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Monday, August 29, 2016

#29. We Demand Liberty and Justice For All



This is Day 29 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 29.

Principle 29 reads in full as follows:

We demand individual liberty and social justice for everyone.

The following paper was written to explain the connection between human rights and mental well-being to the public at large.  It makes clear the truth of this Principle:

No rights, no well being.  End of story.  

Human Rights and Mental Well-Being - Making the Connection  


"It's not just that human rights are important in mental health.  They are mental health.  People talk as if these are different concepts.  But in practice, principle and ultimate impact, they are one and the same. "

    --Sarah Knutson, Organizer, Wellness Recovery Human Rights Campaign

Most people have heard about the need for mental health recovery.  Very few have considered the need for ‘human rights recovery.’  Yet, they are inextricably intertwined.

Missing human rights can cause a lot of distress.  Think about what it’s like to be treated unfairly, go hungry, be thirsty, have nowhere safe to sleep at night or no meaningful way to make a living.   Think about what it’s like to be disrespected, hurt, called names, beaten up, pushed around, held somewhere you don’t want to be, or forced to do something you think is bad for you.

These kinds of things are highly distressing for most of us.  When human rights are violated or insecure, nobody does well.  We don’t have what we need to live and feel well.  Our survival is at risk in some important way – physically, emotionally, spiritually, socially…  We may even be literally fighting for our lives.

Our normal response when our rights feel threatened is anxiety and concern.  If nothing changes, this can grow into full-blown mental distress. A lot of time this is what people are talking about when they say “I have an anxiety disorder” or “I’m depressed.”

Intense, prolonged mental distress can lead to even more extreme states.   We can end up totally disconnected from ourselves, others and the communities we live in.  We can stop feeling like a part of things.  We can stop feeling human.  We can even stop feeling like living or being alive.
We may also stop caring how our actions affect others.  We may look for anything we can that deadens the pain. We may become so physically or emotionally reactive that we lose our capacity to think or be aware.  Once these things get set in motion, they may stay that way for a very long time.  We may get called “suicidal”, “borderline”, “addict”, “chronic”, “unmotivated”, “help-seeking”, “anti-social”  - or even “psychotic”, “psychopathic”, “delusional” or “schizophrenic.”

If that happens to us, it is important to look beyond the labels.  We need to remember that the root cause is not our “mental illness.” It is not our “addict nature.”  These are merely the predictable effects of pain and our subsequent attempt to cope.

The root cause is the insult to our humanity.  Something we needed was missing, disrespected, or threatened.  Yet, no one was there to help us.  Or maybe they tried, but things got worse instead of better.  Either way, we were on our own and continuing to fall.  Before long, we were in so deep that we didn’t know if we’d ever get out.  True, every so often a passerby might come along and poke their nose in our hole.  But, as soon as they saw how deep it was, they’d turn up  their nose and high-tail it on their way.

This kind of disconnection – both from things we need, as well as human beings -- undermines our confidence in life itself.  Neither the Universe nor those in it feel benevolent or worthy of trust.


Human Rights Recovery - Recovering Our Humanity


In Human Rights Recovery, we deliberately set out to reverse the injury to our humanity.  Since ignorance and ignoring human rights created the problem, we raise consciousness and respect for human rights as the solution.

We pay attention to the human rights quality of our relationships.  We support each other’s access to the opportunities that everyone needs to live, feel and be well. We reclaim our birthright as free and equal members of the human family.  We treat each other as people of reason and conscience, worthy of the same respect, dignity and rights as  everyone else.

We offer this freely.  We hold space for each other. We address issues as they come up instead of lowering our standards.  We don’t marginalize people who disagree with us.  We experience feeling seen and heard.  We experience seeing and hearing others.  We hold the same standards with the people we’re more and less fond of.

Everything else follows from there.  It’s about that simple.

  • It doesn’t cost a nickel.  
  • There is no higher law.  
  • No profession can license it. 
  • No corporation can patent, bottle or sell it.  
  • No Government can withdraw our funding.   
  • It only exists if we create it.  
  • We are never off the hook to ignore it.

Welcome to the human family.
Welcome home.


The human rights framework versus mental health treatment as usual


A lot of people mistakenly assume that 'good mental healthcare' and 'good human rights practice' are one in the same.  However, the human rights framework is radically different from mental health treatment as usual.

Mental health recovery is understood to be an individual issue:  A private problem develops.  The identified patient is expected to address it.  The obligation is on the individual to make progress and stop imposing their presumed pathology on unwilling others.

Human rights recovery challenges this worldview.  It argues that mental health, fundamentally, is a shared responsibility.  It stems from the quality of respect and support for human rights in the important relationships (e.g. family, school, work, neighborhood) that affect our lives.  When a human community fails to address these needs, injuries continue to mount. The first person to break down is only a harbinger of more wreckage to follow.

The human rights paradigm was articulated in 1948 to end this collective insanity.  Universal Declaration of Human Rights, http://www.un.org/en/documents/udhr/   It arose in the wake of Nazi Germany,  with a global commitment to ‘never again.’ It is intended not only for nations, but for people everywhere.  It represents the consensus of the peoples of the world as to what human beings need in order to live and be well.  It helps us understand who we are - and how we need to treat each other - to create health and wellbeing instead of distress and disability.  It shows us how to recover our humanity as individuals, families, neighbors, co-workers and communities who affect each other deeply.


A Deeper Look at Human Rights 


“Human rights”, essentially, are socially agreed upon “human needs.” People worldwide have agreed that certain things are so important that human beings can’t, don’t and won’t usually function well without them. We call these things “human rights.”

Human rights include things as basic as access to clean water, breathable air, shelter, food, clothing, physical safety, healthcare, the means to make a living and support a family.  Human rights also acknowledge that human existence is more than material things.  We need to belong, form relationships and feel like a part of things.  We also need the freedom to be ourselves.  We want to explore, learn, develop and express our ideas, convictions, creativity and potential.


What Does This Have to do With ‘Recovery’ and Mental Health…? 


Almost everything! Human beings everywhere do best – physically, mentally, socially, spiritually - when we can count on certain basic needs being met. That’s why the human community has decided to recognize these needs as “human rights.”  No one does well without them.

When human rights are denied or overlooked, it’s bad for everyone.  We don’t have what we need to live well - or sometimes at all.  This triggers concern and anxiety in most of us.  If not addressed, it can grow into full-blown mental distress – like anxiety or depression.  It can also lead to mental and behavioral extremes.  This includes intense, prolonged ‘fight-flight-freeze’ responses that can disconnect us from ourselves, each other and the communities we live in.

When that happens, we definitely need to work on recovery.  But, not from an illness, brain disease or clinical diagnosis..  We need to recover our human rights!


The Human Rights Approach to Mental Health 


The human rights framework takes a deep and thoughtful look at human experiences that many people find difficult, confusing or troubling.  This includes phenomena that are currently labeled “mental illness” – things like mental distress, intensity, extreme feelings or moods, unique ideas or beliefs, loss of memory or awareness, and private realities, images, visions, voices, and tastes, smells or touch that others don't seem to experience.

Instead of labeling people as sick or ill, we take to human rights values to heart.  We see everyone as worthy of respect and dignity.  We see everyone as capable of reason and conscience.  We honor people’s right to think, see, believe and express themselves in ways that may seem strange or irrational to us.  Together, we ask:

  • How might such experiences make sense in terms of the physical, mental, social or moral human rights deprivations a person has endured? 
  • How can these deprivations be repaired? 
  • How might "illness" and "symptoms" change once human rights are restored and made secure? 

This approach is very different from jumping to judgment.  Instead of assuming we ‘know’ better, we ask what we can learn.  We engage in honest inquiry around areas of human difference.  We work to make sense of experiences rather than acting to suppress or exclude what we don’t understand.


Rinse, Repeat for Behavioral Health


We apply this same basic human rights approach to the difficult or confusing things that human beings sometimes do.  This includes behaviors that are commonly labelled "addictive", "self-harming" "unhealthy" or "anti-social."  Even if something is against the law – like drug use, violence, sexual trafficking or theft – we don’t simply stop at the conventional thinking that calls something  as ‘abusive’ or ‘criminal.’  Rather, we seek to understand the underlying human needs, concerns and social dynamics that have shaped its expression.

The human rights paradigm thus seeks to place important social concerns in a larger context of human experience.  It provides a straightforward, reasoned, ecumenical framework to understand much of what is happening in human hearts and minds.  It offers a way to orient ourselves, reflect deeply, and mine the information value of human differences.

The more we approach people in this way, the more we learn -- not only about others, but also about ourselves as human beings. We also discover - and come to deeply appreciate - the value of what we might otherwise have rejected or thrown away.  Much to our surprise, many of the rocks we used to trip on start to look like "gems in the rough."  it may take a long time, and some of us will choose to keep our edges.  But polished or unpolished, if you know what to look for, precious treasures we most certainly are.


But, It Can’t All Be Human Rights  …Right? 


If you’re asking this question,  you’re in good company.   In fact, there are a lot of questions we need to be asking.  For years now, we’ve been hearing that there is a ‘brain disease’ called ‘mental illness’ which results from a ‘chemical imbalance’ that only medication can help.  We’ve also been told that poverty, addiction, violence, and crime are primarily individual rather than community responsibilities. We frequently hear arguments, some of them ‘scientific’, that certain groups of people are irresponsible, anti-social or just plain ‘bad.’

So where do we draw the line?  How much can we explain in terms of personal, biological or moral short-comings?  How much can we attribute to the human rights quality of the communities we live in?

The problem is that we don’t really know…  Mental health professionals mostly focus on signs and symptoms.  But, these could easily be after-effects of human rights deprivations.

As a case in point, we now know that pre-existing childhood trauma (e.g., violence, sexual abuse, neglect, conflict, bullying, discrimination, poverty, homelessness, hunger) is a fact of life for as high as ninety (90!) percent of public mental health clients.  National Council Magazine (2011:2): Breaking the Silence: Trauma-Informed Behavioral Healthcare.  The same (90!) is true for those in substance use, criminal justice and hard to house contexts.  (Ibid.) Human rights deprivations like these can cause a lot of distress, which the body then expresses physically through the nervous system as ‘fight-flight-freeze.

So how do we tell if someone is ‘mentally ill’ versus being understandably traumatized by insecure or violated human rights?  For example:


  1. We currently call a lot of people manic, oppositional, defiant, borderline and antisocial - especially if the person is angry, intense or expressing something strongly.   But what if many of us are just fighting back or hanging on the best way we know how?  
  2. We often pathologize common expressions of fear and sadness, e.g., paranoia, panic, anxiety, depression, obsession, compulsion, addiction, avoidance.  But a lot of us actually have painful, terrifying, overwhelming problems that no one would want to face. 
  3. As a society, we have labeled and marginalized a lot of people as schizophrenic, psychotic, catatonic, dissociative,  disorganized...  But what if freezing off awareness - or creating a different one - is just what humans do sometimes in order to protect ourselves from further hurt?   

How many people is this?  No one has a clue.   The possible impact of human rights deprivation has been almost entirely overlooked!  People are still being treated and labeled as having primary ‘mental illness.’ Virtually no effort at all is made at all to assess for contributing human rights factors and assist people to resolve them.  

This is bad, irresponsible science.  It is also bad, irresponsible healthcare.  It needs to change.
Human rights concerns could be playing a huge role.  We need to find this out.  You can’t expect people to engage in treatment designed for illnesses they do not have.  You can’t expect people to progress when the system of ‘care’ ignores their real problems.

Reputable behavioral health researchers have an ethical duty to ask -- and answer -- these questions. So do providers of mental health services.

In the interim, we should seriously question our continued funding of diagnostic mental illness.  The existing research shows a high prevalence of  trauma among recipients of public mental health services.  Yet, at present we know very little about what this group wants and needs in the way of personally meaningful change.  This is not because they won’t tell us.  It is because no one has been asking.

A human rights approach would suggest that we start here.   There is good reason to believe that our public health funds would be much better spent in pursuing this inquiry, than on continuing the current mental illness course.  Society has been listening to providers for years, with little substantial gains to show for anyone’s efforts or public health dollars.  We therefore clearly have much to learn.  This includes not only what didn’t work, but also, moving  forward, with what might, could or would, from a service recipient’s point of view, be reparative or helpful.

Some might call this unscientific.  They favor a science of experts that studies people as objects and reports about us without us.

In the human rights view, this is not science.  It is a violation.  It denies rights and dignity.  It ignores the principles of equality, autonomy, voice, and self-determination.  It causes the same kind of social injuries that many of us are trying to recover from.

It represents a mental illness of societal proportion.  It defers the responsibility of personal reason and conscience to experts.  It legitimates the few to substitute their judgement for the many.  It sits back and complains and sulks when they get it wrong (they inevitably do).

Mistaking this abdication of human responsibility for science is delusion.  Allowing it to continue to the detriment of all is madness.  


Human Rights Assessment


How do we put these principles into practice? Here are some concrete suggestions:

Study the situation (evaluation):   


There is a good chance our distress is coming from somewhere.  Human rights and mental distress are closely connected. Nobody feels well when their human rights are at ignored, violated or at risk.

Ask the right questions (assessment). 


  • How are we and others being treated?  
  • Are everyone’s human rights present and accounted for? 
  • Do all important needs feel safe and secure - to  us?  to others?
  • Have they always felt safe and secure - to  us?  to others?
  • If not, what impact has this had  - on self? on others?
  • How are human rights concerns affecting what is happening right now?
  • Is something needed to restore human rights?

If anyone’s human rights are missing, the situation is not ‘well’.

Clarify the problem (diagnosis).  


Get to the heart of the matter.


  • What rights are missing? List the rights. 
  • What ways are people being harmed by this.  List the harms.
  • Make a plan to fix it (treatment).  
  • How can rights be restored?  List possible solutions.
  • How can harms be repaired?  List amends needed.

Notice that the plan is not about “fixing ourselves”.  The plan is about fixing the situation.  The thing we are “fixing” is human rights.

Take action to recover rights (recovery).  


  • List the actions that need to be taken.
  • Steps to restore or recover rights that were missing (list them): _____________________________


  • Steps to repair any damage or injuries -- physical, emotional, spiritual, social, etc. (list them):  _________________________________________________________________________ The reparations need to fit the person, the injury and the meaning of the injury in the context in which it occurred.  Sometimes a sincere apology is all that is required.  Sometimes mere apology is unthinkably inadequate. It just depends...

Remember, this is not mental health recovery. The focus is not on ‘fixing’ our heads.  This is human rights recovery.  The focus is changing the situation.  Any changes we make should respect each other’s human rights.  This is how we recover human rights.

September 29, 2016:  Conference on Principle 29 


We will talk about Principle 29, including your responses, on September 29 from 9-11 PM EST.  Call in number TBA.

#28. We Demand an End to Involuntary Psychiatry



This is Day 28 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 28.

Principle 28 reads in full as follows:

We demand an end to involuntary psychiatric intervention.

Basic Rationale

In 1982, survivors and activists demanded an end to forced psychiatry.  In 2006, the United Nations heard their plea.  They approved the Convention on the Rights of Persons with Disabilities (CRPD), which prohibits involuntary detention and forced interventions based on psychosocial disability.  These are considered acts of discrimination that violate the right to equal protection under the law.  Under the CRPD, people with psychosocial disabilities have the same rights to liberty, autonomy, dignity, informed consent, self-determination and security of the individual and property as everyone else.

Shortly thereafter, forced ‘treatment’ was also held to violate the United Nations Convention Against Torture:

States should impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long- and short- term application. The obligation to end forced psychiatric interventions based on grounds of disability is of immediate application and scarce financial resources cannot justify postponement of its implementation. 
Forced treatment and commitment should be replaced by services in the community that meet needs expressed by persons with disabilities and respect the autonomy, choices, dignity and privacy of the person concerned. States must revise the legal provisions that allow detention on mental health grounds or in mental health facilities and any coercive interventions or treatments in the mental health setting without the free and informed consent of the person concerned.
More recently, psychiatry has mounted a counter-attack, arguing, as it always has, that society needs psychiatry to manage so-called 'problem people' and that they segregate, incapacitate and otherwise strip people of their basic human rights for 'their own good.'

In early 2016, Tina Minkowitz, president and founder of the Center for the Human Rights of Users and Survivors of Psychiatry, single-handedly spearheaded an international campaign to respond.  The call to action, known as the Campaign to Support CRPD Absolute Prohibition of Forced Treatment and Involuntary Commitment, sparked more than 40 contributions from activists, scholars, survivors and allies around the world.  The breadth and depth of the contributions was truly amazing as you will see (and read in full!) from the links listed below.  Ms. Minkowitz submitted these contributions to the Committee on the Rights of Persons with Disabilities on March 29, 2016.

Here is what she said:


Intervention by Tina Minkowitz at the opening of the 15th session of the Committee on the Rights of Persons with Disabilities – as delivered

Members of the Committee, Secretariat, respected colleagues. I speak to you today on behalf of the Center for the Human Rights of Users and Survivors of Psychiatry.

I present the results of a Campaign to demonstrate civil society support for the CRPD absolute prohibition of commitment and forced treatment. We asked participants to contribute their own knowledge and experience in the effort to persuade states to end the widespread suffering of those who are being medically tortured with no effective redress.

I will summarize the 41 submissions that are published on the Campaign website, which will be shared in electronic form with hyperlinks for easy reference. The materials are published in their original languages whether French, German, Spanish, Italian or English. A few other submissions are still coming in from people who misunderstood or were unable to finish before now, including from ENUSP (now added, see below).
The home page of the website is https://absoluteprohibition.wordpress.com. Some of the publications can also be found on collaborating blogs Mad in America, Sodis (Peru), PAIIS (Colombia), Dé-psychiatriser (France) and il cappellaio matto (Italy), and on participants’ individual blogs which are linked in their posts.
I begin with the memorials of those who died in psychiatry: M’hamed El Yagoubi writes about his wife and companion Nathalie Dale (in France). Dorrit Cato Christensen writes about her daughter Luise (in Denmark), and Olga Runciman dramatizes her anger and outrage over another death in Danish psychiatry. María Teresa Fernández speaks in honor of her brother (in Mexico), and also reflects from a moral perspective and as a person with a disability who works on the CRPD.
Survivors have a unique vantage point on degradations such as solitary confinement, restraints, injections, forced nakedness, brutality, authoritarianism, the stultifying effects of psychiatric drugs, the sheer destruction of electroshock, and sadistic psychological manipulations. How can we heal from abuse that society condones and that the law allows with impunity? For women forced psychiatry is sexualized and gendered, and should be recognized as both disability-based and gender-based violence. These writings stand as evidence of severe harm and as critique of laws and practices from the bottom up.

Jhilmil Breckenridge and Irit Shimrat evoke scenes of brutality, humiliation, and enforced subjection counterposed to the subjectivity of the survivor who is left to cope with her losses. Shimrat also looks back on a comic book hero she created as a young woman locked up on a psych ward for the first time.

Andrea Cortés describes how society seeks answers from experts, who punish people that don’t fit in, instead of learning to coexist; Katherine Tapley-Middleton relates how forced drugging caused her eyes to roll up in her head, and the nurses withheld a side-effects remedy; Roberta Gelsomino evokes frustration and anger towards those who did not help and refused to see her as a person.

Initially NO (see full original) combines political art and testimony to show how her rights under the CRPD were systematically negated by psychiatric violence; Anne Grethe Teien counters Norway’s claim that it is not violating human rights by comparing its laws and practices with the CRPD and with her own experience. Pink Belette and Agnès, both in France, attest to brutality, authoritarianism, and meaningless review procedures; Pink Belette also uses humor to rebuke psychiatric arrogance.
Connie Neil shares her journey with anger and grief over the destruction wrought by forced electroshock, and finally a possibility of forgiveness; Eveline Zenith describes and analyzes the abusive character of psychotherapy that entails re-traumatization; Corrine A. Taylor relates how she stopped psychiatric drugs in the face of a doubting psychiatrist and calls for everyone to have the same chance; Christian Discher documents the taunting of a young man for his homosexuality as part of his confinement.

Lucila López, a user and survivor of psychiatry, a mother, and a social psychologist, discusses a range of issues related to commitment and forced treatment, including iatrogenic harm, Argentina’s national mental health law, the pathologization of poverty, and the situation of young people affected by consumption of legal or illegal drugs.

Added: Jolijn Santegoeds calls for care not coercion in the Netherlands, and for compensation to survivors, appending her personal experience “16 years old, depressed and tortured in psychiatry.”

Researchers, scholars, lawyers, and clinicians, among them survivors and allies, express their adherence to the Campaign and build our knowledge base.

Robert Whitaker, journalist and founder of Mad in America, and Peter C. Gøtzsche, MD, researcher with the Cochrane Institute, each make a case against forced treatment from a medical standpoint. Clinician Jose Raul Sabbagh Mancilla in Mexico unconditionally supports the absolute prohibition of commitment and forced treatment. Psychologist Paula J. Caplan, PhD discusses inherently illegitimate psychiatric diagnosis as the entry point into human rights violations.

Karlijn Roex, PhD candidate in sociology, counters the use of “danger to self or others” to justify coercive psychiatric interventions, through scientific arguments, ‘user’ narratives, and moral principles. Anne-Laure Donskoy, survivor researcher, highlights the adoption of coercive mental health methods to enforce work requirements on benefits recipients in the UK.

Linda Steele, lecturer in law, characterizes commitment and forced treatment as disability-specific forms of violence condoned by domestic law and thus not amenable to legal recourse. Lawyer Francisca Figueroa notes the tension between the CRPD absolute prohibition and Chilean laws and practices condoning forced treatment. Documenta shared videos from its campaign against the system of inimputabilidad and security measures in Mexico, including a complaint under the CRPD Optional Protocol.

Bonnie Burstow, scholar and activist who advocates abolition of psychiatry itself, welcomes the Guidelines on Article 14 which clarify the absolute prohibition on forced treatment. Sarah Knutson makes the case for 100% voluntary treatment as an ex-lawyer, ex-therapist survivor activist, and presents an alternative approach to conflict and crisis.

Organizations and activists shared their advocacy and calls for action related to the absolute prohibition.

Added: European Network of (ex-) Users and Survivors of Psychiatry (ENUSP) counters the positions of the Human Rights Committee and the Subcommittee on Prevention of Torture in conflict with the CRPD and argues for real development of mental health care starting from the premise that forced psychiatric interventions must be banned.

Added: Fiona Walsh, survivor and human rights defender, reports on Ireland’s enactment of CRPD-noncompliant capacity and mental health legislation.

Erveda Sansi explains how Italian law still permits commitment and forced treatment in civil and forensic institutions. il cappellaio matto shares an interview with Dr Giorgio Antonucci on his work to abolish forced treatment in the 1960s that remained incomplete.

Coalition Against Psychiatric Assault created a video and petition calling on the Canadian government to withdraw its reservation that perpetuates compulsory treatment. Die-BPE of Berlin details the law and practice in Germany that allows substitute decision-making on the basis of a “lack of insight” standard, which violates the CRPD.

Asociación Azul calls for sweeping changes to allow people to be free and enjoy the same rights as others in their communities; survivor activist Don Weitz calls for class action suits and criminalization of forced psychiatric treatments and involuntary commitals; Jules Malleus shares a view of psychiatry as a destructive machine, utilizing images from dystopian films to make the point; Ana María Sánchez calls for creative public policies beyond the elimination of commitment and forced treatment.

******

This concludes the summary of materials that constitute the Campaign. I hope it will strengthen our common motivation and determination to put an end to medicalized torture and insist on consistency among all human rights mechanisms global regional and national to ensure no person remains in a situation of commitment and forced treatment in violation of the Convention. We need to not allow this issue to be left behind in the SDG monitoring, in work on the rights of women and girls with disabilities, in the COSP, or in any other CRPD implementation. It is a huge task for all of us, and survivors and victims remind us of why it cannot be forgotten.

The Campaign will have a second phase, both to reach out again to regions that remained unrepresented, and to pursue common interests that emerge in the materials. For those who are interested I will plan to schedule public discussions via Skype or web conferencing within the next few months, and I can be contacted through the Campaign website absoluteprohibition.wordpress.com and also on Facebook and Twitter as Tina Minkowitz and also on the official CHRUSP page.

Thank you.

September 28, 2016:  Conference on Principle 28


We will talk about Principle 28, including your responses, on September 28 from 9-11  PM EST.  Call-in details TBA.

Saturday, August 27, 2016

#27. The Time is Now: 100% Voluntary, User-Controlled, Community-based

This is Day 27 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 27.

Principle 27 reads in full as follows:

We believe that voluntary networks of community alternatives to the psychiatric system should be widely encouraged and supported.  Alternatives such as self-help or mutual support groups, advocacy/rights groups, co-op houses, crisis centers and drop-ins should be controlled by the users themselves to serve their needs, while ensuring their freedom, dignity and self-respect.

Basic Rationale

Today's piece outlines a proposal for making this Principle accessible and real. Originally published last fall, the proposal challenges the Murphy Bill as the only mental health reform legislation on the table.  It opposes the government policies, like those in the Murphy bill, that seek to coerce people into institutional or treatment settings.  It asserts instead that the proper role of Government is to encourage the natural, inherent capacity of community members to grow, develop and meaningfully support each other to navigate the life crises that inevitably occur.

Here is the proposal:

Federal Minimum Standards for a Community Mental Health Infrastructure


An Outline for Public Policy Reform and System Overhaul Legislation


Principle 1: Grow and Support Community Capacity. 


We must reverse the alarming trend toward permanent disability that results when people come into contact with our current system of mental health services. This system "treats" mental health crisis by yanking people out of their lives, dislocating them from natural supports and making their issues the exclusive prerogative of 'experts.' When public or private health insurance runs out, this profit-dependent system of professionals dumps these same people back into the real world with even fewer supports and resources than they had before their crisis began - and then blames them (or their families) when they fail to successfully reintegrate.

To counter these harms and reverse this trend, we must build the capacity of ordinary people to support each other through difficult times. Far from being the aberration, challenges and hardships are are a normal part of life as vulnerable beings in an uncertain, high-stakes, resource-scarce world. We therefore should anticipate difficulties and breakdown, not pathologize them.

To this end, every community and every citizen in United States should have access to:


1. A safe place for respite


2. A peer support center

3. Hearing Voices groups and training

4. Intentional Peer Support groups and training

5. Emotional CPR crisis supports and training


6. Icarus Project groups and training


7. Wellness Recovery Actions Planning (WRAP) training and wellness supports/ groups that make available health- promoting, capacity-restoring activities like art, exercise, creativity, writing, social interaction, nutritious eating, meaningful vocation, relaxation, meditation, spiritual development, body work, massage, yoga, dance, etc.



8. Alternatives to Suicide training and groups


9. Peer and professional support for coming off psychiatric drugs
  • http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf
10. A 24 hour support line staffed with people who care and want to listen

11. A "When Johnny & Jane Come Marching Home" (citizens listening to veterans) Project to support, honor and begin to appreciate the experiences of our veterans.


12. Trauma informed local governments, agencies and policies.


13. Open dialogue as a support for family communications during times of distress or crisis


14. Support for human rights


Principle 2: Fund Technical Assistance



The above are cost effective promising and/ or evidence-based practices that have the potential to vastly improve the quality of community relationships for citizens at all levels, including individuals, families and neighbors. To make these activities accessible and sustainable, Federal and State Governments must invest the resources necessary for communities to know what that these options exist and how to develop and sustain them. The federal government should therefore expand, prioritize and/or redirect existing funding to a nationwide network of technical service centers that support States, communities, organizations and interested individuals to:



1. Develop and offer the TA support and training infrastructure needed to build the above capacities.


Examples:


2. Ensure that new and existing practitioners are supported to grow and develop their skills

3. Design and implement a robust and integrated public health research approach for collecting broad scale system performance data.
  • The data collected should include not only not only costs and outcomes but also service users' subjective ratings as to how their lives have improved (or deteriorated!) as a result of services received. 
  • It should affirmatively seek out service user recommendations for improvement;
  • It should follow service users over time and see if they continue to rate services the same over the long haul and also to capture the learning effects of hindsight and reflective insight into what, in the long run, was most helpful (and what wasn't!)
This publicly funded research initiative is necessary to counter the current abuses where the only research that gets done into what works is done by corporations with products to sell and profits to make, thereby creating huge incentives to distort and massage results.
Resources for development:

4. Develop independent oversight and regulatory infrastructures needed to ensure that communities and provider organizations meet these standards and support them in meaningful ways.



Principle 3: Leverage Existing Federal Funding to Gain Local Buy-In


Without spending a penny more of federal tax dollars, existing federal healthcare funding has tremendous power to encourage local communities to change in the above directions. To this end, no State, community, organization, agency or hospital should be able to receive federal funding or any taxpayer healthcare dollars unless it:

1. Offers individuals and families non medication alternatives on a par and as an equally respected alternative to invasive high-risk interventions like medications, ECT, TMS, psychosurgery or other procedures.

This is necessary to counter the strong alliance between traditional services and the corporate interests that benefit financially from the medical/ high-tech model of services. This alliance has been resulted from the billing considerations - not participant service needs. It stems from the reality that Medicare and insurance reimbursers have conflated concepts like 'health' and 'wellbeing' with the delivery of traditional medical services. Thus, in order to bill for services, mental health providers are required to offer services that fit the insurer's criteria of 'medical.' This steers treatment recommendations in the direction of expensive high tech services (like Pharmaceuticals, ECT, TMS and psychosurgery) that benefit corporations and 'experts' - but which, in reality, few people in crisis really want or need.To the contrary, the vast majority of those who find themselves interacting with the mental health system would vastly prefer, if given a choice, to be offered basic human qualities like caring, listening and hands on assistance. These services are no more expensive compared to the high tech options. They are time and labor intensive, however, and therefore would require service systems to shift resources away from expensive impersonal technologies and into adequately staffing mental health organizations. It would also require organizations to shift hiring priorities from finding professionals who are good at technology, regulations and paperwork to people who can offer personal qualities like caring, interest, flexibility, creativity and a willingness to meet someone from their own frame of reference in a way that makes sense to them. 
Resources for making this shift include: 


2. Monitors, reports and makes publicly available data related to any and all symptoms and reactions from all high-risk high tech interventions like neuroleptics, ECT, TMS, psychosurgery, seclusions, restraint, hospitalization and the like.

3. Monitors, records, reports and makes publically available data on any and every use of force by any service, program or law enforcement

4. Conducts a post-incident debrief with regard to the above that invites the person of concern to share their experience and recommendations.

5. Implements an ongoing community-based research and system like that above to insure ongoing learning and quality improvement as a result of the federal dollars expended. Such a system should, as a minimum assure that an outside, independent body collects customer satisfaction and recommendation data and that a sincere effort is made to collect such data from every person who uses its services.

6. Has a community review board staffed by at least 50 percent of current or former service users that reviews all services, programs and incident reports and customer satisfaction surveys and makes enforceable recommendations.



Questions for Reflection



We are building this work together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. Have you ever experienced voluntary peer-run or self-help alternatives? 
2. Compare them to your experience of forced psychiatry or professional services.   
3. What would you like people of conscience to know about the differences?
4. What other voluntary, community-based or natural alternatives have you found helpful?  
 5. If we were serious about encouraging voluntary alternatives, what would need to change and how could we make this happen?  

September 27, 2016:  Conference on Principle 27 


We will talk about Principle 27, including your responses, on September 27 from 9-11  PM EST.  Call-in details TBA

#26. Absolute Abolition - Pronouncing Psychiatry Dead on Arrival



This is Day 26 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 26.

Principle 26 reads in full as follows:

We believe that the psychiatric system cannot be reformed but must be abolished.

Basic Rationale

Oh, the co-optation runs so deep.  Would you ever be tempted to think:


  • We shouldn't end white supremacy because there are a lot of white supremists who have helped a lot of people.
  • We shouldn't end misogyny, because there are a lot of good men out there.
  • We shouldn't end classism or management-worker exploitation, because corporate America makes products that some people benefit from.
  • We shouldn't end homophobia and transphobia because a lot of people have become comfortable with homophobic and transphobic practices so they need to have that as an option.



So why is it okay to keep sanism alive simply because a lot of people have become attached to their clinicians, their diagnoses, or their promoted products...?



Ok, so maybe you get rid of sanism.  But does that mean psychiatry has to go too...?

In a word yes.

The short explanation is this:

Getting rid of sanism but keeping psychiatry is like saying we should stop slavery but still have slave traders.  

Here is why:


By APA definition, 'Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.'  A disorder, in turn, is 'a physical or mental condition that is not normal or healthy.'

That's all pretty much tantamount to saying that psychiatry is about enforcing sanist attitudes, derived from dominant culture conceptions of health and normality.   The essential premise of psychiatry is that, once you get the training and license to practice, it's okay for some people to pass judgment on the value of other people's personhood and how they express it.  Moreover, it's okay for some people to substitute their judgment for others about what is right for human beings - how we should think, act, believe, understand reality and express ourselves on this planet earth.

The violation of human rights is painful and flagrant.  It's bad enough that these kinds of sanist judgments are common in contemporary society. As families, friends, neighbors, schoolmates, coworkers, colleagues, we are doing this kind of thing to people who make us uncomfortable all the time.  The harm, even at this garden variety social level is hardly innocuous. As most of us have experienced at one time or another, this private passing of judgment on one's worth, dignity, right to respect, regard and membership and participation as an equal member of the human family is nothing short of devastating.  Adding injury to insult, such treatment results - for many of us - in being cut off from other human rights.  Not uncommonly, the social marginalization is the gateway injury that further violations.  If people don't like or regard you well, then it's really easy to find yourself cut off from other resources  - things every human being needs to live and be well - like access to work, education, meaningful voice and participation, fair treatment, protection from predation, exposure, want and need...

The crime of psychiatry is that it takes all of this even a step further.  It institutionalizes and legitimizes the process whereby those of us with unpopular beliefs, attitudes or behaviors are systematically shut out.  In this system, psychiatry plays the Grand Inspector role of separating human wheat from human chaff.  Those of us designated as chaff are assigned labels as to strain of chaffing and then segregated into camps and classes for assorted levels of formal monitoring.  The purpose of this monitoring is for some other human being (a psychiatric expert) to decide on our behalf how much of our human rights we are supposedly fit to access.  It is a unilateral exercise of privilege is conferred - solely by and because of - the association with the psychiatric profession.  The crux of this profession is its claim of entitlement - through its self-proclaimed medical authority - to determine the relative social worth and merit of the entire range of human diversity.

Thus, the psychiatry system is nothing less than a systematic human rights deprivation system.  In this this system, psychiatrists play the role of designated gate-keeper authorities.  These gate-keeper authorities judge and label whether their fellow human beings are fully deserving of human rights. Those deemed inadequate to the task are categorized according to their relative level of unfitness and then referred for the corresponding level of social control.

The recognized gatekeepers are empowered by mental health laws that only take effect if and when the categories psychiatrists themselves have created are invoked. It's a circular system whereby psychiatrists create the system of human classification that legitimizes blocking the humans so classified from accessing their basic human rights.  The enabling legislation thus empowers the psychiatric system to usurp the personhood of those so labeled and to require the active recognition of their rights by a recognized psychiatric gate-keeper, along with assent, assistance and 'guidance' as to how the person can exercise their own rights.

The illegitimacy of the whole system becomes even more glaringly obvious once you begin to connect the dots as to who becomes a psychiatrist in the first place, as well as how the whole system is maintained.  Once you start to grasp this, the absurdity of psychiatry being positioned as the judge of what is good and right about humanity becomes... well, it would be laughable if it weren't so painfully disturbing and devastating for so many people.

A year back, an old time survivor asked me to think, for a moment, about who becomes a psychiatrist. Then he took me on a tour of the territory from his perspective that was nothing short of eye opening.  Here is the gist of it:

By definition, psychiatry is concerned with medicine, science, brains, and abnormal functioning. The kids to whom this appeals, as a general rule, are eggheads and geeks.  The gods of their world are experts, scientists, researchers and academics. Their most intimate relationships are with textbooks, websites and technology, not human beings.  Their appreciation for the immeasurable, qualitative realms - the feelings, warmth, mystery, expansiveness, hope, possibility that make life worth living for so many of us - is dim to none. Their understanding of these nonrational, subjective factors - emotion, intuition, inspiration, connection and how they relate to the quality of life - is dim to none. Their openness to inexplicable life phenomena - like transcendence, spirituality, even vulnerable feelings of love and longing that go to the core of the meaning of life - are dim to none.

So, this is the basic mindset - the values, orientation and natural affinity - by which the 'normality' of the rest of human experience is being judged.  Point #1.

Now ramp this up a level.  The reality is that it's painful to be that kid - the geek, nerd, dork, dolt - that vast numbers of pre-psychiatrists have been known to be.  If you're this kind of kid, your social life is basically hell.  You get excluded, marginalized, made fun of by your peers.  You feel out of place, socially awkward, unrecognized. You are judged as strange or extreme or weird - and strung up by your underwear in locker rooms -  for your honest interests and talents.  You get routinely ignored by homecoming queens and humiliated by the jocks who make up the popular crowd.

All of this means you can't wait to get to college.  You escape to academia, where finally you feel at home. Other co-eds are off partying, but you're taking the hardest courses.  It's a tough and grueling row to hoe.  But no matter.  The approval of your professors and your admission to med school is more than reward enough.

Finally you become a doctor.  Now, really you've arrived.  Not only does everyone give you the acclaim you always knew you deserved.  Pharma courts you.  The offer you lavish gifts, lavish praise. Your intellect and achievement are endlessly applauded. Your every utterance in the hospital hierarchy is treated as the word of god.

And, you owe it all to science.  Science, yes, science has vindicated your existence.  You knew it all along -  that the rational would and must prevail.  All those inexact, fuzzy thinkers operating by all those arbitrary, unspoken, immeasurable social feeling thingies - now, finally, they will get their just desserts.  There is no room for them in the scholarly domain of medical psychiatry.  No, no no.  The field of medical psychiatry is and shall forever be ruled by minds, fine ones, sound ones, beating only to one beat, the very predictable, measurable, logical, exacting heartbeat of science.

Another way of saying, psychiatry is an authority unto itself.  Enter the hospital and you entire an empire. Woe to those who dishonor the empire of medicine.  Woe to those who fail to pay homage to the emperors of expertise. Untold shall be their punishment, endless misery shall be their days.  Truly, hell had no fury like a doctator scorned.

In other words, there really is no viewpoint allowed but the viewpoint of medicine.  And, there's no sense trying to talk to psychiatry about other viewpoints.  You have no credibility unless you've been to medical school or have a research degree.  Not a lot of people on this planet can meet these standards on a good day.  Certainly the vast majority of us won't meet them on a bad one.  Yet, these are the people, and this is the values system, that has been put in charge of deciding who gets to have or keep their human rights on any given good or bad day.  Point #2

But it gets even worse.  These are twenty-somethings with virtually no life experience.  It's not just that psychiatrists are twenty-somethings - making life-defining judgments about the merits of other people's deep and important problems of living and life crisis - with only a couple decades under their belts.  It's that these particular twenty-somethings are perhaps the least qualified of all human beings to say anything meaningful about the practical problems of living that most people face.  As previously noted, these particular twenty-somethings spent their lives with their heads in books avoiding the lion's share of mainstream life - including the complicated human feelings, interactions and social dynamics that most of us are trying to navigate.

So duhhh!  Of course, they think it is all chemical!  By nature, they're far more interested in equations than people.  Moreover, they haven't participated in the vast majority of practical living so they don't have a clue what they're missing.

This is the level of actual real life preparation of those who will end up judging the relative merits of what the rest of us are experiencing.   How disturbing is that?  Point #3.

It even gets worse from here. Recall the painful outsider experiences (geekdom, dorkdom, locker room persecution) that precede doctor status for so many.  Against this backdrop, it's safe to assume that an awful lot of pre-psychiatrists enter medical school reeling from the social blows and desperate for validation, approval and recognition.   Add to this the sleep deprivation, cult-like training conditions and the financial desperation that only a first rate medical education can produce. If you were Pharma or corporate medicine, you couldn't find a riper, more vulnerable, more dupe-able audience to indoctrinate with sales pitches that you pass off as legitimate 'education.'  To make your propaganda even more effective, all of the instructors are in you pocket because - as Pharma or the med tech industry - you are funding the existing university research.

Really, it's the perfect crime.  You place one life-inexperienced, totally-indoctrinated twenty-something at the top of a hospital hierarchy.  You make them so 'valuable' that they can never spend enough time in any one place or with any one person to actually understand what is going on.  This ensures that they will learn very little and operate exactly how you trained them for a very, very long time.  Point #4.

Better yet (for Pharma, shock, the medical industry), doctors are the generals of the hospital/ healthcare system.  That means everyone in the healthcare hierarchy who wants to keep their job has to do what the doctor says.  As a practical matter, this means that one doctor who spends three minutes a week with a psychiatric inmate effectively overrules every other staff person in the system, no matter how dedicated or trained.

This institutionalized psychiatric supremacy not only kills the voice and perspectives of the person of concern (we already knew that).  It also kills the voice of every other player in this system.  It kills the voice of other professions that have their own orientation and expertise to contribute.  It kills the voice of other staff and workers who may have far more face-to-face and hands-on contact.  It kills the voices of nonprofessional allies - including invited family, friends, teachers, coworkers and neighbors  - who may have known the person for years or even a lifetime.  Point #5.

Morally, this system was dead on arrival.  Yet its corpse lives on, perpetuating untold destruction in zombie-like proportions wherever psychiatry rears its ugly head.  This is one Walking Dead that needs to be debrained and buried.

There was never a better day for absolute abolition than today.

September 26, 2016:  Conference on Principle 26 


We will talk about Principle 26, including your responses, on September 26 from 9-11  PM EST. Call-in details TBA.

Thursday, August 25, 2016

Is It Time Yet for the Change.Org Petition to God from Humans?

Dedicated to Michelle Terese Marracchini - get well soon!  

A friend got me thinking about this the other day.  What does it mean to have faith in modern times?  Where is the line between faith &, frankly, having waited long enough?  

Truth be told, it's not just Robin Williams or an "impulsive few.'  Sadly, the agony and annoyance of every day existence all too often approaches intolerable for far too many of us.  

So, what does it take to access Almighty attention these days?  Historically, we've been led to believe that one lonely voice crying in the wilderness, calling attention to our world of woes should be enough. 

But, perhaps times have changed.  Maybe 'doing what we can for God so that God will do for us' means we have to use all means at our disposal. Perhaps we need to become 'savvy' about our 'God-messaging.'  Get to know the "Divine Demographic' whose Audience we are seeking. 

When you think about it, God is pretty busy.  There's a lot on The God Plate.  So, if we want God to hear our messages, they had better be short, sweet, clear, and very, very catchy.  We need to distinguish our needs from all the seemingly important, similar others. 

Our message should also be fun and entertaining.  Because, think about it, God probably gets very little time for that.  As every Creator knows, creation has its price. The seemingly endless list of thankless chores and daily duties that inevitably ensue is, well, the price of all who dare to risk Deity. 

Finally, we need to make sure that we've got 'the numbers' to back up our claims.  With all the demands on modern omniscience, it's neither realistic nor prudent to expect that God will do the grunt work of gathering data or researching facts.  
      
In sum, we need a marketing strategy designed with the modern Cosmic Consumer in mind.  So here goes with a first draft:  

Change.Org - Petition to God from Humans


Dear God,

After 2016 years, has it gotten hard to remember what it's like to be human...?    Have you kept up your Savior Certifications? Could the Miracle Skill-Set use a bit of a brush up?  Perhaps You might want to consider another visit sometime soon for the Refresher Course.  In case this has been holding you back, there are grants and public assistance available now if you reincarnate some place where finances are short.

There's no better time to schedule us in for some definite dates and start planning your itinerary.  A lot of people are starting to doubt that You really, literally, meant it when you said you were going to come back here.  We know they are weak, doubters and troublemakers, so we defend you every chance we get.  However, we also thought you should know that Santa Claus visits us every Christmas and brings some very nice gifts.   

You may be thinking, "What's a couple thousand years compared to eternity?"  It may interest you to know that the average human lifespan is a bit shorter than yours.  It ranges from 47-87 years, depending on country of origin.  We're sure you are worth waiting for.  But for us, twenty plus centuries is quite a while.  In terms of keeping your numbers up, it could be time for Christianity to poop or get off the pot.  Just sayin...

Very truly yours,

 ~  your 'like' here ~ 

(Remember, God needs to see our numbers!)

#25. Prescribing Pacification- Illusions of Choice for the Brave New World

This is Day 25 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 25.


Principle 25 reads in full as follows:


We believe that the psychiatric system is, in fact, a pacification programme controlled by psychiatrists and supported by other mental health professionals, whose chief function is to persuade, threaten or force people into conforming to established norms and values.





Today's commentary is from Sharon Cretsinger, blogger at Mildly Dysthymic in America. Here Sharon elaborates on a piece (Drug Store) that she published a few months back:


Illusions in Orange Neon: Snap Chats from the Drug Store

I have written a fair amount about the experience of the woman survivor. The blunt trauma
impact of force, in its afterglow. The subtle, seductive-wet mouldering and eventual erosion of
self esteem that accompanies a few sweaty rounds of coercion. What interests me most today
is neither force nor coercion, but illusion. Most specifically, the illusion of choice. The promise
that is a sparkling mirage for those who have been lost too long in a chaos that is possibly not
even their own.


Drug Store

I can recognize the complaint ones.
The mental patient women,
in front of me at the drug store,
without enough money to cover their inane purchases
of hair dye and flavored potato chips.

They are overweight,
but not so grossly obese that some asshole
wouldn’t fuck them
just because they can’t fuck anyone else,
or perhaps because these compliant ones
will take a dick up their ass
or do whatever else they are asked.

Know our people by what they choose and what they carry with them to the counter of the CVS,
Walgreen’s, and Rite Aid. Or, perhaps, it is the drug counter at the Stop and Shop or Target, if a
trip to a completely freestanding monument to pharmaceutical domination and state mind
control is too much of an inconvenience. There isn’t much to worry about in that respect,
though. If CVS is your favorite, as it used to be mine, you will find at least one in any
reasonably sized municipality. Their numbers have, in fact, almost doubled from 5,474* in 2005
to 9,681* in 2015. Other people do not like CVS; and, that is okay. On the other corner, within
walking distance, there will almost certainly be another choice. Walgreen’s? There were 8046*
of them in the US in 2010*. It is so important to have a choice.

It is as though they have a giant,
orange neon arrow above their heads.

SEROQUEL

screams the text above the arrow.

Their hair is cut too short for their large bodies,
partially shaved and partially spiked up
with more product of the drug store.

Their pants never fit.
These women are cut in half
where the pants expect their waists to be.

Something is for everyone at the drug store. There are hundreds of varieties of sugar and
carbohydrate nightmares, guaranteed to satiate the late-night-early-morning-mid-morning and
just before noon Zyprexa fueled cravings. Chose a Coke or a Pepsi to make things go down
more smoothly. Substantially different, aren’t they? Fifty different ways of “family planning”, or
perhaps just plain old pregnancy prevention if you are like me and many thousands who have
been told we will never be able stop our medication long enough to sustain a pregnancy. If
family planning is forgotten today, there is Plan B for tomorrow. Growing older and finding it
more difficult to be smoothly objectified? The lubricant comes in liquid and gel forms, right here
at the drug store. Through chemistry, better living. Behind the miraculous pharmacy counter, at
least a thousand ways to die. Today. Tomorrow. At age 30 or 63. Feeling a little blue on that
Zyprexa? Add Abilify. Still anxious on Klonopin? What about a cheap, purple bottle of
something pretending to be Merlot? Right over here. So many choices.

They speak too much,
and too loudly,
attempting to hold a full conversation with the cashier
about WHY they THOUGHT they had enough money
for the hair dye in a brassy cheerful color.
(Their THERAPIST has recommended bright colors)
along with other bits of useless magical thinking.

It is 2016, the middle of July, six years almost to the day since psychiatry killed the brilliant,
artistic woman I felt as my child from a dimension only slightly removed from this one. She was
30. A junkie, her father, my ex, said. “Who cares what she overdosed on or why?” Tore me the
fuck apart with his goddamn indifference, and confirmed I was wise to have left him two years
earlier.

It’s a month out from when I held the hand of my best comrade and offered him whatever he
could take from my being to make the opening of the channel easier for his passage into the
next dimension. “I don’t want to die,” he said. I told him I knew, but I would also understand if
he changed his mind. Congestive heart failure, they said. Years of smoking, they said, heads
shaking. Overweight. Silently, I filled the blanks. First generation antipsychotics. Tricyclics.
Atypical antipsychotics. SSRI’s. Benzos. He said many times, “We die 25 years before our
peers who are not psychiatrically involved.” Two days later, I documented this for him one last
time. Then, I placed a period at the end of his obituary. Full stop.

I wait
for them to finish
in a line of five, then eight.
The eight cannot see the orange neon sign.
Only I, in my fat, blatant insanity—
a woman with long, greying hair
who speaks infrequently and softly
know it is there.

They leave, the compliant ones,
(finally)
with only the flavored chips and pharmaceutical poisons
that can be purchased with welfare.

I wait
and hardly ever speak.
No one would ever guess I have somewhere to be.

It’s still July and it finally rains—torrents. Even the chilly Northeast is as lush as the tropics, and
oppressively hot. I watch the rain blur the hanging greenery of the branches outside the window
and absently take in the too-loud motor of the window air conditioner that has been installed
through a hole cut just for that purpose in the back, outside wall of this cheap motel room. I
chose the man next to me for his brain, his cock and his politics, not necessarily in that order. I
am not ashamed of my thick, naked waist as he puts his hands there. I want his cock in my ass
and tell him as much, happy, max-chilled and even smiling with the lines on my face softened in
a haze of the Ativan that will facilitate my multiple orgasms directly. I don’t know if this man will
keep my psyche safe, but he respects my freedom and will continue to do so throughout infinity.
I don’t know if my heart is safe with him, but I can, without fear, tell him the truth about exactly
what I would do with a locked building full of shrinks, all the gasoline my heart desired, and a
beautiful, sterling silver cigarette lighter etched with some exotic, foreign word for liberation. In
this moment, I have no fear; only deep, delicious peace.

He pulls the clip out of my hair and it falls everywhere as my energy rises toward him, more
intense and insane in each moment, proportionate to rage and frustration that flowed before
through my bondage. No one is looking for me. My treatment team dissolved eight or ten years
ago. There is no therapist, not even me, to dissect the next two hours of my life into five or ten
bad, terrible, regrettable choices.

Forced treatment is violence
Coercion is violence.
The illusion of choice is violence.

I am as free as most of us get.

I can see the the orange neon motel sign through the rain and steam outside of the dirty window
pane rather indistinctly. It says there is a vacancy. I move in for a deep kiss with my lover,
betting the vacancies are far too few for those who substantially need them.

*quantities of CVS Caremark and Walgreen’s stores retrieved from http://www.statista.com/
statistics/241544/cvs-caremark--number-of-stores-since-2005/ on July 24, 2016

September 25, 2016:  Conference on Principle 25


We will talk about Principle 25, including your responses, on September 25 from 9-11  PM EST.  Call-in information TBA soon.