Mental Health Court

There have been several articles this week in the New York press about "mental health courts". I've been thinking about them a great deal. On the one hand we have to consider the terrible plight of mentally ill people suffering in prison. On the other we have the singling out of allegedly mentally ill people, the criminalization of mental status, and forced mental health treatment. It's hard to know which is the worse of the two evils.

It turns out that there are other specialized courts as well. New York has domestic violence court and homelessness court while Alaska has a court just for veteran's issues. There is even a name for it - "therapeutic jurisprudence". Many people feel that this is a welcome development - the personalization of justice. A woman arrested for prostitution, let's say, might be able to go to drug court, get sentenced to treatment, get job training, and leave the system with no criminal record. This could be seen as a very compassionate response from a usually cold system.

Critics point out that this actually leaves judges, usually white, well educated, and well-off, in intimate control of the lives of poor people. In the case of mental health courts, judges can certainly find themselves out of their depth. For example, a judge may order that a patient take medication, undergo shock treatments, or change their prescription. This seems unwise to me. Whenever the law and medicine overlap, I get nervous.

The place where the law and medicine invariably overlap is at the point of involuntary commitment. Back in 1954 when my grandmother was committed, my grandfather was at first a willing party. He signed a "complaint" against her and that was enough to have her held in the psychiatric hospital. Later, when he wanted to get her out, the psychiatrists would not release her. The fact that he wished to withdraw his complaint meant nothing. Once she was in the jaws of the beast, there was no getting out.

I'm sure that most judges do their best to make proper decisions, but these courts need an impartial observer to ensure that they are dispensing compassionate justice and not becoming a social or moral kangaroo court.

Eugenics and Pope Benedict XVI

Like a lot of other people I've been absorbing the information that the new Pope was once in the Hitler Youth. Today's New York Times discusses the meaning, or lack thereof, of this long past association. The article contained this quote from the Pope's biographer:

Under Hitler, Ratzinger says, he watched the Nazis twist and distort the truth. Their lies about Jews, about genetics, were more than academic exercises. People died by the millions because of them.

This reminded me of why keeping after the truth about psychosurgery past and present is a vital mission. When science and medicine are distorted, people suffer and sometimes even die. It seems impossible, but WWII demonstrates how medical theory gone amok can combine with circumstances to create a holocaust.

Nazis were, of course, not the only ones who believed in eugenics - the idea originated in the UK and was advanced by wealthy American families and research institutions. Before the German eugenics program even began at least seventeen U.S. states had forced sterilization laws. In fact, in 1927 the US Supreme Court legalized the forced sterilization of the "developmentally disabled, the insane, or the uncontrollably epileptic". Before you start yawning over all this distant history, know that Virginia practiced eugenics, forced sterilization, until 1979(!).

Apparently the idea of simply, you know, caring for the poor was considered by many to be a ridiculous waste of resources. Why should the productive members of society be saddled with the inferior, poor ones? Many even believed that "assisting the poor" was actually stealing from the productive and truly valuable members of society (does that remind my fellow Americans of any recent political trends?) "Let them die out and do everyone, even themselves, a favor," was a common refrain. Eventually eugenicists got what they wanted on quite a grand scale. The number of people who died in the name of eugenics is unfathomably immense and painful to contemplate.

Nearly all educated people took eugenics as truth. President Herbert Hoover had actually attended a eugenics seminar in 1921 and I can't help but wonder if this is why he waited so long to act when economic collapse was cascading around him. Maybe the suffering of the unemployed didn't hit him as hard as it would have if he had never been exposed to these "let them eat cake" theories. In contrast, President Franklin D. Roosevelt was one of the few who didn't buy into the idea that a wheelchair-bound man was a useless burden to society, and by extension didn't believe that the poor were inferior trash either.

What awful acts do we commit in the name of science? We hold people down and force pills down their throats or injections into their bodies, even while they scream in protest. We tie them up and hold them indefinitely. We whisper that they are biologically damaged and inferior. We operate on their brains even though we don't really know what they hell we're doing, because being "inferior" is so terrible that we will take any chance to make them "normal". We think they are quite a burden on the productive members of society. We can't even just let them be homeless - they still "get in the way" and we demand their removal from the streets.

I don't really know how Pope Benedict XVI will incorporate what he saw of Nazi brutality into his work. I can only hope that the message is sincere and that he will be an ally of those who seek fairness and justice for all human beings.

A Hole In One

So yesterday I attended a cocktail party for, and a screening of, the film "A Hole in One". Let me give you all the details.

As some of you know, I live on Long Island, a suburb of New York City. I took the train into Manhattan, a pleasant experience when it's off-peak, and walked down to the Chelsea apartment of psychoanalyst Dr. Paola Mieli. Both Dr. Mieli and her apartment were absolutely gorgeous, she with a kind smile and beautiful face, the apartment with light oak wood everywhere.

The people at the party were very New York in that they were a highly educated, artsy crowd. One man emerged and introduced himself as Richard Ledes, the director of the film "A Hole in One". He told me about his interest in the topic of psychosurgery and how he had worked for many years to get the film made. The script alone took over three years to write (and rewrite and rewrite).

I met publicists for the film and one of the actors, as well as Jack El Hai, the author of "The Lobotomist". Jack was nice and seemed to forgive me for not reviewing his book yet. Later in the evening I asked him why he had to call Freeman a genius in the title of his book, and he said he believed that Freeman was a genius in ability and capacity, though he may not have applied his genius in a way that we would have liked. Yuck, Jack. He did say that he thought that Freeman was a manipulator, especially when it came to generating glowing press coverage for lobotomy. He agreed that today's media coverage of current techniques like deep brain stimulation is frighteningly similar, so I decided to forgive him for the genius thing.

We all walked together over to the theater where the film was being shown. With cola and popcorn in hand, I settled in to watch a film that I believed was not gory at all. Boy, was I mistaken. One of the greatest ironies of my life is that, while I am devoted to the study of lobotomy, I am incredibly squeamish. I was in for one wild ride.

It all started nicely enough. The film takes place during "Mental Health Week" when the population is urged to do what it can to fight communism by being screened for mental illness. You see, "every tenth man" is mentally ill and needs treatment. The lobotomy doctor is named Walter Ashton, obviously suggestive of Walter Freeman.

The film stars that pretty blonde woman from Dawson's Creek, Michelle Williams, who is considering a lobotomy because it "will help her to forget", and she thinks that forgetting is the key to being happy. She's trying to forget Meat Loaf Aday who plays her violent gangster boyfriend.

There are several interesting juxtapositions in the film - electricity is used both for execution and shock therapy. An icepick is a murder weapon or a medical instrument. At one point Michelle Williams' character talks about wanting a lobotomy because she "needs another hole". Paging Dr. Freud.

But then there is The Big Scene (in my mind). A man comes into Walter Ashton's office for alcoholism treatment, and is graphically and brutally lobotomized in a very disturbing scene. And it's not just me being hypersensitive - people actually screamed during the Tribeca Film Festival. I can't tell you how bad it was because I covered my eyes and ears -I could not take it. Of course, a few scenes later the man is back in the bar, still a drunk but now a lobotomized one.

At the end of the screening we got to see the "dummy", actually a very complex and expensive piece of equipment, which was used in the scene.

When the film was over Richard Ledes was available for questions, many involving the symbolism he chose.

As I walked back up to Penn Station to catch a train home, I found myself grateful for people who care about and see the injustice in what happened. In the past few weeks I've heard lobotomy poetry, read a lobotomy book, and seen a lobotomy film. Someone needs to write a lobotomy play now ...

The film is opening May 6th in NYC at Village East Cinemas and May 13th in Los Angeles at the Laemmle Fairfax. Eventually a DVD will be available. Please see it if you can, and I will let people know when the DVD is available.

I want to take a moment to thank Richard for making a film about this topic, and for inviting me to the screening.

Salon does it again

Here is a LTE I wrote to Salon in response to their article "Head Case" (sub required or you can watch an ad to access for free):

Dear Editor-

The article “Head Case” asserts that biological treatment of headaches, especially in women, is new. This is flat out wrong. Ask the women who were lobotomized (yes, lobotomized) in the 40s and 50s for “intractable pain”. These were women with no history of mental illness at all. Obviously, since the same operation was used to treat mental illness, there was long ago a supposed connection made between psychiatric problems and pain, including headaches.

It annoys me a great deal to see articles that talk about these treatments and ideas as if they were new. They are as old as the hills and as ineffective as ever as Kamen’s total lack of relief proves.

Freud, with all his supposed sins against women, at least knew bogus cures like hydrotherapy when he saw them. People today will apparently believe anything. Fig leaf tea in the eye indeed.

Sincerely,

Christine Johnson
-------------------------
The fig tea thing refers to the author's attempt to be cured of headaches by having an "alternative healer" drip fig tea into her eye. Throughout the article she's bent out of shape because "old thinkers" believe her headaches are psychological, but then she accepts all this crap about how great modern medicine is and how they understand that it's all biological now. She waxes poetic about PET scans and functional MRIs, yet she fails to acknowledge that no one has cured her of a damn thing - she still suffers from debilitating headaches.

Columbia Journalism Review

I found this interesting blog called the CJR Daily: Real Time Media Analysis from the Columbia Journalism Review. I think I'm going to start visiting it regularly.

One post talked about how credulous the media is about medical reporting:

In an interview with CJR Daily in December, James B. Steele, co-author of Critical Condition: How Health Care in America Became Big Business -- and Bad Medicine, criticized the news media for being a lap-dog of the pharmaceutical and health industries: "The press is filled with tales of the latest wonder drug or a procedure that will dramatically improve our well-being. They read like PR handouts and play to the public's anxieties about health. There is seldom a hint of skepticism."

Another post read:

If you believe what you read or hear in the media, we're a nation of invalids.
...
Greve cites some examples:

A Baltimore Sun report says 20 million Americans suffer from depression. A patient-care newsletter says 10 million Americans older than 50 have the bone-wasting disease osteoporosis. Other published reports say 13 million Americans have hypothyroidism, 7.9 million are alcoholics, 40 million have the hearing defect known as tinnitus, 62 million have digestive diseases and 70 million have some form of arthritis.

U.S. population: 293 million.
...
Who's pushing the numbers? Says Greve: "[B]io-statisticians blame drug companies and reporters for much of the hype. They also blame research institutes and disease foundations seeking more public spending on particular diseases."

It's so good to find others who see what I see.

Your Best Interests in Mind

Have you ever seen a recipe on a bottle of tabasco sauce (or something similar) which conveniently calls for an inordinate quantity of product inside? Makes you suspicious, doesn't it? Who do these people think they're fooling?

That's how I feel about this article from the New York Times. It seems awfully convenient that the the U.S. Government (whose political parties are both in bed with the pharmaceutical companies) and psychiatrists (who make money from mentally ill people) see a huge need for "routine depression screening" and treatment (i.e. medications). And if you object to this, it's because you don't take mental illness seriously.

Who do these people think they're fooling?

If ever the political parties were to unite to protect The People, the time is now. They're just trying to screen adults now. Soon government officials will try to implement this nationally in our public schools. As if the overprescription of ritalin in children wasn't awful enough at present ...
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Depressed? New York City Screens for People at Risk

Doctors in New York City have begun to use a simple questionnaire to determine if a patient is at risk for depression, a practice that health officials hope will become a routine part of primary care, much like a blood pressure test or cholesterol reading.

The new program is the first to carry out depression screening using a scored test on a wide scale. It comes amid a spirited national debate among psychiatrists, policy makers and patient-advocacy groups on the wisdom of screening for mental disorders, especially in children.

In 2003, an expert panel convened by President Bush recommended expanding mental health screening, and Congress budgeted $20 million in supporting money for state pilot programs for this year. Several states, including populous states like Florida and Illinois, have begun to investigate large-scale screening plans, and scores of schools and other youth centers throughout the country have used instruments to test youngsters for suicide risk.
...
Psychiatrists and other proponents say mental health screening is long overdue. They argue that millions of people with serious mental disorders never get help, and that heightened vigilance would not only allow doctors to head off much worse mental problems later, but would also reduce the tremendous costs of untreated illness.
...

Critics like Ms. Sharav contend that screening tests will also increase the use of psychiatric drugs, including antidepressants like Zoloft and Prozac, whose use in children and adolescents has recently come under scrutiny by regulators.

Representative Ron Paul, a Texas Republican and a gynecologist, introduced an amendment last fall to block federal financing for screening programs, in part because of worries about overmedicating schoolchildren. The plan was rejected.

<>"We already have a tremendous number of kids being put on drugs like Ritalin and Prozac," Dr. Paul said, "and I think if these screening programs grow, you're going to see a lot of people pushed into medication programs for behavioral problems."
...
"Depression is a leading illness in New York City, but it can be effectively treated," said Dr. Thomas R. Frieden, the city's health commissioner. "Our surveys show that there are an estimated 400,000 New Yorkers with depression; many have not been accurately diagnosed or effectively treated."

Penelope Scambly Schott

As anyone who knows Penelope's work can attest, she is a wonderful poet. I just loved hearing her read from The Pest Maiden. Her stories are so interesting. She knows so many wonderful people in Chappaqua who were kind enough to come and hear us speak. I'll post pics as soon as I can.

She was so kind to give me some of her time to speak. I wish I had been able to fit in some info about the fight against the Nobel Committee. As it was I ran too long and had to omit some of my text. I could beat myself up about it, but instead I will consider it an homage to the man who is perhaps Chappaqua's most verbose resident. Going by his example, I should have hit all my points no matter how long I was running, and made some extra ones along the way as well. It's all about self-confidence, isn't it?

Thanks again to Penelope. Please buy a copy of her book The Pest Maiden. You'll be glad you did. (yes, that's my review at Amazon. It came up in my maiden name.)

Chappaqua, New York

As I mentioned earlier, tomorrow I will be speaking at the Chappaqua Public Library in Chappaqua, N.Y. as the guest of Penleope Scambly Schott. Hope to see you there!

Author Talk
Penelope Scambly Schott
THE PEST MAIDEN: The Story of Lobotomy

This harrowing narrative is about a woman's experience with mental illness and its inhuman treatment through lobotomy. Told in individual poems, Jean Heuser began as a bright and beautiful ballet dancer, and her sad story is infused with memories of her humor and charm.
TuesdayApril 12, 2005 2pm
Free and open to the public
Reception and book signing to follow

Art to Control Schizophrenia

I thought this story was very touching and wanted to share it with you all. Hope you have a great weekend.
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Artist hopes to help others who struggle
Painting fights mental illness
By ROCHELLE SQUIRES, STAFF REPORTER

During a dark and psychotic period in his life, Nigel Bart sought and found refuge in art. The 30-year-old Winnipegger was diagnosed with schizophrenia 11 years ago and struggled through many chaotic episodes before coming to terms with his illness.

"I was very afraid of what was happening to me. I couldn't concentrate and felt like I didn't have any control in my life," said Bart, who began feeling symptoms of the disease when he was 17 years old.

"I started experiencing bizarre things and would do bizarre things, so I isolated myself socially."

After a few years of periodic psychotic episodes, Bart hit rock-bottom.

"I just lost it mentally in a public library. I felt like I was trapped there," he said.

Bart was diagnosed with the illness after that episode and was put on medication to help control the symptoms of his disease.

"I slept for at least a month," he recalls. "I felt depressed and apathetic, which are side-effects of the medication. I was also left feeling vulnerable because I didn't fully understand what it meant to be a schizophrenic."

The young man, who was 19 at the time, said the illness seemed to take away his voice, his individuality and opinions. He felt he was no longer in control of his life.

Then he sought ways to manage his illness.

"When I was ill, I would do art in my mom's studio. It was low stress, gave me some structure to my day, and I was creating something that gave me a bit of self-esteem," said Bart.

He also discovered that art allowed him to make sense of the chaos in his mind and gave him control over his thoughts and feelings.

<> "There are just some things you can't say. What I learned was how to express my dark experiences and feelings through sculpture and painting," said Bart.

NEWLY-OPENED STUDIO

Bart went to art school at the University of Manitoba. Now the 30-year-old wants to help others by mentoring at the newly opened Artbeat Studio on Albert Street.

The 3,500-square-foot studio is for artists living with mental illness and provides a place where they can develop work and gain skills while being with others who experience similar illnesses.

<> "My life work is to provide hope to others," said Bart, who acts as an advocate for those with mental illness and is willing to share his story of encouragement. "I'm not afraid to talk about my illness and I'm here to say we're not violent and we shouldn't be the laughing stock of the community."

Justice Dep't Investigates Psychiatric Hospital

So, gross abuses of the mentally ill are a thing of the distant, unenlightened past, ey? Note that one of the patients is a Vietnam Vet. What can the Iraq and Afghan vets expect in the future when our country has even less financial wherewithal?:
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U.S. Conducts Inquiry Into St. Elizabeths
Patients' Civil Rights Are at Issue

By Carol D. Leonnig

Washington Post Staff Writer
Saturday, March 26, 2005; Page B01

The Justice Department is investigating whether chronic problems at St. Elizabeths Hospital are violating the civil rights of mentally ill patients.
...

In the past year, several St. Elizabeths patients have been assaulted by other patients, and care at the psychiatric hospital has been criticized by regulators and by an internal review commissioned by the Mental Health Department.

Last April, Martin Allan, 55, was stomped into a coma by a male patient, and just a few weeks later, a frail older woman, Willie Faley, was fatally beaten by another female patient. In both cases, family and workers blamed inadequate staffing.

A review prepared in January by a Mental Health Department consultant found that the hospital had "dangerously low" staffing and needed considerable improvement in its management and use of restraints. The consultant, Richard Fields, said in the report that he was most concerned by the risk posed by staffing problems.

In his review, Fields found that more than half the wards inspected in December were understaffed, nurses were working overtime and staff members routinely were asked to work in wards where they were not familiar with procedures. A third of the staff members lacked the required training for their jobs, wrote Fields, who concluded that the staffing problems represent a "significant risk over time" to patients.

The request for an injunction filed by University Legal Services includes several declarations from 13 patients and their families in which they pleaded for help from the court.

"Staff undresses some of the other patients in the day room while the rest of us are in there. I have seen other patients' private parts. I feel horrible for them because they should be treated with dignity and respect," writes a former Vietnam veteran, whose identity, like that of the others, is not provided. "I don't want to be here. This is a terrible place to live."

A father warned that his son's life is in danger and reported that the son suffered a black eye in February. "My son tells me he has been intimidated, threatened and hit," the father wrote. "Staff personnel are unable to control such activity, they tell me, because they are short-handed."

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Unruly Behavior? Mental Illness? Autism?

This article puports to discuss the problem of "parents who are forced to give up custody of their child in order to gain access to mental health care". But in the article it's clear that no one agrees on the boy's diagnosis, there is no federal funding to help him even if they did decide on a diagnosis, the parents are overwhelmed, and this child is being somehow lost. I think this article is representative of the confusion that is the American health care "system":
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Mother regrets giving state custody of son
Parents forced to give up child so medical care would continue

It's a choice no parent should have to make: Cope inadequately with a son or daughter's ever-worsening mental illness or surrender the child to the state in hopes of assuring the care the child needs.

"A parent should never have to give up custody to get services, but it happens. Believe me, it happens," said Jane Adams, director at Keys for Networking, a Topeka-based advocacy program for mentally ill children and their parents.

It happened to Leslie and Shane Sharp, a Lawrence couple whose 14-year-old son, Jeremiah, has been in and out of psychiatric care since he was 6 years old.

In February, social workers notified the Sharps that Jeremiah was about to be sent home from an Overland Park psychiatric hospital. But the Sharps said there was no way they could handle Jeremiah's erratic behavior while caring for their three other children, ages 6, 3 and 17 months.

"We love Jeremiah with all our hearts, but he lives in another world," Sharp said. "He can't handle more than one thought at a time. The last time he was here, he dropped the baby because he forgot he was holding her."

Difficult diagnosis

Because Jeremiah's illness is so severe, he is eligible for a program administered by Kansas Department of Social and Rehabilitation Services designed to keep children out of state-run hospitals by providing comparable services in the community.

Sharp, a stay-at-home mom, said Jeremiah's diagnosis had been hard to nail down.

He's also been diagnosed "schizoaffective disorder," she said.

"He's very manic," she said. "He has these rapid mood swings. He can be laughing and giggling and in just a few seconds be mad and sad and inconsolable.

"And he obsesses on things. If he gets it in his head that he wants a cookie, he'll ask for a cookie. And if I say ‘No, it's almost dinnertime,' he'll say, ‘But, Mom, I'm hungry.' He won't let go. He'll say it 50 times if he has to -- I'm not exaggerating. It'll go on like that for hours."

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The Pest Maiden

As I mentioned earlier, Penelope Scambly Schott and I will be speaking at the Chappaqua, New York Public Library on April 12th at 2 PM. Here is an article about Penelope's book "The Pest Maiden":

A Mind of One's Own

Penelope Scambly Schott is back with a new book of her poems, and in 'Cool Women Volume Three.'




It's a good thing Penelope Scambly Schott is a poet and not a marketing executive. Had she been the latter, she might have titled her book Dancing with Demons. Bravo to Ms. Schott for calling it The Pest Maiden: A Story of Lobotomy (Turning Point, 2004), a name that more accurately reflects the point she is trying to make: that a woman could be subject to lobotomy merely because she was considered a "pest."

Speaking from her home in Portland, Ore., Ms. Schott brings up the case of Rosemary Kennedy, J.F.K. Jr.'s oldest sister, who died in January: "She didn't even have mental illness," says Ms. Schott. "She may have been dyslexic. Her father had her lobotomized, without telling her mother (Rose), because he didn't want Rosemary to embarrass the family with her sexual escapades."

These so-called escapades were instances where Rosemary would run away from the convent where she was cared for to meet boys, says Ms. Schott. "The irony is, after her lobotomy, she lived out the rest of her life in the care of nuns."

Not only did the lobotomy fail to control Ms. Kennedy's mood swings, but it left her with an infantile mentality, staring at the walls. Her speech became unintelligible babble.

Ms. Schott, a Rocky Hill and Griggstown resident for 30 years, will return to the area for three book-related events in early April. She will read from The Pest Maiden at Chestnut Tree Books in the Princeton Shopping Center April 9. Also a member of the Cool Women poetry group, Ms. Schott will appear at the Princeton Public Library April 10 for the launch of Cool Women Volume Three (Cool Women Press, $15), and then again April 11 at Barnes & Noble in West Windsor.

The Pest Maiden is a collection of poems about Ms. Schott's distant cousin, Jean Heuser, who was afflicted with mental illness — probably schizophrenia — and, without her consent, treated with lobotomy. Sadly, this happened in February 1954, two weeks before Smith Kline Beecham received the patent for the anti-psychotic drug Thorazine. Since then, lobotomies are no longer used to treat psychosis.

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