Archive for March, 2010
…and Dr. Kifuji might not be off the hook after all. In a clear case of parents’ drugging of their children that’s gone beyond abusive, first Carolyn and now Michael Riley have been convicted of murdering their four year old daughter. From the Boston Globe:
Capping one of the most unusual child abuse cases in Massachusetts history, a South Shore father was convicted yesterday of first-degree murder for killing his 4-year-old daughter with an overdose of a psychotropic drug, which he and his wife had nicknamed “happy medicine’’ and routinely dispensed to their three children to manage their day-to-day behavior…
Prosecutors said Rebecca’s parents fabricated their children’s behavioral problems, making up reports of hallucinations and violent outbursts, in order to obtain drugs to sedate them and to help them qualify for government benefits for families with disabled children.
To be clear, we’re not talking about a couple of parents who might have overdone it or a child that had a freak response to slightly liberal drugging. The Rileys did all they could to obtain drugs and when they had them, they used them to poison their children into a state of quiet compliance. Rebecca was on psychotropic drugs since she was two, as were her siblings. In addition to the chemical abuse, Michael was also physically abusive and had even been removed from the home when charged with attempted rape, indecent assault, battery and giving pornography to a minor — his stepdaughter. He returned just two weeks before Rebecca died.
When you have a family so abusive, broken and damaged that a father that could do that sort of thing and be welcomed back to the home — with the children and by the mother — what sort of care can we expect them to give to their children’s minds and how could anyone think they would act responsibly with such powerful drugs that should never have been given to them in the first place? One way that at least one part of a host of problems could have been eliminated would have come down to a responsible doctor. There was none. Not only was Dr. Kifuji aware of Michael’s abuses, she was instrumental in his returning to the home.
A Weymouth Housing Authority manager testified that Michael Riley, 37, had been banned since 2005 from spending overnights in the family’s apartment there, the result of pending charges that included providing pornography to a minor. A social worker said the father’s alleged beating of his son in 2006 triggered a renewed child-abuse investigation, and the mother, while remaining devoted to the father, filed a restraining order to protect the boy. A house guest also testified that the Rileys’ three children often seemed “more timid’’ when their father was around…
Kifuji diagnosed at least two of the Riley children, while toddlers, with mental disorders after only a one-hour consultation, did not order appropriate blood work while they were on potent pills, and seemingly ignored input from preschool teachers and other clinicians who said the children seemed weak and overmedicated.
It looks like Kifuji might still have to answer for her beyond liberal dispensing of drugs and her negligent psychiatric “care” after all — and why shouldn’t she? While she may not get the full measure of the law, she may have to start worrying about her status as a psychiatrist. For the sake of the children she’s still seeing at Tufts, one can only hope.
After the verdict, Plymouth District Attorney Timothy J. Cruz said he plans to ask the Board of Registration of Medicine to reopen its investigation of Kifuji, who he has said turned a blind eye to the numerous signs that the parents were troubled and reckless in dispensing drugs.
“Dr. Kifuji is unfit to have a medical license,’’ he said. “If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts, then there is something very wrong in this state.’’
Kifuji testified in both cases, but only after being granted immunity from prosecution.
Cruz said he plans to assemble the transcripts of her testimony, among other things, to present to the licensing board. That information, prosecutors said, showed negligence in how she assessed and followed patients, not just that she subscribes to the controversial belief — as do some other prominent psychiatrists — that toddlers can be diagnosed with bipolar disorder.
The Rileys are certainly near the end of the spectrum of child drugging and the severity of this case makes it seem like a singular event. It is not. Instead of just focusing on the severity of this one instance, we should question the culture of drugs and control that has allowed us, even in much milder and seemingly harmless instances, to use drugs to turn off the part of children that makes them children. In so many instances, we’ve gone well past the point of not letting kids be kids to not letting kids be human
This is an extreme and terrible case with the Riley children being drugged, one of them to death, in order to keep them under control from the time they were toddlers — not for acting out, not for being out of control kids but for being children. In the end Rebecca Riley was given a lethal dose of Clonidine, a blood pressure medication used off label to treat withdrawal from narcotics and alcohol, for crying out for her mother while she struggled with pneumonia.This is tragic and disgusting every way you look at it.
“People labeled with mental disabilities are largely invisible to the wider world. To the extent that they think of us at all, they usually think of us as a problem that somebody has to do something about and not as human beings, individuals, each one of us — deserving of human dignity.” — Judi Chamberlin
This is a great video created by activist, artist and psychiatric survivor, Leah Harris. I met Leah in Brooklyn at a demonstration and vigil in honor of Esmin Green and in protest of her passing for lack of care in a hospital. Leah immediately impressed me with her outspoken determination and when she’s performing a spoken word piece, she has a gift for getting to the core of what she’s communicating. What I might say in a lengthy rambling post or conversation, she cuts to in a phrase.
Leah’s been bringing that sharpness, conciseness and strength to video editing as well lately. In this short video, she shows viewers what the mental health rights movement is to many of us and what the late Judi Chamberlin is to that movement. You’ll notice I didn’t say was. Anyone who has fought as hard for and had such an impact on such a movement that survives them will always be tied to it. Benjamin Franklin once said something to the effect of, “If you are to be remembered long after you die, either write something worth reading or do something worth writing. ” Judi did both. Some day, when we look back on this movement in the same peculiar light of hindsight as we view the fight for black civil rights, women’s rights and gay rights, Judi will stand out as one of its first and strongest figures. In addition to what she did directly and for its own sake, she inspired many — often at times and in places where inspiration was notably absent. I wish I would have been in a position to meet and work alongside her toward our shared purpose. Instead I am blessed to be in the good company of people she affected directly.
Now that we’re getting all too comfortable taking antipsychotics for almost every perceived illness under the sun, from ADHD to depression and bipolar disorder, what does pharma offer for everyday concerns like…calling your mother? This ad for AstraZeneca’s Seroquel represents a new low in irresponsible attempts at positioning antipsychotics as a happy pill for every problem, feared problem and now even non-problem.
Oh and in case you missed it, the word schizophrenia is in muted type in the corner — snuck in just so they’re not technically marketing off label. That’s what it’s come to, just tack the name of the approved indication on the ad somewhere and sell a drug as the cure for daily life. If this is the shape of pharma marketing to come, what’s next?
As if it’s not bad enough to push the idea of using some of the most dangerous drugs on the market to cope with daily tasks and concerns, they’ve abandoned the idea of even pretending to condone judicious dosing and chosen instead to encourage buyers to take it to the limit. There is a reason the boldest type on the ad says “Up to 800 mg” and the arrow on the chart is maxed out. Even beer commercials tell you to drink responsibly, while this ad just tells you to take more. But hey, when it comes to Seroquel dosing, their slogan says it all, Aim High. If there was ever a line regarding responsible drug marketing, they’ve crossed it.
I don’t have the time or energy to really delve into these intertwining stories so I’m just touching on them and providing links but I do think we should be paying attention to what is allowed to pass for care in this country and what is allowed to pass for accountability.
Florida has a terrible track record, pumping its youth and especially its children in foster care, full of pyschotropic drugs. Foster children in Florida are drugged about three times as much as children outside of the system. These drugs have serious negative effects on developing minds and bodies and one of those effects is suicidal ideation. With that many kids drugged down and such extreme responses, it’s painfully obvious that many of those children are going to suffer terrible outcomes.
This was never more true than in the heart breaking story of Gabriel Myers, a child just seven years old who committed suicide by hanging while on a cocktail of psychotropic drugs including Seroquel. Seven years old. Suicide at that age is unnatural. A child that age taking his own life has been failed by somebody — maybe everybody. It took a long time in my mind to get to even thinking about what this says about broken systems, medication, responsibility and social failure — all I could think about was what a terribly sad, troubled and short life Gabriel had.
Florida’s response? From a CBS News article that does go on to present some critical views of the use of psych drugs in children:
The apparent suicide of 7-year-old boy Gabriel Myers, who was taking several psychiatric medications, has led to the introduction of a bill in the Florida legislature, which would assure that powerful mental health drugs dispensed to Florida foster care children would be more closely monitored…
The bill requires caregivers and doctors to report any adverse side effects, which DCF must document.
The bill also requires children to have a mental health treatment plan that includes counseling for children prescribed such drugs.
Monitoring? We need more than paperwork. Keeping track of your failures and an immediate reversal of your direction are two different things. Gabriel’s prescribing psychiatrist, Sohail Punjwani, is tied to a string of kids drugged down on powerful psychotropics and having horrible negative effects — facing everything from sedation and dizziness to hallucinations, suicidal urges and death either at their own hands or from the drugs directly and while he’s not the only one, he’s certainly at the center of the situation. It’s okay though. He got a strongly worded letter: From the Miami Herald:
A South Florida psychiatrist who was treating a 7-year-old foster child before the boy committed suicide last year has received a warning from federal drug regulators who say he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.
In a strongly worded letter dated Feb. 4, regulators at the U.S. Food and Drug Administration said Dr. Sohail Punjwani over-medicated children who were enrolled in clinical trials for undisclosed drugs. One girl, the letter said, slashed her wrists while hallucinating.
A strongly worded letter? Strongly worded letters are written in response to bad stays in hotels not children dying at the hands of their reckless doctor. Surely, showing a complete disregard for the safety of your youngest patients warrants more than a letter. But then, it seems disregard for patient safety is just the tip of a particularly damaging iceberg. It would appear as though Punjwani, so far without interference from any overseeing agency, may have been using foster children in clinical trials. If that’s the case, the problem is systemic.
If experimenting on kids is the lowest of the low, I don’t even know what to say about hand selecting discarded or displaced children for a pseudo-science project. It is a clear use of a person’s social viability to define them as candidates for clinical trials. You will never see a news report of senators’ children being hand picked for psychiatric experiments. With or without the pretense of clinical trials, children in this country have become the little white mice in psychiatry’s living lab and all too often their real lives are the mazes we watch them stagger through. That’s not good enough.
This morning, I stumbled upon an opinion piece for the Buffalo News pushing for Kendra’s Law to be made permanent. Kendra’s Law is an attempt to prevent violent crime by essentially treating people diagnosed as mentally ill like some sort of pre-criminals. On paper it’s also supposed to be for the safety of the “patient” too but when it’s time to push for support, it’s almost always about protecting “us” from “them.” (As I’ve said before, fear sells when facts fail.) Advocates of Kendra’s Law and similar attempts to criminalize extreme states of mind use phrases like assisted outpatient treatment (AOT) instead of the more truthful involuntary or forced outpatient treatment. These are the types of laws that allow for forced drugging, electroshock and hospital confinement — all based on the unfounded idea of biological mental illness but the idea is just the packaging. It’s essentially a way to keep people under control out of fear of what they might do. This thinking has no basis in fact regarding mental illness and certainly no place in the arena of human rights or a constitutional America. The article is a fine example of fearmongering but that’s the current state of media. Somehow factmongering never caught on.
As with most battles for thought and opinion, this one is very much centered on carefully crafted words and phrases — not unlike much of the current mental health industry. As with force being rephrased as assistance, drugs are renamed and recategorized, some officially and some in the minds and words of the public. (Neuroleptics have come to be called antipsychotics which are now being called antidepressants.) Sometimes words with no previous connection are paired and when spoken with some authority or when used to speak to people’s fear these words become inseparable, creating a false choice scenario. The latest I’ve seen, in the aforementioned article, is “violence prevention medication.” Of course, there is no such thing but it’s another step in grooming the vernacular.
Kendra’s Law—designed to keep people who really need it on their violence-prevention medication—was passed about 10 years ago. It’s up for renewal, again. Just make it permanent…
The law allows judges to order certain mentally ill people to remain on violence-prevention medication as a condition of release and, if that doesn’t work, to order involuntary committal to mental hospitals if shown to be a danger to themselves or others.
The author creates a connection between violence prevention and drugs. Simply by accepting the phrasing, you’d be accept the idea as truth. And if that’s the truth, you are either in favor of forced drugging or you don’t care if innocent children are slaughtered at the hands of madmen. Facts be damned, that’s your choice. Somehow, when I picture people being tackled to the ground, restrained by undue force, faces pressed against a cold hospital floor and forcibly injected with drugs — powerful mind and body altering drugs — it’s hard to see it as “violence prevention.” We are transferring violence at best and at worst and in truth, causing it.
In 1917, three years before women’s right to vote was recognized, a group of more than thirty suffragists, members of the National Woman’s Party, were arrested in DC on charges of “obstructing sidewalk traffic,” the latest in a long line of charges against the protesting women. Their real crime, however, was daring to speak up for themselves and their rights — especially when a woman’s role was one of quiet support for a nation newly at war. But how do you support a nation that doesn’t support you? They dared to stand outside the White House with banners asking how long they must wait for liberty. These women wanted more than answers. They wanted — and fought for — their rights and the rights of their countrywomen and if you can’t have your vote in a ballot box, your vote is cast in the streets, in the press and sometimes in a jail cell.
The thirty-three women arrested that day were taken to the Occoquan Workhouse in Virginia. As protestors returning to the line after a series of unjust arrests and subsequent trips to Occoquan, they were no strangers to the violent and abusive behavior they faced. Many had already been beaten, violently force fed rotten and maggot infested food, denied medical attention and forced to live in unsanitary conditions. Still, little could have prepared them for what has become known as the “Night of Terror” for the appalling treatment it brought them. By order of Occoquan’s superintendent, as many as forty guards armed with clubs went on a rampage, attacking the jailed and defenseless women. They were dragged, beaten and choked, slammed into the hard iron furnishings of the cells, and chained up — injured and bleeding. One woman suffered a heart attack which was ignored while she saw her compatriot lying unconscious and presumed dead on the floor. Shamefully, it took a night of terror to affect change. When news got out about the nightmare endured at Occoquan, public outrage rose to the point that even President Woodrow Wilson, staunchly opposed to women’s suffrage, started to reverse his position. While he may not have cared about the plight of the women, he was shocked at the events of that night and he was not blind to the outrage of his public. The wheels of our government are slow to move and it took three more years for women to get the vote they never should’ve been made to fight for but it was a turning point and tales of that night are often used to urge women to exercise their right vote.
These were women of conscience and conviction gathering from their varied backgrounds and home towns in a shared purpose. Among them was Miss Kate Heffelfinger. Kate was from Shamokin, PA, less than twenty miles from my own home town. She was an art student and a member of the National Woman’s Party, an instrumental part of the movement. When other groups sought to gain respect and favor by softening their position or putting their fight on hold to support our nation’s war efforts, the National Woman’s Party held fast, challenging the idea of fighting for democracy elsewhere while being deprived of their vote at home. As a member of the party, Kate was no stranger to the injustice our courts could deliver. She was sentenced to jail three times — all for her part in meetings and demonstrations on behalf of women’s right to vote. It seems little is known about her exact role in the movement, aside from her arrests and even less about her life immediately after but we know she stood up with the NWP and demanded her rights, faced down impassioned and violent opposition on the street and was subjected to the brutality of Occoquan Night of terror. She earned a Jailed for Freedom pin, designed by Alice Paul and given to her by the NWP in a meeting honoring all of the women imprisoned for their actions in the interest equal voting rights. She was a vital part of the movement that won the vote for herself, her sisters in the suffrage movement and every woman in the nation. For that she is not just a part of women’s history but our broader, shared history.
Sadly, more seems to be known of her later life. With a history of behavior perceived as bizarre and one drastic action, she lost her hard fought right to vote along with the rest of her rights when she was thrown into a state hospital. From an article in the Daily Item, a local newspaper:
One Shamokin resident who preferred not to be identified said her father delivered animal feed for Hex Warehouse to Heffelfinger’s home on Marshall Street.
“You’d just see a hand come out the door and she’d pay for it,” the woman recalled her father telling her…
James R. Holland, of Shamokin, was an independent contractor hired to clean out Heffelfinger’s home and organize the contents for sale shortly after she was committed to Danville State Hospital. Holland’s father, Richard F. Holland, was an assistant cashier and trust officer of National Dime Bank in Shamokin, which handled the sale.
“She ran around town in dark clothes all the time, picking up junk,” Holland recalled.
“She had every kid in the neighborhood scared to death of her,” his wife, Phyllis, said. “She looked like a witch.”
Her outwardly strange behavior may have earned her the name Crazy Katie but I have to wonder what it takes to be called crazy in a place as strange as Shamokin. I don’t know how to describe it other than to say that Shamokin is a depressed mining town with an odd and almost fictional Flannery O’Connor quality about it. It’s a very dull gray place full of very colorful characters. While I don’t know what it was like in Kate’s day, I can say that I’ve scarcely visited Shamokin without seeing someone or something that points to that strangeness. Of course, even then it usually took a little more than scaring kids and collecting junk to lose your freedom to a hospital.
Bernice Shade lives in Heffelfinger’s home today, and lived next door to her before Heffelfinger was sent to Danville State Hospital after throwing a rocking chair through Shade’s front window. Shade and her husband, Bill, were at a movie at the time. Mrs. Shade’s mother was watching their children when someone knocked at the door.
“She looked out from the upstairs window and saw it was Crazy Katie. That’s what they called her,” Shade said.
Afraid, her mother decided to stay inside and hope Heffelfinger would go away.
That’s when Heffelfinger threw the chair through the front window, shouting, “He’s raping his daughter!”
Shade said: “My daughter was screaming because she was getting her hair washed, and you know how little kids hate to get their hair washed.”
The police were called, and Heffelfinger was taken away.
It was just that simple. A woman misinterpreting a child’s screams of protest is “taken away” to spend her days in a state hospital. Some terrible things happen to children in this world when people don’t listen and if we know nothing else about Kate, she was not a woman to sit quietly by. For that she was repaid with the 1950s version of psychiatric care. Sure, she was mistaken and should have been made to pay for any repairs, even a fine, but to be incarcerated in a state hospital for the rest her days was truly an injustice and make no mistake about it — even in a hospital — it’s incarceration. If the door locks behind you and you don’t have the key, if someone else controls whether and when you come and go, it’s incarceration. A woman of strength and conviction lost her autonomy that day. She lost the kind of freedom that not only defined her but helped us define ourselves.
When she was taken away, her belongings which told so much about her were sold and trashed. She had the junk she collected over the years mixed in with treasures from her earlier days and without the benefit anyone connected to her overseeing her belongings, surely some important pieces to the puzzle were lost. I would love to know what happened to her Jailed for Freedom pin — a hard earned reminder given only to a few that could so easily have been swept into a box and mistaken for a mere trinket.
Junk and valuables were so intermingled, it was inevitable that some significant items were thrown away.
Holland recalled seeing boxes of linens, rags, and suffrage banners in the attic.
All were trashed.
In a time when the woman’s vote is taken for granted, it’s hard to even grasp the opposition these women faced but it was more than just speaking up until someone finally caved. It was truly a hard fought battle and Kate was a critical part of that battle. It is unfortunate to say that her name has been all but lost to time. A woman whose sacrifice and successful protest were so important to the course of our history should be recognized and honored in history books everywhere along with her sisters in protest yet even lifelong residents of Shamokin have never heard her name, much less her story. For the few who do know of her around here, it may sadly be as Crazy Katie and not Miss Kate Heffelfinger, the bold, young art student who went down to DC to take a stand.
Her story, even mentioning her name, makes me question how much opposition each of us are willing to face down for our convictions, for our rights and for others. What are we willing to endure to be a part of the change we desperately need? It took the Night of Terror to turn things around back then but every night is somebody’s night of terror and, thanks to inaction, the world is slow to change for the better.
Lately, I see myself adopting Kate as sort of a patron saint of my own convictions and I hope to fight as hard as she did in her early days — for myself and for the many who have ended up in a situation like hers in her later days. The roads are newly clear of snow, the days are getting longer and there is little to truly keep us from gathering where we can be heard. Hasn’t it long been time for us to cast our votes in the streets?
• • •
Library of Congress: Kate Heffelfinger
Library of Congress: Photographs from the record of the National Woman’s Party
A recent opinion piece by Allen Frances for the LA Times is plainly pointing out the dangers of the new DSM’s broad strokes and the potential to paint too many “normal” people as mentally ill. It’s notable enough that mainstream press is presenting any criticism at all about psychiatry in general and the DSM in particular but Allen Frances was one of their own and no silent partner or low level underling either. He was the chairman of the committee that created the DSM-IV.
Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.
The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.
Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status — to say nothing of stigma and the individual’s sense of personal control and responsibility.
It’s interesting to see someone in psychiatry addressing the notion of false epidemics of mental disorder when a committee decision and ever changing public opinion are all that separate a “real” epidemic from a false one. That said, committee decisions and public opinion have proven quite powerful and if you look back, the release of each DSM has brought on a rash of newly mentally ill. If history proves a good indicator, there will be millions of people who are normal today and mentally ill in 2013 — all thanks to a book with the power to categorize and medicalize the human condition. How much sorrow is too much? How excited can you be about everyday things before you are manic? And now with the proposed introduction of psychotic risk syndrome, anyone who isn’t deemed mentally ill can be subject to the book’s reach simply out of fear that they may be in time.
What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.
The media seldom addresses views critical of psychiatry but for psychiatrists to come out against the new proposals in such a public way is truly indicative of what’s at stake with the new DSM. You can bet that if psychiatrists are picking sides on this, it carries huge implications worth looking at. It doesn’t take much to see the power inherent in handing over our culture’s ability to define “normal” to a small committee comprised exclusively of people with something to gain and Frances is not exaggerating when he calls it “wholesale medical imperialization.” How much control are we willing to hand over? How far are we willing to let anyone go in defining us? How widely cast will the net be before it captures you? This is not an issue of special interest only to those marked as seriously mentally ill. Every label of mental illness is serious and with an ever broadening range of perceived illness encroaching upon a shrinking concept of normal, you may not be off the hook. Frances’ article says that it may not be too late to save ‘normal’ but I question whether ‘normal’ is worth saving.
See also: Allen Frances’ Opening Pandora’s Box: The 19 Worst suggestions for DSM5 in Psychiatric Times.