National Public Radio

Talk of the Nation

 
April 24, 2007
 
Balancing Public Safety, Forced Mental Treatment

Guests:

• Rae Belle Gambs, son was diagnosed with schizophrenia in 1998
• Dr. Paramjit Joshi, chief of psychiatry at Children’s National Medical Center in Washington (photo: upper right)
  
• David Oaks, director of MindFreedom International, a non-profit advocacy group (photo: lower right) 

 
REBECCA ROBERTS, host:
 
This is TALK OF THE NATION. I’m Rebecca Roberts in Washington.

As we all try to make sense of the shootings at Virginia Tech, a lot of attention has been concentrated on the shooter, Seung-hui Cho, and whether anyone could have predicted his murderous rampage.
 
One episode of this show last week focused on how well we can predict violence, and as part of that show, we touched on the issue of whether the mentally ill can be forced into treatment. We got a lot of mail about that topic.

 … [Host Rebecca Roberts interviews proponents of forced psychiatric drugging for more than 15 minutes.]
 
ROBERTS: Well, let’s actually hear from a third man, a different perspective by David Oaks. He’s Director of MindFreedom International, a non-profit advocacy group that opposes forced treatment. He’s with us from the studios of Don Ross Productions in Eugene, Oregon. David Oaks, welcome.
 
Mr. DAVID OAKS (Director, MindFreedom International): Thanks for having this dialogue.
 
ROBERTS: And you were forced into treatment yourself back in the ‘70s when you were a college student. Can you tell us your story?
 
Mr. OAKS: I was a working-class kid from the South Side of Chicago and I got scholarships to go to Harvard. And while I was there in my sophomore, junior and senior year I was locked up five times in psychiatric facilities. This was in the 1970s, when I was between the ages of 19 and 21. And what happened was, I entered into extreme and overwhelming mental and emotional problems that were labeled as schizophrenic and bipolar, in other words, psychotic. Things like thinking the CIA was after me, that a neighbor was with the CIA, the TV was talking to me personally, the radio was the voice of God, and all kinds of classic experiences like that during these times.
 
So Harvard referred me to McLean, which is voted one of the best institutions. I remember the drive to McLean thinking, Now I’ll get some help, some rest, some support. And, instead, I found a very aggressive approach of forced drugging. I didn’t want to take the psychiatric drugs because I was concerned about the hazards, and they dragged me to a solitary confinement room, forcibly injected me. And I spent days in solitary confinement several times. And that’s actually where I got kind of recruited to this human rights work, because I remember in that solitary confinement cell very distinctly for several days, forcibly drugged, and I looked out that screen of that window and I said, there are better ways to help people with severe mental and emotional problems.
 
And Harvard, to its credit, in its senior year referred me to a volunteer program where I did advocacy for people. And there is a social change movement led by mental health consumers and psychiatric survivors all over the world that’s been going on since about 1970. And I just had the great privilege of working with MindFreedom that unites about 100 of those groups. But that’s how I got into this work was forcible drugging. It was devastating to me personally to experience it.
 
ROBERTS: And have you voluntarily taken medication or sought other sorts of treatment since then?
 
Mr. OAKS: Not the traditional psychiatric care. When people talk about treatment a lot, we need to dive down deeper. They mean drugs. I’m pro-choice about people’s decision to take prescribed drugs, but that’s what it’s about. The current mental health system, if your listeners take away one thing, it’s about drug, drug, drug, drug, drug, drug, drug. And again, some people, a lot of our members, choose to take it, feel they benefit from it. But I think there’s common ground here with the parents that this is the richest country in the history of the planet, their distressed family members deserve more than just drug, drug, drug, drug, drug and an occasional court order.
 
If you talk to mental health consumer groups, psychiatric survivor groups, you’ll find a whole range of alternatives. Whether or not people are on psych drugs, they want peer support programs, advocacy programs, drop-in centers, peer-run programs such as advocacy and housing programs. There’s all kinds of approaches out there that we need to be talking about. But I think the pharmaceutical industry has kind of taken over the mental health system. And again, totally respectful of our members who choose a psychiatric drug route, but that was not my route, and thank goodness, because back then I was concerned that these drugs could cause brain damage.
 
They were talking about the neuroleptic drugs. Back then it was things like Thorazine, Stelazine, Mellaril, Haldol that I was on. Now there’s Clozapine, Risperdal, Zyprexa, and drugs like that. These are the so-called antipsychotics or neuroleptics. And any discussion about forced treatment has to get into what these drugs do. I tell you, okay, with all of my heart, if thirty-some years ago I had stayed on these drugs for the rest of my life like they told me I had to, I would have dementia. And I respect folks that chose that direction, but these drugs can cause brain damage, and current medical evidence is in that long-term high-dosage use of these drugs can cause brain damage.
  …

ROBERTS: You’re listening to TALK OF THE NATION from NPR News. [A caller describes frustration about psychiatric drugs given to a relative.]
 
David Oaks, let’s get you back in here.
 
Mr. OAKS: Yes, I just like to briefly respond to the caller that there ought to be a whole range of alternatives available, and that starts with a different paradigm. The model of the current mental health system is still very authoritarian, and what we’re finding is that our members who fully recover – and yes, one can fully recover after a diagnosis of even schizophrenia – the common denominator are things like empowerment, self-determination, peer support, community connection, jobs, housing, a whole range of approaches.
 
What helped me back then, when I was diagnosed as psychotic and was locked up five times – family, friends, peer support, we had a drop-in center. I improved my nutrition and exercise. I avoided recreational drugs. And even activism and advocacy were important. Even things like – we did nature outings, this little group of ex-mental patients. I learned from them that peer support is kind of the – it’s kind of the solar power of mental health. It’s really an engine of support that can really be sustainable for folks whether or not somebody is not a psych drug.
 
So the emphasis on force drugging is what we call reductionist; it kind of reduces the whole question down to kind of a really simple bumper sticker, which is more forced drugging. And I just want to warn the nation on the TALK OF THE NATION that incredible suffering and death can be caused by that approach. I’ll just mention my diagnosis was schizophrenia. Those of us with that kind of serious diagnosis, the current study now shows our lifespan is 25 years less.
 
A lot of reasons for that, but one of them may be the super powerful drugs. And we’re finding that in the poorer countries – the World Health Organization did two studies – that the people that have best recovery, full recovery, reintegration into the community are the countries with the least psychiatric drugs and psychiatrists. The poorest countries have double the recovery rate that we do.
 
ROBERTS: David, I want to ask you a question. We have an e-mail from Anne in Jackson, Michigan, who says: “I was recently diagnosed with bipolar disorder after being treated for depression and anxiety for 11 years. I firmly support forced treatment for those with serious mental health programs. Free will and informed decisions require a certain level brain function. When the brain is not functioning properly, you can’t expect decision making to be working well.
 
“You wouldn’t ask a diabetic to somehow make his pancreas work at a higher level than possible, but that’s sometimes exactly what you’re asking someone dealing with significant mental illness. You’re asking his brain to function at a level that allows him to make informed decisions.”
 
Mr. OAKS: Two quick replies. One is, there’s no force treatment for diabetics. Why is that? There’s a lot of folks diagnosed diabetic that are eating horrible foods, doing terrible things to their bodies. They’re not being forcibly treated with diabetes medication. But also, the best doctors in diabetes, when you talk to the cutting edge doctors, they’re finding that all kinds of non- tangible things help us, even for diabetes and heart conditions. Things like our community, our culture, our connections to each other, our relationships.
 
ROBERTS: But what about the specific question of not necessarily being the best judge of the decisions about your own treatment when you are in the middle of a psychotic break?
 
Mr. OAKS: Okay, there I was, middle of the psychotic break. I thought the neuroleptics were poison for me, personally. And again, I respect other people’s decisions. I thought it felt like it was damaging my brain, that it was potentially harmful to me. I was right. The current medical evidence is that there’s a very high risk from these drugs, including frontal lobe shrinkage. Now that’s shown with CT and MRI scans. So I was right.
 
 …

ROBERTS: David Oaks, what do you think the impact will be of the Virginia Tech tragedy on your efforts to fight forced treatment?
 
Mr. OAKS: If we do nothing, if people who are diagnosed with psychiatric labels and our allies do nothing, horrible disaster. I would predict hundreds of thousands of more young people prescribed powerful drugs without adequate advocacy, information, alternatives – and again, I’m totally pro-choice about the decision to take it – but I see mass increase in forced drugging, and also just prescribing drugs to especially college kids.
 
If people speak out, if people with psychiatric diagnoses speak out, if our organizations get a voice like you’re doing here – and TALK OF THE NATION is one of the few places we’ve heard about to have the voice from the sharp end of the needle, as we say. Even though this topic is hot all over the nation, this is one of the few – you’re one of the few shows, thank you, to have this side of the story.
 
So let’s hear from mental health consumer psychiatric survivors and perhaps something could somehow be taken from this horrible tragedy that we can hear from people who’ve been there. What has helped them recover? What is it like to be forcibly treated? A lot of us actually see that as violent. I still have traumatic dreams about being forcibly drugged 30 years later. It was a form of violence.
 
 … [Dr. Paramjit Joshi has responded to comments by Mr. Oaks by saying that the psychiatric drugs and solitary confinement laws are different now.]

 
This is the second time I’ve heard the doctor – I totally respect you – that yes, my experiences were 30 years ago. But we regularly receive calls at the MindFreedom office from folks like the individual that’s under forced outpatient or in his case pressured outpatient commitment.
 
There’s a lot of people now at home under court order to take these drugs, thousands of people all over the USA, and people can turn to our Web site at mindfreedom.org to link up with others who are dealing with that coercion, but it’s happening right now, and the drugs can still cause brain damage. The newer models can still cause brain damage in long-term, high-dosage use, and again, totally, we’re totally pro-choice about people’s decision to take it.
 
ROBERTS: Let’s hear from Judi in Arlington, Massachusetts. Judi, welcome to TALK OF THE NATION.
 
JUDI (Caller): Thank you.
 
ROBERTS: You’re on the air, Judi. What’s your comment?
 
JUDI: Okay. I’m a person who was diagnosed with schizophrenia, forced to take medication, forced into a hospital, and it remains – and the doctor’s going to say, oh, that was a long time ago, so it’s different now – it remains one of the most horrible experiences in my life, and it shaped my whole life because I became an advocate, like David.
 
When I was in the hospital, I said to myself there’s got to be a better way to treat people than this. I was depressed. I was actually looking for help when I went in. I ended up getting involuntarily committed after having gone in voluntarily, and I said there’s got to be a better way. Why are we treating people like criminals whose only crime is that they’re depressed or miserable or unhappy?
 
And so I became part of an advocacy movement that started back in the 1970s, and we are actively out there not only advocating for our rights and for our – especially our right to speak for ourselves, but also developing all kinds of self-help programs, which exist all over the United States, which are funded out of, in many states, out of the mental health budgets of states to provide self-help, peer support, things that people do go through voluntarily, and a lot of people who come to our programs voluntarily won’t go near the mental health system, the established mental health system because they’ve had such bad experiences.
 
ROBERTS: Judi, thank you for your call. David Oaks, I wanted to ask you about that but also about – we heard earlier from Rae Belle Gambs, who felt that the criminal justice system was the only way she could get her son help and that that was much more intrusive and violent than had she been able to commit him through the health system.
 
Mr. OAKS: Well, two things. One is, the vast majority of us, as people have pointed out here, are non-violent. We are peaceful. I am a diagnosed psychotic. I’m one of the few people that come out of the closet and say that. That’s a label you hide, believe me.
 
It’s – we actually have a mad pride movement to encourage people to speak out on that. So number one is, the vast majority of us, like the caller – Judi Chamberlin is a famous advocate in this field whose given her life to this field, and you don’t hear about the Judi Chamberlins. You hear about the Chos.
 
But second, the fact is that when somebody does an aggressive, dangerous act – we know Cho, for instance, was stalking. We heard about other criminal acts people have done, threatening – for instance, one of your guests has been threatened by a person with a psychiatric label.
 
We’re not against the use of state force. I mean, that’s against the law, and the problem is the criminal justice system is just horrible, where people are just thrown into a cage. And we all agree, there’s common ground, that ain’t the way to go. But when the state uses force, isn’t there something more than metal prisons and chemical prisons? Can’t we be more creative with all kinds of support groups and alternatives and advocacy and jobs programs and home programs and housing programs? Let’s be more creative about it.
 
I think, you know, I think the problem is we’re stuck in this medical model, because I’m told all the time that it’s because – supposedly a chemical imbalance, and I encourage any journalist listening to just ask professionals, is there any study showing an actual chemical imbalance? There’s no study on that, so we’re kind of stuck in this one medical model. I don’t even use the term mental illness anymore.
 
Dr. JOSHI: But Mr. Oaks, if I may just respond to your comments. Don’t you think we can all work together? Because it seems to me what this tragedy has brought to the fore really is that we need to educate the public about mental illness, that there is help available, work against the whole issue of stigma so people can reach out and get treatment and get help, and your points about getting other kinds of supports and, you know, family input and the community, I think these are all wonderful ideas. But we all need to work together, and advocacy groups have an important role.
 
Mr. OAKS: I agree, but the missing voice again is often people who have been through the mental health system. They tend not to be listened to, almost – in fact, I’d say – I’d go out on a limb and say every mental health consumer group I’ve heard of opposes expanding forced drugging and commitment laws. Why is that? Because they have found other ways to help other than more forced treatment.
 
So we’re not really hearing from folks. In fact, a lot of the groups in this field get substantial amount of money from the drug industry. MindFreedom has the same position as Amnesty International. We refuse any money from the mental health system, the drug industry, governments, religions. We’re totally independent, and there ain’t that many groups like us out there.
 
ROBERTS: David Oaks is the director of MindFreedom International, a non-profit advocacy group that opposes forced treatment. He spoke with us from the studios of Don Ross Productions in Eugene, Oregon. Thanks, David Oaks.
 
Mr. OAKS: Thank you.
 
ROBERTS: You’re listening to TALK OF THE NATION from NPR News.
 
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Talk of the Nation 24 April 2007 show on Forced Psychiatry, including guest David Oaks, director of MindFreedom.