Incompetence and bad manners

There's a saying, never blame or allege bad or conspiratorial intent for situations that are just as easily explained by incompetence.

From my experience, this should be a major stable datum for understanding the Illinois forensic mental health system. I probably do not repeat it frequently enough to my clients, who hate the plantations and tend to see evil motives in everybody they deal with. I have two examples from yesterday and today.

At a staffing for Adrian, social worker Dan Malone was bound and determined to make the patient feel like he was wrong for refusing to have his vitals checked or to be physically examined. Adrian had told staff he didn't want that "service" several times, but they continued to bug him, thinking he might change his mind or comply just because they kept after him about it. I spoke up, to point out that of course Adrian had a perfect right to refuse any such medical attention, and Malone admitted it but responded very pointedly: "And that's why we didn't make him do it, because he has a right to refuse..." 

I'm not saying Malone's tone was hostile. He did not add, "...you fucking idiot Kretchmar," but his attitude was arrogant and dismissive. I'd rather be straight-out called a fucking idiot than talked down to, any day.

Everybody can be forgiven for having a bad morning and being a little impatient occasionally. At least, everybody except psychiatric slaves. When Adrian gets impatient it gets charted, and the chart notes can be used in court to help prove he's too mentally ill and dangerous to have any privileges or liberty.

Malone insisted on asserting that the only reason Adrian was being harassed by staff for a physical exam or vitals check was for his own good. People went after him and incessantly asked him to comply because they care about his health. This was Malone's nonsense, of course. People harassed Adrian to get his vitals checked or to have a physical exam because they believed it was proper according to the clinical ritual they follow. After all, medicine über alles, right? Everyone should be happy to have their vitals checked repeatedly all the time, and get a complete physical annually, right? Anybody who doesn't agree with and religiously observe those sacred rituals probably has Prodromal Anosognosia (see DSM-5 diagnostic criterion B).

Dan Malone is some sort of clergy of the psychiatric faith. He knows what's best for Adrian much better than Adrian does. His motives cannot be questioned, even if his manners are plainly bad. After going on about how staff's concern for the health of patients was the only reason Adrian was asked if he wanted a physical exam or his vitals checked, Malone proceeded to question Adrian in a very condescending and insistent way (almost like, "What's wrong with you?") about why he would ever refuse these wonderful, helpful medical services provided by such perfectly professional, medical mental health staff.

Adrian didn't have much of an answer, but Malone kept going on, and I finally told him brainwashing was unnecessary. He didn't like that very much. He doesn't believe they do brainwashing at EMHC, but he's wrong. Anyone who doubts it should read Robert Jay Lifton's Thought Reform and the Psychology of Totalism: A study of "brainwashing" in China (Chapel Hill: University of North Carolina Press, 1961). Psychiatric slaves recognize Lifton's descriptions of the Chinese techniques instantly, and staff on the plantations would, too, if they were able to be honest. They can't be honest though, they have to lie to themselves all the time. They probably can't read that book either.

Which brings up the incompetence factor. These people are mostly semi-literate cogs in a machine, pretending to be doctors specializing in the medical treatment of behavior. It's too obvious to almost everyone that they get poor or zero (or harmful) results, for which the taxpayers would never knowingly foot any bill. Dan Malone can't get any handle on Adrian, he can't help this patient, so he just has to blame him, disrespect him, despise him. It's not hard to see that, sitting in the room. It's not like Adrian misses it, either.

Meanwhile, over on N Unit, Gus was recently prescribed a heart monitor because his migraine meds might be having serious cardiac side effects. The cardiac doctor at UIC carefully instructed Gus on exactly how to use the monitor. He also mentioned that he didn't trust the data he was getting from EMHC, so he wanted Gus to take the monitor on and off himself, exactly as instructed. Later at EMHC, Dr. Seema Khan wouldn't let Gus do it, and wouldn't listen to Gus about how to do it. Who knows? Hopefully Gus isn't being denied appropriate medical care for a serious heart condition.

Everybody (staff anyway) at EMHC has to prove they can fight Gus. His social worker Joseph, who is supposed to be on a different unit but comes to N just to fight Gus, told him today that his packet for conditional release has gone to the court. But he refused to say when, or how he knows. A packet that recommends conditional release is a big deal; Gus has been waiting a long time for his packet to work its way through administration, his treatment team, second level review.... It probably should have been in court a couple years ago. In fact, comments by none other than the Almighty Statewide Forensic Medical Director, James Patrick Corcoran himself, suggested that Gus was ready for manumission long ago.

I told Gus to question Joseph closely about the conditional release packet, because a casual statement like, "...it has gone to the court," might be true or it might be just Joseph trying to get Gus to leave him alone. Gus needs to confer with his lawyer about an actual petition for conditional release, so he needs to be sure Joseph's news is accurate. He also needs documents, etc., to support a petition. (Tony Dillard wants to charge him a dollar/page for them though. That's suspiciously steep, to say the least!)

So Gus tried to ask Joseph politely, "When did that packet actually go to the court? What day did it get filed? How do you know?" Joseph simply refused to answer in any way at all, which makes no sense unless he was lying to Gus about the packet, which seems pretty likely to me.

But incompetence explains all of this at least as well as bad motive.

Decent manners would help.