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Toxic Psychiatry
Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the "New Psychiatry"
By Peter R. Breggin St. Martin's Press
Copyright © 1991 Peter R. Breggin
All rights reserved.
ISBN: 978-1-250-10872-2
CHAPTER 1
Psychiatry Out of Control
A gigantic asylum is a gigantic evil, and figuratively speaking, a manufactory of chronic insanity.
— John Arlidge (1859)
Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive.
— C. S. Lewis (1970)
I am still more frightened by the fearless power in the eyes of my fellow psychiatrists than by the powerless fear in the eyes of their patients.
— R. D. Laing (1985)
Nothing could have prepared me for that day on the women's "violent ward," E-3. It was a cement dungeon, long and narrow, and bare except for a few boulder-size oak chairs, benches riveted to the wall, and a badly working TV in the corner of the ceiling. It looked more like an abandoned basement corridor than a hospital ward.
I was eighteen years old, a college freshman at Harvard, and I was standing in the middle of this place because a friend, Mike Dohan, had urged me to join a group of Harvard and Radcliffe students on a volunteer trip to the local state mental hospital. His brother Larry, also an undergraduate, had recently started the experiment in college volunteering. The year was 1954, a landmark in psychiatry, when the neuroleptic drug Thorazine began to flood the state hospitals throughout the nation. But the tidal wave of psychiatric medication hadn't yet broken over Metropolitan State. Met State remained an old-fashioned snakepit.
On the ward, two indifferent attendants were amusing themselves in the office and not a doctor or nurse was in sight. During the day, the patients were locked out of the barracks-like sleeping quarters. Dozens of them were herded together in gray squalor with nothing to occupy their time. Many wasted a lifetime in this place.
The first and most lasting impression was the stench. It reminded me of my Uncle Dutch's reaction to liberating a concentration camp: nausea. When I was ten, I had heard the story of his exploits as an army officer, and now they came back with renewed impact at the age of eighteen. Many of these people actually looked like concentration camp inmates — undernourished, silent, stone-faced with sunken eyes. They would sit in corners or pace about. Some talked to themselves. One gesticulated into space. Another was lying on the radiator by the filthy window. Absolutely no one socialized with anyone else. It was as if each was ashamed and afraid of the others.
A tall, lanky woman stood in front of a stolid, older lady who was sitting motionless on a bench. Then the lanky woman leaned down and smashed the sitting woman in the mouth. There was an audible thud of fist on flesh. That's all there was; not a word or glance between the two women acknowledged the event. When I reported the incident to the aides, one of them came out and checked the injured woman's teeth as if examining a horse's mouth.
The group of us from Harvard and Radcliffe spent the day trying to coax the patients into conversations. Often we succeeded, and many of them perked up considerably. When we got ready to leave, some of the women tugged on our arms, begging us to stay. In words that hardly differed among them, they would tell us, "I don't belong here." We believed them. Nobody belonged in Met State.
Then we learned that the young woman lying in the corner, as disheveled as a street person, as silent as a mummy, had been a Radcliffe student when she broke down and was committed. It seemed inconceivable that she should be in this place. It was intolerable that something better than this could not be done for her.
More than thirty-five years later, my mind easily becomes alive with vignettes from the hospital: the women begging for a chance to relate to us in any way possible, from making lewd suggestions to baking us cookies. The elderly lady taking my cherished watch from my wrist to polish it for me, and my anxiety over losing it, until she returned it later in the day, as promised, with a new shine to the case. Coming upon attendants roughing up a patient and simply bearing witness to their acts until they felt compelled to stop. The giant, maniacal-looking man who confronted me in the corridor, stared down into my eyes, and harmlessly announced, "I smoke Lucky Strike."
Sometimes the volunteers experienced the threat of the hospital firsthand. One volunteer was mistaken for a patient because she was very obese, and an aide told her she'd have to have sex with him or get transferred to the back wards. Another volunteer was left behind when our group went home and remained locked up for over an hour on a crowded back ward with no attendants; he grew terrified he'd have a breakdown and be trapped there for the rest of his life.
While the aides were sometimes menacing to the volunteers, the patients almost never were. Hundreds of students participated, and some remained alone for hours on the "violent" wards; but none were physically harmed or obviously endangered by an inmate.
Sharing the anguish of the patients and their intolerable living conditions took a toll on most of us. A single afternoon in the hospital was more than most of us could survive unscathed. We returned to Harvard and Radcliffe with headaches, upset stomachs, a stench embedded in our nostrils, and nightmares. Ahead of our time, we developed mutual debriefing methods to deal with our upset. We used dramatic techniques, such as playing the role of the patient, to reenact and to express our outrage, to fathom our despair. Sharing our emotional pain with one another helped keep us from quitting the program.
Later I learned that the woman who had become violent in such an unprovoked fashion had severe brain damage from electroshock, lobotomy, and other treatments, many long lost in her voluminous records. I began to think that the treatments had caused or worsened many of the patients' problems.
It also was apparent to me that much of the patients' upset and suffering was induced by the hospital environment itself. When working on a book about the program, I wrote about this extensively; but every word was edited out by the psychiatrist who was in charge of our grant for the book project. I didn't get to tell the story of what psychiatric hospitals do to their patients until my first novel, The Crazy from the Sane (1970).
Asking Questions of the Uncaring
As I became a leader in the volunteer program and gained better access to the hospital and the staff, I began to ask questions. How could the staff ignore the fact that the patients suffered nearly freezing conditions in the winter and sweltering temperatures in the summer?
A staff psychiatrist told me, "Schizophrenics aren't bothered by extremes of heat and cold the way normal people are."
Even then, as an eighteen year old, this did not make sense to me. As I got to know the patients, they seemed at least as sensitive as ordinary human beings. Sometimes they seemed to be much more sensitive. Exquisite sensitivity, in fact, seemed a part of their problem. I wondered what went on in the minds of the doctors, nurses, and aides that enabled them to ignore the patients' anguish and even to compound it with the treatments.
I observed the insulin coma room, where rows of patients were purposely overdosed with insulin, causing a drop in their blood sugar, until they fell into convulsions and a coma from starvation of the brain. As I watched them writhe about on mats, near death, it seemed like a scene from hell. I watched them being fed sugar and orange juice, to awaken into a state of fear and confusion. The once difficult and unruly inmates, with their brains now permanently damaged, became gratefully dependent on their keepers after being brought back from the edge of death. Their righteous physicians called it an improvement and even a cure.
Again I asked questions.
Another staff psychiatrist told me, "Electric shock and insulin shock kill bad brain cells."
I knew from my beginning studies — although only a college student, I was already reading psychiatric textbooks — that no one had found "bad brain cells" as a cause of the psychiatric problems that were labeled schizophrenia, depression, or manic-depressive disorder. The hunt for a physical defect had been going on for centuries, with no success. Besides, how could a process as gross as shocking or starving the brain into convulsion, unconsciousness, and coma weed out the "bad cells" from the "good" ones? The cell death had to be indiscriminate.
"Why would a doctor make up stuff like that?" I asked myself. I saw no mystery in how the treatments worked. By damaging the brain and mind, they made the patients docile and passive — suitable for control within these abusive institutions.
A "Dangerous" Innovation
As the volunteer program grew in size and in ambition, the hundreds of us passing through each year began to transform the hospital. It was no longer so easy for the aides to rape or beat patients. A Harvard or Radcliffe student might stumble upon the assault. We also proved that the so-called violent patients weren't nearly so dangerous as supposed: two of us stole the keys and took half of the women's violent ward for a trip into town. We gave them money to buy trinkets in the local five-and-ten and returned them to the hospital without incident. They appreciated us and would do nothing to get us in trouble. And we realized that much, if not most, of their violence was in reaction to being abused within the state hospital. Living there was wholly demeaning and even life-threatening.
We worked hard to make the concrete fortress more livable, cleaning up and painting the wards and supervising social activities. Some of us focused on these group activities, while others of us, like myself, became more personally involved with individual patients whom we looked forward to seeing each week.
Representing the program as a college sophomore, I went to the superintendent with a simple proposal: let a dozen or more of us have one patient each, assigned for the duration of the year. We would work with the patient one afternoon a week and meet as a group with a social worker, Dave Kantor, for supervision on the same afternoon.
The superintendent was outraged. How could we dare confront him with such a proposal — college freshmen and sophomores treating back ward schizophrenics? It was my first experience with how easily the psychiatric establishment becomes threatened and how dearly it holds onto its dogma about the importance of medical and professional credentials. Only when I explained that I could transfer the entire volunteer program to another state hospital did the superintendent agree to our terms. Our program had brought the hospital its only positive coverage in the local and even the national press.
The president of the Boston Psychoanalytic Society also protested our proposal. This Freudian psychiatrist warned that without extensive professional training we would harm, even ruin, these hapless denizens of the hospital depths. His protest sticks in my mind alongside images from my first day on the wards: the woman being struck in the face, the woman urinating on the floor, the aides amusing themselves in the office. Harm them? Ruin them? With a little caring human contact?
Why would a psychoanalyst feel that his turf was threatened by student volunteers in a state mental hospital?
In my two years of work at Met State, I had never seen a psychoanalyst set foot in the place. I was discovering that psychoanalytically trained psychiatrists could defend their trade union prerogatives and professional turf as fiercely as their more biologically oriented colleagues.
Fourteen of us were begrudgingly given individual patients to work with one-on-one. Many were older, chronic patients. "Burnt-out schizophrenics" was the term used by the staff to describe many of them. Presumably, they were beyond harm — or help.
Mr. Liebowitz Goes Home
My own particular patient, an elderly man I'll call Mr. Liebowitz, was diagnosed as psychotically depressed, overcome with feelings of worthlessness and hopelessness. It was impossible to motivate him to do anything. He was afraid of people and phobic about having a heart attack. When I introduced myself to him, he tried to shoo me away like some vastly annoying fly. I thought to myself, "He'll never even talk with me!"
After a time he began to trust that I actually would show up each week and that I would be a friend to him. Like most inmates, he was absolutely friendless, and my attempts to establish a relationship must have seemed strange and inexplicable to him. Gradually he let me help him get better clothes from the dispensary and encourage him to work on some simple projects in the hospital carpentry shop. Soon he became willing to chat with me about what he might do to get out of the hospital.
Fearful at first about a heart attack, Mr. Liebowitz gradually allowed me to help him walk outdoors around the hospital, and then eventually around the hospital grounds. We became more able to talk about his actual physical condition, which was excellent, and to contrast his fears to reality. We chatted about his concerns about old age and put them in a more hopeful perspective. I am sure that the interest of a young college student did much to convince him that he still possessed some human worth.
Then I helped him select a home for older and retired people in town, where he was able to take advantage of going outdoors, shopping, and visiting in the community. It was more than a decent place to live and he was very pleased to be free of the hospital.
Other students in the program had more extraordinary accomplishments. Some worked with more grossly "psychotic" patients, those suffering from hallucinations and delusions, and helped them return to their families. While Mr. Liebowitz didn't talk much, many of the other patients became quite involved in expressing their feelings and discussing their lives with their student aides. For many of the students, this once-a-week supervision with the social worker became as intense as graduate training in psychotherapy. Nor did medication play any role in the outcome. Our patients were not yet receiving the new "miracle drugs."
The Results
By the end of the year, eleven of our fourteen patients had been released from the hospital. Only three of those eleven would return in the follow-up, which lasted one to two years. This is a far better record than that achieved by trained professionals working in programs relying on psychiatric drugs. We accomplished this "miracle" by showing our patients care and attention; by talking with them and taking them for walks, by helping them get properly fitted with eyeglasses, false teeth, or clothing, by reacquainting them with their forgotten families, or by connecting them with more humane supervised facilities outside the hospital. In some instances, where the patients had been more verbal and the students better able to communicate, the treatment had been indistinguishable from psychotherapy delivered by a trained professional.
Growing Disillusionment
Even then, as a college student in the mid-1950s, I suspected that the "miracle drugs" weren't curing anyone. Three years of volunteering and two summers of doing research involving drugs in the hospital had impressed me more with the robotic indifference of the drugged patients than with their improvement. If anything, they seemed less reachable as people. The claims for "emptying the hospitals" were not being made yet, and in the years that followed, I would doubt their validity, long before the contradictory data began to pile up.
Again and again I found myself wondering what was the matter with psychiatry. Why wouldn't the profession adopt such a humane solution as the widespread use of volunteers? Why wouldn't it follow up our enormous success by trying the program in every hospital in the nation? Why wouldn't it commit funds and staffing to volunteer efforts? Why were drugs preferable? And why in the world wouldn't the psychiatrists see the obvious — that their treatments and their hospitals were doing far more harm than good?
As I finished my college career, I was already interested in psychiatric reform. I had barely an inkling of the forces within human nature, society, and psychiatry itself that would make reform in psychiatry seem beyond reach.
The New/Old Psychiatry
I had learned as a college student that love and care, and supporting the patient's self-determination, were the most effective elements in helping people, even in rehabilitating "lost souls" on the back wards of state mental hospitals. I also was learning that many of these inmates were simply homeless — disheartened poor people with no place to go. But after I entered my medical and psychiatric training, I would never hear another word about the importance of love in helping people through their helplessness and despair. Even supporting the patient's sense of self-determination and personal responsibility would rarely be mentioned. And problems of poverty and homelessness would be wholly ignored. Instead I was taught that the patients had "diseases," like schizophrenia, major depression, and manic-depression or bipolar affective disorder. They needed pills instead of people; shock instead of social reform.
(Continues...)
Excerpted from Toxic Psychiatry by Peter R. Breggin. Copyright © 1991 Peter R. Breggin. Excerpted by permission of St. Martin's Press.
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