Wednesday, November 4, 2009

There Aren't Too Many Books That I Stop Reading In Disgust

There Aren't Too Many Books That I Stop Reading In Disgust

Darby Penney and Peter Stastny, The Lives They Left Behind: Suitcases From a State Hospital Attic (New York: Bellevue Literary Press, 2008). The premise of the book is quite interesting. When Willard State Hospital, a New York State mental hospital closed some years ago, a team looking through the buildings found a number of suitcases in the attic of one building that had belonged to various patients who had died while hospitalized. For whatever reason, these suitcases were not sent to next of kin (perhaps because there were no next of kin). The authors picked several suitcases where the contents seemed quite intriguing, or where it was possible to find information in the hospital records about the owners.

There's plenty of sorrow in each story. Any time you have someone hospitalized against his or her will because of mental illness, it is a tragedy. When they are hospitalized for life, it is even more of a tragedy. If they spend their whole lives inside because they have such severe mental illness that they needed to be there, you want to cry. If they spend their whole lives inside for no good reason, you want to scream in rage.

This book tries very hard to persuade you that at least some of these people were hospitalized for life for no good reason. There have doubtless been such cases. Some persons were hospitalized for no good reason, and held against their will because the bureaucracy refused to admit that someone made a mistake. There are persons who were hospitalized with good cause, but who recovered (either because of treatment, or spontaneously), and yet someone failed to recognize that it was time for such a person to be released.

There is absolutely no question in my mind that both of these situations must have happened, simply because human beings make mistakes. They fail to recognize errors in classification; they become insistent on covering up their own mistakes (or those of predecessors); persons get lost in a large institution. Yet when I have looked into the legal cases associated with such improper commitments, and the work published by lawyers making this claim, I have been struck at how few such examples are clearly in this category. I've mentioned some of these claims made by Bruce J. Ennis, an ACLU attorney, in his book Prisoners of Psychiatry, and the reasons why his presumably strongest examples turn out not so strong upon examining other evidence. I've mentioned that as late as 1963, the ACLU's representative in Congressional hearings about mental illness commitment couldn't give a single example of improper commitment in the D.C. system. I'm sure if there were a lot of examples from outside D.C.'s system, she would have cited them as examples.

The Lives They Left Behind gives examples clearly intended to persuade that such persons were improperly hospitalized at Willard, or who were left in well past the point that they needed to be there. Yet the examples that the authors are hardly confidence inspiring. One of those hospitalized back in September 1917 was a young Filipino man they call Rodrigo Lagon (last names have been altered to protect the privacy of those long dead) who was hearing voices. While they acknowledge that hearing voices is a "first-rank symptom of the disorder called schizophrenia" (p. 52), the authors then spend several pages explaining that auditory hallucinations are actually quite common, and "not a symptom of an illness." (p. 53)

You can make a case that in the bad old days, there was perhaps a bit too much willingness to hospitalize people for odd behavior, or symptoms of mental illness, in the absence of any imminent danger to self or others. Inevitably, our legal system has to draw lines. We may have drawn them too far one direction before; we draw them too far the other direction today. But the authors' decision to imply that Rodrigo Lagon's symptoms were an inappropriate basis for hospitalization seems a bit odd.

Therese Lehner's story similarly leaves me cold. She was a Catholic nun, and at some point, started to have problems that caused her to be removed from one nunnery, and put in some poorly defined state of not being considered a nun--but not released from her vows. Her hospitalization and commitment was apparently the outgrowth of "excited, noisy and destructive" behavior and running around in the nude. She was apparently unable to provide sensible answers to questions. (p. 63) The authors, who have to this point at least acknowledged that there is such a disease as schizophrenia, now refer to it as "so-called schizophrenia," and appear to reject the biological model of schizophrenia that now has a very clear genetic basis to it. (p. 64)

Once hospitalized at Willard, Lehner's behavior conforms to the apparent schizophrenic symptoms she exhibited that led to her commitment: violence against attendants--and the authors tell us, "Such attacks are rarely unprovoked." (p. 66) Based on what? I've talked to people who work in mental hospitals, and they will tell you otherwise. Lehner also started to claim that she had children, including a dachshund. (p. 68) Yet the authors would have us believe that her odd behavior in the hospital and that led to her commitment (both consistent with schizophrenia), were really caused by being in a hospital. (p. 66) You know: sane people get sent to mental hospitals, and become crazy as a result. It isn't that people in mental hospitals end up there because they have mental illness problems.

While there is a Works Consulted section, there are no footnotes, so tracking down the origins of many of the factual claims that might be of real value to someone studying the problem of involuntary commitment is going to be a bit of work. I also notice a few obvious factual mistakes that suggest a certain lack of scholarly care. Lehner was born in Germany, and her father was still there. "In the spring of 1918, with the war over, she once again tried to get in touch with her father, but the letter was never sent." (p. 62) The war wasn't actually over until November of 1918. This is something that almost anyone familiar with the period should know--and it makes me disinclined to trust that the authors put more energy into verifying the more controversial claims.

I then looked at the author bio on the dust jacket, and I began to understand why this book has such a strong bias against the mental health system: "Darby Penney is a national leader in the human rights movement for people with psychiatric disabilities and a former state mental health official who has experienced the mental health system inside and out."

Now, just because she has been inside the system doesn't immediately discredit her opinions. But when someone discounts the biological model of schizophrenia with the quite overwhelming evidence of a biochemical origin we now have (such as I mentioned here), it is rather difficult to take a book like this seriously.

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