Beyond redemption? - Critique of an article by Peter Stastny on treatment for first "psychotic episodes".

Via Gianna's blog, Beyond Meds, I just came across an interesting article by Peter Stastny on MIWatch.org. Although I widely agree to Peter Stastny's observations, two things bother me about his article. One of them is the misconception I see also Peter Stastny obviously holds, that Scandinavia must be paradise when it comes to services offered by the mh system. This is not so! I left the following comment at the post:

Peter Stastny here makes it sound like living in Scandinavia almost is a guarantee for more humane and recovery-oriented care to be provided when a person goes through a "psychotic" crisis. Nothing could be more wrong. "Need adapted treatment", also called the "Vestlapland's model", is, as the name suggests, restricted to a region in Finland, namely Vestlapland. There have been other recovery-oriented treatment approaches that were inspired by the Vestlapland's model, respectively by Soteria and similar projects. For instance the Swedish Parachute Project. All of them have been geographically restricted to more or less minor areas, and many of them are not employed anymore today.

It is true, that community care widely has replaced especially long-term hospitalizations. However, a closer look at how this community care does - NOT - work, shows that it is in fact nothing but what you might call "hospitalization in the community", or, more precisely, on the margins of community. Today, the biological model and thus the almost exclusive reliance on psychotropic drugs as "treatment" dominates psychiatric "care" in Denmark and Norway entirely. In hospital as well as in the community. People aren't warehoused behind the brick walls of a locked ward. They are chemically restrained warehoused in halfway houses respectively in an assisted living facility - more often than not of poor quality; there have been numerous scandals about gross overmedication as well as intolerably filthy and run-down environments here in Denmark over the past years - or, if they're lucky, in their own apartment and at the nearest drop-in center.

About 90 per cent of those who enter the system and receive a "psychosis" or "schizophrenia" label end up as revolving door patients, and on disability.

De-institutionalization has widely failed in Denmark, because it was (mis-)used in order to save the state money, not in order to provide more recovery-oriented services to people in crisis. In the meantime, the overall failure of community mental health care has Danish politicians ask for the re-establishment of hospital beds on locked and secured wards, for the implementation of AOT-laws, as well as for several other initiatives, such as the re-establishment of seclusion rooms, that inevitably will bomb mental health services in this country back to the good old asylum-days. It doesn't occur to anyone that the problem may not be the form - community instead of hospitalization - but the contents - recovery-oriented services instead of drugs, drugs, and even more drugs.

The situation in Norway, Sweden, and as far as I am informed also in Iceland is that AOT-laws already do exist, and are excessively used, and that at least the mh system in Norway has hospitalization facilities at its disposal so as to be able to incarcerate a vast number of people long-term. Norway also is the European country with most incidents of involuntary hospitalization and "treatment", as far as I know, Denmark holds a sad third or fourth position on this list.

By and large, also the psychiatric establishment in Scandinavia has been successful defending a purely biological, and in addition widely on coercion based, "treatment" model, and preventing alternatives from as much as being publicly discussed, or even becoming known to a broader public. IMHO, our system is anything but a model system. And it looks like it will be even less so in the future.
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The other disagreement I have concerning Peter Stastny's article is that also he, as most professionals, seems to believe that when people first had their second, third, or umpteenth "psychotic break" they're beyond redemption. Why his article entirely focusses on alternative treatment options for first "psychotic episodes". I can't tell you exactly how many times I had a "psychotic break" before I eventually received the guidance that made it possible for me to, I dare say once and for all, resolve crisis, but this last of my crises certainly wasn't my first one.

I have no doubt that crisis is "addictive", and habit-forming. The longer and more often someone employs a certain pattern of behavior, certain coping strategies, the more ingrained, probably also neurologically, it becomes. On the other hand, my compared to a teen or twenty-tear-old relatively more extensive life experience also was a huge advantage to me throughout the process of working things out. I'd say, all in all, my chances to recover were maybe different in kind but no smaller than any "first psychotic break" individual's.

No one should ever be regarded "beyond redemption". Recovery is possible and should be aimed at, no matter how many "psychotic breaks" someone has experienced. The services Peter Stastny, and others, are so eager to make available to people who experience their first crisis ought to be available to everyone, disregarded whether they're going through their first, second, or umpteenth crisis.

"Look, even the mentally ill themselves do believe in it!"

This is something, I think I'll never quite get:

Once more, I got into a, luckily very short, but nevertheless, discussion with a person, who identifies as, well, yeah, a consumer, suffering from "manic depression", and, of course, the pills were no less than godsend.

The discussion: Danish psychiatry has made a film, Åbenhed gør stærk - om skizofreni i familien (Strength through openness - about schizophrenia in the family) technically, formally, obviously very much like Daniel Mackler's Take These Broken Wings - cross cutting between sequences of interviews with respectively two young people, Helle and Emil, labelled with "schizophrenia", their relatives, some friends, and, of course, professionals, especially one consultant psychiatrist from the OPUS-project. In regard to the "message" on the other hand, the Danish film, not surprisingly, tells the opposite of what Daniel Mackler's film tells. "Schizophrenia" is a chronic biological brain disease, due to defective genes, that cause abnormalities in brain structure, and the best treatment option is lifelong medication with "antipsychotics".

And the family? Well, it's important to assure the relatives, that it is not their fault. It's all just defective genes. But, of course, it is also very important to involve the relatives, and psycho-educate them - about biological brain diseases, what else?! - so that they can support "treatment" compliance. And when all this is in place, voilà, what a success story! Never mind, that one of the two young people in the film is in need of assisted housing, as she can't take care of herself due to the drugs' side effects. And never mind, that both face a future on disability, and dependent on the system for the rest of their, approximately 25 years shorter than average, life.

Now, during the past couple of weeks I've noticed numerous hits on my Danish blog, search terms "film about schizophrenia", and since I imagine, that it is the above described botched job people are looking for, and not necessarily Daniel Mackler's or Leo Regan's film, I combed the net for reviews, and wrote my own "not-quite-a-review", always just looking to meet the public's needs and desires... Not-quite-a-review, because I haven't seen the film myself, and I don't intend to, since I won't pay as much as one cent for crap like that. I actually won't give as much as one cent for whatever it might be that supports biopsychiatry. Not if I can help it.

And, yeah, right, I do a hatchet job on the film, slamming its message totally as being oppressive, discriminating, and disempowering, calling the "expert's factual information" for a bunch of lies with no scientific evidence to support it, and the filmmakers for fraudulent when they choose to interview a couple of colonized consumers and their just as colonized relatives, only and solely to, as I see it, give the impression that psychiatry's hopeless message is the one and only truth: "Look, even the mentally ill themselves do believe in it!"

The thing is, that even though the film tries to make the viewer believe, that Helle's and Emil's words are their very own words, they are not. They are the system's words. - Actually, this borders to abuse of these two young people. Colonialism controls, displaces or exterminates the original. In order to exploit. Psychiatric colonialism controls, displaces or exterminates its victims' thoughts, emotions and language in order to exploit its victims' capability to talk, making them repeat its own ideology like a parrot. That. is. abuse.

Well, the pain in the neck I am, I let both the filmmakers, the "expert", and the three people, whose hurrays I've based my own review on, know about it. One of them reacts, so far. The "manic depressive" consumer, I mentioned above. She doesn't react commenting on my blog, but by e-mail. Somewhat resentful at the fact, that not all people agree with her on psychiatry and its pills being a godsend, and that some people dare to question that having insight and being "treatment" compliant would be the road to recovery, as she wants to have it in her review of the film.

Now I wonder: what's in for someone like her, that she defends an industry, that ruins people's lives in droves, just to make a profit? I mean, she doesn't make a profit by doing so, as far as I can see. Apart from the purely idealistic profit of a false ego-identification, that is: "I'm manic depressive! I suffer from a real disease!" Does that rotten ego-identification really mean so much more than the lives of millions of people?? I just can't but keep on wondering...

Gaderummet - determined to continue

For quite a while I've intended to write an update on Gaderummet. I had to delay it, time and again. After weeks of waiting, the painters eventually, and rather unexpectedly..., showed up to paint my flat. Great! Finally my dim den - undressed pinewood everywhere: walls, ceiling, floor, and I'm still a quite heavy smoker... - would get lightened up somewhat. And, indeed, it got! But, of course, that meant a two-week stay at one of the guest rooms, that luckily are available here at the farm, right next to my flat. It meant the challenge of having to stay a three-steps walk away from the surroundings I'm used to stay in. I'm not good at that. Especially if I have to sleep in surroundings, I'm not used to sleep in.

Well, and then, actually during my stay at the guest room exile, I had this absolutely breathtaking experience - how to put it? - not just a step in the right direction, more like a leap, a breakthrough, something, that seized all my attention - and still seizes a great deal of it.

Nevertheless, here a quick update on Gaderummet's situation:

Gaderummet's right to use the localities Rådmandsgade 60 at Copenhagen came on last month, and June, 20th the court's ruling was announced: Gaderummet will have to leave the localities, that are transferred to two community mental health organizations, working closely together with several psychiatric institutions. Sad, but not unsuspected: no one has ever won a case against the local authorities at Copenhagen in the latter's entire history. This would have been the first time.

"Is it really possible, that an important part of all initiatives for homeless people at Copenhagen is thrown away in such a way? That from the mainstream and from what there is plenty available of diverting initiatives aren't wanted? That there is no room for initiatives that choose a different approach?" asks Preben Brandt, psychiatrist and spokesman of Gaderummet's board, in an article in the Danish socialist newspaper Arbejderen.

That this is very possible, the example of Soteria has shown, way back in the 70ies. That was the U.S., yes, and Gaderummet is Denmark. But psychiatry, and the politics of discrimination it serves, are international evils.

Gaderummet hasn't yet decided whether to appeal the decision, or not. Meanwhile they're looking for other localities to continue at least their counselling activities at, but hopefully also to be able to offer a place to stay for the homeless among the users at.

Update, July 4th, 10 am: Gaderummet decided to appeal the removal order.