Extended Leave

Francesca Simpson
29
1875

In August of last year, I was held for three weeks in Psychiatric Intensive Care at the Royal Jubilee Hospital in Victoria, British Columbia. While there, I witnessed another patient violently smashing her head into the wall. Security was called and as the troubled young woman was put into restraints, the nurse said to her, “I know you’re angry but don’t hurt yourself — use your words.”

Even in my madness, I could recognize this as powerful advice and have been gathering my words ever since.

I have an episodic, sometimes debilitating, serious mental illness and have been under the care of an Assertive Community Treatment (ACT) team for six years, often on Extended Leave from the hospital. On Extended Leave, a patient is still committed under British Columbia’s Mental Health Act (MHA) but resides at home under a variety of conditions, e.g. having her medication witnessed or meeting with her psychiatrist regularly, to name just two of many possibilities.

If she fails to meet her obligations, the ACT team has the power to have a Warrant issued, the police come to arrest her and she is returned to hospital. Extended Leave lasts indefinitely, with the psychiatrist deciding at regular intervals whether or not a client will have her civil rights reinstated. As a result of my most recent episode of illness and subsequent hospitalization (which I voluntarily agreed to, as I was keenly aware that I was in urgent need of psychiatric care), I find myself yet again an involuntary patient embarked on yet another Extended Leave.

Being on Extended Leave intermittently over the last several years has been extremely unpleasant. Favourable responses to some requests that I have made (such as having injections administered only by a female nurse) have been a long time coming; other similarly reasonable requests continue to be ignored. Choosing to return to hospital rather than continue to suffer the indignities of Extended Leave is not possible, given that there are far, far more patients in Victoria on Extended Leave than there are available hospital beds. My ACT team alone serves 80 clients, the vast majority of whom are involuntary.

Since most patients cannot afford legal fees for a court application (and this is not covered by Legal Aid), the only possible route back to voluntary status — besides simply waiting an Extended Leave out — is to appear before a Mental Health Review Panel, the system’s purported safeguard from psychiatric overreach. The three-person panel, comprised of a lawyer, a doctor and a member of the public, hears evidence from both the patient and her doctor and decides whether Extended Leave should be continued.

Review Panels tend to be stressful affairs and rarely work in a patient’s favour — only one in eight succeeds. Evidence is used against us that would never be allowed in court, and the onus seems to be on the patient to prove that she’s not insane, rather than on the psychiatrist to prove that she is.

At my last Review Panel hearing, my psychiatrist took more than an hour to read from my medical records, which contain gross inaccuracies. He then left abruptly, so I had no opportunity to correct the errors. When it was finally my turn, I wasn’t permitted to present my position verbally but merely allowed to submit the written notes I had made in preparation for the hearing. The Review Panel chair behaved in a biased and highly unprofessional manner, questioning me in a belittling, contemptuous fashion and repeatedly rolling his eyes at my responses.

Review Panels are clearly not a sufficient safeguard, and nothing short of a court adjudication would be. Currently, extreme circumstances such as someone being a danger to himself or others are not nearly required for forced hospitalization or, worse, the diabolical Extended Leave.

Shortly after my recent discharge — which I engineered by flattering my ACT team leader, knowing that a word from him to the hospital staff would be sufficient to secure my release — I made a serious error when a different ACT team member showed up at my home with medication a couple of days later. I believe the exact words I yelled at him were, “Why don’t you do something more respectable for a living like deal crystal meth?”

The next day, as a result of this unseemly outburst, I was offered the choice of attending the hospital for assessment “voluntarily” or being arrested by the Victoria City Police and taken there. So I duly chose to present myself at the hospital, where I waited for six hours to see a physician. I exercised much self control (which is really all it takes to disguise mental illness), spoke calmly and slowly, displayed a passable rendition of sanity and, at 11:00 p.m., received a free taxi voucher to get home. I was grateful for the taxi voucher. I would be even more grateful for an apology from my doctor but none has been forthcoming.

The ACT team member who had driven this whole process informed me a couple of weeks later that she had treated me “respectfully” (I guess referring to the fact that she had spoken softly to me as she threatened arrest), while I submit that coercive psychiatric treatment is, by its very nature, the ultimate in disrespect — towards our minds, bodies and souls. Furthermore, the hypocrisy the ACT team displays in calling my decision to return to hospital “voluntary” in these circumstances is astonishing.

I have since come to realize that all I have to do is pretend to be rational and respectful in the presence of power. The ACT team members, by themselves, do not have power — they just trigger the mechanism that exposes me to power. I can be truculent up to the point where I’m in the presence of Psychiatric Emergency Services staff, doctors (any doctor, not just a psychiatrist) or the police.

This preserves my “freedom,” in that I’m not held at Psychiatric Emergency Services and injected with drugs by a (usually male) nurse, but does nothing to improve the conditions I’m forced to endure outside of the hospital. Being required under threat of arrest to be polite to people who are coercing you is not, I think, what policy makers had in mind when crafting the Extended Leave provisions of the MHA.

Without doubt, Extended Leave profoundly curtails one’s freedoms and rights, and the threshold for what is deemed “unacceptable” behaviour is invariably lowered. Please keep in mind that at the time of the contretemps described above, I had recently been deemed fit to leave the hospital, was taking massive doses of medication as prescribed (three antipsychotics, a mood stabilizer and a sedative) and was doing a competent job of taking care of myself. My only crime was being offensive towards an ACT team member. It seems that the goal I am now reduced to fighting for is merely the right to be rude in my own home.

The Extended Leave provisions of our MHA are often abused by psychiatrists, and in any event, they’re not even required; rather, we need drastic expansion of voluntary in-patient facilities. And I mean truly voluntary, not the all-too-common pseudo-voluntary mechanism I experienced in August. BC’s mental health care system is long overdue for an overhaul, as many anti-psychiatrists have been saying for years.

The most vocal proponents of Extended Leave or Assisted Outpatient Treatment (as it is termed in the US) make several questionable claims, the most pernicious being that the seriously mentally ill usually suffer anosognosia (lack of insight) into their conditions and consequent need for psychiatric treatment. Although anosognosia is indeed an actual phenomenon that occurs, for example, in stroke victims, there is no sound basis for believing it similarly occurs in most of the seriously mentally ill.

As with all mental illnesses, there is no brain scan, blood test or any other physical test which can confirm or deny the presence of anosognosia. Therefore, in practice, it can easily be — and often is — diagnosed in patients simply for daring to disagree with their doctors. Stating that you are not mentally ill almost always works against you, as it will generally be interpreted to mean that you must be mentally ill in order to make such a claim. As Phil Hickey asks: “Can you imagine a criminal justice system where pleading not guilty is routinely taken to be evidence of guilt?”

Despite this lack of objectivity, we are expected to take it on faith that a patient has this insurmountable neurological barrier to insight, rendering her incompetent to direct her own care. As somebody who has been diagnosed variously with anxiety, psychotic depression, schizophrenia, panic disorder, schizoaffective disorder, major depressive disorder, borderline personality disorder and, finally, bipolar disorder (my sole accurate diagnosis), I’m skeptical that disagreement with my psychiatrist as to the presence or absence of any particular mental illness necessarily indicates neurological disease. I think it’s also fair to say that objectivity is not psychiatry’s strong suit.

In any event, insight can be learned, and most of the mentally ill are aware that they are suffering great distress. A journal entry made shortly before my most recent hospitalization reads: “You’re not thinking clearly — be careful.”

I have long felt that community mental health care has been an unmitigated disaster. We need to abolish Extended Leave and, instead, vastly increase the number of voluntary hospital beds, reserving involuntary treatment for rare and extraordinary circumstances. During mental health crises, sedation is often required (sometimes considerable sedation), but it need not invariably be involuntary. For instance, I myself now recognize the need for medication when I am acutely ill, not because there is evidence that these drugs somehow delicately rebalance my neurochemistry, but simply because my experience is that I feel better when I take them.

The seriously mentally ill (especially those of us concurrently abusing alcohol or street drugs, and many of us do) can be violent. I am both middle-aged and middle-class, generally well-behaved, minding my own business and living in a quiet suburb of Victoria, yet I have a criminal record that includes an assault conviction. This arose from a time when the hospital declined to treat me, when I and everybody around me knew that I desperately needed psychiatric care. In frustration, regrettably, I threw a lukewarm cup of coffee at a Psychiatric Emergency Services nurse and then slammed a swinging door against her leg.

(As an aside, I also received a criminal harassment conviction for dialing 9-1-1 repeatedly to ask for assistance and to report that wild pigs were roaming in my backyard, and I received mischief convictions for (a) emptying the salt and pepper shakers at a pub; (b) stuffing a coffee shop’s toilet with newspaper; and (c) rearranging merchandise on a drugstore’s shelves.)

As devastating to my employment and travel prospects as these convictions have been, I do keep in mind that it was only through the criminal justice system that I finally had access to competent psychiatric care (one of the terms of my probation was to receive psychiatric care). Surely we can pave a less harrowing road to mental health care than the one I was forced to travel.

It was generally a chaotic time for me: I threw many of my apartment’s contents out the window, turned over my fridge, destroyed my treasured photographs, screamed incomprehensibly, burned food, frequently got drunk, embarrassed myself on the internet, disturbed my neighbours, wasted police resources, scared the shit out of my parents, destroyed what was left of my long-distance marriage and alienated most of my friends. I knew I was mad and I knew I desperately needed care but none was forthcoming, so the issue of voluntary versus involuntary treatment was moot. It often is.

Provide the beds, offer three square meals and as much sedation as patients want and most of the mentally ill, including the drug addicted living on our streets, will receive the treatment they require. Most involuntary treatment is utterly unnecessary — substantially expanded and run properly, psychiatric hospitals would have little need of force. With the current power structure dismantled, hospital procedures would have to be designed to be inviting, humane and mindful of patients’ rights.

Many people such as myself who acknowledge the presence of a serious mental illness would avail themselves of voluntary hospital services when need be. And street people who may not identify as mentally ill but who surely know that they are tired, poor, hungry and scared, would also flock to safety. The only real problem with this solution, in my view, is that voluntary psychiatric hospitals would be simply overrun, unable to provide for all those seeking sanctuary.

In the meantime, we are left with our current system which is in shambles. People are unable to access mental health care until there’s a crisis which sees them hospitalized, patched up with sedation and then released on Extended Leave.

Extended Leave is a form of social control, not health care, as it’s primarily designed to curb undesirable behaviour. I am no longer allowed to be a harmless, occasionally rude person struggling with a serious mental illness on my own terms and in my own home, even as that home is being regularly invaded by unwelcome guests, coercively medicating me under threat of arrest.

It’s time to phase out Extended Leave. If I’m ill, by all means, hospitalize me (involuntarily if so required); when I am well, let me go and leave me alone.

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29 COMMENTS

  1. Hi Francesca,

    It is courageous of you to speak out in this way, well done!

    First let me recognize what is surely one of the great quotes of the year here on MIA:

    “I think it’s also fair to say that objectivity is not psychiatry’s strong suit.”

    Haha! The understatement of the year.

    I was wondering while reading if you have the ability in the long term to move to a different Canadian county with a less oppressive system. I read about another Canadian psychiatric survivor, a woman – can’t remember her name – who escaped involuntary treatment in British Columbia by moving to Quebec or Ontario. Maybe you know who I mean.

    One thing I found curious was that you seem to both question and believe in the validity of discrete categories such as “bipolar” and “schizophrenia”. In my way of thinking, these labels denote continua of suffering which are non-discrete (i.e. have no sharp boundaries at the lower and upper edges of each continuum), and thus not valid when considered as discrete conditions. Moreover, emotional suffering is not accurately termed as “illness” – because as you again accurately noted, no biological or genetic cause of such suffering has ever been uncovered.

    You can see here, using this image, I explained the psychodynamic model of labels such as “bipolar”, “schizophrenia”, “borderline”, which you might find interesting:

    https://bpdtransformation.files.wordpress.com/2015/03/cam00157update2.png

    Further, I wish to suggest to you a few possible reframings of language; you may or may not find these useful, as they are just my opinion:

    “I have an episodic, sometimes debilitating, serious mental illness” – if I said something similar about my own experiences, I would have said, “I periodically experienced severe distress affecting my ability to function”, excising the use of “illness”. This is less medical.

    “medication” – I would call these tranquilizers or drugs. Since there is no biological illness process with the type of problems being discussed (although there is altered biology due to distress), there is no medication to treat such supposed illness.

    “hospitalization” – I would call this confinement, because there is no medical problem being treated (unless the problems really are also medical).

    “disguise mental illness” – one could say, “hide the fact that I am distressed, confused, terrified, enraged, etc.”

    “Although anosognosia is indeed an actual phenomenon that occurs, for example, in stroke victims, there is no sound basis for believing it similarly occurs in most of the seriously mentally ill.” – this is problematic – anosognosia cannot even occur in people so-labeled, because they have no clearly defined illness. You said this in another part of the article. It is not a question of whether or not the people labeled agree with their psychiatrists, since the psychiatrists have not proven that a valid illness process exists. They have to do this first before anosognosia is possible.

    “bipolar disorder (my sole accurate diagnosis)” – I would question whether any psychiatric diagnosis is accurate or meaningful. One might at one time roughly approximate the behavioral/thinking/feeling description of a particular “diagnosis”, but then over time this may change and one may no longer fit the criteria even remotely. I think you have seen this through your long list of diagnoses (which I also had).

    Francesca, do not take my criticisms the wrong way – I say them out of comradeship with the parts of you that oppose the mainstream system, and to encourage you to think in a way even more counter to establishment psychiatrists and to the system. Which you are already doing.

    I liked your statement: “Despite this lack of objectivity, we are expected to take it on faith that a patient has this insurmountable neurological barrier to insight, rendering her incompetent to direct her own care. “

    It reminded me of when I wrote, “It is almost as if (establishment psychiatrists) believe that by simply asserting that schizophrenia is a valid, discrete illness over and over again in journals and textbooks, by starting each article with “schizophrenia is a chronic, severe brain disease,” that this magically makes it so.” (https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/)

    I agree with you that taking psychiatric drugs can sometimes be useful if it calms a person down. But we need to be honest that these are merely general tranquilizers (or sometimes stimulants), not specific medications taking any illness. Then people can make an informed choice.

    Keep on advocating as you are; you are doing a great job with raising these issues.

  2. I took the now defunct Virginia Human Services Training for a short time when I was in Virginia. This was a course being offered to patients/ex-patients that guaranteed work at the end of it. I dropped out eventually, and without regret. I was told that the position I would most likely have held at the end of this training was as an ACT team member. The idea of making sure that non-complaint mental patients took their psychiatric drugs was one that I would have found unconscionable in the first place. Knowing how psychiatric drugs harm patients, my advice is usually to go against what is taken for medical advice. This situation that evolved for me illustrates quite clearly the problems existing for people who would choose to work as so-called ‘Peer Support Specialists’. Is drugging your “peers” really supporting them!? I believe something resembling what you are experiencing in Victoria is where the mental health system in the USA is headed. Big Brother (and Big Sister) are watching some of us at this very moment. The mental health system has, in this regard, taken an unfortunate turn. It was one thing when mental patients were held in what were essentially psychiatric prisons for a term. It is another thing when they can be held under what amounts to indefinite psychiatric house arrest. I see the mental health system, such as it is becoming, as a serious threat to the liberty of everybody in this country. I feel that if we lose our rights as free people at sometime in the future of this country, it will be through the mental health system, and perhaps the criminal justice system as well, containing many people who have already, to all intents and purposes, lost their citizenship rights. We may not be facing a military coup anytime soon, but this more subtle subversion and corrosion of our freedoms puts everybody at risk for the prejudicial and discriminatory practices that are only likely to increase as time goes on. There is only one answer to this assault on our freedoms, as far as I’m concerned, and that is to fight it. One thing I certainly don’t want to be is complicit in is this creeping loss of civil liberties for people in general.

  3. Three anti-psychotics, a mood stabilizer, and a sedative? How are you able to function?
    What trials have ever been done to suggest such polypharmacy is safe or effective in the short or long term? What evidence base is your psychiatrist using to justify this type of polypharmacy?

  4. Regarding “Extended Leave”
    It costs $1,000.00 a day in hospital(jail) VS $1,000.00 (about) a month for a disability cheque and being a prisoner outside (with an ACT team on the person).
    It is all about the money.
    Regarding “People are unable to access mental health care”. What does this mean? What is the action of “mental health care”?

    If a person can keep themselves clean and feed themselves, there is no need for the $1,000.00 a day hospital care.

    Regarding “all I have to do is pretend to be rational and respectful in the presence of power.”
    Yes, this is what those with the yellow metal (gold/money) desire.
    You can not pretend to be rational.

    I think the trouble with writing down ones “sins” as psychiatry does, they can never be forgiven.
    “The stupid neither forgive nor forget; the naive forgive and forget; the wise forgive but do not forget.” Szasz.

    Where in the criminal system you can do jail time to pay for your sin/crime. In psychiatry they never let you live down your mistakes when you were too emotional. Something I did/you did twenty years ago can be brought up in court as relevant evidence, which is insane. Only the current behaviour in the recent days/months is relevant to someones mental health.

    A person has to forgive themselves and those around them have to forgive. Living one day at a time we try not to make a mistake again, but not being perfect machines, we inevitably sin or make errors again.

    This inevitability of failure is great for the religion of psychiatry, as they can continue to make money from giving ( or forcing) the cure/help/treatment/punishment of medicine(just drugs).
    AND the drugs make people crazy. A self fulfilling prophesy with no end to those that worship the holy molecules of science.
    You do have to pretend worship because psychiatry ( the religion that isn’t a religion) is in power.

    P.S. A jail that isn’t a jail, it’s a hospital. A drug that isn’t a drug, it’s a medicine.

  5. Fransesca.The niacin’s actually better for you than the meds, if you can stand the flushing. Most of the shrinks in BC probably thought he was a quack, as well. Did he give you an HOD test before putting you on the B3? I only brought it up because I’m a schizophrenic and do 9g/day, among other non-med things. But I’m glad I don’t live in BC, because they’d try to medicate me and I don’t find sleeping 15 hours a day to be particularly therapeutic.

  6. Fran, had I not been so terrified of forced-psychiatry, I would have done exactly what you did. Every psychiatrist I’ve ever had has been as dangerous as any drug dealer. Your story is, yet, more proof that “out-of-control, ‘mentally ill'” are created by psychiatry. Here, psychiatry did its damage by neglecting your needs and then saddling you with a MASSIVE amount of self-blame for the inevitable consequences of their neglect. Maybe you’ve heard this already, but I’m going to say it again: You are NOT responsible for the sanism of your friends and loved ones, and YOU’VE DONE NOTHING TO DESERVE THE CRUELTY OF PRO-FORCE PSYCHIATRY. Basically, Mad people have to hibernate when they’re angry and using alcohol, food, etc. to cope with the psyche-shattering problems that get exacerbated by psychiatry and sanism. That is a self-defense strategy which should be taught to EVERYONE, so we’re all equipped to use it, in the event of our Madness. If psychiatry did nothing else, it should have, at least, done that. But, psychiatry doesn’t want to shore up anybody’s “safe spaces”. This pit of pseudoscience would empty out mighty quick, if it COULDN’T impose Draconian punishments on people who’ve exhibited “difficult” behaviors.

    • I have found a safe place out in the country. Away from the crazy makers in my Mental Illness team. (Nothing “Well” about it!) Living with my parents now. The quarters are tight and the TV bugs me. But if I spend half the day “isolating” in my bedroom, they don’t mind. Mom may worry, but she thinks I understand my emotional needs better than they do. Shrinks, friendship sellers (therapists) and all the flunkies beneath think that we’re too dumb to know if we are happy, sad or in pain. My parents are not anti-psychiatry, but they think of me as a human being. Few “experts” do.

      The nearest shrink and MI center is 100+ miles away. Yay!

  7. This is the best written personal account on Mad in America I’ve read since it was founded. Francesca, this just rings with authenticity and power. Thank you! This should be printed and distributed as a part of a mandatory training for every peer specialist, psychiatric nurse, psychologist, any professional who routinely treats individuals involuntarily. Treatment providers need to understand how traumatizing and dehumanizing involuntary treatment can be and story telling and personal disclosure is the only way to get the point across.

    This clearly illustrates how dangerous it is for service users to express even a modicum of the anger and rage that many are inclined to feel, after their basic rights are taken away, and when they are victims of the unchecked power that even the lowest MH workers exercise. Patients can get documented as non compliant for not attending therapeutic activities such as gluing glitter to paper plates cut out in the shape of Easter eggs. Never mind if the patient who is non-compliant is multi lingual and has a PhD in art history or is Islamic. Many professionals document ‘behaviors’ and trifles with the result of a person losing privileges or receiving potentially harmful ‘treatment’ decisions such as increasing medication dosages. I have observed first-hand abuses like this against my daughter by in hospitals, foster homes, and secure psychiatric ‘step down’ facilities.

    Flattery and faking ‘normal’ were the only ways that my daughter could win her discharge from the state hospital but she could never win her complete freedom in the community because she failed to exhibit a textbook definition of ‘insight’ which is basically the willingness to identify with her mental health disorder and accept that she needed maintenance drugs for life. It reminds me of the tortures imposed by the Inquisition against so-called ‘witches’.

    Anyway, our daughter is living at home with us at last. From our daily struggles, I can see how harmful family dynamics can be, like a garden in need of constant weed pulling. It is sometimes tempting to mirror the unhealthy upstairs/downstairs dynamics of the current mental health system, whereby any expression of rage, fear, or grief by the diagnosed one is automatically viewed as a terrifying ‘symptom’ to be repressed at all cost. This reduction ism is robbing families of the opportunity for healthy and honest group reflection and remediation.

    I can’t stand the ‘upstairs-downstairs’ mentality that exists between patients and staff. I also can’t stand the way some families members have been conditioned to view a loved one with a diagnosis. So much of it is bunk and instead of getting real help with the task of drilling down through the family (right on up to line to grandma and grandpa) to find out what is wheat to be treasured and what is chaff to be discarded, most family members can only find milk and cookies from pseudo advocacy organizations like NAMI which reinforce the medical model and exist simply to be a mouthpiece for big Pharma while giving parents a place to have pizza once a week while bitching about their children’s lack of ‘insight’

    Much of this faulty messaging is internalized. My daughter once stated that she is the ‘weak link’ of our family. What a terrible thought! Anyone who can survive the worst that our mental health system can throw out while maintain her dignity and humanity is the strongest link in the chain, not the weakest. So called ‘normal’ people should be getting lessons from psychiatric survivors on how to be resilient and bring clarity and balance back to our toxic, intolerant communities. I can’t believe every day when my daughter wakes up in the morning ready to give life another shot. Believe me, we are going to need this kind of resiliency as a society as we go forward into an uncertain future.

  8. Francesca, I really love your writing. As for your “crimes,” I had to chuckle. Even trashing your apartment, which sounded to me like the most destructive and violent of them all, would be excused if only you didn’t have a psych diagnosis. Say, if you did it while drunk, most likely the event would be dismissed. Or if you did it while 13 years old. Oh, if all of that were a result of a sorority party, stuff like that would be commonplace.

    The label changes everything. It is how one is perceived.

    Julie

  9. When I read these accounts, naturally the first thing I feel is empathy. I hope things turn out well for you. Hopefully, a day will come when I will be able to help at least some people in such crises out of them. I am in a bit of a crisis too anyway, but not as bad as the author of this article.

    The second thing I wonder is, is there anyway for you people to get out of this psychiatry cum legal system debacle in your country? When do they stop looking at you and move on to something else?

    Third, do they ever read the accounts of the people they treat here? What do they have to say?

  10. hi, francesca, my dear. my response is just what you would expect: the piece is gloriously well-written and persuasive, and i wish that such a fine mind as yours was on my side regarding the illness paradigm!

    e.g.

    “the onus seems to be on the patient to prove that she’s not insane, rather than on the psychiatrist to prove that she is.”
    if only you’d stick to “sane vs. insane” by way of terminology!

    “Why don’t you do something more respectable for a living like deal crystal meth?”
    love this, and it indicates insight and humour, though of course to Them it clearly indicates illness. sigh.

    “I exercised much self control (which is really all it takes to disguise mental illness), spoke calmly and slowly, displayed a passable rendition of sanity”
    again, to me, that self-control indicates that this has nothing to do with illness. if your brain is diseased self-control should not be an option.

    “was taking massive doses of medication as prescribed (three antipsychotics, a mood stabilizer and a sedative)”
    that anyone should be subjected to this mishmash of poisons is revolting, and certainly these substances cause true brain problems, even individually, never mind in combination.

    “As with all mental illnesses, there is no brain scan, blood test or any other physical test which can confirm or deny the presence of anosognosia.”
    indeed. which proves, to me and my ilk, that there’s no illness.

    “As somebody who has been diagnosed variously with anxiety, psychotic depression, schizophrenia, panic disorder, schizoaffective disorder, major depressive disorder, borderline personality disorder and, finally, bipolar disorder (my sole accurate diagnosis), I’m skeptical that disagreement with my psychiatrist as to the presence or absence of any particular mental illness necessarily indicates neurological disease.”
    again, this hodgepodge indicates to me that there’s no science in any of this…

    “most of the mentally ill”
    a category in which i assume that you would include me, given that i, too, during certain chaotic periods,
    “threw many of my apartment’s contents out the window, destroyed my treasured photographs, screamed incomprehensibly, burned food, embarrassed myself on the internet, disturbed my neighbours, wasted police resources, scared the shit out of my parents and alienated most of my friends.”
    yet to me this behaviour, awful as it was, had to do with distress and despair, and not with some unprovable neurological whatever…

    “substantially expanded and run properly, psychiatric hospitals would have little need of force. With the current power structure dismantled, hospital procedures would have to be designed to be inviting, humane and mindful of patients’ rights.”
    sounds right, except there should be no need of force and this shouldn’t be a matter of hospital, from my perspective (obviously).

    “street people who may not identify as mentally ill but who surely know that they are tired, poor, hungry and scared, would also flock to safety. The only real problem with this solution, in my view, is that voluntary psychiatric hospitals would be simply overrun, unable to provide for all those seeking sanctuary.”
    ah, sanctuary. exactly. not in any way what hospitals are meant for.

    “Extended Leave is a form of social control, not health care, as it’s primarily designed to curb undesirable behaviour.”
    i agree 100%, except that this is true of psychiatry and not just of the hideously and militarily named “Extended Leave”

    • I have found shrinks typically regard laughter and joking among us as symptoms of our “illnesses” that require lots of drugs. Most of them don’t even crack smiles around us and would starve if forced to work as stand-up comics!

      The only truly evil shrink I’ve ever had the misfortune to know (the rest were merely ignorant) would smile when I showed signs of emotional pain–caused by her. Never at any other time did I see it. When I wept because she ordered me to be locked up she laughed out loud.

      • Hey, “FeelinDissed”, if that’s true – and I do believe you, – that you had a female shrink who laughed at you when you cried because she ordered you locked up – DANG!….
        She is one *SICK* *COOKIE*….To laugh at somebody’s pain and misfortune is sadistic, cruel, and constitutes verbal, emotional, and psychological ABUSE!…. You’re correct, *EVIL* also describes it. She’s probably a rabid, militant atheist, too….
        I’m ok w/atheists. *I* don’t believe in the God *THEY* don’t believe in, either….
        I’m glad to see you share some of your story here! Welcome! ~B./

        • She claimed to be a Catholic. It certainly didn’t seem to influence her behavior though.

          She would put you in solitary for praying silently on the ward. All Bibles had to be kept in the patients’ rooms at all times.

          She might have allowed prayers and worship–if we had addressed them to Her! That would have proven us to be truly delusional, IMO! 🙂

          • I was born & raised Protestant and also have become Buddhist as an adult. I didn’t even know that “Catholic” was anything different until I was all grown up. Yes, there’s something wonderful in Catholicism, but also something very sick and twisted. And sometimes, those 2 things can exist at the same time, in the same person. I’ve known some male shrinks that were ok, but ALL the female shrinks I’ve known have been either clueless idiots, or sickos, or both at the same time. That’s just been my experience in the system. But really, neither kindness nor cruelty knows any specific gender.
            ( And I’m hoping since you’ve been here at MiA, that you do feel just a little bit LESS “discouraged”!)
            I’ve found that when I can, and do, talk about everything – even if I’m just talking to myself – it helps clear things up, head-wise. That’s the real shame of shrinks like you described here. All they really would have to do, is *PRETEND* to listen & care! How hard is *that*, huh?… 😉

  11. As somebody who has been diagnosed variously with anxiety, psychotic depression, schizophrenia, panic disorder, schizoaffective disorder, major depressive disorder, borderline personality disorder and, finally, bipolar disorder

    This is absolutely abhorrent and disgusting. These labellers should look at their own mental sicknesses for labelling another human being with so much horrendous nonsense. Do these people understand what this does to another human being? Are they really so oblivious?

    It is a sign of great resilience that you have written this article so coherently. If people labelled with so much garbage and denigrated and destroyed with so much psychiatric tripe ever killed themselves out of the sheer indignity of the whole thing, they’d become statistics in “Deaths/suicides due to mental illness” or “Deaths/suicides due to *insert particular psychiatric label*”. And then you will hear speeches, and TED talks about how many poor people die because of *insert DSM label illness*, and how they could have been saved. No one will ever know, that some of these people would have killed themselves because of what the psychiatric system (which they entered to get help not knowing what it would turn out to be) did to them or the kind of position it put them in, and how much of anything meaningful to them in life, it destroyed and took away.

    Writing about someone can be done descriptively without labelling them with nonsense.

    Why do these psychiatry people always talk about how much their services are needed, how much they have to expand, how much more brain science they need to conduct, how people with “so-and-so disorder” have X problem/Y problem, how people with *insert DSM label illness* are at risk of committing suicide…or some of the more “benevolent” ones will do research about how pharmaceutical companies do not show true drug trial data, they join organisations like the Cochrane Collaboration etc. All of this is just stuff that improves their own research profile. Whether it helps people or not is a secondary thing.

    You will never hear them talk about the kind of problems people run into after being labelled with so much garbage or what this does to another human being. Nope, never.

  12. Hi Francesca and congratulations for this article.
    I am really empathic with you as I was diagnosed in time with borderline personality, psihotic episod with schizofrenic symptoms and bipolar disorder.
    I think that learning what is truth and what is not in psychiatry is the key for our progress.
    Thank you Matt for your comments from which all of us can learn objectiv terms. Why should we use the terms invented by psychiatry? I personally had the experience of “hospital” and the only good experience there was that I could tell the doctor that she is not correctly using the term illness in my case.
    I only consider usefull the psychiatry for those who choose this way of handling their experiences.
    I agree that many of our families do not know how to handle differently our special states but I strongly believe that if someone can explain us what others see as abnormal, we can agree with drugs for a period and with the necessity of hospitalization.
    I do not understand the differences between psychiatry and any other non scientific treatment for special states.
    Advocacy group sounds great. I am interested in this subject as I would
    like to have one in Romania too, even if my opinion is that a global advocacy group is more efficient. If you like and allowed here, please share some of the advocacy group features, also.
    And Matt, it would be great if we could benefit of objective review of our wording when expressing our experiences and states.
    I have recently discovered this site (after 4 years of searching like a blinde) and it really helps me to feel I am understood which is not happening in my social circle.