Impressive Work!

Hello Dearest Students,

For the last five weeks I have tried to expose you to material that is out of the mainstream, to provide you with a perspective that may be different from the conventional MI content. I have refrained from traditional "teaching" because I believe in facilitating learning rather than telling you what you need to know. Sometimes if instructors participate in online discussions, this creates a hawthorne effect, which may bias commentary from students in a particular way. This is why I have not responded to your posts.

I want you to know that  I am deeply moved by your posts and replies. From my perspective, many of you have explored ideas that may not have occurred to you before. That, in an of itself, makes my job worthwhile.

I am so impressed by the student realization that the Pro-psychiatry v. Pro-recovery is a false dichotomy. That it is. Psychiatry in its best form, provides psychoeducation, TRUE informed consent, and person-centered, individualized planning. Herein lies the conundrum. At this point in time, there are between 30-100 neurotransmitters in the central nervous system, I have read a specific number of 54. Researchers have linked some of these neurotransmitters to symptoms (e.g., dopamine, serotonin), but do not yet understand how these actually work. If you are familiar with the mathematic concepts of permutations and combinations, when you have 54 potential variables, and you target two of them, there are many many combinations possible. Add to this individual differences in brain chemistry, and frankly, anything is possible. This is why, in my opinion, that medications are a "crap shoot" in terms of efficacy for managing symptoms. This is also why I think practitioners should be honest about what we "know" about these medications and their effects on the brain, both good and bad. Then, and only then, is there truly informed consent.

So, I am FOR psychiatry that offers real help to people, and is honest about what we REALLY know about medications and the brain. If you look closely at any antipsychotic medication pharmaceutical handout, or Physician's Desk Reference (PDR), it may surprise you to find that the description states "actual method of action unknown."

Medications CAN help people, and medications can bring lots of bad effects as well. At least the DSM5 finally acknowledged "discontinuation syndrome," so when people go off meds, or switch from one to another, people know that the brain zaps and other weird symptoms are part of the withdrawal process. Prior to DSM5 many consumers were told that antidepressants were not addictive. Now we know better. I believe people should be able to choose whatever level of treatment they feel is best. However, without being told the real potential outcomes of the treatment, there is NO informed consent. For example, someone was told that ECT is like putting a 9 -volt battery up to your head. This, to me, is not informed consent. Many docs are quite cavalier about the treatments they prescribe, and this needs to change.

Community support, employment and/or meaningful activity, housing, and the presence of at least one person who loves unconditionally -- these are the ingredients to recovery. Good health care and pro-recovery psychiatry should also be part of the supports in the community. I truly believe that if we are honest about what we know and don't know about mental illness and its treatment, and present ourselves with an authentic willingness to help, we can help people alleviate their pain and live their best, self-defined lives.

Our responsibility as educators and practitioners is to reflect regularly on what we think we know, and what we actually know about mental illness. The best teachers to support this reflection are people who have mental illness...This I know.

I have so enjoyed reading your responses, and I thank you for your work. You give me hope!

~ Dr.B.

THE ANTI-PSYCHIATRY CONTINUUM

Some practitioners have been publicly critical (and then ostracized) for their antispsychiatry views. In your readings, you have encountered Loren Mosher and Peter Breggin.  The Director of NIMH came out against the DSM 5 in 2013, saying that the organization should no longer fund research based upon DSM diagnostic categories. Story here:

https://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5

It seems there is a continuum of support for the medicalization of mental illness. One one end of the continuum there are anti-psychiatry folks like Breggin (who are totally opposed to using diagnoses AND medications), and some psychiatric survivors like Ted C. Others take more moderate approaches (Anthony, Deegan, Chamberlin) and may question the validity of diagnoses, but in general, don't object to the use of medication, if it is helpful for folks. they would be in the middle of the continuum.  On the other end of the spectrum are folks who take the recipe-book approach to diagnosis and treatment with medications, ECT, cingulotomy, and capsulotomy. "This diagnosis gets this treatment."

Not all psychiatric survivors are radically anti-psychiatry, and not all practitioners are pro psychiatry.  Do pro-recovery principles qualify as anti-psychiatry? Can you be pro-recovery AND pro medicalization/psychiatry? Or is this a false dichotomy?

Where do you fall on this continuum of "antipsychiatry?" Describe your rationale, then comment (respectfully) on at least one of your classmates' replies.

Outpatient Commitment - An Asylum in the Community

(Re-Read Text pp. 169 to 176)

Does outpatient commitment recreate an asylum in the community? why or why not? Give at least 3 reasons for your answer, and then reply to one of your classmates.

Therapeutic Use of Hallucinations...WHUT??????

(READ THE KARON ARTICLE ON Bb -- FOUND IN MODULE 9 -- THEN READ THIS AND POST)

Historically, people with schizophrenia have been told that their symptoms (i.e., hallucinations) need to be medicated away. "Once you are stable, then we can address your other needs..." This week, as we consider deinstitutionalization and people's rights in the community, often it is hallucinations that mark people as "other" or "crazy." Hallucinations can be very stigmatizing.

The recovery movement offers a different narrative. One does not have to be "stable" and "symptom-free" before recovery can begin, quite the opposite in fact. The community is a place one can recover and learn to advocate for rights. One can have symptoms and live well in the community.

What if hallucinations were recast as unconscious needs? What if people in the community, family, and support professionals viewed hallucinations not as an aberration, but as communication? We all have dreams, and some of us even dabble in dream interpretation....what if hallucinations are just waking dreams? What if a recurrent theme in a person's hallucinations means something? A need breaking through into wakeful consciousness?

If we viewed hallucinations as communication, would we still want to medicate them away? Would people be seen as "crazy" by providers and/or society at large?

Reply with your reaction to this premise (using hallucinations in therapy), and the questions above. Then reply to at least 2 of your classmates' posts.

Walter Freeman, Howard Dully, and Lessons Learned

I have so many intense feelings after listening to Howard Dully's account of what happened to him. At 12 years old, he received a transorbital lobotomy, because his step-mother convinced an eager doctor, that the boy was unmanageable. Truth was, he had just lost his mom, and the adults had told him she had just "gone away." At the time she was replaced by this stepmother who was, at best, unkind to Howard.  Of course the cause of the problems was "Howard was a difficult child." That was the story the stepmother and Freeman told themselves.  It seems Howard's Dad was too disengaged to question his new wife's motives and/or judgment. The child, in this case, was labelled and treated, yet was NOT the source of the problem.

Do you think that this happens today? If so, give an example. If children are serving as sacrificial lambs so to speak, what can we do as practitioners to limit the risk to kids?

Answer these questions, and then respond to at least 2 of your classmates.

Milledgeville – Georgia Lunatic Asylum – Central State Hospital by Jackie Hayes

Georgia State Lunatic Idiot and Epileptic Asylum opened and accepted its first patients in December 1842.  It was later known as Georgia State Sanitarium, Georgia Lunatic Asylum, Milledgeville State Hospital and now is known as Central State Hospital.  Dr. Thomas Green oversaw the facilities during its first 30 years and utilized a family model of treatment in which patients were treated and cared for in the manner and kindness of extended family. At one time it housed 13,000 patients and covered approximately 2000 acres and utilized 200 buildings. Over 25,000 patients have died and are buried on the campus, although many grave-markers were thrown in the woods by groundskeepers and they include only numbers as opposed to names. The buildings on the campus resemble large plantation style historic buildings and due to the large population of patients include many rooms, long hallways, and various types of buildings that meet the needs of its large community.  Although the facility was built to support the children, adolescents, and adults with mental health issues, physical disabilities, and epilepsy, many patients were admitted with unclear diagnoses and mere descriptions as “funny.”  The place unfortunately experienced overcrowding with staff to patient ratios of 1 to 100 and utilized less than caring techniques of treatment.  Doctors used lobotomies, electroshock, insulin shock, confinement in cages and straitjackets, cold showers and steam baths.  In 1959, an Atlanta report named Jack Nelson investigated the facility and found that many former patients had been promoted to “doctor” status and participated in treatment of other patients.  At that time a mere 48 “doctors” were treating thousands but not one of the “doctors” was a qualified psychiatrist.  Nelson won a Pulitzer prize for his work.  From 1960 on, the hospital’s population continuously declined.  As the culture shifted to deinstitutionalization, more and more patients and families opted for community care.  In 2010, the Behavioral and Mental Health Department in Georgia determined that Central State Hospital should be closed.  The facility is currently open and caters to 200 patients but is continuously gradually diminishing its services and populations so that it may eventually close entirely.  Most of the buildings are in decay and only a handful are currently used to support the remaining population.

Florida State Institution by Liz Nitzel

The Florida State Hospital for the Insane in Chattahoochee, Florida was originally a military arsenal in the Seminole Wars then it became a state prison but in 1876 it became the State Hospital. The prison already had a history of abuse and it appears that the abuse and unlawful imprisonment continued throughout the next hundred years.
One famous patient, Emmett Foley, is depicted in the movie, “Chattahoochee,” based on the real life experience of a Korean War veteran who returns from war to realize that he cannot afford his family. He attempts to set up a situation to have the police murder him but he is captured and sent to Chattahoochee. Emmett endears horrific living conditions and beatings but soon he decides to document the treatment in the hospital and slip it out of the institution in a bible while his sister is visiting. This prompted an investigation and reforms.
In 2016, Chattahoochee was back in the news when budget cuts led to staff reductions and overcrowding. The Institutions in Florida received $100 million in budget cuts then started doubling up patients in rooms without regard for safety. On April 23, 2016, a 60 year old patient is stomped to death by his 19 year old roommate, this is following a similar incident in January of 2015.
Today the Florida State Hospital is depicted on its official website like a country club with beautiful fountains and happy people of diverse races walking down a perfectly manicured sidewalk. The mission statement reads: “Partners with Stakeholders to Promote Competency Restoration, and Personal Recovery and Resiliency through a Trauma Informed Approach.” The deaths began in the early days of the institution as depicted on a Facebook page: Florida State Hospital’s Lost and Forgotten. The more recent deaths caused by patient neglect, failure to follow safety protocol are still being revealed in newspapers and still protected by laws, Luis Santana, a 42 year old man had been given 5 strong antipsychotic medications then left in a bathtub to die.




https://en.wikipedia.org/wiki/Florida_State_Hospital

http://www.rogerebert.com/reviews/chattahoochee-1990
http://www.tampabay.com/news/floridas-mental-hospitals-are-still-violent-and-deadly-w-video/2295763
http://www.myflfamilies.com/service-programs/mental-health/fsh
https://www.facebook.com/Florida-State-Hospitals-Lost-and-Forgotten-324351667756430/