Sunday, June 19, 2011

Please Complain



For those who don't follow the comment sections of posts, there have been commenters who have been telling us about the awful experiences they have had as psychiatric patients.  In particular (but not exclusively) as  hospital inpatients.  Commenters have used terms like "abuse" and "humiliation" and describe awful scenarios.  One person asked why the mean nurses don't get fired, everyone knows they are mean including the staff.  Others throw the baby out with the bath water, one bad experience.  There is implication by at least one commenter that he/she would rather die (presumably permanently) rather than face a days on a psych unit again.  The suffering in these posts is palpable.

To those who feel better after leaving comments on Shrink Rap, by all means, feel free to continue, but this will not change the world.  May I put in a request?  If you've had an awful experience as a patient on a psychiatric unit, please tell the hospital.  One commenter said she (/he?) complained to the hospital administration and heard that some changes were made.  My thoughts?  You Go Girl!  (If the commenter was a male, I'm at a loss. Way to Go, Joe! perhaps?)  Complain, it can't hurt. 


Oh, you say, no one listens to psychiatric patients, they just say we're crazy so they don't have to listen.  For an isolated complaint, you may be right, especially if the complaint is about something that is not egregious.  But if everyone who feels wronged complains, then it won't be an isolated complaint, and I can tell you that for administrators, one person accusing is a fluke --or a psychiatric patient they don't need to listen to-- but at a very low threshold of two or three complaints, it quickly becomes "PEOPLE are complaining about such and such"  and someone starts to notice.  If the complaint is egregious (My nurse punched me) then a single complaint should have an impact.  

Who should complain?  If you were upset over something that happened and it continues to linger, you can't let it go, and you continue to feel angry, wronged, and injured, then you should complain.


So let me tell you how to complain.


1).  Call the hospital and ask where to direct a complaint and get a person's name and postal or email address.  Also send the same letter to the chairman of psychiatry, and the head of the hospital...why not?  Address the letters to specific people by name; "Dear Sir," "To Whom It May Concern,"  or "To the Sadist Creep on the Psych Unit" will not go far.
2).  Just the facts, ma'am.  Tell the administrators when you were hospitalized and that you continue to feel distress/angst/anger/whatever you feel about things that happened while you were in the hospital and give a bullet point list of the things that continue to trouble you.  Include specific examples, if you can, names of those who were involved.  If you don't recall specific examples, it still seems to me it's valid to say "Shrink John treated me in a harsh and disrespectful manner."   Say how you felt: "It was humiliating to be stripped and placed in a seclusion room." 
3).  This is not the time for name-calling,  hater rants,  or discussing the care of other patients.  "This is why everyone hates psychiatrists," "You people over-medicate everyone,"  Pretty much guarantees that the recipients shut down. Stick to your problem.  Be polite and respectful and try not to compare the mental health professionals who treated you to serial killers.
4) Sign your name and leave contact information.
5) Show it to a friend first and wait a day to send it.


I don't know if you'll get a response or a change, but if everyone who feels as wronged as our commenters do writes to complain, then things will change.  It may take time.  Don't be hater, be a changer.



Thank you for considering my suggestion.

Happy Father's Day to all, and remember to submit your Grand Rounds post now.

61 comments:

Anonymous said...

I would like to think that most people commenting here do know the steps to take to lodge a complaint. Most hospitals clearly state who and at what number or address to contact.
I have done this and got nowhere. I signed my name. It did not matter.
There are patient advocacy group. I have been in contact with lawyers there. You don't seem to understand what patients face when they complain. A brick wall of silence. You can pooh pooh that but it is real.
There are doctors out there who acknowledge the facts but they do not go sticking their necks out to take a stand.
When I worked in a hospital, I saw how "nuisance" patients were doped up. The chart wss always clean. Nuisance is noted as agitated. I know how the system works. I am not accusing every medical professional of professional misconduct but it exists on a systemic level. And families who complained or patients who did were noted as trobule makers. Until doctors speak out nothing will happen. So go to your professional association with some friends and complain. Maybe even write a book about it.

Anonymous said...

I am the person who made the effective complaints against the state hospital and a local community hospital that did result in changes. Oh, and I am a female.

I flipped into hypomania while I wrote those letters and met with administrators. If the depression hadn't switched, I probably couldn't have complained. If the hospitalizations had resulted in high dose risperdal, as a different hospitalizaton did, then I couldn't function well enough to complain. Or if I had ECT.

What I think made the difference was that I took careful notes the entire time I was inpatient and being mistreated or seeing others mistreated. Of course, at the state hospital, I would get a faceful of crap about it because the aides did not want patients to have pens except under supervision, so if I went to the bathroom, I had to turn it in then ask for it back along with a bunch of insults (I was also filling out some of those worksheets you always get when you are inpatient, doodling etc). But anyway, I got copies of my medical records, THEN filed the complaints, based on my detailed notes. (It was extremely difficult to take the notes since I was obviously in a bad way or I would not have been inpatient.)

I filed my complaint with the hospital administrators, and they are the ones I spoke with personally. I didn't realize there was some formal way to lodge a complaint. I also contacted the hospital accreditation agency (JAACO? or something like that), but all they cared about was if the nurses sanitized the electric razors between patients.

It was mostly the less trained staff who were the problem in my experience (the patient haters who deliberately abuse patients). Or, even RN's would not deal with patients well and would escalate the situation due to lack of training.

Those of you who are trying your best to treat patients with mental illnesses are being undermined by these burnouts who hate the patients. One burnout can set back many patients. They are like other abusers, careful when they do their thing - they do it when the nice doctors and nurses are not there to observe. When the nice staff are there, the abusers are nice to the patients. I saw it happening to others, not just me.

The escalation thing happened to others.

Anyway, it didn't help ME one bit to complain. No relief, no closure, nothing. I did it for others, and was gratified to hear that there were some noticeable improvements.

Dinah said...

Anon 1: You don't know you didn't have an impact. One complaint (really from any non-VIP patient, it's not just psych) is just a complaint, but if more people complain, there is a pattern, documentation, something to be addressed. And when they make a change down the line, no one will call to inform you that Nurse Ratched was fired or a policy had changed.

Anon 2: I repeat: You Go Girl!

Anonymous said...

This post is ignorant to actual life events and so completely out of touch with reality; it could have been only been written by a psychiatrist.

I can only suggest Miller & her cohorts seek serious professional help and psychotropic intervention as soon as humanly possible....

Anonymous said...

Hi Duane.

rob lindeman said...

I nearly laughed out loud when I read this.

Social media are precisely the right locations to air these grievances! No one reads newspapers any more, so how else is the public going to find out what is going on?

I can imagine the impact that letters from several freed slaves would have on their former master. The plantation doesn't need to be reformed. Bad taskmasters don't need to lose their jobs. Slavery needs to be abolished.

Anonymous said...

If an individual is responsible for the mistreatment, then lodge a complaint against them with the appropriate state licensing board for doctors, nurses, LPNs, etc. That way there will be an official, public record that a complaint was lodged and what was done to resolve the complaint.

Obviously, this should only be done in valid cases.

RW

moviedoc said...

Agree with Rob, but don't stop with complaints in social media, or the hospital. Go to the state dept. of licensing, the local or state branch of APA or AMA. BTW, I have my own story about JCAHO: While I was moonlighting at a state hosp. in NY in the 80's the hosp. moved a bunch of pts to a different unit to give the appearance of compliance, moved them back as soon as the review was done. Another psychiatrist and I reported this to JCAHO but they didn't do a thing.

Anonymous said...

A post with a suggestion of how to change something and one person says it's not worth bothering, someone else--"the doctors"--need to do it. "Go to your professional association with some friends and complain.."-- unless your shrink is coming to work drunk or hitting on patients in the hall, there's nothing for one shrink to see to complain about another shrink to a professional organization about-- Another anon calls the shrinks ignorant and out of touch with reality, and Rob likens them to slave owners and is stuck on the idea that since he thinks the whole field is bunk, no one should complain about being mistreated because the whole field should disappear. If you all want it to disappear, why do you spend your time on Shrink Rap? Why don't you DO something to make things happen. Why don't you just get your own friggin' haters blog? If you don't think that involuntary treatment is right--and like wasn't there a survey on this and didn't the majority of people say they would want forced treatment-- but screw the facts--...why don't you go to your state legislators and tell them how you feel about the existing laws. Dinah says get off your ass and DO SOMETHING and all you can say is why it's pointless. How do you know that the hospital administrator you write to isn't taking meds himself, or wasn't ever in a hospital (or had a kid or parent) in one...you just want to assume that no one will listen to you so you have an excuse to blame the Shrinks and you don't have to do anything. Maybe you're complaining about stupid things or in a stupid way so that no one will listen? Naa..that can't be..it MUST be that shrinks are banded together in an anti-patient conspiracy to make sure the wall of silence is unsurmountable and nothing ever ever changes and that's why things are exactly like they've always been.
Yet Anon #2--who was in a state hospital and treated with antipsychotics, did get someone to listen. Thank You, anon #2. And I thought the hater was Duane, too, cause no one else starts off with you're an idiot. Of course he knows everything.....

moviedoc said...

BTW: You can combine formal complaints with use of social media to tell us all about the outcome. I did just that with numerous ethics complaints to APA. You can read about the whole works, start to finish, ad nauseum at my opinion blog.

Anonymous said...

leaving a comment on this blog is very much like having a conversation with the vast majority of psychiatrist..a complete waste of time...

Though, one commenter actually was spot on..it really is a futile effort to leave comments on this blog..this is an APA approved one trick pony unable to listen or change...

The Shrink Rap crew are to self absorbed & busy defending the indefensible to do much of anything else.

Anonymous said...

"unless your shrink is coming to work drunk or hitting on patients in the hall, there's nothing for one shrink to see to complain about another shrink to a professional organization about-"

Why do you assume that it is a shrink all the time? If you have the pleasure of being a resident on a shrink ward, you will likely not see a shrink very often. You will see a parade of nurses, aides etc.You will see that often some of these other staff memebers hate shrinks more than any patient and by the way they hate the patients. Not all, nt even most. Some were wonderful. Others are awful. Back to the point. Shrinks do know what is going on. Mine does. I like my shrink but he will not speak out against the abuse he wants to help me recover from and the abuse is one reasone he does everything to keep me out of hospital. Do not go accusing me of sitting on my ass because I would like the people with some power in the system to speak up and out. I work in another system and I have some power there and I get my hand slapped for exposing abuses in that system but I actually get some movement. Not perfect, but better. Our clients can complain all they want. The secretaries hold the phone away from their ear. The director has her admin assistant send a form letter. People snicker behind the backs of these people because while outisde our doors they may be anyone from a student to a subway operator to a CEO of a big corporation, unless they have given big bucks (the VIP) they get the shaft. Likewise, I may have some power in my system but I have none in the hospital where I am a patient sometimes.

Maggie said...

Thanks for this post, it does start to address some of the issues I keep seeing here.

However, as I read your blog, I'm noticing a pattern that hasn't quite been mentioned. You complain about the "psychiatry haters," of which there are several who frequently comment on your blog; people who don't seem to have specific points of contention but just a generalized "anti-psychiatry" agenda.
After you make those complaints, other regular commenters, people who actually have specific things that they're upset about, feel as though you're complaining about everybody who has had any problems with bad psychiatric treatment. Sunny CA's response to your last post captured it pretty well. She said she felt like you were complaining about and dismissing all complaints--you responded that your complaints about "haters" was definitely not directed at her. I can understand why she might feel as though your frustration was directed at people with complaints in general since it is so difficult be taken seriously when a mental health professional has behaved poorly. But at the same time, even as someone with quite a few complaints of my own about bad psychiatry, I'm getting frustrated at the couple of people who seem to use your blog just as a forum for hurling generalized insults. If anything, it's those people who marginalize complaints about bad psychiatrists, because I don't see any real way of addressing those "concerns," and because it's harder to consider the comments with specific complaints when there's a pile of mud-slinging comments landing on top of them.

I've used the example of elementary school teachers before, and it's a pretty good analogy, so I'll use it again. With the exception of a great fourth grade teacher, mine were absolutely awful. They were nasty, screamed constantly, and were not particularly intelligent. I remember learning quite a few things that were just plain untrue. I think elementary education really needs to be re-thought and taken more seriously than it is. But if I were to use my bad experiences in elementary school to declare that elementary education is bad and should be abolished, how could anybody even begin to address that? What purpose would such comments have? If I were to go to the blog of an elementary school teacher and make such declarations, how could they possibly respond? The more I think about it, the bad elementary school teacher analogy parallels mental health situation very well. (I'm sure there are some points that would differ, but I can't think of any right now.)

rob lindeman said...

From Newsweek online today:

http://www.newsweek.com/2011/06/19/mommy-am-i-really-bipolar.html

Dr. Kaplan stumbles, but does not fall. Fascinating read.

rob lindeman said...

More honest talk from Stuart Kaplan:

"The use of the wording 'unambiguous agreement about [the existence of childhood bipolar disorder]' is a coercive rhetorical device that has held sway for more than 15 years in the pediatric bipolar scientific literature. Instead of providing evidence, the [DSM-5 Childhood Disorders] Work Group attempts to persuade the reader that everyone who is smart and important knows this to be true."

Substitute any psychiatric diagnosis for "pediatric bipolar", and "psychiatrist" for "Work Group", and the truth-value of Kaplan's statement remains stable.

http://www.psychologytoday.com/blog/your-child-does-not-have-bipolar-disorder/201103/driving-stake-in-the-heart-the-beast-the-misdi

Anonymous said...

Jesse wrote: At times anti-psychiatric positions are touted that in effect are denials that our field has any validity, and these strike me as quasi-religious stances masquerading as scientific. These are harder for others to address as they are not what they purport to be.

Rob wrote: Substitute any psychiatric diagnosis for "pediatric bipolar", and "psychiatrist" for "Work Group", and the truth-value of Kaplan's statement remains stable.

Anonymous said...

Rob, you seem to want to change the subject of posts to suit your world-view. Here's my idea: set up a blog of your own!

RH

Sarebear said...

Rob, you're introducing topics that have nothing to do with the post.

Dinah said...

Maggie,
Thank you for that great analysis.
It's left me wondering about what it is that people want to get from commenting on a blog? Often, people have just wanted to tell their story, and we've been fine to let them (ah, what happened to 'no one has to listen')...now I feel like people are waiting for us to jump up and yell, Yes You're Right, All We're Doing is Hurting People and We're Quitting Our Jobs Now! Is there something else these commenters want? They should get their own blog, it will get much more traffic then the comment section of ours, and they can find like-minded people.
We're not an "APA-approved" blog, we've never hidden the fact that we're 3 mainstream psychiatrists.
I'm not trying to convert the "haters"---I'm not spamming their blogs, but I am wondering what they want from us, or if they might find more satisfaction elsewhere as it seems to have distressed and intimidated some of our regular readers.

Rob--thanks for the link. We don't treat children, and I don't follow the research on childhood disorders and treatments. Given uncertainties about the long-term effects of these medications on brain/metabolic development, I would hope that their use is reserved for when other interventions have failed and everyone is simply desperate, and not as a first-round go. Kids are really hard because normal developmental stages sometimes look like illnesses, so I'm gonna leave this topic to the experts.

Anonymous said...

I agree with Moviedoc, filing a formal complaint with the state licensing board can be quite effective. Be specific, list the date, time, the witnesses present, etc. Staff being rude or obnoxious is not enough of a reason, you need a violation of standard of care, unethical/illegal conduct, etc.

If it's legal issue, like being threatened to sign an informed consent, it's probably best to get an attorney involved. There are nonprofit agencies that employ attorneys that will help with legal issues.

But above all, be careful that the person you confide in shares similar ideas about patient autonomy and rights so you don't end up with treatment you don't want.

Leslie

Sunny CA said...

I like this blog posting. I really would not have known how to go about filing a complaint.

I have to say, though, that I am terrified to file a complaint. When I got done reading your post I was hyperventilating and literally shaking in fear and heart racing at the thought. I will discuss this with my psychiatrist to see what he thinks, but my take on it is that the in-patient staff scared me to my core and I am still afraid of them. I don't feel safe. What if I ended up in-patient again and they knew I had complained?

I agree with Anonymous #2 that it is mostly the lower level patient-hater staff who are the problem, but when I was transferred to the "daycare" program I was assigned a psychologist who was rude and belittled his patients. He kept boasting that he had never had one of his patients commit suicide and simultaneously was belittling to us. There was an incident when he was especially harsh to a suicidal man, just before my release and a few days later the man committed suicide. I felt that the psychologist had almost egged him into doing it. I'd like to report him and that incident. I remember very specific things he said to us. There are also cruel nurses. They couched their cruel treatment as "teaching you a lesson about taking your medications for the rest of your life". I had never been on medication before I was hospitalized, but the staff refused to believe I had functioned normally before my admission, so they were bent on "teaching me a lesson I would never forget". I have not forgotten.

Anonymous said...

I don't know. I filled out all the forms and surveys that the hospital gave me. I wrote a formal letter that I signed with all my (multiple) respectable and pretentious degrees behind my name. I stated dates, times, specific events, names - of both exemplary staff and abusive, cruel, incompetent staff. I used formal language and carefully ran it by two friends in the mental health field. But I didn't send it, in the end, because I knew an anonymous letter would be ineffective, and I knew signing my own name would be risky.

Four years later, I was rehospitalized in the same hospital and unit. A number of the staff I named in my unsent letter were still there. Variations on a number of the events I described in my letter happened again. If I'd sent the letter, might something have happened? Perhaps. You three would argue yes. But more realistically? Had I sent the letter with my name attached -- my second stay would have been a lot worse then the first.

I would be scared to send an honest letter based on a (perhaps, apparently) realistic concern that I might end up back in that hospital - whether for depression or for appendicitis. I wouldn't want to be labeled as the crazy trouble maker, or worse. There are repercussions, and I can definitely imagine how my neutral-verging-on-unpleasant inpatient stays could have been way worse. Tacking my name on a letter like that -- probably would have found out.

Anonymous said...

Sunny CA

Anon #2 here

It was worth it to complain. It was worth it. If you choose to do this, get your medical records first, so they can't be altered after the fact.

I did go inpatient again at one of the hospitals I complained to (the private one), and was treated better than before (although at that hospital, most of my complaints were on behalf of other patients). There were subtle but positive changes, and my advance directive was carefully read, which before I had to wave it in their faces to defend myself before.

My psychiatrist and other workers want me to stay out of the hospital too (as do I!!) and so we've worked out hospitalization alternatives, like a crisis bed in a local group home, or if I call the crisis line, a psychologist will call me back, or we have mobile crisis teams here. I only need this help about once a year, but if I need it, I need it now, and my workers have figured out ways.

At the state hospital, they actually had stuff about "teaching you a lesson" right in the handbook. Well, I certainly put that in my letter, and that kind of demeaning sarcasm was removed from the handbook.

I was afraid, but I got victimized so much as a kid that I get outraged when abusers bully me or others, and then I fight like hell. I am still afraid of mental health providers, but in hindsight, I'm so glad I did it, and it was worth the fight, even if I had failed.

I recommend advanced directives. You can get a link to one at bazelon.org. I had my psychiatrist as one of my witnesses.

On another note, I think part of the put down of patients happens because most staff only work with hospital patients, and do not realize how wonderful many of their patients are when they are less ill. That's the reason I think the docs are usually better-they see both inpatient and outpatient, so they see their patients doing well, and in crisis. I think it might help if hospital staff rotated into community setting sometimes, if there were a way to do that.

rob lindeman said...

No amount of complaining will change the fact that you can't leave a psyche hospital when you want to.

Anonymous said...

Rob, that's true even if the patient signs in as a "voluntary" patient. You would think if a patient is voluntary, gets in the there and realizes this is a bad idea, they would be able to leave immediately. Not so. They can drag it out for hours sometimes even days, just because they can. The minute they start threatening if you don't sign the consent x or y is going to happen to you, get attorney involved and quick.

Dinah said...

You can't leave an airplane when you want either and they can take you to a city you didn't want to go to or hold you on a tarmac for hours.
You can be arrested for a crime you didn't commit, and even with due process, you can spend months in jail awaiting trial, or the rest of your life in prison for a crime you didn't commit. (I hate to use this as an analogy to a few days in a psych hospital, but when I think of 'due process'). They can even shoot you. You can't get off a roller coaster when you want, no matter how much of a horrible mistake you realized you made at the top of the hill.
When you sign in voluntarily, there is something on the form that says how long (in MD, up to 72 hours) they can keep you. And, if they think you're dangerous, they can then involuntarily commit. So you're right, complaining about this to the hospital won't help, contact your state legislators.

I would look upon the complaining thing differently, I think, in the case of readmission. I would think that once you've complained, they would be afraid to cross you again, because obviously you will complain and cause them hassles or job loss-- that is if the staff member is still there after your initial complaints, if those didn't get them fired, or start the documentation rolling.

In order to fire someone from almost any job, there needs to be an established paperwork trail, not just "everyone knows they're a jerk." With complaints of harsh words, this gets hard because one person's "that's abuse" is another person's "that was the kick in the butt I needed," though we all might agree that striking, pushing, or cursing at a patient are misconduct. But if people complain, one hopes a supervisor pulls someone aside and says "Look, people are complaining about how you speak to them, watch it." And if people complain about policies they feel are abusive or humiliating, then one hopes the administration at least asks, "is there another way to do this and keep people safe?"

rob lindeman said...

Dinah,

The airplane/roller coaster examples are non-sequiturs and the prison analogy is flatly untrue. I suppose the police CAN throw you in jail and shoot you without cause, but they cannot do so without penalty. Not so for psychiatric jailers.

In fact, 14th amendment rights protect legal prisoners but not those incarcerated in mental institutions. I'm aware of legions of legal aid societies poised to protect the liberty of the wrongly incarcerated. Where are the advocates for incarcerated crazy people?

You will counter that Addington gives psyche hospitals dispensation to trash civil liberties. Addington is not Gospel (oops! I let slip a religious analogy! Does that invalidate my comment?) Addington was a bad decision and should be reversed.

moviedoc said...

Rob reminds me civil commitment laws were not designed by psychiatrists, many of whom would be quite happy to let go of their role in their application. When we have been cast in the role of "suicide police" as blogger lockupdoc called us we get blamed for the misconduct of people over whom we neither want nor have control. Patients feel like tar babies, and staff in hospitals are probably as afraid of patient violence as patients are of abusive staff. Examining workers comp claimants I have seen my share of staff injured by patients. What mental health pro in their right mind would want to be treating someone like Cho at Va. Tech and be blamed for the bad outcome? Just a few weeks ago emergency workers stood by while a man killed himself (in San Francisco?), yet a psychiatrist who doesn't stop a suicide will likely lose a malpractice suit.

rob lindeman said...

"Just a few weeks ago emergency workers stood by while a man killed himself (in San Francisco?), yet a psychiatrist who doesn't stop a suicide will likely lose a malpractice suit."

Yes, San Francisco (http://www.sfexaminer.com/news/california/2011/06/alameda-officials-ok-external-review-drowning). Talk about a reason to complain! This was a horror show. And don't get me started on malpractice, another modern enormity.

Maggie said...

Dinah, I think you're underestimating the popularity of your blog.
I'm sure a great many more people are reading this comment than ever read my blog posts. Granted, sewing blogs by nature have a fairly limited audience, (particularly since a large portion of those people who might be interested consider "computer literacy" to be the ability to find the "on" button, and even by that standard many aren't computer literate!) so the comparison isn't completely equal. But the point remains that most blogs don't have many readers--I think the "average" blog has something like 17 followers.

Who would be the target audience for blogs by the "haters"?
There are already plenty of quack sites extolling the virtues of various alternative treatments (and I'm sure some that are at least somewhat legitimate,) so I doubt too many more do-this-instead-of-seeing-a-psychiatrist blogs could gain much popularity.
Just insulting psychiatry on a blog not read by psychiatrists couldn't be particularly satisfying.
If someone wants to read about all the negatives of any particular drug or class of drugs, they can go to crazymeds.us, and that site actually provides decent information and cites sources, so blogs just going on and on about how awful psych meds are would have minimal value.
Blogs about particular bad experiences might be read, but even then, such blogs would also be upsetting to their target audience of other people who have had similar experiences, so there's a limitation on readership there.

In general, a blog will be read if it presents information and/or points of view that aren't easily found elsewhere, and is particularly readable and/or entertaining. Having been up long enough to have gained attention certainly helps, too. And of course it has to continue to present new, interesting, and entertaining content on a regular basis.

Your blog opens up dialogs that really can't be found in other places, responds to feedback from your readership, evolves based on that feeback, addresses multiple points of view, asks questions of a population whose opinions are frequently ignored, and still manages some humor. All those things keep people coming back.
Do you really think that the people who comment on your blog with the singular purpose of insulting psychiatry could write a blog that would get as much readership as your comments section does? I'm sure some of your readers could, but those particular comenters? It's hard to imagine. Most people who have bones to pick with psychiatry still acknowledge its necessity. You've certainly got a slew of readers who have had bad experiences that they don't want to repeat, myself among them. But what those people want is decent psychiatry and to be treated like human beings, not the complete destruction of the field. What would anyone get out of reading a flat-out "lets abolish psychiatry" blog?

jesse said...

Maggie - Amen.

Rob - Dinah's prison analogy is apt. Due process is the issue, and psychiatric hospitalizations are very different from the way prisoners can be treated (I did not say should be treated!).

A schizophrenic man had this experience: he was walking down the median strip of a highway in his city, at night, having had a little to drink (not intoxicated, though). Was arrested. In jail asked to speak with his lawyer. No response. Started calling out "I want a lawyer" over and over. Officer came to his cell, opened it, punched him in the face. Next day he was released, but his record reflected that he had struck an officer the day before, and had to be forced back in his cell. Witnessed by another officer! And this was to a man from a family with near infinite amounts of money.

There will always be people who abuse others if they can get away with it. How does society deal with it once it is exposed, and what process for protection is present? Dinah is doing a service by letting people know how to complain.

Anonymous said...

"I'm not trying to convert the "haters"---I'm not spamming their blogs, but I am wondering what they want from us, or if they might find more satisfaction elsewhere as it seems to have distressed and intimidated some of our regular readers."

Reading your post, I was wondering to whom you are referring as "haters." In over three years of reading your blog I've read many people who are critical of psychiatry on this blog, but only a scant handful who seem to be true "anti-psychiatry" haters.

As for what people want from you when they post comments critical to psychiatry, I can only speak for myself, as someone who has posted a few such comments. So here's what it is--you three psychiatrists seem thoughtful and open to differing opinions. You also have a platform--this blog--with a readership of psychiatrists who seem similarly open-minded. So when I post criticism my hope is that you and a few other psychiatrists will listen and consider my viewpoint. You are in a position to shape the discussion within the profession of psychiatry in a way that few patients or former patients are. So perhaps by me respectfully posting criticism from a former patient's point of view, and by you and your psychiatrist readers listening and integrating any of my viewpoint that you find valid, I can begin to change how psychiatry is practiced in a tiny, minute and second-hand sort of way. And if enough patients and former patients respectfully engage enough psychiatrists then maybe, bit by bit, poco a poco, we can make things better for everyone involved.

Dinah said...

Maggie-- thank you so much...that was a very kind endorsement and a nice reminder of why we do this!

Last Anon-- "haters" is a facetious term, I hope, but refers to any repetitive and rude ("you're an idiot...etc") hounding that psychiatry is uniformly harmful and done by those with bad intentions.
Some of the dialogues seem pointless-- It's as if we can provide no correct answers (ah, my co-bloggers have lost interest in most of these discussions, so I think it's me) and neither side is budging.
If someone wants to tell us about a bad experience, and their resultant feelings, that's fine. If they want to tell us what could be better, that's fine. It's the comments that come at a more personal or pervasive level
Shrink Rap has been a huge, eye-opening, and life/career altering event for me---the commenters have certainly changed the way I think about my work over the years--- and the Shrink Rap commenters were what tuned us in for the need to have a book that explains our work. Thank you for your insights on commenters!

Sunny CA said...

Thanks, Anon #2. I will work on writing and filing a complaint while on my summer vacation and all the other ideas you have. My psychiatrist thinks I should write a book about my experiences. I think that would be most effective in reaching a wide audience if I could do it and it were any good. The whole episode is so painful, though, I can hardly bear the thought.

Roy said...

Maggie, thank you for your perspective. (hmm, maybe another guest blogger?)

Anonymous said...

Dosed in juvie jail: Troubled doctors hired to treat kids in state custody

http://www.palmbeachpost.com/news/state/dosed-in-juvie-jail-troubled-doctors-hired-to-1549240.html

Tragic how doctors (it appears especially Psychiatrist) will tell people to file a complaints, go through the proper channels, & you'll get action.. blah blah blah..

Yet the above article tells you how effective medicine is at monitoring even their most blatant offenders...

I'm sure those kids being drugged without consent in the juvenile justice system by felon doctors really had their complaints taken seriously; talk about playing apologist for criminal injustices!

Dinah said...

Sunny CA: I will buy your book.

The last anon post is a prime example of a "hater"...I put up the Please Complain post out of respect for our readers who've had awful experiences, and to suggest that one do something more powerful --towards effecting change, preventing it from happening again, gaining closure, helping others to not go through this, and to help improve a clearly troubled system which needs guidance in it's evolution--I never promised it would work, I just know how systems work and that times have changed towards requiring that they at least acknowledge complaints, and that repeated complaints may nudge an otherwise stalled situation. If nothing else, the act of doing something (perhaps even just writing about it in the comment of Shrink Rap), empowers the victim, which I believe is a good thing. I'd like to empower them more. In the case where "everyone knows" a staff member is abusive, even the staff will be happy to have documented complaints about someone (though they may not know).

To come in with "Tragic how doctors (it appears especially Psychiatrist) will tell people to file a complaints, go through the proper channels, & you'll get action.. blah blah blah.." implies that it's hopeless, and that it's wrong of psychiatrists to encourage anyone to complain. Would it be better if psychiatrist said "just take it."??? That's not me, you need another blog. You don't like the system, work towards changing it, but telling people it's hopeless does no one any good.

jesse said...

Read the article that is cited by Anon above. After beginning with innuendo and imprecision, the reporter finally describes the case at hand. The doctor mentioned, who is on probation for what he had done in dishonest billing (no small thing), was assigned to a jail by the company that employs him as a temporary replacement for a doctor who was away.

rob lindeman said...

Troubling that the author threw all these docs under the bus, including the gentleman who's only "offense" was being sued for malpractice (no indication of outcome in that case).

He means, I think, to impugn the Florida DJJ, particularly with regard to their alleged practice of inappropriate or involuntary medication of children. He over-reached.

rob lindeman said...

sorry... Dr. McClure's case settled.

word verification "hectivar", a vaccine from Aventis seeking approval from the FDA, covering Diphtheria, Tetanus, Pertusis, Hib, pneumococcus, Hep B, and Varicella

moviedoc said...

Here's some evidence those complaints can have some impact: http://ht.ly/5nL4j

Dinah said...

Moviedoc:
Thank you, I rest my case.

rob lindeman said...

Rockin' good news, moviedoc. It's difficult to believe thisht goes on in the 21st century. Next mountain to climb; giving psyche-ward inmates the same right as medical bed patients: to leave the hospital when they want to.

wv = verboo. One of the lesser-known parts of speechoo

jesse said...

Rob has regularly raised this point so could someone with inpatient knowledge like Roy address it: "giving psyche-ward inmates the same right as medical bed patients: to leave the hospital when they want to."

I recall from my hospital days (a long time ago) that prospective inpatients were asked to sign a "72-hour notice," essentially agreeing to give that much notice if they wished to leave. This was for voluntary patients. My understanding of it was that it was not binding - if they wanted to leave they could be retained for that length of time only if they were assessed to be an imminent danger to themselves or others. So for those patients who were not an imminent danger, if they wished to leave before 72 hours they were breaking that agreement but they could not be held.

Did I understand that correctly? What would be the reason for not allowing a voluntary patient to leave whenever he wants?

rob lindeman said...

Jesse,

And as I've argued further, the ability to determine "imminent danger" is a skill available only to clarivoyants. As it is a skill unavailable to us mortals, we ought not to pretend we have it. Neither should we allow the State to insist that we have it. Rather, we should tell the State boldly and clearly that we cannot predict the future and we will refuse to do so.

moviedoc said...

Rob, as I'm sure you know the plaintiff in a wrongful death case will allow that your crystal ball doesn't work, but the expert will say you have a duty to assess risk and act accordingly. (Sorry if I'm getting you started on malpractice.)

So Jess, the reason psych patients can't come an go at will, even when voluntary, is the hospital will be held liable for the outcome.

rob lindeman said...

...even if they sign out AMA?

wv = foxisti. Not gonna define it. nicht fur der kinder!

moviedoc said...

If I were a voluntary patient I would say, "I'm leaving. I don't have to sign your stupid AMA form, and you have no authority to force me to sign it before allowing me to leave. Unlock the door or I'll have you charged with kidnapping. Or something."

rob lindeman said...

Now That's what I'm talkin' about!

wv = inessess. A female iness

jesse said...

Moviedoc, that is exactly what I thought years ago, that it would be kidnapping (or some such serious thing) to hold anyone against his will, unless that person was assessed to be a danger to himself or others.

Rob, we don't have crystal balls but it is our duty to assess it. "Imminent" is a tough standard. Seems like the minimum it should be. You are arguing (many times) that even if the staff saw the patient throwing a rope over a door and making a noose, they should let him do as he wishes. Free will. I don't understand at all why you would argue such a thing.

rob lindeman said...

Jesse:

http://www.thefreemanonline.org/columns/the-therapeutic-state/the-shame-of-medicine-is-suicide-legal/

money quote:

"If suicide be deemed a problem, it is a moral and political problem, not a disease in need of diagnosis, prevention, punishment, or treatment. Managing suicide as if it were a medical problem will succeed only in debasing medicine and corrupting the law. Pretending to be the pride of medicine, psychiatry is its shame."

Anonymous said...

Rob,

If the potential suicidee were your own child, would your opinions on the matter be any different, or would you hold to your "leave them alone" view?

Anonymous said...

"If I were a voluntary patient I would say, "I'm leaving. I don't have to sign your stupid AMA form, and you have no authority to force me to sign it before allowing me to leave. Unlock the door or I'll have you charged with kidnapping. Or something."

Hmm, wouldn't that cause someone to be hauled to the seclusion room and given a shot of vitamin "H"?

That would be like telling a policemen off even when you are in the right which people advise is not a good idea.

Thankfully, I have never been in this situation but your advice doesn't seem wise. It would be great to hear comments from people who sadly have had first hand experience with this.

AA

Anonymous said...

"If I were a voluntary patient I would say, "I'm leaving. I don't have to sign your stupid AMA form, and you have no authority to force me to sign it before allowing me to leave. Unlock the door or I'll have you charged with kidnapping. Or something."

If only that would work. I told the nurse I want to leave now (keep in mind I signed in "voluntarily" under threat that if I didn't they would sign me in) and the nurse's response was, "You're not going anywhere." Needless to say, I got very upset which is actually a very sane and rational reaction to a nurse being a jerk. I soon learned voluntary patients are competent to say yes to treatment but not competent to say no to treatment. Weird.

Eventually the nurse got around to notifying the physician. The psychiatrist on call had never even met me, not once. She said I needed to wait until the next day and she would see me and we could talk then. I relayed to the nurse who was on the phone with the doctor that "I am not a threat to myself or others and this doctor cannot say I'm a danger if she's never even met me. And I want to leave now or call an attorney I know." At that point the doctor finally relented and "allowed" me to be discharged AMA.

But, the nurse wasn't done with me yet. She would not unlock the door until I signed whatever documents she put in front of me. I tried Moviedoc's suggestion where I said I wouldn't sign anything just let me out now, but she refused and she had the keys. So, I just wrote on all the forms, "I am signing this form because Nurse so and so told me that my leaving is contigent upon my signing this form. I do not agree with what I'm signing." I did eventually leave AMA but they gave me absolute hell about it, and they dragged it out for hours.

Voluntary is far from voluntary if you ask to leave. If you think that you can request to leave and people will begin calmly preparing the discharge paperwork, think again.

Leslie

moviedoc said...

Leslie, I'm sure many psych hospital staff will use delaying tactics, but what happened to you sounds like it went too far. I wonder whether the ACLU might help in such situations.

Anonymous said...

Moviedoc, that's a good question not sure if the ACLU gets involved in situations like that. Advocacy Inc in Texas (Now called Disability Rights) is a great organization, and I have received assistance from them in the past. They have attorneys who are passionate about patient rights, and they get results. One of their priorities is assisting patients in their right to refuse medication and unwanted medical treatment. They are non profit, and I can't say enough good things about them.

People may not have listened to my voice, but they listened to Advocacy Inc's. I hope patients in others states have access to an organization like that.

Leslie

Anonymous said...

My experiences were the same as Leslie's. One doc told me he always puts holds on bipolar patients who are inpatient for any reason, because they often sign out AMA otherwise. He laughed at me when I told him I was distressed being held captive, when I had come in voluntarily and had not attempted to leave.

rob lindeman said...

I'm afraid the ACLU is not the friend of the incarcerated mental patient. Their defense of liberty is selective historically and this is egregiously so with respect to persons in psyche hospitals. This has been well documented by Szasz and others.

The Last Psychotic said...

I was voluntary, I did the same thing. So they said they would commit me. Then I noticed all the patients were getting Haldol shots before court. One person won his commitment hearing, so the appealed it, and increased his Haldol.

IN the state system you'll have to be a bit more savvy than "i'm leaving". "I'm volentary" I'm sure you already know this, but I'm speaking for those of us who enter a hospital in Arivan withdrawal, And finally realize what all the fuss is about :)

The Last Psychotic said...

Ron Linderman, that's what I'm talking about! You have to understand the system. I can not complain on the behalf of others. I just knew to keep my mouth shut, tell my lawyer I do not want to go to court (they don't need me shuffling on Haldol) then call every person I know to call the hospital and say "we will fight if this continues" .... Understanding Complaint Filing is fine. But understanding how to save your skin? I'll take the latter info

Anonymous said...

Does anyone honestly think that complaining to a hospital will stop human rights abuses that start well before the hospital receives the patient and consists of not only the staff lying about the patient in order to get insurance reimbursement for a bogus IC and will this alleviate the human rights abuses of the process that states once accused of mental illness all protections procedurally afforded accused criminala are removed? Of course not. Won't remove the despicable fraud committed by Psychiatrists and hospital staff on a routine basis. Whistleblower laws don't accomplish this either. There's too much $$$ to provide an incentive to shine sunlight--and whilst those in the national news are crying for video on police officers, what we need is video on mental wards and inside mental hospitals because the entire thing operates in complete secrecy and as a result, folks don't realize what goes on. And shrinks will not wish to allow such sunshine to be shone. Ever.