HEAL Book Review: "Mental Health Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens by Art Levine"
By Angela Smith, HEAL National Coordinator/Co-Founder
Author and Journalist Art Levine was kind enough to send me the manuscript of his soon to be released exposé titled "Mental Health Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens". You can learn more about the book at www.mentalhealthinc.net, https://www.scribd.com/user/9995978/Art-Levine-Mental-Health-Inc, and https://www.barnesandnoble.com/w/mental-health-inc-art-levine/1124110816?ean=9781468308372.
I have read the manuscript in its entirety and for a mainstream look at the issues with institutionalized abuse of children, youth, veterans, the elderly, prisoners, and the disabled, it is an excellent read. If you are looking to introduce a novice to many of the major issues with fraud, abuse, and corruption in the mental health industry and government agencies, this book may be the best place to start.
This book does not address the socio-economic conditions of the vast majority of individuals labeled, marginalized, and systematically broken to be easier to manage and control that is the true underlying problem that must be addressed in order to reduce, if not eliminate, mental distress and ineffective or "unhealthy" coping strategies. For a look at arguments and studies showing the environmental and social factors that create misery and mental distress that could be relieved by improving the human condition through progressive economic change and basic human rights or, if not changed, result in self-medication (drug abuse/addiction), see: http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html
Levine does a stellar job in exposing fundamental problems, including cover-ups and a "let them die" attitude towards veterans and anyone "the powers that be" deem to be "unfit" and worthy of sterilization and long-term extermination. (see: http://www.esquire.com/news-politics/politics/news/a56482/tennessee-sterilize-inmates/, https://www.washingtonpost.com/blogs/govbeat/wp/2014/09/26/following-reports-of-forced-sterilization-of-female-prison-inmates-california-passes-ban/, http://www.newsweek.com/one-way-end-opioid-epidemic-let-them-die-639272) Not only do they sterilize or force/coerce sterilization of inmates (even in California, even now), it happens in other institutional settings. HEAL interviewed one young African American woman who sued the residential treatment center in Texas where she was placed for forcibly sterilizing her without her consent and against her will. This is actually happening and if you study social justice movements and the systematic oppression and persecution of poor communities, you will begin to understand that their life experiences tell them daily they are targeted and oppressed and that it is not Schizophrenia or Paranoia, but, trauma-informed living after witnessing the firsthand and repeated abuse and repression of their communities and themselves. (see: https://youtu.be/LBGRfqdD6JU) Of course, those who radically adhere to neo-liberalism, prefer to blame those living in poverty for their circumstances because blaming social and economic inequality is perceived as a threat to the almighty status quo and labeling people who dare to speak out about social and economic injustice as "crazy" (see: http://www.huffingtonpost.com/2015/04/30/bernie-sanders-socialist_n_7182752.html, http://thehill.com/blogs/ballot-box/presidential-races/284011-trump-sanders-is-crazy-as-a-bed-bug, http://www.independent.co.uk/news/world/americas/us-politics/donald-trump-mental-illness-signs-yale-psychiatrist-dr-bandy-lee-dangerous-us-president-goldwater-a7700816.html (Sanders and Trump have both been labeled as "insane". Some pundits calling for Trump to be institutionalized in a psych hospital. But, because of the socio-economic status of both, it only rises to the level of libel or hyperbole. But, when you don't have money and fame backing you, the powers that be find it all too easy to marginalize and/or institutionalize dissidents.)) so they can be marginalized and dismissed by the sleeping majority has proven an effective tool in squashing dissent and coercing or forcing "treatment" (institutionalization) on those individuals neutralizes the threat they pose to the "system". Levine does not make these arguments in his book. I've included them here to hopefully provide additional insight and nuance to the overall discussion of the topics covered in Levine's work.
I've been working in the field of child and family advocacy for over 20 years and while I tend to live in a world of perpetual outrage, "Mental Health Inc" served to confirm my most disconcerting concerns about the entire field of mental health and the corruption by big money from the pharmaceutical industry which coerces and bribes providers to drug all problems away and not look at underlying causes of distress or ways to alleviate the stress without the use of dangerous pharmaceutical drugs.
Levine writes, "...the current mental health system is such a fiasco that even having health insurance doesn't ensure good -- or even safe outcomes." Levine goes on to point out that the majority of the industry is engaging in "scientific fraud" and reports, "...so many people have been damaged by a mental health system that doesn't work and is too often run like a racket."
"Mental Health Inc" provides anecdotal personal accounts of institutionalized abuse and malfeasance along with mostly well-researched documentation showing the systemic problems within the mental health industry. Like many others, Levine wanted to offer some hope or positive outlook and in so doing, may have been too quixotic in some of his recommendations for "good treatment" options. This is one of the primary issues I found with Maia Szalavitz's writing as well. (See: https://www.barnesandnoble.com/w/help-at-any-cost-maia-szalavitz/1101076791) Like Szalavitz, Levine wants to offer hope for recovery and mental illness management, but, appears to have looked in the wrong places for some of his treatment suggestions.
Levine does a great job of promoting empathic or empathetic treatment providers and it is empathic/empathetic providers that are the only professionals HEAL would recommend. However, in Chapter 11, Levine also recommends Trauma-Focused Cognitive Behavioral Therapy (CBT) and EMDR therapy, among other questionable and experimental therapies. For criticism of CBT and Eye Movement Desensitization and Reprocessing (EMDR), see: https://www.psychologytoday.com/blog/the-justice-and-responsibility-league/200903/four-drawbacks-cognitive-therapy, http://www.whywesuffer.com/cognitive-therapys-flawed-premise/#more-2090, https://www.madinamerica.com/2013/05/cognitive-behavioral-therapy-the-good-the-bad-the-limitations/, https://thepsychologist.bps.org.uk/volume-22/edition-5/moving-beyond-cognitive-behaviour-therapy, http://www.theness.com/index.php/emdr-science-or-pseudoscience/, https://www.quackwatch.org/01QuackeryRelatedTopics/emdr.html, https://www.myptsd.com/c/threads/emdr-lashback-when-emdr-goes-wrong.1388/, and http://www.skeptic.com/eskeptic/14-05-21/.
In addition, the last couple of chapters of "Mental Health Inc" seem to suggest that Schizophrenia is a biological rather than environmental/socially-caused form of mental distress. Levine has written in-depth articles expanding on that debate and draws no definitive conclusions, because the science is simply not in nor complete for such conclusions. For example, read his Huffington Post article here: http://www.huffingtonpost.com/art-levine/abilify-is-top-selling-us_b_6282684.html Arguments can be made on either side, but, HEAL would remind readers that the mental health industry was born out of the eugenics movement in the United States (see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579550/, http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.90.2.277?journalCode=ajp, http://www.law.harvard.edu/students/orgs/jlg/vol311/211-236.pdf. etc.) and that as referenced above, sterilizing the "unfit" (particularly people of color) remains a goal of most segregated congregate care facilities, programs, and prisons. Beyond this, it is easy to label someone as "delusional", "paranoid", and "schizo" when their life experience is so foreign to the professional class/upper middle class life experience that those "professionals" engage in delusional and damaging denial of the actual cause(s) of mental distress in poor people and see them as needing to be controlled through chemical lobotomies so they don't make trouble for the "status quo". Even if they don't consciously make the choice using that language, their entire profession has been built on that primary purpose and it can't be ignored when discussing what's wrong with this industry. You don't have to be a person of color to be given a chemical lobotomy, just ask human and civil rights activist, Abbie Hoffman. (see: http://www.heal-online.org/different.htm) Oh, you can't, because he's dead. And, he was labeled after being literally spied on (tapped phones, being followed, the works) by law enforcement who found him to be a "national security threat" because he was charismatic, white, and willing to adopt the class struggle and anti-war agendas alongside African American activists (who were similarly targeted and harassed). For more on this, see other blog entries regarding this with the title: A BRIEF HISTORY OF INSTITUTIONAL ABUSE IN THE UNITED STATES OF AMERICA, ( a multi-part and ongoing series which begins here: http://heal-online.blogspot.com/2014/07/a-brief-history-of-institutional-abuse.html). Was Abbie Hoffman paranoid? No. Did he have a rational understanding of his life experience? Yes. Did that fit with the status quo? No. So, he was labeled and neutralized through chemical lobotomy by so-called "caring professionals". You can't even start a "revolution" when revolutionaries are identified, targeted, and neutralized regardless of whether that "revolution" is peaceful or not. And, the affluent certainly have a vested interest in these methods which they may see as a more humane alternative to death camps. But, that's not saying much.
Speaking of death camps, Levine does mention the Dozier School for Boys where over 100 corpses of children have been found buried in mostly unmarked graves on the property. The Dozier School was a residential "character training" program in Florida before it was finally closed down in 2011. See: http://www.smithsonianmag.com/smart-news/archaeologists-finally-know-what-happened-brutal-reform-school-180957911/ However, he goes on to mention an estimate provided by SIA (www.sia-now.org) that there have been a maximum of 300 institutional deaths of children (including suicides following abusive/coercive treatment) over the years. This was a gross under-estimate and not based on any legitimate fact gathering by SIA "researchers". This may seem a small matter, but, grossly misrepresenting the number of deaths in institutional care or as a result of institutionalized abuse is wholly irresponsible and hurts efforts of those of us who care enough to get our facts straight, understand problems with current laws and legislation, and put in the time to get things right. By misrepresenting the number of victims by providing such a low estimate, SIA helps further marginalize the call for reform by suggesting too few people are affected to have it reach the level of national concern.
So, if it isn't a maximum of 300 dead child victims of institutional abuse (including suicides following institutionalization), what's the number? There's no record of the number of children killed in treatment/institutional settings. The best estimate available is from the Hartford Courant, which reports: "A 50-state survey by The Courant, the first of its kind ever conducted, has confirmed 142 deaths during or shortly after restraint or seclusion in the past decade. The survey focused on mental health and mental retardation facilities and group homes nationwide. But because many of these cases go unreported, the actual number of deaths during or after restraint is many times higher. Between 50 and 150 such deaths occur every year across the country, according to a statistical estimate commissioned by The Courant and conducted by a research specialist at the Harvard Center for Risk Analysis. That's one to three deaths every week, 500 to 1,500 in the past decade, the study shows." (Source: http://www.charlydmiller.com/LIB05/1998hartfordcourant11.html ) This was the last legitimate study by a legitimate research specialist on this issue to HEAL's knowledge and would suggest a minimum of 975 deaths of children due to restraint and isolation (3750 restraint and isolation related deaths, if we include all age groups of the study referenced) in institutional settings in the last 25 years. While the Dozier School for Boys opened in 1900 and closed in 2011 with over 100 children's dead bodies buried in unmarked graves around the facility "over the years". (Source: http://www.npr.org/2012/10/15/162941770/floridas-dozier-school-for-boys-a-true-horror-story) So, why not go back 100 years and apply the modern statistics? That would suggest 3,900 deaths of children in institutional care as a result of restraint and isolation (not including other deaths in care, such as overmedication or medical neglect) since 1917. In addition, 43 adjudicated children* and youths have died while in detention centers in a 4 year (2002-2005, last available data) survey of US juvenile detention centers, but, not all centers reported/participated in the study, so again, the number of deaths in detention may be much higher. (source: https://www.bjs.gov/content/dcrp/tables/juvtab5.cfm) And, that would suggest 11 adjudicated juvenile deaths per year in detention. It is clear that many more than that have been killed in institutional settings as a result of institutionalized abuse with thousands more committing suicide after having been through that trauma. And, that's just the number of institutionalized kids that have died as a result of institutionalized abuse (restraint and isolation) while institutionalized. And, if you want to get really "crazy", consider this.... Let us say that at the "best" segregated congregate care facility there are 0 deaths and at the "worst" (i.e. Dozier) there have been 100 deaths due to malfeasance (restraint, isolation, medical neglect, overmedication, etc.) and take the average death toll over a 100 year period to be 50 per facility. The CDC reports there are 2,250 such facilities in the US. (Source: https://www.cdc.gov/nchs/data/nsrcf/NSRCF2010SelectedSurveyParticipants_091409.pdf ) Then, over a 100 year period, you have an average of 112,500 malfeasance related deaths, or 1,125 deaths annually in institutional care due to malfeasance, across all demographics. If 26% of those deaths are of youth (as the Harvard research suggests), then it would amount to roughly 292 deaths of youth in institutional care annually. This would make the death toll over a 25 year period for youth in segregated congregate care 7,300. But, medical malpractice accounts for 210,000-440,000 medical negligence/malfeasance deaths in the US annually according to a Journal of Patient Safety study in 2013. (Source: https://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals) While these numbers are staggering, they do not even touch on the post-institutionalization suicides of those traumatized by abusive and negligent care in segregated congregate care facilities.
As stated above, most of the information in Art Levine's "Mental Health Inc" is well-researched and invaluable. Even though a couple of his suggestions or sources are questionable, overall, it is a great read and one HEAL would heartily recommend.
[Coming Soon: The HEAL Report youtube series interview with "Mental Health Inc" author, Art Levine. See: https://www.youtube.com/user/HEALwantsTEENliberty]
* Corrected on July 28th, 2017, formerly read 86 which was a calculation error in reading the death total tables from the BJS.
* Corrected on July 28th, 2017, formerly read 86 which was a calculation error in reading the death total tables from the BJS.