[Fwd: Psychiatry: Mercenary Medicine & Social Control in Canada]

Graeme Bacque (gbacque@idirect.com)
Sun, 18 Apr 1999 23:59:54 -0400


-------- Original Message --------
                             The chemical asylum

 The Yu inquest hears of a brave new world where homeless people are
branded
                      insane and controlled with drugs

BY TOM LYONS

It is the sixth month of the inquest into the death of Edmond Yu,
and the lawyers and police officers are starting to lighten up and
show their fun side. After squaring off over the police killing of a
homeless schizophrenic on a TTC streetcar in the winter of 1997, the
opponents adjourn to the lobby to talk about salaries and benefits and
holiday locations and movies. Eventually, the levity drifts into the
courtroom itself. Paul Bennett, the lawyer for the Chinese Canadian
National
Council, tells a very amusing five-minute anecdote about a trick cigar.
Thomas Schneider, the crown counsel, cracks up the courtroom with a quip
about the high salaries of psychiatrists. And Detective Monaco gets
almost
as many laughs saying, "I guess we all need help."

The expert witness for the day is Michael Bay, director of something
called
the Mental Health Education Program of the Ontario health ministry. Bay,
dressed in a rumpled gray suit and pointing at slides on an overhead
projector, looks like an enthusiastic high school teacher. He talks
about
the difference between the "real" mental health law and the
"mythological"
one, explaining that most police officers and doctors don't realize how
much
power they have to commit someone against their will. The person in
question
doesn't have to be "waving a machete" or acting like a "kamikaze." They
can
also be committed if they don't seem able to care for themselves, either
in
the present or within the next few days or weeks. According to Bay's
interpretation, "a homeless person sitting on a steam grate" is by
definition mentally ill.

"It's a very low test, really," he says.

Asked in the lobby whether this definition could be used to sweep the
homeless off the streets, Bay smiles and says his position in the
ministry
prevents him from answering questions like that.

Bay also tells the inquest about the community treatment orders (CTOs)
the
Harris government is in the process of drafting. CTOs -- which
originated in
the United States and have already been introduced to B.C. and
Saskatchewan
-- allow police to arrest outpatients who don't take their medication
and
return them to the hospital for forced drugging.

To their supporters, CTOs are a way to help schizophrenics cope with
life
outside the hospital, and might have saved Yu from the downward spiral
which
led to his homelessness and violent death.

"It's a form of outpatient committal, so it enables people to live in
the
community and receive the provision of services they may need," explains
Janice Wiggins, the executive director of the Schizophrenia Society of
Ontario.

Groups like the Queen Street Patient's Council, however, call CTOs
"leash
laws" and say they "especially threaten the rights of people with a
psychiatric history, homeless people, people living in poverty."
Loosened
commitment criteria of the sort promoted by Bay would leave them
vulnerable
to being swept off the street, placed in an institution and forced to
take
medication before being allowed back into the community. From that point
on,
they could be re-arrested and returned to the hospital simply for not
taking
their drugs.

Patients' rights groups and anti-poverty activists oppose CTOs, arguing
that
they are using medical theories and police powers to solve social
problems.
Critics also point out that CTOs and other ideas heard at the inquest,
which
goes to the coroner's jury tomorrow (April 16), come from an American
mental
health organization that is funded by big drug companies. Soon, they
fear,
police and doctors will able to label most of the underclass as mentally
ill
and subject them to forced drugging with brain-numbing medication.

WHAT IS SANE?

"It seems like quite a coincidence that there's a major epidemic of
schizophrenia all of a sudden, just when Harris' economic policies have
forced a lot of people out onto the street," says Graeme Bacque, one of
the
founding members of People Against Coercive Treatment (PACT). "It's like
what they did in the States, when they brought in CTOs at the same time
that
they were trying to clean up the downtown areas."

PACT is a Toronto anti-psychiatry organization which follows the
argument of
'60s anti-establishment thinker Thomas Szasz, who argued that mental
illness
doesn't exist because, unlike physical illnesses such as cancer, it
lacks
clear scientific proof which can be determined by simple biological
tests.
Psychiatrists generally dismiss Szasz's argument as beneath contempt.
But
even his harshest critics, like Dr. Robert Zipursky at the Centre for
Addiction and Mental Health, concede this last point is still
technically
true.

Few other patients' rights groups and anti-poverty activists argue
mental
illness doesn't exist simply because it doesn't show up in blood tests
or
X-rays. Rather, they stress the inexact nature and loose terminology of
the
discipline has left the field wide open for everything from
profit-driven
drug treatments to social control strategies to over-labelling and
wildly
varying estimates of the prevalence of mental illness.

Dr. Zipursky, for instance, puts the incidence of severe mental
illnesses
such as schizophrenia among Toronto's homeless at 5 to 10 per cent.
Janice
Wiggins of the Schizophrenia Society claims "anywhere from 30 per cent
to 40
per cent of the homeless are suffering from severe mental illness. And
the
majority of those are suffering from some form of schizophrenia." Anne
Golden's Report on Homelessness claimed 35 per cent of homeless people
are
mentally ill (and 75 per cent of homeless women). Past estimates from
the
Clarke Institute of Psychiatry put the general incidence of mental
illness
among the homeless at 86 per cent. And Michael Bay's newly promoted
interpretation grants the police sweeping powers to classify most street
people as mentally ill, the only exception being those who are
"street-smart" enough to somehow thrive on the pavement, in which case
they
would be classified as petty criminals.

"In our society we can't tell the difference between somebody who is
mentally ill and somebody who is extremely poor," argues David Littman,
director of the Parkdale Activity and Recreation Centre (PARC), a
drop-in
centre for ex-psychiatric patients. "They look the same. And that's an
unfortunate truth."

Others add that the whole issue is of numbers distorted because little
distinction is made between homelessness as a cause and as an effect of
mental illness. And why should drug or alcohol abuse be labelled mental
illness among those who live on the street, but not those who live in
Rosedale?

"You read a lot these days about homeless people being mentally ill. In
fact, if you look at any kinds of studies of it, you'll find out the
exact
opposite is true," says Jennifer Chambers, a member of the Queen Street
Patients' Council. "Being homeless will make you crazy. It's so
stressful.
You're so vulnerable. You're such an easy victim of crime that you get
rather unbalanced."

Tess, a 24-year-old girl from Nova Scotia who has spent the last decade
panhandling on the streets of Toronto, agrees. "It's hard to think
straight
when you're cold and hungry from being out here all day," she says,
huddled
against the wall of a Queen Street store with a sleeping bag over her
legs.

Perceptions of the issue are further muddied by the widespread
assumption
that the closing of psychiatric wards is primarily responsible for the
large
numbers of homeless people. But deinsitutionalization in Ontario
occurred
decades ago. In Toronto, the Golden Report also noted that the
phenomenon is
primarily a result of other government policies like the removal of rent
controls, the downloading of social housing, a low minimum wage, cuts to
social assistance and the failure to provide promised shelter subsidies.

The variable estimates of mental illness are obviously not the result of
exact science. Indeed, when the terminology is this loose, any sort of
claim
can be made. The question is, who has the power to enforce their point
of
view and make their labels stick?

TERMS OF ENSLAVEMENT

Terms like mental illness have been loosely applied to an entire class
in
the past as a means of controlling surplus or undesirable populations:
peasants in the Industrial Revolution, women's rights advocates at the
turn
of the century, dissidents in the Soviet Union and American race rioters
in
the 1960s.

More recently, the homeless and poor in major American cities are being
relocated to subsidized housing on the condition they accept that they
are
mentally ill and agree to take medication. U.S. patients' rights groups
say
the programs are nothing more than a profit-driven means of exercising
social control by drugs.

The Harris government is adopting such American concepts as "hospitals
without walls," CTOs, forced drugging, "assertive community treatment"
teams
and loosened commitment criteria at the same time that there is a public
outcry to solve the homeless problem. That gives rise to fears that
similar
patterns of profit-driven social control are about to unfold here.

"They're just trying to find some way to not have people living on the
street, trying to make the place look perfect," says Harry, a
43-year-old
former homeless person sitting in the Archway, a Parkdale drop-in
centre.
"They're hiding the truth. There are people who are abused and
overlooked
and they fall through the cracks and they wind up on the street. But
it's
going to create more paranoia. Because if the police do all this and
round
up people for assessment and subject them to forced treatment, that's a
crime right there."

Bob Rose, a director at PARC, says that point of view is widespread in
the
neighborhood. "There is a real fear," he says, that the loosened
criteria
for commitment and use of forced drugging will replicate the clean-up
campaigns in major American cities. "You hear politicians talk with
sweep
mentality, sweeping the streets. They don't have any understanding of
the
sense of life issues people face. They become chronically homeless.

"There is definitely over-labelling," adds Rose. "And it is not only
over-labelling but the fact that the health system is restructuring
itself
without respect to the people working in the community. That's why
little
programs like my outreach program are going to get very little in the
provincial budget and why all the major hospitals are scooping major
dollars
for ACT [Assertive Community Treatment] team set-ups. Will they function
with an institutional mind-set? Yes, they will. Will they place an
overemphasis on medication? Yes, they will. Is the medication dangerous?
Yes, it is. People die. It's a primitive tool. It can be especially
dangerous if a lot of people's other needs are not being met."

Margaret Gheres is the director of Contact Program, an assertive
community
treatment team serving hostel residents in the downtown core. She says
it is
wrong to dismiss programs such as hers as institutional merely because
they
happen to be based out of a hospital (Wellesley-St. Michael's). Joel
Roth,
director of the New Dimensions program in Scarborough, adds that the
current
assertive community treatment teams use no coercion whatsoever, and
though
they do deliver medication to outpatients, they also provide assistance
in
daily living skills.

ACT teams were in fact popular with patients' rights groups in the
States
when they were introduced in the late '60s and increased in the '80s.
But
the subsequent association of them with forced drugging in the '90s has
led
U.S. patients' groups to despise them as invading armies of "medical
militia."

In Toronto, ex-patients complain that psychotropic drugs are already
being
used for social control purposes within Ontario's mental institutions.
And
they are afraid of any attempt to extend forced treatment beyond the
hospital walls.

ACTIVISTS LOG ON

"I refused to take my medication. So the result of my sentence is that I
was
so heavily medicated that they put me out like a light. And I woke up
with
one hell of a huge hangover, and realizing that I couldn't resist any
longer. So if I wanted to stay alive, I just had to follow orders,"
remembers Paul, a Toronto man who was diagnosed with paranoid
schizophrenia
in the late '50s and subjected to years of intensive psychotropic drug
treatments before the doctors decided he was actually suffering from
epilepsy.

He sits slumped in a chair at PARC, which is filled with worn-out
couches,
card tables and heavy clouds of cigarette smoke. At 62 years of age,
with a
sagging belly and a cane at his side, he doesn't exactly fit the
stereotype
of a wide-eyed radical. But the computer print-outs piled up next to him
on
the office desk are typical of activists in the Toronto "survivor"
movement,
most of whom have web sites and Internet links to the patients' rights
groups in the States. They trade information about CTO laws,
drug-related
deaths, drug company profits and even letters from defecting
psychiatrists.

"At this point in history, psychiatry has been completely bought out by
the
drug companies," wrote Dr. Loren R. Mosher in a 1998 resignation letter
to
the American Psychiatric Association which Paul downloaded and passed
around. "The APA could not continue without the pharmaceutical company
support of meetings, symposia, workshops, journal advertising, grand
round
luncheons, unrestricted educational grants, etc. Psychiatrists have
become
minions of drug company promotions."

Another item which spread like wildfire via the Internet was the
discovery
that the "grassroots" American organization that promotes forced
drugging
actually receives more than half of its corporate funding from major
pharmaceutical companies.

This information turned up in the annual report of the outfit, the
National
Alliance for the Mentally Ill. Headed by Edmund Fuller Torrey, NAMI is
the
organization chiefly responsible for promoting not only forced drugging
but
also the whole array of progams and theoretical justifications
associated
with it -- all of which are now making their way to Ontario. CTOs,
assertive
case management teams, loosened commitment criteria, the notion that
mental
illness is unquestionably a "brain disease," the idea that extremely
high
percentages of homeless people suffer from mental illness and even the
idea
that mentally ill people are inherently violent are all championed by
NAMI.

Aside from noting that it is funded by drug companies, the Toronto
activists
point out that most theories promoted as absolute fact by NAMI are still
debated or wholly discredited by the scientific community. For instance,
despite NAMI's claim that mental illness is a "brain disease like
Alzheimer's or a stroke" and can therefore be treated with drugs,
medical
researchers have yet to prove the exact organic bases of any of the
major
mental illnesses. To choose just one recent example: the National
Institute
of Mental Health concluded that "there is no known single cause of
schizophrenia."

And despite NAMI's claim that mentally ill people are inherently
dangerous
and need to be drugged, the definitive MacArthur Violence Risk
Assessment
Study found that, on the whole, mentally ill people are no more violent
than
the general population.

But aside from questions of force and funding and unproven biomedical
theories, it is the drugs themselves that terrify the activists and
ex-patients, most of whom speak of them in terms usually reserved for
lobotomies or spine extractions.

SAYING NO TO DRUGS

"Take a look at Ewen," says Heinz Klein, another member of the Queen
Street
Patients' Council. Klein is seated on a couch in PARC's deserted second
floor lounge, which is clean, pleasant, covered in hand-painted murals
and
almost completely deserted, presumably because it is a non-smoking
area."Ewen cannot speak very well. But he can smoke six to 10 packs of
cigarettes a day. That's all he can do. And twitching and stuff like
that.
And you see Tardive Dyskinesia."

Brain damage and Tardive Dyskinesia (TD) are the most notorious
side-effects
associated with the first generation of anti-psychotic drugs like Haldol
and
Thorazine (both of which are still widely prescribed). In a particularly
cruel irony, TD produces the lip-smacking, facial twitching and
foot-shuffling that many people assume to be sure signs of madness in
ex-patients they see on the street. First dismissed by doctors as a rare
phenomenon, TD was discovered in the '70s to afflict more than 60 per
cent
of long-term users, and, like drug-induced brain damage, proved to be
irreversible. Other psychotropic side-effects listed by researchers
included
pseudo-Parkinsonism, physical immobility, hypertension, blindness,
seizures,
sudden death and psychotic withdrawal symptoms.

"I remember Sue," says Klein. "Her medication made her suicidal. She
phoned
up the doctor. The doctor said, 'You can come on Monday.' On Sunday,
she's
jumping off the Bloor Street Viaduct. It may work with lots of people.
But
lots of people experience side-effects, up to feeling suicidal, and will
commit suicide."

Psychiatrists at the Yu inquest claimed the new anti-psychotic drugs
like
Clozapine, Risperidone, Olanzapine and Quentiapine have far fewer side
effects. But younger ex-patients like Regler who have tried both the
first
and second generation drugs, say the new "wonder drugs still turn
outpatients into zombies and invalids.

"They switched me over from the heavy take-them-down meds like Haldol to
the
new meds like Loxapines," says Regler, 30, a local musician and another
member of the Patients' Council. "It took me about five months after
being
released before I could get off them. My memory went. I couldn't
remember
half the things I was looking at. Or if I tried to read a newspaper
column,
I'd only get halfway through it. A newspaper column, for Chrissake. I
was
used to reading philosophy text books. It was something I had to get off
if
I was ever to function again in society."

Patients' rights activists say that despite the safety claims made for
the
new drugs and lower dosages, numerous deaths are being recorded from
their
use in the States. In 1995, a 35-year-old Oregon man, Ricky Herron, died
after being forcibly drugged with Clozapine. Four others died from the
side
effects of neuroleptic drugs in the same county. And 15 deaths from
neuroleptic drugs were recorded during a single heat wave in Milwaukee
later
the same year.

The usual defence of psychiatric drugs is that before they came on the
market, patients were locked away in pits staring at the ceiling, or
tearing
down hallways gibbering about bats and lizards as beefy Nurse Ratchet
types
chased after them with rusty electroshock cables and blood-caked
lobotomy
scalpels. But according to Harvard Medical School sociology lecturer
Phil
Brown, author of The Transfer of Care, financial considerations were
just as
much a part of closing asylums. The wonder drug of the day, Thorazine,
was
only a secondary and indeed accidental factor -- it was developed as an
antihistamine.

Indeed, a study in the '70s found that a slight majority of
schizophrenics
fared better on placebos than psychotropics.

Downstairs at PARC a chubby man in his 40s with greasy black hair
shuffles
around next to the piano with his eyes shut. He bobs his head, flaps his
mouth, drops to the floor to do a furious set of push-ups, then bounces
back
up to rock back and forth against the wall.

MORE POWERS FOR COPS

"Rabbi Bob" is a tall, skinny man with gray hair and a beaked nose. He
wanders around town with a Windex bottle full of water squirting it at
trees
and bus shelters and grinning at pedestrians like they could be next.
Near
the beginning of the Yu inquest, when TV crews were still hounding
Officer
Pasquino, the man who shot Edmond Yu to death, Bob showed up with a
collection of shopping bags and a stack of hand-lettered pamphlets
urging
people to call the homicide squad.

"I'm pro-cop," he said, grinning.

Others weren't quite as ironic about the police role at the inquest.
They
say the police are pushing for CTOs and forced drugging just to get one
of
their own off the hook.

"The only thing that would have prevented Edmond Yu's death would have
been
if the police had not shot him. And the focus should be on that," says
Anita
Szigeti, a lawyer for the Mental Health Legal Committee.

Activists were particularly outraged that, despite killing a homeless
schizophrenic, police are likely to wind up with even more powers over
ex-patients and street people after the inquest.

"Anything that acts to criminalize mental illness is a mistake," says
PARC's
Littman, noting that many ex-patients are already pushed toward crime
because 90 per cent of their social assistance cheques go toward
housing.

"I don't think that the treatment of people with serious mental illness
is
going to improve by giving even more power to the police and more power
to
the psychiatrists," he says. "What will help people with mental illness
is
things like safe housing, jobs and the dignity that comes with working."

Especially ironic to many is the fact that, with the addition of CTOs to
their "toolbelt," the police would have the power to arrest ex-patients
for
either taking drugs or not taking drugs, just as they already seem to
have
the power to harass them for being victims or perpetrators.

"I was waiting for the bus and someone came up behind me and cut my
throat,"
recalls Jim Doyle, a long-haired ex-patient in his early 40s who lived
in
Parkdale at the time. "I phoned the police from the hospital after it
happened. They thought it was a drug deal that went wrong. They went to
my
house and asked my roommates if I had been involved in any drug deals.
And
they went to my room, and they found some penicillin that my dentist had
given me because I'd just had a root canal. And they go, 'What's this?
What's this?' "

This habit of lumping together poverty, mental illness and criminality
is
what makes psychiatric survivors and anti-poverty activists worry that
changes to the Mental Health Act will result in a war on the poor, who
will
wind up in detention centres, mental health centres or both.

Lawyers like Szigeti think some of the new powers discussed at the
inquest
constitute are civil liberties violations. "There's the so-called
Section 7
right, which is the right to life, liberty and security of person," says
Szigeti, who is readying a charter challenge of CTOs. "Then you have a
Section 9 right, which is a right against detention that is arbitrary.
And
you also have, under Section 15, a charter protected right to equal
treatment under the law."

And while the civil liberties issues involved in the expanded police
powers
and CTOs and over-labelling may seem as abstract in an article as they
are
invisible at the Yu inquest, they are already an unpleasant reality for
those forced to live on the street.

In month six of the Yu inquest, Susan Fraser, the lawyer for the Queen
Street Patients' Council, asked Edmond Yu's psychiatrist about Yu's
belief
that people were colluding to put him in the hospital against his will.

"What part of that statement is not true," she asked, reasoning that the
court had just heard that was exactly the case.

The psychiatrist paused, stammered and looked baffled.

"What about that statement is not true, that people were colluding
together
to put him in the hospital against his will?"

After several minutes of this, the psychiatrist looked to the coroner,
who
ruled the question out of order, saying he is not about to allow the
medical
validity of Yu's diagnosis as "paranoid" to be challenged.

Any science that needs legal power to protect it from logical questions
is
not a science -- at least not yet. And while few would agree that
psychiatry
serves no purpose, or that mental illness simply doesn't exist, one
would
think that now, nearing the end of the 20th century, society would be
leery
of using unproven theories of biological inferiority to threaten an
entire
socioeconomic class with forced drugging and preventive detention. Just
to
clear the sidewalks.


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