Sorry if I missed that AHunter. Sounds right to me.
That is an interesting point. It seems sometimes that the best way to guarantee that you will get treatment is to pretend to refuse it. It is a disgrace the way that people have to suffer because they can’t afford the medications. I was fortunate that my insurance was continued when I became disabled.
It’s good that you have found a good physician. It makes all the difference in the world. And to a patient who is mentally ill, a psychiatrist can be very knowledgeable and respected by his colleagues, but if he is cold or abrupt or hateful to his patients, he is not good. I had one of those too.
AHunter3, I see your point. We can’t arrest people for what they might do. At the same time, waiting until someone has third degree burns or is lying in a morgue is going too far the other way.
I’m not sure of the law, but I think that threats are assaults and against the law. They would have to be proven beyond a reasonable doubt just like any other crime. Restraining orders should be taken more seriously and fully enforced. And stalking laws should have a bigger penalty for violation.
I don’t know the statistics on the correlation between violence and mental illness. The people that I’ve known on locked wards have been the salt of the earth. If they were dangerous, I suppose they would have been put somewhere else. The schizophrenics that I have known either seem to be absolutely tortured souls who “see” the most frightening things happening around them, or they have been convinced of their extraordinary spiritual insight and are happy to be as they are.
One of the most fascinating conversations I’ve had lasted for hours over dinner with a young woman that my husband and I met at the steps of the Capitol. She was brilliant, sensitive, gracious and paranoid. I think of her often.
DSeid, I realize that I have strayed from the topic and I apologize. As I said before, my experience with involuntary confinement was long ago. But there was one incident that I can relate that proved to me how horrible the system was at least then.
After I had signed myself out of the state hospital and returned to live with my parents, they were so afraid that I was going to take my own life because I had been suicidal two months before. And that awful psychiatrist that had misdiagnosed me had insisted I would be dead in six months without further hospitalization.
I still had a cold and sore throat and went to see our local internist. Without my being aware of it, my parents had contacted him to ask his accessment of my condition mentally.
So there I was, feeling physically awful and taking 300 mg of thorazine (and melaril, stellazine, trofanil). (Only this one doctor had ever diagnosed me with anything other than depression.)Does it seem reasonable that I am going to seem like my old self? Of course not. He saw me for ten minutes and sent me home.
While I was on the way home, he called my parents and said that he agreed with the psychiatrist that I should be confined in a state hospital. Without my knowing it, my parents had apparently gotten a court order and all they needed was the internists agreement with the psychiatrist. I have never understood how this was handled – only that I was not present in court. My father was well-known and highly respected. Maybe his word was enough.
Mother had packed my bags and one of my Dad’s friends had come to drive us the fifty miles to the state hospital.
All that was left for me was to plead with my father. We were very close and he was so afraid for me. He also knew what clinical depression is like. We cried together and he told me that if I did anything to hurt myself he just wouldn’t be able to survive it. That got through to me.
I didn’t have to return to the state hospital, but only because I had the trust of my Dad. After that, when I had suicidal impulses, I put myself on automatic and went to a private hospital. But that was sixteen years later. Once I was taken off of the wrong medications perscribed by a doctor who was himself suicidal, I was able to work and eventually return to school.
Incidentally, I had mentionally earlier that this psychiatrist eventually committed suicide. You might want to know what became of the internist that I saw for the sore throat and cold. He was admitted to the same state hospital that I was to be sent to. It was one of his last attempts to detox from drug addiction. He was eventually found dead in a shoddy hotel room of an overdose. What a waste. He had a lot of potential.
For me the system had absolutely no protections.
And I can only imagine how having all control removed from you makes someone, who is already feeling that they are being subjected to biological forces beyond their control, feel.
I have never been diagnosed with a mental illness myself, just lucky so far, but have had close family admitted (voluntarily) and, along with some excellent docs, subjected to a few docs who seem to get off on the disproportionate power that they, at that moment, have. Even as a family member we are in a very vulnerable position. To be any further infantalized is unconscienable.
I can feel for your parents too. The illness of severe depression comes with hopelessness. Your father knew that there was real reason for hope and that you may not be able to see it. His fear was real as many of those seriously depressed will have the strength to complete a plan only as they begin to apparently recover. In my family’s case we had the resources to not have to let the depressed loved one ever be alone until full recovery. Not all families can pull that off.
But what would we, should we, have done if she was so depressed and so hopeless that she refused to take meds “because it won’t help nothing will help I’ll be like this forever until I die” (repeat)?
AHunter, your proposals seem modest and reasonable. I presume that the big advocacy groups (NAMI, etc) have not jumped on board (given your asides). What are their objections to advocating for these basic rights?
It was once accepted knowledge that commitment was a great relief for patients, who were able to retreat to a safe and secure shelter, far away from the stresses and problems of their normal lives.
No, really. People once thought they were doing patients a favor by having them committed.
Then people actually got a clue and realized that having all autonomy stripped away is extremely stressful.
[sigh]
Zoe:
Yeah, I think this is the right track to be moving on.
I worked for four years as an elder abuse social worker in the Bronx in the mid-90s. We found that the laws provide pretty decent (not ideal, not perfect, but pretty decent) protection if one is being abused by a blood relative, a relative-by-marriage, or a sex partner outside of marriage. Family Court will address abuse (including stalking and variations on violation of privacy) when the abuser fits into one of these categories without requiring that the abuser first commit an arrestible crime. The Orders of Protection are generally constructed around “leave her[or him] alone” lines and are generally crafted so as not to impinge on the general rights of the alleged abuser (who has not had a day in court) – i.e., you can’t get an OOP against your brother with whom you’ve been splitting the rent that orders your brother to leave what is as much his apartment as it is yours, but your brother can be ordered to refrain from approaching you on the sidewalk or calling you up at work.
For non-relative abuse, the laws are poorly written. In the case of elder abuse, it usually came up in cases of abusive neighbors or sometimes abusive landlords or tenants (where the abuse took a form other than violating the terms of the lease or rental arrangement, I mean). Family Court would not take those cases, and Criminal Court would not do anything to restrict one person’s activities (even a “stay away from person X simply because person X wants you to stay away”) until and unless the person in question had violated the law such that arrest would be nominally appropriate. In practice this meant that death threats, other forms of verbal harassment, stalking, etc., were rarely considered sufficient. I think better laws are needed here. I don’t think one person should get into legal trouble simply on the say-so of another, but I think any person should be able to get a legal order telling another person to refrain from approaching them, insofar as I don’t think people have any general right to go approaching anyone once they’ve been told by the approachee that this is not appreciated.
Some areas of conduct more readily than others led to an ability to obtain Criminal Court OOPs: telephone harassment (there are some laws with real teeth in them making telephone harassment an arrest-worthy crime), verbal threat in conjunction with physical contact (e.g., threatening to kill someone while you’ve got their forearm clamped in your fist), verbal threat in conjunction with brandishing a weapon (e.g., threatening to cut someone while actually holding a knife).
Laws in some places and in some specific behavioral areas have improved since then, but personal violence is still sort of a half-completed patchwork of laws. Domestic violence center social workers and advocates will attest to that!
DSeid:
NAMI came onto the stage back when there were more vestiges of Freudian beliefs floating around in society in general, and those theories tended to blame parents (especially the mother) for the psychosis of a child, so NAMI, composed in very large portion of parents of psych patients, tended to embrace the medical model of mental illness. Believing that their kids were sick as a consequence of having a brain disorder that required medication was much nicer than being told that it was something they had done wrong, especially to the extent that any parent worries that it was something they did wrong when something like this happens with their kid.
Then, once there existed a NAMI with that strong tendency, it was friendly turf for parents and relatives whose relationship with their mental-patient child or other relative was more antagonistic: the medical model by its very nature locates the problem in the brain of the patient and removes agency, meaningful intention, feelings that exist for a genuine reason, and so forth from any necessary consideration: my unruly daughter has these unwanted behaviors because her neurons are all fucked up and therefore I do not have to listen to her or attach credibility and meaning to what she says in anger, it’s all symptoms. And every undesireable behavior then becomes a symptom. And the eruption of undesirable behaviors can at any point be dealt with as “decompensations” – call the psychiatrist, who calls the cops, kid is taken to psych ward for the weekend and comes back with a bloodstream full of decanoate injection and a brain full of cotton wadding and a tendency to behave with less fervor and antagonism.
Then add in some funding. Pharmaceutical companies have obligingly funded NAMI and provided them with extensive material and worked hand-in-hand with NAMI to help educate the community to the effect that mental illness is a biochemical brain phenomenon so if your family member is lackadaisical or quarrelsome or has strange ideas maybe what you’ve got is a Prolixin deficiency disease. And parents of newly incarcerated kids come to NAMI worried and confused and get an Eli Lilly or GlaxoSmithKline pamphlet dropped in their lap explaining that their son’s rants are just neurostatic and don’t mean anything other than that his chemicals need balancing.
Now jump to conferences and political agendas and whatnot and NAMI finds us sitting at the same tables and our emphasis is on ending involuntarism, exposing misinformation about psych drugs and electroshock, and questioning the glib reductionistic medical model of mental illness. And we don’t like them positioning themselves as “the advocates for the mentally ill”. We’re the advocates for the mentally ill, insofar as that would be us and we are self-advocating, and we find that in your (NAMI) support for forced treatment you are advocating for our oppression.
Naturally they are not real fond of this. They like to ignore our existence. They seldom acknowledge us unless we are already right there (i.e., if someone interviewed them about involuntary outpatient commitment or something they would not mention the existence of “consumer/psych survivor/ex-inmate liberation” advocates -aka “CSX”- to the interviewer).
For a taste of the kind of confrontations our two groups have had, go to this link and scroll down to three-quarters page or do a Find for “little story about a conference” on the page and read that section.
AHunter3, it was in another discussion of mental illness that we had our previous disagreements about the usefulness of medication.
I won’t go back over my views again, but as before, I am so in awe of your activism. Both of us are searching for the same thing in the long run. You certainly have my respect.
AHunter,
I think, judging from comments on another thread, that you have realized that it is possible, just possible, that your ideas on involuntarism get discounted by their being wrapped up with ideas that there would be much less consensus about. And you probably will accomplish more by finding ways to work with organizations like NAMI on issues that you can likely agree on …
Yep. Selling the important part of the perspective is the name of the game, not being right about everything 
Our loose objectives with NAMI are to form non-adversarial working relationships around issues like quality of physical medical care in the institution (parents are unhappy about their kids’ physical-ailment symptoms being ignored altogether or marked down as delusional symptoms) and less restrictive communication (wards are often equipped with one patient telephone, often a pay phone, that all inmates have to share and make use of only during very short windows of opportunity), while trying to engage them one-on-one about the involuntarism.
It’s not easy; in some locales they have developed ideological antipathy to us. Our latest flareup with NAMI was over our attempts to get a bill passed in NY state requiring reporting of complications and morbidity and mortality in electroshock. NAMI came out against the bill after deciding that the bill was biased insofar as it only required collection of the bad outcome data, and they said our real purpose was to set the stage for banning electroshock. (We are trying to ban involuntary electroshock, actually).
Our Thomas Szasz line makes it easier for them to dismiss us as fruitcakes, and mine is representative of two current perspectives in the movement that are trying to de-emphasize the whole “there’s no such thing as mental illness” stance as counterproductive and unwinnable. (How could we know? I don’t believe in it much as I don’t believe in telepathy, but it’s a “skepical, unconvinced” unbelief not an “ain’t no such thing” unbelief. It’s rarely good practice to assert your certainty of the nonexistence of anything).
There may indeed be such a thing as mental illness. The question is whether we can identify it as such with our current knowledge and technology.
That question underlies the existence of yet another faction, which it could be said I am a member of, that is unfortunately opposed to NAMI. Although all factions would agree that the mentally ill need to be treated properly, they disagree on the nature of the appropriate response.
I am not at all sure that your willingness to overlook NAMI’s false positions will be wise in the long run, AHunter3. There are issues on which it would not be honest to compromise.
Yeah, I know.
The way we usually word our rare joint statements after 96 hours of table-banging argument is usually along the lines of “mental condition conventionally described as ‘mental illness’, which in any given case might have a physical genetic or biochemical cause, might have a social or environmental cause, or may be due to some combination, a full and accurate etiological understanding does not exist as of yet…” after which point “mental illness” is carefully avoided by using phrases like “psychiatric diagnosis” so as to avoid the “do we put quotation marks around ‘mental illness’ or don’t we” argument which is worth another 96 hours by itself.
I do acknowledge your point. I don’t want to go on record as endorsing medical model, I just want us to avoid making medical-model the primary battlefield.