The Mentally Ill in Court

 

Should courts be allowed to force mentally ill defendants to take atypical psychotropic medications in order for them to be found competent to stand trial?

Forced medication is a theme I first met while advocating for parents of children diagnosed with ADHD during their early years of elementary school.  Could schools require parents to have their children medicated as a condition of continuing in school?  I’m not sure that issue is settled, but am thankful most schools have moved beyond that position and are using different approaches to help challenging pupils succeed.

However, courts haven’t come that far.  In fact, recently the Oregon Supreme Court ruled that state judges can force defendants to take medication against their will so they can stand trial, cf. Oregon v. James Michael Francis Lopez (2014).  The decision was in agreement with an earlier decision by SCOTUS, Sell v. U.S. (2003).  From that case, a four-part test has emerged:  is the medication appropriate and unlikely to have side effects that would undermine a person’s ability to aid in their own defense?  Is there no other alternative to medications?  And that forced medications further important government interest in seeing the trial proceed.

It’s important to keep in the mind that the determination of competency to stand trial is very different from the issue of sanity at the time of the offence.   The insanity defense involves that state of a person’s mind at the time of the alleged crime.  Incompetency to stand trial can be determined sua sponte anytime during the process of the trial.  Furthermore, earliest Supreme Court rulings made vigilance concerning a person’s present competency a constitutional mandate placed on all parties in a criminal proceeding.

It is of note that the Sell test is heavily weighed to the Government’s advantage.  The court is not required to ask about the side effects of psychotropic medications generally.  The only enumerated concern is a defendant’s ability to assist in their own defense.  Also lacking is any attempt to decide whether forced medications serve the individual’s interest.  What about those who don’t understand their so-called mental illness as a medical problem at all?  How about those, such as, who might understand their Voices as a spiritual experience not needing to be synthetically extinguished?

Traditionally a very low bar has been used in determining competency at trial – does the defendant understand the proceeding and can they assist in their own defense?  Understanding the proceeding usually means a person can describe a courtroom, can identify the judge, and is aware they are on trial.  Assisting in their own defense usually means they are cooperating enough with their attorney that they don’t interrupt the proceedings.  Given the complexity of every court case, this primitive test seems ludicrous.  I wonder how many folks sit in court wondering, “What’s happening here?”  Do many of us really understand the language being used?  The motions made?  Judges decisions implemented?  And if we don’t understand, how can us, “assist in our own defense?”

At a more fundamental level, how can a society that lacks the will to provide mental health resources to its citizens then allow a court to mandate medication for the sole purpose of proceeding with a trial?  Or, do we know what’s being done in our name?  Do we care?

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Imagine

Imagine all the people living life in peace . . .  imagine all the people sharing all the world . .  the world would be as one.

I don’t recall all the lyrics of that popular Lennon song of my youth, but I remember the sentiment of less war, less greed, less worry, less judgment.  Maybe a world that would be sustainable, livable.

No one has ever called me a dreamer, but I do know of a simple way we could start to live what we earlier imagined – practicing mindfulness.  Letting go of our regrets and anger about yesterday and ceasing our endless worry about tomorrow and just being aware and noticing the present.

Check out what some schools in LA are doing.  Mindfulness meditation is a practice that is backed by an incredible amount of research that demonstrates its usefulness for a wide variety of areas: mood, mental health, attention, cooperation in the classroom and office, etc.  It might not be a panacea, but its the easiest and cheapest tool you will ever find.  It just requires some time and consistent practice.

Let me know how your practice is going.

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Book Shelve: A searing look at Bipolar Disorder

I am not a book reviewer and one should never review a book unread.  However, this book looks so promising and is so needed, that I thought I’d dare.  Since I haven’t read it, many of my remarks are borrowed from other reviewers.

Greyson Todd (the protagonist) is plummeting into madness and the reader has a front row seat on three levels. The novel involves three timelines in the narrative as Greyson undergoes twelve 30 second ECT’s (electroshock treatments) in a New York psychiatric department. The book is timely because ECT has apparently been re-born (mostly for untreatable depression) and become vogue (with refinements).  Many might recall the terrible history of this treatment and how patients were treated when it was being widely used.  After the treatment people would often forget much, if not all, of their past and their personalities would be irrevocably changed.

Garey helps us understand the battle with bipolar by retracing Todd’s childhood trauma and examining his father.  Family history is always significant in discussing mental illnesses.

During these shock treatments, the reader experiences the intimacies of his marriage to Ellen, his surrender to his well-hidden bipolar disorder when he leaves his family, and destruction of his own father who, most likely, was bipolar. Garey puts us inside of Greyson’s mind. We experienced his anguish; his disregard for all that could be sacred to him. As he unravels, his pain is overwhelming and the core of his madness is palpable.

Bipolar disorder ravages people and is often difficult to treat.  During mania phases, many stop medication because their feelings are so exhilarating.  Yet the fall is certain and each time becomes even more unbearable.  Another amazing thing about this novel is that it focuses on a man.  A gender prejudice often permeates mental health diagnoses, especially with this disorder.

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A Lonely Shooter

Like most folks, I too have pondered a solution to Newtown and similar tragedies.  How is it that we Americans kill so many, so often, so randomly?   Michael Moore asks us to examine who we are?  Others have proffered other explanations.  I saw this in the paper and thought it might at least solve the issue of school violence:

Pat Oliphant

The reality is there is no easy or single solution.

The 2nd Amendment to the Constitution guarantees the right to bear arms.  However it makes no mention of bullets, so we might start there.  My eight year old daughter suggested we make everybody secure their guns and bullets at the local police station and check them out when needed.  That probably doesn’t comport with the 2nd Amendment, but it might save a number of children and visitors to shopping malls, movies, schools and local diners.  With upwards of 300 million guns in circulation I’m not sure any kind of gun control will solve anything.  By the time Congress acted most gun stores would be sold out anyway.

We could address mental health.  However the issue of civil liberties (e.g. forced treatment, medication, civil commitment, etc.), not to mention the predictability of violence by those with mental health disorders is not easy to resolve.  Indeed, while Adam Lanza was characterized as strange to his classmates, I haven’t read anything that suggests he was psychotic or violent in any way.

Several years ago I sat on a panel to discuss how to stem violence among young people.  At the time I suggested it might be impossible in America given that our leaders choose violence to solve almost all problems we face.  The panel met not long after the president – with overwhelming popular support – launched a pre-emptive, unprovoked war in the Middle East (I’ve always been somewhat naive).

School security has also been discussed a lot again.  Just remember Sandy Hook already had a number of security measures in place and the Principal ran drills periodically for just the kind of event that took place on December 14, 2012.  Columbine High School had an armed guard on campus the day Klebold and Harris attacked; Virginia Tech had their own police force.

So what do we do?

Don’t teach kids American history, they may repeat it;   Don’t teach them current events, they may mimic them;  Don’t teach them too many stories from the Bible, they may apply them;  Don’t buy them video games, they may enjoy them;  Don’t watch Hollywood movies, they may copy them.

What we have to do is reach out to young boys and men and talk to them.  It appears to me that if there is anything that unites Klebold and Harris and Kip Kinkel and Holmes and Lanza it is loneliness.  In busy cities and bucolic suburbs, these kids were able to isolate themselves.  They weren’t just ‘strange’, they were alone.  Each of us can enter their worlds, make eye contact, and listen.

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Ayn Rand and morality

In case you haven’t read Ayn Rand, here is her “morality of capitalism”: survival of the fittest and radical individualism. In Rand’s world, groups are always weak. Leaders of groups are always manipulators. And religion, specifically, is held up as a foolish enterprise designed to pacify people, so they don’t shine out as the glorious individuals they could be. There is not one shred, not one hint, of people being authentically motivated by serving others or the common good. It couldn’t be more starkly presented than in The Fountainhead, where the Enemy is a religiously-minded person, someone who almost entered the ministry but shied away even from that level of personal excellence, whose goal in life is to sabotage individual greatness. The hero, in contrast, is an arrogant, truly despicable genius, who is driven only by personal achievement, stepping on other men and in one case date-raping a woman (though Rand defended the portrayal saying it was clear she wanted it.)

The Fountainhead is horrifying throughout. It is horrifying at the celebration of aggressive dominance and at the ridiculing of faith. While there are flashes of insight here and there into some of the pitfalls of collectivism, overall the book is a celebration of amorality. Or, to be more precise, as 19th century occultist Alistair Crowley said: “Do what thou wilt, shall be the whole of the Law.”

Ayn Rand would be a horrifying influence on anyone – especially one who might seek to lead our country.

 

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Speaking Out

For a number of years we have been learning about and trying to understand what went wrong in the Catholic Church that would create a culture that hundreds, thousands, of children would be victimized at the hands of the very representatives of God.  The media has asked, in feigned indignation, what happened that the entire Church hierarchy, including the Vatican itself, would be complicit in such horrific behavior by their subordinates?

A more recent revelation has been the news that Penn State and its leadership failed to take any action at all to protect young boys from one of their own, former coach Jerry Sandusky.

Joe Paterno statue removed

According to the Freeh report, the university’s front office and the venerated coach Joe Paterno, knew of and ignored evidence that Sandusky had raped young boys on their campus.  Apparently they knew as early as 1998.

Reports during and immediately following Sandusky’s trial indicated that his adopted son was willing to come forward and testify that “Dad” had sexually abused him as well.  The son’s story, combined with transcripts from the trial, make clear that Sandusky would abuse children in his own home with other family members present.  And Mrs. Sandusky didn’t know?

I’m left with a very disquieting thought:  why don’t people speak out?  How is it that we have allowed the institutions we serve, and benefit from, to silence us?

One of the most indelible memories of my youth was the reaction of my Little League coach when some man was mistreating his dog at the park where we practiced.  He halted practice, ran-up to the man and confronted him with his behavior.  It appeared to this 10 year old that he was attempting to gather as much information as possible to file a police complaint (forty years ago there were no cell phones).

Maybe that doesn’t seem all that spectacular today.  But if my Little League coach could confront a man for mistreating a dog, why couldn’t another coach confront Sandusky when he caught him sodomizing a 10 year old in the team shower?

I’m assuming most of us don’t have the calling of an Old Testament Prophet, the disposition of Soren Kierkegaard, or the courage of Martin Luther King, Jr., so where do we learn to speak up?  To challenge the wrong committed right in front of us?  What space have we created to teach the next generation the art of speaking out, of protest against immorality?

I’d be interested in hearing who taught you how to speak truth to power?  What reservoir of courage do you draw from when speaking up on the job or confronting some evil in your own neighborhood?

 

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The Gift of Suffering

I hope the title of this post arrests you.

Suffering is not thought of as a gift and yet, sages remind us that wisdom and growth only come through suffering.  In the many years my family and I lived in northern Nevada, we appreciated the 300 plus days of sun each year.  However, now that we live in the Willamette Valley of Oregon, we are constantly overwhelmed by the beauty those months of dark clouds and rain produce.

Our culture glorifies the sun.  We have done everything we can to eliminate any pain and suffering.  Of course, finding something to sooth is not new.  All addictions begin with finding something (often accidentally) that makes you feel better.  We’ve just found a way to make the search profitable; incarnate in the evil twins of psychiatry and the pharmaceuticals.

If your child suffers though the school day and can’t seem to perform in our pre-packaged, standardized education system, just get her Ritalin.  If your teenager experiences intense emotions that fluctuate wildly day-by-day, he probably needs Lithium – only maybe a more benign mood stabilizer.  If your thoughts move so quickly you seem to be chasing after them with your spoken words, you have ‘pressured speech’ or ‘tangential thinking.’  By the way, if you want your doctor to be able to adjust your meds appropriately, you have to learn their language.

We have turned our whole interior lives over to those with white coats and prescription pads.  And worse, we are de-humanizing ourselves by fleeing an indispensable component of being human, namely suffering.

The anthropologist Clifford Geertz wrote in an essay “Religion as a Cultural System” that traditional cultures did not search for ways to avoid suffering, but how to suffer, “how to make physical pain, personal loss, worldly defeat, or the helplessness of other’s agony something bearable, supportable – something, as we say, sufferable.”   They knew that suffering enriches the soul.

He that learns must suffer.

And even in our sleep

pain that cannot forget,

falls drop by drop upon the heart

and in our despair

against our will

comes wisdom to us by the

awful grace of God.

Aeschylus

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The Drug War

As befitting current media habits, the big news in Cartagena, Colombia was the scandal involving the Secret Service, not the proposals and dialogue between western hemisphere leaders.  As with most news stories, hype was substituted for content.

Actually, the most important news was the push forwarded by thoughtful leaders that the current “War on Drugs” is a failure.  According to all accounts what’s been achieved since the commencement of this “war” some thirty years ago is the lowering prices of street drugs (reportedly the price for cocaine is currently half what it was in 1990); over 500,000 people are jailed in the US because of drug law infractions (40% of drug arrests are for simple marijuana possession); and, as news reports have shown, an incredible amount of violence on the US-Mexican border, as well as any number of other places we might turn our attention to.  As a result the US is spending approx. $40 billion per year on this war.  Nearly 80% of that is spent on law enforcement alone.

I would hedge a bet that not one reader feels any safer due to the policies followed by the last five US administrations; nor does anyone feel their children are any less prone to try (and possibly) become addicted to one street drug or another.  Statistics demonstrate that 16% of US adults have tried cocaine.

We need to finally admit the obvious and end this war!

We would be well served by turning over the issue of drug addiction to the professionals and take it out of the hands of law enforcement.  Drug addiction is a medical issue and not a criminal justice problem.

Countries that have exchanged treatment for punishment have lowered consumption and substantially reduced public health and safety issues that are linked to drug use.  The Global Commission on Drug Policy reports that safe needle exchange programs in Britain and Germany have reduced the rate of HIV below 5% – in the US it’s above 15%, for those injecting drugs.

Perhaps people might think, “They get what they deserve” (I’m not willing to get into the moral argument).  What we all know is that we all pay for it.  We pay for law enforcement, incarceration, trips to emergency rooms, state care of children in foster care.  And – sometimes missed – the loss of productivity by those trapped in their addictions (some estimate at $39 billion annually).

Everyday I’m in contact with folks who are struggling, not only with debilitating mental health issues, but also chronic addictions.  Discussing when and why people begin using drugs is an obvious waste of time and energy. What we know is that drugs re-wire the brain.  And to think that people can conquer their demons by just saying “no” is magical thinking (very informative link).

People who are addicted to drugs need access to harm-reduction facilities like Insite in Vancouver, Canada.  They need intervention by highly skilled counselors and support from friends and family.  They often need residential treatment.

In this time of scarce resources we should take the advice of other leaders in the Western Hemisphere and declare the war over and realize that drug addiction is a public health issue.  Just think how far that $40 billion could go.

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Taxes

Happy Tax Day!  So much of what we discuss – community mental health, legal reform, workable solutions for homelessness, taking care of our veterans – requires funding.  And each of us has a stake in it.

This program put on by the Americans for Democratic Action Education Fund runs about 1 ½ hours.  You might consider that a little long to watch a discussion on taxes, but I’m figuring you spent a whole lot more time preparing yours.

As we think of solutions to challenges facing us and as we enter the general election season, it might by worth thinking hard about our tax system.

Progressive Tax Reform Advocates Discuss U.S. Tax Code
Progressive Tax Reform Advocates Discuss U.S. Tax Code

At the above link, just go to the right side of the page and click on the Video Playlisting for the program.

After preparing your taxes and hearing different perspectives on the issue, it would be great to hear what you think.

 

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Thought Police

I’m scared for our future.

If there is anything I’m proud of as an American, it’s the 1st Amendment to the Constitution.  Since our inception (or at least since 1791) we have tried to encapsulate what America is through the ideas of freedom of religion, freedom of speech, freedom of association.  From high school civics on, I learned that what you think, what you sing (or with whom you sing), what you write, is off limits to government intrusion.

Yet in the last couple of weeks shocking incidents have occurred that scare me.  The most recent involved a Major League Baseball manager, the other a German poet.

Ozzie Guillen, the 48 year old manager of the Miami Marlins, articulated his admiration for Fidel Castro in an interview.  What he said was basically, he admired him because he stuck around.  Wow!

He didn’t say he wanted to import the Revolution to Miami or he liked the Cuban leader’s position on the Catholic Church.  He simply said he thought it was admirable that, while so many people were trying to eliminate him, he lasted.

So Coach Guillen got suspended for five games.

Now, I passed Constitutional Law and know that major league baseball is not a government activity, but since the government actively protects and promotes its monopoly practices, doesn’t MLB meet the threshold for significant state involvement?  And, if it does, shouldn’t the government be telling the commissioner of baseball, Bud Selig or the Marlins CEO, that they’ve overstepped their bounds?

The first incident was not here, but reflects our increasing intolerance for anything said (or written) that challenges the status quo.  The German writer, Gunter Grass, wrote a poem in which he speaks about the dangers Israel poses to world peace.

That a German of Gunter Grass’ generation (born 1927) would speak out against Israel is a story in itself, but that he would urge Israel to open itself up to the same international scrutiny demanded of Iran, is somehow scandalous.  To be clear, he never equates Israel and Iran or asserts any kind of moral equivalency.  Grass simply says enough of the West’s hypocrisy, enough silence.

The poem is called: “Was gesagt werden muss . . .” (What must be said.)  It has been translated into English and published in The Guardian (link here).  The poem is not going to be ranked in the same category of literature that Grass would normally be found.  However, the poem, like Niemoller’s famous lines after WWII, says the obvious:  We must speak out before it’s too late.

I’ve always been led to believe that Israel was a western-style democracy (whatever that means) that prided itself on being different than her neighbors.  However, post-publication of Grass’ poem in the Suddeutsche Zeitung, he has been named persona non grata by the state of Israel.  Don’t think that couldn’t happen here.

Why do I so clumsily enter into these political discussions?  Only because I’m interested in baseball and poetry (well, yes), or is there some other agenda I see?  There is.

How are we ever going to find the best practices for the treatment of mental illness or advance mental disability law if some of us don’t think outside the box?  Given the orthodoxy of the medical model, the sway of pharmacology, and the unbelievable, unrelenting political power of the pharmaceuticals, the battle is not going to be easy.  It requires fearless thinkers.

General Patton once said, “If we all think alike, than someone is not thinking.”  The truth is never found in group-think.  The truth is found when some courageous fool has the audacity to speak up, or sing, or write a play, a novel or a poem, and say what must be said.

 

 

 

 

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