progress. Many are survivors of the tyranny of psychiatry and compassion.
They've set me a question: what would you do (or imagine could be done)
in a situation where someone seemed to be at high risk of harming
him/herself or harming another person, if forced psychiatry were not an
option?
I've scribbled together a draft over the last couple of days. I need to
go away and think about it more. Here's what I've written thus far. As
usual it's a ramble and there are lots of times I wander off the point.
There's still more thought to put in. Some of this may need to be cut
out too because it is off topic.
Here's what I have so far.
"
You pose an excellent question. Informed choice for self harm, self
destructive behaviour or self termination are things the current mental
healthcare system would attempt to stop. For example a person who self
mutilates to survive psychosis and fight against god's influence (my
personal experience) would ordinarily be the sort of person who'd end up
being incarcerated and forcibly treated, and yet the same person could
have a tattoo done if they were psychotic or manic. It's a judgement
call which a parent might make to stop their child being harmed
but...well...therein lies the problem of compassion, parents and free
will. My self-harm scars are a reminder to me of a dark period in my
life but they also cause sexual disability. (I can't have spontaneous
casual sex and it can still be difficult within a loving relationship
for my partner to accept my scars. There are lacerations upon
lacerations, large gashes and burns from cigars and cigarettes covering
one forearm. I also have a small tattoo on the shoulder of my other
arm.) I do not regret the self harm though. I just wish it wouldn't have
to happen to anyone else. While going through this spiritual crisis I
was forced to stay away from healthcare services because of fear of
coercion. I couldn't even feel safe going to casualty to have a large
gash sewn up because of fear of coercion and forced treatment. I would
have liked physical healthcare but I knew it was not safe to access. I
survived and managed to keep a part time job at a mental health charity.
The experience rapidly dimished after a few months of living hell.
Things got better quickly and I feel I was a lot wiser because of the
experience. I also came to know god and hate god.
Had the CRPD been in force I would have been able to access the
treatment I needed without fear from healthcare services. If, at any
point, I wanted to remove those scars it is possible using cosmetic
surgery however it is something I do not want removed. Is this a
sufficient response to half of your question? I am well aware of the
potential risks and harms to self of a non-coercive mental healthcare
system. For those experiencing their first crisis I think the Soteria or
other advanced paradigm of treatment is far better than the current
system which causes trauma. Evidence-based medicine commissioning rules
require these new options to be cost effective but...true progress is
never cheap.
What is a far harder question is the problem of risk of harm to another
person...but I need to go and have a drink now to help me think about it
and will complete my email tomorrow when I wake up again.
right. I'm back. Primarily there is the risk of physical harm and this
is what the sociopolitical forces will use to continue the coercive
practices of the medico-legal framework. There is also the far more
difficult problem of mental harm, which may often be the causal factor
in homicide and suicide. This is not considered a problem for the
medico-legal framework but in my interpretation of the biopsychosocial
model of how people become and applying this to why people physically
harm others this is important.
I have a background in electronics and computing so I can proffer a few
ideas. Please understand that these are just ideas which are food for
thought rather than ideas I agree should happen. Some of these ideas
infringe on what I perceive is inalienable human rights but these are
ideas psychiatrists may be thinking about. Some of these ideas may seem
nonsensical or be too far out of the box of conventional. Some of these
ideas may be totally crazy but it is my belief that if we can't think
crazy then we'll never solve the problems the medico-legal framework
attempts to solve using coercive methods of incarceration and 'treatment'.
- tracking at risk people. In London there is a high level of electronic
surveillance and this could be made even higher were military
technologies applies. If a person at risk of harming another is
monitored rather than incacerated or coerced into accepting the chemical
cosh and there are rapid response police or mental health teams
available to protect the person at known risk of harm this may provide a
partial alternative to incarceration.
A friend of mine was at risk from a violent ex-partner who had
threatened her. The police installed a panic button and if it were
activated they would rapidly respond (the panic device was designed to
be inconspicuous and did not make a sound when activated). She still
lived in fear of reprisals from him but he had not committed a serious
crime and was not diagnosed with a mental disorder as far as I am aware
so this simple bit of technology. I assume she was also taught basic
self defence. Kick a man in the balls and most men will be stunned long
enough for a second blow to be made then the person at risk can run away
as fast as they can.
Much of our communication is now done electronically. Digital voice
calls, email, social network platforms and other new technologies as
well as the advancement of the automated capability to interpret all
this information may provide an opportunity for a reduction of the risk
of harm. When I worked in children's social services there was someone
experimenting with a piece of commercial software called Autonomy. The
purpose was to prevent the deaths of children in care or at risk. A
child called Victoria Climbe died needlessly. She was beaten and
tortured to death by her carers. People reported what was happening to
her but the systems didn't communicate with each other so the danger was
not flagged up to the right services. This software was capable of
monitoring police, school, social services and hospital electronic
communication systems, understanding the information and getting the
important stuff out to the right people. It could also be applied to the
[rpblem of life events and experiences which trigger people into
dangerous emotional states which cause harm. (boviously there are
privacy concerns related to this but..as I said...this is just food for
thought.) Let's say a person loses their job then the next week their
partner divorces them then the week after their dog dies because they
can't afford the medication to keep them alive. All of this informatiopn
is recorded electronically however their employer, their partner and the
vet may not know each other and what is happening to this one
individual. Any person going through all this life events may end up in
a highly distressed state. In this state the person could be at risk of
harm to themselves or someone else. They are also going through a
terrible experience. A computer system similar to the Autonomy software
could detect the high risk precursors and flag this up to appropriate
services. These services could actively respond by providing comfort and
help to this poor individual who is going through a hell no one should
have to go through or they could take a passive, watchful role ready to
respond only if there was risk of harm to the individual or another. The
latter option sounds uncompassionate but such high levels of pain can
also be useful as long as a person can handle it. I think many of us
could reflect on our negative life experiences which were terrible to
experience at the time but may be seen as useful with hindsight.
Perhaps it would be better if the surveillance technology could be used
to prevent such trauma happening to one person in such a short space of
time...but it would mean the people would have to give up their privacy
rights to computer technology for the reudction of the risk of physical
and mental harm.
- there are people detained in high security mental health facilities. I
assume these people are judged to be at risk of perpetrating violence
towards anyone and without predictability. For some this risk may be due
to uncontrollable action caused by intense emotion. Intense emotion
usually has a biological factor behind it and I would guess the emotion
preceding the harmful action is anger. One way to detect this may be
galvanic skin response. I have seen one paper which looks at the
detection of psychosis by measuring GSR however I'm not sure this
provided a reliable method to detect psychosis yet; if it is possible
people who are going through psychosis could be detected when they pick
up their mobile phone, keys or other object used daily to which a GSR
sensor could be attached. There are other biological parameters like
heart rate, pulse, pupil dilation, body temperature or sweat which are
associated with intense emotions and, of course, there are
neurobiological responses though measuring these outside a laboratory is
a lot harder than measuring the physicals signs of the strong emotions
which precede violent harm.
Bioelectronics is still in its infancy however it may surprise you just
how far developments have come. A (poor) solution for these high risk
individuals may be implanting a system of sensors and micro- or
nanoprocessors to monitor for the intense emotions which may precede a
violent attack. It is a poor solution because it will steal away
emotions from these individuals. This sort of system would need to
release behavioural change chemicals to tranquilise the individual (and
the levels of these tranquilising chemicals would need to be kept topped
up). In a rage some people can also be impervious to the effect of
current tranquiliser chemicals at safe levels; I remember a fellow
psychiatric patient who was "acute tranquilised" (forcibly injected with
haliperidol with the express intention of forcing unconsciousness) twice
but still managed to punch through the safety glass of the seclusion
room he was put in, break out of the psychiatric ward and make a run for
it (he was caught by the police and placed in a high security
psychiatric ward but he never harmed anyone even in this intense rage.
He was a kind and gentle man but he was pushed beyond his limits by the
injustices of the psychiatric ward.)
- Doctors have already returned to cutting out parts of the brain.
Psychosurgery or neurosurgery for mental disorder is being trialled in
the UK. I'm sure other countries are doing this too. This is essentially
a return to the lobotomy and leucotomy but with a much higher degree of
precision. It is very high risk and experimental at the moment. A person
who would otherwise be hospitalised for life in a high security ward may
one day be given the option to continue their indefinite incarceration
or make the Hobson's choice of liberty after psychosurgery.
There may be people who can be violent and dangerous without any
biological or emotional precursor. I assume these people are very rare.
They may be the fictionalised demon of the psychopath which is portrayed
in films like Natural Born Killers. If we took the assumption that these
people were 100% likely to kill someone were they released from a high
security psychiatric ward then would it be ethical to release them and
let them commit a serious crime?
My opinion is these people came to be who they are through their life
experiences. There may be a genotype which provides a basis for this
phenotype however it is the psychosocial part of the model of cause
which society and individuals have control over. Prevention of the
expression of this phenotype may be the better option but this also
means preventing a disability and a human type from existing. We do not
have the social technology to achieve this yet but society has to deal
with the problem of those who are detained in psychiatric wards who are
100% likely to kill someone were they released. The laws in the UK were
modified when the Mental Health Act 1983 was amended in 2007 to included
psychopathy as a mental disorder and remove the need for a treatment to
be available because, at the time, there were no evidence-based
treatments available but there was the risk of homicide from persons
with a "dangerous personality disorder." (Unfortunately this legal power
was probably used by individual psychiatrists to achieve whatever they
felt like and it also broke the fundamental tenets of the criminal
justice system but the medico-legal framework has always been a law unto
itself.)
Personally I believe these dangerous people are also still human. This
means they have basic human desires. To belong. to be loved. To be
appreciated and valued. Someone once told me psychopaths can make good
entrepreneurs or good campaigners. If they had the option to become
useful, to be reconditioned to live amongst people again and steer away
from violence then perhaps these poor souls could have their lives back
and be at no risk to themselves or other people. It may take time and
love and patience and, of course, money, and perhaps there's not enough
of this to go around.
Alternatively perhaps those who are still at risk of harming others
could get a job harming people. What I mean is they could be recruited
to the armed forces. The army takes in young men and women then trains
them to be cold blooded killers. They train people to see through the
sight of a sniper rifle and rather than see a human being's head they
see a target. People have to be conditioned into this and I would guess
that many regret their first kill but the ones after that are easier.
Rather than condition people to be killers why not use those who are
already wiling to kill and see human life as a commodity to be taken
away at the whim of their commanding officer. It is not quite liberty
for those at highest risk of harm were they released into the community
however it is an option for a semblance of a life. It also means people
who aren't accused of psychopathy don't need to be turned into cold
blooded killers.
- psychosis and mania training. Enthogens, or illegal drugs as they are
usually known, offer the opportunity to make people psychotic. In fact
dru-induced psychosis or mania is often a pleasant experience and has an
end point so it is not the same as the sort of psychosis I went through
a few years ago however these drugs may offer an opportunity.
What I remember of this dark period was my sensory reality and
experience of consciousness shifted significantly. There is a theory of
the mind called the Bayesian theory where new inputs are interpreted
based on previous inputs. (I don't know a lot about this Bayesian theory
but it sort of fits with my experiences.) What happens in psychosis is a
truly frightening experience for the initiated. The distorsion of
internal and external reality is pure hell. It can be this alone which
drives people to suicide as I desired when I went through acute
psychosis. The distorsions can also cause people to kill themselves or
harm someone. Take the biblical story or Abraham/Ibrahim. If I remember
it right god commanded him to kill his son and he was ready to do it.
Therein lies a reason psychiatrists would use to incarcerate and
forcibly treat people, and it's a bloody good reason because Abraham
didn't want to kill his son and his son didn't want to die. The
'delusion' caused the risk of harm. Thankfully the delusion also stopped
him killing his son but other people who experience psychosis are not so
blessed. A story from my own culture is the story of Arjuna and his
desire not to fight a war but, if I remember right, his delusion/vision
and conversation with the god Krishna persuaded him to go to war.
Anyway, the risk of homicide and suicide during psychiatric/spiritual
crisis may be able to be reduced if people are prepared for it. By using
enthogens to stimulate psychosis or mania in at risk individuals in a
controlled setting in may be possible to make real psychosis less
dangerous and painful. Creating and controlling psychosis may be able to
create the previous inputs which may make the shift in reality easier to
handle such that a person's consciousness can remain intact and the
individual be kept safe from harm or doing harm while experiencing a
shifted reality. For example a combination of cocaine and delta-9=THC
could be used to make a person experience psychosis in a safe setting.
Trained practitioners would be there to help the person through the
experience. This training would perhaps allow them to have the insight
to recognise the symptoms when real psychosis happens and train their
mind to survive without healthcare if they chose. The goal would always
be for them to attach whatever significance the individual choses so if
the person choses to perceive the experience of thought broadcast as
control by aliens or secret government agencies then this is their right
just as it would be their right to experience it as god. The purpose of
this is to prevent the harms associated with acute psychosis, especially
the risks associated with first episode. A significant proportion of the
suicides associated with schizophrenia happen during the early stages
(the lifetime suicide rate is about 10% but was recalcualted to 5-6% by
a psychiatrist because the other 4-5%.happen in the initial stages).
The other suicides in schizophrenia (and bipolar) are also important. I
think these are due to the hell of a life schizophrenics have to lead.
Shunned, poor, little valued, stigmatised, misunderstood and often very,
very lonely. The medication makes life terrible for many ad suppresses
the qualities of the schizophrenic type, qualities which post-Industrial
age developed world nations, wrongly, see little value for. But i digress.
- There may be better ways to prepare people for the experience of
psychosis but I can't think what they are. It can be a very dangerous
experience and I'm afraid I can't think of a better idea than this sort
of 'vaccination' such that when the real thing happens a person is
prepared and can handle it without harm or harming.
- perhaps the best commandments should be taught. Thou shalt not kill or
first, do no harm. Or something like that. The problem is that these
commandments have been shown not to work. The Crusades are one example
where people of the same god killed each other. Psychiatry is an example
of a flagrant breach of first, do no harm.
However there are lessons from religion which might be useful. Science
does not offer the wisdom which comes from religion. Perhaps it is this
sort of thing which needs to be taught to children so when they grow to
be adults they will not harm or kill.
"
--
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