Saturday, February 20, 2010

Illinois nursing homes

A couple months ago I wrote about this tragic nursing home business in Illinois. I'm going to repeat some points, while trying to be less cynical out of respect for the hard work of the Nursing Home Safety Task Force, which just submitted its final report to the Governor.

Our problem remains that we want mental illness and deviant behavior to be a medical issue. Beyond the crude expedient of disabling bad guys with drugs, this is a very expensive and destructive intellectual error.

We do not have and will never find the pill to cure schizophrenia, depression, bipolar disorder, delusional disorder, anxiety disorder, post-partum psychosis, pre-menstrual syndrome, PTSD, ADHD, or QMRD (Quasitransorbital Malcognitive Revelatory Disorder: I made it up, but that's the same thing they do in the DSM, right? Maybe I'll expand on this new disease in a later post....)

As the psychs say, these things can only be treated, not cured. The fraud enters in by the pretentious definition of treat as giving (supposedly scientific) medical aid. Every culture has treated murder, for example - generally with public shaming, confiscation of property, exile, prison, execution, and so on. We try to treat murder with Risperdol, Paxil, Seroquel, ECT - to no improved effect whatsoever.

In his February 19 introductory letter to Governor Quinn, Chairman of the Nursing Home Safety Task Force, Michael Gelder, says a unique opportunity currently exists for fundamental changes in the system, to assure that the problems of violence and inadequate or harmful treatment of Illinois' most vulnerable citizens do not reoccur.

Reading the report itself, one might be struck by its concentration upon details of process - how to do this or that subsubsidiary task. This is all impressive work, and the recommendations are impressively detailed. Eleven separate workgroups are established to take it further. Target dates are set, things are defined, etc.

But fundamental? Not even close. Here's the tip-off.

While reading this basically well-written report, almost everyone, professional and non-professional alike, will begin to yawn or get slightly distracted or bored or go blank at certain points. The phenomenon results directly from a word in the text which, unbeknownst to the reader, is undefined or mistakenly defined. Now watch for the word resident.

The task force was supposedly in universal agreement right from the start, that nursing home residents are supposed to be old people who can't take care of themselves, not mental patients. Yet within the first few pages, we see repeated references to younger adult nursing home residents with mental illness who need to "receive the care and treatment essential to avoid anti-social behaviors." Now wait a minute...! Are these guys just another kind of resident, or are they a different breed of cat, or what? I don't get it.

There's a fundamental confusion here, and it's going to ruin any opportunity for positive change.

As I've written (many times) previously, I think the error is, very simply, calling people who behave badly "mentally ill" to begin with, and then presuming that they are the way they are because of some brain problem which ought to be dealt with as a medical issue.

I'm sorry, but we just don't know how to FIX people that way. Nursing homes can't do it, neither can state nuthouses. Nursing homes are places for old people to go when they need to be fed and sheltered and their families don't want to do it by themselves. Nuthouses are places for criminals to go when they need to be restrained and society doesn't have the stomach to discipline them in the traditional ways. When we lump these very different tasks together as "care" for "patients" we waste a lot of hard work.

Unfortunately, that's what's happening with the Illinois Governor's Nursing Home Safety Task Force. See whether their report is easier to read when you spot the fact that the word resident is causing some blankness.

Wednesday, February 17, 2010

Hey NAMI, here's a theory...

NAMI's new publication, "A Roadmap to Wellness for Individuals Living with Mental Illness", appears slightly out of the organization's traditional character. I think it's a hopeless PR patch, actually. Nobody's going to forget anytime soon that this group is utterly beholden to big pharma and primarily dedicated to getting everybody to take psychotropic drugs whether they like it or not.

But an interesting passage on page 4 of this paper reads as follows:

Often, when someone tells a health care provider that he or she is taking antipsychotic medications or lives with a serious mental illness, a person will receive a lower quality of care or less attention. NAMI’s Schizophrenia Survey demonstrated that many people find that even informing a health care provider of an illness worsened their care. The survey, wherein participants shared their mental health diagnoses, showed that nearly half (49 percent) of those surveyed say that doctors took their medical problems less seriously once they learned of their diagnosis; an additional 39 percent of those who responded say that their (dx) of schizophrenia made it more difficult to get access to other medical care.

I know this is true. My forensic clients report the problem all the time. Referred by a state nuthouse treatment team for independent consultation about, say, a dermatological problem or an athletic injury, they arrive at the outside medical clinic to be met with clear disrespect and "discrimination" from everybody, especially doctors.

I think I know why this happens, too. Here's my theory.

Put yourself in the non-psychiatric doctor's shoes. First of all, he knows perfectly well that the patient he's looking at is more or less owned by somebody who's not trying to cure disease, but rather to disable the person neurologically from possible future bad behavior. This embarasses a well-intended health care professional with any commitment to the Hippocratic Oath. Instinctively, he wants nothing to do with the situation.

Secondly, the MD knows pretty well how bad psychotropic drugs really are. Yet if he recommends that a patient try to stop taking them, he's in a position of contradicting the state psychiatrist who referred the patient. Chances are pretty good that the complaint which brought the patient to the clinic is about symptoms caused by the meds the referring psychiatrist has prescribed. Big, complex, no-win situation. Bad business. Doctor just wants to avoid, avoid.

Lastly, everybody knows there's pervasive lying all around this case. The psychiatrist pretends the patient has a chemical imbalance or a brain disease which cannot be demonstrated or tested for. The patient probably lies about the same thing, not to mention about past bad behavior ("... schizophrenia/postpartum depression/bipolar disorder/delusions/voices/psychosis made me kill her, judge, I couldn't control it..."), so maybe he/she lies about current symptoms, too. And the whole culture lies about the efficacy of medicalizing behavior and happiness, because we all want a magic pill to save us the hard work of personal discipline.

The arrival of a mental patient at a non-psychiatric medical clinic makes health care providers nervous, at least subconsciously, as in, "Um ... which long-forgotten lie might I need to cover up now?"

When suddenly worried about getting caught, people become ... testy. It's a natural human reaction that's nearly impossible to suppress. If you ask me, this explains the phenomena described by NAMI in the quote above.

The best "roadmap" NAMI could provide for individuals with mental illness might show a route called the truth. Is it too much to ask?

Wellness ultimately never comes from medicating bad behavior.

Drugs disable the senses and the analytical faculties.

Mental illnesses are not known brain diseases.

Tuesday, February 16, 2010

Fast Talk by NAMI Tennessee Executive Director

Sita Diehl, Executive Director for NAMI Tennessee, made a strong Valentine's Day pitch in The Tennessean for tax money. No doubt many readers will find her arguments persuasive. I'm not a Tennessee taxpayer, but I have a sister and brother-in-law who are.

People should question whether what Diehl calls "...the cost-saving value of mental health care for people with severe mental illness" is any more real than the "value" of drugging children for ADHD, which suddenly looks strongly negative with the results of a recent Australian study.

Diehl says 373,000 Tennesseans "have" a severe mental disorder. What she means is they were diagnosed according to the Diagnostic and Statistical Manual (DSM) with schizophrenia, major depression, bipolar or PTSD. She does not mention that none of these diagnoses, unlike such medical diseases as cancer, heart disease or diabetes, can ever be confirmed by any objective medical test. Psychiatric diagnoses are essentially subjective, as evidenced by the facts that different doctors are often happy to argue for different disease labels in the same patient, and court appointed experts often disagree even over whether a patient has any mental illness. So nobody really knows how many Tennesseans "have" any mental disorder. Nobody really even knows what that means.

Diehl says, "Treatment works — if you can get it." (Again, she's obviously not talking about stimulants for ADHD anymore...) She implies that people seek out mental health treatment for themselves. The truth is that people generally try to get psychiatric treatment for somebody else, while the mental patients themselves often try very hard to avoid it. Saying treatment works basically means it's possible to drug someone into sufficient neurological disability that he or she won't seem to behave so badly anymore. It's also possible to quiet them down by hitting them over the head with a baseball bat.

Diehl goes on and on about costs of mental illness. She also repeatedly mentions thoughts of self harm. How exactly does it cost the public any money at all for someone to merely have certain thoughts? She cites a figure of $3,840 a month for confinement in prison, but neglects the fact that confinement in a mental hospital costs three or four times more than that.

The following paragraph is especially egregious:

More than 92,000 children in Tennessee live with a mental illness severe enough to impair daily life. Half of those students age 14 or older drop out of high school. Elementary school children miss 22 days a year. Despite availability of effective treatment, it can take eight years from onset of mental illness to treatment. Children lose their childhood. Families experience heartache, isolation and lost workdays.

What does "severe enough to impair daily life" mean? Does it mean that they can't eat or walk or breathe, or just that they often forget where they take off their shoes?

This is maudlin, meaningless nonsense. Don't all children lose their childhood at some point? The available "effective treatment" she's talking about is addictive stimulant drugs. Is it worse for a kid to be a speed addict, a couple inches shorter than he would have been, with a significantly higher chance of sudden cardiac arrest ... or to miss 22 days of school in a year? Are families who put their kids on drugs thereby immune to heartache, isolation and lost workdays?

Sita Diehl's pitch is cheap, deceptive, emotional propaganda. It's hard to know whether she believes the sob victim story, or just says it because she's paid by drug manufacturers.

It's a con game, Tennessee, don't fall for it.

Friday, February 12, 2010

Is mental health bad for you?

It seems to me as though people who pay attention to mental health do poorly in life.

AP reports that Olympic skater Nancy Kerrigan's brother Mark was on meds and seeing a psychiatrist when he killed their father. What a surprise. This family's whole life now is arguing about whether the father was murdered by the son. That kind of sucks doesn't it? Think their Thanksgiving dinners and Fourth of July picnics will be lots of fun from here on out?

More from AP, the last heir to Camelot is accepting exile from the dreamdom of politics. So-sad RI Congressman Patrick Kennedy made mental health the signature issue of his career. He's been in and out of "treatment" himself for years. What a surprise. They say it never rains 'til after sundown.... Oh my god, that was so long, long ago, let's all cry for a while.

I follow a blog by Dr. Jennifer Howard, who points out that living a content and balanced life really is possible. Well, I guess this doesn't have to make me totally sick ... but I think it demonstrates the fatally mistaken viewpoint implicit in the concept of mental health. Nothing personal against Dr. Howard - after all, I practice mental health law, which must be even more ridiculous than mental health. But I like to believe I operate in some spirit of defiance.

I recall two pieces of advice in this regard.

Kendrick Moxon, surprised that I would consider such an ignoble profession, once explained what the practice of law really is. "It's reasons," he said. "Lower case r, plural." His point, which was soon proven by the verdict in a very expensive jury trial we worked on together, was that the litigator wins and is heroic merely through skillful groveling to an appearance of authority, and by offering up mediocre excuses and justifications in a larger number and for a longer time than the other side.

Rabbi Harold Stern, the longtime spiritual leader of my in-laws' Conservative synagogue, gave one of the finest sermons I've ever heard from any pulpit about why we don't blow the shofar when Yom Kippur happens to fall on the Sabbath. His lesson was that, notwithstanding our attraction to music and drama, the most exciting clarion ritual on the highest Holy Day of the year is far less vital to our existence than the small, daily and weekly duties which connect us to God and to each other.

So, I guess I do understand Dr. Howard's high valuation of a mundane, content and balanced life, in a way.

It's just that I also know, in my heart of hearts, that I would personally do much better in an environment where I'd have to escape from violent death at least three times a day.

And I still imagine that one day I will stand above the field of my greatest victory, looking down at the whole world which I finally command and the whole world's riches which are free for me to take; and in that moment I will turn and walk away with nothing but the shirt on my back, and thereby live forever.

Mark Helprin wrote, "Although we may have risen, we are still obligated and responsible to the battle as it is now being fought, for this is our time, and we have no other." So ... I do practice mental health law.

But responsibility to the current battle is one thing, psychiatry is another. There is no room in their concept of mental health for rising ... to anything. Psychiatry is a slave philosophy, and the promise of a content and balanced life is bait in their slave trap.

Who wants to be a Kerrigan or a Kennedy now? Give me the jungle, and the stars. Like it or not, we all sail with the tide.

Tuesday, February 9, 2010

Smart kids go crazy

A study just published in the British Journal of Psychiatry shows that smart kids are four times more likely to develop bipolar disorder than average kids. Assuming it’s true, what does it mean?

Bipolar disorder being a crippling life-long mental illness, should parents hope their kids just get average grades? Should a forensic psychiatrist, knowing that a defendant once scored above 1400 on the SAT, be more certain that he or she was not guilty of murder by reason of insanity? Should schools expect that A students will be more likely to need mood stabilizers and anti-psychotics? Why not?

For decades, NAMI types have argued that mental illnesses are chemical imbalances in the brain which cause disabilities needing treatment, even prophylactic treatment. Now it looks reasonable to theorize about a hypothetical chemical imbalance which causes bipolar disorder and also makes people smart. Should we screen all straight-A students and be prepared to treat them medically to keep them from being so smart and going crazy...?

On the opposite side of this thing, GlaxoSmithKlein, maker of the antidepressant Paxil, just announced they won't even look for new drugs in that class anymore, because it's way too hard to know if they work. So ... if psychotropic meds may not even work, and if they have side effects like suicide and diabetes ... um ... should we give them to kids ... at all?

This is going to get extremely complicated! As Gregg Easterbrook writes in Sonic Boom: Globalization at Mach Speed, "Does it seem as though no matter how much you know and learn, you'll never really be on top of things? Guess what--you won't."

Well, here's a trick. Let’s give up this goofy, destructive and distracting search for magic-button cures for mental-illness-as-brain-disease. Let’s work out how to deal with different kinds of people, and stop trying to make everyone be average and mechanical and the same. The world will never become a better place because we can predict and control standardized humans. It will only improve if we create more truly new things, and communicate across wider and wider differences.

Mental illness is NOT any chemical imbalance in an individual. It’s the need to medically control individuals for the sake of security in society. It’s a bad metaphor, actually, and it really discourages us from being smart.

Friday, February 5, 2010

The most evil people on earth

In a Parade magazine article last year, Sen. James Webb noted that the United States houses a quarter of the world's prisoners, which should imply that, "Either we are home to the most evil people on earth or we are doing something ... vastly counterproductive." Webb is pushing to establish a commission to study possible reforms of the criminal justice system.

We certainly are doing something vastly counterproductive: we are putting justice and rehabilitation in the hands of "mental health professionals". It's vital to understand that this crowd does not share the older cultural orientation to crime and punishment, morality and personal responsibility. They believe, and operate on the basis that unacceptable behavior is really caused by chemical imbalances, or brain disease, to be "treated" by medical experts. This is a radical departure from universal human experience, but it's absolutely emblematic of our criminal justice system in the USA.

The complaint that prisons are our largest mental health institutions is intended as an argument for more hospitalization and treatment and less incarceration and punishment. In reality, anyone who spends any time in state nuthouses immediately sees there is little or no difference. Some state mental hospitals look cleaner and gentler than some prisons, but that's only a surface manifestation of spending 400% more per person in the mental hospitals.

I've said before, I know people in the nuthouse who have realized after the fact that they would have preferred an honest prison sentence to the total spiritual cruelty and the deep, creeping dehumanization of the mental health gulag. They would rather have worked with the guard with a gun who'd have said, "You murdered your fellow human being so we don't trust you any more, and we're going to keep you in a cage for a long time," not the security therapy aide with a syringe who said, "Your brain is defective and it caused you to act like an animal, so we're going to screw around with your brain to make you a better animal, all for your own good, which of course we understand and you don't."

I can suggest some possible reforms to the criminal justice system for Sen. Webb's commission to study. The insanity defense as we know it should be eliminated. Psychiatric progress notes should be generally barred from criminal court hearings as hearsay, unless whoever writes them is available for cross-examination. Psychiatric and psychological "expert" opinion testimony should be subjected to strict Daubert scrutiny for scientific validity and for relevance verses prejudicial impact.

The criminal justice system must recognize that "mental illness" is not a disease which can be the cause of, or the excuse for, any person's act. "Mental illness" is in fact an epithet, which may be easy and popular, but which really says more about the person using it than the person described.

All "mental illness" indicates, and all it explains, is our unwillingness deal with crazy people face-to-face-in-person, and our rather pathetic hope that medicine will save us from ever having to do so.

Take "mental illness" out of criminal justice completely, separate psychiatry from the state. That is the single necessary reform which will prove that we are not after all the most evil people on earth.

Thursday, February 4, 2010

Optimism and Pessimism

In his new book, Sonic Boom: Globalization at Mach Speed (Random House, 2009), author Gregg Easterbrook writes:
Western ideals -- free economics, freedom of speech, personal dignity, rationality, consent of the governed -- are spreading across the continents at the most rapid rate they ever have spread. The world seems to face two possible outcomes. Either the Western philosophy of life will fail when applied to the world as a whole, or it will succeed. If the former, the immediate global future may turn bleak. If the latter, there will be a Sonic Boom.

Easterbrook celebrates his own ostentatious optimism in this book, even though he was still writing it when the recent economic meltdown went into full swing. I appreciate and generally ascribe to this kind of optimism. I laugh at those conspiracy theorists who suppose that the world is secretly controlled by John Davison Rockefeller and Cecil John Rhodes (never mind they died in 1937 and 1902, respectively), or that airport scanners are really a plot to create pornography for the private consumption of horny TSA officers, so the complete dissolution of the Bill of Rights must be right around the corner.

However, I'd really have to give even odds on Easterbrook's two possible outcomes. From at least the late Nineteenth Century, our so-called Western philosophy of life has contained the seeds of its own destruction. Those seeds are the abandonment of spiritual wisdom in deference to brute physical force and radical materialism.

They were scattered by the winds of war in 1860-65, and in 1914-18. And they germinated in 1938-45 at Wannsee, Dachau and Auschwitz; in 1947-53 at Foggy Bottom; and later in Lubyanka Square, Basel, Langley and Indianapolis.

By the 1980's psychiatry as we now know it was in full flower: An individual human being is a brain, and that's all, dammit! A basket of chemical reactions, a machine. There is no free will, love, honor or purpose. People do not intend, they do not agree, learn or create, but merely react biochemically. The only sensible way to understand or deal with people, the ultimate way to handle them, is by manipulating or fine-tuning chemicals in brains.

If the world is forced or defrauded into adopting our psychiatry, the Western philosophy of life will certainly fail. There will be no point, we might as well all shoot each other, or commit each other to places like Elgin Mental Health Concentration Center to be "treated" whether we like it or not.

But if China will just continue its "rebuke of mental illness" (see my post from January 8, 2010), maybe there's a good chance we'll still quote Homer, Plato, Aquinas, Shakespeare, Jefferson and Twain a thousand years from now.

I supppose it's an even bet.