Monday, September 25, 2017

Comments by Susan Rosenthal

Showing 15 of 15 comments.

  • I apologize for the length of this comment. It’s a letter to the Canadian Medical Association Journal that I think adds something important to the discussion. Bottom line – we must trust people to make their own decisions, right or wrong. Anything else is disrespectful and opens the door to tyranny. Psychiatric survivors, more than anyone, know this to be true.

    Letter: Availability of medical assistance in dying can be therapeutic

    by Ian M. Ball, MD and Scott Anderson, MD

    The legalization of medical assistance in dying (MAiD) in Canada has created many logistical challenges for institutions and health care providers. In a country where diversity is not merely supported, but encouraged, it is not surprising that there are many outspoken critics of MAiD. One of us (I.M.B.) is the medical chair of our hospital MAiD committee; the other (S.A.) acts as a MAiD provider. Having been involved in over 30 referrals since June 2016, we have several important observations to make.

    The gratitude expressed to us by families and patients is staggering. A recurring theme is that patients’ moods are tremendously improved with the knowledge that MAiD gives them control over their disease. In some completed cases, symptoms were not controlled to an acceptable degree by aggressive palliative care. In some other cases, despite excellent symptom control with palliative care, patients desired control over the circumstances and timing of their deaths, and so chose MAiD. As per the law, all MAiD patients’ natural deaths were reasonably forseeable. For patients who received MAiD, being able to prepare for their deaths, assemble their families, and die in a comfortable, dignified manner, were the universally espoused virtues of MAiD.

    We have found that MAiD deaths provide a greater level of patient comfort than even the deaths from the withdrawal of life support in intensive care units. MAiD allows the use of intravenous medications in anesthetic doses, combined with neuromuscular blockade. At our institution, the procedure lasts only a few minutes, and avoids the dyspnea and increased work of breathing, which is so often associated with even the best palliative care or withdrawal of life support.

    Although we support palliative care and believe it to be the right experience for most individuals, we have witnessed cases where palliative care was insufficient to manage the degree of suffering, or where patients simply wanted to avoid perceived indignities and loss of control associated with their progressive diseases. It has impressed us tremendously that the availability of MAiD has improved the outlook of many patients who have not chosen the procedure. The knowledge that MAiD is an option, should symptoms become unbearable, is very reassuring for patients and their families.

  • I am much more optimistic. In my lifetime, I have seen radical and surprising change – the fall of the Berlin wall (which no one anticipated), the growing acceptance of gay marriage on the one hand and on the other hand the reversal of many rights won in the 1970s.

    Change is constant. Which way it goes depends on what we do.

    Discussion forums are excellent for promoting clarity; however, to create real change, clarity must be married with organization, the willingness of like-minded people to work together to do something constructive. If we work together, learn together, and act together, we can make big things happen.

    Get-together, meetings, and conferences are important for building activist networks, raising issues publicly, and planning how to reach more people more effectively.

    Isolation kills. At every level, personally, socially, societally, we go forward together, or not at all.

  • Thank you for sharing this, Helen. I can’t imagine working in such a traumatic and re-traumatizing environment.

    Your story is important not only because it exposes the immense cruelty of the system but also because it challenges the rigid separation between those who work in the psy-industry and those who are victimized by it.

    People who work in the industry are more similar than different from the people we ‘treat.’ We are more likely (than the general population) to be trauma survivors and to have been given psychiatric labels. Our experience of trauma is a major reason why we enter the field. This is a closely-guarded secret because workers who are ‘outed’ as having psychological difficulties can lose their careers.

    Chapter 3 of Psychiatry Interrogated describes two psy-workers who lost their jobs (one also lost her licence to practice nursing) on the false assumption that mental illness = mental incompetence. https://www.amazon.ca/Psychiatry-Interrogated-Institutional-Ethnography-Anthology/dp/3319424734/

    It’s important to challenge the mistaken idea that providers and users can never work together. The psychiatrists who abuse their power are not on our side, no question. However, most of us entered the field in order to help people, which gives us a common interest with those who seek help.

    We have a common enemy – a medical system that prioritizes controlling people over caring about them. When we don’t see that, when we let them turn us against each other, then we all suffer.

    I know many providers like yourself, I am one of them, and we are organizing for mutual support. Please contact me: [email protected]

  • I agree with you, Seth.

    Given the evidence, I don’t see how we can ethically recommend neuroleptics for anyone. Especially since there are so many alternatives, and more could be developed if there was a will to do so.

    If one must use a drug for acute psychological crisis, why not use short-acting opioids as an adjunct to social support? They are calming and induce a sense of well-being when people are frightened or in pain.

    As with post-surgical pain, withdrawal or dependence is not a problem after a few days of opioid use. But I cannot imagine the establishment going for that. Too much is invested in the way things are. And too little is invested in providing what people really need.

  • I am deeply indebted to you for opening my eyes to the medical disaster that is psychiatry.

    I have made Mad in America required reading for the MA-level course I teach, Social Dimensions of Psychotherapy, and I have requested that our graduate school invite you to speak at our 40th anniversary celebration in 2018.

    You ask the most important question at the end of this article. I believe that psychiatry has gained so much power that it will take a massive social rebellion, even greater than the one that challenged it in the 1960s-70s, to uproot it. I believe that the groundwork for that rebellion is being laid today and that you are an important part of that process.

    I thank you from the bottom of my heart for your courage and integrity in showing us what needs to change and for launching the frame of an organization (this website) that can take us forward.

  • As someone who has been on both sides of the patient/provider divide I can totally relate to your comments.

    Those of us who enter the medical industry are taught that the priority is patient well-being. We soon discover that the reality is something else – protection of the profession (cover your ass) and subservience to the hierarchy (mind your betters).

    Professional training takes people who truly care about others and teaches them that those ‘others’ are nothing like them. In dividing us from our patients, they divide us from our humanity, and they block our efforts to do anything else.

    Jeff Schmidt’s book, Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-battering System That Shapes Their Lives (https://www.amazon.com/Disciplined-Minds-Critical-Professionals-Soul-battering/dp/0742516857) explains that the role of professionals is to help manage capitalism, so professional schools weed out those who won’t go along. Those who slip through the cracks are ‘sidelined’ or ‘frozen out.’ I have been ostracized and threatened with the loss of my licence to practice for treating people humanely. That is the true meaning of insanity.

    Nevertheless, I am hopeful. Medical workers are under attack from the same system that attacks our patients. More of us are suffering burnout from impossible demands, suffocating red tape, micro-managed working conditions, etc.

    Patients and providers have a common enemy and a common interest in defeating that enemy.

    We cannot let them divide us. As you pointed out, we all lose when that happens.

  • Privatized reproduction lies at the root of many problems, including women’s oppression and the oppression of those who are seen as less productive.

    When the weight of caring falls on individuals, they cannot do it all, so caring becomes ‘control.’ In contrast, when caring is a shared social responsibility, there are more than enough resources to meet everyone’s needs.

    Diversity is a threat to class societies and an asset to egalitarian societies.

    In societies where human needs comes first (meaning everyone’s needs), there is more acceptance of, and support for, those who are different – for whatever reason.

  • I totally get your frustration and rage. However, your anger is misdirected.

    People to come to realizations in their own time in their own way.

    I admire Stephen for showing his vulnerability, for how far he has come, and for how much he is helping young people to stop blaming themselves for how they manage overwhelming emotions.

    When you are ready, I encourage you to watch the rest of the TED talk.
    I think you will find that his views and yours are not so different.

    We all internalize our pain – that is inevitable.
    And we all need support to work our way out of self-blame.

  • This statement,

    “the base for organizing within this movement will be among psychiatric survivors and their families…While of secondary importance, there IS definitely some value in attempting to win over and unite with dissident and open minded psychiatrists”

    leaves out the many working-class people who form the base of the psy-industry, the ones who do the grunt work.

    Most front-line psy-workers are also psychiatric survivors or are closely related to them. They are overworked and underpaid. They are expected to solve complex social problems while being denied any power to actually do that. This powerlessness defines them as workers and not as managers or directors of the industry. They direct their frustration against themselves and their clients, and rarely against their impossible situation.

    On the other hand, psy-workers are the base and foundation of a powerful industry. They have the collective power to challenge it and (most important) transform the system that requires it. We got a tiny glimpse of what is possible in the strike of mental health workers at Kaiser Permanente in California. http://www.beyondchron.org/when-workers-fight-nuhw-wins-battle-with-kaiser/

    Ultimately, the demand for better working conditions runs parallel to the demand for better life conditions for those we serve. ‘Better conditions’ means the right to choose what happens. Every psychiatric survivor has experienced that right being violated – the right to be safe, understood, accepted, and cared about.

    We can join forces. We can choose to over-ride the needs of the system in order to serve the needs of our clients and patients – as YOU communicate them to us. We can go forward together.

  • I am sorry that you have suffered such oppression.
    Other oppressed groups have organized in self-defense and, if anything is to change, we must too.
    The first step is telling the story, and I so admire your courage in doing that here.
    A Canadian psychologist told his story of self-harming behavior in a TED talk (The Skeletons in My Closet – https://youtu.be/G17iMOw0ar8) and also in an article in the Canadian Medical Association Journal (Cutting Through the Shame – http://www.cmaj.ca/content/188/17-18/1265.full.pdf+html)
    I wish you all the best.