Solitary Confinement: It Defines Who We Are

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via Psychiatric Times:

July 18, 2014 | Forensic Psychiatry, Couch in Crisis, Risk Assessment, Trauma And Violence

By Douglas A. Kramer, MD, MS

Linked Articles

Guns, Violence, and Mental Health: Did We Close the State Mental Hospitals Prematurely?

Heatstroke and Psychiatric Patients

Solitary Confinement: It Defines Who We Are

COMMENTARY

Cruel and unusual—Amendment VIII: Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.

In The New York Times’ “New York State in Deal to Limit Inmate Isolation,” Benjamin Weiser describes an agreement between the New York Civil Liberties Union and the New York Department of Corrections.1The agreement delays litigation of a suit filed in 2012, by the NYCLU, over the use of isolation for punitive purposes within New York State prisons.2 Their comprehensive report, Boxed In: The True Cost of Extreme Isolation in New York’s Prisons, details the basis of the lawsuit.3 Mr Weiser refers to the provisions in the new agreement as “sweeping reforms.”

Highlights of the New York State agreement include: 1) prohibiting the use of solitary confinement for prisoners under age 18 years; 2) prohibiting its use with pregnant women; and 3) limiting its use with developmentally disabled prisoners to a maximum of 30 days.4 The prohibition against solitary confinement for these “special” populations acknowledges that the practice is harmful to human beings. And imposing these limitations by category admits that, however dangerous the pregnant woman or the adolescent is judged to be, somehow the system will find a way to avoid implementing this administrative, ie, non-judicial, punishment.

Sweeping reforms? While it may be a relief to New Yorkers that pregnant women and high-school age prisoners will no longer to be subjected to solitary confinement, the reforms that the New York Times calls “sweeping” in fact allow this practice to continue for a minimum of 2 additional years.1,2 These “sweeping reforms” simply protect those who can’t protect themselves (teenagers, unborn children, and the developmentally disabled), those who almost anyone with a bit of common sense, humanity, or political astuteness would exempt. For the vast majority of prisoners, no such limitations have been imposed, nor will any be imposed in the near future because the agreement means “business as usual” until the next court hearing. In other words, it authorized 2 more years of being at risk for solitary confinement for most inmates. The NYCLU and the Federal District Court in Manhattan gave the state of New York exactly what it wanted, and what the New York Times described as “sweeping reforms.”

Lost, stray, and unwanted animals

Most of our society agrees that lost, stray, and unwanted animals should be treated in a caring and humane manner. Shouldn’t our fellow human beings be treated at least as well as our stray animals while “paying their debt to society?” Would anyone allow a stray or unwanted dog to be socially isolated for 5 months? I doubt it. But 5 months is the average duration for “extreme isolation” in New York State prisons—for human detainees!1,3According to Rick Raemisch, the new head of the Colorado prison system, the average length of solitary confinement in Colorado prisons is 23 months. Some inmates there spend as many as 20 years in solitary.5

In corrections language, “solitary confinement” is referred to as “administrative segregation,” or (even more antiseptically) as “Ad Seg.”

Colorado experience
Rick Raemisch is also the former Sheriff of the county in which I have spent most of my professional life. He was recently appointed to replace Tom Clements as the Executive Director of the Colorado Department of Corrections. Mr Clements was brutally murdered at his front door in March 2013.6 The murderer had been released from solitary confinement directly into the community shortly before the murder. The sad irony is that Mr Clements, described by Mr Raemisch to be “as courageous a reformer as they come,” had already reduced the number of prisoners in solitary confinement by half in just 2 years.5

Linked Articles

Guns, Violence, and Mental Health: Did We Close the State Mental Hospitals Prematurely?

Heatstroke and Psychiatric Patients

Solitary Confinement: It Defines Who We Are

The governor of Colorado gave Mr Raemisch 3 directives when he appointed him:
• Limit or eliminate the use of solitary confinement for mentally ill inmates.
• Address the needs of those who have been in solitary for long periods.
• Reduce the number of offenders released directly from solitary back into their communities.

To begin to understand these goals, Mr Raemisch spent 20 hours in solitary confinement in the Colorado State Penitentiary. Raemisch described his experience in an Op-Ed in the New York Times as “practically a blink” compared to the average stay.5 He later testified before a Senate subcommittee about his experience and recommendations.7

Following his single night in solitary—but before the end of his self-imposed sentence of 20 hours—Mr Raemisch broke a promise to himself and asked a guard for the time. It was 11:10 AM. “I felt as if I’d been there for days. I sat with my mind. How long would it take before Ad Seg chipped that away? I don’t know, but I’m confident that it would be a battle I would lose.”

I do not know Mr Raemisch personally. Before his New York Times Op-Ed, I knew of him only through his red campaign signs in our former neighborhood.8 I had voted for him for sheriff based on our local newspaper’s endorsement. He is a successful and seemingly dedicated individual. How many of us would spend a night in solitary, or a night as a patient in a public mental hospital, to better enable us do our jobs? I’ve never once considered doing such a thing. If Raemisch is “confident” that he would lose his mind in solitary confinement, it seems fair to assume that it’s a battle most of our patients would lose. And so would virtually every prisoner so treated.

The “social brain”
A very benign interpretation of the disciplinary use of solitary confinement is that it began when we didn’t know any better. We now understand that the brain evolved as a social organ—an organ that facilitates social interactions of all types, analogous to the heart and the lungs evolving as cardiovascular-respiratory organs.9,10 Without social interaction, the mental human being ceases to exist, just as the physical human being ceases to exist if the cardiovascular system stops functioning. “I sat with my mind . . . it would be a battle I would lose.”

Perhaps this is naïve, but I recall as a child, touring many of the original 13 colonies with my parents, seeing historic replicas of pillories where convicted criminals endured the humiliation of rotten tomatoes and vegetables being being thrown at them in their obviously defenseless position. This was later declared “cruel and unusual punishment.” At least that punishment was temporary. At least it was actually a social experience. It may have shamed and embarrassed, but it was social, and it was public. It was not an assault on the essence of the human brain and the brain’s emergent property of mind.

Human rights and solitary confinement
Although New York State had earlier banned the use of solitary confinement with seriously mentally ill prisoners, most states have not. This is significant for many reasons, one of which is that estimates of the incidence of serious mental illness in prisoners range from 20% to 40% and growing.11,12 We may assume that over-represented in this population are prisoners with PTSD, major depression, bipolar disorder, and schizophrenia. What is the effect of any length of solitary confinement on persons with these disorders? Mr Raemisch, after 20 hours in solitary confinement, which he knew before hand would both be time-limited and could be terminated at any time, said it was a battle he “would lose.”

All state and federal prisoners have been convicted in a court of law and sentenced to these facilities. The sentence entails a loss of freedom and a loss of certain rights. But the right to be protected from “cruel and unusual punishment” is never lost.13 Solitary confinement for the overwhelming majority of prisoners is not ordered at sentencing. It is non-judicial. It is a second level of punishment wholly administered outside the judicial system. It is unrelated to due process, a trial by one’s peers, the assumption of innocence, the right to council, etc. Solitary confinement for most prisoners, in my opinion, is cruel and unusual punishment. Solitary confinement for prisoners with serious mental illness, in my opinion, is torture.

Solitary confinement literature

Most psychiatrists and other experts working with prison populations have expressed deep concern about the use of solitary confinement with seriously mentally ill prisoners, including excellent reviews by Metzner,14 and Metzner and Fellner.15However, a recent study, flawed in my opinion, deserves comment as it appeared to show no harm associated with solitary confinement for inmates—regardless of whether they were diagnosed with mental illness.16 Coincidentally, it was conducted in Colorado where there is continuing commitment for reform, and at the same facility where Mr Raemisch spent 20 hours in voluntary “administrative segregation.” Furthermore, Dr Metzner and Mr Fellner were co-authors of this recent report, but neither was the lead author.

Study design for this problem is challenging. The logical comparison groups are fellow inmates: those with and without mental illness—subjected to solitary confinement or not. However, that imposes the confounding variable that all subjects are incarcerated whether or not subjected to solitary. Of the 302 inmates in the original study population, 55 either refused to participate or were removed from the study due to behavioral issues. Difficulties with determining subject motivation for participation, and perhaps the skewing of subject responses for the perceived benefit of the investigators cannot be measured.

Lastly, the only measure of psychological distress reported was the Brief Symptom Inventory,17 certainly not comparable to comprehensive psychological or psychiatric evaluations. Of course, no pre-incarceration studies were available either for comparison. Subjects with mental illness subjected to solitary had more difficulty at each measurement interval than their non-solitary comparison groups, but all groups showed diminished symptoms over the one-year duration of the study. The findings could [cynically] be used to argue that all patients could be kept in solitary confinement without concern for psychological harm.

Conclusion
Some detainees in the state and federal prisons have committed crimes that many of us can never forgive. But how we treat such people beyond the loss of freedom and certain rights is entirely about who we are as a society. It is not about them or what they did. It is about us.

The bottom line: solitary confinement is “cruel and unusual.” And solitary confinement for the seriously mentally ill is torture. We don’t subject stray dogs to solitary confinement––because we know it would be unethical. This issue defines who we are as a society. Are we comfortable with that identity? I hope not.

—Douglas A. Kramer, MD, MS

Additional resources from National Public Radio (NPR), 2006-2014
• Mann, B. N.Y. Becomes Largest Prison System To Curb Solitary Confinement. NPR Weekend Edition, February 23, 2014.
• Sullivan, L. In U.S. Prisons, Thousands Spend Years in Isolation. NPR Special Series: Life in Solitary Confinement, July 26, 2006.
• Sullivan, L. At Pelican Bay Prison, a Life in Solitary. NPR All Things Considered, Life in Solitary Confinement, Part I, July 26, 2006.
• Sullivan, L. As Populations Swell, Prisons Rethink Supermax. NPR All Things Considered, Life in Solitary Confinement, Part II, July 27, 2006.
• Sullivan, L. Making It on the Outside, After Decades in Solitary. NPR All Things Considered, Life in Solitary Confinement, Part III, July 28, 2006.
• NPR Staff. Solitary Confinement: Punishment or Cruelty? NPR All Things Considered, March 10, 2013.
• Mann, B. N.Y. Becomes Largest Prison System To Curb Solitary Confinement. NPR Weekend Edition, February 23, 2014.

- See more at: http://www.psychiatrictimes.com/forensic-psychiatry/solitary-confinement-it-defines-who-we-are/page/0/3?GUID=54B1CAB2-FD72-42A9-8931-F69A6A94D106&rememberme=1&ts=02082014#sthash.HqLhrxzn.dpuf

Washington State Constitutional Rights of Psychiatric Patients Violated Under Color of Law

RCW  71.05.520  – Protection of rights.

“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.]

The State of Washington Department of Social and Health Services does not in fact have any appropriately trained investigators assigned to examine records or investigate complaints that criminal violations of any individual's rights, "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." There is no plan to change this.  David Reed works as an administrator for Washington State's the Department of Social and Health Services, Division of Behavioral Health and Recovery, and oversees the Involuntary Treatment program for DSHS. Mr. Reed is the individual who was appointed to investigate complaints of civil rights violations in Involuntary Commitment proceedings in 2008, by then-Governor, Christine Gregoire.  When I called Mr. Reed on the morning of July 8, 2011 to ask if he was aware of any complaints being filed that an individual's rights had been violated in  civil commitment proceedings, I already knew the answer to the question I was asking.  I was asking the question to see whether Mr. Reed would give a truthful answer. Mr. Reed has a poor memory, or he purposely lied to me in giving an answer. If one were to assume that Mr. Reed's memory failed one could further assume he forgot sending the following letters to the advocacy group, Crossroads for Change Campaign, and that he forgot being appointed by the governor to investigate the complaints of civil rights violations...

In a letter dated September 10, 2008, Mr. Reed responded to complaints that multiple individuals civil rights were violated; stating in part, “The documentation you have presented to the Mental Health Division is more than five years old and concerns a single RSN.  The practices you have identified were subsequently rectified and represented a small portion of the detentions in the state.  I have sent you a copy of DMHP Protocols in Appendix I § 6 is a list of Washington State Case Law.  By utilizing the website:  www.legalwa.org  you can review the listed legal decision of Washington State Courts that have previously affirmed the constitutionality of RCW 71.05’s due process provisions.  Other concerns you have addressed are addressed by statute and are monitored by MHD licensure staff.”  here

The law as written was affirmed to be Constitutional, only because the due process provisions the State of Washington and the U.S. constitutions require to be preserved and defended in civil commitment proceedings, are defined within the text of the Involuntary Commitment Statute. Obviously, if the law is not followed by the designated mental health professionals given the authority to implement the law, who detain individuals Under Color of Law, and the mental health professionals who subsequently petition the Court to civilly commit individuals Under Color of Law, an individual's rights will be violated.

In a letter dated January 7, 2009 Mr. Reed writes, "I have discussed your concerns with Mental Health Division management.  After review of the additional information you provided at our last meeting regarding an involuntary hospitalization from 2005, the Mental Health Division is unable to endorse your request for action and investigation.  The concerns you have presented are of concern and will be forwarded to our Licensure staff which is tasked with correcting WAC and RCW violations for detained consumers on the part of RSNs, Evaluation and Treatment Facilities and DMHPs.   I look forward to meeting with you again to continue our discussion the ITA process as it is currently implemented in Washington.” here

SPOKANE QUALITY REVIEW TEAM Investigation and Survey Results Regarding the Legal Representation by The Spokane Public Defender's Office for the Involuntary Treatment Act process

My son, who is now 25 years old, has been victimized by unethical mental health professionals who commenced illegal civil commitment proceedings against him twice as an adult in Washington State. Neither time were his civil rights preserved or defended.  

In 2010, my son was detained based entirely on perjured testimony and a fraudulent affidavit forged by Nancy Sherman, the Designated Mental Health Professional.  The same false tainted "evidence" was used by Jeffrey Jennings; a psychiatrist who relied upon Sherman's falsehoods because he had no "first-hand" information to offer in support of his petition for a Court Order for Involuntary Treatment since Jennings refused to speak to anyone who actually had first-hand information. 

The third hearing at which a Superior Court judge granted a six month out patient involuntary treatment order, lasted all of one minute and 26 seconds--my son was not at this or the two prior hearings; indeed, my son was not even aware that any legal proceedings had taken place. My son wasn't aware that the woman who had him sign papers and who informed the court he understood and waived his Constitutional right  to a jury trial, and that he agreed to follow Jeffrey Jennings' prescribed treatment recommendations was an attorney; much less, that the woman was his own Court Appointed attorney...  

The felony crimes of fraud and perjury were committed by mental health professionals in Yakima County Superior Court; a fraudulent affidavit and perjury were proffered as "evidence" used to detain and involuntarily treat my son. There was no criminal investigation of the crimes reported on my son's behalf, nor was there an investigation of the illegal shredding of Court records that was also reported. The CEO of Central Washington Comprehensive Mental Health, a current NAMI Washington Board member, Rick Weaver, claimed there is nothing wrong with shredding original Yakima County Superior Court records for Involuntary Commitment hearings, telling me,  "we do it all the time."  How is it that the illegal shredding of original Superior Court documents used to detain and Court Order people targeted for Involuntary Treatment allegedly because they are incapable of making treatment decisions, is not referred to Law Enforcement for criminal investigation?

the second time my son was committed in 2011, the attorney appointed by the court to represent my son had an obvious conflict of interest., the attorney also did legal work for the psychiatric facility that sought the Benton County Superior Court's order to treat him involuntarily! The attorney's obvious conflict of interest was never disclosed to my son, or to any of the three people who are designated representatives authorized to protect his interests when he is unable to do so himself. All three of us were present and conferred with the attorney and the psychiatrist.  I discovered that my son's attorney also does legal work for the facility when I conducted an internet search seeking the attorney's contact information. The attorney had failed to provide any of his contact information to my son. no phone number, no e-mail address; no way to contact him at all... 

What do you need to feel safe?

I was just reading "Mother of kidnapped Denver girl speaks of daughter's strength" and I couldn't help but think of what I consider "my first mistake" as a mother responsible for making decisions about how to deal with my son's injuries from traumatic abuse---I desperately wanted to make the decisions that would give my son his best chance of a full recovery from his traumatic injuries. I followed the wrong advice. I should have listened to the Police Officer...

My first mistake was listening to the psychiatrist, instead of taking the advice of Seattle Police Homicide Detective, Don Cameron. His voice still echoes in my memory. There is no way to know how things would have been different for my boy had I taken his advice.  My boy has been forced to live a lie because not one of the "mental health professionals" who "treated" him EVER acknowledged his traumatic injuries, or helped him to process his trauma, or even recognize that his symptoms---which were injuries---were not simply dysfunctional "behaviors." The following week, two of these so-called "professionals" actually attempted to get me to agree that my son needed "to be institutionalized for life" within weeks of his seventh birthday. There is no word that describes how I feel about the intellectual dissonance and willful blindness that must be required for people to repeatedly traumatize my son and in effect---blame my son for his injuries---instead of helping him to feel safe, or helping to prosecute the person who harmed him! These people had a duty to help my son; it would have helped him to know how valuable he is as a human being. He was a child who needed to feel safe; needed to know he would be protected from harm, he needed to know he was defended when he was criminally abused---Some had a legal duty---at the time of the crime---their failure to fulfill their legal duty is itself, criminally negligent---as is the failure of those who lied and helped to cover up these criminal failures; some perjured themselves in Superior Court. My boy was seven, he needed to know that people don't get away with beating little boys up and putting them in a closet.

He still does---he still doesn't feel safe.

A doctor of psychiatry and his medical instruments

When one realizes that Human Rights crimes are legally mandated but it's called providing "effective medical treatment" to people with a diagnosis of schizophrenia, who don't know what's good for them (because they supposedly have a lack of insight) it's truly stunning.  I realized this was happening when I was a kid---I have been aware way too long to be polite sometimes...The fact that a minority of people with a diagnosis of schizophrenia actually benefit from taking the neuroleptic drugs; but that everyone who takes them faces serious risks to their overall health is not relevant, and neither is determining if the person Court Ordered is among the minority of people the drugs help. The Nation's top psychiatrists, and grassroots mental health advocates for the "seriously mentally ill" lobby for public policies and Legislation so that more people can benefit from psychiatric treatment "for their own good." (and 'protect' society)

The fact that psychiatric treatment commonly results in iatrogenic illness and disability and leads to a decades earlier death is a well established; an obviously accepted, if not intended, outcome. It's plain that disability and early death is the most commonly achieved Real World Outcome for people treated by psychiatry; particularly for people who are diagnosed with schizophrenia. Obviously, words like "safe" "effective" and "treatment" had to be re-defined for psychiatry's clinical standards of care; the terms, "clinical care standards," "best practices" and "off label prescribing priveledges" have also been redefined by psychiatry. Psychiatrists who write, recommend, and use drug based treatment protocols and algorithms and who teach students and other medical professionals to use them, must believe that disability and early death are beneficial to patients; acceptable, desirable treatment outcomes and perhaps even deluded enough to believe that consensus is a substitute for ethical medical research. Doctors of psychiatry, leading psychiatric researchers and public mental health policy makers are providing a standard of care with consistent, reliable results; unfortunately, the most probable outcome is death. This bewing the case, one can understand how perjury and forgery have simply been re-defined, they are now part of psychiatry's standard of care which are supported by the specious claim that teratogenic drugs treat undefined "chemical imbalances" and unidentified "brain diseases" which psychiatrists believe may be causing "mental illnesses;" more accurately described as, psychiatric diagnoses. Unsubstantiated claims are the so-called "evidence" that standard clinical practices are based upon. The neuro-biological disease and/or chemical imbalance hypotheses are, at best, slurs which stigmatize; at worst, they are fraudulent claims made in order to deprive people of their human rights based on eugenic theory repackaged then marketed to the masses as valid, ethical "medical science."

People with a psychiatric diagnosis have their Human Rights violated as a matter of course; the rights most people take for granted. Mental health professionals have a moral and an ethical duty to preserve the fundamental human rights of people whom they give a psychiatric diagnosis. Instead, mental health professionals and 'patient advocates' support legally diminishing what are inalienable rights---but what the hell, safe and effective treatment is not actually safe or effective so what is a little deprivation of one's human rights in order to medically treat the diseases psychiatrists voted into existence! Even clinical care standards are determined by pseudo-democratic political process. The standards are not based on ethical, scientific research; or any ethical medical standards used by any other field of science based medicine. Psychiatry uses the Courts to strip patients of their human rights, psychiatry does not conform to legal standards i.e. Rules of Evidence, and Standard Court Procedures, that are required for for every other type of Court Proceeding, whether civil or criminal.

The nature of psychiatric diagnoses and the effects of the drugs is not relevant in commitment proceedings. No where in our society is psychiatry held to the ethical standards other medical specialties are; not even the ethical standards which are legally mandated by International Law for Clinical Research conducted by Medical Doctors on human subjects. Psychiatry is practiced in a dishonest, unethical manner. There is no evidence that the psychiatric profession values the ethical standards of science, medicine or the law. There is no evidence of psychiatry being compelled by an altruistic intent or that it values or is even aware of a primary ethical duty to psychiatric patients. Patients are disabled and killed at alarming rates by teratogenic drugs and shock treatments prescribed "for their own good."

What psychiatrists do not explain is why the ethical standards of science, medicine or the law do not apply to the practice of psychiatry. What psychiatrists do not explain is why fraud, corruption, and lying in professional journals, textbooks, classrooms and to students and professionals is acceptable. What psychiatry needs to explain is why outright lying and using analogies to explain psychiatric symptoms and coercing "treatment compliance" is ethically acceptable. Dishonesty is not honorable, defense of dishonesty shows an utter lack of ethical integrity.

Why does a group of professionals that is so dishonest and unethical have Police Powers? Courts of Law have lowered all of the ethical legal standards for psychiatry so that the Courts and Police have in effect, become medical instruments used to strip patients of their inalienable rights to force compliance with psychiatric treatment. Rules of evidence do not apply to the "evidence" used against psychiatry's patients, and the lowered legal standard is claimed to be necessary for the patient/victim's "benefit."

It is patently obvious that the lower standards in scientific medical and legal arenas serve primarily to keep facts hidden. Lowered Court standards serve to protect psychiatry while failing to protect psychiatric patients or serve the Justice interests of society as a whole. The same patient can be seen by 3 psychiatrists and get 3 distinctly different diagnoses. Psychiatric diagnoses cannot truthfully be called "diseases." Teratogenic drugs and electrical shocks, both of which cause iatrogenic damage and dysfunction, cannot be truthfully called "safe and effective medical treatments."  Without lowered legal standards, a psychiatrist would not be able to offer "evidence" that a person has a "brain disease" requiring "safe and effective medical treatment." If the Rules of Evidence applied, a psychiatrist could offer little, if any, evidence that would support a petition forcing involuntary psychiatric "treatment."

Lowering scientific, medical and legal standards is necessary, but it is not done to provide "necessary medical treatment" that is "safe and effective." I suspect if any of psychiatry's claims were supported by scientific findings, or grounded in ethical medical principles, i.e. based on facts instead of  subjective opinions, innate biases, errors of attribution, and distorted research; psychiatry would not need to pervert and distort the truth. Police Officers have an ethical duty, an Honor Code, "To Protect and To Serve."  Courts of Law have an ethical duty to apply the law equally to all, as if the Courts were blind to special interests; not biased in favor of predetermined outcomes. In effect, to be blind to subjective biases; basing legal rulings on objective evidence offered in compliance with the rules of evidence, adhering to standard legal procedures. Why has human society allowed psychiatry to subjugate the role of Police Officers and Courts of Law to that of serving the interests of psychiatry? Police Officers and Courts of Law now are performing their jobs as if their ethical duty has become primarily to serve psychiatry as "medical instruments."  Police Officers and Courts of Law serve all of society by enforcing the Law, and preserving individual rights. Service in preservation of Blind Justice is honorable when done with integrity. It is a shameful disgrace; a blight on all humanity when it is not.

via Leonord Roy Frank


A SIGN FOR CAIN
An Exploration of Human Violence
FREDRIC WERTHAM, M.D.



The Geranium in the Window
THE "EUTHANASIA" MURDERS
If the physician presumes to take into consideration in his work whether a life has value or not. The consequences are boundless and the physician becomes the most dangerous man  in the state.

DR. CURISTOPH HUPELAND

(1762-1836)

IF we want to understand violence as a whole, we cannot leave any of its major manifestations in a fog of half-knowledge. But this is exactly what has happened with an unprecedented occurrence of mass violence, tile deliberate killing of large numbers of mental patients, for which psychiatrists were directly responsible. To both the general public and the psychiatric profession, the details and the background are still imperfectly known. This is not only a chapter in the history of violence; it is also a chapter in the history of psychiatry. Silence does not wipe it out, minimizing it does not expunge it. It must be faced. We must try to understand and resolve it. read here

Picture Credit: Just Ducks