Suicidal Tendencies, Part III: So, When Do I Get to Call the Cops?


“What if the key to saving someone is to admit you are powerless to save anyone at all?”

In my first article in this series about suicide the tautological trap of “I am mentally ill because I’m suicidal because I’m mentally ill” was explored. In part II, I addressed the fact that the real ‘stigma’ of mental illness lies not in needing to clear a path for people to seek treatment, but in the system’s forceful and silencing reaction when someone speaks openly about the depths of their pain. Thus far, I haven’t crossed paths with anyone who wasn’t able to understand the basic premise of these pieces. Yet, it nonetheless seems the norm that people walk away from all these conversations, and continue to ask:

“Okay. I hear you. Force in the psychiatric system seems to increase the long-term risk of suicide, and all that. But, if it gets really bad, when exactly does it become okay for me to call the cops?”

“So, just between us, how do I know when it’s the ‘real thing’ and I should take action? I mean, I get everything you’re saying, but we both know that underneath it all you’re talking about people who don’t actually mean it. You still get to make the call when they’re serious, eh?”

“Right, right. Sitting with someone in their pain is the most important and useful thing you can do when they’re talking about suicide. Yada, yada. I get it. But, what if they really mean it? 911 is still on the table, yeah?”

“Come on now. Just let me in on the secret. Tell me that magic moment when I can be sure that I’ll be regarded as hero instead of villain for calling for help?”

I get it. The ‘what if’ game is enticing. But the short answer to all these questions (inevitably disappointing to some) is “never.” N-e-v-e-r. It’s never going to be “okay” to call 911 or the cops because someone is talking about wanting to die. Sure, if I found someone in the actual throes of death due to heart attack, overdose (intentional or otherwise), or some other actual medical crisis, I’d call for help. But there’s more than a little bit of difference between medical and emotional ‘crisis,’ and we’d all do well to stop mixing up the two.

“What if we accepted that the ‘who’ we are trying to save in so many scenarios is ourselves? What would that beckon us to change?”

To say it’s ‘okay’ to call the cops when someone utters a certain word or phrase, or you assess them to be at a particular level of seriousness, is to ignore the countless incidents where cops end up killing those they’re called in to ‘help.’ It also ignores that research has indicated that individuals who are forcefully incarcerated in psychiatric institutions come out even more likely to attempt to bring about their own death. Furthermore, it emphasizes the false claim (as the ‘mental illness’ system is so prone to do) that the problem lies within the person, thereby exempting the system or the broader environment from any and all culpability. To say it’s ‘okay’ is to say it’s acceptable to essentially detain someone and take away their liberty based on your own fears, and in spite of the fact that your plight to bolster the illusion of their safety may be just what brings about their ultimate demise.

And yet, all this said, I still understand why people sometimes do as they do. Why they feel compelled to keep someone ‘safe’ (as defined by the system), and why a person would have trouble going home to sleep at night unless they know that an individual who’s threatened suicide is contained in some manner. But being able to understand that sort of desperation is not the same as saying it’s ‘okay.’ What makes sense isn’t necessarily acceptable. In the end, much like suicide is a desperate solution to an often much more complex problem, so is the reflexive action on so many people’s parts to simply lock that person up to stop them.

I’m reminded of a clip from Daniel Mackler’s film ‘Healing Homes,’ where the father of a family that hosts individuals in deep distress speaks about having to come to accept that if they were doing their very best to be present for someone, and that someone still chose to take their own life, that he would have to be okay with that and not blame himself. How wise was this individual with absolutely no clinical training to be able to separate out the limits of his responsibility from the realities that may befall those around him. Even more importantly, he seemed to recognize that if he wasn’t able to come to a place of acceptance about such things, that fear might drive his actions in so many unhelpful ways. If only more providers were willing to do the work necessary to come to that same place.

“If we truly accepted our own powerlessness over others, what possibilities might that open up?”

This question — the one that asks how we might be able to show up for one another if we let go of the idea that we have to be responsible for each other — is at the center of Alternatives to Suicide, an approach I and several others connected to the Western Massachusetts Recovery Learning Community have been a part of developing since 2008.

At the Center of the approach are Alternatives to Suicide groups. They are an hour-and-a-half long, and led by two facilitators who’ve both ‘been there’ themselves, and are committed to holding space that focuses on validation and curiosity. However, the approach is broader than groups alone and at least pieces of it can be employed by anyone.

In speaking to others about Alternatives to Suicide, we acknowledge that it can be frightening to contend with the fact that the best way to create space that someone wants to be in when speaking of their darkest thoughts is to make sure they know that they can leave at any time. No matter what. It requires a great deal of faith in one another, as well as acceptance of potential loss, to relinquish the illusion of control. And that is what we ask of one another when practicing this approach.

Alternatives to Suicide also calls upon people to not assume illness, to recognize that we are each always in the best position to make meaning of our own pain (even if needing a bit of support to lift that wisdom to the surface), and that all emotions have value and validity. It further requires that when one person says something that elicits a big response from another, that we ask that person what they think their response means, rather than calling it a “trigger” and shutting it down.

When we offer trainings or talks about Alternatives to Suicide, people are often looking for the magic formula, the ‘what to do to make it all better,’ and the truth is that formula simply doesn’t exist. What we offer is more unlearning than anything else; more self-exploration so that you’re better positioned to explore with others without needing to sound the alarms. (If you’re interested, we have a three-day training coming up in Massachusetts in October! Click here to learn more.)

“What if I could hold you with my arms wide open?”

A few years ago, I spent a substantial amount of time talking with a man who entered my life because someone in the mental health system told him I might be the one who could save him (or at least, that’s how he heard it). His name was David. (I’ve spent a lot of time thinking about whether or not I should use a pseudonym, but I’ve decided to use his real name in an effort to honor his explicitly expressed desire to have him and his story be remembered.) He was in a tremendous amount of pain, and he was also very angry. And it was an anger that he chose to direct at me after a while when he realized that I, too, did not have a way to ‘fix’ things for him.

The vast majority of our time together was occupied by him telling me he was going to kill himself. He had a plan, and a timeline. I never exactly argued with him about any of it, but I did get caught up in asking him if he thought there was anything that could happen that would change that. But any conversation of that nature resulted in little more than him getting mad and becoming all the more resolute in his own doom.

All I really found that I could do was keep listening, and promise him that — no matter what — I would never be the person who would call the police or emergency services on him, no matter what he said. That promise meant a lot. It was what created the space for the conversation to keep going so long as he remained on this planet. But there were three other subsequent conversations that ended up being even more important.

First, there was a time when he stayed at the peer respite (Afiya) that is a part of the community that I help to lead. During that visit, he told me and everyone else that he was going to kill himself during his stay. And I had to face an ugly truth, which was this: I had to tell him that all those promises I’d made about not calling for help if he tried to kill himself would be null and void if he did that while he was there.

He could still talk about it all, and we’d be there for him without calling in anyone he didn’t want involved. But I had to explain to him that actually attempting to kill himself while staying at the house felt like an angry act toward us, as well. It wouldn’t be just about him. Because he had to know that something like that happening there would have the potential to harm us all — our funding, our reputation, our own piece of mind. I had to explain how it wouldn’t be fair of him to go there specifically to ask us to sit by while he dies.

I wasn’t sure how he’d hear that. Would it ring of betrayal in his ears? But he heard it as a fair request, and as best as I could gather, it helped ground him in the fact that he was still tied to this world through many relationships, and that his choices did have impact on other beings around him.

Next, there was a night when David was basically saying, “This is it. I’m in my car. I’m going to do it. I have everything I need.” I couldn’t help but be scared and tell him I hoped he didn’t, and ask if there was anything I could do. Eventually, our back and forth led to him getting mad, and saying what he described as a final goodbye. When I tried his phone it went straight to voicemail.

I thought that might be the last time I ever heard from him. Then, when he called me around 5am the next morning to let me know he was okay, and explained that he had simply decided to turn his phone off, I allowed myself space for something that ended up being important to both of us: I allowed myself to be mad. Mad at him. Glad he was alive, but angry that he had decided to leave me hanging and wondering all night. I told him it was unfair, and that I didn’t really want to talk to him right then.

Part of me felt like I should be protecting him from all that, and treating him as fragile. Part of me still felt afraid that I might then push him to take action to end his life by withdrawing my support, even if only temporarily. But what happened was that it helped snap us out of a power struggle that hadn’t been useful in the first place. I was no longer the person just trying to save him, and he was no longer just the person who was hurting. He was able to see that his choices had had a direct impact on me, and that I still saw him as a full human worthy not only of compassion, but of being held accountable when he crossed a line that I felt wasn’t okay.

The final turning point happened not long after. Once again, we were embroiled in a conversation about his plan to kill himself. But instead of asking if there’s anything I could do to support him to consider living, I simply said:

Suicide article: Photo credit: David Welch
Photo credit: David Welch

“Okay, I hear that you want to die. That you are going to die. But, is there anything you want to do before that happens?”

What followed was a lengthy conversation about his photography. We talked about creating an art show of his images. We wondered together where he was going to go to take more pictures to add to his collection. How we might work together to make the show happen. How it would be something to remember him by. That conversation extended over the course of a few weeks, and by the end of it he wasn’t so interested in carrying through his plan. Because he’d reconnected with something that gave him some meaning.

David did not end up taking his life, but he did die. After that last interaction I described, he went on to find housing (he’d been homeless, as so many people grappling with the idea of suicide are), and a job of which he seemed very proud (he was going to be housemate to someone else who’d been struggling in similar ways to himself). Then, on February 9, 2017, I found myself snowed in at the spot where I spend so much of my work-related hours, trying to make progress on a huge grant, and he offered to come shovel out my car. I was resistant to the idea, because I didn’t want him to feel obligated, and I didn’t want to take any sort of advantage of my paid role with the Western Mass RLC. He insisted. He wanted to give back. I’m glad I said okay. It would be the last time I’d ever speak to him. (“Okay, you should get out easily now. Be careful of black ice! Goodnight Sera.”) He had a heart attack the next day (the doctors and his family assured me that the shoveling was not the cause), followed by a stroke and died a week later.

David and I walked a hard path together for a while, and his end was tragic in that it came at a time when he’d finally seemed to have found a (more) comfortable place in the world. But I’ll never forget him, and I learned so much from our connection. About what it means to travel with someone in that way. To let go of the need to control. To be honest about my own feelings without allowing them to set the agenda or being afraid that he was too fragile to know he’d made me feel something big. To be honest about the power he had to impact those around him, and have faith that he was strong enough to be accountable to that fact. And, to remain curious and present through it all.

And with that, I dedicate this piece in his honor.


Suicide article, Part III: David Welch, 05/1954-02/2017
David, 05/1954-02/2017

Hold Me with Your Arms Wide Open

You don’t own me
You can’t even see me
This darkness that I reach for ain’t surrender
It’s all the fight that I have left

You are powerless
Over these hands of mine
You may contain my shell
Only as my spirit slips through your fingers

My pain is not yours
To mourn, to mold, to crush
My survival depends on flight
Even if your chains cut and scar me as I try to get free

I am the flower
That you killed
With those hands you call protectors
No matter if out of love, desperation or fear

What if you could let go
Honor and sit beside me
Instead of blocking my light
The only one who can tether me to this world is me


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Lord, this was stunning! And it hits so close to home for me. A “wide open hold” is, basically, what my family did for me. They never stopped me from preparing for my suicide: buying a gun, keeping it at home, leaving me alone to use it, etc. But, they never accelerated my race to the grave. My family told me they loved me, and that I could lead a good life. They told me to just try a little longer to live, that I deserved to live, and that life could become safe for me again. I’m still alive because of their love for me AND their respect for my liberty. Sera’s right. There is NEVER a good time to criminalize suicide.

    We must also do a MUCH better job of condemning the #1 precipitant of suicide – TOXIC FAMILIES!!! The vast majority of people DO NOT “commit suicide”. That is, they don’t assess their lives, identity some intractable, intolerable problem, see NO ONE who caused or hyped it, and, then, decide to rest forever. Instead, the typical suicide results from at least one lengthy period of abuse, neglect, manipulation, and COMPLETE disempowerment. And, intimate relationships are ground zero for that constellation of atrocity. If cops should be called on anyone, they should be called on the Munchausens and domestic abusers. Cage enough of them, and there will be fewer suicides. Believe it! Hell, it’s about the only way to quickly, easily, and permanently achieve a ‘YUGE reduction in death-by-despair. But, do we have the balls to even propose that? No way! We’re ALL stained with the blood of suicide. Until we get tough on perps, our humanity will continue to drown in that filth.

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    • Thanks, J! 🙂

      Yes, problems in families are often a part of what drives people to feel so alienated in the world. Along with poverty, racism, bullying, and so much other violence and hatefulness.

      One of the concepts we talk a lot about in Alternatives to Suicide is that suicide isnt the problem… it’s a solution to so many other problems, albeit a desperate one.

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  2. Beautiful piece.

    Tonight I am visiting someone in hospital who will die soon. It is cancer and she has chosen no more treatment other than palliative.

    I have called the police on someone twice. They have type 1 diabetes and are also long term MH service survivors. They stopped answering the door for a few days. His blood sugar was often out of control and I knew he could go into a coma and die. Both times when the police arrived he answered the door to their knocks so they didn’t have to break the door down.

    Each time it was a struggle.

    I nearly did it another time when someone was not answering the phone or door but in the end she had been sectioned so that was why she was not answering the door.

    Most cases though I’d do what you did, maintain contact as best I could, allow them freedom, but insist they not to kill themselves where and in ways it interfered with me or people I know.

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    • Thanks, John. I can appreciate feeling so desperate about someone potentially being in medical distress that you call for help. I also really appreciate that it’s not what you jump to.

      Unfortunately, overall, I don’t think policies that put it as ‘only in extreme situations’ go far enough because… Well, it still leaves it as an option and we’ve seen through history time and time again that what happens is providers tend to define more and more situations as extreme.

      If we could *at least* get to the point within the provider system that it’s not see as ‘okay’ and is seen as a failure of the system to provide useful options and mandates a review of practices (including an interview with the person themselves)… Well, that would sure be a step in the right direction!

      To come back around what I appreciated about what you offered… That you’ve been able to hold that line and had so few instances where you did resort to calling the police… is really useful toward demonstrating that that level of reduction is possible to folks who believe that ‘extreme situations requiring extreme measures’ are commonplace.


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      • I think the extreme measure called for in extreme situations is knocking on someone’s door, offering to be with them, telling them how you feel, and listening to them. I’d never call services, or go to them for help unless I knew what they were offering something useful. Usually they aren’t.

        But when someone does’t answer the door, the phone or online contact and is at risk for physical medical reasons or is so distressed that they could have committed suicide already (or be in the process of committing suicide) is a real possibility I will call the police. They could be dead, in which case it needs dealing with, or they might not be in which case it might lead to them being sectioned, which while worse in most cases could lead to a constructive convesation about how to proceed when the person gets out if something similar occurs in the future.

        They were difficult choices.

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      • The point about “system failure” resonates deeply with me. Systems that can’t identify failure never grow and develop. If I can’t help a depressed person, it’s not because they have “treatment-resistant depression,” it’s because what I did was not effective. This is not a place of blame, but one of learning from experience, and if one really wants to be more helpful to those in distress, one must be humble enough to admit when one’s efforts were not helpful or made things worse.

        BTW, BRILLIANT idea to ask him what he wants to do before he dies! I’m definitely going to have to remember that if the occasion arises in the future.

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        • And another thought on this point: just because the person continues to feel suicidal or even plan suicide doesn’t mean we have NOT been helpful. The goal should not be to stop the person from doing something or making them do something. It should be to understand their viewpoint and priorities, and in so doing, perhaps help them understand themselves a little better.

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  3. I agree, excellent piece, Sera. It was a tear jerker. I will say, I view how you dealt with him, as how one with common sense and mutual respect, deals with other human beings. Which is largely the opposite of how today’s “mental health professionals” deal with most their clients, unfortunately.

    This, too, was a good point, “it emphasizes the false claim (as the ‘mental illness’ system is so prone to do) that the problem lies within the person, thereby exempting the system or the broader environment from any and all culpability.” It’s all over the internet now, the problems are caused by our sick society and it’s satanic systems, our society’s problems are NOT within individuals’ brains. How the entire “mental health” industry could believe such garbage is staggering, however.

    David’s photography is beautiful, thanks for sharing his story and artwork. We, unfortunately, are living in a society that does not value our creators, and instead, “those we hail are the worst of all.” Because they believe “it’s acceptable to essentially detain [an innocent person] and take away their liberty based on your own fears, and in spite of the fact that your plight to bolster the illusion of their safety may be just what brings about their ultimate demise.” Because there are “countless incidents where cops end up killing those they’re called in to ‘help,’” and “research has indicated that individuals who are forcefully incarcerated in psychiatric institutions come out even more likely to attempt to bring about their own death.”

    A study found that, “From 2,429 suicides and 50,323 controls, they found that taking psychiatric medication made a person 5.8 times more likely to kill themselves. Psychiatric outpatient contact increased the suicide rate 8.2 times. If the person had visited a psychiatric emergency room they were 27.9 times more likely to kill themselves, and if they’d actually been admitted to a psychiatric hospital they were 44.3 times more likely to commit suicide.”

    Our societal systems, particularly our “mental health” system, are the problem. People are finally awakening to this reality via the internet, which is good. A reminder to all working within these satanic systems, a quote from William Casey, CIA Director 1981-1987:

    “We’ll know our disinformation program is complete when everything the American public believes is false.”

    Let’s hope our DSM deluded, appallingly disrespectful “mental health professionals” “take the red pill” and wake up some day. The “systems,” particularly today’s “mental health” system, are the problem. Although, it’s all the systems, including the mainstream medical, banking, legal, judicial – the brainwashing, divisive television programming – and the never ending war and fear mongering systems you “mental health professionals” drug us anti-war and “insightful” people for standing against.

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    • Thanks, Someone Else! I totally agree with you that so much of what I described above is really just about treating one another with basic human dignity and respect. Which is often why – when we do trainings on this topic – we find ourselves talking far more about *unlearning* (of all the layers of systemic crap that gets piled on) than learning.


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  4. Hi Sera
    Wonderful and moving. I often have the same dilemma about sharing another’s story. That you did is so helpful to hear how you struggle being with someone persistently in such emotional pain. For me it is “the struggle” staying with another over time without an agenda other than listening, being curious, validating and witnessing. Henri Nouwen a Jesuit priest who once trained in psychiatric hospital in the fifties wrote a piece that I posted on a bulletin board in my Center at work. It stayed up for months my hoping it would be widely read. I offer it below:

    “When we honestly ask ourselves which people in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing, and face with us the reality of our powerlessness, that is a friend who cares”

    Sera thank you for caring about David.


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  5. This is such a fantastic and touching piece, Sera. Thank you for sharing this. I’ve had a similar conversation a couple of times recently- the need to set aside our own fears, to grapple with our powerlessness and helplessness, to face the bad things and horrible suffering in the world and know that we cannot control it. That often the most helpful thing any of us can do is to be present and share in that dark space. To connect. We can’t connect when we’re too busy trying to fix, save, and control.

    Thank you most of all for sharing your own vulnerability and struggle in this work.

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  6. PSYCHE IS SOMETHING EXTERNAL NOT INTERNAL OR BIOLOGICAL, and it is something which should be respected more than normalcy, apollonan ego. DEATH/PSYCHE should be worshipped by the state, not banned.
    I absolutely disagree that critical states of psyche, urge to die, have something in common with free will (theology) or bad genes, the brain. This is not the right point of view. This is psyche – P S Y C H O L O G Y. This is mythical reality, not brain reality, this is soul reality, and the soul is something which is beyond control and the flesh.

    I also absolutely disagree that psyche have something in common with the biology, the biology/brain is only an answer to the psyche. I learned it from Sarah Kane, Anneliese Michel,Sylvia Plath and so on. I learned it form the TITANS, titanic psychological work. People whose ego was being completely raped/shattered by DEATH/ Hades reality which has nothing in common with the NORMALCY. THEY MEANS MORE than normalcy, BECAUSE THEY FEEL A LOT OF MORE.
    I want the Apollonian psychiatry to kneel down before HADES REALITY. Before gods. Thank you. James Hillman, Re- visioning psychology, Suicide and the soul.

    We are talking about normal states of psyche and those beyond control. State must obey to it to the death/psyche. I want psychological socialism with hierarchization of the kinds of developments. There are people in apollonian ego archetype (normal, the simplest) and there are people WHO WERE NOT CREATED FOR MATERIAL WORLD. Their work is hard and psychological. I want them to be noticed, especially Sylvia Plath, Sarah Kane and Anneliese. PSYCHE IS A VALUE and materialistst must obey to the greater reality which is Hades reality – the STRICT psychological reality.
    Anneliese did for psyche as much as Jesus for the spiritual reality.
    AND I WANT TO THANKS THEM FOR IT. They were heroes of descent.

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    • Hi Danzig, I’m not totally sure I followed all of your comment, but I hope you didn’t think that this piece was suggesting a connection between biology and people’s emotional distress. While I think there are some situations where we might not know exactly what’s at the root for some people and I would never want to presume to know what causes people’s distress other than my own, I do think that so much of it is environmentally based.



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      • No, I write it because someone have to. When we are searching for a victims we are searching for the roots of psychosis, depression and so on. Psychiatry should ask “for what purpose”, instead of asking “why”. Phenomenology instead false empiricism created to control people, PSYCHIATRY MUST SEE THE NEED OF THE PSYCHOSIS AND DEPRESSION AND SO ON. Without seeing the need of it, THE PURPOSE OF THE DEPRESSION, they will remain psychopatic apollonians- enemies of the psyche.

        We aren’t able to cope with suicide, because we are afraid of death, death is an enemy and we are thinking theologically about it. It is not, suicide gives hope for a future without pain and people are choosen to do it. Sara, Sylvia Anneliese, people in utter despair were choosen to kill themselves and this has nothing to do with others or environment, this is internal, and has connections with the death in the psyche which is the essence of the soul.
        It takes courage to think about it that way, Hillman taught to think that way, so they reject him, theology and biology miss the point of the death in the psyche, they reject it. There is no hope in many cases, and soul choose to leave. I want people to accept this. There are people choosen to commit suicide.

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        • Okay, thanks for clarifying a bit. I feel like I understand a little bit more. Although, I’m not sure that I agree with your thoughts about people chosen. Either way, thanks for taking the time to read and share your thoughts!

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  7. Thanks, Sera, for this thought-provoking, brave, and beautiful piece. I found it poignant on many levels.

    How many doctors congruently admit to their suicidal patients that they have to “turn them into authorities” so as to cover their own legal and financial ass — and to cover their own consciences? Not many. Most doctors don’t want to believe that they are acting selfishly, as they need to believe that all their actions are out of concern for the patient. Tragically, being forced to deal with their helper’s self-deception and incongruence is extremely painful for anyone – especially a suicidal person who is already overwhelmed by other pains. Professionals’ self-deception and incongruence is a violence to others but also a violence to themselves.

    Thanks again, Sera, for your integrity, insights, courage, and compassion — Bruce

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    • Bruce,

      Thanks, Bruce. Your point is an important one… If folks in professional roles could at least be more honest (with themselves and those around them) about why they’re doing what they’re doing, that’d be a huge step forward. At the very least, if someone was honest about doing something to cover themselves, at least the person they’re doing it to might be a little less likely to internalize the idea that they’re bad/the problem/hopeless/etc. It is so much of that latter issue that drives people getting stuck in these systems.


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  8. Thanks Sera for another empathetic and informative piece. As the Latino world deals with death in prayer ritual- Presente David.
    We all are dealing with layers of multiple issues with the topic of suicide and as Robert’s previous recent article the water is both deep and wide.
    And kudos for being so wise with him. Education and intelligence sometimes obsufacstes human kindness and compassion.
    To sit with another’s pain is a high calling not taught or recognized in many parts of this world today.
    Henri Nouwen not only was sat with but sat with others in the last years of his life. There is a stream of folks and someday MIA should highlight those.
    In the article you focus on professionals. And I agree with your thoughts.
    The question is why and how come and why not?
    Again history of those folks who could sit and listen and how past communities were able to have them in a much much more available is so so very important.
    The one issue and for another time I hope is the concept of mental health checks and folks using the police to handle their problems and actively and purposefully avoiding any other action. A kind of wiping the hands clean.
    It is another layered quagmire.

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  9. I was reading about childhood emotional neglect, and it said this is a very big problem, where children don’t get the right emotional responses. Another place I think said that as children we learn what our feelings mean by first feeling we have transferred them to a parent or adult, and then from their reaction we get the meaning. So, if we never got this, maybe the problem is not so much the feelings, but that we don’t know what they mean, we don’t know how serious they are. It’s the unknown that makes them so hard to live with. And perhaps the most intense one is that we are not known at all, and thus our survival is in peril. It seems like the answer is to provide the kind of signals and signs that our feelings are at last received and correctly understood, and then by watching the reactions of those who received them, we get the meaning. Maybe our subconscious mind doesn’t respond to a verbal explanation of what our feelings mean. Maybe the helping professions are not giving the right kind of feedback to those in distress. My experience was always feeling like something fundamental was missing.

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    • Thanks, dfk. You’ve offered an interesting perspective on this that I need to digest a bit more, but this certainly seems to be true for many people!: “Maybe the helping professions are not giving the right kind of feedback to those in distress.”


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    • I relate very much to your comments here. In particular, it’s become clear to me that verbal connection between a counselor and client, or any person trying to help and the “helpee”, is insufficient. It is the emotional connection on a real level that matters the most – that sense that the other person really GETS where you are at on a visceral level. And I think that’s also what babies are looking for, and you’re right, their very survival depends upon making such a connection. My sense is that it is terrifying for a baby not to be able to connect with a caretaker many, many times a day, essentially whenever they need something. Once the baby gets the idea that the parent figure is going to respond every time (or almost every time), s/he learns to relax some and be able to tolerate distress without panicking. I think that life can be very difficult for those who never have this primary experience of safety and trust.

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      • Thanks for chiming in and adding to dfk’s comments here, Steve! 🙂 Certainly, childhood trauma can have such deeply integrated impacts on how we walk through the world that it can be hard to realize it’s even happening. Thank goodness for neuroplasiticity!

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      • Dr. Bessel van der Kolk believes that this lack of connection for infants is part of their original trauma that will drive the entire rest of their lives. He and his group tried to get the APA to develop a new diagnosis, since they just love developing stuff for their new DSM, but he said that the APA rebuffed them and stated that trauma, and particularly the inability to connect with the caregiver had no bearing on anything. van der Kolk is no great lover of the DSM from what I can understand but thought that at least having it in the great Bible might move the discussion forward to that professionals would be better informed.

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        • Of course, trying to get anything about systematic traumatization into the DSM is going to be a failure. PTSD only got in there due to war vets, not abused children and partners. It is absolutely against the guild interests of psychiatry as a profession to give any acknowledgement of the role of trauma in creating “mental health disorders.” If they did, the entire edifice of the DSM would collapse under the weight of its on corruption. They only hold their power as long as they can convince people that they can “diagnose” people with different “disorders” that are driven by “brain diseases.” As soon as it becomes clear that traumatic experiences and social stresses are at the center of most “mental health problems,” the psychiatric leaders are exposed for the charlatans that they are. Plus the drug companies lose profits, and we can’t allow THAT!

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  10. Sera,

    Thank you for sharing this moving and courageous story. I do have a question for you. As a therapist myself who works in a state with laws requiring me to send someone to the hospital who is “imminently” reporting a plan, intent, and means to end their own life or someone else’s, how would you advise me to navigate these situations? If I do not send someone to the hospital to endorses imminent intent, I am subject to losing my license, job, and ability to work in the mental health system (or as an independent therapist). I rarely send clients to the hospital as it is, maybe 2-3 a year, and they have all been voluntary. Over the last decade I’ve maybe sent one person to the hospital who did not want to go, and as I recall they were seen and released from the local ED.

    Personally, I think the way you interacted with David is most respectful and honoring of that person’s experiences. Clearly forced hospitalization is rarely appreciated or beneficial to the person who is experiencing it. Quite the contrary, it too often is traumatic, dehumanizing, and increases risk of suicide. I find the entire system in this regard to be inadequate and unjustifiable.

    I do think a person should have the right to end their life if they reasonable deem this to be the best option for them to end their suffering (I don’t, however, when it comes to homicide, which I think is a reasonable position). This is not a position the system takes. I have also seen many people temporarily feel suicidal or homicidal but quickly change their minds after having a few hours or days to think it through. The system intends to create a situation where an upset person can be “safe” until they are more “rational” (e.g., don’t plan to end their lives or someone else’s), but the reality is that hospitals do a poor job of making anyone in distress feel heard, cared about, and respected.

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    • Hi Shaun,

      I can appreciate the realities that clinicians working in the system face, even when they truly want to practice differently. I guess I have several thoughts on this…

      1. Read Bruce Levine’s comment. At the most basic, if you could at least be real about *why* you are doing what you are doing, that’s a step in the right direction. Don’t get me wrong. It *still* can be devastatingly harmful to send someone to the hospital against their will, BUT… If you’re real about the reasons then at least you a) Can avoid contributing to the dehumanizing and disabling affects of telling someone that *they* are the problem in such a screwed up system and b) You can perhaps still partner with them to figure out how to minimize the damage. This might even include things like connecting them with folks who can coach them on what to say to get themselves the heck out of there as soon as possible, etc.

      2. Read ‘Rational Suicide, Irrational Laws: Examining Current Approaches to Suicide in Policy and Law’ by Susan Stefan. Susan is an Attorney in Massachusetts who has reviewed case law, etc. on suicide across the country. One of the realities that she has been able to identify along the way is that a clinician being successfully held liable for someone’s suicide is about as likely as being struck by lightning. Reading this book may give you some useful information as to your options and realities of your and others’ fears.

      3. Be upfront *before* someone comes to you and says they’re suicidal. *Tell* them what that would look like, and what you’d be obligated to do. Perhaps give every person you work with an informational sheet that explains all of your limits on privacy and what you’d be required to do if they said certain things. Be as specific as possible. But, don’t stop there. After you’re done being specific about all that, also give them resources for places where that’s NOT true… even if just a phone support line they can call. (But, be careful which one because many phone lines are also set up to call the cops if they perceive someone to be in imminent danger. But, there are SOME out there where that’s not true. The Western Mass RLC’s peer support line is an example of a place that simply won’t call the cops on someone talking about killing themselves, though it’s hours and funding are limited to 7pm to 9pm from Monday through Thursday and 7pm to 10pm from Friday through Sunday. (The number is 888.407.4515.) There are other options out there, too, but you really need to do your research to be able to be confident that they won’t call the cops, because most lines (including those most frequently promoted) will.

      4. Connect with others in your field who are trying to do things differently. Folks in England (for example) have done a much better job of forming ‘critical’ networks where they can get together and talk about how to do their jobs differently, and support one another to know they’re not alone in trying to do so.

      5. Also be honest about your fear and regret, and be willing to say you’re sorry. These things don’t make up for the worst of it, BUT being willing to talk about your own fears, regrets, worries, etc. *is* a big deal. Being willing to say you’re sorry when you cause harm is also huge. It almost never happens in the system.

      Those are my best ideas for now.



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      • Thank you, Sera for your response and recommendations. Very helpful. I certainly provide informed consent to start off treatment, so anyone who feels acute homicidal or suicidal thoughts or intentions knows what my legal limits are related to confidentiality and contacting the authorities. I have been talking to my colleagues more about these kind of concerns, and I’ve been encouraged by their agreement and support. Hopefully we all can be a part of helping to change this system for the better.

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      • I like the “Miranda Rights” idea. I used to do this when talking to kids who were in difficult situations with their parents (and sometimes with the parents, too) if it appeared they were going in a direction of reporting abuse. I wanted them to know I was a mandatory reporter and that there may be consequences that neither I nor they could fully control if they disclosed abuse to me. That way, at least they had the option of choosing not to talk about details, or presenting a hypothetical case instead of telling me what happened. It seemed the fairest way to give them the most control I could.

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  11. Hi Shaun
    These are the really tough situations persons like yourself and many others face in the public mental health system. There are no easy or definitive answers to such an exquisitely complicated dilemma. How to maintain the dignity of this human interaction when one person (you) have been given (by the state) the power to “take control over” another person i.e. deprive the other of his/her liberty. First to clarify: In my state CT a non MD clinician only has authority to write a paper directing first responders to transport the person to an ER for a “psych eval” by an MD who then has authority to involuntarily hospitalize the person. Perhaps not much distinction for you since control is still taken from the other but you are not ‘forcibly committing someone to hospital per se. OK not much difference I know.

    I have ben in this situation many times; it is always incredibly hard. For me I hope maintaining the dignity of the relationship even with its terrible unequal power differential mitigates the harm. I stay with basic principles. What is the context I find myself in? I don’t decontextualize the situation as almost all of psychiatry does by labeling and diagnosing. So I join with the other in the dilemma that brought us together. I listen as best I can to their pain if they can talk with me about it that has led to us being here in this moment. I acknowledge and validate the awfulness of the situation and ask how we might move through it. What is it they want? Many times the person feels so frightened they wish to be “safe”, do NOT want to die, but not live without hope and with all the hurt. They might then be receptive to an offer of services or not. Either way I can justify leaving without effecting any other intervention without “fear” of liability. This liability issue is more my myth than reality. As long as I have seen the other, formulated an impression with consideration of options and risks, I do not have any liability. I am not responsible for the outcome but for my assessments and considerations.

    In the system I believe liability is used as a cover for one’s anxieties and fears as Sera has clearly described in her piece. Also I have to face the other clinician’s disapproval. Their client may remain “suicidal” leaving the clinician having “to hold and be present with” someone’s overwhelming pain; no easy task.

    Every situation is unique. But having some basic principles as a guide has helped me through these arduous times. Hope this is helpful.


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    • Hi Ken,

      Thank you for the reply. This is helpful. I like your approach of joining with the person. I do agree with the premise that covering one’s anxieties through focusing on liability is common and unhelpful to the person who is suffering. There are examples where professionals have been blamed when they have not warned people of threats or been assumed to be ignoring potential danger signs (I think of the Aurora, CO, shooting where his treatment team was assumed to have missed something). CYA is common in the medical community, and I do feel this is often why we are doing risk assessments and Columbia screens all the time.

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    • Ken,

      I forgot to mention that yes only MDs in hospitals in my state (and I think most others) can decide to keep someone for a 72 hour hold or longer. As someone with an MA in counseling, my only ability is to initiate the process. In most cases I see ER’s will quickly discharge the person back to the community (probably because it isn’t a money maker for hospitals to have inpatient stays for “mental health patients.”) However, the folks with the good insurance coverage are more likely to get unnecessary “services” IMO. We should take the profit motive out of healthcare, but that is a completely different thread.

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      • Shaun and Sera

        Sera has written a very powerful piece here that is filled with enormous wisdom and courage regarding how to relate to people who are in such emotional distress that their very life may be on the line.

        The decisions about how to relate to (not “treat”) someone in this kind of emotional distress where they are suicidal, is almost identical to the decisions involved in the whole “sectioning” debate (that is, forced “treatment” and/or incarceration) that will occur if you (as a professional) notify any doctor and/or psychiatrist of suicidal or violent thoughts on the part of the individual.

        Over several years, as a professional, I have come to (with the help of MIA) the exact same conclusions as Sera, regarding how to handle suicidal thoughts and the related issues of forced “treatment.” Here is a link to a blog I wrote a few years ago on this same subject titled “May the Force NEVER EVER Be With You! The Case for Abolition.”

        Shaun, in response to your question about being a “mandated reporter” with the so-called professional “responsibility” to report someone with this level of psychological distress, and possibly suffer professional and legal consequences if you choose NOT to report that person:

        If you want to take a morally and politically correct stance here, you MUST take the risk of losing your job and/or suffering other legal consequences, by NOT reporting this person AND relate to the troubled person in a similar fashion as Sera has so eloquently demonstrated here.

        The reality here is that If your actions cause someone to be forced into a form of incarceration in a hospital, there is a GREATER overall risk of immediate and/or long term harm, including INCREASING the future risk of this person ending their life by suicide at a future date BECAUSE of the very chain reaction of events that you started by making the initial report.

        Ironically, if that person DID take their life after getting out of a forced hospitalization (that you initiated by your actions) you would suffer absolutely NO professional or legal consequences. Instead, you would only be praised and consoled by other professionals, who ALL want to self justify and reaffirm the workings of an oppressive system that they knowingly AND unknowingly continue to “enable” with “mandated reporting.”

        My blog mentioned above makes it very clear that once you start saying there are extreme circumstances or exceptions where some type of “force” may be necessary, you start reinforcing a slippery slope into a deadly abyss. You might want to read the very long comment section that follows this blog for it is both rich and extremely comprehensive covering every possible argument for and against the use of “force.”


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        • If you want to take a morally and politically correct stance here, you MUST take the risk of losing your job and/or suffering other legal consequences, by NOT reporting this person

          I completely agree with this as it pertains to those who have chosen such matters as their “professional” concern. I also agree that people have as a general principle the right to take their own lives.

          However, I don’t consider someone deciding to kill themselves in my face to be their “right,” and I reserve the right to try to stop them from doing so by whatever means appropriate, not just stand their stoic. And if someone announced upon arriving for a stay at my house that he planned to kill himself while he was there I would insist that he leave immediately.

          As for cops, until people have the right to defend themselves without legal repercussions, they must reserve the right to ask cops to defend them when physically attacked. Why should anyone be expected to do otherwise? I didn’t design this system, and won’t be held responsible for its consequences; nor should anyone. This ultra-shaming about never calling the police is largely another attitude that comes primarily from the privileged faux-left, not from Black or other working class neighborhoods. The Panthers have been gone since they got wiped out decades ago by Cointelpro, who are people expected to call for assistance? Instead of shaming them for calling the cops how about suggesting some alternative means of self-defense?

          Anyway this is veering slightly off-topic but I think at least some people can follow my train of thought…

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          • Oldhead,

            Hopefully you picked up from what I wrote in the original piece that I *also* don’t think someone’s right to kill themselves is equal to their right to do so in front of me. And, I’d be hard pressed to stand by and do nothing if that’s the choice they made. But whatever I did… I’d do as a *human* and certainly not as any sort of ‘treatment’.

            Also, this piece isn’t about not calling the cops at all. If someone was in my home and refused to leave, I’d call the cops, for example. that said, I also think it’s true that all the white folk calling cops on black people for doing things like barbecuing in the park (etc.) *IS* atrocious and a threat of violence.

            We always bring a ton of intersectional buttons to give away whenever we go to a conference. At the last conference we attended, we premiered several new buttons. The most popular one asid, ‘Fuck your help. My cat saved my life’ But not far behind that were buttons that said ‘Calling the cops on a person of color = a threat of violence’ and ‘Calling the cops on a person in emotional distress – a threat of violence’. This wasn’t intended to mean that calling the cops on people who are literally threatening to/are taking steps to harm someone else is wrong… But I think people got the point, and those also flew of the table.

            I don’t think of that as ‘police shaming.’ I think of it as reality. Speaking of shaming, another couple of our buttons said ‘I’m not trying to pill shame you. I’m just sick of of watching people fucking die’ and ‘Speaking truth about bad science & psychiatric oppression does not equal pill shaming.’



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          • Sera — The cop comments would have taken this all in a different direction, not directly related to most of what you were talking about, which is why I broke them off. Calling the cops certainly contains the threat of violence, or the potential for it, and should not be taken lightly. But I’m not going to call the homeless outreach team if someone’s busting down my door.

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        • Thanks, Richard. I agree with everything you say here.

          And for the record, I’m technically taking not entirely dissimilar risks in my work, which is still largely funded by the state mental health system. In fact, in some ways, the risks to us are even greater because if *one* bad thing happens in the ‘peer support’ world people are more likely to discredit *everything* we do than is likely to happen in the conventional system But we also know that if we don’t take those risks we defeat our own purpose. In fact, there is risk even in posting this piece and this particular story. Who knows how folks from our funder will interpret (and I do know that they read my posts here).

          I only wish more people were willing to choose integrity over risk management, and understand that the risk taking not only is absolutely necessary to do their job well, but also often comes with far less actual risk than they fear should something go wrong (as you also point out).

          My one misgiving about your post is the use of the term ‘mandated reporter’… I realize you put it in quotes… But I feel compelled to nonetheless say that that term is wildly used in the system. ‘Mandated reporter’ of course has nothing to do with suicide. Mandated Reporters are required to report when they suspect or become aware of abuse or neglect of a child, someone labeled with a disability, or someone considered elderly by a caretaker. That so many organizations refer to that as ‘mandated reporting’ is a way of silencing the conversation and making people feel forced to behave in certain ways. Because, of course, if it’s a mandate that exists beyond the organization that suggests much less potential to change things than if it’s simply an organization policy.



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          • Sera

            I agree that my use of the terminology “mandated reporting” here was confusing and did not consider the whole issue of protecting children and the elderly.
            Thanks for pointing that out.

            I believe it is more correct to say that there are ethical standards in our profession that say we are “mandated” to report individuals (to doctors, police, and/or crisis centers) who are suicidal, which is what I was trying to focus on.


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          • Midwives in the USA experience similar dynamics. Doctors can have babies and even moms die in their care and their colleagues just shake their heads and say how sad it is that “we can’t save everyone.” But any kind of bad outcome for a midwife is proof that anyone who doesn’t give birth in a hospital with a doctor attending is a fool, and that midwives are dangerous butchers who don’t care about the lives of their patients. It’s amazing they get away with it, but I guess it’s one easy way the people in power continue to exert their control over anyone who poses a threat to their unearned authority.

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        • Richard,
          Thanks for your reply. There’s a couple points I’d like to make. One, I think that it’s unrealistic to ask clinicians to not follow the law. We have invested time, money, and energy into getting education and training to do what we do. If we start breaking the law, as you suggest, we risk losing what we’ve worked to attain. Second, there are people who will do better after being sent to the hospital. I can’t say how many exactly, because that would require some complicated study. But I know that some people feel it helps. The problem is that we don’t have alternatives to hospitalization, which is of course traumatizing to some folks and makes things worse. Many folks in my area who are hospitalized are actually there voluntarily, because they don’t feel safe in their homes, or because they are seeking 3 meals and a bed (homeless folks), or because they feel they need some additional support.

          “Ironically, if that person DID take their life after getting out of a forced hospitalization (that you initiated by your actions) you would suffer absolutely NO professional or legal consequences. Instead, you would only be praised and consoled by other professionals, who ALL want to self justify and reaffirm the workings of an oppressive system that they knowingly AND unknowingly continue to “enable” with “mandated reporting.”’

          You are correct except that professionals don’t believe that it’s an “oppressive system”. Most people in the system, both clients and staff, believe that it’s a helpful system overall. There is an important role of mandated reporting, because we should protect vulnerable individuals in our communities. If a child or elder is being abused, we can’t just sit by and let this slide.

          I will say that my clients tell me that overall hospitalization wasn’t helpful. I think this is because it feels dehumanizing and is humiliating. We need other options, that I’m certain of.

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          • Shaun

            You said: ” I think that it’s unrealistic to ask clinicians to not follow the law. We have invested time, money, and energy into getting education and training to do what we do.”

            My response to you is as follows: Is it unrealistic to ask clinicians and other professionals to TO NOT HARM the very people they claim they are helping!?

            DO NO HARM is the most fundamental precept that should guide ALL our actions when entrusted to be a helping professional.

            AND if it can be proven that the overall use of ‘force’ causes FAR MORE harm than good, than you MUST (as a moral imperative) take all the ethical and legal risks to protect people from harm by NEVER subjecting them ANY forms of ‘force.’

            And Shaun, based on your above response, it is very clear to me that you have not yet read the blog I provided a link for above. Please read this blog along with the entire comment section and THEN tell me it is okay to continue using ‘force’ in your job.

            And BTW, my above short comment clarified my misuse of the “mandated reporting” terminology.


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          • Shaun

            And as a further commentary on your above comment: you said: “Most people in the system, both clients and staff, believe that it’s a helpful system overall.”

            Unfortunately, we all know this to be the case at this time in history. The KEY question here is: What do YOU think is the true and accurate assessment of the current “mental health” system.

            If you believe, as I do, that it causes FAR MORE harm than good, then you MUST (as a moral imperative) act accordingly. And this means (if you carefully analyze the overall situation) that you NEVER EVER use any ‘force’ on those you are entrusted to help.


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          • Shaun,

            I’d be silly, naive and whatever else if I claimed you were wrong when you said ‘Second, there are people who will do better after being sent to the hospital.’ We know it’s true because people’s responses vary, and all that.


            1. Why is it true? What about hospital *actually* helped the person? And what did they need to ignore/avoid/not be impacted by that was negative in order to achieve that positive?

            2. How are we defining ‘doing better’? Inevitably, we’d define that in different ways. (Not just you and I… but so many of us…) Some people have been trained to say ‘doing better’ when all they mean is ‘under control’? Some people have been trained to say ‘doing better’ when all that means is ‘numbed out’… Some people have been trained to say ‘doing better’ when what they mean is ‘right in this moment things look better, and to hell with how what we did to get this short-term result may impact things long-term…’

            3. Let’s assume we can find people we’d *ALL* agree are ‘doing better’ *after* hospitalization… There inevitably are such people. BUT, there are also people who appear to be ‘doing better’ after being tortured. (See the Judge Rotenberg Center as an example of a place that tortures people with painful electric shocks because some of them seem to ‘do better’ and stop serious and life threatening self injury after being so tortured.) How far are we willing to go with justifying torture because it seems to ‘help’ some people? What if something is just morally wrong even if it sometimes has some desirable outcome with a set of people? And what if it still hurts FAR more people than it helps? At what point does that intervention become unacceptable for *all* because it is morally wrong and/or hurts far more people than it helps?

            If we can agree that forced hospitalization is morally wrong and if we can agree (i.e., accept the growing body of research and wide array of individual reports) that it is causing FAR more harm than good… then whether or not it may occasionally ‘help’ some people simply becomes irrelevant.


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          • Richard,
            I did read your blog and you make a strong case for abolition. I would argue that people deserve the right to access current mental health care, BUT that they deserve to be fully informed of any and all negative effects from the “treatments” before ever starting. They should be fully informed that there is no scientific support for the DSM categories, that psych drugs often do more harm than good, that they deserve to have any and all of their questions answered, that they can choose to not engage in the system, and so forth. I do think that people should be able to voluntarily receive treatment like ECT and EMDR, so long as they understand all the risks. One concern I have about the MH system at the moment is it too often fails to fully inform clients before treatment starts what the real risks are. This to me is immoral and unethical to say the least. I have been paying much more attention recently to what I say in my informed consent at intakes, so clients know that they do have choices and that the MH system as it stands is not a scientific endeavor. I tell people that they are walking experiments with psych drugs. This convinces many of them not to see a psychiatrist at my facility, and I feel this is progress.

            I agree that “forced” treatment, like ICs, need to end. To me it’s apparent that this kind of “treatment” rarely works and is often dehumanizing and creates a sense of learned helplessness.

            Going back to what I said earlier I think that people who are voluntarily receiving treatment as usually the ones who tell me that it’s helped in some way–they feel less depressed, more motivated, more able to function in daily life, etc.

            Ultimately I think people benefit the most when they feel heard, understood, validated, and cared about as an equal human being. That is what I strive for everyday in my work. And hospitals are not the place to receive this kind of care.

            Thanks for the dialogue.

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          • Sera,

            Thanks for your reply.

            “1. Why is it true? What about hospital *actually* helped the person? And what did they need to ignore/avoid/not be impacted by that was negative in order to achieve that positive?”

            I would say that some people report that the structured environment of the hospital helped them to change their temporary, distressed emotional state. Generally most people who benefit are the ones who are there voluntarily. I think that “forced treatment” usually is ineffective and too often traumatic. And when I say “beneficial”, I am talking about the person who feels heard by the professional, feels that they have other options than to do something destructive, feel more rational and less impulsive, and so forth.

            I would love to see society have other options in these cases which don’t have a high potential for traumatization. When it comes to forced treatments, the vast majority of my clients tell me that the treatment was unhelpful. This is why I do everything I can to avoid sending someone to the hospital who would be involuntarily going.

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          • Shaun

            Thanks for reading the blog and your positive feedback.

            I get the clear sense that you are trying to do the best you can for the people you work with, and that your education here is a work in progress.

            Just be aware that merely expanding the depth of your explanation of “informed Consent” does not in any way solve all your the ethical dilemmas here, or does it necessarily absolve you of responsibility for possible harm done to people affected by this system.

            First off, there is no such thing as true *informed consent* given all the major power differentials and the billions of dollars spent each year to propagandize the Medical Model.

            And there can never EVER be true *Informed Consent* when it comes to Electro-Shock. And your comparison of ECT and EMDR, would be like comparing the “stoning” of a person to giving someone a sauna bath.

            I have used EMDR to help people, and I am convinced by all the testing that has been done, and by the benefits I have personally witnessed.

            Electro-Shock (ECT), on the other hand, is barbaric, and there is more than enough evidence (both scientific and personal stories) to abolish its use forever. I think you need to go into MIA’s archives and read up on the numerous articles on this topic.


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      • Ken and Shaun,

        I appreciate the truth of what you’re saying… that only doctors often have the right to sign off on papers, etc. to force someone into a psychiatric hold/forced hospitalization.

        HOWEVER, it nonetheless feels disingenuous to me to focus on this in most instances. Because doctors often just take clinicians at their word, and do whatever they suggest is the right thing. Because I’ve heard of situations where doctors have left blank forms with their signature on them for clinicians to use whenever needed. Because it’s not at all common for nurses to be able to go to doctors even in psych hospitals and tell them what is needed with someone incarcerated there and have the doctor just do it (force them into a ‘room plan’ that leaves them in isolation, make a change to their psych drug regiment, etc. etc.).

        The truth is that clinicians often have a TREMENDOUS amount of power when they say what is needed, even if they’re technically not able to sign off on the related paperwork. I realize there are exceptions or places where individuals aren’t int he same organization and if there’s tensions between the organizations that they may be less likely to listen to one another… but it’s true more often than not.



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        • Sera and Shaun

          This is exactly true. Where I use to work a clinician could have less than a 5 minute conversation with a doctor and this could lead to a chain reaction of events that would strip a person of all Constitutional Rights, force them in a hospital, which could then lead to being tied down to a gurney and forcibly drugged. And who knows how long this horrible odyssey would continue and how damaged that person would become if they were able to physically survive.

          This is the state of present day “freedom and justice” in America.


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        • Thanks for the reply Sera. Regarding clinicians influence on docs, I think it depends on the setting and the situation. Most doctors I’ve interacted with, both in outpatient and inpatient settings, seem to listen to me but make their own determination. When I’ve sent a client to the hospital I’ve never seen the doctor defer to my opinion. I’ve actually felt more dismissed by them rather than felt they seriously cared what I had to say. But maybe my experience is an outlier? I venture to guess that for clinicians who work in hospitals this is probably a very different situation. Nearly 100% of the MH holds I’ve initiated have led to the person being seen in the ER and released within 10 hours.

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          • Yes, as I noted in my comment, where people aren’t in the same org and there are tensions or a lack of sense of comraderie between the two orgs it can function quite differently. But, in my experience (not just personal, but decades of experience supporting people in different environments who are going through their own experience with the system), the assumption on the part of those with that power that they can and should just do what whichever clinician contacting them says that they should is absolutely pervasive.

            (There’s a typo in my above comment btw… It should say that it’s not at all UNcommon that psych nurses get to just tell doctors what to do, etc.).


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  12. Thanks for this Sera.

    The thing that chimed with me was in the Mackler film where I think its a therapist who says “first one family member, then another and another, you do the basics, food, exercise and people who like you , and build on that”.

    It’s also very difficult to overcome our natural wish to restrain someone, but actually one of the only things that’s driving them is an unusually intense desire for control and independence. So, rather counter-intuitively, I think it is that feeling that can help them go forward.

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  13. Sera, this particular phrase you used jumped out at me:
    “He was able to see that his choices had had a direct impact on me…”
    Maybe I read your article too quickly, and it does deserve a reread or two, but one thing I didn’t notice here, was the idea of telling someone, “I’m trying to understand your feelings and why you think you want ‘out,’ but I just want to tell you that if you go, I’m going to miss you.”
    Maybe some people think that is emotionally manipulative? That it would be playing on guilt feelings? I don’t know.
    What I do know from my own experiences is that when I was a teenager with big issues, although I didn’t have the insight to realize it then, one of the main things I wanted to hear from my parents (and didn’t) was something like this: “I care about you so much, and it’s hard to see you hurting yourself like this.” Perhaps society today is too much geared toward problem-solving and doing. That too is a form of caring but it’s often too indirect and it took me years to begin to understand even a tiny bit that my parents actually did care but didn’t know how to express it.
    To go back to the phrase I started with: So much (all?) of trauma is based in the feeling of isolation, of not feeling grounded in a network of caring relationships. It’s so easy to sink into that feeling, and it’s also tempting, because it absolves a person of responsibility toward others, of considering how his actions impact others. Maybe this is why your anger was more effective than treating David as fragile. Maybe it jerked him out of his isolation and into a real connection, a mutual one – because any connection that isn’t truly mutual is not really going to have a lasting impact (perhaps).
    Sorry this was a bit disjointed.

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