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Paula Joan Caplan's Authors Guild Blog

Suicidal Thoughts, Psychiatric Diagnosis, and What Really Helps: Part One

Originally published at https://www.madinamerica.com/2020/09/suicidal-thoughts-part-one/

 

This piece is the first of a two-part essay about suicide, diagnosis, what doesn't help, and what does help. This part is about suicide, diagnosis, and some of what fails to help.


By
Paula J. Caplan, PhD
September 24, 2020

Portions of this essay are based on the Mad in America webinar, "Issues in Dealing with Suicidal People…and What Experience with Military Veterans Teaches about Nonpathologizing Approaches for All," April 2, 2019.

 

The arena of psychiatric diagnosis, "depression," and suicidal thoughts is a godawful…and dangerous…mess. And it just gets worse and worse.

 

Consider this development: On June 18 of this year, the American Psychiatric Association (APA) issued a news release that they were adding diagnostic codes and definitions for suicidal behavior and nonsuicidal self-injury to the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM).

 

It is already a serious problem that both having suicidal thoughts and killing oneself are, in a knee-jerk way, considered proof that the person has a "mental illness." When someone kills themselves, if they had a psychiatric diagnosis, the suicide is attributed to that alleged mental illness. If they had no such diagnosis, it is claimed that they had an undiagnosed mental illness.The circular logic of this is astounding. And it could not be farther from scientific thinking.

This is illogical, absurd, and dangerous, if we want to find out what really leads to suicide and how to try to prevent it. In this two-part essay, I am recommending a) intensively and sincerely validating the suffering of people who are suicidal, b) avoiding mental illness diagnosis and psychiatric drugs, and c) a great many things one can do instead of the traditional ones.

 

Consider what the DSM conveys about grief, which is often called "depression." When preparation started for DSM-5, the chair of the DSM-IV Task Force, Allen Frances, expressed alarm that what he called his edition's "bereavement exclusion" would be eliminated in DSM-5.This implied that in DSM-IV, he had said that Major Depression should not be diagnosed in someone who was bereaved.

 

In fact, however, DSM-IV includes the statement that Major Depressive Episode (MDE) should not be diagnosed if someone has been bereaved within the past two months. That is alarming enough, because bereavement does not end or, often, even diminish very much after 60 days, nor should we expect it to do so. Thus, it is hard to see what would justify the intensity of Frances' outrage about the DSM-5 authors diagnosing a depressive "disorder" immediately or after two weeks rather than two months.

 

But even in DSM-IV-TR, the instruction not to diagnose a disorder if the "symptoms" arose less than two months after loss of a loved one is followed by this: "unless they are associated with marked functional impairment or include morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation."

 

Note especially the word "or" in the foregoing. One need meet only a single criterion in that list to qualify for MDE even as soon as the first day of bereavement. It is hard to think of anyone who has lost a loved one and not met at least one of those. It is clear that even Frances' editions of the manual actually have no bereavement exclusion. To ignore that this was the case in DSM-IV is to render invisible the suffering and harm caused to grieving people whose bereavement was diagnosed as "mental illness" and often "treated" with psychiatric drugs.

 

What Causes Thoughts of Suicide?
The term "mental illness" is often assumed to indicate that the person isn't thinking clearly, is out of touch with reality—otherwise, suicide would not enter their mind. Those who make that assumption would do well to listen to people who have been suicidal. Many such people say that death is the only way they can think of to end intolerable emotional or physical pain.

Marsha Norman's Pulitzer prizewinning play 'night, Mother is a brilliant example of this. In the play, a middle-aged daughter tells her mother she is going to kill herself that evening. Her mother tries every way she can think of to persuade her daughter to change her mind, but the daughter explains: "I'm feeling as good as I've ever felt in my whole life." She recounts the many miseries of her life, saying she is worn out from trying to make her life better and never succeeding. She says she is "somebody I waited for who never came and never will. I didn't make it." She is at peace, because she finally feels there is something she can do that will end her misery. So, one kind of reason for wanting to kill oneself is to end what feels like unbearable suffering when there is no prospect of change.

 

Trauma of any kind can be a reason for wanting to die, in part because trauma by definition is a horrible experience, and sometimes suicide can feel like the only way to avoid another such experience or to escape from the effects of the trauma. In addition, trauma tends to be fragmenting and disorienting, which makes it that much harder to reach out and connect with others and with resources that can be helpful in dealing with the effects of trauma and avoiding further trauma. Trauma can come from violence, extreme poverty, and forms of oppression including sexism, racism, classism, ageism, ableism, homophobia, transphobia, and looksism.

In more than a decade of working with veterans, I have met so many who have been told they have "Post-traumatic Stress Disorder" ("PTSD"), an alleged mental illness listed in the psychiatric handbook. Elsewhere (https://www.amazon.com/When-Johnny-Jane-Come-Marching/dp/150403676X), I have extensively critiqued this term, but a major relevant point here is that it consists of a list of effects of trauma. It is a dangerous pathologizing of people's reactions to trauma.

 

What would be a "healthy" response to trauma, then? Not being affected at all by seeing a buddy blown to bits or being raped by one's sergeant?! Veterans often tell me that therapists have said, "You have this mental illness called PTSD and will have it all your life." Just being told that could easily lead to despair and thoughts of ending one's life.

 

In contrast, listening to veterans and other traumatized people when they are devastated, rather than thinking about how to label them, reveals that they variously feel grief, terror, shame, disorientation, moral anguish, loss of innocence. Do we want to say that someone who feels despondent when intensely grieving or deeply ashamed is mentally ill…and should be labeled and drugged?

 

As for moral anguish—the reasons servicemembers experience it are well known, but non-military people can also experience it when, for instance, a mother learns that her children's father is abusing the children, and she desperately wants to stop the abuse but is terrified that if she reports the abuse, the courts will consider her a lying troublemaker and give the children to him … as has been proven to happen 2/3 of the time in cases of child sexual abuse.

With regard to loss of innocence: Many people join the military when they are barely out of high school, maybe going from prom to basic training, and at that age to witness war or experience military sexual assault can clearly be overwhelming, causing despair and hopelessness from the shock of having such experiences while so young and unprepared (as if anyone could be prepared for war or military rape at any age).

 

This applies as well to nonmilitary people who experience trauma: Until the trauma, they have had a narrow view of what life is really like, and now a large proportion of their young life's experience has been horrific. Do we want to call all of this "mental illness" rather than experiences and feelings that seem intolerable and lead to thoughts of suicide?

 

In our death-phobic society, it is little known that many people—perhaps even most—in the course of ordinary lives think about suicide at some time. As soon as one becomes aware of life itself and of the inevitability of death, what could be more natural, more human, than to consider the possibility of choosing the time and method of one's death, whether in a philosophical way, or because one is afraid of how one might die if one doesn't take it into one's own hands, or because it makes one feel more in control? This is often common among adolescents and adults who are sensitive, artistic, and thoughtful. Then there are the people who either are desperately lonely and believe that will never change, or who have what feel like overwhelming burdens and problems for which they can see no escape.

 

Traditional Mental Health Approaches Don't Help Anyway
Susan Stefan, in her brilliant book (https://www.amazon.com/Rational-Suicide-Irrational-Laws-Psychology-Law/dp/0199981191) and in her lectures, urges that when we know someone is thinking of suicide, we offer to listen to whatever they want to say and ask them, "What would make your life worth living?" and then see if we can help with that. And of course, our offering to listen can help reduce their isolation. This could not be more different from traditional therapists' approaches.

 

Stefan has comprehensively reviewed the approaches to dealing with people who have suicidal thoughts in the traditional mental health system and has reported that these approaches tend to exacerbate the problem. That is a powerful reason for refusing to classify suicidal behavior as signs of mental illness. It does not belong in the DSM.

 

Does it help that the DSM staff say they plan to list it in Section II, "Other Conditions That May Be a Focus of Clinical Attention" so that it can have a numeric code? Of course that doesn't help. The book after all has "mental disorders" in the title, and its authors have zero ability to warn the world NOT to classify suicidal behavior as a "psychiatric disorder" even though it is in their book. What reason is there to give it a code to put on medical files and send to insurance companies if not to help therapists expand their territory, power, and income?

 

Although the rest of this section is about military servicemembers and veterans, the principle points about how traditional approaches do not help apply to people who have not served in the military as well.

 

In my book about veterans (https://www.amazon.com/Rational-Suicide-Irrational-Laws-Psychology-Law/dp/0199981191), I raise the question: If traditional mental health approaches are effective, why are veterans' suicide rates so high? When the book first came out in 2011, I warned about the ineffectiveness and harm from psychiatric drugs. And in two chapters called "What the Military Is Doing and Why It's Not Enough" and "What the VA Is Doing and Why It's Not Enough," primarily based on the Department of Defense and VA press releases, I found the following pattern: About every year, the DoD and the VA would issue press releases in which they expressed concern about high rates of suicide among active duty members and veterans, respectively. Each time, they would express mystification about these rates and mention ways they planned to reduce them. But that happened in each announcement, and in each subsequent one, the suicide rates had not declined. Strikingly, they tended steadfastly to avoid considering the role of war trauma and rape trauma in leading to suicides.

 

Concerned about this, Col. (Ret.) David Sutherland and I wrote an essay (https://www.inquirer.com/philly/blogs/phillypharma/Unseen-wounds-Psychotropic-drugs-often-intensify-the-veterans-suffering-and-isolation.html) about the four main reasons veterans kill themselves. These were:

The vileness of war (and rape, sexism, racism, homophobia, classism, and so on);
The soul-crushing isolation most experience when they return home;
Being labeled "mentally ill" instead of being told their reactions to trauma were deeply human responses…and the label often increasing the isolation; and
Psychotropic drugs, which can increase suicidal thoughts and suicides and which often dampen people's emotions, thus making it harder to form or maintain relationships.


Some years ago, I met with the two Army people (one a therapist, one an Army officer) charged with creating the Army's whole suicide prevention plan. It consisted of two things:

Persuading soldiers that the slogan "Army strong" can include "strong means asking for help"; and
Setting up a suicide hotline.

 

But without massive changes in military culture, the first wouldn't work. In fact, we need to look at toxic masculinity for men and the expectation for women to ask for nothing for themselves as barriers to decreasing disconnection and isolation. As for the hotline, more in a moment. But note that Jensen and Platoni (2018)(https://nationalpsychologist.com/2018/11/most-military-efforts-miss-target-on-suicide-prevention/105185.html) have written:

 

The military and the civilian community have missed the mark on suicide intervention and prevention. The truly intervening and healing elements are not treatment programs, not piles of pills, not being encouraged time and again to reach out…but community itself, in the context of compassionate, educated, reciprocal, PROACTIVE social support.

 

Suicide hotlines are often assumed to be important and effective, and that is a dangerous assumption. An Oscar-winning film about the VA's hotline, "Crisis Hotline: Veterans Press 1," illustrated (no doubt unwittingly) the massive drawbacks. The general audience with whom I watched the film gasped in horror when they saw onscreen "22 veterans kill themselves every day." (Note that that famous number is wildly inaccurate, because it was based on VA data from only 21 states, not including Texas and California, which have huge populations of veterans.)

But the audience probably wanted to believe that the hotline takes care of the problem. In the film, one sees no veterans but sees and hears what those who answer the hotline say. One of the most striking aspects was the almost total lack of warmth and connection displayed by the responders, who were described as having had "mental health training."

Tremendous focus was on keeping the veteran on the phone until the police arrived or ensuring the veteran got to an Emergency Room. It's frightening to be in a position of responsibility for people who are talking about killing themselves, so it's understandable that the responders may have been relieved to serve as little more than way stations, directing the callers to the police or ER.

 

Another astonishing feature of the film was the extended conversation a responder was having with a Marine whom we could not hear. Based on the responder's comments, the Marine was having flashbacks of seeing his buddy lying in a pool of blood. The responder said vigorously at one point (no doubt with good intentions, trying to forestall a suicide), "Your children NEED their Marine father!"

 

I would have hoped that whatever training the responders had had would have included the information that when someone is seriously suicidal, they deeply believe that the greatest favor they can do their loved ones is to kill themselves. I fear that that Marine may have felt that the responder utterly failed to understand them, perhaps increasing their sense of isolation and despair.

 

When I once called the VA hotline, because I had good reason to fear that a veteran I knew was going to try (again) to kill himself with the many psychiatric drugs VA personnel had prescribed, I asked the responder what they would do if I could persuade him to call them. The answer: "Get him to an ER to be committed to a psych ward where they could adjust his medications." My pointing out that the drugs were a huge part of his problem completely failed to elicit any other response.

 

In July of this year, the FCC approved the use of the number 988 (as of this writing, that is not a working number) which anyone thinking of suicide would be urged to call, but all callers to that number would be directed to the existing National Suicide Prevention Line, which has many of the same problems as the VA one, as do other crisis hotlines.

 

I have critiqued these hotlines in Chapter 6 of the paperback version of my book, When Johnny and Jane Come Marching Home (https://www.amazon.com/When-Johnny-Jane-Come-Marching/dp/150403676X), and have described the alternative: what are known as "warm lines" that are answered by people whose focus is to connect and be supportive.

Hopefully, it is now clear why it is so inappropriate to conclude that people who are considering suicide or have killed themselves are/were mentally ill. Traditional therapists' approaches simply fail to help them. In Part 2 of this two-part article, I will address some barriers that tend to prevent suicidal people from seeking help—and ways that we truly can be of help.

 

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Big Pharma meets Big Diagnosis, Big Courts, and Big Psychiatric Hospitals

First published January 31, 2020, at https://www.madinamerica.com/2020/01/zyprexa-papers/

 

If you think the truth can set us free, and you care about harm done to suffering souls who seek help from the traditional mental health system, only to discover too often and too late that that system exponentially adds to their burdens, Jim Gottstein's blockbuster new book, The Zyprexa Papers, is essential reading. It should be required reading for every well-meaning friend or family member of someone who suffers emotionally, as well as for legislators who genuinely want to weed out corruption and harm.

 

The book is focused on the neuroleptic drug Zyprexa and two cases related to it — one in which Gottstein represented a client and one in which he became the accused — but importantly, it exemplifies problems throughout the systems of not only Big Pharma but also what could be called Big Diagnosis, Big Psychiatric Hospitals, and Big Mental Health-related Courts. It's a book about how the tsunami fed by the profit motive and the vast systems involved in the politics of mental health, including the so-called justice system, swamps what ought to be primary: the alleviation of emotional pain.

 

Gottstein's book is The Pentagon Papers of the traditional mental health system, because he exposes a mind-blowing number and variety of cold-blooded, calculating actions on the part of Eli Lilly in trying to hide what it knew to be the devastating effects of its hugely profitable Zyprexa, from its lies of both omission and commission about relevant data to what can only be called its persecution of Gottstein himself for trying to sound the alarm. Gottstein, a courageous and brilliant lawyer and tireless activist trying through strategic litigation to prevent people from being harmed by psychiatric drugs and electroshock through his nonprofit Law Project for Psychiatric Rights (PsychRights), also takes us day by day through his attempts to prevent one particular client, Bill Bigley (to whom the book is dedicated), from being involuntarily committed to a psychiatric facility and forcibly drugged. In doing so, he exposes the staggering number of ways the court system that handles such cases amounts way too frequently to a kind of Kangaroo Court, where the odds are so stacked against the person labeled mentally ill that it's almost inevitable they will be deprived of their rights. The hurdles the client and lawyer have to jump are so numerous and various that this part of The Zyprexa Papers will be a revelation to those who have not themselves been through it.

 

Where does Big Diagnosis come in? Without the hundreds of psychiatric categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM), none of this could have happened, because giving a person even one DSM label — even one that sounds relatively innocuous — is what enables therapists, drug companies, and judges (not to mention others) to make a wide array of recommendations and even impose courses of action that they can call "treatment." And when the "treatments," including drugs, cause harm or fail to help, the labeled person's reports are easily ignored, minimized, or used as further "proof" that they are "mentally ill." Equally appalling is that calling psychiatric drugging, electroshock, involuntary commitment, and other intrusions "treatment" allows those who suggest, impose, or enforce them to escape culpability. In a lawsuit in which I was an expert witness, three therapists who nearly destroyed someone's life were not held in the least negligent, on the grounds that they had just been following the mental health system's standard of care.

 

The Zyprexa Papers is a hard book to put down, and it's so worth reading, because we need to know what goes on largely in secret, and as we read, we see clearly the many points where changes for the better must be made… and how each of us can help to change them.

 

Gottstein had had personal experience in the mental health system. In 1982, at age 29, he had become terribly disoriented from lack of sleep and as a result had been locked up in the Alaska Psychiatric Institute (API) — the very entity that had repeatedly hospitalized and forcibly drugged Bill Bigley. At API, Gottstein reports:

 

"I was told I would have to take mind-numbing Thorazine-like drugs for the rest of my life. When I told them I had graduated from Harvard Law School (which I had), I was considered delusional. Those who believed I was a lawyer said I would never practice law again. However, my mother, who was the Executive Director of the Alaska Mental Health Association, steered me to a terrific psychiatrist, Robert Alberts, who said that anyone who doesn't get enough sleep will become psychotic, and I just needed to learn how to keep from getting into trouble. … was lucky not to have been made into a permanent mental patient by the mental illness system. These experiences started my advocacy for people diagnosed with serious mental illness."

 

Gottstein describes having been inspired by Robert Whitaker's classic investigative book, Mad in America, which he describes as both "a terrific read" and "a litigation roadmap for challenging forced psychiatric drugging on the basis that it isn't in the patient's best interest." He explains that drugs like Zyprexa "have been marketed as 'antipsychotic'" when in fact what they do is "suppress people's brain activity so much they can no longer be much trouble—at least temporarily." For this reason, he uses the term "neuroleptic," which means "seize the brain" — it was "one of the first names given to this class of drugs, and is the most accurate description." To call them "antipsychotic," he says, is "marketing hype."

 

Readers discover the ghastly lengths to which Lilly, aiming solely to maximize its profits, went from the outset to conceal the fact that Zyprexa caused, among many other serious problems, high rates of diabetes, rapid and enormous weight gain (in some cases, more than 100 pounds after a year on the drug), and even death. How much money was at stake? In 2005, the year before the book's saga begins, Zyprexa's reported sales were $4.2 billion, with about two million people across the world taking the drug.

 

Gottstein describes his triple efforts, starting in 2006, to help one person protect his right to refuse psychiatric drugs, to help in other strategic litigation, and to publicize widely the truth about Zyprexa's dangers. The incriminating evidence about those dangers had been discovered by an expert witness for a number of plaintiffs in the 8,000-person, multi-district litigation who charged they were harmed by the drug, and Gottstein obtained that evidence by subpoenaing the expert for the documents to be used for Bill Bigley's case against forced drugging. In the multi-district litigation, the large number of lawsuits had been consolidated, and the documentation about Zyprexa's concealed dangers became subject to an order that they be kept secret. Fortunately, however, the information could be produced if it was subpoenaed for another court action and if Lilly was first given "notice and a reasonable opportunity to object."

 

The amount of time that "reasonable opportunity to object" required was unspecified, so when Gottstein subpoenaed the documents from the expert witness, Dr. David Egilman, whom he describes as a man of conscience, Egilman sent them to Gottstein not immediately but before Lilly objected. Egilman had told Gottstein he hoped Gottstein would subpoena him and then, after receiving Egilman's documentation, would turn it over to New York Times writer Alex Berenson for his reporting about Zyprexa. However, to Gottstein's personal detriment, when Egilman only showed Gottstein part of the entire secrecy order, he acknowledges that he "motored past that red flag" and relied on Egilman to indicate when he thought a "reasonable" amount of time had passed since Egilman had notified Lilly of Gottstein's subpoena and thus Gottstein was free to send the documents to Berenson, as well as to many others who would help disseminate the truth.

 

The interpretation of "reasonable" became a major weapon in what can legitimately be called Lilly's persecution of Gottstein for making the information public. On December 6, 2006, Egilman notified Lilly's top attorney that Gottstein had subpoenaed him for a deposition by telephone for December 20. On December 11, Gottstein sent Egilman an amended subpoena, because the original one had included the order for the doctor to bring his documents with him, but since the deposition was going to be by telephone, Gottstein needed the documents sent to him before the deposition. He asked Egilman to notify Lilly of the amendment, but Egilman did not do so. Egilman said that five days had passed since his notification to Lilly, and he believed that that constituted "reasonable" notice, so on December 12, he went ahead and uploaded the material to an internet domain Gottstein had created for that purpose. Gottstein had received a voicemail message from a Lilly lawyer the night before and had left a voicemail for him the next morning. In the meantime, as he said, "feeling Lilly's breath on my neck," he proceeded to give the Times reporter access to the documents, and he sent them in various ways to many other people.

 

Gottstein's courage in doing this is stunning. He knew that he could end up going to prison, given Lilly's power and money, but "thousands upon thousands of people had already been killed by the drug, and we [he and Egilman] were hoping to keep that from happening to thousands upon thousands more."

 

What followed showed both Lilly and the courts at their worst. Lilly's ability to bring in judges to try to intimidate Gottstein was astonishing. Readers will be alarmed to learn in the pages of The Zyprexa Papers how vulnerable truthtellers can be, even when their aim is utterly selfless and when they try to prevent massive harm like that which had already come to huge numbers of people. Lilly demanded that Gottstein not reveal the documents to anyone and that he immediately retrieve them from everyone to whom he had sent them and take them down from anywhere he had posted them. By then, some of his recipients had sent them on to still other people, and in various ways they had been further publicized. In fact, in an article Berenson wrote around that time, the following appeared: "Mr. Gottstein said yesterday that the information in the documents should be available to patients and doctors, as well as judges who oversee the hearings that are required before people can be forced to take psychiatric drugs. 'The courts should have this information before they order this stuff injected into people's unwilling bodies,' Mr. Gottstein said."

 

As media coverage about the matter increased, Lilly, clearly incensed, threatened Gottstein that he would lose his law license and that it would "seek sanctions" against him for having violated the secrecy order from that case that had been settled with the 8,000 plaintiffs. A court order included the instruction to him to "Preserve all documents, voice mails, e-mails, material and information relating to Dr. Egilman or any other efforts to obtain documents produced by Lilly." I recall that around that time, I had called Jim's office about some other matter and was stunned to hear his outgoing message, in which he instructed callers not to leave a message of any kind on his answering machine. It felt Orwellian.

 

The ways that Lilly and the courts conspired against Gottstein must be read to be believed. And it is poignant to read Gottstein kicking himself for the very human mistakes he made when called to testify under circumstances of extreme sleep deprivation, but these errors should never have justified the outcomes. Gottstein had spent vast amounts of money trying to defend himself and was facing even more legal fees beyond the huge ones he had already incurred. In addition, threats of losing his law license and contempt of court charges were hanging over his head. The story of why and how the case ended for him makes one rail at the so-called justice system and the overwhelming power of Big Pharma, as well as how they work together.

 

Gottstein speculates that the judges' decisions were due to their view that Gottstein flouted their authority by sending out the material covered by the secrecy order, and it looks to this reader as though they jumped at the chance to interpret or misinterpret anything in Gottstein's favor so as to allow them to protect Lilly. This impression is strengthened by the fact that vast numbers of the documents covered by the secrecy order had always been public knowledge, including media reports, yet all were subsumed in that order.

 

Bending over backward to understand the court's alarm about exposure of the documents, one might ask what benefit comes to the plaintiffs in settlements like the one that included the secrecy order. Gottstein tells us that the Zyprexa settlement with 8,000 victims averaged a little less than $90,000 per victim and says:

 

"This doesn't seem like a lot for giving someone diabetes, but it is even worse when you consider that the lawyers took 40% and then Medicaid and Medicare were reimbursed another 30%. At that point, even the approximately $27,000 individual victims received, on average, put those who were on Medicaid and disability over the asset limit for eligibility. This meant they had to spend the money from the settlement to treat their diabetes and otherwise spend it over the course of a year or two to maintain or get back their Medicaid and disability payments"

.

Furthermore, Gottstein writes, "judges are supposed to allow the secrecy only if it is in the public interest, but in practice, they don't. The secrecy greases the wheels of settlement as well as litigation, and judges want to have cases resolved and off their docket. … Normally, no one is representing the public interest." He continues:

I think it is fair to say by issuing the secrecy order the … Court was complicit with Lilly in hiding the great harm being done to people as a result of Zyprexa. If this information had become public earlier, thousands of additional lives could have been saved, and hundreds of thousands of people would probably not have taken Zyprexa.

 

Gottstein describes where the Court erred in considering the subpoena he issued and his release of the Zyprexa Papers:

 

"It felt I had violated its secrecy order, and never gave serious consideration to the possibility I had not. Protecting its authority was really the court's only consideration. It did not give fair consideration to PsychRights' legitimate interest in the Zyprexa Papers. It did not give fair consideration to the fact that PsychRights followed the secrecy order's rules in obtaining the Zyprexa Papers. … I had my independent and proper reasons for subpoenaing them, including alerting the public to the great harm caused by Zyprexa. … I believed I received them under the secrecy order's rules and once I had them in that way, they lost their secrecy."

 

The second story in the book, interwoven throughout with the Lilly case, is about the way that Bill Bigley, whom Gottstein brings to life with warmth and respect, experienced tragic losses that understandably made him sad. His deeply human reaction was then pathologized: He was diagnosed with psychiatric labels that formed the foundation for starting him on a cycle of involuntary hospitalizations that grew to number around 70 and of forced drugging that caused him so many problems that he understandably resisted those chemicals. All of this predictably led to his deterioration in many ways, and he began sometimes to act in ways that annoyed some people, but he was never violent. Gottstein writes: "In reality, it wasn't about Bill's quality of life at all but about reducing other people's annoyance with him."

 

In spite of this, the mental health system destroyed this man, whose suffering, like that of so many, led to diagnosis that was then used to justify depriving him of his rights on the utterly unsupported grounds that he must have an incurable chemical imbalance and needed "treatment." As Gottstein describes trying to help Bigley so many times, he shows point by point how the system in Alaska — typical of those across the U.S. — was used to order involuntary commitment and forced drugging was rigged against him.

 

The very fact that someone has been given any psychiatric label is used in a staggering variety of ways to deprive them of self-respect, dignity, self-confidence, employment, custody of their children, the right to make decisions about their medical and legal affairs, and even their lives. Just as Gottstein's accurate statement that he had graduated from Harvard Law School had been construed as evidence of his "mental illness," so when Bigley accurately stated that he had been quoted in the New York Times, that was construed as proof of his "psychiatric disorder." And as so often happens, Bigley's refusal of psychiatric drugs was alleged to be proof that he was too "ill" to know how to take care of himself.

 

Flagrantly ignoring proof of the harm caused by psychiatric drugs, the judge ordered that Bigley could be drugged against his will. The judge's "reasoning" belongs in Alice in Wonderland rather than a court order. Try to find the logic in what the judge held, as Gottstein cites it:

 

"The Court is willing to assume that past medications have damaged Bigley's brain. It is further willing to assume that additional brain damage will result if API is allowed to administer more psychotropics. But that does not end the analysis.

"The Court finds that the danger of additional (but uncertain) damage is outweighed by the positive benefits of the administration of medication and the emotional and behavioral problems that will escalate if Bigley is not medicated. Even if the medication shortens Bigley's lifespan, the Court would authorize the administration of the medication because Bigley is not well now and he is getting worse."

 

Given that Zyprexa and similar medications such as Risperdal have been shown to cause early death, Gottstein is reasonable in concluding: "I guess judges decide who shall live and who shall die all the time, although the death penalty is not even allowed against murderers in Alaska."

 

Bill Bigley's hearings were usually held in a room at the Alaska Psychiatric Institute rather than in a courtroom and were usually not open to the public, as most similar court proceedings are supposed to be in order to help ensure due process and protect the person's rights. When hearings are held within such hospitals, they tend to become Kafkaesque, throwing due process and legal procedures out the window, so that coercive orders are made in the absence of evidence that the criteria for coercion (danger to self or others, gravely disabled, least restrictive alternative) are met. Bill Bigley therefore wanted his hearings to take place in a real courtroom and to be public.

 

Anyone in danger of losing their human rights — or their life — through a court proceeding should have someone like Gottstein advocating for them, because he is a tireless advocate, knows the law inside out, and never loses sight of what is true, what is right, and what is humane in its respect for his clients' dignity. He uses a combination of legal principles and procedures with analysis of whether those principles hold water within legal traditions but also outside of those traditions. Not feeling constrained by precedent in court and practice in the mental health system, he is consistently creative and resourceful in trying to find solutions. For instance, pursuing the principle that the "least restrictive alternative" should be tried, and knowing that court orders in cases like Bigley's were usually based on consideration of only two alternatives — drug the person or don't drug them, period — he makes this commonsense, caring proposal that includes a third option:

 

"…when someone is having a meltdown, they can be approached and told, 'Listen, we can't have you doing these things, because of ______________ [e.g., you annoy people or you scare people], so if you don't calm down, we are going to have to inject you with Haldol or put you in restraints or seclusion (solitary confinement). Which would you prefer?' I think some people would prefer the restraints or seclusion over the drug, but I also think there is some chance simply giving them the choice would allow them to calm down."

 

Of course, since this proposal is based on respect for the person and the assumption that they can use reason, consider options, and have agency, it's not the kind of thing that judges tend to accept. Their dual concerns — that they will be blamed if they don't order hospitalization and/or drugs and "something happens," and their tendency to believe the claims of the powerful, well-funded entities like Big Pharma and Big Psychiatric Hospitals — get in the way.

 

As for the psychiatric hospital's representatives, as Gottstein writes, what their continual pushing for forced drugging "demonstrates clearly is API was incapable of treating people without using drugs. This was and remains basically true of psychiatric 'hospitals' around the country."

 

Gottstein wrote this book in part to try to prescribe a roadmap for approaching these kinds of cases, which, he said in an email message to me, includes the need "to treat these cases like the big-stakes litigation they are." His compelling descriptions of his clashes with Lilly and his advocacy for Bigley make clear how high are the stakes and how dangerous to the brave souls who engage in the struggles. But as he poignantly notes, Zyprexa "is still being used on hundreds of thousands of people, including being forced on many. The same is true of the other neuroleptics." Indeed, even many who advocate for victims of the traditional mental health system in their writings and films legitimize and even valorize former DSM-IV Task Force head Allen Frances, despite knowing that he and two colleagues earned just under a million dollars for creating the fraudulent foundation that allowed Johnson & Johnson subsidiary Janssen Pharmaceuticals to deceptively market the dangerous neuroleptic drug Risperdal for an astonishing variety of "conditions" in people from childhood to old age. (For more on this, see my articles "Diagnosisgate: Conflict of Interest at the Top of the Psychiatric Apparatus" and "Diagnosisgate: A Major Media Blackout Mystery.")

 

Gottstein believes, finally, that:

 

"inadequate legal representation is the lynch pin for the massive harm being done to people through psychiatry. If people were being represented adequately the current system would be unable to lock the legions of people up and drug them against their will and would have to find some other way to deal with people diagnosed with mental illness and being disturbing. If PsychRights had the resources to employ just two or three lawyers full time in Anchorage, Alaska for such representations and funds for expert witnesses, I believe PsychRights could break the system and force provision of different approaches that have been shown to work and help people get through the problems they are having."

 

The book's Kindle edition is available for order starting today, January 31. The paperback is now also available for ordering on Amazon.

 

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