The Murphys Have Their Way With Words

Sera Davidow
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Note: This blog is adapted from Sera Davidow’s post by the same name on the
‘Campaign for Real Change in Mental Health Policy’ website.

Senator Chris Murphy of Connecticut (and his legislative co-pilot, Senator Bill Cassidy) released a new ‘Murphy Bill’ this past week. It’s called the ‘Mental Health Reform Act of 2015,’ though it has yet to be assigned an official number. While many words appear in its more than 100 pages, it’s worth noting that the term ‘evidence’ (most often paired with ‘based’ to form the familiar and supposedly scientific phrase, ‘evidence-based’) appears 27 times. Never to be outdone, the almost 200-page House version (‘Helping Families in Mental Health Crisis,’ H.R. 2646) from Representative Tim Murphy uses the same word 38 times.

This makes sense. Why wouldn’t anyone want anything to do with… well… just about anything… to be, you know, based on research and evidence? I mean, evidence is certainly better than wild guesses, right? Apparently, the most commonly used definition for ‘Evidence-Based Practice’ is this:

“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett et al, 1996).

Most people will hear ‘evidence’ to mean confidence and rigorous standards. They’ll hear that someone has really taken the time to figure things out and get it right. In a most basic way, it (sounds like it) means safety and that inspires trust. Most will read the use of ‘evidence-based’ in these documents in that way, and few will disagree that it’s a good thing, but here’s the problem:

At least in the realm of ‘mental health,’ evidence-based means something more akin to:

The use of current evidence as developed by individuals who had enough funds at their disposal to engage in the bolstering of their own favored ‘best practice’ – often to the exclusion of other evidence to the contrary and commonly more or less in alignment with the dominant paradigm (hence the availability of said funds) – and all too frequently based on research conducted upon such an extraordinarily narrow and contrived group of people and characteristics that it is unlikely to be particularly meaningful or replicable in the ‘real world.’ (Davidow, 2015)

Furthermore, ‘evidence-based’ practice is frequently measured against outcomes that are defined by a clinician or scientist rather than someone whose life is directly impacted. For example, a scientist might interpret reduction in hospitalization as a primary and positive outcome, but ignore the fact that the person no longer hospitalized is so sedated that they have lost their day-to-day ability to function in anything resembling a healthy manner, and will soon begin experiencing medical complications as a result.

Twenty-seven (or 38) uses seems excessive for such a hollow word, particularly in a document that has the potential to change so many lives in such a dramatic way. But, ‘evidence’ is not alone. Alas, there are many words in the Murphy Bills that serve little purpose other than to mislead or fluff up the grand illusion that these legislators are on to something good. Others include (but are not limited to):

  • Assisted Outpatient Treatment
  • Peer Specialist
  • Recovery

Assisted Outpatient Treatment

The ever-euphemistic term, ‘Assisted Outpatient Treatment’ (AOT) appears prominently in both documents, although in slightly different ways. While Murphy 2013 sought to penalize states that did not take sufficient steps to implement so-called AOT, Murphy 2015 in the House claims only to want to incentivize the states that do. Meanwhile, the Senate’s Murphy Bill takes arguably the most timid approach, claiming to only be continuing existing AOT demonstration projects to 2020.

However, the fact is that all three versions essentially seek to expand (in one fashion or another) the practice of forcing psychiatric drugs and other ‘treatment’ on people who may have done little more than be hospitalized too many times for someone else’s liking, and they are simply experimenting with which version of expansion might be most palatable to the general public so as to allow it to slip by. And, while they’re doing so, they’re calling it ‘assistance.’

Personally, when I picture someone providing ‘assistance,’ it conjures up images of helping an elderly individual across the street, or maybe offering a grant to a young person entering college. I certainly don’t ever imagine forcing someone to take chemicals into their body against their will, attend appointments they don’t wish to attend with clinicians they do not trust, or telling them they must engage in any other activity under threat of hospitalization if they refuse, and then smiling and calling it ‘assistance.’ I might as well commit armed robbery and suggest to the bank that I’m simply ‘assisting’ them in correcting my personal financial woes.

Yet, once again, what impression is it that these bills leave with the voting public? Not only are we kindly assisting someone with what they need, but we’re doing it based on evidence! (Never mind that there’s a great deal of evidence that what I prefer to call Outpatient Forced Commitment [OFC] or Involuntary Outpatient Commitment [IOC] does not work unless simultaneously implemented with an influx of other improved and voluntary services, in which case it is still not likely to be said force that is actually leading to any documented improvements.)

Peer Specialist & Recovery

Perhaps the greatest issue with the newly included (and nearly identical) ‘peer specialist’ sections in both current Murphy Bills is the implication that there is actual goodwill toward and belief in peer-to-peer support. Personally, however, I’m brought back to various conversations I’ve had about drug legalization with individuals who otherwise are staunchly opposed to drug use but feel that legalization is the best way to control and regulate it. In other words, the inclusion of ‘peer specialist’ rings of a desire to scrutinize, limit and control these roles rather than to support them.

Both documents define a ‘peer specialist’ (a problematic term all on its own and the only ‘peer’ role recognized therein) as someone who must be working in collaboration with and under the supervision of a clinician. (To those for whom the problems with this are not immediately obvious, I only have time and space right now to say that the list is long, but starts with the fact that most clinicians have no training in or particular understanding of peer roles at all.)  It lists documentation and assessment as among the primary tasks. (See this handbook on ‘peer roles’ for a deeper understanding of why this is problematic.)  Perhaps most frightening, it states that such individuals must not work outside of the ‘scope of their expertise.’ Although it does not specifically define what the supposed scope of a ‘peer specialist’s expertise might be, the implication is that when it is defined, it certainly will not be by the ‘peer specialist’ or anyone they are supporting.

To be clear, this is less ‘peer-to-peer support’ and more co-optation giving way to mandatory assimilation. It represents an uprooting of firmly planted principles already struggling to thrive in many environments. It devalues the potential of people in peer roles to be change agents, ties their hands as ‘advocates,’ and disregards the importance of their operating within the system without being precisely ‘of’ it. The ‘peer specialists’ of a Murphy’s world would be less ‘peer specialists’ and more moles, administrative assistants, and ‘right hands.’

This brings me to perhaps one of the most interesting and overlooked points in the entire document: It also defines a ‘peer specialist’ as someone who has been in active ‘treatment’ for the last two years. Furthermore, in a separate section of the Senate version, when describing a committee to be formed, it designates one seat to a ‘peer specialist’ (as defined above) and another to someone who has been not only in ‘active treatment’ for the last two years but who has expressly ‘benefited from’ it. (The other 21 seats are largely, of course, allotted to various academic or clinical types.) What on earth does any of this say about either Murphy’s actual belief in the word ‘recovery?’

Now, I’m not a particular fan of the word ‘recovery’ (see my blog, ‘The Recovery Trap’ for more on that), but for very different reasons. It’s certainly not because I don’t believe in the potential of people who have been given psychiatric diagnoses to heal, move beyond the need for ‘treatment,’ and get on with their lives.

The word ‘recovery’ appears 12 times in the Senate-driven Murphy Bill and seven times in the House version. But, what could it possibly mean to legislators who have written a proposal that so explicitly and intentionally eliminates the voice of anyone who has ever been given a psychiatric diagnosis but is no longer in ‘treatment’? Lifelong ‘treatment’ is certainly not my vision of ‘recovery’ for myself.

Conclusion

Evidence. Assistance. Peer Specialist. Recovery. The linguistic imagery this Murphy duo paints looks kind of pretty at a distance, and particularly for those caught up in the idea that doing something is more important than what exactly is being done. It’s like one of those paintings that form a beautiful, scenic horizon when one is standing far away enough to see it in that light. However, up close, one can see that the larger image is built on millions of tiny tears and specks of blood.

At a glance, the public will assume that the Murphys intend to prioritize a ‘gold standard’ of treatment – only the very best, most ‘evidence-based’ ‘assistance’ for all. They’ll assume they believe in the potential of treatment and ‘recovery’ so whole-heartedly that they’re even going to invest in bringing in ‘peer specialists’ as living breathing examples of that future-oriented vision.

But, the truth is ugly. The truth is about control, obfuscation, and a game where political careers and appearances reign supreme over the actual issues at hand. These bills pose an unprecedented threat to so many people and organizations engaged in the most innovative efforts, who may be rendered invisible for their lack of ability to fit into the superficial definitions and re-worked meanings that inflate these bills.

What happens to innovative efforts like Recovery Learning Communities, peer respites, Soteria projects, the Hearing Voices Movement, Alternatives to Suicide groups and so many more when they don’t have the money to pay for an ‘evidence-based’ status? When some newly appointed official is told it’s their responsibility to award grants only to those who ‘fit’ a very particular set of standards?

What happens to the others when they call ‘Assisted Outpatient Treatment’ out for what it really is and fight against force? When they fail the newly branded ‘peer’ litmus test for lack of clinical supervision or practicing outside of what someone else deems their scope to be? Are we ready to let all of these efforts die, in spite of the hundreds of thousands of people who say (‘official’ research studies be damned) that they saved their lives?

And, what happens to those of us (myself included) who stand up to speak but are silenced because we are no longer in ‘treatment,’ or want to share how it didn’t work for us?

It’s funny how these bills and their associated Murphys are claiming a desperate need for great change, and yet what their legislation would seem to most readily accomplish is a narrowing of the field to a lot more of what’s already quite strongly represented. I don’t know of anyone who would say the current mental health system is a success (or even vaguely acceptable). However, nor do I know anyone who would say that the mental health system of several decades ago was either, and, at least in part, that’s where the Murphys seem intent on sending us. The only question remaining is who is up for signing on to that ride.

Change is needed, yes. But, why would we trust overworked and under-informed legislators with divided interests to design that change for us? And, since when did change become heaping piles of more of the same?

I’m pleased to note that mainstream journalists are beginning to take note of some of the many dissenting views circulating in reference to this legislation.  Some months ago, I wrote to US News Journalist Kimberly Leonard concerning a piece she published on the House Murphy Bill that quoted primarily sources like the Treatment Advocacy Center.  I welcomed her to reach out when she was getting ready to write on this topic again.  Fortunately, she took me up on that, and although her recent piece, ‘Would Mental Health Laws Threaten Privacy and Patients’ Rights’ still skews toward those who would see these laws pushed through, it also offers some strong quotes in opposition of the Bills.

This is an important step in the right direction, but if we are to have any hope of getting our voices heard loudly enough to really count, there’s a great deal more work to be done. Please join those of us who are fighting to stop these potentially devastating Murphy Bills by signing and sharing this petition and staying up-to-date and well-informed with the help of these sites:

Thank you.

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30 COMMENTS

  1. I signed this petition, thanks.

    This is truly a Kafka-esque document, the main beneficiaries of which are drug companies and psychiatrists. There’s no fixing such a document since almost every other provision is an outright lie, e.g. about “mental illnesses” being valid labels, about medication being a primary or front-line treatment, etc. Distressed people don’t experience their problems or what they want for healing in the same universe as this document is written.

    It’s sad that a former psychologist like Rep. Murphy could be so effectively brainwashed, bought off, and turned into a parrot for corporations and psychiatrists. It makes me think of that famous quote, “For what shall it profit a man, if he shall gain the whole world, and lose his own soul?”

  2. “Lifetime treatment” as “recovery”‘ yes, that would be the goal of an “industry” only motivated by “criminal intent” such as the entire mental illness complex. As far as “peer specialists” go, they are only a way to placate those they have brainwashed through their criminal intent; so they will not be so dismayed as to utter miserableness of their situation as to truly question what is really happening to them and to their fellow “inmates.” Thus, the tragedy is that contact with them is just as damaging as the other alleged treatment modalities from “drugs” to “therapy” to “hospitals” to “clubhouses” to “sheltered workshops” to “group homes” to “CBT” and “DBT”, etc. All have the goal of further dehumanizing and demoralizing the person until all they can do is just sit and watch the television and sleep. And, on the television all they can seem to understand are the commercials. Their brain, their selves, their identities, their dreams, their hopes, what was their lives has been totally raped and plundered from them. I don’t the Christian monks at the hands of the Vikings in ancient Ireland had it as bad. At least, they were able to create and save the fantastic Book of Kells. The problem with what is happening today in the mental illness criminal conspiracy and now speedily seeping over into the many venues of “traditional medicine” is that is insidious, and seemingly so innocuous and allegedly for the good of the person suffering is that we are unable to clearly see how utterly dangerous it is to not only the individual involved as a prisoner; but to the family, the community, and utmost is perhaps the most sincere threat to the security of the Western World only eclipsed by ISIS, other known and unknown terrorists groups or South Korea and perhaps those enemies we are yet to know. I can never emphasize that what is happening from the mental illness criminal conspiracy; now infecting all of our health care industry is a true internal threat to our security as nation and in the western world; we need to take very seriously. Perhaps, the tip of the iceberg has been the increase of these terrible shootings in our movie theaters and other places. It is time we wake up. Toxic drugs and all this other stuff does absolutely no good; only harms and does not cure because we have no need for a cure; as there are no illnesses to consider. Like the atomic time clock, each day the time ticks away. Thank you.

  3. So is this a deliberate conspiracy to keep us off-balance and confused by introducing multiple Murphys and multiple bills to get mixed up until they slip one of them through in the night?

    Are there any Murphys in congress on our side who could introduce more similar-sounding bills and throw the whole process into chaos?

  4. Thanks Sera btw!

    “Evidence” is used by BOTH sides in a court of law. The side with the most persuasive evidence wins, at least theoretically. Also presumably both sides base their arguments on evidence. To suggest that, because evidence or alleged evidence supporting a particular argument exists that argument should be presumed correct, is absurd.

    This is why we need a team of conscious and informed linguistics experts to deconstruct and expose such fraudulent manipulation of language.

    • Can a think tank be formed with no funds ? Be informative to read a book if it was possible on the subject co -written by Sera Davidson and Noam Chomsky. BTW doesn’t this seem like a beyond the McCharthy era witch hunt on steroids with countless numbers of defenseless people including the youngest just being shoveled into a funnel coming out brain damaged compliant or defiant and ripe to be abused further ? Are there places on the planet where there is safety to run to ? How do you really fight something when even your own family turns you in ? We need a grass roots underground survival strategy where those that are able take at least one potential victim under their wing to protect them from the on going and increasing storm until the day it passes as it must, because it is so fraudulent .

      • On the first point — that certainly would be a good read, but it seems destined to remain a fantasy; unfortunately Chomsky in uncharacteristically clueless about the absurdity of the “mental illness” construct. Most disappointing that one of the worlds top linguistics experts, and top progressives would not comprehend such obvious manipulation of language and metaphor, but according to Judi Chamberlin he didn’t on the one occasion that they met.
        http://www.community-consortium.org/projects/chamberlin-judy.pdf
        (page 21)

      • As far as your mention of McCarthy era witch hunts – you should watch X-Men days of future past. Simple premise: mutants are born with a special gene giving them powers. They are used during WWII to help the Good guys win. After the war nobody knows what to so with them because now the “secret is out.” They face stigma and discrimination and must hide. Some find shelter and supper through Professor Xavier’s School for Gifted Young People. Then tge government develops drugs that remove your powers. And a near-war breaks out. There is the norm people vs the mutants. And the mutants are divided – half want to have peace and cooperation and be heard and understood… The other half see themselves as victims of discrimination and want to fight the norm people. It is generally accepted that the mutants would reign supreme if this happened because of their powers.

        The witch hunt as pharmaceutical solution is all too familiar. And it feels, for me, that to fight to support the side of the weak one must formally share the fact that they are “one of them.” And this face the scrutiny, ridicule, Discriminatikm, and dismissal that follows when ones considered “crazy.”

  5. This comment didn’t make it past approval on the site Sera directed me to, so I figured I’d post it here. There has been an official cultivated ignorance on the proposed threshold for committals in the Murphy package. It was officially ignored on the site Sera mentions, under Talking Points. It’s all very curious to me. Here was the comment:

    In the Elliot Rodger incident, much was made that the system ‘failed’ to prevent his killing spree (I am one of the many who don’t accept the media’s version of the event as wholly authentic). There was reporting on the ‘welfare check’ the cops were called to make by Rodger’s psychologist. This is one of the incidents and alleged system failures that is used to lobby for this ‘in need of treatment’ threshold.

    Yet a welfare check has zero to do with any kind of psychological evaluation. It is simply a check on whether or not a resident is alive and physically well. I called for one on an elderly friend who lived alone last year and all the cops did was ring the doorbell, see that he was physically capable of answering it, and leave. That’s all a welfare check is.

    A screening is something totally different and is supposedly what Rodger’s counselor requested the cops order. It would call for taking Rodger into an ER where he could be detained, observed and screened for up to 72 hours – plenty of time to scrutinize the videos he’d posted and speak with his family. The screening process allows for anyone and everyone to have a say in the ‘accused’s’ supposed mental state.

    So the incident which spurred Tim Murphy’s bill’s introduction (which was made very quickly after Rodger’s supposed spree) had nothing to do with a ‘broken system’ that ‘failed’ to detect a ‘seriously mentally ill’ psychopath. The cops didn’t do what they were allegedly asked to do and were legally allowed and possibly obligated to do – force Rodger to the ER or at the least require him to be screened on site. No cop is legally allowed to do this, so the notion that a bunch of police somehow missed anything is absurd and a legal non-sequitur.

    Why has the community failed to acknowledge this? How on earth has AOT been considered more draconian and violating than the spuriously justified change in involuntary committal threshold? At the least AOT allows for some modicum of due process, while imprisonment by whim affords citizens NONE.

    I continue to scratch my head at the seeming incongruity that’s gone on…

  6. Hi, Sera.
    The recent articles I’ve read on Assisted Outpatient Treatment are incredibly disturbing. I also read your newsletter article to the RLC on this topic. I’ve read that over 40 states have AOT programs and that CT and MA are soon to follow suit. While some look at it as an eventuality given that it appears the deck is stacked against us, I view this as an opportunity. This may be the final battleground that we have to shift the momentum in the opposite direction. I am eager to get involved in this movement, but have significant fears about my professional image that have long kept me away from the spotlight. Then again, I’ve been performing standup comedy under the flim jannery pseudo name for a whole now… Edging and inching into the spotlight with many conflicting feelings. It is frustrating because I oppose labels and treatments but in order to ally myself with the community and movement I must represent my labels and issues. In any event, Id love to talk with you about these issues and how I can get involved. I live in Western MA. I was going to attend the Voices training this month but had work/personal issues that prevented me. Let’s talk when you have time.

    Flim

  7. it designates one seat to a ‘peer specialist’ (as defined above) and another to someone who has been not only in ‘active treatment’ for the last two years but who has expressly ‘benefited from’

    Sure that makes sense. Just like it makes sense for peer counselors on domestic violence to be required to have been undergoing active physical abuse for at least two years, and “expressly benefitting” from it. 🙁