Monday, November 24, 2014

Arguments in support

(The following is adapted from recent filings in Cook County, Illinois Circuit Court, Criminal Division, and the Supreme Court of Illinois. Most citations and all footnotes are omitted for brevity.)

1.  The Illinois Mental Health and Developmental Disabilities Code [405 ILCS 5/1-100 et seq.] mandates that the Illinois Department of Human Services and Elgin Mental Health Center formulate an individual services plan, or treatment plan for the Defendant, which must be reasonably calculated to result in sufficient improvement to enable his release, or to arrest his decline, and which takes into consideration his own preferences regarding treatment.

The legally prescribed purpose of the treatment plan does not admit any intention to punish the Defendant for the crime he was charged with, nor does it direct DHS and Elgin to chemically disable him from all possible commissions of bad or dangerous future behavior.  Rather, the most optimistic conception of the purpose of the treatment plan is to enable the Defendant to become a more social and trustworthy person who can live peaceably and as productively as possible in the community.

Toward this purpose the statute recognizes positive value in the Defendant’s own free and willing collaboration with his treatment; and it contemplates the probable negative effects from adversarial coercion or forced treatment.  If a mentally ill person, having been violent in the past due to his mental illness, cannot attain un-coerced insight into his own condition approximating the understanding and diagnoses of those mental health professionals who are treating him, he is not likely to be considered safe for release into the community.  But the treating clinicians are not exact scientists of the mind or behavior.  Their information about their patient comes mostly from their patient. Mutual trust and open, honest agreement are thus great facilitators of positive change; strict orders, poorly understood evaluations, and resentful compliances are not.  The Illinois Mental Health and Developmental Disabilities Code, as a whole, embraces these realities of mental health and mental illness.  Treatment planning cannot avoid them.

2.  Section 2-107 of the Code [405 ILCS 5/2-107] establishes the Defendant’s right to refuse psychotropic medication, for any reason or for no reason; this section also establishes the duty of DHS and Elgin to not make the Defendant take drugs once he has refused, whether or not it may be a current and generally accepted or recommended treatment for his mental illness, unless an immanent threat of serious harm exists and no less restrictive alternative is available.

Whether an individual does or does not take any drug must remain primarily a matter for that individual’s own competent choice under almost all circumstances, and must not become the separate decision of (supposedly) benevolent experts who work for the state.  The only exception must remain situations wherein some serious and immanent harm is truly threatened.  The history of mental treatment in particular is rife with abuse and irrational whim, often recognized only in retrospect.

At the dawn of the discipline of psychiatry, one of its founders (Benjamin Rush, a signer of the Declaration of Independence) believed that terror should be employed to cure mental illness frequently caused by masturbation.  If this seems strange, superstitious or far removed from our modern scientific culture, we should recognize that the bulk of physicians of his time were convinced by Rush’s theories, and his image still adorns the seal of the American Psychiatric Association to this day.

In the 1850’s American psychiatrists generally agreed that African American slaves ran away from their white masters because of a mental illness called drapetomania.  But over 100 years later, in the 1960’s, multiple studies by the National Institute of Mental Health still concluded that blacks had a 65% higher rate of schizophrenia than whites; and a 1974 advertisement for the antipsychotic medication Haldol in a leading professional journal showed an African American man with a clenched Black Power fist, whose symptoms of social belligerence obviously required chemical management.

In 1990, Time magazine declared Prozac a “breakthrough” drug for depression.  Less that a quarter century later, the fraudulent nature of the story told by Ely Lilly and psychiatry is well known, and pharmaceutical companies have backed away from research into new psychotropic medications as they pay billions in fines.   The Director of the National Institute of Mental Health has recently taken the public position that even the latest (“atypical”) antipsychotic drugs cause more long-term harm than good, and the disorders that they supposedly treat are invalid medical concepts anyway.

The Illinois Supreme Court stated a crystal clear precedent, alluding to such history and defining a public policy prerogative with regard to refusal or coercion of psychiatric treatment, in In re C.E. 161 Ill. 2d 200, at 214-215 (1994):

     "Two fundamental concerns have guided our conclusion that the prerogative to refuse unwanted psychotropic medication is a protected right of the mental health recipient. The first of these concerns arises from the substantially invasive nature of psychotropic substances and their significant side effects… Our second concern is the recognition that psychotropic substances may be misused by medical personnel, and subverted to the objectives of patient control rather than patient treatment."  (Internal citations omitted.)

The Unified Code of Corrections [730 ILCS 5/1-1-1 et seq.] does not modify the Defendant’s essential right to refuse psychotropic medication or the duty of DHS and Elgin to not make him take it. Section 5-2-4 [730 ILCS 5/5-2-4] merely specifies certain security procedures and safeguards required before defendants found not guilty by reason of insanity and in need of inpatient treatment may be released back into the community. A “requirement to be medicated” is not specified.

3.  This case presents no relevant issue of fact, and it does not concern the proprieties or standards of practice in psychiatry or any other professional field of medicine; the only issue is one of law alone, regarding the legally prescribed nature of a treatment plan for the Defendant, which DHS and Elgin have a ministerial duty to formulate under the Mental Health Code and the Unified Code of Corrections.

The Elgin treatment team recommends, and would apparently prefer for reasons of their own, that the Defendant take antipsychotic medication. However, they cannot convince him that this would be in his best interest. He refuses to follow their recommendation, and he gives every indication that he will continue to do so indefinitely.

Having taken no psychotropic medication for many years, Defendant yet has not been involved in any serious incidents to indicate that he might threaten harm to himself or anyone else during that entire time.  In fact he is consistently reported to be getting along well with everyone. Thus, DHS and Elgin have had no reason to consider asking a court for any involuntary medication order, and they have not done so.

While unable or unwilling to ask for a court order for involuntary medication, DHS and Elgin have yet stated or implied in the Defendant’s treatment plan that he must willingly take psychotropic medication as a necessary criterion for eligibility for conditional release.  This is equivalent to telling him he will never be released if he doesn’t take medication, because DHS and Elgin know very well that he never will take medication.  Thus, they are simply refusing to formulate a treatment plan reasonably calculated to enable his release, though that is precisely what the law requires of them.

There might be any number of behavioral criteria, to theoretically qualify the Defendant for conditional release.  Indeed, taking medication is itself only a behavioral criterion.  No one knows what the Defendant thinks, whether he secretly believes things that are delusional, whether he harbors grudges or whether he honestly understands his mental illness correctly.  They can only carefully observe how he behaves and what he tells them.  Nobody knows with certainty how (or whether) any drug works against a specific mental illness or whether it will make future violent acts by a specific person less likely, except through observing how the behavior of the person taking the drug changes or fails to change.  When someone refuses to take recommended medication, clinicians in the position of DHS and Elgin have a right to demand whatever behavioral demonstrations or proofs will convince them that releasing the person will be safe. Indeed, it is their job to do exactly that.  But making a person take drugs is a substitute or short cut for careful observation of behavior, at best. More importantly in this case, it is an illegal substitute. At worst, trying to make this Defendant take psychotropic medication at this time is pure coercion, totally at odds with the purpose of a plan for individual mental health services, as envisioned in the law. This is not reasonable calculation of possible future release for the Defendant, but only a continuing strategy to force him to take drugs.

We may suppose arguendo that without taking antipsychotic medication this Defendant can never prove by his behavior, to a reasonable degree of medical and psychiatric certainty, that he is qualified for conditional release.  But the behavioral criteria themselves can and must be formulated, because he will not take the medication, and the law still requires a reasonable plan.  If only drugs will really do the final trick, that will be born out by the obvious failure of an honest non-drug treatment plan.  (And perhaps that, alone, might convince the Defendant to willingly try taking psychotropic drugs.)  In any event, a “treatment plan” that merely acknowledges a permanent impasse is not the ministerial act that the law requires of DHS and Elgin.

4.  A court order is appropriate because DHS and Elgin are refusing to perform an official act required of them; this Court need not prescribe the manner in which they exercise such discretion as they properly have, in ordering them to perform the statutorily mandated ministerial act.

The Illinois Mental Health and Developmental Disabilities Code, 405 ILCS 5/, especially Sections 3-209, 2-102(a), 1-101.2(a), and 2-107, in combination with Section 5-2-4 of the Unified Code of Corrections, cannot be logically understood except to require DHS and Elgin to perform the ministerial act of the formulation and periodic review of a treatment plan for the Defendant, which considers his preference not to take psychotropic drugs, and which is also reasonably calculated to enable his release.

The law does not require any specific behavioral criteria for the Defendant’s release , nor does it detail procedures for evaluation of his progress, nor does it mention any time frame or goal .  DHS and Elgin retain discretion and all professional psychiatric or medical judgment in these matters.  Their refusal to formulate an appropriate treatment plan for this patient, or their refusal to consider his preference regarding treatment, or their refusal to reasonably calculate a way forward toward release for the Defendant (three alternative interpretations of what exactly is happening here) … are not matters over which they have any proper discretion.  As public officials they have a prescribed duty that they are paid by the taxpayers to fulfill, and this Honorable Court must compel them to do so.

5.  Conclusion.

DHS and Elgin are required by law to perform a purely ministerial act: to formulate and periodically review a written treatment plan for the Defendant that is reasonably calculated to result in sufficient improvement in his mental health to enable his release.  The required treatment plan must provide for Defendant’s care and services in the least restrictive environment, and must consider his own views concerning treatment.  Because the Defendant has long and often voiced his objections to taking psychotropic medication, as it is his right to do, and in the absence of any threat by the Defendant of immanent harm to anyone, the treatment plan may not include a necessary requirement that he take drugs.

There is no relevant issue of fact in this case.  The only issues are of law.  DHS and Elgin are arbitrarily refusing to perform a purely ministerial act legally required of them, and an order from this Court compelling them to perform that act is therefore appropriate and necessary.

Saturday, November 22, 2014

A brain disease

The website of Treatment Advocacy Center currently features a short article by Joseph Bowers. I just ordered Mr. Bowers' book, just published about a year ago, which I will read for the purpose of discovering all possible, honest qualification or amendment of the opinion I am about to write here...

The article asserts that serious mental illness is brain disease, without offering any reference to specific supporting evidence, and without acknowledging any dispute, but apparently just presuming that readers simply must agree, perhaps because of the moral authority of the writer (Mr. Bowers), or perhaps because of the background information in the writer's book or in the literature of mental health/illness/psychiatry, or perhaps for some other reason which I am not able to identify at all.

Mr. Bowers begins:

   "When I hear or read about the opinions of people opposed to psychiatry, antipsychotic medication or assisted outpatient treatment, I often think that we are talking about different things and different people.

    "Sometimes I think that those opposed don’t even acknowledge the existence of people like me. I suffer from a serious brain disease that has been diagnosed as schizophrenia."

He claims to believe that his own life condition, his personal existence and experience, necessarily contradict any possible disagreement with psychiatry, antipsychotic medication or assisted outpatient treatment (AKA, forced drugging). People who have such disagreements could not possibly be aware of him. If such people were aware or could consciously consider him, they surely would not disagree.

He's talking about me, because I (mostly, but not categorically) do disagree with psychiatry, antipsychotic medication and assisted outpatient treatment.

This is an entirely natural human view (or lack of view) in a sense, exemplified by expressions like, "If I were you..." and "Walk a mile in my shoes...". But here it's childish, almost as if T.A.C. is robotically repeating the old third-grader chant, "I-know-you-are-but-what-am-I?" to any offered reasoning by nominal opponents. I don't think Mr. Bowers even wrote those opening two paragraphs in good faith. If he authored a whole book, he's probably smart enough to know better. (But I'll wait to read the book before I confirm that, I suppose.)

I certainly do acknowledge the existence of people like Mr. Bowers, especially if by "like" he means "also diagnosed with schizophrenia". I work with a number of them, as well as their doctors, or keepers, and the institutions which society has specially designated to deal with such people whether they like it or not. I spend several days per week working with diagnosed psychotics, and I've been doing it for twelve years. But I don't think of my clients as people with serious brain diseases: I think of them as psychiatric slaves. 

Mr. Bowers wrote those two opening paragraphs to sound reasonable, that's all. But it's too over-obvious. I think it reveals him to be a propagandist and a liar. Come to think of it, "Joseph Bowers" is such a common name, it's a bit "John Smith"-ish. Maybe this is not a real person, and that's why the writer "protesteth too much" that his existence is unacknowledged -- he's disguising it himself! (But again, I should at least read the book....)

Anyway, the writer, whatever his real name may be, continues:

    "When I talk about treatment, I am speaking about people with serious mental illness (a psychiatric brain disease). I put schizophrenia, severe bipolar disorder, schizoaffective disorder and severe clinical depression into this group. Those of us in this group experience psychotic episodes that include hallucinations and delusions, severe emotional swings and sometimes a strong desire to end all of our suffering once and for all.

    "I often suspect that when speaking about mental illness, some people are actually referring to those with much more moderate, less life-threatening symptoms. These people may have a “psychiatric disability” rather than a brain disease.

    "They might benefit from counseling, behavioral therapy or maybe even light doses of medication. But their diseases are not nearly as debilitating or life threatening as those with serious mental illness."

The apparent attempt here is to designate a group identity, and then to appear to carefully qualify who is part of the group and who isn't. As a speaker for the group, Mr. Bowers establishes a moral status that is more difficult to argue with. The implication is, the only way anyone can legitimately disagree with psychiatry, antipsychotic medication or assisted outpatient treatment, is if they disagree with it for those outside Mr. Bowers' self-defined group.

One problem is that the qualifications for membership in the group are very hazy. Schizophrenia is definitional only in the sense that any epithet is. If you're ever "diagnosed" you cannot definitively disprove it with all the science and all the money on earth. "Severe" bipolar or clinical depression (as opposed to "moderate" or "moderately serious" let's say) is completely relative as far as I know. And the category of "schizoaffective disorder" just confuses everybody, including experienced clinicians. 

There is mounting cynicism about these "diagnoses" throughout the professional world of mental health. Even the U.S. National Institute of Mental Health has disavowed their medical validity. Almost no one flatly asserts anymore, that these are, properly in a medical science sense, "diseases".

Again, if Joseph Bower is competent enough to write a whole book that anyone buys (and I just did buy it), I can't help thinking he's aware of these things. There's something wrong with this short article on T.A.C.'s website. There's no way it's as innocent as it appears.

Possibly the most telling paragraphs follow:

    "There is growing evidence that diseases like mine are largely physical in nature and cause. They are not caused by poor parenting, stress or extremely traumatic life events. They cannot be overcome by will power and are not related to a person’s character or intelligence, but instead require a combination of pharmacological and social support.

    "It stands to reason that treatments appropriate for people like me with serious brain diseases are not as appropriate for those less serious mental illnesses."

First of all, no one argues that serious brain diseases are caused by poor parenting, or that they can be overcome by will power. These are straw men. The argument has to do with the fact that there is not sufficient evidence, and it is not growing, that schizophrenia, bipolar, schizoaffective disorder and depression "are largely physical in nature and cause."

But whether or not people should be held accountable for their behavior will never be a matter of evidence. That will forever be a social decision, a question of ethics and policy. What "treatment" is appropriate for what person's mental problem under what circumstances can never be properly adjudicated as a matter of medicine.

Mr. Bowers is stating a religious creed in this article, not a rational argument. And as far as I am concerned, T.A.C. is for all practical purposes a religious cult. They have to convince people to believe in schizophrenia as a biological brain disease, because they think that peculiar faith will save the mental health world. They have to lie about "evidence" and invent straw man arguments. I happen to believe more or less the opposite, that mental illness is best understood as the individual's chosen behavior. (But I sincerely hope I am more relaxed about my faith than T.A.C. is about theirs!)

The final paragraph in the Bowers article is ironic:

    "I think that much of the raging controversy surrounding treatment issues involving mental illness could be lessened if we could just agree on who and what we are talking about."

If he admits there's a raging controversy, how can he blithely presume with parentheses that we'll all acknowledge serious mental illness as "a psychiatric brain disease"? 

And "who and what we are talking about" is not ever going to be the definitional boundary of Mr. Bowers' group, no matter how cleverly T.A.C. changes the subject.

The issue is psychiatric slavery, Mr. Bowers. There are growing numbers of abolitionists out there, and Billy the Torch is coming to burn T.A.C.'s city.

Thursday, November 20, 2014

Baby killers and tears

A woman named Luanne killed her baby several years ago. She was found not guilty by reason of insanity and remanded to the custody of the Illinois Department of Human Services at Elgin Mental Health Center for "treatment". In fairly short order Luanne was "diagnosed" with bipolar disorder and told to take all the latest psychiatric drugs....

The only problem was, Luanne had begun to wonder whether those same drugs had been the cause of her insanity to begin with, whether her baby was in fact dead because she had suffered from an iatrogenic psychosis. After all, SSRI's have that black box warning now, that says their use may be associated with homicidal ideation and other darkly dangerous, crazy behavior. That sounded a little too coincidental to Luanne, so she started doing some research.

The research took awhile, because at Elgin they get pretty restrictive with library privileges. They can't easily afford to let "patients" access information that might be inconvenient to the institutional machinery of coercion. (It's a bit like some classic totalitarianism, perhaps the Soviet Union, where psychiatry was so avidly practiced.)

Eventually however, Luanne decided to wean herself off psychotropic medication. She tried to get her doctor to help, but he refused, so she did it herself, successfully. By the time she told the "treatment" team that she wasn't taking meds and would refuse to take them in the future, she had retained me as legal counsel to protect her rights.

It's not difficult to make sure a client isn't forced to continue taking psych drugs, that's a cut-and-dried strategy for me. On the other hand, getting them released (especially when they were charged with murder) is a much tougher row to hoe. That takes serious work by the client.

I usually try to explain it this way...

      "You killed somebody. The judge decided that you can be fixed instead of just punished, so you're not in prison, you're in this so-called hospital. The judge more or less trusts these clinicians, your treatment team and the administration here at Elgin, to know how you can best be fixed, and whether or not you have been fixed, and when it might be safe to let you return to society.

      "Now society really hates finding bodies that are not supposed to be dead but are, especially bodies of children. So the judge sort of stuck his neck out by not sending you to prison forever. He will need strong reassurance that it's right to let you out of Elgin Mental Health Center any time soon. He'll probably need all relevant opinions on that matter to be unanimous. Your psychiatrist is in a similar position, assuming he's well intended. Nobody wants to be wrong about whether another dead body might turn up because of you.

      "So you have to convince a fair number of people that you are mentally healthy, that you'll never hurt anyone, and that you totally understand what happened and why, with regard to the crime you were charged with. I expect this will be a rather long and difficult task, although I think you can do it and I'll try to help. It is entirely a task in communication, agreement and empathy."

This is what I told Luanne, a year or so ago. She's been working on it but, as anyone would perhaps be tempted to do, she occasionally wishes there were some kind of more convenient shortcut. I have worried that her theory about iatrogenic psychosis would distract her from what she really needs to accomplish.

Today I was trying to explain this for the umpteenth time. Luanne alternately tried to explain to me what it had been like to believe (insanely) that she needed to kill her baby, that somehow it was the right thing to do. She had gotten into this before in a handful of conversations. But for some reason, today she got into it much more deeply. I found myself listening to specific, grisly details: whether it's better to cut a baby's trachea or carotid artery, which hurts more or takes longer to result in unconsciousness, what a surprise the amount of blood was, what Luanne was thinking, how she counted to herself as she drew the knife across her poor baby's neck, how sad she was, how she suddenly wondered too late if it was a mistake....

I shut up and just steeled myself to listen. It took five or ten minutes. Luanne was in tears, sobbing. Then it occurred to me, I'm this woman's lawyer, not her therapist or confessor. (Maybe it was a selfish protest: Why do I have to subject myself to this horror?)

I said, "Can I ask you something, Luanne? In the year and a half that you've been here at Elgin, have you ever been able to tell anyone what you've just told me, in the last ten minutes?"

I was honestly heartbroken and surprised by her immediate response: "No! Because they don't let me, they don't want to listen, they just call me a murderer and insist that I take more drugs like the ones that caused this to happen in the first place."

On the way home, I cried in the car. How can it be so difficult to help a person? What are these people doing, what am I paying for with my taxes? I didn't even ask Luanne to talk about her crime, but she sure wanted to! How can it be possible, that no one at Elgin ever managed to get her through this, in a year and a half? Why do they choose to fight against her? Why can't anybody listen to her?

The only answer I can think of is, this is psychiatry. They declare mental diseases and enforce prescriptions. They just don't know anything about, or deal with, people.

Thursday, November 6, 2014

Help, Harm and Delusion

One suggestion I've always offered to people who wish to understand what state psychiatric institutions are really like is that the patients and the doctors have much more in common than any lay person would ever expect. It's an old joke of course, but in truth, they're almost indistinguishable from each other. I realize this seems unlikely as a serious proposition, and I can't completely explain it, but it is my own subjective experience.

The other day one of my clients, a man who attempted to kill his family some years ago (I'll call him Pedro) gave me new insight about this.  

It was election day, a holiday for all clinical and administrative personnel at Elgin Mental Health Center. Pedro mused that it was a very different atmosphere when the the only staff around were the security guys. He liked it, it was a simpler community, somehow more straightforward. He commented, "When the clinical and administrative staff are gone, you don't feel so much like you're being continuously watched and evaluated. It's subtle, but quite a relief!"

Our conversation eventually came around to a fascinating parallel: When Pedro attempted to kill his family, he recalls really believing that he was trying to help them avoid a terrible spiritual fate. He was deluded, perhaps consciously self-deluded. The result of his action clearly was violent harm.

When psychiatrists and other mental health clinicians coerce and drug their patients and keep them locked up, they believe they are trying to help them. They are deluded of course, perhaps self-deluded. The result of their actions is violent dehumanization and long-term social harm.

What do you know, maybe that's why these two nominally opposing classes, forensic psychiatrists and forensic mental patients, seem so much alike! They're both immersed in delusion obfuscating the difference between help and harm.

When a psychiatrist at Elgin tells a patient he must take anti-psychotic drugs because of his mental illness, and the judge will never release him if he's not medicated, that appears to me to simply be a lie, or (charitably) a mistake caused by incompetence.

Anti-psychotic drugs turn guys into diabetics and zombies, dramatically reducing their life expectancy, etc., for no long-term benefit. This is the conclusion of scientific medicine, it's acknowledged from the very top of the mental health food chain, i.e., by NIMH. The judge who decides on anyone's release from Elgin Mental Health Center defers to the "clinical experts" and doesn't care or much notice what diagnosis or treatment they consider appropriate, so then those experts can be blamed for any bad result, like recidivism or future violence.

When Pedro concludes that the thing he must do from loving concern is kill his family, because otherwise they will all surely be taken by the Devil, that likewise appears to me to simply be a lie, or (charitably) a mistake caused by incompetence.

Attacking human beings with a knife causes violent harm, the blood is visible. There is probably no evidence in the whole history of philosophy and theology that murdering a body will save the soul inhabiting it. The moral codes of every civilization without exception have prohibited this crime. No judge who decides on anyone's release from Elgin Mental Health Center ignores the common-sense implications of an act of violence, or entirely escapes suspicion of complicity, when they say a guilty criminal may be "treated" instead of punished.

The psych and the crazy guy are brothers in delusion. The judges are our own elected enablers. And all our jokes about it are dark indeed, because help and harm cannot be the same no matter what the people in state nuthouses say.

Wednesday, October 29, 2014

Psychiatry and the ultimate security threat

Four years ago, I wrote that,"The ultimate security threat is a catastrophic failure of confidence in authority." Now and then my own warning comes back to haunt me.

Today's Chicago Tribune contains an editorial under the headline, "Vaccine ignorance: Deadly and contagious" by Laurie Garrett and Maxine Builder. The authors point out how public misinformation can cause paranoia and derail rational programs when conspiracy theories go viral and the public proves unable to weigh facts accurately.

Think of psychiatry's long and well-financed misinformation about "chemical imbalances in the brain" needing medical cures, for diagnoses of mental illness.

Today's Wall Street Journal featured another opinion piece, "The Last Anti-Fat Crusaders" by Nina Teichols. It turns out that 35 years of official American nutrition advice favoring low-fat diets was simply bad. The balance of science shows that what almost all the authorities were telling us to do has been more likely to make us obese and diabetic.

Think of psychiatry's "treatments" with drugs causing more long-term disability, dramatically reduced life expectancy, suicide and random violence.

When authority has proven untrustworthy and the world seems out of control, individuals, families and small groups of people look for their own solutions and fend for themselves. Surprising movements rise as if from nowhere, wielding utterly unpredicted power. Safe and comfortable centers no longer hold; anarchy is loosed; a blood-dimmed tide flows.

I believe, as did Thomas Szasz, that psychiatry has had the single most destructive influence on human culture since the Middle Ages. It's basic tenets are falsehoods. A human being absolutely is not merely a brain, and his/her thoughts, emotions, beliefs, dreams and goals are not reducible to neurotransmitters and receptors, or circuitry.

Yet psychiatric misinformation has derailed time-tested religious authority, substituting clinicians for spiritual leaders, biochemistry for ethics and genetics for philosophy. It has steadily reduced centuries of jurisprudence in criminal responsibility to cheap evaluations of DSM criteria. It has even wasted the prestige, utility and honor of medical practitioners and scientists, so the public now sees them as little more than another untouchable class of dubious experts with an agenda for profit and power.

There is no more deadly and contagious ignorance than public belief that psychiatry helps people. The last crusaders for medicalization of all human travail, for coercion of all humanity into psychiatric slavery, are way overdue for their reconciliation with reality.

That, or the rough beast comes slouching.

Tuesday, October 21, 2014

Sherman is coming and he will burn your city!

Allen Frances is pushing his latest article in Psychology Today all over Twitter now. He calls for an end to civil war among the various advocates for the mentally ill. Very reasonable, very appealing...

I give Dr. Frances some credit for his admissions over the past few years, that psychiatric "diagnosis" as exemplified in APA's DSM is highly problematic at best; and that the medical profession has overprescribed psychiatric drugs almost to the point of criminality. When the chairman of the DSM-IV task force concedes these things, people have to listen, and it has a positive effect.

But Frances is wrong on one central point. He's actually so wrong that his broad appeal and visibility in the mental health world may do more harm than good. Coercion is the only public policy issue in mental health.

Allen Frances says coercion is a "paper tiger" because most of the Twentieth Century snake pit state institutions closed, and half a million mental patients were released for treatment in the community. This is akin to arguing in 1850, that since the African slave trade had been legally prohibited, abolitionists would only shed blood needlessly for a cause already won.

Frances says mental patients have a harder time getting into a hospital than getting out. This is akin to assurances in 1850, that Negroes were much better off under the Southern system of servitude, that they did not want and could never thrive in freedom.

I have worked directly with such "patients" as those with whom Dr. Frances presumes to sympathize, for thirteen years. They are not happy in their slavery.

If psychiatric "treatment" is generally valuable to those who receive it, if the "severely mentally ill" really want to be "treated", then laws which force people into "hospitals" and laws which allow "doctors" to force needles and inject hated, debilitating drugs into the bodies of desperately resisting human beings should be completely unnecessary.

The fact that Allen Frances believes such torture is justified makes his whole argument a dark joke. If he wants to help the mentally ill and society, let him renounce involuntary psychiatry. Let him push publicly for repeal of commitment laws and the insanity defense. Let him become an honest abolitionist or continue to protect his investment in psychiatric slavery, but there is no middle ground.

Dr. Frances, do not cheapen the name or the memory of Thomas Szasz! Let civil war among the various self-proclaimed advocates for the mentally ill continue, as Abraham Lincoln said, "...until every drop of blood drawn with the lash is repaid by another drawn with the sword."

Wednesday, July 16, 2014

The final propaganda push

American hyper-medical psychiatry is approaching a climactic moment in its desperate struggle for survival. I believe it will fail, and the world will soon change for the better.

We are hearing some high-pitched propaganda these days. One line is typified by cries for more coercion of "treatment" because, it is said, people only refuse psychiatric drugs when their mental illness prevents them from realizing that it's what's best for them. Perhaps the most succinct expression of this comes from Rep. Tim Murphy and his gurus at the Treatment Advocacy Center (T.A.C.).

Another line is heard from the likes of Cook County (Illinois) Sheriff Tom Dart. The real problem according to these guys is, there are a number of violent people who should be treated by doctors rather than restrained/punished/warehoused by the law, and we've made the error of closing down too many treatment facilities, so now our jails and prisons don't work correctly, and that's dangerous.

The public is supposed to put these two points together and conclude: We really need to force more people to be treated by psychiatrists, and we need to spend much more public money to enable psychiatrists to treat them. Otherwise we are cruel, unscientific and deserving of all manner of terrible consequences.

Propaganda is distinct from other forms of advocacy because it intends to change people's minds through deception and confusion rather than persuasion and understanding. Over the past century, propagandists have had to become more and more skilled to achieve the same level of results because human society has learned from being duped and become more cynical about communications from established interests.

We tend to have great faith in anything perceived as medical or scientific. Doctors eliminated smallpox and physicists built the atom bomb after all, so we're impressed. Then again, there was that guy named Mengele, and the uncertainty principle is a little embarrassing. We are suspicious these days, even of the demigods in our expert classes.

The actual scene of coerced "treatment" includes the unfortunate reality that in a non-totalitarian society it's almost impossible to keep people on drugs which they hate, and which disable them for no long-term benefit whatsoever. Forced psych drugging may be a perfectly legitimate emergency measure in some circumstances of immanent threatened violence. Then again, a policeman's baton and handcuffs work just as well for less money. It's also a pitiful degradation of real medicine and the great humanitarian Hippocratic tradition (not to mention our most fundamental human rights principles) to even call chemical restraint (iatrogenic disabling) "treatment".

The T.A.C./Murphy position in favor of "Assisted Outpatient Treatment" (a despicable euphemism) laws pretends that if we just get mental patients on drugs, they'll recover and realize how much it helps them. The anosognosia will go away. This hearkens back with such shrillness to historical episodes of political psychiatric repression, as in the Soviet Union, that the term anosognosia is rarely even offered to the mass media -- it's usually reserved for websites which are frequented more by zealots. Tim Murphy actually did try to lecture about anosognosia in a Congressional hearing once, but he came across as mean and ridiculous, and got slammed by recovery advocates on the web and social media.

The other propaganda line, the Tom Dart pitch, seems inconsistent. T.A.C./Murphy insist we need to force more people onto drugs, and the traditional institutions where you force people to do things are prisons and jails. It's a quintessential function of the law, not of health care, to coerce people.

Maybe the real bottom line is, we don't even remember the difference between criminal punishment and medicine anymore, it has all become a giant confusion. The expert classes simply demand that we cough up more money, to be spent for whatever they think is best. The state is our only hope and paying for it is our only duty. That's what they tell us.

I think we should stop paying them and stop giving them coercive authority. Meanwhile, we should learn to quickly recognize the two lines of this big push. Whenever somebody implies that more people need to be forced onto psych drugs and/or that more taxes must go to pay for "treatment", they are working for the same establishment experts who brought us more disability from mental illness and more random, unexplained violence.

Future generations will laugh about how anyone was ever expected to believe this propaganda.

Sunday, June 29, 2014

Marva says I'm a bully!

I have a client at Elgin Mental Health Center who drives me nuts. I like that, because it means the person is smart enough to get under my skin a little.

One of the staff on this client's "treatment" team is a nurse or security person (I don't even recall her exact title or role and it doesn't seem to matter) and a union boss (which probably does matter a lot). Her name is Marva. Perhaps that's a nickname for Marvelous, but I don't know.

My client gets under Marva's skin, too. And even though I really don't know Marva, haven't worked with her in the decade-plus that I've been advocating for people at EMHC, only met her once as far as I can recall (and in that instance I was actually impressed -- she seemed marvelous enough to me), it seems that somehow I must be getting under Marva's skin now, too.

Anyway, my client says Marva calls me a bully. Fascinating! Marva is the one who can  have people forcibly held down to be shot up with psych drugs on her whim (and has done so recently in fact)!

All I can do is talk and write. If my words carry any intimidating force, whether they are spoken to a judge in court, to a passerby on a sidewalk, to a public official in a letter, or in this blog; whether they are polite, or clever, or obnoxious, it's only because someone might agree with them.

I have no idea how I can "bully" anyone, unless they are afraid of me because I might find out something they are trying to hide. But anybody like that is "bullying" him or her self really, by his or her own guilty conscience.

I recently suggested that Marva may have been the one who attempted that stupid, anonymous "complaint" about me to the ARDC. She seemed like a long shot as a suspect, at the time. But so far, I've had no denials from anybody I named, so I can't rule any of them out.

I've gone back and forth. I thought Dan Hardy, Medical Director at Elgin, was the best suspect for awhile, because he is trained as a lawyer but hasn't practiced law for a very long time. He'd know the legal term, "defamation per se" but he might fail to realize that the ARDC never takes anonymous complaints about lawyers defaming psychs (the thought of that is just hilarious, really).

I also figured Dr. Malis or Dr. Hussain (two unit psychs at Elgin) might have pulled this goofy prank. But I've seen all three of these guys (Malis, Hussain and Hardy) since I wrote that last blog, and although none of them took any trouble to deny... they just didn't come across to me as very suspicious.

When people are afraid you'll find something out about them, they start being critical of you. It's an instinctive thing, they just can't help it.

So there's Marva, telling my client I'm a bully. Marvelous Marva!

Thursday, June 5, 2014

Abused by a COWARDLY psychiatrist

This afternoon I received a letter dated June 3, from the Illinois Supreme Court's Attorney Registration and Disciplinary Commission (ARDC), informing me that on May 30 they had received an anonymous complaint regarding my conduct. The ARDC enclosed a copy of the complaint and stated, "We have reviewed the communication and have determined that further action by this Commission is unwarranted."

First of all let me just say, HAHAHAHAHAHAHA!!!

But perhaps I should elaborate.

This anonymous "complaint" was (supposedly) from a co-worker of Alicia S. Martin, M.D., the Elgin Mental Health Center psychiatrist whom I excoriated as an abuser, in my blog article of February 3, 2014. I accused Dr. Martin of abusing her patients, her employers and many other people for money, or for status, or possibly for other motives, none honorable.

Just to make sure I'm not misunderstood, I hereby reiterate, for the record, those precise accusations.

The next issue might be, who filed this anonymous "complaint" with the ARDC? What were his/her motives for doing so, and what did he/she expect to accomplish?

There are several people at Elgin Mental Health Center, I'm fairly sure, who don't like me. On one hand, I was once called a valuable member of a clinical treatment team, by a psychiatrist! On the other hand, my natural instinct is honestly to defeat treatment teams rather than to collaborate with them. I resist this instinct when a team is willing to follow the law, and I have considerable respect for many clinicians at Elgin. Almost all are well-intentioned, and many are capable of clever effects in helping. But they do not habitually follow the law, they cheat.

They cheat because they have to. It's impossible to do what the law, and the taxpayers, expect: routinely improve the behavior of bad guys with medicine. So the "forensic mental health" enterprise becomes (as I said in the offending blog about Dr. Martin) a racket.

Right now I am defending another forced drugging petition. The psychiatrist who filed that petition might be one of the best suspects for having authored this recent ARDC "complaint". His name is Dr. Richard W. Malis, M.D. So far, I have nothing quite so bad to say about Dr. Malis, as what I said before about Dr. Martin. However, he and I apparently do not get along. We'll just see.... If he tells me he did not write the anonymous "complaint", I will believe him, and I'll apologize for the accusation here. If he did write the complaint, I'll simply laugh at him, because it was a stupid waste of his time. But I don't think he's very stupid, so maybe he didn't write it.

Other possible anonymous complainants might include the psychiatrist Dr. Syed Hussain, M.D., one particular social worker on the White Cottage Unit named Mario, and another staff on White named Marva. There's also a psychiatrist on L Unit (name escapes me at the moment) who may feel that I've recently been too critical or insulting toward her. I would encourage any or all of these guys to let me know if the complaint was not filed/written by them. I will believe them, and apologize. But if they don't deny, I will probably continue to mention them, by name, as suspected idiots (for wasting their taxpayer-financed time) and cowards (for being afraid to put their name on the complaint).

The ARDC complaint ends with the statement, "This complaint is being filed Anonymously..." (the capitalization strikes me as a bit weird, by the way) " Mr. Kretchmar engages in intimidating behaviors towards the staff at Elgin Mental Health Center." Needless to say, this is my favorite part!

If writing and publishing this, new article is intimidation, well... expect much more of the same, and worse!

However, I'll also keep in mind the possibility, however remote, that somebody was honestly offended by my accusations against Dr. Martin, and that I am seen as a real threat to something that is thought to be good and that needs defense. I would actually love to believe that's the case. If this ARDC complaint was made by a good, well-intended person, I am no threat to that person, and I would consider it a most valuable opportunity if I could somehow engage in a discussion with them.

Friday, May 9, 2014

APA Annual Conference 2014: The Future of Psychiatry

At 3:30 pm on Tuesday, May 6th, APA President Jeffrey Lieberman opened his talk on "The Future of Psychiatry" by asking how many people in his audience were not psychiatrists. Along with only two others, I raised my hand.

Lieberman then asked each of us what we were doing there. I said that I was a lawyer working with psychiatrists. He queried, "What side are you on?" I shrugged from the back of the room and smiled, and after a moment he asked, "Are you on the side of truth?" I answered, "Absolutely! And justice, and the American way."

He then suggested that someone in the crowd should probably take my picture, just in case....

Lieberman is a politician and a PR man, but his viewpoint is a little incoherent, and he just never quite wins.

After a brief, fairly competent lesson on the history of psychiatry (he omitted a few chapters, of course, like the key role psychs played in the holocaust and the highly embarrassing "satanic abuse/multiple personality disorder" craze in the 1990's), the President of the APA offered his key predictions for the future:

     1. Psychiatrists will work more and more for large organizations. They will not be hands-on, direct care clinicians as much as they are now. This is due to simple economics, i.e., no one wants to pay psychiatrists for direct care, because they're not worth what they charge. But ideally in the future they can become the elite advisors or "captains" of treatment teams, mostly removed from human patients.

     2. Breakthrough technologies from scientific research into the brain, and the position of psychiatrists as first implementers of these new technologies, will be the single source of value and power to command public resources for the profession, going forward. Modern culture has not caught up with the overriding significance of the brain, but when it does psychiatrists will be able to assert their role as the real experts on all of life.

Whether these prognostications seem glorious or darkly threatening, there is a major countervailing factor. BRAIN was one of two key words in Lieberman's dissertation. The other word was STIGMA.

Stigma is purportedly the basic reason why psychiatrists don't have the power they should, and why they can't get paid enough. People don't like to talk about mental illness or admit having it, and they don't want their friends to know if they're seeing a psychiatrist.

Ironically, psychiatrists themselves may stigmatize psychiatry as much as the lay public does. An interesting poster in the exhibition hall described a recent research study in Belgium which concluded, "It could be useful to explicitly start with anti-stigma campaigns during medical training in order to avoid a continuing decrease in the number of candidate psychiatrists." One of the authors of the study told me that as little as ten years ago, there were on average seventy candidate psychiatrists per year in Belgium; now there are only ten or fifteen. She said the trends are the same throughout Europe. It's just too socially embarrassing to be a psychiatrist.

So, on one hand Jeffrey Lieberman sees great and increasing power for the psychiatric elite as captains of a medical-industrial complex ruled by those who know the secrets of the brain. But on the other hand, he and the APA are now hiring crack PR firms to fight stigma, because after decades of public campaigning nothing has worked, and psychiatrists around the world can't even admit their profession to ordinary people in social circumstances.

With his forlorn hope that scientific miracles and arbitrary assertion of authority can save the psychs from the black stigma magic in the nick of time, there is an obvious schism between Jeffrey Lieberman and reality. Funny how that reminds one of a once-postulated "disease", schizophrenia.

There is no unity of view, or authority, in psychiatry. It's a profession falling apart.

As I left the hall after the President of the APA had given his speech on the future of psychiatry, I was approached by a doctor who asked me where I practice law. I told him Chicago, and he responded that he had family there, including six siblings who were all lawyers. He said that despite what Lieberman had implied earlier, as far as he was concerned I was welcome at the APA.

Thursday, March 13, 2014

Allen Frances & Samuel Sewell (an Update)

Several years ago, I read one or two articles by Allen Frances and suggested that he might be a constructive force for reforming the cruel, corrupt and inhuman field of "mental health". Little did I know at the time I wrote that blog article that he would soon be considered a leading critic of American-style, "label-'em-&-drug-'em" psychiatry.

Dr. Frances recently published a curious little book: Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (NY: The Guilford Press, 2013). I just got a copy from Amazon of the revised edition (published only four months after the original -- no idea why such a quick revision was necessary & I am curious about that).

On one hand, the book is replete with cautionary statements about various DSM-5 "diagnoses", and Frances does consistently suggest that labeling people with psychiatric disorders is a dicey business.

But on the other hand this is a clear, opportunistic attempt by the erstwhile most-powerful-psychiatrist-in-America to maintain some vestige of his remunerative franchise as a famous diagnostician despite replacement of his very own DSM-IV last May.

I initially found it disappointing and ironic that Dr. Frances is now making money by ostentatiously piggy-backing on the sale of the APA's new DSM-5.  His book even looks exactly like the DSM (albeit smaller), with the same typefaces and formatting.  With the exception of a 16-page introductory chapter, it follows the DSM outline chapter-by-chapter and diagnostic-code-by-diagnostic-code. It is, effectively, a DSM-5 supplement. Minor omissions of individual diagnoses and an altered sequence of disorders are insignificant changes. If I were the APA, I might consider some sort of intellectual property claim...

Under a very thin guise of criticism, it sure seems that Allen Frances is actually supporting the psych status quo. He just wants to continue making money from it like he used to when DSM-IV was king of the hill. Frances has never repudiated the central idea, that unwanted human emotion and bad behavior must be essentially brain disease, treatable according to the medical model. He merely hopes psychs will be more conservative in asserting their philosophy and a bit more careful about damaging people, so the profession can avoid calamitous bad PR.

But there is another interpretation and a more optimistic view. We probably don't need dramatic, road-to-Damascus conversions, or even Judge Sewell apologies, to end specific psychiatric evils in the world and bring a new, freer day of human dignity. Little by little, the culture is changing. It might get much better pretty soon, and in future decades history might credit Allen Frances for some sort of personal mea culpa leading to positive changes, even if he himself never intended any such thing.

The real changes will never come from correcting such middling problems as Frances sees with DSM-5. They will come from total elimination of the one thing which Frances never addresses directly, although his arguments all hint around about it and point toward it: legal coercion of "treatment".

In fact, psychiatric "diagnosis" is not done for any purpose of finding useful treatment, it's done to justify "treatment" which is useful mainly to people other than the patient. The patient arrives, directly or indirectly, because the police bring him in.

And for the moment at least, Dr. Frances is still in the business.

Monday, February 3, 2014

Abused by a psychiatrist

Dr. Alicia S. Martin, M.D., was a staff psychiatrist at Elgin Mental Health Center in Illinois for some years. She just retired last week.

I define psychiatric abuse as physical, emotional, social or financial injury, harm, damages, fraud or deception, perpetrated in the name of or under cover of mental healing.

Dr. Martin abused her patients, her employers (Illinois taxpayers, including me) and many other people. I would guess that she did it for money, to satisfy her appetite for personal status, and to cover up the fact that she had no idea how to do the job she was supposed to do, among other possible motives.

It is freely and officially acknowledged by mental health professionals generally, and by those employed in institutions run by the Illinois Department of Human Services, that treatment of the mentally ill should occur according to collaborative plans which consider a patient's views. The State's Mental Health Code actually requires this model (see 405 ILCS 5/2-102) for involuntary patients.

Part of the reason is that we all want to believe we can refrain from brute force, because we're so modern and scientific and compassionate. I'm cynical about it from the long view, but I'm usually willing to give some benefit of doubt to individuals.

Another part of the reason is that coerced or forced "treatment" almost always does more harm than good, so well-intended people try pretty hard to stay away from it.

But things have not gone well over the last century or so in forensic psychiatry. Society started to expect miracle cures from medicine, and psychiatry started to insist it was a medical specialty. So by the middle of the Twentieth Century, psychiatrists were on the hook to save American communities from all bad behavior, especially violence. Beginning in the 1960's, they sought to fulfill this new duty by fine-tuning the brain chemistry of people who committed violent crimes or otherwise behaved badly enough to land in the criminal justice system.

The whole concept was a categorical, miserable failure, ultimately acknowledged as such from the very top of the "scientific research" food chain.

But today we're stuck with a court system and a huge, bureaucratic, alternative custody establishment, which once had high hopes that psychiatry would make bad people good, and which remains more or less unaware that it was all nonsense from the get-go. Elgin Mental Health Center is a clear demonstration. They talk about collaborative treatment models even as they routinely and constantly coerce their "patients" (slaves) to take dehumanizing, harmful neuroleptic drugs.

Once in awhile some not-guilty-by-reason-of-insanity ("NGRI") murder acquittee says he/she doesn't want to take the drugs anymore, doesn't believe the drugs help, doesn't agree with the whole psychiatric view of things. The system can't really tolerate such dissent.

What happens then is this... The patient's psychiatrist files a petition for involuntary administration of psychotropic medication under Section 2-107.1. It's not entirely inconceivable that such a petition could be filed in good faith; however, most of the time everyone involved knows perfectly well that while the court is theoretically being asked for an order giving clinicians complete discretion to torture a human being, the real intention is merely to convince a particular recalcitrant patient and any others who might take an example to "consent voluntarily" to take their psychiatric drugs.

Dr. Alicia S. Martin filed such a petition in October, against a client of mine. This patient had actually stopped taking his medication unbeknownst to her sometime earlier, and he was feeling much better for that. He told me that without the drugs, he could suddenly think clearly and even read. He didn't feel like a zombie anymore, and he liked that. He wasn't causing any trouble on the clinical unit at Elgin, not fighting or threatening anyone.

The petition recited lots of "history" and many opinions and conclusions, but few if any actual facts. Our motion to dismiss was denied, but the court granted requests for formal civil discovery including leave to take Dr. Martin's sworn deposition.

Confronted with a deposition, Dr. Martin retired and the petition was withdrawn. Oops....

This was ABUSE.

It was attempted extortion of the patient, who was only exercising his right to make his own medical decision by informed consent. There was absolutely no deterioration, suffering or threatening behavior which could have justified involuntary administration of psychotropic medication under the law. The petitioner knew that very well. She proved it by running away from a deposition!

At best, if any genuine mental "treatment" of this patient had in fact been possible, it was delayed for those three months when he was being threatened with court sanctioned torture at the hands of the people who were supposed to help him.

This particular petition was only one nefarious act within the larger racket. The machine cannot run efficiently and legally at the same time, because the statutory and constitutional requirements of "least restrictive environment" and consideration for informed consent cannot be satisfied without revealing the utter falsehood... that mental illness is known brain disease, and psychiatrists know how to treat it with drugs. Section 2-107.1 petitions are simply the preferred tactic to evade those requirements.

Alicia Martin defrauded the taxpayers of Illinois for years by collecting her state salary under the false pretense that she could do the job they were willing to pay her for. She continues to defraud them if she collects any pension in her retirement.

To cover up the lie and the fraud, Dr. Martin's patients were coerced and occasionally brutally forced, to take drugs which harmed them and caused permanent disability (diabetes, tardive dyskenesia) and/or early death. They were also carefully taught to lie, to back up the rotten system by pretending they had been helped, after they were released into the community. 

The implications are even darker over the years. More and more disabled dependents nurse bitter grudges and wait to take their vengeance against the world if they can ever covertly engineer sufficient recovery to work, and plan, and perhaps buy a gun....

Dr. Martin's "patients" were never cured or effectively treated. They were ABUSED.

So was I. And so were YOU!