Wall Street Journal article
There are often stories I want to read in the WSJ, but they don’t post things online. Today I got the following story forwarded to me from Mind Freedom International, and I’d like to be able to verify it ran exactly as presented below. But I can’t because the subscription would run me $99, and I’m not even a Republican!
The issue the article examines—whether mentally ill people should be forced to take medication if they’re considered violent—is probably the most important debate being argued today. It gets to the root of what we mean by “mentally ill,” and what we want to do about it.
Let’s try to start a dialogue about this, kindly blog readers. I’m going to my psychiatrist appointment right now (ironically enough), but I’ll be back at 4:30. That gives you plenty of time to read, absorb and post comments. I know you can do it!
[Note: Mind Freedom is an organzation composed of both consumers and non-consumers. The WSJ got that wrong.]
February 1, 2006 Page A1
Mr. Hadd Goes Underground
By MARK FRITZ
Staff Reporter of THE WALL STREET JOURNAL
Every other week, Jeff Demann drives to
a clinic in rural Michigan, drops his
pants and gets a shot of an
antipsychotic drug that he says makes
him sick.
“If I don’t show up, the cops show up
at my door and I wind up in a mental
ward,” says the unemployed 44-year-old,
who lives on disability in Holland, Mich.
Mr. Demann’s routine reflects a
national trend toward forcing people
with psychotic tendencies to get
treatment — even if they haven’t
committed violent acts. Driving the
trend are E. Fuller Torrey, a
68-year-old maverick psychiatrist who
believes the laws help prevent crime,
and memorabilia mogul Ted Stanley, who
has contributed millions of dollars to
the cause.
Dr. Torrey keeps an online database
with hundreds of grisly anecdotes about
mentally ill people who killed the
innocent. They include a jobless
drifter who pushed an aspiring
screenwriter in front of a subway train
and a farmer who shot a 19-year-old
receptionist to death. Influenced by
such stories, Michigan, New York,
Florida and California are among the
states that have toughened their
mental-health treatment laws since
1998, when Dr. Torrey formed the
Treatment Advocacy Center to lobby for
forced care.
The laws have become the subject of a
heated debate among mental-health
specialists, with some seeing a threat
to civil rights. “There should be a
high standard before you take someone
else’s liberty,” says Tammy Seltzer,
senior staff attorney for the Bazelon
Center for Mental Health Law, a Florida
nonprofit group that has fought the
Treatment Advocacy Center in
statehouses nationwide. Others say the
connection between mental illness and
violence isn’t as well-established as
Dr. Torrey’s anecdotes imply.
Mary Zdanowicz, executive director of
Dr. Torrey’s center, retorts that such
opponents “want to preserve a person’s
right to be psychotic.”
It has long been common for states to
compel people to undergo psychiatric
evaluation after they have committed
acts of violence. If mental illness is
confirmed, they are likely to end up in
the psychiatric ward of a prison or
hospital.
Dr. Torrey was a key adviser to the
National Alliance on Mental Illness
when it began lobbying in the early
1980s for laws that would permit states
to impose treatment on people even if
they hadn’t done something violent. The
number of states to adopt such laws has
jumped from 25 in 1998 — when Dr.
Torrey and Mr. Stanley created their
own, more aggressive organization — to
42 currently. Those targeted by the laws
usually are people picked up for
behaving strangely in public,
threatening family members, or refusing
to take prescribed medication after
being released from a psychiatric ward.
The laws are enforced haphazardly,
sometimes because of inadequate funding
or opposition from mental-health
activists. Implementation varies not
just from state to state, but from
county to county and judge to judge.
Many mental-health departments already
are overburdened with existing patients
and have little interest in pushing
police to round up more people to throw
into the system.
It isn’t clear whether the laws have
led to an increase in the number of
people receiving forced care. Roughly
250,000 people in 1997 who weren’t
institutionalized or jailed were
forcibly evaluated, monitored and
sometimes medicated, according to
federal statistics. Federal health
officials have begun a six-month study
to update that figure.
California passed a forced-treatment
law in 2003 after Dr. Torrey’s group
pushed for it but has yet to use it on
anyone. Researchers say only about
eight to 10 states frequently use their
laws. Still, it is clear that Dr.
Torrey’s movement marks a shift in how
the U.S. treats the mentally ill.
Beginning in the 1950s, the emergence
of behavior-stabilizing medications
helped spur a 40-year movement to shut
down huge asylums and free their
inhabitants. Emptying institutions was
supposed to be accompanied by the
creation of community-based
mental-health programs, treatment
centers, and housing and job
opportunities.
But local programs didn’t have the
money, political will or expertise to
handle the deluge. The result was a
flood of mentally ill people on the
streets and in jails.
In recent years, governments have spent
more on community-based programs and a
raft of new antipsychotic drugs have
come on the market. Still, many
mentally ill go without care, either
because there isn’t a program to treat
them or because they don’t want help.
Dr. Torrey, whose sister suffers from
schizophrenia, was working as a
psychiatrist at St. Elizabeth’s
Hospital in Washington, D.C., in the
1970s when the district enacted one of
the earliest involuntary outpatient
programs. Before the law, patients were
discharged dozens of times with
medication, which they quickly threw
away, Dr. Torrey says. With the law, he
says, “we would have guys come in for an
injection.”
The author of 15 books and hundreds of
papers, Dr. Torrey was an assistant to
the director for the National Institute
of Mental Health and worked at a
mental-health clinic for the homeless
for 15 years. He is well-known in
psychiatry for his iconoclastic views
on a range of subjects. He has
theorized that schizophrenia is an
infectious disease triggered by
environmental factors.
One of Dr. Torrey’s books on
schizophrenia caught the eye of a
wealthy businessman, Ted Stanley, whose
son, Jonathan, became delusional during
college and later was diagnosed with
bipolar disease.
Jonathan Stanley says he accosted
people on the street and believed he
was being trailed by Naval
Intelligence. He says he was arrested
when he stood naked atop a milk crate
in a Manhattan diner, trying to avoid
the lethal radiation he thought was
bombarding him from a satellite dish
across the street.
The elder Mr. Stanley contacted Dr.
Torrey in 1989 and ultimately opened
his checkbook to create the Stanley
Medical Research Institute in Bethesda,
Md. “He said he’d like to help,” Dr.
Torrey recalls. “He said: ‘We thought
we would start with a million dollars
– a year.’ ”
Mr. Stanley, 74, runs MBI Inc., a
Connecticut seller of collectible and
commemorative books, coins, figurines
and other memorabilia. Its units
include the Danbury Mint. Since the
1980s, Mr. Stanley says he has donated
nearly $300 million — including about
$35 million in 2005 — to Dr. Torrey’s
efforts, the bulk of it for research at
universities and start-up drug companies.
Targeting State Laws
In 1998, Dr. Torrey and the Stanleys
decided to target state laws that they
believed had gone too far in
guaranteeing rights for the mentally
unstable. They founded the Treatment
Advocacy Center in Arlington, Va. Mr.
Stanley and his wife, Vada, support it
with about $600,000 a year. In many
states, the center and its allies try
to put a face on a proposed law and
link it to a grieving family.
Dr. Torrey says the laws are aimed at a
minority of mentally ill who refuse to
take medication. Some believe they
aren’t sick at all. Others agree they
have problems but believe the downside
of taking drugs outweighs the benefit
because the drugs can have serious
mental and physical side effects. Dr.
Torrey says failing to control
psychotic tendencies can be dangerous.
“I catch heat for linking violence with
mental illness. This is about as
politically incorrect as you can get,”
he says at his office in Bethesda.
The center soon zeroed in on New York.
Some mental-health professionals had
been lobbying unsuccessfully for a
decade to enact a forced-treatment law.
Then came the death of Kendra Webdale, a
32-year-old receptionist and aspiring
screenwriter.
On Jan. 3, 1999, Andrew Goldstein, a
jobless college dropout, pushed Ms.
Webdale in front of a Manhattan subway
train. The 29-year-old Mr. Goldstein,
who had a history of schizophrenia and
violent assaults, blamed his illness
and failure to get medication. Amid a
public uproar, New York Attorney
General Eliot Spitzer contacted the
Treatment Advocacy Center for help in
drafting a response.
Less than a month later, Mr. Spitzer
announced his support for “Kendra’s
Law.” The law allowed the state to
force outpatient treatment on people if
they were judged a potential danger to
themselves or others. At a news
conference, the attorney general
introduced a man who had come to grips
with his illness and his denial of it,
received treatment and gone back to
school. He now was a lawyer for the
Treatment Advocacy Center.
“I am Jonathan Stanley and I’m one of
the people this law was designed to
help,” the younger Mr. Stanley said.
Seven months after the slaying the New
York state legislature passed “Kendra’s
Law,” allocating $52 million to finance
it. In a nod to opponents, the law was
subject for renewal in five years.
From 1999 to 2004, more than 10,000
people were investigated for acting
strangely, most of them in New York
City, with nearly 4,000 forced into
outpatient treatment.
Sharp Differences
When New York’s law was up for renewal
last year, there were sharp differences
over whether it was a success. A state
report said the law led to a drop in
homelessness and arrests among those
receiving forced treatment. John A.
Gresham of New York Lawyers for the
Public Interest says the law was
applied unfairly, with a
disproportionate number of
African-Americans forced into care.
As they have elsewhere, opponents said
the money would be better spent on
those who are seeking care, not
refusing it. New York state lawmakers
extended “Kendra’s Law” for another
five years.
In Michigan, Dr. Torrey’s group
enlisted the aid of the parents of
24-year-old Kevin Heisinger, a college
student beaten to death in 2000 at a
Kalamazoo bus station by a Vietnam
veteran with a history of
schizophrenia. A year later a proposed
“Kevin’s Law” was unveiled.
In Florida, the group teamed with the
Seminole County sheriff after a plumber
who was diagnosed as mentally ill
wounded two deputies in 1998 and shot
another to death. They quickly won the
lobbying clout of the Florida Sheriff’s
Association.
In California, a law backed by the
Treatment Advocacy Center passed the
Assembly in 2000 but was rejected by
the Senate. Then on Jan. 10, 2001, a
deranged catfish farmer went on a
rampage in a small Northern California
town, killing three people and igniting
public outrage. Backers reintroduced the
legislation as “Laura’s Law,” after
19-year-old Laura Wilcox, the youngest
of the victims.
“We added a face to this issue and we
may have been instrumental in getting
it passed,” says Laura’s father, Nick
Wilcox.
California lawmakers hired Rand Corp.
to study pre-emptive outpatient
treatment in other places. The research
group said there was little evidence the
idea worked, although the reasons
varied. In some cases laws weren’t
enforced. Rand also said some
mental-health facilities saw the laws
mainly as a liability shield rather
than as a therapeutic tool. By signing
up a mentally ill person for forced
care after discharge, the facilities
could protect themselves against
lawsuits by anyone the ill person might
injure.
Ultimately, California in 2003 passed
“Laura’s Law.” But the nation’s largest
state allocated no money and forbade
counties from shifting resources from
other mental-health programs. The law
has yet to be used. In 2004, California
voters approved a 1% tax on people with
incomes of at least $1 million to be
used for mental-health programs, and
Dr. Torrey’s group wants to see some of
that go for Laura’s Law.
Michigan and Florida experienced
similar battles. Their laws didn’t go
into effect until last year. Florida
has only had about a dozen cases of
involuntary outpatient commitments,
says John Petrila, chairman of the
Department of Mental Health Law &
Policy at the Florida Mental Health
Institute.
Still, the laws are having an effect on
some people. Gabriel Hadd, a 26-year-old
unemployed musician from Saginaw, Mich.,
was diagnosed as schizophrenic. He says
he has been repeatedly forced to take
drugs he believes do more harm than
good.
Mr. Hadd spent part of the past year
hiding out in the home of a Colorado
woman who is part of an underground
network of mentally ill activists. The
program was set up in late 2004 by
MindFreedom International, an Oregon
organization of 10,000 mentally ill
people that opposes coerced drug
treatment.
Mr. Hadd says his mother falsely
accused him of threatening to commit a
violent crime. She couldn’t be located
for comment. “They can accuse you of
all sorts of things,” Mr. Hadd says. “I
was in a courtroom, drooling and
twitching from the drugs.” He recently
slipped back in Michigan and says he is
trying to maintain a low profile.
T.J. Bucholz, a spokesman for
Michigan’s Department of Community
Health, says data on the program’s use
aren’t available yet but anecdotally
counties and judges seem to be using it
sparingly. “The law has not been used
maybe as much as we anticipated,” he
says.
Mr. Demann, the 44-year-old Holland,
Mich., man, says he has been in and out
of institutions since 1987. That is when
he was diagnosed as schizophrenic after
he broke up with his girlfriend and
accidentally overdosed on her
antianxiety pills, he says.
Branded as suicidal yet constantly
refusing medication, Mr. Demann says
mental-health authorities are forcing
him to take a drug, Risperdal, that he
says causes him to be moody, angry,
restless and depressed. The U.S. Food
and Drug Administration in 2004 found
that Risperdal and some other
antipsychotic drugs can increase the
incidence of diabetes. Mr. Demann
agrees he needs therapy but doesn’t
want drugs.
“I don’t believe in putting this stuff
into my body,” Mr. Demann says. “It’s
time for the system to let me go.”
liz | 2:53 PM | Uncategorized
you are right. this is important. and my thoughts are that this practice can verge on outright discrimination. among other problems.
This is one of the most biased articles I have ever read. First, these laws have many many due process protections, including requirements that a dctor testify and that the person who is the subject of te hearing have a legal representative. Second, they are only meant to help the SMALL group of people with the most severe mental illnesses who have a history of hospitalization and about 9 other restrictions. Third, the actual research and data shows that these laws work extremely well. (Look at the website of the NY Office of Mental Health.) FYI, the people they would most help will not be able to join the conversation here – they are psychotic and lost to homelessness or prison. The people from Mindfreedom should support these laws because they actually FREE people from psychosis.
The unfortunate thing about medicine is that no one knows how you might react to it. when I was on Risperdal (I called them razor dolls), it made me feel worse. But I was in frequent contact with good doctors who listened and tried something else. It took years.
But for people who are just put through the system because of something they did or not, they get put on some kind of med that may help or make them feel worse. But they are just discharged as if that solves the problem. It doesn’t even come close.
People who are mentally ill need intervention, but it can’t stop at a prescription. It requires a commitment from the health professional to make sure that things are actually better. Who would stay on something that made them feel even worse.
I don’t know. Something’s gotta change.
I can’t help wonder if TAC’s message only achieves two things: 1) Further restrict the rights of mental health consumers and 2) Promote the
misguided belief that persons with a mental illness are inherently violent. This is a belief that has increased over the years despite a
RAND study that mental health consumers are no more violent then non-consumers and other studies which have shown the people with a mental illness are more likely to be victims of violence then
perpetrators of it.
Regardless, the press seems to love focusing on violent acts committed by persons with a mental illness. One need only search on the phrase
“mental illness” on google news, sort by date, and read what is returned.
Regrettably, violence is the trump card of mental illness. The notion of millions of “crazies” running through the streets is catchy but not reality. I have plenty of peers who are disabled by a mental illness and on the whole they are tractable, compliant, and meek. After all, these are considered virtues among too many mental health professionals and the programs they operate. The worst thing a consumer can do is “act-out” (often simply asserting oneself or even gesticulation) which is a term only used to describe the behavior of children and adults with a mental illness.
I drove a guy home this week who was clearly suffering from schizophrenia. He’s on plenty of medication including injectable Haldol (a.k.a. polypharmacy). He told me that when the police come to pick him (a.k.a. outreach) he always resists. Now everyone knows resisting the police is frankly stupid but this is his M.O. They always prevail; he always goes to the hospital but his actions are hardly emblematic of consumers as a whole. His behavior might be understandable, not justifiable, to anyone who has spent time in a psychiatric hospital where care might be limited to the therapeutic milieu, cold turkey smoking cessation, medication, and perhaps a daily session of bingo for ice cream (a.k.a. comprehensive recovery oriented care in accordance with best practices using the team approach.)
I know another consumer who thinks about stopping her medication. To the best of my knowledge she has never committed a violent act on or off her
medication. Medication simply did not provide her with entry to the life portrayed by pharmaceutical companies. She has every right to feel depressed (a.k.a. a sub-optimal functional and symptomatic outcome.)
I’m not saying that medication can’t help. In some cases inspiring stores ensue but no matter how you cut it if the high point of your life is going to the drop-in center or the day program and you have
never been to a party other than one with really large bottles of generic soda and generic potato chips or you have been received the “Prophecy of Doom,” too sick for too long to get any better. No amount of medication is going to hug you when you are cold, encourage you when you feel absolutely hopeless, or befriend you when you are all alone.
Thanks for taking an interest in this article and for contributing to a debate on the subject of forced psychiatric treatment. In my experience this is a complicated and contenious issue that people always seem to have very strong opinions about, so it is sometimes unpleasant for people to consider veiws that may be different from their own. I am always grateful for an opportunity to engage in balanced dialog or debate.
In response to the post made by Phillip Dawdy I would like to say that in my experience the system of checks and balances does not work.
To establish grounds of dangerousness, the petitioner gave an account of an incident in which assualt (a verbal threat)occurred. This is a criminal accusation, but the cases are handled through the civil courts. No investigation is made. An accusation alone can get you hauled-off by police to the psych ward. You may expect to see a public defender for about five to ten minutes before you set foot in a court room. You are not informed of any of the contents of the petition while you are locked up for three or more days leading to your ten to twenty minute hearing. If you at anytime in the ordeal leading up to your hearing give any sign of confusion, aggitation or resistence, you can expect to be forcibly (violently) administered a syringe of Haldol and Ativan by two to five orderlies, many of whom are hired on for their size (I’ve gotten to know a few, and a number of them have served jail time).
As for the testimonies of doctors, I have on several occasions had doctors testify whom I had never spoken with prior to the hearing. Sometimes, I think they just read the charts.
As far as the research data are concerned, I’d have to offer my favorite caveat: statistics in not a hard-science. Really. It’s not. I’d love to accuse the AMA and APA of cooking the books–the majority of pharmaceutical research is funded by drug companies and it seems that they only publish the results that would move more product. There have been some wistle-blowers, but it hasn’t garnered the attention that it deserves yet.
With an issue this complicated, I struggle to find a place to start. I find the FDA to be venal. I think the courts are abusive. I’d like to blame the current presidental administration for trying to fear-monger and invent yet another an “enemy with-in” to distract the populace from what they’re really up to. There are Bush family ties to big-pharma, and (lemme point the finger) many conflicts of interest; Bush has stated that he plans to get 1 in 10 Americans on psych-meds. I have also found a heart-breaking amount of thinly disguised classist injustice regularly carried out against poor people, especially African-American men.
I’d love to reccomend some reading material. Michel Foucault is a French philosopher who does (I beleive) an excellent job of framing the clinical psychiatric setting in the context of the history of ideas. Noam Chompsky’s classic essay “Manufacturing Consent” is a must read. Robert Whitaker wrote a wonderful book called “Mad In America” that details a pendulating trend in what amounts to severity of corporal punishment of persons labelled with mental illnesses though US history. And, Dr. Peter Breggin does an excellent job in “Toxic Psychiatry” of providing an over-view of many of the problems with the biopsychiatric model and it’s methods of treatment.
If you’ve got time, try to download a copy of “The Foucault Tribunal.” It was held at the Free University of Berlin in 1997. Clover Smith, who’s house I stayed at in Colorado in the Fall of ‘04, was present, though she didn’t speak. The arguement against forced psychiatry seems to me to be very clearly presented there, and you’ll get your quotes and sound bites: “collusion and coercion; fear, fraud and force.”
I’ve been subscribing to “The Nation” this year, and in reading about what they call “the torture complex,” I’m reminded of what I underwent here in Michigan. They’re both multi-facted issues in which there seems to be human rights and civil rights violations carried out deliberately and systematically.
I count my blessings every day. My ordeal was dehumanizing, and I’m struggling agaisnt all odds to maintain my dignity in the face of it. After five years, I was ready to leave the country without a penny. I was in Mexico a year ago, and I was very ready to give up on this country. I would strongly encourage every one to engage in rational and balanced discussion of issues.
Thanks,
Gabriel Hadd
Gabriel Hadd wrote a very well reasoned and excellent
analysis of what can go on in the field of mental health.
Thanks for writing it.
Maybe now Spitzer will get a dose of his own medicine, what with endangering the health and well-being of prostitutes and civil society.
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