The American Psychiatric Association's 140th annual meeting May 9-14 was an impressive event and it came off without a hitch -- almost. Here were thousands of the nation's most successful psychiatrists and psychologists milling around in the great halls at McCormick Place, checking their schedules so as not to miss the best lectures, symposia, workshops, and discussion groups. In scores of meeting rooms the dedicated professional could learn the answer to questions like "Do Insanity Defendants Malinger?" or "Why Do Women Use More Services?" and "Can We Avoid Tardive Dyskinesia With Novel Neuroleptic Agents?"
For a break they could watch a movie like The Haight-Ashbury Cocaine Film or Janis Joplin: The Portrait of a Ripoff. Or they could wander through the endless expanse of exhibits featuring the offerings of everyone from Abbott Laboratories and the American Desk Manufacturing Company to the United States Air Force.
But this year the meeting was affected a bit by a band of mischievous agitators who made their presence known in embarrassing ways. On the third day of the meeting, some 40 picketers marched outside McCormick Place with banners that read, "Hey, Hey, APA! How Many People Did You Drug Today?" and "We'd Rather Be Mad With the Truth Than Sane With Lies!" Meanwhile a plane cruised overhead trailing the simple, straightforward message, "Psychiatry Kills."
A similar idea was driven home by the dissidents who attended the meeting itself and even participated in panel discussions and workshops. At one session a barefoot young woman, who was clearly not a psychiatrist, wore a sweatshirt on the back of which was written, "Psychiatry Sucks!"
Psychiatry, of course, has always had its critics. In recent years some of these have joined together in patient support, advocacy, and self-help groups. The largest of these is the National Alliance for the Mentally Ill, which has more than 30,000 members in 600 chapters across the country. There is also the National Mental Health Consumers Association, a smaller group composed entirely of former psychiatric patients.
However, the high jinks at McCormick Place were produced and directed by neither of these respectable, fairly soft-spoken organizations. They were the work of a newer, louder, and far more aggressive aggregation of activists called the National Alliance of Mental Patients (NAMP), which exists on the far left wing of patient advocacy and claims fewer than 2,000 members. "But we're growing fast," said the founder, Judi Chamberlin, "and we are going to be heard!"
NAMP describes itself as "a grass-roots organization devoted to promoting the human and civil rights of people who have been psychiatrically labeled, with special attention to the right to refuse any unwanted psychiatric intervention." In other words, if a mental patient doesn't want help, it should not be forced on him.
It isn't that NAMP members are contrary as well as crazy, said Chamberlin. Rather, it is their contention that psychiatry's infatuation with drugs, its routine reliance on forced confinement, and its pretensions of omniscience are dangerous and destructive.
Chamberlin, a bright, outgoing woman from Massachusetts, has written a book called On Our Own about her experience in recovering from a psychiatric episode. At the APA meeting she sat at a table outside the room where a debate between psychiatrists and expatients was about to begin and handed out leaflets. "We're not saying we have the answer," she explained. "We're only saying psychiatry doesn't either. The medical model -- the treatment of symptoms with strong drugs -- is one way of handling people's problems. But at what a price!"
Long-term use of antipsychotic medicines, she argued, creates side effects more alarming than the original condition for which they were prescribed. Patients are coming to realize this, she said, and they are beginning to demand their rights not to be forcibly transformed into zombies.
Indeed, the use of so-called psychotropic drugs such as Thorazine (discovered only 35 years ago) has caused the population of U.S. mental hospitals to plummet -- from 550,000 in the mid-1950s to 138,000 today. By calming patients, the drugs made possible the great deinstitutionalization movement --quick treatment and early release of hordes of mental patients to their families or into the halfway houses of big cities, where they exist in various states of drugged numbness.
It is true that no one really understands what these drugs do to people over the long haul. For that matter, psychiatrists admit they don't understand how or why they do what they do over the short haul. Some of the papers presented at the APA meeting dealt with the ambiguities of drug use. In fact, the above-mentioned (and much discussed) "tardive dyskinesia" is a highfalutin name for the debilitating effects of antipsychotic medication. And a new, ominous, sometimes fatal illness called "neuroleptic malignant syndrome" -- apparently a result of prolonged drug treatment -- is just beginning to arouse the attention of the psychiatric community.
Another NAMP leader, Wendy Kapp, a former Chicagoan, said the organization regards all forms of forced treatment, drug or otherwise, as unjust "social control." Every year, she said, thousands are confined to mental institutions and subjected to involuntary treatment. "They are held in isolation and restraint, and given electroshock. We believe that such intervention against one's will is not a form of treatment, but a violation of liberty and the right to control one's own body and mind."
The psychiatrist-patient debate, attended by only about 60 interested professionals, shed more heat than light. Jeanne Matoulis, an NAMP advocate who was confined as a teenager in the Elgin State Mental Hospital, described her treatment by a psychiatrist after she refused to mop the floor. "He threw me down on the floor in my hospital gown, put his foot on my stomach, and mopped the floor with me!"
Since the combination of drugs and confinement is so intolerable, she said, she could understand why some disturbed persons would commit crimes -- in hopes of being sent to prison rather than to a mental institution.
NAMP says the reasonable alternative to today's all-pervasive medical model of treatment is the development of community-based self-help approaches that do not rely on drugs or compulsion. "What we need," said Matoulis, "are real services -- benefits counseling, assistance in housing, jobs, and education. If the services are good, people will take advantage of them. . . . We may be crazy but we're not stupid!"
Entirely too simplistic and naive an approach, countered her debate opponent, Dr. Lee Beecher, president of the Minnesota Psychiatric Association. The best possible services may be offered the mentally ill, he said, and the patients still won't come. They need more than an invitation, he said; they need drugs and compulsory treatment.
At that point the niceties of the debate were momentarily suspended when a young man with shoulder-length blond hair rose from his seat in the back of the room. Like Beowulf confronting Grendel, he looked the monster straight in the face.
"I will never take your medicines again, doctors, never!" he shouted. "I was on 1,800 milligrams of Thorazine a day for a year and a half. I got so depressed I couldn't walk or talk. Well, I broke away and I have never felt better in my life!"
His voice was rising and he was moving somewhat menacingly toward the front. "You'll have to leave," said a man, twitching nervously in his chair.
"No, don't leave. Stay!" said another man who later identified himself as a patients' advocate.
"All right," said the young man, suddenly calm, "I'll leave but I will not take your drugs -- ever!" He went to the back of the room but he did not leave. He sat in a chair and seethed.
With a measure of order restored, another psychiatrist and another ex-patient faced off at the microphone, but they could have been speaking in unknown tongues; their arguments did not come within a mile of one another. At the end the listeners filed out, looking somewhat frustrated. The outburst had not been a NAMP caper; it had unquestionably been spontaneous and sincere. And so, on the one hand, it provided evidence of how easily unstable people can get out of control -- especially when they quit their medicine. On the other hand, it was impossible to ignore the man's agonized testimony, almost a primal scream: please stop -- your drugs are killing us!
The point was reiterated in a long poem, copies of which NAMP members were handing out after the debate to the few passersby who seemed interested. "To be a mental patient," it read in part, "is to live on $82 a month in food stamps, which won't let you buy Kleenex to dry your tears. And to watch your shrink come back to his office from lunch, driving a Mercedes-Benz.
"To be a mental patient is to take drugs that dull your mind, deaden your senses, make you jitter and drool, and then you take more drugs to lessen the 'side effects.' . . .
"To be a mental patient is not to die -- even if you want to -- and not to cry, and not hurt, and not be seared, and not be angry, and not be vulnerable, and not laugh too loud -- because, if you do, you only prove that you are a mental patient. . . . And so you become a no-thing, in a no-world, and you are not."
Art accompanying story in printed newspaper (not available in this archive): photo/Loren Santow.