Tuesday, May 31, 2011

English and Inquisitorial law

The Chicago Sun-Times editorializes today on a proposal to encourage questions from jurors in civil trials. Unfortunately, the article perpetuates a critical misunderstanding of our system of law.

The purpose of trials under our English system is not entirely to get at the truth, at least not by any human means. We presume, with humility perhaps tragically lacking under the alternative Napoleonic system, that ultimate Truth may remain beyond mortal ken. When our conflicts go to court, we do what we're actually capable of doing as imperfect beings: we fight it out. Trials are adversarial rituals intended to ensure that even where there must be a winner and a loser, as few bystanders as possible should be hurt by the process of decision.

Carefully limiting violent conflict is a far more practical human purpose than establishing any Secure Reign of Exalted Truth. From the Inquisition, to the black gate and hot mushroom cloud of 1945, we have history's lessons against arrogance. Incidentally, jury service is often a brilliant exercise in this precise social reality!

So, in a much darker way, is any work which gets a person up-close-and-personal with state psychiatry. Mental health systems function on an inquisitorial model. The "doctor" (psychiatrist) knows The Truth - whether a person's chosen behavior is a symptom of disease, what label a person deserves, and what should be done about bad behavior (e.g., forced drugging). Courts abdicate their traditional role of decision in favor of this Medical Truth. A disparaging remark maliciously scrawled in a chart by a medicalized prison guard ("Security Therapy Aide") becomes a scientific fact in court!

Psychiatry degrades both medicine and the law. Psychiatry kills civilized humanity.

Sunday, May 29, 2011

Cruel and Usual

Today's Chicago Tribune has a pair of editorials by Steve Chapman and Clarence Page, about the Supreme Court's order for California to release prisoners. Chapman mentions "Stalinist standards of barbarity," and Page notes how many offenders would actually prefer floggings as dealt out in Singapore or Malaysia, to five years in a California prison.

Ten years of experience tells me that many guys in state nuthouses would prefer prison to the even more barbaric gulag they find themselves confined in. In other words, prison is crueler than twenty lashes, but involuntary psychiatric commitment is worst of all.

Clarence Page says "as long as we insist on fooling ourselves with well-meaning fantasies," our correctional systems and all our attempts to protect good people from bad people will be unsuccessful. Steve Chapman recalls testimony from a former San Quentin warden, that the current system makes people worse.

These editorialists are talking about prison systems. They probably believe that more psychiatry could be part of a solution. How ironic!

The more we spend on state psychiatry, the more mental illness we'll have, and the more danger that mental illness will pose to us.

At best, "mental illness" itself is a well-meaning fantasy, folks. We have NOT progressed beyond the lash; our cruelty increases with every passing year. State psychiatry is a far greater horror than the prison sentences it was supposed to replace, and the more we try to medicalize behavior the more horrible it will get.

We are NOT safer from unpredicted violence perpetrated by our unfathomable fellows. The doctors do NOT have a pill to cure evil, and they never will.

We're better off with overcrowded prisons than Elgin Mental Health Center. Maybe the lash beats them both.

Preventing unnecessary cruelty is a good human impulse, but all we're doing is averting our eyes.

Friday, May 27, 2011


I had a client once whom I'll call Julio, who was NGRI for attempted murder -- long Thiem date, big-time Axis-I diagnosis, the works. He went back & forth from Elgin Mental Health Center to Chester Mental Health Center a couple times. He didn't like taking meds, so he stopped without mentioning it to his treatment team.

Maybe he wasn't too good at "cheeking" the meds. I don't know. But somebody at Elgin suspected him, and they put him on crushed meds mixed in his food. He still managed to not take all his meds somehow. (I never wanted to know his particular technique or slight-of-hand, that would ruin the magic.) Right around this time he called me, because it wasn't easy.

Julio wanted me to convince his treatment team to put him back on the regular meds in pill form so he'd be able to cheek them more easily. I told him, well, I could do that maybe, but I really wanted him to come clean and refuse meds overtly. After a couple months he did that. Awhile later he was advising people that aliens were going to attack them spiritually, and the only way they could escape was to commit suicide. Of course, they sent him back to Chester.

Julio agreed to take some meds at Chester, and stopped talking about aliens and being Christ. The Chester psychs soon decided he was well enough to go back to Elgin. Thus the stage was set for an interesting meeting, which is my main story here....

Elgin, being a medium security facility, had to agree to take Julio back from Chester, which is a maximum security institution. So they all had a big video conference. The object was to figure out whether this patient was really better and could be trusted not to warn anyone about aliens or think he was Christ, in a setting which was not maximum security. It was sort of a parole hearing.

Julio was a smart man. He could put on a very professional face, with loads of intelligent confidence and agreeability. He admitted to everyone in the big video conference that he had "decompensated" and become delusional about the aliens and Christ and so on, at Elgin. He explained in great detail his own understanding of how that had occurred. He answered questions from various inquisitors readily as required. He really seemed like the kind of guy that any medium security nuthouse would be quite happy to have as a patient....

But his previous psychiatrist at Elgin was not buying it. She'd been fooled for months by this guy, when he'd told her he was taking his meds but it was a lie. Her only real job had been to prescribe the meds, manage the meds, evaluate how the meds were working. He had made her look very stupid, and she bore a grudge.

Everybody wanted to know Julio's attitude about meds. Why had he stopped taking them previously? How was he doing with them now? What was the dose? Did he understand that they helped him? Did he agree that he needed these meds to keep the delusions about aliens and Christ from coming back? (It was Abilify as I recall.... Nobody quite asked if he recognized that those delusions had been caused by an Abilify deficit in his brain, at least not in so many words. But they came pretty close.)

Then came key question from the Elgin psychiatrist: "If you're allowed to come back to Elgin, will you promise in advance to take whatever medication any doctor prescribes, and take it in crushed form, and take it in whatever dose your doctor thinks is right, and agree to change the dose or the medication whenever the doctor wants to?"

Julio had explained that the reason he had surreptitiously stopped taking meds was that he was afraid he'd be taken to court and forced to take them if he told anyone he just couldn't deal with the side effects anymore.

In one breath, all these "clinicians" insisted that the whole trick was collaboration. If Julio would just be open and honest with his treatment team, tell them his thoughts and his symptoms, etc., everything would work out well. This should be true. This is the theory of the forensic mental health system, and even the theory of mental health treatment in general, as it's presented to the public.

But in the other breath, the Elgin psychiatrist demonstrated exactly why it was impossible, why it's all a lie: "Promise in advance to take whatever meds your doctors tell you no matter what you think, or you'll never get out of Chester."

That's the way it still is in the state nuthouse system, and probably always will be.

"Take the meds we tell you to take no matter how bad you think they are, no matter how much they hurt you, or you'll never get out of here. Now admit that this is a hospital, and we're all collaborating to help you."

The terms Soviet psychiatry and psychiatric coercion are redundant. Voluntary psychiatry and psychiatric help are oxymorons.

George Orwell, how do you do!