Good morning, I've missed you. Blogging has not been the same lately and I've let some great topics go by.
Let me tell you what I've been up to.
There have been so many things to write about lately, and I will tell you that my brain is just bursting with all the work Clink and I are doing on our new book: Committed: The Battle Over Forced Psychiatric Care. ClinkShrink is doing some of the background stuff, she's being (as always) the forensic expert, she's sweeping up after my grammatical carelessness, and correcting the forensically idiotic things I say. She's focusing on legal cases and a chapter on restraint and seclusion. I'm taking the lead on writing some of the other chapters, and her description of this is that it's like trying to keep up with a hamster in an exercise wheel. That hamster would be me, and I'm having no more luck keeping up with my own thoughts then Clink is, but every now and again, I jump off and take stock. I started with this very funny idea that I would work on one chapter at a time, and that each chapter might take a month. Okay, so some chapters are taking a very long time to get the parties lined up for, and I'm working on 5-7 chapters at once. These days, I'm as much journalist as shrink.
Would you like to hear about the book? Don't hold your breath on being able to read it anytime soon, but it's making progress and some days the progress is much faster than I expected.
The first two chapters are from the perspectives of patients -- wonderful, intelligent, articulate, people -- one of whom found that involuntary hospitalization was traumatizing to her and left feeling her injured, another of whom found it help keep her life from disintegrating. I purposely chose people who had good insight and believable stories -- I didn't want the person who felt her care was unkind to be dismissed; I thought her complaints were valid and warranted a critical look. Both patients allowed me to access their medical records, and to interview their doctors and family members, so I felt like I got a good sense of what went on.
Since the book is "The Battle Over Forced Psychiatric Care," the third chapter is called The Battleground. This is the most difficult chapter to write to date, just because it's taking time to get together with everyone. So far, I've interviewed E. Fuller Torrey of the Treatment Advocacy Center, Ron Honberg of National NAMI, Ira Burnim of The David L. Bazelon Center for Mental Health Law, and an anonymous gentleman from the Church of Scientology in New York City. I have times set up later this month with Paul Summergrad, the President of the American Psychiatric Association, and Daniel Fisher of the National Empowerment Center (a Recovery Group), and I have been working hard with MindFreedom (a survivor organization) to find a time for a conference call. Some other great people have chimed in as well: Xavier Amador, Solomon Snyder, and Paul Appelbaum has been helpful every step of the way.
Chapter 4 is currently on Civil Rights, and it's taken from a news story our readers pointed me to about a woman in Vermont who was held in a hospital for 5 and a half weeks with no hearing. The case is the springboard for discussion, so I've talked with a wonderful legal aide attorney in Vermont as well as the president of the Vermont Psychiatric Society. As in many of our chapters, the laws there are changing as we write and the hamster keeps trying to run faster.
Chapter 5 is on law enforcement and how people enter the mental health system through police interventions. I focused here on Crisis Intervention Teams, and Officer Scott Davis has been a gem to let me ride along with him and share his world with me, and Judge Steve Leifman in Florida has given some wonderful insights and statistics.
Chapter 6 is on the inpatient unit, and the chairman of psychiatry, Dr. Ray DePaulo was truly my hero for allowing me to shadow him on the unit. Steve Sharfstein, a former APA president and CEO of Sheppard Pratt Hospital talked with me about how his institution works, Dr. Bruce Hershfield a former a superintendent of Springfield State Hospital, shared his insights with me, and I had a present-day tour of the state hospital, which now houses 230 people, down from a high over 3,000.
In short, lots of lunches, and lots of insights from really brilliant people.
Clink is working on Chapter 6: restraint and seclusion, and the plan down the line is to look at the legal system through the public defender's office, outpatient commitment, violence and mental illness, guns and mental illness, maybe forced ECT, maybe indefinite confinement of sex offenders (we'll see), and a little more focus on both families and legislation. Jeff Swanson at Duke has provided invaluable guidance, and I've grown very fond of these folks at Penn from The Scattergood Program for the Applied Ethics of Behavioral Healthcare -- and I'm looking forward to spending more time with Candice Player, and John Monahan, once I finish the current chapters and more forward. For my brief blog post, there are many many people missing, but I wanted to give some quick shout outs and just an update on the quite nature of Shrink Rap these days.
What do you think? Obviously our blog readers have been instrumental in shaping in our writing. But if you're looking for a book to either extoll the virtues of forced care or to completely vilify it, you may need to hold back. These are complicated issues and our goal is to talk a close look at involuntary treatment, figure out when it can be made kinder and gentler, and figure out if or where it fits in with psychiatry and/or the prevention of violence.