The Institute of Medicine Best Care at Lower Cost Report

An Institute of Medicine report released Thursday September 6, 2012, "is an expansive indictment of American healthcare" according to Marshall Allen, ProPublica reporter.

"The “Best Care at Lower Cost” report says that waste, fraud and other inefficiencies are costing an estimated $765 billion a year – an amount greater than the entire budget of the Department of Defense. The report also said too many patients are suffering harm, and it’s now recognized that infections and complications that were once considered routine can now be prevented with an evidence-based approach to medicine." Marshall Allen, via ProPublica Patient Harm Community on facebook.

via Institute of Medicine of the National Academies:

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America Report Released:September 6, 2012 

Type:Consensus Report

Topics:Quality and Patient Safety, Health Services, Coverage, and Access

Activity:The Learning Health Care System in America

Board:Executive Office

"America's health care system has become far too complex and costly to continue business as usual. Pervasive inefficiencies, an inability to manage a rapidly deepening clinical knowledge base, and a reward system poorly focused on key patient needs, all hinder improvements in the safety and quality of care and threaten the nation's economic stability and global competitiveness. Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous "learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.

"In the face of these realities, the IOM convened the Committee on the Learning Health Care System in America to explore these central challenges to health care today. The product of the committee’s deliberations, Best Care at Lower Cost, identifies three major imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential." more here 

hat tip SSLoenatik on twitter Starship Loenatik blog

Marshall Allen on twitter

ProPublica.org Journalism in the Public Interest ProPublica on twitter

Medicine Snake at All-free-download.com

Friday Funny: I Got Butter, Dead Fish and Girls That Piss Me Off

MindFreedom i got better links and igotbetter.org

Residents of Lyme Regis, Dorset, are no longer lawfully permitted to slap each other with a 5-foot-long conger eel. It’s officially known as ‘conger-cuddling’ or ‘doing the conger’, and the game — which involves knocking opponents off of a platform by swinging the dead fish at them — was both wildly popular in the community and a source of funding for a local lifeboat charity for 32 years. Despite its long history and general appeal, ‘doing the conger’ was banned in 2006 after an animal rights group complained that the game was disrespectful to dead animals.

Read the full text at: mental_floss "Where Knowledge Junkies Get Their Fix"

(profanity warning)

Jenna Marbles on youtube

A special thank you to my cousin Damien for sharing my optimism! 

The Stigma of a Psychiatric Diagnosis is Real

The word psyche comes from the ancient Greek for soul or butterfly.

Stigma: 

a mark of disgrace associated with a particular circumstance, quality, or person. "the stigma of mental disorder"
originally published 4-25-2012 updated 9-7-2012 and 9-9-2013
The bio-disease model of psychiatry relies on two major errors of attribution.  The first is believing a patient's symptoms are in and of themselves evidence of disease or defect; absent significant empirically validated evidence to support the hypothesis, it is only a belief; the idea lacks scientific/medical validity. The second error of attribution is actually a strange claim; specifically, that a person who does not accept a psychiatric diagnosis and believe the diagnosis is evidence the person has a "neuro-biological disease," a "chemical imbalance," or "genetic defect," is refusing treatment because they have anosognosia, i.e. lacks insight. Some actually seem to believe that a person once diagnosed has no right or even an ability to communicate their treatment preferences or their treatment experiences accurately; this includes any adverse effects, benefits (or lack thereof) of psychiatric treatment.

No one has perfect insight---what utterly angers me is that the belief that a disease exists is without any valid empirical evidence; yet it has been used as a justification for manipulating the truth, coercing patients and family members, and worse, used to dismiss entirely the claims of distress and actual harm caused to countless patient's who were, and are being victimized!  There can be no doubt that psychiatric treatment has in fact traumatized countless patients.  I can attest that it was traumatic to me as a parent to be prevented from protecting my own child. My son was victimized and repeatedly traumatized by the professionals who, he has said, "had no compassion for me mom, and they were supposed to be helping me." Even if there were a disease underlying psychiatric diagnoses, how could that possibly be a justification for the cruel, dishonest, and manipulative nature of using coercion and forceful treatment?  How could a claim that a person has a disease which has not been identified, and for which no evidence that complies with the Rules of Evidence standard is offered be used in Courts of Law as"evidence" sufficient to deprive a person of their liberty and/or force a person to take teratogenic drugs and/or be given electro shock  as a "treatment?"

There are three obvious reasons for patient noncompliance besides the claim that people, 'don't know they're sick' because they have anosognosia:  One is the actual effects of the drugs, including the very real neurological, metabolic and cognitive dysfunction which the drugs cause.  The second is the inefficacy of the drugs for the symptoms they are used for.  The third is the manner in which they are treated---I can assure you, a diagnosis does not mean a person is unable to discern whether or not they are being respected and whether they are treated with compassion or coercion.  It is classic bullying behavior to rely on an abuse of power and authority and the use of intimidation and coercion to control others and gain treatment compliance. The psychiatrists and mental health practitioners who use these social control strategies act Under Color of Law, using the Courts and the Police to force "psychiatric treatment" on unwilling patients to enforce "treatment compliance."

As the 'authority' in the diagnosis and treatment of mental illnesses, it is psychiatry itself that has ensured that people given a psychiatric diagnosis are stigmatized and marginalized, intentionally or not.  It begins with what is claimed about the nature of mental illnesses, what is told to the world, the patients, and their families about a psychiatric diagnoses.  Once given a diagnosis of schizophrenia, treatment is done 'to' not 'for' the patient's benefit...Compliance with psychiatric treatment is the primary focus; 'psycho-education' is the 'Evidence-Based' practice which teaches patients to be compliant, and teaches family members how to coerce their loved one, "for their own good" to become "treatment compliant." The primary measure or end-point used to differentiate 'successful treatment' vs 'unsuccessful treatment' of schizophrenia in the bio-disease paradigm, is treatment compliance.  Whether the treatment actually is of benefit or not, and whether the patient experiences an adverse event, even a life-threatening one; becomes disabled or there is a fatal outcome, is not as important as maintaining a patient's compliance with psychiatric treatment.

Psychiatric patients can be marginalized, emotionally abandoned and discriminated against by their own family members who believe the "professionals." The trust of family members is betrayed when professionals then teach family members to manipulate, coerce and control their loved one in distress "for their own good" instead of seeking to understand, to support, to protect and to assist a loved one who is experiencing emotional and neuro-cognitive difficulties. The "professionals" claim these tactics are justified, is predicated by the notion that the person in fact has a neuro-biological disease. The primary purpose served by the manipulation and coercion is to gain control of the patient. This is all done in an attempt to teach the patient how very important it is to comply with treatment, and take the drugs, it is done to maintain treatment compliance, regardless of the effects of the treatment on the patient.  In this way, people who are diagnosed are then effectively invalidated by their "mental health treatment providers and their families, "for their own good."

A person who experiences being repeatedly invalidated, is traumatized by the experience. Instead of learning to care for and about themselves more effectively; they learn to invalidate themselves, and this is how a person learns to self-stigmatize. They come to believe they have a "disease," and accept that they are less that worthy of the same respect others who are not "diseased" can take for granted. What they feel, and what they think is often reduced to simply being a symptom, a manifestation of their "disease;" instead of simply being evidence of their humanity.  Practitioners who believe in the bio-disease paradigm will claim a patient "lacks insight" if a person labeled with a diagnosis refuses to accept the diagnosis and/or refuses psychiatric treatment, this effectively serves to prevent the person from escaping the psychiatric system of coercive treatment. Are we so naive as to believe that the only reason patients with a diagnosis of schizophrenia do not want to take neuroleptic drugs that cause a myriad of iatrogenic diseases and potentially disabling and fatal impairments is due to the fact that the people with a diagnosis of schizophrenia "lack  insight?"  I'd be willing to bet that noncompliance is more often than not due to the effects of teratogenic drugs which in fact DO NOT WORK, i.e. do not extinguish the symptoms they are supposed to treat, for the vast majority of people who have a diagnosis of schizophrenia.

Psychiatric survivors have for decades been telling about being abused and the harm that they have endured as a result of being BULLIED by psychiatry.  Some have been disabled; and were never informed of the risks involved with the treatment.  People who are diagnosed and treated who claim the drugs do not help them; or claim the drugs make them sick, lethargic and unable to function ironically, are labeled as oppositional defiant, and paranoid; what is not so ironic, these people are often labeled as being overly suspicious and disrespectful of authority.

My son, continues to pay a steep price for being victimized by psychiatric bullies.  I know I was bullied by my son's psychiatrists who were aided and abetted by public servants all of whom ignored the law and the ethical codes of conduct for their chosen professions.  Psychiatrists who bully their patients are unethical and in reality, criminals.  Psychiatric practice relies on subverting the truth about the nature of psychiatric diagnoses, that are "validated" by a quasi-democratic process, not a scientific one.  Diagnoses are conferred, not made through conducting a scientific investigation; but conferred absent reliable, replicable, empirically validated, i.e. scientific, diagnostic criteria. Psychiatry relies on consensus-based  diagnostic criteria, and a consensus based practice parameters and standard practices; in every other branch of medicine, the diagnostic criteria, practice parameters and standard practices used are derived from empirical data, and supported by subjective opinions.  Psychiatry is a long way from being 'Evidence-Based.'

Doctors who determine who is "sick" and in "need of medical treatment" by consensus, and then use toxic drugs to "treat" patients/victims, but fail to Inform or gain Consent for teratogenic "treatment" are conducting experiments on Humans; not providing ethical medical treatment with the primary focus on the best interests of the patient. The scientific Evidence Base does not support neuroleptic drugs as a 'first line' treatment for schizophrenia; nonetheless, it is public policy, and can even be compelled by a Court Order, in effect, being a compliant patient, is the Law in most states.  Being "legal" does not in fact make it valid medical treatment, it does not make the treatment therapeutic; and it does not make it  an ethical medical treatment. What it does is make the stigma of a psychiatric diagnosis horrifyingly real.  A psychiatric diagnosis may in fact lead to a person being sentenced to compulsive psychiatric treatment that can be fatal; it can literally be a death sentence. 

Having a medical license does not make bullying of vulnerable people a valid or ethical way to provide medical treatment. Medicine is based on science---Attitudes, actions and behaviors that in any other context would be recognized as abusive, coercive and manipulative are not magically transformed simply because college educated, licensed medical professionals are exhibiting the behaviors.  The nature of subterfuge, manipulation and coercion are still what they are: dishonest methods used in an abuse of power to unfairly gain control over others.  Relying on the respect historically given to medical experts, psychiatry lobbied for and gained the legal authority to Court Order individuals to their potentially fatal treatments.  Obviously, there is no ethical duty or legal obligation to comply with the Rules of Evidence when obtaining Court Orders for Involuntary Treatment---That would require empirical evidence of the illusory "disease." Opinions, even educated ones, are not facts; and a consensus of educated opinions is evidence only of agreement. 

Let's be clear why the stigma is real: the stigma is the psychiatric diagnosis itself.  Based on the opinions of a relative (albeit educated) few, a person given a psychiatric diagnosis can lose the right to choose where they live, and whether to take dangerous teratogenic drugs or not; which is a significant, if not total loss of autonomy and can happen automatically--no "due process."  A diagnosed person can be confined in a locked psychiatric ward under Court Order without their Civil Rights being preserved, protected or defended in the Court procedure which places them in a locked facility. Standard Court Procedures are not followed in this process in which a loss of liberty results. Many naturally also experience a loss of hope as a natural consequence of a diagnosis; especially when the diagnosis is accompanied by a fraudulent claim meant to coerce the person into being treatment compliant. The claim that psychiatric diagnosis is a disease, a disease which can never be cured; but can only be "effectively treated" with drugs people are told are "safe and effective" but are in fact teratogenic drugs which cause diseases that disable and kill a statistically significant number of psychiatric patients of all ages around the globe..   

Invalidating, abusive, discriminatory treatment experienced by people with a psychiatric diagnosis of schizophrenia is a natural consequence of the manner in which the bio-disease paradigm has been marketed through education and advocacy campaigns; the misinformation spread through "patient advocacy groups."  But just as important is the complete failure of an entire medical specialty to ethically conduct psychiatric research and physician education---The APA membership  has not censured the offenders, one is President-elect of the APA.  Psychiatry has not retracted any discredited, fraudulent 'work product' from 'professional peer-reviewed' journals.  Incredibly, this work is retained as a resource in what has in fact become, psychiatry's pseudo-science "Evidence Base"...and some researcher's whose work has been discredited, are now "Scientific Advisers" and Board Members of 'Patient Advocacy Groups'  

STIGMA is not something than can be 'busted' or educated out of human society.  The Stigma is the psychiatric diagnosis itself.  A diagnosis stigmatizes automatically, because once a diagnosis is attached to a person, the free exercise of their autonomy is questioned, and their legal and political power diminished as a matter of course.  A diagnosis immediately puts the person at risk of losing their liberty; potentially their life.  The stigma is real.  The loss of legal and political status, the deprivation of basic Human Rights is discriminatory, it is also a direct adverse effect of having a psychiatric diagnosis, and the widespread belief that a psychiatric diagnosis is indicative of having a brain disease. The stigma of psychiatric diagnoses are real; and the stigma is entrenched culturally, and politically. When diagnoses are attached through adjudication procedures in Courts, psychiatric diagnoses are used to "legally" deprive an entire class of people of fundamental Human Rights... 

If that isn't a STIGMA, I'm Mary Freaking Poppins! 

photo credit
Mary Poppins gif from reactiongifs.com

AACAP Policy the irony of the pot calling the kettle black

“ . . . No one is really paying attention to what’s going on. . . The issue is how many Medicaid kids are being drugged to death, not how many kids in fostercare are being over medicated." 

Grace E. Jackson, M.D., Author: Rethinking Psychiatric Drugs: A Guide for Informed Consent 

and Drug-Induced Dementia: A Perfect Crime

A Bill of Rights 

For Children with Mental Health Disorders and their Families 

These basic rights should be afforded all children with mental disorders and their families, regardless of socioeconomic, gender, cultural, or racial status.  These rights apply to families and children with neurodevelopmental, neuropsychiatric, and psychological disorders.

1. Treatment must be family driven and child focused.  Families and youth, (when appropriate), must    have a primary decision making role in their treatment. 

2.  Children should receive care in home and community based settings as close to home as possible. 

3.  Mental health services are an integral part of a child’s overall health care.  Insurance companies 

must not discriminate against children with mental illnesses by imposing financial burdens and barriers to treatment, such as differential deductibles, co-pays, annual or lifetime caps, or arbitrary limits on access to medically necessary inpatient and/or outpatient services. 

4. Children should receive care from highly qualified professionals who are acting in the best interest of the child and family, with appropriate informed consent. 

5.  Parents and children are entitled to as much information as possible about the risks and benefits of all treatment options, including anticipated outcomes. 

6.  Children receiving medications for mental disorders should be monitored appropriately to optimize the benefit and reduce any risks or potential side effects which may be associated with such treatments. 

7.  Children and their families should have access to a comprehensive continuum of care, based on 

their needs, including a full range of psychosocial, behavioral, pharmacological, and educational services, regardless of the cost. 

8.  Children should receive treatment within a coordinated system of care where all agencies (e.g., health, mental health, child welfare, juvenile justice, and schools, etc.) delivering services work 

together to support recovery and optimize treatment outcome. 

9.  Children and families are entitled to an increased investment in high quality research on the origin, diagnosis, and treatment of childhood disorders. 

10.  Children and families need and deserve access to mental health professionals with appropriate 

training and experience.  Primary care professionals providing mental health services must have 

access to consultation and referral resources from qualified mental health professionals. 

March 12, 2008 

The final paragraph of the American Academy of Child and Adolescent Psychiatry's 

Code of Ethics:

Principle X Legal Considerations

"In order to practice medicine in optimal fashion, the child and adolescent psychiatrist must have awareness of the laws governing medical practice of those states in which the physician performs professional work, as well as local and federal laws that may apply. While bearing in mind that laws may vary subtly or substan- tively between states, the child and adolescent psychiatrist must consider, in particular, those laws concerning reports of child abuse and/or neglect, custodial arrangements and guardian responsibilities, warnings to others concerning patients’ potential self- or other-directed threatening behaviors, assent and consent, release of information, documentation of care, and medical responsibilities and negligence.  These legal considerations cannot minimize or supercede the ethical principles of this code.   Rather, knowledge and
consideration of pertinent laws is an important component of ethically responsible practice."

via the American Academy of Child and Adolescent Psychiatry:

Enhancing Transparency in Research

Statement from Thomas F. Anders, M.D., President of the American Academy of Child and Adolescent Psychiatry

"Washington, D.C., February 6, 2007 – The American Academy of Child and Adolescent Psychiatry (AACAP), along with other professional organizations, academic institutions, professional journals and the pharmaceutical industry, all are working toward protecting the integrity of clinical research and ensuring that accurate and complete data are disseminated following each clinical study. The commitment made by the pharmaceutical industry to register all clinical trials in public databases, like ClinicalTrials.gov, and to publish accurate results of these trials is necessary.

"The commitment to registration is critical to protecting the child and adolescent subjects in these trials, as well as all children who are treated subsequent to the trials. Child and adolescent psychiatrists, like all physicians, need access to all relevant data in order to make optimal treatment decisions for their patients.

"The AACAP supports these and other actions designed to enhance the transparency of clinical research.

"The American Academy of Child and Adolescent Psychiatry's (AACAP) mission is to actively promote mentally healthy children, adolescents and families through research, training, advocacy, prevention, comprehensive diagnosis and treatment, peer support, and collaboration. Representing over 7,500 child and adolescent psychiatrists, the American Academy of Child and Adolescent Psychiatry is the leading authority on children’s mental health. To learn more about the AACAP, please visit www.aacap.org."

Some Questions that need answers:

What evidence supports the AACAP's continued defense of using SSRIs for children and youth when it is well established that the FDA approval for the these drugs for use in children and adolescents was based on data that was incomplete, biased or altered; i.e. fraudulent?

On what basis does the Academy continue to defend the off label use of neuroleptic drugs? Here again, the FDA approval for the drugs was based on scant evidence of efficacy or effectiveness. The drugs are teratogenic so they cannot be called 'safe.' The FDA approval for neuroleptic drugs in children appears to have been driven by the pharmaceutical industry's marketing expansion agenda; and psychiatry's interest in legitimizing at least some of the widespread indiscriminate use of the drugs on children.

The drugs are, for the most part, being prescribed to poor children who are on Medicaid which means the cost for the off label drugs is billed to the Federal Medicaid program fraudulently.  In effect, and in fact, this makes the Academy itself willing accomplices participating in an ongoing criminal enterprise.  The American people are being defrauded to pay for the drugs children are being given, often to their detriment.  Neuroleptics cause a wide variety of iatrogenic diseases and neurological impairments because the drugs alter the function of the entire parasympathetic nervous system.  The fact that the the drugs cause impairments, means they drive up the costs of medical care for children on Medicaid due to the iatrogenic, or physician caused, diseases and impairments.  The impairments can be disabling and this causes many of them to need federal disability programs increasing the cost of those programs.

The AACAP uses consensus based practice parameters, and treatment guidelines. Study 329 has not been retracted from the Journal of the Academy of Child and Adolescent Psychiatry, which is the #1 "professional" journal in the world, according to it's editor.  The same editor that continues to deny requests from around the world for Study 329 be retracted.

The final report and the raw data from the TEOSS drug trials is still not available and it's been five years since the study was concluded. That this is important I've no doubt. There has been a total of three Senate investigations into the off label drugging of foster children each one has painted a grimmer picture and quantified and increasing number of children and adolescents are being given neuroleptic drugs, when are the America people going to wake up to the fact WE ALL have a responsibility to the children in foster care. We are paying for them to be harmed.  It is a situation that demands action on the behalf of foster children, and remaining silent is to be passively complicit.

All of these facts belie the above statement made by Thomas F. Anders, M.D, that the AACAP, in collaboration with other stakeholders is, "ensuring that accurate and complete data are disseminated following each clinical study." 

the irony of the pot calling the kettle black

Leading Psychiatric Medical Associations Speak Out On 

New Antidepressant Clinical Trials Study

"Leading Psychiatric Medical Associations Speak Out On New Antidepressant Clinical Trials Study Arlington, Va., January 16, 2008 -- The American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) today renewed their call for a mandatory public registry for clinical trials in light of a study that shows medical research is published selectively, effectively suppressing and misrepresenting studies deemed negative." here

Both the APA and the AACAP require members to practice in compliance with the principles contained in their Code of Ethics.  Both the APA and the AACAP fail to hold their members accountable for ethical failures. Analogous to a chain only being as strong as it's weakest link, a profession is perceived to have the ethical integrity of it's most unethical members. In psychiatry unethical professionals become Key Opinion Leaders, are elected President of their organization, and advisers to patient advocacy groups, the ones funded by pharmaceutical companies---such as the groups featured on the Bill of Rights above.

Excerpts from the Excerpts the AACAP Code of Ethics Related to Transparency 

(These values were not evident to me at Child Study and Treatment Center) 

• Child and adolescent psychiatrists’ primary concern is the welfare, functioning, and optimum development of children and adolescents. 

• The child and adolescent psychiatrist’s primary responsibility is to act on behalf of children, adolescents, and their families. 

• Child and adolescent psychiatrists put the health and welfare of children above any other competing interest.  

• As third parties raise possibilities of conflicts of interest, child and adolescent psychiatrists must keep the interests of children and adolescents paramount. 

• Examples of third party influence could include gifts, dinners, educational opportunities, recreational outings, medication samples, financial support, or investments. 

• The first priority of researchers is the welfare of research participants and their families. 

• All aspects of a research study must defer to the safety and well-being of the participant.  

• Child and adolescent psychiatrists who conduct research must ensure that their investigative processes are conducted ethically and are compliant with all federal, state, local, and institutional regulations.  Institutional Review Boards must approve all research protocols before research 

studies are implemented. 

• Child and adolescent psychiatrists conducting research must report all potential conflicts of interest with the research study participants before the research begins. 

• All potential risks and benefits of the research should be clearly described to the study’s participants and their guardians. 

• Study results must be made public in a timely manner after a research project is completed, regardless its findings. 

link to the Code of Ethics link the the Excerpts related to transparency in research

This is one of the efforts that resulted from the latest investigation into the off label drugging of foster children. For an example of how the AACAP plans on "educating" professionals who work at child serving agencies about psychiatric drugs (unethical) read:    

When anecdotal evidence is sufficient adverse events are merely anecdotal at my other blog, Systems of Care Yakima

18 and Depressed: diagnosed with schizophrenia the first time he went to the walk-in mental health clinic

Originally titled,
A Misdiagnosis of Schizophrenia: based on errors of attribution, lack of professional judgement and ethical integrity  
Schizophrenia is a diagnosis of exclusion, however many people do not have the necessary physical or neurological exams to discover if there is a physical or neurological cause for the symptoms they have before a diagnosis is applied, and drugs to treat it are prescribed. Some will, sooner or later, be Court Ordered to take the drugs to treat a diagnosis of schizophrenia, without ever having the requisite medical exams needed to exclude the medical conditions that could be the potential cause for their symptoms.

Then there are situations like what happened to my eldest son who was diagnosed with schizophrenia at the age of eighteen at the local community health clinic, Central Washington Comprehensive Mental Health. The diagnosis was based on the intake staff misunderstanding and misinterpreting what my son said; belief in the bio-medical disease paradigm; and an assumption that he must have a genetic defect. First, he was lied to about the diagnosis he was given, then he was lied to about why the drugs were prescribed.

He was depressed and eighteen and went to the walk-in mental health clinic for help. He saw an individual who did an evaluation and intake. When he came home with a prescription for a neuroleptic drug that he'd been told was to help him sleep; I was alarmed---scratch that---I was pissed off.  I told him that he had been lied to, and that I believed that he had been  diagnosed with Schizophrenia. Being eighteen, he thought mom was overreacting---and overly suspicious, if not "paranoid."  He basically believed I was wrong.

The drug prescribed had negative effects which he could not tolerate, so he went back to the mental health clinic and was prescribed another neuroleptic; again he was told it was to "help him sleep." I convinced him that he needed to go look at his medical record, as he had a legal right to do.  He went down to the clinic with a printout of the section of the law that states he has the right to examine his chart.

He discovered that he had indeed been given a diagnosis of schizophrenia. This psychiatric diagnosis was based on three things:

1. His brother had a diagnosis of schizophrenia

2. He told the person who did the intake and assessment that he was working at Earthlink, an internet service provider that provides technical assistance to it's customers over the phone. This was recorded in his chart as "He thinks he is an "earthling" in training."

3. At the time, he was interested in studying Neuro-Linguistic programming, (NL P™) is defined as the study of the structure of subjective experience and what can be calculated from that and is predicated upon the belief that all behavior has structure. The mental health professional had never heard of "Neuro-Linguistic Programming" and did not think it was an actual field of study; and assumed that my son had made it up.  This interest in an actual field of study was labeled an "entrenched delusion."

Don't forget this diagnosis was given to my elder son based on an intake appointment by a clinician who saw him ONE time--he had no history of hallucinations, or delusions.  He was depressed, he was eighteen and he was worried about his brother.  Nathan has always felt that it was his job to fix what was wrong, and overly-responsible for taking care of his brother and myself.---This is common for adolescent males raised by single mothers.  He was depressed in part because he felt as if he had failed.  

He needed support to deal with a great deal of grief, loss and trauma. He needed help figuring out what he is and is not responsible for.  He needed support in order to figure out it was never his responsibility to fix any of what had happened to his brother.  He needed help to learn how to deal with the emotional trauma he had experienced; and to learn that it is, and never was his fault.  He needed to be assured that none of what had happened and what was happening was his fault. He needed to know it was never his responsibility to take care of his mother and his brother--he was a kid and he had not failed anyone at all.

via The Wall Street Journal:

Confusing Medical Ailments With Mental Illness

An elderly woman's sudden depression turns out to be a side effect of her high blood-pressure medication.

A new mother's exhaustion and disinterest in her baby seem like postpartum depression—but actually signal a postpartum thyroid imbalance that medication can correct.

A middle-aged manager has angry outbursts at work and frequently feels "ready to explode." A brain scan reveals temporal-lobe seizures, a type of epilepsy that can be treated with surgery or medication.

More than 100 medical disorders can masquerade as psychological conditions, according to Harvard psychiatrist Barbara Schildkrout, who cited these examples among others in "Unmasking Psychological Symptoms," a book aimed at helping therapists broaden their diagnostic skills.

Studies have suggested that medical conditions may cause mental-health issues in as many as 25% of psychiatric patients and contribute to them in more than 75%. read here.

via Cold Spring Harbor Laboratory:

ID 899

DSM-IV Criteria for Schizophrenia

Description:
Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) diagnostic criteria for schizophrenia and associated disorders.
Transcript:

DSM-IV-TR: Diagnostic criteria for schizophrenia: A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence (4) grossly disorganized or catatonic behaviour (5) negative symptoms, i.e., affective flattening, alogia (poverty of speech), or avolition (lack of motivation) Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other. B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal (symptomatic of the onset) or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive Episode, Manic Episode, or Mixed Episode have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). Subtypes Schizophrenia Subtypes: The subtypes of schizophrenia are defined by the predominant symptomatology at the time of evaluation. Because of the limited value of the schizophrenia subtypes in clinical and research settings (e.g. prediction of course, treatment response, correlates of illness), alternative subtypes are being actively investigates. Subtypes include 1. Paranoid Type 2. Disorganized Type 3. Catatonic Type 4. Undifferentiated Type 5. Residual Type Schizophreniform disorder, schizoaffective disorder, and delusional disorder are closely related to schizophrenia and their symptoms are also listed below. In addition symptoms are listed for the following related disorders: brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, and psychotic disorder not otherwise specified. 1. Paranoid Type A type of Schizophrenia in which the following criteria are met: A. Preoccupation with one or more delusions or frequent auditory hallucinations. B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect. 2. Disorganized Type A type of Schizophrenia in which the following criteria are met: A. All of the following are prominent: (1) disorganized speech (2) disorganized behaviour (3) flat or inappropriate affect B. The criteria are not met for Catatonic Type. 3. Catatonic Type A type of Schizophrenia in which the clinical picture is dominated by at least two of the following: (1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor (2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli) (3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism (4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures) (5) stereotyped movements, prominent mannerisms, or prominent grimacing (6) echolalia (word repetition) or echopraxia (repetitive imitation) 4. Undifferentiated Type A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type. 5. Residual Type A type of Schizophrenia in which the following criteria are met: A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). Diagnostic criteria for Schizophreniform Disorder: A. Criteria A, D, and E of Schizophrenia are met. B. An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months. (When the diagnosis must be made without waiting for recovery, it should be qualified as "Provisional.") Specify if: Without Good Prognostic Features With Good Prognostic Features: as evidenced by two (or more) of the following: (1) onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning (2) confusion or perplexity at the height of the psychotic episode (3) good premorbid social and occupational functioning (4) absence of blunted or flat affect Diagnostic criteria for Schizoaffective Disorder: A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia. Note: The Major Depressive Episode must include Criterion A1: depressed mood. B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Specify type: Bipolar Type: if the disturbance includes a Manic or a Mixed Episode (or a Manic or a Mixed Episode and Major Depressive Episodes) Depressive Type: if the disturbance only includes Major Depressive Episodes Diagnostic criteria for Delusional Disorder: A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration. B. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme. C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre. D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Specify type (the following types are assigned based on the predominant delusional theme): Erotomanic Type: delusions that another person, usually of higher status, is in love with the individual Grandiose Type: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person Jealous Type: delusions that the individual's sexual partner is unfaithful Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way Somatic Type: delusions that the person has some physical defect or general medical condition Mixed Type: delusions characteristic of more than one of the above types but no one theme predominates Unspecified Type Diagnostic criteria for Brief Psychotic Disorder: A. Presence of one (or more) of the following symptoms: (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior Note: Do not include a symptom if it is a culturally sanctioned response pattern. B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. C. The disturbance is not better accounted for by a Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Specify if: With Marked Stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture Without Marked Stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture With Postpartum Onset: if onset within 4 weeks postpartum Diagnostic criteria for Shared Psychotic Disorder (Folie à Deux): A. A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion. B. The delusion is similar in content to that of the person who already has the established delusion. C. The disturbance is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder With Psychotic Features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Diagnostic criteria for Psychotic Disorder Due to a General Medical Condition: A. Prominent hallucinations or delusions. B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. C. The disturbance is not better accounted for by another mental disorder. D. The disturbance does not occur exclusively during the course of a Delirium. Code based on predominant symptom: - With Delusions: if delusions are the predominant symptom - With Hallucinations: if hallucinations are the predominant symptom Diagnostic criteria for Substance-Induced Psychotic Disorder: A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced. B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): (1) the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal (2) medication use is etiologically related to the disturbance C. The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Psychotic Disorder (e.g., a history of recurrent non-substance-related episodes). D. The disturbance does not occur exclusively during the course of a delirium. Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. Diagnostic Criteria for Psychotic Disorder Not Otherwise Specified: This category includes psychotic symptomatology (i.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific Psychotic Disorder. Examples include: 1. Postpartum psychosis that does not meet criteria for Mood Disorder With Psychotic Features, Brief Psychotic Disorder, Psychotic Disorder Due to a General Medical Condition, or Substance-Induced Psychotic Disorder 2. Psychotic symptoms that have lasted for less than 1 month but that have not yet remitted, so that the criteria for Brief Psychotic Disorder are not met 3. Persistent auditory hallucinations in the absence of any other features 4. Persistent nonbizarre delusions with periods of overlapping mood episodes that have been present for a substantial portion of the delusional disturbance 5. Situations in which the clinician has concluded that some type of psychotic disorder may be present, but is unable to determine whether it is primary, due to a general medical condition, or substance induced.
Keywords:
dsm, schizophrenia, schizoaffective, diagnosis, diagnostic, delusions, hallucinations, paranoid, paranoia, disorganize, catatonic, catatonia, undifferentiated, residual, schizophreniform, delusional, delusion, psychosis, psychotic

Cold Spring Harbor Laboratory / CC BY-NC-ND 3.0

A link from Pat Risser: Medical Problems Related to Psychiatric Symptoms

Portions of this blog post were originally published with the title:

"Making a diagnosis without a complete neurological and physical examination can lead to misdiagnosis" on 8-21-2011

photo from fisher price

An American Hero: Dr. Francis Kathleen Kelsey

via National Library of Medicine:

Changing The Face of Medicine

Dr. Frances Kathleen Kelsey

In 1960, during her first month at the Food and Drug Administration, Dr. Frances Oldham Kelsey took a bold stance against inadequate testing and corporate pressure when she refused to approve release of thalidomide in the United States. The drug had been used as a sleeping pill and was later proven to have caused thousands of birth deformities in Germany and Great Britain.

Born Frances Oldham in 1914, on Vancouver Island, British Columbia, she earned both her bachelor of science and master of science degrees from McGill University, Montreal, in 1934 and 1935. In 1938 she earned her Ph.D. from the University of Chicago, and went on to teach there from 1938 to 1950. Dr. Frances Oldham married Dr. Fremont Ellis Kelsey, a fellow faculty member at University of Chicago, in 1943. Their two daughters were born while she earned her medical degree at the University of Chicago Medical School.

Dr. Kelsey then worked as an editorial associate at the American Medical Association before teaching pharmacology at University of South Dakota from 1954 to 1957. She was a general practitioner there from 1957 to 1960. In 1960 she moved to Washington, D.C., and began her long and distinguished career at the Food and Drug Administration, where she later became chief of the Division of New Drugs, director of the Division of Scientific Investigations, and deputy for Scientific and Medical Affairs, Office of Compliance.

Dr. Frances Kelsey took her stand against thalidomide during her first month at the Food and Drug Administration, on her first assignment. The task was supposed to be a straightforward review of a sleeping pill already widely used in Europe, but Kelsey was concerned by some data suggesting dangerous side effects in patients who took the drug repeatedly. While she continued to withhold approval, the manufacturers tried everything they could to get around her judgement.

In November 1961, reports began to emerge in Germany and the United Kingdom that mothers who had taken thalidomide during pregnancy were now having babies with severe birth defects. Dr. Helen Taussig learned of the tragedy from one of her students and traveled to Europe to investigate. By testifying before the Senate, Tauusig was able to help Kelsey ban thalidomide in the United States for good. At least 4000 children in Europe were affected by the drug, but thanks to Kelsey's rigorous professionalism a similar tragedy was averted here in America.

On August 7, 1962, President John F. Kennedy awarded Frances Kelsey the highest honor given to a civilian in the United States, the President's Award for Distinguished Federal Civilian Service. She was the second woman to ever receive the award. Kennedy acknowledged "Her exceptional judgment in evaluating a new drug for safety for human use has prevented a major tragedy of birth deformities in the United States. Through high ability and steadfast confidence in her professional decision she has made an outstanding contribution to the protection of the health of the American people."

Kelsey helped shape and enforce amendments to FDA drug regulation laws to institutionalize protection of the patient in drug investigations. These regulations required that drugs be shown to be both safe and effective, that informed consent be obtained from patients when used in clinical trials, and that adverse reactions be reported to the FDA. In 1995, the town of Mill Bay, British Columbia, honored Dr. Kelsey by naming the Frances Kelsey Secondary School for her. In 2000, Kelsey was inducted into the National Women's Hall of Fame, and in 2001, at the age of 87, she became a Virtual Mentor for the American Medical Association.

Frances O. Kelsey receives the President's Award for Distinguished Federal Civilian Service 

from President John F. Kennedy, 1962

National Library of Medicine, Images from the History of Medicine, A018057

Dr. Kelsey (age 87) at the FDA Reception commemorating her induction into the 

National Women's Hall of Fame

 photo via wikipedia

via cbc.ca  listen here to Francis Kelsey interview

update 11-9-2012

Now when a scientists have the integrity to take a stand at the FDA, they get spied on and the FDA attempts to discredit them here

training video on how to diagnose ‘Attenuated Psychosis’ demonstrates how not to carry out a psychiatric interview and interact with young people.

via Speed up Sit Still:

Patrick McGorry’s ‘Ultra High Risk of Psychosis’ training DVD fails the common sense test

Is Nick Sick? by Professor Jon Jureidini

“Patrick McGorry’s CAARMS training video on how to diagnose ‘Attenuated Psychosis’ demonstrates how not to carry out a psychiatric interview and interact with young people.”

Describing Nick as being at ultra-high risk of psychosis (UHR) does fail the common-sense test. Even more concerning is that Nick is labelled as having Attenuated Psychosis – in ordinary language, he is already mildly mad.

Professor McGorry justifies diagnosing young people like Nick as being at ‘ultra high risk’ because within the next 12 months they are ‘between two and four hundred times’ more likely to become psychotic than ‘the general population’.

But we must respect the ordinary everyday language meaning of ultra high risk. If I am labelled as being at ultra-high risk of something, I assume that I will probably be affected. I do not interpret that label as meaning I am simply much more at risk than my peers.

Even Professor McGorry acknowledges that nearly two-thirds of the people identified as being at ultra high risk of developing psychosis, don’t become psychotic. Independent evidence shows the conversion rate is as low as 8%. With between 64% and 92% false positives, the true ‘ultra high’ risk is the risk of being incorrectly labelled.

The pay-off for testing for UHR is simply not sufficient to justify the cost. One cost is that Nick is now being taught to see himself as sick. Who knows if this might not even increase this vulnerable young man’s risk of ultimately being diagnosed with full-blown psychosis? And as Martin Whitely points out, it stigmatises him.

But more important to me than stigmatisation is the fact that the UHR label is an unexplanation; it ignores what is going on in Nick’s life. Unexplaining is different from saying ‘I don’t know’ (something we doctors would do well to say more often). Unexplanations distract from the difficult but rewarding task of working with a young person towards finding an explanation for their stress.

Nick makes it pretty easy for the listener. He tells us about being bullied into a trade that he doesn’t want to be in, and he invites the interviewer to explore his relationship with his father. The interviewer doesn’t notice, or chooses to ignore this invitation, instead sticking to a stereotyped list of questions that generate the sterile unexplanation of UHR.

It might be argued that the interviewer would come back to this later. However, in my experience, young people prefer us to show an interest in their difficult and intimate predicaments when they first get the courage to put them into words.

I am grateful to Martin Whitely for putting the CAARMS training video into the public domain because it provides a potential teaching tool for medical students in how not to carry out a psychiatric interview and interact with young people.

1. Orygen Youth Health Centre, 2009, “Comprehensive Assessment of At Risk Mental State Training DVD“, The PACE Clinic, Department of Psychiatry, University of Melbourne.

2. McGorry P. Right of Reply – Patrick McGorry on Early Intervention for Psychosis. December 11, 2010. http://speedupsitstill.com/reply-patrick-mcgorry-early-intervention-psychosis#more-1075

3. Professor McGorry wrote “the false positive rate [for UHR] may exceed 50-60%” McGorry P.D. ‘Is early intervention in the major psychiatric disorders justified? Yes’, BMJ 2008;337:a695 http://www.bmj.com/cgi/content/full/337/aug04_1/a695 (accessed 3 August 2010) Professor McGorry’s close colleague Alison Yung identified the conversion rate from UHR to first episode psychosis was 36% in an article in the Medical Journal of Australia titled Is it appropriate to treat people at high-risk of psychosis before first onset — Yes Available at https://www.mja.com.au/journal/2012/196/9/it-appropriate-treat-people-high-risk-psychosis-first-onset-yes

4. Professor David Castle, Medical Journal of Australia, 21 May 2012, Is it appropriate to treat people at high-risk of psychosis before first onset — No Available at https://www.mja.com.au/journal/2012/196/9/it-appropriate-treat-people-high-risk-psychosis-first-onset-no

The Department of Justice: The Office of Civil Rights Criminal Division does not conduct investigations

ON September 18, 2010 The US Justice Department employee J. Tucker signed for a package sent by overnight express.

In the package was a copy of the entire Yakima County Superior Court Record for the Involuntary Commitment of my son, a copy of the entire record which was available to his attorney, and the entire record given to my son.  These three records should have been identical, but in fact are not; which is why I sent them along with the written complaint I filed on my son's behalf. Also included,  was a copy of the report I had filed with Yakima Police Department; I also added to the complaint that I had learned that Central Washington Comprehensive Mental Health had shredded all of the Original Court Documents; also a crime... I can only conclude that the documents were shredded because they were evidence of the crimes committed by two CWCMH employees, who were acting under the Legal Authority granted to them by the State of Washington.

I am living below the poverty level so the cost of obtaining and sending these records overnight was an expense I could ill afford--but what choice did I have?  The State of Washington has absolutely no interest whatsoever in investigating allegations of people who have a diagnosis of mental illness having their individual rights preserved or defended in Involuntary Commitment proceedings. The drugs used by psychiatry can cause iatrogenic diseases, permanent disability, and have fatal risks; I would think Due Diligence of Duty and Standard Court Procedures, Rules of Evidence, Proper Notice, Proof of Service, Effective Assistance of Counsel, would be required---they in fact are NOT needed in Washington State.  None of these elements which preserve an individual's rights were afforded my son. The State of Washington has no interest in actually investigating criminal complaints when it is  State employees or the State's authorized agents who are the alleged perpetrators.

When I contacted the local FBI office, I was told by the agent on duty that he could not take my complaint, that it would need to be filed with the Department of Justice in order for him to conduct a criminal investigation. This obviously allows time to cover up crimes... In effect, only the State itself can cause an investigation to be launched by State or Federal Law Enforcement when reports are filed in which the State's employees, or the State's contracted agents have allegedly committed Federal Crimes Under Color of Law violating the individual rights of a vulnerable adult...The State has a Conflict of Interest in that it is also liable when one of it's agents causes harm to a person or entity.

My son is physically ill for the third time in less than a year and a half.  He has ongoing damage being done to him and is medically neglected.  Most psychiatric patients with a diagnosis of schizophrenia are, IMO. Psychiatrists prescribe drugs that cause iatrogenic diseases, but they do not medically TREAT the diseases they cause. In my experience, psychiatrists will not make appropriate referrals to appropriate specialists either---unless badgered for months by a MadMother.  I am not ok with the utter failure of those who work for the State of Washington, salaried employees and elected representatives alike. Most disappointing is that fact that my district's elected Representatives, men I voted for, who have failed to do their jobs ethically or honestly; failed their duty to serve the public they have been elected to represent. All three men of these men have refused to respond personally to a single phone message or email. I have to say I am shocked by this.  Their predecessors all personally responded when I sought their assistance; and were helpful to me and my sons.

I am not ok with the the fact that mental health professionals violated the law, and my son's Individual Rights under the US Constitution.  I am not ok with the fact that their corrupt and unethical boss, the CEO of CWCMH, Rick Weaver, told me that the Yakima County Superior Court Clerk loses Original Court Documents all the time and that his mental health clinic shreds Original Court Documents that the Law requires be retained. He claims there's nothing wrong with shredding them, (and breaking the law) because he further stated, "we do it all the time."

Prior to mailing the package, I called the DOJ and was told the correct department to file the complaint with, and given the mailing address.  I was very specific about the nature of my complaint and I was assured prior to mailing the complaint, and after it was reviewed by the  Department of Justice Office of Civil Rights Criminal Division to call them if/when I had any more information.

Today I called with further information.  The person who took my call acknowledged that she had reviewed my complaint, and then asked me what information I had.  I told her I wanted to inform them that Jon McClellan, the unethical research psychiatrist hired as an expert by the GAO testified in a US Senate hearing on December 1, 2011, had in fact drugged my son into a state of profound disability in a Federally-Funded Drug Trial without Legal Authority; and without obtaining Informed Consent.  Jon McClellan did this in spite of my vehement protests. Jon McClellan repeatedly told me I had NO SAY in what he was doing to my traumatized child.

I reported he in fact helps formulate public policy for children in the custody of the State of Washington, and he advises other medical professionals around the State on how to drug children using neuroleptics off label. I reported that Jon McClellan has written numerous Practice Parameters, treatment guidelines and drug treatment algorithms which recommend using neuroleptic drugs off label in the manner being investigated due to rampant the Medicaid Fraud which continues to decimate the Medicaid budget. How many have been disabled and killed as a result is impossible to determine; the  data is purposely NOT collected. This fraud continues unabated in spite of three investigations and several multi-million dollar lawsuits...

Jon McClellan testified at a hearing that was part of the third US Senate investigation into the widespread off label drugging of foster children; but all children on Medicaid are at risk.  Neuroleptic and other psychiatric drugs are dangerous teratogens that cause serious iatrogenic illnesses and diseases, which can disable and kill. Everyone who takes them is at risk for these adverse effects; but children, adolescents and the elderly are particularly vulnerable. It is Medicaid Fraud whether a child is in foster care, or lives at home with their parents...When asked by Senator Tom Carper why so many children were being given these drugs off label, Jon McClellan claimed to have no idea why children are in fact being drugged in the manner he recommends.  Jon McClellan basically 'wrote the book' on drugging children off label.

I was then informed, we "don't investigate the type of crimes" that I had reported on my son's behalf "in this department."  What I want to know is, why ask for further information if there was not going to be an investigation? If my complaint was in fact in the wrong department, why was I assured when it was first reviewed, in September 2010 that it was? The DOJ's Office of Civil Rights Criminal Division had been sitting on this complaint for over a year when this conversation took place.

Believe me, it was quite a shock to hear that the Department of Justice Office of Civil Rights does not investigate Civil Rights Crimes committed against people who are diagnosed with a mental illness, Under Color of Law.  It seems this is discrimination based on disability. My son is identified as a vulnerable adult and he had felony forgery and perjury used as the basis for obtaining a Court Order to detain and subsequently used to obtain a Court Order to involuntarily treat him by mental health professionals.

The Deputy Prosecutor knew the testimony he offered the Court was perjured---he had to have realized after we spoke that the Affidavit offered by Nancy Sherman was fraudulent---I wasn't even aware of any Court proceedings, and certainly did not ask for these illegal proceedings to be conducted. In fact, both the prosecutor and my son's Assigned Counsel went along with this charade.  I had spoken at length to both of these unethical Officers of the Court; my elder son had also spoken at length with his brother's Assigned Counsel.  Nonetheless, in a hearing lasting ONE MINUTE AND TWENTY SIX SECONDS, a Yakima County Superior Court Order was sought and obtained placing my son under a court order for six months. If that isn't a criminal violation of my son's Civil Rights perpetrated UNDER COLOR OF LAW; I am Mary Freakin' Poppins!  The mental health and legal professionals who perpetrated these crimes all had an ethical, a moral and a legal duty to my son which they all abdicated with seeming impunity. In doing so, each of these "public servants" failed their duty to the Superior Court of Washington, failed their duty to the people of the State of Washington, AND utterly failed to preserve and protect my son's individual rights as required by both State and Federal Law. These "professionals" further traumatized a trauma victim and made other people and institutions unwittingly accomplices to their crimes.

Federal Crimes committed Under Color of Law; i.e. using the legal authority granted to mental health professionals, which are in effect, Police Powers; two mental health professionals, and two Officers of the Court broke several State and Federal Laws when they violated my disabled son's Constitutional Rights; and caused him grievous harm. This is NOT the kind of crime the Office of Civil Rights, Criminal Division investigates...This outrageous claim was made over a year after the I had been informed the complaint I had filed on my son's behalf had reached the correct department; and that it would be investigated.

The appearance of Justice and Justice itself is absent.  

My "American Experience" has been a fucking nightmare.   

Statue of Liberty photo via Sky Blue Sight

first published on 12-16-2011 as "The DOJ Office of Civil Rights Criminal Division does not do what?!"

It Took One Minute...

...and twenty-six seconds.

"I believe we must speak our conscience in moments that demand it,

even if we are but one voice"

Richard B. Sanders

This was sent to my State Senator and State Representatives, all the members on the Judiciary Committee, and The Health and Human Services Committee in the Washington State Legislature.  I voted for these guys; now I wonder why...Not a one of them has returned a call, or answered an email.  Not like former Representatives and Senators Mary Skinner, Jim Clements and Alex Deccio AT ALL.... I also sent it to State employees working for the State of Washington at the Division of Behavioral Health and Recovery.

This is the first blog post. It appears here with minor changes for clarity.  An update is also added for the 2 year anniversary of Involuntary Transformation which I started on September 4, 2010.

To whom it may concern:

The hearing stripping my son of his liberty and his Constitutional Rights to Procedural and Substantive Due Process lasted one minute and twenty-six seconds. My son's assigned counsel presented the prosecution's case, and a Court Order was granted authorizing a 14 day extension of a fraudulently obtained Emergent Order to Detain. The order to detain was sought by a Designated Mental Health Professional, "DMHP" who committed forgery, and perjury, which means that everything that followed was based on fraud. The agency that runs the crisis center in Yakima County, claims to have shredded all of the original Superior Court Documents; this is also a violation of the law. Rick Weaver, the CEO of Central Washington Comprehensive Mental Health, told me, "We do it all the time." He also stated that the Yakima County Superior Court Clerk loses documents all the time. I have no doubt the man is a liar. I've known for well over a decade he has no ethical integrity, and it seems he is without conscience.

No evidence was presented other than by my son's assigned (Defense?) attorney, Jennifer Lesmez WSB#34547 informing the judge that Isaac signed everything she had asked him to. He agreed he would stay in the hospital for 14 days and take whatever the doctor prescribed, and that this order could also be extended. He lost his gun rights permanently. (I personally don't care, he definitely doesn't -- he's afraid of them) He has been labeled as unwilling to seek help when he needed it--a lie. However, I do care that in fact, this is a violation of his Constitutional Rights. That there exists an an ongoing violation of his Constitutional Rights as long as this court order stands.

Court procedures are not only supposed to be lawfully conducted, they are to have the appearance of being lawfully conducted. The only evidence presented was his attorney testifying that he agreed he needed to be in the hospital--indeed he had sought to be hospitalized and had not tried to leave or object to being medicated. In fact, in crisis he did not object when Jeffrey Jennings put him back on the benzodiazapine he had been taken off of due to cardiac risk; AT TWICE THE DOSE. Without consulting Isaac's psychiatrist, his primary physician, or speaking to anyone who had direct knowledge of Isaac's care or condition for the previous 10 months! The people he did not consult included me, I am his mother, and care provider, whom he lives with; and his brother. Both of us escorted him to the crisis center and feel betrayed by this experience; we bear a guilt that is not our own. We foolishly placed our trust in this facility; and placed him in harm's way. Nancy Sherman betrayed our misplaced trust, as did Jeffrey Jennings and CWCMH CEO, Rick Weaver.

The entire time he was a client at CWCMH, he was assisted by me when any of the "business" part of getting his care was conducted. Apparently this doctor skipped the day the Hippocratic Oath was taken. I have read the chart of his entire inpatient stay. By the time this kangaroo court was held a little before nine in the morning on August 2nd, Isaac had been at the hospital since a little after 5 pm the previous Wednesday evening. His chart reflects that he remained calm, kept to himself and caused no problems on the unit. I raised holy hell from the time I found out by accident that my son was under a court order. I had visited Isaac Monday evening and I wonder now why he had no copy of the court order itself, or any of the documents submitted as “evidence”--what is missing? I know what is, the appearance of FAIRNESS, i.e. the appearance of Justice being done, is missing entirely.

What would you think if you went to the hospital and were put on a medication at twice the dose that your previous doctor advised you to no longer take due to the risk to your heart? You have Tachycardia, like my son. Would you want a second opinion? Prior to switching to his current doctor, Isaac had received his mental health services at Central Washington Comprehensive Mental Health, (CWCMH.) Isaac didn't want to go there anymore because he said, the doctor did not listen to him. In fact, after his last appointment with the Dr. that he saw at CWCMH and before he had his first appointment with his current one, he told me one evening, "I haven't had a doctor listen to me since Dr. Holttum." My son was almost 22 when he said this. It had been nine years since he had seen Dr. Holttum. He had two doctors in the five years and ten months here in Yakima since I brought him home from CSTC, and at least two for the four years and three months at CSTC in Tacoma; and he doesn’t believe any of them have listened to him. My heart aches for my boy.

I ask you all, "Is this how this law is supposed to be enforced, enacted, perpetrated?" In it's entirety, the court record is actually clear and cogent evidence of a  felony crimes being perpetrated against my son in the hospital and in Yakima County Superior Court.   

Does this chain of events, which were criminal acts reflect the legislature’s intent when due to being heavily lobbied and misinformed by members of NAMI and the Treatment Advocacy Center, it passed RCW 71.05 and the subsequent revisions, to what is informally known as The Involuntary Treatment Act?

I suggest the judiciary committee quickly ascertain what needs to change to ensure this does not happen again. This type of lawless application of the Involuntary Treatment Act puts the State in a position of liability. Agents authorized by the State of Washington violated both Federal and State laws, and violated my son's Constitutional Rights. The people who committed these crimes, and the CEO of the CWCMH appear to have no concept of the ethical treatment of human beings and seem to lack the integrity to perform their jobs AS IF they have an ethical and a legal duty to comply with the law; and  obviously don’t understand that Rules of Evidence need to be followed; i.e. perjury and fraud are not “evidence” that should be used when seeking Court Orders. It is necessary for Court proceedings to comply not only the with letter of the law, but the spirit of the law by having the appearance of Justice being done.  The only conclusion I have come to as a result of the utter and complete failure of the criminals who perpetrated these crimes and made a mockery of the Superior Court, is that the Constitutional Rights of the "mentally ill" and provisions within Washington State’s  Involuntary Treatment Act  which theoretically preserve and defend individual rights when court ordered to involuntary treatment, are outlined within the statute for appearances only. The protections codified in the Constitution of the United States of America and in Washington State’s Constitution to Substantive and Procedural Due Process are not being effectively preserved, and the failures are not being investigated when they are reported.  In fact, it is obvious to me that having  mental health professionals act as agents for the State of Washington who have no clue on how these individual rights are actually preserved and defended is a guarantee that they will be violated as a matter of course with impunity.  The fact that these crimes were not investigated, by Law Enforcement, but were “investigated” by two social workers who did not speak to any witnesses who were present, and did no fact finding whatsoever---and apparently had not read The Hardy Boys or Encyclopedia Brown as kids either... All of this gives the impression that the State of Washington is intentionally violating the individual rights of people who are being committed Under Color of Law to Involuntary Treatment by the Superior Court of the State of Washington.

No evidence based on the facts was presented. Isaac was not present to face his accusers, no accusers were heard giving testimony. Indeed, only my son's attorney's voice is heard on the recording of the third hearing;  she sounds like the prosecutor; not a court appointed advocate for the defense; she basically put forth the State’s case. There is ample evidence this attorney purposely mounted no defense at all.

The following subsection defines the State's responsibility in Involuntary Treatment proceedings. I first informed a staff person at DSHS/BHR/DBHR--Ronald Moorhead, who told me that the department could not do anything since the Court was involved.

He actually claimed the State had no authority in Civil Commitment proceedings! The following is the sub-section of Washington State's Involuntary Treatment law that describes the department's obligation. The law grants the department the authority to investigate; indeed, it states the department has a legal duty to do so.

RCW 71.05.520

Protection of rights — Staff. The department of social and health services shall have the responsibility to determine whether all rights of individuals recognized and guaranteed by the provisions of this chapter and the Constitutions of the state of Washington and the United States are in fact protected and effectively secured. To this end, the department shall assign appropriate staff who shall from time to time as may be necessary have authority to examine records, inspect facilities, attend proceedings, and do whatever is necessary to monitor, evaluate, and assure adherence to such rights. Such persons shall also recommend such additional safeguards or procedures as may be appropriate to secure individual rights set forth in this chapter and as guaranteed by the state and federal Constitutions.

[1973 1st ex.s. c 142 § 57.]
September 2, 2012
The psychiatrist and the Deputy Prosecutor involved in violating my son's rights, are no longer employed by CWCMH and Yakima County respectively.

After these events, Washington State authorities failed to conduct a criminal investigation into the multiple felony crimes I reported.  I called David Reed, Manager for Adult and Older Adult Services Mental Health Division/DBHR to ask if there had ever been any allegations made that any individual's Constitutional Rights were violated in Involuntary Commitment proceedings---I knew the answer; I wanted to know if the man would tell the truth. He did not. He claimed to be unaware of any such complaints at all.

Governor Christine Gregoire appointed David Reed to investigate allegations that several individuals  had their individual rights violated in civil commitment proceedings in 2008. Why were reports that federal crimes had allegedly occurred not investigated by the State Police?  Having social workers who work for the State conduct what is (or should be) a criminal investigation is inappropriate; it is  an obvious Conflict of Interest. Being an Attorney, Christine Gregoire should have known better. Perhaps the real purpose of David Reed's 'investigation' was to provide the appearance that the State of Washington takes allegations of federal crimes committed against vulnerable people seriously. Let's be real, a complaint that alleges an individual has been confined and drugged without Procedural Due Process, is a Criminal Complaint---what training in criminal investigation has David Reed had?  Prior to filing my complaint with the State of Washington DSHS/MHD/DBHR two years ago, I filed a complaint with the Yakima Police Department, on August 7, 2010. After first filing the complaint with DSHS, on the 10th of August 2010, I also filed complaints with Disability Rights Washington, the GCBH Ombudsman both claimed they can not get involved when there is a Court Order... It seems to me that the State's response (and lack thereof) is simply an abdication of duty which is mandated by state law. The State wants to appear as if it takes crimes which violate the individual rights of the mentally ill 'seriously,' and also appear to conduct 'investigations' alleging criminal violations and improper application of statutory authority, without actually doing so. Criminal complaints need to be investigated by people trained to conduct criminal investigations, i.e. Law Enforcement.

The complaint I filed on my son's behalf was not taken seriously, and the so-called 'investigation' was conducted on October 27, 2010. I finally received a copy on November 30, 2010.  The so-called investigation addressed not a single one of the actual crimes which I reported---it consisted of a review of paperwork, and simply repeats the perjured testimony of Nancy Sherman and Jeffery Jennings. The report concludes by stating, "This process is about checks and balances and it is the opinion of the investigators reviewing this case that the rules were followed and that his rights were repeatedly and consistently respected as called for in the law."  Simply ludicrous all things considered.  The 'process' addressed none of the  Federal Crimes committed by Central Washington Comprehensive Mental Health employees when obtaining a Court Order to detain and involuntarily treat my son, and did not even mention that the original Court Documents had been illegally shredded by Central Washington Comprehensive Mental Health.

The basis for the initial detention sought by Nancy Sherman was her own perjured testimony in which she claimed that only Nathan had accompanied Isaac to the crisis center. In fact, both Nathan and I had accompanied Isaac. Nancy Sherman also supported her petition to detain with a fraudulent Affidavit that she attests to attaching to her petition but never filed this forged document with the Court Clerk. There is no polite way to say it: That bitch needs to lose her license to be a mental health professional, and be criminally prosecuted for the felony crimes she committed.  the “investigators” do not even mention that NO original documents existed for them to examine. The fact that all of the original Court record were shredded immediately by CWCMH is illegal, yet this crime is not even mentioned in the “investigator’s” report. In fact, the report states, "the rules were followed" and conclude that my son’s rights were protected. I can only conclude that felony perjury and fraud and shredding Superior Court Records are not against “the rules” when the State of Washington Under Color of Law deprives individuals of their Liberty and Court Orders them to psychiatric treatment based on testimony of people like Nancy Sherman and Jeffrey Jennings who have no problem lying under penalty of perjury in Superior Court and their boss, Rick Weaver, CEO of CWCMH, who stated that there is nothing wrong with CWCMH shredding the Court’s Record because, “We do it all the time.”

The “investigator’s report states that two people conducted the investigation, yet only one person is identified---Furthermore, according to the Law, when the authenticity of a document is in dispute, ONLY the ORIGINAL document can be used to determine the document’s authenticity.  When there are conflicting accounts of the events which have occurred, it is not possible to ethically draw any conclusions without hearing all accounts. Testimony offered by Affidavit the Court’s instructions state, must consist only of information that the attestor knows “first-hand.”  Jeffrey Jennings had absolutely no first-hand information---he refused to speak to anyone who actually knows my son, including his doctors, his brother, and his mother even though he had complete contact information. The so-called "investigators" didn't bother to interview the only people with first hand knowledge, Isaac, myself, and my elder son, Nathan. Isaac's Assigned Counsel allowed what she knew to be perjured testimony to go unchallenged, i.e. EFFECTIVE assistance of counsel was not provided.  The Deputy Prosecutor put forth what he knew to be perjured testimony. 

My son's rights were not respected, not preserved and not defended.

My son's rights were violated in every way possible.

I am trying to:

via Crossroads to Change:

"Due to a letter and request to Washington State Governor Christine Gregoire in early 2008, Carole Willey, a social justice activist & community organizer, Chair of CCC, received a letter from the Governor stating that she would assign David Reed, a staff person to work with Carole on these violations. With the documentation of the WA ST Mental Health Division finally acknowledging the “concerns,” the state agency agreed to forward his concerns to their Licensing staff, which they never did.

"On July 10, 2008, Carole, along with witnesses Therese Holiday & Ann Clifton (two healthcare advocates), met with David Reed of the Department of Social and Health Services / Mental Health Division (DSHS / MHD). They met to review her analysis of the two reports and discuss violations of inpatients’ rights at Sacred Heart Medical Center in Spokane, WA." read the rest here

David Reed's letters to Carole Willey here and  here

There is also a major development in the publicly funded mental health system in this community: Comprehensive Mental Health planning new 16-bed mental health facility. I suspect it is a direct result of CWCMH employees illegally detaining and committing my son.  The actions of Nancy Sherman, Jeffrey Jennings and Rick Weaver in effect and in fact made Yakima County, Washington State and the local hospital, unwitting accomplices to federal crimes which  violated my son's individual rights, deprived him of his liberty and his dignity; further traumatizing him.

It was three weeks before I was finally able to convince my son he was safe, and could go outside. Three weeks until my giant 6'3" 280 lb. son believed  it was safe to step into his own fenced yard.

"Whenever a doctor cannot do good, he must be kept from doing harm."

Hippocrates

"Whenever a doctor cannot do good, he must be kept from doing harm." 

Hippocrates