Debating Forced Treatment and Mental Illness

 

The New York Times has done an admirable job since the Sandy Hook shootings in keeping a spotlight on our mental health system. Here’s an exchange about mandated treatment — sparked by a Harvard psychiatrist — that is worth reading.

To the Editor:

Recent tragic events have linked mental illness and violence. Some people — I, for one — consider this link dangerously stigmatizing. People with mental illness are far more likely to be victims of violence than perpetrators. Moreover, psychiatrists have limited capacity to reliably predict violence. Nonetheless, these events increase pressure to identify people who might conceivably commit violent acts, and to mandate treatment with antipsychotic medications.

For a tiny minority of patients who have committed serious crimes, mandated treatment can be effective, particularly as an alternative to incarceration. But for most patients experiencing psychotic states, mandated treatment may create more problems than it solves.

For many medical conditions, better outcomes occur when patients share in treatment design and disease management. Imposed treatments tend to engender resistance and resentment. This is also true for psychiatric conditions.

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BRAVO: Speaking Out About Mental Illness!

A regular reader of this blog, Laura Pogliano, appeared on national television last week with her son, Zac, talking about stigma and mental illness.  This short news clip is well worth watching!

In an email about the clipping, Laura told me:  “The cutting room floor has the best stuff: Zac’s statements on working on his health, his enjoyment of life & and my personal fave: ‘I’m a moral person. Bad people do bad things. Greed is a huge problem. Greedy people do more bad things than mentally ill people do…’ (I love that!) ”

 Bravo to both of you!

From My Files: What Happened To Linda? She Tells Us In Her Own Words

On Friday, I re-introduced readers to Joan and Linda Bishop, whose two-part story I originally published in February 2010. In today’s blog, we get to read Linda’s own words as she describes how her untreated mental illness slowly takes her life.

Part Two: Linda’s Story 

Joan Bishop tried to help her sister, Linda, after she developed a severe mental illness while she was in her 40s. But Linda didn’t want her help. She refused treatment and medication and Joan’s attempt to obtain a guardianship over her sister was rejected by a judge.

After a drunk driving incident, Linda got further into trouble by throwing a cup of urine at a correctional officer while  in jail. She was charged with a felony. Eventually, she was involuntarily committed to the New Hampshire State Hospital, but she refused treatment and would not take medication. After a year, she was released without any follow-up.

Because Linda had refused to sign a HIPAA wavier, Joan had no idea that her sister had been discharged until several months later. What follows now comes from a journal that Linda began writing four days after her discharge.

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From My Files: A Sister’s Love, A Mental Health Tragedy

 

I was outraged when Joan Bishop told me about the fate of  her sister, Linda.  I was so moved  that I published a two-part blog about Joan and Linda in February 2010.  A writer for New Yorker magazine, Rachel Aviv, would share the sisters’  story with a much larger audience in May 2011. 

Sadly, what happened to Linda still is happening. This is why we must continue speaking out. This is why we must continue to put a human face on failures in our mental health system. 

Linda’s Story: Part One, originally published February 2010

I’m going to tell you a story and I will warn you that it is a sad tale. It is also an important one because it is yet another example of how broken our mental health system is and how people are dying because of our ongoing failure as a society to help them.

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Inspiring Successes and Sad Suicides: A Conundrum

These last few days have been filled with contradictions.

My friend, Elyn Saks, the author of The Center Cannot Hold: My Journey Through Madness, has done us a huge favor by publishing an excellent article in The New York Times.

THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

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From My Files: You Might Not Know The Impact Of Your Words

Those of you who are regular readers know that I believe one person who speaks out and advocates can make a difference in a community. This blog post, published in February 2010, is a reminder of how our words can prompt change — sometimes without us even knowing it.

A mother wrote to me four years ago about her adult son who had been diagnosed with bipolar disorder, but had refused to take his medication.  His apartment was in shambles and he was in horrific shape. Despite everything that she did, her son refused help. Instead, he sunk deeper and deeper into a mental abyss.  Because he was not considered dangerous, there was nothing she could do.
Many of us have walked in this woman’s shoes.