Monday, December 14, 2009

X, Y and Z plus

Patient Z at Elgin Mental Health Center is doing surprisingly well. This is the guy they pretended they could forcibly drug if he continued to refuse psychotropic meds. (See my earlier article entitled "Despicable Coercion", posted November 21, 2009.) I intervened at the court hearing on a petition for involuntary treatment, and they immediately backed off. But if Z had not had a private attorney, he probably would have been convinced to go back on the dope.

I went to Z's monthly treatment plan review yesterday. Psychiatrist Y and social worker X were there, looking a little pensive. Dr. Amin Dhagestani, the head of psychiatry at Elgin Mental Health Center, also attended. I like Dr. Dhagestani, we have good conversations about various things, and he has at least read two books which are extremely critical of the whole mental-illness-as-brain-disease-treatable-with-drugs orthodoxy. I think he is assigned to these monthly staffings which I attend mainly to make sure I don't brutalize institutional staff somehow, or provoke them into saying things that could easily get the administration in trouble or the state sued. Nevertheless, I like him, he's bright.

Everybody acted pretty happy with Z's treatment progress this month. That's more than a little curious, considering that they were all very recently asking a court to allow forced drugging because Z refused meds, and he's still refusing meds. I also thought it was kind of interesting that nobody even mentioned my recent letter, written in my very best "radical bomb-thrower" adaptation (see Nov. 21 post).

Anyway, Z is all about how much better he feels now that he's off all psychotropic meds. He sleeps fine now, his prostate problems have disappeared, various other side effects have abated. He's beating younger guys at basketball and chess. And he looks very good.

Z wrote an 18-page "addendum" to his psychiatric chart. The document is cogent and insightful, perhaps even compelling, unless the reader has a strong prejudice against people labelled mentally ill. One point which Z repeats over and over again is that he's not mentally ill and he doesn't need or want medication to treat a non-existant disease. There are legal and social policy arguments against his position on this, but there are no medical ones at the moment. If Z were behaving in ways which people could generally recognize as psychotic, there would be an argument which would be called "medical" (even if that would require a radical therapeutic-statist definition). But Z's behavior is just fine.

So I think this situation will continue to be interesting. The patient insists he's not mentally ill. Thus he is ostentatiously committing the worst possible heresy, and the system really cannot tolerate that. But they don't seem to know what to do about it, either.

The only person in yesterday's staffing who was even willing to point out Z's "denial" as a problem was social worker X. And as a social worker she looked slightly inappropriate, when neither the treating psychiatrist Dr. Y, nor her boss, head of psychiatry Dr. Dhagestani, was interested in taking up the point. (Mental illness is a medical issue, isn't it? Shouldn't the M.D.'s sitting right there in the room have had something to say about the problem of the patient's denial of a long-recognized, properly diagnosed disease?)

Dr. Dhagestani was actually very complementary toward Z, and made a big point of telling him that his own thoughts and opinions, as the patient, are of utmost importance in the collaborative project of his treatment at Elgin Mental Health Center. This sounded really good.

Dhagestani also told Z that, of course he has every right to utilize any possible legal process which he and/or his attorney think appropriate. This sounded good, too!

But guess what? Z has been at Elgin for almost seven years. Dr. Dhagestani's slick PR is completely contradicted by the reality of Z's experience, and everybody knows it.

They'll either have to find some way to make this patient "mentally ill", or he's eventually going to give the system some kind of a serious shaking.

It looks like a battle, so I'll stay tuned.


  1. Madhouse inamtes have been loudly protesting that they are "mentally ill" for hundreds of years. It's regarded as actual proof of their lunacy. "Denial" the quacks call it.

    What would be truly remarkable is if "patient z" asserted that NOBODY is or can be "mentally ill" because "mental illness" doesn't exist to start with. He'd say that NOBODY at Elgin madhouse has EVER been "mentally ill". His psychowardens wouldn't be so patronizing then.

    "I'm not mentally ill but I accede that others are" is a far cry from "I'm not mentally ill nor is anyone else because mental illness is a fairy tale cooked up by quacks and legislators." Find yourself a client who believes that Randy. Then you'll have something interesting to work with.

  2. Rodney you were, precisely, that client who believes mental illness is pure fairy tale (and you were certainly interesting to work with). Actually, "patient Z" might come closer than you think to sharing your belief.

    I have no problem with this belief, exactly as you state it. But I am not compelled to challenge every other belief about mental illness, except to the extent that it's being forced upon me or a client of mine by the state.

    The guys I work with at Elgin madhouse want to get out, first and foremost. Asserting a pure Szaszian philosophy and insisting that it be acknowledged as acceptable is a really tough row for them to hoe, no matter what they believe.

    But I certainly can hope that once in a while when one of them gets out, he or she will consider that the best amends can be made to society by helping to bring down that system which does nothing but dehumanized people.

  3. An occasional ideological conversion is something I'd like to see. Everyone opposes imprisonment of themselves. I always advocated for the immediate and unconditional liberation of ALL involuntary madhouse inmates, the eviction of most "career mental patients", the remedial care of vegetable-ized inmates, and the sure and swift trial of all criminal defendants invoking psychiatric excuses.

    Elgin and Chester were notorious for NOT freeing their most obseqious, boot-licking "model patients" and this was lost on nobody. The only other option was to become such a pain in the ass they'd want to somehow get rid of the inmate. (Neither option was ever available to me as my captors indicated up front my natural life incarceration was the name of their game.) Given the violence and coercions of the personnel, being a pain in the ass was a hard row to hoe.

    The philosophy I expound is best referred to as "Yoderian". I arrived at it indepenent of Thomas Szasz who I love and admire. Szasz was never a prisoner and hasn't written much on how best to escape from nuthouses.

    I witnessed countless inmates bellowing that THEY weren't mentally ill while denouncing their fellows as "mentally ill" and ridiculing as absurd my claim MI doens't even exist. There is nothing at all novel in this.

    Unfortunately, bringing down psychiatry is a task like bringing down, say, Christianity. An ambitious task.

  4. So long as people believe that others can "get" or "develop" a "disease" that renders them devoid of moral agency, they will clamor for controls and coercions of those others. Coercion goes hand in hand with ANY belief in MI. If I believed my neighbor had "disease" that would "cause" him to push me in front of a subway train, I would naturally want him quarantined, "hospitalized" or otherwise "cured" of his "disease" or removed from a position where he could harm me. One cannot just say, "hey, look, I don't care what your beliefs are regarding MI, I just insist you don't employ coercion against those so designated" doesn't fly. Coercion is the natural and logical result of a belief in MI. Absent the belief, this form of coercion would vanish. Attacking coercion and not the founding belief is ass backwards.

    People have believed in invisible boogeymen in the sky for thousands of years. In MI for a few hundred now. I have zero faith in humanity to not believe in fairy tales. As long as a myth is useful, it will be embraced. MI is a useful myth. Not to me or you--or patient z at this moment in his life. But then again, a have a dim view of humanity. I prefer the company of my dogs over the bulk of humanity.

  5. As to the belief and its consequences, you have a point. I'm sure you've read Szasz's Manufacture of Madness, wherein he relates the historical experience of belief in witchcraft and prosecution of witches, to today's mental illness beliefs and institutionalization.

    Due to the inspiration of that book which I must have read in about 1970-something (not sure when it was published), I later took a history course at Northwestern U which was titled The History of Witchcraft in Europe, taught by a prof who was one of less than a handful of acknowledged experts in the subject.

    There's way more on this than almost anyone thinks. Witches were prosecuted by the smartest, most educated people in Western civilization for HUNDREDS of years -- longer than the USA has even existed. The Malibus Malificarium begins to look a lot like the DSM the more one reads about this.

    I find my self trying to recall all the discussion in that class about why witchcraft prosecutions mostly ended in the late Seventeenth Century. I think the underlying beliefs (e.g., in the Devil's Sabbath and the reality of a personal Devil present in the world) did have to lose credibility. But that was not the only factor, it was pretty complicated and there were various, very interesting details.

    By the way, Szasz's supreme statement on the future of all these things, in my humble opinion:

    "It is possible that religious, political, psychiatric, or some other kinds of evasions of personal responsibility will always be necessary for our existence as social beings. It is also possible that, in the future, some people, somewhere, will become as passionately interested in the pursuit of personal responsibility as they have been, for the past several centuries in the West, in the pursuit of personal liberty. When and if that time comes, the psychiatric enterprize will disappear and become of historical interest only."