Coercion, Zyprexa and Psychiatry

Imagine this. Someone in your life finds you inordinately eccentric, annoying or alarming, and decides you have a “mental illness,” whatever that is. Soon, you are being apprehended, sometimes violently, and locked up on a psych ward, despite your clear statements that you do not agree to being detained or to being medicated against your will. You may be injected with drugs that have a proven record of harming patients, tied to your bed with restraints and otherwise physically abused. You could be killed or sickened or numbed by the drugs forced on you. Clearly, coercive, medical model psychiatry can be dangerous to your health.

Welcome to the world of many modern psychiatric patients. Alaska lawyer Jim Gottstein’s new book, The Zyprexa Papers provides some valuable insight into how the “psychiatric-industrial complex”, made up of highly profitable pharmaceutical companies, psychiatrists, lawmakers, law enforcement and hospital administrators keep this dystopian world turning.  At a time when Canada is facing increased international criticism about its mistreatment of psychiatric patients in its hospital wards and public health systems, this is a particularly pertinent read for Canadians, but it will be of interest to readers around the world.

Once detained in the BC mental health system, the detaining facility controls virtually every aspect of your life and your body. You can be denied access to a phone or the internet. You can be denied visitors or the right to go outside for fresh air. Your clothing can be removed by force from your body and you can be denied access to your own clothes. You can be forcibly administered psychiatric treatment, including injections and Electroconvulsive Therapy. You can be placed in mechanical restraints that tie you to your bed. You can be put in seclusion.

Note that in BC, as in many jurisdictions, you can, if committed to a psych ward, be forcibly medicated, often with drugs that have “side effects” that can include induced psychotic symptoms, tremors, sexual malfunction, morbid obesity, diabetes and death.

It is hard to determine how many people have been exposed to these dangers, as research into involuntary psychiatric detention and drugging seems to be remarkably sparse. Stats Canada informed me that they do not report on involuntary detentions in Canada, and the Canadian Institute for Health Information only started tracking this information in 2018. The figures for 2018-2019 will not reflect any data from Quebec.

Meanwhile BC’s Ombudsperson, Jay Chalke , recently made an assessment  of what has been happening in his province, writing:  “In British Columbia, around 15,000 mentally ill people were involuntarily detained in one of B.C.’s over 70 psychiatric facilities in 2016/17 – a number that has grown by approximately 70 percent in the last decade.” And in the United States, one research paper, while hampered by spotty official reporting, estimates that there were over a million involuntary psychiatric detentions in America every year between 2013 and 2015. Despite the remarkable lack of current and comprehensive statistics, it is clear that large numbers of people in North America have seen their freedom curtailed and their health endangered at the hands of the dubious theories and harmful practices of medical psychiatry.

Full disclosure: I have a personal interest in this issue. Some decades ago, a member of my family was detained and drugged involuntarily in a BC hospital after alarming the public through eccentric behavior and wild talk. For these offenses she was seized by the police, taken to hospital against her will, physically restrained and injected with sedatives.

Our circle of friends and family were able to get her discharged to our care (a release that was a tribute, in part, to the social privilege we enjoyed as white middle class folks, some of us male.) Inspired by the work of anti-psychiatrists like RD Laing and Thomas Szasz, we took our family member home and stayed with her for weeks, witnessing her emotional pain and keeping her safely away from situations in which she might be seized and committed again. Gradually, she allowed her process to unfold without being interrupted by involuntary detention or drugging.  Within a month she was able to resume her regular life. She has not been hospitalized since and has gone on to decades of full and productive life in health care and social justice activism. So, I know from personal experience that there are preferable options, albeit ones that are both labour and love intensive, to the usual dreary and often counterproductive medical model response when people suffer psychosocial crises.

Jim Gottstein, an Alaskan lawyer and Harvard graduate, records his adventures and misadventures combatting aspects of medical psychiatry in his new book The Zyprexa Papers. As a former patient himself and a life-long  advocate for the rights of the involuntarily imprisoned and drugged, Gottstein was already involved in a case about the forced  use of pharmaceutical firm Eli Lilly’s  Zyprexa, an “anti-psychotic” drug ( or “neuroleptic” as some  activists and academic critics prefer to call them), on mental patients when he was approached  in 2006. The pitch? A suggestion he subpoena a large number of internal documents generated by the pharmacological giant from Dr. David Egilman, who had possession of the suppressed files because he was testifying as an expert witness in another Zyprexa case. Gottstein did so, and learned the documents showed a pattern of the pharma giant encouraging doctors to use the drug for the elderly and children (“off label” usages for which it had not been approved) and hiding its own research findings that illuminated just how dangerous this profit generating drug could be.

Unsurprisingly the drug company did not want this information on the public record, and it took steps to force Gottstein to return the documents, invoking a Secrecy Order that Gottstein argued didn’t apply to him.  Much of Gottstein’s book details the ornately complex legal back and forth between him and Eli Lilly lawyers that ensued. However, before Gottstein complied with the legal order to return the papers and to discourage others from copying them or going public with them, the release had taken on a life of its own, posted on websites and circulated by advocates of patients’ rights.  Think of these documents as the anti-psychiatry version of the Pentagon Papers or the Wikileaks release of documents about American atrocities in Iraq.

In 2009, Eli Lilly pled guilty to promoting off label use of Zyprexa and paid a $1.415 billion fine, resolving both criminal and civil charges. It is not at all clear that this resolution would have ever happened without the risks taken by whistleblowers including Jim Gottstein. Nor is it likely that Zyprexa is the only neuroleptic drug to be illicitly promoted by pharmaceutical companies more concerned with profit than with patient well-being. But don’t take my word for this. Consider the views of Dr. Marcia Angell, former editor of the New England Journal of Medicine and currently on faculty at Harvard Medical School. She has written scathing articles about the abuses of Big Pharma for the New York Review of Books and other journals, and her 2004 book  The Truth About the Drug Companies:  How They Deceive Us and What to Do About It documents many of the Big Pharma abuses that Gottstein targets in his book.

The Zyprexa Papers is a book that should be read by anyone who cares about freedom and human decency. Gottstein lifts the veil of secrecy that shrouds far too much of Big Pharma’s malign impact on human rights and human health. If we are lucky enough not to have fallen under the dark shadows of medical model psychiatry and involuntary drugging ourselves, we might want to think that the era of psychiatric snake pits, shock treatment and dubious drugging lies well in the past. We would be wrong to think so. Around the world, too many people are still stripped of their rights because they are undergoing an emotional crisis or acting in ways that make other people uncomfortable. Canada’s mistreatment of mental patients has drawn criticism from a United Nations watchdog.

In 2010, Canada ratified the United Nations Convention on the Rights of Persons with Disabilities, an international statement that pledges governments who sign on to eliminate involuntary detention and drugging of psychiatric patients. However, Canada’s ratification included a clause that said Canada would not be bound by the language prohibiting these brutal practices, and to date they still occur across the country.  In a 2019 report by United Nations Rapporteur  Ms. Catalina Devandas-Aguilar,  the UN official charged with examining Canada’s progress or lack thereof in implementing the United Nations Convention on the Rights of Persons with Disabilities, particularly its call to end all involuntary psychiatric detentions and forced drugging, wrote:  “I have been informed that the rates of involuntary admissions and community treatment orders are increasing across Canada.

But wait, the alert reader will say. Aren’t the rights of mental patients in Canada protected by current regulations that require prompt and regular review of cases in which a patient has been involuntarily committed or medicated? Not so much, concluded BC Ombudsperson Jay Chalke in 2019. According to an Andrea Woo story in the Globe and Mail for March 7, 2019:

Jay Chalke on Thursday released ‘Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act,’ the product of a review of records from all facilities in B.C. that can involuntarily admit patients for the month of June 2017. It found that facilities frequently failed to complete legally required documentation on involuntary admission, stamped generalized treatment descriptions on forms rather than write patient-specific ones, and failed to inform patients of their legal rights.

So it seems clear that even the current protective regulations surrounding involuntary psychiatric detention in Canada, which many critics would see as inadequate, are regularly ignored, at least in BC. There seems little reason to imagine that similar cheating on protective regulations doesn’t go on in other jurisdictions beyond BC. We do know, as reported in an article in the BJ Psych Open Journal in March of 2018 that 77.1 % of all psychiatric admissions in Ontario, for example are involuntary. The rate of involuntary psychiatric admissions has gone up over the past decades in many high-income countries like the UK and Germany, as well as in Canada.

The Zyprexa Papers is an account of one man’s gallant fight against Big Pharma, corporate secrecy and the perverse public policies that allow people to be imprisoned and tortured because of their state of mind. Gottstein makes no grand claims for his own heroism, and is in fact unusually modest in his self-assessment. Nevertheless, this is a heroic story, albeit one told in somewhat awkward prose, and an important part of a larger story of injustice and resistance. We can only hope that readers will be inspired to add their voices to demands that Canada act on its ratification of the United Nations Convention on the Rights of Persons with Disabilities immediately and end the barbaric practices of involuntary detention and drugging. If you live in another jurisdiction, odds are that your tax dollars are, like Canadian ones, being used to detain and medicate psychiatric “patients” without consent. People of conscience should speak out wherever this is happening, and Gottstein’s book is a powerful reminder to us all of our moral obligations.

Tom Sandborn lives and writes in Vancouver, BC. His reviewed appeared on dooney’s café.  He welcomes your feedback at tos65@telus.net