Coercion

An editorial in the Guardian discusses the fact that the number of people with intellectual or learning disabilities “who are being treated with psychotropic drugs far exceeds those with mental illness.” The authors of a new study examining the overuse of psychotropic drugs on people with learning disabilities, published this month in BMJ, argue: “If people without mental illness are given psychotropic drugs… it is probably to control their behavior.”

Representative Murphy has released the second version of the Helping Families in Mental Health Crisis Act (H.R. 2646). Few can argue that the mental health system and the current approach towards helping individuals and families in crisis are abysmal. H.R. 2646 is an effort to create increased service provisions and to enhance interventions that many professionals, family members and service users alike believe to be effective. When people are desperate and suffering they do not wish to be told "Sorry, there's nothing we can do." And so, it is understandable and even laudable that so many support the proposals laid out in H.R. 2646. But the bill is based on distorted and faulty logic that misrepresents the research and evidence base. This is highly disconcerting. And so a collective of mental health professionals, mental health advocates, and persons with lived experience came together to produce the following documents in response to H.R. 2646.

If we accept Robert Whitaker and Lisa Cosgrove’s assessment that informed consent for a person to participate in psychiatry is not informed consent because of the fraud that Americans are subjected to by organized psychiatry, then the consensus for laws that support forced psychiatry have also not been garnered with informed consent. If the average person is offering support to psychiatry via their legislators, because they are operating under the fraud organized psychiatry has perpetrated on the people, then that support is illegitimate.

Recently, the Murphy Bill in the United States Congress has resurfaced as a tangible threat to the civil liberties of individuals labelled "seriously mentally ill." As many others might relate, my reaction was one of rage, sadness, and utter bafflement. Yet, here we are. Having defeated the bill once, it is back like herpes. After my frustration and anger dissipated a bit, I pondered this and was hit with a "duh" moment. Politics is not about facts; politics is about power, money, and playing on the emotions of society.

How we think about health, happiness, and self-fulfillment, how they are linked with flawed systems of government has been assigned to the domain of social scientists. The most influential of those are the psychiatrists who have been given the government-mandated power to diagnose, incarcerate and forcibly drug those who are perceived to have a form of mental illness. I believe that such power is arbitrary, unjust and frequently harmful.

I am a survivor of forced psychiatry, and I bring this perspective with me as a human rights lawyer. People with disabilities have a right to be as we are and not to have our bodies and minds made over to suit other people. We alone have the right to decide whether a medical treatment will support who we are or detract from who we are, and that is why free and informed consent is the essential requirement.

Dear Colin Powell: You shared that your wife was diagnosed by a psychiatrist as having a ‘chemical imbalance.’ You said she was, as a result, put on psychotropics and found success after doing so. I’m not going to attempt to take that away from her, but whereas so many issues encompass shades of gray, the chemical imbalance theory does not. The chemical imbalance theory is not just unproven; It is debunked. But you need not take my word for it.

Until recently the history of psychiatry was a neglected backwater whose murky depths were explored largely by psychiatrist. The impression conveyed by books such as Tuke’s Chapters in the History of the Insane in the British Isles, Macalpine and Hunter's Three Hundred Years of Psychiatry: 1535 - 1860, Berrios and Freemen's 150 Years of British Psychiatry 1841 - 1991, or Fuller Torrey and Miller's The Invisible Plague, is one that sees psychiatry and modern systems of mental health care as the inevitable outcome of progress through scientific thought, a (white European male-led) narrative from darkness and ignorance to enlightenment and knowledge.

Again and again I am told the ‘severely mentally ill’ are impaired and incapable, not quite human. I am told the “high utilizers” and “frequent flyers” burden services because they are different than the rest of us. And when I finally do meet the people carrying that terrible, stigmatizing label of schizophrenia, what do I find? I find – a human being. A human who responds to the same listening and curiosity that I, or anyone, responds to. I find a human who is above all terrified, absolutely terrified, by some horrible trauma we may not see or understand.

One of the most amazing activist campaigns I have been involved in during my 40 years of protest for human rights in the mental health system, was the effort to stop the involuntary electroshock of Ray Sandford of Minnesota. Ray reached MindFreedom in the Fall of 2008, and an international human rights campaign began for him.

-Longreads has posted links to online stories about being committed to psychiatric hospitals.

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.

ProPublica is well known for creating interesting data bases that allow anyone hooked up to a computer to see by name whether a physician is accepting Big Pharma payments — from dinners to speaking engagements to consulting services. What may be lesser known is that occasionally ProPublica will publish other data that when carefully mined can reveal even more about the use of psychiatric drugs especially when there is a public funding source available.

To this day I do not know how I found my way back. I think it might’ve had something to do with willpower, as I was NOT going to lose myself. I was NOT going to end up like those people who were living indefinitely in the hospital—those “chronic schizophrenics”, as they say. I was going to find my way back, back to myself.

We are an unlikely duo, sharing secrets only known to insiders, the inmates and staff of Bader 5, Boston Children's Hospital's adolescent psychiatric unit. I am the nurse who blew the whistle that no one heard in 2010, she is the teenager who was imprisoned on Bader 5 for nine months in 2013. We met for the first time on this past Thanksgiving Day at Yale New Haven Children's Hospital, where she has been a *medical* patient for the past nine weeks.

Coercive situations like the one depicted in this blog subtly replicate older times when colonizers dominated Indian people using guns and ammo. In the contemporary times, oppressive mental health systems of colonizers use pills and labels to force-feed ‘civilizing’ principles. This intergenerational comparison might seem more intriguing if you consider that the psychiatric nurse in question was a Commissioned Corps officer in full uniform blues while meeting with this girl in the bunker-like Indian Health Service (IHS) clinic located along “Fort Road.” If you drive straight out along that road for 23 miles, you’ll end up on the park grounds of the actual historic fort where this girl’s ancestors were once bull-whipped for non-compliance.

Both Michel Foucault and Thomas Szasz dated the beginnings of a distinct Western institutional response to madness to the late 1500s-early 1600s. But while for Foucault it started in France with the creation of the public “hôpital général” for the poor insane, for Szasz it began in England with the appearance of for-profit madhouses where upper class families shut away inconvenient relatives. Regardless of their different ideas on the beginnings of anything resembling a mental health system, both authors agree that it was characterized by the coercive incarceration of a specially labeled group.

A growing body of evidence indicates that forced “treatment” in today’s mental health system, including all forms of forced hospitalization and forced drugging, may actually cause FAR more harm than good. Recent published studies and articles point towards evidence of physical and psychological harm that, in some cases, may contribute to more suicidality and patient deaths, as well as overall worse outcomes in a person’s state of recovery.

On June 13, 2014, United States District Court Judge Carol E. Jackson issued a Memorandum and Order decision holding that a former psychiatric inmate was allowed to bring federal civil rights claims under 42 U.S.C. §1983 against hospital personnel when the hospital continued to hold her against her will after authorization had expired. In her Memorandum and Order decision, Judge Jackson took Ms. Pierce's rights seriously and, reading through it, one gets a sense that the court was offended by the cavalier attitude of hospital personnel towards their patients' rights. It is clear that if the Court's ruling is upheld, it can result in dramatic improvement in the way people are treated in Missouri psychiatric hospitals.

Tom Burns, M.D., Psychiatrist and Professor of Social Psychiatry at Oxford, recently said of Assisted Outpatient Treatment (AOT) that “compulsion added to otherwise decent care makes no difference.” This was no easy conclusion for Burns, who for twenty years “argued ardently” for Community Treatment Orders (CTO’s), which are described as the British version of California’s newly passed AOT laws. "I worked for more than 20 years to get the CTO law passed," he said. "I thought such laws were going to make a difference, but they don't."

Most Americans would agree that we have problem with mental health in this country, but what many do not know when they consider that people who are in distress are not getting the help they need is that hospitals in this country are not giving people a choice when they are in the most need. This is based on laws that currently exist in 45 US States, which allow individuals to be petitioned into an inpatient psychiatric unit against their will if they are deemed to be a “danger to themselves or others.” I have worked for 3.5 years as a Peer Support Specialist within my local public mental health system, where I see this happen to the individuals I serve, on a regular basis. I myself have been forced.

In an article published by the Treatment Advocacy Center, The Shortage of Public Hospital Beds for Mentally Ill Persons, the authors (D. J. Jaffe and E. Fuller Torrey) present the idea that we have far too few hospital beds in this country, and because of that there has been a dramatic shift towards the diversion of people labeled with mental illness into prisons and homelessness. Their answer to this issue is that we should radically increase the amount of hospital beds and we should also dramatically increase our reliance on outpatient treatment in the form of mandated involuntary medication programs. As many people know here, the TAC has been highly influential politically and the authors of this paper have been instrumental in getting laws passed that mandate the outpatient use of psychiatric drugs for people who have been civilly committed.

I am quarantined in Stabilization. In front of me an old woman with cherry lipstick and a clipboard asks questions about sexual abuse, but my mind is through the square window on the door behind her. In that room I see a steel bed surrounded by emptiness. On top of it lay leather straps that are uneven in width where they’re wearing thin. Each strap has a set of holes to fasten the buckles tight, and I can see quite clearly that the ones nearest the end are circles while the ones furthest away have stretched into ovals. Tonight will be a Haldol night.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there. So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean?

It seems almost every week now that we hear of a mass murder/shooting in the media. By now the pattern is too familiar to be as frightening as it once was. The response has also become reflexive: Guns should be made less available, especially to people with mental illnesses, and potentially dangerous people should be treated for their mental illnesses − involuntarily if necessary − so they can live safely in our community. Yet, nothing much changes, outraging the next set of victim’s families and communities.