Saturday, May 21, 2016

Psychiatric "diagnosis"

It has been almost five years since Allen Frances started criticizing the DSM, several years since Ron Pies admitted that no psychiatrist who knows anything should ever talk about "chemical imbalances in the brain", and almost exactly three years since Thomas Insel disavowed the whole system of mental health "diagnosis" as lacking scientific validity.

This week another stellar authority came out as -- exaggerating just a bit, I suppose -- an effective antipsychiatrist.  Stephen M. Stahl made a presentation at the APA's annual conference in Atlanta, in which he stated categorically, "Our psychiatric diagnoses are not diseases." He also informed his audience, "There is no known gene for any major psychiatric disorder, nor is one ever likely to be found. Genes do not code for psychiatric disorders. Genes do not code for psychiatric symptoms."

Dr. Stahl is, of course, the author of Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. In its third or fourth edition by now, the book is absolutely the authoritative text on why it makes sense to "treat" human problems in thinking, feeling and behavior with medicine. We may wonder whether when he points out that there are actually no diseases being "treated", Stahl triggers all kinds of cognitive dissonance and problematic consequences for most of the people who buy his book.

I recently cross examined a psychologist who works for the Criminal Division of the Circuit Court of Cook County, Illinois, who insisted under oath that mental illnesses are in fact brain diseases. State-employed clinicians routinely tell my clients that they need more "insight into their illnesses" (by which is meant, the patient must accept and profess true faith in the "diagnosis" of "schizophrenia"/"bipolar"/whatever, as a lifelong genetically-caused brain disease that he or she "has"), or else they will never be eligible for release from Elgin Mental Health Center.

It is very difficult to understand how state psychiatrists get away with lying and misrepresenting their own field and their own activities as a matter of course, to the extent that they do. It seems to me they will have to start talking about things differently, especially when under oath. There is no rational scientific or ethical excuse for deceiving the public into a false belief that state psychiatric "hospitals" successfully medicate anyone to be better behaved or less dangerous. They restrain people and disable them, but they don't help.

On the other hand, I had an amazing conversation with a state psychiatrist about "diagnosis" just the other day, prompted by my discussion of Stahl's presentation in Atlanta. According to this doctor, who is not originally from a Western culture, there are only two or three valid psychiatric "diagnoses". The first is "disconnected from reality". The second is "too connected to reality". A possible third might be something like, "eccentric manufactured reality", as with a person who is hallucinating on street drugs, or perhaps a truly strange or antisocial personality.

The category of "too connected to reality" is brilliant, and it probably needed a non-Western mind to describe. In Anglo-American culture, we figure "reality" is our benevolent anchor, which we can reasonably hope to shape according to our own purposes. In India however, "reality" is draconian, crushing, absolutely merciless. Of course, depression, anxiety, etc., are a matter of being too connected! One has to separate somewhat from oppressive circumstances to find peace.

My friend also specified -- and by the way, I almost find myself looking over my shoulder, wondering who might have me in a pillory for calling a psychiatrist my friend! -- a critical principle: no matter what diagnosis is assigned to a patient, it becomes appropriate or necessary to treat somebody if and only if they are socially or occupationally disabled by their mental illness. That means that when they get along well enough in their own community with other people, just leave them alone. It doesn't matter how bad their "mental illness" might seem to some professional.

This view is that psychiatrists actually treat conditions existing in the relationships between people and society, not illnesses confined to individual bodies (or brains). That seems honest enough to me.

I just think, still... they do a terrible job and ought to be fired.

Sunday, May 8, 2016

It has to be on purpose

Last week on Thursday, May 5, 2016, at about 10:30 AM, a patient at Elgin Mental Health Center was told by staff that the best way to get permission to have an MP-3 player would be to go to court and sue the state for that privilege. Supposedly, "No MP-3 players allowed" is policy.

But... the same patient has had an MP-3 player before at Elgin Mental Health Center. That was on a different clinical unit, so maybe the "policy" isn't facility-wide. Maybe it's just "policy" for the unit this patient is on now. Or maybe it's a new "policy". Of course, any policy that is real is written. People often say ""It's policy," when the truth is, it's arbitrary retribution or the decision of one person about one other person or one situation in one moment.

Of course, written policy, officially adopted pursuant to administrative codes and statutes by a state agency, if it were unjust or unnecessarily in violation of rights, would call for litigation. One goes to court to deal with such official conflicts. But civil litigation is expensive, and almost any predictable conflict can be resolved by cheaper means. When it comes to states, here are many developed avenues for conflict resolution. This is because states don't want to spend taxpayer money unnecessarily.

A recent Federal Appeals Court decision highlights this situation in Illinois. In Hughes v. Scott, 2016 U.S. App. LEXIS 5349, Richard Posner wrote the opinion overturning a lower court's dismissal of the plaintiff's claim that his First Amendment right to petition the government for redress of grievances had been violated by staff at an Illinois forensic psychiatric institution.

The defendant had argued, and the lower court had agreed, that Hughes' due process rights had not been abridged, because he was able to sue. It was substantially the same argument as that of the Elgin staff member on Thursday: if you want an MP-3 player on this clinical unit, go ahead and sue us for it!

Never mind that the only reason a state mental health employee ever says that is, it's a very easy presumption that the patient will not sue. Forensic psychiatric patients just about never have the resources to hire attorneys for every little complaint. Nobody wants to know or mess with what happens on a daily basis inside state mental hospitals, either. So, "Sue me," really, is kind of like just the common, "F___ you!"

Well, in the one case, Hughes did sue. In his opinion overturning the lower court's dismissal of that suit, Judge Posner wrote,

"(P)erhaps the most remarkable feature of this case is the defendants' insistence in defiance of the Illinois Administrative Code that Hughes has no need to invoke grievance procedures because he can always sue, as he has done. What makes this contention remarkable is the
fact that the interests of Rushville (the state institution), of the Illinois Department of Human Services, and of the taxpayers of this almost bankrupt state, obviously are best served if grievances are handled at the facility level rather than by the court system, which is far more costly. Does Rushville have an unlimited budget, so that it can pay lawyers to defend against lawsuits brought only because the institution refuses to obey the Administrative Code and respond to Hughes' grievances, preferring instead to ridicule him and drive him to sue Rushville staff?

"We don't get it. But we have said enough to require that the judgment of dismissal be vacated and the case returned to the district court to try to make sense of the conduct of the defendants and their institution, and to determine whether they are in fact improperly impeding the plaintiff's constitutional right to petition government for redress of grievances."

So, what do you know? The staff member who told a patient last week to sue for an MP-3 player was glibly, arrogantly, refusing to respond a grievance. Clearly the interests of Elgin Mental Health Center, the Illinois Department of Human Services, and the taxpayers of this almost bankrupt state, are remarkably contrary to what this staff member did, exactly as in the Hughes v. Scott case.

Perhaps we will see whether this was a violation of the patient's constitutional rights.