Bring Back the Asylum?

Thanks for the comment. Although I acknowledge there is no fine line, I am talking about people who are not engaging in discourse which I can follow. I am always wanting to give examples but then constrained by confidentiality. Even in the court system, where they see many people are not not following the rules, they call us in because these individuals stand out as different in a sometimes profound way.

But fundamentally, I think this is what I am getting at with the “both/and”. We should never stop trying to engage in as collaborative and respectful way as possible.

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“I mean that people accused of deeds which are considered “criminal” should be given a choice between trial and treatment.”
Accused? How about they get a trial and at sentencing they get the choice? Maybe we should stop with the Minority report already. You’re only a criminal in the eyes of law when you’ve been adjudicated as such.

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Hi Eric,
You make some very good points including the notion that it is easy to romanticize the notion of asylum. My one quibble is that I do not think it is the psychiatric establishment per se who strangles funding for community services. Some of us are part of that system. I think the psychiatric establishment sometimes undermines the credibility of alternatives and that is important to acknowledge.

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I just wanted to add that having safe places to take people in extreme distress to, takes away any ‘justification’ of AOT (e.g. with proper supervision and care, noone could say these people were a danger to themselves or others)

I just wanted to add that a proper ‘asylum’ could create the environment needed for recovery. Now, people who believe medications hinder the recovery of their loved one try to provide a ‘healing home’ in admist a very prejudiced and misinformed society.

A protective setting could be set up so a person could work gradually to their independence – go by themselves to exercise or swimming or possibly to little shops etc, , go to work or school settings with people other than their family; knowing that there were trained and humane people who could step in when their stress became overwhelming. Maybe a percentage of people would make this their permanent home (research indicates around 10 to 15 %???), and the other 85% could eventually increase their independence to return to the community. Maybe some clients would be ‘day visitors’ living at home with their families, or parttime residents or working there as peer counsellors or in other jobs as they help the newly or more seriously afflicted.

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travailler-vous :

I’m not following your logic. Could you try to explain this a second time? My intuition is following you and is saying a big “YES” but my logic is not concurring.

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“These are ethicists you say?”
I love the people who are making up great humanistic theories from the midst of their ivory towers. Completely ignoring the totality of human history with the special emphasis on the XXth century. Yeah, I’m sure the new day asylums will be nothing like the old day ones. I mean the nature of humanity has evolved so much during the last… well that would be 10seconds because even the current scandals in psychiatry and beyond show we are not past the Milgram and Stanford prison experiments and worse.

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I just want to add although starting at the beginning would be ideal, people on their second break or third break or whatever, should also be given the opportunity to be in a safe place where the crisis can run its course without medical intervention.

The people in many stories of recovery started off on drugs, or had many relapses, or like Katherine Penney, went for years prior to recovery. Somehow -whether it is in an ‘asylum’, soteria house, healing home or hospital people must be allowed the chance to work through a crisis without medical intervention if it seems that this is their best chance for recovery.

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Jonathan: You laid it out brilliantly. Creating choices and alternatives while keeping costs down. If people who are undergoing a crisis, aren’t ‘medicalized’ to begin with, perhaps we could avoid the enormous costs of funneling people through the medical system. The medical system is ballooning out of control in in general, not just in the mental health side. A culture shift needs to happen before we can stop viewing all people who are confused, disoriented, scared, angry, etc. as in need of ‘medical’ expertise/treatment. The only reason why parents like me take a child who is experiencing their first ‘break’ to the ER where they are introduced to neuroleptics, restraints, and where they are inflicted with unfathomable psychological harm, is because we are lacking in imagination due to the homogenous way we have been raised. Plus, we are products of a generation that was raised to believe that doctors were trusted and wise authority figures, like Marcus Welby. We had no idea the level of mediocrity that psychiatry had become due to commercial forces, lack of imagination, and scientific curiosity.

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Thanks for your comments. I have been thinking lately that the way to stop current psychiatric practices — the drugs that debilitate and eventually kill people, which consumes simply enormous public resources, and the extremely expensive recurrent hospital stays and endless psychiatric bills — might be the way to attack the system and put something else in its place. For instance, just to use my own case as an example: A hospital stay, even a brief one, costs many thousands of dollars. When I became psychotic, I cost the system more than $10,000 in just a few days. After I became psychotic, I was given disability — at a cost of more than $1,000 a month. Since I was prevented by the drugs from ever truly recovering, and in fact further disabled by medication even after the real psychosis passed, that meant it became a permanent expense to the public. (In the interests of total disclosure, I’ve only just completely eliminated meds and haven’t yet rebuilt my life enough to get off it, even though I’m getting there.) Psych meds also come at a premium: more than $700 a month for the single drug I was on, and I was one of the lucky ones who resisted being sucked into the system of polypharmacy, where you might be juggling numerous expensive meds. Because that antipsychotic stopped my metabolism, it caused immense weight gain and high cholesterol and high blood pressure and high cholesterol — and now we’re talking more bills to medicare, not only for drugs (insulin alone is $350 for a supply that might last as little as a month, but that really does vary, so it’s only a ballpark number . . . but then there’s the other stuff, which added up to at least a $100 a month.) Now add doctor’s bills — for follow ups and dealing with new problems as they emerge. Even now, I am dealing with the fallout of what happened to my body, and though I have eliminated the big-ticket items like antipsychotics and insulin, the expenses haven’t ended. And there’s another cost: while disabled, social security paid my child support to the tune of $500 a month. So: instead of my returning to being productive as soon as I might be able, for many years I have been an enormous drain on the system — to the tune of roughly $30,000 a year. And since I haven’t had to be rehospitalized or had multiple psych drugs, I suspect that I’m one of the cheap ones.

Perhaps what we need to do is reframe the entire public debate away from the personal costs of current psychiatry, because there seems to be a kind of blind spot about mental difficulties in our country. The public debate is framed mostly by fear of what those with mental difficulties are going to do, and it is from this fear, unthinkingly played on by the media, that psychiatry derives its power. Desperate people will turn to the people who present themselves as having the answers, and in our society, that’s psychiatry. The human picture of what actually happens to most people who come under the influence of that system is completely obscured. Psychiatry’s harms are swept under the rug, maybe because there is this constant triumphal march about their supposed progress, how they’re supposedly helping, while their actual record is almost never examined. That ten years on antipsychotic shortens your life expectancy by five years, for example. And maybe the way to attack the system is to reframe the discussion outside their rhetoric of illusory scientific progress and cast it in terms of actual economic costs. If we can contrast the public cost of community-based models like Soteria, or even the costs of a program like Open Dialogue in Finland, we might discover that all of a sudden people will stop being distracted by psychiatry’s rhetoric and become more openminded to examining actual outcomes. Talking money might wake people up to shift the model away from the current system and get us the funding we need to set up something that works — based on humane conditions, mutual respect, no forced medication, and community support — long enough for us to prove on a large scale that it works.

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Thanks Donna,

Fabulous perspective of what was going on in the psycho / pharmaceutical industries at the turn of the most recent century, I appreciate the link.

I was surprised by the Whitaker quotes:

“Zyprexa” … “It’s a potential breakthrough of tremendous magnitude.”(Whitaker, 2001, p.260-61)”

“Or as the Los Angeles Times (1/30/98) put it: ‘It used to be that schizophrenics were given no hope of improving. But now, thanks to new drugs and commitment, they’re moving back into society like never before.’”(Whitaker, 2001, p. 259).”

But I suppose they prove why Whitaker’s current, thankfully, like Sandra’s, “are a perspective that is much more thoughtful and nuanced … than ‘always in favor of enforced psychiatry.’” And their current perspectives are of concern to the mainstream psychiatric industry. Since they are much more well researched, critical, and open minded, than that of the perspectives of most mainstream psychiatric practitioners.

As a person who was flipantly defamed as a “paranoid schizophrenic,” “depressed by self,” and “bipolar” (all within three weeks, and unbeknownst to me at the time based upon gossip from others and with no personal or family history of any mental health issues) by a PCP and psychologist, who, I later learned from their and others’ medical records, wanted to cover up the PCP’s husband’s role in a “bad fix” on a broken bone of mine, and the medical evidence of the alleged sexual abuse (with medical evidence) of my child for the psychologist’s pastor and/or his friends.

I will definitely say we need the critical voices of the psychiatric industries’ unchecked power within our society. And we need to rethink our respect of all those professions that, when I was a child, were formerly respectable. My personal experience implies we’ve ended up with the psychopaths in the formerly respectable professions. And a decent pastor did confess to me that I’d dealt with “the dirty little secret of the two original educated professions.” Which I guess implies that the religions and medical community were never actually respectable?

I personally think we need to rethink the wisdom of our forefathers, and the importance of returning to a society of “checks and balances.” I know the “antipsychotics” can cause “psychosis,” in a healthy person who is inappropriately put on them. Perhaps force medicating anyone with them should not be the legal right of any doctor for any (especially unethical) reason, particularly since every person reacts differently to these drugs, and they’ve now been proven to be toxic in the long run for all people?

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Beautifully said! Dr. Steingard has already done so much to help give credibility to alternative approaches and we need to all work together for changes to community support. I wonder how this can best be organized?

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They are fighting over who gets to own the prisoners. You have to commit a crime first (with proof and a trial) before you lose your freedom.

ER Nurse bloger writes it is all a set up, they( medical psychiatry) take away a persons freedom then wait for them to get angry (during the long wait) so they can call them sick and drug them.http://emergency-room-nurse.blogspot.ca/2015/01/mental-health-patients-are-treated-like.html

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Todd:

Having a family member residing for several con-consecutive years in the institution you refer to, I agree with most everything you say and I believe that staff members do retaliate against patients who are rebellious, most notoriously by ‘upping the meds’ and adding stigmatizing new labels such as ‘personality disorders’ to a patient’s long list of diagnoses. I believe that sometimes patients are set up for failure in both in-patient and out-patient settings providing an unconscious type of “I told you so” retaliation when doctors are not rewarded with gratitude and adulation from the their most rebellious and antagonistic patients. Doctors who run the gamut when they exhaust their single page prescribing algorithm without success often blame the patient and this too, can be expressed in a type of retaliation such as by cutting them from the caseload.

If you believe, as I do, that meds are used primarily as chemical restraints for the benefit of the caregivers and to foster the smooth operations of an overly large institution, then yes, definitely there is much to be bitter about.

If our mental health system was imbued with values of empowerment and self determination and if psychiatrists were willing to accept that empowering their patients is by far, a more effective prescription, than dopamine binding agents which flatten the emotions and kill desire, then patients who exhibit a healthy desire to run away should be rewarded and reinforced! Every time my daughter ran away from an institution the system’s answer was to rehospitalize her and inject her with higher and higher doses of neuroleptics. Although any normal parent teaches her child that it is completely appropriate to run away from abuse, when one encounters it in the hospital or a foster home, when one is civilly committed, running away is not only not an option, it is viewed as ‘proof’ of illness! I have never witnessed anything as insane, crushing to the human spirit, and as antithetical to healing.

As you know, the experience of torture and abuse does nothing to adequately prepare patients to live fully and independently in the community. I hold that patients who are restrained, isolated, and forcibly medicated are being tortured. Even the United Nations has gone on record saying this constitutes abuse. Once discharged from a facility that routinely engages in psychiatric abuse or is coercive, an individual will always be looking over his\her back and it will take years, if not decades to overcome the trauma of being locked up and restricted, while living in fear of abuse.

As you know from experience, conformity is critical to the smooth running of a secure psychiatric facility, particularly large state hospitals like OSH, which cannot or will not cater to individual needs, even if those needs are rooted in an individuals cultural, ethnic, or religious background. Patient centered care in a large institution is a joke. Once you are in the system, you are prodded through a pipeline like cattle moving down a chute. You have very few, if any choices.

The argument goes something like, if you bend the rules once, such as security rules or visiting policies to meet an individuals needs, soon there will be chaos. After all, if one individual seeks and receives special attention or accommodations, even if it fosters his/her mental and emotional growth, everyone would want the same accommodations. There is a cheaper by the dozen mentality in asylums, after all. And then there is this confounded fear of patients going AWOL and maybe what, do axe murders, while they are on the lam?

On occasion, a staff member will use discretion (often off the radar) and bend the rules to assuage the mental agony that most patients experience by being locked up and having no comforts of home or community; but most employees are not secure enough as individuals to exercise such discretion or they lack the training that would give them confidence they need to trust their own intuition on when it is appropriate and safe for a patient’s well being to bend the rules.

Many of the nonsensical rules in mental institutions should only apply to axe murderers, not patients who are recovering from emotional and mental distress, especially if they are recovering from emotional abuse from controlling family members, which makes these controlling rules even more nonsensical.

Aside from the higher authorities, the harmful actions of staff are usually not so much characterized by cruelty as by toadiness and fear, starting with the fear of losing their livelihood. The fastidiousness by which some staff members conform to nonsensical rules and policies should possibly qualify for a new mental health disorder in the DSM VI: “Obsessive fear of losing a lousy job” Still, I am in no position to judge, as I too, as a worker, have been in numerous situations where I acted on a strong compulsion to seek personal gain or favor in over fulfilling the mission of my organization.

While I tell myself that many could lose their jobs for breaking the rules on behalf of a patient even when the rule is ludicrous and I try to put myself in the shoes of the person whose control and authority is the most limited. I try not to forget that the pay grade for an entry level employee at a state mental hospital is actually not far above the aggregate value of a montly SSDI, food stamps, subsidized housing, etc. Sometimes there is a sliver of difference. Shouldn’t this give us some basis for widening our coalition based on economic justice? After all, I’m sure that more than a few state employees sloshing and mopping the floors of Oregon State Hospital came to resent patients who threw garbage on the floor, then used their diagnosis as an absolution from all personal responsibility.

That having been said, I hope ex patients are willing to expose some of the common practices of these large state hospitals that still operate today such as Oregon State Hospital, so folks advocating for a return to the ‘good old days’ of the asylums will get a much needed reality check; if nothing else, people writing about their experiences may help many of us resolve the anger that we feel about our loved one’s extended commitments there and expose the hypocrisy of our caring mental health system to the ignorant public.

I also want to point out that some individuals who work at OSH stand out for their kindness and humanity. One staff member while rounding up patients to go on a field trip exclaimed loudly in my hearing “I can’t imagine how it awful it must be to be civilly committed and forced to come here!” Another time, Will Hall was invited to speak to my daughter at OSH. This is hopeful! For every unkind or careless word I overhead a staff member make, I probably heard two that were kind and empathetic. Yes, they may have been whispers in private, but they give such great comfort like little candles in the dark!

But even kind words can be a double edged sword when you are a patient or a family member. Thanks to NAMI and its infamous ‘anti-stigma’ campaign, families are inundated with kindness but starved of meaningful support and opportunities for self empowerment. Kindness can be suffocating and patronizing, even diminishing, whereas actions and words that lead to true independent are far and few between.

Finally, although I agree with much of what you say and how you say it, I take issue with the wording of this statement: “When a client/patient cannot leave, this requires them to take extordinary measures after years of fuck ups and incidents that cannot get better in such a situation, including even killing of patients out of retaliation and super high doses of drugs to incapacitate and maim”

First, I will state why I sympathize with your statement. Then I will describe what I don’t like about it. When I took my daughter to the ER for ‘help’ during her first break, I personally witnessed how being forcibly drugged caused her to react violently by punching a nurse, even though she had no history of violence EVER. The greatest irony was that she was immediately charged with assault by the attending physician. Considering she was a victim of psychiatric assault and the first ‘blow’ was issued by hospital staff when they wrestled her to the ground when she tried to escape from the ‘isolation’ room, a stark room that is no more than a jail cell, and when they used goons to put her in five point restraints in order to inject her with a big needle, an experience from which she has yet to recover, without even ascertaining, first if he had a history of sexual assault, it is extremely ironic that she ends up with the criminal record, not the hospital staff. This was the first harsh lesson of anyone caught in the psychiatric system. NEVER EVER ask for any help from the system when you are having a crisis unless you are OK with having all of your rights taken away. Do NOT retaliate with violence even if someone in the system treats you with violence. Once you have the label schizophrenia, your story is not going to be believed so NEVER EXPECT JUSTICE if you experience abuse or harm in the system.

You and I probably can agree on that. But beware of inferring doctors of “killing” people out of retaliation. They will think you are crazy. It’s true that people have been killed by being put on psych meds that made them do dangerous or violent things; its true that elderly patients who are put on anti psychotics experience twice as many cardiac arrests; it’s true that many doctors put their patient on anti neuroleptic cocktails, then fail to recognize the contraindications until the patient is dead; its’ true that some doctors do not even acknowledge that psych meds cause metabolic disorders that lead to early death. But describing these actions as intentional is a slippery slope. Best not use any language that cannot hold up in a court of law. It does not promote our agenda in any way.

We should not use words like ‘killing’ because it infers murderous and criminal intent, which is highly unlikely and difficult to prove. I have witnessed psychiatrists act like petty lords in a fiefdom, rather than collaborative and curious human beings, but all of us can act this way at times. The question then becomes, when a person who is in a place of power and authority acts out of pettiness or dislikes a patient, does it cloud his/her judgement while making decisions that affect the person who is subject to that person’s control? The answer is unequivocally YES but when this happens, righting the injustice may be impossible. To date, most people who were harmed psychologically, mentally, emotionally, physically, legally or financially by a doctor have never received any compensation or apology. Most will never see justice. I think our movement needs to accept this and move on.

The casino is rigged and the best we can do sometime is to restore our dignity, refuse to play, and go on with our lives. I like the plantation metaphor. If a slave escapes to the North, one may live out the rest of one’s life as a free person in the North. But if one has a noble calling, one may risk one’s personal freedom, as some do, to help others travel through the Underground Railroad. This metaphor works for me because it captures the very real dangers of helping others migrate out of the psychiatric system when they are in a very fragile and even dangerously unstable place. People like Will Hall and Dr. Cornwall do this in their work and probably hundreds, if not thousands of others. Some family members like Cindy Fisher do this work for a loved one. But this metaphor has its limitations because individuals in the mental health system are enslaved by forces that are much more complex and numerous than an army of evil doctors or abusive family members.

Some people are under the control of abusive family members or a cult. Some people are haunted by their past. Some, like me, lack imagination for what our lives could be or if we are blessed with a imagination, we allow our dreams to be crushed too easily by others. We often are enslaved by a negative self image and a victim mentality. Though its true that low estimation of ourselves is reinforced by the cruel and inhumane treatment we or a loved one received in the mental health system, in the end, if we allow trauma and abuse to write our life story for us, rather than find a way to rewrite the narrative of our lives, then we ourselves are the ultimate slave masters.

If our imagination is capable of creating great things for ourselves and our loved ones, it is also capable of imagining very dismal futures for ourselves based on our negative experiences in the mental health system. Doctors are capable of creating very negative conditions for us and our loved ones, occasionally out of a low need to outlet their anger and resentment and I think its sometimes it is fair to call this ‘retaliation’ but from my experience, doctors who harm, usually do so more out ignorance, not out of intent to harm which means the harm is usually not a fatal form of harm and is one we can recover from. It’s as if many doctors are in a spell that they cannot make up from and until they do, they can usually offer us very little meaningful assistance other than a pill to numb us or our loved ones. If we can put our lives back together, we are twice blessed if we have the courage to go back to the doctors whose treatment was a miserable sham and off them our recovery as proof of our resiliency and their ridiculousness.

Until they stop viewing we and our loved ones as people with ‘diseases’ until they are out of this collective spell. I think that the most fatal harm that happens to us is the harm we do to ourselves.

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Hi Alex,
It is nice to hear from you. Yes, I have considered a silent retreat.
While I do not disputed that our society could benefit from improvement on many fronts, that is a rather daunting task and it does not address some immediate challenges.

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Very well stated, as usual, Madmom.

The thing is, when it comes to the scapegoat issue, from what I’ve seen and also experienced in my own life, there are some people who walk the planet in a highly empathic way, just naturally. I know of a lot of people who say they can easily pick up the vibes of another person or in a room full of people–and not just when populated, an empty room has a ‘feel’ to it.

Some people pick this up way more easily than others, which creates a two-fold effect for a person–

First, it makes them quite vulnerable in the world, as they pick up energy so easily–whether joy or stress–so they’d fair better in a light, joyous environment. A stressful environment would undo someone with a heightened sense of environmental empathy, until they learn to have self-compassionate boundaries and healthy defenses. But that takes practice, as we are not born with these, but must learn them, from healthy adults, by example.

Also, people with this particular quality–which, once integrated, is a gift, and a tool for navigating life–tend to be more artistic because that vulnerability is what connects us to our creativity, directly. When we are in our truth, we are inherently vulnerable.

So yes, if everyone worked together to create a better environment rather than this dark, dense, oppressive, toxic entity that is called ‘the mental health system,’ then I imagine pretty strongly that healing and clarity would be achieved.

But then again, that kind of describes the world right now, too, doesn’t it? So where do we begin? Something needs to lighten up somewhere.

I think right now, we’re all scapegoats one way or another, considering the political and socio-economic climate, on a global scale.

Clients try to communicate a lot to families and professionals that is simply not understood by the mainstream mentality. That’s where we seem to hit a snag, and it’s somewhat tragically ironic, because if they are the ones carrying the social ills predominantly, then they are also the ones with the solutions.

So I think it’s a good idea to make it a priority to bridge the communication gap here. That’s where I’m never quite sure if progress is being made, although MIA is a good gauge for this, in general. It’s gotta start somewhere!

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Alex: the Film sounds awesome! Can’t wait to view it. I couldn’t agree with you more that NAMI is exploiting the stigma issue to make money with the end result that they actually perpetuate stigma and discrimination, especially the stigma against those who are non compliant; but I know good people who are active in NAMI trying to change it from within. I salute them! I often think we don’t give insiders like individual NAMI members and doctors like Dr. Steingard enough credit for their valuable efforts. I think in the future that it will be easier for mainstream professionals to come out of the closet agains the practices and policies of their own profession or guild. We are standing on the shoulders of giants, the first generation of survivors to organize. People generally want to be on the right side of history and I think this will apply to a lot of people who don’t yet feel safe enough to engage in this dialogue openly out of fear of losing the respect of their peers. But in the future it will become safer to speak out, as the rising tide of evidence becomes generally accepted about the true nature of many psychiatric medications; that they are brain damaging, especially neuroleptics. Sadly, it will probably help out that big Pharma, will put their vast profits into other avenues of research other than mental illness.

I think we should be very respectful of those who have been deeply harmed. Their voices are important.

but so are the voices of professionals who are trying to change things from within, including those in NAMI. One’s livelihood is a terrible thing to risk; Doctors too have families to feed, clothe, etc. and they too, have been duped by the Universities where they received their credentials. I know this statement alone is liable to anger some. Perhaps we could have town meetings to allow reconciliation to occur as Nelson Mandela did after apartheid ended.

I think it would be wise to create more safe communities for dissident psychiatrists to come out of the closet and avoid using a rare forum like this one, as a reconciliation platform. Sadly, there may never be any opportunities for individuals and family members to enjoy full compensation and spiritual reconciliation. Many are already in grave sites, many of them unmarked. Somehow, we must all move forward together in this f**cked up nightmare of a mental health system and move this mountain of ignorance and indifference together but we need a diversity of voices including those who are justifiably very angry about the torture and abuse they endured as well as mainstream voices. Unity is not going to be easy but it could make or break how effective we are

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B,

I appreciate your comment, “B on January 30, 2015 at 8:21 pm said…” and Sandy I appreciate your attempts at trying to change a broken system.

And I think the real issue is that we are dealing with a completely corrupt system, one with some good people working within it but with too many who abuse the power they are given within that system. B, I ran into a similar situation as you, and felt the same way. And I think my situation points out how corrupted the system has become.

I was hospitalized against my will twice. Once because I suffered from a sleep walking talking issue and my husband called the paramedics. I awoke when the paramedics arrived at my home. I explained my dream and agreed to just go back to bed. Five paramedics dragged me out of my own bed, while the sixth paramedic told the other five that what they were doing was illegal since I was neither a danger to myself nor anyone else. I ended up being put on a hypnotic drug and shipped by doctors at my local hospital, which was no longer covered by my new insurance group, due to prior malpractice, to V R Kuchipudi. Here’s his arrest warrant seven years later for doing the same thing to many other patients:

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

The second time I was hospitalized against my will was for lying in a park, minding my own business, staring at the clouds. I was also trying to mentally come to grips with the reality that I had been railroaded into the psychiatric system by a pastor who wanted to cover up child abuse and a PCP who wanted to cover up her husband’s “bad fix” on a broken bone of mine. I was shocked by the betrayal of my ex-religion and doctors, but had just finished chronologically typing up my medical records with the proof of this. I was forcibly given a $5000 physical, resulting in a “medically clear” diagnosis.

Then, without signed HIPPA forms, this hospital inexplicably sent this completely healthy person a long distance back to Kuchipudi’s psychiatric partner in crime, Humaira Saiyed. She, of course, injected me with Geodon, which I had told her I was allergic to and I also told her it was against my religion to have neuroleptics forced upon me. The “professionals” at that hospital commented in their medical records that they’d never seen such an adverse reaction to a neuroleptic. So I ended up being forcibly treated for a non-existent UTI.

The “system” is completely corrupt, and is harming innocent patients for profit, and more insidious greed inspired medical reasons.

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Dr. Steingard,

Thank you for responding to B. in such a thoughtful way. You raise really good points and I don’t envy the position of professionals who are trying to balance the rights of multiple individuals in complex situations. You bring a valuable voice to the debate on whether psychiatry, as it exists today is medical science, a healing art, or a form social control (or a mixture of all three) let alone what psychiatry should or could be.

Your response goes a long way towards healing the anger I feel against psychiatry for harming my daughter. I may never 100% trust all doctors again, as I once did, but it feels really good to hear a psychiatrist who is willing to talk this way, including to people like me who identify with having a loved one who being harmed by psychiatry. She is locked up and has zero options to titrate off or change her medications.

I am very grateful for your donating your time to the Foundation for Excellence and for explaining your views in this community.

I only wish there were more psychiatrists like you in the system!

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1.
 In the first comment on the article Vortex asked you: “So, my question is: does such description fit devoted rebels, dissidents, non-conformists etc.? These are people who are usually described (and treated) as “asocial” and/or “antisocial” not only by authorities, but also by the “silent majority” compliant to authoritarian dominance. Should their protest and resistance be labeled as “delusional” (which, by the way, happens quite often)?”

Your answer: “Although I acknowledge there is no fine line, I am talking about people who are not engaging in discourse which I can follow.”

I may be misunderstanding your stance but it seems to me like you’re equating the fact that someone does not want to cooperate and talk to you in a manner you understand may be a good enough reason to use coercion against that person should they behave “anti-socially”. You acknowledge this is a fine line and indeed it is. It may be difficult for me to comprehend the logic of Mr Brevik (an ultimate “anti-social” guy example) and I’d surely not be able to talk to him in any productive way but I’d be far from deeming him mentally ill (which was attempted) and claiming he needs some medical treatment. The only “treatment” he needs is prison and resocialization if that is ever possible. In the same time there are certain forms of “anti-social” behaviour that are political which I totally agree with but other people would deem delusional and disruptive. Using this kind of logic is making the criteria for committing someone etc. subjective and ripe for abuse. You may be judicial with doing it or you may think you are but there are plenty of people who don’t care. Not mentioning the clear cases of locking up political dissidents and whistleblowers and no, I’m not only talking about China.

2. 
On the criteria of “danger to self and/or others”: I know this is the law but I don’t see why that should be an excuse. If the law is wrong and inhumane one should engage in civil disobedience against it. In this case it’s easy because this is the law you are volunteering to enforce – it’s not like you’re going to be put in prison yourself should you stop working in an environment that requires you to do that.

There are several reasons why these criteria are wrong. First of all the ability of psychiatry to predict if someone is “danger to self and/or others” is practically zero. So this is a law from Minority report – I have a magic mirror into the future which tells me this guy will try to kill himself or that woman is going to strangle her baby. That is simply impossible to predict with any sensible validity and by having this standard thousands of people get tortured because you or someone else making a danger assessment based on your gut feeling. By the same standard you should be locking up any guy who makes a sexist comment and is drunk because they are in danger of raping someone. That’s not a legal standard that would be allowed in any other circumstances. If someone has already committed a crime (and running around threatening people or setting something on fire etc. are crimes) then we have a different situation. Merely being delusional or agitated or refusing “help” is not and should not be illegal.

In terms of “danger to others” specifically I’d also like to mention that people are often brought in against their will for bs annoyances or other none offenses or nothing at all and often are treated with violence from the get go in the process (I have experienced that myself). If that person then gets reasonably agitated and angry – here comes “danger to others”, “verbal aggression” and so on. In other words – coercive psychiatry creates the situation which it claims to be preventing. I’d say that every time someone is brought to you against his/her will and calls you every name in the book or refuses to talk to you or becomes “agitated” – that’s a perfectly normal response whether they were delusional or not to begin with. I know it may not look like that to you because you lack this perspective but that is the fact. You can’t treat people like violent criminals and expect them to be OK with it or subject them to loss of liberty, dignity and often physical and social humiliation and then blame them for getting aggressive.

“Danger to self ” should not be a crime and not be a reason to claim someone is legally insane and/or should be committed. I have the right to kill myself or to harm myself and claiming otherwise is not only ridiculous but also violation of my human rights – the ability to decide about myself. Psychiatry arrogantly claims it can force people to live but then if someone commits suicide on their watch or shortly after getting out of the psych ward they refuse to take any responsibility. This is the most insane and hypocritical part of the whole system to me and I really can’t comprehend the mindset behind it.

3.
 “They are living in their homes and are threatening the people who share the space with them. (…) Now if you tell me that you would prefer to have the person taken to jail,. that is fine.”

That is exactly what I suggest. In this case the only reason of bringing them anywhere is isolation to prevent harm to others which is achieved by the prison. If person refuses any “treatment” that means the only “treatment” you can effectively use is drugs. Which don’t solve anything. You can’t force talk therapy or gardening or yoga or whatever on someone who does not want to participate – you can only torture them with needle rape. That’s hardly more humane than simply locking him/her up in jail. In which you also have rehabilitation programmed (or should have) which can provide this person support should they choose to “get help”. Unless they choose though the function of either institution is locking them up but the “hospital” only adds additional corporeal punishment that should be illegal.

4. “We are trying hard to help everyone live with dignity and autonomy in the community.”
 I think you miss the point. I mean – the very existence of coercive psychiatry will make your job on that harder if not impossible. You may be as nice and as helpful and as well-meaning as you like – the fact is if the person on the other side knows you have a legal right to torture them you’re the enemy. From the get go. Before they even see you, talk to you, before you do anything. It is counterproductive. So sometimes it may seem to you you did everything right and that person will still refuse to talk to you and barricade him/herself in their home or throw rocks at you should you approach. Especially if they already have experience with someone who may not have your ethics. And you will see it as unreasonable and “crazy” but you simply have no idea. I’m not saying it’s always you who are at fault because you did something – you’re at fault because you’re a part of and therefore legitimising these system of abuse. Systemic abuse can’t be fixed by well meaning individuals trying to limit the abuse – it can be fixed by bringing it down.

5. 
“I do know of some people who after the fact were appreciative of being brought into a hospital.” 
Sure, so do people who commit a crime, do their time and get rehabilitated. It doesn’t mean that you should be doing it or calling it medical. Simply put – the potential benefit to a few does not justify a legal system that allows for profiling people, pre-crime and torture.

6. 
“But your charge that I do not engage, is just hard for me to understand.”
 Well, you have not engaged so far – this is the first set of comments where you’ve actually kind of addressed people who have a beef with your opinion on the subject. Which I do appreciate.


7.
 “It seems that the only “engagement” that would satisfy you would be to fully accept your position. I am sorry that I am not able to do that.”
Just to clarify: do you disagree with me that coercive treatment is torture?

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Btw, you mention you don’t want to give specific examples because you’re afraid of possible identification of certain real people. So what if you’re presented with a imaginary narrative? Say a guy calls the police/ambulance on his gf because she has cut herself and told him she will kill herself and refused to get out of her room. She is unarmed though, only crying and “agitated”. She refuses to negotiate with anyone and leave her room but she does not threaten violence against anyone. Would you think this is justifiable to force her out of her room, bring her to the hospital against her will, inject her with sedatives and/or restrain her? She is not cooperating on any of it and is fighting back when physically tackled. What would you do? What do you think, if anything should be done?

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The frostbite example reminded me of Viktor Frankl, Mans Search for Meaning, and the position he found himself in. A Jewish psychiatrist picking the frostbitten toes off inmates in the Concentration Camps. Quite a crossroad to be standing at, the showers or forced labour.

I don’t envy your position at times Sandra, but appreciate your honesty about it.

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Re: Re: #1: That is a situation where you should be allowed to lie. Tell him/her that you’re taking him to meet the aliens or whatever you have to do but don’t abuse this person by using physical force. There are perfectly good ways in dealing with delusional people which do not need to escalate to aggression. These techniques are also used for people with severe dementia (of course when the caregivers actually care and not just drug these people up to their gills). Besides, what if that person told you that they are going out in the cold because they don’t care if they get frozen because they don’t care about their life anymore? Would that be good enough for coercion? How delusional does one have to be and what standard do you use other than your opinion?
The problem I have is that maybe if you’re really as selective as you say it really does not mean that other people who have the same power are. So maybe you only do it when someone is about to jump of the cliff because he/she sees angels on the other side but I can assure you the bar is much lower than that in general. And what you’re doing to this person is not simply something you can do to 10 people when one of them “needs it” and it will be all OK – you’ll traumatize all the 10 of them.

Re: Re #2: “I think it gets complicated when someone presents themselves to mental health professionals because of some act of self -harm but then refuses any offers of help.”
And what if I asked you for help and then decide that everything you have to offer is not only useless but even more harmful and told you to stop “helping” me and let me do what I want to do? Would you accept that?

“The idea is to try to understand what it is the person is asking for when the person comes to you with either the self report of having urges to self harm or after having acted in that way.”
Asking would be a start. I mean it’s totally OK to offer someone a choice of: if you think you may become a danger to self and you’d like to be prevented by harming yourself by force – tell us under what circumstances and how it can be done (who can do it, what force can be used, can you be given drugs). Using force based on pre-consent is OK. Arbitrary violence is not. The bottomline is: you don’t know what is inside my head and each and every time you’re trying to guess you’re bound to guess wrong in a substantial number of cases. Coercion is traumatising and can push people to really commit suicide (speaking from experience here) and you’ll never be able to tell if that was your fault or the plan from the beginning no matter what the person said before (most people who are “suicidal” don’t really want to kill themselves but it seems like psychiatric treatment may actually tip the scale for some).

” I think it matches nicely with what I have tried to do for years but it also enhanced my perspective and was extremely helpful. http://www.intentionalpeersupport.org/”
It’s all nice and good and I agree with the principles but I will never be able to have a constructive relationship with someone who has a legal authority to torture me and insists of keeping this right. Psychiatric treatment is torture (again: not only me and countless other surviviours but also UN said that) even if you disagree with that. That’s why I keep saying that it’s just like any other torture used for other reasons: it’s counterproductive. Unless one’s aim is to install terror in people – for that it’s extremely useful. If you want to have people cooperate with you you have to have their trust. I can’t trust you if you are allowed to do these things to me, period.

To the hypothetical scenario:
“Can I absolutely say that under no circumstances would I condone breaking down the door? No. But as I said earlier, I would look for the ambivalence. If she were 100% ambivalent, I would wonder why she told her boyfriend of her intentions. I have known many people who have chosen suicide and the impact on those who are left behind is severe. So I would have some concern for the boyfriend who as also caught in a difficult situation. But perhaps most important, I would keep in mind for the beginning that I do not have the answers.”
You admit you don’t have all the answers but yet you would allow yourself to act on this lack of information and potentially cause profound trauma to that girl? You mention that you’re concern for the boyfriend – he’s not your “patient”. You don’t treat people for their family – that is not medicine, that is what many here accuse psychiatry of being – social control. Plus I find this example you gave particularly ironic because this hypothetical scenario is in a way similar to my own experience (that’s why I gave it) and your response would be exactly wrong. You’re in a crisis situation, you don’t know a girl and she won’t talk to you. Yet you care about the guy’s feelings. You may not know but what if he is an abuser? What if he has worked long and hard to get this girl to that point and you’re essentially doing his biding? What if he’s concern and worry are 100% fake? You admit people are complex and you don’t know everything, especially in a situation like that yet you would allow yourself to make a judgement call that may haunt this person for the rest of her life. That is my problem with the whole approach: you don’t know and yet you think you have a right and responsibility to act while you have no idea what you’re really doing. I don’t want you to take that personally – I simply don’t think that anyone, safe maybe for people who are very close to the whole situation, can tell what’s really going on. That is not the problem. The problem is that you think you can solve this crisis by coming in and doing some arbitrary thing.
This is again not to an attack on you but an attempt to show you that you may be committing two main sins of psychiatry: ignorance and arrogance. That is what happens in situations like that: you act on poor information and your subjective opinions and that leads to actions based on you “knowing better”. I’m honestly trying not to be offensive but it’s just how it looks for that girl.

As to this and following points: I think again that you simply lack understanding on these issues. You look at it from your point of view and you don’t seem to be able to step into the other side’s shoes. Which would be all good and fine (I also can’t understand you on this subject, I think that is pretty clear) but you’re the one who is allowed to use force on people whom you clearly don’t understand and that is not OK. I’ve tried to explain how it feels and how you may be making mistakes that you’re not able to see from your perspective and how the other side may perceive the situation and you don’t seem to understand and I don’t really know why. You may guess that it’s kind of frustrating. If the issue is whether drugs are helpful or not or if someone is “mentally ill” or having an existential crisis – these are the things that are important for many but people may at least theoretically reject one or the otehr viewpoint. This is different – this is an issue of state violence and the fact you are not able to understand how much harm it does has real life implications for people like me. I’m not sitting here writing these comments because I have nothing better to do in life – I was so traumatized by coercive psychiatry that this is the one of a few outlets I have, not being able to seek justice for myself or prevent others from being harmed the same way. Your responsibility as a doctor is first to do no harm and I am a living example of that harm. I just wish you tried to imagine yourself on the other side. Can you imagine yourself being beaten? Raped? Locked up somewhere in a scary place, tied up? Helpless? Terrified? I believe you are able to empathize with victims of such crimes – why are you not able to empathize with me? These things are no less horrible when you or any psychiatrist does them then they are when some criminal does it. In a way they may be worse because they are legal and you’re not seen as a victim, you’re seen as someone who deserves it and/or should be grateful for it. It’s insult to injury.
I really don’t want to “attack you” I just genuinely wish you could have some more empathy to people you claim to be wanting to help and I am at loss of how can I make myself more clear. Maybe I can’t but I also can’t stop trying…

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“People are complex. I do have a certain notion that many of us are looking to connect and I would try to make a connection.”
I am also trying to connect but so far unsuccessfully…
One more thing to ask about your perspective: why do you choose to get involved in coercive psychiatry? Do you think you’d be responsible if you didn’t stop someone from killing him/herself? Not in a a legal but moral way? I simply don’t understand why you want to take this kind of responsibility on yourself…

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“But to the question of whether I would practice if I did not have this authority – I would welcome it! (…) But if I did not have that authority, I do not think the problem would go away.”
You can practice and not use this authority. You can simply refuse to coerce people ever – there are plenty of psychiatrists who don’t do it for many reasons. It’s not a requirement, it’s an authority you elect to have, not are forced to have it. I agree if you didn’t do it, someone else may but this should never be an excuse for any harmful act – substitute “coerce people to treatment” with “abuse” and I think you see how ridiculous such an argument is. I simply don’t get it – when you don’t want to do it and don’t have to, why do it?
“So what would you propose for the first gentleman I describe above with frostbite?”
Convince him to go with you. Use “white lies” if you need. But don’t use physical force on him.

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A bit more on a frostbite: you may say “I’ve tried everything in my power to convince him to go to safety and he won’t listen and if he does not he will end up dead or at the very least with severe frostbites”. That is all true but using this logic you should also be able to force diet and exercise on a person who is suffering from type II diabetes and obesity or force people who smoke to quit or force someone who has cancer to undergo treatment. Doctors are not allowed to make these choices for their patients even if these choices are as “unreasonable” and “delusional” as any pursue of aliens. It is completely arbitrary that you see the example person as so delusional that you need to “help him” even against his will and have a legal authority to do so but you don’t have the same authority to stop a guy who’s about to die from diabetes to stop eating cakes and take his meds (I know a person who dies this way and it pained me to see it yet I would never assume I had an authority or responsibility to do more than trying to convince him to change his behaviour). This is all a social construct – what is sane and what not, what is rational choice and freedom and what is craziness and delusion.

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Thanks for asking, Sandy. The simple straightforward answer is, I’d off to help and try to get that person to see that their actions are hurting them, but if they refuse to listen or take any assistance, in the end, I’d mind my own business. It’s not for me or anyone to say what another person chooses to perceive, as long as they are not harming others—that’s a different matter. But in this instance, it is himself he is harming, and if there is nothing we can do about stopping this voluntarily, then we are powerless to that person’s well, which is humility, a virtue.

I’d like to say a bit more about what is behind my response, here. I’m re-posting that example in two parts, for clarity.

“Let’s say there is someone who is walking for miles in our sub-zero weather in order to meet up with aliens and in the process he has sustained frost bite. This person is found by a concerned person who sees him walking in the road and calls the police who persuade him to come to the ER for evaluation. If this person refuses all offers for safe shelter insisting he is impervious to the cold (despite the evidence otherwise) and tell us the aliens will meet him and will care for him and I was called, I would likely hold him in the hospital against his will.”

First of all, you are assuming there are no aliens. Perhaps there are, you never know. Just because you don’t believe in them or you haven’t experienced alien energy, doesn’t mean that it is not a reality. Many, many, many—thousands—of people have reported affirming alien experiences. Psychiatrists need to stop “assuming” this is a delusion. Research this on the internet please. Lots of info, of all sorts, from a variety of people in various positions in various cultures. This is a cross-cultural phenomenon.

Although really, the fact that he’s going to meet the aliens is not the problem, that’s his business, his reality. The problem is that he is allowing his body to be harmed in the process. If a person calls the police, they are not ‘concerned,’ they are afraid. I think that’s a very important distinction to make, because fear makes us want to control others. If the person were truly ‘concerned,’ they would take them to a hospital themselves.

If he refuses shelter, that’s his prerogative and his business. Anything else is meddling. The fact that he is hurting himself and cannot perceive this can be addressed, you can try to point out to this person that they are putting themselves in harm’s way from their own actions, but in the end that is his business and fate.

In the healing work that I do, it is part of our creed that we are never responsible for other individuals, we are only there to offer loving support if they want it. If not, then their fate is between them and their God, whatever that would mean to anyone.

We are not saviors, just helpers. To me, it seems you are wanting to ‘save’ people. I don’t think that is sound, and in fact, throws society off kilter. We can only save ourselves, and be responsible for ourselves. Even our children are not our children, as Kahlil Gibran says in The Prophet.

“If on the other hand, a different person comes to the ER with frostbite. He has been camping in the area for a while. He seems to generally know how to manage but on this night things got out of hand, If he says he wants to leave and seems to have some reasonable ability to fend for himself, I might view this as an unusual choice but I would not be likely to intervene.”

Sandy, with all due respect, why should you even have an opinion about what another person decides to do? Mental health clinicians have the mental program of ‘evaluation,’ and we really don’t need to go around evaluating other people, how is that helping anyone? This is an inherent problem in the field, that’s institutional arrogance, pure and simple, as far as I’m concerned.

In this scenario, the difference in your description is striking. If I boil it down to what it feels like to me, it seems you are saying, “We have this crazy guy who believes in aliens and then there is this reasonable guy who I can kind of relate to because he’s generally aware of when he gets frostbite. The crazy guy I’d lock up and the other guy I’d let him go.” I’m putting quotation marks even though I’m not quoting you, but this is how your example read to me, very dualistic and stigmatizing. Now that’s just my reality, but it’s how I read the energy of it, and felt it.

“But to the question of whether I would practice if I did not have this authority – I would welcome it! This was not something I thought much about when I entered psychiatry. It is not what drew me in. But once in, I certainly realized I needed to reckon with this in a serious way and that is an ongoing project.”

But you can choose to never take this option, or is that not true? I know you justify it with your examples, but at the same time, many of us are trying to communicate that this is neither sound nor just, and we are asking you to feel this with your empathy. And I’m saying there’s no way healing can occur, here.

So I’m not sure, from what you say, if involuntary patient incarceration is something you can choose, or is it something which you, yourself, are mandated to do by law? If the latter, then you’re being coerced, too. Unless of course, you are of the same opinion as the government. I’m not sure if we’re talking about your values, or what you perceive to be ‘your duty.’ I think that would be important to clarify.

“But if I did not have that authority, I do not think the problem would go away.”

Hmmm, I beg to differ here. I think that your having this authority is directly and specifically a social ill, and I very strongly believe that if it were to be taken away from you and others, things would most definitely improve.

One thing I hated hearing people say—and these were my professional peers–was “I’m a mandated reporter.” There was such a ring of ‘self-importance’ to it. I urge people to never get near nor talk to anyone who calls themselves this. You never know when you’re going to get reported for pissing someone off. Happens all the time, and it puts people through hell.

The mental health system is drunk with power, and this is why. Imo, not sound, not healthy, needs to change, and yes, it would improve things a great deal if there were no such thing as ‘mandated reporter’ or forced anything. I’m certain of it.

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Thanks, Sandy, I’ve appreciated this dialogue and your openness a great deal. You are definitely high on my list of courageous people.

Btw, I read The Center Cannot Hold a few years ago, and contacted Elyn Saks. We had a pretty long phone conversation one afternoon, very interesting lady. She’s not only an attorney, she’s a psychiatrist.

One of the things about speaking our truth in order to make change is that, more often than not, I’m aware how this can challenge people’s ego and feelings. That’s a necessary bi-product of waking up. Certainly mine went through the wringer, but that was necessary to heal and creative positive change in my own life. Sure did lead to being able to own my sense of self and spirit truth, and that’s what changed everything for the better.

I have a guilt button that wants to go off, nature of my family culture. I was taught, by example, to enable abuse and oppression in my family (in other words, to shut up and go along with it), and that became a template in my mind, so that if others weren’t abusing me for speaking my truth, I’d do it myself.

That’s not longer the case for me, a core aspect of my healing was to validate my own reality, despite the wishes of punishers, intimidators, and fear-mongers–the enablers. I’ve worked very hard with that, so I don’t self-judge, and trust my truth. As far as I know, I speak it with clarity, authenticity, and integrity. That’s always my intention. I can only hope it leads to the necessary changes we seek.

I think by each of us speaking our truths and following our hearts, we are, indeed, already creating change together. That’s in the bag, as far as I’m concerned.

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“I am glad that I work in a state that has a fairly rigorous standard and process for evaluating forced treatment.”
I think you have much to much trust in the system. Many of us here don’t have that privilege. I personally was shocked to discover, partly on my own skin, partly by observation and accounts of others, just how f***ed up humanity is in general. The overall rule seems to be – whenever you give a group of people power over another group of people they are going to abuse it and they will find new and creative ways on how to do as much harm as cruelly as possible. Maybe not everyone of them but in the end the best way to prevent abuse is to give people as little power over others as possible. It’s not a rule that applies only to psychiatry but, because of it’s, let’s call them “loose”, definitions and criteria it’s where it is so clearly visible.

Thanks Sandra for engaging in this conversation nonetheless. It takes some integrity to be willing to participate in it from your position even if I think you’re dead wrong on the issue. I wish you all the best with the other approaches you’re taking and hope that maybe some day “the truth will set you free”.

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Although her book was written awhile ago, she remains active as a scholar and an activist. I would not presume to speak for her.

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