Date: Sat, 13 Aug 1994 00:03:02 -0400 (EDT) From: Quinn D Rossander Subject: What's_Wrong! To: ThisIsCrazy What's Wrong! In his book, _The Discovery of the Asylum_, David J. Rothman makes the following assertion. The original split between the AMA (American Medical Association) and the APA (American Psychiatric Association) came as a direct result from their disagreement about whether the "mentally ill" should properly be warehoused in a separate facility with a minimal expenditure of state funds that would allow the asylum to treat those for whom there was some reasonable expectation that they could return to the community and become productive citizens. (The ones who could be cured) Now the fascinating history of this argument is that the AMA was in favor of such a position saying that it was fundamentally more honest to admit that some people obviously could not be "cured," but the doctors of the APA continued to maintain that they could cure everybody, hence they should be given control. Let me try and explain. When states like New York and Tennessee first set up their Asylums for the orphans, poor and the insane they sent throughout the state to the jails and local charity or public relief facilities that existed to solicit applicants. What happened is that their enthusiasm set the program up to fail and this failure continues into the present and stares at us from around the corner of our healthcare future unless we realize the lesson from our own past. We are still paying most of our Mental Health Dollars in America for Institutional answers to healthcare problems. There is nothing in the Clinton or any other healthcare plan being discussed, that really offers any alternative that I have much faith in. In his book, David Rothman says candidly that the dream of the founders of the asylum movement in this country has turned into a disastrous nightmare where the "deviant and dependent are put out of sight and out of mind." In a historical context it is possible to argue that this is a step above chaining lunatics to the wall or sentencing them for life on prison ships. The main qualifier claiming pride in this advance in psychiatric care is that our present humane systems of treatment tends to entrap more and more people who would have been spared punishment or confinement in an earlier ear. Rothman contends that some among the mad undoubtedly suffered less because of the asylum movement, but many have been made to suffer more. What went wrong? The original idea of the founders of the APA was that "mental illness" was the responsibility of the society in which it occurs. Not so much that poverty and oppression are wrong and therefore the principals of ruthless exploitation and unbridled greed should be changed, but the simpler idea that people who do not conform need to be fixed. The idea of fixing them was to set up people factories. They would be organized and brilliantly structured. Indeed a nationwide movement grew up in America of Asylum building in the 19th Century that still controls how and where we spend our Mental Health Dollars. The Asylum doctors offered to take anyone. They would teach them by regimentation, early rising, and daily habits of industry and cleanliness to be well. For more than half a century these early institution proclaimed their success. They boasted that "mental cures" were possible in 6 months or at the most a year of such structured, controlled living. The only question was which model of institution control provided the best results. Debate raged on issues such as how to build seclusion or privacy or enforced silence into your rules. The supposition was always the same. If we get people to conform to the rules, and they are the right rules, then we will cure them. You and I know the tragic results. It didn't work! Rules, no matter how stringently enforced did not effect healing. What they did lead to was a fantastic rate of recidivism. The very rules of the institution that were seen as healing, led to a state of dependency where the inmate was totally lost when he had to face an independent decision and no one was there to decide for him/her. This is still where our penal system in America is stuck and our Mental Health Care system is stuck right there as well. Most times it is hard to tell the rules governing patients from the rules governing prisoners except that a prisoner usually had some promise as to the length of time he has to serve, assuming of course that he is able to live that long which in many penal institutions may not be a simple task. Every state has a public Loony Bin. Going there is awful, but the truth is that the American people want to keep it that way. We want to frighten, torture and use any possible method to control those whom we do not consider "normal." Now you may wonder what happened to these early people factories. They developed more and more rules. You could not get or send any letters to your family or friends. The institution needed a time of isolation from such distractions in order for you to settle into their routine. You had to be taught to obey because obviously what you thought and had to say was 100% wrong. No one was there to listen to you. Many of these institutions practiced a rule of silence. In some ways those were the kindest places you could end up, because the rule applied to the staff as well. In retrospect there may have been more listening to the patients because generally the staff had to be quiet themselves. On the other hand no one was allowed to scream or cry, so all the screaming went on inside one's own head. Now those of us who tend to be emotional (read that emotional = healthy) in our response to life realize that such discipline while possibly instructive, was hardly healing, and felt more like trying to enjoy life inside a pressure cooker. Not a pretty place to be! How long did this go unnoticed? Well the first people who blew the whistle were other physicians and people who came from the state to examine what was going on in these human factories. It was the AMA who tried to point out that the supposed "cures" keep reappearing on the asylum roles. If people were "cured" then the cures didn't last and often the same name was being "cured" 2 or 3 times a year. To maintain the point of view that psychiatric asylums "helped" people, the medical directors of these institutions came together and incorporated the APA which to this day maintains not only that they alone have the power to decide who is crazy, but they also alone have the power to treat them and decide when they become sane. No one has the guts to ask whether the later power does not depend almost totally upon the former. If this point is somewhat obscure please note that it is the APA that prints, edits and controls all DSM publications (Diagnostic and Statistical Manuel of Mental Disorders. Do you remember that first invitation from the founders of the asylum movement to send in the "worst of the worst?" Well once these inmates arrived, the directors of these institution often did not know what to do with them. Although the APA still proclaims that they are "curing" the mentally ill, most people who knew about what was really going on, did not want their family or loved ones to be there. These people factories or as they more commonly called "nut factories," became a place of last resort for the difficult and incurable cases. Following the Civil War when waves of immigrants poured into our East Coast, this problem became endemic to the Asylum movement. How did the learned doctors respond? Let me quote the words of George Chandler, who was director of Worchester State Hospital around 1850. Before you read this, however, please substitute your own nationality into his comments about the Irish so that you can catch the full effect of his oppression toward these foreign born inmates: "The want of forethought in them to save their earnings for the day of sickness, the indulgence of their appetites for stimulating drinks...and their strong love for their native land...are the fruitful causes of insanity among them. As a class, we are not so successful in our treatment of them as with the native population of New England. It is difficult to obtain their confidence, for they seem to be jealous of our motives." With such an attitude it is no wonder that the grand idea of "curing" inmates was replaced with one of "caring" or more accurately "custodial care" of inmates. The concept of "forced treatment" was maintained and in fact expanded upon. We still send doctors to these same "nut factories" to be trained so of course when they come into power in general hospitals and set up "psychiatric wards," the patients don't have access to phones. They need time to "adjust" to being "mentally ill" and the hospital protocol. We are protecting their "confidentiality" by this planned isolation. Goodness, who would want their friends or neighbors to know about them being "mentally ill". This is not by accident, but rather by a long history of very careful intent to establish a willingness in "the mentally ill" to follow rules. In the same way the c/s/x movement is opposed by these doctors. Their "clinical protocol" never does permit them time to hear the patient's point of view. Hell, our point of view is meaningless to someone trying to cure, control or care for us. We have got to get the idea accepted in the medical/legal field that these terms are c/s/x cuss words. Instead of "shit on, fuck, and damn" when we hear "cure, control or care" you/we are being ultimately profane to those who have been labeled "mentally ill" for these are words designed to destroy the human spirit and punish individuality and creativity. William Hammond, professor of nervous and mental diseases at New York's Bellevue College around 1882 said: "Hospitals of all kinds are to some extent evils" The appropriate course of action, then, is obvious "Keep ... mentally deranged patients or friends at home so long as this can be done with safety." We need to make our communities safe for everyone and let people live with the support they need at home. The only way we can do that is to close these people factories and stop letting them train new professional who are entering the field. We need to stop depending upon violence and fighting evil by supporting and funding more evil. We need to stop letting the denizens of our current healthcare debacle tell us that they have all the answers and they will fix us all if we give them more power and money. Negroes and poor whites in the America have long been aware of the methods and behavior of the Klu Klux Klan. Symbols we associate with the Klan are a burning cross and the letters KKK. They have come to stand for the hate, violence, and destruction of minority person who is not a KKK member. In the same way "Cure," "Care," and "Control" have become synonymous through the Asylum movement with tyranny and enforced dependency. Using these to justify "forced treatment" we have reached the totally illogical and unsupported conclusion that you need to disable and mentally cripple a person who is labeled "mentally ill." Remove him from society and deprive him of all human rights and dignity will somehow make cure him. Those of us who have been subjected to these three CCC's through "forced treatment" realize that they have as much to do with healing as does the KKK or a Nazi concentration camp. Before we accept new Healthcare services in America, we have to be certain that the Asylum movement is totally expunged and "forced treatment" completely abolished. Letting someone, no matter how well intended or medically trained, have control over the lives and freedom of our citizens is wrong. No one should ever have this power over another human being. It is the recognition of this basic truth tht the Constitution of the United States was written to protect. The Asylum movement has not only put people in chains, but continues to keep them there, as anyone who has been labeled "mentally ill" will tell you. Ross qdr@bach.udel.edu This file came from anonymous ftp sjuvm.stjohns.edu cd MADNESS The MADNESS ftp site is a service of MADNESS, an online discussion on LISTSERV@sjuvm.stjohns.edu Please credit the list if you copy this file.