Anyone who is part of, or even aware of, the psychiatric survivor movement in British Columbia will likely have heard of Susan Inman. Ms. Inman writes for the Tyee and the Huffington Post, among other publications. She writes prolifically about the struggles of her schizophrenic adult daughter within BC’s mental health system (the subject of her “After Her Brain Broke”). Here is her latest article.
In it, she sets out several problems she sees with British Columbia’s mental health system. For starters:
“The public isn’t learning about early warning signs of illnesses like schizophrenia, the steps to take when they see these signs, or the kinds of treatments that are evidence-based. This ignorance also contributes to stigma, since people can easily assume that the disturbing behavior they have witnessed from someone in psychosis is freely chosen.”
No. Both the science and our experience show clearly that the opposite is true: When people are taught that psychotic disorders are neurological illnesses, stigma against the mentally ill gets even worse. Also, anti-stigma campaigns that focus on brain-based understandings of psychiatric diagnoses are quite prevalent, so the idea that “the public isn’t learning” is incorrect.
“In seeking to eliminate involuntary treatment, they [the Council of Canadians with Disabilities] argue that the current Mental Health Act is unjust…”
Again, no. The CCD is being represented by the Community Legal Assistance Society and neither CLAS nor its sister organization, Health Justice, are seeking an end to involuntary treatment. This is just fear-mongering on Ms. Inman’s part and reveals her lack of understanding of the issues.
“The CCD never seeks to educate people about or even acknowledges that people in the midst of psychotic episodes are not able to make rational decisions…”
Here Ms. Inman asserts that every person experiencing psychosis lacks the capacity to make treatment decisions. This is highly offensive and, more to the point, is patently false. In 2009, I was psychotic, running around in winter in bare feet. Again and again, I sought treatment but was turned away from Psychiatric Emergency Services at the Royal Jubilee Hospital. A psychiatrist at PES told my mother to stop “enabling” me by bringing me to the hospital for help. I deteriorated even further and ended up in the criminal justice system. One of the terms of my probation was that I receive involuntary psychiatric care. The practice of forcing people into the very treatment they had already been seeking is just one of the reasons why an increasing number of us have become critical of psychiatry and are demanding reform.
“While we do not have adequate public mental illness literacy campaigns, we do have high profile and very public communication promoting the notion that all mental health problems arise from adverse social factors.”
“The president of the American Psychiatric Association recently published this kind of article in Newsweek. It fails to give the public any idea that, for example, genetic research continues to make progress in searching for causes of schizophrenia.”
Continues to make progress? What progress has it made so far? Studies have
found that genetic factors explain less than 3% of why someone gets a diagnosis of schizophrenia, while social, environmental, and childhood factors have a much higher explanatory power, about 17%.
“At family support groups, it is clear that a central problem is that too many people do not stay on anti-psychotic medications that they need.”
And the usual explanation given for this is that patients don’t understand that they need these drugs. I don’t know that anybody needs these drugs over the long term but, even if they do, where is the mention of side effects and strategies to mitigate them? Rapid and alarming weight gain, fatigue, emotional dulling, metabolic syndrome, diabetes, tremors, seizures, tardive dyskinesia, and brain shrinkage are all too common and are either ignored or minimized by psychiatrists.
“This is a link to the study group in Vancouver connected to [the Hearing Voices Network]; too often, this group focuses on leaders in the anti-psychiatry movement. In this instance, the group was exploring the beliefs of Will Hall, a frequent writer for Mad in America. He is especially known for his book encouraging people to “safely” get off their anti-psychotic medications.”
So where, exactly, are we supposed to turn? It’s a rare psychiatrist who will help someone taper off psychiatric drugs. That leaves people quitting the drugs on their own, often too quickly, and experiencing rebound psychosis. And then, inevitably, “symptoms” directly caused by psychiatric drug withdrawal are labeled a recurrence of disease. The phenomenon of rebound psychosis is well documented, and needs to be taken seriously and explored further.
“Disability rights organizations and their allies in academia have made important gains for people with particular disabilities. At the same time, psychiatric survivors have succeeded in supplying the voice of people with severe mental illnesses within these organizations. These are people who usually have had very negative experiences with psychiatry and with medications that they did not need for their mental health problems. As they have been taught, they generalize from their own experiences.”
No. Our growing movement is not limited to those who have had a “negative experience with psychiatry and with medications that [we] did not need.” Many of us have serious mental illnesses and have needed psych drugs from time to time; some of us have been rightfully hospitalized. What many of us are complaining about is not involuntary treatment per se, but rather its cavalier application and attendant abuses, both within psychiatric hospitals and in “assisted” community care. Ms. Inman misses the irony in accusing us of generalizing from our own experiences when that is exactly what she does, here and elsewhere.
“I have not yet seen any disability rights organization acknowledge the existence of anosognosia [here Inman includes yet another link to the Treatment Advocacy Center], the brain based inability of many people in psychosis to understand that they are ill.”
Enough already with the (forced) Treatment Advocacy Center! On a spectrum with Foucault and Szasz at one extreme, we have Fuller Torrey at the other. Torrey’s TAC aggressively promotes forced treatment, striking fear into psych survivors’ hearts. TAC’s fear-mongering and tortured statistics betray an agenda which appears to be having everybody diagnosed with a serious mental illness forced into treatment immediately and forever upon diagnosis.
This is problematic for several reasons, the most important being that psychiatric labels are fluid and the existence of any particular disorder can neither be proved nor disproved. My diagnoses include anxiety, depression, bipolar disorder, schizophrenia, schizoaffective disorder and borderline personality disorder. I find it hard to believe that one person could be suffering from all of these conditions but that’s probably just my anosognosia acting up
Further, TAC fuels stigma by stoking the public’s fear and loathing of the deranged and violent lunatic, a ticking time bomb just waiting to explode. This offensive stereotype is both wrong and unfair. Not only are the mentally ill less likely to be violent than the general population but they also are more likely to be victimized. Nevertheless, Torrey assumes that any violence from a mentally ill person must necessarily be a result of that mental illness. In order to further his agenda, Torrey demonizes the mentally ill in a manner which borders on hate speech. Imagine the outcry if Torrey’s message, rather than discriminating on the basis of cognitive status, were instead applied to disparate racial groups!
Vigorous lobbying from TAC was instrumental in enacting Kendra’s Law in New York in 1999. Kendra Webdale was pushed to her death in front of a subway train. Webdale’s killer, Andrew Goldstein, had sought psychiatric care but was turned away prior to this tragedy. Reportedly, after Goldstein had shoved Ms. Webdale onto the subway track, he turned to a bystander and said “Now I’ll get the help that I need.” The lesson we should have learned from this tragedy is that we need more voluntary psychiatric services; instead, we got a law that forces even more people permanently into the mental health system.
And there are rumblings of expanding the scope of this legislation even further. The New York Post recently published an opinion piece on this very subject. One of the things that is being suggested in the article is to have judges be able to order Assisted Outpatient Treatment directly, without the pesky interference of psychiatry. They’re not even pretending that these are medical issues! It’s just proof, not that more was needed, that AOT is a form of social control.
While claiming to want to prevent violence, Torrey fails to consider that involuntary treatment itself often involves violence. Survivors describe awful conditions on psych wards: being thrown into isolation rooms, being assaulted by security guards, being drugged into oblivion.
“Disability rights organizations have had a lot of success in their efforts to abolish access to involuntary psychiatric treatment. Access to involuntary treatment has become almost impossible in Ontario.”
I can’t speak to Ontario’s mental health system because I haven’t experienced it; I can say, though, that the situation in British Columbia is dire. Disability rights organizations have had no success protecting our rights, at least not in BC. The province continues to be aggressively pro-force and some clients are forced to flee the jurisdiction. At a time when I was mired in the mental health system with no end in sight, I myself considered moving to Ontario.
“Some core ideas in the now widespread recovery model in delivering mental health services are very appealing. The beliefs that mental health systems should foster hope, treat patients with greater respect, and help people be all they can be are admirable. In my experience, good clinicians already were guided by these basic values in their practice.”
Well, that’s Ms. Inman’s experience as a family member; mine, as a patient, has been very different. With the exception of my current psychiatrist and maybe one or two others, I have been treated poorly, often gaslit, bullied, and silenced.
In hospital, I have been put into an isolation room for hours, simply for being rude to the staff. I have been coerced into withdrawing an application for a Review Panel in exchange for release from hospital. I have been denied phone “privileges,” isolating me from my loved ones. The power-tripping and mind games from some of the nurses was difficult to endure, as was being talked down to and belittled by psychiatrists.
After identifying above what she sees as these problems, Ms. Inman moves on to share her proposed solutions:
“Improve mental illness literacy campaigns.”
I agree. We could start by teaching the public that psychiatric diagnoses are entirely subjective; there is no blood test or brain scan or any other objective measure. It is not possible to know the level of various neurotransmitters in the brain; the chemical imbalance theory is exactly that – a theory, and not a very compelling one. Even well-known mainstream psychiatrists argue that the theory was never scientific. We could also let the public know that, although anti-psychotics can be invaluable in a crisis, longer range studies show diminishing returns.
“Provide professionally facilitated psycho-education for clients.”
I agree. We could start by teaching clients that their conditions need not be permanent and that many people recover and are able to walk away from psychiatry forever. Unmedicated people can go months, years, or even a lifetime without symptoms. We have to stop training people to be permanently disabled. We have to give them hope.
“Eliminate the dissemination of anti-psychiatry messages in the delivery of publicly funded mental health services. Lots of people believe in a variety of alternative health care philosophies, like, for instance, the idea that vaccines don’t work. The public healthcare system doesn’t appease these people by publicizing these beliefs or subsidizing the alternative practices they prefer.”
I disagree. We are nothing like the anti-vaxxers and our voices deserve to be heard. There is an abundance of respectable research on our side (e.g. Wunderink, Harrow, Andreason); anti-vaxxers have nothing. Not being vaccinated poses a significant risk to the public; declining anti-psychotics does not.
“Support the laws that protect people with severe mental illnesses and work to reform legislation that leaves too many people left in untreated psychosis.”
I disagree. British Columbia’s Mental Health Act is the most regressive such legislation in North America; it is absurdly easy to have someone involuntarily hospitalized in BC. We don’t have space for willing, voluntary patients desperately seeking help—because beds are mostly reserved for patients who don’t want them.
These are the things BC’s mental health system desperately needs to do:
Expand voluntary psychiatric services.
More voluntary psychiatric beds need to be available. The situation at Victoria’s Psychiatric Emergency Services is ludicrous. We have people sleeping in chairs, waiting days and days to be admitted to hospital.
Psychiatric hospitals need to be welcoming, healing places, asylums in the original and true sense of the word. We need nutritious food, meaningful activities, access to the outside world and, above all, kind and respectful treatment from the staff.
If there were no threat of force and if hospitals offered a safe place to heal, distressed people would be lining up for help. Currently, veterans of our mental health system know that seeking voluntary care is dangerous.
Raise the bar for involuntary treatment.
The current criteria for forced treatment under BC’s Mental Health Act are vague enough to be applicable to almost anybody diagnosed with a mental disorder. A more suitable standard would be danger to self/others and/or gravely disabled.
When someone has been involuntarily admitted to hospital, he or she needs to be immediately provided an advocate at no cost. This is analogous to a criminal defendant being assigned a defense attorney; it’s a basic civil right.
Involuntary treatment should only be used when the above criteria are being met. When they no longer apply, care must proceed on a voluntary basis. The current practice of continuing to force treatment even when someone is stable is obscene.
Abolish forced community treatment (“Assisted Outpatient Treatment” or “Assertive Community Treatment”).
If you’re ill enough to require involuntary treatment, you are entitled to a hospital bed. Currently, people are stabilized and thrown out of hospital way too early and then languish in involuntary community treatment indefinitely.
AOT is insidious because it’s invisible. People are coerced into community treatment for years when they are not meeting even the lax criteria of current legislation. The whole system is based on a false binary: AOT vs. hospital, but those are not our only choices. We need to get rid of forced community treatment altogether; there is simply too much room for abuse.
Ms. Inman has written elsewhere that serious mental illnesses can’t be prevented, but this is often untrue. We need to make people (especially young people) aware that when they smoke marijuana they significantly raise the danger of experiencing first-episode psychosis. Pot is not the benign substance that the marijuana lobby makes it out to be. Likewise, many cases of bipolar disorder could be prevented by doctors not handing out antidepressants like Tic-Tacs. The tragic cycle often entails a bout of depression, followed by treatment, which brings on mania, resulting in a diagnosis of bipolar disorder and then—boom!—you’re well on your way to becoming a career mental patient.
People used to be able to have nervous breakdowns, take some time out, make some changes, recover, and get on with our lives. This is no longer true; any sort of emotional distress is now pathologized and the patient is taught that he or she is suffering a brain disorder that will require life-long drug treatment. This flies in the face of the experience of the many who recover and get on with their lives, without the benefit of psychiatry to guide them.
It’s worth noting, too, that as more and more psychiatric drugs become available, the number of people chronically disabled has skyrocketed. Something is terribly wrong with the status quo.
We don’t need to abolish involuntary treatment, but we can make it increasingly obsolete. We need to foster a humane and effective way to help people in distress. Our movement continues to grow as we organize and find our voice. People like Ms. Inman need to get out of our way.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.