When There’s No Place Like Home…. 

Margaret Altman, MSW
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Editor’s Note: This story contains an account of an involuntary psychiatric hold, which could potentially be triggering for readers. We recognize that this issue is contentious and likely to elicit strong feelings, but we believe it’s important to open up a space to talk about difficult issues.

“Life is not about wishing for better chapters to manifest in your life; it is about continuously writing them with your thoughts, beliefs, decisions and actions.”

Edmond Mbiaka

The most difficult decision I have had to make as a clinician has been to place an individual on a 5150. This is the LPS (Lanterman-Petris-Short Act*) 72-hour hold that sends a person into a locked psychiatric unit for up to 72 hours.  The emotional impact affects the individual who is going to be placed on the 72-hour hold, and their family. The emotions that are involved in the process of observing the person, collecting information, and finally making the life-altering decision are powerful and long-lasting for the person making the decision as well. That is, if they are compassionate and involved.

It is important that all who are involved in the field of psychology/psychiatry at any level be aware of the extensive ramifications of the formidable process of initiating the 72-hour hold, since it affects the course of many individuals’ lives, and profoundly and intimately affects – at the core – self-esteem, the ability to trust, and the sense of control over one’s own destiny.

Throughout this process the person most critically affected is the person in emotional distress, and this is because that vulnerable person will be stripped of their freedom, they will be pressured and possibly coerced into taking medication, they will be diagnosed and labeled, and they may be further traumatized and dehumanized. Their families will suffer similar fates.

As part of my job responsibilities when I worked in the ERs of community medical centers, in the psychiatric ER of a county hospital, in the LA Jail, and in a county-private outpatient clinic I had to take a course and a test in order to become designated to write LPS holds. I was aware from the beginning that having this “power” carried grave implications, and that I hoped I would not have to use it. But in several cases, as I will explain below, I could find no alternative.

I also and unfortunately found that several other clinicians used this powerful tool in ways that I would not have. The 72-hour hold, for example, can be used as a threat against someone who is perceived as noncompliant; a designated writer of holds can transition a person out of a crowded emergency room and into a “crisis evaluation center,” thereby quickly relieving the ER of a “non-medical” patient.

Although the 72-hour hold is for individuals who are at high risk for self-harm, harm to others, or “grave disability,” the majority of the cases that I found in the emergency rooms involved the third category; grave disability.  With time and effort the immediate problem of the person not being able to provide food and shelter could be resolved by locating relatives, or programs for those who are alcoholic or drug-dependent.

My overarching goal was to protect every  individual’s right to self-determination; to avoid labeling and the coercion to be treated medically, and to maintain some trust in people who are trying to help. All of this would disappear once the process of detaining the individual began.

The emotional impact of placing a person on a hold is rarely discussed perhaps because examining this aspect brings up issues of power and control, the reality of rights and freedoms (and their elimination), and the transitioning of an individual to a hospital where they may well be traumatized yet again. All of these issues unfold very rapidly, and as the 72-hour hold is written the feelings are often overwhelming for all involved.

The language of the 72-hour hold speaks volumes about the emotions and thoughts that it generates. The terms and phrases are negative and linked to the criminal domain; “detained,” “mental health disorder,” “court hearing,” “custody,” ” psychiatric evaluation,” and “you may make a phone call.” Often in these cases the person being placed on a hold is already in emotional distress, confused, and in the middle of a loud unfriendly emergency room environment.

They are also probably hungry, possibly in physical pain, and most probably alone. He or she has been brought in by police, and now another person is in an authoritative position telling them that they are going to be “detained” due to their “mental disorder” for a period of 72 hours, and sent to a “facility” for a psychiatric evaluation. They are told that their rights will be explained to them when they get to their destination. They are informed about why they are deemed likely to harm themselves or others, and/or are unable to provide for their own food and shelter. There are many and varied reactions to all of this information – most of them extremely negative – and Mary’s response was just one of them.

Mary G is a 32-year-old woman who lived in the bushes outside of the for-profit hospital where I worked. The hospital has no psychiatric unit, and there is no psychiatrist on staff. When there is a person in emotional distress the social worker is called in and, if needed, an outside consulting psychiatrist is called.

Mary had been brought in by the security guards several times when they found her wandering around the hospital or sleeping under a bush, and she refused to leave the premises. Nursing staff in the ER would give her something to eat after triage showed that she did not have a medical problem, and then they would show her the door.

Ultimately, her condition deteriorated. She had bruises on her face and body, and she was very thin, disoriented and agitated. She appeared to be hearing voices and she was responding verbally and behaviorally by picking up things from patient’s trays. At one point she picked up a plastic knife and made cutting motions against her neck.

When I met her I could find no record of her in the data base and from what she said my impression was that she was from out of state. She denied any mental health history. She said she had no family and that she was “fine.” When the subject of hospitalizations, medications or any related subjects were brought up she became fearful and paced the room. I noted the bruises on her body and several deep scars on her wrists but she denied ever trying to harm herself.

In her disorganized verbalization she did say that people “hit her” and that she thought she might be “dead already.”  After a brief period of interacting with her and bringing her the only food (bread and water) that she believed was not “poisoned” she became more organized, and relaxed with me. She had no plan for herself but did not want to go to a shelter, as there people stole things and were rough with her. She just wanted “to go home” although she had no home to go to.

I could see that Mary was intelligent and had decompensated at least in part due to lack of food, support and abuses she had suffered. She elicited positive feelings in me and I began my search for a place or program that could take care of her. Mary had no ID, no paperwork at all, and this along with the fact that she had no disability income, no Medical insureance, and was seriously decompensated made for formidable barriers.

Programs and a few beds were available for those with chemical or alcohol addictions. Shelters were full, or in very dangerous areas downtown. There was the issue of self-harm and also of her being victimized if she were simply allowed to leave. I did not know her history and what any further decompensation would bring.

As with many other people in similar states Mary became more comfortable in the ER where she was warm and fed and listened to. I, on the other hand, was struggling with the choices, which were quickly narrowing down to the one that I did not wish to make.

Clinicians need to have strong emotional boundaries, but it is terribly difficult – if not impossible – to avoid feeling frustrated and concerned about the well-being of a person that may have to be sent to a locked in-patient ward in a psychiatric hospital.

The conversation with Mary came at a point where I had exhausted all alternative routes and was faced with the fact that Mary needed to be in a safe place where she had food, shelter, and hopefully time to recover enough to make a plan for her own care.  I sat with her in a quiet place and shared with her my concerns about her being alone, being bruised and having no place to live. She repeated that she was “fine,” and appeared unconcerned.

When I said that I was going to put her on a 72-hour hold, and went through the facts of the hold – the detainment, the psychiatric evaluation and the criteria for the hold – she became upset and began to pace the room. She repeated the statement “No, you can’t do that. Not again” several times and I was aware that she had probably been through this before. She was angry and then broke down in tears.  It was a very appropriate reaction to being detained and sent to a hospital. I felt terribly sad for her. I asked again if she could come up with a plan for herself and again she said that she was “fine.”

Although the decision had now been made I was not going to be free from the emotional burden of having made it. Mary was rambling incoherently now and I knew that she was in emotional pain and without much comfort that I could give to her.

Before the ambulance came to take Mary to the hospital I reviewed everything that I had done in an effort to come to terms with the situation. She became very quiet and withdrawn, retreating into some inner place that protected her from further assaults for the time being. I was unhappy about what she might face in the days ahead, and I was again terribly frustrated by the lack of resources that perpetuate the cycle of distress, and severely cripple any attempts to provide the kind of care that she needed.

I do not seek to compare my on-going discomfort with her terror and her trauma. I can move forward with proposing reforms, joining advocacy movements and thinking about a better future for vulnerable individuals. Mary, on the other hand, remains trapped in a system that resists changing its perceptions and its prescriptions for the well-being of people like Mary.

* * * * *

*Editorial note: The Lanterman-Petris-Short Act, signed into law by Ronald Reagan in 1972, was intended to end “all hospital commitments by the judiciary system, except in the case of criminal sentencing, e.g., convicted sexual offenders, and those who were ‘gravely disabled,’ defined as unable to obtain food, clothing, or housing.” (Wikipedia)

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Margaret Altman, MSW
Voiceless in America: Margaret Altman is a crisis intervention specialist and has intervened in many explosive situations within jails, emergency rooms, suicide prevention centers and psychiatric units. She enjoys writing and researching on a wide range of topics, primarily in realms lacking a sufficient knowledge base such as explosive behavior syndromes.

118 COMMENTS

  1. I’m going to be blunt here: if you feel horrible for what you did to that poor woman you should be. This is exactly the arrogance and ignorance that psychiatric survivors are talking about here and which people like you are apparently not able to understand (since I think you’re actually trying to listen to us). I mean, which part of: “No, you can’t do that. Not again” can’t you understand? Why do you think you can take that decision for her when it’s clear she prefers to go back to wherever but not to locked ward.

    This story is extremely triggering for me and shows exactly what is wrong with psychiatry. Compassion rammed down someone else’s throat against his/her will is not compassion. If you can’t provide someone with help they want you can’t provide someone with help period and should be able to accept that and not make choices for that person. You can’t help someone against his/her will – that is not help, that is abuse. If you say that it’s the system that forces you to do that then how can you work within the system that makes you commit such horrific acts? “I was just following orders” is not a valid excuse anymore, is it?

    I can’t express how frustrating that is. I could maybe understand the cluelessness like that of the “pizza lady” who suggested that forced patients would be made to feel better by throwing them a discharge party. But you know what is going to happen to this poor woman, you know how it ruined people’s lives and drives them suicidal – you blog on MIA and read our stories – and yet you did that. This is absolutely disgusting.

    I was trying to take my own life because of a person like you who did the very similar thing to me. Because of the horrific abuse that it started. I didn’t succeed but if I had that person would be personally responsible for my death. Are you prepared to take that responsibility should Mary kill herself (which I pray she will not)?

    Why do you keep doing this? WHY?

    • I hear your anger and I believe that it is about the system and not me personally. My choice for this poor woman was to keep her from being beaten up physically in the bushes outside of the hospital. I couldn’t have lived with myself if that had happened. Yes, sometimes there are bad choices and worse choices but I stay motivated to create a respite in my area which has absolutely nothing for people in crisis. If I took the anger that you expressed as a personal blow I would not have the self-confidence nor the strength to move forward for people like Mary.

      • Margie, I believe that you are a good person and that you want to do what’s right, and I appreciate your writing on MiA and your other efforts toward real alternatives for people in emotional distress. It is because I think very highly of you that, like B, I find this article shocking. I don’t think anyone is criticizing you as a person, but your actions in this case cannot go without criticism. I hope you do stay motivated to create a respite center, but if you do not, you cannot blame that on someone’s legitimate criticism of what you did to Mary.

      • I am angry with you personally too. And disappointed. It was not your decision to take.

        “I couldn’t have lived with myself if that had happened.”
        Can you live with yourself now that Mary is subject to psychiatric torture? As a surviviour of it I can tell you I’d take beating in the bushes any time. And she has taken a decision and communicated it to you and you decided that you’re going to do what felt better for you. Against her will. That’s not right.

        I’m not saying that to be mean or offend you or anything. I’m just saying this because you’re 100% wrong and you have blinders on. You may feel compassion for her but you clearly can’t empathise with her. How many times do we, psychiatric torture surviviours have to tell you that it’s wrong? How many times do we have to explain how dehumanizing and traumatizing psychiatric torture is? And you still act like it was in any way better than whatever possible abuse that she would face in the real world.

        I don’t know what would have happened to her if you let her go. Maybe, possibly it would be really bad. Maybe she would kill herself. But at the very least it would be her decision. She would have the autonomy, she would be the subject and not the object. You clearly don’t understand that you’re taking from people what is the most important. People survive horrific things or they perish but they at least have their dignity left. The control over whatever good or bad decisions. You’re taking the only thing that people really have in this life – the autonomy and control over their own minds. There’s nothing worse than that.

        If you really want to help people like Mary, why don’t you work for a respite centre? For a homeless people shelter? Create a space where people like she could go and get the physical safety that would enable to recover and if not then at least would let her live her crazy life in relative comfort? Why do you have to continue feeding the broken abusive system and taking the “hard” decisions that help no one?

        “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
        C. S. Lewis

        Ponder that for a moment.

      • It would be an illusion to think of Altman’s choice of locking this woman up for 3+ days as making a significant difference to the long-term likelihood of her being beaten up. The forced treatment might make Altman feel she is doing something to keep this person safe – and perhaps that was its main function, to protect Altman’s psyche rather than the woman’s body.

        The poor woman probably got kicked out of the hospital a week later, doped up on meds, and returned to living in the bushes in the same state of vulnerability to being beaten up, or even worse, to when first evaluated. Or maybe she was went to a halfway house, got kicked out of that, and then returned to living in the wilds.

        It is a hard decision and there is no good choice… the reality is that Altman’s decision may have mattered little either way in terms of this woman’s fate… although it may well have disempowered and discouraged her even more. I would have preferred the option that Norman discussed in his post below, of letting the person make their own decision and take their own risks with their mental state, because it is a more respectful position.

        What is really needed in this type of case is long-term housing with peer support and/or psychotherapy without medication, the type of support that existed for example in the Vermont Project, Soteria, or Open Dialogue. Without these, the choice comes down to the metaphorical Scyllas and Charybdises of 1) Throwing a person back out into the wastelands immediately, or 2) Locking them up and then a few days later throwing them out into the wastelands; not much of a choice…

          • I disagree. Perhaps that is a long term issue and one that will require many things, including funds.

            The immediate and most relevant issue here is the taking away of another adult’s free will of choice. To correct this, the only thing required is humility, in the moment. Otherwise, one is playing God, and personally, I don’t ever feel that is a very wise choice to make, as it will inevitably boomerang.

    • To B 9/18/2015 6:40 pm

      I TOTALLY understand your anger. If I’m ever AOT’d, I think I’ll probably be among the millions of people who kill themselves within a year of their discharge from the my “care”. The stakes are life and death, AOT or no AOT. Ms. Altman, though, is different from the majority of psychiatric drones that destroy Mad people’s lives with “coercive compassion”. She seems to want to help develop safe, individualized, and force-free mental health programs. I would imagine that she is one of many people working in the pro-force psychiatric systems who would gladly implement healthy, holistic, and effective alternatives to the abusive and counterproductive psychiatric policies and programs that Mad people hate. Mad people need to be giving Ms. Altman’s feelings and experiences the respect they deserve and we need to keep in mind that clinicians take on huge professional obstacles for themselves when they speak out on behalf of the systemic abuse and neglect of Mad people by pro-force and mainstream psychiatry. What Ms. Altman does for us is immensely important and it’s not an easy thing for her to do, so please try to hate the game and not the players.

      • we need to keep in mind that clinicians take on huge professional obstacles for themselves when they speak out on behalf of the systemic abuse and neglect of Mad people by pro-force and mainstream psychiatry.

        Maybe your apparent grammatical error re: “speaking out on behalf of systematic abuse and neglect” was a Freudian slip, but it seems to describe the situation accurately.

        When one is part of an inhuman system and speaks out about it there are indeed repercussions which may be expected. When one participates in the crimes of that system she/he is responsible for the consequences and must be willing, at the very least, to endure criticism.

        • To oldhead 9/19/2015 3:04 pm

          You know, maybe it was a Freudian slip. I meant to say “speak out AGAINST”. That just goes to show how deeply disturbed this article makes me feel and how unsure I am about what good-hearted clinicians should do to maneuver the sanist psychiatric system that oppresses Mad people.

          • Was it JFK or MLK or RFK that said I paraphrase :
            “Ask not what coercive psychiatry can do for you ?” “Ask what you can do to at least abolish coercive psychiatry ?”

            ( Ok so I said it.)

      • At no point have I said I hate her. I simply expressed my anger and frustration and described my perspective.

        I understand that the system is broken and that many people working within it are not necessarily bad people and they may have the best of intentions but it does not excuse each and every action. Maybe if someone if forced to do things like that because of being in the system then a morally right choice is to quit? I do believe that she does a lot of good things for people but then if I were on Mary’s place I’d not care a bit. The same I don’t care if the person who did something like that too me is a good person in other circumstances. It’s simply not an excuse.

        I know there are places in which you can’t avoid doing things against your convictions. That’s why I’d never in my life join a military unless my country was under attack nor would I go work for an institution which I consider immoral.

  2. Thank you for your transparency so that I can see from where you are coming regarding your internal conflict around this. Still, I find this virtually impossible to reconcile in any way that seems reasonable to me. This is a big split in consciousness, completely mixed messages.

  3. Hi Margaret,

    I think that you express the dilemma that many mental health workers feel. I also feel that it is unfair for people on this board to criticize when they have not been placed in a position of responsibility for someone’s life. Most of the people who post here have thought hard and insightfully about their own experiences. We all know the importance of respect and autonomy of the individual. Yet sometimes for those of us who work in the mental health field, we have to deal with situations where a person’s life may be in imminent danger. We know that the hospital system will not provide optimal care and respect, yet we also now that the outside world can be hostile and abusive.
    In my own practice I never send people to hospital any more, as I know that they will not get reasonable help. I am willing to, with the individual, take the chance that suicidal feelings will result in death. Most of the time, showing this respect and understanding leads to a better therapeutic relationship, and the feeling in the patient that I am willing and able to accept their pain. But sometimes it doesn’t work. A few years ago a very troubled young man, who had been hospitalized in the past, asked me to promise never to hospitalize him. I agreed that I would only do so with his consent. He did end up taking his life a while later, just a day after I had seen him, though had kept any plans he may have had secret.
    The main issue is that there often is no best action. Many people who suffer emotionally don’t have agency of their own, and may not be in a position to make the best choices for themselves. Sometimes, we just can’t abandon them to the world. The points you bring out are excellent. Sometimes we do things that we would prefer not to have to do, but are simply trying our best in a bad system.
    We all need to have empathy for others, including others who may see life differently, or are in positions of authority. It is easy to find fault with mental health workers, but not so easy to find better ways of negotiating the present system.

    • “But sometimes it doesn’t work. (…) Many people who suffer emotionally don’t have agency of their own, and may not be in a position to make the best choices for themselves. Sometimes, we just can’t abandon them to the world. ”

      OK, let’s stop right here. This is the recurrent theme: but if you tried everything and the person is still suicidal? Well, then, you’ve tried everything and it’s the right of that person to decide and you should let them go. You accept this right for people with cancer who decide to forgo chemotherapy because it’s too painful for them and by that forgo the whatever % chance they have for recovery? It goes back to the same issue – people in mental distress are seen as incapable of taking decisions, as children who have to be protected from themselves. And psych professionals see themselves as people who know what the “right” way of thinking is and the right response and suicide is always unreasonable. That is simply not true. And it’s arrogant to say so. This is a cruel world and I can’t say that deciding to say goodbye to it is any more or less reasonable than the decision to keep going. And I’m not inside someone else’s mind to tell them what kind of pain they should be pushing through to get to this better place that may not even be there for them.

      I have a feeling that some people who force others into “treatment” and I mean these more compassionate ones (which in my view are a minority anyway) do that mainly to make themselves feel better. I don’t mean that to offend anyone but that’s just human nature. Everyone wants to be in control and prevent bad things from happening and keep people alive. They can’t accept that sometimes you just have to let go and it’s a decent thing to do. That using force against someone is just pointlessly adding to their agony.

      Why putting Mary in a place where she definitely didn’t want to go and that being confronted with an alternative of going to her less than perfect life? Well, you can only do that if you assume you know better what’s best for her and her opinion can be disregarded. It’s an awful thing to do and all the responsibility for the misery that ensues will fall on a person taking that decision.

      In this example it even looks like there was a theoretical alternative – providing Mary with a safe space, a respite in which she could escape the abuse of the daily life. It reminds me of a discussion that goes around euthanasia for some quadriplegic people. Many compassionate guys deny it saying that many of the reasons that quadriplegic patients cite as a justification for letting them die could be easily fixed by better care. That’s all fine and good but we live in the real world and while we deny these people the right to die citing a theoretical possibility of improving their lives “somewhen” they continue to suffer. So while you tell them to “have hope” and force them to live you’re essentially condemning them to hell on earth. Should that be your decision to take? Because you’re uncomfortable with someone killing themselves? Life is only a value when a person wants to live, not when it becomes torture.

      I can identify with Mary and I can tell you were I in her place I’d rather go on the street and cope with any abuse there on my own than go back to psych ward. There’s no hell worse than this fate.

      If you really want to make positive difference in people’s lives why don’t you join in creating places like this:
      http://www.westernmassrlc.org/afiya
      Why do you continue to work for the system in which you have to go against your own principles?

      And please, don’t use this as an excuse:
      “I also feel that it is unfair for people on this board to criticize when they have not been placed in a position of responsibility for someone’s life. (…) Yet sometimes for those of us who work in the mental health field, we have to deal with situations where a person’s life may be in imminent danger.”
      as a psychiatric surviviour who had this kind of arguments offensive. They were used against me to justify rape, torture and traumatisation . You are not responsible for my life. You’re not a surgeon who deals with me when I’m unconscious. If I’m not passed out I have responsibility for myself and that includes right to follow or not any advice you give me. It includes the right to self harm and to suicide. I reject the idea you can take this right away from me and torture me “for my own good”.

      • I agree with B. If you say we have no right to criticize something like this, then what on earth are we discussing here? This is EXACTLY the point of these discussions, to point out and criticize the actions which undermine a person’s human rights and freedom of choice. Or so I thought.

        Honestly, at this point it feels a bit like quicksand in here. I’m hearing rationalizations and defensiveness on the part the system. This is the problem.

      • I was placed on this earth in a “position of responsibility for someone’s life” by God, the two initially helpless infants I bore. And the psychiatrists I dealt with called this “position of responsibility” for these two actually innocent and helpless lives, “irrelevant to reality,” “w/o work, content, and talent,” and “unemployed.”

        And they proceeded to massively poison me, due to their delusions they were in a “position of responsibility for” my life. Because I was looking for a doctor capable of confessing a synthetic opiod could cause adverse effects, especially when wrongly prescribed with an antidepressant and a NSAI.

        Psychiatrists believe it’s more important to profit off defaming, tranquilizing, and torturing stay at home mothers, thus also trying to destroy their children’s lives, than in confessing to the commonly known adverse effects of wrongly prescribed pharmacutical drugs.

        It is the psychiatric industry which is “irrelevant to reality,” “w/o work, content, and talent,” and should be “unemployed.” And that industry needs to overcome their delusions grown adults suffering from adverse effects of wrongly prescribed pharmacuticals, or even street drugs, are incapable adults. Overcome your own delusions of grandeur, let mother’s raise their children, without trying to profit off drugging them. Drug pushers are sickos, especially when they hypocritically pretend they are doctors.

        • “And that industry needs to overcome their delusions grown adults suffering from adverse effects of wrongly prescribed pharmaceuticals, or even street drugs, are incapable adults. Overcome your own delusions of grandeur…”

          I agree. What we’re witnessing here is ‘nanny state’ thinking. I thought that was what this website is advocating AGAINST.

    • Thanks for the comment. I just wonder; if Mary were the daughter of any of the readers here and she refused to be helped by them and her only plan was to live under a bush and be an abused target for any predator, would any of the readers ask me to just let her make her own decisions and go back to the bush, to starvation, to abuse ? I have never had a family member ask me to step away and let a very confused, disorganized, abused and homeless person go back to a dangerous situation. Never happened. They ask me to keep the person safe any way that I can.

      • If that were my daughter, I’d wonder where the hell I went wrong, and then proceed to understand exactly why this situation would have manifested in my family, as it would OBVIOUSLY have been something I had neglected to see or whatever. Id’ want to correct this immediately, although I’d shudder to realize that it had gone that far. I’d need to do my own personal growth in a awareness at that time, to correct my perception. That’s called “taking personal responsibility.” I would, indeed, not expect others to take charge of my family!

        • AND, I would not in the slightest blame this woman, if she were my daughter, for my mistakes. Anyone who ends up in this state has lacked love in their life, and if I were her father, I could only look to myself for why this would be. After all, from where do we expect the love to come, if not from our own families? This would be a rude awakening for me–about ME–were I to discover that my daughter is sleeping under bushes and allowing herself to be abused.

          • Then, my desire would be to lovingly and sincerely invite her back home, where I’d want to make her feel like the most loved and treasured person in the universe, as the path to healing. We’d both have a lot of growth and healing to do. Hopefully, she would trust me at that point. If not, I’d struggle a great deal with that, but I’d have to let her go, and trust her own spirit to guide her. That would be hard, but I feel it would be the wise thing to do. Then, I’d learn to forgive myself. And in the process, I’d have learned unconditional love and humility like nobody’s business.

            Ok, I wanted to complete the story. Thanks for asking.

          • Yes, a rude awakening but this is not unusual and parents/families struggle with guilt even thought it is often not their fault at all. But what would you be able to walk away from that bush and leave her there?

          • I’m sure I would try all sorts of things and be desperate about it, but in the end, I would neither force nor drag anyone anywhere against their will. I’m sure I’d try to get all sorts of people to appeal to her and reach her. But I would NEVER turn her over, willingly, to a corrupt and dangerous system, under any circumstances! No way.

            I trust that which is greater than ourselves, and often, that is a hard choice, but I always find it to be the best and most wise path to take, as opposed to being controlling. People are inherently free, that is my belief. What you do is unnatural in that it literally goes against nature.

          • Also, regarding this statement,

            “…parents/families struggle with guilt even thought it is often not their fault at all.”

            It’s not so much about ‘being at fault’ as it is taking responsibility. It is a family SYSTEM. Your perspective is what creates the illusion of IDENTIFIED PATIENT, which is a toxic concept and only serves to keep a system stuck in injustice and imbalance.

            If parents react defensively to their child being homeless and at risk with ‘It’s not our fault!” then they are most definitely in denial of something. We all make mistakes, and sometimes we awaken to our mistakes after they have snowballed. But at any time, we can own, shift, and correct. If we stick with ‘It’s not our fault!” then no one grows and nothing at all changes. Things just continue to get worse, despite any thinly-veiled illusion to the contrary.

            Of course they have some kind of responsibility, here, people don’t evolve out of nowhere. Somewhere, communication was not clear and the neglect turned into trauma. Someone was not paying attention.

            Self-compassion and self-forgiveness allow us to correct our mistakes, rather than to continue perpetuating them, while being racked with guilt the whole time. That just continues the cycle, and the guilt never stops. Lose/lose.

          • “But what would you be able to walk away from that bush and leave her there?”

            If that’s what she told me – yes. You can’t help someone against their will.

          • “It is a family SYSTEM”

            …and let’s not forget that some people have sh*tty, abusive families and you’ll never know because they look so normal. So many people end up “mental patients” because of conscious efforts of abusive parents or spouses.

      • So it is OK to abuse and torture someone because his/her family says so?

        I have told my family that if I ever come into contact with psychiatry and they ever cooperate with them I won’t speak to them again. That I’d rather die than to go to this hell again. And I’d never ever condemn any of my family members or friends to psychiatry – not only subject them to forced “treatment” but any of it. I’d not take them to a psychiatrist or psychologist and if they wanted my advice I’d tell them to stay away. So no, I’d rather my daughter went back to wherever she wants to go than be tortured, abused, imprisoned and her mind and body destroyed by drugs.

        I think you have no idea what kind of torture you’re sending people too. Neither do their families.

      • ” I just wonder; if Mary were the daughter of any of the readers here and she refused to be helped by them and her only plan was to live under a bush and be an abused target for any predator, would any of the readers ask me to just let her make her own decisions and go back to the bush, to starvation, to abuse ?”

        Hi Margie, I just wish to comment on this before reading the rest of the comments. I would suggest that detaining a person in an environment where 45% of female patients admitted report being sexually assualted, to then be drugged to deal with the trauma of the environment, finding that nothing can be done, and then releasing them with them knowing they can be snatched from the street at any time the State chooses is ….. That bush might have looked like a very safe place to Mary.

  4. I am a psychiatric survivor and like to think of myself as realist.
    I believe in involuntary commitment. The golden rule, he/she who has the gold makes the rules.

    Mary G aged 32 woman was apparently homeless.
    She could not take care of herself , so what you did was most probably a mercy.

    I would suggest people like this do not have the intelligence and discipline to look after themselves and not a “mental illness”. If people are judged having a mental illness , they would ” need” psychiatric drugs. Or obviously living without a home makes anyone crazy with, no sleep , no food, no clean water to drink and bath in, etcetera.

    If you take away the freedom of people like Mary, you have to give them an honest chance of escape from captivity.
    If the patient is psychdrugged they can not cognitively think to ask – argue for their freedom. The default is drug everyone stupid so they can’t complain about the captivity . The drug companies make billions. The patients can’t prove their innocence (there are no brain chemical imbalances to correct). No one in power is made upset by this nobody being drugged immobile.

    Comic on too much “help”.http://www.smbc-comics.com/index.php?db=comics&id=2879#comic

    • This is an excellent point and it’s one that I think Ms. Altman should have addressed in her article. The days that Mary spent on the ward weren’t the biggest decimation of her liberty. The psych drugs were. That poison will disable and silence her long after her days, weeks, or months on the ward are up. Even if – and this is a BIG if – involuntary treatment was necessary, it should only have been limited to hospitalization and, perhaps, a *very* low dose of medication. Unfortunately for Ms. Altman, she could not control whether or not Mary was force-drugged. The choice to pump this vulnerable woman full of toxic chemicals was made by her Gobbelsian psychiatrist, whoever he or she was. That monster is who we should all be railing against.

    • Your belief in “Involuntary commitment” (i.e. psychiatric slavery) is not shared by me. Nor do I worship at the altar of King Midas.

      Mary G. was obviously upset that she was being, as had happened previously, detained for evaluation. This evaluation, as has happened to me, could lead to your belief, that is, imprisonment in a prison that calls itself a hospital. Mary G. had much very real reason to be viably upset. Of course, what is it to be visibly upset? Oh yeah, in distress, or as the hospital employees put it, symptomatic. How’s that for a game rigged beyond the possibility of winning.

      Cut the melodrama and the hypocrisy, and you don’t imprison people who have committed no crimes. Sure, you were only showing your concern. I’d say there is much more BS there than anybody could cut through with a snowplow. I hope that Mary G. nonetheless manages to wise up, and when I say this I mean maybe there are better bushes to sleep under than the bush beside a hospital.

      Sometimes survival depends on eluding the folks who can and will kill you. Do I have an advise for people in such matters? Sure do. If you’re not physically ill or injured, don’t visit the ER. I had a detective tell me to volunteer myself into the hospital once. I listened to him, went to the ER, and thereby lost 5 months of my life. I know better now. As people have more rights in the criminal justice system than they do in the mental health system, I will tempt arrest first any day of the week before I will give myself up to those bastards in the white suits. I’m not pleading insanity, but if you’re asking for that kind of thing, I’m going to ask you for your proof, and by that I don’t mean some stuffed shirt’s opinion.

      • You don’t worship King Midas , but the world worships money. https://en.wikipedia.org/wiki/Money

        If someone lacks the skills and intelligence to take care of themselves you don’t toss them on the street.
        Intellectual disability https://en.wikipedia.org/wiki/Intellectual_disability

        That the psychiatric drugs can make people appear to have an Intellectual disability, or over time the drugs in fact create one through brain shrinkage/damage, is criminal.

      • “I had a detective tell me to volunteer myself into the hospital ”
        I had my loving parents do this. My unschooled parents (grade 9) believed the lies of men in white coats, doctors.

        When your own parents back stab you for your “health” ( out of fear of the future) , who can you trust?

        Parents naturally fear for the health of their children , and naturally trust someone licensed as a doctor. And the psychiatrist exploits the fear of the possible bad future by selling magical pills that magically make people think and be “good” instead of “bad”.

  5. Margie,

    You and I have emailed back and forth a bit, I believe your heart is in the right place, you know the entire system is set up completely wrong, and you feel this leaves you with no decent alternatives – it’s a systemic problem, and you’re just doing the best you can given the complete stupidity and insanity of the system that the psychiatrists set up for themselves (and/or the higher powers that be set up).

    I agree, the entire US psychiatric system should be scrapped, it’s as invalid and devious as the Nazi German psychiatric industry was. No doubt it was set up, and is being perpetuated, by money grubbing sociopaths. Who in their right mind would think a lack of safe housing problem, could be fixed with psychotropic drugs? Only completely evil, for profit only minded, psychopaths. But reading this does make it clear that neither you, nor any of the “professionals,” have any clue how truly appalling, demoralizing, humiliating, downright evil, and completely inhumane the psychiatric “system,” and the drugs you use, truly are.

    And it’s not just the “down trodden” who are being targeted by psychiatry. Well insured, upper middle class, white women who’ve worked, saved enough to pay off their half of their suburban home, so they could stay home and properly raise their children, are also targets of psychiatry. Anyone, who doesn’t choose to behave as a slave for the psychiatric industry’s monied “masters” is a potential target.

    Learn something about how psychiatry actually functions. It is the evil option, not the benign or benevolent one. Take some neuroleptics, or better yet, some “bipolar” polypharmacy antipsychotics, mixed with some antidepressants and benzos. Create some anticholinerginic toxidrome induced psychosis. Then have every doctor who speaks to any member of your family for years inexplicably defame you with invalid, “life long, incurable, genetic mental illnesses,” of which you have no genetic history. Have them dismiss every word you say, and declare your entire life a “credible fictional story,” all while lying to your face, make believing they’re trying to help you.

    Have five giant paramedics illegally drag you out of the comfort of you own bed, and home, while the sixth paramedic tells all, “this is illegal,” since you are neither a danger to yourself, nor anyone else. Then have them take you to a hospital, that is no longer covered by your new insurance group, since you had to change insurance groups due to the prior
    anticholinergic intoxication poisonings.

    There they’ll put you on a hypnotic drug, claim Jesus speaks through you, and warns them they’re orchestrating your attempted murder. But the looney social worker who believes this hypnotic drug induced verbiage is proof your crazy, rather than she, medically unnecessarily ships you, not to the closest hospital in your new insurance group. No, she ships you a long distance to a doctor like V R Kuchipudi, here’s a little about this psychopathic, now FBI arrested, doctor.

    http://chicagoist.com/2013/04/16/chicago_hospital_owner_doctors_arre.php

    At this next hospital, you’ll be admitted with a fictitious “chronic airway obstruction,” in the hopes the ensuing drug induced torture will result in an unneeded tracheotomy. Then, this “airway obstruction” will magically turn into “bipolar,” and you’ll be “snowed” – drugged until only the whites of your eyes show with different, willy nilly anticholinerginic toxidrome inducing drug cocktails for days on end. Only, to be let out of the hospital when your insurance company refuses to no longer pay for this torture – all to defraud your insurance company out of $30,000 for this unneeded medical care. While the doctors are angered, since their “snowing” didn’t result in the more profitable unneeded tracheotomy surgery.

    And, while you were being held in this hospital, allowed no visitors, friends even turned away after their long trek to visit you. Your husband, who had years ago been brainwashed by psychiatrists into believing you have a “life long, incurable, genetic mental illness” buys into his unethical banking industry siblings’ plan to steal all your money – during this medically unnecessary hospital gaslighting. They set up bank accounts to ferret your money into, while you’re illegally held against your will by psychiatry.

    I could go on and on, there was another medically provable unnecessary hospitalization – by the same psychiatrist as the first unneeded hospitalization, with no HIPPA forms signed, so it’s highly ironic I was once again shipped a long distance to her. My children and I had to go for years without health insurance, after my husband’s untimely death from a heart attack, due to this psychiatric misdiagnosis / gaslighting. This psychiatrist was fraudulently listing me as her “outpatient” at hospitals I’d never been to, according to insurance companies, and at a hospital in a state in which I no longer lived in, according to that hospital.

    I was only able to get the misdiagnoses off my medical records because I am a good medical researcher, thanks to Dr. Google, thus I knew more than the doctors eventually. And decent and self-respecting doctors tend to be able to admit when they’ve met that “one in a million,” and show a little respect (or greed), when respect is due. But God only knows what will happen if I run into another unethical, insecure doctor who believes in the validity of the make believe DSM disorders. The psychiatric industry is making a mockery of this entire country, and has already corrupted, deluded, and destroyed the credibility of the entire medical industry.

    The bottom line is power corrupts, and absolute power corrupts absolutely. Giving psychiatrists or doctors the right to forcibly or coercively medicate any one they want, with any drug they want, for any reason they want legally, has completely corrupted the medical industry. Their iatrogenesis and “proper medical care” are now likely the number one killer of all humans on the planet, at least my research indicates their “care” now results in more deaths than any other cause in the US.

    This country was made great by “rugged individualism” and actual competition, and it’s now being destroyed by international corporate psychopathy, massive misinformation / deception, and extreme injustice. We need to go back to what made the US great, and help bring up the rest of the world. Rather than letting the evil that has and is destroying the rest of the world infect this country, too. God help us.

  6. The benevolent psych doctor up above says we never had any responsibility for another life . Even while I was scuffling across the floor deeply under the influence of coercively receiving 800 mgs. a day of Thorazine ( which at the time I was unaware I was being given a well planned by psych doctor ordered chemical lobotomy ) . A week or so in , of drug induced scuffling they mistook for absolute compliance I guess they felt I had earned a reward and I was allowed outside in the fenced in area to breathe fresh air and see the sky and sun. I was warned to be careful of too much sun exposure. There was no one out there but me in my chemical strait-jacket . Then suddenly a young woman about my age (17) ran outside looked back at me as she grabbed a lawn chair dragged it to the corner of the 8 foot high wooden fence and said to me ” Don’t say anything ” then she stepped on the chair and climbed over the fence . I scuffled to the chair as quickly as I could grabbed it and put it back where it was before the woman grabbed it. Not a minute went by when an orderly came rushing outside . I was sitting in a chair enjoying the idea that someone got free. He asked me if I had seen anyone come out here . I said I hadn’t seen anyone. Later in the day a different orderly asked me “where did she go over the fence ?” I played dumb and said, “I don’t know anything about it”. He said to me just like in the movies ,” You know I can make things hard on you ” I repeated , “I don’t know anything about it. ” I still laugh inside about how I was able to help that teen age girl more cleanly escape, and not a pang of guilt inside me in all these years ( I’m 68 ) for not considering all the “psychiatric care ” I may have had a hand in denying her.

    • Fred,

      The benevolent psych doctor up above is not acting as the one responsible for the *life* of the person, just their pulse– AND, neglects to say that it is liability, not responsibility that drives his willful ignorance of the crime he is committing–.

      Ability to “respond”– responsibility– doing what meets the needs of the person in crisis and acknowledges her basic human rights.

      liability – legally accountable — something of a disadvantage for the licensed professional.– who will be called out by the administrators of the institution that signs his paycheck for “putting them all in harms way”–

      I suspect Margie and Norman were expecting to exert their authority over the topics we discuss — by saying “You don’t know what it is like to be in our shoes”– Hmm– and they seem unconcerned when told what is on their shoes by those of us sitting down wind of them.

      Bravo for your role in a “great escape” — the good karma you created is truly immeasurable.

      ~Katie

    • I feel the same when I remember that even in my drugged stupor I was able to resist. I hardly remember anything since they gave me benzos but from bits and pieces I recall I know I stole a knife from the dinner and went on to cut the “net beds” aka cages they had so that the next person would be able to escape. I’m still proud that even though I was abused and needle raped I was still able to resist the dehumanizing experience and I never gave in.

      I am always laughing and getting angry at the same time whenever I hear psychiatrists whining about patients being “violent” against them. They’re the ones who are violent and any form of resistance is simply self-defense.

  7. I believe that we are all focused upon and heading towards the same goals and views; people in states of emotional distress need intense support and time for them to begin the recovery process. Each person’s experiences are unique and medication does not promote the healing process. The healing or recovery process may incorporate the experiences that they are going through and medication only disrupts and distorts this unique process. Hospitalization is NOT part of the healing process it may be traumatizing and when meds are used it does not facilitate the integration and understanding of the person’s unique experiences.
    The thing is that we are moving towards these goals in different ways. I am working inside the oppressive, often insane and resistant system itself. There are very few who are doing this (in the Emergency Rooms, Jails and in-patient units). I would indeed have an easier time if I took the advice of one of the commenters and went to work in a respite but that would not help achieve the goals. I need to be where I am to change minds.
    I do have a question about self-determination, and safety issues. I have worked with very suicidal people in some cases where I actually had to ask the person to give me the weapon they were going to use. When they have time to reflect and someone to talk to many of them change their minds and then are very very relieved that they did not kill themselves. Time and talking are so important in these cases that I will do almost anything to buy time for them. In this regard, the systems I work in are completely against providing those 2 vital elements. It is a constant battle of wills but this is what goes on inside an autocratic, profit-oriented system.

      • Thank you, Alex!

        There are no more reply buttons for the eloquent dialogue you initiated with Margie– I wanted to add something to your bold introduction of human potential for arousing faith– . Like everything else involved in learning to walk in concert with one’s basic values and beliefs, faith requires courage and practice. It is never a one shot deal. It does not come with guarantees — (hence, the term, “faith”)– what it does offer is a means for actualizing human potential and negotiating the reality of being so many Who’s in Whoville. We are stronger together, but we are only as strong as the individual expressing faith in herself and others to create value under any circumstances.

        What’s the alternative? Allegiance and compliance to the best theories, guidelines and directives proffered by professionals, but wait!– There are no guarantees here either , just lack of proof of efficacy, plenty of evidence of serious harm, and the power to wield authority that takes away our right to choose our own poison– even.

        Here you put forth a perfectly legal option– “keep her safe–by — whatever you can do”-

        “Then, my desire would be to lovingly and sincerely invite her back home, where I’d want to make her feel like the most loved and treasured person in the universe, as the path to healing. We’d both have a lot of growth and healing to do. Hopefully, she would trust me at that point. If not, I’d struggle a great deal with that, but I’d have to let her go, and trust her own spirit to guide her. That would be hard, but I feel it would be the wise thing to do. Then, I’d learn to forgive myself. And in the process, I’d have learned unconditional love and humility like nobody’s business. ”

        This is a courageous action based on faith– that is guaranteed to expand one’s humanity like nobody’s business. So worth the risk — one of he few choices whose benefits will always outweigh the risks.

        ~Katie

        • “Like everything else involved in learning to walk in concert with one’s basic values and beliefs, faith requires courage and practice. It is never a one shot deal. It does not come with guarantees — (hence, the term, “faith”)– what it does offer is a means for actualizing human potential and negotiating the reality of being so many Who’s in Whoville. We are stronger together, but we are only as strong as the individual expressing faith in herself and others to create value under any circumstances.”

          Amen, Katie! Perfect.

    • It’s all fine and good and I don’t have a problem with any of that, in fact I am happy you’re doing a good job.

      In the same time all your good job means nothing when you condemn another human being to psychiatric torture. Do you seriously believe that this is ever preferable, even when most of the people here, notably those who were on the receiving end of this kind of “compassion” tell you “DON’T DO IT”? Even when the very person in question tell you not to do it?

  8. To Margie and Norman Hoffman

    Several years ago I might have agreed with your position on the use of ‘force’ in “exceptional” and “extreme” circumstances such as has been written about in this blog. NO MORE! All ‘force’ must be abolished.

    Pleas read my MIA blog titled “May the ‘Force’ NEVER EVER Be with You! The Case for Abolition” here – https://www.madinamerica.com/2014/10/may-force-never-ever-case-abolition/ Also read the extensive discussion that followed this blog, which in a very comprehensive and exhaustive way covers practically every angle of this controversial topic.

    After reading this blog and discussion (combined with the many articulate and passionate comments above) then tell me if you still support the use of ‘force’ in the mental health system.

    Richard

  9. Margie & norman,

    As a former psych unit insider, I am going to challenge your rhetoric. Or rather, what is missing from your written analysis of the role you are forced to play in a system that strips vulnerable people of their dignity and their human rights.

    You both characterized your position of authority incorrectly within the system. You each have a professional license and are employed in the *system* . You have used the word, responsibility [for another’s life], instead of admitting that your first obligation is to avoid liability– for yourselves and the institution who employs you. What follows the writing of your 72 hour hold order, tells the real story and I want to make sure to make that clear. Once you designate a disposition for a person, the “system” takes responsibility for avoiding liability. You write the order, and move on to your next consultation. IF you truly felt responsible for the life of this person, who is now in crisis, thanks to you, you would not abandon her to the system. Instead, and I strongly recommend you experience fully the of responsibility that you are saying is due to your position of authority, and use your authority to accompany this person through the process you have ordered them into. Use your authority to assess every aspect of the situation you have set into motion. And give clear signals to this person, now patient in a bad system, that you are looking out for her . Meet the staff who will indoctrinate the patient you have turned over to them, with the many losses of liberty she will incur so that you are not faced with accountability for an untoward event that *may have* resulted from releasing her , honoring her right to decide what she believes she can handle. Yes, as you say, there are many risks to being homeless, etc. and no way for you to protect her from those risks outside of the institution where you met her. But, you have assigned her a worse fate, from her perspective, and you owe it to her to use your authority to make sure she is treated with respect and her needs are met without forcing her to give up more of herself so that *you and your institution* are protected from liability.

    I know what you are intellectualizing about, that is; what awaits the person whom you have reluctantly shuttled into a *bad system*. A crap shoot, at best– so many variables, none of them within your control, but things you really need to witness. Who will greet your *patient* on the locked ward? Another licensed staff who has been given a bullet point report and won’t bother reading all the ED notes, who is not looking forward to doing an admission- extra work, an unwelcome imposition. What will be the atmosphere on the locked ward you have decided is where your *patient* will be safe? Will she get wheeled onto a unit that itself is in crisis? A restraint going down? Another patient exhibiting *unsafe behavior* ? Safe bet it there will be no warm, compassionate welcoming committee– but you need to see this for yourself and use your authority and your dedication to changing a horrid system, by assisting to orchestrate the “safe environment” you believe you are providing for a person who has told you, “no”.

    I have the deepest criticism for what you two are writing here, because I know you are opting out of experiencing that which you order. I know you use the rhetoric of a system that is absolutely not about providing a safe landing, or even a respite for the person you claim you have responsibility for. I know that you have spent time on locked wards. I know you have some idea of how terrifying & inhumane these prisons really are— But, you have not committed your time and energy to demonstrating what taking responsibility for another person– who is more than a pulse, BTW– looks like. No. You write the order and book– and here you are talking about this is the best you can do given the bad system.

    Wrong. You are doing the easiest thing for yourselves– and your rhetoric here is deeply insulting to me, a professional who knows you are insulting the majority of commenters here. Changing the system form the “inside” you say? Been there– it is only action taken in full view of those who dehumanize the people you can’t allow to negotiate life anywhere but where they are *certain* to be stripped of the last bit of dignity they have. I used my authority as a charge nurse. I chose to work mostly off shifts– nights/evenings and weekends, where I was under the radar, and prepared to defend my actions when reported by colleagues and staff I was supervising. I demonstrated what taking responsibility for a persons life [experience] looks like by doing it– caring for the very individual needs of vulnerable people in crisis. I brought a travel case on wheels to work with me– stocked with the stuff I knew would demonstrate caring– Camomille tea & honey; chocolate, snacks & treats, scented shower gels and lotions– aromatherapy for the whole unit– personal care stuff that the *safe* unit would not purchase. I have shared shrimp cocktail at midnight with a elderly woman on a locked ward, where she was placed for *safety*, and fed the most horrible diet! I shared conversation and humorous anecdotes at dawn with another who requested old fashioned black licorice. My last gig lasted just over two years, and I did make some inside changes, as I catered to a few of the most hardened staff– a bribe? Maybe. but it kept the reports of my *breach of unit guidelines* at a safe ,minimum for a fairly long stretch. I openly demonstrated the reinvestment of my obscene salary for the benefit of the vulnerable people who were locked up on the orders of professionals, like yourselves, who abandoned them after putting them in crisis. I invested my time, energy and creativity — punching the clock at the end of my shift, and writing my notes off the clock. Really hated for that– so much so that a new guideline stipulated that staff could not remain in the nurses station writing notes *off the clock* and would be disciplined for acruing overtime for doing the work that should have been done– instead of paying so damned much attention to the patients. Yup– that’s the system for you.

    I would never do what you claim is the best in a bad situation– that is; I would never abandon people I put into crisis and fantasize about how I, the professional, deserve compassion for the moral duress that follows writing the 72 hour hold order. Doing your best on the inside of a bad system — while doing the unspeakable to another person? Nope. You are only complicit — and simply remain ignorant of the full extent of your part in these crimes.

    I have already heard all the excuses licensed professionals can make for not even staying with the people they dump into a locked ward. When you join the chorus of excuse makers, then you are more deeply complicit than you realize– The excuse you make for failing to do the most human, decent thing for a terrified person you claim you want to “keep safe”– remaining at his side all the way to tucking them into the safe landing you hope he will have, says it all.

    Be the change — risk your job– while provoking some human consciousness all over this bad system. Stop being lemmings, and stop trying to sell your own sob stories here– It is poor form. You can do better.

    ~Katie

    • I will reply briefly. I have worked in the same in-patient unit that Mary went to for over 17 years and the psychiatric ER in that same hospital where a team will read the 72 hour application for a hold and decide as a team if she is to be admitted or not. I know where I sent her with my recommendations that they pursue finding family etc. I have no need to defend my actions I believe what I did gave her time and people to talk to about what she needed to do to find her own way to where she would be most comfortable…and safe. Perhaps others could have left Mary under a bush and walk away confident that she was able to determine the way that she wanted to live her life. you did not talk to her, see her etc and therefore you have no idea what her history was, why she didn’t want to leave the ER and go to a hospital. She couldn’t tell me that so I dare not put words into her mouth or thoughts into her head and assume that she had been mistreated before. I have to refrain from guessing or assuming what her experiences were and go with the present situation. I am truly sorry that you were unable to make changes after your 2 year experience and that is not my experience. I do not bribe or hide what I do when I buck the system and that is just who I am. Also I am a bit curious why you vent such angry feelings and label my article a sob story and actually the food in the in-patient unit is the same food served in the cafeteria for the staff. I ate there each day and also ate with the patients during our group sessions.

      • Margie,

        Dress it up anyway you like, but you dumped her into a perilous sea — where for her, “there be monsters”. You did not take responsibility for her “life”– just her pulse.

        I wrote in a rush — so, will clarify that I was hiding what I was doing– My bright pink, green polka dotted Kate Spade travel bag on wheels was hardly clandestine — nor were the items I brought in “hidden” — What I meant by “under the radar” meant that I mostly shifts where there were fewer staff and still fewer “brass” around to criticize or obstruct the use my re-humanizing tool kit. I did buck the system– never forced patients to be in their room, lights out– nor did I drug them to “put them to sleep” before 11pm. I did not lock the community space where the only TV was housed– I did not close the kitchenette-. I allowed a patient to write poetry and letters to her treatment team on the unit computer on wheels– printed out her work before the day shift showed up. This woman experienced a rather rapid recovery once given the opportunity and the respect for her writing–Oh, and I bought her reading glasses as hers were broken “during the admission that followed the 72 hour hold order” . I risked being reported for breaking rules– all the time– but on nights, I found that the few counselors who worked with me, appreciated the new calm, enjoyable atmosphere on their shift, and that my constant presence seemed to do the trick for helping patients (triggered at bedtime) to feel safe. On many occasions my staff and I had a very enriching experience being human beings in a *bad system*. That is what I meant by *bribes*–. I see that I am speaking in a language you don’t comprehend as readily as the professional meant health rhetoric of deflecting and rationalizing—

        BTW, you and Norman have much more authority than I did on these units, and in this bad system,. I pushed the envelope on my little bit of authority with clear knowledge (14 years working in medicine, where responsibility for a life is literally, that) that it was my license on the line, in terms of “harms happening to patients” on my shift. On off shifts, I was the bottom line– took it seriously and used it to the full extent –.

        I did not say I did not make changes. The lives of those in my care, my first priority, definitely experienced many positive changes– so did staff whom I supervised–Oh, and, a few new grads that were seeking to learn from someone who wasn’t restraining and drugging patients. I continue to work on dealing with the bad barrel,- outside of it– but I think you might want to consider what each of us can actually do in whatever environment and within whatever sphere of influence we have as professionals inside the bad MH system. I challenge you to reflect on the difference between what you claim to be doing and what you are actually supporting– . At the end of your day, you have a job in a system that you have no reason to trust will provide for the vulnerable person’s actual needs that you have ordered there. Period. Best you can do? Or just all you are willing to do?

        ~Katie

      • M. Altman:

        “you did not talk to her, see her etc and therefore you have no idea what her history was, why she didn’t want to leave the ER and go to a hospital. She couldn’t tell me that so I dare not put words into her mouth or thoughts into her head and assume that she had been mistreated before.”

        Mary, when told she would be psychiatrized against her will:

        “No, you can’t do that. Not again”

      • “Also I am a bit curious why you vent such angry feelings and label my article a sob story”

        Well, because you’re trying to justify what you did throughout explaining how “difficult” the decision is. I can assure you that is is only a billion time more “difficult” for Mary whom you stripped of her freedom, dignity and human rights. Sorry but I am not going to be sympathetic to you for taking such a decision.

  10. To be fair to Margaret, I have heard a number of people say (on-line) that these psych holds “saved them” or words to that effect.

    I think that one of the hardest things for a medical person to do is to just do nothing for a person in severe distress. I always think of an MD I met on-line. When I asked him why he prescribed antidepressants he basically said “What do you want me to do, turn away patients who come to me crying and desperate, unable or unwilling to go to therapy?” – Saul

    • There’s a “slight” difference between someone who comes asking for a pill and someone who says “no”.

      Also doctors have a responsibility for their own actions – at the very least they are responsible of providing information so that the patient can truly enjoy informed consent.

  11. Saul,
    Seems like you are saying “better to choose the devil you know, than the one you don’t know”–

    Status quo thinking is not likely going to be a game changer–

    People claiming that having their human rights tripped from them was there salvation? “Sweet dreams are made of this.. “?

    Yet, Saul– who is having the opportunity to experience something in-between the two devils? Who is even suggesting that right there, on the inside of the bad system a professional with license can use her authority to do something outside the box??

    And, Saul– another question: How can anyone who will comply with the worst of the crimes committed in the MH field, involuntary 72 hour holds , criticize and lament the *bad system* as the force that compels them? Really? Why doesn’t someone just point out to them that they have agreed to give up their free will in service of the bad system? They are voluntarily committed–to a bad system that supplies brain disabling poisons and imprisons vulnerable people

    I. for one, am tired of the cheap excuses– cloaked in the MH jargon that makes my skin crawl. For 20 + years, I was eye witness — on the front line, in the trenches, watching highly educated, credentialed professionals become dissociated in every way from the work of their profession– . Authority without substance, arrogance without excellence– talk, talk, talk, — until it seemed that they created their reality based on words, language, a lexicon of psychiatry.

    Could say– the higher the credential, the greater the authority, and the least likely to solve even the most basic problem in MH– involuntary commitment and forced drugging– . ? Yeah, and then tell us why this makes sense??

    • “For 20 + years, I was eye witness — on the front line, in the trenches, watching highly educated, credentialed professionals become dissociated in every way from the work of their profession– . Authority without substance, arrogance without excellence– talk, talk, talk, — until it seemed that they created their reality based on words, language, a lexicon of psychiatry.”

      I’m no longer associated with the mental health field, but I was deeply entrenched in it for years, as well, as both a client in the system and also a professional. Before that, as a very dedicated student and intern, and later I was a social worker in San Francisco. I’ve moved on, but I still keep my ear to the wall, and try to add whatever I can from my experience that will help bring clarity and movement to all this. I know it is affecting the world at large, perhaps more than we even realize.

      I think what you say here is exactly right, that was my experience and observation, as well. No one is walking their talk, it is either deceit or dissociation (or both) of the grandest proportions. All feedback is taken so personally and with such defensiveness, that there is no way to challenge this without precarious power struggling leading to some kind of abuse and retaliation, it’s just impossible, total oppression. And a big YES, it is created intrinsically subjectively to suit personal agendas, rather than being in the best interest of the client. What more to do other than calling it out whenever possible?

      I’m in awe of your clarity, really speaks to my own perception, here.

    • “I. for one, am tired of the cheap excuses– cloaked in the MH jargon that makes my skin crawl. For 20 + years, I was eye witness — on the front line, in the trenches, watching highly educated, credentialed professionals become dissociated in every way from the work of their profession– . Authority without substance, arrogance without excellence– talk, talk, talk, — until it seemed that they created their reality based on words, language, a lexicon of psychiatry.”

      Thank you for writing that. This piece is so triggering for me precisely because of that. After I recovered somewhat from the abuse I had to endure in my psychiatric imprisonment I went to confront my abusers and guess what – the excuses they made sounded exactly like this article. I was supposed to “understand” their “difficult choices” and that they “can’t help everyone” and that they did the best for me. Even when I was standing them telling them loud and clear “you tortured me”. Blank stares, never an admission of guild, of mistake, never so much as “I’m sorry for what I did to you”. And the pervasive fear of litigation. Because would they ever admit they did the slightest thing wrong them maybe I could sue them. “We are sorry you didn’t enjoy our service” – it sounded as if I was talking to a corporate machine and not actual human beings. They blurted a few excuses and washed their hands. And then when I challenged them on breaking the law (which they also did, even though there’s really no need for that as they have almost absolute powers) – threats. This is exactly what is wrong with this profession and their “compassionate” representatives who have no idea what they’re doing but don’t bother to really listen – they could as well put fingers in their ears and go “lalala”.

  12. WoW! This discussion has been a long time coming!!!!!!! This is really really important and I wish it could be done live at a APA conference!
    Katie, I agree with you in many ways. You have been one of the few profs that I would say actually get the psych survivors or whatever you want to label us folks who have been the system. Why the profs never visit clients on the wards – few ,few have done so -more in the 20th century past than now- but the abuse is then hidden and things look good for the short time they are on the floor. Why family members don’t do this or are not allowed to do so is beyond me! There is more warehousing and abuse on psych units than any surgical floor and most of us know the surgical floors are not what they used to be. Family care is welcomed because the staff is so low and can’t really provide could old nursing care and the the long forgotten TLC. One would think psych units would welcome either an allowed family member or friend to come and stay. One would think if they weren’t fearful of negative reactions there would be no problems with visiting hours.
    So sorry you have had to stand out in the cold with all your years of experience and caring. What does that say?
    Margie, I understand your concern but you missed it, missed like so many folks who care but really can’t comprehend what it is like to be on a psyh unit as a patient.
    No means No. I think this is a phrase one of my children used as a preschooler and he was absolutely right. We need to respect the No’s of folks. And if you don’t understand then you need and be professionally responsible in terms of the Hippocratic Oath first do no harm to listen. Why??????????
    I am thinking there were some pretty damn good reasons for her not to want to be admitted.You effectively lost her then and there. She will not see you as a helper ever again. You will be the enemy.There are indeed some folks who go above and beyond this in their thinking when this happens but it takes and should be acknowledge extra – ordinary grace! And some denial!

    You violated that woman’s personal authenticity by acting over and above and then telling her and placing yourself in a position that you and she were stuck with. Been there done that and I regret every one of my prof actions in this regard.
    You really can’t work under two Masters. Can’t be done well.
    There was no good solution for her. There are few places in our country today for vulnerable folks like her who actually provide good care and good help.
    Knowing what I know now. I would have told her the options – all bad- and let her choose.And when she choose, I would help her make an hour by hour list of options she could choose to use. Usually in times like this family is not an option but you never know always worth a phone call. Churches sometimes have an option or two not many not good but again worth a phone call. Then I would have gotten her a cab voucher with dinner money and prayed and prayed and prayed.
    By feeling like you need to save you are falling into NAMIVille codependency. Sometimes life is sheer awful and the bad choices people make cannot be undone in a way that would be easier for all of us to swallow. Death comes to us all and all we can do is try while at the same time honoring people with the dignity of choice. And damit sometimes that choice is made under duress and behind it comes years and years of trauma. Sometimes those choices others make make it difficult for us as parents, profs, friends, ect to actually sleep at night. We can’t always do the right thing – we don;t unfortunately live on Fantasy Island – we can only do what that person as a legal adult allows us to do. Force makes prof and parents and friends lives easier. WE then can sleep, pat ourselves on the back. WE DID IT – WE SAVAD THE DAY! YEAH FOR US!
    I am also acknowledging here how very hard it is to live and deal with disability. It takes extra time, energy and can be a negative though I am pro disability. The nondisabled have to spend time and money that needs to be acknowledged by us with disabilities

    BUT NO I would have to allow for choice even bad bad scary choice instead of the force of good will.
    All this being said Margie I would strong strongly suggest you go into a psych unit and spend a week there. You get the prison idea in many ways but you are really missing out on the forced involuntary reality that so many of us have lived. Walk through hell and let us know your thoughts.I think it would be good for all of us.

    For those who were triggered yes it should have on alert. It didn’t trigger me but it would have awhile ago. I am healing.

    These are my thoughts. I hope this continues. I hope we can talk through this!!! We can disagree ,be angry, be upset but let’s keep talking. This is what we need to do as a movement. Talk our story through explain and how do we do this when we have been traumatized instead of helped and we are discounted at every turn?

  13. One problem here is that we can’t generalize and assume. Each person’s experience in a psych ward is different, people come in with varied and unique lives, expectations, fears etc. Each psych unit is as different as the staff and culture of that particular unit is. Before assuming and generalizing it is important to ask the questions about the environment and it’s culture. We can’t label people nor can we label mental health professionals or the places that they work in. I thought that this was one thing we agreed upon…not to generalize, label and assume?

    • I imagine you would have expected a variety of passionate responses to this post, given that this is the core issue around here–forced ANYTHING.

      I don’t think this website is conducive to a thorough Q&A, so I know I’m going by what you have laid out, here. Many of us have responded with our reactions to witnessing this, through your telling of it. If there is anything you want to clarify or add about this particular case that might be persuasive to your way of thinking, then by all means clarify.

      From what I see from the information offered, I continue to feel critical of your decision for all the reasons stated in these comments, particularly that it is a violation of a person’s freedom to do what you did.

      Like CatNight says, “No means no!” I believe that is a golden rule when it comes to avoiding personal violation.

      • And btw, I do very much respect your talking about this decision that way you have, I also agree with CatNight that this is a critical discussion, we’ve been waiting for it. You have courageously given us this opportunity, and I really do mean this. THAT is one of the nice things about this community. We are a courageous bunch, I will say that. These are not at all easy topics, but so necessary to unravel. Thank you.

    • Margie,

      It is imperative that we accurately describe and define the premise of every locked psychiatric unit. It is a prescribed amount of space (depending upon the number of patient beds) , that is barren of all that is associated with comfort, privacy and pleasure. Patient’s are allowed a few *safe* personal items, (no sharps, shoes,laces,belts) and expected to assimilate into a schedule of sharing showers, a pay phone – or 2; expected to eat meals on schedule , and ask staff for snacks, water, juice, laundry rooms, hygiene supplies, linens– all behind locked doors. Staff with keys are not as readily available as one would expect considering that a unit of as many as 18 patients depend on them for access to basic supplies. The premise of a locked psychiatric unit, is that by removing all the comforts of home, (including freedom to decide when and what to eat, drink sleep–etc.) a *safe* environment is created & managed (ideally) by a few professional staff, supervising a few counselors– all of whom will claim to be stretched to their human limits. The premise of a locked psychiatric unit is that reducing stimuli, limiting choices, securing most everything behind a locked cabinet or closet, and closely observing (documenting patients whereabouts every 5 to 30 minutes) a severely distressed “patient” will have no means or opportunity to hurt herself.

      There is an error in the premise. Or rather, no consideration for the perspective of the “patient”, whose sense of safety usually depends on their internalized response to signals that she is unworthy, devalued, damaged, deranged. In other words, a psychiatric unit is rarely if ever a *safe* place for those who are involuntarily committed .

      You don’t mention the usual process– that failing to become a voluntary patient within three business days, opens the door for court ordered commitment and forced drugging– You very much down play the reality that most definitely neuroleptics, sedatives, anti-psychiatocs will be prescribed — that should Mary G. lose her composure, she may be subject to forced chemical restraint– pending her compliance or the court order for these drugs that goes and in hand with the confinement. If you are working on a unit where people like Mary are not pounced on by overzealous believers in the power of drugs to organize the mind– I would love to see a presentation of a showcase (that to my knowledge, does not yet exist in MA – or anywhere in the U..S.) for – “Trauma informed care” sans drugs !!

      As a SW you are not privy to three change of shift reports in 24 hours, or the incessant gossip and worse than psych dx labeling shared between front line staff. As a SW you occupy a specific orbit around the nucleus of a virulent culture, one that prides itself on “caring” for those whom nobody wants or nobody can handle. I have heard nurse managers refer to this as, “Doing God’s work”, though it would appear that they have actually sunk to a lower level in terms of their outward displays of disdain for ” non-compliant psych patients” AKA, people nobody wants and/or nobody else can handle. Not a trace of science, medicine or humanism– yet there it is, cloaked in the language that places it inside or near a real hospital.

      That you believe there is any good done for people involuntarily committed to a psych unit– for a bogus three day eval (hardly ever ends there), is somewhat amazing to me– and can only be explained by a peripheral connection to the unit. You obviously buy the PR ; that you work in a therapeutic milieu and provide both recreational and therapeutic activities that enhance recovery ? It is miraculous when a person can recover from their experience on a psych unit, especially those who resisted the premise that anything was wrong with them, and realized that the professionals have no clue what they are doing .

  14. I believe that we all need to have empathy for other people, whether they be individuals in emotional distress or mental health workers. No doubt that the psychiatric system is screwed up, but so is our society. I would like to believe that all people have free will, though the reality is that our society has robbed many people of the opportunity to have free and clear will and judgement. The sad truth is that it is highly likely that Mary, and many like her will be dead within 3-4 years, because our society will not help her, advocate for her, protect her, or get her into the position where she can have the free choice of how to best live her life. She will end up dead under a bush, killed by exposure, violence or malnutrition.
    We also all know what could be best action. That would be for Mary to have a place where she could go, voluntarily, where she could be respected, safe, and cared for; a place that would respect her autonomy, and help her work towards being able to take care of herself. Without proper resources, there is no hope for people like Mary; only pain and eventual death. Margaret tried to forestall the inevitable by using a resource available to her. Whether she should or should not have is a point that can be discussed, but it is not a discussion on what would allow Mary to survive, either emotionally or physically. It is a political discussion that various people have strong opinions on, based on their own experience of the mental health system. Mary’s outcome is unlikely to be affected by Margaret’s choice. We need to have real choices that save both life and dignity.

    • A question; We talk a great deal about “free will” about freedom of choice, about self determination and the gist is that no matter what age a person is, what condition they are in, what drugs or alcohol or toxic substances are in their systems that they must be allowed to do what they believe is best for them. At what age does free will begin? One of the people who commented on this article noted that her 2 year old said “no” a lot at that age. Most kids do, of course, to assert their independence. Again at what age does a person have free will, freedom of choice, etc.?

    • We can have empathy for all involved and still oppose forced psychiatry. We can say that the system is fucked and that there were no good choices here, and also say that forced psychiatry is wrong. I think it’s nonsense to say that Mary’s outcome is unlikely to be affected by Margaret’s choice. We cannot know how much it was, but we do know that traumatization* has consequences. You are passing the buck and again you are trying to dictate what “the real problem” is here.

      *“No, you can’t do that. Not again”

      • Again,, we don’t know what Mary was referring to; as I said she did not want to leave the ER that much I could infer by her behavior but the rest? Lets not assume we know what “that” is because we do not. If indeed she meant that she did not want to go to a hospital…I get that but again we are stepping into an area of meaning that is clear to her via her experiences and we have no idea what those were.

        • When I said that I was going to put her on a 72-hour hold, and went through the facts of the hold – the detainment, the psychiatric evaluation and the criteria for the hold – she became upset and began to pace the room. She repeated the statement “No, you can’t do that. Not again” several times and I was aware that she had probably been through this before. She was angry and then broke down in tears.

          It seems like cause and effect, from the way this is written. Yes, she could have been thinking about football season for all we know, but it sure sounds like she was talking about forced psychiatry. Interesting point to argue though, since throughout the story you are making assumptions about her based on very little information.

          • And then there is this earlier quote:

            When the subject of hospitalizations, medications or any related subjects were brought up she became fearful and paced the room.

        • “She said no but she went to the bar with me and she had a short dress and before she said her ex was a bad guy and I was much nicer and she seemed to like me and how was I supposed to know that she didn’t want it.”

          If you’ve described what happened with Mary accurately then it’s very clear what she didn’t want. No means no. It’s pretty clear.

    • “The sad truth is that it is highly likely that Mary, and many like her will be dead within 3-4 years, because our society will not help her, advocate for her, protect her, or get her into the position where she can have the free choice of how to best live her life. She will end up dead under a bush, killed by exposure, violence or malnutrition.”

      Norman, this is what I consider to be blatant stigma. I know you are not directly judging Mary, but you are giving up hope on her, based on this snapshot in time, and based on second hand information on top of it. To me, that is what kills hope for people.

      There is no way you could know this to be true, even it has been true for others. This is dehumanizing and disempowering to Mary, altogether, this kind of cynical prediction. I was told similar things years ago when I was at my low, and nothing was further than the truth. Although the mental health system sure thought it was the end of the line for me!

      Honestly, I’m so enormously grateful that there are other schools of thought on how we perceive people, healing, and our spiritual journeys through life. Psychiatry almost killed me directly, and then it gave me up for dead. 12 years later, I’m not only alive and kicking, perfectly grounded and healthy, I’m thriving.

      “Mary’s outcome is unlikely to be affected by Margaret’s choice.”

      Again, we have no way of knowing this and putting out this conjecture is no argument for the action of forcing confinement on someone, when that is the issue at hand.

    • I meant to include this, as well, probably more than anything, come to think of it–

      “…it is not a discussion on what would allow Mary to survive, either emotionally or physically. It is a political discussion that various people have strong opinions on, based on their own experience of the mental health system.”

      This quote here I find to be typically dismissive of a psychiatric survivor’s perspective, and downright patronizing.

      I beg to differ. I think, perhaps, those of us who experienced this and have healed from the trauma of it have a clarity like no one else. Perhaps we CAN help someone with our experience, and perhaps more than someone who does not get it, because they haven’t been on that side of things. This is a dark night of the soul. Those who have gone through it perceive things differently than those who have not. Some actually consider it to be a broader and clearer perspective.

      I believe the implication of your statement is terribly misleading.

    • “Mary’s outcome is unlikely to be affected by Margaret’s choice.”

      Really? How about if she commits suicide because of the trauma of forced “treatment” aka rape? It’s not theoretical – I tried to kill myself because of a “choice” that a person like Margaret did with complete disregard for my opinion on the matter. You say you take responsibility for one’s life with such decisions? Well then embrace it. The responsibility for suicide, for homicide (do I have to explain the anger and hatred which being abused creates?), for further deterioration of mental and physical state, for life-long trauma. That is the legacy of forced “treatment”. It is not more compassionate. IT is condemnation of someone to torture.

      If you can’t do something to change someone’s life as you admit then why do you have to submit that person to even more humiliation and abuse before it’s over? As Katie has written so eloquently here – what sacrifices do you take except for “feeling bad”? Why don’t you take that person to your home, offer her warm place to sleep and food and support if you really care? Signing someone off to psych ward is just washing you hands.

    • Just imagine the proper resources we could afford if we were not saddled with the outrageous financial drain caused by funding the MH system–

      ” The sad truth is that it is highly likely that Mary, and many like her will be dead “–
      but what if we could afford to fund proper resources, Norman? Instead of paying up the wazoo for a system that “tries to forestall the inevitable by using a resource available to her ?” which happens to be known as worse than death for the majority who have been ordered to use this resource. —

      Wait. did you say that our screwed up society came up with this?
      ” the reality is that our society has robbed many people of the opportunity to have free and clear will and judgement.”
      But isn’t a psychiatrist and only psychiatrists judging whose free will is to be snatched and who gets judged incapable of making personal decisions? Society makes you do this? But, Norman, it was just a small segment of society that enacted laws defining minors and severely mentally ill people as “wards of the state”- over a hundred years ago– and this was never a topic discussed and debated widely by “society”–did you know that? At the present time, it is a small segment of our society who knows what a disgrace these laws are, that assign psychiatrists to the role of determining the fate of incompetent people, that coincidentally, psychiatrists are labeling incompetent to begin with.

      Yes, political discussion would be great and it is coming, but it is taking longer that I hoped to educate enough of our society toward this end.

      Meanwhile, there you are, the harbinger of doom for those psychiatry can’t kidnap for a go at something worse than homelessness and social isolation. Condemning society in general, while ignoring the fact that by and large society is in the dark regarding what you are calling an “available resource”.

      What I find the most screwed up here, is your rendition of Mary’s plight and certain fate– maybe you don’t see how casually you proclaim there is little hope, while helping to drain society of the resources that would provide some hope for Mary and many others like her– .

      Another thought occurs to me, and it has to do with what our society believes and why we believe it. The premise of your profession as an available resource, comes to mind– It seems to me that one very important aspect of generating all of the political discussions that need to happen is an educated population to demand it. I’d say that a huge barrier to that vital next step is the horrendous amount of propaganda about the resources available in the MH system. Always lobbying for more funding, but never quite accounting for what we are getting for our money. So much misinformation and hardly a hint of the corruption that produced it. These are vital matters to put before the public, because unless our society comes to terms with how expensive the MH system has become we can’t properly assess what it means that what we actually get for our money is an available resource that for all intents and purposes is worse than the deprivation that is currently justifying it.

      What you call a screwed up society, I see as the inevitable product of ignorance combined with one of the most corrupt marketing campaigns ever designed . Society did not design the marketing of psychiatry, Norman. another screwed up group gets credit for that .

  15. I find it really interesting that the folks who think Mary was badly best served by forced hospitalization have never experienced it. This is way we need psych survivor advocates everywhere in the psych units , in the community mental health centers, at the police station, available to deescalate or help someone much more than likely suffering from trauma present or past or both!
    What I would like to hear is an “yes and” approach similar to the improv technique form the profs.
    I haven heard that yet. In my time in the system I went through many hospitalizations at several different academic, general, and private profit systems. IT WAS ALL BAD. What I had known as a prof on an unit was the end of a relatively good era of care, that is not the case now. And I would guess the ones around the pre Reagan era that were good are not anymore… Back then the best and the brightest had gravitated to psychiatry I have seen no evidence of that with my own involvement.

    The mis diagnoses and out right medical malpractice and poor poor therapy and poor insight from the staff about who I was and my concerns was awful, awful, awful. This is what I mean we are not being listened to Margret. You categorically denied the authenticity of my experience!!

    Do you hear me, are you listening to us really really listening to us?

    Norman you fell into the same boat of not listening!!!! I like your posts and thoughts but you did not do a yes and response in the end. You can’t cover for other profs just like officers can’t cover for the bad apples. WE have to speak truth to power in this day of unending deep ended corruption everywhere.
    My last hospitalization the staff was basically taking note of behavior. Not into any way of help or care or TLC. Nada, nada, and more noncaring supervision. This did not help me. It traumatized me.

    Again I really think the only to understand is to experience. I can’t see any other way.

    I think we need to deal with this division. Then we can go on and fight for the options that are good options, the help that is good help, and a world where trauma is treated for what it is.

    But the empathic listening or going into the hole needs to happen, sooner rather than later.

  16. Dear Cat,

    I do agree with you. Over the past twenty years I don’t think that I’v seen anyone who has been hospitalized in psychiatry who haven’t described their experience as horrifying. The sad reality is that there are far too many people in our society who end up dying because of the problems in our society and lack of resources to help them. The only way to not give up on people like Mary is to fight for better, non-psychiatric resources. We need to understand that a large aspect of the fight is not just whether we refuse to commit vulnerable people to psychiatric hospital l ,but how we can fight for change. If people like Margaret refuse to hospitalize anyone, then those people would be fired from their jobs and replaced by lackeys. We need our Margarets and our CatNights and our Marys. I do feel that people like Mary should not end up as casualties of the battle for change. The answer of how one should proceed in the present reality is not clear.

    • OK, I’m going to go over the top and make a Nazi analogy (which in case of psychiatry is not even that over the top given history):

      If you were given a choice to work in at an entry to a concentration camp and save some folks but condemn others to torture, abuse and often death would the fact that you saved some people justify you working in concentration camp and signing others off to awful fate? Would it be a moral choice to stay at that job rather than quitting and finding other ways to stop people from flowing into that camp?

      I’d say no. I’d say that being fired is preferable. Stop giving justifications to a system that’s inhumane and torturous.

      “The only way to not give up on people like Mary is to fight for better, non-psychiatric resources. We need to understand that a large aspect of the fight is not just whether we refuse to commit vulnerable people to psychiatric hospital, but how we can fight for change.”

      And how working in a hospital and signing people off for abuse is fighting for change? For me it’s legitimizing the system. You want better non-psychiatric resources – great but how sitting in a hospital and going about business as usual is going to bring that about? why not become a whistle-blower? Why not join others to create alternatives? Why not go work for an institution that actually helps (a homeless shelter, a soup kitchen)? Working within that system and putting a smiley face on it only ensures that nothing ever changes.

      • You pretty much nailed it, B–

        The real issue here is that neither a psychiatrist or a SW has sufficient exposure to these hell holes to inform their *expert* opinions. And they will continue to justify their authority positions as *the best we can do to commit people* while we fight for change–

        Sheesh– this is starting to sound like thepolitical platform of two candidates who don’t know what they don’t know–

  17. Thanks Norman, B, uprising, and Alex for commenting!
    I think we need a Truth and Reconciliation Project put on by NASW,APA ect
    Folks knew about the concentration camps but it wasn’t until the soldiers saw the true reality and photographs and film was taken that the world experienced a metaphysical shudder. This is what I think the profs need to feel and experience. Joseph Conrad’s Heart of Darkness comes to mind. “The horror, the horror” Kurtz’s last words.

    I think walking away is good- I did and I like where I have landed. It isn’t perfect I have issues with the system but no harm is being done in my range of work.

    Saul Alinsky would say yes you can protest en masse. But it has to be planned and purposeful. Imagine all MH profs wear black armbands stop working for 15 minutes and stand in silence where ever they are! Every day or once a week whatever. You all have agency!!!!!!!!!!!!!! It is up to you to stand up and out.

    Also I would like to hear that fear is part of the prof denial. No I don’t want to take those meds. No I don’t want to spend 5 minutes in a place like that. Be truthful of your fear. I had that fear and I know others did as well. What is so scary that you can’t admit to feeling fear? We brave souls who have survived should be honored not vilified , look down on, pitied , condescended,
    not listened to.

    We all are fighting battles one way or another whether we choose to acknowledge that or not.
    Let’s join our boats and work together. I think both type folks here are trying. The d ialogue is happening painful and uncomfortable as it is. We just need a good and solid compromise!!!!!!!!!!!!!!!!! Who is will to work on this so that we can move the movement.
    forward? A manifesto and plan of action we all can agree on?

  18. “The answer of how one should proceed in the present reality is not clear.”
    To Norman:
    Step # 1 : Confront the present reality.

    Step#2 : Acknowledge, admit and affirm that it is wrong for a Mental Health professional to use their credential to force vulnerable people to endure that which psychiatry has invented and passed off as *treatment*. (It’s one thing to sell bum goods to a sucker, another to force a person who is already struggling to buy into psychiatry’s last desperate hope for its own survival.)

    Step#3: Realistically speaking, If you lose your job because you refuse to *commit* a crime against humanity– you are better off, and so are those you spared. And speaking out as you uphold the human rights of vulnerable people, you start a trend?

    Step#4: Engage in deep reflective soul searching & Prepare yourself for the inevitable moment of truth. Until you win the battle over your own weaknesses, you cannot fight against or for anything else.

    Our survival instinct and egocentric defense mechanisms are not inherently bad, but when survival instincts drive one to protect things like status & financial gain, the risk of rationalizing whatever means seem necessary can cause a state of total blindness. If you cannot see the harm done to those you are bound by duty to protect, try listening to those who have survived and are bound to saving others from your lot.

    I don’t know for whom you speak when you say “we” need people who will continue to “Involuntarily Commit” vulnerable people –and keep their jobs…
    But I do not belong in that group. What the “we” in my camp need is MH professionals with courage and integrity who will not support this unjust, inhumane groundless imprisonment and torture. A political campaign agenda could be started from refusing to commit the crime, refusing to support the crime and speaking out against it — loudly and publicly.

  19. It was with massive anger and disgust I read the article.

    Over 10 years ago I was sent to one of these places. I asked to be allowed to go home and/or to see my private psychiatrist. Instead I was kidnapped and taken to a locked ward. I was house with severely disturbed and heavily medicated males, who sexually threatened me ( I am female), I was forced to share a urine soaked bathroom with them. I was not given appropriate food (I was vegetarian), I was threatened with forced medication via injection. There was not another female in the ward, either patient or staff.

    I fell through the pits of hell that night after they introduced me to the night nurse – a very large and aggressive-looking male. My very first (and only) psychosis, my first experience of forced meds, the end of my trust in the human race. Never had I in my 50-odd years of life experienced such degradation, such terror, such madness, such pure, unadulterated bastardry. I had (and still have) no history of violence or of being a danger to anyone, although I may one day choose to end my own life.

    Don’t try and explain why you do it, or try to excuse yourselves because you feel a little bad about doing it. It is TORTURE, plain and simple. A show of power and massive abuse of privilege and position.

    There is never an excuse for it.

    If I do end up taking my life, it will be because I simply no longer am able to develop trusting relationships and live quite fundamentally isolated from other human beings as a result of that experience. I cannot accept any medical care and dare not share my internal struggles or seek assistance with them for fear of being locked up again.

    Inflicting such terror, such total mental and emotional rape and degradation is inexcusable under any circumstances.

    Please don’t try and justify your behaviour.

  20. have not jumped in in awhile, but i’ve been scanning these posts this morning and i want to jump in and lend my support to b, katie, etc and add my “shame on you” to margie. we have a saying in my house, after all we’ve gone through with this horrific system- “there are worse things than dead”. no one should have the right to make another person enter the current psych system against his/her will. PERIOD. no exceptions. no buts. no ands. keep on fighting, all.

  21. I’ve been reflecting on this conversation and I have one last observation about all this, then I’m done with this topic. After all this, I continue to see absolutely no justification for coercion.

    One thing is clear to me: if I felt a staffer was being unfair, unjust, abusive, oppressive, or whatever, and I filed a legitimate grievance, way more than likely, I would be told to have empathy for the abuser, and that I am not seeing this ‘correctly,’ that I am, somehow, ‘in the wrong.’ There would be no getting past that, there is no negotiation at all, simply a wall.

    That’s what I experienced in the system, repeatedly, and that is what I’m observing here. Those in the system stick together and ask for empathy when abuse is called out. That is the apex of absurd, cruel, and a COMPLETE lack of empathy for the situation at hand. This is why the system is failing–it’s a SYSTEM of abuse and personal torture for which we are asked to empathize, even when we are the ones experiencing it! I don’t think so…

    • And btw, do you know the effects on someone’s mental state when they know they are experiencing suffering at the hands of a professional, and the grievance is not only not taken seriously, but turned around to reflect negatively the one filing the complaint? Whoa, that is such bad news for the person being abused, really pours acid into the wound. That is pure torture for a person. It’s called ‘gaslighting.’ And it is so common in the mental health world, as evidenced here.

  22. My heart bleeds for Mary knowing how the psychiatric hospital is going to treat her, with drugs. I recently sadly had to end all my involvement with a mental healthcare facility where I attended DBT classes, and absolutely my DBT therapist. But because I experienced a ‘fight or flight’ response in her office one day, unbeknownst to me, she called the Police to do a home check for my safety. I will NEVER allow this to happen again so I cut off ALL ties with them. The last time I put myself into a psychiatric hospital was because of after effects of a ‘cold turkey’ Klonopin withdrawal while going through Effexor, Trazodone, & Lithium ‘cold turkey’ withdrawals I not only became extremely suicidal but homicidal as well. I was afraid. I begged Forestview Hospital to treat me without using drugs, but they didn’t see it that way. I was given drug after drug, experiencing severe side effects with each one. And here’s the clincher where I went from voluntary to involuntary status. My psychiatrist told me that if I complained one more time about side effects that he was going to start injecting them. So I complied. I was scared. I was now court ordered to take them- forced. I was so re-addicted to Ambien by the time I left went home while in drug induced Ambien haze my house catches fire and burns to the ground and I have no insurance. And who cares? No one. I will NEVER, EVER set foot into another psychiatric hospital and FORCED to take drugs I don’t want. Even if this means to never, ever setting foot in another mental healthcare facility again for any reason. God help you Mary…

    • “”My psychiatrist told me that if I complained one more time about side effects that he was going to start injecting them. “”

      If someone complained to the media about a regular hospital doing this regarding any non psych med, this would be front page news. But if you did this, it would be totally blown off because the drugs are for the “mental patient’s” own good since they don’t understand that. Never mind that when this has been done in Russia and China, it was seen as torture by the US.

  23. A couple of questions (you don’t have to answer, of course) what is your own description of your fight or flight response? Did the hospital make you involuntary because you said you were suicidal and homicidal? Do you have any respite services in your area for people in acute emotional states? this is what we so desperately need for people who don’t have family or friends who can compassionately see them through the terrible and frightening episodes.

    • “…”involuntary because you said you were suicidal and homicidal? ”

      I think it is critical to note that sanderella was seeking treatment, voluntarily for the severe adverse effects of poly psych drug withdrawal – cold turkey: klonopin, trazodone, effexor Lithium. -She got more drugs and more adverse effects —- and threatened for noncompliance…

      “And here’s the clincher where I went from voluntary to involuntary status. My psychiatrist told me that if I complained one more time about side effects that he was going to start injecting them. So I complied. I was scared. I was now court ordered to take them- forced.”

      So, she was further traumatized— which is not an uncommon result of bad medicine and the lack of compassion prevailing on locked wards. The result goes beyond trauma really, it is more like torture. And this is status quo on locked wards.

      “Do you have any respite services in your area for people in acute emotional states?”

      sanderella said she sought care at Forestville Hospital– Are you suggesting there were no medical concerns around cold turkey WD from Klonopin, Effexor and Lithium? Of course, sanderella may not have known she would not receive appropriate care for the medical aspects of WD– much less a therapeutic environment on a locked psych ward. Not her fault.

      ” this is what we so desperately need for people who don’t have family or friends who can compassionately see them through the terrible and frightening episodes.”

      So, you are saying you need respite services as an alternative to locking people up, drugging & torturing them? Or that yours is the only locked ward that does not do this? I’m sorry– no disrespect intended , but i would have to see it to believe it.

    • We also need medical professionals who understand how to safely taper people off of psych meds so they don’t end up in the position that sanderella did. It is a bleeping disgrace that an internet board, http://www.survivingantidepressants.org is alot more knowledgeable than most medical professionals regarding this situation.

      Anyway, Margie, I was very disappointed that you didn’t seem to realize that was a main issue in this situation.

  24. Please refrain from assuming what happened with Mary is the same as what has happened with you. Please take caution when interpreting what she may consider “worse than death” or what she is thinking and feeling. Please do not base other people’s experiences upon your own. Please move forward and accomplish the goals that are being destroyed by the fear and anger that is obscuring the message.

    • I agree with the other commenters who seem to think that these well-intended ideas are a poor cover for what actually happened with Mary. She was begging not to be sent into the hospital involuntarily, and you still did it. In my opinion, the reason for doing it was likely more to protect yourself, and to create the illusion that you were “doing something” to protect her in a helpless situation, than anything else. Within a few weeks, she would likely be back in the same situation or worse, so your actions made little difference except to add another episode of being controlled by an authority figure. The idea that you were protecting her (for a few days) is mostly a fantasy protecting your own ego. My opinion.

    • 1. “Please refrain from assuming what happened with Mary is the same as what has happened with you.”

      Actually, I am not so sure there isn’t more similarity than difference– when you consider the act of being forced into a locked ward where forced drugging is the norm– the differences are actually rather insignificant– .

      2.” Please take caution when interpreting what she may consider “worse than death” or what she is thinking and feeling.”

      since you can’t know Mary’s inner thoughts and feelings, would be hard to say for sure whether someone who has been forced to stay on a locked ward and forced drugged would know Mary’s actual response–, but a safe bet hers would be closer to the truth than one who has not experienced loss of control over their life decisions– etc.

      3.” Please do not base other people’s experiences upon your own.”

      I think you covered that in #1.–But this gives me a chance to elaborate– It is actually quite natural for people to empathize with others facing circumstances they have found frightening– . Healthy concern and compassion for others is rare these days, I admit. Seems like it is being pathologized — like so many human conditions–

      4. ” Please move forward and accomplish the goals that are being destroyed by the fear and anger that is obscuring the message.”

      If you got the message, press “1”, if you need further assistance, press”O” and an operator will assist you.

      Addendum: From the text on Trauma Informed Care; Authoritative statements and directives are triggers for people who have suffered traumatic experiences–most often abuse by an authority figure.

      I hope sanderella knows that most readers here would understand and appreciate where she is coming from–and that our support is unwavering.

  25. A few things and then I have to do more research on a respite that opened recently (saw it on Facebook) to find out where they obtained their funding so that I can pursue that in my area. As I noted in prior articles I always follow up on people; Mary went to Olive View UCLA where they set a broken finger and she met with an advocate prior to her probable cause hearing. she was not deemed “holdable” was not put on a 14 day hold, she was not given meds because they were concerned about her weight loss and dehydration. She was discharged with a list of shelters. In this hospital system (where I worked for more than 17 years) they do avoid medication keeping people as in-patients partly due to the fact that this is an LA County facility with no private funding and the staff are residents from UCLA. OK, now on to my mission that is to get respite-peer programs in this area; here is the info on the new voluntary short term 16 bed respite that just opened in another area of California. If anyone can help sort out how they obtained funding while I email some of the individuals on the site, I would be grateful.
    Jay Mahler
    NOVEMBER 1, 2012


    Peers Envisioning and Engaging in Recovery Services (PEERS) is a non-profit organization.
    333 Hegenberger Road, Oakland, CA 94621
    (510) 832 7337 | Contact Us
    So thank goodness there was this funding cut, because then I got into a group with other people who had mental health issues, and I had a very good psychologist named Dr. Moore. It was Dr. Moore that encouraged me to go major in psychology so studying other approaches, going back to school was very important, getting a job.
    My mother had passed away, but a good friend of hers worked for Kelly Girls. So I actually got, she got me a job through Kelly Girls working at a drug store, and that was very significant to my recovery.
    So there were a number of things over a several-year period, including going to church. It was very important for me to go to church and kind of get in touch with my spiritual side that was totally denied and devaluated by the public mental health system.
    Today, across the country, started by the National Alliance for the Mentally Ill, Prayer Days, National Day of Prayer Days are happening for those of us with serious mental health issues. And we know that 80 percent of those with serious mental health issues are unemployed.
    So today, I hope we’ll pray that people get jobs. We know that people with mental health issues are dying 25 years earlier than the general public. They die at 52 instead of 77. We recently lost DeWitt, Darnell, Michael Bell. We pray that we live longer, that we get the physical health needs that we need. When I first got involved with the consumer/survivor movement it was very much anti-public mental health system.
    Most consumer/survivors would have nothing to do with the public mental health system. So I was the person who was willing to develop relationships with providers that shared our approach and to try and work with the system to listen to us and to do things that would support us.
    To me, most importantly the consumer movement is a civil rights movement. It really started by many of us who have been mistreated and poorly treated in state hospitals and hospitals, and came together to try and call attention to what was wrong with the system and for us to support each other and validate what we had been through.
    Currently I work for Alameda County Behavioral Health Care Services as the Consumer Relations Manager. We’re responsible to make sure that the consumer voice is reflected in the transforming of the public mental health system.
    Most consumer/survivors would have nothing to do with the public mental health system. So I was the person who was willing to develop relationships with providers that shared our approach and to try and work with the system to listen to us and to do things that would support us.
    To me, most importantly the consumer movement is a civil rights movement. It really started by many of us who have been mistreated and poorly treated in state hospitals and hospitals, and came together to try and call attention to what was wrong with the system and for us to support each other and validate what we had been through.
    Currently I work for Alameda County Behavioral Health Care Services as the Consumer Relations Manager. We’re responsible to make sure that the consumer voice is reflected in the transforming of the public mental health system.
    Literally what I’m doing now, I’m actually kind of phasing out. I’m going through a process of retiring and figuring out what I am going to do. But you never retire from a cause, so what I’m really hoping to do is to work on spirituality and on this 10×10 Campaign which an effort to try and improve the life expectancy of people with mental health issues.
    It is a tragedy that people with serious mental health issues die on an average 25 years earlier than the general public. So people with mental health issues are dying at 52 instead of 77. I think before I had my nervous breakdowns, I didn’t have very much sensitivity to people that were going through difficult times. I think that what I have been through personally has helped me try and be sensitive to other people who are going through difficult times no matter what kind of situation it is. And, also I think that being involved in the consumer/survivor movement has given me a purpose in life. It gives me something meaningful and I feel I’m making a contribution.
    Jay Mahler
    NOVEMBER 1, 2012
    PEERS is a 501(c)(3) nonprofit organization. Contributions are greatly appreciated and are tax deductible.http://www.peersnet.o http://www.acgov.org/board/bos_calendar/docum

  26. I have described the moment when I heard the words “I am detaining you under S 29 of the MHA” as the moment I died. My soul was murdered, but the body lived on.

    I have one thing to say to anyone who has the power to do this to another person. Don’t start enjoying watching their eyes. Say the prayer, and slaughter the animal humanely. Because that is precisely what is being done.

    Thank you Katie for the power of your words.