Ambiguity, inaccuracy and the ‘mentally ill’
Some people in the community of people with disabilities — including this reporter — who have an emotional, psychiatric or mental disability are now using the term “so-called mentally ill.”
This reporter was misdiagnosed with schizophrenia in 1975 and was improperly medicated for six years. Finally another psychiatrist corrected the misdiagnosis and gradually weaned me off the extremely addictive medications that had caused serious side effects, including drowsiness, disorientation, uncontrollable shaking, inability to sleep and unusual sensitivity to heat.
Ambiguous guidelines for psychiatric diagnosis
According to a June 26 Wall Street Journal article entitled ‘”Unspecified Mental Disorder’? That’s Crazy” by physician, psychologist and author Dr. Leonard Sax, “The American Psychiatric Association released a revision of its diagnostic bible in May, the first major rewrite in two decades. ‘The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders,’ or DSM-5, is the official guidebook for diagnosing every conceivable psychiatric ailment.”
First published in 1952, the book once branded LGBTQ people as having “sexual orientation disturbance” until the LGBTQ liberation struggle forced it to remove this bigoted diagnosis in its third edition in 1980.
“In previous editions,” wrote Sax, “you the patient had to meet certain specified criteria in order to be diagnosed for any particular condition. For instance, if I were going to diagnose you as having schizophrenia, then you had to have specific symptoms, such as delusions or hallucinations. If you didn’t have those symptoms, then I couldn’t make the diagnosis of schizophrenia.
“Not anymore. Last month, DSM-5 introduced a new diagnosis, ‘Unspecified Schizophrenia Spectrum Disorder.’ The only required criterion is that you have some distress from unspecified symptoms, but you ‘do not meet the full criteria for any of the disorders in the schizophrenia spectrum and other psycotic disorders diagnostic class.’”
This diagnosis is in one short paragraph at the bottom of page 122 of the DSM-5.
There is also a new “Unspecified Attention-Deficit/Hyperactivity Disorder.” The piece de resistance of this glorification of ambiguity is on page 708, where you can find the new “one size fits all” mental health diagnosis of “Unspecified Mental Disorder” for people who “do not meet the full criteria for any mental disorder.”
“As recently as 1994,” wrote Sax, “it was rare for any child or adolescent in the U.S. under 20 years of age to be diagnosed as bipolar.” But, by 2003, “There was a 40-fold increase in the diagnosis of bipolar disorder among American children and teenagers,” without any change in official diagnostic criteria.
“Most of the new diagnoses were for children under 15 years of age. This phenomenon is peculiar to North America.” During roughly the same time period, the proportion of children under 15 diagnosed with bipolar disorder decreased in Germany.
“In the U.K. and in continental Europe, bipolar disorder is still recognized as a condition that cannot be reliably diagnosed in childhood. Kids have mood swings. Mood swings in an 8-year-old do not signify bipolar disorder; mood swings are a normal part of being an 8-year-old. Unless you happen to live in the U.S., in which case your child is more likely than ever to be put on powerful antipsychotic medications.”
Psychotherapist Gary Greenberg in “The Book of Woe: The Making of the DSM and the Unmaking of Psychiatry,” recounts how Joseph Biederman, a child psychiatrist at Massachusetts General Hospital, decided in the late 1990s that some children he’d been asked to treat for particularly severe attention deficit/hyperactivity disorder were in fact suffering from bipolar disorder or BD.
BD is a serious, probably genetic, lifelong condition that had previously been thought to emerge in early adulthood. It is often treated with powerful, mood-stabilizing drugs with significant side effects.
Although no substantive studies supported the existence of pediatric BD and his child patients did not display one of the key symptoms — manic episodes — Biederman used his considerable prestige to advance his theory.
The 2000s saw a boom in pediatric diagnoses of BD and the prescription, to young children, of medication that carried risks of cataracts, diabetes, obesity and a movement disorder called tardive dyskinesia.
In 2006, a scathing front-page exposé in the New York Times revealed that Biederman had received $1.6 million from drug companies in exchange for promoting his diagnosis and solicited even more to fund research that he promised would “support the safety and effectiveness” of their drugs.
This reporter recognizes that people with and without disabilities have been helped by the treatment of psychiatrists and other mental health professionals, but that the capitalist system, which puts profits before people, encourages and promotes abuse of patients and discourages nurturing, scientifically sound patient care. Witness the current public health epidemic of hospital closings in New York, including four targeted for shutdown in Brooklyn alone.
For years health insurance companies have consistently paid a much lower percentage of patient medical costs for psychiatric care than for other medical treatments, making quality psychiatric care more of a privilege than a right and much more affordable for the 1% than the 99%. Its cost is beyond the economic means of many workers and oppressed people, particularly people of color.
Gun control and the so-called mentally ill
On Dec. 14 last year, 20-year-old Adam Lanza, labeled by the screaming U.S. media as “having a mental illness,” fatally shot 20 children and six adult staff members at Sandy Hook Elementary School in Newtown, Conn.
Almost immediately, Gov. Andrew Cuomo of New York took advantage of the frenetic climate after Sandy Hook, drafting the Secure Ammunition and Firearms Enforcement Act in secret and moving it through the Legislature, according to the June 24 Chief Leader newspaper, “faster than a speeding bullet.” He invoked a message of emergency, which allowed the Legislature to skip the normal three-day waiting period before a bill could be considered. So it was passed on Jan. 15 with no hearings, no public input and minimal debate.
The SAFE Act forbids the possession, except by actively employed law enforcement personnel, of magazines that hold more than 10 rounds. The maximum number of rounds it says can be loaded into a magazine is seven. Standard weapons used by law-enforcement officers use magazines holding up to 15 rounds. On July 8, Gov. Cuomo signed the act, which also exempts police retirees from limits on magazine sizes.
In other words, cops and retired cops have free rein to use these semi-automatic weapons, from which everyone else is banned. What got less publicity was section S20 of the same law, which requires mental health professionals, including any physician, psychologist, registered nurse or licensed clinical social worker, who currently believes a person they are treating is likely to engage in conduct that would result in serious harm to self and others, to report such individuals to local law enforcement authorities.
Every year, the National Alliance for the Mentally Ill organizes a walk across the Brooklyn Bridge in New York City and in many other U.S. cities to stamp out the stigma of mental illness.
NAMI’s April 2013 newsletter featured an article by a BBC writer that asks the alarming question, “Will Gun Law Hurt the Mentally Ill?” The reporter interviewed a woman he described as someone who has battled mental illness since she was a teenager. She said: “If I had the fear that [my therapist] would go to the police, I would feel violated. Like big brother is watching me.”
According to the same article, Professor Paul Appelbaum, director of law, ethics and psychiatry at Columbia University, has complained that the law provides no guidance to mental health professionals. So the requirements to assess if someone constitutes a threat are just as unclear as that for psychiatric diagnosis.
In fact, in July 2012 the American Psychiatric Association issued the following statement, approved by its Board of Trustees and Assembly: “During their careers most psychiatrists will assess the risk of violence to others. While psychiatrists can often identify circumstances associated with an increased likelihood of violent behavior, they cannot predict dangerousness with definitive accuracy. Over any given period some individuals assessed to be at low risk will act violently while others assessed to be at high risk will not.”
On May 1, Wendy Brennan, executive director of NAMI-NYC Metro, testified at a forum at New York Uuniversity’s Langone Medical Center that the SAFE Act’s duty-to-report provision “will not prevent violence and will not save lives but will inhibit some from seeking the vital mental health services and treatment they need. According to a 2006 American Journal of Psychiatric study, only 5% of violent crimes, defined by the FBI as murders, robberies, rapes and aggravated assaults, can be attributed to people with mental health problems. [Yet] there is a strong belief in this country that people with serious mental illness are dangerous and are responsible for a significant amount of the violence in this country.”
Another 2006 survey indicated that the so-called mentally ill are 12 times more likely to be the victims of a crime than they are to be the perpetrators.
Gun control and right of the oppressed to self-defense
Lena Baker was an African-American mother of three children who worked as a maid to support her family in Jim Crow Georgia. In 1944 Baker started working for Ernest Knight, a white grist mill owner, who held her there for days at a time against her will.
One night they had an argument in which he threatened her with an iron bar. Trying to escape, she shot and killed him with his gun. She immediately reported the incident and said she had struggled in self-defense. An all-white male jury convicted her of murder by the end of the afternoon. Because African Americans had been disenfranchised in the South and could not vote, they were disqualified from jury service. On March 5, 1945, Baker was executed in Georgia’s electric chair.
Members of the Black Panther Party for Self-Defense started their community police patrol programs in the 1960s. They listened to police calls on a short-wave radio, rushed to the scene of the arrest with law books in hand, and inform the people being arrested of their constitutional rights. Panther members also carried loaded weapons, which were publicly displayed, exercising their constitutional right to bear arms. They were careful to stand no closer than 10 feet from an arrest so as not to be charged with interfering.
On May 2, 1967, the Panthers sent a group to Sacramento to protest the Mulford Bill, which would prohibit the public carrying of loaded firearms. The Panthers carried loaded rifles and shotguns, publicly displayed, and entered the State Capitol building to read aloud Executive Mandate Number 1, which was in opposition to the Mulford Bill. Unfortunately, the legislature responded by passing the bill, thus creating the Mulford Act, which was signed into law by Gov. Ronald Reagan.
Soon after this incident, FBI Director J. Edgar Hoover declared the Black Panther Party to be the single greatest threat to the national security of the United States, and police departments across the country proceeded to murder Panther leaders like Fred Hampton in Chicago.
On July 31, 2010, Marissa Alexander, an African American who had given birth days before, fired what she described as a warning shot in the air during a fight with her abusive husband. Two children were inside their Jacksonville, Fla., home when she pulled the trigger, but no one was harmed. Alexander claimed self-defense under Florida’s “Stand Your Ground” law, which supposedly allows citizens to defend themselves when attacked. But a judge rejected that argument. Alexander was convicted of aggravated assault by a six-person jury and sentenced to 20 years in prison. Guess who was in charge of Alexander’s prosecution? The very same Florida State Attorney Angela B. Corey who sabotaged the George Zimmerman prosecution that denied Trayvon Martin justice.
Lena Baker, the Black Panthers, Marissa Alexander and Trayvon Martin all had the unconditional right to defend themselves and not be obstructed by U.S. gun control, which has never applied to racist cops or armed bigots like George Zimmerman who are free to hunt down and murder youth of color. They are the real fascists and terrorists of today’s world.
This article is based on part of a July 20 talk by this writer, who is a member of Workers World Party’s Caucus of People with Disabilities.