In today's Chicago Tribune Bonnie Miller Rubin interviews University of Chicago law professor Mark Heyrman under the headline, "Mental health care offers easy target for budget ax". The presumptive attitude is, of course, everyone knows it's a bad thing to spend less money on psychiatric solutions to human problems.
But I rather think the best thing that's happened for mental health, in many years, is states going broke. Heyrman's Trib interview confirms it.
He talks about "low cost, simple services -- medications ... to keep someone healthy." But psychotropic medications don't keep anyone healthy. Sometimes these drugs keep dangerous people disabled from hurting themselves or others. But then again, it seems that sometimes they incite violence. As anyone who has ever taken them knows, they cause weight gain, diabetes, sexual dysfunction and a host of other very unhealthy conditions. If you take psychotropic meds, just deduct 25 years from your life expectancy.
Professor Heyrman believes mental illness makes people quite sick, but he has absolutely no sense that this is metaphorical sickness. He is a true believer in the strict medical model, despite generations of its documented failure. This scientism, this insanity-equals-brain-disease, goes precisely nowhere to improve anyone's life or to make any community safe.
It's so last century, in more ways than one. For this interview, in Heyrman's version of Assertive Community Treatment, people merely "remind you to take your meds, help solve problems...." Of course Dr. Goebbels, we don't mention coercion, which is endemic even in the term ("Assertive...").
People don't forget to take psych meds so much as they stop taking them on purpose or refuse to take them. That's because they hate them, and that's because the meds don't help, they hurt. I'm sure the Gestapo reminded people to do things, too, like salute properly and so on. And nobody believed so strongly in the biological determinism of all things human or sub-human.
The Trib stays in character with it's anti-Semitic founder, Robert McCormick.
But in this century we will not continue to pay for psychiatry's terrible solutions, with or without Obamacare. The DSM/APA/NAMI/Pharma/
NIMH world view is passing rapidly. These days many people know it's possible to recover fully from mental disorders, and it's easier the more you avoid those exact "low cost, simple services" which Mark Heyrman would love to make everyone accept, whether they like it or not.
Be glad Illinois is broke!
Wednesday, July 18, 2012
Wednesday, June 20, 2012
Demise of Psychiatry: A Reading List
Everybody has read Whitaker and Breggin. Lots of people know of Grace Jackson. Szasz has his loyal disciples (I am one). Here are four books less on the radar, but equally as useful and significant.
American Madness: The Rise and Fall of Dementia Praecox, by Richard Noll (2011, Harvard University Press); and Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters (2010, Free Press/Simon & Schuster). These two are really about history.
Noll covers a critical period of psychiatry in intense detail, from about 1895 to the 1930's, when the disease model of mental illness came and went. The lives, careers and mistakes of Emil Kraepelin, Adolf Meyer, Eugen Bleuler and other luminaries are detailed. Parallels with the present are striking, and the reader is seriously tempted to predict what will happen with DSM-5, purely based on history tending to repeat itself. Noll himself does not discourage this, although the connections seem to be an afterthought for him.
Watters is more of an investigative journalist. He chronicles the spectacularly successful promotion over the past two generations, of the biomedical model of mental illness around the world. In a sense, this recent history picks up almost exactly where Noll's left off, and it shows a returning swing of the pendulum, although neither Kraepelin nor Freud even appear in Watters' index. Each of the four stories told in this book - of the rise of anorexia in Hong Kong, the arrival of PTSD in Sri Lanka, the altered concept of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan - is much more interesting with the backdrop of the earlier psychiatric century.
Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, by Raymond Tallis (2011, Acumen Publishing); and Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis, by Paris Williams (2012, Sky's Edge Publishing). These two books suggest a new look at what we can know and what we should do about the mind.
Tallis offers a highly respectable, technical/philosophical disputation of the intertwined ideas, that we are our brains and that consciousness is just another evolutionary adaptation. Aping Mankind is serious reading, but highly rewarding. One is compelled to respect the argument that ascribing thought to bits of brain is less scientific materialism and more mystic faith. The credentials of the author, who was elected a Fellow of the Academy of Medical Sciences for his research in clinical neuroscience, make him difficult to ignore.
Paris Williams is ideally suited to demonstrate the scientific and philosophical arguments of Raymond Tallis. Rethinking Madness is all about clinical and personal experience which points inexorably to the conclusion that the medical model of mental illness is destructive, and must be replaced by a recovery model wherein people can integrate personal experience and overcome distress. Attempts to make people happier and safer by fine-tuning their brain chemistry are shown to be a mistaken and generally dehumanizing project. Psychosis is not brain disease, and schizophrenia does not really even exist.
Read these four books, and then just try to imagine that the demise of psychiatry as we know it is not imminent. It will be hard.
American Madness: The Rise and Fall of Dementia Praecox, by Richard Noll (2011, Harvard University Press); and Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters (2010, Free Press/Simon & Schuster). These two are really about history.
Noll covers a critical period of psychiatry in intense detail, from about 1895 to the 1930's, when the disease model of mental illness came and went. The lives, careers and mistakes of Emil Kraepelin, Adolf Meyer, Eugen Bleuler and other luminaries are detailed. Parallels with the present are striking, and the reader is seriously tempted to predict what will happen with DSM-5, purely based on history tending to repeat itself. Noll himself does not discourage this, although the connections seem to be an afterthought for him.
Watters is more of an investigative journalist. He chronicles the spectacularly successful promotion over the past two generations, of the biomedical model of mental illness around the world. In a sense, this recent history picks up almost exactly where Noll's left off, and it shows a returning swing of the pendulum, although neither Kraepelin nor Freud even appear in Watters' index. Each of the four stories told in this book - of the rise of anorexia in Hong Kong, the arrival of PTSD in Sri Lanka, the altered concept of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan - is much more interesting with the backdrop of the earlier psychiatric century.
Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, by Raymond Tallis (2011, Acumen Publishing); and Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis, by Paris Williams (2012, Sky's Edge Publishing). These two books suggest a new look at what we can know and what we should do about the mind.
Tallis offers a highly respectable, technical/philosophical disputation of the intertwined ideas, that we are our brains and that consciousness is just another evolutionary adaptation. Aping Mankind is serious reading, but highly rewarding. One is compelled to respect the argument that ascribing thought to bits of brain is less scientific materialism and more mystic faith. The credentials of the author, who was elected a Fellow of the Academy of Medical Sciences for his research in clinical neuroscience, make him difficult to ignore.
Paris Williams is ideally suited to demonstrate the scientific and philosophical arguments of Raymond Tallis. Rethinking Madness is all about clinical and personal experience which points inexorably to the conclusion that the medical model of mental illness is destructive, and must be replaced by a recovery model wherein people can integrate personal experience and overcome distress. Attempts to make people happier and safer by fine-tuning their brain chemistry are shown to be a mistaken and generally dehumanizing project. Psychosis is not brain disease, and schizophrenia does not really even exist.
Read these four books, and then just try to imagine that the demise of psychiatry as we know it is not imminent. It will be hard.
Tuesday, June 12, 2012
Mr. D again, Karadzic
On a couple occasions in 2010, I wrote about a client whom I called Mr. D. He was almost killed by a psychiatrist at Elgin Mental Health Center, and his sister has remained very unhappy about that ever since.
Mr. D is not out of the nuthouse yet, he's still there, still getting treated. His monthly staffing was today. His psychiatrist (third or fourth one he's had) was not available, nor was his social worker, nor was anyone from the Elgin administration. His sister and parents attended staffings regularly for years, but they recently gave that up as a useless waste of time. Mr. D himself also refused to come today.
The family are "ethnic cleansing" refugees. They have learned one basic thing from their experience with Egin Mental Health Center, the Illinois Department of Human Services, and American forensic psychiatry: There is no better justice in the USA than there was in Bosnia, and the differences between psychiatrists who wield state power, whether their names are Amin Daghestani, Syed Hussain or Radavan Karadzic, are insignificant.
Despite the complete impasse in this case and the startling record of abuse and malpractice, the substitute social worker at today's staffing indicated that everything was just fine. Mr. D actually attended her therapy group on responsibility this week, and he was participatory. How encouraging!
It's just beyond my imagining, why the system still keeps Mr. D locked up away from his family, drugged and dehumanized. The system is simply evil. It needs to be obliterated.
Mr. D is not out of the nuthouse yet, he's still there, still getting treated. His monthly staffing was today. His psychiatrist (third or fourth one he's had) was not available, nor was his social worker, nor was anyone from the Elgin administration. His sister and parents attended staffings regularly for years, but they recently gave that up as a useless waste of time. Mr. D himself also refused to come today.
The family are "ethnic cleansing" refugees. They have learned one basic thing from their experience with Egin Mental Health Center, the Illinois Department of Human Services, and American forensic psychiatry: There is no better justice in the USA than there was in Bosnia, and the differences between psychiatrists who wield state power, whether their names are Amin Daghestani, Syed Hussain or Radavan Karadzic, are insignificant.
Despite the complete impasse in this case and the startling record of abuse and malpractice, the substitute social worker at today's staffing indicated that everything was just fine. Mr. D actually attended her therapy group on responsibility this week, and he was participatory. How encouraging!
It's just beyond my imagining, why the system still keeps Mr. D locked up away from his family, drugged and dehumanized. The system is simply evil. It needs to be obliterated.
Friday, May 25, 2012
Who Speaks for the Disabled?
Today's Chicago Tribune (page 25) includes the ostensibly pro-family perspective of attorney William Choslovsky. I'm mainly in favor of respecting the choices of families over those of self-proclaimed advocates, and certainly over those of state bureaucrats.
However, it is absolutely critical to presume, first of all, that the disabled may speak for themselves. It's only when an individual disabled person clearly does not speak for him or her self, that we may ethically consider anybody else's choice.
This is more complicated than it looks because disabled people do not really speak for themselves when they cannot pay, in addition to when they are actually incapable of speech. For that matter, to the degree that any of us cannot pay for or independently create what we want, we are all "disabled".
Many Americans may sincerely wish to live in the White House, but they must respect highly ritualized choices of around a hundred million fellow citizens on that, and they only have one chance every four years. This is not an entirely different kind of conflict from one where a profoundly retarded person sincerely wishes to live in their own home, but cannot work to pay the mortgage. Who speaks for another is not an entirely different kind of question from who depends on whom.
Hopefully we each depend, first of all, on ourselves. After that we have families, friends, community groups, organizations and governments, more or less in that order. Who speaks for us is closely tied to whom we depend on. It just has to be.
It's not a question of who, in all cases, ought to speak for the disabled. It's a separate question in each case, which is inextricably bound up with the particular relationships and dependencies of the individual disabled person.
If Johnny murdered his girlfriend and was found not guilty by reason of insanity, and mom and dad have the idea that Johnny was adopted after all, so it's probably a genetic mental illness and they can't help him, then maybe Johnny is not represented any better by mom and dad than he is by the state, when they say he needs to take anti-psychotic medication for the rest of his life. And in fact, if Johnny can't pay for his own private attorney, he'll sure have to deal with other agendas.
NAMI has served the interests of medical psychiatry and pharma for thirty years with a heavy pretense of being all for families who know what's best for their own mentally ill. Obviously it's not always true. Sometimes people just want a magic pill, and they can be fooled. Calling a person disabled can be a power play, too.
I worked for a client who was at Choate Mental Health Center in Anna, IL. That's the facility offered by William Choslovsky as an example of a campus with real community life, where Rita and Kevin Burke's son Brian lives happily. My client would certainly argue that Choate was a prison for him, and the state should close it and every institution like it.
He speaks for himself, and I agree with him.
However, it is absolutely critical to presume, first of all, that the disabled may speak for themselves. It's only when an individual disabled person clearly does not speak for him or her self, that we may ethically consider anybody else's choice.
This is more complicated than it looks because disabled people do not really speak for themselves when they cannot pay, in addition to when they are actually incapable of speech. For that matter, to the degree that any of us cannot pay for or independently create what we want, we are all "disabled".
Many Americans may sincerely wish to live in the White House, but they must respect highly ritualized choices of around a hundred million fellow citizens on that, and they only have one chance every four years. This is not an entirely different kind of conflict from one where a profoundly retarded person sincerely wishes to live in their own home, but cannot work to pay the mortgage. Who speaks for another is not an entirely different kind of question from who depends on whom.
Hopefully we each depend, first of all, on ourselves. After that we have families, friends, community groups, organizations and governments, more or less in that order. Who speaks for us is closely tied to whom we depend on. It just has to be.
It's not a question of who, in all cases, ought to speak for the disabled. It's a separate question in each case, which is inextricably bound up with the particular relationships and dependencies of the individual disabled person.
If Johnny murdered his girlfriend and was found not guilty by reason of insanity, and mom and dad have the idea that Johnny was adopted after all, so it's probably a genetic mental illness and they can't help him, then maybe Johnny is not represented any better by mom and dad than he is by the state, when they say he needs to take anti-psychotic medication for the rest of his life. And in fact, if Johnny can't pay for his own private attorney, he'll sure have to deal with other agendas.
NAMI has served the interests of medical psychiatry and pharma for thirty years with a heavy pretense of being all for families who know what's best for their own mentally ill. Obviously it's not always true. Sometimes people just want a magic pill, and they can be fooled. Calling a person disabled can be a power play, too.
I worked for a client who was at Choate Mental Health Center in Anna, IL. That's the facility offered by William Choslovsky as an example of a campus with real community life, where Rita and Kevin Burke's son Brian lives happily. My client would certainly argue that Choate was a prison for him, and the state should close it and every institution like it.
He speaks for himself, and I agree with him.
Monday, May 14, 2012
Another proposed resolution...
RESOLUTION
WHEREAS, Systematic review has been undertaken over the past decade at national, state and local governmental levels, and in collaboration with private and not-for-profit research, regarding strategies to address potential incidents that could have large-scale health consequences including disease outbreaks, natural disasters and terrorist attacks; and
WHEREAS, The U. S. Department of Health and Human Services, after conducting its own review of these issues, published a National Health Security Strategy of the United States of America in December, 2009; and
WHEREAS, The 2009 HHS Strategy is replete with statements recognizing an overarching necessity to convince the people to trust and independently cooperate, at the individual, family and community levels, with organized efforts by authorities in the amelioration of any significant health incident; and
WHEREAS, Contrary to these overarching security needs for broad trust and cooperation, notable social trends now exist toward increasing public doubt and cynicism, especially with regard to medical science and health care; and
WHEREAS, An example of such doubt and cynicism was a New York Times book review in 2009, which characterized Americans' recent love affair with modern psychiatry as a sub-prime crisis waiting to happen; and
WHEREAS, Over the last several years, the American Psychiatric Association and the world community of mental health professionals have been in an uproar regarding the general validity of psychiatric diagnosis, as evidenced by incessant protests over the new paradigm of "dimensional" definitions of mental disorder to be established in 2013 by the publication of the fifth revision of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5); and
WHEREAS, Endemic, spectacular and increasingly frequent media stories of health care fraud and falsified medical studies are not conducive to pubic confidence in and cooperation with authority on issues of health; and
WHEREAS, An ultimate security threat might entail a catastrophic failure of confidence in authority and cohesion in the face of disaster; therefore
BE IT RESOLVED BY THE LEGISLATURE, That a fundamental distinction shall be recognized: between practical and empirically-proven medical science and clinical health care practices, as opposed to popular or academic scientism embodying mere theories or wishful thinking about easy solutions to human behavior and magic pills for all unpleasant life experiences; and be it further
RESOLVED, That our government shall refrain whenever possible from forcing, coercing or deceiving families or individuals into health care solutions which they do not choose themselves by fully informed consent; and be it further
RESOLVED, That human emotions and complex behavior are not realistically a subject for, and may never be amenable to, medical management, especially such management as should ever be attempted by any state medical or mental health bureaucracy; and be it further
RESOLVED, That fundamental and vital principles of any health security strategy shall be free and honest information, open dialogue, and collaboration with the people.
WHEREAS, Systematic review has been undertaken over the past decade at national, state and local governmental levels, and in collaboration with private and not-for-profit research, regarding strategies to address potential incidents that could have large-scale health consequences including disease outbreaks, natural disasters and terrorist attacks; and
WHEREAS, The U. S. Department of Health and Human Services, after conducting its own review of these issues, published a National Health Security Strategy of the United States of America in December, 2009; and
WHEREAS, The 2009 HHS Strategy is replete with statements recognizing an overarching necessity to convince the people to trust and independently cooperate, at the individual, family and community levels, with organized efforts by authorities in the amelioration of any significant health incident; and
WHEREAS, Contrary to these overarching security needs for broad trust and cooperation, notable social trends now exist toward increasing public doubt and cynicism, especially with regard to medical science and health care; and
WHEREAS, An example of such doubt and cynicism was a New York Times book review in 2009, which characterized Americans' recent love affair with modern psychiatry as a sub-prime crisis waiting to happen; and
WHEREAS, Over the last several years, the American Psychiatric Association and the world community of mental health professionals have been in an uproar regarding the general validity of psychiatric diagnosis, as evidenced by incessant protests over the new paradigm of "dimensional" definitions of mental disorder to be established in 2013 by the publication of the fifth revision of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5); and
WHEREAS, Endemic, spectacular and increasingly frequent media stories of health care fraud and falsified medical studies are not conducive to pubic confidence in and cooperation with authority on issues of health; and
WHEREAS, An ultimate security threat might entail a catastrophic failure of confidence in authority and cohesion in the face of disaster; therefore
BE IT RESOLVED BY THE LEGISLATURE, That a fundamental distinction shall be recognized: between practical and empirically-proven medical science and clinical health care practices, as opposed to popular or academic scientism embodying mere theories or wishful thinking about easy solutions to human behavior and magic pills for all unpleasant life experiences; and be it further
RESOLVED, That our government shall refrain whenever possible from forcing, coercing or deceiving families or individuals into health care solutions which they do not choose themselves by fully informed consent; and be it further
RESOLVED, That human emotions and complex behavior are not realistically a subject for, and may never be amenable to, medical management, especially such management as should ever be attempted by any state medical or mental health bureaucracy; and be it further
RESOLVED, That fundamental and vital principles of any health security strategy shall be free and honest information, open dialogue, and collaboration with the people.
Friday, May 11, 2012
Suggested Resolution to be Introduced in State Legislatures and/or the U.S. Congress
RESOLUTION
WHEREAS, Love and loss are two sides to the same coin of human connection; and
WHEREAS, Bereavement, especially traumatic bereavement such as comes with the sudden death of a spouse or a child, may bring existential grief and the darkest hours of human experience; and
WHEREAS, We cheapen and demean our own humanity and disqualify ourselves from loving, if we merely label the grief of mourning as a "mental illness" on a par with biological dysfunctions like diabetes or cancer, to be "cured" with a pill; and
WHEREAS, A psychiatric diagnosis of depression can be misapplied to a person who is grieving; and
WHEREAS, The several editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) published since 1980 have defined depression, or Major Depressive Disorder, in terms of a checklist which has included sadness as a symptom tending to indicate a diagnosis; and
WHEREAS, An exclusion of sadness due to bereavement, as a symptom of mental illness needing medical treatment, was reduced from one year in the American Psychiatric Association's DSM-III (published in 1980) to two months in DSM-IV (published in 1994); and
WHEREAS, The proposed bereavement exclusion in DSM-5 (to be published in May, 2013) is only two weeks, meaning for example that the bereaved parent of a child lost to murder or suicide, or the spouse of a dead husband or wife of 50 years, would be labelled mentally ill for grieving longer than two weeks and encouraged to take powerful, expensive and potentially dangerous psychotropic medications; and
WHEREAS, Many experts in diverse mental health fields believe this DSM-5 scheme will be patently unscientific, arbitrary and potentially harmful to patients and clinical practice; therefore
BE IT RESOLVED BY THE LEGISLATURE, That all people have a natural human right to grieve for life's losses, and especially for losses of loved ones; and be it further
RESOLVED, That no one should be judged as having a medical or mental disorder because of normal sadness over significant loss; and be it further
RESOLVED, That the right to grieve without being labelled as ill may not be limited to any short time of a few weeks or months, because each individual must face bereavement in his or her own way and in his or her own time, and for many genuine grief over the loss of a loved one lasts for life; and be it further
RESOLVED, That our Government shall always recognize human grief and human love alike as precious to life itself, existential, and ultimately beyond the scope of mere scientific medicine.
WHEREAS, Love and loss are two sides to the same coin of human connection; and
WHEREAS, Bereavement, especially traumatic bereavement such as comes with the sudden death of a spouse or a child, may bring existential grief and the darkest hours of human experience; and
WHEREAS, We cheapen and demean our own humanity and disqualify ourselves from loving, if we merely label the grief of mourning as a "mental illness" on a par with biological dysfunctions like diabetes or cancer, to be "cured" with a pill; and
WHEREAS, A psychiatric diagnosis of depression can be misapplied to a person who is grieving; and
WHEREAS, The several editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) published since 1980 have defined depression, or Major Depressive Disorder, in terms of a checklist which has included sadness as a symptom tending to indicate a diagnosis; and
WHEREAS, An exclusion of sadness due to bereavement, as a symptom of mental illness needing medical treatment, was reduced from one year in the American Psychiatric Association's DSM-III (published in 1980) to two months in DSM-IV (published in 1994); and
WHEREAS, The proposed bereavement exclusion in DSM-5 (to be published in May, 2013) is only two weeks, meaning for example that the bereaved parent of a child lost to murder or suicide, or the spouse of a dead husband or wife of 50 years, would be labelled mentally ill for grieving longer than two weeks and encouraged to take powerful, expensive and potentially dangerous psychotropic medications; and
WHEREAS, Many experts in diverse mental health fields believe this DSM-5 scheme will be patently unscientific, arbitrary and potentially harmful to patients and clinical practice; therefore
BE IT RESOLVED BY THE LEGISLATURE, That all people have a natural human right to grieve for life's losses, and especially for losses of loved ones; and be it further
RESOLVED, That no one should be judged as having a medical or mental disorder because of normal sadness over significant loss; and be it further
RESOLVED, That the right to grieve without being labelled as ill may not be limited to any short time of a few weeks or months, because each individual must face bereavement in his or her own way and in his or her own time, and for many genuine grief over the loss of a loved one lasts for life; and be it further
RESOLVED, That our Government shall always recognize human grief and human love alike as precious to life itself, existential, and ultimately beyond the scope of mere scientific medicine.
Thursday, April 19, 2012
Pass HR0898, rescue the law from psychiatry!
To: Members of the Human Service Committee, Illinois House of Representatives, State Capitol, Springfield, Illinois
Dear Representative,
I intend this letter to be submitted as written testimony in support of House Resolution 898 (HR0898), sponsored by Rep. Mary Flowers, which is currently being considered in the Human Services Committee.
Background
I have lived in Illinois since 1967, when my father moved our family from Flint, Michigan. I attended the University of Illinois at Champaign, Northwestern University, and DePaul University College of Law. My wife of 37 years was born in Chicago, and we raised our three children in this state. We love the winters and will never move to Florida, Arizona or California.
For ten years, my law practice has been devoted almost exclusively to pro bono representation and advocacy for individuals who are involuntarily committed in state mental health facilities in Illinois. I’ve seen the inside of Chester Mental Health Center, Choate Mental Health Center, Alton Mental Health Center, Singer Mental Health Center, Tinley Park Mental Health Center, Chicago Reed Mental Health Center, and Elgin Mental Health Center. I am currently on the “grand rounds distribution list” at Elgin (meaning I get regular notice and invitation to their weekly continuing medical education programs), and I often spend two or three days a week there. Some people probably wonder if the state pays me, but it does not.
Most of my clients are violent criminals. At some point a judge looked at each of them and decided, “Well, maybe instead of just punishing this guy who did this horrible, inhuman thing (e.g., murder), we should try to fix him.” The verdict was therefore: Not Guilty by Reason of Insanity (NGRI).
Formally, an NGRI verdict is an acquittal. However, the defendant is almost always committed to a secure psychiatric facility for a term not to exceed the length of the most severe prison sentence he would have received had he been found guilty on the most serious charge against him. The purpose of this commitment is twofold: protection of the community, and effective treatment of any mental disorder which caused insanity. Once the defendant is effectively treated and he is no longer a danger to the community, the court releases him from the involuntary commitment. This is the essential viewpoint or theory of the law, although there are various bells and whistles.
I will now describe to you what really happens, according to my own substantial experience as an attorney and advocate within this system.
The awkward disaster of psychiatry and Illinois criminal law
When a murderer thinks he can go to a hospital instead of prison or the executioner, it sounds like a pretty good deal to him, and to his lawyer. His family normally agrees, even (or especially) if they are victims of the crime.
Many elements in the community, not directly impacted by the particular crime but nevertheless interested pursuant to various economic, social and political agendas, may want to use a criminal case as evidence in their advocacy for public resource priorities, or to support a certain status quo which generates payroll checks. Couple these interests with modern liberal tendencies and prejudice in favor of medicine or science to solve every human problem, and we have strong background inertia to favor “treatment” whenever mental illness is credibly advanced as an explanation for a tragedy.
On the other side of the issue, there is always a state’s attorney who finds almost any NGRI plea inherently suspicious. There are usually crime victims and their families thinking more in terms of vengeance than merciful medicine. Sometimes there are media stories, and the reporters can be complete wild cards.
In the middle of it all is a judge, who wants to believe his own decision will not be too arbitrary, or at least not transparently so.
So what appeals to all of these troubled dynamics? What hero rescues everyone from confusion? The expert, of course! The psychiatrist allows us all to abdicate our own judgment without feeling irresponsible. We need not punish crime or blame our fellows harshly, because there is a disease to be magically cured by someone else, who is trained.
(If you’re thinking I should not be sarcastic or exaggerate or simplify… then I would ask: When did you last sit down with psychotic murderers? When did you last confer, behind the locked doors of a state institution, with a treatment team charged with fine-tuning somebody’s brain chemistry to keep him from ever behaving badly again? If you would make the law of places where you will not go, the locals may soon come to find you.)
My clients are those who were found NGRI by the judge, and remanded to the custody of the Illinois Department of Human Services for treatment. Sometime later, each of them decided he didn’t like treatment after all, and he began to refuse it.
The first reaction of a normal layperson might be: He isn’t allowed to do that, is he? He killed somebody…. But of course he’s allowed to refuse. It’s medical treatment, right? People have to give informed consent; you can’t forcibly drug a guy if he’s not hurting anyone now. That would be punishment, and we’ve said these people are not guilty (by reason of insanity), so we have no ethical standing to punish them.
Well then one might think, the “patient” doesn’t know what’s in his own best interest but the psychiatrist does, right? No, actually when it comes down to it, most psychiatrists would not, and do not, say that. They stick to procedures in the forensic system, the doctors defer to the law, and they say they are just following the court’s orders. One often feels that they have forgotten whether they’re doctors, lawyers or policemen.
The man in the white coat and the man in the black robe simply point at each other, and shrug their shoulders cynically.
Meanwhile, the patient or criminal goes nowhere, for approximately $700 per day of the taxpayers’ money. He may not believe he’s mentally ill anymore and may be totally asymptomatic, and he refuses to be drugged into subhumanity for anyone else’s “prophylactic” benefit. The whole concept of “treating the mental illness” that supposedly caused a violent crime to occur begins to fall utterly apart. There is no objective, obvious medical problem, so people start making things up to create “evidence”. The fact that a guy says he’s not mentally ill now proves that he is, even if no other symptoms exist. The irony, that precisely the opposite logic (he only says he’s mentally ill to avoid prison or executioner no matter what other symptoms exist) had been part of the prosecutor’s argument at trial, is never lost, especially on the public.
The apparent solution to all of this, within the ruling paradigm, is better psychiatry, better diagnosis and better treatment. The problem is that there just isn’t any.
We have come down a long road in Illinois to a point where forensic psychiatry severely demeans both medicine and our law. Several years ago, I saw the Randolph County State’s Attorney spend hundreds of thousands of dollars to keep a man locked up in Chester, although nothing was wrong with him. Three expert witnesses testified for each side, saying with equal conviction that the defendant was dangerously mentally ill, and that he was perfectly alright. The only thing the jury could be sure of in the end was that nobody had proven anything. It was a giant show of nonsense. The media were entertained and outraged as they always are, the AFSCME Council 31 union members defended their paychecks, and a candidate for local office lost his election because of the charade. It was ugly, debased politics: the best forensic psychiatry money can buy! And it’s getting worse, not better, because the state can no longer afford to pay, and patients are more and more likely to disagree with treatment programs every day.
Since that case in Chester, the FDA has ordered black box warnings for psychiatric drugs, mere placebos have proven to be almost equally as effective, and pharmaceutical companies have paid billions in fines for illegal and deceptive marketing. The hoped-for cures for mental illness have been revealed as problematic indeed. Currently, as the American Psychiatric Association prepares to publish its next diagnostic manual, the mental health profession is almost begging them to avoid the embarrassment. The “diseases” themselves are as discredited as the cures! In short, my clients are certainly not the only ones saying they just don’t believe in psychiatry. A necessary solution will be to actually separate this pseudoscience from the law.
Specific problems (examples)
The definition of “mental illness” as that term is used anywhere in Illinois statutes and regulations is established by 405 ILCS 5/1-129:
…a mental, or emotional disorder that substantially impairs a person’s thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of life, but does not include a developmental disability, dementia or Alzheimer’s disease absent dementia, a substance abuse disorder, or an abnormality manifested only by repeated criminal or otherwise antisocial behavior.
This definition begs any number of questions, e.g.:
The General Assembly apparently presumed either a difference between mental disorders and emotional disorders, or they intended to acknowledge that mental and emotional are alternative terms for the same class of disorders. The former case would refer to scientific evidence; the latter would indicate the field is scientifically uncertain. What’s the story with this language?
Are the terms, “thought, perception of reality, emotional process, judgment, behavior, ability to cope with the ordinary demands of life” used according to any technical definition, or merely intended to convey regular lay usage and understanding? If the former, where are such definitions found? If the latter, isn’t this whole concept left pretty wide open for interpretation?
Why exactly aren’t developmental disabilities mental illnesses? Is there really any fine line between these concepts, in any individual at any moment? What about a seven-year-old having trouble on the school playground? Can’t this be looked at either way?
Why exactly do we exclude dementia, and Alzheimer’s disease absent dementia?
Why do we exclude substance abuse disorders from mental illness? If a college student gets an ADHD diagnosis so he can have access to stimulants (and perhaps share them with friends on occasion), does he have a mental illness or is he abusing a substance? If a teenager takes LSD and has a psychotic break which lasts a few days, is she mentally ill? “Substance Induced Psychotic Disorder” is an official DSM-IV coded diagnosis. Doesn’t that mean it is a mental illness?
Aren’t all mental illnesses manifested only by behavior which is perceived as either criminal or antisocial to some degree? So how can we exclude those very symptoms which are the sole basis for diagnosing the disease?
The bottom line is that we don’t define mental illness with any certainty or consistency under the law. We can’t, because we just don’t know what it is, as a reality. We only know that we would like to control peoples’ bad behavior without being too mean about it, so a medical model has great allure. To the degree that it’s only a metaphor, or for that matter a lie, well, the complexity mounts up rapidly, the law becomes gibberish.
405 ILCS 5/1-119 depends (!) upon the clarity of 405 ILCS 5/1-129 to further define the circumstances under which we justify depriving a person of his or her fundamental right to liberty, through forced imprisonment, in a locked and barred “hospital”:
“Person subject to involuntary admission on an inpatient basis” means:
(1) A person with mental illness who because of his or her illness is reasonably expected, unless treated on an inpatient basis, to engage in conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed;
(2) A person with mental illness who because of his or her illness is unable to provide for his or her basic physical needs so as to guard himself or herself from serious harm without the assistance of family or others, unless treated on an inpatient basis; or
(3) A person with mental illness who:
(i) refuses treatment or is not adhering adequately to prescribed treatment;
(ii) because of the nature of his or her illness, is unable to understand his or her need for treatment; and
(iii) if not treated on an inpatient basis, is reasonably expected, based on his or her behavioral history, to suffer mental or emotional deterioration and is reasonable expected, after such deterioration, to meet the criteria or either paragraph (1) or paragraph (2) of this Section.
In determining whether a person meets the criteria specified in paragraph (1), (2), or (3), the court may consider evidence of the person’s repeated past pattern of specific behavior and actions related to the person’s illness.
It is not necessary to catalogue the vast number of unanswerable questions this section of our law raises. The totem-pole “reasonable expectations” alone would require a flow chart to even begin to decipher. The bottom line? This “law” is embarrassing nonsense. It cannot possibly constitute any common social understanding or agreement, and it only serves to allow some remote, designated expert to decide, according to whim, who gets locked up and who may walk free, who is allowed rights as a human being and who is dehumanized.
Sections 405 ILCS 5/1-129 and 405 ILCS 5/1-119 are two examples with which I am particularly familiar, but they are by no means exceptional or even the most glaring instances of problematic law and regulation due to scientific and medical confusion over mental diagnosis. The fields of school law, child protection, disabilities, health care, employment, discrimination, and welfare are all hopelessly infected (please excuse the irony of my metaphor).
Conclusion
There may come a time when such nonsense as I have described above earns more open and widespread cynicism about the law, medicine, science, and reason itself. Illinois has an unfortunate reputation already in the world of politics. We should not bear this additional burden of disreputable psychiatry, which weakens the fundamental bases of our culture.
House Resolution 898 is a careful statement of the problem, and it merely calls for an organized, democratic evaluation. I believe it will enable our state to get out in front of these issues, avoid much worse controversy down the road, and actually save much expense in lives and treasure.
I therefore respectfully urge you to pass HR0898.
Dear Representative,
I intend this letter to be submitted as written testimony in support of House Resolution 898 (HR0898), sponsored by Rep. Mary Flowers, which is currently being considered in the Human Services Committee.
Background
I have lived in Illinois since 1967, when my father moved our family from Flint, Michigan. I attended the University of Illinois at Champaign, Northwestern University, and DePaul University College of Law. My wife of 37 years was born in Chicago, and we raised our three children in this state. We love the winters and will never move to Florida, Arizona or California.
For ten years, my law practice has been devoted almost exclusively to pro bono representation and advocacy for individuals who are involuntarily committed in state mental health facilities in Illinois. I’ve seen the inside of Chester Mental Health Center, Choate Mental Health Center, Alton Mental Health Center, Singer Mental Health Center, Tinley Park Mental Health Center, Chicago Reed Mental Health Center, and Elgin Mental Health Center. I am currently on the “grand rounds distribution list” at Elgin (meaning I get regular notice and invitation to their weekly continuing medical education programs), and I often spend two or three days a week there. Some people probably wonder if the state pays me, but it does not.
Most of my clients are violent criminals. At some point a judge looked at each of them and decided, “Well, maybe instead of just punishing this guy who did this horrible, inhuman thing (e.g., murder), we should try to fix him.” The verdict was therefore: Not Guilty by Reason of Insanity (NGRI).
Formally, an NGRI verdict is an acquittal. However, the defendant is almost always committed to a secure psychiatric facility for a term not to exceed the length of the most severe prison sentence he would have received had he been found guilty on the most serious charge against him. The purpose of this commitment is twofold: protection of the community, and effective treatment of any mental disorder which caused insanity. Once the defendant is effectively treated and he is no longer a danger to the community, the court releases him from the involuntary commitment. This is the essential viewpoint or theory of the law, although there are various bells and whistles.
I will now describe to you what really happens, according to my own substantial experience as an attorney and advocate within this system.
The awkward disaster of psychiatry and Illinois criminal law
When a murderer thinks he can go to a hospital instead of prison or the executioner, it sounds like a pretty good deal to him, and to his lawyer. His family normally agrees, even (or especially) if they are victims of the crime.
Many elements in the community, not directly impacted by the particular crime but nevertheless interested pursuant to various economic, social and political agendas, may want to use a criminal case as evidence in their advocacy for public resource priorities, or to support a certain status quo which generates payroll checks. Couple these interests with modern liberal tendencies and prejudice in favor of medicine or science to solve every human problem, and we have strong background inertia to favor “treatment” whenever mental illness is credibly advanced as an explanation for a tragedy.
On the other side of the issue, there is always a state’s attorney who finds almost any NGRI plea inherently suspicious. There are usually crime victims and their families thinking more in terms of vengeance than merciful medicine. Sometimes there are media stories, and the reporters can be complete wild cards.
In the middle of it all is a judge, who wants to believe his own decision will not be too arbitrary, or at least not transparently so.
So what appeals to all of these troubled dynamics? What hero rescues everyone from confusion? The expert, of course! The psychiatrist allows us all to abdicate our own judgment without feeling irresponsible. We need not punish crime or blame our fellows harshly, because there is a disease to be magically cured by someone else, who is trained.
(If you’re thinking I should not be sarcastic or exaggerate or simplify… then I would ask: When did you last sit down with psychotic murderers? When did you last confer, behind the locked doors of a state institution, with a treatment team charged with fine-tuning somebody’s brain chemistry to keep him from ever behaving badly again? If you would make the law of places where you will not go, the locals may soon come to find you.)
My clients are those who were found NGRI by the judge, and remanded to the custody of the Illinois Department of Human Services for treatment. Sometime later, each of them decided he didn’t like treatment after all, and he began to refuse it.
The first reaction of a normal layperson might be: He isn’t allowed to do that, is he? He killed somebody…. But of course he’s allowed to refuse. It’s medical treatment, right? People have to give informed consent; you can’t forcibly drug a guy if he’s not hurting anyone now. That would be punishment, and we’ve said these people are not guilty (by reason of insanity), so we have no ethical standing to punish them.
Well then one might think, the “patient” doesn’t know what’s in his own best interest but the psychiatrist does, right? No, actually when it comes down to it, most psychiatrists would not, and do not, say that. They stick to procedures in the forensic system, the doctors defer to the law, and they say they are just following the court’s orders. One often feels that they have forgotten whether they’re doctors, lawyers or policemen.
The man in the white coat and the man in the black robe simply point at each other, and shrug their shoulders cynically.
Meanwhile, the patient or criminal goes nowhere, for approximately $700 per day of the taxpayers’ money. He may not believe he’s mentally ill anymore and may be totally asymptomatic, and he refuses to be drugged into subhumanity for anyone else’s “prophylactic” benefit. The whole concept of “treating the mental illness” that supposedly caused a violent crime to occur begins to fall utterly apart. There is no objective, obvious medical problem, so people start making things up to create “evidence”. The fact that a guy says he’s not mentally ill now proves that he is, even if no other symptoms exist. The irony, that precisely the opposite logic (he only says he’s mentally ill to avoid prison or executioner no matter what other symptoms exist) had been part of the prosecutor’s argument at trial, is never lost, especially on the public.
The apparent solution to all of this, within the ruling paradigm, is better psychiatry, better diagnosis and better treatment. The problem is that there just isn’t any.
We have come down a long road in Illinois to a point where forensic psychiatry severely demeans both medicine and our law. Several years ago, I saw the Randolph County State’s Attorney spend hundreds of thousands of dollars to keep a man locked up in Chester, although nothing was wrong with him. Three expert witnesses testified for each side, saying with equal conviction that the defendant was dangerously mentally ill, and that he was perfectly alright. The only thing the jury could be sure of in the end was that nobody had proven anything. It was a giant show of nonsense. The media were entertained and outraged as they always are, the AFSCME Council 31 union members defended their paychecks, and a candidate for local office lost his election because of the charade. It was ugly, debased politics: the best forensic psychiatry money can buy! And it’s getting worse, not better, because the state can no longer afford to pay, and patients are more and more likely to disagree with treatment programs every day.
Since that case in Chester, the FDA has ordered black box warnings for psychiatric drugs, mere placebos have proven to be almost equally as effective, and pharmaceutical companies have paid billions in fines for illegal and deceptive marketing. The hoped-for cures for mental illness have been revealed as problematic indeed. Currently, as the American Psychiatric Association prepares to publish its next diagnostic manual, the mental health profession is almost begging them to avoid the embarrassment. The “diseases” themselves are as discredited as the cures! In short, my clients are certainly not the only ones saying they just don’t believe in psychiatry. A necessary solution will be to actually separate this pseudoscience from the law.
Specific problems (examples)
The definition of “mental illness” as that term is used anywhere in Illinois statutes and regulations is established by 405 ILCS 5/1-129:
…a mental, or emotional disorder that substantially impairs a person’s thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of life, but does not include a developmental disability, dementia or Alzheimer’s disease absent dementia, a substance abuse disorder, or an abnormality manifested only by repeated criminal or otherwise antisocial behavior.
This definition begs any number of questions, e.g.:
The General Assembly apparently presumed either a difference between mental disorders and emotional disorders, or they intended to acknowledge that mental and emotional are alternative terms for the same class of disorders. The former case would refer to scientific evidence; the latter would indicate the field is scientifically uncertain. What’s the story with this language?
Are the terms, “thought, perception of reality, emotional process, judgment, behavior, ability to cope with the ordinary demands of life” used according to any technical definition, or merely intended to convey regular lay usage and understanding? If the former, where are such definitions found? If the latter, isn’t this whole concept left pretty wide open for interpretation?
Why exactly aren’t developmental disabilities mental illnesses? Is there really any fine line between these concepts, in any individual at any moment? What about a seven-year-old having trouble on the school playground? Can’t this be looked at either way?
Why exactly do we exclude dementia, and Alzheimer’s disease absent dementia?
Why do we exclude substance abuse disorders from mental illness? If a college student gets an ADHD diagnosis so he can have access to stimulants (and perhaps share them with friends on occasion), does he have a mental illness or is he abusing a substance? If a teenager takes LSD and has a psychotic break which lasts a few days, is she mentally ill? “Substance Induced Psychotic Disorder” is an official DSM-IV coded diagnosis. Doesn’t that mean it is a mental illness?
Aren’t all mental illnesses manifested only by behavior which is perceived as either criminal or antisocial to some degree? So how can we exclude those very symptoms which are the sole basis for diagnosing the disease?
The bottom line is that we don’t define mental illness with any certainty or consistency under the law. We can’t, because we just don’t know what it is, as a reality. We only know that we would like to control peoples’ bad behavior without being too mean about it, so a medical model has great allure. To the degree that it’s only a metaphor, or for that matter a lie, well, the complexity mounts up rapidly, the law becomes gibberish.
405 ILCS 5/1-119 depends (!) upon the clarity of 405 ILCS 5/1-129 to further define the circumstances under which we justify depriving a person of his or her fundamental right to liberty, through forced imprisonment, in a locked and barred “hospital”:
“Person subject to involuntary admission on an inpatient basis” means:
(1) A person with mental illness who because of his or her illness is reasonably expected, unless treated on an inpatient basis, to engage in conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed;
(2) A person with mental illness who because of his or her illness is unable to provide for his or her basic physical needs so as to guard himself or herself from serious harm without the assistance of family or others, unless treated on an inpatient basis; or
(3) A person with mental illness who:
(i) refuses treatment or is not adhering adequately to prescribed treatment;
(ii) because of the nature of his or her illness, is unable to understand his or her need for treatment; and
(iii) if not treated on an inpatient basis, is reasonably expected, based on his or her behavioral history, to suffer mental or emotional deterioration and is reasonable expected, after such deterioration, to meet the criteria or either paragraph (1) or paragraph (2) of this Section.
In determining whether a person meets the criteria specified in paragraph (1), (2), or (3), the court may consider evidence of the person’s repeated past pattern of specific behavior and actions related to the person’s illness.
It is not necessary to catalogue the vast number of unanswerable questions this section of our law raises. The totem-pole “reasonable expectations” alone would require a flow chart to even begin to decipher. The bottom line? This “law” is embarrassing nonsense. It cannot possibly constitute any common social understanding or agreement, and it only serves to allow some remote, designated expert to decide, according to whim, who gets locked up and who may walk free, who is allowed rights as a human being and who is dehumanized.
Sections 405 ILCS 5/1-129 and 405 ILCS 5/1-119 are two examples with which I am particularly familiar, but they are by no means exceptional or even the most glaring instances of problematic law and regulation due to scientific and medical confusion over mental diagnosis. The fields of school law, child protection, disabilities, health care, employment, discrimination, and welfare are all hopelessly infected (please excuse the irony of my metaphor).
Conclusion
There may come a time when such nonsense as I have described above earns more open and widespread cynicism about the law, medicine, science, and reason itself. Illinois has an unfortunate reputation already in the world of politics. We should not bear this additional burden of disreputable psychiatry, which weakens the fundamental bases of our culture.
House Resolution 898 is a careful statement of the problem, and it merely calls for an organized, democratic evaluation. I believe it will enable our state to get out in front of these issues, avoid much worse controversy down the road, and actually save much expense in lives and treasure.
I therefore respectfully urge you to pass HR0898.
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