can tell you this from what I am forming in my third book relative to, “The taste/smell of coffee forming from the body and establishing itself in the Medulla Oblongata. This especially forming at the key location of the Vagus nerve and involves how the vocal of inner and outer forces interact as a Psychosocial Script Narration.
As I said I am newly out from mental health and would like any comments from this community if anyone could relate to anything on Vagus nerve testing. I have discovered through wikipedia.com research that this area is infected and causes mental sublime narration via what I say in Common Sense a re-emergence of the Bi-cameral mind.
I have experienced through medication that sleep flowing from the night is continued as Bi-cameral subliminal interaction when awake as a: Script narration via Interpellation of the senses known to the ignorant in the Norm of Society as body language.
So saying the body becomes the instrument of the minds communication via the Vagus nerve interpreting sublime levels of a choral echo where mental health clients are used to block and protect the public. Yes I believe in medication because I say my third book reveals how sublime interaction is a physical instant that forms in the Medulla Oblongata.
How come no one ever mentions that there is a better alternative to Tim Murphy’s bill (H.R. 4574, the Strengthening Mental Health in Our Communities Act of 2014 by Ron Barber, D-AZ).
Huffington post (huffingtonpost.com) is either blocking or editing comments. My comments do not show up on the public city library computer.
“Psychiatric coercion has become largely a paper tiger: rare, short-term, and usually a well-meaning attempt to help the person avoid the real modern-day coercive threat of imprisonment.”
Seriously? How much out of touch one has to be for such a statement?
As a person who has been tortured at a psych ward I feel offended.
With you, B. In fact, you know how Dr. Steingard says “Be careful what you wish for if you want someone besides psychiatrists to work out all thes complex reforms?” in her own words, of course… Well, what was Ken Kesey’s point? That’s the more realistic one: stay with jail and beat the psycho rap.