reprinted with kind permission of author Judi Chamberlin. Although ON OUR OWN(McGraw-Hill 1978) is out of print, copies are available upon request from the author,
c/o the National Empowerment Center, 20 Ballard Road, Lawrence, MA 01843, for $15 plus shipping ($1 per book). This is the British edition.
Chapter Five: When People Go Crazy
There are no commonly accepted definitions, among either physicians or the general public, of mental health and mental illness. The kinds of behavior that get labeled mental illness are deviant acts that don't fit into neat categories, such as "crime or 'immorality." Sociologist David Mechanic has concluded that "mental illness is regarded usually as a residual category for deviant behavior having no clearly specified label." Calling certain kinds of deviance "illness" is a widely accepted convention in this society, but rather than conceding that it is just a theoretical construct, most people accept it as a scientifically verifiable fact. Most of the scientific literature about mental illness is biased in just this way; the possibility that the behavior being described might be explained in other ways than by calling it mental illness is not even considered.
Psychiatrists can have expertise in "diagnosing" and "treating" mental illness only if it truly is an illness; otherwise psychiatrists are merely making moral pronouncements about behavior disguised as objective medical opinions. By calling some kinds of behavior mental illness, psychiatrists invalidate any meaning that behavior might have, since the behavior is merely a "symptom." It is, of course, possible that by calling some behavior mental illness, psychiatrists are obscuring the causes even as they attempt to explain them. As psychiatrist Thomas Szasz has observed:
The term "schizophrenia" is supposed to explain so-called insane behavior just as the term "protoplasm" was supposed to explain the nature of life, and "ether" the transmission of energy through space. Not only have these words failed to explain the phenomena in question, but. . . they hindered our understanding. We realize today that words like "ether" and "protoplasm" obscured important problems in physics and biology; but we fail to realize that words like "schizophrenia" and "psychosis" might obscure important problems in psychiatry.
Szasz calls these terms panchrestons--words that seem to explain all, yet explain nothing. Only history, Szasz of course concedes, will judge whether schizophrenia is a term that obscures more than it explains, but he offers forceful arguments for the essential meaninglessness of the term.
Szasz has also offered persuasive arguments for the essential similarity between the treatment of witches in the past and the present treatment of mental patients:
In actuality, Institutional Psychiatry is a continuation of the Inquisition. All that has really changed is the vocabulary and the social style. The vocabulary conforms to the intellectual expectations of our age. It is a pseudomedical jargon that parodies the concepts of science.
What Szasz does by questioning the concepts that many people in contemporary society accept without questioning is to attempt to shake us out of conventional ways of thinking and encourage us to examine these questions for ourselves. It is impossible to summarize adequately Szasz's voluminous and exciting body of work. Readers are encouraged to familiarize themselves with it and assess it.
Defenders of the medical model of psychiatry tend to be quite dogmatic. The history of psychiatry is frequently presented as a record of steady progress out of a previously benighted period in which the insane were persecuted, followed by the dawning of an enlightenment in which the insane became recognized as ill and as proper subjects for beneficial psychiatric treatment. That the "insane" might have objections to their "treatment" is either ignored or presented as evidence of illness, which is a form of circular reasoning.
A spirited defense of the medical model of mental illness is sociologist Miriam Siegler's and psychiatrist Humphry Osmond's Models of Madness, Models of Medicine. In a nearly three-hundred-page work, Siegler and Osmond never discuss the problem of involuntary treatment. In their fairy-tale world, so-called schizophrenics "present themselves for help, either to a private physician or psychiatrist in his office, or in a hospital admitting office" --hardly the way most mental patients come to the attention of psychiatrists. It is interesting to note that Szasz, whom Siegler and Osmond denounce, treats only those patients who come to him voluntarily. Siegler and Osmond argue that the medical model, better than any other model of explaining deviant behavior, fulfills "the first rule of medicine-to do the sick no harm, ignoring the long history of agonizing (and discredited) "medical" treatments for mental illness (and also ignoring their own circular reasoning). Mental illness is an illness because it is diagnosed and treated by psychiatrists, they argue, totally ignoring the historic social control functions of psychiatry and mental institutions.
In the medical model of mental illness, human emotions are transformed into symptoms. Behavior has meaning in the context of people's lives; psychiatric labeling separates out certain behaviors and calls them part of a disease process. It is impossible to understand what is going on in the life of a person in crisis if his or her behavior is discredited in this way. People behaving in unusual ways are not helped to understand what is going on by the psychiatric labeling process. And despite the arguments of Siegler and Osmond and other defenders of the medical model, psychiatric labeling is an inherently stigmatizing process. People fear the "mentally ill"; and the distress felt by a person in crisis is magnified by the drawing away of those around him or her at a time when he or she most needs closeness and emotional support.
Nor is mental illness" a morally neutral term. As Szasz has pointed out:
"Schizophrenia" is a strategic label, like "Jew" was in Nazi Germany. If you want to exclude people from the social order, you must justify this to others, but especially to yourself. So you invent a justificatory rhetoric. That's what the really nasty psychiatric words are all about: they are justificatory rhetoric, labeling a package "garbage"; it means "take it away, get it out of my sight!" etc. That's what the word "Jew" meant in Nazi Germany; it did not mean a person with a certain kind of religious belief. It meant "vermin," "gas him!" I am afraid that "schizophrenia" and "sociopathic personality" and many other psychiatric diagnostic terms mean exactly the same thing; they mean "human garbage," "take him away get him out of my sight!"
Or, as an ex-mental patient puts it, "If mental illness is an illness like any other, which I don't believe it is, the illness it most resembles is VD. "
A Person is suspected of being mentally ill most often because his or her behavior disturbs other people. Because of the stigma, being labeled mentally ill is an eventuality people attempt to avoid. And those who end up with the label are those with the least Power to resist. Terming someone mentally ill is a judgment by others that one is not behaving up to expectations.
Of course, people do experience difficulties in their lives, and may often respond by behaving in strange or frightening ways. Contemporary American society, with its emphasis on competition and individual accomplishment, makes extremely high performance demands. People who aren't "successful" (whether financially, in their careers, or in their personal relationships) are made to feel that their failure is their own fault, attributable to some flaw or deficiency. Even people who appear to others to be financially or emotionally secure may be plagued with doubts and insecurities. But explaining human unhappiness in medical terms is still nothing but a hypothesis, one which minimizes the possibility that people can change, grow, and develop.
My own experiences with "mental illness" illustrate the nonutility of the medical model, as do those of many other former patients. As I have more fully described in chapter 2, on two occasions, about eight years apart, I experienced the intense distress, depersonalization, and sense of unreality that is often described as the onset of acute psychosis. During the first experience, believing that I needed medical help, I voluntarily admitted myself to a mental hospital. For six months I was in and out of hospitals (several times involuntarily), was given large doses of "tranquilizing" drugs and was generally made into a mental patient. I was told, and I believed, that my feelings of unhappiness were indications of mental illness. At one point, a hospital psychiatrist told me that I would never be able to live outside a mental institution. By the time of my final discharge I was convinced of my own inferiority, a feeling that lasted for years.
The second experience was different. Although I was gripped with terror, I was able to recognize that I was not "mentally ill" and that what I needed was not psychiatric treatment but warm human contact. Fortunately, an alternative in the form of a residential crisis center was available, the Vancouver Emotional Emergency Center, and over a two-and-a-half-week period, I lived through an intense emotional experience culminating in a spiritual rebirth that has had lasting effects on my life. When I was defined as "ill," I felt "ill," and I remained "ill" for years, convinced of my own helplessness. In an atmosphere that emphasized nurturance I was able to grow.
Mental hospitals as they currently exist cannot provide this atmosphere of nurturance and growth. If the whole rhetoric of illness and pathology means anything, it means that parts of people's personalities are defective and diseased, fit only for medical tinkering. The reliance on medical expertise leads to passive patients submitting to "treatments" such as the heavy use of psychiatric drugs, which is often perceived by the patients as torture. But patients cannot object to treatment without bringing on more treatment. Only agreeing that one is indeed ill and in need of help brings the possibility of ending the treatment. Mental patients are caught in a vicious circle, where their own feelings are discredited (unless they are In agreement with the psychiatric viewpoint).
Situations that often end in mental hospitalizations involve emotional conflict, and it is the weakest participant who risks ending up as a mental patient. The process of psychiatric diagnosis and hospitalization is about power far more than it is about medicine. Even people who enter hospitals voluntarily, believing themselves ill, have already gone through a process of defining their problems as psychiatric in nature. Again, it is often the least powerful of the people involved in a situation who come to the conclusion that the cause of the problem is their own mental illness. People who end up as mental patients are people in trouble--with their family, their job, or the community at large. A diagnosis of mental illness lets everybody else off the hook--the mental illness of one participant is responsible for whatever difficulties or conflicts have been occurring. Business can go on as usual. That a particular family or relationship or job might be truly intolerable is not even considered as a possibility. The illness model means that once the sick individual has undergone psychiatric repair, he or she should return and fit smoothly into his or her old life. Further signs of disruption or dissatisfaction can easily be redefined as relapses requiring further medical treatment.
Institutional psychiatry works to preserve the status quo. Psychiatric "reality" is defined in the most conventional terms. Making drastic and Unconventional life choices is frequently cited as evidence of mental illness. A wife who leaves her husband and children. A homosexual deciding to "come out." An adolescent moving away from home--all these are undoubtedly crises, but are they medical ones? When psychiatry gets involved in situations such as these, it is clearly dealing with morals far more than with medicine. Defining the rebellious person as sick invalidates his or her perception of the situation, his or her personal reality. Only the testimony of the "sane parties to the situation" is accepted as reality. In these kinds of situations, where the emotions of all parties run high, it is quite natural to expect that each person will have a different view of what is happening. Invalidating the personal perception of the weakest participant by psychiatric labeling is a demand for conformity masked by medical terminology.
A dramatic example of this kind of invalidation is found in a personal account by Dianne Jennings Walker:
My life story differs in only very particular details from the stories of so many other women who have been labeled schizophrenic. I could escape the label today; I could "pass." When I chose in 1975 not to pass it was the most nurturing thing I have ever done for myself. For once I feel that my mind, soul and body are mine. I was lied to for so many years that I still fear the feeling of being split apart from my body. This so-called symptom of schizophrenia is what happens to us when the perceptions we have of our environment are attacked and ignored and denied over and over again. Ironically, our perceptions are accurate. Even after we are terrorized, drugged or socialized out of expressing ourselves directly we do it symbolically and the feelings are right. I believed as a child that my soul had been stolen from its rightful body. that my real parents lived on a satellite of Betelgeuse. That was not an insane delusion. It was a poetic and actually logical way to handle the unliveable environment that I had the ill fate to be born into.
In my late teens I discovered psychology and psychiatry, which I believed for many years were my salvation. I read case histories in college textbooks and thought, "Oh wonderful: I'm not from another planet... I'm simply crazy!"
Meanwhile my parents' marriage was publicly dissolved. The private dissolution came much earlier. Other longstanding family problems were also kept secret. Oh yes, we had good taste. From time to time I would point out things were not well with us. that, for example, my father and older sister had not spoken to each other in about two years. This was met with any of the following; grunts. silence, hysteria, abrupt change of subject, an assertion that our family was normal, a suggestion that I not worry, an accusation of ingratitude. Ever so often my mother would say, "Where did I get this strange child. She must have come from another planet." Whenever she said that it naturally reawakened my desire to return to my real home in the constellation Orion. Of course I didn't tell anybody. I mean you just can't tell anybody that. Except your friendly shrink.
I went voluntarily to several psychotherapists. I even, God help me, went voluntarily into the insanery. I was suicidal and sought refuge in a private Catholic asylum. I imitated Lisa of the movie David and Lisa. I had planned on resting for three weeks. I was discharged one year, ten months and eleven days later, my doctor's pride and joy because I had been cured of schizophrenia....
For a long time I was so grateful to have my story listened to, so grateful that I was kept in the insanery that I did not notice the crimes being committed against me. My hospital psychiatrist met with my parents, older sister, and brother-in-law in various combinations. He failed to meet with them when I was present. Had he done so, perhaps he could have given me moral support to challenge the way I was treated. He remarked that my history was much like that of other people who had had childhood schizophrenia. Three years after I began seeing him he said, "Everything you told me about your family is true." I was happy to be validated and did not think to demand my money back or to demand an apology for being called crazy.
Years passed. My relatives never admitted their complicity. I was alternately regarded as sick and as uncharitable for bringing up the past. The terrifying feelings returned. I sought help from a psychologist, then turned to another psychiatrist. I said, "I feel like I'm falling off the earth and I think my mother hates me." He asked, "Does that really bother you?"..
Psychotherapy oppresses us by teaching us that we are sick, crazy, maladjusted. We should forget grandiose and paranoid ideas [such as that] some societies just aren't worth adjusting to. My last psychiatrist couldn't understand why I wanted to work and be friends only with people who knew I was an ex-patient. He said, "I don't understand your obsession with honesty." He and another psychiatrist, who was allegedly radical, told me I was not going to change the world by being militantly ex-crazy. Maybe not. Then again I hear there are more than twenty million of us in this country alone.
When people are caught in such emotional tangles, everyone reacts in characteristic ways. These reactions can be defined as either normal or sick; the making of this decision is moral judgment disguised as medical diagnosis. "Sick" is only another way of saying "wrong." What makes it worse is that everyone (except possibly the "crazy" person) denies what is going on.
A poignant instance of this process is shown in the documentary film "Hurry Tomorrow," which was shot in a California state mental hospital in 1975. One of the patients whose story is portrayed is a middle-aged fireman who, because of a heart condition, has been forced to retire. He cannot adjust to this enforced idleness and his wife cannot adjust to having him at home all day. One day the wife, believing that her husband is planning to commit suicide, calls the police, and the man is taken against his will to the state hospital. He is unable to make anyone believe that he is not suicidal. The ward psychiatrist tells him that he will not be discharged until he admits his suicidal feelings. He tries to refuse medication, claiming he is not sick, and is forceably injected. During a visit, he begs his wife and daughter to allow him to come home. "You can come home," his wife tells him, "when you are well." The man's continual protests that he is not sick are seen by both the doctor and the family as confirmation of just how mentally ill he really is. Only by accepting his wife's version of the emotionally charged events between them will he be defined as well.
"Hurry Tomorrow" is filmed evidence that supposedly modern and progressive mental hospitals are different only in their outward appearance from the snake pits that (nearly everyone will concede) mental hospitals used to be. The ward we are shown is clean and airy; the dayroom has a TV set and a pool table; there seems to be plenty of staff. The horrors are subtle. Most of the patients wander about in a daze; a veteran patient explains to a newcomer that the stupor is caused by the psychiatric drugs they are receiving. The staff members lock patients into tiny rooms or tie them by wrists and ankles to beds. A slight, Mexican-American youth begs in broken English not to be locked in, then the door closes in his face. Patients being held against their will insist that they are being held prisoner, only to be told by the ward psychiatrist that they must abandon such ideas in order to be considered well. The psychiatrist has the power to determine the authorized version of reality.
"Brainwashing" is the emotionally laden term used to describe certain kinds of psychological manipulation. Only indoctrination in unauthorized versions of reality is labeled brainwashing; indoctrination in the ways and mores of the prevailing culture is called education or moral training. Psychiatric treatment is a method of socially acceptable indoctrination; calling it brainwashing is likely to be taken as a sign of paranoia.
Psychiatric medication can be viewed similarly. Brainwashing a person by means of drugs is looked on as reprehensible. Drugs, euphemistically called psychiatric medication, are given to patients (often against their will) with the avowed purpose of changing their "sick" thoughts, and the process is called treatment.
Modern mental hospitals, where every method of control has been euphemistically renamed, can be frightening places. The actions of every staff member--the aide who holds a patient down, the nurse who injects the medication, the doctor who prescribed it--all have been defined as benevolent. Patients who dare to utter the unauthorized reality--that they are prisoners and that their "helpers" are jailers--only provide further evidence that they are indeed ill. Succumbing to brainwashing, accepting reality as defined by one's captors, differs from a psychiatric "cure" only because in the latter case the accepted reality is the prevailing one. Holding a minority position makes a person a potential subject for psychiatric brainwashing.
When is it brainwashing and when not? The Patty Hearst case provides an interesting example. When she was being held prisoner by the Symbionese Liberation Army, Hearst made a series of tape recordings. At first, she begged her parents to help her, but in later tapes she denounced them as fascists and capitalist pigs. Public reaction was that she had been brainwashed by her SLA captors. When Hearst was captured by the FBI and jailed, she initially retained her SLA beliefs; listing her occupation as "urban guerrilla" and telling an old school friend that she was committed to feminism and revolution.
Patricia Hearst's family and defense lawyers claimed that her actions after she decided to join the SLA were the result of brainwashing, and a number of psychiatrists were engaged by the defense to examine her. From newspaper reports, it appears that Hearst at first refused the psychiatric examinations, claiming that they were in violation of her rights. It also appears that she was given psychiatric medication while in jail. By the time of her trial for bank robbery, Patty Hearst had changed her views. She now claimed that the SLA had indeed brainwashed her, charges she had previously angrily denied.
One of the psychiatrists in the Hearst case, Louis Jolyon West, had been involved in an unsuccessful attempt to start the Center for the Study of the Reduction of Violence at the University of California at Los Angeles, which would have used experimental techniques, such as psychosurgery and aversion therapy, on prisoners labeled violent. West was well known for his views that participants in ghetto rebellions were exhibiting symptoms of mental illness, as were people who chose a hippie life-style. Of course, with these preconceptions, it would have been difficult for West even to consider the possibility that Hearst had chosen voluntarily to stay with the SLA.
When Patty Hearst mouthed the rhetoric of the SLA, it was called brainwashing. When she instead mouthed psychiatric slogans, the charge of brainwashing did not come up. This is not to say that Hearst may not have been psychologically coerced by the SLA; it is only to point out that she may have also been coerced by her family, her lawyers, and her psychiatrists. Only the SLA's "treatment" was called brainwashing, because only the SLA espoused radical and unpopular causes. Psychiatric "treatment," on the other hand, which Hearst possibly tried to reject, was seen as a neutral force, rather than one that implicitly espouses a particular version of reality.
A number of people, including many psychiatrists, also claim as victims of brainwashing people who have converted to the Unification Church, the Hare Krishnas, and other religious sects. There have been a number of cases in recent years of parents kidnapping their adult sons and daughters from the sects with which they were living, imprisoning them in hotel rooms, and "deprogramming" them of their alleged brainwashing. Clearly, a form of semantic mystification is in use here, since one kind of coercion is being called by the sinister name of brainwashing, while another form of coercion, of which the speaker approves, is given the far more neutral name of deprogramming. Advocates of deprogramming claim that their method is successful, but many of their successfully treated "cases" have later returned to the sects angrily denounced their captors, just as many "successfully treated" psychiatric cases continue to espouse their unpopular ideas once they are free of psychiatric control. The American Civil Liberties Union has called deprogramming a serious threat to freedom of religion in the United States. Only the extreme cults are threatened now, but deprogramming sets a dangerous precedent for dealing with religious dissent, and ultimately other kinds of dissent.
When psychiatrists label as brainwashed people who express minority political or religious opinions, they are taking a moral position and disguising it as objective medical diagnosis. People may be coerced into joining cults; but they may also be coerced into joining established religious or political groups without risking the possibility of being kidnapped and "deprogramming". Only when they join small and unpopular groups are they considered brainwashed.
Many former mental patients refer to their institutionalization as "brainwashing" and "torture," even though, as patients, they went along with what was done to them. Patients who complain to their doctors that they are being brainwashed are frequently called paranoid; only those who go along with the psychiatric reality (that they are ill and need psychiatric treatment) are considered on the road to recovery. Like religious and political dissidents, mental patients are thought to need incarceration and curative "treatment" because they see reality in unauthorized ways.
Psychiatric mystification makes it extremely difficult to see that the protest of its victims might have any validity. Modern mental institutions, cosmetically disguise every facet of coercion. Isolation cells are called seclusion rooms or quiet rooms (in at least one institution, "the blue room"), Drugs (bad) are called medication (good). Psychiatric medication has been referred to as the chemical straitjacket, but real straitjackets are far from outmoded, although they are euphemistically called "restraints" or "camisoles." When doors have been unlocked, patients are punished (although it is not, of course, called punishment) for walking through them without permission. And the locked door, often said to be a thing of the past, is very much present. On one psychiatric ward where I was a patient, there were no locked doors, but we were required to wear pajamas at all times, and our clothes were kept in locked closets. Although not locked in, we were neatly prevented from leaving.
The availability of "therapy" varies from hospital to hospital, but all therapies have in common that the ideas and actions of the patient must be changed. The moral questions raised by the involuntary status of most patients are seldom considered. The patient's ideas of what is wrong are often given less credence than the psychiatrist's assessment.
Psychiatrists often attempt to enforce rigid adherence to traditional sex roles, calling any deviation "sick." Bette Maher recalls going to a staff presentation conference (for which patients had another name):
I had to wait in a small crowded corridor with about twenty other new patients. I waited for more than two hours for my turn. I watched each patient come out from the Inquisition--each one looking as if he'd been demolished. I knew I had to play it cool when my turn came. When I walked in, I was composed as possible. I saw the clinical director of the hospital, Dr. Benjamin Simon, sitting by himself at the end of a long table. Surrounding him, crushed together, were about fifty staff members. I sat down at the table without being invited to do so. Dr. Simon's first question was, 'Why isn't an attractive girl like you married yet?""
Cynthia Cekala consulted a psychiatrist after she decided to drop out of graduate school. The psychiatrist was alarmed by her sexual relationships and recreational drug use and urged her admittance to a mental hospital. "Only now after I have seen my records do I know why I was sent up. .. . My admitting diagnosis was 'Sexual acting-out--if not hospitalized might get pregnant or get VD.' "
Throughout my stay there I wore what I had worn at school--boots and jeans and sweaters. The shrink told me that if! didn't give up being a hippie and wear skirts I could not be considered to be cured. In my records I was "masculine." . . . I nagged my parents to get me out. I wore skirts with a wrathful submission. Finally I was sent to my doctor. He asked me what I was going to do when I got out. I said I was going to get a job at Bell Telephone and go back to graduate school in the fall. I felt that peculiar tightening of the throat one feels when lying outright, and I though I kept my eyes unblinking, fastened on his face tthroughout, I felt he knew 1 was lying. He didn't. "Patient is better motivated toward life." I got released a week later.
Better Ma her didn't see herself as needing marriage, and Cynthia Cekala didn't think she needed a job with the telephone company to prove that they were healthy women, but their psychiatrists had the power to label them sick because they did not conform to conventional female stereotypes.
Similarly, homosexual patients are called sick as long as they express their unconventional sexual preferences; and whatever problems they may have are commonly attributed to their homosexuality. Although the American Psychiatric Association eliminated "homosexuality" as an official diagnosis in 1973 a new diagnosis of "sexual orientation disturbance" was created, which referred to homosexuals "who are either disturbed by, in conflict with, or wish to change their sexual orientation." No comparable diagnostic category was created for heterosexuals who may want to change their sexual orientation.
Mental hospitals tend to call therapy everything that goes on inside them--making the beds and sweeping the floor can be called "industrial therapy," going to a dance or movie recreational therapy," stupefying patients with drugs "chemotherapy," and so forth. Custodial mental hospitals, which offer little treatment, frequently make reference to "milieu therapy," as if the very hospital air were somehow curative. But the availability of more treatment would not improve things much. A horrifying example of the "treatment provided at one of the country's most highly reputed mental hospitals--the Menninger Foundation in Topeka, Kansas--can be found in the story of "Sarah," which appears in Anthony Brandt's Reality Police.
Sarah was committed by her parents at the age of nineteen and spent three and a half years in the institution. For the first year she refused to cooperate with any part of the treatment, which she accurately perceived as being designed solely to break her will. When she finally agreed to talk to the doctor, she found he was unwilling to listen to her own ideas about her problems, and she quickly gave up trying to talk to him, except to try to get "privileges." (In mental hospitalese, "privileges" are such basic human rights as wearing one's own clothes, being able to walk around outside, going to the dining room, and so forth.) After she became twenty-one, Sarah attempted to sign herself out of the hospital, which legally she had the right to do. However, they refused to release her until she got her parents' consent. Shortly after her discharge Sarah's parents, still displeased with her way of life (she was living with a black man and planning to marry him), had her committed to Topeka State Hospital, a truly grim institution, where she was kept in a seclusion room for nine months. Eventually, she managed to escape, and is living successfully on her own. Sarah's assessment of the two "hospitals" where she was imprisoned is illuminating:
As compared to my experiences at Topeka State, Menninger's was more destructive and painful through its more subtle yet undermining techniques. In the state hospital faced with a harsh reality you had to work hard physically and otherwise to keep up with it. Menninger's on the other hand led to a total disintegration of personality and personal autonomy.
Treatment aimed at restructuring the personality of unwilling subjects is rightfully viewed by them as torture.
The important thing about Sarah's story is that her experience is not unique. Mistreatment takes many forms--anything from insensitivity by staff members to outright physical brutality--and it is far too common. Even isolated instances of mistreatment should be intolerable in a system devoted to healing the sick. But a great deal of evidence seems to show that mental hospitals exist to control their inmates. What happens to mental patients. just as what happens to prisoners, arouses little concern. And because mental patients are supposed to be mentally ill, out of touch with reality, their testimony carries little weight. Ex-patient Kenneth Donaldson ironically defines various "substrains of schizophrenia", such as 'being uncooperative' (refusing to buy an attendant a pack of cigarettes), 'being emotionally volatile' (telling an attendant to go to hell when he accused you of having sexual relations with your mother), and 'having hallucinations' (saying an attendant broke your arm when the report says you fell)." In his book, Donaldson describes his fifteen years of horror in Florida State Hospital, culminating in a landmark Supreme Court decision that nondangerous mental patients have a Constitutional right to liberty.
Brutality is not incidental to institutional psychiatric treatment. The history of mental hospitals is the history of the various tortures that have been perpetrated on the insane. Benjamin Rush, a signer of the Declaration of Independence is sometimes called the Father of American Psychiatry. He ran one of the earliest mental hospitals in the United States, the Pennsylvania Hospital, from 1783 to 1813. His picture appears on the seal of the American Psychiatric Association. Among the treatments recommended by Rush were venesection-bleeding (at that time one of the leading medical treatments for many illnesses), purges and emetics (also popular as general medical treatments), hot and cold showers, and the application of two of Rush's inventions, the "tranquilizer" and the "gyrator."Deutsch describes the "tranquilizer" as "a chair to which the patient was strapped hand and foot, together with a device for holding the head in a fixed position." The "gyrator" was a board to which the patient was strapped; it was then rotated rapidly, causing blood to rush to the head. Deutsch describes a number of "treatments" popular in Rush's time, noting frankly that they were "ingenious mechanisms for terrorization"'. In one "treatment," the "patient" was immobilized while a powerful pump directed a stream of water onto the spine for four minutes. Or a patient might be placed on a trap door that concealed a pool of water At the proper therapeutic moment the trap door would be released and the patient plunged into the "bath of surprise." Another "treatment" consisted of placing the patient in a box pierced with many holes, which was then immersed in water. Understandably. the patient had to be revived after the box was fished out again. Deutsch is not horrified by these practices: "Strangely enough, tortures, and terrors that had been applied as outright punishments in previous ages received in this particular age the blessing of respectable medical theory as praiseworthy therapeutic measures." In Thomas Szasz's view, however, it is not strange at all. It becomes completely comprehensible once we recognize mental illness as "a successor notion to heresy; psychiatrists as. . .successor-enforcers to the inquisitors;and psychiatric interventions as.. . successor.punishments to Inquisitorial tortures."
In standard psychiatric histories. Phillippe Pinel's striking the chains from inmates of the French mental institution he ran after the French Revolution is presented as "liberating" the patients. Historian Michel Foucault presents another view. "It is within the walls of confinement that Pinel and nineteenth-century psychiatry would come upon madmen; it is there--let us remember--that they would leave them, not without boasting of having 'delivered' them." According to Foucault, Pinel favored psychiatric confinement for three broad categories of patients--religious fanatics, people who refused to work, and thieves., Although no longer physically chained to the walls, inmates of Pinel's institution were subject to coercion and forced "treatment".
Modern methods of treatment can also be viewed both as treatments (by those who administer them) and as tortures (by those who receive them) Because psychiatric treatments are so often administered against the will of their subject, it is very difficult to accept unquestioningly the often stated views of psychiatrists that these treatments are both painless and beneficial. Nowadays, the most common method of psychiatric treatment, both in and out of hospitals, is the administration of psychiatric drugs. While psychiatrists have speculated that they are correcting disordered brain chemistry by means of these drugs, there is no proof that this is so, and there are as many different theories as to how psychiatric drugs work as there are research psychiatrists.
Psychopharmacologists frequently compare their drugs to insulin, which controls diabetes although it does not cure it. This analogy, although widely accepted, is flawed. Insulin is naturally produced in the body; some people (diabetics) are deficient in it. When diabetics take insulin, their body chemistry is restored to a more nearly normal state. No one, however, naturally produces Thorazine or lithium; these drugs are given to people based on a pharmacological theory that their body chemistry is, in some unknown way, abnormal. Megavitamins. another "treatment"for "mental illness," have the virtue of being less dangerous than tranquilizers and related drugs, but there is no proof that "schizophrenics" suffer from vitamin deficiencies, either. All drug treatments for mental illness are based on unproven theory.
Out of the laboratory and onto the wards, and things begin to appear a bit different. Anthony Brandt, who tells "Sarah's" story in Reality Police, signed himself into a mental hospital as part of the research for his book. After a brief interview with a psychiatrist. in which he claimed to be hearing voices, he was turned over to two aides and a nurse. Without explanation. he was given an injection.
It was the drug, however, which really took me over. Serintil is a powerful, fast-acting tranquilizer used for the immediate treatment of hallucinatory symptoms. It also has powerful side effects. I could not sleep after the aide put me to bed. ... After about an hour I got up for a drink of water and staggered out to the hall. But why am I staggering? I thought. What is happening to me? I couldn't control my legs. I was weaving back and forth like a drunk reaching for walls. Sweating and scared. I barely made it to the water fountain. I had no strength in my body at all. On the way back to bed I fell down twice . The drug was not designed specifically to transform people into jellyfish. Nevertheless, there was no question of my giving the staff trouble while under its influence.
It is not just in the area of drug administration that what actually goes on in mental hospitals differs so drastically from the theoretical formulations of psychiatrists.,whose writings frequently indicate an ivory-tower view of psychiatric treatment. Psychiatrists often state that straitjackets are historical relics; meanwhile, patients on the wards are frequently placed in them Psychiatric historian Gregory Zilboorg, writing in 1941, stated that "the number of people without special training who take care of mental patients is now almost negligible." As Zilboorg was writing, conscientious objectors in the United States were assigned to staff mental hospital wards, not because of any special interest or inclination, but because the work was considered sufficiently unpleasant to be a suitable punishment for those who refused to fight. Innumerable examples of the discrepancies between the psychiatric view of the mental hospital and the experiences of mental hospital workers and patients could be supplied.
For many years psychiatrists thought that the deterioration seen in their "chronic schizophrenic" patients (that is, patients who had been labeled schizophrenic and who remained in the hospital for many years) was an inevitable effect of the disease process. It now appears, however that long-term residence in a mental institution is what causes the loss of social skills, the lack of interest in the outside world, and the stuporousness that were previously attributed to schizophrenia. J. K. Wing and G. W. Brown, who studied the patients in three British mental hospitals over an eight-year period, concluded that. "The various stages of this study point towards a conclusion which is very difficult to resist--that a substantial proportion, though by no means all, of the morbidity shown by long-stay schizophrenic patients in mental hospitals is a product of their environment." Patients who spend long periods of time in mental hospitals become "institutionalized' '--they adapt, as best they can, to the limited world within the institution.
As psychiatrists themselves came to recognize how harmful mental institutionalization can be, some of them began devising "alternatives." The therapeutic community was introduced by Maxwell Jones in England in the late 1940s and early 1950s and was widely hailed by the psychiatric profession as providing a real change in treatment, one that would involve the patient in his or her own recovery rather than making the person a passive resident of a hospital. As described by Jones,
In a therapeutic community the whole of a patient's time spent in hospital is thought of as treatment. Treatment to be effective will not only involve the handling of the individual's neurotic problems, but also an awareness of the fresh problems which the fact of being in a neurosis hospital will create for the patient. and what aspects of the social situation can be used to aid treatment. The patient, the social milieu in which he lives and works, and the hospital community of which he becomes temporarily a member, are all important and interact on each other.
But in Jones's own glowing account of his new methods, we find that things have not changed very much at all from the patients' point of view:
Modified insulin treatment is used extensively, and there are always a few patients on electrical convulsive therapy. Abreactive techniques with ether or sodium amytal are used very occasionally, as is the operation of leucotomy [a form of psychhosurgery]. lnsulin coma treatment is used fairly frequently.
.....A placement conference is held weekly, and attended by all members of the staff of of the unit. . . . The patient himself is interviewed by the conference when this is considered necessary.
Patients in this "alternative" were subjected to physically intrusive treatments and were discussed at staff conferences from which they were excluded, the same kinds of procedures that patients find objectionable in more traditional facilities. Jones does not even discuss whether patient consent was obtained for hospitalization or for treatment.
Therapeutic communities are usually described in the psychiatric literature as places where strict roles (doctor. nurse, patient) are broken down and all members of the community are equally involved in decision making. But psychiatrist Joe Berke.,who worked in one, saw things somewhat differently:
At best, the therapeutic community allowed the staff and patients a large measure of self determination. They then got on with their daily lives as best they could, and with the knowledge that all the rules of interpersonal behaviour were open to question and that definite channels of communications existed among all concerned. A community had been created.
At worst, the programme degenerated into organized brain washing. Patients were supposed to talk honestly about their feelings, and were often punished for what they said, but the staff was under no pressure to do so. Power remained in the hands of the administrator, although everyone would be told that the group was free and open. Minor trappings of therapeutic community life, like men and women patients meeting together, and being allowed to wear their own clothes, substituted for the basic issues of personal autonomy and sexual identity.
Unfortunately, 99-44/100 % of the programmes that laboured under the aegis of "therapeutic community" were of this latter variety.
My own experience in a "therapeutic community" was far closer to Joe Berke's view than to Maxwell Jones's. As a patient in a hospital following the therapeutic community model, I found that the doctors frequently made authoritative statements but misleadingly phrased these as coming from "the group." even though they were clearly coming directly from the psychiatrists. The most notable example occurred when a patient on the ward committed suicide while on a weekend leave (mentioned earlier, in chapter 2). The ward meeting on Monday morning began with the doctors entering together after the other staff members and patients had already assembled. One of the doctors then made a peculiar series of statements. "The group is quite upset by Bill's death." None of us had yet had a chance to express our feelings. "Everyone is feeling insecure, since the hospital is supposed to be a safe place where people are protected from their suicidal feelings." There was no chance to find out whether or not that was true, since he quickly went on, "In order to help everyone to feel more secure, the group has decided to lock the ward for the next few weeks." The group, of course, had decided nothing. The psychiatrists had decided, but by attributing their actions to "the group," they were mystifying the source of power within the group, causing the patients to doubt their own perceptions of what had gone on.
The next innovations in mental hospitals also came from England. Psychiatrists David Cooper and R. D. Laing experimented with changes in hospital wards that they ran. Cooper ran "Villa 21," a nineteen-bed ward in a British mental hospital, from 1962 to 1966, and tried to break down the usual staff hierarchy, as well as staff responsibility for every aspect of patients' lives. Patients and staff ate meals together, and patients were permitted to call staff members by their first names (both startling innovations at that time in traditional staff/patient relations). Cooper realized, however, that the role distinctions were expressions of real differences: "Staff are paid to be there. patients are not." Cooper's suggestion that ex-patients be employed as staff on the ward met with official disapproval. After four years, Cooper recognized the limitations of innovation within the mental hospital framework:
The "experiment" of the unit has had one quite certain "result" and one certain "conclusion." The result is the establishment of the limits of institutional change, and these limits are found to be very closely drawn indeed even in a progressive mental hospital. The conclusion is that if such a unit is to develop further, the development must take place outside the confines of the larger institution.
Early in his career, R. D. Laing also introduced innovations within a mental hospital setting. He selected twelve long-term, out-of-contact patients who had been diagnosed as schizophrenic and brought them together in a large room, where they were treated with dignity and respect and were able to do as they liked. The first day the patients were led to the room and were led back to their wards in the evening. The second day there was a dramatic change. All twelve of the patients gathered before the door of the room where they were treated so differently, talking and laughing with each other. Although many of them had been hospitalized for years, within eighteen months all were able to be discharged. But within a year all had returned to the hospital, leading Laing to formulate his theory that "schizophrenia" is something that is done to the patient by his or her family. Laing soon stopped working in hospital settings.
Laing believes that schizophrenia is not an illness, but a "metanoiac voyage"--literally, a "mind-changing" experience. Traditional mental hospitals--indeed,traditional psychiatric practices generally--are set up to thwart this voyage rather than aid it.
Mental hospitals define this voyage as ipso facto madness per se, and treat it accordingly. The setting of a psychiatric clinic and mental hospital promotes in staff and patients the set best designed to turn the metanoiac voyage from a voyage of discovery into self of a potentially revolutionary nature and with a potentially liberating outcome, into a catastrophe: into a pathological process from which the person requires to be cured. We asked: what would happen if we began by changing our set and setting, to regard what was happening as a potential healing process through which the person ideally may be guided and during which he is guarded? Essentially it is as simple as that.
Laing and his colleagues, realizing that there were limitations to the kinds of meaningful changes that could be made within the hospital, set up a house where patients and staff could live and work together, the famous Kingsley Hall. Mary Barnes, who lived at Kingsley Hall for several years, and experienced the regression and rebirth that Laing believes are the natural outcome of the "schizophrenic" experience, has written an astonishing book about her experiences. Long before she had ever heard of R. D. Laing, Mary Barnes realized that she wanted to "go down" into herself, "to be reborn, to come up again, straight, and clear of all the mess." This was impossible in a mental hospital. When she met Laing, Kingsley Hall had not yet been set up, and for more than a year, as she felt herself beginning to "go down," she held on until the community could be set up. Within days after moving into Kingsley Hall, Mary began to regress, taking to her bed, refusing to eat, drinking milk from a bottle, lying in the dark without talking. She returned to infancy and then began to grow up into a truly different person. Mary discovered a previously unknown artistic talent, and when she left Kingsley Hall, it was to a far more satisfying life as a painter.
Kingsley Hall was not a hospital, it was a large old house in a poor section of London, where people could come to live, to work, to experience a stimulating intellectual atmosphere, and to experience their own madness. In theory, no distinction was to be made between staff and patients. Joe Berke, a psychiatrist who worked with Laing at Kingsley Hall, found that "many a person came to Kingsley Hall with the idea of helping others in the community and wound up having to be looked after by the community."
Kingsley Hall was one of a network of houses set up in London by the Philadelphia Association and the Arbours Association, which were run by Laing and people closely associated with him. David Parker, who lived in several Arbours Association residences, tells a somewhat different story of what these "alternatives" were like:
I was in a house run by the Arbours Association in London. The Arbours Association is a research and training group and a residential center for persons experiencing distress often ex-mental patients or people who would have to go into a hospital. Arbours Association was a shrink-run colony. In any decision of any importance the shrinks made the decisions, and you could just forget about the others. The shrinks had their meetings and made all the decisions.
There were some positive things. They were against psychiatric drugs in general, although they did keep one fellow I knew on drugs. The shrinks also had meetings about the patients with the patients not there. I have a tape of a meeting (I got permission from everyone there to tape it) in which they talk about the "psychopathology" of one particular resident.
There were people who worked in the houses--I always thought of them as stooges for the psychiatrists. One time one of the residents in the house was being criticized for throwing garbage out the window. The stooge told him he would be kicked out of the house. It was really terrifying--it was done in such a brutal manner. So this resident ran away that night. All the psychiatrists came down to the house and decided to call the police to try to get him back. And this was supposed to be a completely free place where no one was forced to stay.
Another resident--the shrinks who ran Arbours had a meeting about her and decided to put her into a hospital for electroshock. I visited her after the shock treatments, and she didn't even remember me, even though we had lived in the same house for months and had been quite friendly. She didn't even remember me.
The one benefit I got out of staying at Arbours was talking with the other patients.
David Parker's criticisms raise an important and disturbing question. To what degree are psychiatrists willing (or able) to give up their tremendous power over patients? As we have seen, therapeutic communities" commonly mislead patients about the distribution of power within the "community." The Laingian houses, although they were far more real communities than any hospital ward could ever be, housed people who had taken on roles as different as "psychiatrist" and "chronic schizophrenic." Without conscientious efforts to break down these roles, those used to assuming power will do so, as will those used to yielding it.
Perhaps the whole idea of having psychiatrists living in the house makes true equality impossible. In San Jose, California, Soteria House (based in part on Kingsley hall) was a place where six "Patients" and four "guides" lived together. Although set up under psychiatric auspices and employing a social worker as house director and a consulting psychiatrist, the empyasis at Soteria was on nonprofessional staff who could "be with" the patients, rather than do things to them.
Soteria House specifically rejected the medical model, seeing "schizophrenia" not as a disease but as a "developmental crisis" with positive learning potential.
It is believed that by allowing and helping the resident to gradually work with and through this crisis in living, or schizophrenia, he will be better able to understand himself and his fears. So rather than ignoring or quelling this altered state, he will explore it. Our House believes that this growth process may leave him with an even stronger sense of identity than before his episode.
Alma Menn, a social worker who was the live-in director at Soteria House (the name is taken from the Greek word for "deliverance"), has described life in the house:
We buy food, bake bread, sew, tie-dye, plant our garden, play ping-pong. Anyone who wants to [can] take a turn preparing a meal and cleaning up afterwards. We write diaries, play guitars, sit on the front stoop, collect data, go to the beach, do yoga and massage, in short, do things that are necessary and interesting to the people living there. We have house meetings from time to time to discuss house problems, such as people using up all the towels, annoyance at another person's freakiness, people running away and getting picked up by the cops or getting taken to the hospital. We have no nursing station, no ground privileges, no group grounds, no weekend passes, no medication room.
Soteria House was set up as a research project to compare the efficacy of a non-rofessionaol, nonmedical approach with conventional hospitalization. Residents formed the "experimental group": a matched "control group" consisted of patients hospitalized at a community mental health center and treated by drugs and other conventional psychiatric methods. This procedure raises disturbing [and unanswered] questions about voluntariness and consent. It appears that the Soteria House residents were there not because they chose this form of innovative treatment but bevcause they fit the project criteria [unmarried, between fifteen and thirty years of age, and not previously psychiatrically hospitalized] and were randomly assigned to the experimental group. I have not found any discussion of this important factor in the published articles by Soteria's founders. Soteria House, although started by a research psychiatrist and funded by the National Institute of Mental Health, is, nevertheless, an alternative because it rejects the usual psychiatric dehumanization and invalidation of the "mad" person, but its definition of itself as an "experiment in the treatment of schizophrenia," shows that it basically accepts the illness model.
Totally nonprofessional alternatives for people in crisis are truly separated from the mental health system. In Boston, for example, the Elizabeth Stone House provides an alternative both to mental hospitals and traditional halfway houses. The first two floors of the house, located in a working-class Boston neighborhood, are the Refuge Center, where women in crisis situations who might otherwise have to enter mental hospitals can stay up for two weeks. Staffing is provided by women who volunteer their time for one or more eight-hour shifts per week. The volunteers are drawn mainly from Boston's femnnist community and include students and some former mental patients. The upper two floors house the Therapeutic Community, a long-term residence that provides "a supportive living environment without the restrictions of a half-way house program." Except for an outside facilitator [chosen by the residents] who comes in for the weekly house meeting, the therapueutic community has no staff; each resident is expected to take "equal responsibility for her own needs and those of the other residents."
The Stone House was started in 1974 through a conferece called "Women and Madness," which led to the formation of a group determiend to bring into existence an alternative center for women. They found a house and raised the rent money through a series of fund-raising appeals to the Boston women's community. Once the house was operating, they were able to getseveral small foundation grants, as well as a grant from the national Institute of Mental Health (from a fund for starting innovative programs). The Elizabeth Stone House operates on the incredibly tiny budget of twelve thousand dollars a year, of which the bulk goes for rent on the house. None of the staff members receives a salary. At the present time there are about forty volunteers, most working a single eight-hour shift each week. Decisions are made in a weekly coordinating council meeting, which delegates specific responsibilties to those women who have more time and energy to devote to the house.
Women come into the Refuge Center as residents through referrals from a number of social service agencies or through self-referral. The Stone House does not take women who are actively homicidal or suicidal or those whose primary problem is drug or alcohol addiction (although it does accept women with drug or alcohol problems in addition to other difficulties). A prospective resident is given an intake interview by the volunteer on duty and by any interested residents, and the decision on whether the woman becomes a resident is made together. Some women decide not to stay at the Stone House because they are looking for a more structured environment than the house provides. While the house provides informal counseling and makes referrals to sources that can help women with their emotional, medical and legal difficulties, the main emphasis is on providing a positive and nurturing atmosphere:
Women often experience emotional crises as a survival reaction to an oppressive environment. Often, not only is it necessary for an individual to change, but also for her environment to be changed. With the Women's Refuge Center Program we have attempted to provide a place for women to make needed personal changes and changes in their environment. We believe that emotional crises are not permanent, disabling "sicknesses" but a temporary experience often necessary for coping with life. Most residential programs that now exist for women in crises are mental hospitals or quasi-institutional halfway houses which lock -people into the role of "sick," strip their decision-making power, and do not allow them to effect change in and have control over their lives and perpetuate the environment which has led to emotional crises in the first place. The Women's Refuge Center is attempting to create an environment which will provide women with space to recreate their lives with support from other women, but without a rigid structure. In order to do this, there is little division between clients and staff. Because of the short-term nature of the program a staff is necessary to provide continuity. However, both clients and staff have equal decision-making power in all decisions affecting the refuge center. In this way, the traditional professional roles which place the authority outside the woman and in the hands of the "experts" are de-mystified and the authority to make needed changes is returned to the individuals.
(The Elizabeth Stone House)
The Elizabeth Stone House is a true alternative because it is consciously trying to break down the roles of "staff" and "patient". Women who live in the house are not patients. Although they are temporarily experiencing extreme distress, they are not seen as incompetent. Cooperation is stressed, but each woman (resident and volunteer alike) is seen as ultimately responsible for her own life.
Drawbacks to the Stone House model include the constantly precarious financial state, the need for maintaining the enthusiasm and dedication of an all-volunteer staff, and the development of some real divisions between staff members and residents. Fund raising is an ongoing problem, and the Stone House has never been able to count on any long-term financing source. This results in much valuable staff time being absorbed by constant fund-raising efforts. Keeping an adequate number of staff members is another ongoing problem. Even those volunteers with the most enthusiasm and commitment have to fit their activities into the free time left over after work or school. Having a paid staff creates its own set of problems, but it at least frees staff members to devote most of their time to the exhausting (but satisfying) work of being with people undergoing crisis.
Even without a paid staff, however, the Stone House has developed some clear-cut distinctions between staff and residents. Volunteers are drawn mainly from Boston's feminist community and tend to be middle class and well educated, while residents tend to come from poorer backgrounds, are less educated, and do not identify themselves as feminists. Poor women, of course, have less time or energy to do volunteer work. Few former residents have returned to the Stone House as volunteers.
In running a crisis facility, it is of course necessary to make some distinctions between staff and residents, since residents are there because they are experiencing distress. What is important is that the distinctions do not become arbitrary--being in an emotional crisis does not mean that the person is incapable of making decisions, only that she may need a supportive atmosphere so that she will be helped quickly to resume management of her own life. The Stone House's requirement of a short stay (which can be extended briefly, depending on individual circumstances) is a forceful reminder that residents are expected to work on resolving their personal situation and not become passive and dependent.
It is hard to know how successful the Stone House is, since there is no formal follow-up procedure. Some residents keep in touch with the program, but many others do not (and it is those residents who had positive experiences who are, of course, most likely to stay in touch). It is the impression of the women who staff the Refuge Center that about half the residents have been helped to make positive changes in their lives.
An important aspect of the Elizabeth Stone House is its recognition that mental hospitals are harmful places. Originally, the house worked closely with the Mental Patients' Liberation Front in two-pronged opposition to the mental health system. (The two groups are no longer connected.) Even the choice of the name for the house had political significance--Elizabeth Stone was a nineteenth-century crusader against psychiatric oppression, having been committed by her family, who attributed her conversion from Methodist to Baptist to "insanity." Elizabeth Stone was a strong woman who dared to fight back, and the Stone House, fittingly, is dedicated to helping other women to find strength within themselves.
In the summer of 1977, the Elizabeth Stone House collective decided to close the refuge center and the therapeutic community. The collective is reevaluating their programs and procedures and planning a funding search, which will enable them to reopen the refuge center with a paid staff. The therapeutic community was scheduled to reopen shortly.
In 1974 and 1975 a unique crisis facility existed in Vancouver, British Columbia. It is hard for me to be objective about the Vancouver Emotional emergency Center (VEEC) because as I related earlier, I was a resident of the house for a few weeks in 1974, and my stay at VEEC had a profound effect on my life. My account of VEEC is based on my own experiences and on many hours of discussion with VEEC staff and residents.
VEEC and the Elizabeth Stone House are the only alternatives discussed in this chapter that were set up completely outside psychiatric auspices. VEEC was started by a group of nonprofessionals who had become concerned about the unavailability of supportive services for people undergoing intense emotional crises. As they saw it, people in crisis had no choice but to apply for admission to psychiatric wards or to the provincial mental hospital, where, rather than getting personal care, they often faced institutional indifference, acquired the stigma of having been psychiatrically institutionalized, and often were started on a round of repeated hospital admissions. VEEC got an initial six-month grant from the Local Initiatives Project (LIP), a Canadian federal agency that funds innovative local service programs; they rented a house in a mixed residential and light-industrial neighborhood in central Vancouver and hired ten staff members. The house had a capacity of five residents, allowing for a great deal of one-to-one personal contact, which was seen as the primary therapeutic tool. A two-week maximum stay was established, since VEEC aimed its services to people in intense crisis situations, and its method was helping people to use this emotion-laden period as an opportunity to make drastic changes in their lives. They did not want to create a dependency relationship, which a longer stay might have encouraged.
Some of VEEC's founders were involved with the Mental Patients' Association (MPA), an organization of ex-patients that provided supportive services for its members but was not set up to provide intensive support to individuals in crisis. (MPA will be discussed in detail in the following chapter.) Some MPA members who wanted help returned to hospitals and clinics, but most were dissatisfied with the services they received there. VEEC provided a nonhospital setting where the emphasis was on intensive emotional support rather than confinement and drugs.
VEEC was organized as a collective, with all ten (later twelve) staff members taking equal responsibility for the various jobs involved in running the house: staffing the shifts; cleaning, maintenance, and cooking; fund raising; and community relations. At various times one or another staff member was given a title for purposes of signing applications and fulfilling the bureaucratic requirements of other agencies, but throughout its existence VEEC operated in a completely nonhierarchical manner. All decisions were made at weekly staff meetings, and there was an attempt to make decisions by consensus rather than by majority vote.
One of the basic VEEC principles was that at little distinction was possible was made between staff and residents. Although residents entered the program in a state of crisis, in which they had little energy to give to helping others, frequently by the time a resident was ready to leave the program, he or she had become quite actively involved in helping. Former residents were encouraged to become volunteers (who staffed the house along with paid staff members), and some later became staff members. It worked in the opposite direction as well: several staff members and volunteers became residents when their own life situations became difficult. In addition, staff members were open with residents about their own lives and the difficulties they might be having; exactly the opposite of traditional psychiatric neutrality.
VEEC was dramatically different from a mental institution. Rather than offering distance and "objectivity", VEEC staff members made direct personal contact with residents. There were only four rules at VEEC:
1. No drugs 2. No alcohol 3. No verbal or physical violence 4. No sex between staff and residents
The no-drugs rule originally applied only to illegal drugs. But after several months of operation, the rule was modified to include prescribed psychiatric drugs as well.
At VEEC, we try to provide an environment of human support for people undergoing life crisis; the experience of the past four months persuades us that the use and abuse of psychiatric drugs seriously interferes with the possibility of this happening.
We recognize that this decision closes VEEC to a large population of people who would otherwise be appropriate residents. We are saddened by this, but we are convinced that a life pattern involving drugging fear and pain into dullness at best, and serious overdose attempts at worst, cannot co-exist with the growth/communication/autonomy promoting work we try to do with folks who use VEEC.
An important point must be made; people do not become drug dependent in a social vacuum. Institutional psychiatry, psychiatrists, general practitioners, and drug companies share responsibility for their promotion of drug dependence. We believe these drugs are flagrantly over-prescribed, in the coercive context of involuntary committal, or the unequal and mystified power relationship between doctor and patient. These drugs, in far too many cases, serve as internal strait-jackets or invitations to dulled-out apathy....
What we attempt at VEEC [is to] invite residents to explore ways of meeting the needs that psychiatric drugs dull and mystify. We hope that VEEC can serve as a pilot and demonstration of this approach.
(VEEC Drug Statement)
There were also practical problems connected with drugs. After several residents tried to overdose, drugs were kept in a locked box. Staff members objected to being placed in the nurselike role of doling out pills. The no-drugs rule was worked out in a number of staff meetings.
The no-drugs policy caused a strain in the relations between VEEC and MPA, since many MPA members were regular users of psychiatric drugs. Although MPA remained supportive of VEEC (and VEEC of MPA), fewer MPA members became VEEC residents after the establishment of the policy.
The rule about sex was also worked out through practice and discussion. Sex between staff and residents was prohibited because of the recognition that residents were vulnerable to exploitation. Sex between residents was felt to be a private matter, but the staff would intervene in instances of manipulation, and sexual harassment was not tolerated. Sex between staff members was prohibited when they were on shift in the house; on their own time, it was considered a private matter.
The weekly staff meetings were held in the dining room, the main social center of the house. Residents were free to come to all or part of a meeting but could also spend time in other parts of the house if they chose. This demystified the meetings without requiring residents to attend them if they chose not to. Architecturally, the dining room was a very open room--there could be no sense of things happening behind closed doors.
There was also a daily house meeting for residents of the house and those staff and volunteers on shift. In the house meeting residents were able to discuss their needs and work out tensions between themselves and other residents or staff members. The form of this meeting was in constant transition--sometimes it was mainly a talk session, sometimes people gave one another relaxing massages or worked off excess energy by singing and dancing together.
Residents entered VEEC either by contacting the house directly, or by referral from another community agency. In the case of referrals, emphasis was laid on the fact that the prospective resident must be wiling to come to VEEC--he or she couldn't be "placed" there by a social worker or agency. The prospective resident was invited to the house, where he or she sat down with a staff member to discuss VEEC and possible residence there. If the person didn't want to stay at VEEC, or if the staff member felt that VEEC wasn't the proper place for that person, the contact was terminated. People who were not suitable for residence were those who had long-term, ongoing problems; who were mainly looking for a place to stay; who were violent; who had drug or alcohol problems; or who were unwilling to give up their use of psychiatric drugs. These limitations evolved through practice in the first few months of VEEC's existence and were always clearly explained to prospective residents.
During the early months several VEEC residents were very "spaced-out," disorganized people whose lives had been in continual crisis. Although they enjoyed staying at VEEC and felt much better when they left, little change had been made in their overall way of dealing with the world. The VEEC staff decided that, with a five-bed house that was nearly always full to capacity, it was better to restrict residence to people who were in the midst of an immediate crisis. It was also felt that since there were facilities in the city for people with drug and alcohol problems and for people who wanted to use psychiatric drugs, it was better to provide services that were available nowhere else.
Shortly before admission each resident was encouraged to make a contract, in which he or she set forth the problems that had brought him or her to VEEC, as well as the desired life changes the resident wanted to make. It wasn't always possible to write the contract right away, and the policy was flexible. The idea behind the contract was that residents were expected to be actively working on making the kinds of life changes that would make it possible for them to leave VEEC with better perspectives on their future. Often, residents had practical problems, such as needing a place to live, and were helped with these practicalities by the staff. Residents were free to modify their contracts at any time.
A typical day at VEEC centered around meals, activities, and the daily house meeting. Meals were usually prepared by staff members or volunteers, although residents were often involved as well. The emphasis was on healthy, nutritious food,with lots of fresh fruit and vegetables. Activities were organized around people's interests. Outings to nearby parks for noncompetitive athletics were popular. Residents were free to come and go as they liked; some residents stuck close to the house and seldom left it, while others were involved in job hunting, apartment hunting, other errands that took them out of the house, either with or without a staff member, as they chose. Occasionally, the problem arose of a resident who spent so much time outside the house that he or she seemed to be using it for little else than a crash pad--but when such problems arose, they were dealt with at a house meeting. Both residents and staff members were free to criticize one another and were encouraged to be open about their criticisms. Staff members emphatically discouraged being thought of as remote authority figures who had their own lives in perfect order. On the rare occasion when a resident would be asked to leave, it would be worked out among residents and staff members at a house meeting.
Another method of facilitating open communication was the house log book. Residents, staff members, and volunteers could all write in the log book about their interactions with one another and their reactions. Everyone expressed their emotions--anger and fear, but also pleasure and joy--in the pages of the log, as well as in direct, face-to-face contact with one another.
The physical setup of the house encouraged interaction, while allowing people to have private spaces to withdraw to when needed. On the main floor was a living room, dining room, kitchen, bathroom, and a tiny office with a desk and a telephone. This was the "public" part of the house, where people could sit and talk, eat, drink tea, listen to music (or make their own), read, or just generally hang out. Upstairs were three bedrooms and another bathroom. In the basement was a small meeting room, a utility area, and the screaming room, a tiny room whose floor was covered with mattresses, where residents (or staff) could go and let out tension in complete safety. (In a public service radio ad about VEEC, mention was made of the screaming room, and VEEC received several calls from people inquiring whether they could drop in just to use the room.)
Of course, not everyone who came to VEEC was helped by it, but most residents found VEEC supportive and helpful, and some experienced dramatic, life-changing events. The following account was written by "Cinnamon", who stayed at VEEC for three weeks:
During the month of march, 1974, I had what I would presume to be, a nervous collapse, which in turn, brought about a complete mental breakdown. I was barely able to call the Crisis Center, and they in turn referred me to the Vancouver Emotional Emergency Center. I called them and spoke at length to one of the workers. I was crying convulsively and could find no apparent reason for my condition. I was convinced by the worker that I needed someone to talk to personally and some time to relax away from my demanding job of being a single parent. I agreed to go to the Center, and so, due to the fact that I could barely walk because of emotional stress and tension, the Crisis Center Flying Squad was called in and I was picked up and driven to VEEC.
Once I was there, I was served tea, and accepted the offer of a quiet place to sit and talk. After a couple of hours of talking to two workers, I decided to become a resident for a short time, with the understanding that I could leave at any time and was there because I chose to be. The staff were of great help in assisting me in finding temporary care for my three-year-old son.
After a couple of days of sleeping, not eating and generally being very withdrawn, I began to take part in group sessions, which consisted of yoga, exercising, massages, and group discussions which were often held over a large pot of tea. At first I kept pretty quiet, not saying much. I felt angry and resentful towards almost everyone, including the other residents. There were one or two of the workers who could talk with me quite successfully, and soon they encouraged me to *deal with* my anger instead of shutting it up. The end result was that before long I was able to express my hurt and bitterness towards the people and events which had caused me to suffer for so long. Much of the feeling that I was able to put out was shouldered patiently by the people working with me, and I remember very little of the actual occurrences during my time there, but I recall the depths of emotion I felt, the reasons I discovered, but more than this I learned how to feel genuine emotion and through this I discovered myself.
I believe that the basic reason for my ability to overcome my emotional breakdown was the fact that I was helped and encouraged by kind, understanding workers. I was not hindered by any tranquilizing or elevating drugs, but rather encouraged to avoid their use.
The people that were most able to help me were also able to admit their own weaknesses and did not in any way appear superior to me in my weakened state. I was extremely vulnerable and needed constant attention, but I am sure that the genuine friendship and caring was what convinced me to trust those around me, which in turn enabled me to pull through my fears and doubts.
I am convinced that the kind of help offered by Vancouver Emotional Emergency Center is one of the things lacking in institutional treatment. As I at one time was a patient in the provincial mental hospital for three months, I believe my opinion to be a valid one. I would like to encourage those involved in the support and organization of such places as VEEC to continue their efforts, for I believe in human involvement that is based on a more personal level than most institutions can offer. In closing, I offer my thanks and gratitude to those continuing their work at VEEC, and I would like to say, may daffodils and sunshine be yours.
Some of the log entries that Cinnamon wrote in the VEEC logbook during her stay reveal the dramatic events that she narrates so calmly in retrospect. During her first few days in the house, she became very withdrawn. She wrote:
I never complained when screaming was going on that ripped me apart, so please leave me alone or I'll scream so loud I'll destroy myself.
Later she recognized her fears and started to discuss them. After an emotionally charged, long rap with a staff member, she wrote:
Much is happening inside. I have discovered parts of me that I never even hoped existed. Good parts so far. I feel like I'm crawling out of a deep, dark hole, so deep I can perceive no bottom. Every now and then I'm forced back down by a fear so overwhelming there are no words to describe it. I fear most of all the insanity of continually falling and not being able to reach solid ground. I have love for so many people here and this frightens me, for it's so new and clean that I'm frightened I'll corrupt the realness of it, with my unreality. I'm slowly (13 days) beginning to accept the love offered and am beginning to give it back in small doses.
Just before leaving VEEC, Cinnamon wrote:
I'm exhausted with existing. I want to live, to be aware of all my senses, all the needs that have been denied me, by others including myself....I feel no loss at departing, but rather a continuation of what has already been....I feel the freedom to love and respect my needs as well as to continually be aware, in a real sense, of others.
VEEC closed in March 1976 because it was unable to find a new funding source. In its twenty-six months of existence it had served about 650 people.
While none of the alternatives that have been discussed in this chapter are patient controlled, all have made attempts to break down the hierarchical authority structure of traditional mental health facilities and to bring residents into the decision-making process. Residents, even when they do not take an active part in running things, at least are not mystified about where authority lies. Staff in these alternatives present themselves not as "experts" but as human beings who, in common with residents, have feelings, experience problems, and try to make their lives as satisfying as possible.
There are some critical differences. Soteria House was explicitly apolitical, which Elizabeth Stone House (based in feminism) and the Vancouver Emotional Emergency Center tried to make important connections between individual unhappiness and societal conditions. David Myers, who was a member of the VEEC staff during almost the entire existence of the house, is writing a critical examination of VEEC, focusing particularly on operating effectively as a collective and on the relationship between "going crazy" and the political and social environment. Making these political connections is essential in developing a true alternative, since it helps to locate the cause of people's distress in the very real pressures of their lives rather than believing that it arises out of some mysterious process.
In the future, as mental patients' liberation groups become stronger and more successful, they will become involved in setting up alternatives that will incorporate ex-patients' special perspectives on "going crazy" and on "coming sane." Ex-patients, for example, probably would be able to relate better than the VEEC staff could to people in long-term crisis. Until then, nonprofessional alternatives are positive examples of the kinds of changes that need to be made so that those undergoing the "madness experience" can grow and change instead of being dehumanized and invalidated, as they are within the present mental health system.