Wednesday, 19 November 2008

"The Doctor Who Hears Voices" - An alternative approach to crisis

The documentary "The Doctor Who Hears Voices" can now be watched at YouTube - or below in this post - as a playlist. For months I've waited to get a chance to watch this film, that shows the British therapist Rufus May's approach to helping people in crisis, documenting his work with "Ruth", a young doctor who hears voices, over a period of twelve months.

His approach of trying to help people figure out the meaning behind their "symptoms" makes Rufus May, who has experienced crisis and has been labelled "schizophrenic" himself at the age of 18, a controversial figure in a system, that regards things like hearing voices a meaningless "symptom" of a brain disease.

Some takes in this film were a bit tough to watch for me, almost "too close for comfort". And I guess, others will experience the same. Nevertheless, this is an important film, that not only can contribute to a better understanding of what crisis really is about, but also takes on the discriminating dimension inherent in a concept that views crisis, "mental illness" as a chronic brain disease, meaningless and incurable, requiring life-long medication, and being a valid excuse for not giving the "mentally ill" person any chance to seek a higher education and/or be employed in a responsible position. Without doubt, it was a wise decision to let the true Ruth remain anonymous. I have seen comments on this film, that say, Rufus May is irresponsible as a therapist, and that Ruth should be reported to the NHS, being a danger to her patients, the "mentally ill" person she is.

In my opinion, we need a lot more Rufus Mays. And, apart from those who are directly affected by crisis themselves, and whom it may help to come to a better understanding of their experience, everyone who works in the mental health system should watch this film. Here it is:


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See also:

Update to this post

My review at IMDb

Indlæg om filmen på dansk/Review in Danish

Monday, 17 November 2008

Ray Sandford - Alert #3

MindFreedom International - 16 November 2008
Ray Human Rights Alert #3: Please Forward

Now see a photo of Ray here:
http://www.mindfreedom.org/shield/ray

   Media ought to ask, "What is Minnesota Governor Pawlenty's
position on Involuntary Outpatient Electroshock (IOE)?"

   Ray gets a one week reprieve.

First the good news.

Within days of MindFreedom launching its campaign on 7 November 2008
to stop the weekly involuntary outpatient electroshock of Ray
Sandford, his doctor has decided to "skip a Wednesday."

Ray says that this coming Wednesday, 19 November 2008, for the first
time in months, Ray will not be escorted against his will, under
court order, from his Minnesota home out in the community to his 34th
involuntary outpatient electroshock.

So there's a reprieve for Ray.

For one week.

The bad news is that Ray's doctor said Ray's forced outpatient
electroshocks will resume on Wednesday, 26 November 2008, the day
before the USA holiday of Thanksgiving.

Ray said his involuntary shock will then continue every other week.

We don't know if the one-week reprieve is because of the MindFreedom
campaign, but we know MindFreedom News readers are having an impact.

Since the MindFreedom first alert went out nine days ago, on 7
November 2008:

    *** Many people from all over the world have e-mailed and phoned
the offices of the Governor of Minnesota, along with social service
agencies, media, and the hospital where Ray receives his electroshock
against his expressed wishes.

    *** For the first time, thousands of people are now aware of the
existence of IOE -- Involuntary Outpatient Electroshock.

    *** A few national and local media are now actively investigating.

    *** Several advocacy agencies and human rights organizations are
expressing concern and getting involved.

    *** Several volunteer attorneys are now in touch to provide
assistance.

    *** Volunteers are visiting Ray and sending him their support,
and Ray tells us he is grateful. One volunteer took the photo of Ray
shown on the web version of this alert:

http://www.mindfreedom.org/shield/ray

    *** MindFreedom's "Zapback" e-mail list is coordinating the
campaign.

    *** A disability professor and her class of students have called
up Ray and are taking on his campaign as a project.

    *** And more.

Thank you, everyone.

Keep up the pressure and the support!

   KEEP IT UP!

First, keep phoning and e-mailing, especially if you have not so far.
Show there is national and international concern!

Here are the links to the original two MindFreedom alerts, which have
information about how to e-mail and phone the Governor of Minnesota,
and how to write or visit Ray:

7 Nov: Alert #1:
http://www.mindfreedom.org/shield/ray-sandford

12 Nov: Alert #2 - Governor Phone-In Campaign:
http://www.mindfreedom.org/shield/pawlenty-electroshock

16 Nov: Alert #3 - Link to this alert with photo of Ray:
http://www.mindfreedom.org/shield/ray

   SOLVE A MYSTERY!

Second, help MindFreedom answer the main mystery.

Despite all this public interest the question remains, "What is
Governor Pawlenty's position on Minnesota laws allowing involuntary
outpatient electroshock?"

Is this Governor, who campaigns for "limited government," for such
laws or against them?

Unfortunately, the Governor's office has not responded to any of the
many e-mails or phone calls requesting his policy position. The
Governor's office is immediately forwarding citizen inquiries to a
voice mail, and then not replying to the voice mail.

We need media to ask the Governor for us. Please forward this alert
to all media, small and large, from newspapers to bloggers.

Media can direct questions to:

Brian McClung
Director of Communications for Minnesota's Governor
phone: (651) 296-0001.

Media ought to ask, "What is Governor Pawlenty's position on
Minnesota laws allowing involuntary outpatient electroshock?"

Sometimes the Governor's office is re-directing calls to the
Minnesota Department of Human Rights. At first that sounds good. But
this office says it is only focused on determining whether narrow
discrimination complaints are legally valid. A spokesperson said this
department makes no statements about policy.

This Minnesota agency said they are planning a major one-day human
rights conference and forum on 5 December. One barrier is the "forum"
costs $200.

For information on this Minn. Dept. of Human Rights, and their
"forum," click here:

http://www.mindfreedom.org/shield/ray/minnesota-human-rights-conference
or use this link:
http://tinyurl.com/mn-human-rights

You can also keep up with some of the latest developments about the
Ray Campaign on the MindFreedom blog by MindFreedom director David
Oaks, here:

http://www.mindfreedom.org/mfi-blog

Disclaimer: Because the State of Minnesota won't reply, portions of
these alerts are based on Ray's personal statements. By Ray's own
admission, he now has severe memory problems. Therefore, journalists
may want to find a second source to confirm accuracy.

Wednesday, 12 November 2008

A call to share your story

I came across the below post at the memoryartist's blog, Why can't the past just die? I think, this is an important opportunity to draw attention to the situation of users, ex-users and survivors of the mental health system, violations of human rights in the system, and the need for change.

"Share your story with the incoming Obama administration

President-Elect Obama has setup a new webpage where people can write in and share their story. Every person with a psychiatric disability has a stake in this. We need to keep our issues open and in the forefront so they don’t get lost.

Please forward this to any person with a disability or a list of people with disabilities you know and encourage them to write in. You do have to give your full contact information. This is a great opportunity for us all."

Update on " 'Coercion in the mental health system' - A Norwegian documentary"

Since I wasn't quite satisfied with it in the first place, below the edited version of my post on the Norwegian documentary with a few, but as I think interesting, additions.

Tuesday, 11 November 2008

Coercion in the mental health system - A Norwegian documentary

On October 28th 2008 the Norwegian television station NRK 1 broadcasted the documentary "Tvang i psykiatrien" (Coercion in the mental health system) in the series "Brennpunkt" (Focus). The program can be watched here (in Norwegian language).

In the program two young women, Kristina and Hege, tell about their experience with commitment and coercion in the Norwegian mental health system. The thought that immediately came to my mind after watching the program was: 'Grotesque'. While I, at the same time and once again, hardly could believe my own luck.

Kristina

Kristina S. Larsen's first experience with psychiatry occurs after she has been assaulted physically and, as a result of this, loses the child she at the time is pregnant with. She says, that what she herself felt she needed, was to be listened to, a calm and safe environment, and her feelings being acknowledged as real enough.

Around Christmas 2007 her mother notices that Kristina becomes more and more stressed, doesn't sleep well, and loses her appetite. Kristina is committed to a psychiatric hospital where she is assessed as being in need of "protection" - "protection" and "protected unit" are euphemisms for seclusion, while there officially is no such thing as seclusion in the Scandinavian mental health system - to "calm down", as her psychiatrist says.

Kristina describes the situation as extremely humiliating, especially being forcibly drugged, and not knowing when she'd be allowed to leave. She says, the only way to get a somewhat tolerable stay at the hospital was to not get angry,not criticize, not cry, not show any emotions, and to just please the staff. "These people act as if they are gods. They may define, they may judge, and no one can in any way re-examine what they say and do", she says.

After some time at the "protected unit", Kristina is moved, only to be sent back into "protection" shortly after again, because she, according to her psychiatrist, has a very "unfavourable influence" on the other patients at the unit, whom she makes refuse to take their drugs.

In March 2008, after two and a half months at the hospital, Kristina is discharged, but is now under outpatient commitment referred to the community mental health system. She asks for a female therapist, preferably with some experience in treating women who have experienced violence and the loss of a child due to spontaneous abortion. She is referred to a young male psychiatrist in training, who hasn't much understanding for her situation, and whom she often becomes angry with. In July 2008 the therapist assesses, that Kristina isn't angry with him, but "hypomanic". He contacts her psychiatrist at the hospital, and they decide that Kristina would have to go back to the hospital, since another "episode" seemed to be on its way.

Kristina's mother arranges for her to escape and hide at Store Torungen Lighthouse Station. The lighthouse keeper says, there were no problems with Kristina whatsoever during her stay. On the contrary, she was cooking, making coffee, and easily socializing with the people in the community.

Meanwhile, her psychiatrist chooses to see her escape as a "sign that her ability of decision making is rather poor. She could have come here, and proven that she was sane, and left again. But she chose not to show up. I experienced this as poor ability of decision making. And it is typical for these episodical diseases that the ability of decision making deteriorates."

Three weeks after her escape, Kristina's mother succeeds to arrange a meeting between her, Kristina and the psychiatrist. On neutral ground. Kristina, of course, refuses to go and talk to her psychiatrist at the hospital as long as the court order for her commitment is effective. "You never know what these people can imagine to do", she says, while she attentively watches the parking lot where her mother is waiting for the psychiatrist. He, nevertheless, arrives alone, and after a one and a half hour long meeting at a nearby hotel, he agrees to lift the commitment order for Kristina if she is willing to stay in touch with the community mental health system and see a therapist.

Hege

The other woman in the documentary is Hege J. Orefellen. In summer 2003 Hege has been in contact with Folloklinikken, a community mental health facility under Aker University Hospital, for a shorter period because of emotional problems. - Interestingly, at the top of the website the terms "openness", "community", "respect", and "involvement" appear in turns. Well, just a - somewhat funny - observation. - Hege, whose baby daughter suffers from a rare condition, and is very dependent on Hege breast feeding her, is not minded to take psychiatric drugs, and wants to end her regular talk sessions at Folloklinikken.

The 3rd of July 2003, while Hege is preparing to go to university to discuss her thesis with her supervisor, she receives a phone call from Folloklinikken and is told, that if she doesn't show up at the clinic within an hour, they'll send the police to come and pick her up. After consulting her GP about the matter, Hege, who feels clearly threatened by the phone call, and says, just as Kristina, that no one knows what these people might imagine to do, decides to go "voluntarily" to the clinic, still convinced, that she'll be able to leave as soon as she has made sure, that she isn't in any need of "treatment". What she doesn't know is that the psychiatrist at Folloklinikken assesses her to suffer from "major depression" and to be "a danger to herself", "acutely suicidal".

Hege says about the conversation: "I realize then, that my words don't count anymore. No matter what I may say, it is of no importance." She is denied permission to call her partner or her GP, and is referred to Blakstad hospital, where another psychiatrist is to assess her within 24 hours, and confirm that she is acutely suicidal in order to keep the commitment order effective. At Blakstad hospital Hege, who according to the psychiatrist at Folloklinikken is acutly suicidal, is asked to wait in a kind of workroom, with scissors, glue, paint, and lots of other stuff that easily could be (ab-)used to commit suicide...

At night, Hege writes a complaint to the control commission at Blakstad hospital: "I write this complaint, hoping that someone might see what a commitment can do to an individual. My story is long, but the way here to Blakstad is terrifyingly short. I admit, that I was in need of help and support, but instead I got a traumatizing commitment."

The next day, the psychiatrist at Blakstad assesses Hege as not suicidal, and she is discharged. Since she hadn't been under commitment for more than 24 hours, her stay at the hospital is registered as "voluntary".

Hege decides to sue Aker hospital for violation of human rights, illegal loss of liberty, and violation of family and private life, in regard to the threatening information she was given in the initial phone call from Folloklinikken, and wins in court.

The commitment procedure has left Hege with a deep feeling of insecurity towards both the health system, telephone calls, and the police, and a couple of months after she is discharged from Blakstad, while passing by a police station on her way to her GP, there's a turn-out that provokes an anxiety-attack in Hege. Her GP gives her a couple of valiums and a prescription for more. Hege isn't quite happy to take the valiums, as she isn't happy to take psychotropic drugs at all, since she has experienced adverse drug reactions before, but agrees to take them anyway. The valium causes an adverse reaction. Hege doesn't recall anything from the time period after she left her GP's office until next day, when she recovers her senses at Moss hospital. She learns, that she has been to a pharmacy and bought the prescribed valium, which she then took altogether.

Moss hospital has Hege assessed by a psychologist while she still is under the influence of the valium - she doesn't recall the conversation with the psychologist either - and the psychologist evaluates that she should be sent to Blakstad psychiatric hospital. At Blakstad hospital, Hege is asked to give up her cell phone which she denies as it is her "last lifeline to the outside world", as she says. The alarm goes, and Hege is violently thrown to the ground by four staff members, her arm twisted around onto her back, and the phone pulled out of her hand, with her fingers getting sprained. The whole incident only takes a few seconds, and Hege says, she didn't even get what was happening to her, and only felt extremely trampled on.

"The first three days at Blakstad were a downward spiral for me, psychologically seen", Hege says. "I can't stand further commitments, I can't stand further assaults. I won't be able to cope if they do implement involuntary drugging, I won't be able to cope if they do implement electroshock, I won't be able to cope with further interventions against me now. I reached a point where ending my life was the only solution. But it wasn't a solution anyway, because I could never have done that to my child."

Also this time, Hege complains to the control commission. At a meeting with the commission on the sixth day of her hospital stay, the commission evaluates her as neither depressed nor suicidal at all, and she is discharged.

Hege, who holds a doctorate in chemistry, went to law school after her experiences with human rights violations in the mental health system, and specialized in human and patient rights. She is active in the user/ex-user/survivor movement, and a member of MindFreedom International.

Accidentally, I came across Sørlandet hospital's reaction to a statement by Hege from 2005, quoted in a Norwegian newspaper, that says that one of the main reasons for people to commit suicide are the mental health system's "own suicide-triggering mechanisms". A statement, clearly based on her own dehumanizing and humiliating experience. Of course, the staff at Sørlandet hospital "believe[s] that Hege Orefellen is wrong to theorize" this. I believe - also from my own (even though only hypothetical) experience - she is right on. My plans in case of a possible commitment were quite clear to me.

Some thoughts about the documentary

There are several things, I found noteworthy about this documentary. First of all the striking difference between Kristina's experience of herself, her situation, and her needs, on the one hand, and the "expert's" perception of her and her needs on the other. While Kristina says, that what she felt she needed most was someone to ask her what had happened to her, that made her react the way she did, and while she, additionally, expresses that she didn't feel any whatsoever need for "protection" (isolation), or to be "medicated" into a consciousness erasing, mental fog, the "expert" states, that he couldn't "expose" Kristina to the "strain" a dialoge with her at the time of acute crisis in his opinion would have been. "Kristina was asking for dialogue. That's right. But during the acute phase, I don't work with dialogue but with treatment to stabilize", the "expert" says. "And when an individual is stable, then the intention is, that dialogue, accordingly to what Kristina is asking for, treatment of her psychological traumas, becomes relevant. Because this in itself, being treated for psychological traumas, is a strain. I can't put strain on someone in an acute phase."

I wonder how it is, that this "expert" doesn't seem to realize how much more straining it can be for an individual in acute crisis to be denied his/her most vital need, the need to come to an understanding of him-/herself through dialogue, to be met, than a dialogue in itself ever could be. And I wonder, if we also here have projection being at work, to be understood in the way that a dialogue with Kristina first of all would have been straining for the "expert", and not for Kristina.

As far as I myself am concerned, the need for dialogue, for being listened to, became overwhelming at periods of crisis. And that I certainly not am an isolated case, this experience can serve as a good example for. In principle, I guess, everyone has at some point in their lives had the opportunity to observe that the more overwhelming an experience is, the greater the need to come to terms with it - through expressing one's feelings about it in words, terms, through a dialogue with another human being - becomes.

It sometimes seems to me like there's a short circuit happening in the thinking of people, especially in that of the "experts": On the one hand it is acknowledged, that people who've had an overwhelming experience need to talk it through, and crisis intervention is offered. But as soon as the overwhelming experience, on the other hand, isn't immediately understandable for one's surroundings, the reaction to it is defined as "sick", the reacting individual as having a brain disease and thus in need of medical "treatment": "protection" (isolation) and the administration of chemical substances, that blunt consciousness, and render clear thought and speech a city in China. Instead of being recognized as in need of a dialogue. If at all, a dialogue is only offered after the individual has been "treated" enough, to make an open dialogue with the potential for coming to terms more or less impossible. Backwards world.

Thus, of course, the "expert" in the program also questions Kristina's ability of decision making. By definition, an individual's ability of decision making is put out of the running - by an alleged brain disease - if the individual is in crisis, and the cause of the crisis isn't immediately recognizable for the individual's surroundings - so that the cause can't but must be the alleged brain disease. Very simple.

Unfortunately - for the "experts" - the outcome of Kristina's story shows, that her ability of decision making obviously, and in stark contrast to the "expert's" allegations, was at its peak. Intuitively, she did what was best for her in her situation. While she mentions, that her immediate reaction to hospitalization and "treatment" - as being the opposite of what she herself felt, she was in need of - was anger.

Kristina's story clearly shows, what people in crisis really need, instead of "treatment": self-determination, personal freedom, and security - for, even if she is on the run for three weeks, this situation feels more secure to her than a commitment, with the inextricably linked to it loss of personal freedom and self-determination, ever could have felt. Security does not equal to be exposed to others' "care", for better or for worse. Security equals to being respected unconditionally.

The worst that can happen to an individual who has had an overwhelming experience, is feeling an additional loss of control over the situation. For instance by being controlled by others, by being told what to do and what not to do, by being "protected" (isolated), by being "medicated" with substances, that make the individual concerned lose control over their own thinking, intuition and body sensation, by being told by others what and how to think, and feel, and how to define oneself, etc. Such interventions in an individual's privacy will already under "normal" circumstances be perceived as a violation of one's limits. It becomes unbearable, if an individual beforehand is in a very vulnerable state because of an acute crisis. Nevertheless, the only logic reactions to the intrusions - in the shape of fear and anger - are regarded a worsening of the "symptoms", of the "illness", thus needing further "treatment", i.e. further intrusions. A vicious circle, or spiral, that unfortunately all too often ends with the individual in crisis going down, breaking. Mentally - or physically.

Quite interesting I also find the system's definition of "voluntary", in the program illustrated by Hege's story. "If you don't show up within an hour, you'll be picked up by the police", and the defence lawyer underlines how much effort is put into making people to show up voluntarily, although they also need to be informed about what will happen, if they - completely voluntarily - decide not to show up. A somewhat strange definition of "voluntary" the system makes use of. Kafka* comes to my mind. Just as I think 'Kafka', as I hear Hege tell about her conversation with the psychiatrist at Folloklinikken: "I realize then, that my words don't count anymore. No matter what I may say, it is of no importance."

I wonder, when the system eventually will start to respect and treat its clientele as human beings. And if the system ever will be capable at all of the humility, this would require. That the outlook, so far, is rather sinister, also this documentary again shows.

Which distinguishes this program from most other programs on the matter I've seen, is that not only Hege but also Kristina is given the opportunity to present herself as a fully accountable human being, fully aware her own situation and absolutely capable of making reasonable decisions about it, that she is given the opportunity to speak for herself, while, even though the "expert" involved in her case also is given the opportunity to tell his view of the situation, there is no attempt made to devalue Kristina's self-presentation as being that of a "mentally ill" person, and thus not trustworthy. On the contrary, the program actually proves the in the psychiatric establishment widespread idea that "patients" with "serious mental illnesses" have poor insight and thus are incapable of decision making, that is explicitly stated by Kristina's psychiatrist in the program, wrong.

Kristina chooses not to name her diagnosis directly in the program. But that it isn't in the category of some sort of "anxiety disorder" or the like, stands pretty clear. Her mother tells that the therapist saw Kristina's anger toward him to be "hypomania", so, figure it out. While, if at all I had to label anything in regard to Kristina, in regard to my own experience, and/or in regard to everything else, that gets labelled as "mental illness", I'd say there is only one "mental illness": PTSD.

No matter how critical of psychiatric practices otherwise, all Danish programs dealing with the matter of psychiatric "treatment", choose to only interview individuals who, in contrast to Kristina, display "insight" and furthermore, and also in stark contrast to Kristina, are compliant with psychiatric "treatment", i.e. drugs. The Danish media still has it coming to them to give people labelled with "serious mental illnesses" who are not "insightful" and "treatment compliant" a fair chance to speak out.

Until today, this group of "patients" is only reported about. Preferably in context with incidents that are meant to prove the insanity and lack of accountability of the individuals in question on the one hand, and to emphasize the alleged necessity of getting these individuals into psychiatric "treatment" as fast and extensively as possible to prevent further damage and deterioration, on the other. Proving psychiatric "treatment" - i.e. drugging and electroshock - to be both life-saving "treatment" measures, and the only reasonable, "evidence-based", "treatment" options for "severe mental illness", and thus being completely in line with the mainstream doctrine.

Individuals labelled with "severe mental illness" who successfully chose to do without the "help" of the system, have not yet been given a chance to present themselves and their reasons to do without the system's "help" in the Danish media. Hat off to the Norwegian NRK 1 for having the courage to do this groundbreaking documentary!

You can read more about the documentary, Kristina and Hege at MindFreedom's website.
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* or Orwell

Saturday, 8 November 2008

Stop the torture!

Go here for full information, and to see what you can do to help end the forced electroshock-"treatment" of Ray Sandford from Minnesota. Take action now, and help end this torture!

"...it is of vital importance that ECT be administered only with the free and informed consent of the person concerned, including on the basis of information on the secondary effects and related risks such as heart complications, confusion, loss of memory and even death." -from the "Report of the Special Rapporteur of the Human Rights Council on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak"