Friday, December 24, 2010

A much uglier picture

Dr. Lisa A. Rone grumbles in today's Chicago Tribune that insurance companies are not helping psychiatrists enough. As immediate past president of the Illinois Psychiatric Society in Chicago, she insists that they change their evil ways.

In the key passage of this embarrassing, utterly deceptive editorial moan, Rone admits, "... one of the primary struggles for doctors dealing with patients who are mentally ill: patient self-awareness and compliance. It's often difficult to convince people that they have a mental illness and that they need therapy/medications for their illnesses."

I certainly hope Rone would at least endorse my original suggestion for a new disorder to be included in DSM5....

The real problem is that people don't want psychiatry for themselves. They want it for other people who are bothering them. I once pointed out the simple, objective difference between the clinical sequence of psychiatric practice and any other medical specialty, and I've never really had anyone contradict me about this.

The immediate past president of the Illinois Psychiatric Society is really trying, with her screed in today's Trib, to agitate for more utility in state coercion. She wants the insurance companies to be forced to more effectively help force people to go to psychiatrists and take psychiatric drugs.

This has nothing to do with real health or illness as most people understand and relate to those subjects. It has nothing to do with curing anything or helping sick people.

It has everything to do with brutal social control of individuals. Picture six guards holding a "patient" down screaming, while a "doctor" forces a needle into her body and injects a drug that will turn her into an uncaring, compliant sub-human.

I'm sorry to point it out on Christmas Eve, but that's the correct picture of Dr. Lisa A. Rone. She's a perpetrator of crimes against humanity.

Tuesday, November 2, 2010

Conferences on mental health

For my concluding remarks at a workshop presentation to the Canadian Mental Health Association's "Thriving in 2010 and Beyond" conference, I wrote:

No brain research or fine-tuning of neurochemistry will ever replace an ability to communicate with a single individual face-to-face, no matter how insane, and change his or her mind. When you fail to do that, and when you are afraid, all the medicine and all the science of the past, present and future cannot rescue you from mental illness.

This essential point comes from my own nine years of experience as a legal advocate in forensic psychiatric institutions in Illinois. My clients are murderers, etc., found not guilty by reason of insanity. My job has been to get them released into the community though they refuse to take psychotropic medication.

I suppose I could have put mental illness in quotes, or made that last sentence read, "... cannot rescue you from what you call mental illness." But the presentation was, after all, to an audience of people who my friend Rodney Yoder has always insisted are professional mental patients. I guess it was unnecessary to rock the boat with Szaszian purity.

It also seems that the mental health world is fracturing. At the Canadian conference, it was clear (at least to me) that only a minority retain any orthodox "medical" view, wherein hope lies exclusively with research into brains and neurochemicals, and stigma is fought by making people believe schizophrenia is the same kind of "disease" as diabetes or cancer.

Most people are becoming aware that medicalization reinforces stigma, and that the best-financed parmaceutical researchers are admitting they can't even tell whether psychotropic drugs work.

The mentally ill are simply people with problems in living and relating to others. Little or nothing new about such general human complexity was discovered in these very recent centuries, or mere decades, which comprise the history of modern medicine. Psychiatrists have taken to descriptions which are a bit more standardized, and they've been clever about enforcing those descriptions to obtain a commercial advantage. Nothing more than that, and needless to say it hasn't helped.

Maybe there is hope for a shorter mass historical delusion than the 300-year Great Witch Hunt. Maybe we will not coerce people into "treatment" they don't want too much longer. Maybe we can soon stop dehumanizing and neuroleptizing and disabling people, "for their own good and to protect the community." That's what I'm working for, and prospects don't look that bad to me.

I have submitted a proposal for a workshop at the national conference of NAMI in July, 2011, based on what was pretty well received in Canada last month. The response from NAMI will tell me more. Stay tuned.

Friday, October 29, 2010

Medicalization = Stigma

The Treatment Advocacy Center recently called for, "Universal recognition that severe mental illness is medical, NOT behavioral". They say this would be a "breakthrough", but in fact it would be meaningless or delusory.

To begin with, how can "medical" and "behavioral" be mutually exclusive categories of illness? This would necessarily imply either that behavior is not affected by anything which medicine can remedy, or that we just never use medicine to change behavior even when it's possible to do so. Obviously, the widespread existence and practice of psychiatry itself contradicts this.

T.A.C. pretends to advocate only in regards to severe mental illness. So perhaps they mean that millions of people taking Prozac who were never actually psychotic or completely disabled by their blue moods have behavioral problems, not any medical illness. The same would probably go for the millions who take Ritalin to stay sharper in school or more focused on the job.

Yet all of these guys, I'm quite sure, would argue long & hard that their condition is medical, too. If not, then why should their insurance pay for their drugs? Seems to me a condition is medical exactly according to whether or not somebody takes medicine for it, simple as that.

I might add, whether people take "medicine" for a condition doesn't have much bearing on whether they are helped or cured, in any objective sense. Last time I checked, good Scotch whiskey was a great "cure" for just about anything according to somebody, somewhere. And those who find that long-honored cure to be more of a nuisance than whatever the disease was which needed "treatment" can then choose to solve their addiction with LSD. This is all perfectly medical, of course. But I think most of us would see some behavioral aspect....

The T.A.C. guys would have us believe that they, or some expert somewhere, can draw a sharp line between "medical" and "behavioral" - that this is a matter of Science after all, or Special Knowledge.

No. Even schizophrenia and bipolar remain putative diseases, with no proven biological basis or etiology. Actually whether anything called mental "illness" is medical or behavioral can only be a matter of viewpoint in social policy, economics, philosophy, prejudice, and/or various other fuzzy and subjective things.

As the National Institute of Mental Health recently put it, "... curremt diagnostic categories likely do not distinguish among causal factors or provide homogenous endophenotypes." (Translation: nobody knows what any of these so-called mental illnesses actually are!)

So why, exactly, do these oh-so-smart guys at T.A.C. think a meaningless and delusory "universal recognition" would be such a breakthrough?

Because they think it would justify forced psychiatry, that's why. That's the only reason.

Tom Szasz has said, "The subject matter of psychiatry is human conflict. However, perhaps because men are men and not animals, they cannot simply coerce, oppress or exterminate their fellows; they must also explain and justify it."

As far as T.A.C. goes, fraud is still fraud, and what goes around comes around.

Friday, October 8, 2010

DSM5 proposal

Diagnostic criteria for 295.001 Prodromal Anosognosia

A. Excessive avoidance for a period lasting longer than a few weeks, for reasons not related to economic austerity, of normally effective medications or over-the-counter remedies for common discomforts such as cold symptoms, allergies, headaches, muscle soreness, hangover, or difficulty falling asleep.

B. Failure to visit a medical doctor for routine checkups for a period lasting longer than two years.

C. Failure to obtain health insurance; or consistent failure, neglect or refusal to answer official communications from insurance authorities, complete necessary forms and questionaires, or otherwise responsibly attend to administrative details which are recognized as necessary for fair and effective medical insurance coverage.

D. Habitual or repeated patronage of internet websites which puport to "expose psychiatric violations of human rights" or "advocate prosecution of psychiatric crimes".

E. A confirmed record of any four or more of the following statements of effective opinion, not subsequently disavowed:

  1. Mental illnesses are not real brain diseases.
  2. Mental illnesses can be controlled by individual will.
  3. There is no objective medical test to diagnose or rule out any DSM disorder.
  4. Psychotropic medications have dangerous side effects.
  5. Children can become addicted to Schedule II stimulants.
  6. Psychiatrists perpetrate fraud and abrogate the right to informed consent.
  7. Psychiatry kills.
  8. The insanity defense should be abolished.
  9. Involuntary commitment should be abolished.
  10. Psychiatry is pseudo-science.

Tuesday, September 7, 2010

Dangerous nonsense by Elizabeth Bernstein in today's Wall Street Journal

It amazes and mystifies me, that in order to suggest perfectly rational collaboration and non-confrontational help among family members, a writer for a well-respected publication would find it necessary to promote absurdities and tortured, irrational, anti-scientific propaganda.

Today's Wall Street Journal contains a featured health & wellness article by Elizabeth Bernstein entitled, "A Way Out of Depression: Coaxing a Loved One in Denial into Treatment Without Ruining Your Relationship."

Bernstein's basic point is, if somebody you love needs help, try to understand them and talk them into getting it without pathologizing them or offending them. Fine, who would argue with that?

But the writer bases her advice on the claim that a common symptom of depression is denial or lack of awareness, also known as anosognosia. This is said to be "a physiological syndrome that makes a person unable to understand that he's sick."

This is dangerous and degrading nonsense.

Major Depression, Bipolar Disorder, Schizophrenia and all other mental disorders are defined completely and authoritatively in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision ("DSM-IV-TR"). All symptoms are listed for every mental disorder. Not a single mention of anosognosia is to be found anywhere in the 943-page volume.

The next (fifth) edition of the DSM is due out in a couple years. The American Psychiatric Association has an entire website devoted to DSM-V, which can be searched efficiently to find scores of references about depression, bipolar disorder, schizophrenia, and how all these disorders will be defined, diagnosed and treated in the future, with all the additional research since DSM-IV was published in 1994. But one searches in vain on this website for any mention of anosognosia.

The question that's begged: Why did Elizabeth Bernstein insert this "physiological syndrome" which is not relevant enough to ever be mentioned in the psychiatric manual, into her article as a supposed common symptom of depression?

Anosognosia is a fairly obscure term coined in 1914 with regard to certain brain injuries and neurological conditions. It's causes are unknown. It's use in relation to mental patients who refuse treatment is new and controversial.

Over the past nine years, I've worked with a lot of people who refuse psychiatric treatment and don't believe they are mentally ill. I've worked with a lot of their psychiatrists, too, and their security therapy aides, and their social workers, and all the other state nuthouse staff who get paid for holding and treating people whether they like it or not. These guys never talk about anosognosia. They know their jobs.

I can tell you this: The only reason anyone would claim that a common symptom of depression is lack of awareness, denial, or anosognosia, is to justify "treating" someone against his or her will.

The only point is to be able to forcibly drug someone - that is, get five or six enforcers to hold her down screaming, as a doctor violently injects neuroleptic poison into her body - while still pretending it's for a "patient's" own good.

There is nothing else behind this, in Ms. Bernstein's article in today's Wall Street Journal. Ms. Bernstein may not make the connection. The Journal's editor may not feel responsible for such ugliness. But that is the only point.

The irony is that Ms. Bernstein's article really wants to suggest the opposite of forced treatment. But that's the trouble with psychiatry, it doesn't work, it's an enforced lie.

The nuthouse psychs I work with don't make stupid excuses like "anonsognosia" because they don't have to. With court orders, locked cells and armed security, they're pretty free to brutalize the people they control.

Wednesday, September 1, 2010

Who ... me??

The Canadian Mental Health Association is hosting a national conference October 22-24 in London, ONT entitled "Thriving in 2010 and Beyond". Several weeks ago they were soliciting proposals for presentations at the conference, and I submitted the following:

Psychiatric treatment cannot apparently be separated from some degree of coercion or deception. Mental ''patients'' are generally presumed to ''need'' overriding judgments by others with regard to their treatment. Yet despite all the intricate rationalizations for bypassing the plainly expressed will of patients under various circumstances, the professional consensus remains overwhelmingly in favor of collaborative treatment models.

The problem of coercion and deception in psychiatry, perhaps more than any factor, has separated mental treatment from other medical specialties. Some advocates have frankly suggested that involuntary treatment should be legally facilitated on a much wider scale than it is, while others have opined that psychiatry as we know it would actually disappear if its facility of formal state coercion were ever lost.

Presenter has worked for nine years in Illinois forensic psychiatric institutions, advocating and litigating on behalf of involuntary patients, usually violent offenders who refuse psychotropic medication or continue to dispute diagnoses related to criminal court verdicts of ''not guilty by reason of insanity''. This niche is a dark place from which the general public, medical practitioners, legal professionals and civil servants desperately attempt to look away.

Unfortunately, the human condition shows no immediate sign of transcending violence and irrationality. Courts and other social institutions will be charged with ''doing something'' about bad behavior for the foreseeable future.

An alternate basic attitude will be suggested, 180 degrees opposite to current prevailing thought that mentally ill people can or should be ''helped'' by their neuro-biological betters whether they like it or not. Specific implications of a radically different attitude will be discussed for the architecture and practices of social institutions which we call either ''mental hospitals'' or ''prisons''.

Attendees will acquire rehabilitated purpose for mental health as a valuable social profession, and a viewpoint to inspire honest institutional innovation.

The Canadian Mental Health Association appears to me to be a close cousin to NAMI, in that their main focus is getting people to believe that mental illness is just like any other disease, e.g., of the kidneys, pancreas, heart or lung, and therefore medical solutions are the appropriate goal, just around the corner of research, etc. Of course, this is not my point of view at all.

Well, lo and behold, CMHA accepted my proposal for a presentation at their conference.... So now I have to deliver what I promised according to the description above. My talk, entitled "How to refuse psychiatry without upsetting the neighbors", will be from 10:15 to 11:15am on Saturday, October 23, at the London (Ontario) Convention Centre.

Should be cool.

Monday, August 2, 2010

Neil Steinberg on the non-fungibility of people

Kudos to Neil Steinberg in today's Chicago Sun-Times! His column is entitled, "Racists live in a world of interchangeable people." He points out that unlike money (one $20 bill is worth the same and has the identical use as any other $20 bill), people are individuals, and totally non-fungible.

Biological/medical psychiatric theory and practice are in fundamental conflict with this fact of life. The clearest statement I have ever read about this was 23 years ago, by Pulizter winner Jon Franklin: "We will have to turn our backs on the duality and, with it, the faith of our fathers.... We will have to look into the mirror, surrender illusion, and make peace with the fact that we're staring at a machine. We are mechanisms, pure and simple, explainable without resort to the concept of soul."

Machines are fungible, built from finite, interchangeable parts, lacking any free will, useful and valuable only to the extent that they are predicted and controlled. They are dead. This is how psychiatry sees people. As historians have often noted, psychiatry is also fundamentally racist.

It is vitally important however, to recognize that the general character of a field of theory and practice cannot be automatically applied to every practitioner in that field. I say that psychiatry is an essentially racist field, but I do not that say Dr. C is a racist, or that Dr. J is a racist. In fact, these individual psychiatrists, whom I know personally, are basically good people. Why they do what they do is a long and complex tragedy which will only end when that central understanding, so well-stated by Neil Steinberg today, becomes universal.

Individual people are alive. Minds are not brains. Emotion, behavior and human society will not actually be improved, and mental illness will not be cured, by fine-tuning neurochemistry. Jon Franklin was wrong, NAMI is wrong.

This is a problem: confront it!

Friday, July 30, 2010

Gimme a break, Judge!

I note in yesterday's Chicago Tribune that a federal judge was upset with nursing home operators who distributed deceptive information sheets to mentally ill residents. Hon. William Hart of the U.S. District Court for the Northern District of Illinois accused the operators of employing scare tactics about a proposed legal settlement to convince vulnerable patients and family members not to take their business elsewhere.

I have to laugh out loud.

What else, exactly, do Judge Hart, the Trib and the public think the whole "mental illness" industry is all about? Medical psychiatry would not exist without fraud and coercion, which are its basic, essential stock in trade.

Ever since I have been advocating for patients at Elgin Mental Health Center, that state institution has continuously, freely and enthusiastically distributed the most deceptive information in existence about mental illness: NAMI fliers and brochures which attempt to convince the public that depression, bipolar disorder, schizophrenia and anxiety disorders (along with anything else graced by a magic DSM code) are proven brain diseases.

This is a bald, flat-out lie, invented for no other reason than to sell drugs that dehumanize and control people. Every state institution I have ever been to in Illinois does the same thing.

I was in a monthly staffing at EMHC on Wednesday, during which the patient (my client) appealed to his treatment team with a manifestly rational and well-informed argument, that psychotropic drugs had never been helpful to him. They had in fact tortured him and damaged him. He wanted the help of these clinicians, to progress toward conditional release on a treatment plan without meds.

This patient was not demanding, hostile, or even very unrealistic. He hasn't taken any meds for about a year now, and there's nothing really wrong with him. If the treatment team dealt with him on just some part of his own terms, he'd quickly prove to them that he is in fact well.

But forget it! State psych-slave-keepers cannot bring themselves to think that way. At least, not until somebody demonstrates that it will cost too much not to.

They were all about interpreting every little disagreement, every departure from the most perfect adherence to their psychiatric religion and unconditional expressions of fealty, as the "rigidity of the patient's thinking" - caused, of course, by his not taking psychotropic meds. It's pure nonsense, every bit as despicable as the nursing home operators' deceptive information sheets, complained of by Judge Hart.

The treatment team seemed to actually believe the nonsense themselves, until I spoke up and agreed with the patient. I was rather quickly cut off with, "Well, enough has been said about meds, let's just move on." The truth was unacceptable, the motive was utterly malevolent.

There's no use in soft-pedaling any of this. The State of Illinois obstructs informed consent and perpetrates a continuing crime against humanity.

Saturday, July 24, 2010

Maybe it's good to imprison the mentally ill

My friend C. Rodney Yoder recently brought an article co-written by George Pawlaczyk of the Belleview (Illinois) News-Democrat to my attention. George had been an ally years ago, but Rodney was disappointed because the article, about abuse of prisoners at Tamms Correctional Center, paid far too much lip service to the mental health racket. Rodney had been involuntarily committed for twelve years at Chester Mental Health Center.

Both Tamms and Chester are singular super-max facilities, the only ones in the state. Rodney commented in an email to me that he would much rather have done twelve years at Tamms than at Chester. I asked him to explain why.

NAMI and other such so-called "mental health advocacy" groups make a huge hue and cry over mentally ill people being imprisoned rather than treated. This is a ridiculous red herring, because there is no difference when they're treated against their will, which they almost always are.

The fact is people in "mental hospitals" are prisoners. In my experience, many of them would rather be in honest prisons.

Anyway, for what it's worth, here's Yoder's perspective:

For one thing, Tamms is safer than CMHC. There is no possibility there of guards dogfighting inmates who are always kept isolated physically from one another. I endured HUNDREDS of physical assaults at CMHC in twelve years. One could conceivably just behave well and catch up on their reading at Tamms, while getting three meals a day and free laundry and dish washing and dental and medical care, optometric care, etc.

And the whole enterprise would be intrinsically more HONEST at Tamms. One would be there to be punished. The guards there are arguably not under intense pressure to concoct spurious bad behavior reports or to engineer "incidents" to be used as justification for the custody. I was on pins and needles at Chester when my involuntary commitments were about to expire, because I knew the pigs, nurses, and administrators would be wanting "incidents" to put in their latest petition. It was easy for a nurse or pig to give some subhuman animal a cigarette or candy bar or cup of coffee to start a fight with me or assault me (they'd then claim my defense of myself was an act of mental illness-driven agression). The Tamms guards don't have any conceivable interest in fabricating bad behavior claims against inmates. At Chester the pigs had an additional psychological need to cast me and other inamtes as wicked, deranged, perverse, symptomatic, or whatever description rationalized their psychiatric slave trade. At Tamms the inmates aren't EXPECTED to act or "be mentally ill".

At Tamms I would never have had to have some punk criminal tell me I'd be there for all my life while he'd be quickly liberated via psychoquack ass-kissing and shucking and jiving. And I wouldn't have had to watch that same punk criminal return and repeat this scenario multiple times all the while evading punishment for serious crimes.

At a place like Tamms. outside do-gooders and bleeding hearts would have given a shit about my welfare. None of these people ever protested what goes down in CMHC. They laughed at my plight and DENIED THE REALITY of it. At Tamms, no Mark Heyrman type lawyer would work to hurt me and claim he was actually helping me.

Incidentally, I tried while at CMHC to get arrested and removed to the safety of a jail.Years later, when I was SPURIOUSLY jailed, I wrote and stated that I much PREFERRED jail to the CMHC. Lest anyone doubt my sincerity.

Monday, July 19, 2010

Psychiatry vs. medicine in seven steps

On a number of occasions, I have explained to people my personal understanding of the difference between psychiatry and other medical practice. I don't think anyone has ever said this particular explanation was inaccurate. Some people have seemed thoughtfully skeptical perhaps, but no one has ever said, no, you're misrepresenting it, or no, that's not true.

I'll try to concisely outline this explanation here, so anyone who reads it can think about it and tell me if, and how, it may be off the mark.

I think of this as a narrative sequence of interactions among a doctor, a patient, possible other people, and facts in a clinical setting.

In most medical practices and specialties it goes this way:

1. A person has some sort of pain, malfunction of the body, or other symptoms.
2. The person takes himself to a doctor and complains, asking for a solution.
3. Doctor listens, inspects the body, does any of various medical tests, verifies presence or absence of objective abnormalities.
4. Doctor evaluates the data and makes a diagnosis.
5. Doctor offers the patient a recommended treatment with full information regarding risks and benefits.
6. Informed patient accepts the treatment or goes elsewhere for another opinion.
7. Patient or third party pays doctor.

In psychiatry, by contrast, it goes like this:

1. A person behaves in ways upsetting to someone else.
2. Someone else who is upset with the person convinces him to go to a psychiatrist, or takes him to one like-it-or-not, and complains about the behavior, asking for a solution.
3. Psychiatrist listens, believes the complaints, briefly interviews the patient.
4. Psychiatrist prescribes treatment which he hopes might restrain the patient's unacceptable behavior about which someone else complains.
5. Psychiatrist looks in the DSM for a diagnosis to justify treatment.
6. Patient is convinced by various devices, or coerced, to accept treatment.
7. Patient or third party pays psychiatrist.

OK. It seems to me the most notable difference is the precisely reversed sequence of steps 4 and 5. (I wrote about this at least once before.) But the only step that is the same for regular medicine and psychiatry is number 7, somebody pays.

You, readers, please tell me what's wrong with this understanding.

Saturday, July 17, 2010

Amazing amazing

Another Elgin Mental Health Center staffing, same day as (actually immediately following) the one I wrote about on Friday, July 9th. Same psychiatrist, Dr. C....

My client, Mr. N, is a foreign national. He's been at Elgin 3-4 years now, NGRI on an aggravated battery charge, Thiem date circa 2028. Never took meds. I don't remember what his Axis I diagnosis is. (But of course, with Dr. C, that's "not so important".)

It took a long time to convince Dr. C that this guy could progress toward expanded privileges and even conditional release without ever taking "prophylactic" psychotropic meds. I went to court once and took Dr. C's deposition. More recently, though, N was finally on a treatment program which consisted of therapy groups only. It still always seemed to me, until this staffing the other day, that Dr. C would make it take as long as possible for N. He seemed in no rush to admit that this patient, with whom absolutely nothing was wrong medically, psychologically or any other way, was progressing at all.

Anyway, first item in the staffing: the facility has a letter of detainer from the Immigration and Naturalization Service. INS wants N, so the Illinois Department of Human Services will give him up.

But ... what of the fact that N is still in need of mental health services on an in-patient basis?

Well, Dr. C says that's no problem. Since INS wants the patient, it'll be easy to convince the criminal court he's suitable for conditional release. If INS didn't want N, he'd be kept at Elgin for more treatment, but a letter of detainer from a federal agency is apparently an instant cure for N's mental illness. It's all a matter of clinical psychiatry, of course.

Or rather, it's all a matter of forensic psychiatry. The "clinical" pretense is only there as marketing. This is not medicine, it's carefully euphemized punishment for and restraint of crime. Psychiatrists who work for the state are not doctors so much as they are jailers and hangmen.

And guess what? Their work only confuses everything and everybody. This system is a disaster and a fraud. It should be torn down, the foundations should be ripped out, and the ground should be plowed with salt so nothing will ever grow there again for the rest of time.

Friday, July 9, 2010

An amazing admission

I had a staffing at Elgin Mental Health Center for a client who's had a tough time of it on-again-off-again. He's had various diagnoses, been put on various drugs, and almost killed. (I wrote about this same guy as "Mr. D" back on June 23.)

The psychiatrist in charge of the treatment team (Dr. C) had been contacted by Mr. D's family attorney (not me), and asked why there appeared to be so many different diagnoses over the short one-year period the guy has been at Elgin.

During the staffing, Dr. C made the point that for purposes of getting Mr. D a conditional release, he was very confident that he could thoroughly support and justify his own diagnosis. This comment, of course, did not answer the reported attorney's question about why there had been so many different dx's. Either I had missed something or Dr. C was being kind of evasive, so I asked him if he had any feeling for why the family attorney, as an attorney, had asked about the multiple diagnoses. He shrugged and smiled, and it suddenly occurred to me that maybe he figured I had put the guy up to it (which I had not). Simultaneously I realized, maybe the family was preparing a malpractice action (which they probably should).

Well anyway, there ensued a somewhat longer discussion relating to this than I had intended. It was mentioned that it's not particularly unusual for a patient at Elgin to be diagnosed with various different mental disorders by different doctors over a period of years.

It also came up that it's somewhat unusual for a criminal court judge to pay a lot of attention to the nature of any particular diagnosis, but it's not unusual for a judge to expect such things to be pretty settled and stable for a while before a patient is released. This was the specific context in which Dr. C said he could thoroughly support his own dx for Mr. D.

Then came the (in my opinion) bombshell comment from Dr. C. I wrote it down word-for-word.

"Diagnoses are not really so important. Symptoms are what's treated with psychotropic meds."

Many people do know this. But in these circumstances, it was a highly incriminating admission. The psychiatric slaves at Elgin Mental Health Center, Chester Mental Health Center, Alton Mental Health Center, and all the other state nuthouses in Illinois, are always told that they must understand they have mental illnesses, which are legitimate brain diseases, which require lifelong medical treatment. They must take medication, or they will never be released.

These often unwilling "patients", and their families, and the public, are told over and over again by very professional salesmen and PR experts and TV advertizing, that mental illnesses are just like any other illness. Elgin has all of the propaganda of the National Alliance on Mental Illness (NAMI) prominently displayed and freely available to anyone who comes there. All state mental health workers are trained to think this way, expected to implicitly believe in this orthodoxy.

Supposedly there is "stigma" attached to mental illness. But man, I can tell you, I myself am severely stigmatized, not for being mentally ill, but for (supposedly) not believing in mental illness. Countless times, I've apparently earned the scorn of state employees for questioning the objectivity of a psychiatric diagnosis or for saying it's all arbitrary.

Now here's Dr. C: "Diagnoses are not really so important."

What he means is, psychiatric diagnoses have NOTHING to do with whether and in what way anybody ever gets "treated" by mental health professionals. Psychiatry is not help, but covertly coercive control. The dx's are all justifications after the fact, subjective b.s., pseudo-medical, anti-scientific ... fraud.

Sooner or later society is going to catch on to this, and there will be some kind of hell to pay.

Monday, June 28, 2010

It's the BEHAVIOR, stupid!

According to an official U. S. government (SAMHSA) website, some people believe that the term "behavioral health" is problematic because: a) it misconstrues the disease nature of mental illness and addictions; b) it implies a choice which a person can change by free will; and/or c) it focuses too much on symptomological behaviors that a person cannot control.

These arguments are presented (by the U. S. government!) as legitimate. But the disease nature of mental illness is quite literally mythical; and if people can't change or control their behavior by exercise of will, I guess we don't even have any basis for law....

There is not one single diagnosis of mental disorder, which can be diagnosed by any method, no matter how much money is available, other than observation of behavior. There is not one single mental disorder which is defined in any terms other than behavior. The "disease nature" of these things is purely a metaphor.

When the most up-to-date textbooks discuss mental disorders, they never fail to point out that all the neuro-chemical and brain theories are precisely theories. The dopamine hypothesis of schizophrenia remains hypothetical. The latest and finest serotonin manipulations still don't don't even beat placebos for effectiveness against depression. The largest pharmaceutical researchers are abandoning searches for cures to mental illnesses. Guess what guys, that's because no "disease nature" can be discovered.

So I think anything other than "behavioral health" certainly misconstrues the non-disease nature of mental illness and addiction. The fact that we control behavior with drugs which neurologically disable miscreants does not change this. Nor does the fact that people sometimes willingly damage their own brains with drugs. And no psychiatrist pretends to cure anything.

As far as abilities to change behavior go, here's a story.

A client of mine (I'll call him Bobby) was found not guilty of first degree murder by reason of insanity, diagnosed with schizophrenia, and committed to Elgin Mental Health Center about fifteen years ago. One of the things everybody noticed about him was that he kept saying he was the King of Egypt. Another thing everybody noticed was that he refused to take psychotropic meds.

When I first spoke to Bobby, he was especially concerned - perhaps obsessed - that I needed to see the official government identification, held for him by the director of the institution, which established that he was King of Egypt.

After a couple monthly staffing meetings, I told Bobby that his treatment team was not likely to stop using this King of Egypt thing against him. I was pretty sure they would continue to say it was a symptom of his psychosis and proof that he shouldn't be released.

I suggested he do one of three things, whichever seemed best to him: a) he could prove conclusively that he was in fact the King of Egypt (his official ID had not been effective for that; but maybe the Egyptian ambassador could vouch for him, or maybe there were other documents proving his lineage); b) he could convince his treatment team that believing he was the King of Egypt did not make him any more likely to be violent in the future, and therefore that what they saw as his delusion was harmless; or c) he could lie about it and tell everybody he no longer believed he was King of Egypt.

Bobby chose to lie, pursuant to option c). Within a year or two, people stopped listing the King of Egypt thing as a symptom in his psychiatric chart. He subsequently was twice granted expanded privileges by the criminal court, and will soon petition for conditional release with the full support of the state institution.

I don't know whether he still believes he's King of Egypt or not. Actually, come to think of it, I don't know whether he ever did believe it. Maybe he was lying to begin with. What I do know is that Bobby's behavior, observed by all the experts as symptomatic of schizophrenia, changed one day, because he decided to change it of his own free will. Nothing else happened, there was no effective medical intervention.

So ... "behavioral health" seems appropriate to me, if it has to be any kind of health to begin with.

Wednesday, June 23, 2010

Mad Scientists and Dupes

There is apparently research suggesting that exercise beats psychotropic meds for effectiveness against mental disorders. The studies aren't funded and promoted with Big Pharma billion$, so the regular authorities whom the Illinois legislature and the Illinois Department of Human Services (DHS) use as mental health experts (e.g., Heyrman at University of Chicago) may not be paying much attention to the implications yet. Let me suggest a couple.

Court ordered "treatment" can be much, much cheaper. When we decide somebody is not criminally culpable and shouldn't be punished for their behavior, well, we just don't necessarily have to go all medical about it.

I have a client, "Mr. D", who was found not-guilty-by-reason-of-insanity (NGRI) for burglary. He's been in the Elgin state nuthouse for a year or so, with various conflicting diagnoses of mental disorder which have justified about a dozen different psychotropic meds. It's just complex as all hell. The guy nearly died from drug side effects at least once. He's young - early twenties - and never had any life threatening health problems before he was psychiatrically "treated". His family is upset with the nuthouse doctors, and litigious. His sister's a pharmacist, so she's not easy to control with PR about medicine. DHS clearly wants this patient out as soon as they can talk his judge into a conditional release. All their clinical expertise is devoted to just stabilizing him for a few months, just making him look good enough to get past the court so they can be rid of him before he becomes their disaster.

Dr. C at Elgin, who took over from Dr. H, after this patient returned from an emergency hospital admission for acute renal failure, asked me one day whether I "believe in" any kind of medications at all. The question presumed of course that I don't "believe in" psychotropic meds. I refrained from laughing, and told him I had occasionally been highly impressed by the efficacy of ibuprofen for shingles. I also said I really have no principles against psychotropics as restraint, if someone is immanently threatening violence. There's nothing fraudulent about that, no betrayal or pretense of help.

But I pointed out that trying to fine-tune somebody's brain chemistry to improve his behavior is a ridiculously complex, expensive and unlikely enterprise. Mr. D is a perfect demonstration. Dr. C was very relieved about recent tests showing medication blood levels better than he expected, because such results should look very positive to Mr. D's court when it is asked to grant his conditional release.

In my experience judges don't know the significance of blood levels of meds any better than they know schizophrenia from schizo-affective, and that is not at all. Dr. C and the Elgin nuthouse have this whole ornate operation going which nobody really understands, and which Illinois taxpayers finance only because they automatically believe in all things medical and think there's no other choice.

At the moment I don't recall the exact amount of the budget deficit Illinois is running. But I know the daily expense of involuntary psychiatric confinement is about $400/person/day. That probably means we spend $350 million annually to keep guys like Mr. D in institutions like Elgin.

Now, what do you know! Maybe Mr. D should have been run around a quarter-mile track for an hour or so every day rather than fed neuroleptic poisons. It would have been much, much cheaper, and it might have worked at least as well for the purposes of the court and community safety, not to mention Mr. D's health.

Another implication: forensic psychiatry has been a major rip-off. The state has been wasting our tax money on a mad-science, vaguely perverted fantasy. The current and prevailing tradition in Illinois suggests somebody should go down for that....

Monday, June 21, 2010

Opportunistic Dx

Dr. Peter Breggin writes in today's Huffington Post that psychiatric diagnoses frequently change, often in an effort to justify a particular drug. But it's worse than that. Diagnoses change to justify any kind of treatment, or none at all.

In regular modern medicine, a patient presents himself to a doctor with a complaint about how he feels or something which is happening to his body. The doctor listens to the complaint, does tests, discovers some kind of objective biophysical problem, and after making a diagnosis looks to clinical experience or medical literature for a cure, which the patient is offered.

In psychiatry, someone else brings the patient in (often under duress). The doctor listens to and automatically believes complaints about the patient's behavior. A decision is made regarding what to do to the patient (usually drug him) to disable him from behaving in such a disagreeable fashion. Last of all, a diagnosis is looked up to formally justify the chosen "treatment".

Regular modern medicine: Dx first - then Rx. (Dx --> Rx.) The treatment depends on the diagnosis.

Psychiatry: Rx first - then whatever Dx will justify. (Rx --> Dx.) The diagnosis depends on the treatment.

In state nuthouses, involuntarily committed patients are told in so many words that they either take the meds or they'll never get out. It's illegal to tell them that; but they are all told exactly that nonetheless. If somebody steadfastly refuses meds and cannot be legally forced to take them, sometimes the only solution is to change the diagnosis. But this can be done with surprising alacrity.

Several years ago I had a client named Jim. He had gone from Chester Mental Health Center to Alton Mental Health Center to Choate Mental Health Center, never taking the meds he had been prescribed for the psychosis which all the doctors were apparently certain he "had". His Thiem date (when the system would be constitutionally required to release him) was fast approaching, and as it turned out, nobody wanted to litigate a civil commitment.

One day Jim called me and reported, with amazement, that his psychiatrist had taken him into an office and asked what diagnosis he wanted. I'd previously given Jim a copy of DSM-IV-TR, so I said, well, that's easy, just look in the book and find a diagnosis that wouldn't be treated with psychotropic meds. He went to pages 338-343, and told his psychiatrist that he should be diagnosed with Substance-Induced Psychotic Disorder (code 292.11), in remission.

This was quickly done. The Illinois Department of Human Services put together all the necessary documentation to make it look medical, and soon petitioned the criminal court for Jim's release, which was granted. Now years later, he lives with his elderly mother and gets along just fine.

In this case, the nuthouse needed to release Jim as successfully "treated", and they wanted credit for it. Because of the timing, they had to justify his not taking meds. No problem, they just changed his diagnosis accordingly.

Psychiatry: Rx --> Dx. Simple, but quite the fraud.

Wednesday, June 9, 2010


Today's Chicago Tribune carries a story all about how mentally ill people should be immune from criminal prosecution because their "brain diseases" cause their violent behavior.

As usual, Mark Heyrman, the leading local proponent of this radical jurisprudence, is cited.

The illustrative narrative in this particular piece concerns Adam Rotheimer, a supposed schizophrenic who told a social worker he wanted to get an AK-47 and kill a judge along with all the people helping him. Professor Heyrman and several other authorities are dismayed that the social worker was obliged to report the threat, because the resulting arrest of Rotheimer was such an affront to that Holy of Holies, psychiatric "treatment".

Ira Burnim of the Washington, DC-based Baselon Center said, "If you want people to avoid mental health treatment, the best way to do that is to ensure they're treated like criminals when they get it."

I see it differently than Heyrman and Burnim. People naturally avoid mental health treatment to the extent that it hurts them rather than helps them, which is a very large extent. Refusing "treatment" is criminalized much more than getting it. Without state coercion on their side, most psychiatrists would be unable to make a living by plying their desperate, ugly political trade.

The Trib article, while purporting to present the problem of Adam Rotheimer's mental health, quotes only others. Adam's mother's and sister's views are presented, as though of course, they have only his best interests in mind, and as though of course, their evaluations of all issues can and should be substituted for Adam's own.

I have represented plenty of people in Adam's situation. Lots of my clients have been plenty crazy, committed violent crimes, and/or caused reasonable fear of harm to those around them. I can say, after nine years of work as an attorney exclusively in this special area (with which most of my colleagues want nothing to do), that this "mental illness" explanation/excuse does not open the door to any solution whatsoever. It makes everything worse, except in the occasional circumstance of an immediate necessity for self defense. (I.e., if somebody's attacking and beating up everyone in sight, a shot of Haldol, like a stun gun, is perfectly appropriate.)

Adam Rotheimer was supposedly "voluntarily committed" in March. This is a cynical euphemism. Adam was told that if he didn't sign a certain document, he'd be involuntarily committed by court order. The document was called a "five-day release". This is a fraudulent, although fairly universal characterization. The form is really used to relieve the hospital of its duty to make legal arguments in court for holding a patient against his or her will, so insurance payments can be collected until coverage runs out without a bill for attorney hours.

Adam's "treatment" is portrayed as something which can keep him out of legal trouble. Nonsense. How long has he been in "treatment"? Why is he in legal trouble now? There are plenty of people who believe, based on substantial evidence, that psychotropic medications cause violence instead of preventing it.

Forensic psychiatry is a corrupt, anti-scientific political racket. History will record our modern love affair with medical solutions to obnoxious and violent behavior as much akin to the 300-year European prosecution of witches. Why does everyone believe in these "brain diseases" which have never been evidenced by any objective signs, for which no etiology can be discovered, and which are admittedly voted into and out of existence according to changing cultural whim?

The answer to the initial question in the Trib article is that there is no line between mental illness and bad behavior.

It costs four times as much per day to involuntarily "treat" someone as it does to imprison them. The result is not better. We are deluded.

Friday, May 28, 2010

Fostering Adherence to Psychotropic Medications

OK, I'm going to tell what is probably my best story from New Orleans. It's Mark Twain funny, like A Scientologist Lawyer in King APA's Court. (If only I could write that well...)

But first of all, several friends have asked me whether I was an "infiltrator" at the APA's convention. No, no, no ... I haven't spied on anyone for years....

Besides that, it's a misconception of the dynamics involved. There were probably 20,000 paid attendees at this annual meeting of the American Psychiatric Association, from all over the world. Nobody cared who or what I was, as long as my credit card authorized. I registered on line like thousands of other people, with my real name, address and personal info, including the fact that I'm an attorney with the email address: It was a very large enterprise with all kinds of people and no perceivable thought or measure against any "infiltration".

The death march (featuring a real coffin) and CCHR picket outside (Hey, hey, APA, how many kids have you drugged today?), and the elaborate, dramatic, "Psychiatry: An Industry of Death" exhibit, which was set up in the Riverwalk Mall directly adjoining the convention center, were all quite well tolerated, even assimilated, as part of the diverse festivities.

The two classes I took on Sunday were a tiny fraction of the information and viewpoints presented during the week-long event. My presence was basically unremarkable. Although in retrospect, there was at least one Aha! (or better yet, ACHA! - with a German accent) moment.

My afternoon class was Fostering Adherence to Psychotropic Medications: A Practical Resource for Clinicians. I had paid the $170 tuition for this figuring it was directly relevant to my work in Illinois state nuthouses, where everyone is simply told from day one that either they take the meds they're prescribed, or they'll never be let out. "Fostering adherence" sounded like a new slant for sure - maybe I could learn something useful.

Well, sure enough, the first discussion was about why we should use adherence rather than compliance as the correct term. This was just practical as all hell, and it showed how much psychiatry has improved.

It turns out that compliance means the act of complying with recommendations (whatdya know!), and that's not collaborative enough, because meds only work if the patient believes in them, and he's less likely to believe if you can't suck him into the idea gradually enough to make him think it was partly his own.

At least, I'm pretty sure that was the point....

My first question was way too basic for this specialist/professional group, although one other guy was at least polite enough to pipe up and say he agreed with me completely.

What about this definition of compliance? Isn't it always something a little more imperative than a mere recommendation with which people are asked to comply? I mean, if a psychiatrist is just recommending meds, then the patient can follow his helpful suggestion or not - right? There's no issue of compliance to begin with.

Anyway, there was a whole lot of research and statistics which proved adherence was a far better word, so the good doctors running the class didn't spend very long discussing my plebeian semantics. Even though everybody tried to call me "Doctor" while I was in New Orleans, I knew my understanding of real psychiatric issues was totally inhibited by my years of legal advocacy in state nuthouses. (It's a lower kind of psychiatry there, you know, it's paid for with taxes, of all things!)

The most exciting part of the afternoon class was when we broke up into groups of three or four students each, to actually drill building collaboration for adherence to psychotropic medications.

In each group, somebody volunteered to play a mental patient and somebody a doctor. Whoever was left was an observer. (For some reason there were only a dozen students all together, so we had less than a handful of drill groups. More people had been expected; the guys running this class had had to move to a smaller room. I can't imagine why the subject wasn't a huge draw.) I volunteered to be the patient.

The character I created for the drill was a composite, off the top of my head, of several clients I've had at Elgin Mental Health Center. But the guy who played doctor wasn't allowed to just say, "If you don't take Risperdol plus three other meds until you're a totally fried diabetic, you'll never get out of here." He had to implement what was called an "integrated adherence strategy." This was cool, but it didn't work. He couldn't get my character to improve his motivation for adherence above a red light level (i.e., I ain't takin' that shit!), even with the help of several very advanced assessments and instruments provided by the class directors.

I felt bad afterwards, like maybe I should have gone along to give my "doctor" a win. But the character I played was genuinely unconvinced. The only reason he would ever consider taking meds or (much more likely) pretend to do so was because a judge had ordered that he be treated. He was actually worried that his judge would keep sending him back to the hospital if he didn't at least pretend to go along with treatment. But that wasn't good enough. It was too much compliance, too little adherence. In this class, it wasn't allowed. So my "doctor" got nowhere with me.

During a break, I suddenly realized how he could have fostered my adherence. He could have told the patient, "Hey, are you just going to be afraid of being sent back, and have to lie and fear discovery all your life? Why not just try the meds long enough to say you tried, and maybe get even better arguments for why you don't like them and shouldn't have to take them? You might actually be able to talk us out of this treatment, if you try it for a little while and really know about how it affects you from experience..."

That sort of appeal might have gotten my character started at least. And if he'd taken that first step, the next one and the next one would be progressively easier. He might have gotten sucked into the idea gradually enough to think it was partly his own.

The student who had drilled the part of my "doctor" listened to this, and suddenly realized that it probably would have worked! He was impressed that I had learned the four steps (or maybe it was ten, I don't quite remember) which a medication provider uses to foster adherence, so quickly and so well.

I was proud of myself momentarily. Then I decided that, being a lawyer and not a psychiatrist, I really wasn't at the same specialist level of technical competence as the other people in this class.

So I took the rest of the afternoon off to cruise the exhibit hall. I got to see MECTA Corporation's newest Electroshock machine.

And (paraphrasing Twain) I wondered whether psychiatry is full of smart people who are putting us on or imbeciles who really mean it.

Thursday, May 27, 2010

The Vanishing Oath and the APA

Immediately upon returning from the American Psychiatric Association's annual meeting in New Orleans, I saw an excellent film entitled, "The Vanishing Oath" - all about the intensely discouraging conditions and changes in the profession of medicine, from the point of view of its very noble and hard-working (if you suspect irony just because I'm a lawyer, forget it - I honestly mean this) practitioners.

I hope I can do justice to the connection here.

Back in January, I wrote that the economics of our love affair with modern psychiatry are inexorable. The broad context of that thought was actually national security. As I watched "The Vanishing Oath" I was filled with apprehension that my instincts in this regard are not paranoid at all; they might even come too late to warn.

Western Civilization, or American Civilization (whatever one wants to name this first cultural superpower since the Roman Empire), has incorporated a fundamental and potentially fatal error: the utter invalidation of individual intuition, free will, responsibility, original creativity and spirituality as the motive force for human improvement, in favor of acquired materialistic data and perfected technical process.

This is obvious in the sad complaints by doctors about the recent ruination of the medical profession. I could be quite unsympathetic, because these same people were perfectly willing to allow the psychiatric charlatans to claim status as healers, when they were never anything but enforcers and punishers.

The degradation of medicine into commoditized "health care" is just one outcome of our conviction that applying rationality and science to human biology is the obvious way to solve the whole human condition and make everybody happy forever.

The ultimate expression of that same conviction may be mandatory psychopharmacology. But the psychiatrists in New Orleans this week were all about collaboration and "Fostering Adherence (N.B., not compliance) to Psychotropic Medications". This was in fact the title of course 36 on Sunday, directed by Luis Ramirez, M.D. and Richard A. McCormick, Ph.D. Dr. Ramirez gave a telling indication of how toxic the prospect of forcibly medicating anyone is these days, with a grinning, almost devilish statement: "I personally LOVE long-acting injections and implants!" When you only have to dose a patient once a month or so, this issue of adherence - or compliance or coercion - needs to be confronted only rarely.

The broad demoralization of doctors is a canary in a coal mine. The increasing complexity and skyrocketing need for great subtlety and ever more creative euphemisms with regard to forcing people into treatment with psychotropics is another one. Maybe something is about to blow up ... "Things fall apart, the centre cannot hold, mere anarchy is loosed upon the world."

Monday, May 24, 2010

From the APA Convention in New Orleans

Everywhere I went at the American Psychiatric Association’s 163rd annual meeting in New Orleans, mental health professionals were in contortions over coercion and treatment. But most of the time they seemed almost completely unaware of it.

The contortions were semantic. E.g., in Course 17 on Sunday: “Treatment of university student populations must be based on a collaborative model; and your best ally will be campus security.”

That one came from Ayesha Chaudry, M.D., a psychiatrist employed by Duke University’s center for student counseling and psychological services. The question apparently never occurred to her, and was not asked during the course: What exactly is the role for the police within a collaboration between a student and a counselor? – or even more fundamentally: Who is a doctor and who is a cop?

Dr. Chaudry cited statistics that almost half of all college students have psychiatric disorders, but only 25% are ever treated. The number of these students prescribed psychotropic medications has gone from 9% in 1994 to 25% in 2006, but it’s not enough. Therefore, it has become the task of clinicians to develop every possible trick and contrivance to get those kids on meds in the face of the irrational and unfair stigma against it.

One of the best tricks has to do with getting around the pesky confidentiality rules, like HIPPA and FIRPA. It turns out that even if a kid refuses to sign a release of confidentiality for a psychiatrist to talk to his parents, he'll often allow her to talk to the dean, or a professor, because he may need permission to drop a course without penalty, or extra time for an exam. The dean or professor is not bound by doctor/patient confidentiality and can call the kid's parents without a release. What a clever betrayal of trust!

Dr. Chandry doesn't know if she's a doctor or a cop, really. Maybe no psychiatrist does, maybe that's the big problem and the reason the stigma seems so intractable. They ought to be more honest about it, at least with themselves.

Thursday, May 13, 2010


The whole social paradigm for drug regulation needs to shift. The bankruptcy of current theories and methods is widely recognized. We are wasting way too much blood and treasure. I say turn the whole thing on its head with two fundamental reforms:

1. Medical authority and control over legal access to drugs should be converted to a legally mandated education/consulting role.

Individuals would not need medical permission, and they would not be legally prevented from buying or using any drug - whether it be a psychotropic medication, a painkiller, marijuana - or for that matter, LSD or crystal meth - for any purpose. However, drugs of certain classes (perhaps DEA schedules I through IV) would be considered to have potential consequences significant enough in terms of individual health and community safety, that any person choosing to buy and use such drugs would be required to document basic competence and familiarity with potential risks and benefits.

Pharmacists could demand "informed certificates", even as they currently demand prescriptions, proving that a customer has consulted with and been briefed by a medical or other suitable expert regarding the particular drug they wish to buy and use.

Such medical consultations/briefings could be meticulously prescribed by statute, to require particular and balanced, empirical information about risks and benefits relevant to any drug consumer's own purpose for taking any particular drug.

E.g., if a parent wanted Ritalin to help a child get better grades, the law might require that the parent be told about evidence that it works and evidence that it doesn't work for that purpose, in proportion to what is generally extant in scientific literature. It would also require that the parent be told about possible addiction risks, common side effects, etc.

Or, let's say, if a twenty-something bachelor wanted meth to intensify promiscuous sexual encounters, the law might require that he be briefed about unpredictable efficacy, as well as various concomitant severe dangers and long term trade-offs.

But once a consumer would be certified as fully informed, his or her possession and free use of a particular drug would be a matter of choice. NO legal prohibition, NO enforcement.

2. Individual responsibility for accurate information, and for the consequences of behavior, should be strictly enforced.

Consumer drug consultations/briefings performed by medical experts who issue "informed certs" would be standardly video-recorded by law, and this documentation would have to be maintained for a time corresponding to statutes of limitations on tort or criminal (or contract) liability. Then, if a consumer wanted to claim any damages from false or insufficient information about any drug used, a court or jury could evaluate the claim with some objectivity, through a reliable evidentiary and legal process.

Any drug consumer would also be utterly responsible under the law for all consequences of his/her behavior while taking any drug for which a valid "informed cert" was issued. If crimes or misdemeanors are committed, if adverse health effects or harms are suffered, or if bystanders are offended or harmed, then traditional jail sentences, fines and/or financial liabilities would be unmitigable by any "intoxication" or "substance-induced" excuse.

Statutes of limitation might be tolled until majority, to enable children drugged for their behavior to bring abuse claims, if they suffer from earlier decisions made for them by adults. 


I agree strongly with Dr. Thomas Szasz that the basic problem with psychiatry is coercion, and that absent coercion, psychiatry as we know it will wither away and cease to exist.

I also agree with the Citizens Commission on Human Rights, The Law Project for Psychiatric Rights, and other groups who point out that psychiatric drugs are ineffective, dangerous and fraudulently marketed.

Maybe my philosophical allegiance to Tom Szasz's libertarianism can be reconciled with an obvious need to protect the public. If everyone were fully responsible for their own health and well educated about medicine, this would be easy enough. But for the present purpose of evolving in the general direction of such a golden age, these two fundamental legal reforms might serve pretty well.

One not-insubstantial advantage of this scheme would be that no one would be out of a job. Physicians would be as much in demand as they are now. Pharmacists, government bureaucrats, researchers, lawyers, etc., would all still be needed in large numbers.

For such a paradigmatic shift, very few completely new processes or institutions would have to be created. It would be a cheap evolution, and it could happen quickly.

The value, in theory, would be exponentially increased participation, awareness and individual responsibility regarding drugs, health and medicine, from all levels and segments of society. Even as wider diffusion of economic participation and production beginning in the Seventeenth Century dramatically improved basic human conditions which had stagnated for millenia, the intractable "drug problem" might be solved, and people might improve in a rather basic way.

This is really just trusting our own and our fellows' common sense over the authority and final beneficence of some mythical expert betters.

Tuesday, May 4, 2010


May is Mental Health Month. The usual advocates are out in full force. An omnipresent message is typified by a recent NAMI-Massachusetts statement on Twitter: "Mental disorders can strike anyone regarless of age, economic status, race, creed or color." I never have understood the point of this.

I responded to NAMIMass this morning with a tweet along the lines of, "Mental disorders (and lightening!) can strike anyone regardless of age, economic status, race, creed or color. So ... what?" Very quickly, I got a reply, "That's precisely the point!"

Well, I still don't really get it. It seems like the critical idea is that nobody should ever be blamed for mental illness, it just not their fault, because it's a disease you catch like a cold or cancer.

If this revelation were true or useful there would be some kind of positive results from it by now, but there are none. In the five or six decades since we all resolved that mental illness is really, definitely, brain disease, there have been no cures, no discovery of actual causes or etiology. Mental illness has grown and grown as a problem, there's just a whole hell of a lot more of it now than ever before.

When we talk about mental illness, we're talking about behavior, and that's all. There is not a single diagnosis in any edition of the DSM which is discussed, defined or accomplished in any other terms. And the forthcoming DSM-V does not list one objective medical test for any mental disorder whatsoever.

The people who are so insistent upon not being blamed for mental illness should just be asked whether they can be responsible for their behavior. If they can, society has no vested interest in what words are used. But if they cannot, society will continue to blame them despite their very best linguistic arguments. And it probably should.

NAMI might say a person's responsibility for his or her mental health includes taking meds when meds will help, when the benefits outweigh the risks. But this presumes that treatment is all voluntary and patients are adequately informed. Certainly while we have civil commitment, Kendra's Law and the insanity defense, treatment is inextricably intertwined with justice and the police. Psychiatry is a coercive arm of the state. Individual responsibility must vary inversely with coercion and ignorance.

I think this mysterious fixation on, "It's not your fault when you're mentally ill..." evidences nothing much better than some fear of being discovered (e.g., as a fraud or a criminal). "Stigma" is a smokescreen, it's not the correct project.

The real project of "mental health" should be improving human behavior, and it's not medical.