Some two hundred people sat in silence as prominent psychiatrist Allen Frances concluded his remarks at the Mad in America Film Festival. Unlike other Film Festival presenters—who were uniformly granted a warm round of applause—Frances’ remarks concluded in silence. Ringing in my mind were the words Frances hadn’t spoken. Frances said nothing at the Film Festival about his August 28, 2014 Huffington Post Blog entitled “Hall of Shame” in which he claimed to speak for “the 5 percent who otherwise lack voice or influence.” In the Huffington Post, Frances asserted that five percent of Americans—that’s approximately 16 million of us—who have what he calls “really severe and incapacitating illness” are “a small, very easily ignored, relatively unattractive, silent minority.”
Are we truly a silent minority? In fact, our voices — those of us with lived experience of extreme states and emotional distress — could be heard loud and clear throughout the MIA Film Festival. Later that night at the Gala Dinner, Mad in America blogger and psychiatric survivor Leah Harris spoke eloquently about her opposition to Representative Tim Murphy’s bill that would compel psychiatric compliance through so-called “outpatient commitment.” Harris echoed her April 21, 2014 MIA blog where she wrote: “Unity in action comes when people with diverse views and life experiences can focus on what they have in common, instead of on their differences. The Murphy Bill is our opportunity to organize stronger and better than we ever have, as persons with lived experience, people with disabilities, and allies who believe in our values.”
Allen Frances also had asserted that we should focus on what we have in common, instead of our differences. It is tempting to believe that Frances — who urged the Film Festival audience to join in what he described as a “Rainbow Coalition” advocating for the needs of the most vulnerable — has reversed his earlier support for the Murphy bill and has become one of our political allies. In fact, Frances and his ally DJ Jaffe of Mental Illness Policy Org — an internet site advocating forced psychiatric compliance — have a very different political agenda.
In their Huffington Post blog, Frances and Jaffe aim to separate off “the 5 percent of the population with the most serious mental illnesses” from the 20 to 25 percent of Americans who the Federal Substance Abuse and Mental Health Service Administration (SAMHSA) says experience “a mental health problem in a given year.” Jaffe asserts:
As Representative Tim Murphy noted, “SAMHSA has not made the treatment of the seriously mentally ill a priority… It’s as if SAMHSA doesn’t believe serious mental illness exists.” [SAMHSA] wants to replace the scientific medical model with their internally invented recovery model, and creates its own “illnesses” — bullying and trauma being the most recent. They advocate for anyone with “lived experience.” They believe everyone should self-direct their own care, thereby ignoring those too sick to do so.
Maddeningly, Frances and Jaffe claim to speak for “the 5 percent who otherwise lack voice or influence.” Now, let’s do that math. Five percent of 317,297,938 Americans — according to the US Census as on January 1, 2014 —is 15,864,896 human beings potentially forced into involuntary psychiatric compliance, both inpatient and outpatient. How are we to put that number into proper perspective? How are we to engage in a civil conversation with Frances, Jaffe and other proponents of the Murphy Bill?
Prior to Allen Frances’ appearance at the MIA Film Festival, I distributed a letter to those attending the festival in which I wrote: “Please join me in being silent no longer! We may be unattractive to Allen Frances, but sixteen million Americans (five percent of the US population) is not a small number, nor should we be easily ignored. It’s time we awaken to a new reality. Our civil rights are threatened more today than they have been at any time since the 1950s.”
Robert Whitaker approached me outside the Regent Theater and asked that I stop distributing this letter because he was concerned that the letter could disrupt the panel he had invited to discuss issues facing psychiatry. Whitaker explained that, as the host of the Film Festival, he was concerned that we “treat an invited guest in a proper way.” He explained that “given how poorly I have been treated at times by my ‘hosts,’ I want to make sure that nobody could say that about us.” I agreed to stop distributing the letter out of respect for all the effort that Whitaker and so many others had put into making the MIA Film Festival such a positive and inspiring event focused on healing alternatives to the Pharmaceutical Industry.
Whitaker is absolutely right that we need to have civil conversations about psychiatry. Gandhi cautioned: “We must resolutely refuse to consider our opponents as enemies.” In fact, Gandhi pushes us even further along the path of non-violent activism by asserting that the person “who is truthful and does not mean ill even to his adversary will be slow to believe charges even against his foes. He will, however, try to understand the viewpoints of his opponents and will always keep an open mind.” We do well to adopt this non-violent approach in our opposition to the Murphy Bill.
At the MIA Film Festival, Allen Frances spoke—as he did in the Huffington Post blog—of one million Americans in “inappropriate prison bondage.” He said we should be funding model programs to get these people back into the community. For Frances, these model programs include involuntary outpatient commitment such as a $250,000 pilot program Massachusetts Governor Deval Patrick quietly signed into law on July 11, 2014 and the approximately $60,000,000 of Federal funding currently slated for similar pilot programs across America. At least for now, advocates of forced psychiatric compliance gain almost as much from such “pilot” projects—which they claim provide empirical support for their agenda—as they would from actually forcing 16 million Americans into psychiatric compliance. The empirical reality is that forced treatment on this scale would prove ineffective and would almost certainly create a political backlash against their agenda. The cultural reality is that these pilot projects already are extremely effective in achieving one simple goal: to deflect a much needed national conversation about guns and violence onto a convenient scapegoat—those of us with lived experience of extreme states and emotional distress.
Our goal should be to redirect the national conversation back to where it belongs. Our goal should be to articulate a vision of the future where confronting guns and violence is a collective responsibility, not merely “outsourced” to psychiatry. In her April 21, 2014 MIA blog entitled “Defeating Goliath: Mental Health is a Social Justice Issue, and People with Lived Experience and Their Allies are Rising Up” Leah Harris asserts “We have a vision that would take us forward, not backwards, as proponents of [the Murphy] legislation would do.” In her remarks at the closing of the MIA Film Festival, Harris called upon us to take an “intersectional” approach which emphasizes the ways that distinct forms of oppression—such as racism, classism, sexism, heterosexism, ableism, and mentalism—intersect.
Liat Ben-Moshe, in a December 20, 2011 article in Critical Sociology entitled “Disabling Incarceration,” looks at “the phenomenon of mass incarceration through an intersectional lens.” Ben-Moshe observes:
While we may oppose the “outpatient commitment” programs Allen Frances advocates as an alternative to prison, he is right to bring our attention to the many millions of Americans in prison today (and not just to the 350,000 prisoners that he claims fit his diagnostic criteria for forced psychiatric care). Liat Ben-Moshe’s continues her intersectional approach to mass incarceration:
In social science research, including criminology, the convention is to think of confinement in terms of placement in jails and prisons, therefore reinforcing a skewed interpretation of ‘the rise in incarceration’ in the USA. Under this interpretation, the first half of the 20th century is conceived as an era of relative stability in terms of incarceration, with an explosion in this area in the 1980s onward, in the form of immense growth in the capacity of prisons and jails. However, if the data on mental hospitalization and institutionalization were also covered in such studies under the prism of incarceration, then the ‘rise in incarceration’ would have reached its peak in 1955, when mental hospitals reached their highest capacity. Put differently, the incarceration rates in prisons and jails today (although appallingly high by any standards) barely scrape the levels of incarceration during the early part of the 20th century because of the then massive confinement in hospitals.
Ben-Moshe urges us to “reconceptualize institutionalization and imprisonment as not merely analogues but as in fact interconnected, in their logic, historical enactment and social effects.” She asserts that “disablement” has become big business:
Class based analysis of disability urges us to shift our understanding of disability oppression from discussions of stigma and deviance to that of systematic economic exclusion of people with disabilities. In post-industrial times, disablement has become big business. A single impaired body generates tens of thousands of dollars in annual revenues in an institution. From the point of view of the institution-industrial complex, disabled people are worth more to the gross domestic product when occupying institutional ‘beds’ than they are in their own homes. Capitalism has found a solution to the ‘problem’ of unproductiveness, for those who are not perceived as laborers. Their bodies generate revenues when placed in institutional beds, such as large institutions, nursing homes, prisons and (some) group homes.
Even as the soaring number of prisoners provides a growing revenue stream for the institutional-industrial complex, increasing psychiatric beds could grow this revenue further, but at what cost? A Pew Charitable Trust 2010 Report entitled “Collateral Costs: Incarceration’s Effect on Economic Mobility” explains that “the collateral costs of locking up 2.3 million people are piling higher and higher.” According to a September 28, 2010 Pew press release, the collateral costs of imprisonment fall disproportionately on non-white men and their children:
Incarceration reduces former inmates’ earnings by 40 percent and limits their future economic mobility. Before being incarcerated, two-thirds of male inmates were employed and more than half were the primary source of financial support for their children.
Collateral Costs details the concentration of incarceration among men, the young, the uneducated and African Americans. One is 87 working-aged white men is in prison or jail compared with 1 in 36 Hispanic men and 1 in 12 African American men. Today, more African American men aged 20 to 34 without a high school diploma or GED are behind bars (37 percent) than are employed (26 percent).
The report also shows more than 2.7 million minor children now have a parent behind bars, or 1 in every 28. For African American children the number is 1 in 9.
We can only imagine what the economic impact of forced psychiatric compliance for 16 million Americans might be. While it could fuel the institutional-industrial complex, what would be the collateral costs?
For now, our most immediate challenge is not the forced-treatment legislation itself— Representative Tim Murphy’s bill—but a pervasive cultural attack on our identity embedded in this legislation. Liat Ben-Moshe explains that we who have lived experience fall under the logic of “handicapitalism” whether we want to or not. She asserts:
People who are psychiatrized and those who are labeled as intellectually or physically disabled all share a common label in administrative categorization, the gathering of statistics and bureaucratic definitions – the label of ‘disability’. This is done despite the resistance of some of these groups seeking to escape from the label of disability, as an administrative label or self-definition. For instance, many with psychiatric labels do not identify as disabled and see their life circumstances as significantly different from those of people with disabilities. But even if certain groups or individuals resist the impetus to collide all these categories, often in social policy, legislation and service provision they are lumped together nonetheless.
Ben-Moshe asserts that “disabled people mark, with their different bodies and minds, the boundaries of normalcy.”
In fact, the boundaries of normalcy stand at the heart of our current predicament. I began to recognize the tremendous cultural impact of what might be described as the “Myth of Normal” as I listened to WBUR Radio in Boston on May 30, 2014. The commentary focused on Isla Vista, California where, a few days earlier, 22-year-old Elliot Rodger had killed 6 people and injured 13 others. WBUR Radio played tape of Richard Martinez—whose son Chris was one of one of six people killed—pleading for stricter gun laws: “Chris died because of craven irresponsible politicians and the NRA. They talk about gun rights. What about Chris’s right to live. When will this insanity stop?” The insanity this grieving father spoke about was not only Elliot Rodger’s horrific actions but the broader cultural context of these actions: a cultural insanity that worships guns and violence.
Asked whether this event will make any difference in the gun control debate, commentator Jack Beatty responded “Probably not, the NRA rules because Congressional fear—‘cravenness’ as Mr. Martinez said—is a bottomless commodity.” Then, without further analysis Beatty switched the focus:
I do think there is something hopeful here and that’s a piece of legislation proposed by Congressman Tim Murphy of Pennsylvania, the only clinical psychologist in Congress… He wants to lower the threshold for institutionalizing people… As it is now, it’s an extremely high bar. He wants to lower that and he wants it to apply much more quickly… It is a bi-partisan bill. It has, I think, over 30 Democratic sponsors. It’s rare that you can look at one of these things and say ‘if only…’. Well here we have it!
Here, in a matter of a few seconds, we see how the Murphy bill—even without the votes needed to clear committee—had already been successful in shifting the national conversation away from our collective hopelessness about passing meaningful gun control legislation onto a new scapegoat—those who Allen Frances calls “the 5 percent.” All the Isla Vista Sheriff’s Department needed to say about Elliot Rodger was: “It was apparent he was very mentally disturbed.” Here is a message that everyone could understand: The shooter is not like the rest of us; he is one those who does not belong among us, one of those who must be forced into psychiatric compliance, one of those who is not normal!
Sixteen million Americans forced into psychiatric compliance is an astounding goal, but perhaps it is easier to achieve than removing somewhere between 270 and 310 million guns held in 37% of American households. Forced outpatient commitment makes the unthinkable, thinkable and psychotropic medications make the impractical, practical. Only in the context of the widely-held cultural belief in a magic pill that can cure all woes does forced treatment of 16 million Americans become an imaginable goal. In fact, Americans have embraced psychotropic medications on a scale that makes the 5 percent goal seem entirely practical. According to the US Centers for Disease Control and Prevention, 11 percent of Americans over the age of 12 already use antidepressant medications, with 60% of these taking their pills for 2 years or longer (NCHS Data Brief Number 76, October 2011).
How appealing it must be is to believe that countless lives could have been saved if only Elliot Rodger in Isla Vista, California or Adam Lanza in Newtown, Connecticut or James Holmes in Aurora, Colorado or other senseless shooters had been forced to swallow a magic pill. It is so much simpler and easier than looking at the “intersectional” forces that motivated these shooters such as racism, classism, sexism, homophobia, ableism, mentalism and a pervasive cultural infatuation with guns and violence. What might Jack Beatty’s commentary have been if he had not so readily swallowed the “if only…” pills hawked by the advocates of forced psychiatric treatment?
A few days before Beatty’s “if only…“ comment, the New Republic published an article entitled “Not Just a White Guy Killer: Elliot Rodger’s perverse sense of racial hierarchy—and his uncertain place in it.” The author, Hua Hsu, observed that Elliot Rodger described himself as a half white, half Asian kid who felt different from the “normal fully-white” kids with whom he grew up. This equation of “normal” with “fully-white” stands at the heart of Hsu’s decoding of the cultural context that motivated Rodger’s madness.
After observing that Rodger “expressed an open hatred of women, the rich and the poor, anyone with a girlfriend, African Americans, Mexicans, Asians, members of his own family, childhood friends, his roommates,” Hsu observed that Rodger “also appeared to hate himself.” Hsu continued:
I currently have a dozen browser tabs open, each page shading in a different aspect of Rodger’s madness. Many of these analyses echo the initial accounts that mistakenly identified Rodger as a white male, slotting him within the larger phenomenon of white, male mass murderers… Does it actually matter that he was half-Asian?
Rodger drew on his identity selectively, much as we do in our search for answers. Sometimes he embraced his [white male] privilege, other times it haunted and gnawed at him. One can imagine a situation where Rodger couldn’t make sense of his mixed race heritage—“I am half White, half Asian, and this made me different from the normal fully-white kids that I was trying to fit in with,” he wrote. With the comfort of distance, we might suppose that he felt scorned by some abstract sense of the “normal” rather than realizing that the word describes nothing. [Emphasis added]
At the heart of Elliot Rodger’s violence is the pathology of normal. Unlike Rodger, Hsu recognizes “normal” as a word that describes nothing at all. The Myth of Normal — a myth that equates being fully American with being fully-white and fully-male and fully-straight and fully-rich and fully-able and fully-sane and fully-armed with guns and ammunition — is at the root of Rodger’s pathology. We — as persons with lived experience of extreme states and emotional distress — can ask ourselves: How often have we too felt scorned by some abstract sense of “normal” that does not include us? How often have we too failed to recognize that the word “normal” describes nothing at all?
One thing is certain: No pill will ever cure the disease of wanting to be normal! We have a rich history of consciousness raising and activism around what Judi Chamberlin called “Mentalism.” Like racism, classism, sexism, heterosexism and ableism, mentalism is a set of cultural assumptions that Chamberlin asserts most people hold about mental patients including that we are “constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational, and so forth.” I would assert that racism, classism, sexism, heterosexism, ableism and mentalism all share a common foundation in the Myth of Normal that cuts across all these forms of oppression.
Leah Harris, in a June 16, 2014 MIA blog entitled “From Self Care to Collective Caring,” points the way for us to begin cutting through the Myth of Normal:
In this society, we have a dichotomized response to distress. Suck it up and adjust to what is, or be put somewhere where you will be made to adjust. It is possible to be so focused on individual illness and wellness that we forget the equally important need to work for collective wellness and social justice. In an ideal world, we are taking care of one other, and working together to change the way things are.
A liberating notion of care would follow from the understanding that most of us need other people. We need truly safe relationships in our everyday lives where we can be vulnerable and real, and let the masks of “keeping it together” fall away. A redefined notion of care would presuppose that we as individuals are all deeply interconnected. The “burden of healing” would be spread around, rather than placed squarely on each of our individual shoulders. Together, we are stronger than alone.
For too long we as a society have outsourced emotional and social care, and it has largely been a disaster. Everyone admits the systems are broken. Our current way of life is not sustainable. It’s time to seriously re-imagine what care means. The future is in our hands.
Yes, the future is in our hands! Many thanks to Robert Whitaker for insisting that we engage our opponents not as villains but with an open mind that allows us to look more deeply into what Allen Frances describes as “prison bondage.” Many thanks to Leah Harris for introducing the intersectional approach to oppression that helps us see forced psychiatric compliance in the larger context of what Liat Ben-Moshe describes as the “institutional- industrial complex.” Many thanks to Hua Hsu for recognizing “normal” as a word that describes nothing at all. Together, we can build a deeply interconnected community where emotional and social care are no longer outsourced to psychiatry but become our shared responsibility. Together, we can step beyond the Myth of Normal to embrace the collective power of our diversity. Not one of us is fully-white, fully-rich, fully-male, fully-straight, fully-able and fully- sane. Not one of us is normal!
The prospect of sixteen million Americans forced into psychiatric compliance is a symptom of a much deeper cultural despair about our capacity to confront violence with non- violence. After suggesting a variety of steps that we can take to defeat the Murphy Bill in Congress, Leah Harris writes:
Together, we can overcome a collective sense of hopelessness in the face of guns and violence and achieve what Martin Luther King called the “beloved community.” In his 1959 Sermon on Gandhi, King said: “The aftermath of nonviolence is the creation of the beloved community, so that when the battle’s over, a new relationship comes into being between the oppressed and the oppressor. The way of acquiescence leads to moral and spiritual suicide. The way of violence leads to bitterness in the survivors and brutality in the destroyers. But, the way of non-violence leads to redemption and the creation of the beloved community.”
Through non-violent direct action — and the many other forms of community engagement recommended by Leah Harris — I believe we can defy Allen Frances description of us as “a small, very easily ignored, relatively unattractive, silent minority” and become a much broader community — a truly diverse and outspoken community that cuts across race, class, sex, sexual orientation, ability and sanity in the common recognition that not one of us is normal. I believe that together we can defeat the Myth of Normal and create the beloved community.