On March 4, 1878, at a meeting of the New York Neurological Society, Edward C. Spitzka delivers a blistering attack on psychiatry, basically dismissing all alienists as incompetent and indicating that “the study of insanity should be considered a subdivision of neurology.” This address was published in the Journal of Nervous and Mental Disease in 1878…
The Medical Community is part of the problem of criminalization of neurobehavioral illness and pervasive misunderstanding.
New England Journal of Medicine Article: “We have seen not only the abdication of medical responsibility for the life circumstances of severely psychotic people, but also a growing acceptance of homelessness and incarceration as legitimate fates for people whose psychotic behavior violates social norms”
Advocates need to be mindful of the factionalism that exists in the mental health industry. The greatest obstacles to reform are spectrum-disordered belief systems and anti-stigma/consumer empowerment activism. These obstructionists have become very powerful and influential upon legislators and the media. Serious neurobehavioral illness should not be stigmatized. All human beings have a right to dignity. However, political activism for the protection of human rights should not result in the most vulnerable citizens being abandoned to the streets and the criminal justice system. This kind of activism, these kinds of ideologies that inform government policies, must be confronted and opposed.
Society needs to stop conflating “mental health” with serious neurobehavioral illness. This is a central point of contention in the advocacy community. Mental health applies to all of us, Neuropsychiatric illness applies to about 18% of the whole, and an estimated 4% of the 18 have serious neurobehavioral illness. In order to confront this nosology and classification problem for which the medical community bears responsibility, this site has moved away from using the term ‘mental illness’ to the extent that is possible without sacrificing the clarity that is needed to engage the reader. There was a transition from “mental illness” to neuropsychiatric illness, and more recently from serious neuropsychiatric to serious neurobehavioral. As advocacy is concerned, it is not the content of mental activity that drives people with these illnesses into the culdron of the criminal justice system – it is the symptomatic behavioral product of the abnormal mentation and consciousness disorder that transgresses the law. It is the neurobehaviors that call for bold, assertive and sometimes courageous advocacy. Inability to care for oneself, a behavior, is what leads to homelessness. Inability to recognize that motor activities are disordered products of abnormal mentation and anosognosia is what leads to unlawful behaviors.
Within DJP’s advocacy network, the word psychiatric has become a point of concern in that it does not signify the biological/neurological nature of illnesses such as “schizophrenia” and bipolar. This site is being audited to update these terminologies it its content. It is critically important that the behavioral consequences of these illnesses not be denied or dissociated from the medical diagnosis. The criminal justice system has codified this dissociation with the construct and application of “guilty but mentally ill”. When the behavioral symptoms are dissociated or diminished as primary factors in unlawful behaviors, this becomes the driver for criminalization.
Misunderstanding serious neurobehavioral illnesses (SNI) makes “Us”, society, a danger to people afflicted with SNI.
TOPICS THAT SHOULD INFORM ADVOCACY
- HIPAA – the corrupted regulatory application that does so much harm
- The illogic of the IMD Exclusion founded on misconceptualization of so-called mental illness
- Segregation of Serious Neurobehavioral Illnesses into a “mental health” system where they do not belong
- The lexicon problem – the unfortunate legacy of psychoanalytical ideas and the split between psychiatry and neurology. Terms like “mental illness”, “psychosis”, dissociative disorders, melancholy and serious neurogenic dysphorias sharing the term “depression”
- Defective and irrational “Insanity” Law – M’Naghten’s Rule
- Misguided “Trauma-Informed” Ideologies promulgated through state and federal policies and promoting false assertions about the cause of serious neurobehavioral illness
- Practitioners of law and justice uneducated about neurobehavioral illness
- The injustice of “Competency Restoration” as preparation for prosecution
- Lack of long-term to permanent congregate housing due to misunderstanding of serious neurobehavioral illness and intentional misapplication of the Supreme Court’s Olmstead Ruling
- Improper conflation of “Mental Health” and Serious Neurobehavioral Illness (“Schizophrenia, Bipolar, and neurogenic “depression” are not “mental health” disorders)
- The irrationality of the dangerous standard for involuntary treatment
- “Mental Health” courts and AOT are not gold standard solutions for managing serious neurobehavioral illnesses in the community
THE MEDIA IS THE DRIVING FORCE, SECONDARY TO THE TROUBLESOME MENTAL HEALTH INDUSTRY IN MISEDUCATING THE POPULACE ABOUT SNI.
The media needs to stop courting the expertise of psychologists, counselors, and therapists as the primary medium through which the mental health industry is spreading its fallacious theories and public service psychology mental wellness prescriptions. The media needs to stop seeking insight from psychologists, FBI profilers, forensic psychologists, and criminal profilers if they want to understand the relationship between serious neurobehavioral illness and violence. The media has been talking to these people for decades and they have learned nothing useful from them to the benefit of society. The media needs to start doing good, in-depth journalism and talking to reputable (emphasis on) neuroscientists and medical doctors that do not subscribe to the nonsensical biopsychosocial constructs of serious neurobehavioral illness.
CALL FOR LAW SCHOOLS TO REQUIRE COMPREHENSIVE COURSEWORK ON NEUROBEHAVIORAL ILLNESS
We can no longer tolerate having prosecutors and judges who do not understand these illnesses trying, convicting, and sentencing people. These practitioners of law and justice do not understand what they are doing wrong. To restate what was just said here in the language of an element of insanity law: Prosecutors and Judges do not appreciate the wrongfulness of their convictions and sentencing. This must stop.
STUDY THE PAST FOR INSIGHT INTO THE FUTURE
E. Fuller Torrey wrote the book “American Psychosis, How the Federal Government Destroyed the Mental Illness Treatment System”. This book documents how the fundamental misconceptualization of SMI during and after the strange mental hygiene movement led to the disastrous broken system that federal and state governments are still in the process of breaking even in the present. Doctor Torrey’s book and DJ Jaffe’s book “Insane Consequences” should be required reading for every legislator in the country. DueJusticeProject has a point of contention with a couple of passages in both books where experimental policy prescriptions are discussed, and American Psychosis may be too bogged down in “story-telling” of the real life narrative of a prominent political family, however, both books provide an excellent analysis of what has gone wrong and why. Advocates need to be knowledgeable about the ethos of the mental hygiene movement and how the belief systems of that era are still informing social policies to this day. Adherents to these beliefs are influencing legislators and thwarting attempts to reform laws and policies.
COMPETENCY RESTORATION AND OTHER MECHANICS OF “DUE PROCESS”
Many if not most states in the U.S. have been sued by the ACLU and Disability Rights organizations for holding people in jail detention for many months, sometimes in excess of a year awaiting competency restoration. The leadership of the organizations launching these lawsuits seem to have little appreciation for the cruel paradox of their lawsuits. Society would not tolerate a system that would hold a jail detainee captive from treatment for any other acute medical condition. Yet, people who are in medical crisis with psychosis (neurologically detached from reality and gravely disordered cognitively) are held like animals in jails, deprived of medical treatment. The truth is that they are not being held for treatment – they are being held so that prosecutors can have them prepared for prosecution. The consequences of these abuses are further damage to the brain, neuro-psychogenic suicide, and potentially the need for higher doses of antipsychotic medications which can have serious side effects.
Supreme Court cases, such as Sell v United States need to be studied by advocates to detect where misunderstanding of serious neurobehavioral illness forms the substrate for these defective and troubling rulings. Advocates need to network to discuss the mechanics of criminalization. M’Naghten’s Rule and Competency Restoration are symptomatic of a pathological system that is convicting and punishing people unjustly. Advocates must stand up against these injustices.
REFORM OF STATE MENTAL HEALTH PROCEDURES – The Dangerousness Standard
States that require that people become dangerous need to change their laws to a need for care standard. As things stand, the anti-stigma proselytizers in the advocacy and mental health industry have succeeded in influencing society to believe that the mentally ill are not dangerous. It is estimated that about 18 percent of the populace has a diagnosis from the DSM. The vast majority of those individuals living with diagnoses that do not involve neurogenic dysmentaion (“psychosis”) are not dangerous to themselves or others. It is the approximately 4 percent of the 18 percent (a very small number of people) that have a serious neurobehavioral illness that involves “psychosis” – which can indeed be a dangerous neurological status which should be treated as an urgent medical crisis. Yes, someone with neurogenic dysmentation can be a grave danger to themselves or others. Juxtapose this with the dangerous standard for involuntary evaluation and treatment! In part, conventional advocacy has succeed in misguiding the populace because mental health and mental illness is being conflated with serious neurobehavioral illness (SNI).
The fact is that someone who is behaving bizarrely to the extent that others feel unsafe, or showing signs of “psychosis” – meaning, becoming neurologically detached from reality, particularly if the person is anosognosic, is at high risk for something dangerous happening. The dangerousness standard requires that the individual deteriorate to an acute medical condition for which there may be no explicit manifestation of dangerousness before someone can even enter into a battle with the system to get the person admitted for evaluation and treatment. (Pennsylvania state codes require moreover, that there be an act in “furtherance of a threat” – an outrageous and patently ridiculous standard that acts as a solicitation for someone to be harmed). The state refuses to step in proactively to compel involuntary evaluation and treatment on the basis of its duty to protect, yet will forcibly medicate someone to make them “competent to stand trial”, after someone has been victimized or killed, under the Sell v United States justification of the duty to protect society – by putting the person on trial.
People with serious neurobehavioral illness are generally no more likely to be violent than anyone else. However, based on biological factors, certain symptom profiles, a small percentage of people with untreated SNI are much more likely to be assaultive, engage in goal-directed behaviors that precipitate violence, or act out in paroxysmal episodes of violence. The general public, juries, and judges, generally do not understand how these illnesses works to cause assaultiveness or unlawful behaviors – they do not understand the consciousness disorder aspect of “psychosis”, command hallucinations, disinhibitions, clinical delusions, and acute dysphorias.
In the future, neuroscientists will come to understand a great deal more about electrical and chemical abnormalities in the brain that can directly cause goal-directed and paroxymal-type violence in human beings. Advocates for people with SNI who commit acts of violent are not indifferent to crime, insensitive to the devastating harms done to victims, or insufficiently outraged about violent crime. These advocates just have rare insights into SNI that the greater part of the populace does not have. SNI is rare and very difficult to understand. Very few people have direct exposure to SNI, particularly in a close family member. These advocates know that many thousands of people are being unjustly prosecuted, convicted, and punished.
One day neuroscience will discover things about the human brain and semblance of mind that will cause humankind to realize that in times past, people were being punished for behaviors that were beyond their neural capacity to control. It is painful and distressing for people who do understand SNI to stand by and watch this injustice happen. One day researchers will be able to reveal their discoveries to lay persons using language that we can all understand. Until then, the work of advocates will continue to be extremely challenging. We know that even then, the “Freudians” will still cling to outmoded theories. They will continue to conduct contra-research studies to “prove” stress/trauma/abuse/epigenetics hypotheses of SNI. They will not outrun neuroscience over the long haul, albeit that their junk science (much of it attributable to the federal government agency SAMHSA) will continue to wreak widespread havoc for a long time to come.
Prominent foundations and federal government must step up funding of research and dynamic diagnostic tools in order to get to the bottom of the neurodysmentation violence connection.
There is another potential benefit of increased attention being paid by the research community to study of the brain: It just may be the case that the brain is not just the seat of consciousness and semblance of mind, of command and control over human behavior. Scientists may just find out that the brain has control over all bodily functions in ways that are not currently known or understood. Unlocking the brain’s secrets may lead to cures for – or insights into other afflictions of the human body.
Talking About “Mental Illness” in the Media Spreads Ignorance Far and Wide.
Misunderstanding of serious neurobehavioral illness is the root cause of the broken “mental health” system, dysfunctional and destructive public policies, and criminalization of SNI. Among the most serious problems is segregation of medical services for neurobehavioral (known as so-called primary psychiatric in the medical community…a flawed construct) into a so-called mental health system.
The medical profession needs to remodel itself to reconcile with the modern scientific understanding of neurobehavioral disorders. Federal and state governments, and modern medicine should leave the “mental health system” to psychologists, counselors, therapists, and psychoanalysts and fully integrate the medical management of neuropsychiatric disorders into the “physical” healthcare system. Those clinicians have plenty of work to do tending to the worried-well and the 18 percent of people living with a diagnosis from their diagnostic bible, the DSM. They should have nothing to do with people afflicted with neurological illnesses such as “schizophrenia”, bipolar and neurogenic “depression”. Many doctors in other medical specialties other than psychiatry do not understand much about SNI – that needs to change.
Parents need to be educated on how to identify the signs and symptoms of emerging neurobehavioral illness. Researchers are making slow progress toward identifying biomarkers for risk of later development of “psychosis”. For now, most competent doctors believe that early diagnosis and treatment may forestall the development of the most serious stages of “psychosis”. Researchers need to develop more effective, less dangerous medications. At present, researchers still do not fully understand why present day pharmaceuticals work to quell neurogenic dysmentation. As researchers understand more about the brain and SNI, other non-pharmaceutical interventions and adjunct treatments might be identified. The populace needs to be educated in order for advances in early treatment to save lives from the devastating consequences of having SNI.
The population needs to be re-educated to dispel folk psychology-based notions of SNI. We must stop talking about SNI using the same expressions that are used in public service messaging about “mental health”. We must cease being afraid and uncomfortable talking about the realities of neurogenic dysmentation in the subset of people that advocates are calling “The 4 percent”. People need to recognize symptoms before tragedy strikes. If the general public is told to look for “depression”, sadness, loss of interest , social withdrawal, etc. then psychosis is probably not going to be caught early. In the U.S., the Surgeon General of the United States, perhaps working in conjunction with the NIMH, may have an important role to play in re-education.
There has been a epidemic of high-profile media stories about school shooters who were said to be “depressed”. In many cases, the parents did not comprehend their child’s illness. Who on earth would expect someone to shoot up a school because they are despondent or “depressed”. The colloquial use of “depression” is a thousand miles apart from the neurological realities or experience of clinical “depression”. Parents also need to understand that distinctly classified disorders such as Bipolar, Schizophrenia, and Clinical ‘Depression'” are a construct and not so distinct as researchers have long suspected (and are substantiating via research studies). So-called Schizophrenia is a generic label for a symptom complex and it is a diagnosis of exclusion. “Primary psychiatric Disorder” or “Schizophrenia” is only diagnosed after differential diagnosis is explored – or this should be the case. Researchers do not understand the pathophysiology of symptoms for “Schizophrenia” any more than it understands what produces the same symptoms secondary to a host of distinctly identified encephalopathies. “Schizophrenia”, Clinical “Depression”, and so-called Bipolar are not mere traumagenic psychological or emotional crises of the psyche. We need to snap out of folk psychology and Freudian ideas of trauma genesis and defense mechanisms.
EXAMINE THE MISINTERPRETATION OF THE OLMSTEAD RULING
Justice Kennedy forewarned against the perverse result that might stem from this ruling in subsequent years from the misinterpretation of the ruling when he wrote: “It would be unreasonable, it would be a tragic event, then, were the Americans with Disabilities Act of 1990 (ADA) to be interpreted so that States had some incentive, for fear of litigation, to drive those in need of medical care and treatment out of appropriate care and into settings with too little assistance and supervision.”
There is an intersection between Olmstead and Criminal Justice. Lack of proper supported housing for the case management of SNI catapults vulnerable people into a criminal justice system that does not understand neurogenic dysmentation – but that is only one aspect of the intersection. Judges are convicting and sentencing people to prison making explicit statements to the effect that they know that diminished criminal liability sentencing or insanity dispositions will result in people being stepped down from high-security hospitals to unsafe community placements where the subject will go off his or her meds and become a danger to society. Ultimately, if judges are sending philosophically innocent people to prison for fear of the application of a Supreme Court ruling, then something is horribly wrong. This abuse of the most vulnerable citizens under the law must stop.
The housing First/Supported housing “recovery-oriented”, self-directed models that are being promoted by federal government are not reconciled to the realities of chronic serious neurobehavioral illness. The denial is palpable when you read documents like this:
VOR, a organization adocating for people with intellectual and developmental disabilities, has an excellent position statement paper on the topic of Olmstead. VOR asserts that state and federal governments have intentionally misapplied the Supreme Court’s ruling. The impact of this willful misinterpretation has been devastating on the lives of people with neurobehavioral illness. Protection and Advocacy Agencies (PAIMI -Which are a requirement of the federal government) may be well-intentioned but they have engaged in some very troubling class-action lawsuits that have not served the interests of people with neurobehavioral illness.
Organizations and individual advocates for disability rights may understand very little about SNI. Serious Neurobehavioral Illness is a particular type of disability that is different from all others for which special protections are needed under the law. Disability and civil liberties advocates have unintentionally harmed people with SNI via their activism. The ADA has failed to protect people with SNI based on their unique characteristics of disability, enforcing one-size-fits-all policies that have led to homelessness and engagement with the criminal justice system. The criminal justice system is exclusively responsible for mass incarceration, but misguided public policies and enforcement policies of the Justice Department against state institutions of custodial care and treatment have channeled the most seriously ill into the cauldrons of criminal justice. SNI advocates need to push back against policies that are ill suited to the needs of people with serious brain disorders.
Some states even have an ‘Olmstead Plan’. Most of them should be scrapped.
DEFINITIONS OF INSANITY
The Supreme Court permitted the states to define insanity for themselves. Under the law, “Insanity” does not equate to serious neurobehavioral illness. This disconnect provides the substrate for a host of abuses and injustices. Serious neurobehavioral illness must have its own explicitly defined carve-out under the law. M’Naghten’s Rule is the most offensive and unjust of all legal definitions of insanity, especially in its abridged forms – but few people can understand why because they do not understand SNI. Advocates for people with SNI must confront M’Naghten’s Rule head on and challenge lawmakers on the basis of the realities of serious neurobehavioral illness. Advocates must not fear ostracization and antagonism.
That said, the law needs to stop trying to define insanity. There needs to be an explicit special defense for SNI and other brain dysfunctions such as TLDs and TBIs.
AOT, MENTAL HEALTH COURTS and INTERCEPT MODELS
Mental health courts propose to be compassionate and merciful toward people suffering from SNI, yet their program language speaks of “recidivism” and reversion to jail time if treatment plans are not adhered to. An institution of the law that speaks of symptomatic behaviors as “recidivism” and which punishes the consequences of anosognosia with jail time is not compassionate. A mental health court that conducts its affairs in this manner demonstrates that its operators do not understand serious neurobehavioral illness. Diversion programs need to be overhauled to reconcile with the medical science of SNI. Someone with SNI who has been assessed to be unsafe, unwell, and possibly a danger to others should be placed in a medical facility or crisis stabilization facility when they refuse treatment, not a jail.
STATE GOVERNMENTS MUST PUT FUNDING FOR SNI AT THE CENTER, NOT THE PERIPHERY OF BUDGETS.
There should be zero-tolerance for letting people with SNI fall through the safety net into homelessness and incarceration. The precursor to Incarceration is harm to society. The law is perpetrating some egregious abuses upon people with SNI via the criminal justice system under the banner of protecting society. State and federal government is only demonstrating that its real goals are to shuttle people with SNI off to the underworld of society, i.e. jails and prisons, when funding for supported housing, state hospitals, and community treatment resources are perpetually vulnerable to budget cuts.
We don’t stash people with Alzheimer’s Disease in independent living units to fend for themselves with case workers to check in on them. We don’t let people with dementia roam the streets as homeless people when it is known that they are afflicted with a neurocognitive disease. Why are state and county governments satisfied to place people who become neurologically detached from reality – cognitively blind in a sense, in housing situations that are inappropriate or allow them to lie in the streets uncared for? The reason why people with SNI are abandoned to homelessness and improper housing is that their brain disorders are misunderstood.
STIPULATE THE CONSEQUENCES OF UNTREATED “PSYCHOSIS”
We need to recognize what serious neurogenic dysmentation (psychosis) can involve an abnormal mental status that can lead to dangerousness. This condition can happen to anyone with the biological risk factors that can cause it. Society should not be shocked when the mother with post-partum psychosis kills her child. Society should not be shocked when someone kills a parent, family member, or someone outside the family when the person was in the throes of “psychosis”. We should not be shocked when an inpatient in a psychiatric ward attacks and harms a staffer. If society should be shocked and enraged at anything or anyone, it should be the system that failed to properly manage serious neuropsychiatric illness in the community. Medical science knows too much about these conditions to be exempted from responsibility for managing this type of illness competently and assertively. Federal laws such as HIPAA have been exploited and corrupted to hinder medical professionals from properly caring for and case-managing individuals with known risk factors for harm to themselves or others.
What we need to do as a society is stop denying the truth that “psychosis” can be deadly – and when something terrible happens, reconcile to what we knew in advance instead of giving ourselves an excuse to act out with vengeance. Instead, societies need to build social policies and criminal justice upon a foundation of what medical science knows to be true about SNI.