Friday, December 24, 2010
Tuesday, November 2, 2010
No brain research or fine-tuning of neurochemistry will ever replace an ability to communicate with a single individual face-to-face, no matter how insane, and change his or her mind. When you fail to do that, and when you are afraid, all the medicine and all the science of the past, present and future cannot rescue you from mental illness.
This essential point comes from my own nine years of experience as a legal advocate in forensic psychiatric institutions in Illinois. My clients are murderers, etc., found not guilty by reason of insanity. My job has been to get them released into the community though they refuse to take psychotropic medication.
I suppose I could have put mental illness in quotes, or made that last sentence read, "... cannot rescue you from what you call mental illness." But the presentation was, after all, to an audience of people who my friend Rodney Yoder has always insisted are professional mental patients. I guess it was unnecessary to rock the boat with Szaszian purity.
It also seems that the mental health world is fracturing. At the Canadian conference, it was clear (at least to me) that only a minority retain any orthodox "medical" view, wherein hope lies exclusively with research into brains and neurochemicals, and stigma is fought by making people believe schizophrenia is the same kind of "disease" as diabetes or cancer.
Most people are becoming aware that medicalization reinforces stigma, and that the best-financed parmaceutical researchers are admitting they can't even tell whether psychotropic drugs work.
The mentally ill are simply people with problems in living and relating to others. Little or nothing new about such general human complexity was discovered in these very recent centuries, or mere decades, which comprise the history of modern medicine. Psychiatrists have taken to descriptions which are a bit more standardized, and they've been clever about enforcing those descriptions to obtain a commercial advantage. Nothing more than that, and needless to say it hasn't helped.
Maybe there is hope for a shorter mass historical delusion than the 300-year Great Witch Hunt. Maybe we will not coerce people into "treatment" they don't want too much longer. Maybe we can soon stop dehumanizing and neuroleptizing and disabling people, "for their own good and to protect the community." That's what I'm working for, and prospects don't look that bad to me.
I have submitted a proposal for a workshop at the national conference of NAMI in July, 2011, based on what was pretty well received in Canada last month. The response from NAMI will tell me more. Stay tuned.
Friday, October 29, 2010
To begin with, how can "medical" and "behavioral" be mutually exclusive categories of illness? This would necessarily imply either that behavior is not affected by anything which medicine can remedy, or that we just never use medicine to change behavior even when it's possible to do so. Obviously, the widespread existence and practice of psychiatry itself contradicts this.
T.A.C. pretends to advocate only in regards to severe mental illness. So perhaps they mean that millions of people taking Prozac who were never actually psychotic or completely disabled by their blue moods have behavioral problems, not any medical illness. The same would probably go for the millions who take Ritalin to stay sharper in school or more focused on the job.
Yet all of these guys, I'm quite sure, would argue long & hard that their condition is medical, too. If not, then why should their insurance pay for their drugs? Seems to me a condition is medical exactly according to whether or not somebody takes medicine for it, simple as that.
I might add, whether people take "medicine" for a condition doesn't have much bearing on whether they are helped or cured, in any objective sense. Last time I checked, good Scotch whiskey was a great "cure" for just about anything according to somebody, somewhere. And those who find that long-honored cure to be more of a nuisance than whatever the disease was which needed "treatment" can then choose to solve their addiction with LSD. This is all perfectly medical, of course. But I think most of us would see some behavioral aspect....
The T.A.C. guys would have us believe that they, or some expert somewhere, can draw a sharp line between "medical" and "behavioral" - that this is a matter of Science after all, or Special Knowledge.
No. Even schizophrenia and bipolar remain putative diseases, with no proven biological basis or etiology. Actually whether anything called mental "illness" is medical or behavioral can only be a matter of viewpoint in social policy, economics, philosophy, prejudice, and/or various other fuzzy and subjective things.
As the National Institute of Mental Health recently put it, "... curremt diagnostic categories likely do not distinguish among causal factors or provide homogenous endophenotypes." (Translation: nobody knows what any of these so-called mental illnesses actually are!)
So why, exactly, do these oh-so-smart guys at T.A.C. think a meaningless and delusory "universal recognition" would be such a breakthrough?
Because they think it would justify forced psychiatry, that's why. That's the only reason.
Tom Szasz has said, "The subject matter of psychiatry is human conflict. However, perhaps because men are men and not animals, they cannot simply coerce, oppress or exterminate their fellows; they must also explain and justify it."
As far as T.A.C. goes, fraud is still fraud, and what goes around comes around.
Friday, October 8, 2010
A. Excessive avoidance for a period lasting longer than a few weeks, for reasons not related to economic austerity, of normally effective medications or over-the-counter remedies for common discomforts such as cold symptoms, allergies, headaches, muscle soreness, hangover, or difficulty falling asleep.
B. Failure to visit a medical doctor for routine checkups for a period lasting longer than two years.
C. Failure to obtain health insurance; or consistent failure, neglect or refusal to answer official communications from insurance authorities, complete necessary forms and questionaires, or otherwise responsibly attend to administrative details which are recognized as necessary for fair and effective medical insurance coverage.
D. Habitual or repeated patronage of internet websites which puport to "expose psychiatric violations of human rights" or "advocate prosecution of psychiatric crimes".
E. A confirmed record of any four or more of the following statements of effective opinion, not subsequently disavowed:
- Mental illnesses are not real brain diseases.
- Mental illnesses can be controlled by individual will.
- There is no objective medical test to diagnose or rule out any DSM disorder.
- Psychotropic medications have dangerous side effects.
- Children can become addicted to Schedule II stimulants.
- Psychiatrists perpetrate fraud and abrogate the right to informed consent.
- Psychiatry kills.
- The insanity defense should be abolished.
- Involuntary commitment should be abolished.
- Psychiatry is pseudo-science.
Tuesday, September 7, 2010
Today's Wall Street Journal contains a featured health & wellness article by Elizabeth Bernstein entitled, "A Way Out of Depression: Coaxing a Loved One in Denial into Treatment Without Ruining Your Relationship."
Bernstein's basic point is, if somebody you love needs help, try to understand them and talk them into getting it without pathologizing them or offending them. Fine, who would argue with that?
But the writer bases her advice on the claim that a common symptom of depression is denial or lack of awareness, also known as anosognosia. This is said to be "a physiological syndrome that makes a person unable to understand that he's sick."
This is dangerous and degrading nonsense.
Major Depression, Bipolar Disorder, Schizophrenia and all other mental disorders are defined completely and authoritatively in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision ("DSM-IV-TR"). All symptoms are listed for every mental disorder. Not a single mention of anosognosia is to be found anywhere in the 943-page volume.
The next (fifth) edition of the DSM is due out in a couple years. The American Psychiatric Association has an entire website devoted to DSM-V, which can be searched efficiently to find scores of references about depression, bipolar disorder, schizophrenia, and how all these disorders will be defined, diagnosed and treated in the future, with all the additional research since DSM-IV was published in 1994. But one searches in vain on this website for any mention of anosognosia.
The question that's begged: Why did Elizabeth Bernstein insert this "physiological syndrome" which is not relevant enough to ever be mentioned in the psychiatric manual, into her article as a supposed common symptom of depression?
Anosognosia is a fairly obscure term coined in 1914 with regard to certain brain injuries and neurological conditions. It's causes are unknown. It's use in relation to mental patients who refuse treatment is new and controversial.
Over the past nine years, I've worked with a lot of people who refuse psychiatric treatment and don't believe they are mentally ill. I've worked with a lot of their psychiatrists, too, and their security therapy aides, and their social workers, and all the other state nuthouse staff who get paid for holding and treating people whether they like it or not. These guys never talk about anosognosia. They know their jobs.
I can tell you this: The only reason anyone would claim that a common symptom of depression is lack of awareness, denial, or anosognosia, is to justify "treating" someone against his or her will.
There is nothing else behind this, in Ms. Bernstein's article in today's Wall Street Journal. Ms. Bernstein may not make the connection. The Journal's editor may not feel responsible for such ugliness. But that is the only point.
The irony is that Ms. Bernstein's article really wants to suggest the opposite of forced treatment. But that's the trouble with psychiatry, it doesn't work, it's an enforced lie.
Wednesday, September 1, 2010
Monday, August 2, 2010
Biological/medical psychiatric theory and practice are in fundamental conflict with this fact of life. The clearest statement I have ever read about this was 23 years ago, by Pulizter winner Jon Franklin: "We will have to turn our backs on the duality and, with it, the faith of our fathers.... We will have to look into the mirror, surrender illusion, and make peace with the fact that we're staring at a machine. We are mechanisms, pure and simple, explainable without resort to the concept of soul."
Machines are fungible, built from finite, interchangeable parts, lacking any free will, useful and valuable only to the extent that they are predicted and controlled. They are dead. This is how psychiatry sees people. As historians have often noted, psychiatry is also fundamentally racist.
It is vitally important however, to recognize that the general character of a field of theory and practice cannot be automatically applied to every practitioner in that field. I say that psychiatry is an essentially racist field, but I do not that say Dr. C is a racist, or that Dr. J is a racist. In fact, these individual psychiatrists, whom I know personally, are basically good people. Why they do what they do is a long and complex tragedy which will only end when that central understanding, so well-stated by Neil Steinberg today, becomes universal.
Individual people are alive. Minds are not brains. Emotion, behavior and human society will not actually be improved, and mental illness will not be cured, by fine-tuning neurochemistry. Jon Franklin was wrong, NAMI is wrong.
This is a problem: confront it!
Friday, July 30, 2010
Saturday, July 24, 2010
Monday, July 19, 2010
Saturday, July 17, 2010
Friday, July 9, 2010
The psychiatrist in charge of the treatment team (Dr. C) had been contacted by Mr. D's family attorney (not me), and asked why there appeared to be so many different diagnoses over the short one-year period the guy has been at Elgin.
During the staffing, Dr. C made the point that for purposes of getting Mr. D a conditional release, he was very confident that he could thoroughly support and justify his own diagnosis. This comment, of course, did not answer the reported attorney's question about why there had been so many different dx's. Either I had missed something or Dr. C was being kind of evasive, so I asked him if he had any feeling for why the family attorney, as an attorney, had asked about the multiple diagnoses. He shrugged and smiled, and it suddenly occurred to me that maybe he figured I had put the guy up to it (which I had not). Simultaneously I realized, maybe the family was preparing a malpractice action (which they probably should).
Well anyway, there ensued a somewhat longer discussion relating to this than I had intended. It was mentioned that it's not particularly unusual for a patient at Elgin to be diagnosed with various different mental disorders by different doctors over a period of years.
It also came up that it's somewhat unusual for a criminal court judge to pay a lot of attention to the nature of any particular diagnosis, but it's not unusual for a judge to expect such things to be pretty settled and stable for a while before a patient is released. This was the specific context in which Dr. C said he could thoroughly support his own dx for Mr. D.
Then came the (in my opinion) bombshell comment from Dr. C. I wrote it down word-for-word.
"Diagnoses are not really so important. Symptoms are what's treated with psychotropic meds."
Many people do know this. But in these circumstances, it was a highly incriminating admission. The psychiatric slaves at Elgin Mental Health Center, Chester Mental Health Center, Alton Mental Health Center, and all the other state nuthouses in Illinois, are always told that they must understand they have mental illnesses, which are legitimate brain diseases, which require lifelong medical treatment. They must take medication, or they will never be released.
These often unwilling "patients", and their families, and the public, are told over and over again by very professional salesmen and PR experts and TV advertizing, that mental illnesses are just like any other illness. Elgin has all of the propaganda of the National Alliance on Mental Illness (NAMI) prominently displayed and freely available to anyone who comes there. All state mental health workers are trained to think this way, expected to implicitly believe in this orthodoxy.
Supposedly there is "stigma" attached to mental illness. But man, I can tell you, I myself am severely stigmatized, not for being mentally ill, but for (supposedly) not believing in mental illness. Countless times, I've apparently earned the scorn of state employees for questioning the objectivity of a psychiatric diagnosis or for saying it's all arbitrary.
Now here's Dr. C: "Diagnoses are not really so important."
What he means is, psychiatric diagnoses have NOTHING to do with whether and in what way anybody ever gets "treated" by mental health professionals. Psychiatry is not help, but covertly coercive control. The dx's are all justifications after the fact, subjective b.s., pseudo-medical, anti-scientific ... fraud.
Sooner or later society is going to catch on to this, and there will be some kind of hell to pay.
Monday, June 28, 2010
A client of mine (I'll call him Bobby) was found not guilty of first degree murder by reason of insanity, diagnosed with schizophrenia, and committed to Elgin Mental Health Center about fifteen years ago. One of the things everybody noticed about him was that he kept saying he was the King of Egypt. Another thing everybody noticed was that he refused to take psychotropic meds.
When I first spoke to Bobby, he was especially concerned - perhaps obsessed - that I needed to see the official government identification, held for him by the director of the institution, which established that he was King of Egypt.
After a couple monthly staffing meetings, I told Bobby that his treatment team was not likely to stop using this King of Egypt thing against him. I was pretty sure they would continue to say it was a symptom of his psychosis and proof that he shouldn't be released.
I suggested he do one of three things, whichever seemed best to him: a) he could prove conclusively that he was in fact the King of Egypt (his official ID had not been effective for that; but maybe the Egyptian ambassador could vouch for him, or maybe there were other documents proving his lineage); b) he could convince his treatment team that believing he was the King of Egypt did not make him any more likely to be violent in the future, and therefore that what they saw as his delusion was harmless; or c) he could lie about it and tell everybody he no longer believed he was King of Egypt.
Bobby chose to lie, pursuant to option c). Within a year or two, people stopped listing the King of Egypt thing as a symptom in his psychiatric chart. He subsequently was twice granted expanded privileges by the criminal court, and will soon petition for conditional release with the full support of the state institution.
I don't know whether he still believes he's King of Egypt or not. Actually, come to think of it, I don't know whether he ever did believe it. Maybe he was lying to begin with. What I do know is that Bobby's behavior, observed by all the experts as symptomatic of schizophrenia, changed one day, because he decided to change it of his own free will. Nothing else happened, there was no effective medical intervention.
So ... "behavioral health" seems appropriate to me, if it has to be any kind of health to begin with.
Wednesday, June 23, 2010
Monday, June 21, 2010
In regular modern medicine, a patient presents himself to a doctor with a complaint about how he feels or something which is happening to his body. The doctor listens to the complaint, does tests, discovers some kind of objective biophysical problem, and after making a diagnosis looks to clinical experience or medical literature for a cure, which the patient is offered.
In psychiatry, someone else brings the patient in (often under duress). The doctor listens to and automatically believes complaints about the patient's behavior. A decision is made regarding what to do to the patient (usually drug him) to disable him from behaving in such a disagreeable fashion. Last of all, a diagnosis is looked up to formally justify the chosen "treatment".
Regular modern medicine: Dx first - then Rx. (Dx --> Rx.) The treatment depends on the diagnosis.
Psychiatry: Rx first - then whatever Dx will justify. (Rx --> Dx.) The diagnosis depends on the treatment.
In state nuthouses, involuntarily committed patients are told in so many words that they either take the meds or they'll never get out. It's illegal to tell them that; but they are all told exactly that nonetheless. If somebody steadfastly refuses meds and cannot be legally forced to take them, sometimes the only solution is to change the diagnosis. But this can be done with surprising alacrity.
Several years ago I had a client named Jim. He had gone from Chester Mental Health Center to Alton Mental Health Center to Choate Mental Health Center, never taking the meds he had been prescribed for the psychosis which all the doctors were apparently certain he "had". His Thiem date (when the system would be constitutionally required to release him) was fast approaching, and as it turned out, nobody wanted to litigate a civil commitment.
One day Jim called me and reported, with amazement, that his psychiatrist had taken him into an office and asked what diagnosis he wanted. I'd previously given Jim a copy of DSM-IV-TR, so I said, well, that's easy, just look in the book and find a diagnosis that wouldn't be treated with psychotropic meds. He went to pages 338-343, and told his psychiatrist that he should be diagnosed with Substance-Induced Psychotic Disorder (code 292.11), in remission.
This was quickly done. The Illinois Department of Human Services put together all the necessary documentation to make it look medical, and soon petitioned the criminal court for Jim's release, which was granted. Now years later, he lives with his elderly mother and gets along just fine.
In this case, the nuthouse needed to release Jim as successfully "treated", and they wanted credit for it. Because of the timing, they had to justify his not taking meds. No problem, they just changed his diagnosis accordingly.
Psychiatry: Rx --> Dx. Simple, but quite the fraud.
Wednesday, June 9, 2010
Friday, May 28, 2010
Thursday, May 27, 2010
Monday, May 24, 2010
Everywhere I went at the American Psychiatric Association’s 163rd annual meeting in New Orleans, mental health professionals were in contortions over coercion and treatment. But most of the time they seemed almost completely unaware of it.
The contortions were semantic. E.g., in Course 17 on Sunday: “Treatment of university student populations must be based on a collaborative model; and your best ally will be campus security.”
That one came from Ayesha Chaudry, M.D., a psychiatrist employed by Duke University’s center for student counseling and psychological services. The question apparently never occurred to her, and was not asked during the course: What exactly is the role for the police within a collaboration between a student and a counselor? – or even more fundamentally: Who is a doctor and who is a cop?
Dr. Chaudry cited statistics that almost half of all college students have psychiatric disorders, but only 25% are ever treated. The number of these students prescribed psychotropic medications has gone from 9% in 1994 to 25% in 2006, but it’s not enough. Therefore, it has become the task of clinicians to develop every possible trick and contrivance to get those kids on meds in the face of the irrational and unfair stigma against it.
One of the best tricks has to do with getting around the pesky confidentiality rules, like HIPPA and FIRPA. It turns out that even if a kid refuses to sign a release of confidentiality for a psychiatrist to talk to his parents, he'll often allow her to talk to the dean, or a professor, because he may need permission to drop a course without penalty, or extra time for an exam. The dean or professor is not bound by doctor/patient confidentiality and can call the kid's parents without a release. What a clever betrayal of trust!
Dr. Chandry doesn't know if she's a doctor or a cop, really. Maybe no psychiatrist does, maybe that's the big problem and the reason the stigma seems so intractable. They ought to be more honest about it, at least with themselves.
Thursday, May 13, 2010
Statutes of limitation might be tolled until majority, to enable children drugged for their behavior to bring abuse claims, if they suffer from earlier decisions made for them by adults.