The Tragedy of Sane People Who Get Put Away ***************************************************** In 1887, the intrepid woman journalist, Nellie Bly, whose name has become legendary in the newspaper world, feigned insanity and had herself committed to the New York City Lunatic Asylum on Ward's Island in the East River (now known as Manhattan State Hospital). Nellie emerged with a cautionary expose' which foreshadowed the coming era of forced treatment entitled, "Ten Days in a Madhouse". Her series of articles, which were printed in Joseph Pulitzer's New York World, exposed the alarming trend of forcing sane people into lunatic asylums under the guise of mental health. Seventy-five years later an investigative journalist from Life magazine, Albert Maisel, wrote his own expose' in Reader's Digest, called the Tragedy of Sane People who Get Put Away (February 1962), on what turned out to be the continuing practice of forcing sane people into treatment. The reasons why these unscrupulous practices continued unabated range from parental control, to vindictive spouses, to scheming relatives and crooked lawyers, to a growing multi-billion dollar industry. Now, another forty years later, newly passed laws have actually made it easier to have an individual forcibly committed. Is the worst yet to come? ***************************************************** THE TRAGEDY OF SANE PEOPLE WHO GET PUT AWAY In Illinois three years ago, Jane Doe (to protect the privacy of the victims, fictitious names are used in this article) was rushed to a hospital after an auto crash. The next day her husband applied for her commitment to a state mental institution. One week later a court "hearing" was held. While she still lay bedridden - with no opportunity to be heard, no chance to call witnesses, no counsel to defend her - Mrs. Doe was branded insane. Now, after two and a half years of illegal incarceration, she has been freed by another judge. In California, Rhoda Roe's husband, a physician, induced her to visit one of his colleagues, a psychiatrist. In his office, after she refused to sign herself into a mental hospital, the psychiatrist forcibly administered an injection. When she came to, she found herself in a psychiatric institution. Though it was established later that she was sane when she was admitted, she was held against her will for two weeks and subjected to shock treatments. In North Carolina, a county court ordered the sheriff to arrest Peter X, after his brother signed an affidavit falsely alleging that he was insane. In jail the next day the bewildered prisoner was notified that a hearing would be held within an hour. When his jailers failed to bring him into court, the court clerk signed a commitment order. That evening, after getting no chance to defend himself, hire a lawyer, or even notify his wife of his arrest, Peter found himself imprisoned in a mental hospital. These cases of normal people railroaded into mental institutions are not rare exceptions selected to shock you. Recent hearings before the Senate Subcommittee on Constitutional Rights have revealed that every year thousands of sane men and women are wrongfully "put away" by divorce-seeking wives, vindictive husbands, estate-grabbing relatives, busybody neighbors or callous public officials. Ohio's Governor Michael DeSalle told the Committee that a survey of his state's mental hospitals disclosed 4500 inmates who were not insane at all! They were simply elderly men and women who had been "dumped" because their relatives or communities had shirked the rsponsibility of caring for them. This swelling epidemic of wrongful commitments has been made possible by a series of so-called reform laws passed in recent years by state legislatures at the urging of psychiatrists, mental-hospital superintendents and the U.S. Department of Health, Education, and Welfare. Ostensibly, the purpose of these laws is to make it simpler to bring the mentally-ill to treatment. But in fact, these statutes have swept away most of the constitutional safeguards designed to protect the wrongly accused. The right to a trial by jury, for instance, is guaranteed by the U.S. Constitution and by the constitutions of all the states, to anyone accused of a crime. In the past, most states extended this right to those suspected of having a mental illness. Today only thirteen states authorize even the occasional use of a jury in commitment cases. Yet forced confinement in a mental institution involves just as great a loss of liberty (if not more) as any other form of imprisonment. Furthermore, in state after state mental health laws are such that the individual whose liberty is at stake need not even be notified that his case is coming up for decision. This strange denial of the right to be heard in one's own defense has been advocated by some psychiatrists on the weird theory that it might be traumatic for a "patient" to receive a document couched in legal terms. Even where notice is still compulsory, the time limit between notice and hearing is often too short to permit the accused a chance to seek witnesses and obtain counsel. Maine, New York and Oklahoma, for example, permit as little as twenty-four hours notice. And though the right to be represented by counsel is guaranteed by every state to all those accused of crime, fourteen states make no such provision for those alleged to be mentally-ill! In place of trial by jury, many speedier ways of rushing accused people behind institution walls have been invented. Twenty-five states, for example, now turn over many or all commitment cases to referees or special commissioners or mental health boards. A few of these boards include a judge. Others are made up of just two physicians. Still others include a lawyer or a court clerk or a county adjuster. In Maine, municipal officers serve as sanity commissioners after completing their other civic duties. What short shrift such commissioners may give a wrongfully accused person is illustrated by the Senate subcommitte testimony of Dr. Chester H. Farrell, medical member of the three-man Douglas County board which handles commitment cases in Omaha, Nebraska. Meeting on weekday afternoons, this board first examines an average of three to four "informations" alleging mental illness. Then it interviews "informants" who must swear to the accuracy of their statements. When all is in order, it issues warrants to the sheriff, who has "patients" picked up and placed in a psychiatric ward at the county hospital (unless they can afford private treatment). The accused gets no notice. In custody he is permitted no phone calls. If he writes letters, they are censored by a nurse. But he can be sure of one visitor: the medical member of the board comes to examine him. When the board reconvenes, the medical member's diagnosis is read to his colleagues - a court clerk and a lawyer- and a decision is made. Thus, upon the vote of three men - two of whom may have never even seen the accused - approximately 1000 residents of Douglas County are, each year, adjudged insane and committed to state hospitals. Along with their freedom, they automatically lose their rights to vote, to drive a car, to control their property, and to make a contract. All this is done by proceedings in which an average of barely one hour is devoted to each case, paperwork, "hearing" and deliberation combined! Even more opportunity for unjust commitment is afforded by another procedure, a feature of the "Draft Act" promoted as a "model" mental health law by the Department of Health, Education and Welfare. Under this procedure, those alleged to be mentally-ill can be deprived of their liberty without a court order, on certification by two physicians. Ten states have already adopted this completely non-judicial process. In most states the examining physicians need not have had any training in psychiatry! These tricky "reform" laws can be stretched to rob you or me or any well-behaved, non-violent individual of his freedom. For in all but six states it no longer needs to be shown that the accused is dangerous or that he suffers from a psychotic disease. All that's necessary is a finding that he is "in need of treatment." In Massachusetts, for example, you can be committed if you are deemed "likely" to conduct yourself in a manner which violates the "conventions or morals of the community." You need not actually have done or said anything out of line. The mere "likelihood" that you might is enough to justify your being seperated from your family, deprived of your civil rights and forced into indefinite confinement in a mental hospital. How easily such vague definitions of mental illness lend themselves to abuse was demonstrated recently by the case of the Rev. John Doe, an African-American professor who violated the conventions of his community by attempting to enroll as a student at the all-white University of Mississippi. He was hauled into court for a lunacy hearing and was promptly dispatched to a mental hospital. At the hospital psychiatrists declared the professor sane and he was allowed to leave the state. Many psychiatrists argue that wrongful commitments pose no great problem because anyone so imprisoned is speedily discharged by the hospital authorities. Even if this were so, loss of liberty would be no less outrageous because it proved short. But it isn't so. Most of out mental hospitals are woefully undermanned. Dr. Harry Solomon, past president of the American Psychiatric Association, has said, "In many of our hospitals about the best that can be done is to give a physical examination and to make a mental note on each patient once a year, and often there is not enough staff to do this much." We sentence even convicted criminals to fixed terms with time off for good behavior so that they may look forward, with certainty, to the day of their release. But for the victims who have been railroaded into mental hospitals there is no such certainty. How many serve out utterly unjust life sentences we shall never know. But the records of those rescued after decades of illegal imprisonment can give at least an inkling. In Michigan, for example, Harry Klein of the Detroit Legal Aid Bureau took up the case of a woman who had been hastily committed on the decision of an examining psychiatrist who declared that she suffered from "delusions of grandeur" because she told him of an invention she had been trying to sell to the auto industry. When Attorney Klein proved that the woman had actually invented a rumble-seat top and had the documents to prove it, the court ordered her immediate release, after commitment had cost her sixteen years of freedom. Another woman was unjustly confined on the diagnosis of a psychiatrist who decided that she was insane because "she says it is an outrage that she is being detained as she is running for office and needs to look after her campaign." When assigned to her case, Klein checked back to newspaper reports of the primary election held at the time of his client's arrest. There, if the doctor had bothered to look, was her name, clearly recorded, as a candidate. The price paid by this victim? Nineteen years! An even more shocking case is that of an Indiana man convicted in 1897 of a $15 petty theft charge and later sent by executive order, that is - without a hearing, from prison to a state mental hospital. Three years ago, at the ripe old age of 83, he escaped and walked into the local courthouse to plead for his freedom. Thus, at last, his sanity was finally affirmed after more than half a century of wrongful imprisonment. How can such denials of justice be eliminated? Only by reforming the "reform" laws, to accord to all accused of mental illness as fair a hearing as we routinely guarantee those accused of a crime. The American Bar Association, such senators as North Carolina's Sam J. Ervin and New York's Kenneth B. Keating, and many leading jurists and psychiatrists have been working for such real reforms. In Ohio last year one such group succeeded in getting a bill passed eliminating many (but unfortunately not all) of the old law's easy commitment provisions. There, too, on Governor DiSalle's orders, 1500 wrongfully held old folk have already been released from mental hospitals; 1500 more are scheduled for release as soon as arrangements for care can be completed. The battle must be fought state by state. To win it, the help of millions of civic-minded citizens will be needed. Only when all men are secure from unjust imprisonment can each of us truly feel free. (by Albert Q. Maisel, the author is indebted to the American Bar Association for the use of information contained in "The Mentally Disabled and the Law," University of Chicago Press, 1960) ***************************************************** REPORTS FROM THE PSYCH WARS, by Richard Ingram SECTION 1: HYPERREAL PSYCH WARS It was the Hollywood mogul Samuel Goldwyn who observed: "Anyone who goes to a psychiatrist ought to have his head examined." Yet most people do not opt to become psychiatric patients. If the psychiatric profession were to rely on voluntary recruits alone, then its scope would be considerably smaller than it is now. As a disciplinary apparatus, therefore, psychiatry has relied on a steady stream of recruits who are press-ganged into service as patients. From the perspective of the state, the use of coercion has been justified as an essential component of what is often called "the war on mental illness." But the narrative of fighting to overcome this enemy has been challenged by a counternarrative that considers the very concept of "mental illness" to be fraudulent. By the 1970's, books such as E. Fuller Torrey's "The Death of Psychiatry" suggested that the profession itself was on the verge of collapse. Looking back, however, it is clear that far from expiring, psychiatry was undergoing a fundamental transformation. Indeed, the profession emerged strengthened from it's breakdown by entering into a Faustian pact with the psycho-pharmaceutical industry. The condition of this pact was that psychiatry was obliged to renew theories of biologically determined behavior that had been somewhat discredited by the events of World War II. Psychiatry's rehabilitation was achieved by resuscitating theories of innate defects in order to shore up the concept of "mental illness," and to gain a more secure position within the medical establishment. The success of the counternarrative that rejects the concept of "mental illness" could be measured in terms of the dramatic reduction in the number of institutionalized patients. By re-inventing itself as psycho-pharmacology, though, psychiatry has become less dependent on the mechanism of confinement. Not only has it managed to integrate the critique of the "stigma" of mental illness, psychiatry has also produced the category of "consumer" to supplement the category of "patient." This shift from patient to consumer enhances psychiatry’s claim that it operates on the basis of consent. Nevertheless, the process of de-institutionalization is being re-evaluated, and there are signs that it may be reversed. I have referred to the prominent American psychiatrist, E. Fuller Torrey, because he embodies this reversal, having mutated from a dissident within his profession into a leader of the new press gangs. In his 1997 book, Out of the Shadows: Confronting America’s Mental Illness Crisis, Torrey states that: "For a substantial minority... de-institutionalization has been a psychiatric Titanic" (11, emphasis in original). It appears that the main reason behind the great push for de-institutionalization in the 1960s and 1970s is being forgotten, and that we need to have our memory jogged. David Gonzalez, psychiatric survivor and creator of the website, the stigma of CineMania, points out the following striking comparison: "Based on figures obtained from the Center for Mental Health Services in 1994 and statistics obtained from the 1995 Funk & Wagnalls World Almanac and Book of Facts (Page 163): Between 1950 and 1964, more people died in United States federal, state and county 'mental institutions' than the number of Americans killed in the Revolutionary War, the War of 1812, the Mexican War, the Civil War, the Spanish-American War, World War I, World War II, the Korean War, Vietnam, and the Persian Gulf War combined." In short, the "war on mental illness" has been the most lethal confrontation in which the United States has ever been engaged. At the heart of this confrontation lies the text that is regularly referred to as the "psychiatrist’s bible," the Diagnostic and Statistical Manual of Mental Disorders (the "DSM"). Since the first edition of the DSM was published in 1952, this text has grown exponentially. One indicator of the rapidity of its expansion is the number of pages needed to list and define the diagnostic categories in successive editions. For the second edition, published in 1968, the number of pages was 51; for the 1987 revised version of the third edition, the number was 350; and for the enigmatically named "text revision" version of the fourth edition that emerged in 2000, there are 742 pages of lists and definitions (Barss 21). One way of approaching the DSM is to treat it as an ideological text in which the traces of battle are inscribed. Louise Armstrong, a journalist who has written about an aspect of the psych wars that she describes as, "the psychiatric policing of America’s children," summarizes the militaristic manoeuvrings in and around the DSM with these observations: "Reading about the evolution of the DSM... is somewhat like reading the history of the Balkans: ongoing border wars, eruptions, skirmishes, the odd assassination, uprising, overthrow..." [The DSM] is an entirely political document. (Armstrong in Caplan ix, emphasis in original) Although I do not doubt the productivity of this approach, the drawback is that it aims to diagnose psychiatry’s underlying traumas by identifying textual symptoms, which entails the embrace of some of psychiatry’s own methods. In an effort to avoid making truth claims about the psych wars, I am going to utilize the concepts of "simulation" and "deterrence" as they are articulated by Jean Baudrillard in Simulacra and Simulation. There is a parallel, I want to suggest, between the nuclear arms race and the stockpiling of diagnostic categories since World War II. The connection between military and psychiatric expansionism is that in each instance, the simulation of an extreme threat triggers a proliferation of security systems, spreading like a chain reaction to cover all social relations. For psychiatry, the danger to be averted is any situation in which a mad person remains anonymous to the authorities. With this simulated threat as its alibi, the American Psychiatric Association has assembled the vast diagnostic machine of the DSM. Aside from being a perfect example of what Deleuze and Guattari call an "apparatus of capture," the diagnostic machine of the DSM functions as a security system that dissuades us from behaviour that risks being identified as symptomatic of "mental illness." A typical response of the "anti-psychiatry" or "mad movement" is to argue that the mad are less violent than the general population, and positively docile in comparison with psychiatrists who practice "involuntary commitment" and "involuntary treatment" — also known as arbitrary incarceration, forced drugging and electro-shock. But the strategy of rationalist critique will be ineffective if, as Baudrillard asserts, "we are in a logic of simulation, which no longer has anything to do with a logic of facts and an order of reason" (16). Following Baudrillard, then, will lead us to the conclusion that the figure of the "psycho" can be neither proved nor disproved because it surpasses the oppositions of "real" and "imaginary," "true" and "false" — in short, it is "hyperreal." As for the DSM, its diagnostic categories have long ceased to represent realities that precede them, and have instead become simulation models that generate hyperrealities. The DSM may once have been compiled from "case studies," as narratives of investigation into the aetiology and trajectory of "mental disorders." However, a threshold has been crossed so that it is the lives of patients that are now expected to conform to the models of "mental disorders," rather than the other way round. As an illustration of how diagnostic categories operate as simulation models, I have reproduced one of the posters from a project known as the "Early Psychosis Initiative" (fig. 3). Towards the end of April 2002, these posters started appearing on lampposts in the Vancouver-Richmond area. In total, there are four posters, each showing a figure who is said to be between the age of 17 and 24. The poster in figure 3 reads: "Mary used to be really popular. Now she won't talk to her friends because she doesn't trust anyone. Psychosis is a treatable medical condition that affects thinking and perception. Three out of 100 people will get it. Worried about yourself or a friend? Visit [website provided] or call us at [phone number provided] for confidential help." On the website, there is a particularly chilling request that promises to usher in a wave of psychiatric McCarthyism: "The Early Intervention Program would like to hear from you if you or someone you know in the Vancouver or Richmond area is showing early signs of psychosis. Please email us at [email provided] or call [phone number provided]." This evangelistic project, which is being co-ordinated by the Department of Psychiatry on the same campus where the "Narratives of Disease, Disability, and Trauma" conference was held on May 9-11, 2002, preaches a script into which we are invited to write ourselves, or those we know, as actors. Its simple narratives precede and have priority over the lives into which they will insert themselves, which is precisely why I consider them to be simulation models. (End of Section 1) If you wish to direct any comments or questions about the "Hyperreal Psych Wars" contributed by Richard Ingram to CineMania, or to obtain additional information about his "Reports from the Psych Wars" you can contact the author directly at richard.ingram@ryerson.ca ***************************************************** Turning "Mental Patients" into Criminals ***************************************************** EIGHT FLEW INTO THE CUCKOO'S NEST In an experiment written up as "Being Sane in Insane Places" Dr. D.L. Rosenhan, of Stanford University, and 8 associates (3 women and 5 men) voluntarily entered twelve psychiatric institutions. They complained to the staff psychiatrists of hearing voices which said "hollow", "empty", or "thud". They reported no other symptoms. The "patients" were chosen for the experiment on the basis of being normal everyday people who represented a wide range of occupations, including housewife, artist and pediatrician. After being admitted to the hospitals, all the "patients" told the staff that their symptoms had disappeared, and all acted as they normally did. In these research trials it took the "patients" between 7 to 52 days to be released. In almost all the cases they were discharged with diagnoses of "schizophrenia in remission"; not once were they discharged as being sane. Once the "patients" were on the psychiatric wards they observed many enlightening facts about what happens to a person when others think he is crazy. They found that patients were considered less than human and were treated as though they were invisible. Often they would address the staff with simple questions such as when a particular doctor would be in, and they would be totally ignored. There was little privacy or activity allowed and when discord arose due to these conditions they were attributed to the patients' illness. Many of the "patients" took notes of their observations, first secretly and then openly when they found out that nobody cared. One nurse, commenting on her "patient's psychosis," mentioned his "compulsive note-taking behavior." All the researchers combined were given a total of 2,100 pills, which they, like many "real" patients, discarded. An interesting sidelight to the experiment was the fact that although not one psychiatrist or nurse suspected the hoax, 35 "real" patients out of the 118 residing in the wards with the researchers suspected that they were faking. You're not crazy... you're some kind of inspector or journalist checking up on conditions here at the hospital" was heard over and over again. To confirm their findings, the researchers notified a leading hospital that within a 3-month period 1 or 2 researchers would attempt to gain admittance to their hospital. The hospital staff was notified well in advance about the experiment. Of the 193 patients admitted during the 3-month period, 41 were alleged to be researchers by staff members, including 23 by psychiatrists. Actually, not one researcher had attempted to gain admittance during that period. ***************************************************** Bellevue Hospital: Unit 19 North SHRINKING THE GAP OF HUMANITY by NAAMA TOKAYER, MA, ABD One of the greatest challenges we face as a society relates to the distance we create from one another. As I reflect upon the HBO "Bellevue: Inside Out" America Undercover documentary, I wonder whether we have made any progress in how we view persons with mental illness. The intent of the episode was to realistically portray events taking place in the psychiatric emergency room at Bellevue Hospital. In some respects, this mission was accomplished. The audience was exposed to a host of illnesses, medications and interventions. The audience, however, did not receive a realistic portrayal of the individuals admitted to the psychiatric units. The scenes of the persons with mental illness were certainly upsetting and often, dramatic. The infantilizing perspective seemed to reflect that the medical staff cared more about their “patients” than the “patients” did of themselves. Little attention was paid to the individual’s own devastation about their personal daily struggles to maintain jobs, relationships and self-care. Instead, it seemed as if the staff were better able to understand their patient’s disease than their patients were capable of. This message, that person’s with mental illness cannot participate in their treatment and cannot fully comprehend the nature of their illness, recurs throughout media. The negative images of persons with mental illness seem to serve a function. It seems to reflect society’s wish to maintain distance from serious mental illness and deny the reality that mental illness can afflict any one at any time. Society’s fear and discomfort with mental illness, as opposed to physical illness, was clearly portrayed in this episode. The makers of the episode drew in the audience to sympathize with a psychiatrist’s personal struggle with cancer. The emotional connection to her and her illness was so close, yet distance from those with serious mental illnesses was maintained. Once we, as a society, are willing to shorten the distance from one another, we will be able to take a good luck at one another and inevitably conclude that we are not so different, after all. ***************************************************** Pandora's Box Links: Panacea or Pandora - Won't Make the News - This Way Lies Ruin - Madness on the Couch - Prozac Scandal - Betraying their Patients Copyright © 2007 MentalHealthStigma.com, All Rights Reserved Fair Use Notice: Please note that MentalHealthStigma.com contains copyrighted (©) material, the use of which has not necessarily been authorized by the copyright owner. These materials are presented strictly for educational purposes only and therefore constitute a fair use of copyrighted material as provided for in section 107 of the U.S. Copyright Law. MentalHealthStigma.com does not sell any products of any kind and does not profit in any way from the use of these copyrighted materials. 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