A response to a Cracked.com article

In order to infuse my posts with humor, I make it a habit to read Cracked.com almost daily; it’s one of the best satirical websites around (superior even to the Onion, in my humble opinion). But when I saw Item #5 in this article today, I didn’t find it particularly funny. It speaks to me of a trend — accelerating rapidly now because of the Jared Loughner incident — towards involuntary institutionalization of the mentally ill. I couldn’t let it stand; I had to raise my voice.

This is what I wrote to the author of that article:

Dear Diana,

I’m a big fan of Cracked… it’s a great source of humor, but, even more important, ya’ll are often DEAD ON when it comes to critiquing the madness this society embraces with open arms. So I’ll frankly admit I consider Cracked to be a good source of social commentary and information as well (and I bet I’m not alone in that…).

Which is why, Diana, I feel it necessary to share some information with you concerning your most recent article [“5 Useful Organizations You Think Are Evil (Thanks to Movies)”]. I understand that as a satirical writer you may sometimes need to bend, stretch, or exaggerate (though our society is ridiculous enough that usually it’s unnecessary)… but most of what you write about Hollywood portrayals of mental institutions under Item #5: Insane Asylums is sadly misinformed. Allow me to share some information with you:

1. You write that Hollywood falsely portrays asylums as places where “you’re… going to be held against your will and tortured by malevolent nurses with electroshock.”

Forced electroshock is NOT a thing of the past. It’s actually pretty common. Nearly 100,000 Americans will receive ECT [electro-convulsive therapy] this year, and while there aren’t specific statistics available for the US, in the UK it was found that 59% of ECT treatments were involuntary. [more info here].

To make it more personal, let me tell you about Elizabeth Ellis, of Moorhead, Minnesota. Earlier this winter, Elizabeth experienced a dozen court-ordered electroshocks. She found them terrifying and unhelpful. Finally, she had enough – on January 27, she stayed home instead of going to her “treatments.” Police were sent to fetch her from her house, and she has now been involuntarily committed to a psychiatric institution, where the involuntary ECT continues. MindFreedom International has started an advocacy campaign on her behalf. I encourage you to take a look and see if there is something you can do.

Here’s another case: Paul Henri Thomas, a Haitian immigrant signed a consent form for ECT at the Pilgrim Psychiatric Center (where he was involuntarily committed) in June, 1999. He underwent the treatment three times in June, but after the third treatment he refused to sign any more consent forms. And that’s when his doctors decided that he was no longer competent to give consent and would be subjected to involuntary ECT. He went to court for his right to refuse the treatment… and lost. Ultimately, he was involuntarily shocked almost 60 times. Here’s an instructive excerpt from the court proceedings:

At the third day of Thomas’ hearing yesterday, his attorney questioned a witness for Pilgrim.

“In June he was competent to consent and received three treatments, and some time after that he became incompetent. Is that correct?” asked Kim Darrow, an attorney for the state Mental Hygiene Legal Service, which is representing Thomas.

“I’m unable to answer that,” responded Dr. Robert Kalani, Pilgrim’s associate medical director.

But State Supreme Court Justice W. Bromley Hall swiftly cut off Darrow’s line of questioning, saying Thomas’ capacity to make decisions about his health may have changed since he consented to the treatment.

“There are a lot of people walking around with capacity for whatever,” Hall said in the Central Islip courtroom. “The fact that you have capacity today doesn’t mean you will have capacity tomorrow,” he added, prompting gasps from Thomas’ supporters…

Testimony ended with Darrow asking Kalani, given that Thomas has called the procedure “torture” and “evil,” how has it improved his life.

“Do you think you have improved the quality of life for Mr. Thomas?”

“I think we have,” Kalani answered.

2. Another false portrayal of mental institutions, you say, occurs “in Batman Begins, where a crazy administrator gives patients hallucinogens that induce nothing but bad trips.”

Actually, there’s a whole genre of psychiatric experimentation called “symptom-exacerbation experiments,” where researchers deliberately induce or exacerbate states of psychosis and mania in order to study their progression or test remedies. You see – the occurrence of psychosis is pretty unpredictable, making experimentation difficult; if it can be induced at a pre-determined time, it is much more experimentally convenient. In the 1950s and 60s, as you are probably aware, these experiments included dosing people with LSD and other hallucinogens (one example here).

There was a bit of a public outcry in the early 70s, but by the 1980s symptom-exacerbation studies were again a hot topic because a of the dopamine-causation hypothesis for schizophrenia. This time, stimulants like methylphenidate (synthetic cocaine, AKA Ritalin) and other amphetamines – known to exacerbate or cause psychosis — were also used. These symptom-exacerbation studies are a thing of today, not the past. Here are a few recent examples: this experiment (1993), this one (1997), and this one (1991). What I’ve linked to our academic articles published in prestigious journals. This points to the fact that the practice is accepted, and mainstream (given, of course, that the researcher masks what he’s doing with incredibly technical and dispassionate (ie objective/scientific) language).

Have you ever heard the story of Shalmah Prince? She’s a portrait artist from Cinncinnati, and in the late 70s she was diagnosed with bipolar disorder. In 1983, after going to the hospital voluntarily for treatment (she feared she was about to have a manic episode and wished to avoid it) she was enrolled in a study. She signed a consent form which read, “I, Shalmah Prince, agree to participate in a medical research study the purpose of which is to clearly diagnose my illness and determine whether treatment with lithium might provide long-term relief of my symptoms.” She didn’t have insurance and desperately needed treatment… it seemed like the best option at the time.

What actually happened was that she was abruptly withdrawn from lithium, which she had been taking for several years, and then injected with apomorphine, known to cause psychosis (withdrawal from lithium alone can cause psychosis/mania, too, especially if done abruptly without any tapering). In short, she was involved in a symptom-exacerbation study. Naturally, she soon suffered a severe manic/psychotic break. She was left in leather restraints for three days, and she herself says “After that, I was never the same person ever again.” She was severely traumatized. She was also billed nearly $15,000 upon discharge from the hospital. She lost most of her memory of the event, but in 1994, after reading a newspaper article on symptom-exacerbation studies, she slowly pieced together what happened. She forced the hospital to produce her medical records and attempted to sue; but she was unable to because the statute of limitations was only 2 years (trauma-induced memory loss being no excuse, I suppose).

***
Diana, I again stress to you that this is not ancient history… this is the present! Forced drugging, social isolation, stigmatization, beatings, confinement, etc. are also standard practice in institutions. For these reasons, I feel confident in stating that folks who are fearful of or resistant to involuntary commitment to asylums/mental institutions are completely justified. I support their right to determine, for themselves, what “wellness” is, and what treatments they think would be helpful.

And please don’t make the mistake of thinking that the seriously mentally ill are somehow “other,” that “this could never happen to me.” Oh, how many have thought that! Diana, it [an “extreme state of consciousness,” as they say] could happen to anyone.

So understand that I also support your right to refuse ECT, drugging, or commitment to a mental institution you don’t think would be helpful, Diana. I support your human right to define wellness for yourself.

In light of the recent Tucson shooting and the media bonanza concerning Jared Loughner (which has people, and LEGISLATORS, glibly calling for more and more involuntary commitment to “protect” the public from “psychotics”)… this issue is only going to get bigger and bigger. I urge you to reconsider what you have written in your article… I urge you to consider the very salient points of the mental health rights movement … I urge you to consider the tenants of the “Universal Declaration of Mental Rights and Freedoms”…

And most of all, I urge you to remember the parable of the Holocaust, which I find imminently applicable to this situation:

“First they came for the Jews
and I did not speak out –
because I was not a Jew.
Then they came for the communists
And I did not speak out –
Because I was not a Communist.
Then they came for the trade unionists
And I did not speak out—
Because I was not a trade unionist.

Then they came for me—
And there was no one left
To speak out for me.”
(Pastor Niemoeller, victim of the Nazis)

Diana, did you know that, actually, they came for the mentally ill first, before anyone else? Food for thought…

Yours truly,