Debating Ghazala Watt

Today, when I attended the appointment that was sent to me in the mail, the PA Hospital psychiatrist Ghazala Watt was prepared to lock me up again. She arranged for a man called Gordon, a middle-aged man with a shaven head and thuggish demeanour, who I recognised to have a Scottish accent, to come into the consulting room with us. I wasn’t told that Gordon was the ‘duty officer’ (I read it later in her report) but I noticed that he sat between me and the door. If Ghazala had decided to “admit” me, Gordon would have provided the muscle to subdue me, if needed. As it was, he sat there silent, unmoving and expressionless, while I debated with Ghazala Watt and tried, again, to correct her misconceptions.

I attended the appointment under duress. I have made it clear that I have no respect for Ghazala Watt and do not want her to be my doctor, or have anything to do with her. I am my own doctor, though I also have a GP, who studied with me at the University of Queensland and I used to consult a private psychiatrist, Frank New, who won my respect when he interviewed me for 3 hours and then wrote a 13-paged report explaining why he thought I was not mentally ill, and didn’t think I ever had been. This was back in 2002, when Dr New was asked to provide an independent psychiatric assessment for the Medical Board of Queensland, following my numerous incarcerations as a mental patient in Melbourne. Since then, he has rung the hospital on several occasions, saying that he does not think I have ‘schizophrenia’, the label Ghazala Watt is trying to pin on me again. The schizophrenia diagnosis (initially made in Melbourne) was discarded by other psychiatrists at the PA in favour of what they termed “psychotic disorder NOS”. NOS stands for ‘not otherwise specified’, meaning not otherwise specified in the DSM (the Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association (APA). It is a misconceived label, open to abuse, that has now been discarded in the current DSM V.

After our debate, I was asked to wait while Ghazala prepared a document that I was given by Gordon titled “CLINICAL REPORT – TREATMENT AUTHORITY REVIEW – MENTAL HEALTH REVIEW TRIBUNAL”, for “Romesh SENEWIRATNE”, supposedly “prepared” by Raghuvan (Raghy) Raman and Ghazala Watt. This is misleading. The ‘interim case manager’ Raghy had little to do with the preparation of the report – it is a repeat of the last one the hospital produced, and the ones before that, with a single paragraph by Ghazala following our debate today. The false claims in the report were initially based on a thorough character assassination of me by the inpatient psychiatric registrar David Nguyen in 2012, then modified and made slightly less offensive by the psychiatrist Daniel Varghese (under whom I was locked up in 2009, 2010 and 2011). It was later added to by subsequent psychiatrists, including Subramanian “Subu” Purushothaman, Justin O’Brien and the registrar Sagir Parkar but no efforts were made to correct the factual inaccuracies (or even the typographical errors) after the most glaring ones in Nguyen’s initial report were amended by Daniel Varghese 5 years ago.

Ghazala Watt’s own contribution is written in bad English and all in lower case without any capital letters except Sri Lanka (the first time, the second reading ‘srilanka’). It reads (under ‘current mental state assessment’):

“presented for the review on time, was seen in the presence of duty officer. remained focused on his father’s actions leading to him having medications and admissions to the hospital. presented with multiple writings about his father, political movements in Sri Lanka and anti psychiatric movements. remained focused on the cause of previous admissions in relation to complain about father and not in relation to medication noncompliance or treatment authority being revoked.

presented less irritable preoccupied with srilankan politics and mental health services being ‘sided’ with his father. insight remains limited with limited understanding on mental illness and the role of medications.”   

Watt and Raman have also changed the diagnosis from “Psychotic Disorder – Not Otherwise Specified’ to ‘Paranoid Schizophrenia’. Someone who uses capital letters correctly, but also with a poor understanding of psychiatric terminology and theory, has written the section on “current treatment”. This may be Raghy or Nigel Lewin, who is English and was my ‘case manager’ and monthly assaulter for several years, until he went on long service leave recently, when he was replaced by Raghy Raman, who is an Indian Tamil man of late middle-age who is sympathetic to the Tamil Tigers (LTTE), the terrorist organization that my father acted as a lobbyist and propagandist for during the war in Sri Lanka, and has praised in his writings and speeches since the military defeat of the Tigers in May 2009. His most recent book claims that the Tamil people in Sri Lanka are missing the Tigers now that they are not there and that the LTTE ran a “well-functioning de-facto state” that had a good police force and legal system with courts superior to parallel courts provided by the Sri Lankan government. This is nonsense. The LTTE “courts” killed, tortured and imprisoned people who stood up against them. They were run not by trained lawyers but by young LTTE thugs. The LTTE kidnapped Tamil children and gave them weapons to fight in a war they knew they were losing (after placing cyanide necklaces around their necks, which they boasted showed their dedication to the cause rather than the organization’s ruthlessness). They used Tamil civilians as human shields and shot civilians who tried to cross to the government side at the end of the war. They killed numerous Tamil leaders who were branded as “traitors” for siding with the government. My father was one of the people who publicly named these “Tamil traitors” who became assassination targets for the LTTE. And this is just what the LTTE criminals did to the Tamils, who they claimed to be fighting for the “liberation” of.

I had a discussion with Raghy about Prabakaran and the LTTE the last time he came to visit me. He was armed with an injection; I was armed with a video camera. I filmed the interview and uploaded it to my YouTube site a week later, after I was told that I would have to see Ghazala Watt despite my objections to her. This may be why Ghazala asked me, as soon as I entered the room, “Are you recording this? Because I don’t give you permission to record this”.

I answered that I don’t even have a mobile phone. She said “I heard that you sometimes record interviews”. I explained that when people come around to my house to inject me I am in the habit of filming them and the camera is visible for all to see. I reassured her that I wasn’t recording us. She, on the other hand, had a “witness” who would agree with everything she said (Gordon), and act as her bodyguard too. It is ironic that she called me “paranoid schizophrenic” when it was she who demonstrated the paranoia.

During our discussion, Raghy expressed conviction that AIDS is man-made (as I have long suspected) but also came out with some strange delusions, with a political twist. He said that the LTTE’s military leader Prabakaran was not a terrorist in his opinion, but an “activist”, who only killed the “other groups” (of Tamils) after he converted to Christianity and this killing was directed by the Church. He also accused the Catholic Church and Sonia Gandhi of killing her husband Rajiv Gandhi (the ex-PM of India) “to win the sympathy vote” so that Sonia could become Prime Minister of India. When I told him that the LTTE had admitted to killing Gandhi (by a female suicide bomber), he said that this was due to a deal made between Sonia Gandhi and Prabakaran and that the LTTE had been promised help by India to win the separatist war but that India had let them down.

I corrected Raghy, and told him some things he needed to know about the LTTE’s terrorism and other crimes against Tamil as well as Singhalese and Muslim Sri Lankans, but I didn’t confront his delusions as strongly as I could have. As it was, he evidently thought I had “elevated speech”!

It was Raghy who gave me the last injection and also gave me the bad news last week that if I didn’t attend the appointment I had been sent I might be “returned to the hospital” by force. Raghy also told me that rather than stopping the injections, Ghazala and the “team” had decided to increase the dose. The report I was given today claims that I have “elevated speech”, in the section on “Current treatment”:

“Assertive case management for ongoing review of mental state, risks and compliance with medication. Paliperidone IM medication increased to 100mg every 4 weeks in the context of possible relapse in mental state evidenced by elevated speech with the treating team. To have monthly reviews by case manager and psychiatry registrar, and regular reviews with a consultant psychiatrist.”

This is a confusion of psychiatric jargon. There is such a thing as an elevated mood (often misdiagnosed), but I have Raghy on record saying that I did not have one and that I was euthymic – presenting with a normal mood. The other psychiatric term is “pressure of speech” which is described as a sign of mania, not schizophrenia. An elevated mood is a sign of hypomania and mania, according to the DSM; there is no such thing as “elevated speech” in psychiatric terminology, such as it is.

Ghazala Watt claims in her CV that she has expertise in writing medico-legal reports. Yet she has written a report to the Mental Health Review Tribunal with poor grammar, incomprehensible sentences and no capital letters as required according to the accepted rules of English grammar, which are insisted on in legal reports. My 8 year old daughter uses appropriate capitals at the beginning of a sentence. One might think that a Fellow of the RANZCP should too.

My fresh recollection of this morning’s debate and interview are rather at odds with the brief assessment by Ghazala. Let me take it sentence by sentence, correct and include what she omitted.

“presented for the review on time [I was 15 minutes early], was seen in the presence of the duty officer”

I did not want Gordon, who looked like a neo-Nazi thug, to come into the room with us, but Ghazala insisted. She said she wanted him there, but not why. I had never met him before, and didn’t want to discuss personal matters in his presence. The real reason is that she wanted “backup” if needed. I didn’t know and wasn’t told that he was the duty officer, responsible for admissions from the clinic to the hospital.

 

The report’s next sentences are:

“remained focused on his father’s actions leading to him having medications and admissions to the hospital.” and “presented with multiple writings about his father, political movements in Sri Lanka and anti psychiatric movements”.

She has omitted some important information and misinformed the tribunal about what I carried with me to show her when I “presented”. I didn’t have “multiple writings” about my father. I didn’t have any at all. What I did bring with me, was my diary (which I showed her) and a folder I had titled “Public Image and Personae – Me vs. the people who are calling me MAD”. I didn’t show her this folder, but I selected particular documents for her to keep and read, including one piece by my father and two pieces by myself – “Theorising About the Pineal Gland” and “Royal Park Admission (1995)” printed off from my new WordPress blog. She had never heard of WordPress, so I explained what it was, and that I was writing about my psychiatric experiences. I didn’t have any of my own writings on the anti-psychiatry movement, though I mentioned it in my books The Politics of Schizophrenia (2000) and The Pseudoscience of Schizophrenia (2011) which I have not shown her yet.

At the end of the interview I also gave her a document that I hoped would give her some insight into my father’s modus operandi. This is a long and highly defamatory piece that he had published in the Britain-based expatriate website Colombo Telegraph (CT) a few years ago that purports to be a “psychiatric analysis” of the highly respected Sri Lankan politician Gotabaya Rajapaksa, who is hated by the LTTE supporters for his role in defeating the Tigers in his role as Defence Secretary. I gave Ghazala the first 10 pages of the article so that she could compare the sanity of my father’s writing with my own. This is the only thing I had in my folder about “political movements in Sri Lanka”, and it was not written by me.

What I did have in the folder, apart from these, were documents printed off the internet, from Google, Linkedin, Facebook and Youtube, comparing the work and image of four people – myself, my father, Ghazala Watt and her boss Balaji Motamarri, an undistinguished Indian psychiatrist who heads the “service” she kept referring to – the Metro South Addiction and Mental Health Services (MSAHMS) of which the PA is one of several hospitals. I was ready to debate the fact that madness and sanity are relative terms, but Ghazala rejected all talk of madness or sanity.

“What’s madness?” she asked

“Insanity.”

“What’s insane?”

“Crazy.”

I would have explained my reasons for thinking that everyone has false beliefs or delusions, and that these are propagated by several means, including the media, religions, cults, political parties, schools, universities and families. But such a discussion requires the other person to be open-minded and receptive to new ideas. Ghazala was only interested in denying concepts of madness and sanity in order to try and convince me that she and the “service” were “helping me” with my “mental illness” and not taking sides in what the report admits is an “acrimonious relationship” with my father. I doubt that Ghazala knows what acrimonious means.

 

I didn’t have writings of my own about “political movements in Sri Lanka” or the “anti psychiatric movement”. I had asked her about what she knew about the anti-psychiatry movement and she said she’d never heard of it. I showed her a printout of the first page of the “Worldwide Protest of the American Psychiatric Association” Facebook page, with a posting by myself, saying:

“It seems to me that psychiatry is primarily a system of character assassination”

“Why are you showing me this?” she asked.

I pointed out that the posting had many likes, and that it was part of a world-wide movement against abuses by her profession.

 

It is a sad reflection of psychiatric education for specialists in Australia that Ghazala Watt became a consultant and member of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) without being aware of the anti-psychiatry movement and scientific, ethical and legal criticism of her profession. Raghy and Nigel, the case managers, both psychiatric nurses, had heard of it but that’s about all. Raghy said the movement had been active for at least a hundred years, and he thought it was active in Melbourne, but I never saw signs of this during the 20 years I spent in Melbourne, during which I was locked up and injected more than 40 times between 1995 and 2007, when I returned to Brisbane.

In our brief conversation after my debate with Ghazala,  I asked Gordon if the anti-psychiatry movement was active in Scotland.

“No!” he answered, emphatically.

I then asked if he thought I had schizophrenia.

“I’d have to go along with the doctor on that, I’ve never met you before.”

“Do you think I am elevated?”

“Maybe.”

I explained to Gordon that I wasn’t elevated, or irritable, I was justifiably angry that the hospital kept siding with my father, who used to work at the hospital, against me.

The next sentence is hard to comprehend, but I think she’s trying to say that I was (and am) blaming my father for getting me locked up, rather than my not taking medications. I’m not sure what she means by “previous admissions in relation to…treatment authority revoked”. I have not been locked up because I was taken off the ITOs (Involuntary Treatment Orders – there were no such things as “treatment authorities” until the new Queensland Mental Health Act of 2017):

“remained focused on the cause of previous admissions in relation to complain about father and not in relation to medication noncompliance or treatment authority being revoked.”

In fact, as I explained to Ghazala, a previous psychiatrist, newly employed at the PA Hospital in 2015 by the name of Dr Jill Schilling had visited my house with Nigel in July and came to the conclusion that I was not psychotic and could not be legally kept on an ITO. After a single visit she took me off the ITO. The report says only that “ITO was revoked on 28/07/2015” but not why, and the fact that Dr Schilling thought me sane.

I told her what happened after that: my father pressured my mother to ring up the hospital complaining that they should not have taken me off the ITO and I was “again” saying that my father was involved with the Tamil Tigers. The fact is that I had never stopped, and that this was not just the truth but it was demonstrably true from his writings and speeches which are freely available on the Internet. The PA responded, to my mother, that as I had been taken off the ITO the only way I could be forcibly “assessed” was if she went to court and took out a “Justice’s Examination Order” (JEO), which she had never heard of. My father was in charge. It was he who drove my mother to court, but “kept his hands clean”.

I was then visited by police who told me I had to go with them back to the hospital, where I was locked up for a few days and discharged. Unsatisfied, my father continued his efforts to get me locked up and evicted from my house, enlisting the help of my next-door neighbour Jeff Miller, with whom he had several phone conversations (while refusing to speak to me on the phone and ringing the case manager to allege that I was harassing him by ringing him all the time, which was untrue).

This pattern of hostile behaviour by my father has continued to the present day. Only last month he shouted to my mother, “He’s getting worse. He’s completely bananas. You’ll have to call Miller and get him to call the hospital”. When my mother demurred he got angry, “What about the other neighbours? We can jump up and down and they [the hospital] won’t take any notice of us”. This was because Nigel Lewin had recognised my father’s animosity towards me and took what he said with a pinch of salt. Nigel and Sagir Parkar had also spent some time looking into my father’s political activities on the Internet and concluded that what I had been saying about his involvement with the LTTE was, in fact, true.

I was locked up again on my 55^th birthday, on 22^nd September 2015, after my neighbour Miller and my father reported me together, one (my father) to the Mental Health Services and one (Miller) to the police. Miller said I was armed with a knife and he feared for his life lest I run across the road and stab him, because in his paranoid imagination I hated him that much. The truth, as I reported to the police who eventually dropped the case,  was that I had not even seen Miller and had walked across the road to cut some bark off a paperbark tree for my art. Ghazala Watt’s report contains the version of this event as recorded by Justin O’Brien who was the consultant at the hospital responsible for keeping me locked up for the next two months, while my father emptied my house of its contents and convinced my mother to put it up for sale (rendering me homeless). He also employed workmen to chop own all the trees and shrubs I had planted over the past 8 years, and got my mother to sign a curt, legalistic note informing me that if I attempted to return to my house she would take out an ‘Apprehended Violence Order’ (AVO), though again, she had no idea what an AVO is or its legally correct use. My mother signed the letter in three places as directed by my father, and copies were sent to Justin O’Brien and the case manager. She has no recollection of signing this cruel letter two years later, and eventually relented and let me return to my home (she owns the house, but the title deeds are in the hands of my hostile older sister’s lawyers).

After she told me she was increasing the injection I told Ghazala that I was disappointed that she and the hospital consistently took my father’s side against me.

“There are no sides” Ghazala tried to persuade me, “Not your side, or the hospital’s side or your father’s side. I can assure you that the hospital is quite independent of your father.”

In her “assessment” she continues:

“presented less irritable preoccupied with srilankan politics and mental health services being ‘sided’ with his father”

Less irritable than when? I have never been irritable. I am a very calm and forgiving person, but I get irritated (not irritable) when I am insulted by people calling me mentally ill or psychotic, especially  by people who are wilfully ignorant or prejudiced. I was justifiably angry because Ghazala Watt had just told me that she had decided to increase the dose of the ‘antipsychotic’ injection from 75 mg to 100 mg. This was despite my explaining at the beginning of the interview that I was suffering from deteriorating physical health because of these abusive injections. I told her that I have gained 10 kg of weight and my daughter has recently commented on my “pot belly”, which I didn’t have in the past. Ghazala is well aware that weight gain is a common side-effect of the drug she insists on ordering be given to me against my will, under threat of being locked up again. Today when I challenged the science behind her “clinical decision” to increase the dose (rather than stopping the drug, which would be the ethical and scientific thing to do) she asked me, threateningly, “do you want to be hospitalised again?”

It was Ghazala who raised the matter of my father with me. She said he had contacted “the service” several times and complained about me, which is why she was increasing the injection (she later said that there were other reasons too, when I accused her of siding with my father against me). She said she had not spoken to him herself, but asked me to explain why I had posted things about my father on the Internet. She then said that she’d heard that I’ve also posted things about “our service” in which I had named names. I couldn’t deny it and explained that I am naming them and shaming them.

Interestingly the new report has taken out the previous report’s naming of the Tamil Tigers (LTTE) as the terrorist organization I was accusing my father of supporting. Instead it says that I was, in October 2016, “preoccupied with delusional thoughts about his father’s involvement with a political group”. I have never heard the LTTE described as a “political group”, or as Raghy would have it “activists”. Most people know them as ruthless terrorists, which they were.

Finally, she ends her contribution to the character assassination with:

“insight remains limited with limited understanding on mental illness and the role of medications”

My understanding of mental illness and the correct use of medications is at least as good as Ghazala Watt’s. I worked for many years in family medicine, including psychiatry. I know the role of the drug companies in shaping the thinking of doctors, and that drugs are over-prescribed and over-consumed. I am also aware of the pseudoscience prevalent in psychiatry with its various “chemical imbalance theories”. I have also researched the Australian psychiatric system and the role of eugenics in shaping psychiatric doctrine in Australia, the USA and elsewhere. I had to admit to Ghazala Watt, though with a smile, that I thought she was heavily brainwashed.

I explained to Ghazala that I needed to defend myself when people called me mad.

“Who called you mad?”

“My father. He calls me a bloody madman, all the time.”

“You don’t like that?”

“Would you?”

“I don’t know. No-one has ever called me mad.”

I held my tongue, but I confess to the urge to be the first to do so. That was a wise decision that may have stopped me from being locked up again, something Ghazala and Gordon were ready for.

“Let’s get this clear, I am not involved with mad, crazy and insane, I am a doctor treating mental illness”, she said.

A label of ‘mental illness’ is worse than a label of mad. It’s cool to be mad. It’s good to be mad at bad things, evil actions, oppression, torture and abuse of power and position. I’m mad at my father, and mad at Ghazala Watt, but I am not mentally ill. I am angry, and my anger is justified and rational. They say that the pen is mightier than the sword. I’m hoping that the pen is also mightier that the needle.