Podcast: The Rise in Forced Treatment and Abusive Guardianships

Guest Bio

Rob Wipond is a freelance investigative journalist who writes frequently at the interfaces between psychiatry, civil rights, policing, surveillance and privacy, and social change. His articles have been nominated for 17 magazine and journalism awards for writing in medicine, science and technology, business, and law. He has taught journalism and creative nonfiction at the University of Victoria and Royal Roads University and also works and volunteers with non-profit groups that do neighborhood community building.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Part 1

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to the show, everyone. I’m your host, Gabe Howard, and calling in today we have Rob Wipond. Rob is an investigative journalist who frequently writes about the interfaces between psychiatry, civil rights, policing, surveillance and privacy and social change. His articles have been nominated for 17 magazine and journalism awards, and his new book, “Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships” is out now. Rob, welcome to the podcast.

Rob Wipond: Oh, thank you for having me.

Gabe Howard: Rob, welcome. I loved your book. But as someone who lived with bipolar disorder, I have to admit I found it super disturbing. Now, your book is all about the problems with psychiatric detentions and forced treatment. And I, I think when most people hear about this subject, they’re like, well, look, you got the crazy, violent, scary, dangerous, mentally ill person off the streets. Why is this a problem? Why is this a controversial subject? What’s next? You’re going to say that criminals shouldn’t be in prison. That’s the general attitude that I hear when I talk about involuntary hospitalization and forced treatment, that it’s okay. It’s a necessary evil and it’s a public safety measure. And these laws surrounding it are designed to keep us safe. The best that I can really get is somebody acknowledging that the person who is involuntarily treated is going to go through some sort of trauma or have a negative experience in it. But all in all, they don’t see a problem with this in any way. Is this line of thought that this is a necessary evil? These laws are here to protect us, and it’s a public safety measure part of the problem.

Rob Wipond: Yeah, it’s a real problem that all of the media attention around involuntary commitment has focused on really a relatively small subgroup of people who get targeted by these laws, so when people are violent, they’re actually getting committed under a different set of laws altogether, a different process altogether. When they plead not guilty by reason of insanity. I barely touch on that in my book. My book is focused on civil mental health laws. So, the ones that are meant to be helping relatively ordinary people like ourselves who may go through crises in our lives and act in ways that could put us in some sort of risk. A risk of potentially hurting yourself in some way, getting into a dangerous situation of some kind, perhaps because you’re not behaving under the normal ways you might have behaved previously. So, I kind of say we’re just over focusing on that group. If we want to understand what these laws are, how they work, who’s being affected by them, we have to step back and really look at the vast spectrum of people who are being affected. This is happening to like literally millions of people across America where they’re getting detained in psychiatric hospitals when somebody around them thinks that they might be struggling in some way, people do it because they think they’re helping someone else.

Rob Wipond: And when someone gets caught up in that system, it can be quite risky because it’s a really wide-open exercise. We don’t really have clear definitions of what mental disorders are. The these laws have broadened a lot now. They’re not focused only on dangerousness at all. So, they give broad discretion to psychiatrists to hold people for prolonged periods and potentially give them a powerful psychotropic drugs against their will. Even before we get to a guardianship and all of that, which is a long-term thing. In the short term, you can be held for days or weeks. And forced treatment is often not a nice process if you agree to go along. Sure. But if you say, no, I’ve tried that drug, I don’t want it. It doesn’t help me. I don’t like the adverse effects. I want to try some other kind of treatment. Is there something other than drugs available? Well, now we have security guards, we have restraints. People are put in four-point restraints on gurneys. They’re forcibly stripped. They’re forcibly injected with medications that could last for a month or two in their bodies. This can be a very intense and traumatizing process for people to go through. And that goes to your original question of why would people be concerned about this? I think everyone should be concerned about it because if it happens to you or someone you care about, it’s shocking and very disturbing.

Gabe Howard: What did you mean when you say that the laws are not focused on dangerousness? Because my understanding is that the standard is literally imminent harm, that you can only be involuntarily hospitalized if you are a danger to yourself or others. Are you saying that’s not true?

Rob Wipond: Yeah. The most states have and Canadian provinces, I will add, have largely ignored the Supreme Court cases in both countries that were set around dangerousness and all the laws have been whittled down to be much broader than that. Now even the application of dangerousness isn’t what people would ordinarily imagine. The Supreme Court tried to make it that like real imminent threat, you know, expressed through vocalizations of I’m like, I’m going to kill you or I’m going to harm myself. Like, they really tried to kind of lay it down in that way. But by and large, now in actual hearings and in actual situations, it’s much more about being at risk of potentially in future, maybe and even many laws have gone far beyond that, like the most common one now, too, that’s really gone far is to just simply say if you in future might meet the criteria for being detained, well, we’re going to forcibly drug you to prevent you from getting into that state. If you could be at risk of possibly deteriorating in some way, that’s literally the wording in some of these laws. So, it’s very unclear, very Orwellian, almost in its phrasing. And so, it’s not even that you’re actively hurting yourself, but somebody just looking at you going, well, I’m thinking based on your circumstances, that you might not be able to meet your physical needs in some way, and therefore I’m going to detain you.

Gabe Howard: Some of the largest mental health advocacy groups in America are saying that detaining people like this is, in fact, a good thing, that if someone is looking at a loved one and they’re saying, look, I’m telling you, I know my loved one, they might look like they’re doing okay right now, but they’re going to become violent. They’re going to become suicidal. They’re going to have an issue. They’re heading down a bad path and they’re not going to be able to take care of themselves. It’s coming, I can tell you, as their mother, father, aunt, uncle, brother, sister, trusted confidant that it is coming. these organizations say that this is crime prevention. It keeps people’s loved ones safe. It keeps the public safe. And they have all sorts of reasons that we don’t need to listen to the person with the mental illness. They lack insight. They don’t have the ability to know what’s best. They can’t help themselves. And these are all of the reasons that they give that that someone else, the public, the police, law enforcement, doctors, hospitals need to step in. It’s always, always, always tabled as being helpful to the person with mental illness and that if we left them to their own devices and did nothing, that would be the cruel thing.

Gabe Howard: We would be setting them up to fail, that we would just be leaving them in harm’s way. They really look at it as a protective factor. It’s it really is always tabled as Yeah, they may be okay now, but trust me, there’s going to be a problem later and that’s why it’s okay to intervene. I want to ask what you have to say to all of that, because I really do think that these groups and these parents and these loved ones, they’re well intentioned. I don’t think this comes from a place of malice. They believe that they are doing the right thing, but it seems like it often doesn’t turn out well.

Rob Wipond: Wow, that’s quite a question you’ve asked there. I want to point out, I think it’s very important that really you just covered like eight chapters in my book where I kind of break each of the little assumptions or beliefs that are within that question. Right. That people articulate and break them down. So, let’s try to do a few of them quickly now. Right. But the question of insight and that’s just very amorphous term that when we really think about, well, what does that actually mean? Are we saying this person literally doesn’t know who they are or where they are? What they are like? Are we saying that a person who’s got a label of schizophrenia or psychosis or depression or anxiety is as out of it as a person who has severe dementia and literally can’t remember their own name or where they are? Is that what we’re saying? Because that’s almost never the case. Right? And in actual practical terms, if you look at hearings like I did, if you’re watching this play out, legal scholars write about this by and large, insight in a mental health context means you agree with the psychiatrist. If as soon as you disagree with the recommendation of the psychiatrist that you have Diagnosis X and you need drug Y, you can be labeled as having lack of insight. And this is so clear. This is so undisputed in a legal framework that a lot of states have actually written this literally into law. So, you can go to read the laws and you will see a statement to the effect of if you disagree with the psychiatrist’s recommendation, you can be changed from a voluntary patient to an involuntary patient. So that’s how clear this really is. And it’s not often talked about. We just sort of assume that insight has this grander meaning to it that just isn’t borne out in the science. So that’s one piece of that puzzle that I think is really important.

Gabe Howard: But what about the parents, the majority of people pushing for these kinds of laws and this kind of intervention are parents of adult children with mental illness, and they claim that they have insight into their kids’ best interests. They know their children and they know that this will be helpful. Now, you’ve been talking about problems with doctors or hospitals, but family members are often the ones pushing for this, not the medical establishment.

Rob Wipond: Yeah. So, I have a couple concerns about that that are really deep. And one of the biggest ones is this is of course a very important group. This is the strongest lobby group in America and Canada that have been reshaping these laws. Family members are very vocal and very passionate about trying to forcibly drug their own loved ones. And they have influenced legislation around the country. So, this is the dominant voice on these issues. And one of my biggest concerns is that almost never when these families are talking do they seem to have any awareness that some families are abusive. Now, I don’t want to accuse those particular people of anything. What I’m saying is you have to look at America and what we know about family abuse and know that it is very common. Child sexual abuse, physical abuse, parents themselves who have emotional difficulties of different kinds. And so, you need to account for that if you’re going to lobby legislators to expand the powers of families, to make sure that someone else in the family gets forcibly medicated, heavily tranquilized against their will. You need some sort of level of accountability and oversight to ensure that this is not nefariously and abusively used by a family member who doesn’t have the best of intentions in mind. And this is really common and this is what I found, is that it’s doctors just don’t have the time or resources to do, you know, an extensive investigation into a family and really figure out what’s truly going on here. So, they often just take the testimony at face value, go, oh, that’s how Person X was behaving? Okay. You know, and this testimony is enormously powerful.

Rob Wipond: So, I just want to say to those people, be careful, please. When you’re advocating, don’t think about only your own situation. Think about other families and how well do you really know them? The other piece I want to highlight is this does create an enormous rift in families that can go on for years and decades. And often they’re struggling really because they don’t have any other resources. This is the only thing that’s available today. If you want help for somebody who’s really struggling, people are coached and taught to admit them to a psychiatric hospital. And as one psychiatrist said to me, I think a lot of families have illusions about what we can do up here. We don’t really solve people’s problems. We only medicate them. And there’s a percentage of people that does help, but there’s a very large percentage. It really doesn’t make a huge difference in their lives. And so, then families start putting pressure on these doctors, keep them longer, do more, and then they’ll sue if these people aren’t cured. But this again, I want to emphasize and I really want to highlight how this really distorts the public discussion around these issues because this is a relatively small group when, again, there are many other people that are being affected by these same laws. When you create a law that’s so broad and so powerful. Right?

Gabe Howard: Yeah, but nobody thinks about it like that. People believe that there are safeguards in place and that everybody involved is well-intentioned and we’re just taking care of and loving and supporting and helping people. And frankly, the majority of the public cannot understand why there is such a fuss. They don’t get why anybody would be against this.

Rob Wipond: Exactly. There’s because there’s a huge lack of data coming out. So even just the numbers alone, when I looked into that, I found that the people often say, oh, we hardly ever forcibly treat anyone anymore. But anywhere we can get decent data. And it’s very hard because a lot of hospitals, a lot of states are not actually formally tracking this data or they’re hiding it. But wherever we get good data, we see the numbers have been increasing and increasing a lot for decades now. And we have more beds, far more beds than people recognize. The only number that’s typically cited in news articles is the number of state hospital beds. Well, that’s a fraction of the number of beds that are out there. I actually ultimately calculated 60 times as many beds as is typically cited. It’s certainly much, much more than is typically discussed. So that’s important to know. And so, we don’t track outcomes. There’s anecdotal stories out there, but do people get better? Do they actually somehow at some point in this process, become glad that they were forcibly treated? Are they getting worse? We don’t know. Because a lot of evidence to suggest they might get worse So there’s all sorts of reasons to suspect that forcibly treating somebody over a prolonged period might be very detrimental to their long-term functionality. But we’re not tracking that at all. So, this is a real concern. And the other thing I highlight was the terrible lack of oversight. So basically, it’s just simply government watching itself in a lot of cases or these institutions watching themselves. And I found rampant, widespread, egregious cases of abuse that go way beyond what we’re talking about right now.

Rob Wipond: It going on really in almost every state in the country where these hospitals get reprimanded and they’re wrist slapped. But it just goes on and on and on because there’s no reasonable penalties in a lot of cases. We need more robust protections and that should be occurring in the legal context. So right now, psychiatrists have extraordinarily broad powers and discretion. Judges who are supposed to oversee these situations and make independent decisions. But unfortunately, right now, most judges really just follow the lead of psychiatrists. They look at this as a medical issue, even though by and large, it’s not. There’s no medical evidence that’s put forth. What’s put forth is subjective, anecdotal types of evidence about people’s behavior, not any sort of analysis of what’s actually going on in the biochemistry of their brains. But even then, judges simply defer to the expert opinion expert opinion of psychiatrists. And this is really problematic and we have to change that and that needs to change legislatively in how these laws are written but also there needs to be a real reeducation of judges across the country about how to be more independent of psychiatric opinion in these kinds of cases.

Sponsor Break:

Gabe Howard: And we’re back with the author of “Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment and Abusive Guardianships,” Rob Wipond. As a man who lives with bipolar disorder, one of the things that always disturbs me is that there are all of these laws and procedures for how somebody like me can be forcibly committed or medicated against their will. But we don’t seem to have a plan for how this ends, because once you get caught up in the system, there doesn’t seem to be a clear path to get out of the system. I love analogies and the example that I always use is what happens if somebody is unconscious? Obviously, someone who is unconscious can’t make decisions about their own treatment. So frankly, they are the ultimate in lacking insight. So, if EMTs or bystanders find me unconscious, they do what they think is best for me to save my life. They don’t have to ask my opinion. They don’t have to get my consent. They don’t have to consider, you know, really my thoughts or feelings at all. However, once I regain consciousness, once I regain insight, they do. Immediately they do. Once I’m awake and alert, what I say goes. And that includes if I tell them to stop treating me. Even if they disagree, they have to stop.

Gabe Howard: They have to follow my wishes and everyone agrees that that makes sense. So, what is the equivalent of regaining consciousness in mental illness? How do I know when the person has regained their insight and it’s time for everyone to step back? What is that definition? And whenever I ask anybody about it it’s always, we know it when we see it. Well, you can just tell. Well, this is why you have doctors. Just no one seems to have a clear answer. It doesn’t seem to be spelled out in the law. It doesn’t seem to be well understood. Now, am I wrong about that? It just seems to be this incredibly nebulous idea of how or when a person gets their power, control and autonomy back.

Rob Wipond: Well, you’re absolutely right. And it is one of the most dangerous aspects of these laws that it is not clear at all. It’s no one even attempts to articulate it. So, it’s not codified anywhere in law. And to my knowledge, it’s not even I’ve not even seen it in the scientific literature. It really is just a case of whenever we decide that you’re free to make your own decisions again and how that actually plays out in practice is that. And again, I’m not just making this stuff up. This is what you literally hear discussed in these kinds of hearings where this this issue comes up, where a patient is saying, hey, like I’m okay. I want to make my own decisions. Like I kind of understand your perspective on my situation and they can recite it perfectly. Yeah, you think I’m this and you think that and okay, I see where you’re coming from, but I’m coming from a different place. And let me articulate why I want these things. And the argument usually hinges on them saying we’re the judge is essentially saying back to you like, I’m sorry, clearly, you’re doing better on these drugs. Therefore, you should stay on them regardless of what you want. So, your own sanity, if you will, your own sanity works against you. It prevents you from getting freedom. Conversely, in the in a catch 22, if you’re not really articulate in what you want, they use the same argument. They say, well, you’re on the drugs and you’re still not doing better. So, we really think you probably need even more drugs if anything, but definitely got to stay on them. So, it becomes a no-win situation, very much a catch 22. And that’s very, very dangerous.

Gabe Howard: This topic is very difficult for me, Rob, because I want to give full disclosure to you and the audience. I was committed to a psychiatric hospital almost 20 years ago now. I was placed on a 72-hour hold because I was a danger to myself. I was actively suicidal and I absolutely needed to be there. And I can tell you unequivocally, that it absolutely saved my life. And I always thought that my experience was typical for everyone. I was evaluated by a psychiatrist. I was brought in by a friend and she provided me with support. I was only there for three days and then I was released to a stepdown unit. Now, now, young and naïve Gabe believed that there were safeguards in place. And then years later, I learned that there’s. Well, frankly, not a lot of safeguards in place and that things could have gone very differently for me.

Gabe Howard: It’s possible that I could have been kept there for weeks against my will. I could have been forcibly medicated with these, like you said, super intense medications with lasting side effects. And all of this could have happened without me contributing or consenting in any way. I did not understand while I was there how powerless I actually was. And that scares me to think about now. But here is where I struggle, Rob. It still saved my life. And it’s what started me on the path to getting well. I really do see that psychiatric commitment as the first domino towards me reaching recovery. I’m sitting here listening to you, and I’m like, everything you say is terrible. And it 100% happens. And I agree with you. I know that you are telling the truth

You’re not making this up. You’re not being dramatic. And I know what you’re saying is accurate. And that’s why I’m so frightened. But on the other hand, I know that being committed to a psychiatric hospital absolutely saved my life. How do I reconcile these two things?

Rob Wipond: Well, I like to talk about the situation you were in. And already the way you’ve described it, I’m getting the sense that you were treated respectfully in this situation, that you felt that you were rapidly put into a collaborative sort of situation, like, hey, what’s going on? Is that correct?

Gabe Howard: Yeah. Yeah.

Rob Wipond: Yeah.

Gabe Howard: So, so far, you’re describing it pretty well.

Rob Wipond: Exactly. And that works for people. And I call that nominally involuntary. So perhaps I don’t know how you ended up there, whether you went in on your own or were, you know, cajoled by your friends or whatever. But some people can, even if they’re brought in by police, some people will in retrospect say, yeah, you know, I was behaving like pretty wacky. And I can see that I was annoying my neighbors at a level that, yeah, if someone else was doing it, I’d want to see them detained. So, people can understand that. I don’t know many people that have a big problem with that. And I think if the situation plays out respectfully and collaboratively, it is quite different. And if in many patients say that too, if at least everyone involved in the system was treating them respectfully throughout the process, something like, we’re really sorry that we feel compelled to hold you right now, let us explain why and let’s talk together about what we can do. You know, really, that’s more like open dialog or one of these other alternatives where people collaborate together to find a best solution. It’s more like an equal process. Let’s talk about collaborative solutions together. That’s completely different. That is really not forced treatment in the way it’s playing out in our society for a lot of people right now.

Gabe Howard: Rob, thank you so much for all of this great information. And thank you to all of our listeners for tuning in. If you like this topic and want to hear more of Rob’s insights, there is a Part 2 that is available for listening right now. You can also find out more information about Rob on his website, which is RobWipond.com. And his new book is called “Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships.” And it’s available right now. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I’m also the author of “Mental Illness Is an Asshole and Other Observations” which you can get on Amazon or you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and hey, can you do me a favor? Recommend the show whether it’s on social media, a support group, in person by the water cooler. Hell, send somebody an email or a text message or give your mom a phone call. She likes hearing from you. Because sharing the show is how we grow. And I’ll see everybody in part two.

Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.

Part 2

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hey, everyone. Welcome back. I’m your host, Gabe Howard. And this is part two of our discussion with Rob Wipond. Rob is the author of the new book, “Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships.”

Gabe Howard: Rob, I want to continue the discussion by talking more about the loved ones of people living with mental illness. In part one of this episode, you said that the strongest lobbying groups in the US and Canada are working to shape laws and practices surrounding forced treatment are family members, and many times the driving force behind forced treatment are the parents or loved ones of an adult living with mental illness. Now the doctors, the legislators, the judges, they just sort of go along with whatever family members say or want to do because they feel like they’re in the best position to know. I do really want to clarify that. I do believe that many of these family members are operating in good faith. They think they’re doing something well, the lobbying groups, the mental health advocacy groups, they believe that they’re listening to the right people to get help for people who are sick and do need some sort of intervention. But I got to tell you, a lot of this really harkens back to the 1800s and the 1900s and well, frankly, into the 1950s and 60s when a husband could just have their wife committed to a psychiatric hospital for hysteria or for not doing the dishes or for not knowing how to cook or for backtalking or frankly, because the husband just wanted to have an affair or get their wife out of the way.

Gabe Howard: And there just wasn’t any oversight. The husband said it. And everyone took his word for it because clearly, he knew what was best for his wife. And then just like that, the wife was committed despite what she wanted, despite what she said, and despite what her actual needs may have been. And in some ways, it sounds like we’ve gone back to that, except we’ve broadened it to the family and friends have said it versus just the husband and therefore it’s true. Am I overstating this? Because when I talk about how widespread this is, frankly, people don’t believe me. They really think that what I’m talking about is ridiculous. And they even tell me, Gabe, there’s no conspiracy out there to abuse mentally ill people.

Rob Wipond: The way I’d word it is this. It’s just very unpredictable and chaotic what’s happening. It’s not a conspiracy in that way. It’s not like there’s some organized cabal with one message out there and it’s permeated the entire country. And this is the way it’s playing out. It is much more that mental health and mental disorder as ideas are very nebulous, very hard to pin down or define. And that isn’t to say that some people are really, really struggling. But it’s just to say it’s not really that scientific. And in any given situation, you know, whether it’s more what’s happening inside the person or the difficulty of their circumstances that’s causing that problem, it becomes harder and harder to kind of really figure that. Because it’s becoming more common to use this term, to just look at someone and struggling and say, oh, they must have a mental health problem, ergo, that’s a medical problem. Ergo, we better call 911. And they get taken by police to a psychiatric hospital when that’s just an average person who kind of made that assessment just by looking at how the person was behaving. They’re just trusting in this whole process.

Rob Wipond: And so, the person ends up at the psychiatric hospital. And again, here this becomes a very subjective sort of process. They don’t do brain scans. They just talk to you for five, ten, 15 minutes and they start to make an assessment as to what they think your situation is on that basis. Honestly, Gabe, when I looked at medical records, I often see that a lot of these doctors do less investigating than I do as a journalist. They do less fact checking than I do. I was interviewing many of my sources for multiple times for hours on end, directly and watching them over a period of weeks and months in in a relationship, as I, you know, would come back to fact check more, see how things had changed, you know, all that sort of stuff. Doctors don’t even do that in a lot of these cases. Right? So, because of this breadth now, these kinds of laws are being used definitely to police streets and shelters, but they’re used very much in the management of schools. So, children who are distressed or disruptive, often teachers or administrators will call 911 and get children and youth taken to psychiatric hospitals. They’re used in workplaces. Oh, I’m concerned about this person. They might be depressed. I’m going to call 911 like there’s actual training programs and workplaces to get people to do this to each other when they’re in distress.

Rob Wipond: When conflicts emerge in workplaces, often the underling gets pressured into a situation where they may feel, feel pressured or forced to take psychiatric medications. Then we have it being used against for very political purposes. I found cases with that. It wasn’t uncommon for whistleblowers to be targeted by these kinds of deliberate attempts to force them into psychiatric evaluations or get them locked up to discredit them. It’s they’re widely used against pregnant women right now. If for whatever reason, the medical system or wants to get control of a pregnant woman because they don’t like their behavior relative to the fetus, there’s a lot of conflict and these laws are being used against pregnant women as well. So that’s the kind of thing we’re dealing with here, right. Is a real expansion of how these laws are used because they are so unscientific. So, again, I wouldn’t say, oh, it’s a conspiracy to do X or Y. It’s actually really hard to pin down because it’s really just a lot of well-meaning people mixed in with a lot of nefarious intent and with really unclear laws governing the whole thing and a lack of oversight.

Gabe Howard: But then why are these laws so widely misunderstood? I think most people feel like these laws are good. Like you said, many people are well-meaning and I believe that too. They honestly believe that they are helping. But it sounds like whatever goal they had in mind when they put these ideas into practice, that’s not how these laws are actually being used out in the real world.

Rob Wipond: Yeah. And I think that goes to the real reason we have these laws. And of course, you need to contextualize it so that it doesn’t sound like a conspiracy theory, right? But it’s clear that these laws are not there to help people truly. Right. These laws were there to control people, which may sometimes overlap with helping them. Right. But the intention is control. And this is something David Cohen talks about a lot. This is the thing that legitimizes everything else. It’s like, why can psychiatry get away with such weak science and drugs that look like, you know, of questionable effectiveness at in aggregate, you know, and all of these things and sort of the questionable science of diagnoses. And why does society accept all of this, right, from psychiatry in a way that it won’t accept that from lots of other medical treatments or whatever? Right. And it’s because somewhere in there people just feel very attached to the capacity to have this sort of power over a non-criminal. A non-criminal situation, but to have the ability to exert that kind of power and control.

Rob Wipond: So, I don’t think in that sense that we are in a different place to where we were in the 1950s when women were locked up for the things you were talking about. Right. But the reasons are different now, like the reasons given. But it’s the same impulse. It’s people who are really annoyed or really upset or really frightened by someone else around them. And this becomes the excuse or the legitimation. Right. But it is still social control. That’s the predominant element, you know, and it’s so obvious when you look at long term care facilities or schools like, well, that’s exactly what it is. The teachers are not able to truly make a diagnosis in the moment. It was the kid was simply doing something that the teacher considered unmanageable. All right. So, they’re going to send them up to the psych hospital and now the kids in the system.

Gabe Howard: I think it’s also fair to look at fear. Right. People are afraid that if they if warns you, hey, my loved one might do X and then you do nothing and then their loved one does the X that you will be blamed.

Rob Wipond: Oh, yeah.

Gabe Howard: Just there’s. There’s this better safe than sorry mentality that we’re playing with people’s lives. And I understand being afraid. And there’s let’s face it, there’s nothing more scary than mentally ill. People we’re unpredictable. And nobody wants to get this wrong.

Rob Wipond: Yeah, and it’s been amplified exponentially by media coverage and anecdotal stories and that so and I absolutely agree that I think that’s widespread in the system right now is a sense that when judges are looking at these situations, attempting to be a neutral party, making an assessment independent of the psychiatrist. Nevertheless, they still have in their minds, I don’t want to be the one that lets somebody go and they might do something dangerous to themselves or someone else. So, it seems like in their mind the safer solution is just keep forcibly drugging them. Keep locking them up. Right. What could go wrong kind of thing, right. It’s like the same attitude we have towards criminals where we just go, gee, well, if they’re in jail and restrained forever, gee, they can never commit a crime again. But the reality is the way this actually plays out in real life is those people often become more violent, more dangerous, they become more harmed. All sorts of terrible things can happen as a result of that better safe than sorry attitude. And we really need to look at it and reopen our minds. And of course, I’m not the only one saying this. In fact, this is the predominant message you get from people who have been forcibly treated. They often just say, hey, I want the freedom back in my life to just live a bit larger than other people may be comfortable with.

Gabe Howard: But there is a fear element with that too, right? Specifically, from the parents or loved ones of people living with mental illness. Family members are afraid for their loved ones. They are scared that the behavior that they are witnessing and that the behavior that they are not comfortable with is going to lead to their loved ones being hurt or maybe even lead to their loved one’s death. And listen, I struggle because I talk with a lot of these parents and they’re fighting for their children. And they say to me, Gabe, listen, we need to do this. We need to be in total control. We know what they need and our loved ones do not because of their illness. And this will save their lives. And Rob, honestly, it is really compelling. They are super worried about their children. But on the other hand, in the long run, they seem to be doing a lot of damage and they are really misguided. Do you think this type of fear could be driving some of this?

Rob Wipond: Yeah. Yeah. I mean, it can be. It’s a bit helicopter parenting, right? Like, okay, like, I, maybe I have a higher tolerance for some of the risk-taking that she will engage in. And I think that that’s something that these parents may need to sometimes learn, too, that. Yes, I’m sorry. It does sound really difficult and painful. But you know what? This is not a solution. Like you’re calling it a solution. It is for you. But clearly your loved one is continuing to resist. Right. Even when they’re on these drugs, and they continually need to be coerced. And is that truly, in the long run, like we’re such a risk averse society. But it’s difficult to say that. People think that you’re dismissing their the danger or whatever. But I do think we’re overly our whole approach to this is very much like we can’t let I think an NDRN lawyer said it to me he goes yeah once you’re in this system, you’re not allowed to make ordinary mistakes anymore. You can’t live like a normal like a normal person is allowed to make bad choices. When you’re in the system, you’re no longer permitted to make bad choices in your daily life. And the helicopter sort of control of the family or the practitioners of the overseers.

Gabe Howard: Exactly. You are in the worst position to live a perfect life because we are sick, but we have the highest expectation to be perfect mistake free.

Rob Wipond: Yeah. I mean, and that’s just one piece of this whole puzzle.

Sponsor Break

Gabe Howard: And we’re back with the author of “Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment and Abusive Guardianships,” Rob Wipond. You have spent years researching your book and following up on all of these cases, can you share some examples of what you have witnessed and how these things are playing out in the real world?

Rob Wipond: A great example to use because it’s so well documented, is the case of New York Police Department whistleblower Adrian Schoolcraft. He’d been complaining internally for some years about a certain kind of corruption within the New York Police Department. And he’d he was ultimately forced by his fellow police officers into a psychiatric hospital. And they spun a story, such a good story, that, in fact, then in the psychiatric hospital, they diagnosed him with paranoid schizophrenia because he thought all the other police officers were against him. And in the end, what he had been doing, though, is he had been recording the conversations. He had a lot of documentation. And when he got released about six days later from the psychiatric hospital, he contacted news media and began to expose everything. And so, he was vindicated. And he won a lawsuit against the city of New York and the police department and the hospital and all of that. So great for him. Right. But not many people out there have, you know, had the wherewithal. Right. To do all the recordings of all the conversations and all of that that vindicated him. They would have just been labeled as a paranoid schizophrenic rather than a hero, a whistleblower who exposed corruption within the police force. Right. And so, I highlight that just to go, this is the situation we’re in where this kind of thing can happen and it can happen relatively easily, so easily that police consciously and deliberately used it as a way to discredit somebody.

Rob Wipond: And that kind of knowledge permeates the whole country. So that’s the kind of example I want to highlight from a more nefarious angle. Now, one that’s a little more, let’s call it legitimate, but I think is equally concerning is Cindy Fisher. Here was a woman who really was concerned about her child, who was struggling. He’d gone through some crisis in in his life, and she was concerned and took him to a psychiatrist who within a half an hour diagnosed him with schizophrenia and gave him antipsychotics. And she and the son, indeed, at that time, agreed to take them. So, they were voluntary patients and you know for years. Then Cindy was increasingly needing to be coercive with these medications with her son because he wasn’t experiencing any positive effects and indeed was experiencing negative effects, but at that point was confused too. Like how much of this is the drug? How much of it is my own struggles that I was having? And so was she confused, but she just trusted and believed in in the doctors and what the doctors were saying and so became increasingly coercive with him and started to call 911 on him if he wasn’t going to take his medications. Get him locked up so that he would be forced to take them again and all of that. And then gradually, though, she saw it still was not helping. And over time, she switched around and started to defend his rights and become concerned that, okay, maybe the drugs are not the solution.

Rob Wipond: They were African-American, so she was saying, are there African-American therapists who could speak with my son? No. Were there alternative approaches? Could they taper the medications? Because the medications seemed very powerful? No. Like the doctors had started to object to who are you to tell us what should take place here? And she ended up in extraordinary conflict then with the treatment providers such that they then tried to seize control guardianship over her son and they were successful in getting that. And again, this is not an uncommon story. I heard this from many families who there are some that just continue to believe that the drugging is the best that could possibly happen for their child. But other family members start to question it and say, well, what are the alternatives? What other approaches could they take? And then they find that the system is very resistant to change, very resistant to providing any kind of alternatives, and they end up in conflict and they quickly discover they have no rights, that these laws have been deliberately set up in a way to prevent them from being able to influence this kind of a situation.

Gabe Howard: One of the things that worries me so much about forced treatment is that it is ultimately harmful. You only get one bite at the apple, right? And forcing someone to do something only works while you are forcing them. Once you stop forcing them, they don’t trust you anymore. They don’t have faith in the system anymore. They don’t have faith in the process anymore and they’re not going to reach out for help. And, well, frankly, they’re going to stay the hell away from you. They’re going to stay the hell away from the mental health system entirely. They will probably avoid everything and start getting no treatment at all. So, family members who are like, look, I know they need treatment. I know this is what’s best for them and that’s why I’m doing this, even though this is not what they want, I just have to say, okay, but is this the long-term solution you’re looking for? Or have you only solved the problem for a year, two years or hell, five years? And that’s really such a small amount of time, especially if your loved one is showing the symptoms at the stereotypical ages of 16 to 24. Let’s say that you get them stable and I’m going to go from 24 to 29. What happens from 29 on? They’re going to be just very, very traumatized. I just they avoid everything and they get nothing. And it really seems like your data is backing up that this is not a good long-term solution.

Rob Wipond: Yeah, and that’s such a good point, very important point that it really only works once. because, okay, now that you’ve done that, that person’s never going to feel safe calling anyone. Because they know there’s this extreme risk of being subjected to something that they that that traumatized them. So how can you believe in this as a like I ask these practitioners that I’m frankly aghast that psychiatrists aren’t the one speaking out against forced treatment, because I think you see this every day. But instead, what they’ve done is they’re expanding it right? Their justification for the fact that it’s clearly failing a giant segment of their own patient group. It’s clearly not working for them. Their reaction to that is, okay, we need it more. We need to do it longer. We need to get in earlier, got to get them younger. You know, all of that. Everything right now is moving towards expanding and expanding and expanding the amount of time and the degree of the force. And I’m saying it’s time to look in the other direction. It’s time to back up from that and go, look, there’s a huge segment of the population of these patient groups that this is not working for. All it’s doing is driving them away. They become afraid to seek help even when they when they know it, even when they want it.

Rob Wipond: And that’s what I want to highlight, too. We should not equate help with force, and that seems to be what we’re doing. When we have this dialog, we say, oh yeah, if we’re not, if we’re not sending the police out, we’re not helping them. Well, wait a minute. There’s a lot of other ways to help a person who’s in distress. I’ve seen people I’ve been with people in extremely high states of distress, and you can still find ways to talk with them. You can still find ways to connect. And that’s what we need to do way more as a culture, as a society, as families, is look for those things to say, look, I really do want to help you. What do you need? What do you want? Turn that question back to the person. What’s really distressing you? Because often you keep that conversation up beyond the initial high-level fear the person might have. Often, they’ll start to articulate things that aren’t that unreasonable. Like, well, I really want a safe housing. I don’t feel safe in my housing and here’s why. Or I really want to talk to a person that I do trust and here’s that person’s name and things like that.

Rob Wipond: There’s very little science out there to suggest that forcibly treating people actually helps them. This is not a scientific thing at all. So, I’m saying let’s at least get the data, Let’s find out how many people in America really are being forcibly detained and forcibly treated. Let’s find out what’s actually happening to them. What do they report as their feelings? Are they are they glad? Are they not glad? What sort of outcomes are we getting? Are they getting housing? Are they getting jobs? Are they feeling better, getting back to their families, getting along well with their families? Or is their whole life starting to spin out of control? Are they traumatized? So, I find lots of evidence for negatives, but the numbers in the end we really don’t have. So, I say we need we need to be way more transparent about the fact that this is going on and how brutal for some people it is and then start doing some more analysis and then much more robust oversight to prevent the kinds of abuses that are clearly coming on. Happening right now in psychiatric care

Gabe Howard: Rob, thank you so much for being here. His book is “Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships.” It’s out now. I’m sure you can get it on Amazon. Rob. Where can folks find you online?

Rob Wipond: So, they can find me easily enough at my website if you know how to spell my name. Rob Wipond, W I P O N D, RobWipond.com. And I also have a newsletter and a blog there and they can find me on Twitter, Facebook or YouTube as well. And yeah, and they can also order the book through their local bookstore or anywhere online.

Gabe Howard: Awesome. Rob, once again, thank you so much for being here.

Rob Wipond: Thank you.

Gabe Howard: You are very welcome, Rob. And a big thank you to all of our listeners as well. My name is Gabe Howard and I am an award-winning public speaker who could be available for your next event. I’m also the author of “Mental Illness Is an Asshole and Other Observations,” which is on Amazon. But you can grab a signed copy with free podcast swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow subscribe to the show. It is 100% free and do me a favor. Tell people about the show, mention it in a support group, put it on social media. Hell, send a text. Sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.
Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.