Jamie, I agree with you. I used to work at a residential adolescent treatment facility in Miami (It has since closed down) and juveniles were put into the program and labled drug addicts simply because they admitted to smoking a single joint with friends. These kids were primarily warehoused in the program. This book showed us the fact that these people were also warehoused. It makes me think about the places that are still open around the world. It's sad and scary at the same time.

Jamie, Gersome, I agree with your assessments.... people lives were and still are...so impacted by the judgements of others. Beth really makes a good case for the fact nothing really changes ...if nothing changes. Money is still the number one problem today for competent, extensive care, one on one care, which is really what most people need. To think about what the client Beth referred to went through...blows the mind. To think how much $ would have been saved if good common sense treatment would have been given to begin with. What a waste of peoples lives, sanity and resources. Our system has got to change...it does not appear to working very well for those who really need it most. Though we have made great strides in the field of psychopharmacology in the past 50 years it appears many in the medical field have lost the compassion, grace and mercy they once had. It seems to be all about a power structure that believes they have the true and instant answers to every ailment. Just pop a pill...and then another to counter act the side effects...then another to relieve other sides...then another..and another...and still another. Yes, meds have a place but so does good old fashion therapy along with it. Thanks Beth for your story.

You are right! Money has just about everything to do with it. Like Dr Allgood said about the DSM-IV, it's a tool to help put a monetary value on the diagnosis. Money and politics runs it all. Medication would not be a primary concern if it didn't involve millions and millions of dollars. People are institutionalized every year (be it state hospitals or state and federal prisons) because it is a big business. Then they have the nerve to call it rehabilitation. When was the last time a person in jail was rehabilitated? People are not rehabilitated simply because there would be no recidivism. That, in turn, means a loss of a whole lot of money.

So very true Gersome, so very true and so very sad. I think it was Karen who said something to effect.....it will only change when it cost an institution more $$ not to change. There is a lot of truth to this insight.

I agree with you both, but I am starting to see some change here at the Department of Corrections. Apparently, Governor Crist and the Secretary of the DOC think that help for offenders (and that includes many mentally ill people) and rehabilitation are things we should and can work toward. I am very surprised but very gratified to see the new "language" coming down from Tallahassee. I think maybe they are seeing that what we have been doing isn't working (finally!) This book was very sad all the way through, but I wonder if many of the doctors/caregivers, etc. were just doing the best they could with what they had to work with also? I can't believe that all of them were cavalier and unconcerned, maybe they were misinformed, ignorant of the truth, etc. I hope so anyway.

Dawn, i have no knowledge what of is coming out of Tallahassee but I can't agree with you more about the doctors/caregivers. There are' bad apples' in every field but, on the whole, I believe that most people try to one extent or another to do the best that they can with their own abilities and within the institution that they work.
The tone of the book did give the impression that the staff, except for one or two occupational therapists, Nancy Jaycot Caniff comes to mind, was cavalier. The authors' attitude has bothered me as I have read each of the chapters. I can only hope that there were more than just a few who cared. That the interpretation by the authors' of the treatment given was 20th century attitude judging 18th and 19th century science.

http://www.nytimes.com/interactive/2008/07/16/health/healthguide/TE_BIPOLAR_CLIPS.html?th&emc=th

This came from today's nytimes.com. It is an article interviewing people with Bipolar Disorder. It is worth watching.

Wow, thanks Wayne for sharing that link. I really enjoyed the young man who is not currently taking medications and has been able to control his bipolar for a couple of years. I think that it just goes to show that, for some people, medication is not the answer. He was able to advocate for himself and realized that he didn't like taking the medications. I think that as social workers we have a duty to our clients and families to help them decided what is best for their body and advise them of the alternative treatments out there. Obviously someone who is a threat to themselves or others, that is a different story, but there are other ways out there to deal with a mental disorder.

Yes Wayne... Thank you! I very much enjoyed Patient Voices link. I agree with Melissa the young man Steve from Atlanta really impressed me too. The fact he has been "psychotropic drug free" for two years and doing well should cause some to do a little more research into exactly what he is studying by Karl Jung to help balance his mood swings. He mentioned meditation, exercise, nutrition and dream therapy as a part of his treatment. I am curious about what dream therapy is ....anybody know?

Mia,
He may be referring to Jung's dream therapy where it is believed the subconscious expresses itself through dreams. Freud was also big on dream work. Generally, social workers do not go there unless they receive advanced education on the techniques.

I think the case of Rodrigo is pretty interesting. Especially how an "earnest and promising young student became a domestic, then went on to spend his entire adult life in a mental institution so far from home". Mrs. Louise Maycock, the wife of physician who was his employer and sought to have him committed, used the word "patient" to describe him to the judge in the court proceedings, apparently confident in what the outcome would be. Otherwise he, would have been homeless. ( It seems that institutionalization was used to deal with those that were indeed homeless at this time.) However, family relationships are questionable. It is also notable that his father was noted as being "insane". So perhaps he wasn't really insane, but the factors of being homeless and having a family history of "insanity" were deciding factors for him in his institutionalization. It also seemed that he was able to successfully cope witht he voices in his head, as can two out of three people who do. He was never offered any help to silence them; the answer was to be institutionalized. However, his active interest in the Filipino independence movement and correspondance with other activists showed that he was able to participate and maintain some activities in current events successfully, and probably would have been able to live and function in the oustide world.

April, I agree with you about the case of Rodrigo. It does seem as though he was, as I think Jamie put it, "very impacted by the judgements of others" a real shame too for him. It did seem he was able to successfully cope with the voices in his head without any help to keep them quieted, I wondered about it when I first read it and felt frustrated and angry for him. But, I heard or read somethng in the past few days that made me shudder as I read your posting. It may have been the New York Times link from Wayne, or what someone in Dr. Lawrences class said ....but...whoever it was, when the voices in the patients head were finally quieted with medication, the person killed himself. The voices had become his friends and the treatment, in it's good intentions, silenced them... he became lonely, despondent, and took his own life. This really made me look at it in another light. As you said in your posting, 2 out of 3 people can successfully cope with the voices. So sometimes to silence may not necessarily be the right approach.

Yes, but you also have to take into the consideration the role the voices play. In Rodrigo's case, they did indeed "torment" him and "keep [him] from [his] studies"...so perhaps even though he was somewhat effectively dealing with it, we do not know how exactly effective he was...after all, he was institutionalized. He should have received some type of treatment. In the case that you mentioned, the voices did have good intentions, so they were probably reassuring to the patient, just as you stated.

That is REALLY sad about the case that you mentioned though. :( Sounds like that might have even been a defense mechanism for the patient that the medication removed....

I deal with clients daily with voices...it is interesting that I have yet to meet one of those individuals who wanted the voices...So this is a huge shift in thinking for me....but frankly it does make sense though....thanks for the paradigm shift......Michael

When I think of the case Mia mentioned and Roderigo it is difficult for someone who has been living with voices to immediately get rid of them. When I watched "A Beautiful Mind" I remember John Nash being depressed because he when his voices and hallucinations went away there was no purpose for him. Eventually he no longer needed meds to live. Very interesting topic!

I keep coming back to how easy it seemed to have been to have some one "sent away". I can't imagine having an employer, like in Rodrigo's case, being able to have someone committed. It is very difficult now to actually get someone the help when it is needed. I read back to Beth's post and I can comiserate. I currently have a client who is in need of mental health care, she has been trying to get herself an appointment for weeks and can't get one. I have a friend with a 29 yr old son who has schizophrenia. She knows when he is about to have a psychotic break but unless she's willing to say he is a danger to himself or to her she can't get him the help he needs.

Which sometimes can cause a lot of problems...In my internship last semester, at the Juvenile Assessment Center, I had clients in the same predicament- the parent of the juvenile in question would have the child claim that he was suicidal in order to get treatment for drug problems and bipolar disorder. If the son failed to do so, the mother would make up stories in order to convince the professional on staff or site to committ the kid. In one case, she called law enforcement and asked them to baker's act to kid- he ended up getting arrested, and being involved in the system. Of course he did not receive the help he needed, and once I did a psychosocial, it was clear that he did indeed need a lot of help- however, he couldn't be unarrested and committed instead. All I could do was ask JDC that upon their receival of him, that he receive a psychiatric evaluation within 24 hours. However, after a lot of beauracratic red tape, the kid ended up being taken to Lakeside because he did start claiming that he wanted to harm him himself- notably, after speaking with his mother.

Unfortunately, as April addressed with her example, I do feel as though individuals can still "send people away" if they try hard enough. I have interned at a children's home at which children reside. Most of the children are children of the state, but others have been sent to live their by their families. While some families have legitimate reasons for doing so (ex- financial problems, addiction, etc) I feel as though some of the children's families simply knew what to "feed" the system (so to speak) when their acceptance was being determined. While it does not seem as though the numbers are as great as during the Willard days, the system can still be manipulated.

Here is a website that addresses safety in institutions very dramatically.

www.break-the-silence.org

I haven't had time to respond to the excellent postings here, but I wanted to share this article on cnn.com about a 112 year old man, diagnosed with schizophrenia, who has been in mental institutions since 1952. He paints murals which the hospital is selling. http://www.cnn.com/2008/LIVING/07/20/elderly.artist.ap/index.html#cnnSTCText

Thank-you,Janine

What an uplifting posting!

In response to Aprils comment, it is terrible that children are being taught at a young age to lie in order to get help. Children are being taught at a young age that they can not get the help they need unless they state more serious problems then what they are having inorder to get help. I once heard a story of a mother who told her child in Spanish to tell the doctor that they were hearing voices in order to get medical treatment. The child siad they were not hearing voices and the mother informed her child that if they did not say they heard voices they would not be able to receive the medical treatment that they needed. Now this child is going to be diagnosed and for some people labeled with something just inorder to receive medical treatment.

Sara, Jessica, manipulation does seem to be a legitimate way, in some people thinking, to get the help. Unfortunately, it makes it difficult to separate the wheat from the chaff, to really be able to hone in on those who really need the help. If you look at the stats for those diagnosed with bipolar disorder, you would see a huge number in proportion to the population in the U.S. as compared with other Industrialized countries..WHY?
Some figures estimate 2.6% of pop. (6 million) some nearly 5% (11-12 million) this does not include children/ adolescents whose numbers are raising dramatically in the U. S....again .WHY? Misdiagnosis,the "Big Bipolar Sell "of drug companies, lack of finances making it necessary to lie to get treatment? These are just a few possibilities, I am sure there are many more that have to do with our desire as a "Quick Fix Nation" to use a pill instead of the old fashion painful hard road of personal truth and honesty. What ever the causes it is a problem and will not improve until our medical culture does, this includes the high $ of medical treatment, the ready availability of treatment to anyone who is in need (nearly 50 million w/o insurance), the de-idolizing of the industry, the re-education of Americans to learn to problem solve on thier own...in other words we need a paradigm shift. I believe we have for too long, been at the mercy of letting others in industries of power have control over our lives. We do need medical industries...but we do need to really look at where it, as an industry has taken us, as a nation in just the past 15 years. High cost, low service availability, frustrating waiting periods, too many meds, not enough monitoring, lack of qualified assistance ....it does go on. To be fair...there are many good advances as well...but, we need to start doing some weeding before it becomes overgrown and clogged beyond help. Just my opinion.

Another case that is very interesting is that of Margaret Dunleavy, the nurse who had "persucatory delusions"; accusing other people of talking about her, accusing the switchboard operator of listening in on her conversations, and "annoying people". (However, they really were talking about her because there was gossip about her relationship and there were no private telephone booths) She had basically lost her job because of this, and thus, the lodging that came with it, so she did reluctantly agree to stay at Willard until she could find a place to live. However, she never left- she lived for decades on the psych ward until her death thirty two years later. She was an educated women with a career, social connections, traveled freely and even owned her own car in the 1930s. She had been removed from her home due to allegations of neglect and by her tenth birthday her father had passed as well. While the ACE (Adverse Child Experience Study) shows that exposure to adverse events in childhood has a strong impact on physical and emotional well being later as adults, it does seem, by all outward appearances, that Margaret had been doing well for herself. She was viewed a hypochondriac for her malady of physical problems, although they did have easily identifiable causes and real symptoms. Some of the drugs she was given may cause psychiatric and neurological symptoms, however this was never considered, and she ended up being institutionalized for life.

In reference to the jail/prison debate in regards to mental health:
There is now assistance from the Mental Health Court Program (I am not sure where these are in action; I saw the link in the "Letters to the Editor" section of the August/September 2007 issue of Scientific American Mind.) This is a strict probation and case management program that prevents the mentally ill from being wrongly house in prison, while also protecting society from their criminal behavior committed when they are off meds/relapsing, etc. For more info, visit

www.consensusproject.org

After reading a bit about the program April described to us, I fell upon this book which I think could be an informative read for anyone who is interested. It's called "Criminalization of Mental Illness." The summary talks about how the three largest inpatient psychiatric instituations are actually jails, rather than hospitals. I found that piece of information very interesting because I had no idea. More info is at http://www.cap-press.com/books/1781

In response to the discussion regarding children being incouraged to lie to receive medical assistance: I remember that sometime ago that the state would give money to families that had children with diagnosed mental illnesses. When I was doing my interrnship for my undergraduate degree in psychology, I was at an Adolescent Drug and Alcohol Treatment facility and one of the kids explained to me that she received a "crazy check" for him because he had problems. He then explained that he had two other siblings that his mother was getting "crazy checks" for. When I later discussed this with my supervisor, he stated that it was probably true and that it was common for parents to request documentation from the facility to assist in proving mental instability. I believe that sometimes parents need to expand a childs issues are not always honorable. I do believe that their are some families that are in need of services and feel that they may not receive it if they do not expand the truth. I am just unsure that the cost to the child is worth it. The child is taught to lie and manipulate inorder to get what you want.....what happens if you don't get your desired outcome?.......will the parent and child continue to lie and create problems that don't exist?......what is the long term damage to the child?.....will they really get the treatment that they need , if they need it, when they are misdiagnosised based on lies?........and if the child does not need assistance, doesn't that take time and energy away from those that really need assistance?

Back to the discussion posted awhile back about ECT...I did my paper on Bipolar Disorder and found that electroshock therapy is useful for this disorder as well. The Mayo clinic page was helpful..thanks Janine!

tstallworth, I completeky agree with you in regards to it being unhealthy for these children to lie about a disorder for money. UNfortunately it does not seem far fetched. You brought up several questions and it reminded me of a conversation my class had last semester in medications. we were discussing how in some countries they do not believe in labeling people with mentak disorders. This is due to some research that shows that when a country/ community labels a child with a disorder, the child or adult will live up to the expectations of the disorder. I wonder if the children who lied about a mental illness ended up actually acquiring one due to the role they had to play, the expectations of that role, possible medications effects, etc.

There are probably many children who have been forced into malingering so that their parents can get a SSI/disability check and take advantage of the system.

In South Carolina, I worked at a child abused treatment facility in the toddlar classroom. I had a situation very similar to this where a parent claimed their toddlar suffered from bi-polar disease in attempts to recieve a disablity check. I think what shocked me the most was how far this almost played out, hello the child is 2 :) I also wanted to comment on the post earlier about Margret Dunelvy because I also thought with this case, as well as some others in this book, that there was not much recorded about how the medications given to the patients at Willard, could they possibly be causing additional negative side effects to patients.. and if so, was this under consideration because it just wasn't thought of at that time period? or did it just not matter?

Reluctant to read the book, The Lives They Left Behind: Suitcases from a State Hospital Attic, I found its very topic to be dark and drab. I could not help but to think, “Why would someone want to write a book about those who were institutionalize? As I read, I noticed there were different emotions I felt. There was anger, for I questioned how Mrs. Louise Maycock’s word was enough to place Rodrigo Lagon, her servant, and a young Filipino man sent by his family to study in America, to the mental hospital. I had feelings of sorrow as empathized with Marek, whose meticulous upkeep of graveyard at the mental institution ultimately became the very reason why he was robbed of the opportunity to live in the community. There were times when I felt confused, for I wondered if prejudices against those patients who immigrated to the United States, or if there was racism influencing decisions to sent people to mental institutions. If one expressed their feelings given the circumstances, that was license to send them away isolated from society: Rodrigo, recently separated from his family in the Phillipines; Dmytre who just lost his wife and unborn child; or Frank Coles, who may have been fed up with constantly being mistreated by the racial institutions set up against blacks, took his frustration out on a trash can. These, as well as others, were tragic, horrifying, and just plain unfeeling.

The story that stood out to me was that of Dmytre, young, newly married to Sofia, and just arrived to the US from Austria. Ready to start a new life, he was met with tragedy when on 12-5-1951 his wife miscarried and died. He lost his wife, and his unborn child. Understandably he was bereaved, yet he continued to as was expected.

It was later, when he tried to make contact with Margaret Truman, the daughter of the present, which led to his being institutionalized in mental hospitals. After 20+ years, he would be released (which was pretty rare).

My focus on this particular case was the different diagnosis he received, first schizophrenia, then and dementia praecox; the language and cultural barrier; and caring attention he received from the occupational therapist. I learned that diagnosing should be done with the utmost care and caution, and in doing so cultural competence is a huge factor. The different diagnosis was the result of not being abreast of the latest information. The initial diagnosis was schizophrenia due to his identification with Christ, and his involvement with the present’s daughter. He may have had a psychotic break, which may have been brought on by the death of his wife and unborn child. However, had psychiatrist been culturally competent they may have learned that Dymtre’s English was not very good and may have been trying to say that he identified with Christ’s suffering, not that he is the Christ. In addition, religion was apart of his culture. Also, his demeanor seemed to always be calm, pleasant, and cooperative.

He was eventually released, which was rare to read. Most patients died and were buried on the grounds of the mental institution. But this led me back to my originally hesitancy in reading this book: Why write about patients’ and their items that occupied the suitcases in the attic? The answer for me was to connect a life to those articles. These people had lives prior to admittance. Some were searching for better opportunities such as education, economically, etc. Some were servants of this country. Their articles of clothing and memorabilia told the story of their existence.

As a future social worker, I am never to forget that clients are more than their diagnosis. They are merely people who may be experiencing disorder in their lives and may need help to reorganize.

I would like to sum up the book as I read it. So many of the patients seemed to be either within normal ranges or not. Some simply lonely, others different or foreign, others unwanted or inconvenient to the people around them. Some probably did need treatment but didn't get it. Some were able to help themselves through there own pride of self and desire to maintain that pride no matter the environment that they found themselves.
The manner that they were treated has some connection to the way patients are treated today as so many of us showed in our personal references and website referrals.
For those who become social workers of any ilk, there is so much that appears to be related to understanding and interest in the wide range of experience that people can exhibit.
Culture is not limited to those from other countries or even other parts of this country. The stories of some of the people in our class are very interesting and need to be understood to broaden our own horizons. Taking interest in age (of course), sex, race, religion, ethnic upbringing are extremely interesting and can add to our capabilities as helping, empathetic professionals.

I agree with you, LaShawn, that the book was very dark. There were very few positive references in it. I have been a "social worker" all my life, I just didn't have the credentials! I, and I know you also, feel such compassion for people who are suffering and feel such anger toward people who appear not to care about others at all. Sometimes it seems like it would be easier not to care so much! I hope things have changed at least a little, though we know there is a long way to go. I am glad I read the book, though I wish there were more happy endings!

I have to begin by syaing that I would have loved to have been involved with this research and book writing project. Real stories and lives of people make them less of a diagnosis and more of a human being. The truth behind mental illness is that manifestations of behaviors related to acute stressful situations contribute to provisional diagnosis and in patient treatment that last for longer periods of times than should. This book talked about these circumstances and made me realize that the only real thing that has changed is that now people who really do need institutionalization can't get it and that medications have improved. Neurological advances have also helped to seperate dementia, alheimer's, and other organic diseases from tru mental illness. People adjust to their environment and this book showed that clearly through some of its stories. I see first hand the difference of treatment based on first assumption and judgement. The workers then and now are no less callous and cynical. There are alwys a few who care and are empathetic. Families much like in the book have had enough and this was a lst ditch effort. The story of the woman, Josephine Smith, whose family was well off when she had her first bout of depression, made it clear how economic factors effect choices for families ven today. She ended up the rest of her life because economically the family could provide no better services. The stories and statistics of women who were sent to Willard by their spouses reminds me of stories I have been told about how women were locked up for no apparent reason except that they were non compliant or nagging. Mental illness has no boundaries of race, age, gender, ethnicity or social status. The war, famine, the depression were all factors of suicidial thoughts, depression, and substance abuse. These are still factors today. Another woman in the book was very intelligent. I happen to know that people with mental illness are intelligent.

Heather Pepe said

I know a woman with several master level degrees who was a professor and is now living in an assisted living facility unable to care for herself. The treatment using methods at Willard were the best available at the time. Doctors and researchers were still searching for solutions. They did not have the understanding they do today. Halifax Psych still uses ECT therapy today. Not to the extreme. Willard tried to provide holisitc treatmetn to its patients the best it could. They also had consequences for not following protocol. The patients had opportunities to engage in activities conducive to physical and mental health. Happen to think that Willard was not that bad when all things are considered. If I had to imagine what it was like I would have to compare it to the NEFSH which is an institution I have been to and observed patients. I am also at the Crisis Unit everyday and I have seen some types of restraining procedures that have caused me some trauma so I can imagine the client's perception. These methods were necessay though. The book was wonderful and I have loaned it out for several colleagues to read.

Kristin,
possibly the medications that were given to the patients were cocktails of pills or maybe they were experimenting with the meds. the experimentation could have led to some serious side effects and as you noted, they might not wanted to release that information. Also, they could have recorded in detail the medications and dosages but kept a more general file that could be shown to others and the detailed one for their personal reference. Just thought I'd throw some more ideas out there :)

I had some similar reservations and ideas about the book at first. In the beginning it was kind of slow, but just like some of the best movies I've seen it picked up and got me hooked. I did not have a necessarily favorite case, everyone has a story to tell and no one's story/life is any less significant. I've realized everyone handles stressors differently and what happens to one person may be a traumatic experience to them but to another it could not phase them. Reading the book brought me back to when I was in my preteens to something personal. Someone close to me struggles with a mental illness and when I was around 13 years old, that person had a psychotic breakdown. I remember how the whole day unfolded and how it led to the "event". I visited the person in a mental facility. I remember feeling scared and not knowing what to expect. It was very white and bare. A woman of three small children laid on a little bed behind the nurses station with bandages wrapped around her wrists. Patients in gowns walked the halls or were watching tv. The person I knew showed me the room he/she was staying in. It had 2 beds, 1 small desk, and 2 chairs. That's it. Most everyone had to share a room with someone they did not know, nor know what mental illness the person was living with. I realized that the person I knew did not understand why he/she was there and did not think anything was wrong with the behaviors exhibited earlier, because they were not recalled the same way they occurred. It made me understand a little into that world. The fact is that, that is their world, their perception, and their reality. Even though they may see or do someone "wrong" according to society's standards that does not make how they feel during those situations any less real or relevant. I hope my explanation is making sense. Dr. Allgood, I have a feeling you will understand what I am saying throughout this. However, if anyone does not feel free to ask. Wishing everyone the best on their final!