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Paula Joan Caplan's Authors Guild Blog

When Psych Diagnosis Means Life-or-Death

Originally published at https://www.madinamerica.com/2020/10/psych-diagnosis-means-life-or-death/? October 30, 2020.

 

Many people know that getting a psychiatric label referring to emotions or behavior exposes the labeled individual to a wide array of kinds of harm, the ultimate harm being death. What is less widely known is that one label in the Diagnostic and Statistical Manual of Mental Disorders that applies to cognitive abilities—"Intellectual Disabilities"—is crucial in determining whether people accused of crimes in some U.S. states will be executed. This interests me as a psychologist and as a filmmaker working on a documentary about this subject, "Execution by the Numbers" (executionbythenumbers.com)

 

Like all psychiatric categories, "Intellectual Disabilities" (I.D.) is not scientifically derived. Decades ago, when I was a naive advocate of psychiatric diagnosis generally, I was shocked to discover that what was then called "Mental Retardation" (now called "I.D.") appeared in the handbook of psychiatric disorders, although it was about cognition, not emotions!

 

It's alarming and reprehensible enough that those who write and market the DSM and the International Classification of Diseases (the latter's psychiatric section is similar to the DSM) have acquired so much power to decide who is "normal" and who has a "psychiatric disorder," and many of us for decades have been warning of the harm that can result from getting any of those labels—the harm can range from plummeting self-confidence to loss of jobs, child custody, the whole variety of human rights, and even loss of life, this last usually from drug effects. But the path from diagnosis of "I.D." to execution by states that have the death penalty is direct and spelled out in the laws of those states.

 

What actually happens? When a person is (accurately or falsely) accused of committing a crime that is considered a capital crime in that state, that means they are eligible for the death penalty. Different states have different criteria for deciding what is a capital crime, such as the degree to which it is "heinous." But the key point for this essay is that in 2002 the U.S. Supreme Court in Atkins v. Virginia ruled that people with (what was then called) "Mental Retardation" must not be executed, such executions being cruel and unusual punishments and thus, according to the Eighth Amendment, unconstitutional.

 

Writing for the majority in Atkins, Justice John Paul Stevens gave as reasons for the ruling the following:

"[people with "MR"] have diminished capacities to understand and process information, to communicate, to abstract from mistakes and learn from experience, to engage in logical reasoning, to control impulses, and to understand the reactions of others…

"…they often act on impulse rather than pursuant to a premeditated plan, and that in group settings they are followers rather than leaders. Their deficiencies do not warrant an exemption from criminal sanctions, but they do diminish their personal culpability."

 

Justice Stevens further wrote that the two presumed aims of the death penalty—retribution (getting their "just deserts") and deterrence (preventing them from causing future harm)—do not apply to such people. Retribution should only apply to the most culpable, and he felt that they were less culpable due to their impairments. As for deterrence, he said that because such people were more likely to act on impulse than were other people, the death penalty's existence was less likely to come to their minds to inhibit them from committing capital crimes.

 

Death penalty retributivists (proponents for purposes of punishment) like New York Law School Emeritus Law Professor Robert Blecker argue that Stevens' reasoning treats people with limited intelligence as having less humanity than other people. He says if we credit them for good behavior for running into a burning building to save children, we cannot suddenly excuse them when they commit harmful behavior. That subject warrants extensive discussion beyond the scope of this essay but is an important one to raise.

 

A major problem with the Atkins ruling was that each state was left to decide how to define and determine "Mental Retardation" ("M.R."), although Atkins included a reference to the crucial I.Q. cutoff point of 70.  There causes a host of problems. One is that some people who "qualify" to be executed in a particular state would not meet the criteria in another. Further, readers of Mad in America will not be surprised that the whole business of deciding how to define and evaluate "M.R."—currently called "I.D."—is not an objective, hard-and-fast matter.

 

The two criteria lists most widely used appear in successive editions of the DSM and in publications of the organization that, at the time of the Atkins decision, was called the American Association for Mental Retardation and is now called the American Association on Intellectual and Developmental Disabilities (AAIDD).

 

Debates about how to define "intelligence" have raged for well over a century, because the concept is a construct, like "love," in that different people can define it in different ways. Both the AAIDD and the DSM descriptions list three factors—(1) intellectual functioning (conventionally measured by a standard I.Q. test), (2) deficits/limitations in adaptive functioning (such as holding a job, social judgment, making friends, finding one's way on public transportation, feeding and clothing oneself, etc.), and (3) present before age 18. The AAIDD description includes somewhat less emphasis on I.Q. test scores than does the DSM one, which latter at the time of Atkins included specifying that the I.Q. score needed to be 70 or below.

 

That number 70 has held great sway over the decades, as defense and prosecution attorneys have argued about whether someone with an I.Q. score of 73 "really" had I.D. because their 73 indicates a range going as low as 68 to 70 and thus they should not be executed…and whether someone with a score of 68 "really" did NOT have I.D. but was not trying their hardest when tested and thus probably qualified for execution.

 

Every one of the three usual criteria for "I.D." is problematic, for reasons we recount in our film-in-progress, "Execution by the Numbers," and I will address these, but first I want to highlight other compelling concerns.

 

First, the public generally believes that the decision to sentence someone to death is made by judges and juries. In fact, however, enormous weight is placed on what psychologists tell judges and juries, to the extent that it's not much of a stretch to say that the psychologists are making the life-or-death decisions. This granting of so much power to psychologists is done to a great extent under two fictions: (1) that psychologists are unlike other humans in that psychologists are strictly objective, and (2) that I.Q evaluations are strictly scientific and not subject to bias.

 

That (1) is a fiction is reflected in the facts that some psychologists are known to be hired guns for the prosecution (one in Texas was called "Dr. Death") and that even the best of psychologists, being human, likely have some conscious or unconscious attitude toward the death penalty that could affect their choice, administration, and interpretation of I.Q. evaluation instruments in either direction.

 

That (2) is a fiction is reflected in the very instructions of standard I.Q. tests, which reflect that the psychologist often has to judge whether a person's answers merit 2 points, 1 point, or 0 points, and sometimes those judgements are hard to make. Furthermore, it can be a matter of judgement how many adaptive functioning limitations a person has, whether they are substantial enough to be called limitations (when life itself is at stake), and whether to take into account any strengths they have in adaptive functioning.

 

In a recent case coming from Texas, prosecutors were using the fact that a person on trial had any strengths in adaptive functioning to claim that the person did not have "I.D." and thus could be executed. The Texas Court of Criminal Appeals cited the character Lennie in Of Mice and Men as an example of someone who should not be executed because of his limitations. However, that character represents one stereotype of people with "I.D." that many intellectually limited people fail to fit.

 

The Briseno Factors used in Texas included such questions as whether the person had formulated plans and carried them through and whether they responded rationally to questions. If the answer was "yes," prosecutors had an easier time arguing that the person couldn't possibly have an "I.D.," no matter how many limitations they did have. Of course, it is hard to find someone with an I.Q. score between, say, 60 and 70 who has never formulated plans and carried them through, and many people with intellectual limitations have put a lot of energy into learning how to act "rationally" or in socially acceptable ways that can mask those limitations. Fortunately, a SCOTUS ruling recently was aimed to end use of the Briseno Factors.

 

As for the criterion that the person had to have "I.D." before age 18, that makes no sense to me, because to the extent that I.Q. is considered relevant in death penalty cases, surely what matters is the person's cognitive capacities at the time they either committed a crime or falsely confessed to one. I think of a case a few years ago in which a man had above average intelligence and no criminal history, then suffered a brain injury when he was trimming a tree, and a chainsaw entered his skull. His test results were certainly lower than before the accident, when he was decades older than 18, and the crime was committed afterward.

 

In addition, although I am grateful that the Atkins decision has saved many people from execution, I think it is not ideal. Why? Because the elements of an I.Q. evaluation do not correspond for the most part to what is relevant for the court cases. What does a person's ability to answer math problems or learn a nonverbal code have to do with these questions: Did they think about the consequences when deciding to commit the crime (IF they committed a crime)?

If their Miranda rights were read to them or they were asked to read them aloud, did they understand them? Were they easily led to sign a false confession? Did they understand the confession they were asked to sign? Were they easily led into participating in a crime? Can they participate in their own defense?

 

(Samuel Oates, defense attorney in a case that made legal history, said in his interview for our film that at the end of the first day he spent with Jerome Bowden, he realized Jerome had no more idea what he was being asked than at the beginning, so he could not help with such things as recalling whether, months before, there was a witness to his having been somewhere other than the crime scene.)

 

Can they understand crucial aspects of court proceedings (such as the implications of being offered a plea bargain)? Do they understand what execution and death are? During their time in prison, have they, like many prisoners, improved their reading and vocabulary skills, so that an I.Q vocabulary test given now will not reflect what they knew at the time the crime was committed?

 

Until the criminal justice system and psychologists come together to come up with reliable and valid ways to answer the above kinds of questions, and unless Atkins is superseded by a later SCOTUS ruling, Atkins will hold sway. So I hope readers will educate as many people as possible about how some psychologists—and wrong beliefs about psychologists and I.Q. evaluations—literally have the power over life-and-death decisions.

 

As I have often felt in my decades learning about what psychologists can and cannot do, what our strengths and our limitations are, I am alarmed by the huge divide between those realities and what many people mistakenly believe, i.e., that many of us are better and have more skills and power than we do and that we are solid scientists with no biases of our own. When life itself is at stake, these myths cry out for drastic revision.

 

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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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How Many Times Must the "PTSD" Label's Harm Be Exposed?

First published October 7, 2020, in

https://www.madinamerica.com/2020/10/ptsd-labels-harm-exposed

 

A recent Wall Street Journal (WSJ) article and a recent American Psychiatric Association (APA) press release reveal the power the APA has wielded through its various DSM editions in pathologizing the effects of trauma.

 

What's Wrong With the "PTSD" label?
Before I examine the problems with the article and press release, it is important that readers not assume that if "PTSD" ("Post-traumatic Stress Disorder") is a harmful label, "PTS" (just removing the "D") is fine. There is little difference, because "PTSD" is so widely used—even by people who rightly criticize the use of other psychiatric labels—that it will be generations before people stop thinking "Disorder" when they hear "PTS." Instead of using either term, what is accurate and useful is to call the trauma what it is—war trauma, rape trauma, hurricane trauma, etc.—and to call trauma's effects what they are, such as terror, grief, fragmentation, moral injury, loss of ability to trust, total exhaustion, etc.

 

As with any psychiatric label, its application subjects the labeled person to a vast array of kinds of harm, ranging from plummeting self-confidence to loss of child custody, employment, respect, all possible human rights, and even death.

 

Neither the WSJ article's author, Andrea Petersen, nor the unknown author of the APA press release ever questions what "PTSD" means in the DSM, what people will assume it means, and whether there is any scientific validity to it at all.

 

As I found when on two DSM-IV committees, there is no scientific validity to it. Still worse, when it first went in a DSM edition as a description of (some) reactions to trauma, there was a sentence noting that these were normal responses to abnormal situations. That meant it was weird to include it in a manual of mental disorders, but the DSM authors have rarely worried about consistency in their rush to include as many labels as possible. But that sentence was useful for traumatized people to see, because sometimes it made them feel less like they were overreacting and "crazy." However, even that little bit of help vanished when Allen Frances headed DSM-IV's Task Force, for that sentence was removed.

 

Not only is "PTSD" not scientifically derived, but even caring therapists apply the diagnosis without ensuring that their patients even meet all the DSM's required criteria, as researcher Meadow Linder wrote in a chapter in Bias in Psychiatric Diagnosis.

 

In a way, that is irrelevant, because what good does it do to stick scrupulously to arbitrarily chosen criteria? But this means that, as I have written elsewhere, "PTSD" now consists of shifting sands on shifting sands—an unscientific label, unscientifically and unsystematically applied.

 

When a Label Has No Validity, It's Absurd to Study What Helps "It"…and Other Problems
The Wall Street Journal author starts by referring to the pandemic, wrongly assumingthat it is creating skyrocketing rates of "PTSD"—rather than NONpathological suffering, and reviewing what she says therapists have described as "new" and needed treatments for the "disorder." It is especially troubling that she mentions that the most common reports of "PTSD" during the covid-19 pandemic in a large study were about loneliness and worries about the virus. Does it make sense to call loneliness and worries about the virus signs of mental illness?

 

And she mentions another study, this one of frontline healthcare workers during the pandemic, in which 16.7% are said to have "PTSD." Does it make sense to claim that it is a mental illness for people constantly exposed to a mysterious, dangerous, contagious illness to be traumatized? What is the point of all that, other than to alarm people and provide more money, power, and territory for therapists?

 

What the author mentions only briefly in her lengthy article is how helpful self-help groups for traumatized people can be. Instead, she writes endlessly about one drug after another after another and various forms of traditional talk therapy.

 

The author then zooms ahead, naming the psychiatric drugs (she calls them "medications") Zoloft, Paxil, MDMA (called "Ecstasy" on the street), and ketamine, all of which have negative effects ranging from upsetting (e.g., sexual problems) to dangerous (e.g., increased violence against self or others). Acknowledging that only small percentages of people who take these drugs are helped, she asserts that "Scientists" (who?) are seeing (based on high-quality research…or not?) "early" (oops) "positive studies combining psychotherapy with certain drugs." Even so, she does note that "About 40% of people who received the MDMA treatment reported side effects including anxiety, headaches and nausea." She might also have cited this report of even more serious kinds of harm.

 

Petersen also reports that an unspecified "growing body of research shows that transcranial magnetic stimulation, which uses a high-powered magnet placed on the scalp to stimulate neurons in certain parts of the brain, can ease PTSD symptoms." To begin with, I know from direct experience with one of the top marketers of such devices that they often fail to warn of negative effects and fail to disclose that these devices cannot be targeted to particular neurons, so little is known about what effects they will have—good or bad—in any given individual.

 

Further food for thought is that leaders in the movement challenging the traditional mental health system have asked the rhetorical question, "Why should we assume that when these marketers say that their devices are safe because they send LESS current through people's brains than traditional electroshock, we should believe them?"

 

Petersen asserts that the best psychotherapies for "PTSD" are cognitive processing and prolonged exposure therapy. In my decade of listening to military veterans, as well as to other traumatized people, I have learned that sometimes the former—examining one's beliefs that cause them suffering—helps and sometimes not, because often the moral injury and powerful emotions caused by trauma and the painful isolation are never addressed. And I have learned from them that exposure therapy—going over and over the trauma—helps some people but is horribly retraumatizing for others, and it, too, does not in and of itself include working on the moral injury, the isolation, or the other strong emotions.

 

Toward the end of the article, Petersen does mention the potential effectiveness of aerobic exercise, though only combined with prolonged exposure.

 

In summarizing concerns about the WSJ article, it is important to note that it is always a good thing to allow people to try anything that has helped some people who are similarly suffering, but it is essential for those people to be told in advance and fully what the potential benefits and the known kinds of harm are.

 

APA Wants Exclusive Control Over Prescribing Drugs for Veterans with "PTSD"
In a September 24, 2020, news release, the APA's headline came across as gloating: "Successful APA Advocacy Assures Veteran Patient Safety Regarding MH Care." The piece was about the House of Representatives' Veterans' Affairs Committee removing a proposal from suicide prevention legislation that would have given psychologists the right to prescribe drugs to veterans. A major problem in the release is that they automatically assume that the veterans who killed themselves had "PTSD."

 

Unsurprisingly, after a lengthy description of its lobby efforts about this matter, the release included this quotation:

 

"We will continue our work with the VA, Congress, and partner organizations to improve the mental health and substance use care available to our veterans through the VHA and beyond," said APA CEO and Medical Director Saul Levin, M.D., M.P.A.  "We must work with policymakers on genuine solutions that promote the recruitment and retention of critically needed psychiatrists, psychologists, and other mental health providers who are in short supply within the VA system. Meanwhile, with the help of our members, we have avoided the enactment of a false solution that could have put many veterans at risk, without any improvement in access to the care they truly need."

 

Note that Levin acknowledges that psychologists can help veterans but that allowing them to prescribe drugs would be "a false solution that could have put many veterans at risk," as though psychiatrists prescribing drugs does not put veterans at risk. This is reprehensible in light of the well-established fact that so many psychiatric drugs increase rates of suicide. My own view is not that it is worse for psychologists than psychiatrists to prescribe these drugs but that the fewer people of any discipline who are prescribing them, the better.

 

What would be amusing if it were not so frightening is that Levin is also quoted as saying:

"We believe that nothing is more important than ensuring that veterans are given high quality mental and physical health care by qualified, appropriately educated, and trained medical clinicians, not more prescribers and more prescriptions…."

 

Nowhere in the news release is there mention of any attempts to prevent suicide except through psychiatric drugs, and all the gloating is about how impressively the APA prevented psychologists from doing this. Wouldn't it have been great if he had:

surprised everyone by saying that psychiatrists should be prescribing fewer such drugs;
said that traumatized vets should be told they are having deeply human, understandable reactions to trauma instead of pathologizing them by saying they have "PTSD," and pointed out that labeling people as "mentally ill" increases the chance they will be put on drugs;
mentioned any of the many nonpathologizing approaches to helping traumatized people (such as the many at this website: http://www.youtube.com/playlist?list=PL51E99E866B9D735E)?
 

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Is Covid-19 Making Everybody Crazy?

Originally published at https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/ 

 

The coronavirus pandemic has provided a golden opportunity for some psychotherapists, Big Pharma-funded entities, and others, who have sounded an alarm, claiming that massive numbers of people are "mentally ill" because of fears of the virus and reactions to social distancing.

 

Media producers have promoted these warnings during May, which was deemed Mental Health Awareness Month. A recent Washington Post article headlined "A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic" made that claim. And in a recent New York Times article, psychologist Andrew Solomon, reporting data that nearly half of respondents said the pandemic harmed their "mental health," shockingly equated this with mental illness becoming "universal reality."

 

In a June 5 press release, the American Psychiatric Association (APA), a lobby group for psychiatrists, reported an increase in psychiatric disorders during the pandemic that it based on an anonymous, online screening tool. Screening tools that allegedly tell the test-taker whether they have a "mental illness," including this Mental Health America (MHA) tool, are usually based on a list of feelings and difficulties that most people feel sometimes, and the cutoff points they give for when you should seek professional help are not scientifically based.

 

This tool includes instructions to take their Depression test if you are feeling overwhelming sadness. Do we really want to call overwhelming sadness in response to the isolation, fear, and unknown future occasioned by the pandemic a mental illness? They say to take their Anxiety test if worry and fear are affecting your daily functioning. Who these days doesn't worry whether their mask is adequate, whether they have washed their hands enough times and in hot enough water, whether to stay away from a beloved, elderly relative for fear of communicating the virus and thus increase their loneliness or go see them, wearing mask and gloves and staying six feet apart but still worrying because we might find out later that six feet of distance was notenough?

 

Such claims promise a vast expansion of the market for therapists, but such claims carry great potential for harm, adding to the burdens of people with upsetting but understandable, deeply human feelings by informing them they have psychiatric disorders. Anyone having upsetting feelings deserves love, help, understanding, and support, whether from family and friends or, if they choose, from clergy or therapists. But people also deserve to know about the dangers of classifying all upset as mental illness.

 

There are two common meanings of the term "black box," and both apply here. One meaning comes from the Food and Drug Administration's black box warnings to alert potential consumers to a product's dangers, and as applied here, people should be warned not to rush to call their upset "mental illness."

 

When people are struggling, suffering, or responding in unusual ways, they frequently fear their feelings mean they are "mentally ill," that they should be "doing better" than they are. One of the most helpful things that therapists can do is to let them know that their feelings are deeply human reactions, not signs of illness.

 

A hard look at four facts makes it clear that caution is warranted before pathologizing reactions to the current pandemic:

(1) Little is known about COVID-19 or how to protect oneself from it, and its effects can be fatal, so feeling confused, frightened—even terrified, powerless, and helpless—should not be classified as psychiatric disorders but rather as a normal and understandable reaction to extremely unusual events.
(2) As poet Heather McHugh observes, in our daily lives under ordinary circumstances, we tend to avoid "our fundamental terror at our own deaths," but the pandemic's massive concentration of so many deaths at once, and the fact that our own death is now more likely to be imminent, "makes the burden of the knowledge of mortality weigh" heavily on us. McHugh cites Audre Lorde's poem, ""A Litany for Survival," which ends with the line "we were never meant to survive." Suddenly to be confronted with something so terrifying for many people that they usually drive it out of awareness is a shock and disorienting in its own way: The fleeing doesn't work as well now, so how to begin finding other ways to cope with our mortality?
(3) Physical isolation from others interrupts the participation in community that is proven to be healing; but social distancing and stay-at-home policies drastically reduce participation in community. Connections via zoom calls have skyrocketed and can be helpful but have drawbacks. Many include numerous participants, which can inhibit deep conversations about feelings and creation/maintaining of meaningful relationships. Further, there is some strain involved in monitoring who is speaking and when to jump in, and it requires extra energy to remember to stay within camera range, monitor when to mute and unmute oneself, and project enough to be heard. No zoom call can replace human touch, which promotes security, happiness, and belonging. Being unable to hug a loved one without fear of unknowingly transmitting or getting the virus seriously interferes when we want to see people with whom we do not live—grandparents, elderly parents, grandchildren, friends, neighbors.
(4) Many people are grappling with increased loneliness, alarm about losing jobs and work identity, new financial crises, and child or spousal abuse. Asians and Asian Americans have been targets of discrimination and abuse because of claims that COVID-19 originated in China. Many African Americans and Latinx people and people in nursing homes, prisons, and psychiatric hospitals know that their risk of getting the virus is higher than that of others, compounding fear, suffering, and anger about the reasons for the increased risk. Upset due to any of these causes should not be called mental illnesses. The same applies to frontline healthcare and other essential workers and people who have suddenly had to provide constant care for family of all ages and education for offspring or those grieving loved ones' deaths. As with military veterans traumatized by war, or victims of all forms of oppression and violence, the last thing such people need is to be told their reactions are proof that they are psychiatrically disordered; the message that they should be "coping better" only adds to their burden.


No wonder so many people are feeling upset!

 

People who are suffering emotionally from the effects of COVID-19 deserve help, but it must be real help, such as lifting their economic burdens, protecting them from violence, and increasing community support, including all of us showing we are willing to listen to what they are going through and acknowledging how common these struggles are. Importantly, we must let them know that their suffering does not warrant classifying them as mentally ill (as psychiatrist Dainius Puras, Special UN Rapporteur, notes).

 

An increasingly pervasive pattern is the leaping to recommend "therapy" or "mental health services" when attention is drawn to human suffering. This relates to the older meaning of "black box" as something whose inputs and outputs can be viewed but whose internal workings are unknown. The terms "therapy" and "services" are black boxes, so vague that they can include the entire range of good and bad therapists and approaches. Often, well-meaning friends and family, and certainly legislators, feel they have done their bit by sending someone to therapy or voting to increase funding for such services without ensuring that the therapists are caring and effective or that the services actually help. Some therapists are terrific, and some approaches classified as "mental health services" help some people, but some therapists cause harm.

 

Likewise, psychiatric drugs sometimes help but very often harm, and their use has skyrocketed early in the pandemic, perhaps due to people assuming they would need them, but has now declined to around pre-pandemic levels. Other approaches can cause harm, and some services actually increase suicides. Furthermore, as soon as a person is diagnosed as "mentally ill," their own focus and that of professionals tend to veer sharply away from nonpathologizing, low-risk and no-risk approaches that are known to be effective.

 

More than two dozen of the latter, such as involvement in the arts, physical exercise, meditation, having a service animal, doing volunteer work, and having a listener, can be seen here (these are from a conference about veterans but can be helpful for anyone) (see also here). But entities like the APA do not tend to mention such approaches but only focus on therapy and drugs, and the MHA screening tool they cite urges people to see a mental health professional.

 

Lauren Tenney, Ph.D., a psychologist with expertise in trauma and human rights violations, says that "emotional responses people are having to the unnatural and traumatic circumstances created by the pandemic are not signs of supposed 'mental illness.'" She stresses that people who are "experiencing a range of emotions outside of their comfort zone ought to see these emotional upheavals as par for the course and attempt to embrace the depths of feelings social isolation can create."  She urges those who are suffering: "Actively work to connect with others who are having similar experiences" and suggests that "People should be supported in finding resiliency in the face of environmental adversities."

 

Even Google is getting into the act, partnering with the National Alliance on Mental Illness (NAMI) to post an "anxiety self-assessment" tool. The announcement of the partnership included description of NAMI, which is heavily funded by Big Pharma, as a "grassroots" organization and uses a tool that is based directly on a psychiatrized description of anxiety and is titled with a psychiatric disorder's name. Furthermore, they will "provide access to resources"—there's that black-box word again, "resources," developed by NAMI.

 

A major source of confusion is that when the terms "mental health problems" or "mental health conditions" are used—instead of, for instance, "emotional upset" or "suffering"—it is very often taken to mean "mental illness." As a result, media reports of increases in which understandable reactions to the pandemic are described as "mental health problems" are easily assumed to indicate increases in psychiatric disorders. Compounding the confusion is that psychiatric disorders are widely—but wrongly—assumed to be scientifically validated entities, so in the face of claims of increases in mental illness, rarely is the basic question, "But isn't 'mental illness' defined unscientifically and by whoever has the power to define it?" Instead, the assumption is made that it's clear what "mental illnesses" are and that they are rising.

 

One example is a recent warning that the pandemic will increase "postpartum depression" and "perinatal mood and anxiety disorders." The author, a psychiatrist, comes nowhere near to questioning the validity of these categories and simply alleges that they are partly neurobiologically caused, and she pathologizes expectant mothers' totally reasonable fears the pandemic provokes, despite acknowledging that social supports (harder to get in the coronavirus era) are crucial to preventing what would more properly called postpartum isolation, fearfulness, and sadness rather than psychiatric disorders.

 

Curiously, the World Health Organization's Director-General Dr. Tedros Adhanom Ghebreyesus warns that the "pandemic is highlighting the need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months," despite noting that pandemic factors like "social isolation, fear of contagion, and loss of family members is [sic] compounded by the distress caused by loss of income and often employment."

 

The psychiatrizing of America has been so efficacious that many professionals and laypeople readily assume the traditional mental health system can and should solve all emotional problems. Evidence of the limitations of that system include high and increasing rates of suicide and death and high and increasing rates of long-term disability of people treated in that system. Good therapists—and laypeople—can help normalize feelings and explore useful ways to cope.

 

But therapy must not be seen as the only option or as the one that will definitely help. What has been proven helpful to suffering people has included freedom from economic pressures, poverty, violence, oppression, and inadequate physical health care; a safe place to live; and meaningful human connections. Even the authors of a recent British Medical Journal article warning of a "tsunami" of "mental health cases" note that the people most at risk are those with "precarious livelihoods" and "poorest health," and fortunately, some groups are assuring people that their upset is understandable in light of the strange, new, massively and abruptly changed circumstances and being torn from their usual communities and sources of support.

 

Controlled studies of approaches aimed to reduce emotional suffering are nearly impossible to create, but an interesting contrast of the effects traditional, pathologizing approach and those of nonpathologizing ones is reported in a recent articleabout two neighboring Ohio regions. Although more information is needed from similar contrasts, the report from these two is of interest.

 

The Richland County Mental Health Board, which has encouraged the traditional use of counseling and crisis hotlines, reports a recent increase in suicides. Nearby, Ashland Mental Health and Recovery Board executive director Steve Stone, whose Board advocates nonpathologizing approaches, or what he calls "self-care" and "natural support systems," reports that their crisis services have not increased and in some respects have slightly decreased, and there have been no suicides and no increase in new people seeking help. He cited peer support programs as crucial to keeping their numbers low, including a sewing group, in which community members made hundreds of face masks, and a writing group that will write letters to patients in state hospitals during the pandemic. Stone is quoted as saying that they rely very little on state hospital and inpatient programs, and he "thinks the need for professional mental health services will remain low based on common sense approaches of people taking care of themselves as well as each other."

 

It will add to the tragedies caused by the current pandemic if all hope is focused on the mental health system and is diverted from the many things that reduce suffering and that do so without calling all suffering mental illness.

 

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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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The Invisibles: Children in Foster Care

Initially published on December 30, 2019, at https://www.madinamerica.com/2019/12/invisible-children-foster-care/

 

For people who have recently lost a loved one, holidays that others seem to be happily celebrating are hard. For the uncountable thousands of children of refugees whom the United States government has taken from their parents and put in cages, isolation from their families must be excruciating. But what about the nearly half a million foster children in this country, who are even less visible than refugee children, rarely the subjects of media reports except in the case of a death or a lawsuit? How are the holidays for current and former foster children? To be sure, some foster parents are loving and supportive, but far too often, being a foster child means something terrifyingly different.

 

I learned this 40 years ago when I was working as a psychologist at the Toronto Family Court Clinic in Canada. Some of the people we were asked to evaluate were children or youth deemed neglected or abused by Children's Aid Society (CAS) workers. Each time one of us clinicians was asked to recommend whether to leave the person in their home or send them to foster care, it pained us to know that there might be pros and cons for each option. We couldn't be sure whether or not a child who was living in a home where there were difficulties had a strong love or need for their parent(s), and we knew that, while some foster parents were wonderful, others were cruel (and some that had seemed wonderful turned out to be terrible). In still other cases, the foster parents were just a bad match for a particular child.

 

We also knew that in order to acquire greater certainty, we would have had to do far more observation and information-gathering than we had time for, and that in some cases, only the passage of time would reveal what mattered most, but that might be too late for the child. When what is at stake is nothing less than the security and happiness of a human being, these uncertainties and practical barriers often leave the frontline workers and clinicians feeling all at sea, helpless to find the truth but given the task of making crucial recommendations.

 

Forty years ago, both the children and teenagers who were in the system and their birth or adoptive parents were likely to be labeled as incorrigible, resistant, unworkable, and "mentally ill" and to be much less able to resist the system's dictates if they were poor and/or belonged to racialized groups than if they were white and wealthier. Times have changed far too little. Two major changes in recent decades have been the explosions in the use of psychiatric labels and prescription of psychiatric drugs for children — not just by psychiatrists but also by other clinicians and frontline workers (many of whom are quick to recommend the drugs even if they themselves cannot prescribe them).

 

Being a Foster Child
Please join me in imagining trying to live through just one of the following kinds of trauma, keeping in mind that many foster children experience more than one and often all of them:

--Being moved often — dozens of times not being rare; never knowing when one will be moved yet again; being shifted from one school — and thus one teacher and set of classmates — to another
--Never feeling loved and secure
--Being abused by foster parents or siblings
--Being diagnosed as "mentally ill" even though one is feeling utterly understandable grief, terror, and/or rage at being separated from one's original family or at never having felt secure and loved even in that original family
--Feeling overwhelmed, bewildered, unseen, and unheard as the system moves one around, often with little or no attention to what is helpful
--Having little chance to learn social and other skills for coping with everyday problems, never mind those that plague foster children
--Being put on psychiatric drugs that are more likely to harm one's body and brain than to help in any way (see Robert Whitaker's Anatomy of an Epidemic)
--Turning to illegal drugs to dull the grief, abandonment, helplessness, and/or despair
--Sliding into the juvenile justice system and later the adult prison complex because of how one expresses painful feelings or because, once turning 18, one has no way to support oneself and begins stealing food or dealing drugs just to get by
--Imagine homelessness, literal homelessness after long years of emotional rootlessness.

 

Jana Kaplan, a former foster child now in her sixties, summed it up well when she told me that foster children are "bromeliads, sometimes called 'air plants.' We grow without roots, without soil."

 

What the Numbers Show
All of this is documented in a welcome (and unusual) six-part investigative series published this month in the Kansas City Star, to which Kaplan drew my attention recently. Based on a year's worth of research by reporters Laura Bauer, Judy L. Thomas, and Eric Adler, the series, titled "Throwaway Kids," shines a spotlight on the vulnerability of foster children and on a Senate initiative to address their needs and growing numbers. The series is one every American should read and never forget.

 

The reporting team found that 23,000 children go into foster care each year, and in 2017, 443,000 children in the United States were in such care, an increase of 12 percent from five years earlier. They then recount the kinds of problems that send children into foster homes, including poverty and the kinds of neglect that are fairly easy and inexpensive to fix.

 

Part Two of the Star series includes this stunning news: Despite U.S. Congressional action in 1980 that set family preservation as a higher priority than removing children from their families, only a small fraction of all monies spent in the child welfare system is used for that purpose: "Collectively, in child welfare budgets across America, more money is spent on investigating families than on trying to keep them together — 17 percent for child protective services versus 15 percent for in-home preventive services."

 

As a result, "Kids who could have stayed in their homes take up beds in good foster homes that are needed for severely abused and neglected children whose safety is in jeopardy. Because of that, kids from Oregon to Florida and states in between are forced to sleep in child welfare offices or homeless shelters."

 

According to the Star, the National Council for Adoption estimates that the yearly foster care cost per child is about $25,000, whereas the cost of preserving a family average only $5,000-10,000 per child. But even if the cost of family supports were higher, is it fair to compare the immeasurable value of keeping children where they may be otherwise secure and loved to the monetary cost of helping their parents stay or get out of poverty? These efforts could include providing comprehensive, low-cost or no-cost health insurance, so that a family member's illness doesn't send the household spiraling into poverty, or providing practical, community-based help and moral support to a parent who is ill or coping with someone else's illness to prevent their being deemed negligent of their child, who is placed into foster care as a result. A woman who stays with an abusive partner because of a realistic fear of not being able to feed her children without the abuser's financial support would also benefit from financial help, and one who stays because she fears the abuser will implement threats of more physical violence if she leaves could certainly benefit from both moral and practical supports to help her do so rather than having her children taken away.

 

While politicians and other talking heads in the media describe the economy as thriving, they ignore those at the low end of the income scale, and clearly, child welfare matters more than money. Sadly, though, as a nation, the U.S. generally harshly judges rather than genuinely helps poor people. Years ago, Barbara Ehrenreich commented on this judgmental attitude's creation of a barrier to change, making the tongue-in-cheek suggestion that the government give the poor enough money to live on decently… but subject them to public shaming on a regular basis.

 

Possible Solutions… and Barriers to Implementing Them
To be sure, some families are dangerously neglectful or abusive. For those parents whose drug or alcohol abuse leads them to mistreat their children, stricter government oversight of doctors who hand out drug prescriptions like candy and states paying for and directing parents into proven substance-abuse programs would be far better than removing their children from an otherwise loving home. The alternative is sending them into the black hole of foster care, playing Russian roulette with the children's need to feel cherished and secure.

 

Regardless of the justifications offered for taking children into foster care, classism and racism plague the system today, just as they did four decades ago. "Black children enter foster care at a significantly higher rate than white children," according to the Star, and poor families and families from racialized groups are more likely than wealthier and/or white families to be punished in this way for being "dysfunctional" or having a physically messy or dirty home. Too often, child welfare workers — whether because they are overworked or for other reasons — don't see, or consider, the love between parent and child in such situations.

 

Furthermore, once the child welfare system connects with a family, those who are poor or from racialized groups tend to lack "the money or power to push back against government intervention," according to attorney Ira Lustbader, an attorney who represents children in class action lawsuits.

 

Where is the legal system in all this? In the past 40 years, nearly three dozen states have faced lawsuits citing foster care abuses, a remarkable figure in light of the powerlessness of foster children. But even in Illinois, a state that had improved its foster care system, a recent lawsuit was necessary to get it to stop transporting foster children in handcuffs and leg shackles. Alarmingly, the Star's review revealed that some states are currently being sued "for the same issues that plagued other systems 15 to 20 years ago," and a recent Rhode Island lawsuit alleged that "children in Rhode Island are more likely to suffer abuse or neglect if they are in foster care than if they are not."

 

Outcomes
What happens to children who go through the foster system and then age out of it at just 18 years old? More than 4,000 of them become homeless each year, thus making them subject to sex and/or drug trafficking. Former foster children are about half as likely to graduate from high school as are their peers, the Star found.

 

The reporters also surveyed prison inmates and found that one in four had been in foster care, some of whom reported moving more times than they had birthdays. Compare that to the mere 3 percent who graduate from college. The journalists also quoted Gerald Marshall, a 37-year-old Texas death row inmate, who observed, "The state that neglected me as a kid and allowed me to age out of its support is the same state that wants to kill me."

 

And consider those foster kids who, even if they have not ended up in the prison system, have been slapped with psychiatric labels and put on psychiatric drugs. These young people can suffer for the rest of their lives from the woefully mistaken belief that, because they were so labeled, they are "mentally ill," defective, or twisted. As documented in Robert Whitaker's book Anatomy of an Epidemic and countless Mad in America articles and webinars, the negative consequences of taking these drugs even briefly, and the effects of withdrawing from them, can last for many years.

 

Uncounted millions of former foster children remain invisible — at holiday times and throughout the year — in the loneliness and rootlessness that they feel. This is true even for many of those who have stayed out of the prison system, graduated from college, raised children, and contributed in many ways to the good of society. They deserve our attention and our care.

 

 

What's to Be Done?

What can parents do when they see that the authorities plan to take their children from them? I would say they can hire a lawyer, but that means either having enough money to do that or finding attorneys or other entities that provide legal help pro bono. And it's not as though family courts are devoid of racism and classism, as well as rampant mother-blame, so even if parents get their day in court, there's no guarantee that even deserving ones will be able to keep their children. Such parents can also assert their rights under the Adoption Assistance and Child Welfare Act, the 1980 legislation mentioned above, which mandates a focus on keeping children in their original home and trying to help and preserve the family, by contacting local and state officials. But do I have faith that that will change the system? Not much.

 

One useful step that any of us can take is to contact the bipartisan Senate Caucus on Foster Youth, co-founded by Republican Sen. Charles Grassley and Democratic Sen. Mary Landrieu, now chaired by Sen. Grassley and Sen. Debbie Stabenow. Their goal, they say, is to break the silence about current and former foster children and they have listened to them, leading to the passing in 2018 of the Family First Prevention Services Act, aimed at keeping as many children as possible at home… and safe. We can express appreciation for the Caucus's work and ask how we can help.

 

We can also urge our legislators to support the Fostering Stable Housing Opportunities Act, now making its way through the 116th Congress, which would give foster youth access to affordable housing when they reach 18.

 

And no matter where we live, we can contact our representatives in the U.S. Congress and our state legislatures and governors to ask them to increase expenditures to help struggling families. And we can demand they ride herd on the vast array of abuses that plague the foster care system, crushing the souls of children who deserve so much better.

 

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