"new meds are better" claim in their notebooks without checking out the assertion with other sources, then they are little more than shills for pharmaceutical companies.

Sorry--but I have to insert my diabetes observations, which parallel the mental health issues on several levels. While you chastise reporters for being pharma shills--docilely accepting that "new meds are better," diabetic healthcare professionals have acted in precisely this same manner. When rDNA insulin was introduced, Eli Lilly used a couple of "slogans" to cement their position. "Newer is better" ensnared many diabetic caregivers; some, however, stuck by their guns believing if a diabetic was doing well on "old" medicine, why change. Next came: "it's just like the human body makes--who wouldn't want to use HUMAN insulin." At best, this was only a partial truth--but had such a compelling argument, that more caregivers were ensnared. The coup de grace--which has not yet been thrust upon the mental health group--was the removal of competing products. Synthetic, genetically engineered insulin is the ONLY product now available to U.S. patients! Suppose Zyprexa was the ONLY antipsychotic available?!

I think reporters who cover mental health in this country should undergo an analogous form of immersion in their beat.

You state that it might be beneficial for disengaged, unknowing reporters to experience a week or two of Zyprexa/Seroquel treatment. This, in my opinion, doesn't go far enough. I would wish upon those who hawk dangerous drugs for nothing more than increasing an ever-expanding bottom line to experience THE DISEASE (be it mental illness or diabetes). Only then could they truly appreciate the concept of victimization. To offer or compel the use of dangerous drugs to a population that is already vulnerable smacks of the most inhumane treatment imaginable!

Yeah, I agree many reporters do a less-than-adequate job of investigation. Pharmaceuticals--because of their size and power--are able to manipulate information or demand a disproportionate amount of space to advance their position. But doctors--who ARE the interface between patient and medicine--more often than not, choose to remain silent and let the travesties continue; they have a bottom line, too.

Slam dunk. Very well done -- you've hit the nail on the head. The media consistently reinforces the message that newer treatments are always a sign of scientific progress rather than a sign that companies needed some new drugs under patent in order to maintain high profit margins.

Philip you wrote "...And why he wasn't being administered an injectable antipsychotic given his track record of cheeking meds."

If you haven't commited a crime, this is preventive justice. We(society) think you will commit a crime , and instead of jail ( too expensive and looks cruel) we will control you with meds that inhibit your brain to function and make you feel sick/weak all the time .

So fine, one potential killer is off the street, but what happens if they come for you and your thought crimes?
With all this web blogging I am sure you made some dangerous ideas of yours known. Who decides if you are enough of a danger to be forceable drugged?

Find me one killer that is sane.
Hindsight bias (http://en.wikipedia.org/wiki/Hindsight_bias) of the mentally ill is bullshit. Sane people kill just as much or more than mentally ill.

Proven by their own story of 50,000 homeless with nothing to lose are still relatively law abiding individuals. Stick 50,000 sane working people on the street with nothing and how angry and violent would they be?

Yeah, geez, I was under the impression that personal liberty was one of those constitutionally guaranteed rights.

.."as a result, lawmakers will have a chance soon to make California safer and saner."

Are you fucking kidding?!

..rather than a sign that companies needed some new drugs under patent in order to maintain high profit margins. "

Yep. Got Seroquel SR coming down the pipeline to save profits from a patent-threat.

Extended release of "Fifth of Whiskey Head"; I can hardly wait.

Nah. You've got the dosages all wrong Philip.

Try 15 mg. a day of Haldol combined with 30 mg. a day of Zyprexa. That DOES get a person into a locked down seclusion room.

OR, 800 mg a day of Seroquel. THAT gets a locked-down seclusion room too.

Then, make sure they are on a 90 day court-ordered hold; when they finally get out, I doubt they will have ability to write or type what they experienced. Especially if those are discharge medications.

Those are just a couple of examples of discharge medications that my daughter received; was unnstable and MED COMPLIANT.

Landed back in a locked-down seclusion room.

Reckless journalism from the Times. I've got a record going now of how many times I've used the word reckless and psychiatry.

Looks like it's time for a Letter to the Editor. I think my daughter residing inside of 4 psych wards has given me a unique perspective.

Hi,

I really enjoy reading your blog, but I have to ask: Don't you think there's some good things about psychotropic medications? And about Pharma (and no, I'm not a Pharma person; nor have I ever taken any money from them for my research). I mean, despite all of the bad side effects, I've personally seen clozaril work miracles.

And related to this post, doesn't it seem obvious that if Qawi had been forced to take his medicine that the crime would not have happened? Given the lack of insight that many (but not all) people who suffer from SMI have, we're left with two opitons: forced meds or long term hospitalization.

Guess I'm just looking for some balance here.

steve: on occasion i actually say nice things about psych meds (lamictal and lithium for example), but i've been in this world for two decades and have gotten very tired of how pharma companies, researchers and some advocacy groups do business. the sad truth is that the percentage of people who get miraculous results from meds is small, and weighed against the problems with the meds (esp in long-term use) and the fact that far too many people see poor clinical results (have you ever met more than one or two schizophrenics who've been rock solid stable for years on meds? obviously there are a few but not many) that i have to introduce a high degree of skepticism and criticism into the mental health world. it's easier to have that discussion about bipolar and depression than it is with schizophrenia.

my main purpose here is to introduce some transparency and accountability into the mental health system and the media coverage of the same in order to counterbalance the cheerleading out there and unskeptical media coverage of these issues.

for ex, have you ever noticed that researchers never study people who do well with bp, say, or depression? instead they focus everything on the illest of patients and then declare that everyone is just like them and the treatments that produce short term results for 30 percent of the illest patients are how treatment for everyone should be guided. that's unfortunately only looking at one end of the spectrum.

hope that makes sense.

and yes qwai was slam dunk case for forced medication. someone dropped the ball big time with him. but i happen to agree with the supreme court ruling he was part of. even the sickest of schizophrenics have the right to help determine what goes into their bodies...assuming they are competent enough to help make those decisions.

thanks for your questions.

I have a family member who was diagnosed with paranoid schizophrenia. She also has a past history of heavy drug use, so it's difficult to know if she has schizophrenia or fried her brain from drugs. She wrecked her car several times. She's delusional. Members of my family went to court and had her license revoked, and sold the car that they had given her. I think they did the correct thing. She was a danger to other people on the road. When a person's actions threaten the safety of others, I think it makes good sense to intervene.

i agree lisa. and good for your family. btw what kinds of drugs are we talking about here? lsd? pot? meth? crack? just curious.

"And related to this post, doesn't it seem obvious that if Qawi had been forced to take his medicine that the crime would not have happened?"

Umm, maybe if he was bombed to the point of immobility until he was geriatric. Or if they'd amputated his arms and legs.

But there was probably a few less radical things they could have done.

If you read the story carefully you'll note that he'd had a lot of bad reactions to the pills and even when he was on them he experienced hallucinations and delusions. Nonetheless, when he was in a stable environment he was not violent - either when he was on the pills or for the year or more after he was off them.

When he was in a largely unsupported community environment and sharing a hut with someone with an alcohol problem, that seems to have changed. I find that pretty suggestive - especially considering that his earlier violence was in the context of heavy alcohol use. Alcohol has a much higher correlation to violence than mental illness.

Of course we don't know for sure that he was drinking just because his roommate was and that he had an earlier problem with it.

But it seems to me that this is far more a story of the need to give proper support to the mentally ill living in the community than it is one suggesting that they should be forced onto meds.

I'm a little surprised at Philip's analysis of this story all up. Its probably worth noting that for schizophrenia in general, there is no measurable increase risk of violence when you control for factors like socioecomic stress, substance abuse and a history of abuse victimisation and institutionalisation. If you narrow the focus to psychosis involving command auditory hallucinations, persecution delusions, hostile thought insertion, etc there is an increased risk of violence though. And there's increased risk for people with an existing history of violence whether or not they are mentally ill (but you don't need a p-doc to tell you that).

But the vast majority of even floridly psychotic patients will never commit a serious violent offence. So how many do you keep forcibly drugged in the hope of immobilising the tiny minority who will commit serious violence and the much tinier number who will kill?

So I reckon the take home message is that while you might prevent the odd violent offence with a widespread campaign of forced drugging, you will stop a lot more by properly supporting mentally ill people living in the community.

Of course, given Qawi's previous history of pharmacological abuse, there was very little chance he was going to go to authorities to ask for help if he felt he needed it.

BTW, for those who are interested, here is another TAC style beatup of homicide and mental illness - complete with the call for more forced drugging - by the usual suspects in Australian forensic psychiatry. Interestingly, the editorial in the same issue does a pretty thorough job of trashing the design of the study and the conclusions of the authors. Makes you wonder why they ever accepted it for publication.

I've always wondered about that term "lack of insight" as used by mental health professionals. Once I snuck a peak at some of my records and saw that term on there. It sounded really damning, but I didn't know what it referred to. It seems to be a term that is applied to anyone who doesn't wholeheartedly endorse whatever diagnosis a psychiatrist puts upon them, even though such diagnosis is likely to be subjective and unverifiable.

Much of my own troubles seem to have been caused by poverty, and I believe that if a fraction of the money spent on pharmaceuticals were spent on ensuring decent housing, adequate food, and some kind of realistic job training or job placement for everyone in need of it, many more people would be prevented from having psychological problems than the number who think they are helped by using drugs to help them cope with such problems. The problem seems to be that noone is paid for preventing emotional distress - only for dealing with it after it gets very severe. And even after it does get severe, there is no way anyone can make a profit by treating it with a supportive environment.

I concur with Michael in the observation that Qawi did well when in a structured setting - with meds or not. Yet the focus is on medication. When the VA was contacted to have someone evaluate Qawi, no one showed. Mental heath support for our active enlisted and veterans is a joke. What did his outpatient care look like? Why wasn't he in a halfway house that would be better able to meet his needs? He was stuck in the VA system and was left no options but to utilize their subpar resources.

The reporter for this story said the following in reference to John Milton: "Still, he was a fighter." And Qawi isn't?

So everyone posting here believes mental illness is real medical illness. Never mind there is no blood, urine , brain test for it.

Once you have it, you have it for...life?

from http://www.szasz.com/phlogiston.html
"We have one set of principles to explain the functioning of the mentally healthy person, and another set to explain the functioning of the mentally ill person: we attribute acceptable, "rational" behaviours to reasons, unacceptable, "irrational" behaviours to causes. The mentally healthy person is viewed as an active agent: he makes decisions, he chooses, for example, to marry his sweetheart. In contrast, the mentally ill person is viewed as a passive body: as patient, he is the victim of injurious biological, chemical or physical processes acting upon his body, that is, diseases (of his brain), for example, of an "irresistible impulse" to kill.

Phil,

Thanks for your comments. I've seen probably about 500 patients so far in my career and, yes, only a handful have had solid stability for more than a few years. But I think that speaks more to the illness than the medicine. That said, there's no doubt that Pharma has relied far to much on Dopamine drugs and the atypicals have been oversold. But, what I detest is when psychoparm critics fail to point out the HUGE AND OVERWHELMING evidence that AP tx is still better than no tx. I've worked a lot with patients who've gone without tx for long periods and it's just readily apparent that AP drugs are life saving medicines. No, they're not perfect *far from it) but you use what you have.

I'd like your take on a proposition that I often hear from other docs: that NIH should develop new drugs. I think NIH would be more willing to risk agents that act on novel mechanisms but I fear that the process would become so bureaucratic.

I'm going to say one thing right now.

My daughter was never violent in her life until she was medicated with psychiatric medications.

The WORST violence was on antipsychotics:

1. Haldol
2. Zyprexa
3. Risperdal
4. Abilify
5. Seroquel

She is living non-violently at home now on Clozaril.

Medications induce delusions, and all of it.

Read the online prescribing information. It's all there; and not a secret.

Diabetes and Zyprexa?

THAT is the least of the adverse side effects people should be discussing and be worried about.

Get informed. It's really easy to read. It's really easy to judge. It's really easy to judge people based on history of adverse side effects from medications.

THIS is why the Times, and TAC love this type of commentary.

Haldol injections will be the next preventative measure to prevent society from "possible harm". Just like the forced injections of the vaccine for girls in Texas to prevent sexually transmitted 'possible' cancer outbreaks.

Give me a break.

Why do I use Haldol for an example?

Fuller Torrey believes in it's anti-viral properties; and he believes in forced medication.

The next step for his goal in life:

Haldol injections in mental health patients (even those who have never been violent or hospitalized); to prevent harm to society, because YOU are labeled with any form of mental illness.
TAC and Torrey are dangerous.

Watch your labels and watch your back. Torrey equates schizophrenia with bipolar disorder.

This is just my opinion, based on much experience and research.[and listening to Torrey speak in person]. Of course I sound like an alarmist. So does Torrey. I don't have the influence he does.

IF I JUDGED my own daughter; based on a short history of medication-induced violence; she would not be living under my roof at night.

When fishing, do not cast such a broad net.

From Robert Whitaker's "Mad in America,"

"The WHO first launched a study to compare outcomes in different countries in 1969, a research effort that lasted 8 years. The results were mind-boggling. At both two-year and five-year follow-ups, patients in three poor countries--India, Nigeria, and Colombia--were doing dramatically better than patients in the United States and four other developed countries. They were much more likely to be fully recovered and faring well in society--"an exceptionally good social outcome characterized these patients," the WHO researchers wrote--and only a small minority had become chronically sick. At five years, about 64 percent of the patients in poor countries were asymptomatic and functioning well. Another 12 percent were doing okay, neither fully recovered nor chronically ill, and the final 24 percent were still doing poorly. In contrast, only 18 percent of the patients in the rich countries were asymptomatic and doing well, 17 percent were in the so-so category, and nearly 65 percent had poor outcomes....the WHO researchers concluded that living in a developed nation was a "strong predictor" that a schizophrenic patient would never fully recover.....

....The notion that "cultural" factors might be the reason for the difference has an obvious flaw. The poor countries in the WHO studies--India, Nigeria, and Colombia--are not culturally similar....The obvious place to look for a distinguishing variable, then, is the medical care that was provided. And here there was a clear difference. Doctors in poor countries did not keep their mad patients on neuroleptics, while doctors in rich countries did. In the poor countries only 16 percent were maintained on neuroleptics. In rich countries 61 percent were kept on such drugs."

I think neuroleptics keep you crazy.

"HUGE AND OVERWHELMING evidence that AP tx is still better than no tx."

Umm, you've really got to wonder what the absolutist external standard that you could measure that 'HUGE AND OVERWHELMING evidence' against is.

If its the patients themselves saying it makes them better - fine. More power to the p-docs prescribing what they say makes them better. Ditto for the people giving them illegal drugs, psychoanalysis, acupuncture, aromatherapy or 'angel adjustment' - as long as it helps them through the day and they're aware of the risks.

But exactly who has the right to say that a tx is better if the patient says it makes them feel worse?
And the non-compliance rate for psychiatric medication sort of speaks for itself in that regard, no?

Of course the question is more complicated if the patient is a threat to others. But you'd want very good evidence both that they are a threat and that the therapy you are forcing upon them will reduce that threat.

Current actuarial risk assessment tools do not provide good evidence as to whether someone is a threat. They give about five false positives for every one psychotic person who really does go on to commit serious violence and their accuracy is far worse in evaluating homicide risk.

Of course if you pump someone full of enough antipsychotics they will not be able to commit violence - especially if you give them enough so they can't even stand up.

But if that's good public policy for reducing violence, why restrict it to the mentally ill?

Actuarially speaking, young men who binge drink and play contact sport are far more likely to commit a serious violent offence than people with a psychotic disorder.

So when are we going to start forcibly drugging all of the football teams?

Kent, you state:
The problem seems to be that noone is paid for preventing emotional distress - only for dealing with it after it gets very severe. And even after it does get severe, there is no way anyone can make a profit by treating it with a supportive environment.

You've nicely isolated the REAL problem--and it exists across disease paradigms (mental illness, diabetes, etc.) Support, and treatment with the "safest" (safest = longest history with least harm done = OFF-PATENT) do not fit the "business model" of pharmaceutical corporations, nor of many doctors. Do you think the predominance of Type 2 diabetics (whether Zyprexa-induced or otherwise) are first and foremost strictly admonished to exercise and make dietary changes? It is ever so much easier to push a pill and schedule the next office call.

Doctors, because of liability concerns, are often aware of drug interaction, and exhibit a measure of caution to consider a patient's "other meds." But in truth, any drug, introduced into a unique biologic system (person) does NOT perform in a vacuum. We are all now aware of the Zyprexa/diabetes interaction . . . and the Vioxx/heart attack situation; but how many other medication/disease issues exist--they just haven't been acknowledged or studied or written about YET.

It's still all about the money, and the adversarial roles of pharma vs MD vs patient, where do you think the power currently resides.

Addressing something Steve brought up in earlier post wanting to 'find a balance' and Clozaril working mircles.

Due to my daughter being on Clozaril, and at one time having resided in a residential care facility for SMI; I had an opportunity to observe adults (far beyond her age)that according to the attending psych there; 60% of the patients are all on Clozaril.

Finding the balance, and possibly calling Clozaril a 'miracle' drug:

These patients are not in a locked down State Mental Institution is a good thing for obvious reasons. Yet, their lives are far from being what anyone would consider 'quality'.

Not wanting to comment on patients that I know; I will use my daughter as an example:

She does have an organic brain malformation that could be an entirely diff reason for her 'psychosis NOS'.

BUT, right now, she is on the average dose of 300 mg of Clozaril per day, and cannot read, write or think. She is not functioning in her life in a quality way at all.

She is not locked in a State Mental Institution either; yet I question the freedom. Living a life on Clozaril, has given external freedom; yet she is trapped in her mind.
Life is there for the taking, and she cannot take part. It's a repeat every single day. Wake up, take the med, eat, med, eat, sleep.

I am finding it difficult to find a balance as well in my mind.

Locked up in your mind is just about as bad as being locked up in a psych ward.

I've read these comments with interest. There's no doubt that we have a long way to go with our psychotropic meds, but there IS solid evidence that meds are better than nothing. I think the comments about Fuller Torrey are over the top (and yes, i'm aware of what he's said). What many of you have ignored, I think, is how bad the disease of mental illness is (and to the person who said we have no blood test, etc, etc. This is a strawman: We have lots of evidence of gross physiologic and functional impairment in the brains of people with SMI, including those who have never received meds. Szasz might have been onto something back in 1969, but he's a fraud now). The "failure" that many folks have with meds is much more likely attributable to the disease itself. The WHO report was flawed and has been refuted. Also, risk assessment is good -- what all of the old studies neglected to mention was that they didn't include patients who were actually retained; it only followed those released. I admit we have a LONG way to go in the tx of MI and that Pharma needs to be reformed. But if you deny that MI exists or that psychotropics have any benefit -- well you just have no creditability frankly.

"But exactly who has the right to say that a tx is better if the patient says it makes them feel worse?"

The data strongly shows that those who take meds for their SMI have:

-fewer hospitalizations
-less severe symptoms
-fewer arrests
-less violence
-higher employment rates
-less homelessness
-a 4 fold reduction in the risk of suicide
-improved cognitive abilities

Now, unless you're going to argue that these are bad things, then I don't think your point stands.

A bit of clarification regarding myself/ thus my comments. I'm not anti-med. I also don't buy a lot of stats/data on success vs. medications.
Though none of us can speak for another.
I am bipolar, and I do take medications every single day. I did poorly on Seroquel. Lamictal is working. Prozac nearly killed me; when used in combination with Zyprexa. I speak based on 8 years of very intense psychiatric issues re: my daughter; and have observed quite much. My comments are over the top re: Fuller Torrey, for a reason. I think I am not off-base, he seriously believes in forced medication laws that could end up medicating people unnecessarily. I feel my comment is equally as controversial as Torrey. Big difference: I do not have NAMI supporting me with public speaking, or a background of being known as a leading authority on schizophrenia. Anyone with that backing, can get something promoted and not necessarily be a good thing.
It is sad, no question, how mental illness can steal lives; no doubt some people wouldn't be here today if not for their medications.
I still question the quality of life on those medications. That's okay for anyone to question, and desire a better outcome and better medications. Not just new versions of them.

I don't think my other post went through (got a weird error msg), so I will try again - a little more brief this time. Philip, the relative I was speaking about did a lot of LSD (from her own admission) and god knows what else for years. So, maybe it was schizophrenia maybe it was years of drug abuse, who knows. In addition to the repeated car accidents, she shot up her front door when she hallucinated that a tiger was trying to get into her apartment. So, she lost her car and her gun. Society is safer as a result. I have come to the conclusion that the point at which a person's mental illness presents an imminent danger to other people, then family/friends or authorities (if it takes that) have to intervene. What's the saying, "You're rights end where mine begin" or something like that? At that time she had to be contained somewhere - the only options were jail or a hospital. My family members chose the hospital route, not a pleasant decision. Did hospitalization make her all better? No. But, as much as I love her, at that time the safety of other people had to be the first concern.

"The data strongly shows that those who take meds for their SMI have: ..."

How about some refs so the rest of us can check that data Steve?

Not sure if you should be throwing 'strawman' accusations around without checking your definitions either. While you're at it, you might also look up ad hominem and then come back and address Szasz's arguments instead of deploying terms like 'fraud'.

Seems to me, given many of your 'improvement' indicators, what you're actually saying is that people who are more compliant (i.e. take their meds) are more compliant (i.e. can hold down jobs, don't get locked up so much [which is often triggered by refusing to take meds - especially in PACT areas], don't end up in confrontations that lead to violence so often, etc).

Most of the indicators you are using are also consistent with the partial immobilisation induced by the meds and would be expected in any population kept pharmopacified - diagnosed as schizophrenic or not.

But I'd be particularly interested in any data you have showing improved cognitive abilities in people whose dopamine pathways are suppressed. Seems pretty counterintuitive to me - but I'm always ready to be surprised.

Of course if you're talking properly blinded RCTs, most of my criticisms of the data will evaporate. Especially if they're not all drug company funded ones.

A good example of how illusory a lot of pharmadata is comes from the imaging studies that tried to show that schizophrenia is a neurodegenerative disease. Like the MJA study I link to above, it all just disappears into dust in the sunlight of critical analysis. (non-subscription extract here - which unfortunately omits a lot of the interesting neurodevelopmental stuff that doesn't fit the position taken by the website owners).

And if you're talking about the WHO survey that shows better outcomes for schizophrenia sufferers in societies that don't use so much pharmaceutical intervention (which is supported by studies on remote indigenous communities in Australia) I would also appreciate some refs for the 'refutation'.

But even if you can show some non-patient selected measures that allegedly show improvements on meds, do you really think you're ethically justified in claiming that the tx is better?

Maybe some people actually value their physical and psychological integrity above their ability to pass psychological tests and stay out of trouble with the authorities. Just because you see someone's thinking as pathological doesn't mean they have to. Maybe they consider it part of their personality.

I've not usually got much time for Robert Pirsig, but in 'Zen and the Art of Motorcycle Maintenance' he makes some telling first-person observations about the effect psychiatric intervention can have on the notion of 'self'. Don't forget that psychiatrists were telling us for years that ECT, prefrontal lobotomies and corpus callosectomies have no impact on cognitive functions, in spite of patient claims to the contrary - at least until they'd learned how to measure them.

So I think the profession would be well advised to listen a bit more to their patient's subjective feelings about interventions and a bit less to their own professional solipsisms.

Yep, schizophrenia sure can be a serious problem - especially (but not exclusively) in a society that stigmatises and pathologises it. But simply saying the problem is very bad doesn't justify potentially harmful intervention unless you can demonstrate favourable risk-benefit for it.

And I stand by my earlier statement that the only valid measure of 'benefit' is the patient herself.

Lisa,
That was very well said; and I personally appreciate you telling the story about your relative. It really helps me understand better. As you know, it is a difficult struggle I have living with having to make that decision re: my daughter. I hope I am never faced w/ that again; and most importantly I hope she is never in that position again herself. Thanks for sharing this.

"The data strongly shows that those who take meds for their SMI have:

-fewer hospitalizations
-less severe symptoms
-fewer arrests
-less violence
-higher employment rates
-less homelessness
-a 4 fold reduction in the risk of suicide
-improved cognitive abilities"

I'd like to know where these statistics come from. Some of them may be true. But drugs have stripped me of cognitive functioning and the ability to work. (I'm on disability now after working for 12 years while medicated) They have slowly taken me downhill. Since I've started to withdraw from drugs, my mind is clearing and I feel empowered for the first time in 15 years. I DO NOT have more symptoms of mental illness...I have fewer.

I have read, studied, participated, listened, had introductions to educated, informed, professional and non professioanls. People, organizations involved in the study and treatment of various forms of schizophrenia, biplar and/or post traumatic stess disorders all in an effort to find help for my adult son. I find no comfort or hope with Torrey or NAMI aside from education regarding insurance, trusts, any type of monetary help for the support of a child who has grown up in locked facilities, or wandering homeless on the streets..............preferring to sleep behind garbage cans behind restaurants to "safe" housing or returning to his home state. Jails, state hospitals where he has been held in 4 point restraints for days, screaming for water, medicated to the point of immobility, and prisons or the streets have been his "life".

This is a young man who, as a teenager was president of his school, travelling team in basketball, quarterback on the football team and a defensive lacrosse player. Handsome, intelligent, articulate, personable and angry. The anger results from abuse by a catholic priest in Portland, Oregon which happened at the age of 6 or 7 but was not known to his family until he was 20 or so. The archdicese was aware of it in 1995 as opposed to his family learnong about it in 99 or 2000. And abusive, negligent parenting.

I am his mother. He has two brothers who are able to live independently and succcessfully although, at least one , holds me accountable and responsible since I gave my son who is now "mentally ill" an ultimatum at 13 years old. An ultimatum which he defied. Three gifted, intelligent, diverse boys grew up with a dysfunctional mother who only succeeded in business but was emotionally unstable personally.

There is a Doctor in Boston.....Bill Anthony...known as the "father of recovery". His program at Boston University for persons diagnosed with "schizophrenia" has brought people out of the back wards of state hospitals and through training, education, and life skills support...........on to lives that range from the ordinary to extraordinary. Simple, common sense...believing in the person and giving the "person" a reason to get up every day, recieve respect and an opportunity to advance/increase/expand their quality of life.

The truth??? Regardless of the rhetoric, the "biological" origin of the illness.........it comes down to family. The bottom line is the relaionships, stability, extended family, structure and love during childhood.

Once we reach the choices of "medication", hospitilization (which is criminal in itself....no, horrific is a better term) jails, prisons with their SMUs, SHUs, etc., where a person with a mental illness can be sent after a privatized "non-profit"...."for profit"...company determines that a person does NOT need medicine that brings that person to wellnes, a miracle...........a wellness that is beyond comprehension......after a kind, caring, and concerned psychiatrist spends months and finds a way to help this person become well.........this privatized company sees this young man "well and highly functioning" determines he does not need the $700/mo medicine, but removes hin abruptly after 8 months of daily medication, tells him he has no illness, puts him on a $50/mo antidepressant and is left on his own. (money, money, money)

He vilolates a probation by having "Marijauna" in his system, faces a judge who sees that the public mental health system has determined that he no longer has an illness, which is questionable anyway since I truly believe he has simply endured more abuse, isolation, rejection and humiliation than he could endure, I am digressing, I know. However, he is on a 10 month probation and the judge finding the marijauna violation and no support from public mental health leaves him no choice but to send my son into a state prison for 10 months.Two weeks into Florence State Prison, he is found in the showers with head and face injuries and placed into "protective segregation". 60 Minutes happened to do a story on "protective segregation" in Florence State Prison at that time. You don't want to know.
10 months turn into 19 months, the last 10 months in SMU where death row prisners are held.
I had moved to the state, joined the Human Rights Commission, began my education re SMI, had my son transferred to a hospital and saw him arrive at the hospital after being locked up, isolated 23 1/2 hours a day............weighing 111 lbs., his head with three long scars acorss the top, burns all over his body, telling me that he had to regurgitate the dinner I brought him each time he took a bite as he had discovered that this only made him use the bathroom once a month. He was psychotic, unable to focus or hold any type of conversation and looked like a survivior of a Nazi War Camp.

Abu Graib??? Would anyone care to read some of his writings when he was in isolation at SMU ll in Florence???

There is so much more and this is only one family's introduction to Mental Health??? Madness for us all.

A home, a purpose, family, friends and faith, loving and being loved and respected. Nothing can replace the simplest of all. In other, poorer, countries I would imagine that acceptance and family love contibute to the significantly higher rate of "recovery" or wellness. Here.............our world is greatly divided.......clearly, heaven and hell.

One positive comment........ignore Torrey, instead read Imagining Robert, Transforming Madness by Jay Neugeboren, Dante's Cure and No Language But a Cry, also, A Quiet Mind..........these true stories will give you hope and understanding.

If anyone would like to contact me with potential answers.........anywhere in the world..........for bringing back a young man from the depths of prisons and streets and hospitals.........isn't there a "whisperer" for a person such as the "horse whisperer"..........someone to take away the rage, mistrust and humiliation??? Please do not talk to me about religion............only a human being.
please read my previous post. Thank you.
geraldinepmc@yahoo.com

Thank you for so frankly laying out the pain your family has gone through Geraldine.

Its the experiences of people like your son that keeps me slogging away at my thankless work.

Yesterday we took the experiences of a mental health prisoner to a coalition of supposedly 'progressive' and 'human rights oriented' lawyers and NGOs.

A complete waste of time of course. They are really only interested in listening to each other and playing stupid games of political oneupmanship. As this person's experiences weren't 'on-message' for their campaign to give more legal power to the shrinks, lawyers and bureaucrats of the NSW Mental Health Tribunal (MHRT) they just didn't want to know.

The prisoner was arrested on 18 Jan 1998 after injuring a neighbour with a firearm while in the grips of persecutory delusions. He was found not guilty for reasons of mental illness and has now been imprisoned for considerably longer than he could have expected had he been found guilty in NSW of assault with a deadly weapon occasioning actual bodily harm.

Below is the text of a letter from the prisoner's grandmother. I've stripped the names for confidentiality reasons.

(Note: Long Bay is a prison in Sydney).

LETTER TO THE MHRT from his grandmother.

To the chairman of the Mental Health Tribune in regards concerning my grandson M_ D_ K_ who has been kept in Long Bay Hospital for nine years because the Tribunal does no listen to facts they only want to believe in what they want not medical modern issues but medieval medical books.


I am M_’s grandmother. I have devoted my life to him and his siblings. Because of the drug addiction of the mother, my husband was the father image one who was so beloved that when he died when M_ was eleven he lost his spirit and became a rebellious juvenile. He was a small size boy and was bullied quite a bit and got into trouble with the law. He had a child at fifteen when he ws in Gosford Boys Home. He attended the birth and became a pint sized young father.


The girl he was with was the mother of his daughter. He became greedy for things he did not have so he settled into more crime and was picked at and bashed continuously by police because they did not like him and I am a witness to all of this because I was his only caretake and attend every court case. This became his hate and anger because of the brutality of people and big police officers.


I have written to the Ombudsman who informed me to write to you with my complaints.


M_ was on medication when he did his crimes, because he took silly pills which played with his head. He accepted this and now he has not been on any medication for a long time. The doctors have told the Tribunal this, but they won’t listen. When is it time that these people listen to facts? They say he still has anger. The only anger he has is being deprived of being a good father. His daughter now goes to High School. His five year old son hardly know him. I believe that the Tribunal is depriving a boy of his children anad he is better so that is what you call child abuse.


I want the Tribunal to know of an incident that happened many years ago at Callan Park Mental Hospital where I was a visitor to one of the patients who had drinking problem. In those days like today at Long Bay Hospital there was no other place to put people who did not have a mental problem but only a minor problem.


Facts to this day prove the Superintendent Dr S_ committed suicide in the grounds because he was taking sane people in and putting them with serious mental patients and sending them our eight percent insane. This is the case with M_. He was sick. He was cured and still they keep him with them. If anything happens to his mental state because of the stupid incompetence of the Tribunal. Who knows he is well then I will take it further. He does not need help for his anger. The anger he has now is being deprived of his children, who will heal his sadness with all their love.


M_ is not a murderer. He is a victim. Let him out. Murderers are getting out before him for more devious crime. Release him to his children and family.


Grandmother signed.

michael:

I can understand your desire for references, but frankly, much of what I stated is well known in the research community. I can't do your work for you. But for a good overview, see:

http://ssrn.com/abstract=949229

I know what a strawman is and my comments on Szasz are right on because his arguments in light of our current scientific understanding are fraudulent. I mean, are we really going to say that there is no such thing as schizophrenia or bipolar disoder outside of being some socially constructed control mechanism? That argument would be akin to those who state that the Twin Towers were not brought down by two airplanes. Such arguments are so ludicrous that no amount of empirical evidence will dissuade the believers and it then becomes pointless to even engage in discussion.

In terms of the neurodegerative v. neurodevelopmental aspect of psychosis. You pick evidence only from one side. The truth in all likelihood, like many things in life, is that it's probably a bit of both. Nonetheless, there is good evidence that there is some sort of neurodegenerative aspect. Of course, many folks at NIH built their careers on the alternative theory, so funding for projects that seek other explanations may have a harder time.

Not sure how looking for data to prop up your allegations is my job, steve. So I guess we'll just call them unsupported claims and leave it at that.

Unless you think the data-free spin of a mob of forensic psychiatrists is evidence of course. After all, these guys object to the use of the term 'mind altering' in connection with psych drugs. Makes you wonder what they think the pills do alter.

But I must admit, you managed to hit two of my prejudice buttons at once with that ref, so its hard for me to be objective.

I've been researching forensic psychiatry for well over a decade now and I'm convinced that it is a discipline that owes far more to bad television than to good science. Much of it is about collecting the bias and prejudice of our own society, dusting it off, wrapping it in technical jargon then feeding it back to us dressed up as science. I think their success rates in profiling criminals, predicting violence, treating aggression, paraphilias etc speaks for itself. But their constant attempt to manipulate and misrepresent the data on what they do speaks even louder.

Did you check the MJA articles I ref above (including the editorial). Real researchers hold their noses when dealing with the claims of forensic psychiatrists.

It is a discipline that is deeply challenged, scientifically and ethically.

But you got my irrational prejudices too, by referencing an abstract by people with names like "J. Richard Ciccone" and "J. Steven Lamberti".

There's just something about that structure that to me says 'authoritarianism', 'manipulativeness' and 'dishonesty'.

J. Edgar Hoover, G. Gordon Liddy, E. Howard Hunt, L. Ron Hubbard, E. Fuller Torrey ...

Maybe I should put in for a research grant to collect the data and calculate the correlation. Should produce data plenty good enough to be published in the forensic psychiatry journals - especially as it has the potential to stigmatise a lot of people.

Of course you can find counter-examples - like 'F. Scott Fitzgerald'. Or can you?

"I know what a strawman is and my comments on Szasz are right on because his arguments in light of our current scientific understanding are fraudulent. I mean, are we really going to say that there is no such thing as schizophrenia or bipolar disoder outside of being some socially constructed control mechanism? That argument would be akin to those who state that the Twin Towers were not brought down by two airplanes."

Well, I guess equating scientific skepticism with 9/11 conspiracy theories sure shows you know what a strawman is Steve.

Now can you explain to slow witted people like myself how Mark's comments about blood tests constituted a strawman?

If he'd said something like "E. Fuller Torrey is a psychiatrist who believes that schizophrenia is caused by cat parasites - but has been unable to show any evidence in blood tests or brain biopsies. All psychiatrists are like Torrey. Therefore no claims by psychiatrists have an evidential base" - that would be a strawman.

But if he said anything like that I must have missed it.

Seems I was too hasty in my earlier post Steve.

Only realised later that the download button at the bottom of the screen was for the whole paper, not just another copy of the abstract.

Erickson, et al do provide refs for their claims about cognition and APs. Will check them later and get back.

"my comments on Szasz are right on because his arguments in light of our current scientific understanding are fraudulent."

Jeez there must be a lot of fraudulent psychiatrists out there then.

For example, the ones who wrote this article for the BMJ and many of these ones who commented on it.

But it seems to me that Szasz's position is somewhat more nuanced that you understand it to be anyway Steve. See for example, this piece suggesting that the term 'mental illness' be abandoned and Szasz's outraged reply to the suggestion.

I think in general you would be well advised to read up on the history of psychiatry.
There are few other fields in which the 'scientific understanding' of one decade is so often seen as 'fraud' or worse only a few years later.

How confident are you that today's schizophrenia won't become tomorrow's 'homosexual paraphilia' or drapetomania?

Stephany, I appreciate your kind words. These are tough issues.