High-handed treatment by the PA Hospital

I am angry. After giving him the benefit of the doubt, despite our history, Professor Mark Taylor has betrayed my trust in him and his considered judgement. I should have been more wary – in 2001 he wrote that I had a psychotic illness when I said (and wrote) that AIDS is man-made. At the time, he opined that before I became “ill” I had a paranoid, narcissistic personality disorder. This character assassination and drugging was at the Alfred Hospital in Melbourne and I had hoped that the last 17 years would have improved Mark Taylor’s judgement and medical practice. A competent psychiatrist can ascertain whether a person is mad or sane in a few minutes, and can do it over the phone.

Last week I received a note in the mail from Raghavan ‘Raghy’ Raman who has been appointed my “case manager” since the English nurse Nigel Lewin went on long-service leave a few months ago. Lewin had been injecting me on the orders of a succession of psychiatrists at the PA since 2012, when I was locked up for 2 months for maintaining that my father was a supporter of Tamil Tiger terrorism and had worked as a lobbyist of the organization. The hospital refused to look at the evidence that I provided of my claims and put me under the authority of an Indian Tamil psychiatrist many years my junior who is known to my father.

The note Raghy sent informed me that “my” injection will be due today but that he would be on leave for two weeks. I was asked to come in for the injection, to be given by one of the other 200 staff of the MSAMHS. I was given a number to ring – that of the “psychosis team”.

I rang the number and asked to speak to Balaji Motamarri, the long-time director of MSAMHS, who also qualified in India, before coming to Australia in 1998. “We don’t have a Dr Motamarri working here”. I said that he was the director of the organization and I was put through, instead to Sharon Locke, the “team leader”. I have spoken to this woman many times in the past, and expressed my objections to the PA Hospital’s negligent, high-handed treatment of its patients, including myself. She listens and notes things down, but says she can’t comment on matters that I need to “discuss with the doctor”, including my diagnosis and need for treatment.

When I met Mark Taylor after 17 years I had 24-hours notice to prepare. I had been phoned by Raghy Raman the day before to say that rather than Ghazala Watt, I would be seeing “Dr Taylor”. I told him that Mark Taylor had been responsible for locking me up in Melbourne in 2001, and was one of the psychiatrists I had named in the Statement of Claim I sent to the hospital, but was not accepted by the courts. The hospital psychiatrists referred to this as my being “litiginous” and further evidence that I was mentally ill.

In 2001 Mark Taylor wrote that I was deluded about “AIDS, eugenics etc” and misrepresented my statement to him that my father was a supporter of Tamil Tiger terrorism, and was trying to stop me from asking him what he knew about biological warfare. Taylor wrote that I believed that my father was spreading AIDS and that he is a “biological terrorist”. He wrote that these beliefs (about AIDS, eugenics and my father) were evidence of schizophrenia and recommended that I be injected with zuclopenthixol (Clopixol) against my will under a “Community Treatment Order” (CTO). I successfully appealed against the CTO was was released from forced treatment by the Alfred Hospital, but now Mark Taylor has turned up again, and has been given power over me.

I answered Mark Taylor’s questions about me honestly but did not get a chance to show him any of the evidence of my sanity that I had carefully packed in my briefcase to show him. The opportunity never arose, since he was sitting in front of the computer screen and typing my responses to his interrogation of me. He was particularly interested in my drug intake but also asked general questions about my health. I was relieved to speak to somebody who was fluent in English and encouraged by his assessment that I was “no longer” psychotic and his promise that would consider reducing the injections.

After I expressed my concerns to Sharon Locke last week, Mark Taylor phoned me back and asked how he could help me. This is a first from psychiatrists at the PA Hospital. I said he had said he would think about stopping or reducing the injection. He agreed he had done so, but wanted to be sure that I was “stable” fiirst. I assured them that I was, and the only problem I have is side-effects from the 100 mg of paliperidone that Ghazala Watt had insisted be injected into me when my father contacted the “service” complaining about me again.

Rather than assessing my mental state over the phone, Mark Taylor said he wanted to “check with your case manager Raghy”. This is ridiculous and negligent. I have already told Taylor how Raman, who is an Indian Tamil with poor English skills, thought that the Tamil Tigers were “activists” rather than terrorists, and was clearly sympathetic to the terrorist organzation I have long been opposed to and my father supported. Today I told Sharon Locke more disturbing facts about Raghy Raman that I had not shared before, since he asked me to keep his confidence. These related to his own medical problems, including the cause of his psoriasis and hypertension. He was blaming the antihypertensives he was on for worsening his psoriasis, but I suggested that maybe stress was a common factor in both. He agreed that he was stressed, but blamed his wife’s behaviour towards him as the cause of the stress, and that there was nothing he could do about it. He then told me he expected to commit suicide when he was forced by his age to retire. This man is not in a position to judge the sanity of me or anyone else.

The injections don’t need to be reduced, they need to be stopped. It is patently obvious that I don’t have schizophrenia, if the the term is to be understood by the contents of psychiatric texts.

Evidence against Princess Alexandra Hospital, Wooloongabba, Brisbane

via Threats by the PA Hospital

Debating Psychiatry with the PA Hospital

 

This is a debate from two years ago (February 2016) between me and Nigel Lewin, an English psychiatric nurse from the Princess Alexandra (PA) Hospital.

Nigel had been appointed my ‘case manager’ and I was being made a “medical case” and “mental case” by my medical colleagues at the hospital that empoyed my father from 1976, when my family migrated to Australia from Sri Lanka. I was 15 then and remember staying in a house on the grounds of the hospital when we first arrived. Later, I avoided the hospital where my father and sister worked, and had a poor opinion of it, reinforced by my father’s claims (for which he was eventually sacked) that the hospital was “in chaos”. This was in 2001 and he got me locked up at the “chaotic” hospital (in his own written opinion) in 2002. In fact, he got me locked up 5 times in 4 months, culminating in my rib and finger being broken by security guards and male “nurses” immobilising me so that I could be injected with a drug called Zuclopenthixol, a treatment for ‘schizophrenia’ and other ‘psychotic disorders’

I began my debate with Nigel by asking him what he thought about “Psychotic Disorder – Not Otherwise Specified”, the label the hospital was trying to pin on me at the time, after revising the diagnosis from one of schizophrenia. Now, under the treatment of Jumoke Banjo (from Nigeria) and Ghazala Watt (from Pakistan) the diagnosis has been changed back to “paranoid schizophrenia”. Nigel Lewin has now gone on long service leave and a new case manager, an Indian man by the name of Raghy Raman, has been appointed. Raghy has expressed the opinion that the leader of the Tamil Tigers, Vellupillai Prabakaran was an “activist” rather than a terrorist, and described me as having “elevated speech” when I debated with him about the Tamil Tigers. In response to this, the psychiatrist Ghazala Watt increased the dose of depot antipsychotic she has abusively ordered.

 

 

 

 

 

 

 

Considering ‘Insight’

©2018 Romesh Senewiratne-Alagaratnam (MD)

Being insightful is considered a virtue. It is similar to being thoughtful, but insight implies intuitive knowledge and perception of truth. There has been much study of insight in psychology in recent years, mainly looking at the phenomenon from the perspective of problem solving. It has been found that insight is promoted by good mood and sleep, which help solve problems. An insight is described as an “aha moment”, “penny-drop moment”, “eureka moment” or epiphany.

 

However, ‘insight and judgment’ mean something quite different in psychiatry – in this medical specialty, insight specifically means willingness to accept that you are, and have been, mentally ill. This is problematic and constitutes a widely used circular argument – that refusal to agree you are mentally ill is itself evidence of mental illness. It means that mentally healthy people who are mistakenly admitted as psychiatric patients harm their chances of discharge if they maintain that they are not mentally ill.

 

The Positive and Negative Syndrome Scale (PANSS), widely used in evaluating antipsychotic drugs for schizophrenia, is explicit about this. Section G12, titled “Lack of Judgment and Insight” states that ‘extreme’ (grade 7) lack of insight is to be recorded due to:

“Emphatic denial of past and present psychiatric illness. Current hospitalization and treatment are given a delusional interpretation (e.g., as punishment for misdeeds, as persecution by tormentors etc.), and the patient may thus refuse to cooperate with the therapists, medication or other aspects of treatment.”

 

Good judgment involves the ability to make sound decisions, based on knowledge of what is true and what is false. It is insulting to accuse someone of poor judgment, and uncalled for if the accusation is based on reasonable refutation of an incurable mental illness label. People can make sound judgments about many things, but not be convinced that they are mentally ill, especially if the illness is claimed to be due to unmeasurable chemical imbalances in their brains that are of uncertain origin, the dominant paradigm in psychiatry.

 

This item in the PANSS is one of 16 items taken from the older Brief Psychiatric Rating Scale (BPRS), which was developed in the USA in the 1960s and used to evaluate “general psychopathology”, as well as to evaluate psychoactive drugs. The PANSS also includes 7 “positive symptoms” and 7 “negative symptoms” for a total of 30 items that are evaluated. This results in a score from 30 to 210. “Improving” scores on the PANSS constitute the main claims for efficacy of the newer antipsychotic drugs; the older drugs were evaluated by the BPRS and other scales, usually when compared to the “benchmark drugs” chlorpromazine and haloperidol, rather than placebo.

 

A glaring problem with the PANSS and BPRS is the fact that known side-effects of dopamine-blocking drugs, such as “flattened affect” are described as signs of schizophrenia, rather than the treatment of the condition. Other signs such as hostility and uncooperativeness can be explained as legitimate objection to being called mad (or insane), by whatever name.

Predictably, people with some mental illness diagnoses resist the label of “illness” more than others. People with phobias, anxiety and depression often come to see doctors for help and so do people with auditory hallucinations (usually diagnosed as schizophrenia or schizo-affective disorder). In these people the diagnosis of illness can be a relief, and they accept drug treatment without objection. In other cases, patients resist the label of illness vehemently, especially when they are said to have elevated mood (diagnosed as hypomania and mania) or delusions.

It is not surprising that many people accused of having an elevated mood resist the judgement. The BPRS grades “moderately severe” elevated mood (rating 5 on a scale from 1 to 7) as:

“Reports excessive or unrealistic feelings of well-being, confidence or optimism inappropriate to circumstances, much of the time. May describe feeling ‘on top of the world’, ‘like everything is falling into place’ or ‘better than ever before’. OR several instances of marked elevated mood with euphoria”.

Needless to say, people who feel on top of the world, better than ever before, or for whom everything is falling into place, are often not inclined to think they are mentally ill, and with good reason. Likewise people with an increase in goal-directed activities, increased zest for life those who see connections they didn’t see before and have insights. Ironically, the process of coming to conclusions through insight, especially if they are unique or ‘idiosyncratic’, is itself viewed as a sign of mental illness.

The Young Mania Rating Scale (YMRS) rates elevated mood on a scale from 1 to 5, with grade 3 being:

“Definite subjective elevation; optimistic, self-confident, cheerful, inappropriate to content.”

The key to the diagnosis is the subjective evaluation of what is “inappropriate to content” or “inappropriate to circumstances”. This is done by the interviewer, and depends on his or her own belief system, judgement and understanding of the patient’s circumstances.

Persecution by Tormentors and Punishment for Misdeeds

 

The belief that one is persecuted is not necessarily delusional. Many people, over the ages, have been persecuted, for various reasons including their race, their ‘caste’ and their beliefs. People are sometimes tormented by the families, or by their peers (for example victims of bullies at school or work). Siblings sometimes torment each other, and so do cousins and other relatives. Sometimes it is neighbours who do the tormenting. People often gang up against people who are stigmatised as strange, mad, crazy or odd and this can amount to persecution. Children are often punished for disobedience and it is not unreasonable for people to regard their imprisonment as mental patients a punishment. This is not helped by a punitive culture in the mental health systems of many nations.

 

There are many dysfunctional families, and family dysfunction comes in many forms. Some families are very competitive and sibling rivalry, as well as competition between parents and children, can be a problem. Some parents, especially fathers, are very authoritarian and demand obedience from their children. Disobedient children are labelled as “difficult” and taken to doctors for diagnosis and treatment. Here the power imbalance is obvious. The child has little power to resist being labelled as the “problem”, however much the doctors protest that they can’t help their behaviour because they have a chemical imbalance in their brains. When the children misbehave it is inevitable that the adults and siblings blame the “illness” and ask if they are complying with taking their their tablets.

The adults in this situation include parents and other family members as well as teachers. Some teachers are inclined to suspect their students of having “attention deficit disorder” when they are not interested in their lessons, and become visibly bored, restless and fidgety. Teachers provide a large number of the referrals for ADD and ADHD. It is rarely asked as to whether the teacher is to blame for being boring and failing to engage the student. This requires introspection, which is sometimes lacking in any profession, including teaching.

Apart from scape-goating a particular family member, there are problems with looking for a chemical solution or “magic bullet” to life’s difficulties. This can form a pattern of behaviour in the child and in their carers and family. When they are down, rather than looking for activities and experiences that will bring them back up, the tendency is to take an antidepressant. When they are anxious, instead of listening to music or going for a walk, or any of a wide range of actions that can lessen anxiety, they look for a benzodiazepine.

It is also a problem when children are medicated for what is basically disobedience. The drugs that are used for ADHD are stimulants, related to amphetamines, known on the street as ‘speed’. Though they can improve concentration and keep you awake when you are tired, it has been known for over a century that amphetamines are addictive, and can also cause psychosis. Despite this they were widely used as weight loss drugs and “pep pills” in the 1960s and were again promoted in the 1990s for the newly-named “mental disorder” known as ADHD (Attention Deficit Hyperactivity Disorder). In the 1980s it was said that only 1 in 200 children had ADD; this rocketed up to 1 in 20 with the new label, with a corresponding explosion in prescriptions for stimulant drugs. This was in the 1990s, and was a precursor to the explosion in addiction to amphetamines a decade later. Many of the youth who are addicted to metamphetamine (‘ice’) were initially diagnosed as having ADHD and given stimulant drugs.

 

Family abuse occurs at all ages. Children and the elderly are especially vulnerable and can easily be pathologised for being “difficult”. Rebellious adolescents are also vulnerable to being given a disease label for their behaviour, as well as young people who reject the religious beliefs of their parents and embrace other philosophies and religions.

 

The concept of insight should be considered holistically. There is a difference between insight (introspection) and insights (epiphanies). One aspect of introspection is to be able to look critically at our own mistakes, flaws, vices and poor judgements in the past. It requires us to challenge our indoctrination from various sources as we grew up. The process of growing up and learning from our environment (including family and school) inevitably results in some false beliefs and delusions. Some of our beliefs are not congruous with reality, and it is a challenge, throughout life, to rid ourselves of such delusions. Sometimes, when one realises ones previous error, especially about long-held beliefs, it comes as an insight. Such insights are often pleasant, and can be exciting. They can elevate the mood.

Seeing connections you didn’t notice before and making new associations can also be exciting and elevate the mood. Elevating the mood itself has the effect of increasing insights and insightful thinking. How many potentially beneficial insights have been suppressed or destroyed by the practice of regarding “gaining insight” as a synonym for accepting that you are mentally ill?