Forced Mental Health Treatment–The Elephant In The Room

Not that long ago I left a comment on a Huffington Post blog. The blog was that of an East Anglia University student, Beth Seward, in the UK. The post was entitled The Elephant in the Room: The Stigma Around Mental Health. My comment, and I stand by it, was as follows:

The elephant in the room is not “stigma”. The elephant in the room is forced mental health treatment. If it were otherwise people wouldn’t be pretending, very intently in fact, to ignore it. Want to do something about prejudice and discrimination? Repeal mental health law. When you’ve gotten rid of forced treatment, you’ve gotten rid of much of the rationale for prejudicial mistreatment. Forced treatment outside of the mental health system is assault.

I will always admire the late Dr. Thomas Szasz for his dedication to the abolition of forced mental health treatment. I think all doctors of psychiatry should oppose forced mental health treatment, and I would like to see more psychiatrists express their doubts as to its effectiveness. I feel the same way about patients and former patients. I have heard the view expressed by some folks that the forced treatment he or she endured did him or her some good. This was never my experience.

Out of forced treatment we get two castes of citizens. Citizens with full citizenship rights, citizens who have not known forced treatment, and citizens with a portion of their citizenship rights violated, denied and ignored, citizens who have known forced treatment. Mental health law is that law that allows for the detention, and prejudicial maltreatment, of people who have broken no law. From this detention come permanent records that will follow that person around to the end of his or her days, and beyond.

Mental health law should be repealed. There should not be a law for locking up non-law breakers. I don’t think a person can be adamant enough on this point. Mental health law is a very real threat to the freedoms that Americans hold so dear. Nobody is immune from the diagnostic labeling bestowed by well, nor not so well, intentioned meddlers. To deprive the rights to some that we allow for others should be considered, and this is my point, criminal. By doing so, we’ve just made a rift between those citizens we consider worthy and those citizens we consider less worthy based entirely upon prejudice.

To quote from the Declaration of Independence:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Forced mental health treatment jeopardizes people’s right to Life, Liberty and the pursuit of Happiness. When a person is detained in a prison masquerading as a hospital that person’s right to liberty is being violated. When a person is subjected to life threatening treatments in that prison that persons right to life is being violated. When a person’s opportunities are diminished due to such an experience, that person’s right to the pursuit of happiness is being violated.

The elephant in the room has been doing much damage, and yet so many people are pretending that everything is fine. Everything is not fine. We had the same problem when people were mistreated on account of their skin color. Now people are being mistreated on account of their run ins with the mental health authorities. Forced treatment is mistreatment, now and always. Forced treatment involves depriving a person of his or her liberty. All the harm that comes to people in the mental health system comes from this one little exception to the laws that govern our land.  I think it about time we got rid of the exception.

More Or Less Biology In Psychiatry–That Is The Question

Much newsprint has been wasted recently on the split between the APA (American Psychiatric Association) and the NIMH over the revision of the DSM (Diagnostic and Statistical Manual of Mental Disorders)  that is going to be called the DSM-5. In my view, letting the 100,000 manuals bloom is not going to be any better of a solution than letting the 100,000 diagnoses bloom in the long run. If we are going to treat every patient as an individual, for the sake of the individuality of his or her condition (and genetic makeup), that’s going to make for a whole lot of variation in disorder (and/or order) expression.

The New York Times covers the story, regarding the NIMH APA divide, in a story with the heading, Psychiatry’s Guide Is Out Of Touch With Science, Experts Say. Of course, it always depends on which experts you ask. The experts the mass media is still slow to consult, and the New York Times is no exception in this regard, are those experts with lived experience on the receiving end of mental health treatment.

While typically critics of the DSM have tackled the subject from one side of the political psychiatric spectrum, here comes mob boss Thomas Insel, godfather of the NIMH, attacking from the other. In the first instance, you have people who object to the biology in biological psychiatric theory, (Theory, now there’s as important a word as any.) in the second, you have a group that doesn’t think the APA is biologically grounded enough.

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

The DSM focuses on symptoms precisely because we don’t know the causes. Dr. Thomas R. Insel, apparently, thinks otherwise.

Precision seems to be a big part of the problem. In psychiatric diagnosis, theoretical speculations aside, there are no precision tools.

The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

Or, a possibility not considered here, we’ve got five misdiagnoses floating around for which there was no underlying condition in the first place.

Solution. The NIMH is developing it’s own manual, Research Domain Criteria, or RDoC.

About two years ago, to spur a move in that direction, Dr. Insel started a federal project called Research Domain Criteria, or RDoC, which he highlighted in a blog post last week. Dr. Insel said in the blog that the National Institute of Mental Health would be “reorienting its research away from D.S.M. categories” because “patients with mental disorders deserve better.” His commentary has created ripples throughout the mental health community.

Consider, ripples sent throughout the mental health community, ripple throughout the “mental illness” community (i.e. the mental health ghetto). Now whether “patients with mental disorders” are going to get “better” treatment thereby is a big leap. Too big a leap in fact to make. So sorry, my poor victims of standard psychiatric malpractice!

Whatever you call it, my guess is that this switch still represents a way of billing insurance companies, the most important role for patient consumers a psychiatrist assumes. Of course, given that this paradigm change is all about biological explanations, I expect the treatment the insurance companies will be paying for is a chemical fix. Given this situation, the extent to which pharmaceuticals damage patients is still the great unasked question biological psychiatrists do their best to avoid asking.

The Evolution Revolution

Forced treatment is the big secret in the mental health “care” world today. Once upon a time, not that long ago, there was only one form of mental health treatment available, and that was it.

The American Psychiatric Association in fact grew out of the Association of Medical Superintendents of American Institutes for the Insane. Where once you had the heads of what were then called Lunatic Asylums, now you have an association of professional pill pushers.

The big lie is that the pills they are pushing, and whose usage they are promulgating, are good for people, and not people in general, but specific people. People diagnosed with a “mental disorder”. This diagnosis is thought to make the people who have been given one somehow different from the general run of humanity and, therefore, in need of the fix that comes with a drug.

The truth is that mental health treatment is about social control. We have this law that permits confinement of anybody acting oddly on the grounds that they may cause harm to themselves or others. It would be a serious mistake, albeit a common one, to assume that people are held in psychiatric institutions because they are dangerous.

People in mental hospitals are not there because they were given a trial by jury. Usually they are there because they were given a hearing by judge, attorney, and psychiatrist in which judicial opinion subordinates itself to the whims of professional bias and procedural habit. Mental health commitment hearings, in other words, in the present day and age, are little more than kangaroo courts.

Drugs can’t fix people. Drugs can damage people. Drugs can’t straighten out faulty logic. Education can teach logical deduction. Drugs can’t supply insight. Drugs generally mask a problem rather than correct it. Masking a problem is not dealing with it, and coming  up with a solution to it.

Waiving independence in order to be treated by the mental health authorities, usually as a charity case, is not the best course of action to take as a rule. Doing so often involves forfeiting rights we think of as basic to our species. This revelation may take time to register and resonate, but it should come in time.

Yes, Virginia, there is life beyond the confines of the Mental Health clinic. One is not bound to the human services system the way a rat can be restricted to its track through a maze.  The thing is that that system shares many similarities with a rat maze. If it didn’t, researchers wouldn’t be studying rats with the idea of better understanding human behavior. I would strongly suggest that if success in the world is at all important to you, you should abandon the maze.

The irony found in the heading of this post comes with the realization that more complex organisms evolved from less complex organisms. The butterfly in a display frame is not a butterfly in flight. Our capacity expands to the extent that we learn to escape those boxes that other people would try to contain us within. Quite apart from biological limitations, and barring extreme circumstances, we have minds that allow us this advance and that departure.

Pre-psychosis In The News

Attenuated psychosis syndrome, alternately called psychosis risk syndrome, pre-psychosis and prodromal disorder is going into section 3 of the DSM-5. This is the section for disorder labels that need more review, and which will not be reimbursable. The bad news is that it is in the DSM at all, and being in the DSM, it’s going to be considered as a disorder. The good news is that it is not an “official” disorder label, insurance companies are under no obligation to pay for it, and so its not likely to explode into an epidemic next year.

Researchers, it seems, much less fastidious than DSM revisers, are intent in studying people afflicted with this fictitious and elusive label. The latest rage in pseudo-scientific discoveries concerns this nebulous early stage in the development of psychosis. An article in the Detroit Free Press, Schizophrenia may give early warning signs, is typical.

Researchers in Chapel Hill looked at brain scans of 42 children, some as young as 9, who had close relatives with schizophrenia. They saw that many of the children already had areas of the brain that were “hyper-activated” in response to emotional stimulation and tasks that required decision-making, said Aysenil Belger, associate professor of psychiatry at the UNC School of Medicine and lead author of the study.

Now whether psychiatrized families actually think differently from non-psychiatrized families is anyone’s guess, and it could always be the topic for additional research should anybody choose to go there.

People who have a parent or sibling with schizophrenia are about 10 times more likely to develop the disease than those who do not. Signs of the illness typically begin in the late teens to mid-20s. These include declines in memory, intelligence and other brain functions that indicate a weakening in the brain’s processing abilities. More advanced symptoms may include paranoid beliefs and hallucinations.

Perhaps this sounds like an astonishing figure until you realize that it actually means 1 in 10 people rather than 1 in 100 people.  This is to say that among the 1 in 100 people that get described as psychotic, 1 in 10 of their closest relatives could also be so described. Unlike in the rest of the world where the rate stays more or less at 1 %. 1 in 10 means that chances are, if you are in a family haunted by the phenomenon of psychosis in one of its members, 9 out of 10 of it’s members most probably wouldn’t be described as psychotic anyway.

“Of all the people who seem to have compromised circuitry in their brain, if we come back and image them in later years, some may be moving toward the cluster of symptoms for schizophrenia while others may have other types of deficits,” such as bipolar disorder or attention deficit disorder, Belger said.

The article goes on to add, “Still others may avoid serious disorders altogether”, but the damage has been done. If you were an agent of the inquisition, let’s say, looking for witches, you are not going to be questioning the existence of witches. If you want to find fault in anyone, or anything, no problem. Just conduct a fault finding mission. If you are out to praise those people, well, hunting for future “mental illnesses” is just not the way to do so.

I think these researchers have better things to be doing with their time. We really have a problem when the DSM starts predicting disorders in people.  Ignoring any fork in the pathway that may lead to dysfunction, from functionality, is a major shortcoming, I would imagine. Ditto, in the case of paths that lead to folly from reason and wisdom. You are postulating that mental and emotional disturbances are a matter of predestination, and I imagine such leaps of faith belong in the realm of superstition rather than in the realm of scientific inquiry and skepticism.

This doesn’t mean that pre-psychosis isn’t going to make it’s way as a reimbursable disorder in a future edition of the DSM. I imagine, if things continue going the way they are going, it will. There is a lot of nonsense in the DSM. I would say maybe 100 % of the DSM is sheer nonsense. All the same, quite literally, even a listing as a category for diagnosis won’t make future psychosis a real disorder in present time.

The Current Crop Of Whoppers On Capitol Hill

The vote on a bill to restrict the Second Amendment rights of people in America is described as still “too close to call”. The story, as reported in FloridaToday.com, goes under the heading, Background check plan needs GOP.

Words, words, words–it all becomes a blur, especially when so many of those words are just plain lies.

The plan would “strengthen the background check system without in any way infringing on Second Amendment rights,” Maine Sen. Susan Collins said in a statement explaining her support for the measure. But she added that “it is impossible to predict at this point” what will be in a final bill.

Excuse me, Senator Collins. If you are going to enter the names of people, many of whom are citizens, who AREN’T criminals, into a criminal background check system, for the express reason of denying them their Second Amendment rights, you CANNOT do so without infringing on Second Amendment rights.

Do I need to repeat myself!?

These background check measures that may be pushed through congress are unconstitutional so long as we have a bill of rights, but this is hardly the first time we’ve had unconstitutional laws on the books. If I remember correctly there was once this remedy to the mixing of the races called Jim Crow for the longest kind of time in the southern states of the USA.

The measure requires background checks for people buying guns at gun shows and online. Background checks currently apply only to transactions handled by the country’s 55,000 licensed gun dealers. Private transactions, such as a sale of a gun between family members, would still be exempt.

Thus, family members will still be able to sell arms to ex-felons, illegal aliens, spousal abusers, mental patients, and other errant human beings, and all is hunky dory. It is just licensed gun dealers who won’t be able to make such sales.

[Senator Joe] Manchin urged lawmakers to read the 49-page proposal. He said it should dispel any misconceptions about infringing on the constitutional right to bear arms.

I’m sorry. It will take more than a 49-page booklet to convince me that legislation enacted expressly for the purpose of infringing on the constitutional right of American citizens to bear arms is not legislation infringing on the constitutional right of American citizens to bear arms. When you diminish the citizenship of a segment of the population by subtracting this right or that, usually we have to call this subtracting, or restriction if you will, an infringement.

This attack on civil liberties and civil rights is plowing ahead full stream. It has been in effect, through unevenly enforced, since the insanity defense was used to condemn and excuse John Hinkley for shooting President Reagan. Blast the insanity defense! Incarceration should be about punishment, and not about therapeutic rehabilitation, regardless of the criminal’s mental state at the time of the commission of the crime. “Mental illness”, that ‘will o’the wisp’ of consensus reality, should not be an used to excuse people from punishment for criminal activities and, likewise, ill health should not be used as an excuse to imprison people.

The Great Need For Systemic Change In Mental Health Care

Failure and success are manufactured by people. This is part of the problem with the mental health system. On the one side you have the success stories, these are the people described as mental health providers. They make a considerable amount of money, live in enviable conditions, and support lifestyles to match. On the other side you have the failure stories, these are the people described as mental patients or mental health consumers. They tend to be chronically un or under employed, live in conditions of squalor, and seem to be doomed to repetitive cycles of failure that come of lamentable and impoverished circumstances.

Somehow advantage and privilege are built into a system that doesn’t serve it’s recipients so much. Instead you’ve got a self-perpetuating public service system that serves it’s service providers while crippling and impoverishing it’s service recipients. One career option, mental health professional, determines the role of the other, mental patient or mental health consumer. Trouble is the first, middle, and last name of the service recipient while the service providers official name is Help. The service provider is there to Help with the person in Trouble, the recipient, and the process continues. Should Trouble ever find an acceptable role in life Help is out of luck and out of a job.

Given that the provider’s lot is substantially above that of the recipient as a rule, this maintenance of Trouble is not such a tall order. The provider is paid to fail the recipient in his or her endeavors. The provider is essentially in the superior, more predatory, role and position. To draw a parallel from the animal kingdom, you always need more prey in relation to predators and, likewise, recipients must outnumber providers because the provider draws his or her sustenance from the recipients. Were the recipient not in a weaker position, the provider would not be in a stronger position vis-a-vis the recipient. Of course, this structural arrangement requires much collaboration from the community at large in order to persist.

Obviously if we haven’t got a sickness in the first place this isn’t about finding a cure. The cure to a bad situation is a better situation. Problem: if this be the case, you can’t cure the recipient without sickening the provider. When we’re dealing with essentially the lost causes of the survival game, no problem. The provider’s role is to survive by perpetuating the lost cause mythology of the recipient. The recipient’s role is to be the lost cause that supports the provider’s continued existence. Survival is more important to the providers than it is to the recipients in that the recipient’s role is fundamentally not to survive, but rather to be victimized. We don’t have an interdependence of equals, instead we have the relative independence and interdependence of superiors based upon the dependence of inferiors.

There is no way to label and treat people without making these more or less arbitrary value judgments regarding the relative merit of human beings. A wannabe is not a star attraction, but both wannabes and star attractions  are interchangeable. It is the audience that makes the wannabe a wannabe and the star a star, or further, the wannabe a star and the star a has-been. We’ve got more than enough overblown mediocre talents who make megabucks to go around. There is a world of worth beyond the dependency system that I have been critiquing that needs to be mined. This is a matter of rather than expanding mental health care services unto perpetuity, of contracting them. This is a matter of  creating a door crack  into the world at large rather than warehousing certain individuals in the world’s invalidated parenthetical doppelganger, that is, in a would be rehabilitation zone that rehabilitates no one.

The system needs changing. The system needs to lead to that which is not system. A self-perpetuating system of facility and debilitation is what we don’t need. While this system has been very good at convincing recipients of their debility,  it has been very bad at convincing them of their ability. This is because the recipients are not the only people in this system that need treating. The privilege and authority of the providers needs treating as well. They are all too often “sick” with their own sense of self-worth and power.  This conceit has blinded them to the assets of their clients. The providers need another role besides that of benevolent paternalistic dictator. The recipients need another role besides that of victim. The other side of the recipient’s misfortune is the provider’s fortune.  They just aren’t sharing enough of it yet, and this situation needs to change if some people are ever to achieve a better station in life.

Civil Rights Under Seige

If you thought former President George W. Bush, who wanted to screen every man, woman, and child of us for “mental illness” was bad, President Barack O’bama has climbed onto the same band wagon. President Obama essentially wants to turn our entire public education system into a mental health police state.

According to a report in the Bangor Daily News on the subject, White House wants $235 million for mental health programs.

President Barack Obama’s budget proposal will include $235 million in funding for new mental health programs focused on initiatives to help schools detect early warning signs and train thousands of new mental health professionals, an administration official said.

Alright that sounds benign enough, but just keep reading.

The new budget plan will propose $130 million for programs that train teachers and other adults to help recognize the early signs of mental illness in students. That includes $55 million for a new program called Project AWARE (Advancing Wellness and Resilience in Education), which will give states and local school districts grants to administer such programs, while also collecting data on how well they work.

I’ve got nothing against ‘wellness’ nor ‘resilience’, I just have many reservations about whether that’s what we’re going to get out of these programs or not. On the other hand, training people to recognize signs of “mental illness” can be very questionable, especially when one of those early signs is being under the age of 18.

Another $50 million would go toward training master’s-level mental health specialists, such as psychologists, nurses and counselors, who work in schools. The idea is to expand the mental health workforce to prepare for the demands of millions of Americans who will gain health insurance coverage next year under the Affordable Care Act.

The “mental illness” labeling rate has been skyrocketing for years. Imagine the present “mental illness” labeling rate. Imagine that rate going up even further. It’s got to be extremely difficult to sell insurance plans, treatment options, and anti-”stigma” campaigns, without also selling the “diseases” that go along with them.

The consequences of this “mental illness” selling platform doesn’t concern the President very much as, following the Newton Connecticut tragedy, making scapegoats of people in the mental health system rather than achieving any real gun control legislation is one way for him to give the appearance that he’s doing something about the problem of gunmen in schoolyards. I’m afraid it is going to be causative in so far as increased “mental illness” labeling is concerned, and I’m also afraid that it’s not going to be preventative when it comes to massive acts of violence.

Sooner or later, later apparently, it’s going to come around to acknowledging that these citizens who have had their citizenship rights taken away from them are still citizens. Then comes the revelation, now that we’ve got two unequal castes of citizens, how do we refer to them? Dividing people into sick and well no longer works as what we’ve actually got is a legal distinction rather than a medical one. Sick people get well. Lower class citizens get lower wages, if they get wages at all, substandard living conditions, and the distinction of being deprived of their constitutionally guaranteed rights.