Covid 19 and Its Impact on Seattle's Homeless Population

Before the the global pandemic of Covid 19 impacted the City of Seattle our city was already in a state of emergency regarding homelessness. Seattle already has a very large homeless population compared to other major cities in the U.S. Seeing homeless tents on street corners and in parks is a common sight in Seattle. Seattle also has several large homeless tent cities where homeless individuals live in large groups.

Disasters like the Covid 19 pandemic tend to intensify problems that are already occurring in Society. This has definitely applied to homelessness in Seattle. Due to the Covid 19 Pandemic most of the organizations responsible for managing homeless individuals have shut down or have significantly reduced the services they offer.

Before they Covid 19 Pandemic housing and shelter space where already scarce. Now homeless shelters have become absolutely deadlocked. Most shelters are not accepting new clients and are actively turning away individuals who come to their door. Public housing organizations in Seattle, such as Bellwether housing for example, have significantly reduced services. Individuals who were eligible for housing before the pandemic are likely having difficulty obtaining housing as of now.

Mental health organizations such as Navos and Sound have shut their doors. They may be seeing clients by phone appointment only. Homeless individuals who go here for services will likely have difficulty getting services at these organizations.

Most homeless individuals receive or are eligible for State welfare health insurance, known as Medicaid. The State Medicaid offices have closed their doors and clients can only do business over the phone. The Medicaid system was already overburdened before the pandemic I can't imagine what it is like now.

Places where homeless individuals would go to during the day, like parks, coffee shops and libraries are  closed. Homeless individuals have nothing to do and nowhere to go during the day. Some homeless individuals ride the same bus lines all day until it's time to return to the shelter. Many homeless individuals wander around downtown Seattle. Almost all individuals that can be seen in downtown Seattle during the day right now are either homeless people or police officers.

Although additional homeless shelters have opened, it is likely that for the time being services for the homeless will not occur or occur in a very limited way. It concerns me to think of the implications of these individuals not receiving services for a long yet undetermined period of time. I could see the pandemic potentially making the conditions of homelessness much worse and more desperate than they already are. While most citizens are riding through the pandemic doing spring cleaning and working on self improvement projects, homeless individuals may be experiencing an much worse disaster. 

I could potentially see many individuals not getting access to their psychiatric medications or heroin addicted individuals not getting access to their opioid maintenance drugs like Suboxone. Homeless individuals might be deprived of basic needs like food, housing and clothing. Also, the desperate nature of the situation may cause homeless individuals to rob and victimize one another.

Individuals who are homeless face extreme risk of Covid 19 infection. The conditions of homelessness make the transmission of viruses like Covid 19 much more likely to occur. Homeless individuals often don't have access to hygiene products that protect against the spread of infection. In most homeless shelters individuals live and sleep in very close proximity to others making social distancing to prevent disease transmission very difficult.

Eventually an individual infected with Covid 19 will come through these shelters and infect other clients and staff unknowingly. In fact this has already occurred at the homeless shelter where I work. Staff are now frantically scrambling to get themselves tested. I watched one elderly employee frantically search for place that could provide a Covid 19 test after he learned he had come in close contact with the infected client. The fear in his eyes was real.

Silver Lining

A silver lining of the Covid 19 pandemic is that all the homeless tent cities in Seattle are still very much in operation. While most homeless shelters have shut their doors tent cities are still open and accepting new clients. These encampments were once demonized in the City of Seattle and now they are picking up the slack of the overburdened shelter system. 

A Conflict Theory Perspective of Anosognosia or "Lacking Insight"

In medicine once a person is diagnosed with a psychiatric illness it is set in stone. Usually the person is considered permanently mentally ill and their illness is expected to last the rest of his or her lifetime. There are situations where a person is said to be misdiagnosed. However, these situations are rare and usually due to another more serious condition being discovered that can explain a person’s mental health symptoms, like a brain tumor.

The diagnosis of mental illness is so irrefutable that if a person were to question whether or not they actually have a mental illness the doctor will diagnosis them with an additional mental illness. This illness is known as Anosognosia also referred to in psychiatry as lacking “insight.” Anosognosia is an illness in which a patient cannot understand or recognize that he or she has a psychiatric disorder.

In reality, questioning if you really have a mental illness is understandable. There are many alternative ways of thinking about and viewing mental illness. Consider the following:

• There is little to no empirical (scientific) evidence that psychiatric disorders are really illnesses. Because of this, mental illness could be conceptualized as a social construction, something that only exists conceptually through shared consensus among individuals, like currency.
• Mental illness could be viewed as a reaction to stressful experiences or a stressful social environment which would not necessarily mean that it involves an underlying pathology or defect. Rather, it is a normal reaction to a person’s environment or circumstances.
• Mental illness is only viewed as illness in Western Society. Historically, other cultures have viewed mental illness as a religious or spiritual problem.
• Some view mental illness as part of the human experience and best understood on philosophical or existential terms.

Patients are likely to have their own view of what is causing their experiences and behavior which may contradict the view held by a psychiatrist. Because of this, inevitably, there are going to be some mental patients that disagree that they have a mental health diagnosis for one reason or another. When a mental patient rejects their diagnosis it creates a problem for psychiatrists. It undermines the validity of the mental health diagnosis they give a patient and, therefore, their work as psychiatrists.

In my opinion, diagnosing someone with Anosognosia or stating they lack “insight,” is really just a way for psychiatrists to solve this problem. It gives psychiatrists not only a convenient explanation for what causes a person to think and feel this way but also a way to eliminate it. If the person disagrees with their diagnosis the psychiatrist can just increase the medication they are on or put the person on a new treatment until the person agrees that they have a mental illness.

A Conflict Theory Perspective of Anosognosia or “Lacking Insight”

According to conflict theory in sociology, laws are created in society to support the interests of dominant groups at the expense of less powerful groups (Gottschalk, 2015). To illustrate this principle imagine a society where one class of people rules the entire society and owns all the food. Naturally, other classes in this society are hungry and want some of the food, so they start stealing it from the ruling class. The ruling class wants to keep all the food so they invent a law against stealing. In this imaginary society stealing is outlawed not because it is morally or philosophically wrong but because it maintains the interests of the ruling class.

This picture provides a visual aid to show the relationship
between psychiatrists and patients. Psyhciatrists maintain
there powerful position at the top of the pyramid by diagnosing
patients  who question them with "Anosognosia."

This idea could easily be applied to psychiatry and mental illness. Mental disorders are also created and maintained due to the interests of certain groups. For example, homosexuality was once considered a mental illness. At the time when this was the case there was widespread prejudice against homosexuals and homosexual behavior. One could argue that homosexuality was considered a mental illness because viewing it as such represented the interests of individuals and groups that had prejudice against it. Homosexuality lost its official status as a mental illness in 1973 (Drescher, 2015) because attitudes about it changed.

I propose that psychiatrists have invented Anosognosia not because it is an illness but because it supports their interests, similar to the manner in which powerful groups impose laws in society. When a mental patient disagrees with a psychiatrist about their diagnosis it undermines the validity of the patient’s mental health diagnosis. Consequently, psychiatrists label this perspective an illness.

Conflict theory is based on the works of Karl Marx. Marx explained that in a capitalist society the ruling class also known as the bourgeoisie constructed social institutions in a way that supported their interests (Spitzer, 1975 p.643).Thus, everything from the education system to the legal system was tailored to promote the bourgeoisie at the expense of the proletariat or working class. The bourgeoisie could do this because they owned the means of production or the infrastructure to produce goods and services. Thus, they had the power and wealth to create social institutions in their image.

Similar in the way that the bourgeoisie own the means of production psychiatrists have the power to decide what is and is not considered mental illness. The text that contains all officially recognized mental disorders, known as the DSM or Diagnostic and Statistical Manual of Mental Disorders, is created through consensus and voting by a large prestigious group of psychiatrists (Davies, 2016). It’s likely that many psychiatric disorders and symptoms are created to promote and maintain the interests of psychiatrists.

A Final Word

In reality, there are strong philosophical arguments against viewing problematic behaviors and experiences as mental illness. However, if you explained these arguments to a psychiatrist he would probably suggest that you had a psychiatric disorder and needed mental health treatment. Diagnosing someone with Anosognosia or stating they lack “insight,” is really just an underhanded way for psychiatrists to suppress a view that contradicts their own.

What distinguishes a mental illness from a different point of view? In my opinion, separating the two is not possible. Over time in our society, problematic behaviors and experiences are increasingly medicalized, meaning they are seen as mental illness. Because of this, in the future it could be that all kinds of perspectives are considered illnesses. Imagine a world where disagreeing with the government is an illness. Unfortunately, This could become a reality.

References

Davies, J. (2016). How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Anthropology & Medicine,24(1), 32-46. doi:10.1080/13648470.2016.1226684

Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences,5(4), 565-575. doi:10.3390/bs5040565

Gottschalk, P. (2015). Social Conflict Theory and White-collar Criminals: Why Does the Ruling Class Punish their Own? Pakistan Journal of Criminology,Vol. 7, P.4-P.4. Retrieved April 27, 2018, from https://brage.bibsys.no/xmlui/bitstream/handle/11250/298089/GottschalkBystrova_2015_PJC.pdf?sequence.

Spitzer, S. (1975). Toward a Marxian Theory of Deviance. Social Problems,22(5), 643-643. doi:10.2307/799696

Gaslighting and its Relation to Social Influence, Reality and Mental Illness

Paul: - Look on the wall behind you.

Bella: The picture, it's gone again.

Paul: Yes. Where have you hidden it this time?

Bella: I didn't take it. Why should I?

Bella: It's no use to me.

Paul: Why should you take other things? Pencils, knives...

Bella: Paul, don't.

Paul: Bella, where's the picture?

Bella: I didn't take it. I swear I didn't.

…

Paul: - Why do you persist in lying to me, Bella?

Bella: - It's the truth.

Paul: If you're not lying, there's only one alternative: You're losing your wits.

This is a frame from the  1944 film, Gaslight.

The preceding dialogue was taken from the 1944 Film, Gaslight. In the film, the character Paul hides household objects from his wife Bella. Paul later accuses Bella of hiding the objects herself. Paul does this to make Bella question her own sanity. Jewels are hidden somewhere in their house. Paul makes Bella think she is crazy so he can easily search the house for the jewels.

The film is responsible for spawning the term: gaslighting. Gaslighting is a colloquial term for a manipulation tactic in which someone seeks to influence another by making them question their own sanity. Gaslighting is commonly used by abusive and/or manipulative people.

According to psychoanalyst Theodore L. Dorpat (1996), gaslighting works because it causes the target to question his or her own beliefs. Because the person is not confident in their perspective, he does not challenge the person who gaslights them P. 91-96. It's anecdotally known that someone who is gaslighted may not be crazy however gaslighting may drive a person to become insane.

Gaslighting and its Relation to Social Influence, Reality and Mental Illness

Gaslighting occurs because one individual is able to exert social influence over another. Social influence has a profound effect on the perception of reality. A famous experiment by Muzafer Sherif demonstrated this. Look at the picture below. Which of the two horizontal lines are longer?

Actually, they’re both the same length. Most say the bottom one appears longer. The fins on the right and left of the lines create a frame of reference that affects how long the two lines appear. Sherif wanted to study what he called the social frame of reference, the effect that a social situation has on perception.

In Sherif’s experiment subjects sat in a dark room and watched a light on the wall. During different intervals of time subjects were asked how much the light had moved. Sherif found that the subjects tended to agree about how much the light moved over time. At first, the subject’s answers were all different but after a while they all gave the same answer. In reality, the light never moved at all. The subjects in the experiment relied on the group for information to form an opinion about how much the light moved. Because of this, the subjects mistakenly believed the light had moved when it didn’t.

Another experiment created by social psychologist Solomon Asch showed that social influence can affect a person’s perception of reality to a remarkable degree. In the experiment a group of eight participants were asked to look at two pictures and determine which line on one picture matched the length of one of several lines on another picture. Look at the picture below. The answer seems pretty obvious, right?

Amazingly, one third of the time the subjects of the experiment selected the wrong line. The reason was seven of the eight participants were actually actors who were part of the experiment. In the experiment, the actors would intentionally pick the wrong lines. The subjects did not want to stand out in the group so they picked the same lines as the actors. The experiment showed that peer pressure can cause a person to betray their own judgment.

Both these experiments demonstrate principles that explain how gaslighting works. Social influence may affect the information a person uses to form a belief or it may pressure a person not to trust his own judgment. The act of gaslighting involves these same principles. For example, in the Film, Gaslight, Paul would isolate Bella from others thus becoming her only informational reference about what was real. Paul would also argue with Bella about what was real pressuring her not to trust her own judgment.

Gaslighting and the Social Construction of “Reality”

In reality, the U.S. Government is a social construction. It only
has power over citizens because we mutually agree it does.

Gaslighting is a means of controlling what someone believes is real. We tend to think of reality as something concrete. As sociologists Peter Berger and Thomas Luckman (1966) have explained, our concept of reality is socially constructed P. na. In a society, reality isn’t really permanent or fixed; it is constructed socially through consensus between individuals. Our concept of reality isn’t based on what is real, it is based on what people agree is real.

Sometimes the question of what is real can be extremely political. For example, in Western society, there is debate over whether or not global warming is real. Global warming is something that we do not easily see in our everyday lives making it easy to dispute.

A person or group may deny or confirm a belief, like global warming, because they will benefit from it. What people say they think and what they actually think doesn’t always align. Sometimes reality isn’t observed it’s decided.

What people believe and what they say they believe doesn't
always align. In reality, there are many reason why someone might say
they believe something. Here is a table of possible reasons.

The question of whether global warming is real has an enormous impact on how we behave as a society and as a species. In my opinion, to control what is real socially is basically a form of power. What people determine is real has enormous impact on what they think and how they behave. For example, arguing that global warming isn’t real allows large corporations to profit from exploiting natural resources and polluting the environment.

Shared reality determines the rules by which social interaction takes place. For example, at a library you know you should not talk loudly because it is part of the mutual reality you share with other people there. Shared reality or as sociologist Erving Goffman (1959) calls it, the “definition of the situation,” determines what appropriate behavior is P.3.

When someone gaslights another person they alter the mutual reality the two people share. For example, in the film, Gaslight, when Paul convinces Bella she is imagining things Paul establishes a social reality in which Bella is insane when actually she isn’t. Because of this, he can do virtually whatever he wants to Bella. If Bella complains about how Paul treats her Paul can just tell her she is imagining things. Paul is truly evil.

Gaslighted or Crazy?

The implications gaslighting has for people diagnosed with mental illness are truly frightening. In the film, Gaslight, a detective saves Bella just before Paul attempts to have her put in a mental institution indefinitely. It’s possible that there are people who aren’t as lucky. There may be people who are considered mentally ill but are actually victims of gaslighting.

How can we tell the difference between someone who is genuinely delusional and someone who is being gaslighted? The frightening reality is we can’t. Gaslighting causes a person to question his or her own sanity. Consequently, they may adopt the social role of a mentally ill person and behave and act like they are mentally ill. In effect, for all intents and purposes, they become a mentally ill person.

Conventional minds believe that the boundary between sanity and insanity is clearly demarcated. Really this isn’t true at all. Considering someone mentally ill or not is largely determined by the social context. Someone is considered mentally ill or not depending on the situation they are in. For example, if a completely normal person were admitted to a mental hospital as a patient they would probably complain about the conditions of the hospital, the food, the doctors, being forcibly injected with drugs and how they generally had no rights. However, in a mental hospital this behavior is exhibited by all the patients and is seen by the staff as a symptom of their mental illness.

Have You Been Gaslighted?

Gaslighting is a severe form of psychological abuse. Undermining a person’s sense of reality to control them is very harmful to the person. It damages the integrity of the person’s mind.

In my opinion, gaslighting likely occurs a lot more often than conventional thinking might lead one to believe. Gaslighting is usually covert and, therefore, likely often goes unreported or even unnoticed. It’s possible you or someone you know is being gaslighted on an ongoing basis right now.

It is not uncommon for someone to be gaslighted by someone close to them like a family member or significant other. Gaslighting occurs in relationships where one party is able to exert more social influence over the other. Power differentials like this occur in relationships such as between parent and child or supervisor and employee.

People with psychiatric diagnoses are particularly vulnerable to being gaslighted. A psychiatric diagnosis can be used to manipulate a person. The abuser/manipulater will cite the person’s supposed mental health issues as a way of undermining their beliefs and perspective.

Solutions to Gaslighting

In conclusion, if you have a mental illness diagnosis you may not be mentally ill but being gaslighted by other people. Don’t let yourself be a victim of gaslighting. Follow these guidelines:

Maintain healthy relationships with others. Only have relationships that are mutually satisfactory. Have healthy boundaries with people in your life and don’t let someone isolate you from other people.

Get the facts. Document everything. Take notes meticulously. You would be surprised how much taking notes can aid in situations in which “reality” is in question.

Finally, the best defense against gaslighting is independent thinking. Don’t be swayed by social influence. Practice good critical thinking skills. Take in as much information as you can, analyze it, and use it to make your own judgments. Be skeptical of everything, even this post. 

References

Berger, P., & Luckman, T. (1966). The Social Construction of Reality. Anchor Books.

Cukor, G. (1944). Gaslight. United States: Metro-Goldwyn-Mayer.

Dorpat, T. (1996). Gaslighthing, the Double Whammy, Interrogation and Other Methods of Covert Control in Psychotherapy and Analysis. Lanham: Jason Aronson, Inc.

Goffman, E. (2008). The presentation of self in everyday life. New York: Anchor Books [u.a.].

Drug Midazolam a.k.a. Versed likely Used to “Chemically Restrain” Vaneesa Hopson Resulting in Her Death (Updated 2/22/18 with New Information)

On February 8, 2018, thirty-five-year-old Vaneesa Hopson died due to first responders forcibly drugging her. Sam Costello, a police lieutenant in Olympia, Washington, told The Seattle Post Intelligencer that Hopson pulled the fire alarm at an apartment building. Once police arrived, they detained her for a mental health evaluation, believing she was under the influence of narcotics or experiencing a mental health crisis. Officers decided Hopson needed "chemical restraint." They held her down as paramedics injected her with a drug, the identity of which is not yet publicly known. She became unresponsive and later, after arriving at St. Peter Hospital, she died.

The phrase "chemical restraint" is a political dodge to disguise the horrible practice of forcibly drugging individuals to make them more compliant, easier to manage. Chemical restraint has received a lot of criticism especially its use in correctional facilities and nursing homes. In these facilities individuals are sometimes unnecessarily drugged for long periods of time by staff. The Olympia Police Department states that paramedics injected Hopson with drugs so she could be transported safely. Regardless if this is true or not, arguing that patients need chemical restraint for their own welfare is frequently used to justify forcibly drugging them unnecessarily.

Hopson’s death is currently under investigation. Because of this, Olympia Police and Thurston County Medic One will not release the name of the drug that killed Hopson. However, I spoke to Director of Medic One’s Emergency Services, Kurt Hardin. He told me that the product used to inject Hopson was manufactured by a medical supply company called Cardinal Health. Cardinal Health carries several products that could have potentially been used to inject Hopson. Recently a public records request revealed that Thurston County Medic One purchase the injectable form of the drug Midazolam from Cardinal Health several times in the past year to be used as chemical restraint. 

In the Thurston County Medic One Book of Protocols on page 35 next to the words “chemical restraint” is says “Midazolam 10mg IM or IN.” The document also lists some of the protocols for chemical restraint. It states, “If the patient continues to struggle once secured…chemical restraint is indicated.” This possibly explains what occurred on February 8^th. Hopson may have struggled when in restraints and because of this she was injected with the drug Midazolam. 

Click here to go to Cardinal Health’s website. At the bottom there is a link that says “See our Full Product Catalog.” Click that and enter the word “Midazolam” to find the product that may have been used to inject Vanessa Hopson. 

Click here for the Thurston County Medic One Book of Protocols

Midozolam, also known by the brand name Versed, is in a class of drugs known as Benzodiazepine. Benzodiazepines include drugs like Valium, Xanax and Ativan. Benzodiazepines are used to treat anxiety. They are one of a variety of drugs used for chemical restraint. 

In medicine, benzodiazepines are generally considered safe. However, doctors habitually underestimate the danger that Benzodiazepines pose. Benzodiazepines are highly addictive and extremely difficult to withdraw from. Benzodiazepine withdrawal is described as hell by some. While benzodiazepines are used to treat anxiety many have reported that anxiety returns after long term use of these drugs. This may cause a vicious circle in which the longer a person takes the drug the more they increase the dosage to treat their anxiety.

Midazolam can also cause sudden death. A person can overdose from Midazolam just like opiates, such as Morphine and heroin. If taken in high enough doses, Midozolam can cause respiratory depression, which can be deadly. The dosage for a prescription of Midozolam is usually 1mg to 2.5mg. The Thurston County Medic One Protocols list the dosage and drug for chemical restraint as “Midozolam 10mg IM or IN.” This is a very high dose of the drug. It’s possible Hopson died as a result of an injection of Midozolam. It is also possible Hopson already had drugs in her system and she died because of the combination of Midozolam and the other drugs.

Abolish Chemical Restraint

I am not an advocate of restraint by any means, but I understand that if someone is a danger to others they should be restrained. Ideally, intervention should occur before people reach the point of needing restraint. However, so called chemical restraint should be abolished.

Chemical restraint is often misused. In practice, facilities like nursing homes and jails use chemical restraint as an additional form of controlling behavior. For example, in a juvenile detention facility, a person might be forcibly drugged in addition to or instead of put in physical restraints or given solitary confinement. Chemical restraint is sometimes used to make work for staff easier, like reducing a patient’s ability to self-advocate or cause trouble. Citing a person’s supposed mental health problems in order to use chemical restraint is really just an excuse to forcibly drug them.

Also, chemical restraint is unsafe. All drugs used for chemical restraint can cause death. If Hopson hadn’t been injected with drugs it is likely she would still be alive today.

Medical Control

Something about the term “chemical restraint” is inherently disturbing. It is a veneer covering a frightening truth. Olympia police state that Hopson was injected with drugs so she could be transported safely in an ambulance. Hopson wasn’t injected with chemicals because she needed them for her physical health. She was injected with drugs as a means of controlling her behavior.

A mental health evaluation is a medical procedure. Hopson was restrained by first responders for a medical reason. Because of this, first responders could subdue her using medical means. Chemical restraint is a medical way of controlling a person’s behavior.

Medical knowledge and technology are increasingly used as social control in western society. It is part of the work, academic, and correctional environment. Today, employees at a company may be forced to seek psychiatric treatment or face termination. Children who act up in class are diagnosed with psychiatric illness and given psychotropic drugs. Juvenile delinquents who misbehave are chemically restrained in correctional facilities.

Psychiatry is a form of medical social control. It eliminates bad or "undesirable" behavior from society by diagnosing and treating people for mental illness. Mental health conditions are invented by doctors and pharmaceutical companies to include an ever widening scope of problem behaviors. These behaviors can then be controlled using medical means.

Medical social control eliminates "undesirable" behavior in frightening ways. Medicine treats illness by altering or manipulating a person’s body. When a person has cancer their body may undergo surgery or chemotherapy to eliminate the cancer. Medical social control may eliminate bad behavior the same way, by altering a person’s body. Medical control might involve administering different chemicals or performing surgery on a person who misbehaves. For example, in the 1950’s, the pre-frontal lobotomy was used widely on mental patients who exhibited aggressive behavior.

When we hear that someone was “chemically restrained,” if feels wrong. It is because we know that the sanctity of someone’s body was violated to control their behavior. This is the danger of medical social control.

Mental Health Police

Officially it was a medical decision to inject Vanessa Hopson with drugs. However, according to thesplinternews.com Hopson was held down by police when she was injected. Police were involved in the act of forcibly drugging Vaneesa Hopson.

Police restraining individuals for mental health reasons is nothing new. However, the manner in which Vaneesa Hopson died causes me to reflect on an important trend. As more problematic behavior are seen as mental illness the more that administering mental health treatment becomes part the job description for police.

Many do not realize that in the U.S. police work on behalf of the mental health system. Deciding if someone should be detained for a mental health evaluation is largely up to the discretion of a police officer. Police are usually the first to intervene when someone is in mental health crisis.  

In my opinion, there are aspects of this trend that are positive. For example, arguably, because more individuals are seen as mentally ill police receive training on how to deal with people who are in mental health crisis. This helps ensure the safety of both officers and the public. However, there is a frightening consequence of this trend. 

It’s possible that in the in the future the scope of behavior that are seen as mental illness will widen to include all problem behavior including all forms of criminality. If this transpires police will no longer be agents of the legal system; they will be agents of psychiatry. A new kind of police brutality may emerge where police forcibly subject members of the public to psychiatric treatments, like chemical restraint.

This isn’t as far-fetched as it may seem. It may desirable for the police to use medical technology as a way of controlling criminals. Police may argue that using medical technology this way makes their job safer. Also, because mental health treatment is considered a medical procedure it can be (and often is) administered to individuals in violation of their right to due process. Civil liberties, like the right to due process, will not prevent widespread use of psychiatric treatment to control criminals.

Imagine a world where if you shop lift a loaf of bread to feed your family police claim that you are in “crisis” and need to be chemically restrained. Unfortunately, this world may become a reality.

This post will be updated as more news of Vaneesa Hopson’s death develops.

How Psychiatry Can Change Who You Are

Most people do not know what goes on inside a mental hospital. They simply assume that patients are getting much needed psychiatric treatment there. It might be shocking for someone to learn what really goes on inside one of these places.

As well known and highly influential sociologist Erving Goffman (1961) has explained, in the psychiatric hospital every aspect of a patient’s life is considered a component of their psychiatric treatment. P. 149 For example, if a patient is given food, allowed to quietly read a book, or attend to his own personal hygiene these things are considered privileges that are given to the patient as part of a therapeutic program. A patient who misbehaves will have these things taken away. A patient may be reduced to very poor living conditions. A patient may be reduced to sleeping on a wooden bench, eating very little poor tasting food and having nothing to preoccupy his time. As Goffman (1961) explains in a psychiatric hospital patients are subjected to a system of punishments and rewards p. 163. Through this system nurses and doctors exert total control over the patient.

According to an anonymous interview with a former psychiatric patient (2017), the existence of this system is not explicitly communicated to the patient. In fact, according to the former patient (2017), if a patient articulates anything about this system then it might have adverse consequences. Also, the former patient (2017) goes on to say psychiatric treatment may be used as a punishment for behavior the psychiatric staff deem undesirable. For example, if a psychiatric patient has an intense argument with staff they could be forcibly injected with drugs.

Goffman (1961) explains the inpatient hospital alters the person’s self. This process of punishments and rewards is applied to the mental patient’s sense of self p. 148. Goffman (1961) goes on to explain that in the psychiatric hospital a patient’s level of privileges mirrors his current state of mental health and is considered a direct expression of his self p. 149. Meanwhile, the person’s former identity is discredited. A case record of the patient’s past behavior is constructed. Goffman (1961) explains that in the patient’s case record his past experiences are reframed as symptoms of mental illness P. 156. Also, the patient’s own story for why he is in the psychiatric hospital is discredited verbally by the hospital staff.  As Goffman (1961) states, “If the psychiatric faction is to impress upon him its views about his personal make-up, then they must be able to show in detail how their version of his past and their version of his character hold up much better than his own” P. 154.

In my opinion, this process is basically a form of brainwashing. Through psychiatric treatment, the patient is punished for retaining his former identity and rewarded for assuming a new identity. A patient is transformed from someone that believes he is an ordinary person to someone who believes that he has a mental illness. This alters the very core of his identity.

Frightening Consequences

The social environment of the mental hospital can have frightening consequences. For those that haven’t heard of Catatonic Schizophrenia, it is a psychiatric condition where someone, who has nothing medically wrong with them, becomes completely motionless and mute for a long period of time. People diagnosed with Catatonic Schizophrenia can sometimes remain mute and motionless for years. Goffman (1961) points out that the tendency for patients to become mute in mental hospitals is actually a result of the mental hospital itself. Goffman (1961) explains that becoming completely mute for long periods of time can be a kind of tactic to survive in the psychiatric hospital. As Goffman (1961) states,” For these patients withdrawn muteness was the official stand-a defense presumable against both importuning attendants and fellow patients that was grudgingly accepted as a legitimate mental symptom” P. 257.

A person  diagnosed with Catatonic Schizophrenia
 may remain motionless for years. 

In my opinion, withdrawn muteness may be a direct result of the social environment of the institution. Unlike normal life where self-expression is expected to occur freely without too much inhibition, in the mental hospital the patient’s ability to express himself is much more limited.  As Goffman (1961) explains, for the mental patient, any kind of self-expression against the institution is considered a psychotic symptom p. 307. Because of this, as Goffman (1961) explains, a kind of vicious cycle can occur where the more the patient expresses his dissatisfaction with the institution the more he is likely to suffer punishments in the form of deprivations and psychiatric treatment p.306. This process may continue until the patient has very little means of self-expression at his disposal.

The things the patient can use to distinguish himself as a person become very valuable to him. The patient may cling to hospital issued clothing or bits of trash because the patient sees these objects as representations of who he is. To outsiders this may seem irrational but to the mental patient this is a way to cope with living inside a mental institution.

In my opinion, because of this, withdrawn muteness may be a way for the patient to express his rejection of the institution. Withdrawn muteness may be a means of self-expression that the doctors and staff cannot stop the patient from engaging in. As Goffman (1961) states, “From the patient’s point of view, to decline to exchange a word with the staff or with his fellow patients may be ample evidence of rejecting the institutions view of what and who he is” p. 306. 

A Final Word

In my opinion, through examining the social environment of the psychiatric hospital, it is evident that the psychiatric staff are not really trying to understand the perspectives of the patients they treat. Instead, the psychiatric staff are engaged in a process to coerce patients into conforming to conventional social norms and values. Such a process may cause the patient to behave in an agreeable way but at a cost.  The patient is forced to change. His free will and autonomy as a person are compromised.

I do not deny that individuals at times enter psychological states where they become unreasonable, unreachable or cannot take care of themselves. I write this to point out the often destructive transforming power that the psychiatric hospital can have on the individual and to question if it is always justified when people think and act abnormally.  It seems like an approach to returning a patient to consensus reality that does not coerce the patient but instead recognize him as a thinking, feeling person who is capable of free will could be achieved.

A peer-run crisis respite is one such approach. A peer-run crisis respite is an alternative to the psychiatric hospital. It is a building, typically a house, where individuals can go and stay for two weeks and recover from a mental health crisis. A peer-run respite is not operated by psychiatrists but by individuals that know the path to recovery best, former mental health consumers. There a person who is having a crisis is free to act as they choose and is never coerced. Peer run respites exist in various locations across the country. Perhaps in the future peer-run crisis respites will be widely available to everyone. 

References

Goffman, Erving. Asylums. 1st ed. Garden City, NY: Anchor Books, 1961. Print.

Former Psychiatric Patient, Anonymous. 2017. in person.

The Treatment Advocacy Center: a Portrait of an Extreme Mental Health Interest Group

The Treatment Advocacy Center (TAC) is nonprofit mental health interest group in the U.S. People who are not familiar with the U.S. mental health system may have never heard of them. The TAC is an organization that advocates for the most extreme views of mental health care. Basically, the TAC’s stance is that people with mental illness are inherently dangerous and their civil rights as well as inability to recognize their own illness are barriers to providing them effective mental health treatment and maintaining public safety. 


In my opinion, the TAC ‘s agenda is to increase stigma for people with a mental health diagnosis in order to eliminate their rights and segregate them from society. The TAC does this by perpetuating negative mental health stereotypes in the media, advocating for mental health legislation that implements coercive mental health treatment practices and increases the number of inpatient psychiatric hospitals. In reality, people with mental illness are no more violent than the general population and mental health stigma prevents them from living successfully in the community. 

The TAC is a big advocate for a practice called Assisted Outpatient Treatment (AOT). AOT refers to mental health treatment laws and programs that require a person to take medication under court order while living in the community. If the person refuses to take medication while on an AOT order they can be committed to an inpatient psychiatric hospital. AOT is a drastic curtailment of a person’s civil rights. A person on AOT is not in control of their own body. Medication used to treat mental illness can have very serious and harmful side effects. If a person on AOT finds a particular medication intolerable or has an adverse reaction to it they have little choice but to continue taking it. The TAC advocates for AOT laws across the nation.

The TAC was founded by a man named Edwin Fuller Torrey. In the early 1970’s Torrey help build the National Alliance on Mental Illness (NAMI) to the organization it is today, the largest nonprofit mental health advocacy organization in the U.S. From 1976 to 1985 Torrey was employed at the prestigious and historic St. Elizabeth’s Hospital in Washington, D.C., (the same place inspired the creation of the transorbital lobotomy and served as an asylum before the Community Mental Health Act in 1964). Sometime during this period he developed his personal theory of the cause of schizophrenia. His theory, which he still promotes to this day, and this is not a joke, is that bacteria found in cat feces has caused schizophrenia in the U.S. on a widespread scale. In 1983, he self published his most well known work, “Surviving Schizophrenia,” which, in my opinion, is actually a very comprehensive reference book about mainstream psychiatric theories and treatments of schizophrenia. However, unfortunately, the book compares treating schizophrenia with pharmaceutical drugs to treating diabetes with insulin injections. This, at the very least, dramatically overstates the efficacy of psychiatric medications.

In 1985 Torrey quit his position at St. Elizabeth’s hospital following a demotion in 1983. In my opinion, 1985 to 1989 or so marked a turning point in Torrey’s career. After he left St. Elizabeth’s, Torrey began to focus more on how the U.S. mental health system cared for people diagnosed with severe mental illnesses, like schizophrenia. Perhaps, this was in part due to the fact that his personal theory of the cause of schizophrenia did not pan out.

Torrey often makes media appearances. He has become the mainstream media’s go to authority on mental illness and violence. Torrey has built a career by stigmatizing people with mental health conditions. So much so that even NAIMI (who is itself is funded primarily by Big Pharma) tried to publicly distance itself from TAC in 1998. In 1997 NAMI was making plans to join forces with the TAC. However, because of outcry from mental health activists who felt that the TAC’s views were too extreme, NAMI abandoned this plan.

Parents and Children

In 1989, after becoming an independent researcher, Torrey met billionaire Ted Stanley and his wife Vada. Ted Stanley had made his fortune selling collectables. His son had been diagnosed with bipolar disorder. Their son had experienced a mental health crisis just a year earlier in 1988. The Stanley’s had been frustrated with their inability to have their son treated for mental illness and expressed concern that when their son was in a inpatient psychiatric facility he was going to be released too early because he did not pose a imminent danger to others.

The Stanley’s saw their perceived inability to provide effective mental health care to their son and the lack of research into the etiology of severe mental illness as a worthy cause to donate their money to and the Stanley Medical Research Institute (SMRI) was formed in 1989. Since then, the SMRI has been one of the largest donors to research in the causes of severe mental illness becoming a virtual pillar of mainstream psychiatry. E. Fuller Torrey developed a philanthropic relationship with Ted Stanley, and in 1998 the TAC was formed by Torrey funded primarily by the SMRI.

The TAC is the most publicized, most financed organization advocating for restrictive mental health policies and practices in the U.S. Torrey has written many books about his views on mental illness. Many of the people that buy Torrey books and ascribe to his beliefs are parents of people diagnosed with severe mental illness, just like Billionaire Ted Stanley. It is not uncommon in the U.S. for parents of individuals diagnosed with severe mental illness to become very involved with their children’s mental health treatment. NAIMI hosts support groups for parents and family members of individuals diagnosed with mental illness across the nation. Some of these parents identify with Torrey’s extreme views of mental health treatment. They share Torrey’s belief that people diagnosed with severe mental illness should be coerced into receiving mental health treatment and that their child’s belief that non-medical explanations for their experiences and behavior are plausible is itself a symptom of mental illness.

Many members of the TAC themselves have family members diagnosed with mental illness. I do not assume to know anything certain about the social dynamics of the families that these individuals belong to, however, it is undeniable that the experiences of some of these individuals are troubling. Torrey himself had a sister who was diagnosed with schizophrenia named Rhoda Torrey. Sadly, Rhoda passed away in 2010. Surely, there is no question that with the aid of E. Fuller Torrey’s extensive expertise his beloved sister would have become a normal productive member of society, right? Unfortunately, despite being 25 years old in 1964, when the Community Mental Health Act was signed by John F. Kennedy, Rhoda Torrey spent the majority of her life hospitalized in psychiatric treatment facilities. The Community Mental Health Act of 1964 lead to the deinstitutionalization of vast majority of mental patients and was intended to allow people who have a mental health diagnosis to live in the community. Such was not the case for Rhoda Torrey.

Natalie Fuller, daughter of Doris Fuller the Executive Director of the TAC, was 16 when she wrote a book with her mother titled, “Promise You Won’t Freak Out: A Teenager Tells Her Mother the Truth About Boys, Booze, Body Piercing, and Other Touchy Topics (and Mom Responds).” The book details Natalie’s experiences from ages 13 to 16 using drugs and alcohol, experimenting sexually, breaking the law and her relationship with her mother. After attending college for four years, she began hearing voices. She was subsequently diagnosed with bi polar disorder in 2008. Following being diagnosed, Natalie often did not take her prescribed medications because she believed that they were not helping her. Sadly, Natalie passed away in 2015. She ended her life when she was 29 years old by stepping in front of a train in Baltimore, MD.

Although I am sure that Doris Fuller cared for her daughter a great deal, in a Washington Post article Doris Fuller stated that Natalie suffered from a, “terminal mental illness.” I would like to point out that epidemiologically speaking mental illness cannot kill you. Perhaps if Natalie had found alternative mental health therapies to help with the other forms of mental health treatment she received she would not have met the fate she did.

The TAC claims to an advocacy organization. In reality, the TAC is a thought leader of a segment of the American public who want to impose draconian mental health laws and practices on individuals who are diagnosed with mental illness. Many members of the TAC have relatives who are diagnosed with mental illness. Perhaps for these individuals their crusade to implement these laws is fueled social dynamics of their own families.

This is E. Fuller Torrey presenting Tim Murphy with an award.

In recent years, the TAC has been very involved in pushing forward a piece of federal legislation known as HR 2646, aka the Murphy Bill. The Murphy Bill will create more mental health hospitals, provided financial incentive for states to implement AOT laws, eliminate patient’s rights and defund many existing mental health treatment programs among other terrible things. Torrey is working with Tim Murphy, the congressional sponsor of the bill, to have it passed through congress.

A Final Word

Torrey was born in a time when if a person experienced a mental health crisis they would be confined in an institution and possible never get out. Now 78, he is one of the last psychiatrists born in this era. Although our society clearly could do a better job of accommodating people with mental health challenges, the days of institutionalizing mental patients in the U.S. are largely over. Torrey’s views are backward. Instead of funding institutions to house people with mental illness we should provide services to better accommodate them living in the community. We should fund services such as day centers and peer run crisis respites. We should increase funding for community mental health centers and create more jobs and affordable housing. Instead of funding crisis based services we should fund services that help people before they reach mental health crisis.

Individuals with mental illness are not only capable of being integrated into society but making important contributions to it. In the past, people diagnosed with mental illness have made significant contributions to many areas of knowledge like art and mathematics. However, if the TAC had its way people such as these would be locked away in an asylum. Torrey and the TAC have a vision of our society that is very repressive. Hopefully, in the future our society will not repeat the mistakes of the past by returning to an era where people with mental health challenges are confined in asylums and our society will remain a relatively accommodating environment for individuals that think and act differently.

Sources Used

(2015). Retrieved June 6, 2016, from www.treatmentadvocacycenter.org

STUART, H. (2003, January 1). Violence and mental illness: An overview. Retrieved June 6, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

Winerip, M. (1998, February 22). Schizophrenia's Most Zealous Foe. Retrieved June 6, 2016, from http://www.nytimes.com/1998/02/22/magazine/schizophrenia-s-most-zealous-foe.html?pagewanted=2

(1996, January 1). Retrieved June 6, 2016, from http://www.pbs.org/wgbh/americanexperience/features/transcript/lobotomist-transcript/

Mental Health Workers Bring Psychiatric Drugs To Your HOME To Assure Compliance: Stop PACT! (n.d.). Retrieved June 6, 2016, from https://web.archive.org/web/20050310192202/http://www.mindfreedom.org/mindfreedom/ioc/workers.shtml

ROBERTS, S. (2016, January 8). Ted Stanley, Whose Son’s Illness Inspired Philanthropy, Dies at 84. Retrieved June 6, 2016, from http://www.nytimes.com/2016/01/07/us/ted-stanley-medical-philanthropist-dies-at-84.html?_r=0

(n.d.). Retrieved June 6, 2016, from https://www.nami.org/

Rhoda Niven Torrey. (n.d.). Retrieved June 6, 2016, from http://www.legacy.com/obituaries/uticaod/obituary.aspx?pid=143619266

Fuller, D. (2015, April 20). My daughter, who lost her battle with mental illness, is still the bravest person I know. Retrieved June 6, 2016, from https://www.washingtonpost.com/national/health-science/the-demons-got-my-beautiful-loving-daughter/2015/04/20/cdaaa338-dfc2-11e4-a1b8-2ed88bc190d2_story.html

HR 2646, The Murphy Bill. (2015, December 11). Retrieved June 6, 2016, from https://stopmurphyslaw.wordpress.com/

Representative Tim Murphy Wins 2014 Torrey Advocacy Commendation. (2015). Retrieved June 6, 2016, from http://www.treatmentadvocacycenter.org/solution/implement-aot/get-aot-where-you-live/2756-representative-tim-murphy-wins-2014-torrey-advocacy-commendation- 

Frightening Psychiatric Technology

In this day and age we are surrounded by technology. The technology we have available inevitably affects our society and our everyday life. We carry cell phones in our pockets all the time, we stare at computer screens all day long at our employment and we use a variety of appliances in our homes. Technological advances affect our lives in unexpected ways. Sometimes advances in technology may even be employed as a means of controlling us. New psychiatric technologies are being developed in our society. These technologies have dangerous and frightening implications for how we live our lives.

Proteus digital health has developed a new device that may lead to draconian measures in the way people are administered medication. The device is known as the Helius. It is a form of smart pill technology designed to give a doctor digital information about a patient’s compliance with their medication regime. The device replaces a patient’s ordinary medication with pills that contain tiny sensors. When the patient swallows a pill the sensor transmits digital information indicating the pill was swallowed to a patch worn on the patient’s body. The patch relays this information to the patient’s doctor. This technology is already being developed for psychiatric uses. The pharmaceutical company Otsuka is currently seeking approval from the FDA to have the device used with their antipsychotic Abilify.

The Helius has frightening implications for how people are administered medication in the future. Medication monitoring technology might be appealing for uses in court ordered outpatient treatment programs to ensure patients continue to take medications. People in such programs may have to endure the effects of medication or face the threat of involuntary hospitalization. As the number of mental health diagnoses increases and more behaviors are conceptualized as illness the more people may be subjected to medication monitoring technology as a compliment to the usual

ways of eliminating crime and other undesirable behaviors in our society.

Such an approach to addressing a person’s mental health leads loss of humanity in mental health setting. Through use of this technology all that is important is that the person continues to take their medication. The person becomes something simply to be controlled through observation and medical treatment. How a patient feels when they are on medication is of little concern. The only thing that matters is that the medication produces the desired behavior.

Use of medication monitoring technology in court ordered outpatient treatment programs is a clear invasion of privacy. Medication monitoring technology monitors a person not only in their home but in their own bodily systems. Because Information that a person has stopped taking a drug may be used as evidence that the person is in need of involuntary hospitalization, such technology prevents a person from keeping this information private and making judgments and decisions based on it.

Medication monitoring technology for psychiatric uses seems like something that should be considered unconstitutional. However, because people who are considered mentally ill are regularly deprived of their civil rights, medication monitoring technology may circumvent the normal constitutional protections that ordinary citizens are afforded. Medication monitoring technology is an example the insidious and pervasive nature of medical control. Because people labeled with mental illness are seen as sick and in need of medical treatment, they are not protected in the same way as ordinary citizens against the deprivation of liberty.

Tele-psychiatry

Tele-psychiatry is the use of telecommunications technology to allow a patient and a psychiatrist to meet face to face over a computer. Instead of going to see a psychiatrist in person you use a computer to speak with the psychiatrist remotely. Tele-psychiatry is already being used in correctional facilities and rural areas.

Tele-psychiatry likely leads to the loss of the human element in psychiatric settings. How can a psychiatrist treat a person’s mind and soul when they meet over a monitor? A session with a tele-psychiatrist is prone to offer the patient little individualized attention. Furthermore, tele-psychiatrists most likely tend to offer quick easy solutions to a person’s problems. These solutions are almost certain to take the form of drug treatment. Tele-psychiatry makes psychiatry more routinized. Addressing a person’s life problems becomes a quick efficient exercise.

Tele-psychiatry also allows psychiatrists to exert their influence in a greater range of circumstances. As psychiatry becomes more pervasive so to do the negative aspects of medical control become more evident in our society and culture. For example, tele-psychiatry is ideal for the prison or correctional setting because it costs less than employing a psychiatrist on site. Forms of Medical control like psychiatry eliminate bad behavior through medical treatments. The more psychiatry becomes part of the prison environment the more inmates will be subjected to medical treatment to control their behavior. Harmful somatic treatments such as psychoactive drugs or electroshock therapy can be administered to inmates on a widespread scale. Often times the use of psychiatric treatments in the correctional setting is a means of making inmates more compliant and passive rather than promoting their mental health.

Tele-psychiatry could be considered a form of surveillance. Instead of going to see a psychiatrist in person the patient can be viewed over a monitor. The patient can be monitored in the home, academic or prison environment. During tele-psychiatric sessions the patient is controlled through observation and analysis just like other forms of surveillance. The patient is not free to act any way they chose. For example, if the patient divulges information indicating they are a harm to themselves or others, their tele-psychiatric sessions may be used as evidence that they are in need of involuntary hospitalization.

Panopticism

The panopticon is an architectural design created by Jeremy Bentham. It is a circular building comprised of cells on the circumference. On interior face of each cell is a window. In the center of the building there is a tower. In the tower one can observe every cell through their window. Blinds on the tower prevent individuals in these cells from knowing they are being observed.

The panopticon is a means of imposing power onto the individuals that comprise it in the most efficient way possible. The person cannot communicate to the people in the cells that adjoin his. Because of this, the inmates in the building cannot work together to accomplish their own aims. And since the person does not know they are being observed, they must assume that they are thereby taking on the burden of their own surveillance. The panopticon controls and individualizes the person through, routinzation, separation and observation. In the panopticon everything can be observed, analyzed and addressed accordingly. Even the lone individual that conducts surveillance in the tower can be placed under scrutiny. The panopticon replaces the need for locks or bars.  In Michael Focault’s words, “It is a fortress of certainty.” Bentham originally created it to be a prison but had theorized it could have other uses such as housing the insane, school children, factory workers, hospital patients, any situation where power was imposed on other people.

The panopticon is a tool of totalitarian control. It effectively prevents the individual from acting in anyway other than his or her intended function. In the panopticon, there is no such thing as self expression, leisure or social change. It is a place void of any kind of humanity. A person is not a human being. They are simply part of a machine of control.

Psychiatric technologies like tele-psychiatry and medication monitoring have the potential to become a true panopticon of medical control, a mechanical and inhuman way of addressing a person’s life problems. The loss of the human element is present in both tele-psychiatry and medication monitoring. These technologies control the individual through observation and analysis. These approaches to mental health are cold and routinized. They are an inhuman way of addressing human conditions.

These new psychiatric technologies sound like they are something straight out of a dystopian novel. They are the signs of our ever increasingly medicalized and technological world, a frightening world of panoptic control. A world we may not want to live in.