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.