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Mental Illness and The Law: How We Got Where We Are June 29, 2010

Posted by Crazy Mermaid in History, Insanity, Involuntary Committment, Mental Hospital, mental illness, Mental Illness and Medication, Psychotic.
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If you want to change things, first you need to understand how they got the way they are.  In the case of mental illness law, politicians and lawyers had the best of intentions, but as with other ventures, the devil was in the details.  The unintended consequences of their actions continue to remain the source of frustration and even danger.

In his 1946 article “Bedlam 1946: Most Mental Hospitals Are A Shame and A Disgrace” http://www.mnddc.org/parallels2/prologue/6a-bedlam/bedlam-life1946.pdf in Life Magazine, Albert Maisel made the case that mental hospitals were terrible institutions.  The final paragraph of his article summarized his point succinctly: “Given the facts…the people of any state will rally… to put an end to concentration camps that masquerade as ( mental) hospitals and to make cure rather than incarceration the goal of their mental institutions.”

While the sentiment is perfectly understandable given the horrific conditions he found when he investigated the state of mental hospitals throughout the United States shortly after the close of World War Two, he threw out the baby with the bath water when he declared, in effect, that nobody should have to be institutionalized.  The wildly popular Life Magazine gave Maisel a platform from which to launch his idea of closing all mental hospitals, also called deinstitutionalizing the mentally ill.

Helping this idea along was the development of the first generation of antipsychotic drugs in the 1950’s. Used to treat schizophrenia and other psychoses as well as acute mania, agitation and other conditions, their discovery allowed many mentally ill people once hospitalized to return to their families, hopefully with their illness under control and able to function as productive members of society in many cases.  In many cases this was true, but not in all.

The advent of these new antipsychotics lent fuel to the fire of the deinstitutionalization movement, and, combined with the publicity of the atrocities perpetuated in the mental hospitals, served to throw the doors to the mental institutions wide open in the mid-1950’s.

From the mid-1950’s to the mid-1960’s, a small percentage of the eventually deinstitutionalized were released. But from that point forward, the trickle became a flood, culminating in the release of the majority of the mentally ill by the mid-1980’s. And as the mentally ill were released from the hospitals, rather than wait to see whether whether the experiment was going to work, those hospitals were closed down forever, shrinking from a high of around 550,000 beds in the mid-1950’s to around 40,000 today. As this experiment failed,the homeless and prison populations of every major city and State ballooned.

In the meantime, California was the first state to pass the Lanterman-Petris-Short Act in 1967, giving the mentally ill the legal right to avoid treatment for their mental illness, regardless of how damaging that mental illness became. Unless the person was in imminent (immediate) danger of severely harming or killing themselves or someone else, they had the right to be left alone, free to wander the streets, homeless and victimized, eating out of dumpsters, lost in their own world. Other States followed their example, with the former Governor of California, Ronald Reagan, leading the charge on a national level as he ascended the highest office in the land, the Presidency.

The mistakes the do-gooders made in this two-pronged approach of first deinstitutionalizing and then arming the mentally ill with the right to refuse treatment were twofold.  Their first mistake was  in perceiving all hospitalization to be bad hospitalization. Secondly they assumed that anyone who has a mental illness has the presence of mind to know when to seek treatment for that illness.

Treating mental illness like any other illness, disregarding the fact that one of the symptoms of the illness can be a failure to realize they are ill, and denigrating all mental hospitals as evil are poor choices for which we have all paid dearly, in the form of the fallout from our endless supply of suicides, the incarcerated mentally ill population, the homeless population, and mentally ill people who attack and assault others.

Until we realize that mental hospitals can also be used for good, and that mentally ill people can’t always help themselves, nothing will change.

(Note:  Part of my research for this article was done with the help of Dr. E. Fuller Torrey’s book The Insanity Offense. (2008).

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Book Recommendation: Surviving Manic Depression May 28, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Healthcare, History, mental illness.
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I just finished reading Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers by E. Fuller Torrey, M.D. and Michael B. Knable, D.O.   I’ve read books devoted to exploring Bipolar Disorder, but none of them hold a candle to this one.  I heard about this book when a gentleman from NAMI graciously provided me with the name of this book after I asked him how Manic Depression re-branded itself to “Bipolar Disorder”.  Dr. Torrey meticulously wades through society’s current beliefs, making a compelling argument that Manic-Depressive is a more accurate term and should be brought back into general use.  Besides providing an excellent platform for his argument, the book delivers on many different levels.

I found my hardcover copy at Amazon.com, for about $4 plus $4 in shipping in the Used Books section.  The publication date of my copy is 2003, but there is a 2005 paperback version that I can’t speak to. Anyone with information on the newer book is welcome to send me your thoughts. I’d love to hear them.

Dr. Torry wrote his first book on Schizophrenia (which I haven’t read yet), which qualifies him to compare the two illnesses with authority.  He takes advantage of his knowledge to bring his audience on an expedition to explore those differences in great depth.  When I finished the book, I had a better working knowledge of Schizophrenia, which I wasn’t expecting from a book on Manic Depression.

My only complaint is that he doesn’t really get into depth on definitions until Chapter 3, and I would have liked to see that done right up front in Chapter 1.

Risk factors, causes, medications, and treatment strategies are all areas I’ve found in other books, but this one is done better than most I’ve read. He uses the lens of the Scientific Method to standardize knowledge, allowing him to easily gut some of the urban myths that have grown up around Manic Depression, while moving others from that urban myth category into reality. No sleight-of-hand here.

The coup d’gras is the appendix section. It’s amazing. He’s done a review on every major book I’ve ever heard of having to do with manic depression as well as on ones I never would have known about any other way. He’s reviewed websites, and in the process opened my eyes up to organizations I’ve never heard of but want to explore now that I know about them.  This part, at the very end of the book, is worth the price of the book. He wraps up the book by declaring that we need a 21st century Dorothea Dix- someone to research and meticulously take note of the existing system and shine a public spotlight on the broken parts.  I couldn’t agree more.

Dorothea Dix, Mental Health Pioneer September 24, 2009

Posted by Crazy Mermaid in History, Mental Hospital, mental illness.
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As I was doing research on the history of mental illness, I kept coming up with obscure references to a woman named Dorothea Dix.  She seemed to have a lot to do with treatment of mental illness, but it was difficult to find out much about her. She wasn’t in many of the history books I was reading at the time about mental illness. Who was this woman?  Why hadn’t I ever heard of her?

Dorothea Dix was a teacher who began a second career as an advocate for mentally ill at the age of 39, which was spinster-hood back in the mid 1800’s. She had volunteered to teach Sunday school to a bunch of women inmates at East Cambridge Jail in Massachusetts. What she found there changed her life forever.  She couldn’t believe the horrible conditions the inmates were kept in. There was no distinction made between criminals, mentally retarded, and mentally ill prisoners. All were kept together in filthy conditions.  She asked why the prisoners were kept in such horrible conditions and was told that the insane don’t feel heat or cold (Viney & Zorich 1982).  From that point forward she dedicated her life to improving the lot of the mentally ill.

Earlier in her life, she had befriended two men who became powerful politicians. One was the Governor of Massachusetts. She made extensive and copious notes about the abominable conditions in the jails and reported her findings to the Massachusetts legislature, begging for more money to improve their lot. She got the funding, and after the mental hospitals in Massachusetts were expanded and cleaned up, Dorothea went to the other States and began her method all over again. She was successful in cleaning up the conditions of the mentally ill in the United States, and then went to Europe and did the same thing.  All in all, her contribution to improving the treatment of the mentally ill was enormous.

The reason we can’t find much about her in the history books was because she avoided the spotlight, refusing to take public credit for her work. Despite the extensive funding she managed to secure for hospitals, she refused to have any named after her. She refused to have her name on most of her publications. She was embarrassed if anyone tried to express gratitude for her work and its effect on their lives. And the medical community hasn’t recognized her in general because they think she doesn’t deserve acclaim because she didn’t contribute to our understanding of the nature of mental disorders. Regardless of history’s treatment of her, we owe her a great debt.

Lobotomies and Rosemary Kennedy September 23, 2009

Posted by Crazy Mermaid in History, 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.

Bedlam: 1st Mental Hospital September 23, 2009

Posted by Crazy Mermaid in History, Mental Hospital, mental illness.
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The name “bedlam”, meaning uproar and confusion, is derived from the world’s first psychiatric hospital, Bedlam Royal Hospital of London. It began admitting patients in 1357.  Bedlam isn’t the only mental illness-related word that has made its way into our everyday language. An even more popular word is “lunatic”, derived from the Latin word “luna” for moon. “Lunatic” was originally used to describe what was thought to be the connection between phases of the moon and insanity, but has been popularized to mean someone who is dangerous, foolish or unpredictable, or possibly but unlikely, mentally ill. Mental institutions were, and still are, called “lunatic asylums” or “loony bins”.

Throughout history, as theories about what mental illness is and how to treat it have shifted, knowledge and approaches have changed time and time again. As early as 400 BC, the Chinese recognized and treated mental illness, and asylums were established in the 8th and 9th Centuries in a few Arab countries. As a sign of enlightened thinking, some monasteries housed and cared for the mentally ill in the early Middle Ages. But then things took a turn for the worse. In the later Middle Ages, when the primary treatment was ritual and magic, at least 100,000 mentally ill people were executed because they were thought to be witches.

In the early 1700’s, the medical community changed its perception of the mentally ill.  With that change came a change in names.  Instead of referring to the mentally ill as “lunatics”, they were referred to as “patients”. The situation improved somewhat, but was far from ideal. Around that time, Bedlam established labels of “curable” and “incurable” for the mentally ill patients, and began separating patients by these labels. As a testament to how misunderstood mental illness was at that time, lunatics were viewed much the same as zoo animals are now.  For a small sum of money, “tourists”, bringing their own sticks to poke the inmates, could go to Bedlam and watch them, much as we go to zoos to watch the animals nowadays.