Madness about Madness

Back in the day, before psychiatrists could offer effective medical treatments for psychosis, patients suffering from paranoia and schizophrenia committed horrific acts of violence, against themselves and others. They were often locked up in psychiatric hospitals, discarded as hopeless cases.

With the advent of neuroleptic medication and tricyclic antidepressants, the incidence of violence dropped significantly and many of these patients were capable of living outside of the hospital. Later medications have improved their chances.

While it is certainly true that these patients can also profit from coaching, they cannot be helped by talk psychotherapy. Recent research has shown that they are suffering from a brain disease and that the disease must be treated with medication.

Back in the day, R. D. Laing and David Cooper launched an anti-psychiatry movement that encouraged patients not to take their medication. Laing and Cooper believed that psychotics were trying to speak truths that the capitalist imperialist colonialist powers wanted to suppress.

It was appalling and irresponsible. Psychotics do not need to be encouraged to believe that they have a special access to a higher truth. They do not need to be told that God is speaking to them and through them. They do not need to hear, from a medical authority, that medication will only compromise their access to God. And yet, that is what the anti-psychiatrists were telling them, often to their detriment.

At one French psychiatric clinic in the 1970s, a place called La Borde, where no less than David Cooper himself was in residence, the director of the clinic, Dr. Jean Oury, began one of his famed lectures one day by saying: Anti-psychiatry just killed one of my patients. 

Apparently, the patient had been lured by anti-psychiatry into refusing his medication. He ended up committing suicide. In the days before the new medications were available this was not a rare occurrence at La Borde.

You would have thought that medical science would have buried the anti-psychiatry. And yet, like Lazarus, it is rising from the dead… and this is bad news for psychotics and for the society at large.

Now, a bright-eyed and bushy-tailed young psychiatrist named Irene Hurford has written a column for the New York Times where she asserts, based on nothing more than what appears to be her superior capacity for empathy, that psychotics live in an alternative reality. Scrupulously ignoring science, Hurford asks what gives us the right to decide that their reality is less valid than ours. (Via Dr. Joy Bliss, of Maggie’s Farm)

If you did not know that this was coming, you haven’t been paying attention. The culture has already accepted that for certain psychiatric patients, their belief about their own gender trumps their biological gender. In the past this would have been called a delusional belief. Now it is a higher truth that you can only question at your own peril. 

The same applies to people who hold the delusional belief that one of their legs is 6 inches longer than the other. When they insist on having the offending leg amputated, they do find surgeons who will perform the surgery and advocates who will defend their right to it. Would Hurford say that their alternate reality is just as valid as anyone else’s?

Hurford believes that psychotics merely see reality differently. In her words:

Psychosis refers to an experience of reality that is fundamentally different from the reality of others. As doctors, we expect those with psychosis to realize that their reality is false, and to agree that they need treatment. Perhaps unsurprisingly, they often don’t, exhibiting what we refer to as “lack of insight.”

If, however, lack of insight is defined as a failure to accept an alternative view of reality, then do the rest of us lack insight, too?

The assumption that someone else’s reality is invalid can foster distrust; it sends the message that we don’t respect this person’s experience of his or her own life. Many people who have been in the mental health system describe themselves as “survivors” — not of mental illness, but of treatment.

For all I know, some psychiatrists call psychosis a lack of insight. But, to be perfectly serious, when someone tells you that Moses or Napoleon has been telling him to shoot up a school or to jump off a cliff… the term “lack of insight” does not really do it justice.

Moreover, at a time when we ought to be questioning our failure to commit dangerous schizophrenics against their will—think Adam Lanza, Jared Loughner and James Holmes—lest they commit mass murder, it is not helpful for a physician to suggest that we ought to be LESS willing to impose treatment on people who do not want it. Sufferers from the brain disease called psychosis cannot exercise free will.

Appallingly, Hurford does not understand that her own position will encourage psychotics to refuse treatment. It is grossly irresponsible.

The best response to Hurford’s article was written by mental health advocate D. J. Jaffe for the City Journal. While City Journal tends to be a more conservative publication, Jaffe also blogs for the Huffington Post. That covers all the bases.

Jaffe makes the case against Hurford:

When Mary Barksdale’s son was psychotic and untreated, he killed two police officers because he thought they were aliens from outer space. Mark Becker was also psychotic and untreated. He thought his football coach was Satan so he killed him. Russell Weston Jr. wasn’t forced into treatment. He killed two U.S. Capitol Police officers in Washington, D.C., in order to get at a time machine he “knew” was hidden in the Capitol basement.

These individuals weren’t exercising free will; they had serious mental illnesses that kept them from doing so. The organ charged with regulating their behavior was damaged. The mental-health system should have stepped in to help them before they hurt themselves and others. If necessary, that help should have been given over the patient’s objections. But a system that should offer treatment before tragedy has instead made tragedy a prerequisite for treatment. There are now 140,000 seriously mentally ill Americans living on the streets, 365,000 in jails and prisons, and 770,000 on probation or parole. More than 5,000 seriously mentally-ill people kill themselves every year. Common sense dictates that we should provide a path to treatment, but there isn’t much common sense in the $147 billion mental-health system. 

Of course, Hurford was being politically correct. She was offering up a dogma, not the truth about severe mental illness.

Jaffe is appalled:

Hurford, like many in the mental-health industry, minimizes an association between mental illness and violence. That’s ridiculous. If there is no association, then why do hospital psychiatric units have doors that lock while cardiac units don’t? Why do nurses in psychiatric units have to wear panic buttons, while those in cancer units don’t? Why are police called to restrain people with untreated, serious mental illness, but not those with untreated psoriasis? Pretending there is no association between untreated serious mental illness and violence is delusional, dangerous, and cruel to those who could benefit from treatment. While the mentally ill and the seriously mentally ill are no more violent than others, research clearly shows the untreated seriously ill are more violent than others. Political correctness may require denial of the association, but reality doth protest.