Thursday, December 17, 2009

At least they are reading my column...

I opened up Wednesday's Davis Enterprise to discover the entire letters to the editor section covered in letters dedicated to me. They were about my recent column on the mentally ill; and they were all very similar to each other and to a series of anti-Rifkin letters which The Enterprise published following my first column regarding how we treat the severely mentally ill.

The first epistle was posited by three authors, Guille Libresco, Marilyn Moyle and Leslie Carroll. I don't know any of the trio, but did some searching to see where they come from. Guille Libresco is a local "psychotherapist" who is associated with a leftist-peace group. Marilyn Moyle and Leslie Carroll are associated with the Yolo County chapter of NAMI. The local website says, "NAMI strives to reduce stigma and ignorance of psychiatric disorders and to help eliminate discrimination and restrictions accessing essential treatments and life supports such as employment, housing, and health insurance."

The letter they wrote says I am dangerous and that I am trying to further discrimination against the mentally ill.

Here is how they begin:
Rich Rifkin's recent Enterprise column needs clarification. We agree that the mentally ill need our help, but Rifkin's attitude is potentially more dangerous to society than the individuals and tragedies he mentions in the article.

Rifkin implies that most mentally ill people are not capable of 'running their own lives.' We know this is not true.

This is an unfair characterization of my column, which focused on people who are insane and therefore not capable of running their own lives. I never discussed anyone who has mild depression or any other minor disorders. I wrote, "Until those of us who are sane take full responsibility for people who are insane and accept the fact that they cannot run their own lives, we will have more and more tragedies like the one at Bellissimo Pizza."
Many people are able to learn how to manage their chronic illness, just as diabetics or other people with chronic illnesses can.

Nothing I suggest would harm the interests of those who can manage their problems. However, many cannot manage; or think they can manage and it turns out they were wrong.

The analogy with diabetes is completely off for someone who is suffering from severe schizophrenia. A diabetic can manage his disease because his mind is not his problem. The severe schizophrenic cannot always be expected to make rational decisions about his own care, because his disease, his chemical imbalance is in his brain. I wonder if these writers have ever had experience with a family member who suffers from a severe mental disorder like schizophrenia? Apparently not. Anyone who has -- such as me -- knows how completely wrong these writers are. Tragically wrong.
For those who are more seriously disabled, we need to provide support that from the beginning gives individuals hope for a meaningful life.

Providing support and guidance is what I would like to see for those who need it. But it goes beyond that. When someone has a debilitating mental illness, he CANNOT be relied on to make proper decisions about his psychiatric health. To say so, as these three do, is crazy. A person who has such a problem normally can be helped by psychotropic medications. But if the patient "chooses" to go off his meds, his mental health will decline and his life and the lives of his family will deteriorate severely. That is why the family needs to have the authority, backed up by the law, to make sure their family member is treated, no matter what the patient "wants."
The mentally ill are human beings with the same rights and privileges as the rest of us.

Of course they are human beings and deserve our compassion. The reason I care so much about this issue is because I am very sympathetic to people who have been victimized by these terrible disorders. I abhor our society for its neglect of the mentally ill who are locked in prison cells and living on the streets.

Someone with severe mental illness SHOULD NOT have the same rights and privileges to run his own life. It's funny that these folks think I am dangerous. Their attitude is really, terribly dangerous -- both for the severely mentally ill and for those around them.
There will always be extreme cases that require more intervention, and we need to find new and better ways to solve these old problems.

The better way to solve these problems is for those of us who are sane to take charge of their lives. Every patient who is diagnosed by a medical doctor as having a severe psychiatric disease needs to have a guardian -- normally a family member -- who can serve in loco parentis. The guardian needs the legal authority to make his ward take his medications, if meds are believed to be salutary by psychiatrists. And if medications don't work, place them in a locked mental hospital until their symptoms are manageable.
Simply locking people up will not solve the problem and is neither curative nor humane.

I have never called for locking people up willy-nilly. The only people who need to be treated in a locked hospital are those who are suffering terrible symptoms, those whose cases are not being managed. In most cases, the hospitalizations would be short. But they would not be released on their own. They need to be managed if they have a severe disease.

The second letter to the editor was by Roger M. Pehlke. He is apparently on the Board of Directors at Yolo-NAMI. Mr. Pehlke writes:
Rich Rifkin's Dec. 9 article, 'The mentally ill need our help,' was ironically titled given that what he wrote is so hurtful.

His column was not original. He said the same things in a May 2, 2007, Enterprise article, 'Common sense for the mentally ill.' At that time, he lamented the 'deinstitutionalization of the 1960s, when we emptied out and ultimately closed most of our insane asylums.' He argued that a mentally ill person 'shouldn't be treated like a regular adult.'

It is nice to see he keeps copies of my old columns. He continues:
Now, in last week's column, he's at it again, blaming 'successful lawsuits decades ago by the ACLU that 'freed' the mentally ill from psychiatric hospitals.' He cites a recent violent stabbing in San Francisco and says, 'I've scoured news accounts of this tragedy, looking for reports of 'mental illness' and have not found any. However, the second I read about this attack I was sure what was going on.'

That is accurate.
Rifkin's confidence in identifying mentally ill is misplaced. He goes on to suggest 'prophylactic action' be taken with the mentally ill and, while it is unclear what he means by this, the implications are disturbing. This is an unfortunate and ignorant refrain.

I am interested to know what Mr. Pehlke thinks is disturbing, unfortunate and ignorant.
I wrote a letter to the editor in 2007 about Rifkin's first article. My response here is not original either because I feel the same.

It is clear Mr. Pehlke feels the same.
I said, 'You choose demeaning phrases and inappropriately use words interchangeably: Mad, insane, psychotic, lunatic and mentally ill.

Because of the outcry by people like Pehlke the last time I discussed this issue, I purposefully used no politically incorrect terms in this column. Thus, for him to dredge up words he thinks are hurtful from a 2007 column to attack a 2009 column is a diversion.
You imply all those with mental illness are 'madmen' who are therefore violent, dangerous and ought to be locked up.

I didn't use the term "all" or imply that "all those with mental illness" are dangerous or violent or ought to be locked up. Rather, I have discussed people who have severe diseases -- specifically people who are violent -- and cannot manage their own lives. It is shocking that Mr. Pehlke is so irresponsible with his characterization of my views.
In short, writing like yours fuels the stigma surrounding mental illness that mental health professionals have been trying to curtail for decades.

Pehlke does NOT speak for all mental health professionals. I don't know of any polls of psychiatrists, but I suspect the vast majority share my views about changing our policies with regard to people with severe mental illness. (I get the sense that Mr. Pehlke speaks instead for most far less educated, far more politicized "psychotherapists" who look at the world through a dimmer lens than medical doctors do.) I am fairly certain most psychiatrists believe our civil libertarian approach is Crazy.

The Treatment Advocacy Center's co-founder contacted me, for example, and said as much. I highly recommend that Mr. Pehlke read one of the TAC books: The Insanity Offense (2008) by E. Fuller Torrey, M.D.; or Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill (1990) by Rael Jean Isaac and Virginia C. Armat.
I suggested Rifkin was essentially 'advocating taking away the rights of the mentally ill that you and I enjoy.' I pointed out that prejudice like this has no place in our local newspaper. I repeat.

Pehlke is right. I do advocate taking away the civil liberties of individuals who have severe mental illness. The reason I believe that is the right course is because I know from the experience of a family member that someone who has severe psychosis cannot make rational decisions for himself. People in that state often "choose" to go off of their medications; and the results are very often tragic.
Indeed, people with mental illness are more likely to be victims than perpetrators of violence.

I agree. Often people with severe psychosis end up homeless and derelict. If we helped them out and forced them into a treatment program and saw it as a societal responsibility and not the individual's responsibility to care for these victims, we would not have a large population of homeless mentally ill victims. What Mr. Pehlke advocates, a civil libertarian approach to these unfortunate souls, is the reason they are victims.
To persist in stigmatizing this group of people by highlighting the worst stories and stereotyping them as Rifkin does is madness.

The folks I am talking about have lost touch with reality. They have severe diseases and they need treatment. To call that "stigmatizing" is stupid.

The final letter was by Derrick Wydick. He attacked me in a 2007 letter on this topic, as well. Wydick is a local "psychotherapist". He writes:
For the second time, Rich Rifkin has produced a column that paints people with mental illness as some kind of ticking time bomb.

Untrue. I painted a picture of some people with untreated, perhaps even undiagnosed severe mental disorders as "a ticking time bomb." I made no reference to people with minor problems. The fact that Wydick and the other "psychotherapists" infer that I am talking about people with social anxiety, for example, shows me that they have closed minds, that they are blinded by a strange hypersensitivity.
His idea that the mentally ill need 'prophylactic action' suggests a broad and uniform solution reminiscent of the 'lock 'em up' approach that our society used in the past.

I do want our society to go back to an approach used in the past. Advances in pharmaceuticals have made it so we don't need to lock up most people suffering from very severe mental health issues for very long. The drugs are for many people salutary. On occasion, when someone is very sick and is not taking drugs or the drugs are not working for him, lock-up and forced treatment -- the old approach -- is the best approach.
The truth is that the issues of mental health are extremely complex. Even to use the label 'the mentally ill' ignores the fact that an amazingly large percentage of our population deals with varying degrees of illness at various times, with various treatments and interventions.

I have never written about people with minor issues. I have only discussed people who are severely psychotic. The kind of people who cannot manage their own lives.
This is not a one-solution-fixes-all disease.

Agreed. My solution is not for all and it is not for the disease. I am not a psychiatrist. My solution is for the law and only for those who are diagnosed by psychiatrists as having a severe form of mental illness.
Rifkin's article offers no reasonable solutions ...

That's not true. I offer the solution to the legal problem as I see it. Wydick, oddly given his accusation, offers no solution. What would he do for someone living on the streets who is hearing voices but does not "want" to take psychotropic meds?
... but paints a dramatic image of the crazed, dangerous stranger waiting to kill us.

Yes, that crazed, dangerous stranger has a serious disease and is not responsible for his behavior. Yet, if we continue with a civil libertarian approach, that person harms himself or others. Most of the time, if someone else is harmed, it is a member of his own family.
This is an irresponsible use of his platform. Professionals who work with people who are mentally ill will be the first to say that the system needs fixing - but without promoting a fear of mentally ill people. Cut it out, please.

This is an irresponsible letter, Mr. Wydick, which tries to portray me as a man of prejudice who hates the mentally ill and wants others to hate them as well. The truth is I want the severely mentally ill helped. And your civil libertarian approach is harming them. That far left ideology needs to be cut out.

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