Is manic-depression a disease to be cured?

AHunter3, I’m glad you brought up some of these points.

In the past, it was very difficult for me to find a suitable counselor. My family is Jewish, and there were some cultural issues that a non-Jewish therapist would find abnormal if not pathological. I’ve also found the converse to be true; that is, a therapist can operate under some major misconceptions about a person’s culture.

I’ve also had the misfortune of being “ordered” to go into counseling as a young-ish (maybe 9 or 10) child. I was being bullied constantly by a group of older boys, and found the only way to make it stop was to bring a razor blade to school, with the intention of using them. These boys were bigger than I was, and they reinforced it by physically assaulting me. Since I knew I’d be the one to get into trouble if I fought back, I didn’t bother until I brought the blade.

My point is, the therapist I was forced to see turned the situation back onto me. It wasn’t the boys’ fault for beating the snot out of me; it was my fault for being such an attractive target. Imagine the messages I got from this. I grew up feeling that I was odd, and that odd is bad. (Now that I’m older, I don’t care how odd I am, because it doesn’t matter.)

So, it’s important to “audition” therapists to find one who’s going to work for you.

Robin

How do you know that? How come you know that YOU are the only sensitive one here? Oh sure, YOU recognize there is a current injustice no one else sees, but NO ONE here would have recognized the injustices in 1961, because we ALL FELT THE SAME BACK THEN.

Look, I have plenty of distrust of forced committals, especially those that impose a financial burden on the committed, but to say that I myself don’t hold views that will be considered cutting-edge for my time, nor would I be able to see the inherent skewedness in another age, is a big assumption.

Huh??

I make no claims for being gifted with spectacularly unusual & empathic insights. I happend to understand the schizzy lib stuff because I’m on the receiving end of the shit, not because I’m more sensitive than thou. In 1961, the people who got it about homosexuality would have been almost exclusively gay themselves, but because of the movement and its message a considerable portion of the rest of us get it too – nowadays.

But sorry if I’ve offended you. I think.

And why “especially those that impose a financial burden on the committed”? That’s like deploring the activities of Pol Pot because he caused so many families to lose their farms and cattle, isn’t it?

Peace, AHunter3! :slight_smile:

I knew I’d be called on this. What I mean is that, despite the fact that forced committals are nasty no matter what, there will still be people who will benefit by it, either patients whose lives were saved, or victims of patients who would have been harmed by them. So, in essence, one must balance liberty versus safety, and I am not sure which side to lean on*.

On the other hand, when money comes into the equation, you have the double effect of depleting the resources of the patient while at the same time creating an incentive for the psych. community to “diagnose” as many people as possible, for financial gain. Now, if the diagnosis is incorrect, the patient AND their insurance company should NOT have to pay, someone else should, most likely the facility or the government, then the facility could sue, if they wanted to, the person who called the person in to recover damages from the frivolous committal.

*Although I am sure that probably the police, perHAPS psychologists, and definitely not judges should be the ones to decide if someone is criminally dangeous, since the police are the ones who deal with acts of non-psychologically disturbed violence.

In point of fact, Ludovic, this is a lot less likely to happen now than it used to.

In the Seventies and Eighties, there was such a profit motive to mental-health services that psychiatrists were holding people against their will purely for the money these patients’ insurance would pay. And the insurance companies, for their part, were complicit in this abuse, because they’d pay whatever the hospitals demanded without question. Got a kid who got caught once with a pill? He’s an addict, get him into a six-week rehab program. Who cares about the cost; the insurance company will pay, and we get credit for another patient. Makes the bottom line look good for Corporate, dontcha know.

As a consequence, insurance companies stopped covering mental health services as comprehensively as they once did. Services were severely restricted; some patients couldn’t get help at all.

Now, the pendulum is somewhere in the middle. New laws have helped patients get access to mental health services, while demanding accountability from therapists and hospitals to justify their decisions. An insurance carrier can (and often will) ask for information to justify lengthy courses of counseling (in the form of progress notes). Inpatient care now requires precertification to make sure that is the best course of action for the patient.

In Pennsylvania, where I live, an insurance carrier MUST cover at least 60 outpatient or office visits AND 30 days of inpatient care. (This is Act 150.) The patient can swap 1 inpatient day for 2 outpatient visits. However, as I said, the carrier can refer a patient to Case Management to make sure their dollars are doing something for the patient besides of fattening a shrink’s wallet.

Robin

Well, I acknowledge that there are financial issues. I usually think of them as being in the “insult added to injury” category, like Linda Andre who was charged for the electricity used to give her involuntary electroshock. More often than not, insurance companies eat it, and some hospitals are notorious in our community for suddenly determining that stabilization has occurred right around the time the insurance benefits run out.

The biggest economic/financial damage done by psychiatry is loss of housing: you’re not dirt poor perhaps but paying your monthly rent eats up a big part of your monthly income and then POW you get committed, and then if you’re reasonably lucky you get your tongue out of the gears of the system only to find out that eviction proceedings were started while you were locked up because you weren’t paying your rent. You may in fact be homeless, or you may end up that way after not much longer. And then of course people will say you’re homeless because you’re mentally ill. (Certainly some people are indeed homeless as a direct consequence of their mental condition, but there are also a lot of homeless people who have pyschiatric intervention to thank for the loss of their rental situations).

No, I don’t buy that. Who benefitted when Leonard Roy Frank was committed?

I think it is still statistically true that we (people who have been labeled “mentally ill”) are no more likely to assault people than folks not so labeled, and furthermore that the psychiatric profession has not shown itself to be an accurate predictor of future dangerousness. You could not have been reading my posts if you still think that when involuntary commitments occur “there will still be people who benefit from it”.

There may now and then be involuntary commitments that benefit someone. That’s not sufficient reason for them to continue to exist.

Before psychiatric treatment is forced on a person who doesn’t want it, it should have to be proven that the intended recipient is incompetent according to the legal standard thereof, without reference to psychiatric diagnosis. (i.e., whether I am a schizophrenic or not is completely irrelevant – to force treatment upon me it should be necessary to show that I’m incapable of making my own decisions and that I am in need of a guardian, as if I had late-stage Alzheimer’s or something).

It seems to me that perhaps even sven and a few others are failing to sufficiently consider and empathize with their loved ones and others with whom they come into contact. Everyone I know personally who suffers from bipolar disease is surprisingly egocentric when it comes to analyzing the impact of their illness and their decision to take medication or not, almost always focusing far more on how they feel about it than the effects of their medically uncontrolled disease on others.

In one truly sad case, the wife of someone suffering from bipolar disease killed herself apparently out of the extreme anguish and frustration and sense of failure she experienced because she couldn’t manage to get through her husband’s “selfishness shield” wherein he refused to take his meds because he didn’t like how he felt on them, regardless of the huge cost he was making her pay in terms of the incredible emotional and financial stresses his illness brought upon the marriage.

In my experience, this is an all-too-typical dynamic. The sufferers I’ve known who elect not to take their medications consistently give far too little regard to the costs of their selfishly anti-medication stance on their loved ones and friends and coworkers, essentially expecting them to yield their own happiness to the happiness of the sufferer. This is just one of the consequences of the phenomenon discussed earlier in this thread whereby the illness in the absence of medication results in making the sufferer exceptionally susceptible to very poor judgements regarding their own treatment.

It is for such reasons that I can’t help agreeing with those posters who’ve expressed similar thoughts – and as I’ve suggested in the past after the mentally ill brother of a friend of mine viciously murdered his own mother with an axe after deciding that he didn’t want to take his medication any longer – that there’s a vital societal interest in isolating (even forcibly, if necessary) those among the seriously mentally ill (which ordinarily wouldn’t include depressives or the bipolar), who would otherwise present low risks to society as long as they continued to take their medication but nevertheless refuse to do so. I’m a strong advocate of expansive civil liberties, but I’m an ever stronger advocate of the most basic civil liberty of defending life itself from those who are unable to control their own behavior due to their mental illness. (I’m glad to see some support for this idea in this thread. When I expressed this same idea some time back, I was roundly condemned as a malevolent “enemy of civil liberties”)

So I should drug myself so that I don’t bug anybody?

No. If I am going to change my brain, your damn right I’m going to be concerned about what it will do to me. Because my brain is all I got. It’s who I am. It’s me. And I really don’t care what my mom, or aunt Susan, or my next door neighbor thinks I should do with my brain. If you could change your brain to make you more likable and easier to be around, would you do it? Of course not. You probably have the same standards for mucking around with your brain chemistry as I do- which is that there better be a damn good reason to.

This is exactly what I get upset about. I’m sorry it’s so inconvient that I’m crazy. I’m just…you know…trying to figure out the essense of self, the meaning of life, the role of myself in society. I know it makes your luncheon a bit uncomfortable when I’m grappling with these issues instead of complimenting your cucumber sandwiches. I’m glad you like the life you’ve got going for you. Theres times that I’m not too thrilled with mine. But I really don’t think the automatic solution is for me to change myself so that I’m happy with your life, too. I’m still thinking about it. Still trying to work things out. I may never mesh seemlessly with the rest of the sane world. I’ve got some pretty fundamentally different ideas about reality. And I’m not convinced that they are wrong just because they arn’t what everyone else thinks.

I’m not saying that my way is any better or any worse than yours. But it’s the way I’ve been given and the life I know. I won’t actively hurt anyone. I’ll work my hardest never to have dependents, and if that should happen I’ll realize that I have responsibilites that extend beyond myself. I will always strive to be honest and earnest about the things that I do. But in the meantime, I’m not going to swing my whole world around just so that I don’t ever run the risk of causing a scene now and then. There are some things that are more important than keeping the status quo, like being true to oneself, even if that self.

…errr…

even if that self is a little nutty.

Yikes!!

Thank you for demonstrating with all-too-disturbing candor the truth of exactly what I was talking about.

You mean, “Screw my loved ones and everyone else if they don’t slavishly bow to my selfish need to do whatever the hell I want,” eh?

How about we put the normal ones on enough tranquilizers that our egocentric and eccentric behaviors no longer upset them and drive them to suicidal acts?

This fellow ambushed is looking rather upset to me, and given his state of mind and his sentiments, I fear that he might try to assault one of us. What do you think, even sven? Do you concur?

Come now, mister ambushed (hee hee hee gotta love it, perfect screen name for the situation). It’s for your own good, you’ll be less upset. And even if that isn’t entirely true, you’ll be less upsetting to us…

You must not have been reading my posts when I said that a person should be held as a legal danger to others or themselves, rather than per a psychologist’s opinion. Since the only reason to hold people involuntarily is for safety, and legal authorities (i.e. cops) are the ones most experienced in safety from the non-psychiatric standpoint, it stands to reason they are the most competent in determining an individual’s danger, period. The only downside is that they, too, could be in some cases too rash to commit someone out of fear of bad PR if that person is indeed dangerous, but they have to deal with that sort of pressure anyway in their everyday dealings with people. IMO they arent perfect but they have more experience.

In other words, a situation needs to be pretty close to a situation in which you’d call the cops, anyway, regardless of mental condition, before I would acquiesce to forced committals. But doesnt mean I want to do away with them altogether.

Look at your own reasoning, in light of what I’m about to say.

Cops aren’t clinicians. They aren’t trained to recognize psychopathological behavior; they’re trained to recognize criminal behavior, which is as it should be. Someone who is behaving consistently with mental illness may not be breaking any laws, yet they may still be a danger. Since they’re not breaking laws, the police are powerless to intervene. There have also been situations where mentally ill people were killed or severely injured because the police did not know how to deal with them.

Which brings us back to the issue of having a psychiatrist certify a commitment. Psychiatrists and psychologists are trained to recognize psychopathology; it’s what they do. True, there may be a profit motive to committing people, but this is easily solved by removing that. It’s not that hard to do; all the law has to do is specify that the psychiatrist authorizing the commitment must have no financial or other relationship with the patient.

Robin

even sven, that’s fine. However, say someone with bipolar disorder has a child. Said bipolar refuses to take her meds, yet without them, she cannot care for her child properly, and refuses to let someone else care for the child.

Is THAT right?

Mental illness DOES have a lot of stigma attached to it, and that’s one thing I get so angry about, practically on a daily basis. I have Obsessive Compulsive Disorder. I can’t change that. It’s there.

But my disorder is not who I am. It’s something that has an adverse effect on my life, and I can’t function without medication. I don’t like having to take my meds-but I do anyways, because otherwise, I’m a wreck. And that’s not fair to myself, or my loved ones. The main reason this sticks in my craw is because for ages I’ve had people tell me I don’t REALLY need my meds, and I should go without them. And when someone else says that Oh, meds are just to drug someone into submission, that pisses me off. Because that’s NOT true.

We’re not talking about someone asking you to cater to THEM, we’re saying-if your actions are having a negative effect on those you care about-and you (generic you, not YOU, personally) refuse to change that-what does that say?
If a person cannot function in society, without medication and/or treatment, but refuses to get that treatment, then that person should not expect everyone else to cater to him/her.

However, I do think ambushed is rather harsh. I don’t think those of us who have a mental illness and/or disorder are any different from someone with a physiological illness who needs treatment.

Ludovic, would you want police officers to have the authority to arrest and detain you if that police officer happened to hold the opinion that you might do something dangerous? Wouldn’t you prefer it to be the case that the police officer can only arrest you if the police officer is going to charge you with a crime, and that you have some protections against false arrest? Is there anyone on this board who – without reference to the presence or absence of psychiatric diagnoses – thinks the public good would be well-served if police officers could arrest anyone at any time on the basis of thinking that the person is dangerous and might do something violent?

Put those hands in the air. Higher, so I can count them.

All right, now the rest of you: justify treating someone different on the basis of alleged psychiatric condition. If I’m a law-abiding paranoid schizophrenic with delusions of grandeur, why the fuck should I be subject to detainment and arrest (let alone forced psychiatric treatment!) just because some grandiose personage with delusions of omniscience thinks I might do something?

I should not be held responsible for what you, some cop, or some shrink thinks I might do.

If I engage in an arrestible action – an action that would be arrestible if any John Q Citizen engages in it – then you get to intervene. That would include making threats.

If you think I might hurt myself as a result of being incompetent, start a guardianship proceding and me and my lawyer will be present to contest your allegations. If it’s an emergency – i.e., I’m climbing bridges or apparently trying to hurl myself out of windows or something – the police have the authority to intervene immediately.

Aside from those rather narrowly constructed responses, though, your opinion of my mental processes should not count for much.

And the presence of an MD and a specialization in psychiatric medicine on your resume shouldn’t change that.

I have to ask-what happens then when someone IS a danger to him/herself and/or others?

Let’s pretend my next-door neighbor is. (dangerous, I mean) What happens next is he acts on it, or he threatens to; or else he doesn’t.

If he doesn’t, the world keeps spinning on its axis and nothing in particular happens. My next-door neighbor may be, as Ian Anderson once put it, “eyeing little girls with bad intent”, perhaps from his apartment window, but insofar as he hasn’t done anything yet (not even downloaded kiddie porn as far as we know), we don’t do anything, even if both you and I are convinced that Mr. Neighbor is Evil in the Making®.

That’s the American justice system, that’s its basic premise. We intervene when people actually do something, in order to stop them from doing more of the same; but we do not intervene when we think someone might do something.

So if what happens next is that Evil Neighbor confronts some little girls and asks them things like if they’ve ever seen an adult guy’s parts, maybe that’s enough to take some action, yes? I’d think at least an Order of Protection making it a crime for him to approach them again, and now we can open a file on the dude. Mister Child Sexual Abuse Waiting to Happen, we got your number. As of yet, though, I doubt that he’s committed an arrestible crime.

That’s the gist of it with regards to “danger to others”.

Danger to self works a bit differently. It is a victimless crime but common law says you dont have an unimpeded right to bleed all over my rug or litter up the streets or rivers with your corpse, and that you or I or Society in the form of its uniformed representatives are within our rights to intervene if you threaten suicide or engage in action that looks rather specifically geared towards killing yourself.

But suppose we’re worried about Joseph, the young 20something guy down the block. He seems to have a death wish. He’s joined one of those clubs where folks climb trees and mountains using ropes and not much in the way of safety equipment, he rides a motorcycle in rush hour city traffic and weaves in and out of lanes, and perhaps more to the point in conversations with us at parties and such he says provocative things about preferring to live a short electrically charged life full of risk and dare because whenever he is safe he is so bored that the prospect of remaining alive for years to come makes him wish he were dead.

What comes next is, he either does something overtly and immediately self-destructive like playing Russian Roulette with a loaded revolver or he doesn’t, and if he doesn’t we don’t get to intervene against his wishes. (We can berate him and plead with him to take some safety precautions, that’s about it).

Then there’s Tom who is walking out into the midst of the West Side Highway and attempting to lay his hands upon the hoods of the rushing cars and says he is “blessing” them, which would seem to constitute “danger to one’s self”, don’t you think? We can call the police to get him out of the road (or drag him to the curb ourselves if we’re so inclined) and if this kind of thing happens often we can initiate a competency hearing to see if he is so out of touch with reality that he meets the legal criteria for “lacking capacity”. If he doesn’t, though, he’s in a grey area and what happens is that we err on the side of respecting his right to make stupid judgments and engage in silly behaviors as long as it seems that he knows what he’s doing and understands the risks and issues.

How about Laura, though? She’s extremely nearsighted but refuses to wear her glasses, and fumbles around when she travels, needing to get within inches of signs to read them and otherwise has to ask questions of strangers; when we last went to visit her, she was lying face down in the garden in back of the house. Later the same evening, she says she is profoundly unhappy about something but won’t tell us what, and she asks you to step on her chest and put nearly your full weight on it because it makes her feel better because it matches how she feels inside. Oh, and she has something she wants to show us in her room, and when we go to her room it looks like she has every piece of paper she’s ever owned since she was in 3rd grade lying in piles on the floor, and she crawls around blind as a bat on her floor peering at different piles until she comes up with a petition she thinks we should sign. And she has lots and lots of clothing, some folded in piles and some kind of wadded up, also on the floor, along with some blankets and pillows and it looks like she sleeps on the floor too. She has this really intense way of talking, like she’s coldly angry, talking very fast and clipped and moving from one subject to another often with very little warning. Oh, and she has a psychiatric history but is not taking any medication and does not see a psychiatrist. She says they try to poison her. What do you think we should do about her?

What I did was work with her and try my best to keep up with her, as she is one of the hardest-working and efficient leaders in the movement. She’s one of us and this is how she is and she is entitled to be left alone. Protection and advocacy groups and conference leaders and workshop leaders in the movement all across the country and internationally know of her and her work.

even sven

We don’t care how you accomplish that goal. The discussion starts when the bugging won’t stop. Change the way you behave, seek talk therapy, take drugs, cook up some weird delusion were you “pretend” to be someone else 24-7. As long as you’re not bugging anyone, the issue of your brain isn’t going to come up.

If you are, in fact, “bugging” anyone, and cannot respond to their dialog about please stop the bugging, then eventually, people are going to stop expecting you to stop the bugging on your own, and find some other way to end the bugging.

(As far as I know, you, even sven are not currently bugging anybody. Just using “you” as an example of how to deal with a bugger.)

AHunter3

This is what I think you should do about her: You should teach her to understand that if the way she talks makes her seem coldly angry, and if she often jumps erratically from subject to subject, she can’t expect to be a popular conversationalist. And you might want to try and find out where she got the idea that she’s so important the shrinks feel the need to poison her.