You make the call ...

[Anonymous]

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

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 [email protected] . Read his last article for Ragged Edge, CATIE & You.

[Anonymous]

Here it is, algorithyms and all:
http://www.dshs.state.tx.us/mhprograms/Disclaimer.shtm

[Anonymous]

On 2006-02-05 19:52:00, Deborah wrote:

"http://www.raggededgemagazine.com/departments/overtheedge/000766.html

Some great comments follow the article.

I guess someone typed this up, it must be true!

It is difficult to not call you an idiot for posting this crap.

I will try not to call you an idiot, miss cut and paste, no matter the content!

[Deborah]

On 2006-02-05 19:09:00, Anonymous wrote:

"

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

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.



"

They can't expand the DSM? The only reason that would be true is if they had already listed every human distress known to man.
"Then, in 1994, the manual exploded to 886 pages and 365 conditions, representing a 340% increase in the number of diseases over 42 years."


http://www.latimes.com/news/opinion/sun ... ay-opinion

January 1, 2006
Los Angeles Times
Psychiatry's sick compulsion: turning weaknesses into diseases
By Irwin Savodnik, Irwin Savodnik is a psychiatrist and philosopher who teaches at UCLA.


IT'S JAN. 1. Past time to get your inoculation against seasonal affective disorder, or SAD - at least according to the American Psychiatric Assn. As Americans rush to return Christmas junk, bumping into each other in Macy's and Best Buy, the psychiatric association ponders its latest iteration of feeling bad for the holidays. And what is the association selling? Mental illness. With its panoply of major depression, dysthymic disorder, bipolar disorder and generalized anxiety disorder, the association is waving its Calvinist flag to remind everyone that amid all the celebration, all the festivities, all the exuberance, many people will "come down with" or "contract" or "develop" some variation of depressive illness.

The association specializes in turning ordinary human frailty into disease. In the last year, ads have been appearing in psychiatric journals about possible treatments for shyness, a "syndrome" not yet officially recognized as a disease. You can bet it will be in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, published by the association. As it turns out, the association has been inventing mental illnesses for the last 50 years or so. The original diagnostic manual appeared in 1952 and contained 107 diagnoses and 132 pages, by my count. The second edition burst forth in 1968 with 180 diagnoses and 119 pages. In 1980, the association produced a 494-page tome with 226 conditions. Then, in 1994, the manual exploded to 886 pages and 365 conditions, representing a 340% increase in the number of diseases over 42 years.

Nowhere in the rest of medicine has such a proliferation of categories occurred. The reason for this difference between psychiatry and other medical specialties has more to do with ideology than with science. A brief peek at both areas makes this point clear. All medicine rests on the premise that disease is a manifestation of diseased tissue. Hepatitis comes down to an inflamed liver, while lung tissue infiltrated with pneumococcus causes pneumonia. Every medical student learns this principle. Where, though, is the diseased tissue in psychopathological conditions?

Unlike the rest of medicine, psychiatry diagnoses behavior that society doesn't like. Yesterday it was homosexuality. Tomorrow it will be homophobia. Someone who declares himself the messiah, who insists that fluorescent lights talk to him or declares that she's the Virgin Mary, is an example of such behavior. Such people are deemed - labeled, really - sick by psychiatrists, and often they are taken off to hospitals against their will. The "diagnosis" of such "pathological behavior" is based on social, political or aesthetic values.

This is confusing. Behavior cannot be pathological (or healthy, for that matter). It can simply comport with, or not comport with, our nonmedical expectations of how people should behave. Analogously, brains that produce weird or obnoxious behaviors are not diseased. They are brains that produce atypical behaviors (which could include such eccentricities as dyed hair or multiple piercings or tattoos that nobody in their right mind could find attractive).

Lest one think that such a view is the rant of a Scientologist, it is no such thing. Scientology offers polemic to lull the faithful into belief. Doctors and philosophers offer argument to provoke debate.

It's a natural step from using social and political standards to create a psychiatric diagnosis to using them to influence public policy. Historically, that influence has appeared most dramatically in the insanity defense. Remember Dan White, the man who murdered San Francisco Mayor George Moscone and Supervisor Harvey Milk in 1978? Or John Hinckley, who shot President Reagan in 1981? Or Mark David Chapman, who killed John Lennon? White, whose psychiatrist came up with the "Twinkie defense" - the high sugar content of White's favorite junk food may have fueled his murderous impulses - was convicted and paroled after serving five years, only to commit suicide a year later.

The erosion of personal responsibility is, arguably, the most pernicious effect of the expansive role psychiatry has come to play in American life. It has successfully replaced huge chunks of individual accountability with diagnoses, clinical histories and what turn out to be pseudoscientific explanations for deviant behavior.

Pathology has replaced morality. Treatment has supplanted punishment. Imprisonment is now hospitalization. From the moral self-castigation we find in the writings of John Adams, we have been drawn to Woody Allen-style neuroses. Were the psychiatric association to scrutinize itself more deeply and reconsider its expansionist diagnostic programs, it would, hopefully, make a positive contribution to our culture by not turning the good and bad into the healthy and the sick.

The last thing the United States needs is more self-indulgent, pseudo-insightful, overly self-conscious babble about people who can't help
themselves. Better, as Voltaire would put it, to cultivate our gardens and be accountable for who and what we are.

==
You can write a letter to the editor here: [email protected]

[Anonymous]

Yup, Irvin, Thomas Szasz buddy:
http://www.szasz.com/SymposiumProgram.html

Enough said.

How about reading, just the posts here,
of those that are being treated for
SMI, and what they have tried to tell
you time, after time.

Why is it so important to ignore your
peers and quote the fringe niche anti
psychiatry money makers in all your
obsessive negatives posts about anything
to do with psychiatry, meds, light therapy
you name it, your twist is negative.

Now, again, why is it so important to you,
someone who avoids finding out something
about the serious mentally ill first hand
to be so obsessed on this issue.

You have nothing to do with mental illness
except to cut and paste any negative story
you can find in the nice anti market out
there.

But you are obsessed?

Why?

On the issue of treating those that are sick ...

Why would you want to spread your biased info
around and even ignore your peers on this forum
who have tried with really well written testimonials to help you to understand, until
you drive them away.

Why?

[Anonymous]

I forgot to mention, go and read
the damn information from TMAP.

All 80 pages, on average, for each
diagnosis.

Then when you are done, and still have
your brick barrier blocking all logic,
then, go and type "forcibly injected"
and tell me where it is? What page?

Idiot!

[Deborah]

On 2006-02-05 20:03:00, Anonymous wrote:

"Here it is, algorithyms and all:

http://www.dshs.state.tx.us/mhprograms/Disclaimer.shtm"

And here's the investigative reports on the TMAP scam in Texas, and 'how well' it helped those forced into 'treatment'.
http://fornits.com/wwf/viewtopic.php?to ... 120#122792

[Anonymous]

What the heck does that link have to do with TMAP?

Gotta go, help out the mom I just posted about ...

[Deborah]

Oh course it?s true.  Written by a psych survivor.
Ben Hansen- Member of the Department of Community Health Recipient Rights Advisory Committee, submitted this report concerning Michigan law. Michigan law states that a person may not receive involuntary ECT if s/he has no guardian, but probate judges in the state are ignoring the law. This report details cases where the probate judge violated state law in issuing orders that would allow involuntary ECT. Says the author, "Consent laws are made a mockery by judges who rule that individuals are competent when they consent to treatment, but incompetent when they refuse treatment."
http://www.ect.org/news/forced.shtml

He also wrote this:
Excerpt: To determine if these drugs are worth their outrageous price, the National Institute of Mental Health conducted one of the largest and longest independent studies ever, the Clinical Antipsychotic Trials of Intervention Effectiveness, or CATIE. Four years and $44 million later, the CATIE study, published in September 2005, reached a startling conclusion: the new drugs "have no substantial advantage" over the old ones.
Atypical antipsychotics, it turns out, are a massive rip-off. They're no better than old drugs which weren't very good to begin with.
Government programs like Medicaid pay for over 90 percent of all antipsychotic prescriptions. Across the nation, state budgets are being squeezed by Medicaid, and Medicaid is being squeezed by the high cost of prescription drugs. Atypical antipsychotics are among the most expensive.
http://www.raggededgemagazine.com/depar ... 00666.html

And this informative piece on ?insidious, life-long, psychiatric disease?
http://www.adhdfraud.org/commentary/11-30-00-2.htm

He works with and advocates for the ?SMI?, just in a different way than you do. Very bright and articulate.

If you?re looking for info on ?forced treatment?, you?re not going to find it in TMAP documents. Those guidelines are for direct care, whether voluntary or involuntary. And, the link has everything to do with the scam around how TMAP was created and how it affected Texas citizens used as guinea pigs.

From another "SMI" survivor
How do We Recover? An Analysis of Psychiatric Survivor Oral Histories, by Oryx Cohen, in Journal of Humanistic Psychology, Vol . 45 No. 3, Summer 2005 333-354
Excerpt:
Recovery has only recently become a word used in relation to the experience of psychiatric symptoms. Those of us who experience psychiatric symptoms are commonly told that these symptoms are incurable, that we will have to live with them for the rest of our lives, that the medications, if they (health care professionals) can find the right ones or the right combination, may help, and that we will always have to take the medications. Many of us have even been told that these symptoms will worsen as we get older. Nothing about recovery was ever mentioned. Nothing about hope. Nothing about anything we can do to help ourselves. Nothing about empowerment.
Nothing about wellness. (p. 315)
Most consumers/survivors/ex-patients involved in the modern movement reject the "medical model" of biopsychiatry and argue that "mental illnesses" are an emotional/behavioral/biological/spiritual manifestation of a complex interplay of social, emotional, and cultural stressors (Bassman, 2001; Breggin, 1991, 2003; Chamberlin, 1990; Fisher, 1998, 2003; Fisher & Ahern, 1999; McLean, 1995; Neugeboren, 1999). We view "mental illnesses" as temporary crises as opposed to physical diseases. We stress empowerment and recovery versus maintenance, hope versus resignation
(Bassman, 2001; Fisher, 1998, 2003).
Evidence for Recovery
Under the medical model, in which "mental illnesses "are viewed as "brain diseases," complete recovery is not a possibility. However, research and experience show that many of us labeled as "severely mentally ill" do recover over time, especially when involved in programs that emphasize hope, optimism, and potential (Fisher, 2003; Fisher & Ahern, 1999). Courtney Harding's longitudinal study that tracked more than 1,300 subjects originally diagnosed with schizophrenia during several decades found that one half to two thirds "had achieved considerable improvement or recovered" (Harding, Brooks, Ashikaga, Strauss, & Breier, 1987, p. 727).
Other studies have compared traditional hospital environments to nontraditional community programs such as residential lodges and clubhouse settings. None of these studies has found traditional models to be more effective. In fact, the bulk of this research points to the superiority of nontraditional alternatives, especially in terms of cost and the promotion of independent living (Mowbray & Freddolino, 1986).
http://akmhcweb.org/recovery/oryx_journ ... _psych.pdf

[Anonymous]

On 2006-02-05 20:36:00, Anonymous wrote:

"Yup, Irvin, Thomas Szasz buddy:

http://www.szasz.com/SymposiumProgram.html



Enough said.



How about reading, just the posts here,

of those that are being treated for

SMI, and what they have tried to tell

you time, after time.



Why is it so important to ignore your

peers and quote the fringe niche anti

psychiatry money makers in all your

obsessive negatives posts about anything

to do with psychiatry, meds, light therapy

you name it, your twist is negative.



Now, again, why is it so important to you,

someone who avoids finding out something

about the serious mentally ill first hand

to be so obsessed on this issue.



You have nothing to do with mental illness

except to cut and paste any negative story

you can find in the nice anti market out

there.



But you are obsessed?



Why?



On the issue of treating those that are sick ...



Why would you want to spread your biased info

around and even ignore your peers on this forum

who have tried with really well written testimonials to help you to understand, until

you drive them away.



Why?



"

Please answer this post, I prefer that you stop
being evasive. Be honest, thank you.

[Deborah]

Who are the 'peers' that I have ignored, Paul?
Are you suggesting that I defer to your and Julie's bias?
I have not once suggested that either of your flush your drugs and seek alternative treatment. What exactly do you need from me?
The only obsession that I can see, is your ongoing lame, slanderous, attacks on me for posting information contrary to your beliefs.
I was posting here long before you descended upon the forum with your pro-drug, pro-program attitude. Get over it. We are having discussion/ debate here. If that's uncomfortable for you, then spread your propoganda elsewhere. It's that simple.