Ending Coercive “Help”: A Review of “Reimagining Crisis Support”

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Reimagining Crisis Support: Matrix, Roadmap and Policy by Tina Minkowitz

 

Just leave me alone!
Please, please don’t leave me alone!

I have felt both ways, at different times, in moments of emotional crisis. So I love the idea that either wish could be accommodated by a sea change in how crisis is viewed and addressed. That is why I’m so excited about Tina Minkowitz’s thoughtful, comprehensive plan for replacing the current coercive, pernicious medical model of crisis “support” with something that actually helps, rather than harming.

Photo of two silhouetted people on top of a rock at sunset. One is helping the other.

Minkowitz speaks with authority, as an experienced human rights lawyer who represented the World Network of Users and Survivors of Psychiatry in the drafting and negotiation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). She categorically rejects “the framing of crisis as a medical emergency” in favour of the provision of “support as an act of respect and solidarity among fallible individuals who are all vulnerable in their shared humanity.” She also speaks personally, as someone who has been tortured with “antipsychotic” drugs in the past.

Minkowitz understands that individual crises can differ wildly, not only for each person, but also for the same person in different circumstances. This certainly rings true for me. I have had times in my life when, due to relationship break-ups, academic failures, ill-advised experimentation with street drugs and other reasons, I became extremely distressed, or weirdly elated, and my relationship with consensus reality frayed and then dissolved. On one occasion I went up and down the halls of the building I lived in, naked, in the middle of the night, banging on doors and yelling, “Emergency!” when there was no emergency other than the state of my life and mind. On another, I danced and sang with a band that no one but me could see or hear.

In the first case, I was causing a serious disturbance; in the second, I was just having fun in a way that made no sense to others—no crisis for me, but evidently a crisis in the perceptions of those around me. Each occurrence resulted in prolonged periods of psychiatric incarceration and forced treatment. Each could, I believe, have been dealt with quite differently if our society were not geared to shutting down social disturbances by shutting up, and shutting out, the person at their centre. In the first instance, if I’d had the option of talking to someone who could listen calmly and sympathetically, that could have alleviated my sense of “emergency” and prevented me from scaring my neighbours and ending up incarcerated and evicted. And in the second instance, what harm would have resulted from my being left to dance and play with invisible musicians?

Like so many of my friends, and like Minkowitz herself, I am living proof that the sort of crisis response provided by the mental health system is not only unhelpful but dangerous. Again and again, I have been handcuffed by police, dragged into a hospital, stripped, force-drugged and held against my will, because I was behaving in ways that, though not dangerous, were alarming to others. When the police, and then orderlies and nurses, were brutalizing me, I would have dearly liked to be left alone. But when I was drugged, shackled and left to languish for days in a seclusion cell, I longed for the presence of another human being. Eventually, each time, the drugs would turn me into a zombie with no desire other than to eat, sleep, and, someday, get out of the hospital.

Minkowitz sensibly questions how anyone could possibly be helped by “detention and control by others … aggression against the body and mind through restraints, solitary confinement, subjection to neuroleptic drugs and electroshock against a person’s will or without her prior free and informed consent, and other degrading and inhuman conditions of confinement.” She wants these practices outlawed and replaced with crisis support that is “provided as a community service mobilized in response to an individual’s call for assistance”—never because a third party wants professionals to step in and act on the  person’s behalf.

And wouldn’t it be great if, instead of crisis response based on the perceived need to suppress thought, feeling, and behaviour, the person in crisis was assumed to still be human, and have a functioning mind? Minkowitz suggests asking a series of simple, common-sense questions: “[W]hat do you need right now? … Where are you going to sleep and how are you going to eat? How will you settle down and sleep or make it through a wakeful night?”

“Understanding that every person has the capacity for discernment,” she writes, means “never giving up on anyone and never imposing one’s own meaning on them…. hard choices, risks and responsibility, intense pain, all can be witnessed and moved through.” Even suicidal thoughts and feelings are not taboo, and not a reason to violate a person’s human rights.

Minkowitz explains in detail what supported (as opposed to substituted) decision-making looks like. It starts with “meeting the person where she is, both literally and figuratively, engaging with her ethically, and respecting her choices [as opposed to allowing others] … to make choices that profoundly affect the person’s life: even decisions about her own body like ingesting psychotropic drugs or undergoing sterilization or electroshock.”

I particularly appreciate her idea that “the right to remain at home, to maintain one’s connections to the world and not be placed in a detention setting during a crisis, is crucial to re-situating crisis as part of the life we share in common.”

Best of all, Minkowitz has plenty of specific suggestions for better ways to help someone in crisis. “Practical crisis support could involve help with household tasks and navigating the community … navigating service systems and financial and legal issues … and/or emotional support to get through the days and to confront difficult tasks. It could include going to a crisis respite center or a spiritual or healing retreat, or otherwise finding a place to go that feels safe, comfortable and nurturing….”

And trying to fix these problems through mental health legislation will never work, as it still leaves us “reacting against the status quo and replicating it rather than actually imagining something new.”

“What,” Minkowitz asks, “would society have to look like, in order for crisis support to be integrated into ordinary social, cultural and economic life”; to “allow people to experience crisis without the baggage of exclusion and harm”?

It all begins with solidarity: “[W]hatever we can do, wherever we are already exercising reciprocity in our lives, where we nurture a whole beyond the parts, where we accept the ebbs and flows of relationship that include forbearance as well as giving and receiving…. Living with enough and giving away the rest, sharing rather than hoarding what we have, means creating the bonds with others that allow us to trust in communal rather than personal wealth…. We need to see each other in ourselves and ourselves in each other, and act accordingly … our crises, our unusual states of consciousness, our distress do not happen in a vacuum.”

Anyone who cares about human rights; anyone who questions psychiatric hegemony and deprivation of liberty, and use of force, on the grounds of “help”; anyone who seeks better, non-medical ways of dealing with crises caused by adverse personal, social and political circumstances, will be thrilled, as I am, by this short, smart book.

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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.

29 COMMENTS

  1. Irit,

    Thank you for reviewing the work of Tina, a lioness of human rights. I agree with the words you quoted from her work W]hatever we can do, wherever we are already exercising reciprocity in our lives, where we nurture a whole beyond the parts, where we accept the ebbs and flows of relationship that include forbearance as well as giving and receiving…. Living with enough and giving away the rest, sharing rather than hoarding what we have, means creating the bonds with others that allow us to trust in communal rather than personal wealth…. We need to see each other in ourselves and ourselves in each other, and act accordingly … our crises, our unusual states of consciousness, our distress do not happen in a vacuum.” and I have this comment. The prescription that Tina describes is of a spiritual nature. My spiritual orientation is Christian or ‘Christ-centered’ flavored by Wiccan and Buddhist elements. I have witnessed the co-option of my Christian religion by fundamentalist, right-wing extremists who bring the ‘baggage of exclusion’ as Tina calls it. The spiritual prescription that she is calling to affect the change in the mental health system is already codified in most of the worlds sacred texts and most world religions that I am aware of. The principles of compassion, sharing, interconnectedness, etc are embodied in the lives of the saints, mystics, and justice/peace seekers, however the spiritual texts are being co-opted and abused by people lusting after power. If we want a lasting revolution in the mental health system, we should strategize to create deep alliances within religious institutions but there is no time to waste. NAMI, with its vast network of parent lemmings is already polluting the congregations and temples and mosques, with pharmaceutical, medical model nonsense.

    • Your take is very interesting to me! I agree that spirituality is one important way that the kind of orientation I envision can be focused and put into practice. I also share your deep concern about the fundamentalist and right wing co-option of Christianity that has become a political force in the US threatening everyone who doesn’t fit their narrow prescriptions.

      In the section of my book where I talk about situating my own values and standpoint in relation to others, I identify ‘lesbian ethics’ as a core part of where I’m coming from and a community I relate to personally. Communities of any kind that are willing to challenge oppression, whether they are based explicitly on spirituality or on some other set of values, are important allies to work with in creating practices of supporting one another that don’t depend on the mental health system – and that start from the point that nobody gets thrown away, that calling 911 (or 988) on someone experiencing personal crisis is not an option.

    • And the truth is, at a minimum, some of our paternalistic religions literally “partnered” with the DSM “bible” thumpers decades – or centuries – ago. And the DSM “bible” thumpers function as the child abuse and rape cover uppers for these religions. A confession, from an ELCA insider, about these systemic child abuse covering up crimes of the bishops of my former religion.

      https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_
      summary_r&cad=0#v=onepage&q&f=false

      And these systemic child rape covering up crimes are known as “the dirty little secret of the two original educated professions,” according to an ethical pastor of a religion, other than my childhood religion.

      I do agree, “The spiritual prescription that she is calling to affect the change in the mental health system is already codified in most of the worlds sacred texts and most world religions that I am aware of. The principles of compassion, sharing, interconnectedness, etc are embodied in the lives of the saints, mystics, and justice/peace seekers, however the spiritual texts are being co-opted and abused by people lusting after power.”

      And this has been going on for decades.

      Thank you for your truth telling, Irit.

  2. Irit, SO well said. And so glad Tina wrote the book. I think it to be utterly important to educate, not to expect change in the medical fields, but rather at this point, to warn even a few to run as fast and as far away from GP’s or psychiatry that hint at their client needing psychiatry.

    The medical system has gone completely psychiatry. It is convenient in the busy doc’s office, because after all, emotional stuff is baggage for them to listen to, and so are chronic illnesses. Best to write stuff on the charts of patients that hints at “psychiatric” and thereby invalidating them as anyone worth listening to.

    And most of the system cooperates in this, mostly out of fear of colleagues. It’s just easier to agree and keep your job until retirement and who cares about the client.

    But they NEVER hurt just the one client, they hurt the whole family, punishing the whole family, children, etc.
    They create so much hurt and disability, with governments playing along and sending out those measly disability checks because it’s a hell of a lot easier than to grab the bull by the horns and say, “ENOUGH”.

    Change is possible, but since when do governments change anything that requires actual work.
    No official would EVER dare to stir this pot of psychiatry, that has enshrined all our lives.

    There is not a shrink that has not caught on to what their purpose in life is. That they in fact ARE NOT “doctors”, but simply have a management degree, rife in wordyness.
    Their jobs are full of living in denial, governments included.

    There was a doc in ER a few years back that glared at me and said “don’t you know psychiatry is a science?”
    He was using every ounce of power he had. He knew he was a winner in this game, but yet, he wanted to draw me out and tell him why he was full of shit.
    All he had was power, not science and he wanted to take that out on me.

    It would have been funny if not so outright stupid. I cannot get over the stupidity and lack of intelligence in that management practice.

    If we want to establish mental weirdness, psychiatry wins. Some huge “disorders” going on there, but they have power to stay “clean”. 🙂

    And that is ALL they have. The power to make a lousy income, spouting their daily carnage.

    The more as time ticks along, the more I see the sheer crazy in many people. And they have “crazy”, all wrong.

    The truth is, there are some neurological damages in brains, leave that to neurology.

    But all the woes of humanity are not “MI”, as neither a shrink’s cruel behaviour is an “MI”.

    It is simply diversity where power is the ultimate winner until the tides change.

    So thanks for helping with the tides, even if for a few, and Thanks Tina for the book and continuing education.

  3. Thank you so much for this important article. I too was tortured during
    supposed “psychiatric interventions” courtesy of our local police department. I offered no threat to anyone but I was not “blending in”. One “intervention” resulted in a dislocated clavicle, another caused a horrendous, nightmarish, long-lasting reaction to an extended release haldol shot. The hospitals were another nightmare. Thank you for this important work. As a former social worker I have seen this from “both sides”. I now work in direct care for a mental health agency. What I noticed is they really mean well but, unless you’ve been there you really have no clue what a nightmare this issue really is.

  4. I have not read Tina’s book yet , but from this review I get the general idea. I agree that calling for ending psychiatry and its abuses isn’t going to work until we start talking about how to deal with people’s troubles in a nurturing and helpful way. I myself, who literally grew up in the insane asylum, was greatly helped at a very difficult time in my life, when I stayed in a Canadian place similar to a Soteria House, where I got emotional support and respect, instead of the drugs and humiliation that psychiatry offers. I think it would be very fruitful for our movement, whatever name we call it, to advocate for what we think should be done, not just criticizing what is done now. Of course, though, we have to do both.

  5. Irit, great blog and review of Tina’s book and work to have dangerous crisis responses outlawed. After my brother died taking psych drugs as prescribed by a psychiatrist I was reeling with many unanswered questions. I would learn later via my own encounter with a psychiatrist while in cancer treatment that psychiatry violates human rights with unquestionable power and control. (was referred to “someone” under the pretense I would get “help with sleep meds” after chemo/steroids caused sleep issues but hastily given 4 psych labels without my knowledge and stripped of the liberty to make further medical decisions)

    A system that claims to ‘care’ about ‘mental health’ and provide ‘help’ cannot be so vacuous as to think violating human rights and treating people with contempt and subjugation is ‘help’. It’s cruel and sadistic that people in distress who have done nothing wrong get treated far worse than criminals and somehow psychiatry gets away with this.

    The ethical and humane changes Tina has outlined are very much needed. Many thanks to Tina for all her important work.

  6. Hello Irit,
    thank you for this review.

    I have begun to read Tina’s booklet. Much of what Tina has suggested I have done for my wife these last 15 years, and so, fundamentally, I agree with her, and yet, I am struggling with her desire to see this done on a larger scale than within families as we have done (how many have the commitment level outside of a family to go 15 years and counting???). Yes, I think others who are willing should be taught the things that Tina espouses. Yes, the laws certainly need changed to stop the inhumane treatment and stripping away of fundamental rights of others simply because they are experiencing mental distress.

    …But I think you hit the nail on the head when you wrote that others do so because of their fear which I believe is driven by ignorance. Until we can cogently articulate what is going on when a person is experiencing extreme states to demystify them so that others can empathize and realize that they are just like I am, not crazy, mad, dangerous or anything else, then I fear people will continue to demand the right to subdue what they fear rather than embrace it.

    Thanks to both of you and I will continue to try and make my way thru her booklet.
    Sam

  7. I hope that what comes out of this discussion are some efforts to organize Soteria Houses in the United States and Canada. I know there are some scattered around the world, and I have heard that there are nine such places in Israel. People need to know that places doing what Tina advocates already exist, and that will help a lot if/when we try to organize new ones.

  8. “She wants these practices outlawed and replaced with crisis support that is ‘provided as a community service mobilized in response to an individual’s call for assistance’—never because a third party wants professionals to step in and act on the person’s behalf.”

    And given the “partnership” of the “mental health” workers with my childhood religion, and likely most of the other mainstream religions. The current psychiatric/psychological approaches are done specifically “because a third party wants professionals to step in and act on the [pastor’s] behalf.”

    This means the religion’s “partnership” with the “mental health” workers, “the dirty little secret of the two original educated professions,” needs to end. Since the sole purpose of such “partnerships” is to have “a third party … step in and act,” in my case, for a child abusing pastor.

    “imposing one’s own meaning on” others is a huge problem for the “mental health professionals.” Especially given the fact that their DSM is scientifically “invalid,” thus their own belief system is insane.

    “like Minkowitz herself, I am living proof that the sort of crisis response provided by the mental health system is not only unhelpful but dangerous.” Me too, since I have medical proof of 14 different anticholinergic toxidrome poisonings – to cover up a “bad fix” on a broken bone and the rape of my child – written in my medical records.

    “Understanding that every person has the capacity for discernment,” … means “never giving up on anyone and never imposing one’s own meaning on them…. hard choices, risks and responsibility, intense pain, all can be witnessed and moved through.” I agree.

    “I particularly appreciate her idea that ‘the right to remain at home, to maintain one’s connections to the world and not be placed in a detention setting during a crisis, is crucial to re-situating crisis as part of the life we share in common.’”

    But, sadly, the criminal psychiatric industry have set things up such that people must move away from the states where their friends live. Since the criminal psychiatric industy fraudulently list non-patients, as “out-patients,” in hospitals they’ve never been in before. At least that’s what health insurance companies told me.

    “And trying to fix these problems through mental health legislation will never work, as it still leaves us ‘reacting against the status quo and replicating it rather than actually imagining something new.'” Well, if that’s all the fraud based legal system can do, I do agree it is worthless.

    “What, … would society have to look like, in order for crisis support to be integrated into ordinary social, cultural and economic life”; to “allow people to experience crisis without the baggage of exclusion and harm”?

    I, for one, had to leave my former religion twice. The first time, because a pastor wanted to cover up the abuse and rape of my children. The second time, because I stood against psychiatry’s harm of millions of children, as described in “Anatomy of an Epidemic.”

    Which the leaders and psychological and social worker “professionals” of my former religion, who handed over legal evidence, of the crimes they hoped to cover up. And the systemic, DSM inspired child abuse covering up crimes, of my former religion, and the social workers of my former neighborhood schools and CPS, are also provable, given the evidence I have.

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