The anosognosia of Congress and the new Murphy Bill

The problem with many bills is not just what it makes legal but what it makes possible. So it is with the new Murphy Bill. It isn’t just what it proposes but what it makes possible or likely latter. More on that a little later.

I asked a friend with a lot more political knowledge and savvy than I will ever have why the committee voted yesterday 53-0 to pass this Bill on to the House for consideration. His feedback was very blunt (and will probably upset many people reading this post) :

“The reason many people voted yes was they saw it as a victory and not a defeat. They see politics as being about compromise and they saw Murphy who had refused to even consider compromise being forced to compromise. In their eyes many of the more noxious parts of the bill were substantially weakened or even eliminated. One congressman pointed out the difference in the original hipaa language and the “sense of Congress” in the new bill as being a major difference. He also pointed out the change in AOT as a victory. Larry if your criteria for political success is to get all of what you want then you will never feel like you are a success. Right now your campaign has no traction. If you can’t explain to people how what they see as a victory is really a defeat in language and terms they can buy into you will not influence many people. Messaging is a problem for you.

Like we have talked before the real battle is in the Senate. When Upton presented what was really his bill the issue in the House was decided. The Democrats got what they thought they could get. They made a deal. Upton got what he wanted…. “A bipartisan bill…” They made a deal that they thought made them both winners.

The votes have been there in the House from the beginning. Just waiting on the leadership to act. I do think it is election driven right now though. Paul Ryan really needs some political victories right now before Donald Trump totally submerges him.

The issue of guns has waylaid this in the Senate right now. Things may change but we will see. Some people are worried it may not make the floor at all. If there is no Senate Bill it doesn’t matter what the House does. I suggest you try real hard to make an impact there. You may find you can make a difference there. These are just my thoughts. I don’t know if anyone really knows for sure where this is going. ”

We talked about a lot of issues. I don’t know if he is right or not but you do not have to be too smart to realize something was wrong. It matters more what people hear sometimes than what we think we are saying. A lot of very gifted, very committed and very hard working people just weren’t heard.

We talked about Murphy as the Republican answer to Sandy Hook and the disaster that was. I told him I thought legislation dealing with mass murder guns was essential. I said that without it the passage of increasingly repressive legislation affecting those with psychiatric diagnosis was inevitable as they were increasingly blamed as being the source of a problem not going away and only sure to reoccur. I told him that I could see a time when people were increasingly hesitant to even seek any kind of help for fear of the real life consequences that being diagnosed or labeled by the system might mean for them.

I told him that what the Bill said about anosognosia was one of the most dangerous things in it and laid the groundwork for more bad legislation. Rep Murphy may get his name on this Bill but I find it hard to believe this is the last rodeo for him. The only living psychologist in the Congress will strike again.

Most psychiatric ideas and terms are defined by some sort of reference to research or something like that. Rep. Murphy has defined it as a legal term. That section of the bill explains the concept of anosognosia as if we’re passed down on tablets by E Fuller Torrey. It is presented as gospel truth without any mention of how controversial an idea it is and how many people look upon it as little more than ideological nonsense in defense of a narrow political agenda.

If mass shootings continue and who really thinks they won’t the pieces have been put into place to justify increasingly harsher action. “Those people biologically lack insight into their problems and thus control as proven by more and more murders. The only answer is for us to provide more and more control until things get better both for their own good and our protection.”

Several comments in the bill are worth specifically looking at.

“The vast majority of individuals with mental illness are capable of understanding their illness and caring for themselves.” It sounds like he is saying the vast majority of what I am about to say doesn’t apply to most of the people I am talking about. But then again why say it at all? The passage had a couple of important functions. It is their “don’t worry I am not talking about a lot of people” statement. That way any critical voice can be dismissed as hysterical nonsense.

“Persons with serious mental illness (in this section referred to as ‘‘SMI’’), including schizo spectrum, bipolar disorders, and major depressive disorder, may be significantly impaired in their ability to understand or make sound decisions for their care and needs. By nature of their illness, cognitive impairments in reasoning and judgment, as well as the presence of hallucinations, delusions, and severe emotional distortions, they may lack the awareness they even have a mental illness (a condition known as anosognosia), and thus may be unable to make sound decisions regarding their care, nor follow through consistently and effectively on their care needs.” In other words their decisions about treatment may be less about their feelings and thoughts about the options presented them and more a symptom of their illness. Any criticism or doubts about the course of treatment presented them may be a symptom of brain damage in other words. Scary stuff….

I won’t go into a point by point discussion of everything laid out in that part of the bill. That section as I said before is printed below. Anosognosia is according to the bill the culprit in everything including dying 25 years earlier. You have to read it to believe it.
The real curious part is the end. Instead of proposing action based on this curse of anosognosia they simply say we need better education about the exceptions in hipaa. I thought the thrust of the whole section was to say we agree with everything Rep Murphy said but we can’t win the vote right now so we will accept this for now. You read it and tell me if you read it any different.

One cynical friend who believes he is really funny expressed it like this. “People who believe that Donald Trump would be president are accusing other people of being brain damaged. What can you say?

This post has raised a lot of issues and not really offered many answers and this doesn’t begin to even talk about all the issues.

We need to make a difference and how to do this should be a big point of discussion. A lot of people I listened to were shocked at how little we were heard.

If anosognosia is defined as a chronic lack of insight into your problems then perhaps Congress is the biggest concentration of anosognosia in the country. Perhaps our role could be to bring a little bit of insight into their poor suffering souls.

The Bill

(1) The vast majority of individuals with mental illness are capable of understanding their illness and caring for themselves.
(2) Persons with serious mental illness (in this section referred to as ‘‘SMI’’), including schizo spectrum, bipolar disorders, and major depressive disorder, may be significantly impaired in their ability to understand or make sound decisions for their care and needs. By nature of their illness, cognitive impairments in reasoning and judgment, as well as the presence of hallucinations, delusions, and severe emotional distortions, they may lack the awareness they even have a mental illness (a condition known as anosognosia), and thus may be unable to make sound decisions regarding their care, nor follow through consistently and effectively on their care needs.
(3) Persons with mental illness or SMI may require and benefit from mental health treatment in order to recover to the fullest extent of their ability; these beneficial interventions may include psychiatric care, psychological care, medication, peer support, educational support, employment support, and housing support.
(4) Persons with SMI who are provided with professional and supportive services may still experience times when their symptoms may greatly impair their abilities to make sound decisions for their personal care or may discontinue their care as a result of this impaired decision making resulting in a further deterioration of their condition. They may experience a temporary or prolonged impairment as a result of their diminished capacity to care for themselves.
(5) Episodes of psychiatric crises among those with SMI can result in neurological harm to the individual’s brain.
(6) Persons with SMI— (A) are at high risk for other chronic physical illnesses, with approximately 50 percent having two or more co-occurring chronic physical illnesses such as cardiac, pulmonary, cancer, and endocrine disorders; and (B) have three times the odds of having chronic bronchitis, five times the odds of having emphysema, and four times the odds of having COPD, are more than four times as likely to have fluid and electrolyte disorders, and are nearly three times as likely to be nicotine dependent.
(7) Some psychotropic medications, such as second generation antipsychotics, significantly increase risk for chronic illnesses such as diabetes and cardiovascular disease. (8) When the individual fails to seek or maintain treatment for these physical conditions over a long term, it can result in the individual becoming gravely disabled, or developing life-threatening illnesses. Early and consistent treatment can ameliorate or reduce symptoms or cure the disease. (9) Persons with SMI die 7 to 24 years earlier than their age cohorts primarily because of complications from their chronic physical illness and fail to seek or maintain treatment resulting from emotional and cognitive impairments from their SMI.
(10) It is beneficial to the person with SMI and chronic illness to seek and maintain continuity of medical care and treatment for their mental illness to prevent further deterioration and harm to their own safety.
(11) When the individual with SMI is significantly diminished in their capacity to care for themselves long term or acutely, other supportive interventions to assist their care may be necessary to protect their health and safety.
(12) Prognosis for the physical and psychiatric health of those with SMI may improve when responsible caregivers facilitate and participate in care.When an individual with SMI is chronically incapacitated in their ability to care for themselves, caregivers can pursue legal guardianship to facilitate care in appropriate areas while being mindful to allow the individual to make decisions for themselves in areas where they are capable.
13) When an individual with SMI is chronically incapacitated in their ability to care for themselves, caregivers can pursue legal guardianship to facilitate care in appropriate areas while being mindful to allow the individual to make decisions for themselves in areas where they are capable.
(14) Individuals with SMI who have prolonged periods of being significantly functional can, during such periods, design and sign an advanced directive to predefine and choose medications, providers, treatment plans, and hospitals, and provide caregivers with guardianship the ability to help in those times when a patient’s psychiatric symptoms worsen to the point of making them incapacitated or leaving them with a severely diminished capacity to make informed decisions about their care which may result in harm to their physical and mental health.
(15) All professional and support efforts should be made to help the individual with SMI and experience acute or chronic physical illnesses to understand and follow through on treatment.
(16) When individuals with SMI, even after efforts to help them understand, have failed to care for themselves, there exists confusion in the health care community around what is currently permissible under HIPAA rules. This confusion may hinder communication with responsible caregivers who may be able to facilitate care for the patient with SMI in instances when the individual does not give permission for disclosure.
(b) SENSE OF CONGRESS.—It is the sense of the Congress that, for the sake of the health and safety of persons with serious mental illness, more clarity is needed surrounding the existing HIPAA privacy rule promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act (42 U.S.C. 1320d–2 note) to permit health care professionals to communicate, when necessary, with responsible known caregivers of such persons, the limited, appropriate protected health information of such persons in order to facilitate treatment, but not including psychotherapy notes.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s