The Therapeutic/Protective Service State: Guerrilla Actions

Individuals who refuse psychiatry when their betters think they should accept it are quite likely to suffer wrathful coercion from what Tom Szasz calls the Therapeutic State.

Families and groups who are cynical about the proclaimed beneficence of the Protective Services State (e.g., "Child Protective Services" or "Department of Children and Family Services") may also be regarded essentially as though they are mentally ill. They will be presumed to not know what is best for their own children, and they will be asked to prove negatives which are impossible ("How can we know for sure that this won't happen again?").

Children misbehave, sometimes badly. Parents are not supposed to punish them anymore, they're supposed to turn them over to experts outside the family who are employed by the state. It's very similar to (and sometimes it directly and explicitly involves) forensic psychiatry.

So if your 13-year-old child rebels against a type-1 diabetes diagnosis, runs away from home, gets pregnant and learns how to selectively manipulate you and the CPS bureaucrats back and forth against each other depending on whom she wants to defy on any given day, well guess what? You're quickly going to feel very much like somebody who is involuntarily committed in a state nuthouse.

The key to understanding the similarity is the concept of institutional machines meant to do things that individual people shouldn't have to do or don't want to do. Forensic psychiatry and child protective services are attempts at dependable, impartial, no-fault, objective processes to relieve real people from having to pay attention. The experts running the machines supposedly know how people -- as cogs in other machines -- ought to work. It's all nonsense, of course. The real world results are consistently and embarrassingly terrible. And anyone who knows himself or herself to be more than just a cog in somebody else's machine instinctively hates both forensic psychiatry and child protective services, or at least they do when these institutions are aimed "incorrectly" (at them).

But by the time people find out that forensic psychiatry and child protective services alike are all about state tyranny, not about state therapy or state protection or helping anyone, well, it's too late, you "can't fight city hall." You have to collaborate (which means surrender) or the machine crushes you, and everyone -- even your family -- will say it's your fault!

Back in 1964 a young man named Mario Savio gave a beautiful speech in Berkeley, about making the machine stop. It was a clarion call for civil disobedience and guerrilla actions.

Now, a half-century after the Berkeley Free Speech Movement, we confront forensic psychiatry and child protective services, and we lose over and over again. How can we put our bodies upon the gears and upon the wheels and upon the levers, and upon all the apparatus, and make it stop?

The following three tactics or principles are suggested, as the most basic guerrilla strategy.

Tactic/principle #1. Don't participate, even tacitly. Don't acknowledge that anyone is trying to help you, if it doesn't feel like help to you. Don't let anyone say you agreed to something, if you don't think you actually did agree, freely. Never let anyone call something your duty or your job, if you never actually accepted it as such, yourself.

If your psychiatrist can't confirm that you have a "chemical imbalance" by way a blood test or a brain scan (which of course, they cannot do), don't accept his explanation about why the meds are therapeutic. If they get a court order for involuntary medication, make them hold you down to inject the drug into your body, never let them pretend it's not forced.

Never acknowledge the social worker's expertise or the guardian ad litem's authority over your child. Never fail to challenge their motives, which are egocentric, elitist, ignorant and mercenary. Never believe these people are acting in anyone's best interests but their own.

Just don't ever cave or agree, at least not in your heart. The little tyrants are trained and drilled to trick you into thinking that you have agreed when you haven't, that something was your idea when it wasn't, that something is best for you when it's their own arbitrary, pet theory. You might pretend, just to gain somebody's confidence or a tactical advantage. But don't ever forget what you know yourself.

Tactic/principle #2. Make it an expensive, time consuming nuisance. The reason the state makes machines and automatic, uniform processes is that people think they can't afford to deal with live individuals. So, be a very live individual. When somebody mentions a policy, make them show it to you in writing, then make them tell you its purpose. If answers don't make sense, keep asking, don't let it drop. Be that child who asks "Why?" to every answer, endlessly until all the parent has left is, "Because I say so!" The state pretends to rationality, not force, so it is more vulnerable than a parent, it has to keep explaining.

A friend told me years ago that the law is reasons (small r, plural). Whoever has more of them and is willing to stand up and say them longer than the other guy, wins. The reasons don't have to be all that good, either. They just have to be good enough that nobody is sure you don't believe them yourself. If you have more reasons, more questions, if you're staying longer and talking more than the little tyrant wants to, you'll win. You have to wear them down, be the squeakiest wheel they've ever heard.

The state appears to have all the money, but the little tyrants are often answerable for their efficiency or lack of it. If it's generally expected that one hearing will result in the efficient disposition of a case, the bureaucrat who can't finish it in three hearings can look pretty bad to his or her boss. When a member of a mental health treatment team has to have legal representation for a deposition and that has to go into his boss's budget, well, maybe the machine will figure out it's easier not to petition for involuntary treatment, or not to place a child in a foster home, after all.

Always ask for a change of venue, always ask for a different judge, but always have more reasons than anyone thinks you could possibly need. Always make them late for dinner.

And by the way, when it comes to this factor of expense, if you can easily pay thousands for a lawyer, it can help you a lot. But many lawyers (especially the ones whom the court appoints for you for free) really believe in the system you're fighting against. You can still use them, they are ethically required to follow your instructions and your strategy if they are representing you. But be aware that you may be spending (or paying for) lots of hours arguing with your own attorney. I hate to say it, but sometimes it might be better to study the law and represent yourself.

Tactic/principle #3. Always look for the good in each individual, even while you never miss an opponent's lie or illogical, arbitrary claim. Ultimately you can separate well-intended individuals from the state machines which they think they have to slavishly serve. Expect this to happen.

You are in the right, and a good person will know that. Get them to betray the empire, remove them from the matrix. Love your enemy.

If you are more persistent than they predict you could ever be, if you are a very creative nuisance, and if you look for the good in individuals and presume they will ultimately come around to your side, you'll be surprised how often you'll get defectors.

And you might end up a hero.

How do you "develop" alcohol abuse?

Today's Chicago Tribune headlines its Health & Family section with an article about teen drinking. The federal Centers for Disease Control did a survey which supposedly "indicates that youths who start drinking before age 15 are five times more likely to develop alcohol dependence or abuse later in life."

I know it's politically correct to believe in alcoholism as a disease. Mental illness is also, of course, a disease or a bunch of diseases. One "develops" such diseases just like cancer or the measles.

That's how we're supposed to think, otherwise we might tend to blame somebody instead of curing them. God forbid any one of us should ever impose any idiosyncratic morality on anyone else, or judge anyone on any standard which is not explicitly and expertly medical....

And of course, modern medicine could eventually cure every human problem if we mere mortals will just pay enough taxes, and subordinate our inferior lay judgment for those superior understandings of the proclaimed experts about what's best for us.

On the other hand, maybe not.

Another article, this one in the Chicago SunTimes on the same day, features psychologist E. Scott Geller of Virginia Tech's Center for Applied Behavioral Systems. Geller's research doesn't seem to show that kids just inadvertantly catch the disease of drinking too much. His conclusion is more like, well, they get drunk on purpose because they like it.

Education toward "alcohol awareness" has proven useless in efforts over thirty years. When researchers took breathalyzers to college parties and bars to show students their blood alcohol content, it actually encouraged them to drink more.

What a surprise. But perhaps only to those who delude themselves with this fantasy of medical cures for any and all socially problematic or disagreeable behavior.

The rest of us know stupid and bad when we see it, not to mention free and responsible. We resort to time-honored moral constraints like blame, shame and regret, which actually work better than psychiatry.

Will psychiatry die without psychosis risk?

The sudden demise of "Psychosis Risk" as a DSM-5 diagnosis may foretell the doom of psychiatry as we know it.

History tells us that empires occasionally crumble overnight. My favorite example is the Aztecs. In 1519 the wealth and power of Tenochtitlan was literally beyond European imagining. Only two years later Hernan Cortez had not just taken Montezuma's throne, he had wiped out the Aztec religion and obliterated their whole society.

And who would doubt that things change faster today than they did in the sixteenth century?

Robert Whitacher loses hope against the wealth and power he sees lined up with the forces of the psychiatric empire. I've heard similar pessimism from no less than Thomas Szasz.

But that power is spread very thin. Subject peoples are bitter and impatient, and our modern sun god - science - is no longer easily placated.

Sometime back in 1950's America the idea arose: We've got some really bad people who do terrible things, but with modern medicine and the atomic bomb and so on, maybe instead of just punishing them we can fix their brains! Then we'll all be good people, no more bad people.

Everybody believed in modern medicine and feared the atomic bomb, so biopsychiatry was an easy sell.

But half a century later, nothing has happened. We have no improved definition of schizophrenia, let alone an objective diagnostic test or cure. The latest drugs are still no better than simple exercise, or a placebo. It requires the idiosyncratic charisma of a snake charmer like Patrick McGorry to inspire government budgets for mental health, and the twisted talent of an old adman like D.J. Jaffe to propagandize the crowds into "seeing" the emperor's new clothes.

In the last decade or two, basic genetic and biological research has made it more and more obvious that there will never be a simple cure for any "mental illness" - partly because we don't even know what we're talking about when we use that term. The disease model applies no better here than it does to poverty, or war. We are not improving human behavior medically. The naive, 50's-America optimism was evidently a delusion for psychiatry and its true believers.

But true believers must defend the faith, no matter how desperately. Enter "psychosis risk" and "prodromes" calling for "early intervention".

My friends at CCHR and elsewhere think these ideas are marketing schemes contrived by pharmaceutical companies. I rather see them as desperate, last-ditch, hail-Mary rationalizations for a doomed paradigm.

I can imagine old guys like Nate Kline and Freddy Goodwin (and let's add Bennie Rush into the mix, too) on the golf course or sitting around a coffee table with Pat McGorry, wondering what the hell's wrong. "It's too complicated, after fifty years and all the money we ever wanted, there's still no cure?!?! We can't just fail, guys. We can't let Pasteur and Salk be the last heros. Maybe if we start treating kids real early, these drugs will do something. Maybe the disease gets smart enough to hide, or fool us, unless we go after it when it's just getting started, even before anything's wrong... Let's just test 'em all and treat 'em, then we'll finally figure it out, and we'll finally create our super... uh, better... man."

But oops! Paddy (he's Irish, rght?) McGorry flat-out abandoned the plan just the other day. His renunciation of "psychosis risk" for DSM-5 purposes presents the sudden possibility that biopsychiatry is really coming to the end of its road. Not even Allen Frances, who has taken the early interventionists to task more than any other establishment figure, really seems to appreciate this.

These guys are all still dragging human sacrifices up the mountain. But the empire may be gone forever.

An utterly wonderful turn of phrase!

I LOVE this:

"He gets symptomatic over rights."

I heard it from a social worker at Elgin Mental Health Center the other day, I'll call her Cindie. A patient for whom Cindie was responsible had been complaining that several dvd's had been confiscated from him for no good reason. The patient is a straight-A, on-line college student. The confiscated dvd's were relevant to an anthropology class he was enrolled in. He even had a letter from his professor saying so.

But the bossman of the clinical unit, a nurse's aide named Alfonso, had to prove to this patient that college success counted for nothing. The staff at a state nuthouse can take away anything they want to take away, any time they want to. Patients are bugs to be squashed at Alfonso's whim!

Cindie supports this kind of squashing in the bughouse, because it's really the only way she can obtain respect for her profession and activities. Patients who go to college tend to avoid therapy groups, because they find out that their classes are infinitely more valuable than the basket weaving and navel gazing Cindie teaches. When one of these (upstart!) college kids gets out of the nuthouse, Cindie and her therapy groups might get less credit for it.

Alfonso just steps on bugs directly, and laughs. I actually have been amused in a sick sort of way, by his unflinching cruelty.

Cindie, being much weaker, has to say, "He gets symptomatic over rights."

That is just wonderfully pathetic.

English and Inquisitorial law

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

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

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

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

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

Cruel and Usual

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

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

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

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

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

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

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

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

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

1984

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

George Orwell, how do you do!