“A loveless world is a dead world, and always there comes an hour when one is weary of prisons, of one’s work, and of devotion to duty, and all one craves is a loved face, the warmth and wonder of a loving heart.” ~Albert Camus
The subject of mental health sparks a plethora of emotions and arguments among advocates, patients, family members, and providers. The history of mental health treatment itself is a controversial one, dating back to ancient times when early humans would chip into afflicted individuals’ skulls using crude stone instruments, in order to release evil spirits.
In the 1400s, the first mental asylum opened in Valencia, Spain. Asylums were known for their notorious conditions. They were not places to heal the ill but places where the ill could be abandoned. The most infamous of these was the monastery-turned-asylum “Bedlam,” where violent patients were put on display as a freak show. The public could watch a crazy person for a penny.
In 1935, the first lobotomy was performed. This procedure involved shocking a patient into a coma, then hammering an ice-pick-like instrument through the top of each eye socket. The instrument would then sever the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain, leaving the patient in a subdued, often vegetative, state.
While skull-chipping, asylum freak shows, and lobotomies are now shadows of the past, the contemporary emphasis is on medication. From Ativan to Zoloft, from Xanex to Seroquel—the variety of chemical mental health remedies is astounding. Some of the most commonly used are anti-depressant, anti-anxiety, anti-psychotic, mood stabilizing, and stimulant medicines.
From survivor to advocate
Laura Van Tosh, a national mental health peer leader, spoke this afternoon in Eugene. In the mental health community, the “peer” movement involves community-based services and supports provided by peers, and peer support specialists, to individuals or family members with similar lived experience. A key aspect of her presentation involved this modern emphasis on chemical treatments and ways in which she believes it might be too emphatic.
Van Tosh was featured at the council meeting of the Lane County Mental Health Consumer / Survivor Advisory Council, a council of mental health groups and advocates. The Council holds regular meetings on the fourth Tuesday of most months from 1 to 3 pm at the the Lane County Behavioral Health Services building on Martin Luther King Jr. Blvd. This free public forum is open to everyone. The Council said on its promotional papers that,
“All are welcome, including family members, mental health workers, and the public. Mental health consumers and psychiatric survivors are especially invited!”
The monthly forum involves a moderated discussion on important mental health issues in Lane County.
This month, the Council had Laura Van Tosh present her perspective on where mental health practices are and where they should be in the future.
Van Tosh, a resident of Portland, Oregon, is a nationally-recognized expert in the mental health field. In 1997 Van Tosh received the Consumer Advocate Award from the International Association of Psychosocial Rehabilitation Services. In 2003 she was the Washington Psychiatric Society’s Advocate of the Year. She has spent years providing her expertise to local, state, and federal governmental agencies on the subject of mental health.
For Van Tosh, this advocacy comes from a very personal place. The subject of a 1999 PBS report, Van Tosh herself has suffered from mental health problems her entire life. In 1999, PBS health correspondent Susan Dentzer explained how Van Tosh suffered
“from bipolar disorder, also known as manic depressive illness. She was committed involuntarily to a hospital by her mother when she had her first breakdown at 17. There she got her first taste of the insensitivities surrounding treatment of mental illness.”
Since then Van Tosh has made a career out of advocating for people with similar experiences. Today, she began her talk with a history of her own experience as a mental health patient and how her experience informs her current perspective. Much of the progress she has made recently came after she quit taking medications, though she was careful to say that everyone’s experience is different.
“I am here to say that I don’t have a lot of definitive opinions about medications as a whole. Everyone is different and everyone should be exerting their rights as patients or clients or survivors, exerting the right to choose and participate in your own treatment—because if you aren’t, no one else is going to do it for you.”
Van Tosh explained that, while she could not say with certainty that her recent progress has been due to quitting her medications, the quitting — in conjunction with healthy lifestyle changes — has made a noticeable difference.
“Not everything is black or white. I don’t really know that cutting off the medication was the key for me, but since then, effects have emerged. I have clearer vision—literally, my eyes are working better. My emotions are intact but different.”
Van Tosh recommended focusing one’s energies on a healthy lifestyle, regardless of if one is medicated or not.
“Coming off of psychiatric medication, I’ve had a lot of discussions with people about that. It’s my path and it’s unique to me—eating less fast food, eating more veggies, and taking long walks. It’s not just coming off the meds, or just the fast food, or dabbling in spirituality. It’s hard to know what it is exactly. Maybe it was that I just turned 50, or menopause. It’s hard to know. So I can’t say—It’s the diet. Or—It’s the meds. But something happened. And it was triggered by looking at the medication first. That’s when I quit smoking cigarettes and changed my life.”
To Van Tosh, having the freedom to decide what you personally think is best is crucial.
“I was forcibly medicated a long time ago. So for me, it’s more or less looking at your life and deciding what helps you.”
The theme of time has struck Van Tosh as crucial to her own recovery. Time itself can heal. And more importantly, giving oneself the time to heal — in the sense of patience — can be immensely healing in and of itself.
“Time has been critical in my recovery. Time is a healer but it takes a really long time to heal. I was medicated and locked up when I was 17, so it was from 17 until 50 when I had a cloud over me. And now the cloud has lifted and I feel like I have a new life. So I am taking all the time I have to feel well.”
Van Tosh is especially concerned about how upcoming healthcare reforms will address the necessity of time with regards to mental health.
“In healthcare and healthcare reform, and especially with managed care, time is an issue. People have to been seen promptly and efficiently and save money. But other things do take time. And so my hope with healthcare reform is that the system is patient, and waits for people like me who need time, who are traumatized, and who need support for an extended period of time. You can’t be hustling people out of waiting rooms.”
Changing the focus
Much of current mental healthcare focuses on taking pills. The pharmaceutical industry is huge in the United States. The rate of antidepressant use alone has increased nearly 400% since the 1980s. Eleven percent of Americans over the age of 12 take antidepressants. That is more than 1 out of every 10. Part of this is how easy it is to access the medication: about 80% of antidepressant patients are receiving care from someone other than a psychiatrist, such as a family doctor untrained in mental health.
While not discrediting the necessity for some individuals to take these medications, Van Tosh talked about the value of alternatives.
“Acupuncture along with massage and counseling made a big shift in my body. When you put together a menu of things like that, things change. I hope these alternatives are available in healthcare one day. There’s acupuncture, not just Ativan. So our concern is parity between ease of access and the options available in the behavioral health arena.”
After Van Tosh finished her presentation, discussion commenced among attendees, with a particular focus on the prevalence of medication in Lane County’s mental health centers.
A 70-year-old man told his own success story, of having gone from checking himself into the Sacred Heart Behavioral Health Services inpatient care program (otherwise known as the Johnson Unit) to, after healing, wanting to volunteer at the Unit. But for him, there was a caveat: he had decided to not use medication to treat his symptoms. And he wanted to give inspiration to those at the Unit that wanted alternatives to medication as well. But, according to him, the Johnson Unit only uses medication as therapy and would not allow him to talk to people who similarly did not believe in using medications for mental health problems.
“The Johnson Unit ignores the fact that medications do not work for 30% of the populace.”
David W. Oaks, Executive Director of MindFreedom International, has been a psychiatric survivor human rights activist since 1976. Oaks is also on the Board of Directors of the United States International Council on Disability and Oregon Consumer/Survivor Coalition. In response to this individual’s negative experience with the Johnson Unit, Oaks spoke of a developing and positive relationship between Peace Health’s Johnson Unit and advocates of alternative therapies.
“Representatives from the Johnson Unit, and Peace Health, have spoken here [at the Council meetings] before.”
While Oaks said the Johnson Unit has been increasing its doctor training with regards to electro-shock therapy, he said,
“They are opening themselves up to dialogue [on alternative therapies].”
An official representative from Sacred Heart’s Behavioral Health unit could not be reached for comment by the time of publication. However, one employee that EDN spoke to expressed surprise over this perception and indicated that medication is by no means the only available therapy.
Part of the reason medication is so emphasized, said Jose E. Soto, Executive Director of NAMI Lane County (the local chapter of the National Alliance on Mental Illness), is that treatment is subsidized by the pharmaceutical companies.
“Here in Lane County we try really hard to be pro-choice [on medication] and not push drugs on people. But the education and campaigns are funded by pharmaceutical companies. A lot of our educational material has [for example] ‘Astra Zeneca’ printed on the back because they pay for the materials. But we’re definitely looking for people who want to share alternative perspectives.”
Another important issue raised during the forum was the future of mental health treatment with recent developments in healthcare reform, both nationally and statewide. Oaks asked Van Tosh about Oregon in particular.
“In the state of Oregon, on the one hand, we’re ahead of the game. On the other hand, we’re one of the few states that has little state funding for mental health peer activities. How do we fix that?”
Van Tosh said that it is up to the voters to make it a priority. She said,
“To be honest, it is up to you. People in Oregon need to say, ‘We want this.’ I don’t understand it myself. There are millions of dollars in New York that go to the peer movement. They do an awful lot. It’s about people coming together. Money goes to roads and bridges. But why not to peer programs, too? The people of Oregon have a lot of potential to speak up.”
The Lane County Mental Health Consumer / Survivor Advisory Council holds regular meetings on the fourth Tuesday of most months from 1 to 3 pm at the the Lane County Behavioral Health Services building located at 2411 Martin Luther King, Jr. Blvd, Eugene, OR 97401.