The link above is to a recent post on this blog. “The six pillars of coercive psychiatry”. What follows is a look at each of these pillars…. some possible questions and ways to counter each of these pillars. It might prove helpful to you to read the initial post before you go further. Although Rep Murphy is referenced much in this post these ideas are not simply his. Most of them originate with the Treatment Advocacy Center and are the foundation of their nation wide blitz to get AOT in every state.
1. You either are or you are not.
The Murphy mythology has a bizarre take on the mental health system. He says it is composed of two homogeneous groups : those who really need help and those who don’t. Those who don’t are the “worried well”. Those who don’t are the “seriously mentally ill.” He says we spend way too much money on the worried well that should be spent on the seriously ill and puts the blame for this on Samhsa and other mental health advocates.
The key to this is to understand what it means and that requires some translation. Murphy’s position is not about treatment. It is about politics. It is an argument for a specific agenda, a different way to use power and money.
His basic argument is we spend far too much money on community services on people who don’t need help and far too little on hospitalization for people who need hospitalization. He believes more people need to be hospitalized for longer periods of time.
His argument for “either you are or you are not” makes a lot of assumptions about psychiatric diagnoses. He assumes that they are discovered realities and not constructed realities. He assumes they are objective truths that professionals can readily discern. He ignores the experience of thousands of people who know first hand that diagnoses are often neither obvious or clear, that they change with regularity and are often more a function of who does the diagnosis than the person being diagnosed. He assumes that diagnoses have a validity and reliability that the APA’s own studies dispute.
He assumes that diagnoses tell you the truth of a person, that life is about what you got and not what happened or what you would like to see happen. He ignores the context of a person’s life and thus acts to minimize all manner of injury, trauma, and injustice.
2. We know how to help
Murphy likes to talk about evidence based practices in the same way other people like to talk about things revealed by God. But he ignores the fact that many practices he does not like are labeled evidence based and some things close to his heart are not.
I have never heard of anyone who claims psychiatric hospitalization is an evidence based practice. Insurance companies don’t pay much anymore because there is no evidence they work. Putting someone in a psychiatric hospital does not make them more likely to not be hospitalized in the future. It makes them more likely.
Murphy believes in medication. He believes it is reprehensible to suggest that someone should have a choice about taking prescribed medication. I have known people who believed medication was a key to them making it in life. But I have known many who have dealt with serious and even life threatening side effects. I have known many that apart from side effects have seen little or no benefit. To tell people that psychiatrists “know” medication and their recommendations should be accepted without question or argument is dishonest.
Murphy seems to believe that diagnosis determines treatment, that treatment is differential. In the real world diagnosis does not determine treatment. It justifies it. It’s primary function is to tell insurance companies why they should pay. Much treatment is cookie cutter stuff and had little to do with what you are called. Ask anyone who has been in a psychiatric hospital.
And finally the role of the psychiatrist. Murphy tries to sell the fable of the psychiatrist with special knowledge and talent.
In the real world psychiatrists monitor medication. Their exposure to patients is in 10-15 minute chunks. They direct little if anything. Often it seems their function is to justify to insurance companies the medical necessity of what other people do.
3. There is a conspiracy to prevent help.
This is the hocus pocus part of his argument and in some ways the most important part. A conspiracy is the easiest way to disqualify people who disagree with you and is particularly important as in Murphy’s case a lot of people disagree. It requires no proof, only the faith of those who want to believe you know. Witness Donald Trump.
Murphy’s call to crusade is clear. Anyone who believes that seriously mentally ill people can and should make choices for themselves and who does not realize that sometimes people have to be forced to do things for their own good obviously doesn’t care about these people and has some hidden motives behind their behavior.
Part of the skill of any ideologue is to make it impossible for any person to honestly disagree with them and Murphy has plenty of skill.
4. The lack of insight
This is the foundation of coercion. It is the “we have to do this for their own good” statement that justifies anything. It is seen by them as an article of religious faith and any argument against it as sacrilegious.
The scientific absurdity of the claim has been well documented. If you would like to read further many posts on this blog deal with it but I strongly suggest you read the writings of a psychiatrist named Sandra Steingard. She nails it as well as anyone I have read.
The word for all this is anosognesia. It is his justification of the wholesale ignoring of the human rights of the people he says he is trying to help. It will never cease to amaze me how many atrocious things we will do to people who don’t want us to “for their own good.”
5. The limits of improvement… A chronic disease
This is an extremely important pillar. It serves to disqualify the testimony of witnesses. If this is true and yet you have began to build a better life, if you have found some measure of “recovery”, then obviously you were never “sick” to begin with. Your testimony is groundless and has little to do with the real needs of the seriously ill we are talking about.
A great way to deal with any contradiction to true faith is to make that contradiction irrelevant. This pillar tries to do that.
6. The issue of violence.
This is the final nail in the coffin. Fear will motivate when a lot of other things won’t. Murphy has been a regular feature after every tragedy in the last couple of years explaining how his bill could have prevented it. He knows no shame where political gain is involved.
There are many other things that could be said about the Murphy Bill and the notion of coercive psychiatry. My hope had been to share some of the things I believe and hopefully leave you a little better armed and able to share your views with your legislators.