Thursday, February 28, 2013

It's cheaper to kick somebody's ass

My attention returns from Hollywood to Southern Illinois. Chester to be precise, in Randolph County.... One reverts to a peculiar frame of mind, about as far away from Hollywood as it's possible to get culturally, without departing (which has become, in my lifetime, amazingly difficult) from Western Civilization itself.

C. Rodney Yoder was my first client, and he remains my closest conscious connection to both Southern Illinois and Dr. Thomas Szasz. Rodney referred me to an article today, which reports that a Cook County judge recently found a 55-year-old defendant not guilty of attempted murder by reason of insanity. (NGRI verdicts are still curiously common in bench trials, although they've long been a much tougher sell to juries.)

This defendant had been held as unfit to stand trial at Chester Mental Health Center and forcibly drugged with various psychotropic poisons for several years. All the heroic "treatment" ultimately had produced no change, according to a testifying state psychiatrist.

The article makes special mention of a proclamation the defendant once made in court: "I'm not a psychopath, I'm a sociopath." Many people would say this was just an incoherent outburst from a sub-human madman. However, my own professional experience has taught me to consider whether it might mean something. This murderer might have been telling us he'd rather be in prison for the rest of his life than in a state nuthouse.

I think the distinction between sociopath and a psychopath boils down to this: If you're a sociopath, the rest of us will sooner or later gang up to kick your ass; if you're a psychopath, the rest of us will sooner or later gang up to "treat" you.

From the criminal's point of view, the right to choose one situation or the other might be desirable. Some would rather fight to the death, others would rather be (psychiatric) slaves.

For society on the other hand, it's a simple question of utility. There's little or no benefit from either course of action, but it's probably much cheaper to kick somebody's ass.

I'm not sure whether I would stand for the rights of murderers to decide their fates or not. But when somebody wants to go to prison, maybe they should be allowed to save the state the 400% higher expense of involuntary psychiatric "hospitalization". The only counterpoint to that, as far as I can see, is that if we find a murderer to be mad instead of bad, it allows some of us us to pretend we're being humane and scientific.

That's nonsense, of course. They know it down in Chester, too, even if they don't in Hollywood.

Monday, February 25, 2013

Jennifer Lawrence blew it

Oh man, I liked her! Falling up the stairs was cool, but how could she say something this stupid?

"It's just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it's such a stigma behind it."

Nobody has to take medicine for their mind. In fact, there's probably no medical doctor anywhere who would hand a patient a prescription and say, "This is for your mind."

Psychotropic medications can be said to either control behavior or treat the brain. But doctors don't consider that they medicate minds, because they don't know what minds are, or even whether they exist. It's just not their business.

Maybe Jennifer Lawrence believes the mind and the brain are the same thing, so she uses the two words interchangeably.

And maybe she has no clue that asthma and diabetes are pretty objective conditions of the body which any given person either has or does not have, whereas the mind is a concept which has never been nailed down, photographed or perfectly tested for.

Maybe she has never heard that it's theoretically entirely impossible to prove an absence of mental illness, though courts and juries expect defendants or prosecutors to try from time to time, usually to the detriment of somebody's most fundamental rights to privacy and liberty. Maybe she's oblivious to the problem of a complete lack of scientific validity in the diagnosis of specific mental disorders, and even an embarrassingly low degree of simple reliability.

Maybe she's never heard of black box warnings on the "medicines" which she thinks people take "for their minds". Or maybe she thinks the FDA has also warned that asthma and diabetes drugs cause suicidal and homicidal ideation, long-term disability and early death. So everything's equally risky, everything's the same as everything else.

Or, maybe she's just really stupid, which would be upsetting considering what a beautiful, great actress she is.

There's one darker possibility. Maybe, like many people who glibly repeat the Pharma/APA/NIMH/NAMI orthodoxy, Jennifer Lawrence figures it will pay well enough that she doesn't care who it hurts.

Sunday, February 24, 2013

Hollywood and psychiatry's demise

I have often referred to Thomas Szasz's theory that absent the facility of state coercion, psychiatry as we know it would rapidly fade away. And I think my own objections to psychiatry would become effectively irrelevant if all forms of the insanity defense and involuntary treatment were simply abolished.

However, if you see psychiatry as a legitimate medical specialty, and believe or hope that brain research will enable more effective treatments and understanding of the causes of mental illness, you might not imagine that it ever could or would fade away, any more than physics, or society itself, or truth.

Culture is the continuing combined attempt of humanity to assign meaning to the experienced world. It is created truth, rather than discovered truth. It may randomly partner or compete with science, and it may be a stronger or a weaker influence than science upon events of all kinds, depending on circumstances. Any prediction of cultural trends is probably arrogant by definition. (Oh, well...)

The high priests of science do research funded by the United States government, and the high priests of culture make Hollywood movies. Right now, from the perspective of us common people who merely market and consume brands, we have apparent competition.

President Obama is calling for breakthrough brain research and "mental health" solutions to endemic human violence. Hollywood is making movies like Silver Linings Playbook and Side Effects.

At first glance, these two films present dramatically different pictures of psychiatry.

Silver Linings shows both psychiatrists and patients as entirely human, tragic and adorable. The mental health system is part of the background, but it's not very relevant because ultimately things can turn out the way good people want them to. In almost total contrast, Side Effects shows both psychiatrists and patients to be criminals, motivated entirely by money and spite. The mental health system is utterly, irredeemably corrupt, and no one ever helps anyone, no matter what they say.

But the contrasts are less interesting, as culture, than the complementary influence these two films might exert toward undermining psychiatry's brand.

Hollywood now seems to completely discard all reference to the 20th Century ideal of beneficent scientific medicine, in these portrayals of bad behavior as a public health issue. The characters in Silver Linings and Side Effects are all equally out of control and unpredictable. The "diagnoses" are random and irrelevant, and the doctors are clearly not Ben Casey or Marcus Welby.

Never mind whether someone on a "therapeutic" dose of Seroquel can ever be a beautiful dancer, dance still cures unhappy and crazy people. And never mind whether a drug can really cause a sleepwalking murder, everyone in the mental health business is a dangerous liar anyway.

These are not ideas which enable psychiatry as we know it. In fact it's pretty safe to say that if most people agreed with the reality of these ideas, they would not come up with a system wherein psychiatric experts get primary jurisdiction over who should be locked up without trial, who should be forcibly drugged, who should be excused from criminal responsibility.

The reason psychiatry has the power it has in Western countries, is that once upon a time a couple of generations ago, people would have found Hollywood's depictions of mental health issues in both Silver Linings Playbook and Side Effects to be completely unrealistic or even offensive.

We live in a different world now, and I think despite President Obama's urgings, psychiatry as we know it is a nearly lost cause.