In a recent post to Mad in America, psychologist John Read outlined the astounding case of Garth Daniels, a 39-year-old Melbourne man who has spent fourteen of the past twenty years in mental hospitals. Melbourne is a city of some 4.5 million people (by comparison, Chicago is 2.7 million) which consistently scores at or very close to the top in the world for quality of life. It is generally regarded as a conservative place and, perhaps coincidentally, is the home of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), also a very conservative body. Victorians, in general, regard themselves as cultured, sophisticated and genteel, which makes the bizarre treatment meted out to Daniels seem even more outlandish.
Daniels has been diagnosed as suffering from schizophrenia and has been prescribed every possible psychiatric drug, generally in large to heroic doses. He was regarded as uncontrollably dangerous and placed in seclusion but over the past few years, whenever he “shows aggression,” he has simply been shackled to his bed by his four limbs. During 2015, he was shackled for about 110 days in all including one continuous period of 69 days. Over the past seven months, he has also been given thrice-weekly ECT against his will.
Treatment has been ordered in regular series of twelve shocks, where each order issued by the Victorian Mental Health Review Tribunal (MHRT) follows seamlessly when the existing order expires. So far, he has had 94 shocks at three per week, and Victorian Mental Health Services (VMHS) indicate this will continue indefinitely. He has been deemed incapable of giving consent to ECT because he refuses it, but also because he can’t remember why he needs it. His treating psychiatrists acknowledge that the reason he can’t remember is that he has received ECT. However, he is deemed capable of agreeing to take medication even though he often doesn’t remember what drugs he is taking.
In October 2015, his family approached me to provide a second opinion to submit to the MHRT. I spent an afternoon at the hospital, firstly interviewing him, then seeing him with his father before I spoke to the treating psychiatrist who provided me with access to his files. As his files now amount to something like 15,000 pages, I was only able to look over the most recent 1,500 pages, but it confirmed what I had suspected. I then spoke to the head of the department and finally went back to talk to Garth himself, the whole process taking nearly four hours.
Garth Daniels is a lightly built chap of mixed South African race (formerly known as ‘coloured’) who presents as bright, alert, aware and pleasantly, even obsequiously, cooperative. When I saw him, he showed absolutely no signs of mental disorder whatsoever. He is bright and at least of average, if not superior, intellect, but I have never found evidence he has been formally assessed. His personality is anxious, unassertive, socially insecure, and submissive. Oddly enough, the majority of his admissions were voluntary; he takes himself back to the hospital sometimes as little as a week after discharge.
I returned to Melbourne on January 4th this year and saw him again before putting a submission to the MHRT to the effect that ECT could not work and that he did not need to be in a secure unit. I argued that he could safely be treated in private, that his case could be understood in psychological terms, and that “more of the same” treatment (incarceration, shackling, drugs and ECT) was no more likely to be successful this year than it had been over the previous twenty years. My submission was built around formulating the generic case for compulsory treatment. Bizarrely, in the history of psychiatry, this has never been done. Of course, as soon as it is put in writing, its logical errors and fallacies are blindingly obvious (it will be published elsewhere). I also advised that if the current program continues indefinitely, Garth Daniels will surely die. The tribunal gave no weight to my evidence and pressed ahead with more ECT
Since giving this opinion to the family, they have decided that they must leave Victoria. In early March, I received a call from the professor who is head of the Eastern Health Region in Melbourne, who wanted to discuss with me arrangements to transfer Daniels to my care in Brisbane. After talking with him, I said I needed to review Daniels before making a final decision and went to Melbourne the next day. Again, I spoke to him, his father and everybody involved in his management and left the hospital that evening believing we had an agreement to begin making arrangements for his travel and accommodation (he has relatives in Brisbane). The next week, I responded in writing to further requests for details of his transfer and management (e.g. how he should travel, details of community placements in Brisbane, etc.). Unfortunately, despite the additional reports, this did not happen, and he has since been transferred to a secure unit where his family is severely restricted in their contact with him. The ECT is continuing.
Why did the family choose me to provide a second opinion? They haven’t said, but my career and interests are readily available on the internet. I have practised psychiatry as a consultant for almost forty years, most of that time spent in the remote north of Australia as a solo practitioner. For the rest, I have worked as the head of the department of psychiatry of a Veterans’ Affairs hospital, as the head of a general hospital unit of 29 beds, in military psychiatry, prisons, and private practice. I have very extensive experience working at the rough and isolated end of Psychiatry. My private practice is funded entirely by the national insurer, Medicare, so I see pensioners, unemployed people, students and young people who could otherwise not afford private fees (they pay nothing, but I get a reduced fee from the government). That means that I see patients who would otherwise have to see public mental health services. Having worked for decades in public service, I know exactly what sorts of patients are seen in public hospitals and mine are no different. Indeed, about half of them have left the public system for an alternative approach.
Also, I have published extensively in the area of the application of the philosophy of science to psychiatry and the field of psychiatric theorising generally. I am highly critical of modern psychiatry on the basis that it does not have a theory of mental disorder and is, therefore, non-scientific. For the record, I am strongly opposed to the position claimed by the late Thomas Szasz, that mental disorder doesn’t exist. It does. I have argued that he was just another academic making a comfortable living by blaming the victims [1].
In my forty years, I estimate I have personally treated well more than ten thousand cases, meaning they have seen me and me alone. At all times, I have been entirely responsible for the whole of their management. I have not used other staff nor been accountable to anybody but the Medical Board. I have also directly supervised several thousand more patients in hospitals, meaning at least fifteen thousand patients in all. Not one of them has ever received ECT. A series of fifteen thousand consecutive, unselected public patients managed without recourse to ECT constitutes a major test of that form of treatment.
The RANZCP Position Statement on ECT (No. 74, March 2014) states at point 7.2: Pt. 7.2:
ECT remains a useful and essential treatment option that should be available to all patients in whom its use is clinically indicated.
This is often quoted in tribunal hearings as binding the hospital to use ECT, but this overlooks the fact that the Position Statement is nothing more than an opinion. Moreover, it is an opinion formulated by a group of psychiatrists who were convinced before they joined the committee that ECT is “useful and essential” and should be used. The committees that formulate RANZCP position statements are committees of the convinced and do not include critics. My lengthy experience shows that their opinion is empirically false. The official RANZCP publication (Australian and New Zealand Journal of Psychiatry) refuses to publish my figures. It should not be overlooked, of course, that if ECT were discovered today, it would never be approved.
A mental health tribunal consists of three people, a lawyer, as chairperson, a psychiatrist and a layperson as “community member.” The process is that the hospital submits its application, the tribunal asks a few questions then it retires to discuss the matter before announcing its decision. Inevitably, the psychiatrists on the panels are all convinced ECT is necessary: they regard the RANZCP opinion as confirmed fact.
They are mostly retired government psychiatrists who were trained by people who believed ECT is essential; they were examined by psychiatrists who believed ECT is essential; they were appointed to their jobs by the same people; they used ECT, often extensively; they are generally long-term friends and socialise with one another and train the younger generation of government psychiatrists who are applying to use ECT.
My experience of tribunals shows that the “evidence” to support the application consists of three points: He is depressed, and drug treatment hasn’t worked. Therefore, he must have ECT. I have never seen a tribunal where the government psychiatrists cite references etc. to show why it is necessary. Their applications are simply waved through.
On the other hand, any suggestion that ECT is not necessary is met by hostile questioning from the psychiatrist member of the panel. I am convinced that when the tribunal secretly considers its decision, the psychiatrist member actively introduces new evidence to counter the references and other evidence against the use of ECT. I know for a fact that one psychiatrist secretly dismissed my long experience as “anecdotal.”
The lawyers, of course, have never heard of the proposition that mental disorder may not be biological in nature and are simply unable to comprehend the notion that even psychotic people can be treated without incarceration, forced drugging, seclusion, restraint, and ECT. That is because they have been subjected to thirty years of relentless propagandising by mainstream psychiatrists, who are all the panels ever see. Very few patients can afford a psychiatrist for a second opinion, and quite often they don’t even attend the tribunal hearings because it is a waste of time. In my experience, they all believe the outcome is a foregone conclusion.
Just to clarify my position, I never prescribe the group of drugs known as “mood stabilisers” (lithium, carbamazepine, valproate, lamotrigine, etc.) and very rarely (once or twice a year) prescribe antidepressants. I never use antipsychotic drugs for a person who is not actively psychotic and then only for a short time. In particular, I do not use them for patients who would elsewhere be given the diagnosis of bipolar disorder. Very few of my patients are ever admitted to a hospital. I suspect these facts influenced the family to engage me to see their son. Since that first visit, I have been back to Melbourne twice and have spent a lot more time with him, but nothing has happened to change my view of his case.
My opinion is that he is not, and never has been, “schizophrenic.” At the age of 18, he suffered some brief psychotic episodes after heavy marijuana use which lead to him being detained and treated under an order. He has never been free of mental hospitals since. From time to time, usually when agitated over being restrained, he may accuse people of trying to hurt him or that they are conspiring against him, but he shows nothing that would constitute a convincing delusion (a fixed, false belief out of context with the patient’s social, cultural, educational and intellectual background) or a hallucinatory experience. He is well-dressed, neat and tidy, studiously polite and does not show any stereotyped or manneristic behaviour. He can conduct a perfectly sensible conversation and is never intrusive, overbearing or otherwise odd. When unshackled, he cares for himself normally and has regular leave from the hospital to walk around the streets.
The question of whether he is dangerous is important. He is currently being treated as the single most dangerous person in the history of the State of Victoria, if not in the entire history of this country. While in the hospital, he is normally kept on a closed ward but has recently been transferred to a long-stay secure unit. At some stage, he was detained in a forensic psychiatric unit for two years even though he has never broken the law. In twenty years, there have been only two episodes of aggression, one in which he assaulted a nurse who was trying to restrain him and once when he whacked his father who was pushing him. He has been assaulted a number of times in hospital over the years, including a fracture, but does not retaliate.
I need to impress that I am accustomed to dealing with aggressive patients. I have extensive experience of treating serving military personnel (at least one thousand patients over the past twenty years) and of veterans of every conflict this country has entered since 1916. I am also very familiar with dealing with acutely psychotic patients, including Aboriginal people in remote areas who lead semi-traditional lifestyles, e.g. many of them speak their own languages in their daily lives. Over the years, I have treated many murderers and rapists including men with significant records of violence. In my current office, with absolutely no security facilities whatsoever, I see veterans of Iraq and Afghanistan who are so paranoid that they insist on locking the office door behind them and then sit between me and the door so they can watch out the window. Believe me; I know aggression. Garth Daniels is not dangerous.
Bearing in mind that he has seen something of the order of four hundred psychiatrists over his long career as a mental patient, how could so many people be so totally wrong? The first point is that, as expected, his files reveal that not one of them has actually taken a history from this man. There were some very skimpy histories taken in the distant past but everybody since then has simply recorded “This well-known patient…”
Second, there is the “emperor’s new clothes” effect, where nobody is prepared to question the status quo. This is very powerful in psychiatry because the five-year training program (which is much more extensive and intensive than in the US and the UK) enforces compliance with the received view. It is directed almost entirely at turning out psychiatrists who are obedient to the party line endorsed and embraced by their “elders and betters.” Anybody who questions the professor won’t last long. As Chomsky noted in another context:
“…the people who make it through the institutions and are able to remain in them have already internalised the right kinds of beliefs: it’s not a problem for them to be obedient, they already are obedient, that’s how they got there [2].”
Third, when orthodox psychiatry looks at mental disorders, it sees brain diseases. Orthodox psychiatrists always want to be the first to come up with the most serious diagnosis; this has now reached the point where most psychiatrists are blind to the personality and neurotic disorders. I have argued [3] that modern psychiatry is actively engaged in a process of reassigning personality-disordered people to the category of psychotic disorders so that they can be treated with drugs. The illiberal use of powerful psychoactive drugs is producing the current epidemic of major mental disorder [4], particularly so-called bipolar disorder. That is, psychiatrists can’t tell when they are being manipulated, and they give drugs and then more drugs in a vain attempt to “cure” personality or neurotic disorders.
Finally, I now believe the Victorian MHS panicked when they realised the family was serious about moving. After having spent something like $10 million over the past twenty years only to wreck this man’s life, they could not take even one chance in a thousand that somebody else could achieve what they couldn’t. If they had let him come to Brisbane and he improved, they would be in serious trouble. Do I successfully treat patients diagnosed and dealt with as psychotic elsewhere, using non-intrusive methods with little or no reliance on drugs and ECT? Most emphatically, yes, that is exactly what I do. How come? Because in my decades in remote Australia, I had to learn to manage without all these modern labour-saving devices (meaning the labour of having to talk to patients and sort out their tangled lives). If I could get by without ECT in areas about as remote as Canada’s North-West Territories, then so too can all these clever professors in their luxury air-conditioned offices in the major cities. The reason they can’t get by without ECT is that they don’t want to: they are wedded to the procedure for ideological reasons [5].
A cynic might even suspect that Victorian MHS is hell-bent on giving Daniels so much ECT that he won’t be able to testify. Even if they aren’t, that will happen if they continue their present program.
I hope the information given here has allowed at least some readers to see the problem. Daniels is a very mild, submissive and socially anxious man who has hardly ever lived independently. These are personality factors, not “disease” factors. There is absolutely no reason whatsoever to believe that being doped to the eyeballs with psychiatric drugs and then strapped spread-eagle to his bed while undergoing ECT month after month can change personality. It is a measure of the scientific naivete of mainstream psychiatry that they could ever believe this. It is also a measure of their intellectual arrogance that they are unable to acknowledge their error.
References:
- McLaren N (2012). The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press (Chaps. 12-13)
- Chomsky N (2002). The Fate of an Honest Intellectual. Understanding Power. The New Press pp. 244-248
- McLaren N (2012). v.s. Chaps. 14-16.
- Whitaker, Robert (2009). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. New York: Random House.
- McLaren N 2013 Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.
