Full Moral Status, as defined by ethicists, is a stringent moral presumption against interference with a being in various ways—destroying the being, experimenting upon it, and directly causing its suffering, etc.
The American Medical Association states in its standards of conduct defining essentials of honorable behavior for doctors that “a physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” Further, bioethicists list the following principles as essential: autonomy, justice, beneficence, and non-maleficence.
And then there’s the psychiatric industry that drives mental health care in the U.S., defined as the undeniable and open symbiotic partnership between pharmaceutical manufacturers and their public face and sales rep, the American Psychiatric Association. They represent with an ambitious, high-minded statement that includes excerpts from their Vision: “working together to ensure humane care and effective treatment,” Mission: “promote the highest quality care for individuals with mental illness,” Values: “Best standards,” “Advocacy for patients,” ”sensitivity for patients,” and “Scientifically established principles of treatment,” and Goals: “To improve the rights and best interests of patients…” (APA website 2018)
My Bona Fides
I’m a former psychiatric client who ‘juked’ the industry right out of their shoes. I had my 2004 acute, chronic, lifelong bipolar 1 diagnosis, with a ‘forever’ SMI designation, completely removed (or as I prefer to call it, “vacated”)… with the paperwork to prove it. By 2016, I had also negotiated a safe, guided withdrawal of all psychotropics. My dedicated path out took 2.5 years as the singular patient of the CMO/VP of the largest behavioral health provider in my state. I had long since lost my private coverage. He was motivated by the combo-platter of liability issues, his immediate career arc, and doing the right thing. After searching over the years, I found one other who had traveled ‘my’ path; a former Navy and United pilot who had also been diagnosed in 2004, carrying the diagnosis for 10 years, like me, until ‘vindication’. I hope there are others.
I had made my initial, damning appointment looking for relief from some financial stress and the resultant insomnia. My bills were current, but I knew things were teetering. And I had great insurance.
“…years ago, you practically had to be hospitalized to get a diagnosis of bipolar. Today, it’s available to anyone with insurance.” DJ Jaffe, Mental Illness Policy Org.
I was part of the well-documented tidal wave of profit-propelled bipolar diagnoses following the expansion of criteria in the Allen Frances-piloted, infamous DSM-IV. I could expound on this subject for hours; I’ll let better writers do that for me here. Dr. David Healey’s well-regarded, 2006 PloS Med article “The Latest Mania: Selling Bipolar Disorder” is a concise explanation of what occurred forensically. It was my ‘gateway’ article and it made me weep; here was someone who knew. Gary Greenberg’s 2013 The Book of Woe: The DSM and the Unmaking of Psychiatry is the longer explanation; equally entertaining and grotesque. My perspective was very different by then; I was cynical and tougher, but no less terrified and trapped.
I am the wrench in the works of the psychiatric industry’s well-oiled machine as I hold dual-citizenship in their world. I was declared bipolar-for-life, incurable and perilously close to eternal psychosis, courtesy of a 9-year SMI certification.
11 years later, they declared me… well… not.
I am a troubling paradox in their insular, absolute world. Apparently admitting a mistake regarding their behavior is… a problem for the behavioral experts.
Their parting advice to me was priceless: “Don’t dwell on ‘this’, be in the present, we wish you the best.” In 2.5 years, they couldn’t force themselves to speak the words ‘mistake, false diagnosis, conflict-of-interest, tragedy, irresponsible, or venal’ (that last one is mine). I didn’t press it, as the first lesson I had learned in those years was the intentional, industry-serving ambivalence in psychiatric language; talk is simultaneously authoritarian and cheap. A 20-minute appointment with a stranger resulted in a ‘lifelong’ definition of who I was and who I would forever be, and it was all bad.
On the flip, when it came time to ‘take it back’ and acknowledge and repair the very real consequences of those nine years, they needed over two more years, infinite paperwork, and no acknowledgement of how all this ‘fuss’ came about. The experts in psychotic behavior were detached from the reality they had birthed and the catastrophic results to a human life.
The legal, moral, and ethical issues were acute: if I was authentically mentally ill (according to them), how could they ethically assist my withdrawal off the drugs and give me a changed, corrected, absolving exit diagnosis?
I had quickly learned that having it ALL ways was the biggest hallmark of the industry. The first casualty would be my credibility. The second would be my former excellent health, oh yeah, and a decade of time. The third casualty was losing trust in everything and everyone.
Well, bless their hearts.
As Sun Tzu said, ”Know the enemy, know yourself”… check and check.
Psychiatry is absolute with their declaratives—everyone is flawed or fatally flawed, viewed as a profitable target or not. They are situational in their approach to ethics, standards, and behaviors (irony alert). In other words, the behavioral health experts insist on having it not just both ways, but ALL ways. And why not, if the world allows you to self-define your import and credibility; writing your own rules, resume, and achievements?
Of course, it’s perfection as a business model: defining lifelong consumers through a lifelong diagnosis that begets lifelong treatment that they bestow unchallenged. As the brain is a mysterious, wonderful, yet sometimes scary place, the government and the public at large are supplied with exaggerated statistics regarding frequency and dangers of mental illness, conveniently defined by the pharma-dictated, APA-produced ‘Bible’, the frightening DSM. The DSM has something for everyone, literally and again, situationally. It gives the industry an All-Access-Pass in medicine and the judiciary, no questions asked.
This circular house-of-mirrors, snake-eats-its-tail shell game coupled with the billions of dollars that buys any protection, marketing or legal, necessary for the industry’s public face is a fait accompli. If you find yourself in the system, push-back against the infinite, dizzying Catch-22’s is impossible as your credibility has been stripped… and you’re drugged. Collateral damage created by the drugs is ‘acceptable’ (to whom?) as they patiently explain, “it’s the price for ‘stability’.” Huh?
By 2013, I was a seasoned member of psychotropic gladiator school. How strong was my psyche, my physical stamina, my emotional reservoir? Would my heart, liver, kidneys, or nervous system fold first, symptomatic of my acute, chronic, lifelong mental illness? Some clients white-knuckled it and held on, some sank slowly and permanently. Everyone was in danger.
The dominos begin to fall…
In June 2013, a clinic prescriber made a couple of sloppy decisions (again), over my objections, and anaphylactic shock was the result. I do not recommend it as an exit strategy, but… despite my subsequent dramatic and lengthy downward spiral (plus withdrawal, rebound, and neuroleptic malignant syndrome #2), I was acutely conscious of the gravity of the 1st-year-med-school mistake and what it represented. I had been hospitalized in the past for heart and nervous system ‘crashes’ caused by the drugs, but these were summarily dismissed as symptoms of ‘my’ illness, the usual dismissal of any liability.
This was different. Having two RN’s in my family background paid off big… I knew the weight of the term anaphylaxis and the universal legal and medical implications that transcended the psychiatric industry. Here was the leak in the dike, the chink in the armor, the break in the glass.
Of all the side effect horrors over 11 years that I had experienced mentally and physically, that one word cracked the door open. I had never seen faces freeze with dread when describing my other side effects: not heart, neuroleptic, kidney, liver, or diabetic conditions. Those were met with a polite pause until I stopped talking, then on to the next prescription.
Anaphylaxis was the Sword of Damocles over all their heads. It was their Kryptonite. They remained silent but hung on my every word. I never had to say “attorney” one single time. It would have been overstating the obvious. For the first time, the very big ball was in my court, but I needed game strategy right away before the spell wore off.
The mess was still at a local level; if it leaked up the food chain, it would start to damage staff and bigger forces would swoop in to contain me… NOW was my moment; but how to capitalize, with what tools, toward what goals?
And then… during the sickest I had been in a decade, my brain abruptly separated from the internal chaos of emotion and panic and slapped me with a clear “fight or flee” primitive, visceral thunderclap:
If ‘we’ stayed, we were going to die.
Snap out of it, Kris.
Do it NOW.
Medical malpractice is extremely difficult to prove in conventional medicine replete with tests results, labs, and imaging. Justice is virtually impossible in psychiatric malpractice as the client is ostensibly mentally unstable and the treatment is for their ultimate benefit and inseparable from their chronic ‘hysterical’ state. There are, of course, no other ‘official’ voices. Although the industry would never characterize it to a client this way, among psych workers and the judiciary the parallel to cancer treatment is popular—surgery, chemo, and radiation can be vicious, but it can save lives, if you survive it. It’s for their own good.
And there it is… the real-world, on-the-ground, private practice and clinical position of the APA is Plato’s “Noble Lie”—a myth or untruth propagated by an elite or authority to maintain and advance an agenda, using a “common good” justification.
During my ‘unfortunate incarceration’, I had attended over a hundred independent ‘groups’. Most people wanted to engage in defending their health and improving safety standards; it was a constant topic. But they didn’t know how to start the convo besides complaining. Provider guidelines to address grievances were an exercise in cynicism. They also exposed the client to reprisal; passive aggression or real bias in clinical notes. The party line I had experienced coast-to-coast was “we encourage you to be a self-advocate”… until I started being one. There wasn’t one single ‘group’ I attended where the quality of care wasn’t referenced. And it all centered around drugs, drugs, drugs. And drugs. The lack of well-educated, compassionate care was a distant second… which circled right back to the drugs.
I needed a plan, a manual, some tools for survival, some guidance. The ‘advocacy’ community and appeals programs were agents of the system I was pushing against. Their universal advice was to stop maligning the caring experts working to protect me from myself. It showed how shockingly little they knew about the subject they were pontificating on. I minimized the time I spent being frustrated and angry over the unfairness of it all. I needed to move towards safety and exit… NOW.
I was finally forced to embrace the concept of self-rescue. It sounded ridiculous, but I was out of moves. After slogging thru the quicksand of ‘options’ ranging from malpractice attorneys (don’t ask), appeal boards, human rights agencies, advocate organizations, and legal aid for the disabled, I was left standing alone and sinking rapidly as everyone (including friends & family) moved quickly away from my ‘worsening condition’. My ‘condition’ was viewed as scary and deteriorating; an angry, mentally ill woman; the trifecta of crazy-dangerous in this culture.
It was going to have to be me on that white horse. I was back, if just for a last, loud flame-out.
The Light Bulb Has to Want to Change….
Veterans and observers of the psychiatric industry are gaining strength in numbers and volume, questioning the absence of Full Moral Status in mental health care; there is entirely too much indifference to the damage caused by ostensible ‘treatments’, exacerbating the original, presenting complaint and creating a larger, more dangerous physiology; amputation for a paper cut and calling it medicine.
Why isn’t this the highest priority in mental health care when prescribing psychotropic drugs, the ‘first line’ (and often only line) of treatment in the U.S.?
We all know the answer is greed… excuse me while I stifle a yawn.
These statements embody the ongoing caged death-match that envelopes the mental health discussion among academics, patient’s rights groups independent of pharma, veterans of the industry and observers. The industry easily swats it away with perfunctory dismissals and dog whistles associating the movement with Scientology or ‘anti-psychiatry’, conflating criticism with naïve notions of a world devoid of DTS/DTO (danger to self or others), which most agree is real.
At the risk of alienating the movement’s leaders, I have followed them for years and have become frustrated by the amount of familiar rhetoric devoted to pointing fingers, blaming, and vilifying the APA, pharma, and the supporting cast of remora fish attached to its decaying carcass. Existential angst, targeting the usual suspects, and repeatedly pointing out their moral corruption is a big ‘so what’ if you are grinding out the day-to-day ugliness that characterizes millions in the trenches of psychiatry’s private practices and community clinics.
A popular saying in the 60’s was “Think global, act local.” ‘Big picture’ wasn’t an effective strategy; it had to be ‘hand-to-hand’, on the ground, in my appointments.
I achieved safe passage away from the industry and their ‘treatment’ of 11 years with the paperwork from one of their esteemed own, repudiating their absolute commandment of “lifelong.” ‘Seizing the moment’ was crucial. I desperately needed objective guidance and tools.
This event was not only life-changing for me, but game-changing for others, if they knew it was possible. Simply: hope can save lives.
The statistics reflecting the tidal wave of bipolar diagnoses across all age groups in the U.S. following the DSM-IV expansion of criteria and in decades following informs me that I am no outlier. It strongly suggests there were millions of diagnoses dropped on people who had no business occupying the same zip code.
The effect of the diagnosis coupled with the drugs and propaganda of the industry effectively immobilizes any energy or will to resist. They have accepted someone else’s script for their life, and I had been one of them: drugged into inertia and living a life of (mostly) quiet desperation as the years ticked by.
How to Get Safe and Get Out NOW
THIS is what the movement should prioritize while still challenging the big-picture, status quo… how to improve the quality of life of clients in the system RIGHT NOW and tomorrow, as quickly as possible. The urgency is very real.
One-at-a-time seems slow but is profoundly significant if it’s you or a loved one.
The industry is clear; Full Moral Status impedes economic expansion and growth. It is antithetical to cost and liability containment. “Stay down for your own good; it could get worse” is the consistent response to requests and demands for Full Moral Status from clients suffering within the system.
I was going to leave on my terms, with all the paperwork proving them wrong. Or… I was going to roll the dice and run for my life with an open diagnosis, hoping I would survive withdrawal, rebuild my shattered life, lying when necessary, and taking my secret to the grave. It was a real but sh*tty option.
As I surveyed the landscape for any other path, there was only institutionalization.
There was no template for what I had to do… so I made it up.
In part two, I will share a how-to guide based on what I learned.
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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