Book Excerpts 5.12-5.21: The Mental “Health” Industry

5.12 The Mental Health Industry and Involuntary Commitment

Most mental facilities are still fairly medieval in their approaches and therapies. Pre-frontal cortex lobotomies are still performed in mental facilities across the globe. (These involve severing connections or removing parts of the brain to produce a “desirable” behavioral response.) There is also widespread corruption in mental institutions mainly due to the monetary incentive created by pharmaceutical companies and for-profit mental health facilities to keep patients committed as long as possible. Patients have to pay thousands of dollars in many cases to stay against their will and be prescribed the latest pharmaceutical “cure-all.” (At least prison is free and it doesn’t require medication.)

Any person accused of psychosis (even without committing a crime) can be detained by police for questioning and committed to a mental health facility on an emergency application (also called a Section 8 in the US) with a doctor’s permission. Police just need “reasonable suspicion” that the person accused is a threat to himself (or herself) or others, but they define what is reasonable. Their judgment along with the doctors’ is not allowed to be questioned until a trial can be convened after ten days of hospitalization have passed. Some of those committed never get to trial. They die waiting for a trial in a cell or in a hospital.

Police can detain suspicious individuals or people accused of being terrorists or threats without rights, especially in very populated places, like trains stations, stadiums and airports. Body scanners that can see through clothes and inside people and other kinds of invasive technology are accepted as long as corporations say they put them in place to “fight terrorism.” But the actual threat of terrorism does not warrant such intrusions of privacy and freedom. As Benjamin Franklin said, “A man who would give up his liberty for the sake of a little more security deserves neither.”

Anyone can accuse anyone else of being psychotic or a threat, and the police alone have the legal ability to hold the accused for 48 to 72 hours depending on state law. Those who are formally arrested have Miranda rights, which give them the right to remain silent and not answer questions during a police interrogation, as well as the right to counsel, even if they do not have the money to afford it. (In this case, individuals are appointed public defenders.) These rights are guaranteed by fifth and sixth amendments, which protect people from self-incrimination and guarantee the right to counsel. Ignoring a person’s Miranda rights as a police officer is unconstitutional. However, individuals taken in for psychiatric evaluation do not have these rights, even though they are stripped of their freedoms, just as those held in county jail. Individuals brought in for an evaluation do not have the right to remain silent or to free counsel and if they do remain silent, doctors can use this against them in court by claiming this is symptom of a mental disorder.

Being ‘psychotic’ does not mean violent, even though the word is used that way colloquially. Psychosis is just an inability to distinguish internal from external stimuli as stated. It is far from a crime, even though it often results in detainment, interrogation, hospitalization or arrest. Psychosis is a temporary condition and those who experience it are not always a danger to themselves or others. The alleged intention of harm always needs to be proven when someone is involuntarily committed for “protective” reasons. If a crime has not been committed, there needs to be substantial evidence to show that the person will hurt himself or others if not separated from others. But what makes this determination difficult is that anyone can be said to be a threat. Anyone who can pick up a knife, gun, or a sharp object is a potential threat to others and themselves, and it is impossible to predict with complete accuracy what people might do to themselves or others.

When a person admitted involuntarily finally gets to court, if the judge agrees with the doctors (and they usually do) they can potentially hold that person indefinitely. Nothing could be more Orwellian, and it can happen to anyone. Michael A. Jones, a man accused of schizophrenia and shoplifting a jacket and was hospitalized for twenty years in America. He took his case to the Supreme Court in November 2nd of 1982 and lost. The court claimed it was constitutional to keep someone hospitalized for a period longer than the maximum prison sentence for their crime, which was a landmark decision. They argued that the time necessary for recovery is not necessarily correlated to detention time. But in many cases it has nothing to do with recovery. People are just kept longer for profit. The Supreme Court did not make a clear distinction between punishment with therapy, and they did not recognize the necessity of patient consent for effective therapy.

If the court believes the doctors and police involved made a mistake, the accused is free to go. But even in this case such an experience can be traumatic, as well as finically costly. A one-month stay in a psychiatric ward can cost tens of thousands of dollars. There are also no reparations offered for those wrongly accused (the same applies to prisoners) unless they successfully sue, which costs more money.

When a person is involuntarily committed solely because of what he or she said or wrote, this is a violation of the first amendment as well, because this amendment gives all Americans the right to free speech. If what we write can be used against us, should our thoughts be considered crimes too? The “mental health” industry is a systematic way of creating uniformity and obedience and perpetuating mainstream ideologies. It is a mechanism of control and it maintains the status quo.

There are a few wonderful, well-intentioned and effective therapists who do not just work for the money, but such therapists usually work outside of these mental institutions where they are most needed, and they are hard to find. They generally gravitate towards more progressive practices or work independently.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.13 The Rosenhan Experiment

The Rosenhan Experiment conducted in 1973 demonstrated just how easily innocent and healthy individuals can be locked away in mental hospital without any legitimate cause. In this experiment psychologist, Dr. David Rosenhan, and eight mentally healthy colleagues attempted to gain admission to psychiatric hospitals by arranging appointments and feigning auditory hallucinations. Six of Rosenhan’s eight colleagues were medical professionals. Three were psychologists; one was a psychology graduate; another was a pediatrician and the last was a psychiatrist. None of the individuals had a history of mental health issues.

During their initial evaluation, they pretended to hear voices saying things like “empty” and “hollow.” The doctors who evaluated them were not able to tell these were feigned, and they were all admitted. Rosenhan and his colleagues were transferred to a total of twelve different hospitals. After being admitted, they acted normally and reported they did not have any more hallucinations, but despite this seven of them were diagnosed with schizophrenia and one with manic depressive psychosis. They were forced to take anti-psychotics and held against their will for weeks. Some were held for 52 days. They were only released after the doctors at the hospitals believed their schizophrenia was “in remission.”

Rosenhan himself was forced to stay for two months; he later published his account of the experiment called Being Sane in Insane Places in Science magazine. In an interview with the BBC after the experiment, Rosenhan explained that the only way he could get out was to placate the psychiatrists by “admitting” he was insane and willing to change:

“I told friends, I told my family, ‘I can get out when I can get out. That’s all. I’ll be there for a couple of days and I’ll get out.’ Nobody knew I’d be there for two months … The only way out was to point out that they’re [the psychiatrists] correct. They had said I was insane, ‘I am insane; but I am getting better.’ That was an affirmation of their view of me.” – Dr. David Rosenthal.

Rosenthal’s experience is still very common. When patients in mental hospitals want to be released because they feel they do not belong there, (regardless of the circumstances) doctors can say this is symptomatic of an “illness.” The only way to show “improvement” in some cases is to agree with doctors on every issue and feign their definition of “recovery.”

While the hospital staff could not identify Rosenhan and his colleagues as healthy impostors conducting an experiment, many of the patients did. 35 out of 118 patients in the first three hospitals believed they were faking symptoms, and some of them realized they were conducting an experiment. Rosenhan realized that the psychiatric diagnosis is subjective and that mental patients are often dehumanized due to the stigma attached to mental disorders and the “mentally ill.” Many experiments have since been conducted with similar results, yet there has been very little reformation of mental hospitals in recent history.

We cannot forget mental institutions are big businesses like any other. Private psychiatric hospitals make more money the longer their patients stay and they decide when they leave. No other legal business has the ability to hold people against their will, except for private prisons, which are also large problems I have discussed. Of course, people in restaurants cannot be legally chained to the floor. Yet since punitive psychiatry only affects a minority of the population behind closed doors and many people are also skeptical about first-hand out accounts from very severely abused former and current mental inmates, these abuses continue.

I believe an “involuntary hospital” is an oxymoron. Hospitals are supposed to help people, but when psychiatric hospitals are places of punishment and patients are being dragged in kicking and screaming, this is hardly helpful. Not everyone who needs therapy will want it, but therapy always has to be consensual. The likelihood of a positive change in patients is far greater if they have the desire to change. Forced medication should also never be applied, and no one with a mental disorder should be held against their will in a “hospital” if they have not committed a crime.

People with mental disorders who commit violent crimes ought to be held for a certain period in a setting with doctors and other healthcare professionals until they see improvements, but this ought to be the only “punishing” aspect. The therapy must still be consensual and about patient needs first. Otherwise, it is not therapy. If criminal patients do not want further therapy and they have served the maximum time allowed for their crime for mentally healthy individuals, they should be released. Voluntary hospitals could also be separated from involuntary hospitals. This would make punishment and therapy into two clearly separate mechanisms. If patients get abused in hospitals as a punishment, it is highly unlikely they will ever trust the doctors or staff enough to make any progress in therapy, nor will the hospital be likely to help.

Using house arrest or community settings with doctors can be better alternatives to the punitive mental hospitals in use today. Merely grouping all mental patients together is not always constructive because they are often all dealing with different issues. Individuals suffering from similar mental health issues can certainly benefit from talking to one another. However, current hospitals take everyone, including people with all kinds of disorders and histories, and this can just create chaos. Just as criminals can band together to become better at crime, patients can reinforce each other’s negative behaviors.

Those with mental health issues can benefit from being surrounded by happy people with no significant mental health issues as well. Home-based therapy can also be very effective, (and the only legal option available for those under house arrest). Regardless of where therapy takes place, as long as it is used to pursue meaningful goals agreed upon by the doctors and the patients, it is much more likely to help patients live happy and productive lives.

5.14 Psychiatric Medications and Overmedication

Of course, the mental health industry does not just affect mental patients. It affects their families, and hundreds of millions of people who currently take one or more psychiatric medication. Many of the most popular of these medications were made just years ago and they have not been thoroughly tested. For example, Alprazolam (Xanax), the most commonly used antidepressant in 2005, 2009 and 2011[i] was made in 1969 by Upjohn, (now Pfizer). It is a powerful benzodiazepine that can be habit-forming.

Citalopram (Celexa) was the second most commonly used anti-depressant in 2011 with 37.7 million prescriptions written that year. It was made even more recently in 1989 by Lundbeck. (Their original drug label indicated that a dosage of 60 mg was necessary for some, but it was later discovered that it can cause abnormal heart rhythms at just over 40 mg per day.) Pfizer released Setraline (Zoloft) in 1991, which was the third commonly used anti-depressant in America Prozac in 2011. The fourth most commonly used was Ativan (Lorezpam), another benzodiazepine, which was introduced in 1977 by Wyeth Pharmaceuticals. Ativan has been marketed under 70 different brand names due to its widespread popularity and recreational effects. In 1998 after Mylan obtained exclusive licensing agreements on certain components of the drug, they made it 26 to 32 times more expensive.[ii] (They were subsequently sued and they settled for $147 million.) The fifth most commonly used anti-depressant in 2011 was made in 1977 by Eli Lilly Company. It took a little over a decade for the FDA to approve the drug. (I take this drug for depression among other things and have not been able to quit.)  These drug companies that make these drugs generate billions in revenue.

Eleven percent of Americans twelve years or older were prescribed one or more antidepressants from 2005-2008[iii] and US citizens are prescribed more psychiatric medications than residents of any other country. Since 1988 there has been an overall 400% increase in antidepressant use. Many of these medications are not prescribed to improve mental health, but are rather prescribed to make people act “normally” and adhere to societal norms, which pharmaceutical companies, doctors, governments, corporate leaders and other authority figures all help define to achieve their own separate agendas.

5.12 The Mental Health Industry and Involuntary Commitment

Most mental facilities are still fairly medieval in their approaches and therapies. Pre-frontal cortex lobotomies are still performed in mental facilities across the globe. (These involve severing connections or removing parts of the brain to produce a “desirable” behavioral response.) There is also widespread corruption in mental institutions mainly due to the monetary incentive created by pharmaceutical companies and for-profit mental health facilities to keep patients committed as long as possible. Patients have to pay thousands of dollars in many cases to stay against their will and be prescribed the latest pharmaceutical “cure-all.” (At least prison is free and it doesn’t require medication.)

Any person accused of psychosis (even without committing a crime) can be detained by police for questioning and committed to a mental health facility on an emergency application (also called a Section 8 in the US) with a doctor’s permission. Police just need “reasonable suspicion” that the person accused is a threat to himself (or herself) or others, but they define what is reasonable. Their judgment along with the doctors’ is not allowed to be questioned until a trial can be convened after ten days of hospitalization have passed. Some of those committed never get to trial. They die waiting for a trial in a cell or in a hospital.

Police can detain suspicious individuals or people accused of being terrorists or threats without rights, especially in very populated places, like trains stations, stadiums and airports. Body scanners that can see through clothes and inside people and other kinds of invasive technology are accepted as long as corporations say they put them in place to “fight terrorism.” But the actual threat of terrorism does not warrant such intrusions of privacy and freedom. As Benjamin Franklin said, “A man who would give up his liberty for the sake of a little more security deserves neither.”

Anyone can accuse anyone else of being psychotic or a threat, and the police alone have the legal ability to hold the accused for 48 to 72 hours depending on state law. Those who are formally arrested have Miranda rights, which give them the right to remain silent and not answer questions during a police interrogation, as well as the right to counsel, even if they do not have the money to afford it. (In this case, individuals are appointed public defenders.) These rights are guaranteed by fifth and sixth amendments, which protect people from self-incrimination and guarantee the right to counsel. Ignoring a person’s Miranda rights as a police officer is unconstitutional. However, individuals taken in for psychiatric evaluation do not have these rights, even though they are stripped of their freedoms, just as those held in county jail. Individuals brought in for an evaluation do not have the right to remain silent or to free counsel and if they do remain silent, doctors can use this against them in court by claiming this is symptom of a mental disorder.

Being ‘psychotic’ does not mean violent, even though the word is used that way colloquially. Psychosis is just an inability to distinguish internal from external stimuli as stated. It is far from a crime, even though it often results in detainment, interrogation, hospitalization or arrest. Psychosis is a temporary condition and those who experience it are not always a danger to themselves or others. The alleged intention of harm always needs to be proven when someone is involuntarily committed for “protective” reasons. If a crime has not been committed, there needs to be substantial evidence to show that the person will hurt himself or others if not separated from others. But what makes this determination difficult is that anyone can be said to be a threat. Anyone who can pick up a knife, gun, or a sharp object is a potential threat to others and themselves, and it is impossible to predict with complete accuracy what people might do to themselves or others.

When a person admitted involuntarily finally gets to court, if the judge agrees with the doctors (and they usually do) they can potentially hold that person indefinitely. Nothing could be more Orwellian, and it can happen to anyone. Michael A. Jones, a man accused of schizophrenia and shoplifting a jacket and was hospitalized for twenty years in America. He took his case to the Supreme Court in November 2nd of 1982 and lost. The court claimed it was constitutional to keep someone hospitalized for a period longer than the maximum prison sentence for their crime, which was a landmark decision. They argued that the time necessary for recovery is not necessarily correlated to detention time. But in many cases it has nothing to do with recovery. People are just kept longer for profit. The Supreme Court did not make a clear distinction between punishment with therapy, and they did not recognize the necessity of patient consent for effective therapy.

If the court believes the doctors and police involved made a mistake, the accused is free to go. But even in this case such an experience can be traumatic, as well as finically costly. A one-month stay in a psychiatric ward can cost tens of thousands of dollars. There are also no reparations offered for those wrongly accused (the same applies to prisoners) unless they successfully sue, which costs more money.

When a person is involuntarily committed solely because of what he or she said or wrote, this is a violation of the first amendment as well, because this amendment gives all Americans the right to free speech. If what we write can be used against us, should our thoughts be considered crimes too? The “mental health” industry is a systematic way of creating uniformity and obedience and perpetuating mainstream ideologies. It is a mechanism of control and it maintains the status quo.

There are a few wonderful, well-intentioned and effective therapists who do not just work for the money, but such therapists usually work outside of these mental institutions where they are most needed, and they are hard to find. They generally gravitate towards more progressive practices or work independently.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.13 The Rosenhan Experiment

The Rosenhan Experiment conducted in 1973 demonstrated just how easily innocent and healthy individuals can be locked away in mental hospital without any legitimate cause. In this experiment psychologist, Dr. David Rosenhan, and eight mentally healthy colleagues attempted to gain admission to psychiatric hospitals by arranging appointments and feigning auditory hallucinations. Six of Rosenhan’s eight colleagues were medical professionals. Three were psychologists; one was a psychology graduate; another was a pediatrician and the last was a psychiatrist. None of the individuals had a history of mental health issues.

During their initial evaluation, they pretended to hear voices saying things like “empty” and “hollow.” The doctors who evaluated them were not able to tell these were feigned, and they were all admitted. Rosenhan and his colleagues were transferred to a total of twelve different hospitals. After being admitted, they acted normally and reported they did not have any more hallucinations, but despite this seven of them were diagnosed with schizophrenia and one with manic depressive psychosis. They were forced to take anti-psychotics and held against their will for weeks. Some were held for 52 days. They were only released after the doctors at the hospitals believed their schizophrenia was “in remission.”

Rosenhan himself was forced to stay for two months; he later published his account of the experiment called Being Sane in Insane Places in Science magazine. In an interview with the BBC after the experiment, Rosenhan explained that the only way he could get out was to placate the psychiatrists by “admitting” he was insane and willing to change:

“I told friends, I told my family, ‘I can get out when I can get out. That’s all. I’ll be there for a couple of days and I’ll get out.’ Nobody knew I’d be there for two months … The only way out was to point out that they’re [the psychiatrists] correct. They had said I was insane, ‘I am insane; but I am getting better.’ That was an affirmation of their view of me.” – Dr. David Rosenthal.

Rosenthal’s experience is still very common. When patients in mental hospitals want to be released because they feel they do not belong there, (regardless of the circumstances) doctors can say this is symptomatic of an “illness.” The only way to show “improvement” in some cases is to agree with doctors on every issue and feign their definition of “recovery.”

While the hospital staff could not identify Rosenhan and his colleagues as healthy impostors conducting an experiment, many of the patients did. 35 out of 118 patients in the first three hospitals believed they were faking symptoms, and some of them realized they were conducting an experiment. Rosenhan realized that the psychiatric diagnosis is subjective and that mental patients are often dehumanized due to the stigma attached to mental disorders and the “mentally ill.” Many experiments have since been conducted with similar results, yet there has been very little reformation of mental hospitals in recent history.

We cannot forget mental institutions are big businesses like any other. Private psychiatric hospitals make more money the longer their patients stay and they decide when they leave. No other legal business has the ability to hold people against their will, except for private prisons, which are also large problems I have discussed. Of course, people in restaurants cannot be legally chained to the floor. Yet since punitive psychiatry only affects a minority of the population behind closed doors and many people are also skeptical about first-hand out accounts from very severely abused former and current mental inmates, these abuses continue.

I believe an “involuntary hospital” is an oxymoron. Hospitals are supposed to help people, but when psychiatric hospitals are places of punishment and patients are being dragged in kicking and screaming, this is hardly helpful. Not everyone who needs therapy will want it, but therapy always has to be consensual. The likelihood of a positive change in patients is far greater if they have the desire to change. Forced medication should also never be applied, and no one with a mental disorder should be held against their will in a “hospital” if they have not committed a crime.

People with mental disorders who commit violent crimes ought to be held for a certain period in a setting with doctors and other healthcare professionals until they see improvements, but this ought to be the only “punishing” aspect. The therapy must still be consensual and about patient needs first. Otherwise, it is not therapy. If criminal patients do not want further therapy and they have served the maximum time allowed for their crime for mentally healthy individuals, they should be released. Voluntary hospitals could also be separated from involuntary hospitals. This would make punishment and therapy into two clearly separate mechanisms. If patients get abused in hospitals as a punishment, it is highly unlikely they will ever trust the doctors or staff enough to make any progress in therapy, nor will the hospital be likely to help.

Using house arrest or community settings with doctors can be better alternatives to the punitive mental hospitals in use today. Merely grouping all mental patients together is not always constructive because they are often all dealing with different issues. Individuals suffering from similar mental health issues can certainly benefit from talking to one another. However, current hospitals take everyone, including people with all kinds of disorders and histories, and this can just create chaos. Just as criminals can band together to become better at crime, patients can reinforce each other’s negative behaviors.

Those with mental health issues can benefit from being surrounded by happy people with no significant mental health issues as well. Home-based therapy can also be very effective, (and the only legal option available for those under house arrest). Regardless of where therapy takes place, as long as it is used to pursue meaningful goals agreed upon by the doctors and the patients, it is much more likely to help patients live happy and productive lives.

5.14 Psychiatric Medications and Overmedication

Of course, the mental health industry does not just affect mental patients. It affects their families, and hundreds of millions of people who currently take one or more psychiatric medication. Many of the most popular of these medications were made just years ago and they have not been thoroughly tested. For example, Alprazolam (Xanax), the most commonly used antidepressant in 2005, 2009 and 2011[i] was made in 1969 by Upjohn, (now Pfizer). It is a powerful benzodiazepine that can be habit-forming.

Citalopram (Celexa) was the second most commonly used anti-depressant in 2011 with 37.7 million prescriptions written that year. It was made even more recently in 1989 by Lundbeck. (Their original drug label indicated that a dosage of 60 mg was necessary for some, but it was later discovered that it can cause abnormal heart rhythms at just over 40 mg per day.) Pfizer released Setraline (Zoloft) in 1991, which was the third commonly used anti-depressant in America Prozac in 2011. The fourth most commonly used was Ativan (Lorezpam), another benzodiazepine, which was introduced in 1977 by Wyeth Pharmaceuticals. Ativan has been marketed under 70 different brand names due to its widespread popularity and recreational effects. In 1998 after Mylan obtained exclusive licensing agreements on certain components of the drug, they made it 26 to 32 times more expensive.[ii] (They were subsequently sued and they settled for $147 million.) The fifth most commonly used anti-depressant in 2011 was made in 1977 by Eli Lilly Company. It took a little over a decade for the FDA to approve the drug. (I take this drug for depression among other things and have not been able to quit.)  These drug companies that make these drugs generate billions in revenue.

Eleven percent of Americans twelve years or older were prescribed one or more antidepressants from 2005-2008[iii] and US citizens are prescribed more psychiatric medications than residents of any other country. Since 1988 there has been an overall 400% increase in antidepressant use. Many of these medications are not prescribed to improve mental health, but are rather prescribed to make people act “normally” and adhere to societal norms, which pharmaceutical companies, doctors, governments, corporate leaders and other authority figures all help define to achieve their own separate agendas.

All of the anti-depressants mentioned are potential teratogens, which are drugs that can cause congenital disorders or birth abnormalities. Many lawsuits have been filed by mothers who were prescribed Prozac and other SSRIs while pregnant and who had children with birth defects as a result. (Most have been settled out of court or dismissed completely.) Citalopram, Setraline, and Prozac are all selective serotonin reuptake inhibitors. They inhibit the reuptake of serotonin in synapses by targeting select serotonin receptors. (However, some are more “selective” than others.) These drugs are prescribed for depression because the serotonin hypothesis of depression speculates that low serotonin causes depression. However, several studies have found that large increases in serotonin do not generally relieve depression and medically induced serotonin depletion does not always cause depression either.[iv] SSRIs like those mentioned can lead increases in suicidal ideation and suicide, especially among individuals 15 to 25-years-old, but this age group is still prescribed them. SSRIs can also cause serotonin toxicity (from overdose), death, and sexual dysfunction (like reduced libido, anorgasmia and even genital anesthesia). They can also cause serotonin discontinuation syndrome when they are discontinued abruptly.

The number of possible adverse effects of many SSRIs is larger than the number of their potential benefits, and advertisements for them today even will recognize that at times for liability reasons. However, some doctors try to convince their patients these drugs are harmless. SSRIs and benzodiazepines are seen as the “standard treatment” for depression in America and other rich countries because of large, unscrupulous pharmaceutical companies, despite their negative effects.

There are many natural remedies for depression like Saint John’s Wort (Hypericum perforatum), Rhodiola rosea, chamomile, Ashwagandha, green tea, cannabis (in moderation), many other plants and herbs, exercise (especially aerobic exercise,) setting goals, improving lifestyles, and more, which can be much more effective than psychiatric drugs. But these drug companies advertise their drugs as the sole answers. The most profitable antidepressants and drug companies are currently those that are most marketed and actual efficacy has little effect on profits. They rule the marketplace purely because they have the money to fill the airwaves with their advertisements. As long as enough people are told a medication will work, the medication will be profitable.

Some individuals taking these medications have reported improvements in their conditions, but there needs to much more testing done on the long-term effects of drugs like these before they are allowed to be prescribed. Short-term efficacy of antidepressants is often tested, but long-term efficacy needs to be tested in-depth as well. It also important to recognize that one drug is never the sole answer. If medication were free worldwide, we would see far more effective medications being used and prescribed.

Over-medication is also prevalent in mental hospitals throughout the world. Doctors do this to keep neurochemical activity in patients as consistent as possible to avoid erratic behavior, but they often create emotionless, zombie-like behavior in the process.  Such negligent overmedication can also cause legitimate mental disorders, brain damage, disease, and death. This happens regularly to perfectly healthy, innocent people who are accused of being mentally “ill.”

5.15 Rethinking Normality, “Insanity”, and Mental Wellness

 

The Diagnostic and Statistical Manual for Mental Disorders (DSM) lists over 500 mental disorders, but it does not once define mental health or explain how to achieve it. This is a serious problem for those who look to the DSM for this information. Mental health is flexible and different for everyone. But the manual is not flexible. It just provides proper names for all of the most common, unusual behaviors. It focuses far too much on sickness and not enough on health, as many therapists do.

Psychology is a young and developing field of study. Psychology literally means “study of the soul” from the Greek ψυχή or psukhē, meaning “soul” or mind and λογος or logos, meaning “study of.” It did not begin as a scientific field of study since the underlying neural processes that create consciousness were not understood at this time, but today the focus is shifting to these processes and the science that drives them.

Psychoanalysis was only founded about 100 years ago by Sigmund Freud and his ideas were not at all rooted in science. He developed many wild theories about human behavior that were based purely on his own observations like his “Oedipus Complex” theory, which speculated that during the “phallic stage” of development, children want to kill their fathers and have sex with their mothers. (He believed this largely because he assumed infants breast fed due to sexual desire, which is not the case.) Freud focused far too much on the subconscious, dreams and other processes that were not scientifically understood.

Normality is a very subjective concept. Many doctors essentially strive to remove strong emotion from their patients because they are mostly easily controlled if they are docile and emotionless. Being sad, angry, anxious or even happy can be considered abnormal or interpreted as mania or some other ridiculous condition. But these emotions are unavoidable facets of a healthy life. Being sad and angry can be healthy emotions. It all depends on the source of these emotions and how individuals react to them.

What is considered normal and sane is just what is popular, and what is popular is defined by the forces that control us. “Normal” people support their government. They refrain from questioning authority; they pursue mindless jobs in order to buy bigger houses, better cars and anything corporations tell us we need. “Normal” people are religious and they pray to their God every night. They also act like the people they see in the media and in television and aspire to be them. This conception of normality encourages sameness for the benefit of the few people who control us. But what is often not seriously considered is that the most common and popular beliefs are irrational, and this is why the radicals who go against the majority are almost always marginalized and considered insane or abnormal. But the most useful ideas are often the most initially unpopular.

Punitive psychiatry has been used by dictatorships and “democracies” alike to punish and silence political dissidents. Many therapists who work in psychiatric wards and state mental hospitals, as well as most political and corporate powers see selflessness as a mental disorder. If individuals put the interests of strangers before their own, they are often considered insane. This is why self-less political dissidents were put in labor camps and mental institutions in the Soviet Union era and during many other dictatorships.

It is impossible to know what it feels like to be someone who is deemed insane if no one asks the individual. This is what therapists should be doing. They should be learning from mental patients and not merely instructing them. Many psychiatric doctors treat their patients like animals. They try to analyze humanity and feel they are separate from it. But in order to understand anyone, we must realize the sameness in humanity. We become different, but if we are born healthy and intact, we are almost indistinguishable.

Many mental patients do need support and guidance, but most are not getting it because of the money to be made on unnecessary hospitalization. Most of money generated by mental hospitals goes to their owners and the insurance companies that bill them. Psychiatric doctors and even social workers are often incentivized to keep people longer than they need to be held and the nurses often understandably follow their directions. Owners of hospitals and insurance companies, also receive pay-outs from large pharmaceutical companies for endorsing, as well as facilitating the over-prescription of their medications. The longer patients stay, the more medication they can prescribe. They also lie about the effects of these drugs to their patients. Big pharmaceutical representatives often visit hospitals and cozy up to doctors in order to push whatever they are selling, much like illicit drug dealers, and many doctors buy them. These kinds of corrupt doctors are most prevalent in under-funded mental institutions.

Many popular positions could be considered symptomatic of greater mental disorders than the so-called “disorders” many hospitalized for. For example, many of the most powerful CEOs qualify as psychopaths on different tests for “psychopathy.” Many politicians do as well, because they answer questions like “Should some people have much, much more than others?” with “Absolutely. Why not?” It would not be surprising if most zealous pro-war and sectarian individuals also qualified as psychopaths on many tests for it. Capitalism turns life into a zero-sum equation and it is therefore psychopathic in a sense or at least misanthropic. 

Religious convictions are often fueled by self-interest as well, even though they are often disguised as philanthropy. Many claim they know their religion is best and that they are “helping” people by converting them, and many believe this. Those of us who pray also literally believe a being in the sky can hear our thoughts and grant us wishes. Most of our religions are not considered crazy because they have a great deal of history. But put in context with what we can demonstrate is true from science, our convictions are often bizarre, unrealistic, primitive, and not very relevant. We live in the present and we should learn from our ancestor’s trials and errors and try as best we can to avoid repeating their mistakes.

Many people tolerate social conventions that are imposed on us to avoid negative social or legal consequences that can come from opposing them. But many normal conventions do not exist for justifiable reasons. Abhorrent human rights abuses like slavery and rape can become normal in cultures. Questioning them is considered insane by some who believe human beings are tools and not equal beings with equal rights. Many more people thought this way in history when slavery was more common and this prolonged its use.

Normal human behavior could be measured as the average of all of human behaviors or the most common behaviors. But if all of human behavior was compiled, the most common behaviors would likely seem strange to most people. People have their own different beliefs about normality, and media outlets, governments, corporations and religions help shape them. Normal behavior is rarely measured for its positive social impact because the forces that shape normality do not do so for the greater good.

Defining normality and insanity is also difficult because popular behaviors and trends are always changing. Every action we take is technically a natural reaction because we are a part of nature. Neurological activity causes all actions, and given the right stimulus any behavior (within the confines of scientific laws) is possible. Many separate their conception of themselves from the physical processes that cause our thoughts and actions, but they ought not to because it alienates people with certain personalities and behaviors. “Insanity” becomes some ambiguous, scary “disease.” But any behavior deemed insane has a neurological cause. It can be understood and explained. Insanity could be defined as irrationality, but irrationality can be subjective as well.

Another problem with attempting to define insanity is that individuals can also act in ways deemed insane by society just to be perceived insane, but have perfectly healthy brains. Insanity can be feigned, but cancer cannot since there are blood tests that measure cancer cells and PET (positron emission tomography) scans that can show the development of cancerous tumors. There are no scans or blood tests relegated for insanity, however. Behaviors deemed insane can be triggered by a host of different stimuli, internal and external. Psychosis is measurable, but “insanity” is not. Anyone can do “insane” things.

Most often legal “sanity” in court is determined by the nature of the crimes in question and not by the mental state of the accused, which results in inappropriate verdicts. The word insanity is not used by doctors in medical contexts who deserve diplomas. Some doctorates, especially those in forensic psychology use the word, but it is simply a legal term that removes culpability. Doctors, juries and judges decide who is insane without an agreed upon, universal definition of “insanity.” These individuals have their own biases about normality and insanity and they can easily misunderstand people and their behaviors as a result. Contrasting behaviors can also be used by therapists to diagnosis patients with mental disorders and justify their institutionalization.

Albert Einstein defined insanity as “doing the same thing over and over again and expecting different results.” This is a good start, but people can do this because they are uniformed, psychotic or have physical brain damage or symptoms of obsessive compulsive disorder. None of this implies “insanity.” A more complete definition might be that insanity is repeating the same thing and expecting a different outcome while having the information to know that the outcome will be the same. In this context, insanity means extreme irrationality.

The word sane derives from the Latin word Sanus, which means “healthy.” Therefore, insanity, means unhealthy or, more specifically, it refers to poor health of the mind. But it can be difficult to define mental health. The severity of brain damage and its effect on mental health can be fairly accurately assessed. But when the mental issues individuals have are less tangible, it is much more difficult to make objective assessments of their mental health. A healthy mind could be considered a happy mind or a mind that correctly discerns what is real and what is not. But those two states are not always correlated. One could also be very happy and very disconnected from reality or be very sad without being at all psychotic or delusional. Since there is so much we have yet to learn about our world, very different interpretations of reality can also be considered equally plausible, which further confuses the issue.

Despite all of this, insanity remains a legitimate and all-encompassing legal term. The words “psychotic” and “psychosis” have replaced insanity in most medical contexts and these words are often used synonymously with schizophrenia, which just adds to the confusion about these terms.

Psychosis is derived from the Greek word I mentioned, ψυχή or “psyche” and ωσις or “osis.” Psyche means mind or soul and osis means an abnormal condition, so psychosis literally means an abnormal condition of the mind. If a person has real hallucinations, this does not mean they are necessarily incapable of acting rationally or peacefully, so it should not always remove culpability in court. This determination should be affected by a range of factors. Psychosis can range from very severe to very mild, and psychosis can be induced by a wide range of unrelated conditions and natural processes (like menstruation as stated), so it hardly always requires hospitalizations. (Fortunately, women are not being institutionalized for menstruating.)

The purpose of the brain is to collect information from external stimuli, process it coherently and produce a meaningful, appropriate response. Psychosis occurs when internal spontaneous activity (caused by one or more of the aforementioned conditions) in the primary sensory areas of the brain is misinterpreted by secondary sensory areas of the brain as information from external stimuli. When this happens the mind will sense things that do not physically exist.

Hallucinations can also be induced by drugs as stated, some of which increase spontaneous cortical activity and overwhelm real information gathered from external stimuli in the real world. Hallucinations are not always considered psychotic, however. If a person has sensory hallucinations but can recognize that they are hallucinations created by their minds and not real external stimuli, then that person would not be considered psychotic. This is sometimes not taken into account in court.

Another word is also needed to describe a condition in which a person is uncertain whether the stimuli sensed are internal or external. (“Quasi-psychotic” may be fitting.) Surely, a person could still act rationally with some uncertainty about the source of sensory activity, especially with guidance from others who could help ground the person to reality.

The label of psychosis is often used pejoratively by doctors to brand behaviors they deem unwanted, even when these behaviors are not psychotic and desired by the patient. The word psychosis was synonymous with madness or insanity up until the definition was divided to describe bipolar disorder and schizophrenia separately. But splitting the definition of psychosis to describe two different disorders was not all that sensible because it just created two different labels for sets of behaviors that doctors cannot fully explain or measure using scientific means or even discern in many cases. (The diagnoses are often mixed up.)

5.16 Questioning the Distinction between Acceptable and Unacceptable Forms of Violence

 

Mental hospitals and prisons are supposed to “prevent harm,” but hospitals, courts, cops and prisons are very selective about which potentially dangerous people they incarcerate. It is irrational to harm people, including yourself, without reason. But monetarily vested actors define what it is good reason for just cause for force and incarceration. There are plenty of violent people who harm for irrational reasons who go unpunished as a result and some of them are even considered honorable. The distinction between acceptable and unacceptable forms of violence is made primarily by what controls us and the popular beliefs they maintain. It is not a distinction made by critical thinking about morality or human rights. A select few individuals wage wars and decide which acts of violence are acceptable and which carry punishment, but everyday people fight them and bear the brunt of the damages.

Most people who commit violent acts are not psychotic. They know what they are doing. They are in control of their motor functions and they have the intent to harm. Most act out of intense anger or sadness, and there are acceptable, legal forms of violence around the world.

The desire to be violent or even kill is not a desire exclusive to “crazy” people. Most people have considered killing another person or at least being violent. The only thing that separates those who just think about it and those who actually do it is generally a difference in the severity of the experiences that led to those emotions. Pain collects. When people believe they have nothing to lose and no one cares about them, it becomes easier for them to separate themselves from humanity and inflict harm.

Millions are slaughtered by government-sanctioned wars and thousands are killed by corrupt police every year. Some people join the military just because they want to kill or control people. This does not necessarily mean these individuals have mental disorders or are psychotic, just as not all serial killers are psychotic. Many just have intense anger. But soldiers are not put in mental hospitals or prisons like serial killers are, even though what they do is often no different. It is merely perceived differently because some soldiers have good intentions and they buy into the big lie of the necessity of war. Soldiers are often considered heroes, whereas those who kill without government approval, no matter what the rationale for their actions, are often looked down upon as our villains.

Even a soldier who kills hundreds in a war fought for oil, revenge, or petty ideological differences is often still considered a hero. As the famous filmmaker Charlie Chaplin said, “Wars, conflict, it’s all business. One murder makes a villain. Millions a hero. Numbers sanctify.”Governments can commit mass murder for revenge or money and enjoy complete immunity. But we cannot allow this. Governments cannot be given the right to decide who lives and dies or to decide which murders are moral or to even use force of any kind without there being a clear threat and no other alternative. It is contradictory for governments to reward soldiers while punishing some individuals who may have had more sound and pressing reasons to take aggressive actions.

This black-and-white moral distinction that exists between government-approved violence and violence without government approval is not logical, because most wars are unjustified and police often use excessive force. (They could also use other means than force to prevent crime like words, a novel concept.)

Most individuals are not put in prison or mental institutions to prevent crimes or societal harm, and these institutions most often have the opposite effect on these individuals. The concentration of psychiatric care into large hospitals with underpaid doctors and staff make them care less about helping people and more about getting a paycheck. The United States government calls its prisons part of their retributive or punitive justice system because retribution through punishment is its primary goal. 

While self-harm should be prevented, this issue is also about personal liberty. Every human being has the right to do whatever they choose with their own body, even if they choose to be self-destructive or die. We should do all we can to deter individuals from being self-destructive through our words, actions and compassion, but not by force and law. Punishment for self-inflicted damage often drives individuals to be even more self-destructive.

 

 

 

5.17 Reforming the Insanity Defense and Creating Alternative Criminal Defenses

 

As mentioned insanity is not a diagnosis and there are no psychological criteria to determine insanity. There are psychological tests for insanity that have been developed slightly, but ultimately judges and juries decide who is sane and who is not, and they can produce any verdict they would like to so long as there is no oversight. These individuals are not vetted for their knowledge of mental disorders, “insanity” or psychosis. In fact, in some states, it is illegal to inform a jury of what insanity means. Doing so can be ruled as jury tampering and result in a mistrial. If the forensic psychologists involved in a trial are not neutral parties (with no financial ties to the defense or the prosecution) then their definition of insanity will be highly malleable in every case due to their interest to win. Insanity also often has very negative connotations, so it insults people deemed insane in court rooms. In my opinion, it should carry as much legal weight as similar, inane terms like “bonkers” or “bananas.”

Replacing the insanity defense with a very clearly defined psychosis defense and two broader, more flexible defenses for those with mental disorders and those with mental deficits could be a good solution to prevent the problems created by the “insanity defense” and the lack of alternative legal remedies for mentally unwell people. The psychosis defense could be used by anyone, regardless of mental health because anyone can become psychotic, but sufficient evidence would have to be present for this defense to succeed. The mental disorder defense could be used by defendants who were not technically psychotic at the time of their crime, but who feel their crime was caused or at least influenced by a disorder. The mental disorder defense exists in Australia and Canada, but it is essentially the more politically correct term for their insanity defense, and it does not cover the vast array of disorders that can affect culpability. (They are essentially equivalent to the US insanity defense.)

When an insanity defense succeeds, (which is rare) the accused will usually receive a verdict of not guilty by reason of insanity, (NGRI). A successful psychosis defense could result in a verdict of not guilty by reason of psychosis. However, in cases in which defendants are sentenced to mandatory hospitalization (in some cases for life) and therefore, deprived of their liberty, it still does not make much sense to call them “not guilty.” Factual guilt is important and NGRI verdicts tend to confuse people since they do not always reflect what the accused actually did. Therefore, two verdicts that might make more sense would be “factually guilty but psychotic” and “factually guilty but mentally unwell.” These verdicts would recognize the influence mental disorders can have on crimes and the need for treatment while acknowledging the fact that the defendants did physically commit the crime.

These alternative defenses (or even more progressive ones) are necessary because the insanity defense is so flawed. It can be used to malinger (pretend or exaggerate insanity) and to unfairly prosecute mentally unwell and mentally well people alike, as I have shown. A person can be found to be psychotic but sane at the time of their crime, and a person also does not have to be psychotic in order to be deemed insane.[v] This does not make any sense. There is no congruency in the relationship between psychosis and insanity in courts. The relationship is not agreed upon outside of courts either. Psychosis and insanity are often used synonymously in court, and in many cases, psychotic episodes are identified by courts as episodes of “insanity,” but this just confuses matters more.

Psychosis should not always remove culpability. A sane individual could conceivably make the conscious decision to become psychotic and do everything possible to achieve that mental state just for the sake of becoming immune to the law. Such a person ought not to be held less accountable for their actions, but the nature of the person’s psychosis should remain relevant. Again, blanket laws or distinctions can’t be made because every case is so different.

The alternative defenses I have discussed might be more popular than the singular insanity defense in place if we were all aware of these terms and their legal consequences. It is not always hard to prove a person was psychotic at the time of their crime. This can be determined if the person is evaluated by a knowledgeable physician immediately after their crime. If a person claims they became psychotic from drug use, a blood test can at least validate or challenge this claim. Brain scans can also be used to determine if a person has recently experienced a psychotic episode.

Psychosis is not a crime, but if it contributes to a crime, its influence ought to be examined carefully. Determining culpability is a complex process that is distinct in every case. Mental disorders can significantly impair our ability to function. Schizophrenia or long-term hard drug abuse can result in what is sometimes called “settled insanity.” Settled insanity is actually settled psychosis or lasting unscientific beliefs or delusions formed by the persistence of mental disorders and their effects on belief systems, cognition and memory. Verdicts involving it should be largely determined by psychological experts, not judges or juries to prevent unjust rulings. In cases in which a person commits a crime because of persistent delusional beliefs or significant impairment in their thinking and reasoning caused by their disorder, that person should be considered less culpable.

Even very common mental disorders like depression ought to qualify for the mental disorder defense. Severe depression can seriously affect a person’s decisions, and result in very self-destructive and destructive behavior. If someone with obsessive compulsive disorder (OCD) is repeating a ritual and commits a crime accidentally in the process, that person could also feasibly use the mental disorder defense. A successful defense may not eliminate culpability, but just reduce it.

Four states (Kansas, Montana, Idaho, and Utah) have abolished the use of the insanity defense altogether. However, their courts usually fail to even recognize psychosis or severe mental disorders as mitigating factors. In these states, even if all of the evidence shows defendants were psychotic, they can still be incarcerated instead of hospitalized. This has likely resulted in the incarceration of thousands of people with mental disorders who need treatment they are not getting. Idaho, Montana and Arizona allow for a “guilty but insane” verdict, which is self-contradictory because “insanity” by its own legal definition eliminates culpability.

A verdict of guilty but mentally unwell is acceptable in certain cases because mentally unwell people are capable of knowingly doing wrong, but they still have special needs because of their condition that will not be addressed in prison. Mental disorders can become debilitating in prisons and sadly lead to suicide.

There is a common misconception that NGRI results in total freedom. But this is never the case. Those who receive NGRI verdicts are forced into mental hospitals, which can be more punishing than prisons, and they decide when patients leave. Sometimes a person can stay longer in a mental institution than they would have if found completely guilty and sent to prison. In the Supreme Court case of Michael Jones vs. the United States that I mentioned earlier this was found constitutional and it was upheld. Another piece of recent legislature is supposed to prevent this, but it usually does not.

The relationship between premeditation and mental disorders is also a complex one. Individuals can methodically plan a crime due to severe delusions developed by persistent psychosis or other symptoms of mental disorders. In fact, some disorders can improve their ability to plan. The idea of committing a crime can build in the minds of mentally unwell people for long periods, but a psychotic episode can be what it takes to push them over the edge.

Before the trial of Daniel McNaughton in 1843, any defendant who had conscious criminal intent was considered guilty in the United States. That year McNaughton attempted to shoot Robert Peele, then British Prime Minister, but instead he shot and killed his secretary Edward Drummond in the back. McNaughton’s very well-paid defense team argued he was acting out of paranoid ideation. When he was acquitted due to reason of insanity, there was significant backlash from the public, which eventually led to the establishment of the McNaughton rules (or “M’Naghten” rules). These rules state that anyone pleading insanity defense has to prove they had a disease of the mind that made them unable to know right from wrong.[vi] Daniel did not meet these criteria. (If tried today his lawyers would probably claim he was “under duress.”) Because of his acquittal, the distinction was made to prevent acquittals of similar defendants in the future. The M’Naghten rules still make up the Federal Insanity Defense Test.

Twenty-five states still use the M’Naghten Rules today (or a modified version of them), which have been the standard criteria for insanity since McNaughton’s trial. It is a testament to our legal system that such an old conception of insanity could still be in use. 21 states use the Model Penal Code Rule (MPC) or a modified version, and 35 states leave the burden of proof of insanity on the defendant, while only 11 place the burden of proof on the state.[vii] The burden of proof ought to be on the state in all cases, regardless of the circumstances because a person is always innocent until proven guilty. Presumption of innocence is an important facet of many justice systems and it was included in the Magna Carta in 1215.) It is also virtually impossible to prove your own insanity because insanity is not a medical term.

The American Law Institute devised the Model Penal Code (MPC) rule in 1983. The MPC is somewhat more progressive than the basic and broad M’Naghten rules. It establishes five gradations of culpability. Individuals can be convicted of purposely, knowingly, recklessly or negligently breaking the law. They can also be found strictly liable, which means they are guilty, regardless of their mental state. The progressive part of the MPC is that it considers any action not explicitly outlawed as legal, which means people cannot be punished just for odd or unusual behavior. However, they often are anyway.

The M’Naghten rules and many other tests for insanity ask two primary questions: Was the accused in control of his functions and was the accused aware the act was morally or legally wrong. However, these are distinct concepts. Spontaneous verbal or motor behavior used as a criminal defense is called automatism, which in some cases is caused by psychosis. (It can also be caused by sleep walking, REM sleep, epileptic seizures, and many other conditions. Homicide while sleep walking has occurred and been used as a defense.) However, knowing right from wrong can have little to do with psychosis. Our conceptions of right and wrong are formed over our lifetimes, and they should not always necessarily affect culpability. In some cases, it does not matter if defendants believe they were right or wrong because our belief systems are highly varied and subjective, and individuals may believe they are very much right in committing acts that most of society would consider terribly wrong. As is often said, “One man’s terrorist is another man’s patriot.”

When individuals lose control over their verbal or motor behavior or become psychotic and accidentally harm others, it does not matter if they believe what they are doing is right or wrong since they have no control. However, automatism, is rarely used a defense, even though it does occur. In some states, involuntary action is not even considered a legitimate defense.

The two separate concepts of the M’Naugten rules need to be treated separately. The defense of “not knowing the act was wrong” should only be applied to children (who cannot be considered insane, just undeveloped) and people with serious mental deficits like Down syndrome or significant brain damage. But a healthy adult’s conception of right from wrong is determined by their surroundings. Everyone has their “reasons” for committing crimes. Whatever motivation they had could be conceivably used as a defense. Most of the people who do the most horrific things believe they are morally right. But should two people who commit the same heinous crime be tried differently because one thought he was right and the other knew he was wrong? To the victims, it shouldn’t make much of a difference because the same damage has been done.

The insanity defense or any criminal defense cannot be defined by a person’s knowledge of right and wrong because these concepts are too subjective. People don’t all agree about what is morally right and wrong. The court’s purpose is to prosecute based on the law, not define morality, and many laws themselves are not moral. If justice were to be fully served, every sociological influence would have to be taken into account in every court case.

Robert Sapolsky, a neurobiologist at Stanford said in an interview, “You can have a horrendously damaged brain where someone knows the difference between right and wrong but nonetheless can’t control their behavior. At that point, you’re dealing with a broken machine, and concepts like punishment and evil and sin become utterly irrelevant. Does that mean the person should be dumped back on the street? Absolutely not. You have a car with the brakes not working, and it shouldn’t be allowed to be near anyone it can hurt.”[viii] This is the essence of what is wrong with the M’Naghten rules. The existence of mens rea (criminal intent) does not matter in cases involving automatism.  Of course, in every court case, regardless of the nature of the crime, the mental state of the defendant needs to be taken into account. Understanding why crimes occur can help us prevent them from reoccurring.

Any individuals rendered guilty but mentally unwell should receive adequate treatment based on their case, and no mentally unwell person should serve the remainder of their sentence in prison after therapy. Cases that do not involve psychosis, but do involve mental disorders should be examined carefully. The mental state, thoughts, severity of the deficit, and specific history of the accused should all be factors taken into consideration. Put simply we are our brains, so if a person is born with severe deficits or they acquire deficits from an abusive or neglectful environment, this should affect culpability.

Our brains are where all stimuli is processed, translated and turned into something meaningful, and our brains respond to these stimuli and send signals back to different parts of the body to produce a response. We receive an unfathomable number of stimuli in our lifetimes affects our brains, and they make us. But we can gain greater control over who we become by choosing to interpret information differently, moving to new locations and receiving different sets of largely unpredictable stimuli, and responding to these stimuli in a multitude of ways. Uncontrollable environmental factors are rarely discussed in most court cases, whether or not an insanity defense or a mental disorder defense is employed.

The philosophy of determinism can work in our legal system. Determinism simply states that the future will be one way, but this does not mean that free-will does not exist or that we cannot shape our own realities. It just means there is one thread of time. It does not remove responsibility from people, but creates gradations of culpability. Although all behaviors and events are reactions and not actions in a sense, we can still reflect on our reactions before we make them. Determinism does not take away human choice. (It actually has little to do with it, even though the two concepts are often linked.) The degree to which different sociological factors lead people to crime should affect their burden of legal responsibility in all cases, especially in cases that involve the psychosis defense or the current “insanity” defense.

When a mentally unwell person at their wits end commits a very violent crime, it is tragic for everyone involved, but visceral, reactionary outcries for punishment do not serve much purpose. The person left alive (the mentally unwell one in most cases) should at least have a chance to live a good life and the people affected by the tragedy ought to focus on rebuilding their own lives, instead of achieving petty vengeance through the court system. Punishing people does not address the root causes of crime nor does it forever mend emotional or physical wounds. When mass murderers kill themselves after their spree, the media tends to still vilify them and celebrate their deaths. But this is just wasted energy that could be put to more positive endeavors. The hysterical media coverage only makes killers and mentally unwell people infamous, spurring vulnerable individuals to copy them in some cases. It also keeps frightened people watching, generating revenue for large media conglomerates.

The court system needs compassionate and knowledgeable forensic psychologists, psychiatrists and judges who are completely neutral and committed to the health and wellbeing of all parties. They have to be moral people who cannot be bought by the prosecution or the defense. This should be the case in all court cases, regardless of the mental state of the accused. In order to achieve this, law would have to be a non-profit enterprise. Lawyers, judges, police, and everyone else involved in the court system would have to be volunteers or subsidized by governments and non-profit organizations to earn a living wage. This may seem like “radical” idea, but it is the only way any decent measure of justice could ever widely be served.

 

 

5.18 Bipolar Disorder, ADD, Schizophrenia, Childhood Psychiatry and Anti-Psychotics

Along with most mental disorders, bipolar disorder and schizophrenia are diagnosed far too often. From 1994 to 2003, the estimated number of children diagnosed with bipolar people increased by 4000 percent in the United States according to patient records from the National Ambulatory Medical Care Survey.[ix] This is unprecedented. The number of children diagnosed with attention deficit disorder (ADD) has also risen exponentially in recent years. Children who have trouble focusing in school are often under-stimulated and lack motivation and enthusiasm from teachers. Children would also likely have less difficulty focusing if they were not bombarded with the constant stimulus of media outside of school. And children who act out for whatever reason are often pathologized in some other way by therapists who do not know how else to brand their behaviors.

Large pharmaceutical companies have no misgivings about getting kids addicted to amphetamines, bipolar drugs and antipsychotics, whether they need them or not. There are a number of moral child psychiatrists, but pharmaceutical companies influence them as well. They can assure doctors and patients a medication is safe for children when they know it is not and receive little legal recourse.

As a whole, child psychiatry may be even more corrupt than adult psychiatry because children are easier to exploit. Their opinions often matter less to doctors, parents and courts because they do not have the same legal rights as adults. Child psychiatry also has a tendency to become more punitive when the parents are abusive and dishonest. Parents are in control and they are expected to do what is best for their children, so abusive parents sometimes go undetected by therapists, teachers and judges. Abused kids are also sometimes labeled as the “problem kids,” which leads to further punishment and negative cycles of behavior.

The development of many children can sometimes look abnormal to adults. But it is helpful to be mindful of the fact that we are all on our own paths, and sometimes pitfalls and bouts of depression or rebellion can be constructive. Most phases are learning experiences that come and go. Children are still developing and their brains are vulnerable, so psychiatric medication should be a last resort in all cases. It should only be prescribed if they have been informed about it and they give consent.

There are no medical tests for schizophrenia or bipolar disorder, aside from subjective, behavioral tests, and there is not a singular organic cause for them or any mental disorder. Only one single doctor is needed to make the diagnosis, which is based on their personal biases and sometimes the opinions of other staff. This diagnosis often affects those given it for the rest of their lives. Some children have been branded as schizophrenic before they even reach ten years of age.

Because schizophrenia and bipolar disorder can produce so many different symptoms, it is possible that they are not discrete disorders but are rather several disorders or just sets of behaviors. Most people with schizophrenia have less grey matter in their brains than average persons, but this may just be due to the widespread prescription of anti-psychotics, which can substantially reduce grey matter.

Another similarity among people with schizophrenia symptoms is many have been shown to have greater spontaneous activity in the right hemisphere of their brains while people with bipolar disorder often have greater activity in the left hemisphere of their brains[x]. Superstitious people who believe in the paranormal, have strong religious beliefs or both, as well as very creative individuals usually have greater spontaneous activity in the right hemisphere of their brains. The right hemisphere favors making more “loose” connections, as opposed to the left hemisphere which makes more focused, mathematical connections. Both areas of the brain have their purpose as does magical thinking. But if a person is not grounded by a strong, scientific perception of reality, it seems that too much spontaneous activity in either hemisphere of the brain can evolve into mental disorders or personally unwanted behaviors.

Most mental institutions treat magical thinking as a symptom of mental illness. But religious beliefs are usually only considered magical thinking if they are very extreme or egocentric in nature, (e.g. beliefs about being or embodying a prophet or a God). However, when mentally troubled individuals are indoctrinated with religion, many expectedly take their beliefs to these kinds of extremes. These extremes already exist in religious literature as well, so this is not surprising. I cannot imagine why filling the heads of mental patients with more magical thinking (religious or not) would be constructive. Some religious staff and doctors make genuine efforts to introduce religion as a way to help, but it is rarely helpful in the long-term.

Schizophrenia in practice is the catchall term used for people therapists cannot otherwise label, but people who exhibit schizophrenia symptoms are all different. Schizophrenia symptoms are often caused by years of trauma and abuse, and the solutions need to be discussed with doctors, loved ones, and ideally with people who have overcome similar experiences. 

“Mania” is the symptom of bipolar disorder that separates it from depression. Mania comes from the Greek word, μανία, meaning “madness,” and it is a state of elevated energy, mood, agitation or sexual drive. Depressive episodes do not have to present with a manic episode for a diagnosis of bipolar disorder to be made, which may be another reason the diagnosis is made so often. Individuals can certainly suffer during episodes of mania and even become psychotic, but mania is not always negative because it can increase a person’s creativity and productivity and even feel euphoric. The condition itself certainly does not always require hospitalization.

Every mental disorder is unique because every person is unique, and this has to be considered by psychiatric doctors. Patients ought to be seen as distinct individuals and their needs should be most important for therapists. When there is no existing label for the symptoms therapists perceive, they often diagnosis these patients with “unspecified psychotic disorder” just to keep the patient institutionalized, medicated or both. Unspecified psychotic disorder is an extremely vague label that is unhelpful for both patients and doctors. It is considered one of the thirteen subtypes of schizophrenia. Most of the categories of mental disorders also have similar subtypes termed “not otherwise specified,” which are used when patients do not fit the exact criteria for any disorder. This demonstrates the need for a more fluid conception of mental health and disorders. People cannot be labeled and put into categories because our stages of development are all so different.

The underlying problems that cause mental disorders cannot always be identified or measured scientifically. Diseases that attack the brain like brain cancer can be, but disorders like depression are not diseases and they can be very abstract and fleeting. They do not have to be life-long. People with these disorders usually have unusual neurochemical activity, but the sources of these chemical differences can be very disparate. They can be external, inherited, or self-imposed. Identifying and discussing the sources is often very important. Many disorders are just learned behaviors, and these behaviors can be improved and “un-learned.” For patients with severe emotional and physical trauma, talking about these experiences can be more helpful than any medication.

Anti-psychotics used to “treat” schizophrenia mostly bind to dopamine receptors and interrupt signaling resulting in reduced production of dopamine. People with schizophrenia are prescribed these drugs because the dopamine hypothesis of schizophrenia speculates that schizophrenia is caused by an excess of dopamine due to signaling malfunctions triggered by environmental and genetic factors. Dopamine re-uptake inhibitors like cocaine, meth and crack have essentially the opposite effect. They bind to dopamine receptors and increase dopamine in the synapses temporarily, which produces effects that can resemble the “positive symptoms” of schizophrenia. But these drugs ultimately decrease dopamine levels when addiction sets in due to reduced signaling and loss of sensitivity to dopamine. Some dopamine reuptake inhibitors may actually have a positive long-term effect on those with schizophrenia for this reason if long-term dopamine reduction is what they need, but this is very speculative. However, this (along with the temporarily alleviating high) may be why so many schizophrenics try to self-medicate with these drugs.

Most anti-psychotics have high affinity for the D2 subtype receptor, which is one of the five major subtypes of dopamine receptors, but many anti-psychotics can also bind to other dopamine subtypes, serotonin receptors, and many other receptors, which can produce a host of side effects. They can also cause many separate mental disorders like tardive dyskinesias that cause involuntary movements, twitching and twisting of the limbs. Most of the negative symptoms of schizophrenia (like avolition, flat affect, lack of speech) seem to be caused by the very dopamine antagonists used to “treat” it, and there are many other side effects to anti-psychotics, which are far from minor. These include lowering life expectancy, weight gain, loss of motor control, decrease in white blood cell count, neuroleptic dysphoria, (unhappiness or general malaise) neuroleptic malignant syndrome, and even tardive psychosis. Chronic use of neuroleptics can also lead to neuronal death, irreversible abnormalities in brain function, and large decreases in brain volume.

Many doctors believe that schizophrenia is a neurodegenerative disorder, but this may not be the case. Most individuals with schizophrenia have decreases in brain volume, but many only receive the diagnosis of schizophrenia after having been on anti-psychotics for years. In 2010 doctors Joanna Moncrieff and Jonathan Leo analyzed data from multiple studies on the subject and found that patients diagnosed with schizophrenia in every study who had never taken anti-psychotics showed “no major differences in global cerebral, grey-matter, ventricular, or CSF (cerebrospinal fluid) volumes,” whereas patients with chronic use of anti-psychotics “showed a greater reduction in whole-brain, cortical or grey-matter volumes, or a greater increase in CSF or ventricular volumes, compared with controls” in 14 of the 26 MRI studies.[xi]

The life-time occurrence of substance abuse is about fifty percent among people diagnosed with schizophrenia[xii] and most (regardless of drug use) are prescribed anti-psychotics as well, so it is possible drugs of one form or another are the most common cause of schizophrenia symptoms. Most of the symptoms can be experienced by anyone. The symptoms of delusions and hallucinations also do not have to be present to be diagnosed with the disorder. The “positive”, “negative” and “cognitive” symptoms of schizophrenia like avolition (inability to experience pleasure), disorder of thoughts or words, blunted or flat affect (reduced emotional response), poor executive functioning, catatonia (motionlessness or excess motor activity) and movement disorders like “facial grimacing” can all be produced by certain drugs like neuroleptics and dopamine reuptake inhibitors. They can also result from depression and other mental disorders.

Drug addicts (especially stimulant addicts) and users who do not have schizophrenia are often incorrectly labeled as schizophrenic by doctors. Cocaine and amphetamine psychoses are considered separate mental disorders by the DSM. These drugs can cause severe psychosis, but it does not make much sense to identify temporary, drug-induced psychosis as a mental disorder. The DSM also classifies just about every illicit drug as a potential cause of psychosis and a “mental disorder.” Many drugs can cause psychosis but only at very high doses. Any drug can become poison at a high enough dose.  

Individuals with schizophrenia are still widely over-prescribed neuroleptics because when they are administered, patients become easier to control and subdue. Dopamine antagonists block the binding of the endogenous agonist dopamine to dopamine receptors, thereby inhibiting the signal produced by the agonist. This may have a temporary anti-psychotic or tranquilizing effect, but when administered for a long period time patients become overly sensitive to dopamine to compensate for the dulling effect of anti-psychotics. This can lead to a malady of side-effects mentioned, which are often mistaken for worsening symptoms of schizophrenia and treated by doctors with more anti-psychotics, resulting in a vicious cycle.

A number of therapists like Dr. David Healy, an Irish psychopharmacologist and author, have claimed that drug companies have tried to legitimize the dopamine hypothesis of schizophrenia (like the serotonin hypothesis of depression) in order to increase the sales of their drugs. Schizophrenia’s cause is likely more complex than drug companies would have us believe. It is a poorly understood mental disorder and the “quick-fix” of anti-psychotics will likely be seen as malpractice in the future. Electroconvulsive therapy (ECT), which is sometimes used in conjunction with anti-psychotics, will likely be seen as medieval when less dangerous therapies become more common. Yesterday’s medicines are often considered barbaric by today’s doctors, but few consider current medications and treatments may be just as primitive as our older treatments. Some individuals who have received ECT “therapy” have sued for consequent, significant brain damage and memory loss.

Before anti-psychotics were invented lobotomies were common “treatments” for schizophrenia, and they still are used when patients do not “respond” to medication. A lobotomy is a procedure in which one or more parts of the brain (usually connections to the prefrontal cortex) are destroyed by literally burning or removing them completely. The first lobotomy was conducted in 1935 and it was a very commonly used procedure for two decades in mostly developed, rich countries. By 1951, 20,000 lobotomies had been performed in the United States alone.[xiii]  

In my opinion, using a lobotomy to “cure” a mental disorder is much like trying to fix a TV set by smashing it with a hammer. It is one of the most crude, invasive and amoral procedures to ever be used as a “treatment” for a condition and it is still used today for schizophrenia, addiction and even minor mental disorders like depression and OCD, particularly in the US and the UK. The only reason lobotomies are supported by doctors is because they make patients easier to control like anti-psychotics.

In 1948 MIT professor and author, Norbert Weiner, explained “Prefrontal lobotomy… has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier.” The most upsetting aspect of lobotomies is that victims may never know how they were affected by them. They might feel fine despite being drastically different, less intelligent and suffering a host of other side-effects.

5.19 Rethinking Mental Disorders, Brain Diseases and their Relationship with Bodily Diseases

The mental health industry pathologizes not only normal human differences, but also normal human emotions. However, it is not sensible or realistic to only expect to experience consistent emotions and never act irrationally since the world is not always sensible or rational. If we never question ourselves and attempt to understand why we are who we are and instead we just do what is most commonly accepted, we become complicit to the agendas of the institutions that control us.

Differences in animals further evolution. Those most fit for their environments survive. But we have left it up to people in power to decide which differences are beneficial, and they thereby have the power to direct the course of our evolution. They select what they perceive as “natural” behaviors and weed out the extremes while significantly changing our environments.

In my opinion, real mental health can only be achieved by being fully in tune with the irrationality, harshness, and uncertainty in life, and not accepting easy answers. A healthy life includes a gamut of emotions, the pursuit of meaningful goals while having the ability to achieve balance. Generally, such people who are in tune with these unpleasant realities tend to act more uncommonly. But the most common behaviors are not always the most socially or environmentally productive behaviors. When there are fewer human extremes and more uniformity in personality and identity, fewer people feel as stimulated to change and improve.

 

Defining a mental disorder is difficult because mental health is subjective. Most mental disorders are not like illnesses that affect other parts of the body like viral infections or cancer, which can be physically seen and treated often using the same medications time and time again. Sometimes changes and abnormalities in the brain can be seen by using fMRIs, brain scans or microdialysis, but these technologies only provide a glimpse into an individual’s mental health.

Bodily illnesses like cancer cannot be treated with cognitive behavioral therapy (CBT) or by “thinking them away.” They are identified and diagnosed using medical instruments while mental disorders are not. A perfectly healthy, “sane” individual can fake the symptoms of any mental disorder and be admitted for life. But a person cannot “fake” high cholesterol or cancer. Most individuals with depression and other common disorders don’t receive tests to determine which neurotransmitters are too abundant or scarce or which receptors are overactive. Very unusual results alone are not enough to make a diagnosis anyway. Doctors cannot know exactly what is wrong (if anything) without talking to their patients extensively. The brain is just too complex for mental health to be summed up entirely by either current hard science or observational theory alone.

Therapists cannot view psychiatry as a way to “fix” minds. Almost all brain abnormalities are considered diseases. But it only makes sense to classify an abnormality as a disorder if it interferes with the quality of life of the patient. Diagnosing a person with a mental disorder in order to describe a vague and broad set of observed behaviors and symptoms oversimplifies the human mind and the person being observed. Psychiatry should only be seen as a way to create health, as opposed to an approach to cure individuals because helpful strategies can be dynamic, abstract and different for everyone.

There is too much focus on the diagnosis of mental disorders rather than the reason for the diagnosis. Diagnoses of mental disorders stigmatize certain behaviors. They make those who are diagnosed overly aware of them, but behaviors are not the sole problems, just as drugs are not the sole problem for addicts. They are coping mechanisms. Until the causes of mental disorders in each specific case are addressed, the sufferers can only mask their symptoms or tone them down but not achieve real peace of mind.

Although mental disorders are sets of cognitive and physical behaviors, this does not mean they are all voluntary or always voluntary. Some are hard to control; some are easier to control, and some are impossible to control. But they are all just behaviors in the sense that they do not infect people. Someone diagnosed with depression is not “sick” with depression. The underlying neuronal components to depression are numerous and highly variable. A person could just look up that the sky and observe the universe and all of a sudden feel very alone. It doesn’t make sense to classify such transient moments as mental disorders.

The pathologizing of normal human differences in psychiatry today can seriously hinder the minds of brilliant people. For example, creative geniuses can have “schizoid” personalities that make their everyday functioning difficult, but their avoidance of social interaction and potential external criticism can also help them create brilliant works. While a lifestyle choice of isolation may not be very healthy nor enjoyable, it is ultimately a choice. “Schizoid” people can still positively affect other people to a great extent.

Positive and negative outliers can teach us the most about what makes people be perceived as good or bad and strange or normal. They can be a product of social constructs or other underlying, broader problems and recognizing these can help influence the most common behaviors. Positive and negative habits, lifestyles and personal traits, unwanted and wanted, are too often grouped together and labeled as distinct mental illnesses. But many are just changeable behaviors.

Social withdrawal, high sensitivity, and introversion are all symptoms of “schizoid personality disorder”. But these can be healthy qualities. They are traits only a minority has, but this doesn’t mean they are always detrimental. Dr. Nancy McWilliams wrote, “one reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority.”[xiv] This is accurate and unfortunately, normal behavior right now, for the most part, is not very positive.

People can be diagnosed as “schizoid” without determining whether or not they prefer this lifestyle, but this doesn’t make any sense. Having an active social life may be more healthy and enjoyable for most, but a person can also have many friends and still feel very alone. (Patient needs cannot always be determined only by what is made most evident.) Short periods of isolation can be very beneficial for most people. If we are constantly stimulated by other people, we will have little time to reflect and look inside ourselves and develop very unique identities. However, the regular stimulus of other people can also be grounding and comforting. The point being we are all at different stages of development. Some need more time by themselves than others and some need or thrive from constant interaction, but no one lifestyle should be seen as the only healthy one. Lifestyles and behaviors also constantly change. One day a person may feel like an introverted hermit and the next feel like a convivial extrovert. Stigmatized or pejorative labels for behaviors can prevent people from improving their habits and lifestyles. These labels can make us believe that we are not capable of changing ourselves, but we can in most cases.

One of the symptoms of the many mental disorders defined by the DSM is literally “unconventional beliefs” that go against “societal norms.” If unconventional beliefs are symptomatic of mental disorders, then every brilliant thinker who challenged societal norms should be considered ill. Einstein or Copernicus could be perceived as having been “ill.” (Many dogmatic people likely did them see this way.) Unconventional beliefs are what change conventional beliefs. Without them, society would never change. As Karl Marx said, “the ideas of the ruling class are in every epoch the ruling ideas,” and this only keeps the ruling class in power. We should not assume that society will head in the right direction by conforming to societal norms that were created by a small group of people who never had public interest in mind. The forces that control us define what’s normal. We do not collectively, but we certainly could.

The spectrum approach to mental disorders attempts to explain a broader variety behaviors and symptoms that can overlap. Because people with bipolar disorder, for example, are very different, a spectrum is used to describe more traits as bipolar. The word spectrum is better suited to describe mental health. Narrowly defined labels, on the other hand, often just push people to stretch the limits of what is expected from them, and unwanted behaviors can worsen and become more frequent.

Another problem with traditional psychiatry is the approach, which can be likened to the uncertainty principle of quantum mechanics. This principle states that a light is needed to measure a particle’s position and velocity, but by measuring a particle with that light, the outcome changes. Similarly, doctors change the outcome (the patient behavior) by observing it. Knowing your behavior is being analyzed (especially if you are insecure about your behaviors) often leads to paranoia and anxiety and can be used to validate pre-existing concerns doctors have, and ostensibly symptoms can worsen across the board as a result. Patients need to feel they are under no pressure, which is nearly impossible for any patient involuntarily committed. Even those admitted voluntarily are under the same amount of scrutiny.

I believe modern psychoanalysis is also flawed because it is not intended to be a natural conversation, but more like an interview or an interrogation at a court room. It is very one-sided. It can be accusatory, demeaning, and condemning of perceived behaviors and thoughts. It is also not an equal trade. Many therapists do not exchange anything personal about themselves. They believe they should be “neutral parties” who are not emotionally invested, but as a human being it is impossible to be completely neutral. You can strive for to be as objective as possible, but personal biases inevitably affect diagnoses and their treatments, which is why they should be made open to patients. I believe it is incredibly important to know who your therapist is and what you have in common in order to establish trust and a beneficial therapist-patient relationship.

Michael Foucault, a notable critic of psychiatry and mental institutions argued that the mental asylum is “not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned.” Punishment is still such an often used tool in psychiatric institutions.

When certain patients have delusions, doctors often provoke them by asking questions that make them expand on their delusions.  They provoke them to be more irrational and delusional, instead of asking why they believe in what they do and trying to help them adopt a more scientific perspective of the world. Therapists often make patients incriminate themselves by admitting to violent or sexual thoughts or urges they have. This information is sometimes used against them in court, instead of being used to help control or curb negative urges or thoughts. Patients in mental hospitals should not have to worry about self-incrimination in their sessions because crime is not prevented by betraying the trust of patients.

Overall, there is far too much law involved in psychiatry. Mental hospitals feel it is necessary for liability reasons to monitor and record all of their patients. The job of therapists is to get in their patients’ heads by using in-depth psychoanalysis, so it is understandable why some patients believe doctors have literally “entered their heads” with recording equipment or that their thoughts are being “broadcast.” Paranoid delusions and many symptoms of mental disorders are often created by mental institutions because patients have every reason to be paranoid or afraid. Some may develop irrational fears but usually because of very real dangers and intrusions. Many mental institutions are not safe places. Patients can be abused by the staff and other patients. But doctors define what constitutes paranoia and which fears are irrational or rational, as well as what is true and false. Patients are almost always considered less “reliable.”

One common symptom of schizophrenia is “delusions of grandeur,” which are delusions of having extreme personal significance. These can be brought on by mental hospitals when they treat mental patients so differently than other people. Therapists in mental hospitals assume these roles as superior caretakers who decide their patients’ fates, much like prison wardens. Some of them assume these positions because they are narcissistic and power-hungry or they have what could be called delusions of grandeur.

Formally educated therapists in the Western hemisphere go to school to learn about traditional psychology, psychiatry and basic medicine, but there is no requirement to learn about different ideologies, cultures and the psychology of these people. This makes it difficult for some to understand those who have lived extremely different lives. Their conception of normative psychology is too limited. For example, a happy, rich, Harvard graduates who has never had any major mental problems is not likely to understand (much less relate to) an institutionalized, crack addict diagnosed with schizophrenia and PTSD. The two individuals would not likely have much common ground, but the therapist may say the patient has delusions of grandeur if he ever insinuates to know more about his own disorder.

In an ideal mental facility or community patients would not be constantly monitored, dehumanized and they would be allowed more personal space. Doctors and nurses could be monitored the most by independent agencies and patient advocacy groups to prevent abuse. There would be a greater focus on the improvement of interpersonal skills and relationships, and doctors would actually listen to patients and try to learn from them. Patients could also be offered a variety of courses on a range of subjects to facilitate independence.

Perhaps most importantly, no one should ever be held against their will if they have not committed a crime, (even if they are suicidal, because everyone has the right to choose to live and die) and patients should have the same Miranda rights (right to free counsel, right to remain silent and so on) that suspects of crimes have immediately when admitted involuntarily or even voluntarily for an evaluation. If patients feel they are being persecuted and doctors are not listening, they have every right to remain silent.

How a defendant’s disorder developed should matter in court as well. If a person was physically unable to control him or herself, cannot remember the episode or was experiencing a hallucination and had no criminal intent, these factors should lessen or eliminate culpability, depending on the circumstances. However, because “insanity” is often defined purely by the perceived senselessness of crimes and not on the mental and physical state of those accused, many people are wrongly labeled insane. People are capable of doing extremely sadistic, violent and cruel things without being at all psychotic.

A complete overhaul of the mental health sector is necessary. It would function best as a not-for-profit sector that used very open-minded, patient-driven approaches that allow for all different types of people to prosper and grow based on their own wants and needs.

 Some individuals taking these medications have reported improvements in their conditions, but there needs to much more testing done on the long-term effects of drugs like these before they are allowed to be prescribed. Short-term efficacy of antidepressants is often tested, but long-term efficacy needs to be tested in-depth as well. It also important to recognize that one drug is never the sole answer. If medication were free worldwide, we would see far more effective medications being used and prescribed.

Over-medication is also prevalent in mental hospitals throughout the world. Doctors do this to keep neurochemical activity in patients as consistent as possible to avoid erratic behavior, but they often create emotionless, zombie-like behavior in the process.  Such negligent overmedication can also cause legitimate mental disorders, brain damage, disease, and death. This happens regularly to perfectly healthy, innocent people who are accused of being mentally “ill.”

5.15 Rethinking Normality, “Insanity”, and Mental Wellness

 

The Diagnostic and Statistical Manual for Mental Disorders (DSM) lists over 500 mental disorders, but it does not once define mental health or explain how to achieve it. This is a serious problem for those who look to the DSM for this information. Mental health is flexible and different for everyone. But the manual is not flexible. It just provides proper names for all of the most common, unusual behaviors. It focuses far too much on sickness and not enough on health, as many therapists do.

Psychology is a young and developing field of study. Psychology literally means “study of the soul” from the Greek ψυχή or psukhē, meaning “soul” or mind and λογος or logos, meaning “study of.” It did not begin as a scientific field of study since the underlying neural processes that create consciousness were not understood at this time, but today the focus is shifting to these processes and the science that drives them.

Psychoanalysis was only founded about 100 years ago by Sigmund Freud and his ideas were not at all rooted in science. He developed many wild theories about human behavior that were based purely on his own observations like his “Oedipus Complex” theory, which speculated that during the “phallic stage” of development, children want to kill their fathers and have sex with their mothers. (He believed this largely because he assumed infants breast fed due to sexual desire, which is not the case.) Freud focused far too much on the subconscious, dreams and other processes that were not scientifically understood.

Normality is a very subjective concept. Many doctors essentially strive to remove strong emotion from their patients because they are mostly easily controlled if they are docile and emotionless. Being sad, angry, anxious or even happy can be considered abnormal or interpreted as mania or some other ridiculous condition. But these emotions are unavoidable facets of a healthy life. Being sad and angry can be healthy emotions. It all depends on the source of these emotions and how individuals react to them.

What is considered normal and sane is just what is popular, and what is popular is defined by the forces that control us. “Normal” people support their government. They refrain from questioning authority; they pursue mindless jobs in order to buy bigger houses, better cars and anything corporations tell us we need. “Normal” people are religious and they pray to their God every night. They also act like the people they see in the media and in television and aspire to be them. This conception of normality encourages sameness for the benefit of the few people who control us. But what is often not seriously considered is that the most common and popular beliefs are irrational, and this is why the radicals who go against the majority are almost always marginalized and considered insane or abnormal. But the most useful ideas are often the most initially unpopular.

Punitive psychiatry has been used by dictatorships and “democracies” alike to punish and silence political dissidents. Many therapists who work in psychiatric wards and state mental hospitals, as well as most political and corporate powers see selflessness as a mental disorder. If individuals put the interests of strangers before their own, they are often considered insane. This is why self-less political dissidents were put in labor camps and mental institutions in the Soviet Union era and during many other dictatorships.

It is impossible to know what it feels like to be someone who is deemed insane if no one asks the individual. This is what therapists should be doing. They should be learning from mental patients and not merely instructing them. Many psychiatric doctors treat their patients like animals. They try to analyze humanity and feel they are separate from it. But in order to understand anyone, we must realize the sameness in humanity. We become different, but if we are born healthy and intact, we are almost indistinguishable.

Many mental patients do need support and guidance, but most are not getting it because of the money to be made on unnecessary hospitalization. Most of money generated by mental hospitals goes to their owners and the insurance companies that bill them. Psychiatric doctors and even social workers are often incentivized to keep people longer than they need to be held and the nurses often understandably follow their directions. Owners of hospitals and insurance companies, also receive pay-outs from large pharmaceutical companies for endorsing, as well as facilitating the over-prescription of their medications. The longer patients stay, the more medication they can prescribe. They also lie about the effects of these drugs to their patients. Big pharmaceutical representatives often visit hospitals and cozy up to doctors in order to push whatever they are selling, much like illicit drug dealers, and many doctors buy them. These kinds of corrupt doctors are most prevalent in under-funded mental institutions.

Many popular positions could be considered symptomatic of greater mental disorders than the so-called “disorders” many hospitalized for. For example, many of the most powerful CEOs qualify as psychopaths on different tests for “psychopathy.” Many politicians do as well, because they answer questions like “Should some people have much, much more than others?” with “Absolutely. Why not?” It would not be surprising if most zealous pro-war and sectarian individuals also qualified as psychopaths on many tests for it. Capitalism turns life into a zero-sum equation and it is therefore psychopathic in a sense or at least misanthropic. 

Religious convictions are often fueled by self-interest as well, even though they are often disguised as philanthropy. Many claim they know their religion is best and that they are “helping” people by converting them, and many believe this. Those of us who pray also literally believe a being in the sky can hear our thoughts and grant us wishes. Most of our religions are not considered crazy because they have a great deal of history. But put in context with what we can demonstrate is true from science, our convictions are often bizarre, unrealistic, primitive, and not very relevant. We live in the present and we should learn from our ancestor’s trials and errors and try as best we can to avoid repeating their mistakes.

Many people tolerate social conventions that are imposed on us to avoid negative social or legal consequences that can come from opposing them. But many normal conventions do not exist for justifiable reasons. Abhorrent human rights abuses like slavery and rape can become normal in cultures. Questioning them is considered insane by some who believe human beings are tools and not equal beings with equal rights. Many more people thought this way in history when slavery was more common and this prolonged its use.

Normal human behavior could be measured as the average of all of human behaviors or the most common behaviors. But if all of human behavior was compiled, the most common behaviors would likely seem strange to most people. People have their own different beliefs about normality, and media outlets, governments, corporations and religions help shape them. Normal behavior is rarely measured for its positive social impact because the forces that shape normality do not do so for the greater good.

Defining normality and insanity is also difficult because popular behaviors and trends are always changing. Every action we take is technically a natural reaction because we are a part of nature. Neurological activity causes all actions, and given the right stimulus any behavior (within the confines of scientific laws) is possible. Many separate their conception of themselves from the physical processes that cause our thoughts and actions, but they ought not to because it alienates people with certain personalities and behaviors. “Insanity” becomes some ambiguous, scary “disease.” But any behavior deemed insane has a neurological cause. It can be understood and explained. Insanity could be defined as irrationality, but irrationality can be subjective as well.

Another problem with attempting to define insanity is that individuals can also act in ways deemed insane by society just to be perceived insane, but have perfectly healthy brains. Insanity can be feigned, but cancer cannot since there are blood tests that measure cancer cells and PET (positron emission tomography) scans that can show the development of cancerous tumors. There are no scans or blood tests relegated for insanity, however. Behaviors deemed insane can be triggered by a host of different stimuli, internal and external. Psychosis is measurable, but “insanity” is not. Anyone can do “insane” things.

Most often legal “sanity” in court is determined by the nature of the crimes in question and not by the mental state of the accused, which results in inappropriate verdicts. The word insanity is not used by doctors in medical contexts who deserve diplomas. Some doctorates, especially those in forensic psychology use the word, but it is simply a legal term that removes culpability. Doctors, juries and judges decide who is insane without an agreed upon, universal definition of “insanity.” These individuals have their own biases about normality and insanity and they can easily misunderstand people and their behaviors as a result. Contrasting behaviors can also be used by therapists to diagnosis patients with mental disorders and justify their institutionalization.

Albert Einstein defined insanity as “doing the same thing over and over again and expecting different results.” This is a good start, but people can do this because they are uniformed, psychotic or have physical brain damage or symptoms of obsessive compulsive disorder. None of this implies “insanity.” A more complete definition might be that insanity is repeating the same thing and expecting a different outcome while having the information to know that the outcome will be the same. In this context, insanity means extreme irrationality.

The word sane derives from the Latin word Sanus, which means “healthy.” Therefore, insanity, means unhealthy or, more specifically, it refers to poor health of the mind. But it can be difficult to define mental health. The severity of brain damage and its effect on mental health can be fairly accurately assessed. But when the mental issues individuals have are less tangible, it is much more difficult to make objective assessments of their mental health. A healthy mind could be considered a happy mind or a mind that correctly discerns what is real and what is not. But those two states are not always correlated. One could also be very happy and very disconnected from reality or be very sad without being at all psychotic or delusional. Since there is so much we have yet to learn about our world, very different interpretations of reality can also be considered equally plausible, which further confuses the issue.

Despite all of this, insanity remains a legitimate and all-encompassing legal term. The words “psychotic” and “psychosis” have replaced insanity in most medical contexts and these words are often used synonymously with schizophrenia, which just adds to the confusion about these terms.

Psychosis is derived from the Greek word I mentioned, ψυχή or “psyche” and ωσις or “osis.” Psyche means mind or soul and osis means an abnormal condition, so psychosis literally means an abnormal condition of the mind. If a person has real hallucinations, this does not mean they are necessarily incapable of acting rationally or peacefully, so it should not always remove culpability in court. This determination should be affected by a range of factors. Psychosis can range from very severe to very mild, and psychosis can be induced by a wide range of unrelated conditions and natural processes (like menstruation as stated), so it hardly always requires hospitalizations. (Fortunately, women are not being institutionalized for menstruating.)

The purpose of the brain is to collect information from external stimuli, process it coherently and produce a meaningful, appropriate response. Psychosis occurs when internal spontaneous activity (caused by one or more of the aforementioned conditions) in the primary sensory areas of the brain is misinterpreted by secondary sensory areas of the brain as information from external stimuli. When this happens the mind will sense things that do not physically exist.

Hallucinations can also be induced by drugs as stated, some of which increase spontaneous cortical activity and overwhelm real information gathered from external stimuli in the real world. Hallucinations are not always considered psychotic, however. If a person has sensory hallucinations but can recognize that they are hallucinations created by their minds and not real external stimuli, then that person would not be considered psychotic. This is sometimes not taken into account in court.

Another word is also needed to describe a condition in which a person is uncertain whether the stimuli sensed are internal or external. (“Quasi-psychotic” may be fitting.) Surely, a person could still act rationally with some uncertainty about the source of sensory activity, especially with guidance from others who could help ground the person to reality.

The label of psychosis is often used pejoratively by doctors to brand behaviors they deem unwanted, even when these behaviors are not psychotic and desired by the patient. The word psychosis was synonymous with madness or insanity up until the definition was divided to describe bipolar disorder and schizophrenia separately. But splitting the definition of psychosis to describe two different disorders was not all that sensible because it just created two different labels for sets of behaviors that doctors cannot fully explain or measure using scientific means or even discern in many cases. (The diagnoses are often mixed up.)

5.16 Questioning the Distinction between Acceptable and Unacceptable Forms of Violence

 

Mental hospitals and prisons are supposed to “prevent harm,” but hospitals, courts, cops and prisons are very selective about which potentially dangerous people they incarcerate. It is irrational to harm people, including yourself, without reason. But monetarily vested actors define what it is good reason for just cause for force and incarceration. There are plenty of violent people who harm for irrational reasons who go unpunished as a result and some of them are even considered honorable. The distinction between acceptable and unacceptable forms of violence is made primarily by what controls us and the popular beliefs they maintain. It is not a distinction made by critical thinking about morality or human rights. A select few individuals wage wars and decide which acts of violence are acceptable and which carry punishment, but everyday people fight them and bear the brunt of the damages.

Most people who commit violent acts are not psychotic. They know what they are doing. They are in control of their motor functions and they have the intent to harm. Most act out of intense anger or sadness, and there are acceptable, legal forms of violence around the world.

The desire to be violent or even kill is not a desire exclusive to “crazy” people. Most people have considered killing another person or at least being violent. The only thing that separates those who just think about it and those who actually do it is generally a difference in the severity of the experiences that led to those emotions. Pain collects. When people believe they have nothing to lose and no one cares about them, it becomes easier for them to separate themselves from humanity and inflict harm.

Millions are slaughtered by government-sanctioned wars and thousands are killed by corrupt police every year. Some people join the military just because they want to kill or control people. This does not necessarily mean these individuals have mental disorders or are psychotic, just as not all serial killers are psychotic. Many just have intense anger. But soldiers are not put in mental hospitals or prisons like serial killers are, even though what they do is often no different. It is merely perceived differently because some soldiers have good intentions and they buy into the big lie of the necessity of war. Soldiers are often considered heroes, whereas those who kill without government approval, no matter what the rationale for their actions, are often looked down upon as our villains.

Even a soldier who kills hundreds in a war fought for oil, revenge, or petty ideological differences is often still considered a hero. As the famous filmmaker Charlie Chaplin said, “Wars, conflict, it’s all business. One murder makes a villain. Millions a hero. Numbers sanctify.”
Governments can commit mass murder for revenge or money and enjoy complete immunity. But we cannot allow this. Governments cannot be given the right to decide who lives and dies or to decide which murders are moral or to even use force of any kind without there being a clear threat and no other alternative. It is contradictory for governments to reward soldiers while punishing some individuals who may have had more sound and pressing reasons to take aggressive actions.

This black-and-white moral distinction that exists between government-approved violence and violence without government approval is not logical, because most wars are unjustified and police often use excessive force. (They could also use other means than force to prevent crime like words, a novel concept.)

Most individuals are not put in prison or mental institutions to prevent crimes or societal harm, and these institutions most often have the opposite effect on these individuals. The concentration of psychiatric care into large hospitals with underpaid doctors and staff make them care less about helping people and more about getting a paycheck. The United States government calls its prisons part of their retributive or punitive justice system because retribution through punishment is its primary goal. 

While self-harm should be prevented, this issue is also about personal liberty. Every human being has the right to do whatever they choose with their own body, even if they choose to be self-destructive or die. We should do all we can to deter individuals from being self-destructive through our words, actions and compassion, but not by force and law. Punishment for self-inflicted damage often drives individuals to be even more self-destructive.

 

 

 

5.17 Reforming the Insanity Defense and Creating Alternative Criminal Defenses

 

As mentioned insanity is not a diagnosis and there are no psychological criteria to determine insanity. There are psychological tests for insanity that have been developed slightly, but ultimately judges and juries decide who is sane and who is not, and they can produce any verdict they would like to so long as there is no oversight. These individuals are not vetted for their knowledge of mental disorders, “insanity” or psychosis. In fact, in some states, it is illegal to inform a jury of what insanity means. Doing so can be ruled as jury tampering and result in a mistrial. If the forensic psychologists involved in a trial are not neutral parties (with no financial ties to the defense or the prosecution) then their definition of insanity will be highly malleable in every case due to their interest to win. Insanity also often has very negative connotations, so it insults people deemed insane in court rooms. In my opinion, it should carry as much legal weight as similar, inane terms like “bonkers” or “bananas.”

Replacing the insanity defense with a very clearly defined psychosis defense and two broader, more flexible defenses for those with mental disorders and those with mental deficits could be a good solution to prevent the problems created by the “insanity defense” and the lack of alternative legal remedies for mentally unwell people. The psychosis defense could be used by anyone, regardless of mental health because anyone can become psychotic, but sufficient evidence would have to be present for this defense to succeed. The mental disorder defense could be used by defendants who were not technically psychotic at the time of their crime, but who feel their crime was caused or at least influenced by a disorder. The mental disorder defense exists in Australia and Canada, but it is essentially the more politically correct term for their insanity defense, and it does not cover the vast array of disorders that can affect culpability. (They are essentially equivalent to the US insanity defense.)

When an insanity defense succeeds, (which is rare) the accused will usually receive a verdict of not guilty by reason of insanity, (NGRI). A successful psychosis defense could result in a verdict of not guilty by reason of psychosis. However, in cases in which defendants are sentenced to mandatory hospitalization (in some cases for life) and therefore, deprived of their liberty, it still does not make much sense to call them “not guilty.” Factual guilt is important and NGRI verdicts tend to confuse people since they do not always reflect what the accused actually did. Therefore, two verdicts that might make more sense would be “factually guilty but psychotic” and “factually guilty but mentally unwell.” These verdicts would recognize the influence mental disorders can have on crimes and the need for treatment while acknowledging the fact that the defendants did physically commit the crime.

These alternative defenses (or even more progressive ones) are necessary because the insanity defense is so flawed. It can be used to malinger (pretend or exaggerate insanity) and to unfairly prosecute mentally unwell and mentally well people alike, as I have shown. A person can be found to be psychotic but sane at the time of their crime, and a person also does not have to be psychotic in order to be deemed insane.[v] This does not make any sense. There is no congruency in the relationship between psychosis and insanity in courts. The relationship is not agreed upon outside of courts either. Psychosis and insanity are often used synonymously in court, and in many cases, psychotic episodes are identified by courts as episodes of “insanity,” but this just confuses matters more.

Psychosis should not always remove culpability. A sane individual could conceivably make the conscious decision to become psychotic and do everything possible to achieve that mental state just for the sake of becoming immune to the law. Such a person ought not to be held less accountable for their actions, but the nature of the person’s psychosis should remain relevant. Again, blanket laws or distinctions can’t be made because every case is so different.

The alternative defenses I have discussed might be more popular than the singular insanity defense in place if we were all aware of these terms and their legal consequences. It is not always hard to prove a person was psychotic at the time of their crime. This can be determined if the person is evaluated by a knowledgeable physician immediately after their crime. If a person claims they became psychotic from drug use, a blood test can at least validate or challenge this claim. Brain scans can also be used to determine if a person has recently experienced a psychotic episode.

Psychosis is not a crime, but if it contributes to a crime, its influence ought to be examined carefully. Determining culpability is a complex process that is distinct in every case. Mental disorders can significantly impair our ability to function. Schizophrenia or long-term hard drug abuse can result in what is sometimes called “settled insanity.” Settled insanity is actually settled psychosis or lasting unscientific beliefs or delusions formed by the persistence of mental disorders and their effects on belief systems, cognition and memory. Verdicts involving it should be largely determined by psychological experts, not judges or juries to prevent unjust rulings. In cases in which a person commits a crime because of persistent delusional beliefs or significant impairment in their thinking and reasoning caused by their disorder, that person should be considered less culpable.

Even very common mental disorders like depression ought to qualify for the mental disorder defense. Severe depression can seriously affect a person’s decisions, and result in very self-destructive and destructive behavior. If someone with obsessive compulsive disorder (OCD) is repeating a ritual and commits a crime accidentally in the process, that person could also feasibly use the mental disorder defense. A successful defense may not eliminate culpability, but just reduce it.

Four states (Kansas, Montana, Idaho, and Utah) have abolished the use of the insanity defense altogether. However, their courts usually fail to even recognize psychosis or severe mental disorders as mitigating factors. In these states, even if all of the evidence shows defendants were psychotic, they can still be incarcerated instead of hospitalized. This has likely resulted in the incarceration of thousands of people with mental disorders who need treatment they are not getting. Idaho, Montana and Arizona allow for a “guilty but insane” verdict, which is self-contradictory because “insanity” by its own legal definition eliminates culpability.

A verdict of guilty but mentally unwell is acceptable in certain cases because mentally unwell people are capable of knowingly doing wrong, but they still have special needs because of their condition that will not be addressed in prison. Mental disorders can become debilitating in prisons and sadly lead to suicide.

There is a common misconception that NGRI results in total freedom. But this is never the case. Those who receive NGRI verdicts are forced into mental hospitals, which can be more punishing than prisons, and they decide when patients leave. Sometimes a person can stay longer in a mental institution than they would have if found completely guilty and sent to prison. In the Supreme Court case of Michael Jones vs. the United States that I mentioned earlier this was found constitutional and it was upheld. Another piece of recent legislature is supposed to prevent this, but it usually does not.

The relationship between premeditation and mental disorders is also a complex one. Individuals can methodically plan a crime due to severe delusions developed by persistent psychosis or other symptoms of mental disorders. In fact, some disorders can improve their ability to plan. The idea of committing a crime can build in the minds of mentally unwell people for long periods, but a psychotic episode can be what it takes to push them over the edge.

Before the trial of Daniel McNaughton in 1843, any defendant who had conscious criminal intent was considered guilty in the United States. That year McNaughton attempted to shoot Robert Peele, then British Prime Minister, but instead he shot and killed his secretary Edward Drummond in the back. McNaughton’s very well-paid defense team argued he was acting out of paranoid ideation. When he was acquitted due to reason of insanity, there was significant backlash from the public, which eventually led to the establishment of the McNaughton rules (or “M’Naghten” rules). These rules state that anyone pleading insanity defense has to prove they had a disease of the mind that made them unable to know right from wrong.[vi] Daniel did not meet these criteria. (If tried today his lawyers would probably claim he was “under duress.”) Because of his acquittal, the distinction was made to prevent acquittals of similar defendants in the future. The M’Naghten rules still make up the Federal Insanity Defense Test.

Twenty-five states still use the M’Naghten Rules today (or a modified version of them), which have been the standard criteria for insanity since McNaughton’s trial. It is a testament to our legal system that such an old conception of insanity could still be in use. 21 states use the Model Penal Code Rule (MPC) or a modified version, and 35 states leave the burden of proof of insanity on the defendant, while only 11 place the burden of proof on the state.[vii] The burden of proof ought to be on the state in all cases, regardless of the circumstances because a person is always innocent until proven guilty. Presumption of innocence is an important facet of many justice systems and it was included in the Magna Carta in 1215.) It is also virtually impossible to prove your own insanity because insanity is not a medical term.

The American Law Institute devised the Model Penal Code (MPC) rule in 1983. The MPC is somewhat more progressive than the basic and broad M’Naghten rules. It establishes five gradations of culpability. Individuals can be convicted of purposely, knowingly, recklessly or negligently breaking the law. They can also be found strictly liable, which means they are guilty, regardless of their mental state. The progressive part of the MPC is that it considers any action not explicitly outlawed as legal, which means people cannot be punished just for odd or unusual behavior. However, they often are anyway.

The M’Naghten rules and many other tests for insanity ask two primary questions: Was the accused in control of his functions and was the accused aware the act was morally or legally wrong. However, these are distinct concepts. Spontaneous verbal or motor behavior used as a criminal defense is called automatism, which in some cases is caused by psychosis. (It can also be caused by sleep walking, REM sleep, epileptic seizures, and many other conditions. Homicide while sleep walking has occurred and been used as a defense.) However, knowing right from wrong can have little to do with psychosis. Our conceptions of right and wrong are formed over our lifetimes, and they should not always necessarily affect culpability. In some cases, it does not matter if defendants believe they were right or wrong because our belief systems are highly varied and subjective, and individuals may believe they are very much right in committing acts that most of society would consider terribly wrong. As is often said, “One man’s terrorist is another man’s patriot.”

When individuals lose control over their verbal or motor behavior or become psychotic and accidentally harm others, it does not matter if they believe what they are doing is right or wrong since they have no control. However, automatism, is rarely used a defense, even though it does occur. In some states, involuntary action is not even considered a legitimate defense.

The two separate concepts of the M’Naugten rules need to be treated separately. The defense of “not knowing the act was wrong” should only be applied to children (who cannot be considered insane, just undeveloped) and people with serious mental deficits like Down syndrome or significant brain damage. But a healthy adult’s conception of right from wrong is determined by their surroundings. Everyone has their “reasons” for committing crimes. Whatever motivation they had could be conceivably used as a defense. Most of the people who do the most horrific things believe they are morally right. But should two people who commit the same heinous crime be tried differently because one thought he was right and the other knew he was wrong? To the victims, it shouldn’t make much of a difference because the same damage has been done.

The insanity defense or any criminal defense cannot be defined by a person’s knowledge of right and wrong because these concepts are too subjective. People don’t all agree about what is morally right and wrong. The court’s purpose is to prosecute based on the law, not define morality, and many laws themselves are not moral. If justice were to be fully served, every sociological influence would have to be taken into account in every court case.

Robert Sapolsky, a neurobiologist at Stanford said in an interview, “You can have a horrendously damaged brain where someone knows the difference between right and wrong but nonetheless can’t control their behavior. At that point, you’re dealing with a broken machine, and concepts like punishment and evil and sin become utterly irrelevant. Does that mean the person should be dumped back on the street? Absolutely not. You have a car with the brakes not working, and it shouldn’t be allowed to be near anyone it can hurt.”[viii] This is the essence of what is wrong with the M’Naghten rules. The existence of mens rea (criminal intent) does not matter in cases involving automatism.  Of course, in every court case, regardless of the nature of the crime, the mental state of the defendant needs to be taken into account. Understanding why crimes occur can help us prevent them from reoccurring.

Any individuals rendered guilty but mentally unwell should receive adequate treatment based on their case, and no mentally unwell person should serve the remainder of their sentence in prison after therapy. Cases that do not involve psychosis, but do involve mental disorders should be examined carefully. The mental state, thoughts, severity of the deficit, and specific history of the accused should all be factors taken into consideration. Put simply we are our brains, so if a person is born with severe deficits or they acquire deficits from an abusive or neglectful environment, this should affect culpability.

Our brains are where all stimuli is processed, translated and turned into something meaningful, and our brains respond to these stimuli and send signals back to different parts of the body to produce a response. We receive an unfathomable number of stimuli in our lifetimes affects our brains, and they make us. But we can gain greater control over who we become by choosing to interpret information differently, moving to new locations and receiving different sets of largely unpredictable stimuli, and responding to these stimuli in a multitude of ways. Uncontrollable environmental factors are rarely discussed in most court cases, whether or not an insanity defense or a mental disorder defense is employed.

The philosophy of determinism can work in our legal system. Determinism simply states that the future will be one way, but this does not mean that free-will does not exist or that we cannot shape our own realities. It just means there is one thread of time. It does not remove responsibility from people, but creates gradations of culpability. Although all behaviors and events are reactions and not actions in a sense, we can still reflect on our reactions before we make them. Determinism does not take away human choice. (It actually has little to do with it, even though the two concepts are often linked.) The degree to which different sociological factors lead people to crime should affect their burden of legal responsibility in all cases, especially in cases that involve the psychosis defense or the current “insanity” defense.

When a mentally unwell person at their wits end commits a very violent crime, it is tragic for everyone involved, but visceral, reactionary outcries for punishment do not serve much purpose. The person left alive (the mentally unwell one in most cases) should at least have a chance to live a good life and the people affected by the tragedy ought to focus on rebuilding their own lives, instead of achieving petty vengeance through the court system. Punishing people does not address the root causes of crime nor does it forever mend emotional or physical wounds. When mass murderers kill themselves after their spree, the media tends to still vilify them and celebrate their deaths. But this is just wasted energy that could be put to more positive endeavors. The hysterical media coverage only makes killers and mentally unwell people infamous, spurring vulnerable individuals to copy them in some cases. It also keeps frightened people watching, generating revenue for large media conglomerates.

The court system needs compassionate and knowledgeable forensic psychologists, psychiatrists and judges who are completely neutral and committed to the health and wellbeing of all parties. They have to be moral people who cannot be bought by the prosecution or the defense. This should be the case in all court cases, regardless of the mental state of the accused. In order to achieve this, law would have to be a non-profit enterprise. Lawyers, judges, police, and everyone else involved in the court system would have to be volunteers or subsidized by governments and non-profit organizations to earn a living wage. This may seem like “radical” idea, but it is the only way any decent measure of justice could ever widely be served.

 

 

5.18 Bipolar Disorder, ADD, Schizophrenia, Childhood Psychiatry and Anti-Psychotics

Along with most mental disorders, bipolar disorder and schizophrenia are diagnosed far too often. From 1994 to 2003, the estimated number of children diagnosed with bipolar people increased by 4000 percent in the United States according to patient records from the National Ambulatory Medical Care Survey.[ix] This is unprecedented. The number of children diagnosed with attention deficit disorder (ADD) has also risen exponentially in recent years. Children who have trouble focusing in school are often under-stimulated and lack motivation and enthusiasm from teachers. Children would also likely have less difficulty focusing if they were not bombarded with the constant stimulus of media outside of school. And children who act out for whatever reason are often pathologized in some other way by therapists who do not know how else to brand their behaviors.

Large pharmaceutical companies have no misgivings about getting kids addicted to amphetamines, bipolar drugs and antipsychotics, whether they need them or not. There are a number of moral child psychiatrists, but pharmaceutical companies influence them as well. They can assure doctors and patients a medication is safe for children when they know it is not and receive little legal recourse.

As a whole, child psychiatry may be even more corrupt than adult psychiatry because children are easier to exploit. Their opinions often matter less to doctors, parents and courts because they do not have the same legal rights as adults. Child psychiatry also has a tendency to become more punitive when the parents are abusive and dishonest. Parents are in control and they are expected to do what is best for their children, so abusive parents sometimes go undetected by therapists, teachers and judges. Abused kids are also sometimes labeled as the “problem kids,” which leads to further punishment and negative cycles of behavior.

The development of many children can sometimes look abnormal to adults. But it is helpful to be mindful of the fact that we are all on our own paths, and sometimes pitfalls and bouts of depression or rebellion can be constructive. Most phases are learning experiences that come and go. Children are still developing and their brains are vulnerable, so psychiatric medication should be a last resort in all cases. It should only be prescribed if they have been informed about it and they give consent.

There are no medical tests for schizophrenia or bipolar disorder, aside from subjective, behavioral tests, and there is not a singular organic cause for them or any mental disorder. Only one single doctor is needed to make the diagnosis, which is based on their personal biases and sometimes the opinions of other staff. This diagnosis often affects those given it for the rest of their lives. Some children have been branded as schizophrenic before they even reach ten years of age.

Because schizophrenia and bipolar disorder can produce so many different symptoms, it is possible that they are not discrete disorders but are rather several disorders or just sets of behaviors. Most people with schizophrenia have less grey matter in their brains than average persons, but this may just be due to the widespread prescription of anti-psychotics, which can substantially reduce grey matter.

Another similarity among people with schizophrenia symptoms is many have been shown to have greater spontaneous activity in the right hemisphere of their brains while people with bipolar disorder often have greater activity in the left hemisphere of their brains[x]. Superstitious people who believe in the paranormal, have strong religious beliefs or both, as well as very creative individuals usually have greater spontaneous activity in the right hemisphere of their brains. The right hemisphere favors making more “loose” connections, as opposed to the left hemisphere which makes more focused, mathematical connections. Both areas of the brain have their purpose as does magical thinking. But if a person is not grounded by a strong, scientific perception of reality, it seems that too much spontaneous activity in either hemisphere of the brain can evolve into mental disorders or personally unwanted behaviors.

Most mental institutions treat magical thinking as a symptom of mental illness. But religious beliefs are usually only considered magical thinking if they are very extreme or egocentric in nature, (e.g. beliefs about being or embodying a prophet or a God). However, when mentally troubled individuals are indoctrinated with religion, many expectedly take their beliefs to these kinds of extremes. These extremes already exist in religious literature as well, so this is not surprising. I cannot imagine why filling the heads of mental patients with more magical thinking (religious or not) would be constructive. Some religious staff and doctors make genuine efforts to introduce religion as a way to help, but it is rarely helpful in the long-term.

Schizophrenia in practice is the catchall term used for people therapists cannot otherwise label, but people who exhibit schizophrenia symptoms are all different. Schizophrenia symptoms are often caused by years of trauma and abuse, and the solutions need to be discussed with doctors, loved ones, and ideally with people who have overcome similar experiences. 

“Mania” is the symptom of bipolar disorder that separates it from depression. Mania comes from the Greek word, μανία, meaning “madness,” and it is a state of elevated energy, mood, agitation or sexual drive. Depressive episodes do not have to present with a manic episode for a diagnosis of bipolar disorder to be made, which may be another reason the diagnosis is made so often. Individuals can certainly suffer during episodes of mania and even become psychotic, but mania is not always negative because it can increase a person’s creativity and productivity and even feel euphoric. The condition itself certainly does not always require hospitalization.

Every mental disorder is unique because every person is unique, and this has to be considered by psychiatric doctors. Patients ought to be seen as distinct individuals and their needs should be most important for therapists. When there is no existing label for the symptoms therapists perceive, they often diagnosis these patients with “unspecified psychotic disorder” just to keep the patient institutionalized, medicated or both. Unspecified psychotic disorder is an extremely vague label that is unhelpful for both patients and doctors. It is considered one of the thirteen subtypes of schizophrenia. Most of the categories of mental disorders also have similar subtypes termed “not otherwise specified,” which are used when patients do not fit the exact criteria for any disorder. This demonstrates the need for a more fluid conception of mental health and disorders. People cannot be labeled and put into categories because our stages of development are all so different.

The underlying problems that cause mental disorders cannot always be identified or measured scientifically. Diseases that attack the brain like brain cancer can be, but disorders like depression are not diseases and they can be very abstract and fleeting. They do not have to be life-long. People with these disorders usually have unusual neurochemical activity, but the sources of these chemical differences can be very disparate. They can be external, inherited, or self-imposed. Identifying and discussing the sources is often very important. Many disorders are just learned behaviors, and these behaviors can be improved and “un-learned.” For patients with severe emotional and physical trauma, talking about these experiences can be more helpful than any medication.

Anti-psychotics used to “treat” schizophrenia mostly bind to dopamine receptors and interrupt signaling resulting in reduced production of dopamine. People with schizophrenia are prescribed these drugs because the dopamine hypothesis of schizophrenia speculates that schizophrenia is caused by an excess of dopamine due to signaling malfunctions triggered by environmental and genetic factors. Dopamine re-uptake inhibitors like cocaine, meth and crack have essentially the opposite effect. They bind to dopamine receptors and increase dopamine in the synapses temporarily, which produces effects that can resemble the “positive symptoms” of schizophrenia. But these drugs ultimately decrease dopamine levels when addiction sets in due to reduced signaling and loss of sensitivity to dopamine. Some dopamine reuptake inhibitors may actually have a positive long-term effect on those with schizophrenia for this reason if long-term dopamine reduction is what they need, but this is very speculative. However, this (along with the temporarily alleviating high) may be why so many schizophrenics try to self-medicate with these drugs.

Most anti-psychotics have high affinity for the D2 subtype receptor, which is one of the five major subtypes of dopamine receptors, but many anti-psychotics can also bind to other dopamine subtypes, serotonin receptors, and many other receptors, which can produce a host of side effects. They can also cause many separate mental disorders like tardive dyskinesias that cause involuntary movements, twitching and twisting of the limbs. Most of the negative symptoms of schizophrenia (like avolition, flat affect, lack of speech) seem to be caused by the very dopamine antagonists used to “treat” it, and there are many other side effects to anti-psychotics, which are far from minor. These include lowering life expectancy, weight gain, loss of motor control, decrease in white blood cell count, neuroleptic dysphoria, (unhappiness or general malaise) neuroleptic malignant syndrome, and even tardive psychosis. Chronic use of neuroleptics can also lead to neuronal death, irreversible abnormalities in brain function, and large decreases in brain volume.

Many doctors believe that schizophrenia is a neurodegenerative disorder, but this may not be the case. Most individuals with schizophrenia have decreases in brain volume, but many only receive the diagnosis of schizophrenia after having been on anti-psychotics for years. In 2010 doctors Joanna Moncrieff and Jonathan Leo analyzed data from multiple studies on the subject and found that patients diagnosed with schizophrenia in every study who had never taken anti-psychotics showed “no major differences in global cerebral, grey-matter, ventricular, or CSF (cerebrospinal fluid) volumes,” whereas patients with chronic use of anti-psychotics “showed a greater reduction in whole-brain, cortical or grey-matter volumes, or a greater increase in CSF or ventricular volumes, compared with controls” in 14 of the 26 MRI studies.[xi]

The life-time occurrence of substance abuse is about fifty percent among people diagnosed with schizophrenia[xii] and most (regardless of drug use) are prescribed anti-psychotics as well, so it is possible drugs of one form or another are the most common cause of schizophrenia symptoms. Most of the symptoms can be experienced by anyone. The symptoms of delusions and hallucinations also do not have to be present to be diagnosed with the disorder. The “positive”, “negative” and “cognitive” symptoms of schizophrenia like avolition (inability to experience pleasure), disorder of thoughts or words, blunted or flat affect (reduced emotional response), poor executive functioning, catatonia (motionlessness or excess motor activity) and movement disorders like “facial grimacing” can all be produced by certain drugs like neuroleptics and dopamine reuptake inhibitors. They can also result from depression and other mental disorders.

Drug addicts (especially stimulant addicts) and users who do not have schizophrenia are often incorrectly labeled as schizophrenic by doctors. Cocaine and amphetamine psychoses are considered separate mental disorders by the DSM. These drugs can cause severe psychosis, but it does not make much sense to identify temporary, drug-induced psychosis as a mental disorder. The DSM also classifies just about every illicit drug as a potential cause of psychosis and a “mental disorder.” Many drugs can cause psychosis but only at very high doses. Any drug can become poison at a high enough dose.  

Individuals with schizophrenia are still widely over-prescribed neuroleptics because when they are administered, patients become easier to control and subdue. Dopamine antagonists block the binding of the endogenous agonist dopamine to dopamine receptors, thereby inhibiting the signal produced by the agonist. This may have a temporary anti-psychotic or tranquilizing effect, but when administered for a long period time patients become overly sensitive to dopamine to compensate for the dulling effect of anti-psychotics. This can lead to a malady of side-effects mentioned, which are often mistaken for worsening symptoms of schizophrenia and treated by doctors with more anti-psychotics, resulting in a vicious cycle.

A number of therapists like Dr. David Healy, an Irish psychopharmacologist and author, have claimed that drug companies have tried to legitimize the dopamine hypothesis of schizophrenia (like the serotonin hypothesis of depression) in order to increase the sales of their drugs. Schizophrenia’s cause is likely more complex than drug companies would have us believe. It is a poorly understood mental disorder and the “quick-fix” of anti-psychotics will likely be seen as malpractice in the future. Electroconvulsive therapy (ECT), which is sometimes used in conjunction with anti-psychotics, will likely be seen as medieval when less dangerous therapies become more common. Yesterday’s medicines are often considered barbaric by today’s doctors, but few consider current medications and treatments may be just as primitive as our older treatments. Some individuals who have received ECT “therapy” have sued for consequent, significant brain damage and memory loss.

Before anti-psychotics were invented lobotomies were common “treatments” for schizophrenia, and they still are used when patients do not “respond” to medication. A lobotomy is a procedure in which one or more parts of the brain (usually connections to the prefrontal cortex) are destroyed by literally burning or removing them completely. The first lobotomy was conducted in 1935 and it was a very commonly used procedure for two decades in mostly developed, rich countries. By 1951, 20,000 lobotomies had been performed in the United States alone.[xiii]  

In my opinion, using a lobotomy to “cure” a mental disorder is much like trying to fix a TV set by smashing it with a hammer. It is one of the most crude, invasive and amoral procedures to ever be used as a “treatment” for a condition and it is still used today for schizophrenia, addiction and even minor mental disorders like depression and OCD, particularly in the US and the UK. The only reason lobotomies are supported by doctors is because they make patients easier to control like anti-psychotics.

In 1948 MIT professor and author, Norbert Weiner, explained “Prefrontal lobotomy… has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier.” The most upsetting aspect of lobotomies is that victims may never know how they were affected by them. They might feel fine despite being drastically different, less intelligent and suffering a host of other side-effects.

5.19 Rethinking Mental Disorders, Brain Diseases and their Relationship with Bodily Diseases

The mental health industry pathologizes not only normal human differences, but also normal human emotions. However, it is not sensible or realistic to only expect to experience consistent emotions and never act irrationally since the world is not always sensible or rational. If we never question ourselves and attempt to understand why we are who we are and instead we just do what is most commonly accepted, we become complicit to the agendas of the institutions that control us.

Differences in animals further evolution. Those most fit for their environments survive. But we have left it up to people in power to decide which differences are beneficial, and they thereby have the power to direct the course of our evolution. They select what they perceive as “natural” behaviors and weed out the extremes while significantly changing our environments.

In my opinion, real mental health can only be achieved by being fully in tune with the irrationality, harshness, and uncertainty in life, and not accepting easy answers. A healthy life includes a gamut of emotions, the pursuit of meaningful goals while having the ability to achieve balance. Generally, such people who are in tune with these unpleasant realities tend to act more uncommonly. But the most common behaviors are not always the most socially or environmentally productive behaviors. When there are fewer human extremes and more uniformity in personality and identity, fewer people feel as stimulated to change and improve.

Defining a mental disorder is difficult because mental health is subjective. Most mental disorders are not like illnesses that affect other parts of the body like viral infections or cancer, which can be physically seen and treated often using the same medications time and time again. Sometimes changes and abnormalities in the brain can be seen by using fMRIs, brain scans or microdialysis, but these technologies only provide a glimpse into an individual’s mental health.

Bodily illnesses like cancer cannot be treated with cognitive behavioral therapy (CBT) or by “thinking them away.” They are identified and diagnosed using medical instruments while mental disorders are not. A perfectly healthy, “sane” individual can fake the symptoms of any mental disorder and be admitted for life. But a person cannot “fake” high cholesterol or cancer. Most individuals with depression and other common disorders don’t receive tests to determine which neurotransmitters are too abundant or scarce or which receptors are overactive. Very unusual results alone are not enough to make a diagnosis anyway. Doctors cannot know exactly what is wrong (if anything) without talking to their patients extensively. The brain is just too complex for mental health to be summed up entirely by either current hard science or observational theory alone.

Therapists cannot view psychiatry as a way to “fix” minds. Almost all brain abnormalities are considered diseases. But it only makes sense to classify an abnormality as a disorder if it interferes with the quality of life of the patient. Diagnosing a person with a mental disorder in order to describe a vague and broad set of observed behaviors and symptoms oversimplifies the human mind and the person being observed. Psychiatry should only be seen as a way to create health, as opposed to an approach to cure individuals because helpful strategies can be dynamic, abstract and different for everyone.

There is too much focus on the diagnosis of mental disorders rather than the reason for the diagnosis. Diagnoses of mental disorders stigmatize certain behaviors. They make those who are diagnosed overly aware of them, but behaviors are not the sole problems, just as drugs are not the sole problem for addicts. They are coping mechanisms. Until the causes of mental disorders in each specific case are addressed, the sufferers can only mask their symptoms or tone them down but not achieve real peace of mind.

Although mental disorders are sets of cognitive and physical behaviors, this does not mean they are all voluntary or always voluntary. Some are hard to control; some are easier to control, and some are impossible to control. But they are all just behaviors in the sense that they do not infect people. Someone diagnosed with depression is not “sick” with depression. The underlying neuronal components to depression are numerous and highly variable. A person could just look up that the sky and observe the universe and all of a sudden feel very alone. It doesn’t make sense to classify such transient moments as mental disorders.

The pathologizing of normal human differences in psychiatry today can seriously hinder the minds of brilliant people. For example, creative geniuses can have “schizoid” personalities that make their everyday functioning difficult, but their avoidance of social interaction and potential external criticism can also help them create brilliant works. While a lifestyle choice of isolation may not be very healthy nor enjoyable, it is ultimately a choice. “Schizoid” people can still positively affect other people to a great extent.

Positive and negative outliers can teach us the most about what makes people be perceived as good or bad and strange or normal. They can be a product of social constructs or other underlying, broader problems and recognizing these can help influence the most common behaviors. Positive and negative habits, lifestyles and personal traits, unwanted and wanted, are too often grouped together and labeled as distinct mental illnesses. But many are just changeable behaviors.

Social withdrawal, high sensitivity, and introversion are all symptoms of “schizoid personality disorder”. But these can be healthy qualities. They are traits only a minority has, but this doesn’t mean they are always detrimental. Dr. Nancy McWilliams wrote, “one reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority.”[xiv] This is accurate and unfortunately, normal behavior right now, for the most part, is not very positive.

People can be diagnosed as “schizoid” without determining whether or not they prefer this lifestyle, but this doesn’t make any sense. Having an active social life may be more healthy and enjoyable for most, but a person can also have many friends and still feel very alone. (Patient needs cannot always be determined only by what is made most evident.) Short periods of isolation can be very beneficial for most people. If we are constantly stimulated by other people, we will have little time to reflect and look inside ourselves and develop very unique identities. However, the regular stimulus of other people can also be grounding and comforting. The point being we are all at different stages of development. Some need more time by themselves than others and some need or thrive from constant interaction, but no one lifestyle should be seen as the only healthy one. Lifestyles and behaviors also constantly change. One day a person may feel like an introverted hermit and the next feel like a convivial extrovert. Stigmatized or pejorative labels for behaviors can prevent people from improving their habits and lifestyles. These labels can make us believe that we are not capable of changing ourselves, but we can in most cases.

One of the symptoms of the many mental disorders defined by the DSM is literally “unconventional beliefs” that go against “societal norms.” If unconventional beliefs are symptomatic of mental disorders, then every brilliant thinker who challenged societal norms should be considered ill. Einstein or Copernicus could be perceived as having been “ill.” (Many dogmatic people likely did them see this way.) Unconventional beliefs are what change conventional beliefs. Without them, society would never change. As Karl Marx said, “the ideas of the ruling class are in every epoch the ruling ideas,” and this only keeps the ruling class in power. We should not assume that society will head in the right direction by conforming to societal norms that were created by a small group of people who never had public interest in mind. The forces that control us define what’s normal. We do not collectively, but we certainly could.

The spectrum approach to mental disorders attempts to explain a broader variety behaviors and symptoms that can overlap. Because people with bipolar disorder, for example, are very different, a spectrum is used to describe more traits as bipolar. The word spectrum is better suited to describe mental health. Narrowly defined labels, on the other hand, often just push people to stretch the limits of what is expected from them, and unwanted behaviors can worsen and become more frequent.

Another problem with traditional psychiatry is the approach, which can be likened to the uncertainty principle of quantum mechanics. This principle states that a light is needed to measure a particle’s position and velocity, but by measuring a particle with that light, the outcome changes. Similarly, doctors change the outcome (the patient behavior) by observing it. Knowing your behavior is being analyzed (especially if you are insecure about your behaviors) often leads to paranoia and anxiety and can be used to validate pre-existing concerns doctors have, and ostensibly symptoms can worsen across the board as a result. Patients need to feel they are under no pressure, which is nearly impossible for any patient involuntarily committed. Even those admitted voluntarily are under the same amount of scrutiny.

I believe modern psychoanalysis is also flawed because it is not intended to be a natural conversation, but more like an interview or an interrogation at a court room. It is very one-sided. It can be accusatory, demeaning, and condemning of perceived behaviors and thoughts. It is also not an equal trade. Many therapists do not exchange anything personal about themselves. They believe they should be “neutral parties” who are not emotionally invested, but as a human being it is impossible to be completely neutral. You can strive for to be as objective as possible, but personal biases inevitably affect diagnoses and their treatments, which is why they should be made open to patients. I believe it is incredibly important to know who your therapist is and what you have in common in order to establish trust and a beneficial therapist-patient relationship.

Michael Foucault, a notable critic of psychiatry and mental institutions argued that the mental asylum is “not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned.” Punishment is still such an often used tool in psychiatric institutions.

When certain patients have delusions, doctors often provoke them by asking questions that make them expand on their delusions.  They provoke them to be more irrational and delusional, instead of asking why they believe in what they do and trying to help them adopt a more scientific perspective of the world. Therapists often make patients incriminate themselves by admitting to violent or sexual thoughts or urges they have. This information is sometimes used against them in court, instead of being used to help control or curb negative urges or thoughts. Patients in mental hospitals should not have to worry about self-incrimination in their sessions because crime is not prevented by betraying the trust of patients.

Overall, there is far too much law involved in psychiatry. Mental hospitals feel it is necessary for liability reasons to monitor and record all of their patients. The job of therapists is to get in their patients’ heads by using in-depth psychoanalysis, so it is understandable why some patients believe doctors have literally “entered their heads” with recording equipment or that their thoughts are being “broadcast.” Paranoid delusions and many symptoms of mental disorders are often created by mental institutions because patients have every reason to be paranoid or afraid. Some may develop irrational fears but usually because of very real dangers and intrusions. Many mental institutions are not safe places. Patients can be abused by the staff and other patients. But doctors define what constitutes paranoia and which fears are irrational or rational, as well as what is true and false. Patients are almost always considered less “reliable.”

One common symptom of schizophrenia is “delusions of grandeur,” which are delusions of having extreme personal significance. These can be brought on by mental hospitals when they treat mental patients so differently than other people. Therapists in mental hospitals assume these roles as superior caretakers who decide their patients’ fates, much like prison wardens. Some of them assume these positions because they are narcissistic and power-hungry or they have what could be called delusions of grandeur.

Formally educated therapists in the Western hemisphere go to school to learn about traditional psychology, psychiatry and basic medicine, but there is no requirement to learn about different ideologies, cultures and the psychology of these people. This makes it difficult for some to understand those who have lived extremely different lives. Their conception of normative psychology is too limited. For example, a happy, rich, Harvard graduates who has never had any major mental problems is not likely to understand (much less relate to) an institutionalized, crack addict diagnosed with schizophrenia and PTSD. The two individuals would not likely have much common ground, but the therapist may say the patient has delusions of grandeur if he ever insinuates to know more about his own disorder.

In an ideal mental facility or community patients would not be constantly monitored, dehumanized and they would be allowed more personal space. Doctors and nurses could be monitored the most by independent agencies and patient advocacy groups to prevent abuse. There would be a greater focus on the improvement of interpersonal skills and relationships, and doctors would actually listen to patients and try to learn from them. Patients could also be offered a variety of courses on a range of subjects to facilitate independence.

Perhaps most importantly, no one should ever be held against their will if they have not committed a crime, (even if they are suicidal, because everyone has the right to choose to live and die) and patients should have the same Miranda rights (right to free counsel, right to remain silent and so on) that suspects of crimes have immediately when admitted involuntarily or even voluntarily for an evaluation. If patients feel they are being persecuted and doctors are not listening, they have every right to remain silent.

How a defendant’s disorder developed should matter in court as well. If a person was physically unable to control him or herself, cannot remember the episode or was experiencing a hallucination and had no criminal intent, these factors should lessen or eliminate culpability, depending on the circumstances. However, because “insanity” is often defined purely by the perceived senselessness of crimes and not on the mental and physical state of those accused, many people are wrongly labeled insane. People are capable of doing extremely sadistic, violent and cruel things without being at all psychotic.

A complete overhaul of the mental health sector is necessary. It would function best as a not-for-profit sector that used very open-minded, patient-driven approaches that allow for all different types of people to prosper and grow based on their own wants and needs.

 

 


[i] Grohl, John M., Psy. D: Top 25 Psychiatric Medication Prescriptions in 2011. 2012. <http://psychcentral.com/lib/2012/top-25-psychiatric-medication-prescriptions-for-2011/&gt;

[ii] Labaton, Stephen: “Generic-Drug Maker Agrees to Settlement in Price Fixing Case.” New York Times, July 13 2000. Print.

[iii] Laura A. Pratt, Ph.D., et al. NCHS Data Brief: Antidepressant Use in Persons Aged 12 and Over: United States, 2005-2008. October 2011.

[v] Ellsworth Fersch: “Thinking About the Insanity Defense,” 2010. Pg. 12. Print.

[vi] Canter, David: A Very Short Introduction to Forensic Psychology 2010. Pg. 7. Print.

[vii] Findlaw.org: “The Insanity Defense Among the States.” 2013. Thompson Reuters. Online.

[viii] Jeffrey Rosen: “The Brain on the Stand.” New York Times. March 11, 2007. Pg 13. Print.

[ix] Moreno C. et al. National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth. NCBI. <Pubmed.gov> September 2007. Print.

[x] News-Medical.net: “Psychosis Pathophysiology.” Retrieved June 21st 2013. Online.

[xi] Joanna Moncrieff and Jonathan Leo: “A Systematic Review of the Effects of Antipsychotic Drugs on Brain Volume.” Psychological Medicine, September, 2010.

[xii] Brady, KT. and Sinha R.: Review of Co-occurring Mental and Substance Abuse Disorders: The Neurobiological Effects of Constant Stress. AM J Psychiatry, August 2005

[xiii] Hornstein, Gail A.: To Redeem One Person Is to Redeem the World: A Life of Reida Fromm-Reichmann. Simon and Schuster, January 10 2002. Print.

[xiv] Mcwilliams: Psychoanalytic Diagnosis, Second Edition: Understanding Personality. (The Guilford Press, 2011) Pg. 196. Print.

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8 responses to “Book Excerpts 5.12-5.21: The Mental “Health” Industry

  1. You can definitely see your enthusiasm within the work you write. The sector hopes for more passionate writers like you who are not afraid to say how they believe. At all times go after your heart.

    • VERY INTERESTING QUESTION!I have wondered the same thing as my bipalor is clearly a medical issue and I respond well and quickly to medication. “Therapy” would do me absolutely no good since the problem is clearly chemical. Not only that, but the mood stabilizer I take is also used to treat epilepsy as well (and was originally designed to treat it)So… why the distinction between the two, since they both involve the brain? Oh, and MRIs of Schizophrenic patients DO show abnormalities, so I don’t understand why it’s not considered a brain disease, rather than a mental disorder. Again, very interesting question and one I have been meaning to ask myself because of the stigma of mental illness. Why not epilepsy too? Some forms of epilepsy include seizures that disorient the individual (no convulsions, just staring into space) and cause mood changes as well. There are so many different types of seizures, yet they are not considered a mental illness. +5

  2. Interesting article. Yesterday I’ve read very intriguing text in NYTimes about companies which are starting to realize productivity can be better if employees don’t have to take phones when they go out from work and not burn out from being on call. The text is available on the NYT website http://www.nytimes.com/2012/07/14/your-money/companies-see-benefit-of-time-away-from-mobile-devices.html?_r=1&pagewanted=all. Quite exciting article for people interested in psychology.

    • Non of us can answer that. It’s ideal to ring the pharmacist and just ask him over the phone.I suspect they would say it’s not safe.the truth is that there really are not good meds to treat anxiety and I dont’ blame her for doing this cause she’s probably already figured out that anti-depressants are good to treat depression but they don’t really help ppl with anxiety and I dont’ care what ppl say cause I know cause I’ve tried many. I’ll be honest with you I’ve had anxiety/panic disorder for many years now and I’ve tried many meds and I’ve seen many therapists and I’m still trying to live with this panic disorder. I’ve wondered many times if perhaps schizophrenia meds could help somone with anxiety cause sometimes I feel like I’m hallucinating the fear and I feel like I’m psychotic. Anxiety disorder is a horrible mental illness and those of us that have it are desperate to get well and try anything just to get our life back and not live in fear anymore.

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