Return to Asylums?
Let’s Not!

Susan Rogers
19
139

A recent JAMA opinion piece calling for a return to asylums – not the bad kind, the authors (three Penn bioethicists) insist, but a “safe, modern and humane” kind of asylum – led to a radio debate between co-author Dominic Sisti, associate professor of medical ethics at the University of Pennsylvania, and Joseph Rogers, chief advocacy officer of the Mental Health Association of Southeastern Pennsylvania (MHASP) and executive director of the National Mental Health Consumers’ Self-Help Clearinghouse. The debate, on WHYY’s Voices in the Family, was moderated by the show’s host, Dr. Dan Gottlieb. To listen to the archived program, click here.

Dr. Sisti began by insisting that “we do not want to return to those asylums … that are now infamous for incarcerating thousands of Americans … What we were calling for is a rehabilitation of the term ‘asylum’ … [as] a safe sanctuary where they may be able to heal and reclaim their lives in recovery.” Asked about the reason for the widespread use of chemical restraints, Dr. Sisti responded that it is “a lot easier to maintain control and safety in an overcrowded institution when individuals are chemically controlled. We’re seeing this now in prisons,” where individuals with mental health conditions who are often without access to adequate treatment are “oftentimes given large doses of drugs to keep them both safe and comfortable” (emphasis added).

Throughout the hour-long program, Joseph Rogers was the voice of reason, debunking Dr. Sisti’s arguments. After establishing his credentials – “I’ve been in hospitals; I’ve been in jails; I’ve been homeless; I have a diagnosis of bipolar disorder which at times has left me incapacitated” – Rogers talked about his experience in a state hospital: “When I hear the term ‘asylum’ I get my back up because there was no asylum. These places … are not safe places … You were warehoused.”

“We can create alternatives” such as peer-run crisis respites, he continued. This model, he said, “has had wonderful success, even with people with some very difficult challenges.”

Rogers also noted that, although Dr. Sisti is based in Philadelphia, he didn’t talk about the Philadelphia experience, when “we closed down Philadelphia State Hospital and years later they found that those individuals” who had been released from the hospital when it closed were living successfully in the community.

“We know how to do it,” Rogers said. The key is providing for people’s individualized needs. The question, he continued, is whether we have the power politically. It’s a matter of funding community-based, evidence-based programs that we know work for even individuals with the most serious mental health conditions. “And we need to fund them fully and not let them become budget basketball.”

Among those who called in to the program, the most compelling was “Christy,” who said she had recently been released from Norristown State Hospital after six days. “I ended up there for some severe depression. I was forced to take medication against my will; I was disrespected; any time I tried to advocate for myself, I was told to cooperate or threatened with a longer stay,” she recalled. “I thought it was completely unethical. I think it goes to show how few rights you have when you are deemed mentally ill. I don’t think it was set up to help people succeed. Many people were just drugged. I didn’t get any therapy. I repeatedly told them about myself and how meds affect me – and I was forced to take medication. I went in voluntarily and was forced to stay longer. I’m a college-educated person and I tried to advocate for myself and I was not listened to. I’m seeing an outpatient therapist but the experience at Norristown scarred me for life. It was very extreme.”

In response to the moderator’s question about what works and what doesn’t, Rogers responded: “We have to treat people as individuals.” Perhaps referring to the fact that the moderator consistently avoided the use of “people first” language, Rogers said, “We don’t like to label people as ‘the mentally ill’; we talk about people with mental health challenges.”

“What we have found here in Philadelphia,” he continued, “is that we have to really meet the person where they are at.” Referencing some of the individualized outreach efforts in the city, including a street outreach program called ACCESS (operated by MHASP), he said that “we learned early on” that you can’t set up a big community mental health center and put the counselor on the fourth or fifth floor and expect people with serious problems to make an appointment and come to the fourth or fifth floor. “You need to be on the street, to work with people where they are at, to find out exactly what they are concerned about that you can address, and by addressing those issues you gain their trust.” That is how you are able to help a person seek and gain the support they need, he said.

“One thing that doesn’t work is overmedicating people,” Rogers noted. “Many people do much better on small amounts of medication or no medication at all.” Some people’s behavior may be the result of heavy medication, he added.

To the moderator’s question about people who don’t have loved ones who can help them, Rogers responded, “A lot of times family members burn out or aren’t around … We’ve got to create an artificial family. One of the things peer-run crisis respites do is use peers who have been trained to work one on one with individuals in crisis and provide a homelike environment and prevent hospitalization or going into a jail. You thus prevent further trauma.”

Rogers also talked about Housing First, a program in Philadelphia and elsewhere: “You provide decent, affordable housing for that person and you build the supports around the person based on their needs….You can help the person get involved in the community.”

In response to Dr. Sisti’s continued insistence that institutions can be effective, Rogers countered that with large, congregate living situations, even with 15, 20, or 30 people, “the rights situation is problematic. At 3 in the morning, when there are no advocates around and no chance to make a phone call to an advocate, that’s when the abuses take place. This model of a ‘safe congregate living place’ is not one that is borne out, with years of research into it.”

Rogers emphasized the need for adequate resources, saying that Philadelphia probably needs 3,000 or 4,000 more supported housing units than the city currently has. “That would just address people rotating in and out of hospitals and jails, just in Philadelphia alone, not the whole region.” MHASP is advocating for additional resources with the Pennsylvania state government.

Asked by the moderator to define his dream, Rogers responded that his dream would be to create a massive movement of individuals with lived experience, families, and allies. “That’s the only way we’re going to change things.”

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19 COMMENTS

  1. So frustrating to keep reading about these academic tug-of-wars, while more and more people are neglected, discriminated against, oppressed, and abused daily in all facets of the system.

    “Asked by the moderator to define his dream, Rogers responded that his dream would be to create a massive movement of individuals with lived experience, families, and allies. ‘That’s the only way we’re going to change things.'”

    I don’t know, I see more fighting and fierce competition, including back-biting and betrayal, within these groups. When communities connect over suffering, rage, and dysfunctional family dynamics, it can be hard to imagine clarity and cooperation, in the long run. There’s a lot of confusion here that can’t seem to get sorted out, because so much of this reality is myth, illusion, and indoctrination. It’s hard to tell who’s who and what’s what.

    With that said, it’s hard to know WHAT exactly will make the difference at this point, although I’m always a big fan of speaking truth with as much clarity and compassion as possible. Sometimes that’s hard, but I think it’s a good goal for which to shoot, imho. That’s the only way I can see how any difference will be made, leading to the radical changes we so sorely need. Something’s gotta give…

    • Thanks 4 ur comment
      After a recent [not first!] hospital stay that was infvoluntary and involved forcible medication administration during which honest staff admitted things were WAY screwed up and higher-up “professionals” remained dense in response and unwilling 2 answer questions, I now wait with anticipation and curiosity what the “something giving” will look like.

      It’s perhaps the most unchecked form of oppression in our country today.

      “Give” it will, though, as all wrong does eventually.

      Now, I just try as hard I can to be a part of the change and hope I’m around wen it happens!

      • “It’s perhaps the most unchecked form of oppression in our country today.”

        Indeed it is, and it’s obvious that unless one has been through this charade of smoke and mirrors, one doesn’t get it. Being treated as second–or even third–class simply for turning to professionals for support is insane and insane-making. That’s systemic vampirism.

        I’m eager to see how this all goes down, myself. I feel the pressure building. The resistance to seeing and owning the truth is over-the-top. That’s a damn just waiting to burst. You are certainly part of the change. Thank you for speaking your truth!

  2. Thank you Joe Rogers for debating the issue, and thank you Susan Rogers for responding to the JAMA opinion piece with your own post here at MIA.

    Of course, deinstitutionalization need not end with reinstitutionalization. That’s more than silly, the idea is patently absurd. There was good reason to close the places they have closed, and there always has been good reason to close them. Mental institutions are neither asylums nor hospitals in reality. What they are, what they were, and what they will always be, is psychiatric prisons.

    Western State Hospital in Staunton Virginia, one of the psychiatric prisons I was confined in, is going through its 3rd incarnation as a mental hospital. In the process, although there are fewer “patients” than ever before, under 200, confined there , they are confined in more prison-like conditions. Each of those inmates wears a electronic bracelet that informs the staff of their location, and their status, at all times of day. Even with fewer prisoners, I know someone who just underwent 2 consecutive 1 year plus sentences of confinement there. It makes much more sense, to my mind, just to shut such places down lest they undergo another even more prison-like and tortuous transformation.

    There are a little more than 600 such patient/inmates North East Florida State Hospital in Macclenny. I campaigned for the release of a patient from that institution who was held there for a number of years. I’ve read that the average stay at Macclenny is something like 2 and 1/2 years. It is my belief that anybody who thinks that such stays are good for a person’s health should spend a few years vacationing there. I would think that then one would find that it’s not quite the spa one imagined it to be.

    No, we don’t need more psychiatric institutions. We need fewer. Fewer, fewer, and fewer yet. In fact, we don’t need them at all. Forget revoking the age of consent for certain individuals, and allow them to live in the real world, with real people.

  3. “return to asylums – not the bad kind, the authors (three Penn bioethicists) insist, but a “safe, modern and humane” kind of asylum”
    Sure. Because that approach has always worked wonders. These people have degrees in medicine and/or psychology? Seriously?

  4. I disagree. We need an asylum… a gigantic asylum should be built to incarcerate miscreant psychiatrists and devious pharmaceutical company workers. People could pay to go there and watch them in their cells… like a zoo.

    I don’t see why there should be any divisions within a movement that opposes psychiatry. There should be great unity in joining the forces of good against the forces of evil psychiatry. Good vs. evil, truth vs. error, right vs. wrong, justice vs. injustice. It’s time to set aside differences and slay the dragon of psychiatry.

  5. This whole thing is in lockstep with the current political climate of force, damnation and a police state mentality.

    The Drug companies, make a mint of their hemlock. They will make more now if they can force people to eat more and at the same time get money for their strangle holds/ forced treatment centers: staff, buildings, paid thugs and other bureaucratic mouthpieces to justify their greed and actions.

    They will not ever talk about the poisons they hand out, accept about the benevolence it brings and money saving. In this game they aim to make billions on the game of forced incarceration/treatment….nice money maker.

    They will not talk about the life on the streets, that is nothing short of a war. The stress, the fear, the constant experiences coming in of the unkind sort or even good – you have no time to process the incoming actions and situations.

    A person diet goes to hell, and coffee and cigs takes up the time between meals if you can get them. Meanwhile the GOP calls for severe cuts to the downtrodden: a death sentence really but no one says a thing, but we now the check cashing people are Salivating now!!

    Career or job, stabilization and normalization of the self or again: put in stifling situation with no room to expand or grow and at the mercy of Stigma and At Will Employment…sent to hell and A for profit Prison and again the money Men Salivate.

    So then: No talk of

    1) Housing
    2) Fair Employment
    3) Self Help Centers – Real ones not the Type Say Santa Clara County has run with is immoral and pathetic.
    4) Access to safe neighborhood and the ability to be human and related to one as such.

    Currently people who think they are normal – best understand- they can be put down here too, based on political attack, or by out malice – Stalin understood this as others – it becomes a nice system to end the Maladjusted to their system.

    In the US the attack is clear: In the psychological sphere: Empathy, Compassion, Rationality and Love and dignity and value are hindrances to: Consumerism, War, Greed and the Cult of Domination and Sadism…..Will Come to the 21 Century and American Style

  6. This whole thing is in lockstep with the current political climate of force, damnation and a police state mentality.

    The Drug companies, make a mint of their hemlock. They will make more now if they can force people to eat more and at the same time get money for their strangle holds/ forced treatment centers: staff, buildings, paid thugs and other bureaucratic mouthpieces to justify their greed and actions.

    They will not ever talk about the poisons they hand out, accept about the benevolence it brings and money saving. In this game they aim to make billions on the game of forced incarceration/treatment….nice money maker.

    They will not talk about the life on the streets, that is nothing short of a war. The stress, the fear, the constant experiences coming in of the unkind sort or even good – you have no time to process the incoming actions and situations.

    A person diet goes to hell, and coffee and cigs takes up the time between meals if you can get them. Meanwhile the GOP calls for severe cuts to the downtrodden: a death sentence really but no one says a thing, but we now the check cashing people are Salivating now!!

    Career or job, stabilization and normalization of the self or again: put in stifling situation with no room to expand or grow and at the mercy of Stigma and At Will Employment…sent to hell and A for profit Prison and again the money Men Salivate.

    So then: No talk of

    1) Housing
    2) Fair Employment
    3) Self Help Centers – Real ones not the Type Say Santa Clara County has run with is immoral and pathetic.
    4) Access to safe neighborhood and the ability to be human and related to one as such.

    Currently people who think they are normal – best understand- they can be put down here too, based on political attack, or by out malice – Stalin understood this as others – it becomes a nice system to end the Maladjusted to their system.

    In the US the attack is clear: In the psychological sphere: Empathy, Compassion, Rationality and Love and dignity and value are hindrances to: Consumerism, War, Greed and the Cult of Domination and Sadism…..Will Come to the 21 Century and American Style or Corporate Universal Style