Wednesday, December 5, 2012

Proposed change in the Illinois Mental Health Code

(I'm not writing this as a bill yet, just want to get it written down so I don't forget...)

State law currently defines psychotropic medication:

(405 ILCS 5/1-121.1) (from Ch. 91 1/2, par. 1-121.1) 
    Sec. 1-121.1. "Psychotropic medication" means medication whose use for antipsychotic, antidepressant, antimanic, antianxiety, behavioral modification or behavioral management purposes is listed in AMA Drug Evaluations, latest edition, or Physician's Desk Reference, latest edition, or which are administered for any of these purposes. For the purposes of Sections 2-107, 2-107.1, and 2-107.2 of this Act, "psychotropic medication" also includes those tests and related procedures that are essential for the safe and effective administration of a psychotropic medication. 
(Source: P.A. 89-439, eff. 6-1-96.)

This section could, should be changed to:

"Psychotropic medication" means any drug which is used for antipsychotic, antidepressant, antimanic or antianxiety purposes, and which is listed in AMA Drug Evaluations, latest edition, or Physician's Desk Reference, latest edition. For the purposes of Sections 2-107, 2-107.1, and 2-107.2 of this Act, "psychotropic medication" also includes those tests and related procedures that are essential for the safe and effective administration of a psychotropic medication.

"Psychotropic medication" does not include purely experimental drugs, or drugs which present such risks that, in the opinion of a reasonable, fully-informed patient, those risks would not be outweighed by any likely benefits.

The modification or management of behavior by any individual or agency with coercive authority under the law is a non-medical purpose. Drugs used only for non-medical purposes are not included in the definition of "psychotropic medication".

State law should reflect a difference between medical treatment for the benefit of a patient, and iatrogenic restraint or punishment of criminals for the satisfaction of justice or the security of the community.

Monday, November 19, 2012

Jubilant email from a heroic crusader

Date: Nov 19, 2012 8:56 AM

TeenScreen is dead, according to their website

Their announcement"We are sorry to inform you that the TeenScreen National Center will be winding down its program at the end of this year. Accordingly, we will no longer train or register new programs. We will provide updates on the TeenScreen website for a limited time with respect to any other screening programs of which we become aware.”

TeenScreen was a huge program for psychiatrists. This was their massive plan intended to infiltrate every school and mentally screen every kid in the United States. It was THE program the psychs were counting on to get their hands on every child in America - so that the next generation would all become their victims.  

And now - it is dead.

We dealt TeenScreen various fatal death blows from which it never recovered and that ultimately led to its demise.   We won the internet fight.  OnGoogle we never relinquished the top 2 or 3 spot when searching for TeenScreen.  We defeated TeenScreen on YouTube by never giving up the #1 spot when searching for TeenScreen.  We worked with the press across the country and had a massive number of stories published. We informed schools who booted it out.   This all spawned coast to coast demonstrations.

TeenScreen was a very controversial national so-called "diagnostic psychiatric service", aka suicide survey; done on children who were then referred to psychiatric treatment. The evidence suggests that the objective of the psychiatrists who designed TeenScreen was to place children so selected on psychotropic drugs.

TeenScreen was originally investigated and exposed by when there was ZERO negative information on the net.   We were informed about TeenScreen by Sylvia DeWall, a Clearwater event promoter who was alarmed after seeing a TV news report, where the Florida Mental Health Institute was attempting to implement TeenScreen in Pinellas County schools. DeWall’s alarm was justified.   

TeenScreen’s pharma connected Director Laurie Flynn had her sights set on Pinellas’ kids. This was revealed in one of Flynn’s emails to a Florida official, which obtained in a public records request: “I’m looking for a horse to ride here!” and “I need to get some kids screened”. investigated and the resulting expose’ led to a firestorm of emails to Pinellas County school district officials from concerned citizens protesting TeenScreen. This resulted in Tampa Tribune and St. Petersburg Times stories and the Pinellas County school board booting TeenScreen out.

The controversy was then off to the races as it exploded on the World Wide Web and spread across the country spawning media across the country as school after school rejected TeenScreen.  We lost track of how many reporters we provided documentation and quotes to.  

Recently we have been tracking the departures of TeenScreen’s directors Laurie Flynn and Leslie McGuire. One source close to the scene said that Flynn and McGuire left with disagreements over policy issues. The source said that psychiatrist Mark Olfson was the “interim director” who we discovered only showed up once a week on Wednesdays for one hour!

What has been happening at TeenScreen has been hush-hush.  Even one of TeenScreen's National Advisory Council members, psychiatrist Joe English told us.  "Your e-mail is the first information I have on what may have happened here."

Thanks to all of those Clearwater area folks who were there in the beginning, went to battle and kicked butt!   See Video

Thanks goes to the legal team at the Rutherford Institute, writer Evelyn Pringle, the Eagle Forum and all those groups from many walks of life, nationwide, who fought this.

Special thanks  goes to those I call the TeenScreen Dream Team, Sandra Lucas in Salt Lake City, who offered public relations guidance and political strategy; Doyle Mills, Clearwater, Fl who commanded the Letters to the Editor Attack Force (LEAF) and wrote articles himself and Sue Weibert, Buffalo, New York, investigator and google-fu master.

And a very special thank you to my good friends Michael and Teresa Rhoades, who fought with the fury you would expect from parents whose child was mentally screened without their permission.

We have never really tooted our own horn, but today, for your enjoyment, we solemnly play Taps(wink wink)

To the psychiatric adversaries in our path – get a head start on your counterparts - surrender now! J

I am not kidding.


Ken Kramer

P.S. If you now believe is worthy of your support, click the below red button.  If we haven't won your confidence yet, perhaps you will be convinced
when you hear very soon what else has been accomplished!

Trashing Dear Abby (again)

Jeanne Phillips, 70-year-old daughter of the original Abigail Van Buren, Pauline Phillips, has always told almost everyone who writes to her to see a psychiatrist as the "common-sense" solution to whatever problem they are having.

Today, her omnipresent Dear Abby column inadvertently reveals the obnoxious agenda of all psychiatric shills, particularly so-called "family support" groups like NAMI.

Abby sagely suggests to a writer she calls "Hearing Voices in Illinois" that the only reason her family might think she doesn't need psych drugs is that they're "reluctant to admit" what Hearing's psych would confirm -- that in fact, there is a mental illness in the family.

In other words, if the family weren't so irrationally prejudiced against people with diseases of the brain as opposed to the heart, kidney or stomach, then they'd surely see the obvious logic of taking drugs which reduce your life expectancy by twenty-five years and do virtually nothing to help you.

Abby speculates that Hearing's nephew could go online to research mental illness since he is gifted. She presumes that this gifted nephew will clearly see the truth -- that the orthodox, hyper-medicalized view of all human problems absolutely must rule.

Families are only to be respected when they tell people to take psych drugs. If they tell people not to get "treatment" then they're wrong, and they deserve no respect. That's the way NAMI has always operated. Today's Dear Abby just takes the implication to a more obvious, blatant and pedestrian level.

I could just laugh at something so utterly stupid as Dear Abby. Jeanne Phillips is really so out of touch with the issues she's writing about that I have to wonder where she is in time, and why anybody pays her anymore. Her readers are certainly smarter than she is -- they've heard about black box warnings, billions in judgements for false advertising and fraud, etc.... haven't they?

This "most popular and widely syndicated column in the world" has the common sense of a late-night TV commercial and the youthful perspective of ... someone about Jeanne Phillips' age!

But people are stupid. Maybe such destructive falsehood should be kept out of the mass media for the protection of the public.

Saturday, November 17, 2012

Two cases (discussion)

I was down at 26th & California today to pick up a transcript of Dr. Watson's testimony in Billy's case. When I walked into the courthouse, there was a small demonstration (3 or 4 people) out in front.

One guy had a flag and a megaphone, but in my rush I did not recognize his cause for protest. His voice was remarkable, however, with a cadence almost Martin-Luther-King-like.

When I left the courthouse, the demonstrator was still there, yelling over his megaphone and waving the flag. I remarked to someone walking by that he had a great voice, and got the response, "Yeah, but he talks the wrong shit."

I wasn't quick enough, so I missed the opportunity to paraphrase William Munny, my all-time favorite Clint Eastwood character: We all talk the wrong shit, kid.

Maybe we all helped put both Billy and Johnny in the nuthouse. After all, Billy murdered somebody, and Johnny tore up too much furniture in the middle of the night. So something had to be done with both of them, and the psychs are convenient "experts". Who wouldn't wish for a clean, merciful, medical solution to stuff like this?

The problem is, that clean, merciful, medical solution is a delusion.

If Billy had gone along with the state plan, he'd be taking antipsychotic medications just because his psych wanted him to, even though it didn't do anything but disable him. He would be more dangerous and less able to ever contribute to society again under his own steam. That is definitely not what the taxpayers want, nor what the Illinois Department of Human Services advertises.

If Johnny had bought into his psych "diagnosis" he'd be on drugs, too. He be a mental health consumer for life, chronically mentally ill, a confirmed victim, with every excuse to fail his family. His daughters would worry about genetic risk of mental illness. That's definitely not the result Johnny's parents were after when they called the police, nor any advantage of paying medical insurance premiums up-to-date.

We will have to walk and talk with our own crazy people, not just give them away to experts. Otherwise we will all be slaves.

Or at best, we'll sure be talking the wrong shit.

Saturday, November 10, 2012

Two cases (continued)

I'll call my client in the second case Johnny.

Johnny was having business problems, and stress at home due to his basement flooding repeatedly. He had also decided to get himself off Ambien, which he worried he had become physically dependant upon.

Johnny's family actually did not know about the Ambien. When he began getting up in the middle of the night to battle mice and bugs which he believed were infesting the furniture, they figured he was having a psychotic break. Finally one morning the police were called and Johnny was packed off to a local emergency room. Although he had no previous psychiatric issues, the behavioral health in-take coordinator (after scouting out the insurance coverage) assured everyone that Johnny was in serious need of treatment whether he wanted any or not. She coerced family members to re-write their initial affidavits and add statements about fears of suicide.

Johnny had never been violent or suicidal in his life. He was not violent that morning, and he had no thoughts of suicide whatsoever. No matter, with just the right words on a piece of paper, the in-take coordinator had her paying involuntary patient. Johnny was committed and drugged into insensibility.

After a few days Johnny got out. But the hospital was paid in full by his insurance provider, even though he called them and specifically ordered them never to pay a single dime. Johnny also had a new label, "bipolar", which would be with him for life. After several days of being constantly asked about suicide and surrounded by people who were suicidal, he had actually become slightly obsessed by the idea.

After a year Johnny was pretty well back to normal. He had stopped all psych meds, stopped seeing "counselors", and pried various records out of the hospital, which convinced him that the in-take coordinator and others had broken the law and committed various torts. It took awhile for him to reconcile with his family, but he finally decided not to make them defendants in the lawsuit he intends to file.

Johnny remains outraged by what was done to him. He was assaulted, insulted, falsely imprisoned, dehumanized. He is determined to get justice. The idea of just forgetting about it is contrary to any sense of legitimate society or self respect.

I met with Johnny and his family. Nobody believes that what happened was OK. They are all horrified by the actions of the so-called "mental health system" and happy to tell anyone who asks to stay as far away from psychiatrists as they possibly can.

(To be continued...)

Thursday, November 8, 2012

Two cases

(Opposite ends, in a sense, of the spectrum of legal complexity which is psychiatric coercion...)


I'll call my client Billy. He is a college graduate, former stockbroker, English teacher at a foreign university, and a Navy veteran of the Vietnam War.

In 1986 Billy was fired from his job with the Veteran's Administration. Twelve years later he laid in wait at a train terminal for his former supervisor, and fatally shot him several times in the back.

At trial it was found that Billy had believed he was the victim of a conspiracy wherein the government had been reading his mind by electronic means, and that he had been forced to kill his supervisor in order to stop the intolerable government intrusion. He was adjudicated not guilty by reason of insanity (NGRI) and committed to Elgin Mental Health Center for treatment. Prior to the murder and NGRI commitment, Billy had no psychiatric history and no history of substance abuse.

By 2004, Billy had recovered sufficiently that he no longer suffered hallucinations or delusions. He began to refuse psychotropic medications because they made him feel worse and prevented him from thinking clearly. Possibly because he did not accept the orthodox treatment model, he was not granted expanded privileges for several years. However his recovery continued unabated.

I began to advocate for Billy, and the treatment team was soon willing to collaborate. In late 2011, the facility recommended to the court that he be granted supervised off-grounds passes. The psychiatrist in charge never completely stopped hoping he would take psychotropic medications again some day, but she indicated that the drugs were not necessary for him to qualify for these passes.

For his part, Billy promised he would be willing to go back on meds if he ever became symptomatic of psychosis. The obvious point was, he hadn't been symptomatic for many years.

As is usually the case in Cook County, Illinois (largest criminal jurisdiction in the USA), the State's Attorney's Office simply considers it their job to keep anyone like Billy locked up as long as possible, "treated-or-punished-who-cares". Thus, presented with a motion for privileges, their knee-jerk response in this case was to find any possible way to prevent Billy from progressing toward an eventual conditional release.

The SA's first tactic was to request an independent evaluation from the court's own stable of psychiatrists up on the 10th floor at 26th & California, in the hope that such evaluation would be contrary to the Elgin treatment team's request. As luck would have it, the 10th floor didn't like Billy much, and the doctor up there made kind of a big deal about the fact that he's not taking meds. So, that was probably all the court needed to say no to the privileges request.

Billy and I decided that although this was only a privileges request, not a motion for conditional release, sooner or later the prejudice about taking meds would have to dealt with head-on anyway. He has some money, and he was willing to hire a truly independent psych.

Enter, a brilliant mental health professional: Dr. Toby T. Watson, Psy.D.

Dr. Watson testified as an expert on behalf of Billy's privileges motion on November 6th. He was compelling in his arguments that, a) antipsychotic drugs may be helpful at reducing positive symptoms in the very short term, but they increase the likelihood that a person who continues to take them will become chronically ill; b) long-term recovery rates are much higher for unmedicated patients; c) antipsychotics cause a host of debilitating side effects and lead to premature death; d) the new "atypical" antipsychotics are not better than the older drugs and may be worse; and e) being diagnosed with schizophrenia or any other psychiatric disorder does not indicate any real disease: mental illness is, rather, a metaphor.

Basically, the idea that Billy should be held back in his progress through the system for not taking psych drugs was revealed as arbitrary and contrary to the whole purpose of the system itself. The SA's cross-examination of Dr. Watson was quite ineffective.

When the State presents testimony by the 10th floor psych, I'll cross-examine. And I sure am looking forward to it.

(To be continued...)

Thursday, October 18, 2012

An Appeal for Unity and Collaboration

The people of Earth deserve a break. This scourge of psychiatric rule over mental health, the "expert" admonition that people are brains only -- without valid claim to spirituality, purpose or consciousness except as reduced neurochemical mechanisms -- this terrible dehumanization, must be eliminated from history.

The would-be controllers of behavior and manipulators of brain chemistry do not have a beneficent agenda. They never have. Their purpose is and always has been simply death: death of consciousess, death of honor, death of love. However they protest and whatever they say about "help", they mean only to die and to get all of us to die with them.

The majority of people in the world have very little confidence in the American, hyper-medicalized, mental health orthodoxy. But the psychs and pharma together have almost unlimited money and influence within the most powerful governments on Earth. If they are to be fought and successfully defeated, those of us who oppose them will have to be united.

I am a Scientologist. There are people who fight psychiatry but remain quite happy to waste my license to practice law, and any wealth or social influence that I can bring to bear, just because they hate my religion. I would work with them whatever they believe, but they refuse to work with me. Guys like Torrey and Jaffe just have to love this! It's very bad strategy, and it will land us in the clutches of those who think we should all be "treated" whether we like it or not.

Maybe some think my religion is more dangerous than psychiatry. If so they should be honest about it and go do research on pills to deprogram people from errant beliefs. Good riddance and lots of luck with that delusion!

Meanwhile, people are held down by guards and needles are forced into their bodies to inject poisons "for their own good"; disability rates rise rapidly as wealth and human culture evaporate; criminals practice telling courts that their violent crimes were caused by their genes or their overactive killing glands; the urban legend of a chemical imbalance in the brain is still presented fraudulently as science; our children and their children fail without honor, ethics, purpose or future; the world collapses on itself and has only the bomb left, only suicide. The rough beast's hour comes round at last.

Come on guys! Fight psychiatry, don't fight anyone else.

Monday, August 27, 2012

Gold-plated psychiatry? Ha!

The August 26 edition of the Southtown Star, a neighborhood newspaper in Chicago, includes a letter from one Cornell Hudson of Steger.

Mr. Hudson complains that U.S. Rep. Jesse Jackson Jr. (D-2nd) is receiving the best medical care in the world from the Mayo Clinic, which most of his constituents could never afford.  He continues, "Because of a recent lack of funding, his constituents can no longer visit the recently closed community mental health center that has served the South Side for 37 years. Had Jackson sought care from this center, it might still be open."

But community mental health centers, and state institutions like Tinley Park Mental Health Center, are being closed because the people of Illinois simply do not want to pay for this garbage any more. Psychiatry has clearly failed to reduce mental illness by operating under a medical model, given the opportunity of almost unlimited funding for at least two generations. Arguably, the total efforts of the mental health orthodoxy have dramatically increased the incidence of mental illness and disability!

This is no great mystery, or rocket science. What's happening is, the state's broke, and it's absolutely going to stop wasting money on many worthwhile things, let alone on utter nonsense.

Take Cornell Hudson's sarcastic statements literally for a moment. How many of Jesse Jackson's constituents would just happily "visit" the old community mental health center? Most of those who ever found themselves there as "patients", I guarantee, were under some sort of duress. They might just as likely be thrilled that they never have to go back there again.

Perhaps Mr. Hudson is upset that he can no longer get a family member drugged out of difficult-to-manage behavior for free. Or maybe he's just upset about the bum who is ensconced more often on the corner by his house. That doesn't mean that these individuals ever wanted or needed the neuroleptic poisons which were dispensed by the community mental health center.

It also doesn't mean that Jesse Jackson Jr. will ever benefit from the so-called "treatment" he's getting for his so-called "mood disorder" at Mayo. If I were to bet my own money, I'd say Jackson's political career, if not his life, is over unless he can extract himself from the machine trying to "diagnose" and "treat" him.

There's one other bet I would make. I attended one of the public meetings on the closing of Tinley Park Mental Health Center, and I was struck by the total disconnect between the media coverage of the situation and the obvious reality. So-called "consumers of mental health services" were NOT the the people protesting closure: unionized state mental health workers were.

So I'll wager that Cornell Hudson is a member of AFSCME, or a paid lobbyist.

Monday, August 13, 2012


OK, here's a simple question for any and all criminal defense attorneys:

Out of your last 100 cases, how many defendants never had any contact at all with the mental health system or a mental health professional before they were arrested?

This can be an educated guess, or a careful survey of files. I would bet dollars to donuts that the actual percentage is pretty low. We could also ask:

Out of your last 10 cases of violent crime, how many defendants had never taken psychiatric drugs before they were arrested?

If you're not a criminal lawyer, ask one you know these questions. I would love to get a good volume of data.

I think psychiatry creates crime.

Wednesday, July 18, 2012

Thankful for the budget ax

In today's Chicago Tribune Bonnie Miller Rubin interviews University of Chicago law professor Mark Heyrman under the headline, "Mental health care offers easy target for budget ax". The presumptive attitude is, of course, everyone knows it's a bad thing to spend less money on psychiatric solutions to human problems.

But I rather think the best thing that's happened for mental health, in many years, is states going broke. Heyrman's Trib interview confirms it.

He talks about "low cost, simple services -- medications ... to keep someone healthy." But psychotropic medications don't keep anyone healthy. Sometimes these drugs keep dangerous people disabled from hurting themselves or others. But then again, it seems that sometimes they incite violence. As anyone who has ever taken them knows, they cause weight gain, diabetes, sexual dysfunction and a host of other very unhealthy conditions. If you take psychotropic meds, just deduct 25 years from your life expectancy.

Professor Heyrman believes mental illness makes people quite sick, but he has absolutely no sense that this is metaphorical sickness. He is a true believer in the strict medical model, despite generations of its documented failure. This scientism, this insanity-equals-brain-disease, goes precisely nowhere to improve anyone's life or to make any community safe.

It's so last century, in more ways than one. For this interview, in Heyrman's version of Assertive Community Treatment, people merely "remind you to take your meds, help solve problems...." Of course Dr. Goebbels, we don't mention coercion, which is endemic even in the term ("Assertive...").

People don't forget to take psych meds so much as they stop taking them on purpose or refuse to take them. That's because they hate them, and that's because the meds don't help, they hurt. I'm sure the Gestapo reminded people to do things, too, like salute properly and so on. And nobody believed so strongly in the biological determinism of all things human or sub-human.

The Trib stays in character with it's anti-Semitic founder, Robert McCormick.

But in this century we will not continue to pay for psychiatry's terrible solutions, with or without Obamacare. The DSM/APA/NAMI/Pharma/
NIMH world view is passing rapidly. These days many people know it's possible to recover fully from mental disorders, and it's easier the more you avoid those exact "low cost, simple services" which Mark Heyrman would love to make everyone accept, whether they like it or not.

Be glad Illinois is broke!

Wednesday, June 20, 2012

Demise of Psychiatry: A Reading List

Everybody has read Whitaker and Breggin. Lots of people know of Grace Jackson. Szasz has his loyal disciples (I am one). Here are four books less on the radar, but equally as useful and significant.

American Madness: The Rise and Fall of Dementia Praecox, by Richard Noll (2011, Harvard University Press); and Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters (2010, Free Press/Simon & Schuster). These two are really about history.

Noll covers a critical period of psychiatry in intense detail, from about 1895 to the 1930's, when the disease model of mental illness came and went. The lives, careers and mistakes of Emil Kraepelin, Adolf Meyer, Eugen Bleuler and other luminaries are detailed. Parallels with the present are striking, and the reader is seriously tempted to predict what will happen with DSM-5, purely based on history tending to repeat itself. Noll himself does not discourage this, although the connections seem to be an afterthought for him.

Watters is more of an investigative journalist. He chronicles the spectacularly successful promotion over the past two generations, of the biomedical model of mental illness around the world. In a sense, this recent history picks up almost exactly where Noll's left off, and it shows a returning swing of the pendulum, although neither Kraepelin nor Freud even appear in Watters' index. Each of the four stories told in this book - of the rise of anorexia in Hong Kong, the arrival of PTSD in Sri Lanka, the altered concept of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan - is much more interesting with the backdrop of the earlier psychiatric century.

Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, by Raymond Tallis (2011, Acumen Publishing); and Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis, by Paris Williams (2012, Sky's Edge Publishing). These two books suggest a new look at what we can know and what we should do about the mind.

Tallis offers a highly respectable, technical/philosophical disputation of the intertwined ideas, that we are our brains and that consciousness is just another evolutionary adaptation. Aping Mankind is serious reading, but highly rewarding. One is compelled to respect the argument that ascribing thought to bits of brain is less scientific materialism and more mystic faith. The credentials of the author, who was elected a Fellow of the Academy of Medical Sciences for his research in clinical neuroscience, make him difficult to ignore.

Paris Williams is ideally suited to demonstrate the scientific and philosophical arguments of Raymond Tallis. Rethinking Madness is all about clinical and personal experience which points inexorably to the conclusion that the medical model of mental illness is destructive, and must be replaced by a recovery model wherein people can integrate personal experience and overcome distress. Attempts to make people happier and safer by fine-tuning their brain chemistry are shown to be a mistaken and generally dehumanizing project. Psychosis is not brain disease, and schizophrenia does not really even exist.

Read these four books, and then just try to imagine that the demise of psychiatry as we know it is not imminent. It will be hard.

Tuesday, June 12, 2012

Mr. D again, Karadzic

On a couple occasions in 2010, I wrote about a client whom I called Mr. D. He was almost killed by a psychiatrist at Elgin Mental Health Center, and his sister has remained very unhappy about that ever since.

Mr. D is not out of the nuthouse yet, he's still there, still getting treated. His monthly staffing was today. His psychiatrist (third or fourth one he's had) was not available, nor was his social worker, nor was anyone from the Elgin administration. His sister and parents attended staffings regularly for years, but they recently gave that up as a useless waste of time. Mr. D himself also refused to come today.

The family are "ethnic cleansing" refugees. They have learned one basic thing from their experience with Egin Mental Health Center, the Illinois Department of Human Services, and American forensic psychiatry: There is no better justice in the USA than there was in Bosnia, and the differences between psychiatrists who wield state power, whether their names are Amin Daghestani, Syed Hussain or Radavan Karadzic, are insignificant.

Despite the complete impasse in this case and the startling record of abuse and malpractice, the substitute social worker at today's staffing indicated that everything was just fine. Mr. D actually attended her therapy group on responsibility this week, and he was participatory. How encouraging!

It's just beyond my imagining, why the system still keeps Mr. D locked up away from his family, drugged and dehumanized. The system is simply evil. It needs to be obliterated.

Friday, May 25, 2012

Who Speaks for the Disabled?

Today's Chicago Tribune (page 25) includes the ostensibly pro-family perspective of attorney William Choslovsky. I'm mainly in favor of respecting the choices of families over those of self-proclaimed advocates, and certainly over those of state bureaucrats.

However, it is absolutely critical to presume, first of all, that the disabled may speak for themselves. It's only when an individual disabled person clearly does not speak for him or her self, that we may ethically consider anybody else's choice.

This is more complicated than it looks because disabled people do not really speak for themselves when they cannot pay, in addition to when they are actually incapable of speech. For that matter, to the degree that any of us cannot pay for or independently create what we want, we are all "disabled".

Many Americans may sincerely wish to live in the White House, but they must respect highly ritualized choices of around a hundred million fellow citizens on that, and they only have one chance every four years. This is not an entirely different kind of conflict from one where a profoundly retarded person sincerely wishes to live in their own home, but cannot work to pay the mortgage. Who speaks for another is not an entirely different kind of question from who depends on whom.

Hopefully we each depend, first of all, on ourselves. After that we have families, friends, community groups, organizations and governments, more or less in that order. Who speaks for us is closely tied to whom we depend on. It just has to be.

It's not a question of who, in all cases, ought to speak for the disabled. It's a separate question in each case, which is inextricably bound up with the particular relationships and dependencies of the individual disabled person.

If Johnny murdered his girlfriend and was found not guilty by reason of insanity, and mom and dad have the idea that Johnny was adopted after all, so it's probably a genetic mental illness and they can't help him, then maybe Johnny is not represented any better by mom and dad than he is by the state, when they say he needs to take anti-psychotic medication for the rest of his life. And in fact, if Johnny can't pay for his own private attorney, he'll sure have to deal with other agendas.

NAMI has served the interests of medical psychiatry and pharma for thirty years with a heavy pretense of being all for families who know what's best for their own mentally ill. Obviously it's not always true. Sometimes people just want a magic pill, and they can be fooled. Calling a person disabled can be a power play, too.

I worked for a client who was at Choate Mental Health Center in Anna, IL. That's the facility offered by William Choslovsky as an example of a campus with real community life, where Rita and Kevin Burke's son Brian lives happily. My client would certainly argue that Choate was a prison for him, and the state should close it and every institution like it.

He speaks for himself, and I agree with him.

Monday, May 14, 2012

Another proposed resolution...


WHEREAS, Systematic review has been undertaken over the past decade at national, state and local governmental levels, and in collaboration with private and not-for-profit research, regarding strategies to address potential incidents that could have large-scale health consequences including disease outbreaks, natural disasters and terrorist attacks; and

WHEREAS, The U. S. Department of Health and Human Services, after conducting its own review of these issues, published a National Health Security Strategy of the United States of America in December, 2009; and

WHEREAS, The 2009 HHS Strategy is replete with statements recognizing an overarching necessity to convince the people to trust and independently cooperate, at the individual, family and community levels, with organized efforts by authorities in the amelioration of any significant health incident; and

WHEREAS, Contrary to these overarching security needs for broad trust and cooperation, notable social trends now exist toward increasing public doubt and cynicism, especially with regard to medical science and health care; and

WHEREAS, An example of such doubt and cynicism was a New York Times book review in 2009, which characterized Americans' recent love affair with modern psychiatry as a sub-prime crisis waiting to happen; and

WHEREAS, Over the last several years, the American Psychiatric Association and the world community of mental health professionals have been in an uproar regarding the general validity of psychiatric diagnosis, as evidenced by incessant protests over the new paradigm of "dimensional" definitions of mental disorder to be established in 2013 by the publication of the fifth revision of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5); and

WHEREAS, Endemic, spectacular and increasingly frequent media stories of health care fraud and falsified medical studies are not conducive to pubic confidence in and cooperation with authority on issues of health; and

WHEREAS, An ultimate security threat might entail a catastrophic failure of confidence in authority and cohesion in the face of disaster; therefore

BE IT RESOLVED BY THE LEGISLATURE, That a fundamental distinction shall be recognized: between practical and empirically-proven medical science and clinical health care practices, as opposed to popular or academic scientism embodying mere theories or wishful thinking about easy solutions to human behavior and magic pills for all unpleasant life experiences; and be it further

RESOLVED, That our government shall refrain whenever possible from forcing, coercing or deceiving families or individuals into health care solutions which they do not choose themselves by fully informed consent; and be it further

RESOLVED, That human emotions and complex behavior are not realistically a subject for, and may never be amenable to, medical management, especially such management as should ever be attempted by any state medical or mental health bureaucracy; and be it further

RESOLVED, That fundamental and vital principles of any health security strategy shall be free and honest information, open dialogue, and collaboration with the people.

Friday, May 11, 2012

Suggested Resolution to be Introduced in State Legislatures and/or the U.S. Congress


WHEREAS, Love and loss are two sides to the same coin of human connection; and

WHEREAS, Bereavement, especially traumatic bereavement such as comes with the sudden death of a spouse or a child, may bring existential grief and the darkest hours of human experience; and

WHEREAS, We cheapen and demean our own humanity and disqualify ourselves from loving, if we merely label the grief of mourning as a "mental illness" on a par with biological dysfunctions like diabetes or cancer, to be "cured" with a pill; and

WHEREAS, A psychiatric diagnosis of depression can be misapplied to a person who is grieving; and

WHEREAS, The several editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) published since 1980 have defined depression, or Major Depressive Disorder, in terms of a checklist which has included sadness as a symptom tending to indicate a diagnosis; and

WHEREAS, An exclusion of sadness due to bereavement, as a symptom of mental illness needing medical treatment, was reduced from one year in the American Psychiatric Association's DSM-III (published in 1980) to two months in DSM-IV (published in 1994); and

WHEREAS, The proposed bereavement exclusion in DSM-5 (to be published in May, 2013) is only two weeks, meaning for example that the bereaved parent of a child lost to murder or suicide, or the spouse of a dead husband or wife of 50 years, would be labelled mentally ill for grieving longer than two weeks and encouraged to take powerful, expensive and potentially dangerous psychotropic medications; and

WHEREAS, Many experts in diverse mental health fields believe this DSM-5 scheme will be patently unscientific, arbitrary and potentially harmful to patients and clinical practice; therefore

BE IT RESOLVED BY THE LEGISLATURE, That all people have a natural human right to grieve for life's losses, and especially for losses of loved ones; and be it further

RESOLVED, That no one should be judged as having a medical or mental disorder because of normal sadness over significant loss; and be it further

RESOLVED, That the right to grieve without being labelled as ill may not be limited to any short time of a few weeks or months, because each individual must face bereavement in his or her own way and in his or her own time, and for many genuine grief over the loss of a loved one lasts for life; and be it further

RESOLVED, That our Government shall always recognize human grief and human love alike as precious to life itself, existential, and ultimately beyond the scope of mere scientific medicine.

Thursday, April 19, 2012

Pass HR0898, rescue the law from psychiatry!

To: Members of the Human Service Committee, Illinois House of Representatives, State Capitol, Springfield, Illinois​

Dear Representative,

I intend this letter to be submitted as written testimony in support of House Resolution 898 (HR0898), sponsored by Rep. Mary Flowers, which is currently being considered in the Human Services Committee.


I have lived in Illinois since 1967, when my father moved our family from Flint, Michigan.  I attended the University of Illinois at Champaign, Northwestern University, and DePaul University College of Law.  My wife of 37 years was born in Chicago, and we raised our three children in this state.  We love the winters and will never move to Florida, Arizona or California.

For ten years, my law practice has been devoted almost exclusively to pro bono representation and advocacy for individuals who are involuntarily committed in state mental health facilities in Illinois.  I’ve seen the inside of Chester Mental Health Center, Choate Mental Health Center, Alton Mental Health Center, Singer Mental Health Center, Tinley Park Mental Health Center, Chicago Reed Mental Health Center, and Elgin Mental Health Center.  I am currently on the “grand rounds distribution list” at Elgin (meaning I get regular notice and invitation to their weekly continuing medical education programs), and I often spend two or three days a week there.  Some people probably wonder if the state pays me, but it does not.

Most of my clients are violent criminals.  At some point a judge looked at each of them and decided, “Well, maybe instead of just punishing this guy who did this horrible, inhuman thing (e.g., murder), we should try to fix him.”  The verdict was therefore: Not Guilty by Reason of Insanity (NGRI).

Formally, an NGRI verdict is an acquittal. However, the defendant is almost always committed to a secure psychiatric facility for a term not to exceed the length of the most severe prison sentence he would have received had he been found guilty on the most serious charge against him. The purpose of this commitment is twofold: protection of the community, and effective treatment of any mental disorder which caused insanity. Once the defendant is effectively treated and he is no longer a danger to the community, the court releases him from the involuntary commitment. This is the essential viewpoint or theory of the law, although there are various bells and whistles.

I will now describe to you what really happens, according to my own substantial experience as an attorney and advocate within this system.

The awkward disaster of psychiatry and Illinois criminal law

When a murderer thinks he can go to a hospital instead of prison or the executioner, it sounds like a pretty good deal to him, and to his lawyer.  His family normally agrees, even (or especially) if they are victims of the crime.

Many elements in the community, not directly impacted by the particular crime but nevertheless interested pursuant to various economic, social and political agendas, may want to use a criminal case as evidence in their advocacy for public resource priorities, or to support a certain status quo which generates payroll checks. Couple these interests with modern liberal tendencies and prejudice in favor of medicine or science to solve every human problem, and we have strong background inertia to favor “treatment” whenever mental illness is credibly advanced as an explanation for a tragedy.

On the other side of the issue, there is always a state’s attorney who finds almost any NGRI plea inherently suspicious. There are usually crime victims and their families thinking more in terms of vengeance than merciful medicine. Sometimes there are media stories, and the reporters can be complete wild cards.

In the middle of it all is a judge, who wants to believe his own decision will not be too arbitrary, or at least not transparently so.

So what appeals to all of these troubled dynamics? What hero rescues everyone from confusion? The expert, of course! The psychiatrist allows us all to abdicate our own judgment without feeling irresponsible. We need not punish crime or blame our fellows harshly, because there is a disease to be magically cured by someone else, who is trained.

(If you’re thinking I should not be sarcastic or exaggerate or simplify… then I would ask: When did you last sit down with psychotic murderers? When did you last confer, behind the locked doors of a state institution, with a treatment team charged with fine-tuning somebody’s brain chemistry to keep him from ever behaving badly again? If you would make the law of places where you will not go, the locals may soon come to find you.)

My clients are those who were found NGRI by the judge, and remanded to the custody of the Illinois Department of Human Services for treatment. Sometime later, each of them decided he didn’t like treatment after all, and he began to refuse it.

The first reaction of a normal layperson might be: He isn’t allowed to do that, is he? He killed somebody…. But of course he’s allowed to refuse. It’s medical treatment, right? People have to give informed consent; you can’t forcibly drug a guy if he’s not hurting anyone now. That would be punishment, and we’ve said these people are not guilty (by reason of insanity), so we have no ethical standing to punish them.

Well then one might think, the “patient” doesn’t know what’s in his own best interest but the psychiatrist does, right? No, actually when it comes down to it, most psychiatrists would not, and do not, say that. They stick to procedures in the forensic system, the doctors defer to the law, and they say they are just following the court’s orders. One often feels that they have forgotten whether they’re doctors, lawyers or policemen.

The man in the white coat and the man in the black robe simply point at each other, and shrug their shoulders cynically.

Meanwhile, the patient or criminal goes nowhere, for approximately $700 per day of the taxpayers’ money. He may not believe he’s mentally ill anymore and may be totally asymptomatic, and he refuses to be drugged into subhumanity for anyone else’s “prophylactic” benefit. The whole concept of “treating the mental illness” that supposedly caused a violent crime to occur begins to fall utterly apart. There is no objective, obvious medical problem, so people start making things up to create “evidence”. The fact that a guy says he’s not mentally ill now proves that he is, even if no other symptoms exist. The irony, that precisely the opposite logic (he only says he’s mentally ill to avoid prison or executioner no matter what other symptoms exist) had been part of the prosecutor’s argument at trial, is never lost, especially on the public.

The apparent solution to all of this, within the ruling paradigm, is better psychiatry, better diagnosis and better treatment.  The problem is that there just isn’t any.

We have come down a long road in Illinois to a point where forensic psychiatry severely demeans both medicine and our law.  Several years ago, I saw the Randolph County State’s Attorney spend hundreds of thousands of dollars to keep a man locked up in Chester, although nothing was wrong with him.  Three expert witnesses testified for each side, saying with equal conviction that the defendant was dangerously mentally ill, and that he was perfectly alright.  The only thing the jury could be sure of in the end was that nobody had proven anything.  It was a giant show of nonsense.  The media were entertained and outraged as they always are, the AFSCME Council 31 union members defended their paychecks, and a candidate for local office lost his election because of the charade.  It was ugly, debased politics: the best forensic psychiatry money can buy! And it’s getting worse, not better, because the state can no longer afford to pay, and patients are more and more likely to disagree with treatment programs every day.

Since that case in Chester, the FDA has ordered black box warnings for psychiatric drugs, mere placebos have proven to be almost equally as effective, and pharmaceutical companies have paid billions in fines for illegal and deceptive marketing.  The hoped-for cures for mental illness have been revealed as problematic indeed. Currently, as the American Psychiatric Association prepares to publish its next diagnostic manual, the mental health profession is almost begging them to avoid the embarrassment.  The “diseases” themselves are as discredited as the cures!  In short, my clients are certainly not the only ones saying they just don’t believe in psychiatry. A necessary solution will be to actually separate this pseudoscience from the law.

Specific problems (examples)

The definition of “mental illness” as that term is used anywhere in Illinois statutes and regulations is established by 405 ILCS 5/1-129:

…a mental, or emotional disorder that substantially impairs a person’s thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of life, but does not include a developmental disability, dementia or Alzheimer’s disease absent dementia, a substance abuse disorder, or an abnormality manifested only by repeated criminal or otherwise antisocial behavior.

This definition begs any number of questions, e.g.:

The General Assembly apparently presumed either a difference between mental disorders and emotional disorders, or they intended to acknowledge that mental and emotional are alternative terms for the same class of disorders.  The former case would refer to scientific evidence; the latter would indicate the field is scientifically uncertain. What’s the story with this language?

Are the terms, “thought, perception of reality, emotional process, judgment, behavior, ability to cope with the ordinary demands of life” used according to any technical definition, or merely intended to convey regular lay usage and understanding?  If the former, where are such definitions found?  If the latter, isn’t this whole concept left pretty wide open for interpretation?

Why exactly aren’t developmental disabilities mental illnesses?  Is there really any fine line between these concepts, in any individual at any moment?  What about a seven-year-old having trouble on the school playground?  Can’t this be looked at either way?

Why exactly do we exclude dementia, and Alzheimer’s disease absent dementia?

Why do we exclude substance abuse disorders from mental illness?  If a college student gets an ADHD diagnosis so he can have access to stimulants (and perhaps share them with friends on occasion), does he have a mental illness or is he abusing a substance?  If a teenager takes LSD and has a psychotic break which lasts a few days, is she mentally ill?  “Substance Induced Psychotic Disorder” is an official DSM-IV coded diagnosis. Doesn’t that mean it is a mental illness?

Aren’t all mental illnesses manifested only by behavior which is perceived as either criminal or antisocial to some degree?  So how can we exclude those very symptoms which are the sole basis for diagnosing the disease?

The bottom line is that we don’t define mental illness with any certainty or consistency under the law.  We can’t, because we just don’t know what it is, as a reality.  We only know that we would like to control peoples’ bad behavior without being too mean about it, so a medical model has great allure. To the degree that it’s only a metaphor, or for that matter a lie, well, the complexity mounts up rapidly, the law becomes gibberish.

405 ILCS 5/1-119 depends (!) upon the clarity of 405 ILCS 5/1-129 to further define the circumstances under which we justify depriving a person of his or her fundamental right to liberty, through forced imprisonment, in a locked and barred “hospital”:

“Person subject to involuntary admission on an inpatient basis” means:

(1) A person with mental illness who because of his or her illness is reasonably expected, unless treated on an inpatient basis, to engage in conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed;
(2) A person with mental illness who because of his or her illness is unable to provide for his or her basic physical needs so as to guard himself or herself  from serious harm without the assistance of family or others, unless treated on an inpatient basis; or
(3) A person with mental illness who:
(i) refuses treatment or is not adhering adequately to prescribed treatment;
(ii) because of the nature of his or her illness, is unable to understand his or her need for treatment; and
(iii) if not treated on an inpatient basis, is reasonably expected, based on his or her behavioral history, to suffer mental or emotional deterioration and is reasonable expected, after such deterioration, to meet the criteria or either paragraph (1) or paragraph (2) of this Section.
In determining whether a person meets the criteria specified in paragraph (1), (2), or (3), the court may consider evidence of the person’s repeated past pattern of specific behavior and actions related to the person’s illness.

It is not necessary to catalogue the vast number of unanswerable questions this section of our law raises. The totem-pole “reasonable expectations” alone would require a flow chart to even begin to decipher. The bottom line? This “law” is embarrassing nonsense. It cannot possibly constitute any common social understanding or agreement, and it only serves to allow some remote, designated expert to decide, according to whim, who gets locked up and who may walk free, who is allowed rights as a human being and who is dehumanized.

Sections 405 ILCS 5/1-129 and 405 ILCS 5/1-119 are two examples with which I am particularly familiar, but they are by no means exceptional or even the most glaring instances of problematic law and regulation due to scientific and medical confusion over mental diagnosis. The fields of school law, child protection, disabilities, health care, employment, discrimination, and welfare are all hopelessly infected (please excuse the irony of my metaphor).


There may come a time when such nonsense as I have described above earns more open and widespread cynicism about the law, medicine, science, and reason itself. Illinois has an unfortunate reputation already in the world of politics.  We should not bear this additional burden of disreputable psychiatry, which weakens the fundamental bases of our culture.

House Resolution 898 is a careful statement of the problem, and it merely calls for an organized, democratic evaluation.  I believe it will enable our state to get out in front of these issues, avoid much worse controversy down the road, and actually save much expense in lives and treasure.

I therefore respectfully urge you to pass HR0898.

Monday, February 20, 2012

Jail and the mentally ill

Bridget O'Shea's article on yesterday's NY Times Health page featured Sheriff Tom Dart and others, complaining about Cook County Jail being the biggest mental health provider in Illinois. I never quite know what to say to people who seem to think this is so pathetic.

The presumption of course, is that individuals who are sick belong in hospitals, not jails. But there's a highly ironic and eery similarity between mental "hospitals" and jails. The people of Illinois should notice, just for example, that these hospitals have locked doors and guards to make sure the "patients" don't escape.

I would love to walk around the cell blocks at 26th and California with Tom Dart, and say, "OK Sheriff, point out one guy here who's mentally ill as opposed to just a bad guy, and explain to me how you yourself can tell." My guess is, he'd only be able to reliably distinguish between the regular criminals and the mentally ill in his own jail by looking at a file or a record, or asking somebody else who had looked in a file or record, which might include pronouncements by psychiatrists or other so-called mental health professionals.

These pronouncements are called diagnoses. But the people who make them are completely confused these days about whether and in what sense they are valid at all. There's is never any objective test, and DSM-5 intends to define mental illness of every kind on an unbroken continuum with normal behavior. In other words, nobody knows exactly where to draw a line between the guys who are sick and the guys who are bad at Cook County Jail.

For ten years, I've worked with "patients" in this system who were found not guilty of violent crimes by reason of insanity. I'm down at 26th & Cal almost every week. Some of my clients have been basket cases who didn't brush their teeth or bathe; others have been smart, totally symptom-free, unmedicated murderers. Sometimes their doctors have insisted that they had to take psychotropic drugs, or even threatened to get court orders to force them; other times the clinical team has carefully contrived to change a diagnosis so a non-drug treatment plan could be justified to a true-believing judge.

The one thing that's always obvious is, it's not medicine or science in any sense that the public could ever recognize. It's a tortured attempt at a giant social control machine which can run on automatic without any responsibility by any individual human being, so nobody ever has to be punished, or blamed, or wrong. People can just get their brains fine-tuned by the experts, and we can all live happily ever after.

This is the probably most destructive social delusion in history. Maybe it's easy for Sheriff Dart to pretend he's being humane and scientific and medical, when he moans about too few state nuthouses to relieve his crowded prison. The truth is he's just passing the buck like all the other helpless, wasted bureaucrats we pay.

And ultimately, the New York Times reporter has no excuse not to know that. Nor do any of the rest us.

Thursday, February 9, 2012


(Summarized upon request of a state hospital treatment team and patient "Mr. X", and offered as an earnestly recommended, though admittedly radical strategy: February, 2012, by the patient's attorney.)


Mr. X was found "Not Guilty by Reason of Insanity" for murder over thirty years ago. He is diagnosed on Axis I with schizophrenia. He’s in his mid-sixties now, and has had no symptoms of psychosis for many years, despite not taking any psychotropic medication. The court has granted increased privileges gradually, but very likely remains impressed by a supposed bottom-line necessity for psychotropic medication if this type of patient is to be granted a conditional release. The treatment team wonders what to do next.

Relevant considerations

1. Viewpoint of the court.

The court has only one valid purpose consisting of two elements: See that Mr. X is treated humanely, and keep him secure to ensure the ultimate safety of the community.

Mr. X was not culpable for the murder he committed because he was insane. The court, as society’s agent, is not supposed to have any interest in punishing him. However Mr. X's treatment is not entirely for his own benefit. In fact, it’s much more for society’s safety as far as the court is concerned, and this is the first element of the court’s only valid purpose. Iatrogenic neurological disability would actually be justified, even if it were grossly dehumanizing (think of the old fashioned ice pick lobotomy), on this basis alone.

However, the second element is the social imperative to be humane. Society places very high negative value on cruelty, so it becomes the court’s job to minimize or eliminate cruelty. Society believes, and the court is utterly committed to the idea, that scientific medicine is one of the best solutions man has devised to increase human comfort and happiness with less perpetration of cruelty among competing individuals in a severe world.

Therefore, the court remanded Mr. X to the custody of the state’s experts in mental health, a scientific medical specialty, to miraculously improve his personality and behavior by fine-tuning his brain chemistry until he becomes an upstanding citizen and society is secure.

Although the court is essentially aware that the state’s experts in mental health are not really miracle workers to this degree, it rather desperately wishes they were. And it may bitterly resent any reminders that the experts fall short of such an ideal, because the court, like the society which it serves, is afraid of being fooled or cheated.

Judge Z should not be interested in the treatment team’s uncertainties. He theoretically wants only their relatively confident synopses of empirical knowledge, applied to the case and question at bar. However, the court and (even more so) the State’s Attorney, will welcome almost any artifice to argue or justify a decision for keeping a murder defendant locked up. Thus, any uncertainties of the clinical team (or the court's “independent” experts) might be seized upon to serve that purpose more readily than if they favor release.

There is a standard described as “reasonable medical certainty” - but all that really means is any confident opinion voiced by a doctor. Opposing and equally reasonable “medical certainties” are presented to the court all the time, and those win which just sound a little bit more confident and understandable to the judge who’s there that day. The court knows very well that expert testimony is only “objective truth” in some small, nominal way. It’s mostly persuasion, and that is not any problem, but part and parcel of our system of law.

2. Viewpoint of the clinical team.

The team consists of public employees who have varying levels of medical and non-medical expertise. As a team, they are expected to restore the mental health of a patient to a point where he or she will not be a danger or severe burden to the community, before the patient will “Theim out” (be released pursuant to a U.S. Supreme Court precedent regardless of treatment success or failure).

There is a presumption that poor mental health was in fact what caused the patient to be dangerous, before the team ever laid eyes on him. The team is not really allowed to dispute that issue, but is paid by the state to work within the presumption.

For at least a couple generations now, mental illness has been conceived to be a proper medical problem. This is basically because there was once great optimism that it must be caused by brain disease, which could with improving scientific research, etc., be identified and ultimately cured. In any event, nobody yet claims any ability to cure mental illness: it just gets treated, with the goal being a limited, temporary, or at least more modest improvement than a true, simple and permanent cure.

The only thing relevant to mental illness or the lack of it, which the team can objectively observe or test, is the patient’s behavior. (This includes what the patient says, or writes, as well as how he acts.) No clinician, no matter how good they are or what tools they have, can know with any certainty what the patient thinks, or how he feels: such conclusions are entirely derived from observed behavior.

Applied medical technology, e.g., psychotropic meds, may have observable and predictable correlations with behavioral changes. However, nobody is sure how or why that works. These days, people pretty high up the food chain of cutting-edge psychiatric research are admitting (just for example) that the “chemical imbalance” theory of mental illness was always an urban legend, and any competent psychiatrist should have always known that.

So treatment does not equal medication. Treatment is rather whatever can, without a lot of ugliness, produce a stable, positive change in the bad guy’s behavior. This is where the team’s real expertise lies. For all practical purposes, the public pays the forensic mental health treatment team not for expertise about the mind or neurology or philosophy. They pay them to be experts at mercifully changing very bad behavior.

Treatment must be collaborative. Involuntary “treatment” is never more than a desperate emergency measure. Dr. Y doesn’t prescribe medication unless Mr. X agrees to take it, as long as Mr. X is not beating up everybody in the room daily. Although he killed somebody, and society will not let him walk out of the state hospital now, the only valid treatment for Mr. X must have his un-coerced stamp of approval. It just doesn’t qualify as treatment otherwise. This is an element of the team’s empirical, clinical expertise. It is part of why they are a team, not just Dr. Y alone, dictating medical details without need or allowance for questions, perspectives or other help than his own. It’s part of why we have mental institutions and a professional specialty of forensic psychiatry, not just police forces, prisons and pharmacies.

The treatment team’s professional pride is in delicate collaboration and caused stable behavioral change among people who can only be feared and loathed by the lay public. This is a relatively heroic activity.

3. Viewpoint of Mr. X’s attorney.

I couldn’t care less whether Mr. X has schizophrenia, epizootiphrenia, drapetomania, or any other specific, defined “mental illness”. He killed somebody and he’s not being punished for that, but everybody wants to be sure he’ll behave himself in the future. It’s an extremely dicey speculation, and I never would have become involved with it at all, except that this state has unfortunately made it a very bad part of the law (my profession), which needs cleaning up!

It seems to me that convincing Judge Z, the Department and the treatment team to arrange the conditional release of a schizophrenic killer who is not taking psychotropic meds will help. For one thing, it will remind everyone of the practical responsibility to change a bad guy’s behavior, as opposed to just pretending they can fix his brain whether he likes it or not.

As a society, we have gotten too damn complex and glib about evil. We call Dr. Y-the-wizard-with-a-magic-pill to “cure” killers, instead of personally standing on the bridge and telling the X-monster, you shall not pass! We have a death penalty in our state, but no capital case juror will ever be required to flip the switch personally. When the law is a machine and a Rube Goldberg menagerie of impersonal processes, it insults me. And it makes me feel terribly insecure, like nobody’s really there.

I think Mr. X has been successfully treated and cured of schizophrenia, or he has outgrown it, or he has learned not to act crazy, whichever works. The Department, the state hospital, Dr. Y and the treatment team deserve full credit for this result. Mr. X’s behavior has been exemplary and stable for a long time. The fact that he has been so symptom-free without medication for an extended period actually makes the prospect of his continued recovery in the community even better.

In any event, beyond a certain point in time there is no further clinical treatment purpose for keeping Mr. X at a state hospital, running up the taxpayers' $450/day tab! The chance that Mr. X will hurt anyone because of mental illness is slim already, and it can never be reduced to absolute zero. We could keep him psychiatrically confined for many more years, and we would be no more certain about this than we already are, unless we just keep him until he dies.

Mr. X should be conditionally released to a situation where he will be closely monitored for five years, and where regular reports will be sent to the court, random drug screens done, etc. He should not be required or even encouraged to take psychotropic medications, while he has no symptoms of psychosis. Given that Mr. X is healthy and in his sixties, I think he would be crazy to start taking meds now. It would be more likely to destabilize him than serve any hypothetical “prophylactic” purpose.

Suggested handling

1. Start putting a packet for conditional release together now, and file it with the court as soon as possible. The violent crime and schizophrenia dx, with no psychotropic meds, will certainly be a sticking point at all levels. Work through this problem, which exists almost exclusively in institutional culture, not in empirical medicine. Do not merely fudge the paperwork to make it look like a new evaluation just happens to change the Axis I. There are plenty of published, empirical psychiatric research studies to justify an expert opinion that Mr. X’s dx does not have to be wrong to explain the observed fact that he’s fine now. Locate and read the professional research, and get comfortable with that perfectly valid opinion.

2. Send a straightforward, confident recommendation to the court stating that Mr. X is suitable for conditional release; and that the risks of treatment with psychotropic medication would outweigh any possible (e.g., prophylactic) benefits in his case, hence they should not be prescribed. State this as the expert opinion of the Department treatment team, held with a reasonable degree of medical certainty.

3. When the court's independent evaluation comes back in total disagreement (which it will), litigate the issue aggressively. Judge Z will almost certainly go with the opinion of the court's independent evaluator, rather than the Department opinion. So what? Use the opportunity to move the court’s opinion in our direction as much as possible. Enter every possible study into evidence, showing that people perhaps do spontaneously recover from schizophrenia without meds, that nobody really knows the brain basis of schizophrenia and there may not be one, that schizophrenia may not even be properly described as a unitary “disease”, etc. Enter every study showing the dangerous side effects and complex downside of psychotropic meds. Recruit outside expert witness testimony to back these points up.

4. When Judge Z denies the petition for conditional release (which he will), file another one as soon as the statute permits, and litigate the whole thing all over again, but better.

5. Repeat this procedure until a conditional release is granted without any recommendation for psychotropic medication, despite an Axis I schizophrenia dx.

6. Keep in close touch with Mr. X after he is conditionally released and don’t let him screw up.