It’s a blog, blog, blog, blog world

Two more blogs you should check out. Go now – these guys may be rogues in their fields. Somehow I’m picturing Jack Sparrow right now, and you can’t beat a mental picture of that!

First up, The Last Psychiatrist. He doesn’t name himself, but does say he’s an academic who specializes in forensics. Hmm. He doesn’t seem to be the “typical” psychiatrist and says things like this:

Psychiatry is politics, it is politics in the way that running for office is politics. It is not a science, it is not even close to science, it is much closer to politics.

No wonder he doesn’t seem to use him name. That kind of statement isn’t likely to earn him new friends in psychiatry. It’s SCIENCE DAMMIT! And if you say anything to the contrary, then you’re…..a SCIENTOLOGIST! (Or if you’re in the ECT Boys’ Club, you’ll drag a label out of the DSM Scrabble bag and fling that instead.)

So check out Dr. Jack Sparrow, The Last Psychiatrist. He’s got a touch of sardonicism, and I’m always a sucker for that.

Next up, Clinical Psychology and Psychiatry, A Closer Look. Start with this article on biased research and then keep reading. He’s got a number of hot buttons and they’re all dandies.

These are two high quality, interesting blogs and if you start reading, I think you’ll have a hard time getting out of your computer chair. I’m not responsible for eye strain.

In Russia, Psychiatry Is Again a Tool Against Dissent

Washington Post
Saturday, September 30, 2006; A01

In Russia, Psychiatry Is Again a Tool Against Dissent
By Peter Finn
Washington Post Foreign Service

DUBNA, Russia — On March 23, police and emergency medical personnel stormed Marina Trutko’s home, breaking down her apartment door and quickly subduing her with an injection of haloperidol, a powerful tranquilizer. One policeman put her 78-year-old mother, Valentina, in a storage closet while Trutko, 42, was carried out to a waiting ambulance. It took her to the nearby Psychiatric Hospital No. 14.

The former nuclear scientist, a vocal activist and public defender for several years in this city 70 miles north of Moscow, spent the next six weeks undergoing a daily regimen of injections and drugs to treat what was diagnosed as a “paranoid personality disorder.”

“She is also very rude,” psychiatrists noted in her case file.

In person, Trutko presents a different profile, reserved and formal as she recounts her legal and psychiatric ordeal and invokes the minutiae of Russian law without having to refer to texts. An independent evaluation found that although she did not have an “ordinary personality,” she was “very gifted and creative” and displayed no psychiatric symptoms.

Trutko is new evidence that Soviet-style forced psychiatry has reemerged in Russia as a weapon to intimidate or discredit citizens who tangle with the authorities, according to human rights activists and some mental health professionals. Despite major reforms in the early 1990s, some officials are again employing this form of repression.

“Abuse has begun to creep back in, and we’re seeing more cases,” said Lyubov Vinogradova, executive director of the Independent Psychiatric Association of Russia, an advocacy group. “It’s not on a mass scale like in Soviet times, but it’s worrying.”

In those years, tens of thousands of dissidents were wrongfully subjected to forced hospitalization, sometimes for years, based on trumped-up diagnoses of “schizophrenia.” Dissidents were said to exhibit inflexibility of convictions and nervous exhaustion brought on by anti-government activities. “Reformist delusions,” the Soviets called it. If you were against communism, in other words, you were insane.

Some of the new cases have been abetted by institutions or doctors involved in it in the Soviet period. Trutko, who is originally from Uzbekistan, was diagnosed at the Serbsky Institute for Social and Forensic Psychiatry in Moscow, one of the most infamous of the Soviet institutions that imprisoned dissidents. It remains a secretive institution that has never faced up to its repressive past, according to human rights groups.

As recently as 2001, the institute’s director, Tatyana Dmitriyeva, denied that the Soviet Union engaged in any more psychiatric abuse than Western countries, according to the report “Human Rights and Psychiatry in the Russian Federation” by the Moscow Helsinki Group.

One of signatures on Trutko’s official evaluation, which declared she had paranoid personality disorder, is that of Yakob Landau, a longtime Serbsky psychiatrist who headed the institute’s notorious Unit No. 4 during Soviet days.

Officials at the institute, a walled and forbidding complex in central Moscow, said no one was available to comment for this article. Investigators in Trutko’s case declined to comment.

The charge that psychiatry is again being abused is not universally accepted within the profession. “The problem of forced treatment or psychiatric persecution existed more than 20 years ago, but it was solved. And since then I haven’t heard of any case of forced psychiatric examination or treatment,” said Vladimir Rotstein, president of Public Initiative on Psychiatry, an advocacy group.

The Independent Psychiatric Association, however, says that the number of activists being wrongfully hospitalized in mental facilities totals dozens of cases in recent years and is increasing. Doctors and the courts are complicit with investigators who insist on a forced psychiatric evaluation or treatment, it says. Activists have also documented an increase of family or business disputes in which wrongful hospitalization provides an opening to seize a person’s property, Vinogradova said.

Most of the targeted activists are not affiliated with major human rights groups. Rather, like Trutko, they are stubborn gadflies who are involved in long-running feuds with local authorities. Their sometimes intemperate complaints against authorities are used to open criminal investigations for slander. This allows authorities to seek hospitalization. Unlike Soviet dissidents, these activists are put away for relatively short periods of a week to several months.

Roman Lukin, a businessman in the Volga River city of Cheboksary, was hospitalized last year for “unexplainable behavior” after he held up a sign on a public square calling three judges “creeps.” Seeking redress for a bad debt that ruined him, Lukin felt he had not received justice from the courts. He spent two weeks in the local psychiatric hospital, which recommended that he undergo further examination at a specialized clinic in Moscow for possible “paranoid personality disorder.” Independent Psychiatric Association specialists evaluated Lukin and found no sign of mental illness.

Nikolai Skachkov, who protested police brutality and official corruption in the Omsk region of Siberia, was ordered to undergo a psychiatric evaluation last year because investigators said they suspected he was suffering from “an acute sense of justice.” He spent six months in a closed psychiatric facility where he was diagnosed as paranoid. The association, which conducted a separate evaluation earlier this year, found that he was healthy.

“Psychiatry in this country has always been a tool of the authorities, a tool for managing people and pressuring people. And it still is,” said Boris Panteleyev, head of the St. Petersburg Committee for Human Rights.

In an interview in her apartment, Trutko recounted her own long run-in. “Now I have this stamp on my forehead that I am a psychiatric patient,” she said. “I will always have this medical record now. That means I cannot go to court because judges say I’m a psycho and call for an ambulance.”

Trutko is well known in the courts in this town, having argued dozens of court cases against the local authorities and police. She is studying to be a lawyer, and for several years has acted as a public defender, as advocates without law degrees are called here.

Her troubles with mental health authorities began four years ago in a courtroom in Dmitrov, about 35 miles from Dubna.

Trutko asserted that the judge displayed bias against her client in a property dispute, and she moved to have the judge withdrawn. She also complained that the judge was not wearing her robe as required and that the Russian flag was improperly displayed. The judge, who later left the bench and could not be reached for comment, alleged that Trutko said, “Look at that fat pig sitting up there,” according to legal papers.

Prosecutors opened a criminal case against Trutko on charges of contempt of court. In July 2003, the court ordered Trutko to undergo an involuntary psychiatric evaluation. Psychiatrists at the hospital said she was uncooperative, illogical and displayed emotional reactions that were “not adequate” — a common phrase here for mental illness.

The Independent Psychiatric Association questioned these conclusions. Its own evaluation of her, conducted by four psychiatrists, found that “she is not an ordinary personality, but a very gifted and creative person. . . . No psychiatric symptoms were observed. She shows high intellectual ability and good memory. She does not need any treatment.”

Trutko continued to battle the criminal complaint in court. Before a hearing at the higher Moscow regional court, she filed a motion seeking the removal of a panel of judges from her case, again asserting bias. In this case there was no claim of verbal abuse, but prosecutors said her motion amounted to slander and contempt.

In April 2004, after leaving a hearing on her case in Moscow, Trutko was detained by investigators and taken to the Serbsky Institute. It was a Friday evening when she was admitted and there was no expert commission available to evaluate her, Trutko said. Human rights groups protested her detention and threatened legal action. Trutko said she was released the following Tuesday morning without having undergone any formal examination by psychiatrists.

But the institute issued a six-page evaluation that said she suffered from a “paranoid personality disorder.” The condition manifested itself in her “subjectivity,” her “tendencies to verbal aggression,” her “suspicious” personality and her “inability to understand the peculiarities of interpersonal relations and communication,” medical records show.

The report recommended that she undergo forced hospitalization and treatment.

In September 2004, a Moscow court approved that approach. But the authorities, for reasons that remain unclear, did not act on the order until they stormed Trutko’s apartment earlier this year.

Despite her subsequent release, Trutko said, the court order remains in effect and she could be institutionalized again at any time. “My career is ruined,” she said. “I just stay at home.”

The Pope

Apparently the Pope has gone mentally ill due to his recent call for peace.

http://www.jihadwatch.org/archives/013138.php 

So far, no indications that he might be forcibly shocked, though there have been calls for him to be forcibly shot.

The Evolution of the Consumer Movement: Letters to Editor

An absolutely fantastic response to the June report on the consumer/survivor movement in Psychiatric Services. Well done, my friends.

Psychiatr Serv 57:1212, August 2006


David Oaks

To the Editor: The essay “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism” (1) in the June issue attempts to impose false labels and a skewed history on activists for human rights in mental health, including the nonprofit organization that I direct, MindFreedom International.

The origin of our social change movement cannot be traced to a few antipsychiatry theoreticians and campus intellectuals. Many of us actually credit the civil rights movement and our own experiences of psychiatric abuse as the original sources of our inspiration. We can and do organize on our own. The authors use the undefined term “antipsychiatry” 34 times in their essay, applying that label to many of us who do not describe ourselves or our groups in that way. There are, for example, compassionate, practicing psychiatrists who play an active role in MindFreedom.

The authors claim that psychiatry has addressed our key grievances “to some degree.” Even if some psychiatrists have reduced the dosages of neuroleptics prescribed, overall neuroleptic prescriptions are skyrocketing. Neuroleptic prescriptions for youths have shot up more than fivefold in less than a decade (2). From our perspective, both electroshock and psychosurgery have experienced a resurgence in popularity within psychiatry and the mainstream press. Many states have greatly expanded commitment criteria, and most states have implemented involuntary outpatient commitment. Courts now order some MindFreedom members who live peacefully in their own homes to take neuroleptics involuntarily.

The authors appear to observe us from afar through a flawed lens, which may explain their factual errors. The well-respected activist Leonard Roy Frank is not the founder of Support Coalition International. Support Coalition International and MindFreedom International are not two separate organizations—our name change occurred in 2005. The essay aligns the history of our movement with the “radical left” to a great extent, ignoring decades of outstanding work by conservatives and libertarians in fighting psychiatric abuse. Today, conservatives lead the grassroots opposition to mental health screening in schools.

Consider the bias inherent in this sentence: “Psychiatry continues to fight antipsychiatry disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults.” The authors appear to transmogrify into “antipsychiatry disinformation” all public education efforts that are inconsistent with the American Psychiatric Association’s official position.

This is my 30th year working for human rights and alternatives in the mental health system. We have made mistakes. We are not perfect. But I am very proud of our social change movement, which includes concerned family members, advocates, attorneys, mental health professionals, and interested members of the public. The authors claim that the psychiatric profession finds it difficult to communicate with us. The fact is that the American Psychiatric Association has generally refused our repeated invitations for conversation.

Somehow, some people who have experienced serious human rights violations in the mental health system—including unscientific labeling, forced drugging, solitary confinement, restraints, involuntary commitment, electroshock, and more—have reached deep within the human spirit and found the power to speak out and unite nonviolently (3). Please reply with dialogue, not distortion.

David Oaks

Footnotes

Mr. Oaks is director of MindFreedom International, Eugene, Oregon.

References

1. Rissmiller D, Rissmiller J: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism. Psychiatric Services 57:863–866,2006

2. Carey B: Use of antipsychotics by the young rose fivefold. New York Times, June 6, 2006, p A18

3. Mahler J, Unzicker R, Foner J, et al: Taking issue with taking issue: “psychiatric survivors” reconsidered. Psychiatric Services 48:601,1997

———–

Paolo del Vecchio

To the Editor: The Rissmillers’ Open Forum article in the June issue linking antipsychiatry with the mental health consumer movement does a disservice to the thousands of consumers working to improve the lives of people with mental illnesses. The essay also fails to acknowledge the many psychiatrists who partner with them.

Today’s consumer movement is not “radical.” It is a mainstream, cornerstone approach to improve mental health care quality as called for by the U.S. Surgeon General (1), the President’s New Freedom Commission on Mental Health (2), and the Institute of Medicine (3).

Rather than “fighting against pharmacological treatment,” the movement supports the consumer’s choice of treatments—including medications—and is often active in promoting increased financing for mental health services, insurance parity, and the protection of individual rights, such as health care privacy.

The movement comprises courageous individuals who, at some risk to their own livelihoods, come out of the closet about their own experiences with mental illness and give back to their communities by forming support groups, operating drop-in centers, and educating the public against stigma and discrimination. It is unjust to discredit mental health care consumer advocates and their hard work by linking them with antipsychiatrists, including Scientologists.

Contrary to the authors’ assertions, psychiatrists are engaged in ongoing collaborations with the consumer movement, with activities that range from conducting local public awareness events to convening a national dialogue series to identify collaborative approaches to improve care (4). Past APA president Steven S. Sharfstein, M.D., reinforced this effort when he endorsed the need for “a collaborative approach with input solicited and accepted from the patient” (5).

Psychiatry recognizes that alliances with those served—whether on the clinical, community, or policy levels—are in our mutual interest: the promotion of mental health recovery.

Paolo del Vecchio, M.S.W.

Footnotes

Mr. del Vecchio is associate director for consumer affairs at the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

References

1. Mental Health: A Report of the Surgeon General. Washington, DC, Department of Health and Human Services, US Public Health Services, 1999

2. Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President’s New Freedom Commission on Mental Health, 2003

3. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC, Institute of Medicine, 2006

4. Consumers and Psychiatrist in Dialogue. Rockville, Md, Department of Health and Human Services, 1997. Available at www.mentalhealth.samhsa.gov/publications/allpubs/OEL00-0009/

5. Sharfstein S: Recovery model will strengthen psychiatrist-patient relationship. Psychiatric News, Oct 21, 2005, p 3

————

Gregory Ludwig

To the Editor: During the past 27 years, I have studied psychiatry and psychology as a student, as a patient, and as a professional, and since college I have written and edited published work in these areas. From this perspective, I would say that although the Open Forum by the Rissmillers, which claims to survey the “antipsychiatry” movement, aims for a worthy goal, it is weak because of its imprecision about concepts, its less-than-adequate research, and its rather stereotyping characterization of certain intellectual figures in the 1960s and 1970s and the significance of their more responsible ideas.

Perhaps the best way to undermine the authors’ central apparent argument—that antipsychiatry was a golden banner that started as an intellectual game among a few radicals and then, after virtual exhaustion, was picked up by a movement among obstreperous consumers that seemed nostalgic for 1960s leftist political and intellectual styles—is to quote from Dendron, a sort of samizdat newsletter that eventually provided the basis for the organization Support Coalition International, whose name was changed last year to MindFreedom International. In a 1988 interview with none other than the renowned psychiatrist R. D. Laing by David Oaks, editor of Dendron at the time and currently director of MindFreedom, Oaks asked, “How can ex-inmates [of psychiatric wards] and progressive therapists work together?” Laing answered, “I’d have to sit down with actual people, and simply talk about it. I don’t know enough about what Americans call the ‘hands-on’ situation to come up with a formula, some key to open up possibilities. The whole thing is: this is stitched together by personal trust [and] confidence between actual people” (1).

If he was describing how a “progressive therapist” might help the budding “psychiatric survivor” movement, Laing was also characterizing the most fundamental method of relating between doctor and patient. But if this was so, it may have been unintended and ironic because he definitely seemed surprised that Americans—with their homely “hands-on” efforts—could have a pragmatic way of organizing a pro-patient movement. In fact, his tone seems that of a musty old European doctor-patient fundamentalist.

So much for the Rissmillers’ claim or suggestion that there is some substantive continuity—almost on the order of a grand, insidious historical error—between Laing, Szasz, and others and between their hermetic intellectual efforts and the more modern consumer efforts, now enabled by the Internet.

The more likely reason for the growth of the consumerist movement might be today’s widespread style of practice of psychiatry and such things as the pharmaceutical industry’s medical hegemony. More fundamentally, the better reason among many people involved in the movement might simply be good sense.

Gregory Ludwig

Footnotes

Mr. Ludwig is a freelance editor and writer, Highland Lakes, New Jersey.

Reference

1. Exclusive Dendron interview: R.D. Laing. Dendron, Feb 1988, pp 1,6,7

————

Kathleen M. Hill

To the Editor: The description in the June Open Forum of consumer activists and their history might lead your readers to conclude that the consumer movement is a fringe group—marginalized and bent on spreading disinformation. Readers should understand that the movement to ensure the human rights of people with disabilities is international in scope.

After many years of advocacy by the disability community, the United Nations General Assembly established a committee in 2001 to develop an international convention on the rights of persons with disabilities. The International Disability Caucus, currently composed of more than 50 nongovernmental organizations, was established the next year to help draft such a convention. The committee will hold its eighth session in New York this month to discuss the current draft of the convention.

Mental health advocacy groups have sought to include in the convention a universal prohibition of involuntary hospitalization and involuntary treatment. They oppose any language or action that would allow for mental health treatment, such as drugs or electroconvulsive therapy, to be forced upon any individual. They oppose any exceptions to be made to this prohibition for “exceptional circumstances,” with “appropriate legal safeguards,” or when it is “in the best interest of the person.” Advocates oppose the model of substituted decision making because it gives away a person’s legal capacity to another person, including a person’s right to make treatment decisions (4). Instead, they stipulate a model of supported decision making to be the keystone of a voluntary system of services that provides noncoercive support for an individual experiencing a mental health crisis.

Users and survivors of psychiatry are not “antipsychiatry”—we are anti-psychiatric oppression, because we have witnessed or experienced such oppression under existing mental health laws and practices.

More information about the United Nations Programme on Global Disability and the work of the International Disability Caucus can be found on the United Nations Enable Web site at www.un.org/esa/socdev/enable.

Kathleen M. Hill, B.S.

Footnotes

Ms. Hill, who lives in Cobalt, Ontario, is a mental health industry reform activist and a member of Support Coalition International and Survivors of Psychiatry.

————–

Ted Chabasinski

To the Editor: Psychiatric Services has done a disservice to any of its readers who might want an accurate picture of our movement for the human rights of psychiatric consumers/survivors. Anyone familiar with our history would have a hard time recognizing us from the bizarre and highly inaccurate article that appeared in your most recent issue.

The authors got it partly right when they mentioned two of our long-time leaders, Leonard Frank and Judi Chamberlin. If the authors had interviewed either of them, their account might have some resemblance to reality. Instead, the authors seem to have relied completely on articles and books, rather than first-hand reports from the people who have actually been involved.

As for myself, my 35 years of activity in our movement wasn’t inspired by any books written by Drs. Szasz or Laing or the other seminal thinkers named, although I respect their contributions. It came about from my ten years in a state hospital as a child, after I received electroshock treatment at age six at the hands of one of the profession’s most honored child psychiatrists. And most activists in our movement have also become involved because of their own experiences.

Though I would hardly expect a journal of the American Psychiatric Association to support our criticisms of psychiatry, I think that it would be much more useful for your readers—and more interesting—if you exposed them to accurate reports of our positions and activities. Any psychiatrist who relied on articles such as this to get a picture of our movement would be living in a dream world.

Ted Chabasinski, J.D.

Footnotes

Mr. Chabasinski is a patients’ rights attorney, Berkeley, California.

———

Nathaniel S. Lehrman

To the Editor: The Open Forum essay by the Rissmillers in the June issue omits the real reason for the antipsychiatry and consumer movements—the spectacularly harmful effects of biological, drug-based psychiatric treatment. That harm is reflected in the sixfold increase in the number of people receiving Social Security disability payments for psychiatric disabilities since psychopharmacology took over psychiatry 50 years ago (1). During this period, the percentage of the population said to be mentally ill has nearly tripled and the total number of inpatient care episodes for severe mental disorders, on a per capita basis, has quadrupled (1). This wave of mental illness is accelerating. The number of people disabled by mental illness has almost doubled in the past 15 years (1).

Another major omission is an account of how the replacement of psychoanalysis by psychopharmacology as the specialty’s ideological basis (which the essay mentions) produced these effects. In presenting psychoanalysis and psychopharmacology as the specialty’s only therapeutic alternatives, the paper omits, and thus denies, the role of counseling and psychotherapy, which has always been a major tool of physicians. The psychoanalysts maintained that their method, with its primary focus on childhood experiences and passive free association, was deeper than other methods. When its uselessness as a treatment for psychosis was finally recognized, the role of present-focused nonpsychoanalytic psychotherapy was ignored and a new emphasis on drugs took its place. However, when psychiatrists limit their therapeutic focus to medication and to its effects on symptoms, they abandon a fundamental part of their treatment armamentarium: a trusting relationship within which the psychosocial problems behind the patients’ symptoms are actively addressed.

Effective treatment should be the first demand of psychiatry’s critics (2). To attack what is wrong, which is the approach taken by the antipsychiatry movement, is necessary but not sufficient. The Rissmillers’ focus on Foucault, Laing, and Szasz, and their omission of respected professionals, such as Loren Mosher and Peter Breggin, erroneously imply that antipsychiatry’s criticisms have come almost entirely from a small, marginal, left-wing group. The authors do not, for example, mention either the International Center for the Study of Psychiatry and Psychology or its peer-reviewed journal Ethical Health and Human Services.

The Rissmillers’ account makes other errors. Although the Support Coalition International became MindFreedom International in 2005, the essay lists them as separate organizations, and David Oaks, not Leonard Roy Frank, is the founder.

The consumer-survivor movement has problems not mentioned by the Open Forum authors. In objecting to psychiatric abuses, the movement ignores the importance of good psychiatric care—as though such care does not exist—and essentially denies that professionals know how to provide it (3). The movement’s focus on the national and international political scene ignores where public mental health care decisions are really made—in individual states. The movements’ efforts at times to place supporters on psychiatric payrolls (as “consumer advocates,” for example) represent a co-optation that provides benefits to past survivors of the system while ignoring its current victims.

The Rissmillers’ account raises important questions about these movements. Its answers fall short.

Nathaniel S. Lehrman, M.D.

Footnotes

Dr. Lehrman is former clinical director of the Kingsboro Psychiatric Center, Brooklyn, New York, and is currently retired.

References

1. Whitaker R: Anatomy of an epidemic: psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry 7:23–35,2005

2. Lehrman NS: Effective psychotherapy of chronic schizophrenia. American Journal of Psychoanalysis 42:121–132,1982[CrossRef][Medline]

3. Lehrman NS: The rational organization of care for disabling psychosis: “if I were commissioner.” Ethical Human Sciences and Services 5:45–55,2003

———-

Michael Haan

To the Editor: Of particular interest to me were a few sentences near the end of the June Open Forum on antipsychiatry and the consumer movement: “Organized psychiatry has found it difficult to have a constructive dialogue with the evolving radical consumerist movement. Consumerist groups are viewed as extremist, having little scientific foundation and no defined leadership. The profession sees them as continually trying to restrict ‘the work of psychiatrists and care for the seriously mentally ill.’ “

Our message is actually very simple. We don’t like the way the profession treats people. The purpose of a consumer-driven mental health system, as suggested by the President’s New Freedom Commission Report, is to give life to the voices of the people who are being affected by the system.

Michael Haan

Footnotes

Mr. Haan is a consumer advocate in Seattle, Washington.

——-

Wesley Sowers

To the Editor: In the June issue, Rissmiller and Rissmiller provide an interesting report on the development of alternative perspectives on the nature of mental illness and the role of treatment. The authors describe two movements: the intellectually and academically based antipsychiatry movement and the community-based-populist “consumerist” movement. They contend that as the antipsychiatry movement lost momentum in the early 1980s, it was essentially transformed and incorporated into the more mainstream “consumerist” movement. They believe that antipsychiatry tactics had a significant impact on the course followed by the “consumerist” movement and that it became more radicalized as a result.

Although there may be some controversy with regard to this view, their report does provide an accurate assessment of the reforms that these two movements, alone or in combination, brought about. Their concluding remarks are unfortunate, however, stressing divisions between psychiatrists and consumer activists. Although it is true that some psychiatrists have had difficulty interacting with the more hostile elements of the consumer movement, and these elements have likewise had difficulty softening their perception of psychiatry, psychiatrists and consumers have made great strides in creating a dialogue in recent years, regardless of sometimes divergent viewpoints. Failure to acknowledge this evolution misses the key to the transformation that is currently under way.

Wesley Sowers, M.D.

Footnotes

Dr. Sowers is president of the American Association of Community Psychiatrists and medical director of the Office of Behavioral Health, Allegheny County Department of Human Services, Pittsburgh.

———

Laura Van Tosh

To the Editor: I am writing in regard to the Open Forum essay, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” From a historical perspective the essay was interesting and provocative. However, I was left with a hollow feeling. I wondered about patients and psychiatrists who work hard every day and toward greater understanding of mental illness and recovery. I especially wondered about the hesitancy a patient may have to take the first step for help, either in a self-help program or a psychiatrist’s office.

The authors’ conclusion was profoundly concerning in that it maintains acrude and cold separation between patient and doctor that does not further the relationship on which so many depend. In fact, it could easily drive help-seeking consumers from the development of a therapeutic relationship. This relationship must be seen as key to consumers who wish to delve further into analysis or clinical interventions that are required for many of us to maintain lives rooted in recovery values.

At a time when consumers are most vulnerable, we must foster the clinical dialogue, not drive a wedge that creates a problem to which there is really no solution. The authors’ message, while academically controversial, merely emphasizes this schism. Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.

Laura Van Tosh

Footnotes

Ms. Van Tosh, who is an editorial consultant for Psychiatric Services, is director of consumer affairs at Western State Hospital, Tacoma, Washington.

———

David J. Rissmiller and Joshua H. Rissmiller

In Reply: We appreciate the numerous letters regarding our article, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” We apologize for erroneously listing Mr. Frank as the founder of Support Coalition International. We also acknowledge that a fundamental problem was the need to summarize in 3,000 words three decades of history. This required limitation necessitated, as Mr. Oaks points out, “the authors appear[ing] to observe us from afar.”

Mr. del Vecchio writes, “Today’s consumer movement is not ‘radical.’ It is a mainstream, cornerstone approach to improve mental health care quality.” We disagree. Quoting from the eighth edition of Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, “it is important to distinguish between the mental health ‘consumer movement,’ which has been positive through empowering patients … and the ‘consumer/survivor’ movement, which has advanced a radical reform.”

Mr. Oaks, Mr. Ludwig, Dr. Lehrman, and Mr. Chabasinski all maintain that our basic hypothesis is false. They maintain that the survivor movement had nothing to do with the antipsychiatry movement. We dispute this point of view. As Tomes (1) noted, “The modern consumer/survivor movement arose in the wake of a radical restructuring of the U.S. mental health system between 1950 and 1970, resulting from deinstitutionalization, new psychotropic drug treatments, the widening legal conceptions of patients’ rights, and the intellectual critiques associated with the antipsychiatry movement.” We maintain that the antipsychiatry ethos, as disseminated by its seminal thinkers, was maintained as the antipsychiatry movement declined. It significantly affected two other movements: the consumerist movement that had been in existence since the late 19th century and the survivor movement, which dates back to worldwide deinstitutionalization. Many of the resultant hybrid radical consumer-survivor coalitions have carried forward, to this day, a message almost identical to that of the earlier antipsychiatry movement: that organized psychiatry is a self-serving guild that oppressively sacrifices consumers’ needs and has little basis in science.

Mr. Haan and Ms. Hill state that the survivor movement is “not ‘anti-psychiatry’” but is against “the way the profession treats people” and against “psychiatric oppression,” which Ms. Hill defines as “any language or action that would allow for mental health treatment … to be forced upon any individual.” Her listed doctrine could have been taken directly from the 1960s antipsychiatry manifesto, which contended that society deals with undesirables by locking them away. Foucault, as noted in our article, argued against society’s pressing need to sequester members who would not comply with its definition of “Reason.”

Mr. Oaks notes that survivor organizations encompass many disciplines, including psychiatrists. We never asserted otherwise. As Dain (2) notes, “Over the years psychiatry has been a target for antipsychiatry groups competing for influence or authority over the mentally ill. At various times these groups have included neurologists, social workers, new religions, consumers, and psychiatrists themselves.” The authors of several letters state that members of their movements do not consider themselves antipsychiatrists. However, many members do. Weitz (3), in an article titled “Call Me Antipsychiatry Activist—Not ‘Consumer,’” made the point, and organizations such as the Antipsychiatry Coalition emphasize it.

Mr. Oaks disputes our contention that in response to pressure from the antipsychiatry movement, psychiatry marginalized electroconvulsive therapy and psychosurgery, and he states that both are now resurging. In 1991 Fink (4) noted, “In spite of its acknowledged efficacy and safety … electroconvulsive therapy remains a controversial treatment, with limited use … the controversy results from attack by the antipsychiatry movement.” The demise of psychosurgery following the antipsychiatry movement has also been documented by Feldman (5). He noted that after the turbulent 1960s, “Public and political scrutiny severely restricted, or actually banned, the use of psychosurgery in many American states, as well as in other countries such as Germany, Australia, and Japan.”

Finally, the authors respectfully disagree with Ms. Van Tosh, who maintains that our essay widens an already existing schism and “could easily drive help-seeking consumers from the development of a therapeutic relationship.” We believe our essay offers a balanced view of the antipsychiatry movement’s evolution. However, we applaud and close with her sentiment, “Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.”

David J. Rissmiller, D.O. and Joshua H. Rissmiller

References

1. Tomes N: The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health. Health Affairs 25(3):720–7292006

2. Dain N: Reflections on antipsychiatry and stigma in the history of American psychiatry. Hospital and Community Psychiatry 45:1010–10141994

3. Weitz D: Call me antipsychiatry activist—not “consumer.” Ethical Human Sciences and Services: An International Journal of Critical Inquiry 5:71–722003

4. Fink M: Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. Psychiatric Clinics of North America 14:793–8011991

5. Feldman RP, Goodrich JT: Psychosurgery: a historical overview. Neurosurgery 48:647–6592001[CrossRef][Medline]

The Evolution of the Consumer Movement

Psychiatric Services
August 2006
David Oaks

Letter to the Editor

To the Editor: The essay “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism” (1) in the June issue attempts to impose false labels and a skewed history on activists for human rights in mental health, including the nonprofit organization that I direct, MindFreedom International.

The origin of our social change movement cannot be traced to a few antipsychiatry theoreticians and campus intellectuals. Many of us actually credit the civil rights movement and our own experiences of psychiatric abuse as the original sources of our inspiration. We can and do organize on our own. The authors use the undefined term “antipsychiatry” 34 times in their essay, applying that label to many of us who do not describe ourselves or our groups in that way. There are, for example, compassionate, practicing psychiatrists who play an active role in MindFreedom.

The authors claim that psychiatry has addressed our key grievances “to some degree.” Even if some psychiatrists have reduced the dosages of neuroleptics prescribed, overall neuroleptic prescriptions are skyrocketing. Neuroleptic prescriptions for youths have shot up more than fivefold in less than a decade (2). From our perspective, both electroshock and psychosurgery have experienced a resurgence in popularity within psychiatry and the mainstream press. Many states have greatly expanded commitment criteria, and most states have implemented involuntary outpatient commitment. Courts now order some MindFreedom members who live peacefully in their own homes to take neuroleptics involuntarily.

The authors appear to observe us from afar through a flawed lens, which may explain their factual errors. The well-respected activist Leonard Roy Frank is not the founder of Support Coalition International. Support Coalition International and MindFreedom International are not two separate organizations—our name change occurred in 2005. The essay aligns the history of our movement with the “radical left” to a great extent, ignoring decades of outstanding work by conservatives and libertarians in fighting psychiatric abuse. Today, conservatives lead the grassroots opposition to mental health screening in schools.

Consider the bias inherent in this sentence: “Psychiatry continues to fight antipsychiatry disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults.” The authors appear to transmogrify into “antipsychiatry disinformation” all public education efforts that are inconsistent with the American Psychiatric Association’s official position.

This is my 30th year working for human rights and alternatives in the mental health system. We have made mistakes. We are not perfect. But I am very proud of our social change movement, which includes concerned family members, advocates, attorneys, mental health professionals, and interested members of the public. The authors claim that the psychiatric profession finds it difficult to communicate with us. The fact is that the American Psychiatric Association has generally refused our repeated invitations for conversation.

Somehow, some people who have experienced serious human rights violations in the mental health system—including unscientific labeling, forced drugging, solitary confinement, restraints, involuntary commitment, electroshock, and more—have reached deep within the human spirit and found the power to speak out and unite nonviolently (3). Please reply with dialogue, not distortion.

David Oaks

Footnotes

Mr. Oaks is director of MindFreedom International, Eugene, Oregon.

References

1. Rissmiller D, Rissmiller J: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism. Psychiatric Services 57:863–866,2006[Abstract/Free Full Text]

2. Carey B: Use of antipsychotics by the young rose fivefold. New York Times, June 6, 2006, p A18

3. Mahler J, Unzicker R, Foner J, et al: Taking issue with taking issue: “psychiatric survivors” reconsidered. Psychiatric Services 48:601,1997[Medline]

Evolution of the Antipsychiatry Movement Into Mental Health Consumerism

Psychiatric Services
June 2006
Rissmiller DJ, Rissmiller JH.

Department of Psychiatry, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Cherry Hill, New Jersey 08002, USA. rissmidj@umdnj.edu

This essay reviews the history and evolution of the antipsychiatry movement. Radical antipsychiatry over several decades has changed from an antiestablishment campus-based movement to a patient-based consumerist movement. The antecedents of the movement are traced to a crisis in self-conception between biological and psychoanalytic psychiatry occurring during a decade characterized by other radical movements. It was promoted through the efforts of its four seminal thinkers: Michel Foucault in France, R. D. Laing in Great Britain, Thomas Szasz in the United States, and Franco Basaglia in Italy. They championed the concept that personal reality and freedom were independent of any definition of normalcy that organized psychiatry tried to impose. The original antipsychiatry movement made major contributions but also had significant weaknesses that ultimately undermined it. Today, antipsychiatry adherents have a broader base and no longer focus on dismantling organized psychiatry but look to promote radical consumerist reform.

Radical antipsychiatry in the past four decades has changed from an influential international movement dominated by intellectual psychiatrists to an ex-patient consumerist coalition fighting against pharmacological treatment, coercive hospitalizations, and other authoritarian psychiatric practices. This Open Forum article explores the history of the antipsychiatry movement and attempts to define how the movement has evolved.

The antecedents of the antipsychiatry movement can be traced to the early 1950s, when deep divisions were developing between biological and psychoanalytic psychiatrists. Psychoanalytic psychiatry, which had exerted unchallenged control of the profession for decades, endorsed treatment that was subjective and dynamic and that involved protracted psychotherapy. It was being challenged by biological psychiatry, which claimed that psychoanalysis was unscientific, costly, and ineffective.

Conversely, an outcry was mounting against psychiatry’s practice of compulsory admission of mental patients to state institutions, where they were coerced into taking high doses of neuroleptic drugs and undergoing convulsive and psychosurgical procedures. The antipsychiatry movement arose as a group of scholarly psychoanalysts and sociologists shaped an organized opposition to what were perceived as biological psychiatry’s abuses in the name of science. This protest was joined by a 1960s worldwide counterculture that was already rebelling against all forms of political, sexual, and racial injustice.

The term “antipsychiatry” was first coined in 1967 by the South African psychoanalyst David Cooper (1) well after the movement was already under way. It was internationally promoted through the efforts of its four seminal thinkers, Michel Foucault in France, R. D. Laing in Great Britain, Thomas Szasz in the United States, and Franco Basaglia in Italy. All four championed the concept that personal reality was independent from any hegemonic definition of normalcy imposed by organized psychiatry.

In Madness and Civilization: A History of Insanity in the Age of Reason (2), Foucault traced the social context of mental illness and noted that external economic and cultural interests have always defined it. During the Renaissance, madmen were characterized as fools who figured prominently in the writings of Shakespeare and Cervantes. Beginning in the 17th century, madmen were confined and locked away, justified by the state’s “imperative of labor.” The poor, criminals, and the insane were all isolated as a condemnation of anyone unwilling or unable to compete for gainful employment.

In the early 1800s madmen were separated from prisoners and beggars and forced into hospitals run by medical doctors. Madness was reinvented as a disease, and inhumane treatment was begun. It consisted of classification, custody, and coercion by a psychiatric authority, which operated as an arm of the state, ridding it of unwanted individuals. Psychiatry became “a jurisdiction without appeal … between the police and the courts … a third order of repression” (2).

While Foucault was writing in France in the early 1960s, R. D. Laing, in England, joined other authors of the period who were describing the social origins of behavior. Fanon (3) demonstrated how blacks often would fulfill racist stereotypes; Lessing (4), how women commonly conformed to society’s expectation of passivity and femininity; and Goffman (5), how patients, stripped of normal social responsibilities, developed institutional behavior. Laing promoted the idea that severe mental illness, similarly, had a social causality.

In The Divided Self: An Existential Study in Sanity and Madness (6), a best-seller in colleges across the United States and Great Britain, Laing noted that a patient with psychosis could be viewed in one of two ways: “One may see his behaviour as ‘signs’ of a ‘disease’ [or] one may see his behaviour as expressive of his existence.” For Laing, paranoid delusions were not signs of an illness but an understandable reaction to an inescapable and persecutory social order. If Laing was correct, and schizophrenia were not a disease but rather an existential fight for personal freedom, then logic allows that it could be cured through social remediation. Laing, through the Philadelphia Association founded with Cooper in 1965, set up over 20 therapeutic communities throughout England where staff and patients assumed equal status and any medication used was voluntary. A recounting of a seven-week stay in one of these communities was chronicled in the 1972 film Asylum (7).

Other psychoanalysts were also exploring the social context surrounding mental illness. Thomas Szasz, having recently been appointed to the faculty of the State University of New York, in 1957 wrote his most influential paper, “The Myth of Mental Illness.” Over the next three years, it was rejected by at least six psychiatric journals, including the American Journal of Psychiatry, until it was finally accepted for publication in the American Psychologist (8) in 1960. As the antipsychiatry movement gained momentum, this article became the core of his best-selling book (9) by the same name and the slogan around which many in the movement rallied.

Because schizophrenia demonstrated no discernible brain lesion, Szasz believed its classification as a disease was a fiction perpetrated by organized psychiatry to gain power. The state, searching for a way to exclude nonconformists and dissidents, legitimized psychiatry’s coercive practices. Equating the resulting psychiatry-government collusion with the Spanish Inquisition, Szasz (10) called it “the single most destructive force that has affected American society within the last 50 years.” Such a conspiratorial link between the government and psychiatry was an appealing concept to such counterculture icons as Timothy Leary (11), who, preceding his termination from Harvard, wrote to Szasz in 1961 that “the Myth of Mental Illness is the most important book in the history of psychiatry … perhaps … the most important book published in the twentieth century.”

Citing the principle of “separation of church and state,” Szasz argued for a similarly clear division between “psychiatry and state.” Otherwise, the state would ultimately corrupt psychiatry for its own purposes, as occurred in Nazi Germany and the Soviet Union. As a preventive measure, Szasz helped launch the Libertarian Party in 1971, and its platform called for a halt to government-psychiatry mind control operations.

Others involved in the antipsychiatry movement were even more condemning. In 1969, Scientology’s charismatic founder, L. Ron Hubbard (12), wrote, “There is not one institutional psychiatrist alive who … could not be arraigned and convicted of extortion, mayhem and murder.” Hubbard and Szasz cofounded the still powerful Citizens Commission on Human Rights, which encouraged the arrest and incarceration of psychiatrists for their crimes against humanity.

Alliances were formed with other contemporary activist groups. In May 1970, hundreds in the antipsychiatry movement joined gay activists in forming a human chain barring psychiatrists from entering the American Psychiatric Association’s 124th annual meeting. During a similar disruption the following year, gay activist Frank Kameny grabbed the podium and declared war on psychiatry for its DSM classification of homosexuality as a psychiatric disorder. Wanting the protests to stop, the American Psychiatric Association formed a task force, which, by a vote of 58 percent, officially deleted homosexuality as a mental illness in 1973.

Psychiatry’s purported abuse of patients was popularized in Kesey’s 1962 novel, One Flew Over the Cuckoo’s Nest (13), which contributed to reforms in mental health public policy. David Bazelon, a jurist of the powerful United States Court of Appeals for the District of Columbia, deplored authoritarian psychiatric practices. In 1966, he established in Lake v. Cameron that all psychiatric treatment must be carried out in the least restrictive setting possible. In the early 1970s the antipsychiatry attorney Bruce Ennis created the “Mental Health Bar.” Its goal was to completely abolish involuntary commitments or prevent them by making them too arduous to secure. These and other initiatives heralded the release of hundreds of thousands of patients from state hospitals.

Deinstitutionalization in Europe occurred over a decade later. The Italian psychiatrist Franco Basaglia, its leading proponent, while working at the asylum in Trieste, came to believe that mental illness was not a disease but rather an expression of human needs. Over the next decade he personally mobilized an antipsychiatry movement in Italy that culminated in the 1978 Italian National Reform Bill that banned all asylums and compulsory admissions and established community hospital psychiatric units, which were restricted to 15 beds. This reorganization of mental health services in Italy resulted in the “democratic psychiatry movement,” wherein hundreds of psychiatric institutions were closed throughout Europe, New Zealand, and Australia, including many in Ireland and Finland, where the highest number of asylum beds were located.

Despite such notable successes and after nearly two decades of prominence, the international antipsychiatry movement began to dramatically diminish in the early 1980s, both in visibility and impact. Organized psychiatry, by addressing some of the movement’s key grievances, was able to defuse it to some degree. The adoption of the biopsychosocial model narrowed the gap between analytic and biological practitioners. Neurotransmitter discoveries and schizophrenia twin registries offered support that schizophrenia was at least partially biologically based. As comparison studies failed to support efficacy and as tardive dyskinesia became more apparent, psychiatrists markedly reduced dosages of neuroleptics prescribed. Electroconvulsive therapy and psychosurgery became marginalized as treatments and compulsory commitments came under close judicial scrutiny.

But by far the most important determinant of the movement’s demise was its loss of broad-based support. To a great extent, the antipsychiatry movement was derived from its close relationship to other progressive leftist coalitions that, by association and overlapping membership, supported the movement. With the decline of other student, feminist, gay, and black coalitions, the antipsychiatry movement could no longer rely on counterculture support. The radical left, with its utopian vision, was being replaced, worldwide, by an emerging conservative political landscape. Since the antipsychiatry movement’s raison d’être was inherently antiestablishment, it, like the other militant movements of the day, was at risk of becoming increasingly irrelevant.

The mental health consumerist movement offered a struggling antipsychiatry coalition the mainstream collaborator it needed for rejuvenation. Since its inception in the early 1900s by former patient Clifford Beers and through organizations such as the Anti-Insane Asylum Society and the National Committee on Mental Hygiene, the consumerist movement had achieved significant international mental health reforms. Its tactics of forming political alliances and lobbying instead of confrontation appealed to conservative politicians who were weary of civil disobedience. The movement’s vision of patients helping one another addressed a growing concern over the cost of mental health treatment.

But consumerists considered the antipsychiatry movement as “largely an intellectual exercise of academics” (14). Consumerists wanted to keep their movement in the hands of prior patients. They had no interest in being led by psychiatrist intellectuals who had done little during the antipsychiatry movement to “reach out to struggling ex-patients” (14). As a result, as the antipsychiatry movement evolved from being campus based to being patient based, its founders were marginalized as bystanders to a movement they had begun. Appelbaum (15) in 1994 observed, “Now, more than three decades later, … Szasz, Laing, and their colleagues are no longer fixtures … and … most college and graduate students have never heard of them or their argument that mental illness is a socially derived myth.”

With over a half million deinstitutionalized patients to draw from, there was a potential for the new antipsychiatry consumerist coalition to be extensive. Many former patients, angry about the coercive treatment they had received and looking for support and identity, would be ideal carriers of the antipsychiatry message. They joined local consumerist radical groups, and new ex-patient leaders arose. Leonard Frank, founder of Support Coalition International, after undergoing over 80 insulin comas and electroshock treatments, became electroshock therapy’s new outspoken critic. Ex-patient Judi Chamberlin, cofounder of the Mental Patients Liberation Front, mobilized the movement with On Our Own: Patient-Controlled Alternatives to the Mental Health System (16).

The formative years of this movement in the United States saw “survivors” promoting their antipsychiatry, self-determination message through small, disconnected groups, including the Insane Liberation Front, the Mental Patients’ Liberation project, the Mental Patient’s Liberation Front, and the Network Against Psychiatric Assault. The fragmented networks communicated through their annual Conference on Human Rights and Psychiatric Oppression (held from 1973 to 1985), through the ex-patient-run Madness Network News (from 1972 to 1986), and through the annual “Alternatives” conference funded by the National Institute of Mental Health for mental health consumers (from 1985 to the present). Similar groups arose throughout Canada and, later, Europe, where the name “survivor” brought more public criticism because of its association with the holocaust. The movement searched for a unifying medium through which to integrate.

The growing Internet “global community” offered just such a medium. Numerous radical antipsychiatry Web sites, such as Support Coalition International, Citizens Commission on Human Rights, the Antipsychiatry Coalition, and MindFreedom International, linked antipsychiatry movements in over 30 countries. Their capacity to instantaneously reach millions meant that “despite its modest head count, the consumer/survivor movement … exerted a significant sociopolitical influence on the mental health care system” (17). By avoiding the antipsychiatry movement flaw of being radicalized without being politicized, radical consumerists continued to maintain informal ties with more conservative consumerist organizations such as the National Alliance for the Mentally Ill in the United States and the Mental Health Foundation in England. Mainstream consumerist groups benefited from such unofficial relationships through increased impact in grassroots lobbying and legislative advocacy efforts.

Such joint efforts exerted a palpable effect. In 1986 the survivor-antipsychiatry-consumerist triumvirate succeeded in getting Congress to mandate independent protection and advocacy programs for people with mental illness in all 50 states. The mission to investigate allegations of patient abuse came with a mandate that at least 60 percent of the membership of the governing advocacy councils be ex-psychiatric patients or their families.

In 2000 the National Council on Disability, an independent federal agency charged with making recommendations to the President and Congress, heard strong antipsychiatry testimony from survivors “describing how people with psychiatric disabilities have been beaten, shocked, isolated, incarcerated, restricted, raped, deprived of food and bathroom privileges, and physically and psychologically abused in institutions.” The council concluded that “People with psychiatric disabilities are routinely deprived of their rights in a way no other disability group has been [and] … the manner in which American society treats people with psychiatric disabilities constitutes a national emergency and a national disgrace” (18).

Radical consumerists were instrumental in getting the United Nations General Assembly to adopt its 1991 Principles for the Protection of Persons With Mental Illness and the Improvement of Mental Health Care. In 2002 the Scientology-funded Commission on Human Rights successfully petitioned the Secretary-General of the United Nations to report annually to the General Assembly on the progress of human rights, including as it relates to persons with mental illness.

Organized psychiatry has found it difficult to have a constructive dialogue with the evolving radical consumerist movement. Consumerist groups are viewed as extremist, having little scientific foundation and no defined leadership. The profession sees them as continually trying to restrict “the work of psychiatrists and care for the seriously mentally ill” (17). Psychiatry continues to fight antipsychiatry disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults.

Conversely, radical consumerists remain disinclined to soften their antipsychiatry stance toward a territorial and biologically oriented profession that, in their view, has profited from patients it neglected and abused. Seeing themselves as “the last minority” (17), unfairly stigmatized by psudoscientific classification, and denied self-determination, they will undoubtedly continue to play an assertive role in the delivery of mental health services worldwide.

Footnotes

Dr. Rissmiller is affiliated with the Department of Psychiatry, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Cherry Hill, New Jersey 08002 (e-mail, rissmidj@umdnj.edu ). Mr. Rissmiller is attending Harvard College in Cambridge, Massachusetts.

References

  1. Cooper D: Psychiatry and Anti-Psychiatry. London, Tavistock Publications, 1967
  2. Foucault M: Madness and Civilization: A History of Insanity in the Age of Reason. New York, Random House, 1965
  3. Fanon F: The Wretched of the Earth. New York, Grove Press, 1963
  4. Lessing DM: The Golden Notebook. New York, Simon and Schuster, 1962
  5. Goffman E: Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York, Anchor Books, 1961
  6. Laing RD: The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth, England, Penguin, 1960
  7. Robinson P (director): Asylum. Kino Video, 1972
  8. Szasz TS: The myth of mental illness. American Psychologist 15:113–118,1960
  9. Szasz TS: The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York, Hoeber-Harper, 1961
  10. Szasz TS: The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York, Harper and Row, 1970
  11. Leary T: A letter from Timothy Leary, Ph.D., July 17, 1961. Available at www.szasz.com/leary.html
  12. Hubbard LR: Crime and psychiatry, June 23, 1969. Available at http://freedom. lronhubbard.org/page080.htm
  13. Kesey K: One Flew Over the Cuckoo’s Nest. New York, Viking Press, 1962
  14. Chamberlin J: The ex-patients’ movement: where we’ve been and where we’re going. Journal of Mind and Behavior 11:323–336,1990
  15. Appelbaum PS: Almost a Revolution: Mental Health Law and the Limits of Change. New York, Oxford University Press, 1994
  16. Chamberlin J: On Our Own: Patient-Controlled Alternatives to the Mental Health System. New York, Hawthorne, 1978
  17. Satel SL, Redding RE: Sociopolitical trends in mental health care: the consumer/survivor movement and multiculturalism, in Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 8th ed. Edited by Sadock BJ, Sadock VA. Philadelphia, Pa, Lippincott Williams and Wilkins, 2005
  18. Bristo M: From Privileges to Rights: People Labeled With Psychiatric Disabilities Speak for Themselves. Washington, DC, National Council on Disability, Jan 20, 2000

Sweet Words that Hurt

The Make-Believe World of User Participation, Rights and Voice
Michael McCubbin, Ph.D.

McCubbin, M. (2000). Sweet words that hurt: The make-believe world of user participation, rights and voice. The Rights Tenet (quarterly newsletter of the National Association for Rights Protection and Advocacy), Spring/Summer 2000, pp. 5, 8.

Posted with permission of the editor of The Rights Tenet, Dr. Ronald Bassman.

Many persons exercising or seeking coercive power in the name of mental health care justify their actions by the supposed “lack of self-insight caused by mental illness”. This is a circular argument because lack of self-insight is often the psychiatrist’s explanation for treatment refusal, and then used to support the diagnosis of mental illness and the proposed treatment. Inability of health professionals to recognize this false logic and the catch-22 this puts people in displays quite a bit of lack of self-insight!

In fact, lack of self-insight in mental health practices is so widespread, so entrenched, that it is reasonable to conclude that the whole system lacks self-insight. What do I mean by the mental health system? I mean much more than health and social service programs, the workers in those programs, and the patients and clients. The mental health system also includes:

* family members of patients and clients – who have powerful lobby groups seeking policy and laws in the opposite direction from what user groups themselves are seeking;

* professional associations – who try to enhance their professions’ prestige and power by enlarging their roles in directing mental health care and treatment programs and policies and by increasing medicalization of their practice (today social workers use DSM and psychologists are seeking prescription privileges);

* pharmaceutical companies – who finance many of the professional and family lobby groups and provide direct and indirect incentives (trips, conferences, advertising in medical journals, continuing education, mental illness screening campaigns, research funding) for psychiatrists and other physicians to prescribe their psychotropic drugs;

* general public – who have difficulty imagining that they themselves could at some point end up being a “mental patient”, and who have no sources of information about psychological distress, and what to do about it, other than the line of the family and professional lobby groups that “mental illness” is a brain disease that has to be treated, perhaps forcibly, with drugs or ECT, and that without such treatment the person could be “dangerous”;

* scientists, like myself – who are increasingly finding that they will not get money for research, or access to data, if they challenge that line; with the result that scientific “knowledge” is at worst very biased and at best increasingly geared to the questions that professionals, family lobby groups, and pharmaceutical companies want to ask, rather than toward what service users want to ask;

* and finally, and definitely last in terms of influence, the mental health service users themselves – whose fledgling cooperatives, mutual support groups, and self-advocacy groups are run with little or no money and are simply not heard by all the other actors mentioned above.

Once we think about the mental health “system” as a social, cultural, political and economic system – which is driven not only by love, caring, compassion, scientific evidence, and good intentions, but also money, power, prestige and other less lofty human motivations – then we can think more clearly and realistically about the apparently enlightened and humanistic discourse that those with power within the system have increasingly been using.

Increasingly we hear that programs, practices, policies and laws aim to be “participatory”, in “partnership” with users, “empowering”, “community-based”, “psychosocial”, and respectful of human rights. However, we are far from achieving these objectives. Indeed, it appears that these concepts have often been distorted into meaninglessness or even into their opposites:

Empty rights. Not only have the rights of users – to autonomy, to dignity, to refuse treatment, to informed consent – been systematically constrained by civil commitment laws, by forced outpatient treatment laws, and by the legal privileges and protections of the professions, but even those remaining legal rights on paper are insufficiently, or almost never, translated into meaningful practice. In some places people are not even informed when a court hears a request from a family member to commit that person for psychiatric examination, obviously making it difficult to contest! Difficulties accessing competent lawyers or other advocates, and the kind of counter-expertise that a court will listen to (particularly psychiatric) make contesting civil commitment futile for many patients.

Furthermore, no matter how tight the law is supposed to be regarding “danger” to self or others, in actual practice the decision to commit depends heavily upon risks to mental health and hence “need for treatment”. Need for treatment is too often based on the fact that a diagnosed person declined the recommended treatment – which refusal suggesting to the psychiatrist “lack of self-insight” which adds to the “proof” of mental illness. Finally, it is anybody’s guess how many forcibly treated persons have at least had an independent assessment of competence and independent and properly monitored proxy decision making processes that aim to decide what that person would if temporarily competent.

Coopted voices. The trend among mental health planners over the last decade has been to adopt the discourse of democracy and inclusiveness. But usually this discourse has remained symbolic, or worse: coopting users’ voice – drawing them into “cooperation” with the system and muting their opposition to its disempowering features. Too often we have seen health authorities say that they have “community participation” on their governing bodies – leading many to assume that this includes user participation – when the “community” persons are actually government paid health and social service professionals. Or, if there is user representation it is token and the user representative is snowed under by professional power, arrogance, agendas and technocratic language.

At the larger level, the public and even health professionals, planners and researchers believe or pretend that family and psychiatry lobby groups are user groups or speak for users. For example, in Canada there was a national consultation meeting for the establishment of a mental health research institute; what was worse than the fact that there were no users present was the fact that the organizers announced that there were, even saying so in the consultation report. Incredibly, they confused user groups with the family and psychiatry lobby groups who were there! Whether intentional or not, such constantly repeated errors allow those persons actually privileged to make decisions to justify them by the supposed participation of users. What is worse than making someone else’s decision is to do it while pretending that you are not.

The above examples are only a few of the many indications of empty user rights and coopted user voices that typical users experience on a daily basis. In the scientific literature there is much talk about empowering and rights-advancing programs and objectives but almost no serious attempt to discover whether the rights attributed to users are actually enjoyed, or whether the language of participation is more than pretence. Few academic researchers will instigate such research, because it isn’t users who pay for it but governments and corporations. We need such research so that we can hold programs and professionals accountable. It isn’t enough for laws, program descriptions, language and professional guidelines to talk rights and participation. We have to walk the walk.

To ever be able to do so we need people who are truly concerned about the rights, dignity and empowerment of users, whoever they are – members of the public who are activists on rights issues, users themselves, dissident practitioners and academics – to demand and get involved in research ensuring that the sweet words of participation and rights are not a replacement for action. Because, if they are, then the sweet words hurt – they camouflage what is really going on.

Michael McCubbin is a researcher with the Saskatchewan Population Health and Evaluation Research Unit, University of Regina. Email: michael.mccubbin@uregina.ca For further reading see his articles co-authored with David Cohen:
* Extremely Unbalanced: Interest Divergence and Power Disparities Between Clients and Psychiatry, International Journal of Law and Psychiatry, 1996, pgs. 1-25.
* A Systemic and Value-Based Approach to Strategic Reform of the Mental Health System, Health Care Analysis, 1999, pgs. 57-77.
* Should Institutions that Commit Patients also be Gatekeepers to Information about Civil Commitment? Implications for Research and Policy, Radical Psychology, 1999, http://www.yorku.ca/danaa/mccubbin.htm (also with Bernadette Dallaire and Paul Morin).

Chinese Activist in Mental Hospital

Chinese Activist in Mental Hospital

The Associated Press
2/13/2001

Thursday, February 8, 2001; 12:51 PM

SHANGHAI, China– A doctor confirmed Thursday that a Chinese labor activist is being held in a mental hospital, but insisted he was ill and downplayed reports that he was being forced to receive electric shock treatments.

Cao Maobing, an electrician, was forcibly committed in mid-December for trying to form an independent labor union at a silk factory in eastern China, according to human rights groups.

The New York-based Human Rights in China said Thursday that Cao was being force-fed psychiatric drugs and given electric shock treatment after going on a hunger strike in January.

But a doctor at the Yancheng No. 4 Psychiatric Hospital in the eastern city of Yancheng said the reported electric shock treatment was an “exaggeration” and maintained the hospital was merely treating Cao for mental illness. The doctor refused to give his name or any details of the treatment.

Human Rights in China said Cao stopped eating to press his demand to be allowed to visit his family for the lunar new year holiday in late January – the most important family event of the year in China.

It said Cao was being held in a room with more than 20 mentally ill patients, who it said were harassing him and threatening his safety. The group said he had been held there for more than 53 days.

Cao was detained after talking to Western reporters about efforts by 300 workers to form an independent union at a state-owned silk factory in Jiangsu province.

China allows only unions controlled by the ruling communist party. Activists complain they have failed to protect workers against widespread layoffs and other wrenching changes at ailing state firms.

China has been accused of forcing other labor and human rights activists as well as members of the banned Falun Gong spiritual movement into psychiatric hospitals.

“This is a serious method routinely used by the Chinese Communist Party to tackle independent labor activism,” Human Rights in China said in a statement faxed to reporters.

Psychiatry’s roots in paternalism: why the field has not kept up with contemporary thinking

This is an article I wrote for a feminist publication. I’m going to have to hunt down its name and when published.

Psychiatry’s roots in paternalism: why the field has not kept up with contemporary thinking

By Juli Lawrence
ect.org

At its core, the field of medicine has always been paternalistic: doctor knows best. Even the Hippocratic Oath included a line that encouraged physicians to perpetuate the imbalance of power between doctor and patient: “I will prescribe regimen for the good of my patients according to my ability and my judgment.”

But while patients’ rights activists have provoked change in this power struggle, the field of psychiatry maintains roots deeply planted in paternalism and patriarchy. This imbalance of power is evident in the privacy of the doctor’s office, among colleagues, in hospitals, and even in the courtroom.

The very nature of psychiatry seeks to modify emotions and behavior, whether through therapy, medications, electroshock and other methods, and the doctor-
patient relationship revolves around a paternalistic imbalance of power. Psychiatrists label their patients as compliant or noncompliant to characterize whether or not the psychiatrist’s power has been accepted.

The doctrine of informed consent theoretically gives a patient information about a treatment, and the right to refuse treatment for any reason. But the doctrine hinges on the patient’s competence, and in psychiatry, the concept of competence is often used to reassert the psychiatrist’s power.

In many states, a person’s competence can be decided by the views of one psychiatrist. Some states require a second opinion, though it’s rare that in a simple competency hearing one doctor will disagree with another. In the court system, psychiatrists are given even more power and it would take a unique judge to listen to a patient – particularly a psychiatric patient – over a doctor.

Consider a case of forced electroshock involving an elderly woman in St. Louis, Missouri in August, 2000.

Kathleen Garrett was a woman in her 60s, recently widowed and undergoing treatment for breast cancer, as well as enduring a recent estrangement from one of her sons. Most women in such circumstances would find themselves with feelings of grief, if not downright depressed. Mrs. Garrett, with a lifelong history of episodic depression, did become depressed. Her psychiatrist adjusted her medications, but the depression remained. He then told her she needed to have electroconvulsive therapy, or electroshock. Mrs. Garrett refused, and immediately transformed into a “noncompliant patient.”

Instead of spending time discussing other options or why she didn’t want electroshock, her psychiatrist rushed into court, told the judge that he knew best, and that Mrs. Garrett was not competent to make such a decision. He didn’t mention that until the moment she said no, he considered her competent to make the decision.

Mrs. Garrett had very little time to put together a legal defense, and her Social Security income limited her access to an experienced attorney. The judge quickly ruled against her, ordering the doctor to begin electroshock treatments against her will. Mrs. Garrett would have been just another silent victim of the abuse of psychiatric power, but a loud and angry e-mail campaign against the doctor and hospital focused negative attention on her plight, and she was released from the hospital before completing the full series of treatments against her will.

Psychiatric patients often find themselves labeled noncompliant if they dare to speak back to their doctors, challenge his authority, or even ask questions. If a prescribed treatment, such as medication, is unsuccessful, the patient is again labeled noncompliant, with the psychiatrist just assuming that the patient has not followed directions. Psychiatric patients are at a distinct disadvantage because of the psychiatrists’ ability to use force to maintain the power structure.

Certainly “noncompliance” is a term used in other medical specialties, and doctors complain that patients with high blood pressure, diabetes, and other diseases sometimes do not take medications as directed. However, despite a potential life-threatening outcome, a person with high blood pressure won’t find herself plunged into a courtroom drama to force compliance. A woman with diabetes who skips an insulin injection, or decides she’s tired of the routine, will not open her door to a nurse with a hypodermic in hand.

Psychiatric patients often face scenarios like this once they threaten a psychiatrist’s power, and states are enacting laws making it easier to force “compliance,” such as Illinois SB0198, currently undergoing Senate review. As it went through the Rules Committee, the proposed bill has had its language changed from “cause serious harm to self or others” to “engage in dangerous conduct.” Past experience has shown that dangerous conduct could be anything from eating unhealthy foods to disagreeing with a psychiatrists’ order to take medications despite having caused dangerous side effects in the patient’s past. Or dangerous conduct, more often, would simply be a “noncompliant patient.”

A mental health rights activist once said that if someone prepares a buffet of delicious, healthy food, people will come. But if that buffet serves food that makes people feel sick, they won’t return. It is an excellent analogy, and one that needs attention in the world of psychiatry. Too often, patients who tell their psychiatrists that the medications make them feel worse than their original symptoms made them feel are quickly tossed into the basket of “noncompliant patients.” The atmosphere quickly shifts from the psychiatrist’s comfortable balance of “Doctor says, patient obeys,” to one of “I am the expert, you must do as I say.” It can easily disintegrate into the psychiatrist labeling the patient incompetent, because she did not submit to his power and authority.

Experienced patients quickly learn they have a choice: they can submit and follow orders, or they can play “the game.” Most psychiatric patients fully understand that the game involves pretending to do exactly as ordered, and to put on an air of gratefulness. Unfortunately, this also means that the patient no longer confides in the psychiatrist with regard to symptoms, and their emotional disorders may grow worse. Alternately, the symptoms may abate on their own, as is common with psychiatric disorders. In the end, the doctor proclaims his methods are successful, he asserts his superiority, and the power game goes on. But under the surface of cooperative relationship, the truth reveals a relationship based on distrust and deception.

Psychiatrist Sally Satel, author of “PC, M.D.: How Political Correctness Is Corrupting Medicine,” has written extensively about the need to maintain the status quo of doctor over patient. Her writings reveal her anger that women are trying to take control of their healthcare, particularly with regard to mental healthcare.

“But it is wrongheaded to confuse the need to know more – an imperative that will always be with us – with the unwarranted and poisonous notion that women are somehow second-class subjects in the world of medicine,” she writes.

She chastises health activists for interfering with “effective diagnosis and doctoring.”

Psychiatric patients are fighting back, however.

A growing movement of patients and ex-patients is demanding change in the system, and asking that patients be given a long-overdue voice and control of their healthcare choices. Not surprisingly, activists are not generally well-
received by psychiatrists. But psychiatrists still have their secret weapon, and it’s a weapon that the general public accepts without question: the issue of competence. To discredit an activist’s words, simply declare she is suffering from mental illness, and doesn’t know what’s best. Reassert psychiatry’s authority, and you have an effective method of discrediting just about anything.

The courts buy into it, because psychiatry has been given special status in the court system. The public buys into it, because they don’t have the experience to understand how paternalistic psychiatry is. And of course the medical industry buys into it because paternalism fits in with their views to “help” anyone who needs help, even when the help is intrusive, inappropriate and unwanted. The doctor knows best.

Psychiatry has a long way to go in moving into modern times. Psychiatrists want so badly to be taken seriously as medical doctors and legitimate scientists, but until they confront a history that is full of abuses, and a method that continues today to abuse authority, psychiatry will remain mired in an atmosphere of paternalism, controversy and resentment.

How do psychiatrists decide to use forced electroshock?

by Linda Andre
Director of CTIP

Have you ever wondered how psychiatrists make a decision to shock a person against his or her will? Who’s a candidate for forced shock, and why?

These questions were publicly answered by the two psychiatrists who signed the papers seeking a court order for involuntary shock of Paul Henri Thomas.

In some but not all states—New York is one of them—a person must be found to be legally incompetent before he or she can be shocked against her will.

The general public, upon hearing this, sighs in relief: of course; that’s as it should be; that could never happen to me; of course there must be safeguards in place, and standards as to what constitutes competence; a person must have to be really bad off, really crazy like catatonic, to be ruled incompetent.

Treating psychiatrist Andre Azemar and supervising psychiatrist Bob Kalani of Pilgrim State Psychiatrist Hospital both testified against their patient Paul Henri Thomas in hearings held in March and April 2001.

They were asked how they decided that Paul lacked the capacity to make this own treatment decisions.

They made it clear.

Having a diagnosis of mental illness helps you get ruled incompetent, but it’s not enough by itself. And you sure don’t need to be catatonic or psychotic. Here are the rules:

Rule # 1: You’re incompetent if you think you’re not crazy.

“Lack of insight” was cited an overwhelming number of times by witnesses against Paul as justification for forced treatment. Both doctors said, in essence, that any person who says that he is not mentally ill when a doctor says he is lacks “insight into his illness”, and that this means he lacks the capacity to make his own treatment decisions.

Paul’s lawyer Kim Darrow was thorough in his questioning, trying to elicit from the doctors any other factors they might have weighed in making their decision that Paul lacked capacity and therefore qualified for forced shock.

There were none. On further questioning, Dr. Azemar was asked why Paul doesn’t think he is mentally ill. His answer: “Because mental illness clouds his judgment.” It was clear to everyone who watched this trial (except the judge) that this was a Catch-22, no-win situation. As long as you say you’re not crazy, you’re considered crazy.

The audience waited in vain for further justification of the claim that Paul was mentally ill. He was said to have various diagnoses, including schizoaffective disorder (also the diagnosis of this reporter), bipolar disorder, and mania. Neither doctor had enough evidence against Paul to justify these diagnoses by DSM criteria. Paul was said to be “loud”, “noncompliant”, “threatening”, to have worn inappropriate clothing on the ward and to have hoarded food (which would have been entirely appropriate for someone looking to escape from the hospital, former patients concurred later). His hygiene was said to be poor; he was accused of cluttering his hospital room with books and dirty clothes—”dirty clothes on top of clean clothes!” in the words of Azemar.

The other shrink, Kalani, conceded that on the day he testified—as well as on the day he signed the petition for forced shock—his patient had no symptoms of mental illness other than denying he had a mental illness.

An independent, unpaid psychologist who examined Paul in the hospital at the end of March, interviewing him as well as performing some psychological testing, testified that he found no evidence of psychosis, mania, or mental illness. He testified that Paul is competent to make his own decision regarding ECT.

Rule #2: When you say yes, you’re competent; when you say no, you’re incompetent. Either way you get shocked.

“The staff would ask him, are you going to consent or are we going to have to go back to court?” —Bob Kalani

If Paul was really incompetent, he was incompetent not only to reject treatment, but to accept it. His yes would not have been legal. Yet both shrinks testified about attempts to talk the legally incompetent Paul into saying yes to shock.

“Did you try to get Mr. Thomas to consent to ECT in January? If he had consented, would you have sought a court order?” asked Darrow of the treating psychiatrist.

The judge objected.

“If Paul had said yes, would you have tested his competency?” Azemar looked baffled and answered, “If they say no, we have to do it.”

At this point the judge interrupted, saying, “I don’t understand the question”. No one else in the courtroom seemed to have any difficulty understanding the question or the point that had been made.

“If he accepts the illness then he can make his own decisions and we don’t have to force him,” Dr. Kalani had testified. Sure Paul can make his own decisions—-as long as he consents.

Rule #3: If you disagree with what your doctors say about treatment in general or your treatment in particular, you’re incompetent.

When asked: What constitutes capacity? Azemar replied as follows:

—Capacity depends on the person understanding what the treatment is about.
—Capacity means he understands the consequences of the treatment, and has the ability to assess benefits and risks.

Paul has had over 60 ECTs, but no one thinks this makes him qualified to understand what the treatment is about, or to understand its consequences. Only a psychiatrist can know these things.

Both doctors said Paul was incompetent because he refused to acknowledge that previous ECT had been beneficial for him. Azemar said, “Even when we tell him he is improved, he never accepted the fact that he had any benefit from it.”

Both doctors said that Paul was incompetent because he “is unable to assess the risks and benefits of ECT.”

Further questioning from Darrow clarified the situation. Did Paul have the mental capacity to understand that his doctors thought he had improved with ECT? Yes. He understood this. “Did he understand what you thought were the benefits and risks?” Yes, the doctors said. Paul was perfectly capable of hearing and understanding what his doctors were telling him.

He just didn’t agree with them.

As long as patients and doctors disagree about the nature, risks and benefits of ECT, and as long as doctors get to define the “right” answers to these questions, everyone is at risk of forced ECT. Persons who have previously had ECT, know about it from personal experience, and will not deny what they know to be true, are most at risk.

Dr. Kalani testified that he “knew” about ECT from reading a book. All books about ECT for professionals are written by financially compromised ECT proponents like Richard Abrams, shock machine company owner. Kalani couldn’t remember which book he had read…Fink’s, Kellner’s, Coffey’s? He went on to make further blatantly false statements about what he “knew”. He knew the FDA had approved shock machines. (Never happened.) He knew the FDA had conducted animal trials of shock. (Not only has it never conducted animal trials, neither the FDA nor anyone else has ever conducted human trials.) Kalani’s source was revealed when he claimed that the FDA had studied baboons. The baboon line comes�from Harold�Sackeim, prolific ECT advocate and shock machine company consultant. Even Sackeim, famous for his lies, did not say that FDA studied baboons; his claim was that epilepsy researchers had studied baboons and concluded that seizures didn’t damage their brains. Kalani got his misinformation garbled. The Pilgrim shock doctor went on to testify that there have been “lots of” before-and-after MRI studies showing that ECT doesn’t cause brain damage. Wrong again. There have been less than a handful, and they don’t show that.

Dr. Azemar wasn’t any more knowledgeable. He claimed that his own facility did not do “bipolar” ECT (the correct term is bilateral), that this was the “old fashioned way” of doing ECT that’s still done in Haiti but not here. In fact, Paul has been getting bilateral ECT at Pilgrim.

If capacity is determined by what you know about ECT’s risks and benefits, then both Kalani and Azemar flunked the test, and can now be legally forcibly shocked.

Unfortunately Darrow did not challenge Dr. Kalani’s false statements. The judge was left with the impression that ECT has been proven safe because no one contradicted it.

If Darrow had been able to raise doubt about ECT’s efficacy and safety—by invoking the FDA classification of ECT devices, for instance—a logical further question would have been: “If it were true that Paul did not benefit from ECT, would he be incompetent? What if Paul is right that the risks of ECT outweigh its benefits? Is he still incompetent?”

The judge got very upset once Darrow made the point that Paul understood but did not agree with his doctors, yelling at him to move on. This was one of three outbursts on the part of the judge that day, each one louder than the last. The judge was very, very loud.

Forced treatment and biological psychiatry go hand in glove.

If biological psychiatry is a kind of law—if we as a society have decided it is the only acceptable or permissible way to think about and treat problems—then it must have its police force for those who don’t find it helpful or agree to abide by it. It must have the doctors and judges who force treatment on these people.

Both shrinks testified that drugs and ECT were the only treatments available for Paul. When challenged, however, they claimed to be doing psychotherapy. They were questioned further about what that meant. It turns out that psychotherapy doesn’t mean what it used to mean.

“Psychotherapy consists of making him understand his mental illness and accept therapy and understand the impact of medication and ECT. Noncompliance is the issue,” said Bob Kalani. He also explained that there had been family psychotherapy, consisting of trying to talk Paul into consenting to ECT.

Dr. Azemar called his brand of psychotherapy “insight psychotherapy”. “Insight psychotherapy” consisted of trying to get Paul to accept that “It’s all chemicals. There are all these chemicals in the brain—for anxiety, for appetite, for sleep. It’s getting him to understand what these chemicals do and what drugs he needs to take.”

The drugs he has been taking have caused liver damage and tardive dyskinesia. Dr. Azemar testified that Paul wanted to take a computer class, but his hands now shake so badly that he is unable to type. He characterized TD as a “disorder of the fingers”—it’s actually permanent brain damage.

It was nearing the end of the last day of the trial when the topic of drug-induced brain damage came up. Darrow began a dramatic summing-up type question. “They’ve damaged his liver, they’ve damaged—” he might have been beginning to say “His brain”.

He didn’t get to say it because he could not longer be heard over the judge. Judge Hall pounded on his desk, stood up, and yelled at the top of his lungs: “You should be ashamed at yourself!” He said it twice. It was far from clear to anyone in the courtroom what, exactly, he was referring to. Should Darrow be ashamed because he was bringing up tardive dyskinesia in a case that was just supposed to be about ECT? Was Darrow being reprimanded because he was only allowed to talk about ECT brain damage, not drug brain damage? Was the judge himself, who is known for signing forced drugging orders, actually ashamed of himself and simply projecting those unmanageable feelings onto Darrow? Why the emotional outburst?

It was a better ending to the case than the State’s lawyer, Laurie Gatto, could have hoped for. She’s clearly clueless on shock, and her idiotic questions had her much more educated audience laughing—-like when she claimed that the MiniMental Status Exam (which you can hardly do poorly on unless you’re in a coma) could measure memory loss from ECT, or when she tried to disparage Paul’s good performance on an IQ test by saying that math doesn’t involve problem solving. But even she could sense that she didn’t need to add a single word.

Had anyone wandered into the courtroom at 4:20 p.m. on April 2nd, observed the behavior and demeanor of both Paul Henri Thomas and Judge Hall, and been asked to pick out which man was suffering from mania, there would not have been any doubt that it was the one in the black robe.

If you think you can protect yourself against forced ECT with an advance directive, think again.

Paul had an advance directive. He had signed it on October 19th, the day before his doctor signed the petition for forced shock. Paul couldn’t have executed a legal document like an advance directive if he were considered incompetent. Dr. Azemar clearly found him competent on the 19th; in fact, he even signed the advance directive as a witness. Azemar’s position at trial was that Paul became incompetent the very next day.

But wait—even if that were the case, wouldn’t the advance directive have been valid? After all, this is exactly the situation an advance directive anticipates. It specifies what should be done should a person become incompetent. Paul’s directive said that his brother would act as his proxy to make his health care decisions. He should have been consulted, and his yes or no would have been the final decision on shock for Paul. But the hospital disregarded the advance directive and went ahead with its forced shock petition.

In the words of Judge Hall: “What that document said at that time, it doesn’t say now.”

From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves

All the recommendations in this report emphasize the basic principle that people with psychiatric disabilities are, first and foremost, citizens who have the right to expect that they will be treated according to the principles of law that apply to all other citizens. All laws and policies that restrict the rights of people with psychiatric disabilities simply because of their disabilities are inharmonious with basic principles of law and justice, as well as with such landmark civil rights laws as the Americans with Disabilities Act.

“…public policy should move toward the elimination of electro-convulsive therapy and psycho surgery as unproven and inherently inhumane procedures. Effective humane alternatives to these techniques exist now and should be promoted.”

Download full report (pdf: 380k) From Privileges to Rights