American Folk Art Museum to showcase Martín Ramírez as so much more than a “schizophrenic artist”

It’s the 1930s: California police pick up a depressed and confused Mexican immigrant named Martín Ramírez, who doesn’t speak English. Ramirez is diagnosed as a “catatonic schizophrenic” and committed to a state hospital.

Early 1950s: Ramírez is still trapped in a mental institution, and has barely spoken in all this time. But he has become a self-taught artist—a master who has saved some of his drawings rolled up in his jacket and tucked under his mattress so the hospital staff wouldn’t discard them. (The staff believed the works were tainted because Ramírez has tuberculosis.) A visiting professor of psychology “discovers” Ramírez and provides him with art supplies.

Thirty-two years after Ramírez was first institutionalized: The artist is released and, well, to read the rest of the story you’ll have to follow this link to an article at Artdaily.com.

To see 90 of the artist’s works, you can check out the Martín Ramírez exhibit on view from Jan. 23 through April 29 at The American Folk Art Museum in New York City.

If a trip to NYC isn’t your budget, you can at least see a sampling of drawings by Googling for Martín Ramírez images.

posted by Daniele Sadres

CMS Publishes Patients’ Rights Rules on Use of Restraints and Seclusion; An Expert Responds

After the Centers for Medicare & Medicaid Services recently issued new rules (to become effective Feb. 6, 2007) mandating more rigorous training of health care workers in the use of restraints and seclusion, we received a response from Linn Cohen-Cole, who is a nationally known expert and writer on restraint and seclusion, committed to ending their use. Among her published work is “Restraint and Seclusion: The Physiologic Catastrophe of Psychiatric Control and the Fallacy of a Psychiatric Science.” She has testified before the President’s New Freedom Commission on Mental Health and has consulted with the National Association of State Mental Health Program Directors and others on this issue.

More information about the new CMS rules is available at the following link: http://www.medicalnewsservice.com/fullstory.cfm?storyID=4281&fback=yes.

Cohen-Cole has agreed to allow her remarks to be posted. She writes:

“The improvements they suggest are Orwellian. They are training people in ‘proper’ abuse, in careful anti-human rights actions. They do not understand the fundamental principle that mammals (of any kind) can’t go through [seclusion and restraint] without massive physiologic consequences (and that is leaving off all of the massive psychological ones).

“They are also missing the point that mental health patients really do finally deserve to be full-fledged human beings as measured by their also having the full panoply of human rights (or at least a recognition that their rights are being violently violated) and should not be captive victims anymore of a field that is unbound by human rights or even standard law. . . .

“What does ‘freedom from the inappropriate use of all restraints and seclusion’ mean except to imply there is appropriate use? And where are there any legal avenues set up for these patients, whose freedom is bandied about as an empty word? Where is the slightest effort to establish the most basic of safeguards: due process? . . . How about actual freedom? How about laws to allow patients to reach a lawyer mid-restraint? These people do not even have habeas corpus rights, as a prisoner would.”

Responding to a written comment by Eric B. Broderick, D.D.S., M.P.H., acting deputy administrator of the Substance Abuse and Mental Health Services Administration that “Today we are taking needed steps to solidify training requirements and essential reporting to reduce and ultimately eliminate seclusion and restraints,” Cohen-Cole added, “They haven’t the first clue that elimination takes only saying, ‘This is wrong to its core and it’s over.’ ”

(See also the Hartford Courant’s coverage.)

posted by Susan Rogers

Eli Lilly Responds to NY Times

In the interests of balance, I feel it is necessary to provide the complete text of Eli Lilly’s response to The New York Times’ Dec. 17 article. http://biz.yahoo.com/prnews/061216/nysa019.html?.v=16

Then, today, Lilly issued a statement in response to the Times’ Dec. 18 piece, in which the Times quoted Lilly documents promoting off-label marketing to people who had neither schizophrenia nor bipolar disorder. Lilly’s response is a flat-out denial: “At Lilly, we do not engage in off-label promotion – as alleged in The Times article. Lilly is committed to the highest ethical standards and to promoting our medications only for approved uses.” http://www.upi.com/HealthBusiness/view.php?StoryID=20061218-011405-8077r

Meanwhile, Lilly’s 2005 annual report notes that it is facing an investigation by federal prosecutors in Pennsylvania and had been subpoenaed by the Florida attorney general’s office in regard to its Zyprexa marketing practices. Readers of this blog can review the Times articles and Lilly’s response and interpret the information for themselves.

One more thing: In 2004, Lilly issued a warning – mandated by the Food and Drug Administration – describing the heightened risk of hyperglycemia and diabetes in people taking Zyprexa and similar drugs.

posted by Susan Rogers

Eli Lilly Covers Up Zyprexa Risks, According to New York Times

Eli Lilly and Company, manufacturer of Zyprexa, its best-selling psychotropic medication, spent from 1995 to 2004 minimizing the drug’s side effects so as not to harm its sales, according to in-depth pieces in The New York Times on Dec. 17 and 18, 2006. Experts, including the American Diabetes Association, say that the drug – which causes weight gain and tends to elevate users’ blood sugar levels – is more likely to cause diabetes than other medications used to relieve the symptoms of psychosis. However, according to documents sent to the Times by Jim Gottstein of the Law Project for Psychiatric Rights (http://psychrights.org/index.htm), Lilly was more worried about its bottom line than about the well-being of those who were liable to receive Zyprexa prescriptions from doctors who were unaware of the risks.

In fact, the Times reports, in 1999 and 2000 Lilly was so avid about promoting Zyprexa sales that it encouraged off-label use, marketing it to primary care physicians as a treatment for dementia – a condition for which the drug has not been approved by the Food and Drug Administration (FDA). In fact, the FDA warns that Zyprexa boosts the risk of death in older adults who have psychosis related to dementia. Lilly also has attempted to market the drug for people diagnosed with mild bipolar disorder who had been previously diagnosed with depression, even though Zyprexa is meant to control the symptoms of mania, not depression.

In an effort to be balanced, I will add that Lilly’s response is that there is no proven link between diabetes and Zyprexa – which is far and away Lilly’s best-seller, with 2005 sales of $4.2 billion representing nearly a third of its entire revenues.

In 2005, Lilly agreed to shell out some $700 million to settle about 8,000 legal claims by Zyprexa users who said they had developed diabetes or other medical problems; thousands of additional cases are pending.

By now, I should be so jaded by reports of corporate malfeasance – Enron, et al. – that this story doesn’t shock me. I guess I’m not that jaded. I also want to congratulate Jim Gottstein on his great work!

Here are links to the Times stories:

“Eli Lilly Said to Play Down Risk of Top Pill”
“Drug Files Show Maker Promoted Unapproved Use”

posted by Susan Rogers

New ADA Toolkit

On December 5, 2006, the Civil Rights Division of the U.S. Department of Justice issued the first installment of a new technical assistance document designed to assist state and local officials to improve compliance with Title II of the Americans with Disabilities Act (ADA) in their programs, services, activities, and facilities. The new technical assistance document, which will be released in several installments over the next ten months, is entitled “The ADA Best Practices Tool Kit for State and Local Governments.”

The Tool Kit is designed to teach state and local government officials how to identify and fix problems that prevent people with disabilities from gaining equal access to state and local government programs, services, and activities. It will also teach state and local officials how to conduct accessibility surveys of their buildings and facilities to identify and remove architectural barriers to access.

Here's the Toolkit on the ADA's website. We'll probably also add the files to the Resources section of the Clearinghouse website.

Comic Book Heroes

I just read “Darkness Calls,” a comic book on suicide prevention, which the publisher calls “the story of the struggle between good and evil over the spirits of youth.”

The hero is Kyle, a talented teenaged artist who has one good friend but is tormented by bullies and a teacher, and is thinking about taking his own life. Kyle, an Aboriginal Canadian, attends an assembly where the speaker is a tribal elder, who is introduced as “know[ing] a lot about the ancient storytelling ways.” (His clueless teacher throws Kyle out of the assembly for drawing in his sketchbook.)

Later, the assembly speaker shows up at Kyle’s door and says, “I’m your grandfather.” When Kyle is understandably nonplussed by the appearance of a grandfather he’s never heard of (except earlier in the school gym), the man says, “Well, I’m your grandfather’s brother on your mom’s side.” Despite the conflicting stories (“No, wait, I’m your . . .”), Kyle, whose parents aren’t home, invites the old man in. (Our resident expert on teen suicide, Daniele Sadres, pointed out that it’s a little dicey to invite strangers in and that maybe this was not a good behavior to model. Daniele liked the book but also worried a little about the references to other kids’ suicides. Experts say that hearing or reading about suicide – real or fictional – can increase kids’ suicide risk, and describing methods, as “Darkness Calls” does, exacerbates the problem.)

The story concludes with a battle between Kyle and a towering creature with talons and a jaw full of enormous teeth. Kyle, who at first is having little luck keeping the creature at bay, is finally able to vanquish it by saying, “I don’t wanna die!” At this point, the elder says, “Just believe in yourself and you’ll be okay.” And that seems to be that. So my final caveat is, I think it’s a little more complicated. (Treatment might be one suggestion.) However, except for Art Spiegelman, R. Crumb and Chris Ware, I haven’t read any graphic novels in a long time and maybe the author is just trying to keep it simple.

The publisher is also putting out some comics drawn by teens themselves, on such topics as drug addiction, diabetes, what it’s like to have a family member with a mental illness, and the importance of being accountable for what you do – in this case, a hit-and-run.

The diabetes story is told by a diabetic crow, who seems to be a folk hero. It begins, “Hi, my name is Crow. You may know me from such stories as, ‘Crow Steals the Light’ and ‘Crow Releases the Tides.’ This is a picture of me with the light. This is a picture of me after I released the tides. This story is about my diabetes.” If that isn’t a great opening, what is?

For more information, contact the Healthy Aboriginal Network, http://thehealthyaboriginal.net, 328 East Thirty-Second Avenue, Vancouver, BC, V5V2Y4.

posted by Susan Rogers

NPR Reports on Soldiers' Care

Soldiers Say Army Ignores, Punishes Mental Anguish

All Things Considered reports on the Army's treatment of soldiers who seek mental health services. They discuss their perceptions of mental health problems, the serious barriers against getting help, and their experiences with the Army's mental health system. Their opinions vary greatly: Is Post-Traumatic Stress Disorder a legitimate concern? Are soldiers just looking for an easy way out of another tour in Iraq? You can read or listen to the story here; some additional material about mental health and the Army is offered as well.

posted by j melinn

Some Free Research

http://info.wlu.ca/~wwwpsych/gnelson/self-help.htm

Research on consumer/survivor initiatives isn't so easy to come by, especially not for free. Here are some journal articles, evaluation tools and a DVD all related to a study funded under a Community Mental Health Evaluation Initiative in Ontario.

posted by j melinn