Be Wary of the American Psychiatric Association

by Dr. Keith Ablow, published on May 14, 2012 by www.foxnews.com

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com.

The American Psychiatric Association (from which I resigned in protest, some time ago) is at it again—making up, then retracting, new diagnoses that their committees generate and debate.  It’s as if those committees have some sort of microscope trained on humanity, identifying new pathologies and yelling, “Voila!  We have found another illness!  Behold the mind malady on the slide!”

In this case, while preparing to publish its big seller (and huge profit center), the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)—organized psychiatry’s compendium of known psychiatric illnesses—the powers that be at the APA have decided to remove from its latest revision of the manual a few diagnoses they thought they would include:  “attenuated psychosis syndrome” and “mixed anxiety depressive disorder.” They are, however, sticking with their notion of jettisoning from the DSM-V, the diagnosis of Asperger’s Syndrome, while picking up one they call, “Autism Spectrum Disorder.”

This would be really funny, if it weren’t really dangerous.  The DSM-V will be used by hundreds of thousands of clinicians who may think that they are understanding their patients better, or treating them more expertly, by labeling them with one of 300 or so disorders listed in it, then matching medications to those supposedly genuine labels.  But those labels aren’t driven just by science, but by political, economic and commercial forces within the American Psychiatric Association that may have nothing to do with the wellbeing of patients – or with reality.  

The labels in the DSM-V (like the Diagnostic and Statistical Manuals that came before it) have really become little more than the roadmap by which psychiatrists chase both insurance reimbursement and applause from special interest groups who lobby—sometimes very effectively—for one diagnosis to be included, or another to be removed.  

See, without a numbered diagnosis—such as number 312.30 Impulse-Control Disorder Not Otherwise Specified or number 307.47 Nightmare Disorder (formerly Dream Anxiety Disorder)—insurance companies won’t write a check to social workers, psychologists or psychiatrists who help people who have terrible outbursts or can’t sleep.  Without a numbered diagnosis, pharmaceutical companies can’t get an FDA indication to use a particular medicine for that diagnosis.  And without a numbered diagnosis, psychiatric wards can’t get paid to treat patients who hear voices or see visions or are dependent on heroin.

Never mind that splicing and dicing the range of human experience into a recipe book of contrived illnesses does damage to the miraculous healing power of empathy, which just happens to be psychiatry’s birthright.  Never mind that creating a constantly-evolving dictionary of disorders wrenches the wonderful tools of psychotherapy and psychiatric medications into a realm of fiction that can paralyze them—like, for instance, the time that the American Psychiatric Association removed Ego-Dystonic Homosexuality from the DSM, essentially making the case that people who have sexual impulses they themselves dislike and wish to resist need no help at all and are pretty much normal.  Similarly, now, for those with Asperger’s Disorder, which no longer exists as a distinct entity because someone on some committee convinced other people on that committee that it just doesn’t.  

So, there.  Take two of those, and call me in the morning.

Mind you, this is the same organization purporting to represent American psychiatrists while refusing to say just what percentage of those psychiatrists belong to it.  It is the same organization that has presided over the near decimation of insight-oriented psychotherapy—still far-and-away the best technique, in capable hands, that we have to truly heal those suffering with mental disorders.

We in America face an epidemic of fiction—manipulations of the truth on a scale never before known, fueled by technology and media.  This epidemic threatens to rob us of ourselves—what we truly think and truly feel and truly know as fact.  And this epidemic has clearly infected the American Psychiatric Association, which puts them on the wrong side of Truth, and puts patients at needless risk.

Read more: http://www.foxnews.com/health/2012/05/14/be-wary-american-psychiatric-association/#ixzz1v0W43vSX

Psychiatry’s bible, the DSM, is doing more harm than good

Published on April 27, 2012, by Paula J. Caplan in the Washington Post

About a year ago, a young mother called me, extremely distressed. She had become seriously sleep-deprived while working full-time and caring for her dying grandmother every night. When a crisis at her son’s day-care center forced her to scramble to find a new child-care arrangement, her heart started racing, prompting her to go to the emergency room.

After a quick assessment, the intake doctor declared that she had bipolar disorder, committed her to a psychiatric ward and started her on dangerous psychiatric medication. From my conversations with this woman, I’d say she was responding to severe exhaustion and alarm, not suffering from mental illness.

Since the 1980s, when I first made public my concerns about psychiatric diagnosis, I have heard from hundreds of people who have been arbitrarily slapped with a psychiatric label and are struggling because of it. About half of all Americans get a psychiatric diagnosis in their lifetimes. Receiving any of the 374 psychiatric labels — from nicotine dependence disorder to schizophrenia — can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions. And if patients take psychiatric drugs, they risk developing physical disorders such as diabetes, heart problems, weight gain and other serious conditions. In light of the subjectivity of these diagnoses and the harm they can cause, we should be extremely skeptical of them.

Psychiatric diagnosis is unregulated, so the doctor who met briefly with the aforementioned patient wasn’t required to spend much time understanding what caused her heart to race or to seek another doctor’s opinion. If he had, the patient would have realized that her bipolar diagnosis wasn’t necessary or appropriate. Neither on her ER trip nor in later visits to therapists did anyone explain how sleep deprivation impairs the body’s ability to handle pressure.

In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization; even electroshock is still performed.

According to the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines the criteria for doling out psychiatric labels, a patient can fall into a bipolar category after having just one “manic” episode lasting a week or less. Given what this patient was dealing with, it is not surprising that she was talking quickly, had racing thoughts, was easily distracted and was intensely focused on certain goals (i.e. caring for her family) — thus meeting the requisite four of the eight criteria for a bipolar diagnosis.

Continued here

DOES INSANITY CAUSE CRIME

by Thomas S. Szasz, M.D.

The following essay is reproduced here by permission of Sheldon Richman, Editor, Ideas on Liberty. Ideas on Liberty is published by The Foundation for Economic Education, Irvington‐on‐Hudson, NY 10533.

Szasz, T. “Does insanity ‘cause’ crime?” Ideas on Liberty, 50: 31‐32 (March), 2000.

ʺThe madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.ʺ ‐ Gilbert K. Chesterton

For three hundred years we have sidestepped confronting the truth about human desperation and depravity, and the horrors the desperate and the depraved can inflict on us and themselves.

In November 1999, Andrew Goldstein, a man with a long history of psychiatric encounters, was tried for murdering a young woman named Kendra Webdale by pushing her under a New York subway train. The defense was insanity. The jury was unable to agree on a unanimous verdict. Goldstein was retried in the spring of 2000.

Crimes Have Reasons, Not Causes
There was no dispute about the fact that Mr. Goldstein pushed Ms. Webdale to her death. Nor was there dispute about what, regardless of the juryʹs verdict, was to be Mr. Goldsteinʹs fate for the foreseeable future: he would be deprived of liberty (by being incarcerated in jail, a mental hospital, or a hybrid institution called a ʺforensic facilityʺ). The problem is that whenever a person factually guilty of committing a serious crime pleads insanity, the jury is asked to answer an intrinsically nonsensical question, namely, what ʺcausedʺ the defendant to commit his wrongful act: his self or his mental illness? If the former, then he is a guilty victimizer. If the latter, then he is an innocent victim (of insanity). I say the question is nonsensical because, regardless of whether a person is (deemed to be) sane or insane, he has reasons, not causes, for his action. If we regard the actorʹs reasons as absurd or ʺcrazy,ʺ we call him insane or mentally ill. However, that does not prove that an alleged condition (ʺinsanityʺ or ʺmental illnessʺ) caused him to commit the forbidden act. In short, the insanity defense combines and conflates two problematic elements about ʺinsanityʺ: 1) what is ʺitʺ (as a phenomenon or disease)?; 2) does it cause and excuse bad behavior?

Although no one can define insanity, nearly everyone believes that he can recognize it ʺwhen he sees it.ʺ Still, the question remains: What is ʺitʺ? In principle, this question ought to be debatable. In practice, it is not: all socially recognized authorities agree that insanity is a brain disease.

For the sake of clarifying the issue before us, let us admit that (false) claim. In that case, insanity is similar, say, to Parkinsonism or a stroke, brain diseases diagnosed and treated by neurologists. A brain disease may, indeed, be a cause. But a cause of what? Typically, of a behavioral deficit, such as weakness, blindness, paralysis. No brain disease causes complex, coordinated behaviors, such as the crimes committed by Andrew Goldstein or John Hinckley, Jr.

The insane person is, after all, a person, a human being. Only legal tradition and psychiatric‐professional self‐interest, not facts or logic, compel the law to frame the juryʹs task as a choice between deciding whether an insane defendant is bad or mad—guilty (by reason of free will) or not guilty (by reason of insanity). If a ʺmad killerʺ is sick, he could—like an HIV‐infected killer or a tubercular killer—be imprisoned for his crime and ʺtreatedʺ for his illness in prison.

Millions of people are said to be mentally ill or insane. Not all of them commit crimes. Although a mad person such as Mr. Goldstein is regarded as being mad much of the time or even all of the time, he kills only some of the time. When a mad person kills someone—just as when he petitions a court to be released or eats his dinner—he does so because he decides to do so. Hence, if the madman commits a crime, justice demands that we take him seriously and punish him for his deed.

The Insanity Defense: From Solution to Problem
The insanity defense, as we know it, is a relatively new cultural invention. I believe it is not possible to understand the problems it causes unless we understand the problems it solved in the past and solves today.

The ʺcrimeʺ that led to the creation of the insanity defense was not murder, but a deed long considered even more heinous, namely, self‐murder or suicide, punished by both ecclesiastic and secular penalties: the suicide was denied religious burial and his estate was forfeited to the Crownʹs Almoner. Because punishing suicide required doing grave harm to innocent parties—that is, to the suicideʹs children and spouse—men sitting on coronerʹs juries eventually found the task to be a burden they were unwilling to bear. However, prevailing religious beliefs precluded repealing the laws punishing the crime. The law now came to the rescue of the would‐be punishers, offering them the option of finding the self‐killer non compos mentis and hence not responsible for his deed. In the eighteenth century, it became a matter of routine for juries to arrive at the posthumous diagnosis that the suicide was insane at the moment he killed himself. (The criminal law against suicide was repealed only in the nineteenth century, by which time it had been replaced by mental health laws.)

The celebrated English jurist William Blackstone (1723‐1780) recognized the subterfuge and warned against it: ʺBut this excuse [of finding the offender to be non compos mentis] ought not to be strained to the length to which our coronerʹs juries are apt to carry it, viz., that every act of suicide is an evidence of insanity; as if every man who acts contrary to reason had no reason at all; for the same argument would prove every other criminal non compos, as well as the self‐murderer.ʺ It was too late. By validating the fiction that suicides could, post facto, be found to have been non compos mentis, the law had crafted a mechanism for rejecting responsibility—the criminalʹs for his deed, the juryʹs for its duty—and, aided by the medical profession, wrapped the deception and self‐deception in the mantle of healing and science.

We must keep in mind that the impetus for excusing self‐murder did not come from its ostensible beneficiaries, the victims of the law against suicide. Clearly, it could not have come from them: the self‐killer was dead; his family, bereft of means and reputation, was powerless. Instead, the impetus for the insanity defense came from those who needed it and had the political clout to make law and medicine embrace it—that is, judges and lawyers, coroners and mad‐doctors. Coronerʹs juries and judges could thus evade the burden of having to impose harsh penalties on the corpses of suicides and the widows and orphans they left behind; and physicianʹs could pride themselves for saving innocent persons from suffering for the sin‐crimes of ʺinsaneʺ self‐killers.

The result of the practice of routinely excusing suicides of their sin‐crimes by viewing them as insane was that persons suspected of being suicidal began to be incarcerated in insane asylums. Soon that, too, became a routine practice and reinforced the belief that persons who kill themselves or others are insane, and that the insane are likely to kill themselves or others.

Copyright 2001, by The Foundation for Economic Education
Thomas S. Szasz Cybercenter for Liberty and Responsibility:
Copyright © 1998‐2001 by the author of each page, except where noted. All rights reserved.

The Illegality of Forced Drugging and Electroshock

 

POSTED ON MAD IN AMERICA, on MARCH 21, 2012

BY JIM GOTTSTEIN 

Court ordered psychiatric drugging and electroshock is illegal when measured against the constitutional requirements for forcing someone to ingest drugs, or be subjected to electroshock, against their will.

Under the United States Constitution, if a right is considered “fundamental,” in order to infringe on that right, the government is (a) required to have a compelling interest (reason),  (b) the method chosen to further that interest must be reasonably assured to achieve its objective, and (c) the method must be narrowly tailored, meaning there cannot be a less restrictive or intrusive means of achieving the objective.  This was most recently articulated in 2003 by the United States Supreme Court in Lawrence v. Texas, as follows:

Our opinions applying the doctrine known as “substantive due process” hold that the Due Process Clause prohibits States from infringing fundamental liberty interests, unless the infringement is narrowly tailored to serve a compelling state interest.

Let’s apply these principles to forced drugging and electroshock.  In 2003 the United States Supreme Court  also decided Sell v. United States, in which the government wanted to force Dr. Sell, a dentist, to take neuroleptics, to ”restore” him to competence so he could stand trial for health care fraud.  The U.S. Supreme Court held such forced drugging permissible under the constitution only when the following conditions are met:

1. The court must find that important governmental interests are at stake.
2. The court must conclude that involuntary medication will significantly further those concomitant state interests.
3. The court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.
4. The court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.  (emphasis in original).

This is classic analysis of a fundamental right under the due process clause.  I will address each of these requirements in turn.

Governmental Interests

What is the government’s important interest in forcing someone to be psychiatrically drugged or electroshocked against their will?   It depends.  (The answer to all legal questions)   More specifically, there are various situations in which the issue comes up and the government’s interests are different in each one.

Standing Trial On Criminal Charges

In Sell, the government’s interest was to restore Dr. Sell to competency so that he could be put on trial for healthcare fraud.   To be competent to stand trial for a crime, a defendant must be able to understand the nature of the charges and be able to assist his or her lawyer.   Clearly, being able to put someone on trial for murder is an important enough governmental interest.   However, is putting someone on trial for “illegal use of telephone,” such as calling 911repeatedly, an important enough interest to force someone to take psychotropic drugs against their will?   I don’t think so.

 Civil Commitment

Most of the time we think of forced psychiatric drugging and electroshock in the context of civil commitment.   In this setting, there are two justifications (governmental interests).  The first is known as Parens Patriae, which is Latin for ”parent of the nation,” and means the government is stepping in to act as a parent for someone who cannot take care of him or herself.  In other words, “We are from the government and are here to help you.”    In order for the government to be able to assert this right, it has to prove the person is incompetent to decide for him or herself.  These determinations, in themselves, are illegitimate and could be the subject of an entire article, in itself.  However, I will limit this to a couple of comments.

First, one can look at the transcript of Faith Myers’ testimony (pp 0123-0148)) to decide for oneself whether she was incompetent to decline the medication and then look at the judge’s decision (pp  12-14).  To me, the judge’s decision that Faith was incompetent to decline the medication was a travesty.

Second, I will note that the reasoning to find someone incompetent to decline the medication or electroshock, is often circular in that when a person says they don’t want the psych drug(s) or electroshock because it doesn’t work and/or is harmful, that is cited as proof the person is delusional and incompetent.  In the Myers case, the psychiatrist testified in a deposition (pp 39 – 43) that if someone agrees to to take the medication, he decides the person is competent and if not, the person is incompetent.

In fact circular reasoning is enshrined in Alaska Statutes 47.30.837(d)(1)(B), where it provides, “denial of a significantly disabling disorder or impairment, when faced with substantial evidence of its existence, constitutes evidence that the patient lacks the capability to make mental health treatment decisions.”

The second justification for forced drugging and electroshock in the civil commitment context is safety, i.e., that the person must be drugged for their own safety or those of others.  This is known as the “Police Power” justification.  Forced drugging under this justification also tends to be an illegitimate process.  First, the safety risk must be extreme.  For example, under Alaska Statutes 47.30.838 (a)(1), emergency forced drugging is only allowed if, “there is a crisis situation, or an impending crisis situation, that requires immediate use of the medication to preserve the life of, or prevent significant physical harm, to the patient or another person.”

In one of the Bill Bigley cases, I took the deposition (PDf pages 34-37) of the hospital psychiatrist about her use of “emergency” medication, which makes clear that (a) she didn’t know what the legal requirements were and (b) Mr. Bigley was being drugged for non-existent emergencies.

Whether the government has a sufficiently important interest in most civil commitment cases is certainly subject to challenge in many cases.

Prison

Another common setting for forced psychiatric drugging is people convicted of crimes and in prison.  Being convicted of a crime and in prison as opposed to being charged with a crime and in jail is a huge difference, legally.  People in prison have the least legal protection.  Thus, with respect to forced psychiatric drugging in prison, the United States Supreme Court held in Washington v. Harper  that the government doesn’t have to show an important or compelling interest, just that it is ”reasonably related to legitimate penological interests,” holding :

[G]iven the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.

Note, that even here, in order to be constitutional the court ordered drugging must be in the person’s medical interest.

OUTPATIENT COMMITMENT

Outpatient Commitment, where people are court ordered to take psychiatric drugs in the community has taken what I consider a bizarre turn.  In 2004, the high court of New York held in the K.L. case that a finding of incompetence was not required, nor was the fundamental right to be free of forced psychiatric drugging involved, because the outpatient commitment statute did not authorize forced drugging, saying “it  simply triggers heightened scrutiny on the part of the physician, who must then determine whether the patient may be in need of involuntary hospitalization.”  In other words, the New York high court held that an [outpatient commitment] order mandating a person take psychiatric drugs does not really compel the person to take psychiatric drugs.  This is a classic example of a court decision being divorced from reality.

There is, however, a 2008 New Mexico case, Protection and Advocacy System v. City of Albuquerque, that recognizes the delusional (my word) nature of the New York high court’s holding that New York’s outpatient commitment law does not involve court ordered medication:

‘R]egardless of whether there are sanctions in the Ordinance for failure to comply with court-ordered treatment, the coercive nature of a court order requiring treatment would clearly allow an act contrary to the statute’s mandate that an individual’s consent be obtained as long as the individual has capacity.”

However, since the City of Albuquerque  case involved whether the city’s ordinance conflicted with state statute and was therefore invalid, the issue was not front and center.

In any event, with respect to the governmental interests involved, in K.L. the New York high court held the police power justification applied as follows:

Inasmuch as an [outpatient commitment] order requires a specific finding by clear and convincing evidence that the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to self or others, the state’s police power justifies the minimal restriction on the right to refuse treatment inherent in an order that the patient comply as directed.

The court also held the parens patriae justification applied as follows:

[T]he state’s parens patriae interest in providing care to its citizens who are unable to care for themselves because of mental illness is properly invoked since an AOT order requires findings that the patient is unlikely to survive safely in the community without supervision;  the patient has a history of lack of compliance with treatment that has either necessitated hospitalization or resulted in acts of serious violent behavior or threats of, or attempts at, serious physical harm;  the patient is unlikely to voluntarily participate in the recommended treatment  plan;  the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the patient or others;  and it is likely that the patient will benefit from [outpatient commitment].

There are many aspects of this that could be discussed at length, but I will just make two short comments.  The first is that the court held the patient must benefit from the drugging, which is highly dubious, at best.   The second, more over-arching, is that many of the requirements for obtaining an outpatient commitment order in New York cannot, in fact, be properly proven in most cases, such as the person is unlikely to survive without the forced drugging.  Again, that so many of these orders get issued demonstrates where I think the legal system vis-à-vis involuntary commitment and forced drugging is most broken, which is the lawyers assigned to represent people don’t do their job.

Forced Drugging Furthering Governmental Interest

The second Sell requirement is that the involuntary medication will significantly further the state interests justifying the forced drugging.  In other words, the forced drugging must accomplish the goal that justifies it.   So, again, the setting matters because that determines what is the state interest(s).   In the restore-a-criminal-defendant-to-competency situation so the state can put the person on trial, the forced drugging must therefore have a good likelihood of making someone competent to stand trial.   However, while in some cases drugs do knock down psychosis, most of the time they merely sedate the person so they are not bothersome.   This was classically stated in the recent reporting in connection with forced drugging of Jared Loughner:

He was removed from a May 25 court hearing when he lowered his head to within inches of the courtroom table, then lifted his head and began a loud and angry rant. But his psychologist has said that since Loughner has been forcibly medicated, his condition has improved. He sat still and expressionless for seven hours at a hearing in September.

Query:  Is sitting still and expressionless for seven hours an indication someone understands the charges against him and can assist his lawyer?   Of course not, it merely shows that the drugs prevent him from being disruptive.  In other words, the assertion that the drugs cause someone to become competent to stand trial can be challenged.  As an aside, I am not in favor of people using mental illness as a way to avoid criminal responsibility for their actions.

In the civil commitment and outpatient commitment contexts, it is also very dubious that the forced drugging will actually achieve the stated goals.   First, we know from Anatomy of an Epidemic and other sources that psychiatric drugs (a) increase rather than decrease violence, (b) dramatically shorten lives, (c) dramatically increase disability; and (d) dramatically decrease recovery.  Thus, it is quite questionable in many cases whether especially the parens patriae justification, in fact, exists.   However, even though psychiatric drugs, especially the antidepressants and neuroleptics, increase violence, the neuroleptics can also render people incapable of causing much trouble.  Thus, neuroleptics very well may further the governmental police power interest in that.

However, it is most often not true that the drugs accomplish the asserted justification for the forced drugging.  Again, the reason why so many forced drugging orders are issued is because the lawyers assigned to represent people, don’t do so.

Less Intrusive Alternatives

The third Sell requirement is the court must conclude that involuntary medication is necessary to further those interests; that there are no less intrusive alternatives.  The Alaska Supreme Court, in the Bigley case, addressed what the requirement means under the Alaska Constitution,

Although the state cannot intrude on a fundamental right where there is a less intrusive alternative, the alternative must actually be available, meaning that it is feasible and would actually satisfy the compelling state interests that justify the proposed state action.

(p. 31)

As Anatomy of an Epidemic, and many studies and other sources demonstrate, as a factual matter, this is rarely the case, especially if the government has to prove there are no less intrusive alternatives by clear and convincing evidence.

Here too, the lawyers appointed to represent people facing forced drugging rarely fulfill their obligation to assert the right to a less intrusive alternative.  However, proving there is a less intrusive alternative can be difficult even if the attorney tries because the hospital has an automatic “expert,” the testifying psychiatrist, while the defendant often does not have the resources to employ an expert or otherwise prepare a case.

In Bigley,  starting at page 30, the Alaska Supreme Court’s discussion of this issue can give one an idea of the way a court looks at it and the difficulties in prevailing.   In addition to the lawyers assigned to represent people not doing their job properly, one of the biggest obstacles is appellate judges, just like trial court judges, believe the common wisdom that the drugs are helpful and nothing else works.  As I wrote in A Three Pronged Approach to Mental Health System Change, this is one of the reasons why educating the public about the truth is so important.

 Best Interests

The final Sell requirement and the one that ultimately leads me inexorably to the conclusion that forced drugging  and electroshock cannot be properly ordered, is the “court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.”  The truth is that while a small percentage of people might rationally decide to take neuroleptics with full knowledge of their lack of effectiveness for most and harm to all, it is not possible for a court to legitimately find by clear and convincing evidence that forcing someone to take them is in their best interest.   Frankly, I don’t think it is possible under the preponderance of evidence standard.

Space doesn’t allow me go through the evidence on this, but Anatomy of an Epidemic  does.   Much of the evidence has also been compiled as part of PsychRights’ and MindFreedom’s Forced Drugging Defense Package.  It includes an affidavit from Robert Whitaker, the“clickable”  verson of which has hyperlinks to the cited studies.   Also, my 2008, law review article, Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course has much of the same material woven with the legal standards and the perspective of people faced with such court proceedings.  The bottom line is the evidence does not support forcing someone to take psychiatric drugs against their will is in their best interests.

The same is true of electroshock in light of the harm and lack of benefit from electroshock.  In contrast to the neuroleptics, however, I think electroshock should be abolished altogether in light of its complete lack of benefit and extreme harm.

 Conclusion

Under the United States Constitution, as well as state constitutions, the government is not allowed to force someone to take psychiatric drugs or be electroshocked against their will unless it can prove such drugging or electroshocking is (1) necessary to achieve a compelling governmental interest, (2) the least intrusive alternative, and (3) in the person’s best interest.   In most cases, neither the 1st or 2nd requirement is met because  (1) the drugging or electroshock does not accomplish the government interest asserted, and (2) there are less intrusive alternatives.   The last element, that the forced drugging or electroshock is in the person’s best interest, however, cannot be legitimately proven, which is why I conclude forced drugging and electroshock in the United States is illegal.

The question that jumps out from these circumstances is why people’s rights are being so pervasively violated?  The short answer, as I indicated in A Three Pronged Approach to Mental Health System Change, is the lawyers and judges believe the conventional wisdom that if the defendant wasn’t crazy she would know it is good for her so we won’t let her pesky constitutional rights get in the way.  This is why educating the public is so important.

In addition to this, however,  a big reason why people’s rights are being violated as a matter of course is the lawyers appointed to represent people faced with forced drugging and electroshock proceedings are not fulfilling their professional obligations when they go along with this.  But that is the subject of a future blog.

 

Electroshock Therapy: Is Oprah Right? Electric Shock Mental Health Treatment, Breeding Psychetruth

Medical Beauty Center, March 21, 2012

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Could DSM-5 Be Harmful to Your Mental Health?

By Elayne Clift, posted on February 2, 2012 by the Women’s Media Center

The APA diagnostic manual revision process, in the news recently over the definition of autism, holds other potential threats for women’s health. Elayne Clift investigates the gender issues in DSM-5.

Debbie N. (not her real name) was a college student in the 1990s when she traveled to the Mediterranean to recover from an abusive relationship. Partying hard, a cultural norm for her immigrant family, she was diagnosed schizophrenic. Back in the States, using alcohol and drugs to numb her pain, she entered Harvard where she earned a master’s degree.  There, diagnosed bi-polar and prescribed Lithium (which permanently impaired her thyroid function), she was given anti-depressants and told she would require meds for the rest of her life.  Now, after several hospitalizations and agonizing self-doubt, she is free of medication, owns her own business, and leads a healthy lifestyle based on rest, nutrition, exercise and meditation.  “I consider myself to be a sensitive person who’s been through a lot of loss. I changed my lifestyle and took responsibility for my behaviors.  I’m a survivor.”

Stories like Debbie’s are ubiquitous, and so troubling that as the new Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is being prepared for release in 2013, clinicians formerly involved in its preparation are calling for major reform of the text that has driven psychiatric diagnosis and treatment for decades.  Many of them will participate in “Boycott Normal,” a demonstration planned for May 5, when the American Psychiatric Association (APA) meets in Philadelphia and is likely to vote to go forward and publish the DSM-5.

“This is not a civil war between establishment psychiatry and so-called radicals,” says boycott organizer David W. Oaks, executive director of MindFreedom International.  We are trying to put the debate into a human rights framework because the DSM has been used to discriminate, to take away liberties, and to allocate resources.  It’s a quasi-legal document written by a few hundred people voted on by rich white males.”

Dr. Allen Frances, who chaired the task force revising DSM-4, is among those psychiatrists now calling for reform, along with organizations like the American Counseling Association, the British Psychological Society, and a division of the American Psychological Association. But that effort focuses on the process of deciding what diagnoses should be included in the “psychiatrists’ bible” and how those diagnoses should be determined within the existing framework of the DSM.

Many feminist psychologists, psychiatrists and social workers are calling for stronger actions, including a boycott of the DSM-5 by clinicians, and Congressional hearings to address psychiatric diagnosis and the damaging effects of labeling people deemed to be “mentally ill.”

Foremost among these advocates is feminist psychologist Paula J. Caplan, a fellow in the Women and Public Policy Program at Harvard’s Kennedy School, and the Joan-of-Arc of the new PLAN T Alliance (Psychiatric Labeling Action Network for Truth). The alliance is a coalition of individuals and organizations formed because of frustration with the unscientific nature of the DSM, the harm done to many people who receive arbitrary diagnostic labels, and the unwillingness of the APA to undertake serious reform.

“It is increasingly clear that the editors of the major psychiatric manual, which reaps huge profits for the APA, are ignoring the massive evidence of harm done by the labels of previous editions of the manual and of likely harm from what they plan to put in the [DSM-5],” says Caplan, who resigned from two prior DSM committees because “they were playing fast and loose with the unscientific research related to diagnosis.”

Critics of the alliance’s call to action believe its attempts at serious reform are what one called a “broadside” against psychiatry.  Many support a parallel petition seeking DSM-5 revisions.  While one prominent psychiatrist active in the development of previous DSMs acknowledges that there are serious problems with DSM-5, he argues that activist groups are criticizing the DSM-5 to smear all psychiatry in a way that is detrimental to people whom it could help.

But given what’s coming in DSM-5, the manual itself appears to be detrimental, especially for women, children and the elderly.  For example, grief after the loss of a loved one could be labeled “depression,” leading to medication if it lasts longer than two months.

“Premenstrual Dysphoric Disorder,” PMS, is slated to return to the DSM, pathologizing many menstruating women.  “Binge Eating Disorder,” with alarmingly normal indicators, will be included, as will “Borderline Personality Disorder,” with roughly 75 percent of patients given that label being women. according to Dr. Dana Becker of the Bryn Mawr Graduate School of Social Work.

“Sexual dysfunctions” such as “Female Orgasmic Disorder,” defined as a “persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase” is another concern.  The diagnosis is “based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable given her age, sexual experience, and the adequacy of sexual stimulation she receives.”  DSM-5 modifications describe further symptoms, an exercise NYU psychologist Dr. Leonore Tiefer calls an attempt at “rearranging deck chairs on the Titanic.”

Feminist psychologists have been challenging DSM diagnoses since the 1980s when the Association for Women in Psychology coordinated a petition regarding DSM-III-R.  Today they are joined by others in a groundswell of opposition to the APA’s newest effort.

Al Galves, executive director of the International Society for Ethical Psychology and Psychiatry, is among them. He wants to see DSM-5 jargon replaced with relevant terms reflecting the stresses of modern life—loss, despair, loneliness, hopelessness—words relating to “emotional distress, spiritual emergencies, life crises, and difficult dilemmas.”  The question, he says, is “how do you get the psychiatric establishment and the pharmaceutical industry to revamp totally” so that they move away from the language of the medical model and use ordinary words to facilitate helping people who are suffering.

Dr. David Elkins, professor emeritus of Psychology at Pepperdine University, agrees it’s time to frame harm done by the DSM as a “social justice issue,” although he stops short of endorsing the PLAN T Alliance call for a boycott just yet.  In a letter to the DSM-5 Task Force and the APA on behalf of the division for Humanistic Psychology/American Psychological Association, he called for “an external, independent review” to ensure that the DSM-5 is “safe and credible.”

But perhaps Paula J. Caplan put it best in posting a petition at change.org:  “This call is not an attack on or a questioning of psychotherapy or even diagnosis across the board but simply an attempt to draw attention to this minimally investigated enterprise of psychiatric diagnosis and to find ways to protect people from the harm that can result.”

Injustice in Healthcare

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Dr. Martin Luther King, Jr. 

Psychiatric Labeling Action Network for Truth

by Dr. Paula Caplan, Clinical & Research Psychologist, Harvard University

Alarmed by the massive numbers of people who have been seriously harmed over the decades because of psychiatric diagnosis, which is not scientifically grounded, rarely helps, and often has negative consequences, and knowing that the next edition of DSM will likely be sent to press this coming May at the American Psychiatric Association convention, we have decided it is time to stop asking the DSM editors to listen and instead to take actions. The first two actions of our PLAN T Alliance (Psychiatric Labeling Action Network for Truth) are…

Boycott the DSM

and

Call for Congressional Hearings about Psychiatric Diagnosis

The following video and information was uploaded by prokopton on Dec 4, 2007

The idea of mental illness as a biological entity is easy to refute. In 1988, Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of Psychobiology, both of Harvard Medical School, said “an impartial reading of the recent literature does not provide the hoped-for clarification of the catecholamine hypotheses, nor does compelling evidence emerge for other biological differences that may characterize the brains of patients with mental disease.” 

In 1992 a panel of experts assembled by the U.S. Congress Office of Technology Assessment concluded: “Many questions remain about the biology of mental disorders. In fact, research has yet to identify specific biological causes for any of these disorders. … Mental disorders are classified on the basis of symptoms because there are as yet no biological markers or laboratory tests for them.”

Columbia University psychiatry professor Jack M. Gorman, M.D., said “We really do not know what causes any psychiatric illness.” Another Columbia University psychiatry professor, Jerrold S. Maxmen, M.D., said “It is generally unrecognized that psychiatrists are the only medical specialists who treat disorders that, by definition, have no definitively known causes or cures. … A diagnosis should indicate the cause of a mental disorder, but as discussed later, since the etiologies of most mental disorders are unknown, current diagnostic systems can’t reflect them.” Psychiatrist Peter Breggin, M.D., said “there is no evidence that any of the common psychological or psychiatric disorders have a genetic or biological component.”