September 04, 2008

Seattle Newspaper Advocates For Fuller Torrey

Today's Seattle Post-Intelligencer has a lengthy article examining "another failure" of Washington State's system for handling people with mental illnesses. The article was spurred by the recent mass murder north of Seattle. In some respects, the article does a decent job of capturing the mess that is the public mental health system, but unfortunately the reporters turn for solutions to outpatient commitment and the Treatment Advocacy Center, the ultimate ambulance chasers in mental health advocacy.

I'm no fan of playing journalism police, especially in my own town and especially with a paper I generally like, but if I am going to do it with the Wall Street Journal, the Washington Post and wire services, then I've got to do it here as well.

The basic premise of the article is that the mental health system is in disarray, much money is spent but positive results are few, too many people diagnosed with mental illnesses ignore their treatments, so they should be forced into taking treatments because the treatments are safe and effective and always work and this will prevent violent acts committed by the mentally ill. Oh boy.

Here's the lede:

"The shooting rampage that left six dead Tuesday in Skagit County is the latest tragic incident involving a person with apparent mental illness who didn't get treatment in time to prevent violence."

And, then, off to the slippery slope we go.

"People with untreated schizophrenia and bipolar disorders committed about 1,000 of the estimated 16,000 homicides in the United States last year, according to figures kept by the Treatment Advocacy Center."

Given TAC's long history of sloppy data collection and questionable methodology (it mostly relies upon press accounts for its information and the media isn't doing unbiased science) and the fact that data like this hasn't stood up to peer review, it's odd that the P-I would just swallow this assertion whole.

Then comes an absolute error:

"Currently, about 40 percent of the 4.5 million individuals with schizophrenia and bipolar disorder in the United States are not getting treatment, said Torrey."

Only 4.5 million people with schizophrenia and bipolar disorder in the US? NIMH estimates peg schizophrenia at a little over 2 million adults, whereas bipolar disorder affects anywhere from about 4 million adults to as many as 8 million adults (even higher according to some estimates), so this 4.5 million figure is in error and should be corrected.

Then this:

"In this state, more people don't get treatment -- or stay in it -- for a complex array of reasons: shortages of beds and housing, overextended mental health care workers and no legal means to treat people early on in the progression of their disease." (Emphasis mine.)

Actually, a lot of people get treatment in this state--in the private health care system. I suspect the authors mean people in the public mental health system, but that's not what the article says. That's something an editor should've caught.

More troubling is the paper's assertion that there's no legal means to treat people early on, a line that's straight out of TAC's playbook. First, there is no particularly solid science on the progression of schizophrenia and bipolar disorder over a lifetime. Some people do well using standard treatments, some do horribly (both Charles Barber and I have written about the fact that perhaps 20 percent of seriously ill schizophrenics simply don't respond to medication of any kind), some people do OK over time by blowing off treatments, and there is now published data establishing that bipolar disorder is being wrongly diagnosed at about a 50 percent rate. There's even some research showing that bipolar disorder tends to fade with time. Second, research seeking answers to how well early interventions work in schizophrenia have come away with very mixed results and a swamp of ethical issues. Third, two decades into the psychopharmacological revolution, there is little consensus among researchers as to what actually causes schizophrenia, bipolar disorder and depression. And any source who tells a reporter they know what causes these disorders should be immediately suspect.

Given all of that, why would the P-I be advocating for a system of early intervention, since it's not even clear such a system would work consistently or that it would be humane? I think any reporter or newspaper editor (or doctor) who is going to adopt the line that all people need is treatment should experience that treatment for themselves by taking 10 mgs. of Zyprexa (or Risperdal or Seroquel) each day for a month and then get back to me on how fine they feel and how their blood sugars are doing. Perhaps they will learn that treatments cause about as many problems as they solve.

Another thing the paper missed is that TAC ignores the fact that acts of violence are committed by people who are on-meds (and, here, I am not even thinking of shootings and SSRIs) and that the group sometimes tells the public that someone was off-meds when they were in fact on-meds. That really makes for a weird evidence base for an advocacy group.

Perhaps even weirder is that the paper's reporters seem to have missed the news that drugs used to treat schizophrenia and bipolar disorder are, in some cases, causing deaths or injuries or other problems to the very people who these drugs are supposed to be helping. In the 18 months since the Zyprexa documents have been in the public realm, I have not read one mention of the scandal involving that drug in the P-I and I read the paper every day (I could've missed something though). I've not seen the paper acknowledge that other psych meds like Risperdal and Seroquel are causing deaths and injuries as well much less that they are being wildly over-used in adults and children (and that Seroquel has turned into a street drug). And, apparently, the paper has completely missed the news that anti-depressants don't work so well and are, in fact, believed to be behind the lack of success some patients with bipolar disorder experience.

Then the article gets onto a theme I first flagged locally four years ago:

"A shortage of places to discharge patients also keeps them in the hospital longer than necessary.

"'Today we have 120 people at Western State who are clinically cleared for discharge -- no longer at risk to self or others -- but who have significant support needs, and nowhere to go,' said Richard Kellogg, head of the mental health division of the state Department of Social and Health Services.

"'We wouldn't have backups if we had patient flow -- if we could get people out in a timely manner," he said. 'In the short term, what is significantly lacking is housing alternatives -- housing connected to support services, employment and social networks.'"

Ah, welcome to the show, daily newspaper reporters.

Posted by Philip Dawdy at September 4, 2008 10:26 AM
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Comments

I just got off of the telephone with a person at the Seattle PI.

I asked these questions:

1. Do you know if he was on medication?

I think the mother said he wasn't"

2. Do you always report print news using hearsay?
No.

3.Do you know if he was on meds?
No.

4. Do you know who owned the gun?
No.

Before that, I read the riot act about using Fuller Torrey who believes in forced medication which is less than efficacious, I told them they were stigmatizing, and as a mental health advocate I found their article to be full of errors, and recommended to them that they get the facts before they report and hype "with apparent mental illness who didn't get treatment in time to prevent violence."

I ended the call with "Do your job", when he answered no to some of what I believe are the most important questions that need to be answered before a print media paper writes such an inflamatory stigma-producing piece.

Posted by: Stephany at September 4, 2008 12:28 PM

They're just repeating the same old crap. The main reason those with mental illness stop treatment is because of lack of insight, they don't realize they're sick, blah, blah, blah. Nowhere in the article does it mention the % of people who stop treatment because they don't appreciate being treated like crap. Honestly, would anyone want to stay in a hospital that's run like a prison - where they're afraid & talked to disrespectfully? Who wants to stay there to get all better? Where's the common sense? Maybe, just maybe if the hospitals were actually hospitals where patients were treated with dignity & respect, where nurses didn't rip the phones out of the wall while patients were talking, etc people might not leave AMA. I went inpatient voluntarily, and if I had been treated respectfully I would not have left AMA. But, I would have to say that staying in an environment that is increasing my anxiety & depression isn't a good place to be. That's lack of insight? Please...

Posted by: Lisa at September 4, 2008 04:16 PM

Stpehany-
You are awesome. I love how you call people on their B.S. I wanted to mention having worked at the Skagit County Sheriff's Office myself, that there is a very large mental health facility in the area and living in the woods is not abnormal. What needed to be addressed and was not in the article was the absence of the Department of Corrections failure to do their job. Every parolee must maintain a regular address, stay on meds, off drugs alcohol, etc. I am sure this guy somewhere in his conditions of release had these mandates. It is not good enough to allow our DOC workers to have people come in once a month for their urine sample. Apparently the family was screaming out for help and no one was listening. The exact thing happened to a previous co-worker who was shot in the head by a parolee who was recieving minimal supervision from the DOC. The wife of the fallen officer is now suing the state. Quite frankly, I hope others involved in this tragedy do the same.

Posted by: Angie at September 5, 2008 03:39 AM

Angie thanks for your perspective about this story, I know each time I drove to one of the psych hospitals my daughter was at, I would drive thru White Center and on display in a small police sub-station there is a poignant portrait of an officer who was killed, and it always, always touched my heart.

I also agree, someone dropped the ball big time in the DOC and that is why I'd like to know where he got the gun, along with what you've added, the address, etc.This is another example of an under-funded (and recent budget cut!!)system, the caseloads are too many, and they aren't even hiring more PO's, there's a hiring freeze!

Washington state needs such a massive overhaul for this and mental health--that it's hard to imagine the Mayor of Seattle is more concerned with not using plastic bottles, and promoting canvas grocery bags!

Elected public officials need to see what really is important and he for example COULD express concern down in Olympia, but then I am dreaming of an ideal world.

The headlines the PI did still make me irate!

Posted by: Stephany at September 6, 2008 04:34 AM

Fuller Torrey's a dangerous extremist. The basic trouble seems to be that the categories schizophrenic and bipolar are meaningless, as are all other mental labels.

Trying to compare two bipolars is hopeless. Did one develop mania and thus bipolar as a result of AD medication? Should such a person be counted as bipolar? Did the psychotic break that led to a schizophrenia diagnosis follow drug abuse? Should such a person be counted as schizo?

Psychiatry is an absurd attempt to categorize the human condition. Real science, like neurology, is very skeptical of psychiatry's claims. Psychiatry is basically the study of psychotropics on the human mind. That's not science -- it's advertising.

Lack of insight is a red herring. I'm perfectly willing to admit that I have certain vulnerabilities and that I have to take extra precautions. Whether this constitutes a disease or not is a philosophical question that won't get answered any time soon.

Fuller Torrey's sensationalistic crap-spewing technique may make him a media darling but it exposes him for what he is -- a slut under the influence of the psychiatric machine.

Torrey-like policies have kept me inside a psych ward for 1/3 to 1/2 of the last 7 years. If I were a member of any other marginalized group, some advocacy group would file a human rights complaint on my behalf. But, somehow, when it comes to the loonies, a lot of otherwise tolerant and accepting people lose their moral principles.

TAC is guilty of hate speech (defined as speech likely to expose a group to contempt and hatred) and any newspaper that quotes them is also guilty. There is plenty of evidence that the (we) loonies do better without psychiatric intervention. If psychiatry really cared about the patients, they'd want to find out why.

Posted by: Francesca Allan at September 7, 2008 04:07 PM

Torrey can eat cat poo.

Posted by: myob at September 8, 2008 07:17 AM

A quick check of the P-I archives found 20 or more stories on Zyprexa. You must not read the paper very well. Should we question your journalism?

Posted by: Thomas Shapley at September 8, 2008 11:26 AM

as an fyi for readers, thomas shapley is the newish communications direction (press release here) for the washington state department of social and health services. i sent him to following reply by email:

"feel free to question whatever you want about my journalism and i'll question dshs all i want. in fact, when is jim stevenson going to get back to me on that 8-month old kid who was being given zyprexa? or do i need to do a pdr (public disclosure request) on it?

as for the p-i, the zyprexa stuff they've run has all been tucked in the biz section and is little more than stripped down ny times wire copy. kind of weird for a paper that's actively pushing for forced medication with a class of drugs that have huge problems and that your department has been writing checks for. and your department has been aware of the problems with the atypicals for a long, long time yet has remained silent. why?"

Posted by: Philip Dawdy at September 8, 2008 11:56 AM

Philip-

an 8 month old child given Zyprexa?


I thought this was an abnormality when I met a six month old baby given Prozac,


I cannot believe that babies are given drugs like this....For shame.

Posted by: susan at September 8, 2008 12:05 PM

All I know is this....i have known many peole with bi-polar who self medicated, or used alternatives to cntrol their moods, like St. Johns Wort, and were perfectly functioning individuals but for occassional bouts of minor issues, until I met one young man who became a piano player for my group and then a roommate when I was desperate to stay in a particular apartment. A few weeks later I was fighting for my life to survive! After the fact I found out he had "gone off" his meds, and that his illness had progressed from illness to suicide attempt and now to attempted homicide. I was lucky. I survived. The law enforcement agencies did "nothing' to secure my safety and botched the whole situation. He is free to walk the street with a history of medical non-compliance and escalating psychosis, and I am left with having to try to decide what I can do to protect myself from further injury from this man in a system that gives perpetrators more rights than victims. I was assaulted, I was battered, I was terrorized, and it was a religious intolerance hate crime. This man was going to sacrifice me for his own salvation in his delusional state. I have no doubt in my mind he was going to rape,
torture, and then murder me. Not knowledge that is something easy to live with or deal with emotionally. So now I am left to deal, without significant professional intervention, with the distinct possibility that in a future lapse he may come after me as the "obsession" of choice, and the knowledge that this man is going to kill someone because he is not getting the intervention he , I, nor those he comes in contact with in the future require to be safe from his delusions. What can be done?

Posted by: margot at December 23, 2008 11:30 AM
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