Monday, August 19, 2019

Comments by Francesca Allan

Showing 491 of 491 comments.

  • Oldhead, I am coming to the conclusion that I have very poor writing skills because some of these countering responses aren’t countering anything I (meant to) say.

    You write: “Is anger a disease caused by adrenalin?”

    No, but adrenalin is required to have the sensation of anger. If the neighbour’s music is making me angry, knowing that there’s an intermediate step (adrenalin) in no way changes the basic relationship of that noise = anger relationship. But here’s where we differ: The structure and function of adrenalin is still worthy of study even after the neighbour turns off his stereo.

    And earlier in the same post you write: “So the answer lies in changing the “environment,” not screwing around with the chemicals and the brain.”

    But you’re assuming that the culprit MUST be the environment and that’s not always the case. And even when it is the case, sometimes the environment can’t be immediately changed and sometimes changing the environment doesn’t immediately affect the brain state.

    Psych drugs remain and always will remain a valuable tool. Unfortunately, in rare and extraordinary circumstances, using them is completely justified even over someone’s objections.

    Clearly, involuntary treatment happens way too often and outpatient commitment is generally a bad approach. However, in a crisis intervention, there may be no alternative. Arguing otherwise is a lost cause.

    PS to CS2013, I concede that my “intellectual ability” (your words) precludes my agreeing with your position.

    And, with that, I will be leaving this thread and Mad in America. I wish everybody well but I prefer not to participate here anymore.

  • Abolitionists would forbid such practices even when completely warranted as in the situation you describe here. Their rule seems to be that the only grounds for intervention are AFTER a criminal act has been committed. It’s an untenable position and will never be taken seriously.

  • Here in BC, one could certainly be paid a visit from the police for a “wellness check” on the say so of a 3rd party but that by itself wouldn’t be grounds for a mental health apprehension. I’ve never heard of any such 3rd party being either sued or charged for a bad faith report. I’d be interested to see how that would play out.

  • Hi, Oldhead. Anon had already suggested to me that it wasn’t an appropriate post and I responded in agreement. The notion of assessing who’s doing more to help does not strike me as an absurd approach, however. What was inappropriate about the post was my suggesting that CS2013 hadn’t helped which of course I have no way of knowing. That’s why I agreed with Anon.

  • Destroyed her metabolism, I’m guessing. Sorry to hear about your friend.

    When I became stable, my doctor wanted to maintain me on Risperdal on the grounds that “if it ain’t broke, we needn’t fix it.” But it was broke! I was taking harmful and unnecessary medication.

    Perhaps my biggest objection was that I was not willing to have my mental health attributed to pills. In any event, I got off that crap in April 2013 and have never looked back.

  • Jonah, you’re quite right. My tone was unnecessary and I apologize, sincerely.

    My frustration is driven by your comments such as:

    “Even if/when on can clearly establish, that “Without the neurochemical state XYZ, one wouldn’t have the sensations/perceptions” that are suggestive of ‘fear,’ that proof will not, in and of itself, be convincing evidence, that XYZ has created those sensations/perceptions.”

    I KNOW THAT AND SAID AS MUCH! You take such a professorial tone to state such obvious truths. My point was simply that the research Jill is talking about is still valuable and worthwhile REGARDLESS OF HOW ANY PARTICULAR NEUROCHEMICAL STATE CAME TO BE.

  • And what if this hypothetical person adamantly refuses support? Are you prepared to ignore him or her? If your answer is “yes,” you’ve solved the riddle of why anti-psychiatrists aren’t taken seriously.

    I’m sorry you went through such trauma at the hands of the psychiatric system. I must say though that you seem to be leaving out a few details here. There must have been some context to the police coming to your home. I’m not saying that the context necessarily justified the actions, just that the police do not generally show up at peaceful, law-abiding citizens’ houses and Tazer them.

    BTW, the comparisons to slavery and Sharia law are very offensive and add nothing to the discussion.

  • I think Boans might counter that children aren’t entitled to their full rights yet but your example certainly also applies to removing an adult out of harm’s way. You’re quite right that the notion of abolition involves morally indefensible positions. That’s why it’s going nowhere.

  • CS2013, let me rephrase. Please give one example of any impact you have had on the lives of those suffering from mental disorders. For instance, one report of somebody reading your wisdom and improving his or her life as a result.

  • Jonah, this is really getting tedious. Without the neurochemical state XYZ, one wouldn’t have the sensations/perceptions. If you want to argue mind vs. brain, I’m too bored to continue.

    Your assumption that if I don’t agree with you then I don’t understand you is both amusing and reminiscent of the psychiatric approach. Have you considered the possibility that you’re just not that interesting?

  • Boans, I do agree with you that forced psychiatry necessarily involves human rights violations. The question is when is it justifiable? We might agree that a 14 year old should be prevented from cutting herself in response to bullying at school.

    This gets back to the arguments I have had with other posters: What do you suggest instead? On a different thread on a different topic, I was describing a situation I was in several years ago. Long story short, I was in agony and was incapable of either consenting to or refusing treatment. Anyway, when I described my circumstances as a counter-example to the “all force is evil” camp, one poster in particular gave a smiley face and talked about my responsibility for my own distress. It actually chilled me to the bone that someone could read what I had described and say the equivalent “Oh, well ….” In fact, every time I think of it, I ‘m thinking antisocial personality disorder.

  • CS2013, you’re right that statins are never court ordered but you’re wrong that physical medicine is never done over a patient’s objections. There are several exceptions where public safety trumps an individual’s freedom. I know that’s likely a scenario that sickens you politically but it exists and it exists for good reason.

  • Jonah, can you understand that if neurochemical state Y is found to be responsible for what we term mental state Z, that does not preclude a causal relationship between environmental factor X and mental state Z via neurochemical state Y?

    The scientific fact that the brain creates our sensations and perceptions seems to threaten an awful lot of people.

  • Actually, I believe migraine is the disease and migraine headache is one symptom of that disease. I therefore correct and resubmit my analogy accordingly.

    The point is that migraine headaches exist and respond to treatment, even without objective diagnostics.

  • I think it’s a mistake to tar all psychiatrists with the same brush. If Dr. Steingard just wanted to maintain her “livelihood,” I’m guessing she wouldn’t spend much time writing for MiA.

  • Can’t remember what all NIMH had to say about this beyond that they are no longer funding research based on symptomology. I assume that means more resources than ever will be sunk into the genetics/neurology end of things.

  • Cannotsay2013, at the risk of provoking you, may I ask how your “thinking big” has translated into improving the lives of those who suffer from mental disorders/emotional distress/fill in your favourite term here?

    I believe that Dr. Lawhern is encouraging us to actually get something done rather than just keep bickering.

  • Steve, you make an excellent point about migraine headaches. Would you allow me to try again with fibromyalgia? I believe that’s considered a disease, rather than just a cluster of symptoms.

    Anyway, my point is that lacking an objective test isn’t what kills the endeavour. It’s far more useful to argue that outcomes are generally worse with treatment or that the diagnostic criteria are too fluid to be meaningful.

    I would argue that mental disorders certainly exist but they are rarely diseases. Many go much further and claim mental disorders are never diseases and some go further still and claim there’s no such thing as a mental disorder.

  • Absolutely. Psychiatry is way, way too quick to medicalize human emotion. At the same time, we do need to acknowledge that in rare and extraordinary circumstances some people require support, up to and including treatment they may not want. The issue for me is short vs. long term treatment. There is far more justification for emergency intervention than outpatient commitment. In my view, reform should focus on the latter. Abolition, however, is a non-starter.

    I completely agree with you as far as losing sympathy with the “anti psychiatry” position. Listening to some of these “activists” exactly proves psychiatry’s point.

  • Well, we can argue all day about who the “average person” is. Let’s just say our experiences differ and leave it at that.

    I certainly never said that psychiatrists are going to be the driver of psychiatric reform.

    And, again with the slavery analogy!

  • I really like this post and agree with everything you’ve written. I think you might find, though, that abolitionists will either attack you or write you off. Many “activists” are only interested in the black and white: “Psychiatry is pure evil. Nobody has ever been helped by treatment. Intervening in a crisis is a human rights violation. We will stand for nothing less than complete abolition.” Such an extreme stance will never be taken seriously by either psychiatrists or the general public and it’s a mystery to me why they bother. I see that the first commenter here has already trotted out the chattel slavery comparison.

  • It would be truly wonderful to have Biederman or Torrey or Jaffe or someone like that post here and it would be a shot in the arm to MiA that such prominent figures in the establishment wished to engage with us. I can imagine what would happen, though. Some commenters would choose to shriek “Nazi brain rapists, all of you!” or equivalent phrasing. I can certainly understand what drives the anger but the issue is how we’re going to make change. Blindly raging at them just gives them more fodder.

  • Believe it or not, I make a genuine effort to just read the comments and not engage in the dialogue because I completely agree with your criticism. Too much of the conversation after these articles becomes irrelevant and distracting. This is a thought-provoking article that merits serious consideration. If it’s to be criticized, it ought to be on the basis of specific offending points made in it (which I didn’t find), not general backlash on the basis that the author isn’t 100% in agreement with the MiA audience.

  • There is no basis to claim that the choice to undergo ECT cannot be free and informed. A patient can be provided with all information available, be entirely aware of the risks, and choose nonetheless to proceed.

    ECT cannot reasonably be compared to cutting one’s self. But if you choose to “advocate that this is everyone’s right,” then your assertion that ECT ought to be abolished outright is even more untenable.

    I read your work carefully, Bonnie, and agree with much of it. However, all I’m getting from you on this subject is that you don’t like ECT so nobody should be able to have it. As I said before, your position on this is parallel to the top down “we know best” attitude that psychiatry exhibits.

    From a pragmatic standpoint, ECT is not going to go away. Why don’t we work instead on promoting full disclosure and abolishing forced ECT? Those are achievable goals.

  • I agree with you, Darby. With respect to certain specific circumstances, it is not the least bit “irrational” (author’s word) to believe that things will never improve. Do you remember the movie Sophie’s Choice? I’m sure the protagonist would have considered the description “permanent solution to a temporary problem” a mere platitude, which it often is.

  • I wrote this letter to our local rag last month but it wasn’t printed:

    “I was surprised to read in your June 24th editorial that mental health outreach teams help ‘steer people away from drugs.’ In fact, standard psychiatric care promotes drug use, albeit of ones that profit pharmaceutical manufacturers rather than street dealers. The chemical distinction between prescription and illegal drugs can be murky ….”

  • Took the words right out of my mouth (typing fingers), Wayne. Judging by the quality of the critical thinking I see at my university, I would suggest that mere credentials don’t equal knowledge, intelligence and understanding. In fact, more education can just lead to more confidence in one’s incorrect assumptions. Seriously, I doubt I will continue my studies for exactly this reason. Regurgitating what one’s told doesn’t seem a likely route to intellectual enlightenment.

  • Hi, Monica. I don’t know what the situation is in your state but here in BC there are far more people on “assisted” community treatment orders than could possibly fit in our psych wards. If such patients were to organize (a “Mad Union,” if you will), they would have considerable power. The spectre of hundreds of clients denying medication providers access to their homes at the same time would, I believe, make the establishment sit up and take notice of such demands as assisted tapering programs.

    Because involuntary treatment is happening in people’s homes rather than hospitals now, otherwise concerned people are turning a blind eye. The legal standard for forced treatment should be the same, no matter where the treatment occurs. Community “care” is just a cost-saving measure for the government. There is no fundamental difference between psychiatric incarceration and outpatient commitment except the veneer of civility.

  • Hi, Bonnie. Informed consent entails two separate concepts, of course. “Freely given” is implied in the second.

    Clearly, psychiatry is not going to be voluntarily forthcoming with information about the risk/benefit ratio of ECT and there is a huge need to get further information out to the public. Beyond that, we could lobby for legislation that insists individual doctors provide such information.

    Consent, however, is far more problematic. Not just for ECT, but for all psychiatric treatments, I would like to see an advocate made available to all patients facing forced treatment or the more insidious, grey area of coerced treatment. Can’t stress enough that such an advocate would be chosen by the patient and be immediately available, free of charge.

    Of course, it’s not just the routine lack of informed consent, though, that you and others object to. It’s the notion of someone choosing a course of action that you would not. I would suggest that this is similar oppression to what psychiatry practices: “We know better than you do what’s good for you so what you think really doesn’t matter.”

    There are many medical procedures that carry little or no benefit yet substantial risk so ECT isn’t unique. Unfortunately, what works against Breggin’s position is that ECT does often give short-term improvement measured subjectively. Now, for most of us, that very brief relief is not nearly worth the brain damage that accompanies it. For others, though, it is and that’s a choice that needs to be respected. The only issue is whether that choice is truly informed and truly free.

  • It’s really a shame that so much legitimate criticism of psychiatry is ignored or minimized because this one slice, albeit very well-funded and famous slice, of the psych reform movement is so vocal.

    The irony is that Scientology has actually ended up promoting psychiatry because any serious critical writing gets tarred with the same brush. The esteemed E. Fuller Torrey wrote off Peter Breggin’s work largely on the basis that Breggin’s wife was a former Scientologist. Even respectable magazines like The New Yorker point to Scientologists as though they were representative of the movement against psychiatry.

    Note to public: Terrorists are not representative of Islam and Scientologists are not representative of psych reform.

  • Hi, Russerford. Your doctor is quite correct that serotonin levels likely vary across the blood-brain barrier and thus merely measuring blood levels is of limited use. However, I’d like to point out that in science theory is derived from strengthening and confirmation of a hypothesis. In other words, the onus is on psychiatry to PROVE the serotonin theory of depression, not on skeptics to DISPROVE it.

  • One could make a case that every time a man takes a woman out to dinner with the expectation of sleeping with her and if the woman feels obliged to sleep with him, that the arrangement nears prostitution. Ditto very rich men and their trophy wives. What appalls us about more obvious prostitution is just that – that it’s too obvious. We will never be able to get away from the fact that sex is often used as a commodity.

  • “So I would say that the defendant should be offered the opportunity to describe any extenuating circumstances including anything that impacted on their decision-making at the time – and that the defendant’s lawyer could put on information and evidence, it does not have to be the defendant testifying if they don’t want to.”

    Isn’t this already true, though?

  • Still wondering about this. Why should a defendant be entitled to only the benefits of an insanity defence? It’s a bit like saying the mentally ill should get a free pass from their responsibilities. Now, I do understand (but don’t agree with) Thomas Szasz’s position but this article seems like a new twist.

  • Jonathan, I would prefer more points of view on this blog, too. However, it seems that whenever somebody comes along who doesn’t partake in the groupthink, they are savagely disparaged. That’s not an environment that fosters healthy dialogue. It’s fine to disagree, of course, but if we want to change the status quo, we have to engage with the “other side.”

    By “pile on,” I was referring to the general tone of the thread not any particular post of yours. Sorry for the misunderstanding.

    I feel it’s just being assumed here that as Dr. Hassman is a psychiatrist that he must promote overmedication and I think if people are going to make that kind of leap, they should at least make a cursory enquiry before publically misstating his position. Believe it or not, there actually are good psychiatrists.

    I do find some of the discussions here at MiA incredibly frustrating. I support widespread psychiatric reform but I’m often discouraged by some of the things written here and I wonder what on Earth a random member of the public (who may not have yet formed an opinion on these matters) is going to think when they read some of these discussions.

  • Richard, I’ve never heard prostitution being referred to as “liberating.” And from a legal standpoint, I support harm reduction. By way of analogy, I don’t think street drug use is either desirable or “liberating,” either but I don’t think the answer to it is shaming users.

    Rather than the personal attack, Richard, could you tell me specifically what logic of mine you find “almost beyond credibility” if you wish to discuss it? And, yes, I often change my mind about things as I learn more about them. It’s just that I haven’t learned anything here.

    Jonah, my comment about “bullying” was a general one directed at some sectors of the psych rights movement, not any particular individuals here. I’m sorry that you chose once again to select the very least generous interpretation of your opponent’s words.

    I’ve read Peter Breggin and find his position hard to reconcile with the facts. I agree that forced and/or coerced ECT has to be abolished but, as far as voluntary ECT goes, I’ve frequently seen people decline further treatments. Given that the USA’s mental health laws are much more user friendly than Canada’s, I assume that it happens in the USA too. Bottom line is that some people choose ECT and some in the psych rights movement choose not to respect other people’s choices, much as psychiatrists deny choice to their patients.

  • Our legal systems may be vastly different, of course. Here, you plead NCR (not criminally responsible) instead of going to trial so it’s really not accurate to call it an insanity acquittal. It’s more like an insanity bypass. As many have already noted, it’s a difficult decision to make.

  • As Anon pointed out above, Dr. Hassman has been more than clear that he’s vehemently opposed to overmedicating patients. But, by all means everybody, just ignore that inconvenient fact so that you can continue with the pile on!

  • Anon, we have somebody here at MiA (not on this thread, but on this site) who went to Dr. Hassman’s blog which is called “Can’t medicate life” and has a header which reads “If you want to get better, take a pill, but if you want to get it right, face the truth” and publicly summed up his position jeeringly as “If you want to get better, take a pill.”

    I called her on this virtual libel and she retorted that the missing critical phrase “but if you want to get it right, face the truth” was merely a “non sequitur.” Not only did the commenter not apologize to Dr. Hassman but I was criticized by another commenter for bringing this dishonesty to light. Okay, folks, this is why we’re not taking seriously.

    Unfortunately, this kind of crap is what passes for debate in some sectors of the psych rights movement and the hell of it is that it harms us, all of us. The other side could (and perhaps does) quote many of the comments here at MiA and reasonably conclude that some of us are both illiterate and irrational and not to be taken seriously.

    None of us holds the monopoly on pain and suffering. It is appalling that some of us are so ready to lash out that we don’t even take the time to consider the target. If you take the time to actually read and think about what he says, you’ll see that Dr. Hassman is actually an ally or would have been before he was subjected to this.

  • If you don’t like the “psychiatric” descriptor, we don’t need to use it. The term intervention (or crisis intervention or emergency intervention) can stand by itself. My point is just that there are situations where it’s ethical and appropriate to intervene, even though a person may have broken no law.

    I agree that there are often a range of services that can be offered beyond involuntary hospitalization in a crisis and, of course, we should encourage use of those services first. However, if a person is declining such help, then, yes, the choice is between forced intervention or nothing. You can’t force a person to be talked down.

    If a police officer comes across a suicidal woman standing on a bridge railing, it is only mental health legislation that allows him to physically prevent her from jumping. Without such laws, he would actually be committing assault if he grabbed her. That’s an untenable scenario and just one reason why we’re never going to get rid of involuntary psychiatric treatment. The real issue is in its application and how civil liberties are balanced with public safety.

  • Tina, could you please tell me who makes the decision? Is it solely up to the defendant or does the prosecutor and/or Judge have input into the decision? What happens if a defendant declines the insanity defence but then clearly displays symptoms of a mental disorder during Court proceedings?

    Also, when you say you would want leniency for someone who is “in a state of altered reality or extreme distress when committing a crime,” I am wondering what “leniency” means here. Do you want lesser punishment without specifying that the defendant has a disorder? I’m not sure how that would work. What would be the basis for the leniency, then?

    I had never thought about comparing insanity acquittals with regular acquittals in terms of discrimination. If the insanity defence were removed, regular acquittals likely wouldn’t increase. In other words, I don’t think it’s usually a choice between two kinds of acquittals but rather between a guilty verdict and an insanity acquittal.

    I’m also aware that involuntary psychiatric treatment happens in prison, too, so it’s not like declining an insanity defence guarantees a person won’t be medicated against his will.

  • TSIB, I sort of wonder if the drive to force drug more and more of us is ever present but just becomes more public when a shooting tragedy comes to light. In other words, I don’t think it’s as simple as “Hey, crazy person with a gun killed people so let’s force drug ’em,” but rather “Hey, this is a great opportunity to further our agenda of force drugging ’em!”

  • Well, ECT is a medical treatment if we’re going to call depression an illness. ECT often provides short-term relief. For some, that small gain is worth the substantial risks.

    The problem is forced or coerced ECT because it’s way too invasive and dangerous a procedure to use on this basis. I completely, 100% support an absolute abolition on forced/coerced ECT.

  • Jonah and Richard, it seems you’re having trouble wrapping your mind around the fact that someone may want to make a decision that you would not want to.

    Even with memory loss, brain damage, spontaneous seizures and a raft of other problems, some patients want ECT when they can’t see another way out of their depression.

    If you really want to reduce ECT, please stop alienating those who voluntarily choose it and concentrate instead on public awareness of the risks and promotion of alternatives for people who suffer from crippling depression.

    I’m quite serious about what I said before. It is actually disturbing to me to see psychiatric survivors being bullies. The major complaint most of us have against the psychiatric system is being denied choices and not being listened to. Yet here we are doing exactly the same thing to some of our comrades.

  • I’m a Canadian, Richard. Prostitution is legal here. And many feminists are of the view that prostitution is not oppressive to women. In fact, there’s an entire movement to legitimize the sex trade with a goal to keeping prostitutes safe. Merely saying “Eew, it’s blecchy!” does make a cogent argument for abolition.

    As for my idea of government in society, in a nutshell, I think needs to be there to gather taxes and to provide services for all in exchange.

    Like it or not, many people find that psych meds help them. People voluntarily choose them and there is no reason to deny them their choice. It’s offensive that survivors of psychiatry are so willing to inflict their ideology on others just as psychiatrists did to them.

    Now what we do need to do is work towards greater public awareness of the dangers of psych meds so that people know what they’re getting into. But many are already fully aware of the dangers of these drugs and still choose to take them.

    What we should be focusing on is strategies against coercion and unwarranted involuntary treatment. Those are goals that I can see being reached in my lifetime. Abolition of forced psychiatry and/or psychiatry in general, on the other hand, has no possibility of succeeding, ever.

  • How is it a contradiction in terms? A patient can be given the facts (informed) and genuinely choose the treatment (consent). I think what trips anti-psychiatrists up is their disagreement with other people’s choices. The irony is that limiting choice is the primary complaint they have against psychiatry! We do, indeed, bear responsibility for what we offer but we also bear responsibility for denying choice.

  • Informed consent is still possible even if forced treatment exists in other situations. What’s critical is to guard against the insidious grey area of coercion where people are “consenting” under threat of force when they don’t actually meet the criteria for involuntary treatment. In BC, the threshold for involuntary treatment is far too low and is so vaguely worded it could pretty much apply to anybody. “Imminent danger,” on the other hand, does seem a reasonable standard. I’d be happy with that in BC, provided a patient was entitled to a court hearing.

    There are, unfortunately, rare and extraordinary circumstances where intervention is justified. Intervention need not necessarily mean medication but it may mean a 72 hour hold. The need for such a legal mechanism has to be acknowledged because it’s never going to go away.

    I am adamantly opposed to psychiatry but I would never support absolute abolition of emergency psychiatric intervention. If somebody is writing down their fantasies about killing schoolchildren, they are not breaking any law, merely exercising free speech. If they don’t want counselling or other services, are we really going to ignore them? The public is never going to get behind a movement that answers “yes” to that question.

  • Hi, Bonnie. Thank you for not being offended (or not expressing offence). I agree that whatever gains we make will definitely be over the long haul. I must disagree, though, with your assertion that if people knew the biomedical model was a fraud, they wouldn’t pursue psychiatric treatment. I’m fully aware that mental disorders aren’t biological illnesses yet I’m grateful to have meds available, if and when I choose to use them.

    And, as with Frank’s comment above re: lobotomy, if a patient really exercises informed consent in choosing a 2 x 4-ectomy, then there’s no ethical reason to deny same. Empowerment means giving people choices, not restricting choices to those we happen to agree with. In this respect, I find certain aspects of the anti-psychiatry movement to be as oppressive as psychiatry.

  • I think the abolition of psychiatry is a non starter. In fact, I think the abolition of forced psychiatry is a non starter. I wish our considerable efforts were going instead into informed consent (which rests on public awareness), raising the criteria for forced treatment to where it belongs, providing effective voluntary care and (especially) fighting outpatient commitment.

    With respect to ECT, abolition is the wrong goal. In response to an email, I wrote back to one of the organizers of an abolitionist outfit to say that some people choose ECT and the real issue is whether their consent is true consent (as in no coercion) and informed (as to risks).

    Lack of choice is exactly what we complain about when we criticize psychiatry. Why are we doing the very same thing to others? If somebody finds that ECT works for her, why shouldn’t she have that option? It’s paternalistic to declare that she can’t reasonably make that decision.

    Anyway, the organizer said there is no such thing as informed consent to ECT because it always causes brain damage. That doesn’t logically follow. A person can be aware that a procedure causes harm and still choose to go that route.

    Anyway, the concept of abolition of psychiatry or even abolition of forced psychiatry turns off an awful lot of influential people who would otherwise be our allies.

  • I think much (if not most) of the bipolar boom can be attributed to harmful, ineffective treatment for depression. Every psychiatrist I’ve ever consulted has declared that antidepressants merely “triggered” my underlying disorder. This rather bold conclusion is made in the face of no evidence: there were no prior mood swings nor any family history of same. Seems a very convoluted way to explain away a pretty obvious cause and effect relationship.

  • Because a true believer will just look at this situation and conclude the problem was that he didn’t have ENOUGH treatment. If someone’s doing well on meds, it’s proof that they work, but if someone’s doing poorly, it’s proof that we need more. They pretty much have the situation covered.

  • I am very curious about the notion of subjecting somebody to forced treatment and then charging them for it. I’m not a lawyer and I don’t know how contract law works in your country but that seems to fly in the face of standard modern legal principles. Does anybody know if this practice has ever been challenged in court? I’d be fascinated to read what a judge has to say on the subject.

  • Am wondering if there are separated twin studies yet on ADHD or whether it’s too new a diagnosis for that. I really have to wonder about these parents! If your doctor is telling you that your child is defective and needs stimulants, GET A NEW DOCTOR!

  • Seth, it is my consciousness that allows me to look at an apple and recognize it as such. Obviously, when I’m asleep, I lose that awareness. That doesn’t mean that the apple only exists when I’m awake!!!

    We don’t require consciousness to have neurochemistry. We have neurochemical states even when we’re in a coma. And, yes, in accordance with science, I know that consciousness cannot exist in the absence of physicality.

    I really have no idea why you are trying to compare your theory to quantum physics or, indeed, to any scientific field whatsoever. What you are describing belongs, along with all other perfectly unfalsifiable theories, under religion’s umbrella.

  • Jonah, the fact that Szasz was one of the founders of CCHR has never been in dispute. We’re talking about the religion of Scientology as a whole, not the organization called CCHR. Szasz was a devout atheist.

    You are of course correct that Szasz is no longer “still alive and kicking,” however I doubt he changed his mind about Scientology after he died 🙂

    (As an aside, it is not unusual to use the present tense in such instances, e.g. “Freud says ….” or “Shakespeare says ….”)

  • “Francesca writes ‘neurochemistry… leads to individual thoughts, feelings and experiences, regardless of the origin of any particular neurochemical state.’ That’s backwards. It is thoughts and feelings that most often lead to neurochemical changes.”

    Seth, you have utterly misunderstood my point. I do not have this “backwards.” Ask yourself this: Can one have thoughts and feelings without neurochemicals? No, one cannot. As I said, REGARDLESS OF THE ORIGIN of any particular neurochemical state, it is in fact one’s neurochemicals that provide our consciousness.

  • Vet, this statement of yours amazed me: “The trouble is, where can an attorney or law firm be found with the stones to take such a case? The Bars of most states have considered a person with a psychiatric label to be unfit for admission to the Bar based upon its “Character and Fitness”portion of its exam.”

    Are you referring to the disqualification of someone who is actively suffering from a mental disorder? Or do you mean someone who merely has been so diagnosed at some point in his/her past? If it’s the latter, I can’t imagine that human rights legislation allows such discrimination.

  • Yes, Steve, I am well aware of the structure, function and location of neurotransmitters. My point was simply that SSRIs (or any other psychoactive drug, for that matter) can mess with a person’s neurochemistry and cause distress as a result.

    I think if you’re willing to agree that meds can cause brain chemical changes that can lead to mental distress, then you are logically forced to at least consider the possibility that in some cases brain chemical changes can do the same without the triggering psychoactive drug.

    I have never claimed that the answer to emotional distress is better living through chemistry. It’s still important to recognize, though, that it is in fact neurochemistry that leads to individual thoughts, feelings and experiences, regardless of the origin of any particular neurochemical state.

  • I don’t think it’s unreasonable to think that an SSRI, for instance, creates a serotonin balance. And it’s certainly true that many people become manic on antidepressants, trading a sometimes resolvable problem (depression) for a psychiatric disaster (bipolar disorder).

  • I don’t understand the distinction people try to make between orthomolecular psychiatry and biopsychiatry. Both allege biological dysfunction as the cause of mental disorders. The fact that a particular agent happens to be a vitamin does not necessarily make it “safe.” Many of the treatments used by that quack Abram Hoffer involved massive doses of non-water soluble vitamins which are definitely toxic at high enough doses. The absolute lack of effectiveness of orthomolecular treatment is another issue altogether.

  • These proposals would bring the USA’s bar for involuntary treatment down to the shamefully low Canadian one. Essentially, in Canada a patient can be deemed competent to consent while incompetent to refuse. There is simply no mechanism for refusal, no matter how well-considered that decision may be.

    In general, it’s a bad idea to craft policy that will affect individuals on the basis of statistical characteristics of their group. There are other common threads beyond psychiatric labels and substance abuse comorbidity in these shootings. They always seem to be perpetrated by young males. Is anybody going to support locking males up between the ages of 18 and 24 or so?

  • The thing is that mega-vitamins don’t equate to “no more poison.” Many of these vitamins are not water-soluble and can be toxic in mega-doses such as Hoffer prescribed. I don’t know how widespread orthomolecular psychiatry is since Hoffer’s demise but the idea that because they’re vitamins they must be benign is a dangerous one.

  • Please keep us posted, Boans.

    There was a Supreme Court of Canada decision (Starson v. Swayze) from over a decade ago that separated the issue of competence from treatment decision. Unfortunately the SCoC decision never trickled down to the provinces, in part because the plaintiff was not really a poster boy for non-compliance.

    As it stands now, refusal of treatment is sufficient grounds to deem a patient incompetent. One of the things I’d really like to do here is encourage people to have their competence established without getting into treatment discussions.

  • Orthomolecular psychiatry ought to be dead by now. Thomas Szasz said that Abram Hoffer was a quack and Szasz was absolutely right on this point. I met this idiot Hoffer in the late 80s. The reason he could claim such great results is because he was willing to diagnose just about anybody with schizophrenia. If vitamins worked, Big Pharma would be all over it with vitamin uptake enhancers or some such. It doesn’t make any sense to rail against BIOLOGICAL psychiatry but then be willing to entertain mega-vitamin mumbo jumbo.

  • Very, very hard to say what ought to count as a suicide attempt for statistical purposes. As you point out, there’s the issue of accidental overdoses. There’s also a difference between a genuine suicide attempt and a cry for help that is not intended to be lethal. As always with psychiatric research, data is interpreted in whatever way fits the agenda of those doing the research.

  • I’d like to know more about this, too. In British Columbia, there’s an offensive phrase, “deemed consent,” which is often applied. In practical terms, what it means is that you can either consent or you can be deemed to have consented; there is no mechanism available for refusal. This is what passes for “consent” in British Columbia’s mental health care system.

  • Wileywitch, from the paper you linked to:

    “Treatment with AD has been associated with mania or other forms of excessive behavioral activation [28]. These responses may reveal an unrecognized bipolar illness or may be drug induced, since they may also occur in allegedly unipolar patients.”

    The word “allegedly” here speaks volumes about how psychiatrists have so little capacity to acknowledge the harm that they cause. Depressed patient consults psychiatrist and is given Prozac. Three weeks later, she’s stark raving mad. “Aha!” concludes the psychiatrist, “an underlying bipolar disorder has been triggered. We’d better add a mood stabilizer and an antipsychotic to her cocktail.” And thus a lifetime of chronic disability is launched.

    In my own case, and that of many others I have spoken to, there was no prior personal nor family history of mood swings yet our doctors managed to twist the facts around to suit their agenda. I’ve even had somebody tell me that I must have had prior mood swings but I’m just a poor “self-historian.” That’s an interesting assertion because not only would I have to have been poor at noticing mood swings but this blindness would have been shared by my family and friends, all of whom were interviewed at one point or another.

  • Steve, without this particular chapter of the Unitarian Church telling us exactly the reason(s) for their decision to stop providing a venue for Rethinking Psychiatry, it might be premature to say that their concerns were not legitimate.

  • Hi, T-V. I don’t understand your comment. I certainly don’t think I “focus on terms,” nor do I “naturally” oppose Szasz. I salute Szasz for the work that he did but that’s not to say that I have to agree 100% with everything he said. As for terminology, I use the term mental “disorder” in an effort to make a distinction from mental “illness.” Could you clarify what the “essential problem” is that you feel that I am missing? I don’t think we have any evidence that Dr. Schroeder is “pretending” anything.

  • Uprising, everybody here wants reform in mental health care. For some, that means getting rid of psychiatry altogether. For others, that means ensuring informed consent and providing alternatives to conventional care. There are myriad approaches possible. While our specific goals may differ, our overriding principle is the same: current psychiatric practice stinks!

    Is referring to my comments as “verbiage” your contribution to the new, improved communication style we’re striving for? Please see Emmeline’s thoughtful comments on this subject.

    I am not concerned about what a “hypothetical shrink” might think about what’s posted in these discussions. My concern is how much credibility the public is going to give us after reading some of the rants here.

    I’m sorry you’re feeling disrespected and disregarded. That’s never been my intention.

  • Oldhead, repeatedly putting my name into your comments in a derogatory fashion is hardly “ignoring” me. If you are truly interested in more civilized discussion, then consider examining your own words rather than just assigning blame to those who happen to disagree with you.

  • Uprising, I think I’ll be in charge of how I express myself, thanks. Although every comment on this blog represents somebody’s own opinion, our overriding goal (to reform psychiatry) seems to be uniform. So when I say something like “XYZ doesn’t help us,” that’s not to say that XYZ doesn’t further any particular individual’s goal; it’s stating that XYZ doesn’t help the cause.

  • Uprising, I don’t see those as necessarily mutually exclusive options. If NAMI were to come to my hometown and make a presentation, the best thing I could do would be to try to get involved and give some balance to the discussion. Then, presumably, when the media reported on the presentation, the public would be made aware that there were dissenting voices.

  • Oldhead, I can assure you that I most certainly do not intend to provoke people and I challenge you to review from start to finish any discussion that I have participated in here on MiA and show me an instance where I have been the first to introduce a non sequitur or an ad hominem attack. If you’re waiting for censorship to bolster your argument, you’re going to be waiting an awfully long time.

  • Yes, I do see what you mean, Boans. I have, however, received emails from the other side which indicate that these types of discussions are read and judged so, even though we might be just thinking out loud in the comments section, we should keep in mind that we are doing so publicly.

  • We will all do what we think is best. I don’t think your analogy of the evolution of Gay Pride works, though. For example, we achieved marriage equality through rational debate and litigation.

    Please consider the civil rights movement instead. Although the anger of the Black Panthers was completely justified and understandable, they scared the public and may have slowed the movement down.

    It’s true for a lot of issues. In my neck of the woods, agricultural animal welfare (another cause I support) is being brought into the spotlight once again by the release of videos showing appalling abuse of dairy cows. Getting the truth out there is way more effective than holding up “Meat is Murder” signs.

  • I apologize for my poorly worded comment. I most certainly did not mean to say that either Jonathan’s group or the psych reform movement in general are unsavoury. I was mostly just sticking up for the United Church which I consider to be an admirable organization.

  • “Did you really just say that?” No, I did not. In fact, I am very much opposed to censorship. My point was that much of the psych reform debate is framed in a way that is guaranteed to fail. It has nothing to do with what I “like.” It has to do with assessing how to calmly and intelligently put forward our message.

    I’m sorry that you can’t see how the Unitarian Church could make such a decision but there is no indication that the Church lacks an understanding of either human rights or social justice. What is clear is they are not interested in being associated with a particular, often unsavoury, slice of the psych reform movement. Neither am I.

  • Jonathan, it’s a shame that your group has lost its venue and I hope you are able to find a suitable replacement soon. However, the Unitarian Church’s decision is valid and understandable. Much of the rhetoric of the psychiatric reform movement IS offensive and really doesn’t further our cause. A member of the public could do a quick blast through these comments, see the reference to Mengele and reject our entire point of view. It’s time for us to figure out what are realistic goals and what is the most likely way to achieve them.

  • If females attempt suicide 3 times as often as males do but males actually “accomplish” suicide 4 times as often as females do, then I would have to dispute your assertion that a previous suicide attempt is a reliable indicator of suicide risk.

  • Donna, a quick glance at your most recent comments shows they are just as incoherent as your earlier ones and I’m not willing to spend the time to read and address them carefully.

    So I will ask you once again: Could you either BRIEFLY specify which words or phrases offended you OR stop nattering at me, please?

    Your rabid attack on a general comment about the supposed link between mental illness and violence is absolutely mystifying to me. There was absolutely nothing inaccurate or insulting in the comment and it was certainly relevant to the GENERAL topic. In what universe does that make my comment “absurd”?

    As for Suzanne Beachy, you’re right that she wasn’t pleased when I called her on her dishonesty. People usually aren’t pleased to be proven to have acted unethically. Suzanne deliberately took another person’s words out of context which is tantamount to libel. That’s dishonest and I’m glad I pointed it out to readers.

    My “ideology” is not what makes me speak up when people like you make a laughingstock of the entire psychiatric reform movement. It is my legitimate fear that mainstream psychiatry will never take us seriously and it’s times like these that I can understand why they don’t.

  • Seriously, Donna, I don’t know what the hell you are talking about. I didn’t even ADDRESS your comment in mine, never mind make insulting remarks about it. (But I do thank you for one thing. You have perfectly encapsulated why I don’t often participate in these go nowhere discussions that accomplish absolutely nothing. Any member of the public or potential psychiatric ally who reads this bizarre analysis of yours is going to have even further doubts about our movement.)

  • Donna, the comment to which you have your knickers in a twist about is pasted in its entirety below the asterisks. I challenge you to find ONE insulting or ill-informed remark within it. You are correct, though, that I very unusually did not read the article in question and I explicitly said so for exactly this reason. My comment was a general one covering the supposed mental illness/violence link.

    I am sorry if “verbose and redundant” struck a nerve. It is, though, an entirely accurate description. So, either read the comment and tell me BRIEFLY what specific language offended you or please let this go. Now that I’ve seen the comment that so upset you, I really have to wonder.

    *******************************************************************

    Haven’t read the article but from the description it seems like a positive development. In general, when Fuller Torrey et al talk about preventing violence, they are targeting the severely ill, i.e. those alleged to lack insight (because we all know that NOT doing something equates to CAN’T do something). These are the same folks targeted for involuntary treatment. What’s lost in the debate, however, is that involuntary treatment IS violence.

    I know there are lots of studies showing lots of conclusions: some say mental illness is an increased risk factor, other say it makes no difference, and still others alleged a lower correlation with violence. I think there probably is an increased risk of violence but that’s mostly due to mental illness itself being correlated to risk factors, i.e. drug abuse, homelessness, poverty, unemployment, isolation, etc. If you held those confounding factors steady, most of the risk would disappear. The thing is, though, that removing the risk factors would be an uphill battle and would require a paradigm shift in how we deal with poverty, etc.

    But all this misses the point. Even if a person with MI is statistically ten times more likely to commit a violent offence, it is just not acceptable to target individuals on the basis of group statistics. It’s illegal when it comes to race and it ought to be illegal when it comes to mental status.

    One final concern is how we define violence. Are we talking actual criminal convictions or ‘not criminally responsible’ pleas? Or are we talking about the prediction of an underqualified psychiatric social worker? The most common victims of MI violence are psych staff, family members and the police. What’s got to be acknowledged is that these three groups are also the most likely to be inflicting or attempting to inflict violence upon the MI person.

  • Uprising, people aren’t making extreme anti-psychiatrists out to be “bogeymen.” They don’t have to because the extremists are taking care of that all by themselves. What’s happening is people who may otherwise have been sympathetic to the cause are reading the extreme rhetoric and rejecting not only the extremists’ position but ALL criticism of psychiatry, including very warranted and well-articulated criticism. That is the tragedy of the psych reform movement.

  • Jonah, if you wish not to engage in discussion with me (and, trust me, I’m not getting anything out of it anyway), then it’s best not to directly address me in your comments. And, just so you know, the reason I didn’t read your whole comment is because your writing isn’t that interesting.

  • Donna, as to my making a comment without reading an article, I have no memory of the article or the comment so I’m really not in a position to say why it happened.

    However, I would be surprised if my objection to your comment would have been negated by anything in the article. If someone’s comment is “black is white,” then I think I can fairly disagree without finding out what s/he was trying to challenge.

    Again, I don’t recall the comment but it’s not at all clear to me that I would have had to read the article in order to have grounds to disagree with something you wrote.

    As I said, I don’t think I comment on ARTICLES without reading them. I might, however, look at something in a comment underneath if it catches my eye.

    Lastly, gracious of you to allow me my opinion.

  • Someone Else, Bob Whitaker can’t “point out” the reason for deinstitutionalization. Nobody can. All we can do is look at the many possible factors and make our best guess as to what was the primary impetus.

    As I clearly stated in my comment, some very good evidence for Whitaker’s claim is the increase in numbers of the chronically ill DESPITE the advent of antipsychotics.

    I’m thinking Donna took umbrage at my comment because I pointed out (and, yes, “pointed out” is the correct phrase here because I made a provable assertion) that hospitalization initially spiked after Thorazine. That finding is actually evidence against the bioreductionist model yet once again some of you choose to pontificate rather than reflect.

  • Donna, you’re saying that “rational” people believe that only criminal acts warrant intervention? So a person who believes in emergency suicide prevention must therefore be irrational?

    Why you are calling me “irrational” when you can’t even comprehend what I’ve written? Nowhere have I said that I defend biopsychiatry; indeed, I’m very much opposed to it.

    Nor do I “support” coercion. I do acknowledge that there are rare and extraordinary circumstances where we have no other choice. Forced intervention/treatment must always be the very last option but nevertheless it will sometimes be necessary.

    What I do support is more effective and earlier voluntary care. Now if you want to talk about what that entails, absolutely, that’s a worthwhile discussion. But a blanket statement along the lines of all involuntary treatment is evil just doesn’t pass the laugh test never mind foster worthwhile dialogue.

  • Donna, I have no idea where Jonah made that criticism nor do I have the interest level sufficient to search for it. Unfortunately, I am not (like many others are not) interested in reading verbose and redundant comments but when I came across my name followed by bold print, I did of course take a look and respond to what was addressed to me.

    When I said I didn’t comment without reading what I meant was I don’t comment on an ARTICLE without reading the article. However, if somebody starts a page-long comment with the assertion “black is white,” I certainly don’t feel obliged to read the whole comment if I want to dispute the opening point.

    Yes, I do suffer from memory troubles so that’s an accurate (though irrelevant) point. However, I am not in the least bit interested in forcing my opinions upon anybody. Never have been. When I see something that I believe is egregiously wrong, I say so but it’s not my concern whether anybody changes their mind as a result of my input.

    Your accusation that I “inflict [my] ideology” is a perfect example of the kind of irrational, overwrought statement that ensures that your writing won’t be taken seriously. Donna, I don’t have an “ideology” beyond trying to mitigate the damage that you and others inflict upon the psychiatric reform movement. If my responses “give [me] away,” then I see that as a good thing.

  • This really surprises me. Are you referring to involuntary treatment? It used to be the case that, for some defendants, prison was preferable to pleading NCR and going to a forensic hospital for the sole reason that they wouldn’t be medicated in prison.

  • Jonathan, I completely agree. The unrealistic (and ill considered) call for abolition endangers the psych reform movement as a whole. And this fracturing of our otherwise collective voice plays right into psychiatry’s upper hand. The reformers want less forced treatment and the abolitionists want less (as in no) forced treatment. You would think we could find some common ground here.

  • And in your scenario does forced treatment include all forced intervention? What are your thoughts on suicide prevention? Grabbing someone off a bridge railing is using force.

    There are profound implications to the civil libertarian argument that ensure abolition will never happen and for good reason.

  • Too late, Donna. Read them, bought them, cite them in papers. I am fully aware of the harm inflicted by biopsychiatry.

    Not sure what you mean about me not reading before commenting. I always read the article in question. I don’t, however, take the time to read comments that go on for paragraphs pretty much saying the same thing over and over.

    A lot of those comments don’t demonstrate any “basic homework” being done and don’t appear particularly “informed.”

    My points were merely that:
    1. There was an initial spike in hospitalization after Thorazine.
    2. That spike was followed by a steady decrease in hospitalization rates.
    3. We can’t go back in time and remove Thorazine from the equation so we are just making our best guess about how deinstitutionalization came to be.

  • Hi, Jonah. I didn’t read your whole comment but the boldface type caught my eye. I want to make it clear that I would never presume to choose another person’s words. I am just trying to suggest to people that if the goal is to be heard by one’s opponents, the wording of the message has to be designed with that in mind.

  • AA, I think I’ve been misunderstood (again). Accurately labelling one’s own horrific experiences is a natural part of the healing process. However, in the bigger picture of dealing with the psychiatric system as a whole (as opposed to a particular victim of that system), inflammatory language comes across as emotionally overwrought and diminishes our message.

  • Uprising, yes, it’s usually (though not always) in reference to forced treatment. People are of course entitled to use whichever words they choose however inflammatory language (e.g. Scientology’s “industry of death”) doesn’t open doors to productive discussion.

    I certainly don’t think people should “just shut up about” psychiatric abuse. I very much support getting the truth out there. However, I do think we should do it in such a way that gets us listened to. IMO, the phrase “brain rape” doesn’t accomplish this.

  • AA, that’s certainly a fear many of us share. A couple of years ago, I was experiencing what I termed “dizzy spells” several times a day. They would last 20 seconds or so during which time I had the frightening sensation of falling backwards. Afterwards I would often be completely disoriented.

    Anyway, I ended up in a neurologist’s office and we got the spells under control eventually. However, the doctor later told me that he had just “assumed they were panic attacks.” An EEG later showed they were actually frontal lobe seizures.

    I truly doubt he would have made such a dismissive assumption had I not come to him pre-labelled as a crazy person, i.e. a patient whose legitimate complaints were not to be taken seriously.

  • No, things without value can become obsolete also. My comments are neither defeatist nor cynical; they are realistic. For the most part, what passes for discussion at psych reform websites does not help the cause. In fact, much of it hurts the cause because Fuller Torrey et al point to it (sometimes correctly) as naïve, uninformed, irrational outbursts that are not to be taken seriously.

  • I’m not experiencing confusion. I am well aware that psychiatrists can and do forcibly drug their patients. I just happen to believe that “non-biological psychiatrists” (awkward phrase) are de facto psychologists and I don’t see how one person can FORCE talk therapy upon another. And there are in fact two types of psychiatrists: those who solely rely on drugs versus those who are interested in the bigger picture.

  • I don’t know if that’s accurate. Once Thorazine became widely available, there was an initial spike in hospitalization but fairly soon after that asylum populations decreased. Now, whether one had anything to do with the other is far from clear but what is clear is that even as inpatient care has decreased, the number of the chronically disabled on the outside has risen.

  • AA, I really don’t think the problem is our “extremist” position. The problem is the lack of respectful debate about it. I am not at all talking about you here so please don’t feel attacked but there are survivors who shriek about “brain rape” and the “Holocaust of psychiatry,” etc., etc., etc. and it is these voices who ensure that psych reform is not taken seriously.

    For example, if someone comes along and declares that schizophrenia = excessive dopamine, the productive response is to ask for convincing evidence of that position while providing our own evidence against the position.

    Ditto if someone comes in guns ablazing and equates antipsychiatry with Scientology, patiently and respectfully demonstrating that the former does not equal the latter is a lot more helpful than what usually goes on in these discussions.

  • Yes, survivor rage although understandable is not productive, in fact it’s very counterproductive. We should have welcomed Dr. Hassman here and encouraged respectful dialogue. Both sides could have gained a lot of insight about the other. There’s not a lot to be gained by insisting on speaking only to people who share your point of view. Let’s all of us make a pact to do better next time.

  • One doesn’t need to provide physical evidence of a disease in order to collect disability benefits. Fibromyalgia (I believe) can’t be physically confirmed yet is grounds for benefits. If fibromyalgia isn’t a good example, there are other diseases without objective diagnostic tests. The criteria for receipt of benefits is (and ought to be) a genuine inability to support yourself financially.

  • You’re quite right, Jonathan. And upon thinking it over, I remember that it was my skepticism that led me to my research, not the other way around. Also, in general, it is not unreasonable to assume at first that a medical professional has a patient’s best interests in mind and is going to make the best decision based on his medical training and experience. Perhaps I should have said that patients really ought to do some research, not that they have an obligation to.

  • Someone else, I think you’ve misunderstood me. I don’t believe there’s such a thing as “bad DNA.” I’m just saying that from psychiatry’s point of view, it’s the assumptions of bad DNA and general biology that is their justification for chemical intervention.

    With kindness, I’d like to suggest that your narrative of your child’s not being baptised having some kind of connection to 9/11 may have been the kind of thing that psychiatrists wrongly attributed to neurobiology.

  • Since pretty much all human traits appear to have a genetic component, it’s not unreasonable to guess that some people may have more trouble with addiction than others do.

    I agree with you that actual “beliefs are not genetic” but tendencies appear to be. A fearful person who is prone to panic attacks is more likely to have trouble without Xanax at the ready.

  • Phil, yes he certainly did mean that as would be obvious to anyone from the context.

    And Suzanne, quoting 1/2 of a sentence that suits your purpose as a stand alone is a dishonest citation.

  • I don’t know about it being “fully the responsibility” of the prescriber. With the Internet so easily available, I think there’s some onus on the patient to at least investigate what they’re being prescribed.

  • I think psychiatry’s position would be that people “without defective brains” and having “good DNA” wouldn’t be prescribed Clonopin and Xanax.

    I’m willing to believe that there can be a genetic predisposition to addiction, making some more likely than others to have trouble coming off meds.

  • B, your position on involuntary treatment ignores real world situations that are never going to disappear. There are rare and extraordinary circumstances where involuntary treatment in the form of emergency crisis intervention is the only humane and ethical thing to do. The far more serious issue arises once the patient is stabilized.

    With respect, I am not learning anything from you and I don’t get the feeling you are even understanding what I’m saying so I’ll bow out of this discussion now.

  • I’m not happy with the quote either because I don’t approve of using psych diagnoses as put downs but I must say that I’ve been thinking this discussion over and I do think Dr. Hassman has some cause to criticize us. Some of us do make preposterous arguments and are content to rant and rave rather than get busy with realistic improvements to our mental health system.

  • I think you’ve confused me with another commenter — I don’t have any children.

    I didn’t mean to imply you had no credibility. It’s just that I believe there may be more to your story than you have divulged or more than you are aware of.

    If you were neither a danger to yourself nor anyone else and if your husband can testify to that, I cannot imagine why this hasn’t been addressed in a lawsuit.

  • Your quote is dishonest because it’s clearly out of context. The header on Hassman’s blog actually reads “If you want to get better, take a pill, but if you want to get it right, face the truth.”

  • Your position is that there was absolutely no reason to believe that you were posing a danger to yourself or others? You were sleeping soundly when your door was kicked in by 6 goons and you were dragged off to hospital? There was no indication that you were suffering from a serious mental disorder at the time? If this is true, it should have been front page news.

  • Francesca: “B, the reason the cops can show up and get involved is BECAUSE of mental health legislation.” B responds: “No, they show up because the person is posing a risk to public safety or disturbing the traffic or whatever other legal term is for that action.”

    No, I can’t see that standing on a bridge railing is a criminal activity. Sure, it may distract some drivers but what law does that fall under? Ditto writing down fantasies about killing school children. There’s no law against free speech. So, yes, mental health legislation is required.

    “First of all, what ‘treatment’?” Treatment can be any number of things depending on the person and the particular circumstances.

    “Because if you’re on MIA you should no that drugging is not an answer, frequently it makes matters worse.” Well, I have to disagree here too. I am in fact a contributor to MiA and I agree that drugging is not always the ONLY answer and I also agree that it can make things worse but I certainly don’t agree there is never, ever any value in it.

    “Secondly, there is no voluntary treatment at all in these cases: “are you going voluntarily or should we force you?” is as voluntary as someone putting a pistol to you’re head and asking if you’re going to give them the money “voluntarily”. It’s a legal fiction.” Yes, what you’re describing is coercion and that’s one area we should really be focussing on. We need to ensure that consent is true consent, i.e. does not come with the threat of force. That’s not to say though that involuntary treatment is never warranted.

  • I apologize if I’ve misunderstood you but if you support abolition of mental health legislation, then the only thing left to prevent a suicide is the criminal justice system. If attempting suicide correctly remains not a crime and there are no mental health laws, then there is literally nothing a person can do to intervene without himself committing “assault” against the potential suicide.

  • I don’t think there are many who deny the existence of what is referred to as “mental illness.” Seems to me the argument is whether we’re talking about minds or brains. Myself, I prefer the term “mental disorder” which implies neither one over the other. It’s merely a neutral term for dysfunctional thoughts and behaviour.

    The quest for abolition is futile and resources spent there are subtracted from realistic goals such as effective legal advocacy within our existing system. We cannot outlaw psychiatry but we can make it increasingly obsolete.

  • I made this comment already and I’m concerned that it may have been censored. My point was to thank Monica for emphasizing that the psych reform movement includes a vast array of positions. IMO, some of them are extremist to the point of absurdity and these harm the credibility of the movement overall.

  • Wow, you are expressing a lot of anger. Are you sure you are directing it at the right target? In my experience (and I have a lot) with our psychiatric system, it’s always been the doctors who are demanding adherence to the medical model. Nattering on about financial woes or an unhappy marriage will only get you labelled lacking in insight.

    I am heartened that you promote a multifactorial approach. I would certainly consult a psychiatrist like you.

  • B, the reason the cops can show up and get involved is BECAUSE of mental health legislation. Otherwise, they would have no authority to do so. Expressing disturbing thoughts (such as fantasies about killing children) is not in itself against the law.

    Your argument doesn’t work in the real world. I agree it is always better to try voluntary treatment first. But the reality is sometimes that’s just not possible. That’s why we will never, ever be able to do without mental health legislation and pushing for abolition erodes the credibility of the entire psych rights movement.

  • This thoughtful article is a valiant effort towards gathering forces within the psych reform movement. I would love to see that happen but I must remain skeptical. IMO, the word “biological” is implied in the word “psychiatry.” Take biology out of the equation and most people will assume that we’re now talking about psychology.

    How (or whether) we come to a meeting of the minds on our terminology depends on our approach and I see little cause for optimism. With opinions on forced treatment arranged along a spectrum, at one end sits Fuller Torrey (force okay once there’s a diagnosis) and, at the other, Thomas Szasz (force never okay). If you’re not a Szaszian (which I’m not) you’ll be accused of being a forced drugging enthusiast and the inevitable vitriol shuts down conversation.

    We might learn from the errors of the animal rights movement. The extremists who shriek about how evil it is to own pets actually harm animal rights because their opponents point to them as representative of the entire movement and they clearly are not. If the true goal is treating animals better, pushing for stronger legislation regarding the humane rearing and slaughter of livestock is where the effort should go, not into holding up “Meat is Murder” signs.

    The extremists don’t help in the psych rights movement either.

  • Well, B, you guess wrong. I have frequently been arrested and involuntarily hospitalized and I really cannot see how it could happen as a result of a “prank.” You can’t call the police up and have them arrest Crazy Person A when there’s no evidence the person is suffering from a mental disorder. And if it did ever somehow happen, the prankster would be subject to severe penalties, both civil and criminal.

    And you also read wrong. I said emergency intervention wasn’t the REAL problem; I didn’t say (or even imply that) it wasn’t A problem. As I’ve made clear in many comments, the REAL issue is outpatient commitment which is based upon the notion that mental disorders are permanent and necessarily debilitating.

    We’ll just have to agree to disagree on the criminal responsibility issue. I believe prison is no place for a delusional person.

    As for suicide, I agree everybody has the right to take their own life. I also have the right to prevent you from exercising that right if you choose to do it right in front of me. That’s not going to change.

  • No, beating and drugging someone is not humane and effective suicide prevention. You say it’s arrogant to decide that someone can’t kill himself in front of you but then right after that you seem to acknowledge that standing idly by is not the right answer either.

    Sure, in some cases, mediation can be used to talk someone down but in other cases that’s not a possibility. Without mental health legislation, there is no mechanism to prevent a suicide in one of these latter cases. That’s why these efforts are unrealistic and will never gain the support of the public (or, more importantly, our lawmakers).

    This time and energy should instead be put into training suicide prevention and mental health crisis experts so intervention entails as little intrusion as possible.

  • I agree high income kids potentially have more opportunity to safely play outside but the reality is that kids aren’t allowed out to build tree forts anymore. They are driven in SUVs to structured “play dates” and equipped with cell phones so Mum and Dad can check in on them regularly.

  • Agreed. A psychiatric label can poison the viewpoint of every other professional you consult. I slowly developed epilepsy in 2012 (in my opinion, due to ECT) and until I had full blown grand mal seizures, my frightening and disorienting severe dizzy spells were chalked up to “panic attacks.” In fact, they turned out to be frontal lobe seizures. Had I been given the proper neurological care I was entitled to, ECT would have been stopped immediately and I would have been prescribed an anticonvulsant.

    By the way, when ECT patients require anticonvulsants, the psychiatric protocol is just to increase the voltage. I am in the midst of a complaint against my former psychiatrist and in his defence he provided a meta-analysis alleging that ECT does not cause epilepsy. There are, however, glaring flaws in that analysis and I note that it comes from India, a country so enthusiastic about ECT that they routinely do it without anaesthesia. Sorry, this is rather off topic but I wanted to get it off my chest.

  • Hi, AA. I just want to clarify that I do not consider the terms illness and disorder synonymous. And I completely agree with you that we blame mental illness for far too many crimes. Just as we blame mental illness for children’s inattention or adults’ maladjustment to our artificial, isolating society. People aren’t born evil; they learn to be evil and there is always a reason (no matter how ugly and twisted) for someone’s actions.

  • B, I didn’t say that killing people IS a mental disorder; I said it INDICATES a mental disorder. And, yes, I believe that anyone who commits such a violent act is suffering from a mental disorder (however fleeting) at the time. I don’t see the irresponsibility in that position nor do I see the harm. I agree that not all fantasies are dangerous. My dream of lining up and shooting every psychiatrist who has ever tortured me puts nobody in danger.

    And, again, you misunderstand me about the concept of problems in perception. Somebody “depressed because of his partner’s death” is not suffering a mental disorder (despite the grieving time limit imposed by the DSM). I don’t see the arrogance in believing that people can enjoy a better outlook than dwelling over their lack of control in their short lives just as it is not arrogant to believe that someone who wants to shoot school children is not receiving or processing perceptions accurately.

  • Oldhead, you quoted me correctly where I said: “Do I really need to provide “rational support” for the radical notion that if lives are in danger, intervention is appropriate? Isn’t it self-evident?”

    And then you responded to me with: “That’s not at all what you said.”

    You’re not making any sense. You quote me and then deny that I said the very words that you quoted.

  • My apologies, Oldhead. It wasn’t clear which post you were responding to. Anyway, as for the existence of mental disorders, examples abound. Our world has many people doing bizarre things that clearly demonstrate irrationality. Since I’m a Canadian, Vinci Li springs to mind as somebody suffering a severe mental disorder.

    I think the misunderstanding between us might relate to my terminology. I am not suggesting that all mental disorders result from brain pathology and that’s why I use the term disorder rather than illness.

  • The term mental disorder works better than mental illness for the reasons both you and Oldhead describe. A disorder (can but) need not indicate any sort of underlying pathology. So although minds can’t be ill, they certainly can be disordered.

    But the problem, as always, is figuring out how to help those suffering. Some of us are spending too much time engaging in rather fruitless linguistic debates.

  • Absolutely. These laws apply to “sane” people, too. I think it’s worth noting that in the absence of a criminal act (such as uttering threats), imminent danger by itself will not land someone in jail but could get someone involuntarily hospitalized.

    Although this position enrages many, truly imminent danger does justify intervention and has my wholehearted support. To me, the relevant considerations are who applies the criteria, what does the intervention entail, how are the person’s rights vs. public safety balanced, who is advocating for the person, what safeguards exist, what options are being given, etc.

    Emergency intervention isn’t the real problem with our mental health system and the goal of doing away with mental health legislation altogether is hopelessly naïve. Saddest of all, these misguided efforts not only waste time and resources but also actively undermine steps towards realistic, positive change.

  • I don’t see any inconsistency. This entity exists. I call it mental disorder. Others may refer it as an extreme state, a spiritual crisis, a psychiatric illness, a psychotic break, etc. You can call it anything that you want, but you can’t reasonably claim it doesn’t exist.

    I agree with you that classification schemes aren’t helpful. All mental disorders ultimately boil down to problems in perception. People deal with these perceptual difficulties in various ways and it is these reactions (as opposed to causes) that are classified in the DSM.

  • Actually, Britta, your position is not at all clear. If the term “mental disorder” can be improved upon, then by all means let’s come up with some better language. However, in the interim, the term “mental disorder” is not an “irrational man-made construct” unless you believe that, to use just one example, a teenager fantasizing about killing school children is not suffering from an identifiable condition that requires immediate intervention.

  • James, I liked your compassionate, rational article. Some of these commenters attack you for even acknowledging that there’s such a thing as a mental disorder. To them I would ask how many suicidal, psychotic people they have taken under their wing. We can (and should) argue about what a mental disorder actually is but to claim that such a thing doesn’t even exist is absurd.

  • Since for myriad rational reasons we’re never going to do away with involuntary hospitalization altogether, I like the idea of disability-neutral policy. If a police officer comes across someone standing on a bridge railing preparing to jump, I think most people are okay with him preventing that suicide. Ditto intervention for somebody expressing their fantasies about killing a group of school children. What the person’s psychiatric diagnosis happens to be (or if there even is a psychiatric diagnosis) is irrelevant.

    You guys have no idea how lucky you are in the States. Up here in BC, the standard for commitment is as low as “has a mental disorder “and is “capable of deterioration.” I would be thrilled if that standard were raised to imminent danger to self or others. Another option I would like to see explored is abolishing the notion that forced hospitalization must mean forced drugging.

  • Harriet, these are entirely reasonable questions. I can’t speak for the comment author but he (or she) may have meant that psychiatric medications promote more serious and longer lasting symptoms. SSRIs, for instance, are well known to cause bipolar disorder although psychiatrists claim that they can merely “trigger” pre-existing asymptomatic conditions. Stimulants for ADHD can also lead to bipolar disorder.

    I don’t think that anybody would try to claim that psych drugs are the only possible cause of mental disorder. And as for teachers benefiting financially from drugging school kids, I’m afraid I just have no idea where that idea springs from.

  • AA, as you know, Inman is a big fan of Fuller Torrey of TAC. Torrey’s stated objections to Advance Directives are that:

    (a) the patient may not be competent to appoint a representative
    (b) the patient’s representative may not him/herself be competent

    I find both these objections very offensive and typical of the toxic paternalism inherent in forced psychiatry. Here in BC, mental health decisions are specifically excluded from our Representation Agreement Act. The best someone can do is attempt to find a reasonable, cooperative doctor and to establish/maintain a network of friends and family who will assist appropriately in a crisis.

    For those not so lucky, the Mad Community really needs a group of individuals ready, willing and able to show up at a moment’s notice and act as psych advocates. Just having a third party present at an intervention can do wonders if the person is knowledgeable and has dispute resolution skills.

    The notion that only compliance is proof of competence is probably the most infuriating concept in all of psychiatry.

  • I completely agree that there’s sexism inherent in psychiatry. Just look at the gender stats on ECT. Something like 75% of victims are women. No doubt the APA would counter that women are more likely to be afflicted with depression. That would, however, fly in the face of gender stats on suicide.

    There’s a note in my medical records from a consult report which reads “This unmarried lady not wearing makeup ….” This was 1988, not 1958, and the comment just breathes sexism.

  • It may be the case that schizophrenia is associated with increased violence (though several studies come to the opposite conclusion) however lots of things are also associated with schizophrenia such as unemployment, poverty, victimization, alcohol and drug abuse, isolation, etc., all of which factors are themselves associated with increased violence. Trying to draw a clear cause and effect relationship doesn’t seem to be an avenue worth pursuing. We’d be better off spending those research dollars on supported housing and humane, effective community care.

  • Alex, how do you know these people aren’t just responding to kind, caring interaction? The fact that your clients give you glowing testimonials doesn’t address that question.

    Your claim that different emotions somehow emit different levels of energy is absurd. What do you do? Take an electrical measurement of the air around somebody who’s jealous? Sad? Elated?

  • But that’s not “all [you] need as evidence”! Before you tell vulnerable and frankly gullible people that their emotional energy levels are the source of their suffering, you need to subject your therapy to randomised controlled trials to compare against the placebo effect. How much are you charging these people for your work? I’m sorry if I seem hard on you but it makes very angry when I see people being taken advantage of.

  • But you’re not just stating a belief. You’re holding yourself out as a healer. You’re encouraging people to accept your theory as valid by saying patently false things like emotions can be measured in Hertz.

    Our current mental health system is appalling. It’s unscientific and unhelpful and costs way too much. Yes, we need change but change for the better.

  • Sorry, have to reply here because the thread won’t allow another comment.

    This sentence jumped out at me: “So perhaps we simply don’t perceive reality the same way. ” Are you suggesting that we have different realities? We don’t. I disagree with you based on the merits or lack thereof of your position. That doesn’t indicate a break from reality.

    And, as always, of course it’s fine to disagree. But if you’re going to claim that your approach follows a falsifiable, scientific theory, be prepared to be challenged.

  • The trouble with this type of thinking is that it can be stretched around absolutely anything. So if someone decides that fear causes physical disease, one can negate the high blood sugar = diabetes relationship by saying it’s fear that causes the high blood sugar. As the poster later clarified, it wasn’t meant to be presented as a theory so the criticism doesn’t apply but if it were a theory, it would certainly be unfalsifiable and unworthy of consideration.

  • I got all my psychiatric records and they made me furious. Anybody would be able to see that the less psychiatric intervention I suffered, the better my life was. I did come across some gems, though. One in particular still makes me laugh: “This unmarried lady not wearing makeup ….” Do I detect a whiff of male chauvinism there?

    On a sadder note, there was also lots of stuff like this: “uncooperative . . . security called . . . writing incoherent essays . . . looks physically unwell . . . [electroshock] next week . . . fearful and tremulous . . . self-inflicted knife wound, sutured . . . gait shuffling and stiff . . .”

  • Jonnylucid, I’m curious about your option (1). If this were the case, why would the mind need to be thought of as distinct from the brain at all? Speaking conceptually here, of course; I’m not referring to two separate physical objects.

    I still like the hardware (brain)/software (mind) analogy. While it’s true that everything that happens in your mind is reflected in your brain, it doesn’t follow that mind events are driven by the brain beyond the rather trite observation that the brain is required for all sensations, emotional or physical.

  • I’m very impressed with your GP because her sensible approach is unusual. Personally, I don’t think depressed people should carry as much blame as psychiatrists. It’s not unreasonable to start from the premise that medical professionals are well-informed and conscientious. Unfortunately, as we all know, neither of these adjectives apply to the average psychiatrist. It’s not just psychiatrists, though. I’ve been given bad advice by doctors in other specialties too.

  • Yes, I appreciate that but one could make an argument that anybody who kills another without justification (e.g. to defend himself) is at least temporarily suffering from a mental disorder. To me, any measure that reduces the number of guns has my support. And if somebody is fantasizing about killing schoolchildren (as that fellow in Orange County was), that is definitely not somebody that should have access to a gun.

  • I liked this article and I certainly believe that various forms of trauma can and do lead to psychological problems. However, I’ve always been skeptical of the 22%/7% statistics. I don’t know if these numbers are based on criminal convictions or on self reports. I also think the 7% might be artificially low due to males being less comfortable reporting physical abuse. I think rather than trying to compare numbers and decide which group is being more victimized, we should simply acknowledge that people sometimes treat other people dreadfully and see what we can do about improving that situation.

  • Tina, if this is too personal, please forgive me. I am just wondering what effect your experiences with the psychiatric system had on your family dynamic. For myself, my parents and I have made amends but it took years for me to forgive them. One of my biggest gripes with psychiatry is that they place one’s allies (in my case, my parents and then later my husband) on their side. I fear that this becomes possible in part because the people around the person with MI are the most inclined to believe the bioreductionist stuff the psychiatrist spouts. No parent wants to look at the link between childhood stress/abuse and later psychological disorders. Like to point out here both that I love my parents very much and that I did not come from an abusive home in the sense of physical or sexual abuse but nevertheless it was a crazy making environment that left me ill-equipped to handle the challenges of early adulthood when my madness started.

  • Haven’t read the article but from the description it seems like a positive development. In general, when Fuller Torrey et al talk about preventing violence, they are targeting the severely ill, i.e. those alleged to lack insight (because we all know that NOT doing something equates to CAN’T do something). These are the same folks targeted for involuntary treatment. What’s lost in the debate, however, is that involuntary treatment IS violence.

    I know there are lots of studies showing lots of conclusions: some say mental illness is an increased risk factor, other say it makes no difference, and still others alleged a lower correlation with violence. I think there probably is an increased risk of violence but that’s mostly due to mental illness itself being correlated to risk factors, i.e. drug abuse, homelessness, poverty, unemployment, isolation, etc. If you held those confounding factors steady, most of the risk would disappear. The thing is, though, that removing the risk factors would be an uphill battle and would require a paradigm shift in how we deal with poverty, etc.

    But all this misses the point. Even if a person with MI is statistically ten times more likely to commit a violent offence, it is just not acceptable to target individuals on the basis of group statistics. It’s illegal when it comes to race and it ought to be illegal when it comes to mental status.

    One final concern is how we define violence. Are we talking actual criminal convictions or ‘not criminally responsible’ pleas? Or are we talking about the prediction of an underqualified psychiatric social worker? The most common victims of MI violence are psych staff, family members and the police. What’s got to be acknowledged is that these three groups are also the most likely to be inflicting or attempting to inflict violence upon the MI person.

  • Kate, I do hope you realize that if your daughter is truly a voluntary (as opposed to “voluntary” i.e. coerced) patient and if her consent is truly informed (knowledge of worsened outcomes, metabolic syndrome, diabetes, obesity, tardive dyskinesia, shortened life span, etc.) and if she believes that drug treatment is what works for her, then there is not a person on this board who will do anything except wish her the very, very best of health and happiness.

    That’s not what our fight is about. It’s for the people who have had a look at what’s on offer and would prefer to find their own path to mental health. Many of us were never given that chance. Many of us were taught to think of ourselves as neurologically defective, fit only for assisted treatment teams and welfare benefits. We were trained to be disabled. We were encouraged to give up our dreams. How about some consideration for us before pushing through legislation to make it easier and easier to destroy more lives? The psychiatric industry promotes the spectacle of the unmedicated mental patient running naked through the street brandishing a meat cleaver. A far more representative situation would be someone confronting very difficult circumstances, consequently experiencing extreme emotional states and, as a result, acting in ways which bother other people. That is simply not high enough criteria to warrant forced psychiatric incarceration (inside or outside the hospital walls).

  • Kate, you are missing the point. You say if you have insight and don’t want treatment, just don’t go to the doctor. But we’re not talking about people going/not going to the doctor! We’re talking about people being ripped out of their homes and dragged to the hospital or, more insidiously, being forced to receive antipsychotic injections at home under threat of being dragged to the hospital.

    If you protest, your “lack of insight” is assumed to be indicative of your illness. That’s a preposterous logical position to take. You either know you’re ill (in which case you’re ill) or you deny that you’re ill (in which case you’re ill). WHAT ABOUT THOSE OF US WHO AREN’T ILL? Where’s our category?

    Earlier, I declined to list the symptoms of mental illness seeing as we both know what it looks like. You responded “Then you are aware that some people have symptoms that prevent them from accessing services voluntarily. Thanks.” How on Earth are you assessing which symptoms prevent accepting voluntary treatment? The only symptom of lack of insight is refusing voluntary treatment. Me pointing out your blind assumptions is completely warranted.

  • I’m quite sure antipsychotics ARE effective in treating oppositional defiant disorder, etc. They’d also be effective in treating cantankerousness or argumentativeness. They are major tranquilizers (their original name) and as such tend to dampen ALL behaviour, whether dysfunctional or otherwise. Some nurses have been quite forthright in reporting that APs are used as chemical restraints in hospitals and retirement homes.

  • The trouble is with your phrase “able to access care voluntarily.” By “able,” one can only assume that you mean “willing.” So what you appear to be saying is that you can “consent” or we will make you consent. Such use of the word renders it meaningless.

    In practice, you can agree that you are ill or you can deny that you are ill. If you agree, problem solved. If you disagree, that’s just proof of your illness. Problem solved. Can you not see how ridiculous this is?

    I don’t know of anybody who’s not aware how severe mental illnesses can be. Declaring them “brain disorders,” as you do is where the problem lies. Many, many of us make quite spectacular recoveries after abandoning our labels and our drugs. That’s hard to reconcile with the “brain disorder” theory. Well, I guess you could say that I was misdiagnosed. But for 10 years???

    It’s sometimes true that people’s brains malfunction and cause psychiatric symptoms. But the opposite logic where ANY severe behavioural dysfunction MUST be as the result of a “brain disorder” only benefits the psychiatric industry.

  • Really like your comment, 8_balloons. That is an excellent point that you make. I’d also like to caution that the poster that even if 50% of the mentally ill would benefit from forced treatment, is such a bill really fair to the 50% who wouldn’t?

    Also, the definition of violence is a bit murky. Are we talking about actual criminal convictions/not criminally responsible pleas or are we talking about the prediction of some arrogant and misinformed social worker?

    And, even if we’re talking about convictions, there’s room to examine these too. The most likely victims are family, police and psych staff yet these are the very groups that are the MOST likely to be inflicting or attempting to inflict violence on the mentally ill. In any other circumstances, this would be considered a significant mitigating factor.

  • “In fact statistics indicate that they are more often, in their vulnerability, subject to being targets of violence.” Isn’t this true of everybody? You’re more likely to be a victim than a perpetrator. I’ve seen variations of the quoted statement elsewhere and I’ve always thought that, while it’s true as far as it goes, it doesn’t really add to the debate. I think it’s more helpful to point out that the mentally ill are exponentially more likely to be a victim of violence than the average person is.

    For myself, I’m not afraid of crazy people. The only people who have ever assaulted me have been wearing uniforms and collecting paycheques.

  • Thank you for this article, Jonathan. Too many people’s idea of reform is just ranting and raving about how they were wronged. Their energy should instead be put into providing better alternatives. If humane and effective alternatives like Soteria were widely available, it could be proved that our methods are better. Once that information gets into research studies in a big way, mainstream psychiatry will have to reckon with us. This is why I think the emphasis on repealing mental health legislation is misguided. We don’t need to make it illegal so much as we need to make it obsolete. Unpopular point of view, I know.

  • mah3md,

    I don’t usually post at MIA anymore but you’ve made a few comments here that I feel the need to address.

    First, Andrew Goldstein (whose murder of Kendra Webdale became the impetus for Kendra’s Law) did most certainly *NOT* refuse treatment and you are libelling him when you say that he did. Mr. Goldstein knew he was in serious trouble, requested mental health care and was turned away repeatedly. This tragedy represents another failure of our *voluntary* system. What should have happened is increased access to uncoerced mental health care but instead it became further encouragement for the forced drugging enthusiasts.

    We don’t have enough resources for those who want help because we’re too busy forcing it upon people who don’t. In my own case, three years ago, I was extremely psychotic and manic. We went to the emergency room many, many times and I was turned away as having “borderline personality disorder,” i.e. couldn’t be helped. My mother was told to stop “enabling” me by bringing me to the hospital. As I got sicker and sicker, my behaviour became more and more bizarre. Eventually, I broke the law, stood trial, was convicted, and one of the terms of my probation was to receive mental health care (Yes! The very same mental health care that I had been requesting.) So, mah3md, would you characterize me as one of those patients lacking in insight and requiring forced treatment?

    Secondly, you confidently state that a patient’s illness can make him refuse treatment. But the only evidence you’ve got for this is that he’s refusing treatment. What about those who refuse psych treatment for good medical reason, e.g. that they do much better without it? The trouble is that the only test we have for lack of insight is disagreeing with the mental health system.

  • Yes, our current system is appalling. ECT is a drastic treatment and harmed me greatly. I don’t think memory loss and epilepsy were a good trade for situational depression. Nevertheless, some people are informed and they do want it. I hope I’ve made it clear that I believe ECT should never, ever be done involuntarily. Too invasive, too risky and too permanent.

  • Tom Jones, you write:

    “What I do not quite understand, Francesca, about your account is that you say both that you were rejecting treatment and that you were incoherent and could not communicate. Somehow, I cannot see these both being true at the same time.”

    My rejection was very clear and non-verbal and was apparent through my body language and physical actions. These two factors are not at all incongruent. By saying I was incapable of communicating, I mean that I couldn’t speak coherently and couldn’t understand what people were saying to me. My brain was simply not processing information appropriately.

    I very much agree that we have to be as respectful as possible when debating these very thorny issues. I do my best and I will continue to do my best. If I need to do more, I will try harder.

  • Tina, you say:

    “You reject out of hand what I propose and are not willing to engage in further discussion about it except to insist on your ideological position in favor of maintaining permission for forced treatment.”

    Actually, this is EXACTLY what you do to me. You reject my argument and will not discuss except to repeat the “all involuntary treatment is torture” mantra. I gave you a very pertinent counter-example which pretty much demolishes your position and you respond by giving me impractical solutions that do nothing to further your position, except to show that you have no understanding of the neurological concept of phantom pain. (I’m still waiting for you or any of your followers’ practical suggested alternative to drugging in this instance.)

    “You and I don’t have much basis for trust, so I am not surprised that this is not a helpful way for you to figure out what might work for you. I encourage you, if it is something you are interested in pursuing, to find people whom you would want to work with to figure such things out.”

    Not sure what you mean by “something you are interested in pursuing” here. Trying to uphold mental patients’ rights? I’m already doing my best to work towards that. And I am in contact with many people with the same views and we all want to work towards a safer, more respectful mental health system. We are not interested in pursuing unachievable goals.

    “From your posts it appears that you are dead set on arguing against abolition.”

    Just as you are dead set on arguing for it. It’s not correct to assume that one of us MUST be right. It’s quite possible (and I suspect this is true) that the answer lies in a blend of the two positions.

    “Yet you yourself present no alternative that will guarantee me or others who have been abused by psychiatric violence that we can be safe in our minds and bodies and lives from this violation.”

    Tina, I have presented several alternatives and avenues for psychiatric reform; you just don’t want to hear them. And make no mistake, please: I have been horribly abused by the psychiatric system. It’s not a question of me not having an interest.

    “You have chosen to dominate the comments to my post on the CRPD with your agenda. If the Mad in America editors allow this, it is their decision. I think it does a disservice to the discussion I was aiming for. Nevertheless, we have both presented our views and anyone who bothers to read this far will be judging for him or herself.”

    The difference between MIA and your Facebook group, is that here we foster genuine discussion. I have been told privately (via email) by several members that I am a valued part of this community. You are quite right that a reader will judge for him/herself. That goes without saying.

  • “Francesca, I added a post in the conversation chain above, but again – I apologize I’ve accidentially got multiple emails/accounts at MIA and I’m working with site admins to fix that and get the old one discontinued.”

    No problem. I’m just embarrassed that I didn’t figure out that Andrew L. Yoder and Alyoder were the same person!

    “When I use the language of forced treatment, I was including the act of holding someone in the hospital or admitting them into an acute psych ward as forced treatment. And I was saying there seem to be a few extreme situations in which that becomes the least harmful, least inhumane option.”

    Yes, I have been inconsistent in terminology but I do make a distinction between hospitalization and drugging. I do believe, as you do, that there are some situations (like the one I was in) where forced treatment is the right thing to do. This point of view makes some abolitionists nuts, to the point that they can’t even argue coherently.

    “But I’m also curious, if you could see the place for emergency psych intervention, but not forced treatment (and again, i don’t feel like I have any core disagreement here) what should be done for, and in partnership with, persons who have been admitted into the hospital on an emergency basis because they were a danger to someone?”

    I guess it totally depends on how they’re presenting and I really don’t have a “one size fits all” answer. I certainly wouldn’t advocate releasing them while they were still in such a state though. And, indeed, perhaps drugs would end up being necessary but I would prefer them to be the last resort after trying everything else. My medical records show that once I was pretty wacked out and they put me in isolation for a while they did some paperwork or drank some coffee or something. Two hours later, I was completely rational and they were amazed that this happened without drugs. Not advocating isolation here, just pointing out that sometimes a little time out can help enormously.

    “I sense that we basically agree in our objection to the idea that you just shoot them full of drugs they don’t want with the idea that they should then be on these drugs forever because they have a permanent “illness.” ”

    Yeah, this is terrible policy for a few reasons including that it’s soul-destroying, fundamentally misguided and too costly for the taxpayer. I have no doubt that in some cases psychological disorders originate in brain malfunction but when it’s assumed that this is always the case, we’ve got real trouble.

    “What about a selective use model, in which certain medications were seen as a last resort, and used as minimally as possible for the least amount of time possible, and only in the most rare of extreme situations, with the sole goal of stabilization from the most acute phase of a very severe crisis that has put a person at severe risk? A model that included the expectation that immediately after acute stabilization, a titration OFF any medication administered would be considered the “standard of care” for most cases?”

    I think this is what the alternative European programs are all about. Sounds wonderful. Don’t know their position on forced treatment but even were it included it would still be a wonderful model.

    I have to take Lamotrogine as I developed epilepsy in response, my neurologist and I believe, to ECT. Now that it’s been a year post-seizure, my neurologist and I are going to try tapering that down and see how I do. My psychiatrist was aghast at this, absolutely dumbfounded that a doctor would want to reduce meds once a patient has stabilized.

    “My disposition at present (open to change) is that I am not anti-medication as a blanket absolute. What I object to, is the “drugs first, frequently and forever” model of practice in the West. I think psychiatric medications, possibly even “antipsychotic” medications, have a limited place in a selective use model. What do you think?”

    Me too. My question is how much of a shitstorm do you have to put up with for stating your well-thought and rational views?

  • A lot of people blame ECT for Hemingway’s suicide. In fact, he had very serious mental health issues before ECT.

    I think it’s up to the individual to decide what they want to do with their body (same as with assisted suicide).

    I really don’t think ECT (except for forced ECT!) can be compared to slavery. There was no such thing as voluntary slavery.

  • Alyoder, I agree with you that we need a serious overhaul of the mental health system. So let’s work on that. Let’s not waste our energy, time, money and other resources on the unattainable.

    In your example of the crazy neighbour, I too would call the authorities even though no crime had been committed. Once the neighbour was hospitalized, however, I would not advocate forced treatment in that scenario. The imminent harm aspect would disappear once he/she was hospitalized and imminent harm is pretty much the only justification (that my tired brain can think of at the moment anyway) for forced treatment.

    It’s not the emergency psych intervention that troubles me. It’s the “you’re diseased, you need to take these drugs for life, if you don’t take them, we’ll make you take them” scenario that I most object to. Whether the psychiatric industry chooses to admit it or not, the fact is that people often make spectacular recoveries from mental illness and they deserve the chance to go drug-free.

    A lot of people who swallow the Kool Aid essentially give up their lives. They have been trained to be disabled, to have no hope, to give up on their growth potential. It breaks my heart seeing them in my doctor’s waiting room.

  • Uprising, you said “I’m glad that you are against forced electroshock. I respect that. I am against all electroshock and I said so up front. I am also against all “psycho-surgery.””

    I think the issue should only be informed and uncoerced consent. Some epileptics, for instance, have surgery that they know will have profound negative effects because the benefits (getting rid of the seizures) outweigh the risks. We can’t take that away from people.

    “I don’t feel that any civilized society should sanction these practices. This carries no “judgment” aimed at “patients” who might find these things desirable for themselves.”

    But in fact you are making a judgment. You are judging consenting patients as being unable to make a good decision. You are deciding for them. That is infantilizing them. That’s exactly what’s wrong with psychiatry, remember?

    “It does carry a judgment – mine alone – that these practices ought to be illegal everywhere.”

    You’re not alone; lots of people feel that way.

  • Nancy, thank you for not writing me off entirely. I find a lot of people just will not tolerate dissent or any discussion unless it’s to be in total alignment with their viewpoint.

    By “recovery,” I’m referring to people genuinely saying their depression lifted as a result. For them, just knowing ECT is an option is immensely reassuring to them.

    The “do no harm” thing makes a good point but, again, you can always find an exception, e.g. chemotherapy certainly does harm yet it doesn’t violate the Hippocratic Oath.

    For myself, I will never agree to ECT again (and often, I wasn’t given the opportunity to agree or disagree) under any circumstances and I have been quite clear on this with my family, friends and care providers.

    The long-term results were horrendous and the awful thing about it is that environmental factors (or, more accurately, environmental causes) of my depression weren’t even considered so we rushed to what should have been a last-ditch effort.

    Consent needs to be enshrined in law as both informed and uncoerced but banning ECT altogether is a non-starter.

  • No problem, Jonah. Take care. I should probably give it a rest myself. I take these kinds of arguments way, way too seriously and they’re not really a good use of our time because we are never going to find any common ground.

    Sometimes when I’m a little stress-y (exams or whatever) I make myself unplug the phone and turn off the computer for the whole day. This works well for me but I’ve never had the willpower to do it for longer than that.

  • Some people find it helps them. And I think patients should be free to choose whatever route to recovery that they want without judgment by us. Always acknowledging, of course, that consent has to be both informed and uncoerced.

    Hey, if the campaign was against forced electroshock, I’d support it in a heartbeat. It’s not though and they should say so upfront.

  • Yes, you answered my dilemma. Your suggestion, as I recall, was a gentle talking to and offer of medication. However, that was not an option because I was beyond talking to. I told you this but couldn’t discuss it further as you had banned me from your group. It’s hardly inflammatory to say that you haven’t been open to discussion with me.

    Please acknowledge that I’m making a distinction between psychiatric practice in general and emergency intervention.
    And, again, as with someone else’s suggestion of analgesics, your scenario of ice packs, blankets, etc. wouldn’t have worked for exactly the same reason. There were no messages to be interrupted coming from my sensory neurons.

    To be honest, I think the source of the unpleasantness between us is that I have come up with a serious counter-example to your position and you are unable to respond to it. Rather than fault me for this (“inflammatory”), perhaps you might entertain the possibility of a little flexibility on your group’s part.

    Allowing people to talk but only if they agree with you isn’t a very promising or progressive approach. Also, it’s going to turn off a lot of otherwise sympathetic people who could have been your allies.

    A ban on forced treatment would certainly not be enforced in the situation I have described. And, as stated elsewhere, once it’s understood that it’s okay to break the law, mental health laws in their entirety will be ignored. That will strip us of the meagre rights we have at present. In other words, we would be worse off, not better. I’m not going to lose any sleep over it though because there is zero possibility of this succeeding.

    Sure wish we could focus our energy on more pressing and realistic goals like abolishing long-term, soul-destroying outpatient commitment programs, providing real alternatives and getting accurate information out there.

    I certainly do agree with you that the situation that we have at present is not acceptable. Where I disagree is on what we should do about it.

  • Cannotsay2013, you said “This goes back to the “retrospective validation” argument combined with anecdotal evidence that denies free will (what might be good for you, might not be good for somebody else), which, as I said, could be used to force all kinds of paternalistic interventions by government.”

    Regardless of what kind of argument you think I am making, could you please just answer the question? What should they have done? According to you, absolutely nothing because I hadn’t been convicted of a crime. If involuntary treatment were illegal, I would have just been left rolling around there screaming. Are you sure this is okay with you? I agree my story is necessarily merely anecdotal evidence, but it has an understandably powerful effect upon me.

    My doctors’ actions in that circumstance really don’t require further validation, retrospective or otherwise. They were at the time prima facie valid actions, to say nothing of humane, ethical and effective.

    I don’t think it’s consistent to decry all coercion in psychiatry but then to be okay with criminal diversion. Avoiding having a criminal record is a powerful incentive to comply, just as is keeping your housing or government benefits.

    I have written elsewhere that abolishing involuntary treatment would merely encourage doctors to break the law. No court would have found my doctors liable in the situation I have described. What, therefore, is the point of pushing such a law? There are profound consequences to your philosophy that I don’t think you have considered here.

    In any event, my situation was certainly unusual but not at all singular. There is lots and lots wrong with psychiatry, but this kind of emergency psychiatric intervention isn’t part of that. And as for something being good for one but not another, I really can’t imagine another person wanting to continue with the burning hands and feet, drinking herbal tea and waiting for the hypnotist to arrive.

  • Jonah, I did not say withdrawal effects. Cold turkeying may have been what started be on the path, but it was clearly the alcohol, etc. that did me in. I know this from previous circumstances that didn’t become psychiatric in nature.

    “It’s the explanation (and, indeed, reveals a clear, physical cause) for your burning pain, at that time, IMO.”

    No, what it provides is an excuse for you to jump on the one factor that could conceivably support your position. There is no evidence to suggest that the problem was solely with withdrawal. In fact, there’s a good deal of evidence that withdrawal was the least of my worries.

    “I recall having experienced effects, along those lines, at least briefly, decades ago, as I went CT, off psych-’meds’.”

    Every person is different. We all experience drug changes differently. “Along those lines?” As in similar to what I described?

    “Wish I had realized that you were talking about withdrawal effects…”

    But I wasn’t.

    “Had I known that, prior to offering my last comments (above and below), I might have offered somewhat different suggestions.”

    Perhaps. But I doubt any of them would have been practical. Just as, leaving aside the remote possibility of withdrawal effects, none of your suggestions (pain reliever vs. antipsychotic) were practical.

    “However, that’s not to say I feel I should retract anything I’ve written.”

    Nor should you. We have differing viewpoints. No biggie. Happens all the time.

    “Simply, consider what I wrote as suggestions for those who might encounter someone whose extreme, burning sensations really have no physical explanation.”

    No, I can’t consider what you wrote as valid suggestions. Hypnotherapy? Really? How about chanting and meditation?

    “As for your faith, that so-called “anti-psychotic” drugs were the only way out of your pain; that you received the best possible ‘treatment’ from psychiatrists is your belief, I won’t begrudge you it.”

    Nope, it’s not a matter of faith; it’s an accurate assessment. Wasn’t the only way out — suicide would have worked too. Thank you for not begrudging me a personal, well-support opinion.

    “You have considerable faith in Psychiatry. I have no faith in it.”

    Wrong. I have no faith in psychiatry. My situation had very little to do with psychiatry. A regular doctor would have done exactly the same thing.

    “I can respect you nonetheless.”

    Likewise.

    “Just, please, don’t expect me to buy that faith.”

    I can’t sell it to you because I don’t have it.

  • In my opinion, certain members of the anti-psychiatry group are just as oppressive as psychiatry itself. There was a petition circulating to “end forced electroshock,” a cause I wholeheartedly support. Read a little further, though, and what they’re actually pushing for is ending ECT altogether. That’s quite a different animal and it’s deceitful not to make that clear in their title.

    If people want ECT, then let them. Denying choice is EXACTLY what we complain that the psychiatric system does. I was kicked out of Psychiatric Survivors (another Facebook group) for stating that when I can’t sleep I take an occasional benzo. For this I was shrieked at for “advocating psych drugs.” I actually started my own Facebook group called “Surviving Psych Survivor Groups.”

  • Jonah, yes, I did read your answer, and thank you. It’s just that it’s higher up the string because it’s a reply rather than a new post. And I have replied to your post up there.

    I call the abolitionist position extremist because it involves a blanket statement, with absolutely no exceptions. Extreme. It disregards all factors except an unsupportable ideology. It’s not attainable and, if it were somehow attained, it would be neither practical nor desirable.

    Holders of the abolitionist position tend to be extreme. (I wouldn’t include you here.) Discussion is shut down. I was BANNED from the Repeal Mental Health Laws facebook group for describing my situation. Wasn’t even allowed to discuss it. Refusing to engage in rational debate is one of the hallmarks of extremism.

    It is an extreme position and it harms the entire psychiatric reform movement. It is unsupportable and will just give the general public more to reason to write us off.

  • Jonah, I was going by this (November 20, 2013 at 7:50 pm): “Francesca, No, my comment was not directed at you.”

    What you call scant details I would characterize as deeply personal information. If anything, I have given too many details.

    I’ve always been clear about the pain I was suffering. Not sure if it should be termed “physical” because there was no stimulus for it. In that sense, I guess, it might be called mental but I don’t know.

    I said: “I don’t advocate forced treatment except in very rare and extraordinary circumstances like the ones I described.”

    To which you said: “Well, if you are talking about psychiatric ‘medicine,’ I oppose all of it, if and when it’s offered by force.”

    I take it, then, that I shouldn’t have been treated and should have just been left rolling around on the floor, screaming in agony.

    As to your advice, pain relieving medicines wouldn’t be effective because there was no bodily mechanism for the pain. And tranquilizers might have made me more okay with the pain, but it wouldn’t have diminished it. There was no “offering” possible. I could not communicate except to scream incoherently.

    Again, antipsychotics were the appropriate choice. The problem wasn’t pain it was perception.

    Their actions were not based in any kind of ideology, as you suggest. They were the appropriate actions in an emergency, just as you would rush to push somebody out of the way of car, even though it could be termed assault if you really insisted.

    I have shared more of my story than I am comfortable doing. They did a good job. Your suggested alternatives would have been ineffective. And, yes, I guess I’ve been fooled into thinking that they relieved my agony. Silly me.

    There is nothing a regular doctor would have done except to seek advice from a psychiatrist and do it himself.

    Yes, the path to outpatient commitment is through the emergency psych system. My point all along has been that it doesn’t have to be this way. They are two completely different scenarios.

    “Quietly waiting out the crisis” is a naively formulated alternative. How long would have you let me scream?

    I would have absolutely no interest in treatment from a hypnotherapist. In any case, in order for hypnotherapy to work, there has to be communication. This was not possible.

    Looking for psychological problems would have been a dead end. This disaster was as a result of cold turkeying off various meds, consuming way too much alcohol and (cough) other chemical factors. I needed antipsychotics not talk about toilet training and unresolved issues with my parents.

    When you say you “would have done your best,” what your words actually convey is that you would have left me to suffer. Please think about that for a moment.

  • IMO, ECT works the same way any assault would work. You could probably get the same result by dunking someone in ice water twice a week.

    In my case, it did appear to help with my very severe depression. However, the costs were enormous (catastrophic memory loss and epilepsy) so ECT didn’t pass the risk/benefit test for me.

    From a consultation report dated June 30, 2010:

    “If [Francesca] is unable to refusing to go to ECT, I recommend the next step is that she have a direct admission to the hospital on the Step Down Unit where she will receive involuntary ECT.”

    And this passes for consent!

  • Even if psychiatry didn’t have the force of law behind it, it would still be toxic. Teaching people to voluntarily accept the notion that they’re biologically and chronically defective is a vile practice.

    But voting on the issue of involuntary treatment wouldn’t further your position. In the emergency psychiatric situation I have described, you would simply never find a majority of people willing to leave me on the floor screaming in pain.

    And, as I’ve already stated, even if you did find such a majority, doctors would not honour that law (in situations like the one I have described) and no court would find them liable. Once that door is open, then psychiatrists would be free to utterly disregard the meagre rights that we have, e.g. to Review Panels up here. This is not a road we want to go down.

    There is a huge distinction between emergency intervention and ongoing treatment. Outpatient commitment (or assisted community treatment as we euphemistically call it up here) is insidious and needs to be reviewed. That’s where we should focus our attention.

  • In general, I think, there is no assumption that the individual is agreeing. What’s being assumed is that it doesn’t matter if the individual agrees or not. I think it’s only up here that we have the offensive notion of “deemed consent.”

    And, cannotsay2013, as you have stated we usually agree about most of these issues. Clearly, here we part. The word treatment, in the situation I described to you, need not be in quotes. It was a bona fide medical treatment — appropriate, effective, ethical, humane. It cannot be rationally faulted.

    Yet again, nobody has provided an alternative to involuntary treatment in the situation I have described.

  • Jonah, I don’t understand this. Please clarify:

    I said: “Like it or not, some of those drugs are anti-psychotic.”

    To which you said: “Sorry, but I quite disagree. In my view, some of those drugs may possibly be ‘anti-psychotic’ sometimes (briefly).”

    These statements aren’t at odds with each other. I don’t get the distinction. Would it have been better if I put “anti-psychotic” in quotes?

    Anyway, I appreciate being included in the dialogue but could somebody please answer the question?

    WHAT SHOULD YOU DO WHEN SOMEONE IS SCREAMING IN PHANTOM PAIN, IS ABSOLUTELY INCOHERENT, CAN’T RECOGNIZE FAMILY MEMBERS, IS BEYOND REASSURANCE AND IS REFUSING HELP?

    Are you still going to deny relief on ideological grounds? This is why this extremist position is doomed.

  • From your link:

    “And finally, what about compulsory detention and treatment? Well first, we have to acknowledge that this is essentially incompatible with choice and control. In the short term we really need to ensure that there is a requirement for every organisation to have explicit plans to reduce its use (via increasing choice of support/treatment using personal budgets, easy access to support when a crisis is looming rather than when it has already arrived, joint crisis plans, advance directives, etc).”

    This short-term plan would make an excellent long-term plan. I would completely support this in any way I could. But here it falls a part a little:

    “Longer term equal citizenship requires equality under the law and repeal of laws that apply to only one group of people. There may be times when any of us lack the capacity to make decisions for ourselves, and we may decide that at such times others (of our choosing) need to make decisions for us based, where possible, on our previously expressed wishes in crisis plans and advance directives. The right to refuse treatment must be the same for mental and physical health conditions … this must be part of the ‘equality of esteem’ between mental and physical health services enshrined in the English mental health strategy.”

    If our representatives are to follow our advance directives, then why would we need representatives? We would just have the law prohibit disregarding advance directives. Or is it somehow alright to get forced treatment if it’s on the say so of your representative? And the right to refuse treatment cannot be the same for mental and physical health conditions. Also like to point that not all physical health conditions are exempt. If you have active tuberculosis, you get treated. If you’re a JW and your kid needs a blood transfusion, he gets one. There are exceptions to every rule and that’s why blanket statements like the abolitionists want are doomed to fail.

    There are other consequences too that should be considered. Say involuntary treatment was made absolutely illegal. Then along comes the situation I described. Any humane and ethical person would override the law. And no court on this continent would penalize that person. Once it’s understood that the law is meaningless, then the meagre rights that we presently have are in danger.

  • @ Theinarticulatepoet

    Certainly I would agree with that! If effective, voluntary treatment was available, we wouldn’t have this mess to deal with. Remember Andrew Goldstein? Here was a guy who was desperately seeking help but was turned away. We don’t have the resources to help those who want it because we’re too busy forcing it upon people who don’t. And what did they do in response to this tragedy? Well, of course, they expanded forced treatment laws. Makes perfect sense to Fuller Torrey.

  • Love to, and thanks for answering. Here’s my present list and I apologize if I posted some already:

    – define consent in law as both informed and uncoerced; there can be no such thing as “deemed consent”
    – define competence by independent assessment; merely declining medication cannot suffice
    – legal standard for outpatient commitment has to be as high as for hospitalization [note below]
    – include the mentally ill as an identifiable group under existing hate speech legislation
    – amend Representation Agreement Act to allow for advance directives related to mental health
    – make psychiatric coercion illegal [another note below] in any form including threatening involuntary treatment, losing social benefits or subsidized housing, avoiding the criminal justice system
    – providing a free legal advocate for anyone given a serious mental illness diagnosis (this is a role I’d like to play, from something as simple as accompanying a client to her bullying psychiatrist’s appointments all the way to challenging forced treatment orders in court)
    – making involuntary (except for emergencies) treatment impossible without a court order (I believe this is where our countries differ)
    – something about drugging children but I don’t know what the hell to do here
    – encouraging universities to do research on how many people with serious mental illness are actually just regular people who have had toxic reaction to their meds
    – make medical support for tapering mandatory as too many patients get dumped by their doctors and end up going cold turkey with disastrous effects

    Note: With respect to equalizing outpatient vs. inpatient criteria, this is going to help a lot of us. If the legal standards were the same, they’d be screwed. There simply aren’t enough hospital beds to hold us all. I have talked with others about this maybe being an avenue for effective civil disobedience.

    Note: I use the term coercion separately from the word force. My reasoning is that coercion is a much trickier concept, harder to spot and thus more insidious.

  • Jonah, I wanted to write directly under your post but the “reply” button wasn’t there. Perhaps there’s a limit? Anyway, just a couple of things I wanted to say quickly:

    1. I do have a tendency to take things too personally and for that I do apologize but it was easy to assume that you were referring to me when you talked about a woman here who wanted to be force drugged in order to alleviate her pain. That’s a very unfair characterization of the situation I was in.

    2. Please understand that I don’t advocate forced treatment except in very rare and extraordinary circumstances like the ones I described. IMO, it’s not emergency psychiatric intervention that is the problem; it’s the soul-destroying lifelong outpatient commitment crap that’s got to go.

    3. I can’t help but note that you were unable to answer my question, though. If force drugging is an abomination, then what exactly would you have done to help me? The phantom pain was still excruciating even though there was no stimulus. Surely to God you wouldn’t have just left me on the floor, would you have?

  • Jonah, I don’t know if your comment was directed at me. I certainly do not advocate forced treatment but at the same time I acknowledge that it can be a necessary evil in a psychiatric emergency (or any kind of medical emergency for that matter).

    I didn’t “claim to have benefited immensely.” What I said was that I was in absolute agony and antipsychotic injections brought me back to reality. I was beyond coherent conversation; I couldn’t even recognize my parents. Big Pharma had nothing to do with it! Being on fire hurts! I do defend their actions and I don’t think they can be fairly described as “violent.”

    You say “yes, here we have a case of a person who claims to have received a kind of ‘pain’ relief from her having had so-called “anti-psychotic” drugs forced on herself.” That’s pretty offensive, Jonah, and you might want to think it over. It wasn’t merely a “claim” and it wasn’t merely “pain relief” and, like it or not, some of those drugs are anti-psychotic. You imply that you respect my views yet your response is riddled with snot quotes.

    If you think what happened was a human rights violation, then by all means state what should have happened instead. Funny thing is that, out of everybody who takes your extreme position, not one has yet come up with a viable alternative. SO PLEASE TELL ME: WHAT SHOULD THEY HAVE DONE????

    Then you say “I will not dispute her interpretation of her experiences,” but clearly you are disputing them or at least belittling them.

    I certainly acknowledge that most forced treatment is unconscionable but that doesn’t change the fact that an outright abolition isn’t going to fly.

  • As usual, you make excellent points, cannotsay2013, but tell me what you would do in the situation I was in: writhing around on the floor, screaming that my hands and feet were on fire, rejecting medication. Seriously, should involuntary treatment in this instance really be characterized as a “travesty” or a “human rights violation.”

    There are lots of problems we can fix. We can raise the standard for civil commitment. We can also raise the standard for outpatient commitment. We can amend the Representation Agreement Act to allow for mental health advance directives. We can provide a legal advocate to every person diagnosed with a serious mental illness. We can force psychiatrists to provide support for tapering meds.

    But the biggest thing we can do is work towards cohesion in the psychiatric reform movement. I disagree with the motives of the Repeal Mental Health Laws Facebook group. Okay, fine. Instead of lambasting me and censoring me and shrieking at me, why don’t we see what we have in common. We both agree that involuntary treatment needs to be way reduced. So let’s work on that together. Then, if we attain that goal, we can split off and you can continue to work towards full abolition.

    Seriously, attempting to remove it altogether won’t succeed and will have various negative consequences for all of us in the system. Also, it will turn off people like me who do have something to offer.

    Lastly, even if this were to succeed (which it won’t), no Court would enforce it because it would be a fundamentally unjust law.

  • Hi, Ted. Yes, I certainly agree with you on your definition of “voluntary” in this circumstance. British Columbia’s Representation Agreement Act should be amended to include mental health and, when I have time, I’ll investigate why it was drafted this way. I expect psychiatrists were given undue influence over the legislation.

    I actually do have an Advance Directive but of course it doesn’t have the force of law behind it. I am just hopeful that my wishes would be respected. My family and friends know what and when I want something to happen.

    I have several problems with this push for absolute abolition of involuntary treatment:

    1. It has absolutely no chance of succeeding so it’s diverting legal and other resources from accomplishing realistic goals.
    2. It makes it easy for the public to write off the entire psychiatric reform movement.
    3. It makes no provision for situations like the one I described myself in several years ago.
    4. It could be, at times, unethical and inhumane to uphold the new law.
    5. If it were passed, mental health professionals would simply disregard the law. Once that door was opened, they would feel (more) free to ignore the limited rights we have at the moment.

    There are lots of things that we could be working together on that would more effectively and quickly improve the lives of the psychiatrically labelled. I’ll save my proposed list for another post.

  • Andrew, in general, I find that almost all statements that include the words “never” or “always” turn out to be fundamentally flawed. The examples you gave are very apt in describing situations where the “all involuntary treatment is torture” mantra really doesn’t apply. I was kicked out of the Facebook group called Repeal Mental Health Laws for exhibiting the same kind of rationality that you do here.

  • Stephen, I think the answer might be in “baby steps.” Here are some achievable goals that I would like to see in my lifetime:

    1. Consent to be defined in mental health laws as informed and uncoerced.

    2. Make sure that the test for “competence” is not merely compliance.

    3. Raise the legal standard for outpatient commitment up to that required for hospitalization.

    4. Include the mentally ill as an identifiable group under hate speech laws.

    5. Amend our Representation Agreement Act to include mental health decisions.

    6. Make coercion (e.g. threatening to make voluntary patients involuntary, threatening to take away housing or other social benefits) illegal (this is, of course, related to my point above about the meaning of consent).

    7. Establish safeguards to protect children against unwarranted psychiatric drugging.

    8. Make a legal advocate available for anyone diagnosed with a serious mental illness.

    These are just a few reasonable and attainable goals that I prefer to work on.

  • Andrew, I am so glad you’re working in the field. Please keep doing what you’re doing.

    I am subjected to a lot of anger by my co-survivors when I say that an outright ban on involuntary treatment is both unattainable and likely undesirable. I support the use of drugs in psychiatric emergencies. When I was writhing around on the floor while screaming that my hands and feet were on fire, antipsychotic injections without my consent were both humane and ethical.

    What am I concerned with, like you are, is the lifelong chronic disease model. I see these folks in my doctor’s waiting room all the time. They have been trained to be disabled, to have no hope, to have no self-esteem. Just collecting welfare and shuffling in for their drug injections.

    I wish the psychiatric reform movement could focus their goals a little. I’m not interested in devoting my life to a goal that can’t be attained and abolishing psychiatry is just that. What I would like to see is genuine reform.

  • My psychiatrist wanted me on long-term Risperdal and completely minimized the risks to me. I know that Risperdal isn’t the answer to preventing mania and accompanying psychosis. The answer is not to get depressed and, if I do get depressed, not to seek medical attention.

    I dumped the Risperdal in April and have had absolutely no return of my symptoms. I’m now in the comical position of having to sit through these appointments while the shrink attempts to “prove” that I’m well only because I’m drugged. Not sure exactly when I’m going to tell him the truth. Maybe not for a couple of years so he can’t just say “You were lucky.”

    In between psychiatric nightmares (the first lasting 3 years, the second lasting 10), I had a happy, fulfilling and productive 13 years, all of which time I was med-free. This has yet to be explained to me via the neurotransmitter imbalance model.

  • This article just makes me more and more furious. I can’t believe she has the arrogance to play God and not feel a need to question her own actions and wonder about the ethics of this kind of “treatment.” I looked her up on Google (wanted to find a contact email for her) and her picture looks smug and self-satisfied.

    The thing that’s most frightening about these monsters is that they actually think they’re doing some good. I think the parents of these children should be sued for neglect. It is just sickening how Big Pharma behaves.

    There is something profoundly sick about our society which only cares about money, status and conformity. It’s no wonder so many of us become mentally ill; we’re living in a mentally ill world.

  • Nice article, Bruce. For myself, imagine Jerry Seinfeld’s voice here: “But I don’t wanna be a normie!”

    I do think many of us have forged a new culture. Some of my most creative, intelligent, loyal friends are psych survivors. I have a sense of comraderie with them far more valuable than I do with the rest of the world.

    I actually believe that my mental health system nightmare overall may even have improved me. I learned to be strong, to think critically, to engage in coherent argument, and to defend myself against attack. In short, I am a better person now.

    As an aside, I am wary of AA, especially one of their 10 guidelines by which you’re supposed to concede your personal power. Also, I’m not at all religious so these groups wouldn’t be a good fit for me.

  • You’re quite right, Ted. Bob certainly did address this issue (although I can’t remember at the moment in which book). I just cannot believe that anybody would think drugging or shocking a child would be therapeutic. “Underlying disease”! These psychiatrists will twist and turn, anything to avoid taking responsibility. I actually quite like my current psychiatrist yet he still encourages me to “drink the Kool Aid” that he was clearly taught at medical school. I really don’t know what it’s going to take.

  • Just wanted to add that it’s entirely possible that “switching” (from unipolar to bipolar 3) is under-reported simply because it’s under-recognized.

    Given my case history, switching is clearly what happened to me yet they persist in calling me bipolar 1 (you know, when I’m not schizoaffective or borderline or any of the other labels that have been applied to me).

    I really want this phenomenon addressed. Many, many people have had the same experience that I have and their doctor has just done the “Aha, so you must been bipolar all along” thing. It’s just a way to deflect criticism, I think.

    I’m just guessing from anecdotal reports (I am not a researcher) but I would think switching happens often enough that the FDA should do a black box warning. Being honest about bipolar 3 might vastly change psychiatry’s approach to mood disorders. As always, I dream of change for the better.

  • Thank you, Olga. Curious that Videbech (sp?) claims that “switching,” i.e. from depression to bipolar disorder after taking antidepressants is “very rare.” I know of many people this has happened to, including myself. It might be “rare” in the sense of not being acknowledged by psychiatry. Typically, when switching happens, this is just taken as “proof” that you were already bipolar or at least genetically susceptible to bipolar disorder. These clowns wouldn’t pass a first year philosophy course.

  • Sorry, just can’t remember what it was called. The gist of it was that all agencies would be involved in the case of an emergency. My case worker was quite surprised that I refused to sign. He said “This is just an annual update to allow us to provide the same service we’ve already been providing you.” Fair enough, but the thing is that I don’t want their service to continue.

  • Coercive psychiatric treatment has exploded thanks to the rise of outpatient commitment (called “assisted” community treatment in my neck of the woods). There are far more people under these orders than ever would be able to fit into our psych hospitals. Thus our standard for ACT gets lower and lower because it’s an inexpensive social policy (financially speaking, of course, ignoring the horrendous human cost).

    I have been reading a bit about the difference in our respective legal standards and it would appear, in British Columbia anyway, that the criteria for ACT in my country is way, way, way lower than in yours.

    ACT was far more traumatizing to me than hospitalization. In hospital (as an involuntary patient) you know you’re being assaulted. You can say to yourself “this won’t last long … I can get through this.” With ACT, the assault is much more insidious. Having the sanctity of your home threatened when they come with the hypodermic needle. Having to listen to the psych-speak of the deliverers. It’s soul destroying.

    One specific goal that I support (as opposed to getting rid of involuntary treatment altogether) is to raise the standard for ACT to that of what’s required for hospitalization. If that were to happen (and it’s within the realm of possibility, as opposed to repealing mental health laws altogether which is a non-starter), then somebody faced with ACT could reasonably decline with a fair amount of confidence that their position would hold. They can’t lock all of us up.

    The criteria for ACT should at least be raised to include past violence. And I’m talking a genuine criminal conviction in court, not the say-so of a psychiatric social worker. Further, that conviction should be reviewed in context. Assaults against psychiatric staff are often justified. Sorry, Torrey, but it’s true.

    These are the kinds of issues that I wish the psych rights movement could come together on. We are so fractured and there is so much infighting that I often despair that we will ever be heard. I’ve rejected (and been rejected by) a lot of survivor groups that I find just as oppressive as psychiatry. Merely shrieking and “raging against the machine” will get us nowhere. What’s required is rational, informed discussion, a phenomenon woefully scarce in our movement.

  • I’m really and truly torn on this issue. Personally, I believe that anything that will reduce the number of guns is a good thing. I think having the general public carrying guns is absolutely insane.

    Now, as to the discrimination against the so-called mentally ill, again I’m conflicted. Clearly, seeking help voluntarily for emotional distress shouldn’t be penalized. As Deron points out, all that will happen is that people won’t reach out. (As an aside, I do find the drug/alcohol exclusion intriguing.)

    But are we really going to take the position that somebody who experiences psychosis should be allowed to carry a gun?

    The bigger issue here, I think, is what else that database will be used for. I was recently asked to sign an information release form that would permit the free flow of information between my psychiatric team and the police, hospital, various social services, etc. but I declined. I know the thin edge of the wedge when I see it.

  • Copy-cat, I’m currently reading Gary Greenberg’s “The Book of Woe – The DSM & the Unmaking of Psychiatry.” Greenberg refers to Biederman being questioned about his university position. Biederman states that he holds a very influential post, to which he was asked “And what’s higher than that?” and Biederman answers “God.” Greenberg rightly notes that this is a very strange response from a man who has devoted his career to pushing a disease, the symptoms of which include grandiosity.

  • I agree that schizophrenia is a fraught, loaded term but I don’t think that PSS will fare any better if it becomes commonplace. As a poster alluded to above, having my manic depression relabelled as bipolar disorder hasn’t improved my life any.

    “Susceptibility” is a rubbery concept and with PSS it’ll be assumed to be a biological or genetic susceptibility being referred to. I think we should get rid of these labels altogether and stop teaching people that they’re fundamentally different.

    I’ve been corrected after using the term “wacko” or something similar, to which I respond “How about you let someone who has a mental illness decide how to refer to it?” I’m generally opposed to political correctness anyway.

  • Unfortunately, the term “peer support” has lost all meaning for me. In theory, it sounds like a great thing but, in practice (in my experience, anyway), it means being tutored by someone who has drunk the Kool Aid and wants you to do the same. I fired my peer support worker.

  • mjk, I agree with you that far more latitude is given to the middle-class, the educated, the gainfully employed, etc. I know several professionals that would probably meet the criteria for psychiatric labelling but they’re allowed to be themselves because they’re deemed just “eccentric” or “opinionated,” etc. but Heavens, No! They’re not “delusional” or “diseased.”

  • Yes, I believe that schizophrenia and related disorders are far more likely to be attributed to biology. In my intro text, it refers to everything else as “psychological disorders” and then switches to “brain disease” when we get to psychosis.

    Psychiatrists may play lip service to psychological factors, environmental stressors, etc. but they don’t really give them much weight (in my experience, anyway). My psychiatrist attributes my success to Lamotrogine (which I have to take for epilepsy, probably caused by ECT) even though (a) I recovered before I started the drug; and (b) My recovery coincided with moving out of my parents’ basement into my own home. My doctor assured me that “a simple move couldn’t account for it.” That told me all I needed to know about his biases.

  • This is a great article, Sandra, but I part company with you on these two points:

    (1) “I am not someone who finds it useful to make a distinction between the mind and the brain. In my view, we are talking about the same thing but at different levels of abstraction”

    (2) “Phineas Gage, whose personality changed after a tamping iron was lodged in his brain’s frontal lobe. This was an early confirmation that things as complex as social comportment and motivation were related to brain function.”

    With respect to (1), I have found mind vs. brain to be absolutely critically when debating psychiatry. Breggin’s analogy of the crappy television show (the mind) not being the fault of the cable connection (the brain) is perfect. Rather than saying the mind and the brain are the same, I think it’s more accurate to say that the mind is “reflected” in the brain.

    And regarding (2), certainly Gage’s experience (and strangely we’re just covering that now in my introductory psych course) confirms that the mind can be changed by changing the brain. It’s a very far cry from that, though, to suggest that all trouble with the mind originates in the brain (which I’m not suggesting for a moment is the position that you take).

    I think it’s very telling that for all psychiatry’s bluster, they are still forced to stick with the term “mental illness” rather than “neurological disease,” at least when they’re talking to their patients or to the media.

  • If I wrote about all the ways psychiatry nearly destroyed my life, it would be a pretty big book.

    And, Chaya, I love your “Praise Biederman.” I’m guessing that’s a reference to his response “God” to being asked something like “What’s higher than a Harvard department head?”

    Am currently reading Greenberg’s The Book of Woe and he refers to this exchange with his usual dry wit. He notes it’s an odd response from a man who has devoted his career to diagnosing a disease which includes grandiosity as a symptom. Greenberg makes a good point, me thinks.

  • My psychology (cough) professor says that the proof that depression is a chemical imbalance is that when normal people take an antidepressant they don’t become euphoric.

    I guess elementary logic isn’t required to attain a PhD. The placebo effect is based on hope. A depressed person is desperate to feel better. A normal person isn’t desperate to become euphoric.

    Oh, yeah, and our textbook refers to SSRI disasters as “alarming anecdotes,” akin to people claiming brain cancer from cell phones. I wrote to my prof pointing out (among other issues) that these “alarming anecdotes” happen frequently enough that the FDA forced the manufacturers to post black box warnings to that effect on their products. Never heard back from the prof. Anybody surprised?

  • Peter, your comment raises an issue that I have often thought about. If a lawsuit is commenced over an issue like psychiatric malpractice and a win would have significant implications, is it possible to make a deal with your client ahead of time that he/she will refuse to settle out of court no matter what sum is offered, on the basis that establishing the precedent law would be more valuable?

    Would such an arrangement contravene any kind of practice standard? And what about a prior agreement that settlement would only be agreed to on the condition that the terms were not private, i.e. that the plaintiff would be free to report them to the media (even if a private settlement was for more money). Would this be ethical?

  • “Preventative treatment.” Now there’s a concept that should strike fear into our hearts. If our social policy re: mental health is ultimately based on the fear of violence (and I believe that it is) then, really, everybody should be on antipsychotics. Except for oddball circumstances where they actually cause violence, in most cases they act as one would expect major tranquilizers (their original name) to act. Antipsychotics would make anybody less likely to be violent because they make you less likely to be able to act at all. They call it the “Thorazine shuffle” for good reason.

  • Just like a poster suggested above, I too am mystified by this emphasis on genetic research. Think what we could be doing with that money instead! Getting people off the street, providing supportive housing, good food, decent medical care and counselling are a few things that spring to mind.

    The grimmer possible outcomes from this genetic research (and I have no doubt that genetics makes a person more likely to break down from an environmental stressor) are:

    – pre-emptively targeting youths deemed at risk (just like NIMH tried to do with its thankfully doomed Violence Initiative)
    – ever-expanding market for antipsychotic drugs
    – pressure for women to abort SZ-likely fetuses
    – central registry of those like to develop SZ
    – profound despair and hopelessness on the part of those deemed likely to develop mental illness
    – a few even more dim possibilities that I don’t feel like discussing

  • I’m sorry I didn’t come across this article until now and I’m pretty disgusted by NCMHR, who until now I thought were on our side.

    I presume “violence” would be limited to criminal convictions? Even if it was, that would still be problematic if you don’t know the circumstances. I have an assault conviction from throwing a cup of coffee at a psych nurse. (Strange how throwing someone into an isolation cell, body slamming them to the floor, ripping their pants down and injecting them with a neurotoxin is just business as usual but what I did was assault).

    Anyway, a mental illness registry is just another step towards their ultimate goal of eradicating us altogether.

  • Great article, Maria. I, too, try to use humour to see me through all this. Trouble is, I’m just not as funny as you are.
    I think when we’re dealing with emotional rather than medical issues, a therapeutic alliance can be enormously helpful but still, as you suggest, be approached with caution. There is something very odd to me about the guy on the other side of the desk being “designated sane,” leaving you, of course, to be the “designated insane.”

    I saw my psychiatrist recently and we continued the same battle we’ve been having for years. I said that my depression had lifted due to my moving into my own place (from a fraught environment), focusing on exercise and good nutrition, working part-time, going back to university, etc. He corrected me: No, it was due to Lamotrogine. I take Lamotrogine (Lamictal) for my epilepsy which I developed in response to ECT, which was coerced. Trouble is, I felt better way before I started the drug but I didn’t want to split hairs.

    I stressed that the single most important factor was moving out and creating a warm, inspiring, safe place for me to blossom in. He said, no, a “simple move” wouldn’t account for it and called me “misguided.” I basically said “Same to you, buddy.” And this is actually a shrink that I like!

  • Thanks, Ted. You can reach me at victoria1 (at) mindfreedom (dot) org

    I think it does have some possibility. There is a vibrant network of psych survivors in Vancouver. I’ll talk to some of my friends and see what they think.

    One problem I foresee is that many people are under the needle, so to speak. That is, the team comes to your home and shoots you up every 2 weeks. Since there is no support for tapering, that would leave these folks in a very dangerous position.

    One potential solution is to publicize our action way ahead of time and explain to the doctors that yes, we are doing this. They can either let us go “cold turkey” and deal with the fallout or they can switch us to oral meds and let us proceed.

    Even if this didn’t work and fewer people were able to participate, the publicity would help us enormously. There would be lots of commentary in the media which we could respond to coherently and intelligently as a group, rather than as grievous individuals (not as effective and less likely to be published).

    Although the participants wouldn’t be guilty of civil disobedience, the organizers’ actions might be chargeable. I’m not sure so I’d have to look into that. Personally, I’d be rather proud to be charged with/convicted of such a worthy endeavour.

  • I really don’t think the mental health system believes in recovery. What they promote is despair. “Success,” to a psychiatrist is having a barn full of well-behaved patients not causing any trouble as he bills the insurer or the government for 6 minute consultations and prescription refills.

    When I wait to see my shrink, I see them shuffle in for their daily medication. If they don’t appear, the police will pick them up and take them to the hospital. Their sentences are indefinite; their possibility of recovery is nil. I would slit my wrists if I was subjected to coerced treatment again.

    I’m been thinking about the whole outpatient commitment thing or, as euphemistically phrased in our neck of the woods, “assisted community treatment.” If we could get a radical bunch of us together and simultaneously declared that we would be tapering off our meds, the system would be overwhelmed. There aren’t enough beds available anymore to hold us all. Sure, they might grab 10% of us but the rest would have a shot at a real life. Just thinking out loud before, no need to comment.

  • I was taught (quite recently, actually) that sociopathy and psychopathy were just older terms for what we now call Antisocial Personality Disorder. Are they discrete entities? Do they exist under the APD umbrella? I’ve never thought of the term psychopathic being synonymous with psychotic. If somebody has time, please straighten me out on terminology.

  • Tom, I agree that psychiatric labelling is applied differently across varying groups and it’s especially pronounced between men and women. There’s also a difference between how behaviours are viewed based on whether or not a person is designated sane. I know several well-employed and high-status individuals whose behaviour, if I were to try it, would be classified as pathological. One particularly angry professor that I know frequently gets furious and has in the past broken things. If I were to do that, it’d be classified as manic rage and the police would be called.

    Not quite on the subject, but I did want to say that our society’s acceptable standards also vary wildly. Believing that little green dwarves are in your kitchen cabinet: not okay. Believing that there’s a guy up there in the sky watching everything that you do: acceptable.

  • I’d like my psychiatrist to acknowledge that antidepressants actually caused my bipolar disorder years ago. The most I’ve ever gotten him to admit is that antidepressants can sometimes cause “mania.” This statement is misleading, at best, and makes it sound like antidepressants merely have side effects (as do all drugs, of course). The truth is if you’ve got depression and you develop mania, then you’ve got bipolar disorder.

    Upon a toxic reaction to a drug, a rational physician would at least entertain the thought that the patient should immediately be taken off the drug, to see if the new adverse situation resolved. Not a psychiatrist, though. Oh, no! The antidepressant must have “triggered” the underlying bipolar disorder. More drugs required: mood stabilizers, antipsychotics. I’m long past considering a psychiatrist a “rational physician.”

    I’d like to see some effort towards making an educated guess as to how many “bipolars” are actually just mis-medicated “depressives.” That’s not a very sexy area of study and Big Pharma wouldn’t be interested, I’m quite sure.

  • Great article, Tina, thank you. You don’t seem angry to me, just wrongfully accused and treated and demanding better for yourself and the rest of us.

    E. Fuller Torrey and his (forced) Treatment Advocacy Center is surely one of the (if not THE) primary impetus behind psychiatric profiling.

    This is not only blood libel; this is hate speech.

  • This study doesn’t surprise me and I hope it gets some acknowledgement from the “treatment” community.

    In my introductory psychology course, the text asserts that now that mental illness has come to be seen as biological and largely genetic, that stigma against the afflicted has been reduced. This, of course, is horseshit. It’s on the basis of this “science” that the forced drugging lobby has flourished.

    Perhaps the measuring of stigma ought to be left to the voiceless who suffer its consequences. But, as usual, the people most affected are left out of the conversation. On a forum somewhere, I read “the only people who are against outpatient commitment orders are those without a mentally ill family member.” Again, where is the voice time for that very same family member?

  • Hi, Donna. No, the text doesn’t get into any of that. They mention bipolar, ADHD, etc. as psychological disorders and then they get to schizophrenia when all of a sudden they switch to “brain disease manifested in the mind.” Funny you mention Hare, as we’re just dealing with psychopathy now and Hare’s “research” was indeed talked about.

    I’m interested in what you say about Torrey et al staying away from psychopathy. I wouldn’t have expected that. Would you mind expanding?

  • Dr. Jaffe of the Mental Illness Policy Organization made a comment on the 60 minutes blog thanking CBS for including the point of view of schizophrenics’ who were grateful for treatment. Could somebody please explain this aspect of the show to me? Were patients saying they found forced drugging “liberating”? Were they presuming to speak for the rest of us? Why do people almost invariably think that what “works” for them has to “work” for everybody?

  • Even if I had a TV, I wouldn’t have been able to stomach watching this crap. In my opinion, Torrey’s pontification verges on hate speech. I believe his motivation is to attempt to present psychiatry as both a valid medical science and a boon to our society.

    I doubt very much that 60 minutes will even consider our protests, never mind air something from us in the interests of fair reporting. Rational discussion doesn’t improve consumer ratings and make money.

    Sometimes I get awfully tired of this struggle. I really hate Torrey. “Hate” doesn’t even cover it. I loathe and despise this man. I’m taking an introductory psychology course at the moment and our textbook briefly praises Torrey, saying he provides schizophrenic brains to researchers all over the world. This is a bit like listing influential world leaders of the last century and mentioning Hitler only to say that he was kind to dogs (just an example, not sure if it’s true or not).

  • You’re dead wrong. Asylum populations actually went up immediately after the introduction of antipsychotics. When they went down afterwards, there were many reasons, most of them economic. And your quote “they have fewer side effects than some of the other medications we use” sounds like it comes directly from the esteemed Dr. E. Fuller Torrey’s mouth. We don’t even know what “schizophrenia” is, never mind what it does to the body.

  • Here in British Columbia (not sure about the rest of Canada), Advance Directives aren’t enforceable with respect to psychiatric treatment. Our provincial Representation Agreement Act specifically excludes mental health “care.” I’m not sure how this sorry state of affairs came to be, but one local journalist summed it up as something like “So you can refuse tube feeding or resuscitation but not forced drugging or electroshock.”

  • For a long time, I’ve been disenchanted with the word “peer.” Based on my experience, a “peer” now refers to a current or former consumer of mental health services who is very much indoctrinated and is trained to promote the biomedical model. A few months ago, I was seeing a peer support worker myself and was not impressed. I told him about my rage at having a decade stolen from me by the system and he responded “It wasn’t the system that stole those years, Francesca, it was your illness.” Then I said how well I was feeling and he responded “You need to realize that you’re only doing well because you’re on medication.” Both of these statements seemed astounding to me at the time, given that he didn’t know (a) what medication I had been prescribed, and (b) whether or not I was compliant, and (c) what I had endured for the last ten years. In fact, I found his “help” pretty useless, patronizing and infuriating and I severed that interaction.

  • Great article, Bruce. Thank you.

    With respect to Fuller Torrey, I agree he’s hard to figure out. I’ve seen old, old quotes from him that make him sound almost Szaszian. I don’t know what “turned” him but I suspect it has something to do with generous funding from the Stanley Institute. In any event, he is one of our biggest threats.

  • I’ve been devastated by ECT. Often it was given to me involuntarily and sometimes “voluntarily” when I was so depressed I would have consented to euthanasia (strange how one can, at the same time, be competent to consent yet not competent to refuse).

    Like any physical assault would, it did “work” in the short term, in that it kind of smacked some sense into me. That improvement quickly disappeared though and I was left with severe memory loss (both short and long term), continued severe depression and an inability to concentrate.

    It is still almost impossible for me to concentrate enough to get through a magazine article and there are vast chunks of my past that are no longer available to me. It is my faint hope, though, that neuroplasticity is a valid phenomenon and that I’ll eventually recover.

    I support the continued use of ECT only with true informed consent and never, ever as involuntary treatment. If that consent were truly informed, I doubt very much that people would do it.

  • Jim, any chance you could clone yourself and come down to BC? As it is here right now, no court order is required in order to commit someone. All it takes is two doctors’ signatures and often the second doctor doesn’t even examine the patient.

    The “choices” in this situation are as follows:
    (a) “Consent” to incarceration and treatment; or
    (b) Have the director of the mental health facility provide “deemed consent.”

    Forced treatment can (and usually does) begin right away. There is a long wait for a Review Panel and, by then, you can be seriously messed up on neurotoxins.

    Please keep up the fantastic work you do in Alaska and let’s all hope that the effect of your continued successes will trickle down to BC.

    Best wishes,

    Francesca

  • My unhappiness was diagnosed as depression, aka a biochemical balance. I reacted very badly to the “treatment,” became manic and was thus upgraded to “bipolar.” It was ten years of hell: in and out of the hospital, often via Mental Health Act warrants, various diagnoses based on my pill reactions: schizoaffective, borderline personality, and probably others I don’t remember. I lost my job, my home, my marriage, my soul. Not one “care” provider ever asked me why I became depressed. Was I happy at home? Was life fulfilling? Was I taking care of myself? Did I have unresolved issues? Oh, no, we went straight to the brain chemicals. I will never forgive them for what they did to me. They owe me ten years.

  • Mental health laws may be different here in British Columbia, of course, but they don’t need a court order for forced outpatient drugging. The procedure is the same as for forced hospitalization; the doctor has to assert that someone (a) has a mental disorder; and (b) is capable of deterioration. “Capable of deterioration”??? Can you imagine a more rubbery concept? Anyway, I know Torrey et al would have you believe AOT only applies to those who are naked and running down the street with a meat cleaver. In fact, though, it can happen to anyone unfortunate enough to be psychiatrically labelled. It happened to me and it was more traumatic and soul-destroying than inpatient treatment. Your post is pretty dismissive. Maybe you should listen to some psych survivors.

  • SethF, you quote from the article:

    Patients were much less likely to end up back in psychiatric hospitals and were arrested less often. Use of outpatient treatment significantly increased, as did refills of medication. Costs to the mental health system and Medicaid of caring for these patients dropped by half or more.

    There are a few problems with this analysis:

    – Patients who go off psych meds usually do so without the support of a doctor. They tend to do it cold turkey. The resulting rebound psychosis is a well-established phenomenon. This explains a large portion of the re-hospitalized.

    – This also applies to the arrest rate. As we all know from listening to NAMI, individuals that “support” patients are firmly satisfied with the medical model and view any non-medicated patient with suspicion. Thus, an action that a normal could get away with is grounds for arrest for a nutter.

    – Patients who don’t participate in the system are dumped back into real life with no support. Without adequate housing and food, normals would be acting strangely too.

    – Use of outpatient treatment increasing: this isn’t an improvement. Ditto refills of medication.

    – Costs to the mental health system may indeed be lowered by AOT in the short term. It’s much easier to make people obedient when they’re drugged. The trouble is, though, that in the long term, this cost saving will disappear. First, there will need to be treatment of all the physical side effects of long-term use of the meds and that’s expensive. Then we’d have to factor in the relative costs of keeping someone drugged and out of the work force permanently as opposed to short-term emergency intervention and then recovery and return to self sustainability.

    – Lastly, studies like this are put out by researchers like E. Fuller Torrey. Torrey is an admitted perjurer (he says surprisingly candidly in Surviving Schizophrenia that he exaggerates a patient’s dangerousness in order to commit someone — his defence is that everybody does that) and is notorious for manipulating statistics to reflect his own pro-forced drugging agenda.

    All in all, this article doesn’t impress me and I believe it should be viewed skeptically.

  • And ‘in hospital’ self defense violence is perfectly understandable. Occasionally those carrying out forced drugging get socked in the face during a take-down. What do they expect? Us to just lie down and take it? I think that is what they expect.

    Anonymous, isn’t it strange that society accepts without question that those in power have the authority to arrest, hospitalize, drug, electroshock, isolate, restrain, etc. a citizen yet there is so little tolerance for violence when it flows up from the bottom of the power structure.

    I’ve been seriously assaulted and battered by the psychiatric squad. Yet, when I threw a cup of coffee at a nurse and slammed a door in her face, I was charged and convicted of assault. Now, I’m not condoning my behaviour; I’m just asking that it be seen in the context of what I endured.

  • Anonymous, you said: The UK has just, predictably, launched efforts to censor the internet, one of their targets is any site that in the government’s determination ‘promotes’ so called ‘self harm’.

    This is terrifying. Can you point me to a link? I’d like to read about it.

  • Vincent Lee was an unmedicated nutter. Vincent Lee beheaded someone. Here’s another unmedicated nutter. Clearly, it’s only a matter of time before he beheads someone. It’s simple logic.

    Remember the esteemed E. Fuller Torrey commenting on one of the gun massacres? He said something like “totally predictable — an unmedicated schizophrenic.”

    God, it’s an uphill battle isn’t it?

  • Below the article was this disturbing comment by “Susan”: “Sometimes whether or not a person likes it they are far, far better off medicated then to live in fear, anger. It certainly sounds like this lady needs some kind of treatment to calm her fears. Vincent Lee (who behead a young man on a bus in Ontario I believe) was let out a hospital because he didn’t want to take the meds.
    The mentally ill have brains that are broken and need to be hosptialized [sic] until they are stable however long it takes.”

    Unfortunately, comments are now closed so I didn’t have an opportunity to fight this hate speech.

  • Speaking of Pete Earley, he has a new post on his website: “Virgil Stucker describes healing, building bridges and a ‘recovery college’ concept.”

    I submitted a comment along the following lines:

    You charge $17,000 a month yet you are a “non-profit”? How much is your salary?

    My comment was held for moderation and now appears to have been deleted.

  • I ache for this anonymous mother’s son yet her letter and accusations hurled at Bob Whitaker made me furious. Blood on his hands — good grief! The only blood on anyone’s hands belongs to those perpetrating the mental death system and the colluding families of mental patients.

    We are so lucky to have you on our side, Bob. It’s sickening that they imply those diagnosed with mental illness should be protected from valid science, i.e. the truth. This is, I believe, part of what Sally Satel refers to as “benign paternalism.” Well, it’s not benign; it’s toxic.

    Had our social policy reflected this science, this anonymous man would have been provided safety, shelter, good food, psychosocial support, a judicious tapering off his neurotoxins, and an opportunity for counselling to deal with his obvious fear of and rage at his parents.

    I actually like Pete Earley, though I vehemently disagree with him on most things. We’ve emailed a couple of times and he seems to me more thoughtful and moderate than would be obvious from his blog.

  • Beautiful and moving article, Chaya. I think it’s right and just (to say nothing of healthy) to tell the truth. Following your lead, I’d like to say here that although I came from a very loving environment there was emotional violence, the effects of which I struggle with to this day. I feel that I was betrayed twice: first, by not being protected from the emotional violence I experienced as a child and then, second, by my family colluding with the psychiatric industry which utterly ignored all obvious factors for my so-called mental illness. Just wasn’t discussed; never came up.

  • Someone Else, you write:

    “As someone who had bad reactions to a “safe” smoking cessation drug (actual dangerous antidepressant) misdiagnosed as bipolar and dealt with “Foul up” after “Foul up” with antipsychotics, I know I am owed an apology. I know all who were turned into bipolar patients with antidepressants or ADHD drugs, then tortured with antipsychotics are owed an apology and proper compensation.”

    This is similar to my own experience. Can you think of a way of measuring how many “bipolar” diagnoses are actually a reaction to psych meds? Do you know if this has ever been studied? And as for an apology and proper compensation, the only way that’s going to happen is through groundbreaking and successful lawsuits.

  • I like to think of families and psych survivors healing together and your post raises some interesting points. The problem is though that, of all interested parties, families might have the most invested in the biochemical theory of psychiatric distress. And, in some tragic circumstances, psych survivors actually need to heal FROM their families.

  • There seems to be very little acknowledgement of the link between electroshock and epilepsy (which has been my own experience, sadly). There are available studies suggesting this link, including one that asserts that post-ECT epilepsy is way under-reported. From a common sense point of view, it certainly seems possible that inducing seizures would cause seizures. My psychiatrist denies this (big surprise!) but my neurologist confirms he sees lots of strange neurological symptoms after ECT. I’m much more inclined to listen to a neurologist.

  • Thanks for your article. Just one thing — how long are the LAIs designed to last? I am fearful of what the consequences might be if this becomes standard treatment for the non-compliant (aka misbehaving upstarts who have the radical philosophy of “my body, my choice”).

  • I hope so too but my expectations are low.

    From the abstract:

    “To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice.”

    I don’t think any amount of additional studies would change general practice. The whole system is predicated on an assumption (rather than an inference) that mental illness equals brain disease. They’ll keep pumping that until it’s made illegal and we all know that’s not going to happen.

  • Great article, Sera. You were able to put into words for me why I chose to no longer see my “peer support worker.” I was horrified at some of the things he said to me, particularly when he would ask me my opinion and then correct it to realign with his organization’s mandate. Eventually, I came to understand that he wasn’t my “peer” at all and I’ve been doing much better without him.

  • I appreciate your article, Matt, and it certainly has relevance to my own experience. After all the years I had stolen from me, staying angry is just wasting even more years, isn’t it? Usually I have my anger under control until, for instance, a loved one says something like “You respond very well to treatment” or “ECT saved your life,” then I’m enraged and let him/her have it. I’m angry because I have a lot to be angry about! At the same time, though, I know I simply have to learn to let it go. It’s very hard but you know that.

  • Yes, one of my biggest complaints about our mental health system is that it trains people to be disabled, i.e. the system doesn’t believe in recovery. They seem to want well-behaved and obedient cattle shuffling in for their antipsychotic injections and waiting for their next disability cheque. I’m angry at the system, sure, but I also get angry at some patients for not having the courage and insight to see beyond.

  • This study really doesn’t surprise me. Once a diagnosis is alleged/admitted, all of a person’s actions and speech are seen through that lens. If you’re alleged to be bipolar and you start acting out and resisting assault (perhaps restraints, isolation or both), then you’re even “sicker,” perhaps borderline, perhaps schizoaffective. So it only stands to reason that if you’re a normal who talks nonsense (perhaps religious gobbledygook) then you’re fine. But if you’re mentally ill and do the same thing, then you’re biochemically deformed.

  • Valuable post, thank you. As you suggest, psychiatry’s trouble with informed consent is that if it was truly informed then nobody would consent.

    Of course, psychiatry (as opposed to medicine) is distinguished by its legal power to force those who don’t consent. In our provincial (BC) Mental Health Act, this is called “deemed consent.” I would much prefer the honest term “refusal.”

    Good luck with your PhD. I hope you publish your thesis here on MIA.

  • Anonymous said: “There is a reason I know even just personally people who have pledged to commit suicide if forced psychiatry ever touches them again. I would never confirm or deny in writing whether I hold such a position about my own future should I be forced into psychiatry again.”

    Anonymous, I wouldn’t confirm or deny the above in writing either but I will say this. The next person who tries to arbitrarily incarcerate and/or force drug me is at risk of serious bodily injury.

  • “If someone is screaming obscenities all night at his voices is it better that he get jailed for disorderly conduct or put into a psychiatric hospital?”

    Jail, no question, I’ve been in both and I would much prefer jail.

  • Anonymous, I don’t think it’s a question of restraints being replaced with forced drugging. In my experience, they’re both used at the same time, the restraints facilitating the drugging. My record for time in an isolation cell is 22 days.

  • I’m with you, Chaya. A big factor in my recovery was deciding to work only part-time so that I could spend more time, as you beautifully put it, “on the dirt road, unpaved, picking berries in the sunshine, or being poured on in the rain.” I don’t know how we (society) got into this insanity that we have to work harder and harder to obtain the things that we don’t need and don’t even have time to enjoy because we’re working so hard.

  • I agree with you, Joanna. And I think the author of this article completely misunderstands the nature of hurtful words. It’s not just what a person thinks of themself (as suggested in the article); it’s also living with the knowledge that the speaker actually thinks these hurtful opinions.

    I, too, was declared incurable and told that I wouldn’t return to work and that I’d have to be on psych meds the rest of my life. I believed them until I came to the understanding that psychiatry is just an obscene power struggle and that such proclamations are meaningless, stigmatizing, hurtful and arbitrary.

    That’s why we’re all participating in this website, right? We’re searching for alternatives.

  • I had a look at the website and didn’t find it terribly informative. Nowhere is it mentioned that seeking psychiatric help can expose you to forced treatment and that the only way to guarantee yourself against forced treatment is to avoid a psychiatric diagnosis altogether. Perhaps the website is designed only for those with very minor mental health concerns. In any event, there’s no new information here.

  • My original comment cleaned up in accordance with posting guidelines:

    More of the same — a very disappointing opinion piece. Very insulting to those who legitimately question psychiatry.

    Lieberman says: “Being ‘against’ psychiatry strikes me as no different than being ‘against’ cardiology or orthopedics or gynecology—which most people, I think, would find absurd. No other medical specialty is targeted by such an ‘anti’ movement.”

    Perhaps that’s because, Lieberman, that yours is the only branch of medicine that doesn’t have real science backing it up.

    Perhaps that’s because, Lieberman, that yours is the only branch of medicine that has the force of law behind it.

    Perhaps that’s because, Lieberman, that yours is the only branch of medicine where outcomes are better without your interference.

  • Good for you, Michael!

    I’m not surprised by the resistance you encounter. I’d love to read their warning letter(s).

    I was considering taking mental health support worker training with a view to working with clients and opening alternatives. But then a professional who had been through the same program told me I’d never find a job if I stayed vocal about my opinions.

    If you do get fired, I hope you sue their asses off.

    Best of luck.

  • Great post and now I want to read your book. I’m reluctant to read Linda’s article because I find people’s obedience to the traditional pseudo-biomedical system so frustrating.

    For myself, I had two long experiences with the psychiatric system: the first wasting 3 years of my life, the second consuming over a decade. Both series were precipitated by depressions and, in both cases, my life circumstances clearly weren’t conducive to emotional health.

    No psychiatrist ever explored any of this, of course. Oh, no, I suffered from a chemical imbalance, I was diseased, I was faulty, I needed drugs and would be on them for life. In both cases, aggressive and harmful treatment for those depressions brought on mania and thus it was “discovered” that they had triggered my pre-existing (but latent) bipolar disorder. This new diagnosis led to even more drugs and hospitalizations, of course. The simplest and most obvious explanation was overlooked: Perhaps they had CAUSED my bipolar disorder.

    Even now, as a voluntary patient, I have to put up with the patronizing and belittling attitude of my caregivers. I told one of them recently that I was enraged at the years I had stolen from me. His response? “It wasn’t the system that stole those years, Francesca, it was your illness.”

    At times, I get so discouraged I want to give up. Psychiatry’s not a science; it’s a marketing empire.

  • Sera, I love this: “Just when was it decided (and by whom) that what you get to call ‘life,’ I have to call ‘recovery’?”

    For myself, I do use the term “recovery” but I’m referring to recovering from the psychiatric system. Coerced and forced treatment are the most traumatic things I’ve ever had to deal with. The chemical imbalance theory has been the most negative factor in my life.

    And, in response to one of the posters above, I believe a lot of people receiving disability benefits do so because their spirits have been broken. They’ve been trained to be “disabled.” Who knows what they’d be capable of if their case managers treated them as human beings?

    How many lives have been destroyed and dreams shattered by this religion (cult)?

  • The pressure to stay on psych drugs is intense. And I’m not even talking about coerced or forced treatment. Their guarantee that I couldn’t live without them turned out to be false. I argued about this recently with my psychiatrist and I mentioned Bob Whitaker’s books. The doctor replied “But he’s not a scientist.” That’s right, he’s not, but it doesn’t take a scientist to point out serious fallacies in a pseudo-science like psychiatry. Next time the topic comes up, I’ll tell him that psychiatry isn’t science — it’s a marketing empire.

  • Good article. I agree that terminology is very important. That’s why I prefer “forced drugging” over “involuntary treatment,” etc. Too often, bad policies are smoothed over by politically correct terminology. I think we’re all better off if we say what we actually mean.

  • I have some skepticism about the Subotnik study.

    First, it was only 2 to 4 weeks between the withdrawal and the follow up assessment. That’s not long and I suspect rebound psychosis was a factor.

    Second, how was compliance measured? Were there blood tests? If it was just patients’ accounts, that’s a problem. Many people who are well (and I’m one of them) lie to their doctors and say they’re compliant in order to avoid coercion and forced treatment.

  • I’d happily make a small contribution (I’m unemployed at the moment) but I don’t have a credit card. Is there a mailing address I could send a cheque to? Also, would it be made out to “Mad in America”? I love this website and have very high regard for Bob Whitaker. Just let me know and I’ll get on it.

  • Sinead said above “YES, I do work with “some” involuntary patients, but they do not ALL fall into the category of ‘people who do not wish to be worked with'”.

    I don’t understand. Isn’t that the very definition of involuntary patients?

  • From Pies’ response: “Nor is it fair to blame psychiatric “labels” for the abridgment of civil liberties, as Ms. Davidow does. Psychiatrists, like all physicians, are governed by civil law and judicial oversight.”

    It’s not FAIR to say psych labels abridge civil liberties? Is this guy insane? I’m in British Columbia and here civil law affords patients’ practically no rights. You can consent or you can be deemed incapable of consenting; there’s no room for someone who dares to simply disagree with treatment. As local journalist Rob Wipond puts it in an excellent article (which I can get for you if you like), with an advance directive you have the right to refuse rescusitation (sp?) but not forced drugging and electroshock. BC allows advance directives for every area of medicine EXCEPT mental health. People with psych diagnoses are subhuman — that’s the impression I get. Now, it may be true that many psychiatrists follow the law. The trouble is that the law needs to be changed.

  • Great article, Jim.

    The most frustrating thing, to me anyway, is the idea that refusing meds is proof of incompetence. There is absolutely no room for someone (like me) who has considered all the evidence available and decides to go drug-free. The only thing you can do is stay a voluntary patient and, often, one of the conditions of staying “voluntary” is to accede to their demands. It’s very unfair and society would not tolerate this with any other group of people.