The DSM-5 May 21, 2013
Posted by Crazy Mermaid in DSM 5, mental illness.Tags: DSM 5, mental illness
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On May 18, 2013, the American Psychiatric Association released its latest version of the Diagnostic and Statistical Manual of Mental Disorders, called DSM-5. This manual provides a common language and standard criteria for the classification of mental disorders. It is relied upon by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. 
It is news, then, when the National Institute of Mental Health’s (NIMH) director, Dr. Thomas Insel, said they will no longer be using the recently updated manual. In his latest blog entry, Dr. Insel diagnosed the problem with the new manual as follows: “The weakness is its lack of validity”.
Dr. Insel had the following to say about the new manual:
“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:
- A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
- Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
- Each level of analysis needs to be understood across a dimension of function,
- Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.
It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.
That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes.
RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning. Many NIMH researchers, already stressed by budget cuts and tough competition for research funding, will not welcome this change. Some will see RDoC as an academic exercise divorced from clinical practice. But patients and families should welcome this change as a first step towards “precision medicine,” the movement that has transformed cancer diagnosis and treatment. RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders.”
With the power of the Federal Government behind him, Dr. Insel’s brave step of disregarding the DSM-5 has the capability to transform the entire mental health field.
Mental Illness: Worst Disease in the World? March 14, 2013
Posted by Crazy Mermaid in mental illness.Tags: Involuntary Committment, mental illness
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As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.
Unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no little plastic bracelet color for mental illness awareness. In fact, because of its enormous stigma, you would be hard-pressed to find victims and family members willing to take the spotlight for mental illness.
Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by brain chemistry imbalance. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.
Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern. You just don’t tell anyone.
Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients, so they get emotional support from those around them.
Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes. You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the horrible voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.
No legitimate insurance company would dare decline to authorize or pay for mainstream treatment of a cancer victim, but up until a very recent change in the law, insurance companies had little or no such coverage for mainstream treatment of mental illness, reasoning that it wasn’t, after all, a real physical illness. When they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”. We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.
When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.
If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.
Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets before they’re ready all of the time.
The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.
Once in a hospital, a cancer patient has the option to discontinue medication at any time. Mentally ill patients who have been involuntarily committed, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized.
Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges. Whereas the cancer victim fights for her life, the severely depressed victim fights to die. Is the physical pain of cancer worse than the emotional pain of continually hearing horrible voices in your head nonstop? Is radiation sickness worse than lithium side effects? Is prostate cancer preferable to schizophrenia?
I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases -all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.
For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet. This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves. We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.
Chenille: Reality Check Service Dog December 16, 2012
Posted by Crazy Mermaid in Delusions, Hallucinations, mental illness, Uncategorized.Tags: Delusions, Hallucinations, Hearing Voices
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I met the cutest service animal the other day at a mental illness support group. She’s a friendly, bouncy Chihuahua named Chenille. I never thought about using a service animal for help with mental illness symptoms, but that’s exactly what she is. She is a reality checker for her master.
As with many people suffering from mental illness, her master’s symptoms include hallucinating. He sees people and things that aren’t there and hears things that aren’t there. Her job is to help him determine what is real and what isn’t.
For example, if there’s someone suddenly sitting in a chair in his living room that he’s never seen before, if she barks he knows it’s a real person. If she doesn’t react, then he’s seeing someone who isn’t really there. The same goes with noises. Dogs are sound-sensitive, and if there’s a lot of racket or unexplained noise, the dog will react to it. If someone calls his name from another room (and he thinks he’s alone in the house), and she doesn’t react, he knows he is hearing things that aren’t there.
What a relief it is to be able to tell reality from fantasy by using the unbiased opinion of a dog.
People not suffering from mental illness take for granted their ability to tell reality from fantasy every waking moment. They can’t appreciate what a gift it is not to have to questions whether what they see or hear is real. If the average person sees someone new sitting in their living room, he doesn’t even have to wonder whether that person is really there. But for people with certain forms of a mental illness, they can’t depend on their eyes to know whether that person is real. It is challenging to live in a world where your mind plays tricks on you. You need help detecting reality. Who better than a dog to do that for you?
Imagine hearing a loud noise coming from the bedroom. Or hearing someone call your name from the room next door that you thought was empty. There’s no one else with you in the house. Or is there? What would it be like not knowing the answer to that question on a regular basis? A dog can be a lifesaver.
People who use the “reality challenged” phrase in jest might want to reconsider whether that term is appropriate, given the fact that certain people are living the embodiment of the true meaning of that phrase. In order to leave a semblance of a normal life, they need a way to tell whether their perceived reality is real.
During the height of my psychotic break with reality, I met someone at a Starbucks for coffee who was probably not real. He was a green-skinned merman who I thought was my long-lost son from 500 years ago. Long story. But the point is that person was as real to me as anyone I have ever met. I sat across a table and had coffee with him for several hours. Now at this juncture of my life, I realize I was probably one of those people you see who are sitting there in a restaurant talking to someone who isn’t there. Imagine going through this every single day of your life. You need an outside, unbiased source to tell you whether that green-skinned merman sitting across from you having coffee is real. For my part, it never dawned on me that it could be anything but real. But what if it wasn’t?
This use of a service animal is a clever and fascinating way to help people manage the symptoms of certain mental illnesses. This is the first time I have ever heard of this use. I wonder if more people could be helped by these service animals.
Anosognosia Rears Its Ugly Head (Again) October 17, 2012
Posted by Crazy Mermaid in Hearing Voices, Insanity, mental illness.Tags: Delusions, Hearing Voices, mental illness
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Anosognosia is the term for the most dangerous symptom of mental illness. It’s the belief that you’re not mentally ill and don’t need your meds. I have been suffering from this symptom a lot lately. I have almost convinced myself that my diagnosis is a big mistake and that I don’t need my meds. If I go off them, my memory and reasoning ability will return, as will my ability to get up at a reasonable hour. I will be employable once again, and because I’m so good at my job, I will easily find a position as a project manager and be back to my beloved profession, building buildings. All of this is not possible while I’m on my meds.
I know consciously that going off my meds would be a bad idea, but because of this symptom, the concept seems perfectly reasonable.
Unlike many others, I have the sense to discuss my plan with my loved ones.
My sister, when confronted via phone with my idea, told me to open my copy of An Unquiet Mind by Kay Redfield Jamison. It’s a book where Jamison details out what it’s like to have a mental illness. My sister pointed out that Jamison, like me, convinced herself that she’s the exception to the rule of needing her meds. In her book, she goes off them and repeats her cycle of mental illness, finally coming to terms with it and returning to her meds. Reading that passage gave me doubts about going off my meds. Maybe that wasn’t the answer, but maybe it was.
If I stop taking my meds, the voice will probably- but not necessarily-return. But I’ve been hearing that voice for years, so it’s not a big deal. In my mind, it doesn’t mean I’m psychotic. I can manage to keep living in the “real” world without my medication as long as I can put up with a voice. My backup plan would be a return to the mental hospital if my psychotic state returned.
Bouncing this idea off my husband brought up a little problem. If I went off my meds, and a voice returned, wouldn’t this mean I was psychotic again? he asked. I disagreed. One voice doesn’t make you psychotic. But if the definition of psychotic excludes hearing one voice, then how do I know when I’ve crossed the threshold into my definition of psychotic again? How many voices and delusions does it take to be psychotic? And would I recognize it if it was happening? Therein lies the problem.
Between my sister and my husband, I gave in to their logic and stayed on my meds. But the battle never ceases.
Here We Go Again: Reducing Mental Hospital Beds August 19, 2012
Posted by Crazy Mermaid in Delusions, Mental Hospital, mental illness, Schizophrenia, Uncategorized.Tags: Delusions, Hallucinations, Mental Hospitals, mental illness, Schizophrenia
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Here we go again: more psychiatric hospital beds are disappearing in Washington State. How do I know? Not from anything in the news. It’s because I got a phone call from a 75 year old woman whose 54 year old schizophrenic son is being released from Western State Hospital. She called because she was desperate to find housing and help for her son before he is released, which will be soon. She explained that she is an old lady and can barely care for herself, much less her son, who has been at Western for many years.
At Western, he has case managers and people who make sure he takes his medication as well as living support. He never learned how to shop or care for himself because his symptoms were so severe that they required him to be permanently hospitalized. I’m guessing that even with proper medication, he isn’t symptom-free or he would have been released years ago. Even with proper medication, delusions and hearing voices is fairly common in hard-to-treat cases like his. Once out of that protective environment of the hospital, she is concerned that when he stops taking his medication, his symptoms will increase and he will become unmanageable. She is looking for housing for him that will also provide help in adjusting to life on the outside. And she doesn’t have much time.
This situation is tragic. They’re taking a man who has spent most of his life in an institution getting the help and support he needs in order to function, and throwing him outside to fend for himself. Had there been any adjustment support for him, she wouldn’t be so desperate. Programs like those he needs are overfull. He won’t be able to get into those programs for years because they’re at or over capacity right now. And with the State releasing more people like this man, more people will fall through the cracks. The State hasn’t funded stop-gap programs for people like him. There simply isn’t anywhere he can go. Who knows what will ultimately happen to this man?
Although I understand the need to balance the State budget, balancing it on the backs of the more vulnerable population is unconscionable.
Contrary to popular opinion, 99.9 percent of people housed in institutions like this aren’t dangerous when released. So we shouldn’t be afraid of him. In fact, statistically they are the ones who are more likely to be assaulted and victimized because they’re not equipped to survive outside their institution. Turning a man out who has been taken care of most of his life will not make his quality of life improve. In fact, the type of living situation that he was in had allowed him to have his “home base” at the hospital, able to freely come and go at will. The point of the hospitalization was to keep him taking his medication allowing him to live with and manage his schizophrenic symptoms. If he is left to his own devices at this late stage of his life, he will likely discontinue taking his medication, which will mean the symptoms of his illness, barely contained anyway, will return in a big way. I’m not saying he will be a danger to others. I’m just saying that hearing voices and other negative symptoms will likely return in a big way without proper medication and supervision. Clearly, his case must be particularly difficult because had he had an “easy” case, he would have been released years ago. He’s there because that’s where he needs to be.
His institutionalization is very different from involuntary commitment, so his release shouldn’t scare anyone from the standpoint of him being a threat. Far from it. He is allowed to come and go at will, but his base is always at Western State Hospital. He goes on outings and to visit his parents, but he never stays there for any length of time. He always has to return to Western so they can give him the care he needs. He hasn’t gone grocery shopping or done the dishes or any number of things we are all used to doing in order to survive. If left to his own devices without any education in performing these relatively easy tasks, he will risk his well-being to the point of being dangerous. Just turning him loose out into the world will be a hardship. His 75 year old mother won’t be much help, and because of his symptoms he can’t live with her- especially once he’s off his medication.
They say the mark of a civilization isn’t how they treat their rich. It’s how they treat their poor and vulnerable population. And from the way this gentleman is about to be treated, it’s clear that we’re not exactly the best civilization in the world.
Precognition and The Minority Report June 12, 2012
Posted by Crazy Mermaid in mental illness.Tags: Hallucinations, mental illness
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Here in Washington, yet another “crazy” person killed five people last week. The murderer’s friends and family say they knew he was a time bomb waiting to explode and tried to notify the proper authorities, but nothing was done. After the crime was committed, there was the usual handwringing and blaming the system for not having the tools in place to stop this crime. Some even suggested that a new department be created so that people could report those with bizarre behavior in order to lock them up before they committed the crime.
It reminds me a little of the plot for “The Minority Report”, a movie starring Tom Cruise. In the movie, people were jailed by police for supposedly intending to create a crime. Plot summary: In the year 2054 A.D. crime is virtually eliminated from Washington D.C. thanks to an elite law enforcing squad “Precrime”. They use three gifted humans (called “Pre-Cogs”) with special powers to see into the future and predict crimes beforehand. John Anderton heads Precrime and believes the system’s flawlessness steadfastly. However one day the Pre-Cogs predict that Anderton will commit a murder himself in the next 36 hours. Worse, Anderton doesn’t even know the victim. He decides to get to the mystery’s core by finding out about the ‘minority report’ which means the prediction of the female Pre-Cog Agatha that “might” tell a different story and prove Anderton innocent.
Once you get into the probability that someone will commit a crime, you move down the slippery slope to The Minority Report. Jailing someone for “intending” to create a crime is wrong. When you start to jail people for this, you start down that slope.
When it comes to the mentally ill, it takes more than someone thinking a crime is to be committed beforehand unless that person is a known danger to himself or others. The problem with this law when applied to mentally ill people is that most people suffering from mental illness, especially including paranoid schizophrenia (which I believe that shooter had) don’t seek help beforehand. They aren’t labeled mentally ill because they haven’t entered the mental illness system. They simply aren’t diagnosed. And one of the symptoms of those illnesses includes an inability to understand that they are sick. So you have tragedies like last week’s happening because of a culmination of the flaws in our system. And yet “precognition” isn’t the answer either.
I understand the nature of the frustration with the current system. We have had several bouts of paranoid schizophrenia-induced attacks on the general public within the past few years. Actually, this type of thing has been going on for eons, and it’s simply due to the rapidity of the news cycle that we learn about these types of occurrences as quickly as we do now- which is to say almost immediately. They have always been there, but they were under-reported.
The answer at this juncture is to carefully consider the effect that limiting personal freedom would have. Too much damage would occur were we to move to a “Minority Report” type of system, which is what is being talked about now. I vote no.
Lobotomies and Rosemary Kennedy March 7, 2012
Posted by Crazy Mermaid in Mental Hospital, mental illness.Tags: mental illness
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During World War II, the military became increasingly more interested in treatment of mental illness, given the high number of war-related new cases it was seeing. Coinciding with that new interest was the development of new mental illness therapies including lobotomies, where part of a patient’s brain was cut away in an attempt to cut out their mental illness- much as we cut cancer away from a body now. But instead of removing a cancerous growth from a brain, they removed part of the patient’s brain. Between 1936 and 1960, about 50,000 lobotomies were performed on mental patients in the United States alone, with devastating results.
The ugly spotlight of reality was finally shined brightly on lobotomies when the sister of a President of the United States got one, with disastrous results. Rosemary Kennedy, the sister of President John F. Kennedy, received a lobotomy in 1941, when she was 23 years old. At the time, her father was told by her doctors that a cutting edge procedure would help her DEPRESSION (Note: Many media reports incorrectly say she was treated for retardation, but in reality she was treated for depression). At the time of her operation, only 65 previous lobotomies had been performed. Dr. Watts, who performed the surgery while Dr. Freeman supervised/observed, described the procedure on Rosemary as follows:
We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch.” The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. “We put an instrument inside,” he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord’s Prayer or sing “God Bless America” or count backwards. … “We made an estimate on how far to cut based on how she responded.” … When she began to become incoherent, they stopped.
Instead of producing the hoped-for result, however, the lobotomy reduced Rosemary to an infantile mentality. She had to wear diapers because she was incontinent. She could do nothing except sit in a chair and stare blankly at walls. Her verbal skills were reduced to unintelligible babble. The procedure left her completely incapacitated, and her family was devastated and filled with guilt.
Although Dr. Watts’ license to practice medicine was revoked after he performed over 3,000 of those operations, it wasn’t because of the horrendous nature of the operation. It was because of the death of one of his patients. After the procedure destroyed many lives, it finally became viewed as the destructive tool that it was. It is no longer in use.
Suicide By Cop Wannabe February 22, 2012
Posted by Crazy Mermaid in mental illness, Psych Ward.Tags: Depression, mental illness
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- At 9 am, a handsome, barefoot 60 year old man wearing a hospital gown obviously open in the back was wheeled into our group meeting at the mental hospital. His medium frame was covered in scratch marks and black and blue bruises. His dark blue bloodshot eyes were ringed with purple and black. He looked like he had survived a terrible car wreck. He said his name was Chuck.Chuck explained that he had been bipolar for years, but like many manic-depressives, he never experienced the manic state. He only experienced the depressed state. And alcohol made things much, much worse.
- As he sat at a bar in downtown Seattle downing drink after drink, he became increasingly more depressed the more he drank. He became so depressed that suicide started to look like his best option. But he was too chicken to do it himself. He wanted someone to do it for him. Then it came to him: he could get a cop to kill him! And so he decided to go the “suicide by cop” route. His intent was to escalate his bad behavior to such an outrageous, over-the-top point that a cop would be forced to kill him.
- He proceeded to put his plan into action, stirring up quite a scene until at last the cops were called. He fought hard with the cops, trying to force them to kill him. But instead of killing him, the cops were forced to beat him until they managed to subdue him. Then they hauled his ass to the mental hospital. That outcome wasn’t in his plans at all. He expected to be dead.
- Chuck was very angry about being at the mental hospital. Know why? Because according to his plan, he was supposed to either be dead or ship out on a fishing boat back to Alaska in three days. He clearly wasn’t dead, and it didn’t look like he would be able to make that trip to Alaska. When the boat left, he would remain behind, locked up at the psych ward as an involuntarily committed mental patient. Boy was he pissed!
Competency Restoration February 11, 2012
Posted by Crazy Mermaid in mental illness.Tags: mental illness
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Competency restoration is the practice of medicating a person who has committed a crime to the point where they can stand trial for their crime. This doesn’t mean that they automatically are incompetent because they’re mentally ill. It means that they understand the charges against them and can assist their defense attorney in their defense. If they are competent to stand trial, the insanity defense is still open to them if they believe that their mental illness was the cause of their crime.
The way it works in Washington State is this: Say a man beats his grandmother on the head until she’s dead because he believes she’s part of a conspiracy to murder him.
After he’s caught, he’s interviewed by his public defender. If the public defender believes he suffers from a mental illness that makes him incompetent to stand trial, the public defender orders an evaluation. The State has up to fifteen days to perform that evaluation. The reality, though, is that the man sits in jail for six to eight weeks, waiting for a bed to free up at Western State Hospital so an evaluation can be performed. Unfortunately, what used to be two weeks is now eight weeks because of two factors. The first factor is that the number of beds at Western (and other locations) has been reduced significantly within the past two years due to lack of funding. The second problem is that the Veteran’s Administration is stealing doctors who would have worked at Western because the Federal Government is now competing with the State for the same doctors because of the new national focus on PTSD in war veterans.
As part of the evaluation, the doctor uses a data base to track the subject’s history of mental illness as well as review the subject’s criminal history and medical records. The doctor interviews the subject for one to two hours. After all of this is done, the doctor writes a report that makes a determination of whether the man is competent to stand trial.
If the man is competent to stand trial, he proceeds to the next process through the court system. If he is found to be incompetent to stand trial and mentally ill, he proceeds to Western State Hospital for up to 90 days in the hope that he will have his competency restored. If, after 90 days, he is still found to be incompetent, he can be held for an additional 180 days. If he still isn’t competent to stand trial, he can be held for up to 180 more days if it is a felony case or the charges can be dismissed against him, with the understanding that he will spend a lot of time at Western State Hospital in their forensic (criminal) section.
It seems logical that if someone is being evaluated for competency restoration, they are by definition mentally incompetent, but this is not the case. After competency restoration, they can still plead insanity as a defense, but they have to be able to assist in their own defense. Most of the people who are evaluated decline to pursue the insanity defense, because of the stigma of that defense.
As an extreme example of the competence versus insanity, there was a man who was tried for the murder of his grandmother by way of beating her to death with a rock because he believed she was part of a conspiracy by the Federal Government against him. But the delusion that she was part of the conspiracy was not enough to deem him incompetent. He declined a public defender, instead deciding to represent himself. On the stand, he readily admitted to his crime, but declined the insanity defense. He was sentenced to prison.
At the end of the day, the entire competency restoration issue is driven by money- sort of. There is no mandate that people with serious mental illness be given proper treatment prior to their committing crimes. The State waits until the mentally ill have been accused of committing a crime before much effort is expended in giving them a mental health evaluation.
Jail and Prison are expensive- more expensive than treatment for mental illness. And then there are the costs that are difficult to put a price on, like loss of life. We simply can’t afford for our mentally ill population to be stored in our prisons and jails, which is what happens now. Treatment prior to criminal acts being committed is far less expensive than housing them in jail or prison. And yet the dollars for mental health care are shrinking more with each passing year. Hospital beds are being eliminated, to the point where Washington State has the fewest mental hospital beds in 50 States.
If you care about this issue, please contact your legislative representatives and tell them to properly fund mental health. It could save someone’s life.
A Journey Into Madness… February 1, 2012
Posted by Crazy Mermaid in Insanity, mental illness.Tags: Insanity, mental illness
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A journey into madness begins with the first step. It isn’t a case where you wake up one morning and say to yourself “Oh no! I’ve lost my mind!” Rather, it’s more like someone who gains say 25 pounds over the course of one year. It’s a very gradual thing. One pound. Then a leveling off for a few weeks. Then another pound. Then a pound two weeks after that. And so on.
The same with mental illness. One small step towards madness the first day. Maybe you think you can communicate with one person via ESP. And then a leveling off for a little while, as that small step (communicating with one person via ESP) becomes the new “normal”. Then a few days later, another person is added to the ESP repertoire. Day after day, another person or two is added to the number of people you communicate with via ESP. Then you start seeing green people. Then zombies. Day after day these small steps play out little by little. Step upon step, all becoming the next “normal”. It’s not like a heart attack where you wake up and your world changed overnight. It’s more like Alzheimer’s or Parkinson’s or some other relatively slow-moving disease where your world changes slowly but surely.
But I won’t kid you here. The progression of my illness wasn’t in years. It was in months. I went from being a relatively sane 49 year old professional woman (with no history of mental illness or drug or alcohol use) the first week in February 2008 to involuntary committment to a mental hospital with a full-blown case of Bipolar I with psychotic tendencies at the very end of May 2008. Almost four months from start to finish.
That would seem relatively quickly to some, but again think of weight gain. You don’t feel every single pound of weight gain on a day to day basis. You don’t feel every single daily aspect of the loss of memory that’s the hallmark of Alzheimer’s. One little change at a time, piled upon the other little changes. And so it goes for insanity.
