Kellevision

A few thoughts on the Kelly Thomas verdict

Someone asked me what I thought about the Kelly Thomas verdict.  It brings up an interesting question for me.  When I worked at the state hospital there were a few incidents where we had to "take down" someone who was floridly, and violently, psychotic.  We were required to do so without putting a mark on them.  If we weren't successful and the patient ended up with a bruise, a scratch or any other mark, we were required to document it in triplicate and report an "incident".  Incidents reports were rare and were taken very seriously.  When I see police beatings of people who are mentally ill this question always comes to my mind.  If mental health workers can do it, why can't the police?

With that said, I do acknowledge the following:

1.  I'm a mental health professional, not a police officer.  So my experience and my opinions are coming from a different field of experience.  I welcome input from police officers about this matter and the opinions I post here.

2.  Police working out in the field don't know the person they are approaching or whether they are carrying any weapons.  (However, we did have a patient leave on a day pass, purchase a gun and return to the hospital.  And silverware, etc. could be used as weapons too, so we weren't totally working with "disarmed" folks.)

3. Even after 20 years in the mental health field I sometimes find it difficult to differentiate between a patient who is psychotic from mental illness and someone who is psychotic because of drugs, such as crack.  Dealing with someone who is schizophrenic is very different from dealing with someone on drugs in terms of the potentiality of the situation to escalate to violence.  Regardless, I wasn't allowed to hit anyone on crack either.  

4. I have had the privilege of working with many Austin police officers who were compassionate, professional and extremely helpful when working together to meet the needs of the mentally ill.  Some have bent over backwards to help these clients while treating them with the utmost dignity and respect.  I do not think it is fair to judge all police officers by this one case.  I am extremely grateful for those I have worked with through the years who are more than worthy to wear that badge.  

Whenever questions like this arise I am reminded of two outreach workers who would go out into the community when a citizen was having a mental health issue.  One woman, Ann, would frequently end up with injuries.  The other woman, Elizabeth, would bring the patient in laughing and smiling and I never saw her sustain an injury.  Why?  Attitude.  It has been my experience that when you approach anyone with respect and treat them with compassion and dignity you have a much better chance of achieving a good outcome and avoiding injury.  By contrast, approaching people with excessive authoritarianism, barking orders and insisting on putting them in a subserviant position often provokes a negative response.  And rightly so.  

Finally, most people who are psychotic are not violent or dangerous, just distracted by the cacophony in their minds and acting accordingly.  I've worked with a lot of schiziophrenic clients through the years and I cannot imagine any situation where hitting someone was appropriate or required.  As I said above, even the few clients who became violent were taken down without putting a mark on them.

So why can't the police do the same?

 

 

 

 

 

Alcoholics Anonymous and Psychiatric Medications

Throughout the years I've agonized when working with dual diagnosis clients who attend Alcoholics Anonymous (AA) or any of their sister programs.  Too often there are well-meaning people in the groups who take it upon themselves to give psychological or medical advice.  All too often, this results in tremendous damage.   One of the major offenders is the idea that any member of AA, CA or NA who is taking psychiatric medications is not "clean and sober".  Not only is this bad advice it's not the official policy of AA.

The Caine Mutiny and the Scapegoat Role

While watching The Caine Mutiny* this weekend I realized that this classic movie has a powerful portrayal of the Scapegoat role playing out in a military crew.

"The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations."

This statement was made by British psychologist Oliver James in a recent article by The Guardian. 

I hope James is right.  I fear he is not.

James is referring to new research which suggests major psychiatric disorders are not biological but situational - a response to a childhood trauma.  Why is this going to set the psychiatric community on its ear? 

DSM V and the Diagnosing of Human Behavior

http://www.psychiatrictimes.com/display/article/10168/1425378?pageNumber=4

A recent story in U.S. News and World Report states, "The Diagnostic and Statistical Manual of Mental Disorders, as it is known, is hugely influential because it determines what is and is not a mental disorder. In turn, it is responsible for much of the sales growth in prescription drugs."  In a recent article in Psychiatric Times Dr. Allen Frances discusses his concerns about the way the next version of the DSM is being formulated and the possibility that formerly normal human behaviors will be become "medicalized".   

Trauma and Schizophrenia

I read an interesting article by the same name, "Trauma and Schizophrenia" (Karon 2007).  In it Karon states,

"Schizophrenia is a chronic terror syndrome.  In World War II there were battlefield traums that always produced classic schizophrenic symptoms.  However, if the patients were healthy before the trauma, they spontaneously recovered.  The myth of the incurability of schizophrenia led to the belief that these individuals could not be schizophrenic if they recovered.  But all schizophrenics are the victims of lives filled with trauma, sometimes subtle but usually obvious.  Professionals have tried not to listen.  But if one investigates, most of the bad things patients talk about or symbolize in their symtpoms are not delusional, but real traumas.  It helps to face the truth."

The Most Important Thing for Mental Health

When considering the most important elements for mental health, a really basic one is often overlooked.  It's not stress reduction, a healthy diet, exercise, healthy relationships, or taking your medications.  What is it?

The Medical Model for Treating Mental "Disorders"

When I began working in the mental health field I began as a caseworker for the county mental health authority.  This essentially involved working under psychiatrists as a caseworker.  The system being utilized to diagnose and treat mental health "disorders" was, and still is, referred to as "the medical model".  What is the "medical model" and why is it important for the general public to understand it?

The Schizophrenic Artist

Years ago I worked in a county mental health clinic that treated serious mental health issues utilizing the "medical model".  (For more information on this model see my article, "The Medical Model for Treating Mental 'Disorders'".)  I worked with a client who was diagnosed with Schizophrenia.  I always remember his story when I hear of clients being "noncompliant" and refusing their psychiatric medications. 

"The Patient is Noncompliant"

There are two terms in the medical model for treatment which really bother me.  One is "orders" and the other is "noncompliant".  Why?