Treatment Abuse, Behavior Modification, Thought Reform > Public Sector Gulags

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Anonymous:

--- Quote ---But, in most practical situations, you'd have to be fuckin' nuts to kill yourself or anyone else.

--- End quote ---


Oh, I agree with that, but it is the slang "nuts"
and not the clinical definition.

Perhaps it would make sense to expand the DSM to include homicide and suicide. There must be a reason they are not in there.

In reality they couldn't expand the DSM, most of the pressure is to reduce the diagnosis, not increase.

Anonymous:
SMI vs the blues

I just want to clarify that this discussion,
I believe, is about serious mental illness,
not the blues.

When discussing this issue of involuntary
treatment, which is difficult, for all parties
when the goal is how to help when the disaster
of negative symptoms persist. One thing that
creeps in, by accident, is differentiating
the cases, or examples where the mental illness
is not so clearly obvious as severe, or "SMI".

In those cases as you correctly point out,
that "making people feel like they are mentally
ill" is, IMHO, correct.

I just found this quote, which I think is reasonable:

http://www.webheights.net/depression/glenm/pb.htm

Dr. Glenmullen argues that antidepressant drug therapy is justified only in moderate to severe cases -- no more than 25 percent of patients currently taking these drugs -- and that we should avoid patients' exposure to these drugs whenever possible.

---

To this end, perhaps, it is my fault when a discussion starts and I seem to be mis-understood
that I should clarify I am talking about SMI. That is what I am exposed to in my daily activities, the really serious mentally ill. No one would doubt that there is a sad, and bad, problem with these folks.

So, now I can understand how, mine, and many others here can differ so much in our opinions when it seems we shouldn't be.

I am not clarifying the type of patients often enough.

I think in many ways I agree with just about everything that is said here, if it where clarified as the not-SMI.

I will try to do better.

Anonymous:
Jails vs Psychiatric Hospitals (forensic)


Psych hospitals are not the big manipulative gulags that many think they are. Forever underfunded the complaint is too little care, too little interaction with doctors and professional staff. What they are know as is a safer envirnment than jail.

Why would anyone want to put someone with a chronic disease in a jail, instead of a hospital?

---

There are three types of facilites we are talking
about.

Jails / Prisons ... nothing needs to be said, except it is not a very safe enviornment if you
are not up to full capacity.

Regular psych hospitals, meaning to criminals.
This would be like a private chain of psych hospitals, or a wing on a local hospital.

Forensic Psych Hospitals, this would be like where Andrea Yates just got transferred to, and St. Elizabeth's in Washington DC, where John Hinkley is housed.

The problem in these places, is too little care, not too much care.

To a larger degree in the forensic hospitals, than the regular hospitals.

Oops, there is another class: IMD, institutes of mental disease. These are voluntary, although I will need to check if I am right, where the patient has had no luck with treatment and they go there for a six month minimum. Some may differ on the minimum time.

Now, if they get better, great they get out.

There need to be a big explanation here. In a normal psych hospital the insurance companies are doing a review, literally daily, to toss the patient out and save money.

So, if a person is doing poorly and want the help the regular hospital with the discharge pressure is a lousy place for a long term treatment solution (when the short term solutions did not work).

So, it is not like they are getting locked up, remember these IMD's have nothing to do with criminals, or courts. (hmm, saying that I need to check, once again, for accuracy).

It is just a facility where they can work on their illness without the staff determining if they should be released everyday.

Anonymous:
Outpatient "forced treatment" is confusing.

"ORLY! And how, prey tell, do you think they enforce this outpatient treatment?"

Good point!

If a misdemeaner is committed a diversion program is offered called ACT, an outpatient program.

BTW - did you notice that the new legislation cutting funds for Medicaid are cutting funds for case managers, which will torpedo ACT. So, go figure, one arm of legislature is passing laws to do diversion programs to offer the SMI ACT, while the other arm is making it non-fundable.

At the same time, in California the Governator just announced an 11 billion dollar prison building program!

It is no guess which direction the Gov. wants to go. Jail them, wharehouse them. Which makes the whole involuntary treatment issue moot.

Sorry, got off track.

The person can always refuse and just do the jail time that they where convicted of, there is no manipulation. If one wants to go to jail, go. The outpatient diversion programs are an alternative to jail.

Deborah:
http://www.raggededgemagazine.com/depar ... 00766.html
Some great comments follow the article.

Schizophrenia Treatment in 7 Easy Steps
Adapted from the Michigan Implementation of Medication Algorithms Physician Procedural Manual, Appendix I: Guidelines for Treating Schizophrenia

Excerpted, abridged, and translated into plain English by Ben Hansen, MindFreedom Michigan

If you're a doctor treating a patient for schizophrenia, the Physician Procedural Manual will help guide your clinical practice and make things a lot easier for you.

At each step of the way, always remember your three options: continue the present drug regimen, adjust the drug dose, or move on to another drug. Don't even THINK about taking your patient off drugs. The manual plainly states, "The schizophrenia algorithm contains no guidelines for antipsychotic medication discontinuation, which is anticipated to be a rare event in the typical mental health clinic patient population."

Your main task as a physician is to prescribe drugs. As a rule of thumb, it's always best to prescribe a new drug before its patent expires. For this reason, the new drugs called atypical antipsychotics are an excellent choice as first-line treatment.

Atypical antipsychotics cost twenty times more than older drugs, but cost is only one factor to consider when making a clinical judgement. Another factor is profit. With this in mind, schizophrenia can be treated in seven distinct stages, outlined below.

STAGE 1. Prescribe an atypical antipsychotic such as Zyprexa, Risperdal, or Seroquel. Some physicians will select a drug based on whichever sales rep last visited the office, but this is not recommended. Whatever brand you choose, if your patient shows little or no improvement after 4 weeks, go to the next stage.

STAGE 2. Switch to a different atypical antipsychotic. You may select a particular drug based on the quality of free ballpoint pens provided by the manufacturer, but this is not recommended. If results are unsatisfactory after a few weeks, go to the next stage.

STAGE 3. Switch to yet another atypical antipsychotic, or try a conventional antipsychotic such as Haldol for old times' sake. If progress remains unsatisfactory after a few more weeks, go to the next stage.

STAGE 4. Prescribe Clozaril. Since there's a 50-50 chance the patient will respond unfavorably to Clozaril, you may skip this stage and go directly to the next stage.

STAGE 5. Prescribe Clozaril in combination with another antipsychotic, or Clozaril in combination with electroshock. The manual says, "Almost all studies have shown beneficial effects of electroschock for persistent psychotic states." The manual also says, "There are no controlled studies of electroshock for schizophrenia in which number of treatments, duration of treatments, and electrode placement have been systematically evaluated." Therefore, if you're going to use electroshock on the patient, be sure to use it at least ten times, on both sides of the brain. If this proves unsuccessful, go to the next stage.
---------------------------------------------

Your main task as a physician is to prescribe drugs.
 
STAGE 6. Try one of the few remaining atypical antipsychotics you haven't tried yet. If results are satisfactory, that would be nice but it's not very likely at this stage, so go to the next stage.

STAGE 7. Prescribe any combination of two antipsychotics OR two antipsychotics plus electroshock OR two antipsychotics plus a mood stabilizer such as Depakote. Maintain this regimen for at least 12 weeks, if your patient lives that long.

Helpful hints for the clinician

In addition to prescribing drugs for schizophrenia, you may need to prescribe drugs for various "co-existing symptoms" of schizophrenia, such as sedatives for agitation, mood stabilizers for hostility, hypnotics for insomnia, antidepressants for depression, and so on.

You may also need to prescribe drugs to treat adverse side effects of drugs prescribed for schizophrenia, such as diabetes caused by Zyprexa or tremors caused by Risperdal, not to mention side effects of drugs prescribed for co-existing symptoms, such as hostility caused by antidepressants prescribed for depression and/or depression caused by mood stabilizers prescribed for hostility, and so on.

Before long, you'll be prescribing drugs to manage side effects of drugs prescribed to manage side effects, like a dog chasing its tail. The manual explains, "Using a medication to treat a side effect can result in additional adverse effects." This is why "side effects algorithms" are included in the manual as well. Don't worry. Just follow the manual.

Always remember to monitor your patient's progress. This is a routine task which may be performed in 5 minutes or less during regular office visits. Use the 8-point rating scale summarized below.

1. Does patient believe others have acted maliciously or with discriminatory intent?

2. Has patient had odd, strange or bizarre thoughts in the past 7 days?

3. Has patient had visions or seen things others cannot see?

4. Is patient's speech confused, vague, or disorganized?

5. When asked a question, does patient pause for long periods before answering?

6. Does patient's face remain blank or expressionless? ("Disregard changes in facial expression due to abnormal involuntary movements, such as tics and tardive dyskinesia," the manual advises.)

7. Does patient seem withdrawn or unsociable?

8. Does patient dress sloppily, or come to your office with poorly groomed hair? ("Do not rate grooming as poor if it is simply done in what one might consider poor taste," the manual advises.)

If the answer to all eight questions is no, your patient is probably not taking medications as prescribed. When noncompliance is a problem, the patient should be restrained if necessary and forcibly injected with a timed-release antipsychotic. Maintain this regimen until patient gains insight into the need for treatment.

The cutting edge of science

This project was modeled after the Texas Implementation of Medication Algorithms. A distinguished panel of 25 Michigan experts very carefully replaced the word "Texas" with the word "Michigan" in all appropriate spots.

As new studies financed by drug companies discover ways to expand the market, and new products developed by drug companies enter the market, "this algorithm will be periodically revised and updated."

Funding for the Michigan Implementation of Medication Algorithms was provided by the Ethel and James Flinn Foundation of Detroit. The Michigan Pharmacy Quality Improvement Project, promoting the same agenda and with several of the same committee members, is funded by Eli Lilly, maker of Zyprexa. Lilly sales representatives carry a wide variety of ballpoint pens and other cool stuff.

If you think this is a joke, look at the original document: http://www.mimentalhealthebp.net

Ben Hansen is an anti-psychiatry activist who lives in Traverse City, Michigan.
His email address is heartofbear@hotmail.com . Read his last article for Ragged Edge, CATIE & You.

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