University of Copenhagen researchers led a nationwide study in Denmark comparing individuals who died from suicide to matched controls between the years 1996 and 2009. Essentially, the researchers found that increasing levels of psychiatric care are associated with “a severely increased risk of dying.” They concluded, “The public health significance of this finding may be considerable.” You would think the press and public would be outraged. The study was totally ignored.
The researchers found that taking psychiatric medications during the previous year made a person 5.8 times more likely to have killed themselves. If a person had made contact with a psychiatric outpatient clinic, they were 8.2 times more likely to have killed themselves. Visiting a psychiatric emergency room was linked to a 27.9 times greater likelihood of committing suicide. And if someone had actually been admitted to a psychiatric hospital, they were 44.3 times more likely to have committed suicide within the year.
“Mom, won’t you tell the world how we’re treated?” This was Luise’s last request to her mother, Dorrit Cato Christensen. She wanted her to describe the treatment she had received in the Danish mental health care system. With this book Dorrit fulfills her daughter’s wish.
What follows is a heartrending account of a life in our psychiatric care system, a life cut tragically short – the same fate suffered by many vulnerable people being treated for mental health problems. Every year more at-risk psychiatric patients end up like Luise – we know that this population’s lifespan averages 15 to 20 years less than others in their age group. This is a clear sign that we have to change the way we treat psychiatric patients.
We must improve conditions by offering quality time, attentiveness, compassion, evenhandedness and respect to every patient, so we can design the best treatment solution for each person. We need to talk openly about mental health issues and strengthen our networks of patients, families and friends. To this end I have set up a virtual meeting place, the website Psykisksaarbar.dk, now consulted by a growing population in Denmark. In 2009 I took the initiative to found an association called Det Sociale Netværk af 2009 (The Social Network of 2009), bringing together a wide range of national voluntary mental health organizations in a joint effort to improve conditions in Denmark for the mentally ill and their relatives. The organization of which Dorrit Cato Christensen is president, Død i Psykiatrien (Death in Psychiatric Treatment), is now part of our network.
I come in contact with many people who have been, or currently are, admitted to a psychiatric ward. Most have inside experience of various facilities and all agree that there are significant differences in approach from one institution to the next. A young girl said to me: “As soon as you set foot in the ward you know what kind of hospital stay you’re in for. Whether the mind-set is caring and responsive, or whether the place is ruled by coercion, constant evaluation and a staff that ignores you.”
We should not, in all conscience, allow sub-standard treatment in a country like Denmark, yet it happens all the time. I have often heard patients say: “You must be strong to be psychologically vulnerable.” When studies show that psychiatric caregivers harbor more negative expectations and prejudices about the mentally vulnerable than the general population, it means there is a problem inherent in our mental health care system. This is exacerbated by a dreadful lack of resources in psychiatric treatment wards.
The most important thing to remember is that first and foremost we are all human beings. We must not forget this for one second, before any incapacity or vulnerability is analyzed, defined and written down. This is why it is so important to see behind the facade of a diagnosis. A diagnosis is like an overcoat – the real person is found underneath it. This is one part of her daughter’s life story that Dorrit describes so movingly for us – her personhood, her humor, her compassion and her zest for life.
When I meet people who support The Social Network, who form networks on our website Psykisksårbar.dk, or participate in our regular Sunday get-togethers, it strikes me how similar we humans really are and how much we have in common. There is basically no real difference between you and me and a person who happens to have been given a psychiatric diagnosis. It is not a question of these people being completely different, but more that sometimes they may experience so much inner noise that they are thrown off-balance and become vulnerable.
The most important thing we can do for psychiatric patients is not to keep them isolated. Loneliness is their worst enemy. And it is crucial that we nurture hope, that we hope and believe we can find the best in each other, and that we make room for the individual. Hope is the vital life-giving elixir for the soul, mind and body – to be able to sense that the people around you believe in you, that you are valued, that you are needed. We become whole when others believe in us. And we’re most likely to find this when we feel the solidarity of good fellowship.
I would like to thank Dorrit Cato Christensen for her work with mental health patients and their families and friends, and for the very important work she is doing as president of the association Død i Psykiatrien. Her book is a poignant contribution to the debate, in which she openly and candidly tells the story of her daughter’s sad fate and gives us a glimpse of our mental health care system groping for the right treatment. Luise’s hospital records show that she told her caregivers she felt she could not tolerate the drug treatment they prescribed and wanted them to phase it out. But instead of less medication, she got more. This turned out to be fatal.
Many patients and relatives will already be familiar with the situations and events Dorrit portrays here. Many will see their own lives reflected in this story and perhaps even find the energy to fight for a dignified life. I also hope that mental health practitioners will read the book, then stop and think carefully about how they can deepen their professional skills through respect for the individual. We can be certain of one thing – pills are not and never will be enough. We must constantly listen to our patients and think carefully about whether we are giving the right medicine to the right person. The “medicine” that always works for the psychologically vulnerable is to approach them with compassion, nurturing, trust and calmness.
Poul Nyrup Rasmussen
Danish Prime Minister 1993-2001
Member of European Parliament 2004-2009
Read more about Poul Nyrup
Estranged from his parents at an early age, Hammond made up for the loss by exerting his sense of adventure, coupled with an uncanny ability to socialize positively with just about everyone he met. Consequently, where others might have faltered, he moved from scene to scene – first on the West Coast, later in Europe and Morocco – almost magically protected by his innate bonhomie and easygoing lifestyle, while having extraordinary and often hilarious adventures.
We first met in San Francisco in the late 1960s when the Haight-Ashbury was the Mecca of the American youth diaspora; draft dodgers were leaving for Europe, and particularly England. Though Hammond was clever enough to dodge the draft without having to emigrate, the cost of freedom had become too expensive, and he split the US with his wife Wendy and headed east. As Hammond and Wendy passed through London we met again, this time in the squats of Prince of Wales Road, a half-derelict inner-city zone where all you needed to steal a house was a jimmy and a lookout.
All sorts of happenings and counterculture events were flowing in a continuous stream. The underground press, arts labs, psychedelic nightclubs and sheer exuberant street life, coupled with the international exchange of ideas and experiences, made the cities of Western Europe a cultural melting pot. For a life-artist like Hammond this was evidently more than just fun.
Adept at writing, staging spontaneous events and ingesting neuroactive substances, Hammond swam through the culture like a salmon in familiar ocean currents. He could have become a well-known poet or a masterly oil painter, a filmmaker or a travel guide. But the thing about generalists is you never know where they are going to pop up next. And through the whole of AsEverWas runs his laidback delivery, serious yet very funny, with an old-world politeness reminiscent of Alistair Cooke’s Letters from America (and unlike Mr. Cooke, Hammond doesn’t suffer from the impediment of a hungry ego).
The dramatis personae of AsEverWas include many figures, both well known and little known, too numerous to name. But to pick a few at random from a cast of hundreds, look out for poet Allen Ginsberg, author William Burroughs, singers Nico and Carmen McRae, streetwise Hube ‘The Cube’ Leslie, musician Pete Townshend, Digger Emmett Grogan, and TV presenter Kenneth Allsop. Or the cameos of actor Del Close, an unreformed happenings artist (who later wrecked my own piano in a Notting Hill church hall, but that’s for another time). Then there are the funny episodes. I can’t even remember laughing so much as I did at the surreal absurdity and nail-biting suspense of Hammond’s Moroccan adventure.
One other thing, this is a true story, all of it. And the fact that it stops at 1976 can mean only one thing: watch out for the sequel folks. Hammond has returned to his artistic root and he’s riding high.
John ‘Hoppy’ Hopkins, London, 2002
Page one, chapter one, Mirrors of the Mind:
The protagonist in the 1999 fantasy film Being John Malkovich is Craig Schwartz, an out-of-work puppeteer. One day Craig discovers a hidden doorway behind some cabinets in an office building where he has landed a temporary job as a filing clerk. Intrigued, he crawls into what seems to be a damp tunnel. Suddenly the entry door slams shut behind him and Craig is hurtled through a space-time vortex that thrusts him into the mind of the film’s namesake, actor John Malkovich.
Later, back in the office, Craig tells the story of his amazing experience to his coworker, the opportunistic Maxine. She speculates that other people might be willing to pony up for a brief sojourn in a famous person’s head. They place a newspaper ad and soon people are lining up at the portal after work hours with cash in hand. Delivered through the tunnel, the mind travelers delight in experiencing the world through the eyes of a celebrity, even if he is engaged in such mundane activities as ordering towels over the phone, rehearsing lines for a play or flagging down a taxi.
These mind trips are short-lived. The eavesdroppers are again sent flying through the vortex only to come tumbling down into a ditch beside the New Jersey turnpike just outside the Holland Tunnel. Craig retrieves the dazed travelers and guides them back home. These mind ventures seem to have an effect like travel to a foreign country. The sojourners not only have a vicarious experience of another person’s life, they also gain new insights into the existence from which they were temporarily extracted.
Summing up the experience, Craig exclaims to Maxine: “I don’t think I can go on living my life as I have lived it.” For him, the journey “raises all sorts of philosophical questions about the nature of self, about the existence of the soul.”
What we might call the Malkovichian transformation is an exaggeration, or perhaps even a parody, of what can occur when we read a work of fiction, watch a play, study a painted or photographed portrait, or participate in other acts of the imagination. We are released from our current preoccupations and drawn into the life and times of other human beings. We may feel the guilt of Dostoevsky’s Raskolnikov, the sorrow of Shakespeare’s Ophelia, the joy of the figures in Matisse’s painting, The Dance. Characters and scenes stay with us as if etched in memory and come back to us, unexpectedly, in times of struggle or triumph or boredom.
Though it is not quite like reading a novel or looking at a painting, delving into the autobiographical works of individuals who have made the life of the mind their central preoccupation – certain highly influential philosophers – can produce something along the lines of the Malkovichian transformation, triggering for us, as it did for Craig Schwartz, important questions about “the nature of the self, existence of the soul.”
When Jorvik Press author Ron Manheimer retired in 2009 as founding director of the North Carolina Center for Creative Retirement, he thought he knew how to leap into the next chapter of life.
Heading up this lifelong learning, leadership and community service program at the University of North Carolina, Asheville, he had led countless weekend workshops for hundreds of people considering their next chapters.
He formulated his approach as Ten Keys to a Creative Retirement. One of the keys, “adaptive reuse,” advised pre-retirees to reflect on how they might extend their accumulated talents, knowledge and interests, and project them into new yet related activities. Ron borrows the term from the field of architecture where it refers to restoring an old building to house new functions, like turning an empty warehouse into an art museum or an outdated fire station into a restaurant.
As an example, Ron points to a former banker with a love of classical music who became the treasurer of the non-profit board of a civic orchestra.
But instead of following his own best repurposing advice, Ron headed elsewhere. “For a truly creative retirement, I decided I should try to come up with activities that would be unprecedented for me,” he says.
Not much of a gym guy, he found a personal trainer, developed an exercise program, lost 25 pounds and took up hiking. Apprehensive about death, he became a hospice home visitor. A longtime grant seeker, he joined the board of a foundation that funds other people’s projects.
“I loved these new ventures but then I started running out of inspiration,” he says. “I still had lots of time on my hands and, though I was beginning to feel anxious, I didn’t want to fill up my time just to keep busy.”
Ron went back to his keys to a creative retirement and took another look at adaptive reuse. “I thought, how can I extend the things I’ve done for many years and make them fresh again?”
An author of several books and a raft of scholarly and popular articles, he came across a deferred book project. “Clearing out some old computer files, I discovered the chapters I had put aside. Work and family demands had halted any progress on the book several years earlier.
“But I felt the spark of intellectual excitement still alive in those pages. It was about how philosophers portray their own life experiences and realize their most noteworthy ideas.
“I loved tracing how thinkers who have had such an important impact on world history described their own life-changing experiences. What if I could put myself into the mind of a Jean-Jacques Rousseau, a Simone de Beauvoir, or someone I admired as both philosopher and social activist, Mahatma Gandhi? Where could that take me and take my readers? Maybe I could hitch my midlife transition to their self-transformation.”
Find out for yourself how the project turned out. Buy Mirrors of the Mind here, or order it from your favorite bookstore.
Ron Manheimer lives in Asheville, NC and is available to talk about his new book and the creative retirement process that led him to write it.
“For the first time ever the Danish mental health system has been found guilty of causing the death of one of its patients,’ writes Dorrit Cato Christensen, author of Dear Luise. “This is important news. One hopes that far more psychiatric healthcare providers will be found guilty of causing death with their dangerous treatment. The psychiatric ward where this patient was treated I know very well. My daughter Luise died there from overmedication.
“After the verdict the Clinic Manager claimed that they have learned from the sad story so treatment will be safer, with less medication. I don’t believe them at all,” says Dorrit. “They said exactly the same eight years ago when my beloved Luise died in their care. In our organization Death in Psychiatric Care we see how bad psychiatric treatment really is. People contact us constantly to tell us how a beloved relative who sought psychiatric help suddenly ends up as a dangerously ill zombie. Many report that a relative has died from overmedication.”
Translation of a January 9, 2014 article in Politiken, a leading Copenhagen-based daily newspaper, covering the ruling on Adel’s suicide:
Psychiatric Hospital in Amager harshly criticized for overmedicating 26-year-old man. Clinical Manager claims that incidents involving medicine in large doses have led to ‘cultural change’ in psychiatric treatment.
By HANS DRACHMANN
A 26 -year-old psychiatric patient who committed suicide by throwing himself in front of a subway train in June 2011 had been so heavily medicated at the Psychiatric Center in Amager that the side effects were ‘unbearable.’
After two years of deliberations, the Patient Safety Commission has severely criticized the psychiatric hospital for providing treatment to the patient, Adel Saidane, which ‘did not meet generally accepted professional standards.’
‘My older brother suffered so many side effects that were so unbearable that any human being might commit suicide in that situation.’ said the patient’s brother, Hafed Amin Saidane , who brought the case before the Patient Safety Commission.
The report criticized the Psychiatric Center on five specific points. The 26-year-old was overdosed with medication. The doctors did not given any reason for the high doses, as they should have. They failed to take proper care of the patient and were not sufficiently focused on side effects. The hospital ward should have provided Adel Saidane with an individual caretaker so he could not leave the center unaccompanied.
‘All our complaints have been upheld. We were in no doubt that he committed suicide because of the medication’s side effects,’ says Hafed Saidane.
His brother was bipolar but had not been hospitalized for two and a half years. Then in May 2011 he felt distressed and checked himself into the hospital. Over the next four weeks he was treated with several antipsychotics combined with sedatives in amounts that, in his brother’s words, changed him from a vigorous 26-year-old to looking like ‘a 90-year-old patient in a hospice.’
At Copenhagen Metro Mental Health Services they’re deeply apologetic over the incident. ‘I take this very personally. We are so sorry and my heart goes out to the relatives. It’s a terrible thing and I feel awful about it,’ says Inger Merete Terp, Clinical Manager at Amager Psychiatric Center.
The case is an example of the wide-ranging practice of overmedicating psychiatric patients, which was prevalent in the Copenhagen area until mid-2012, when Politiken began covering the situation.
Overmedication, among other things, led to the dismissal of a Clinical Manager in Glostrup and a reprimand to a deputy director of Copenhagen Metro Mental Health, prompting the adoption of an action plan mandating close monitoring of medication to prevent overdoses.
Subsequently the proportion of patients treated with heavy doses of the antipsychotic Zyprexa was reduced from almost 25 percent to about 5 percent.
‘I think we’ve got a good grip on it and we’ve now ensured that action can be taken on the same day if any mental health center starts prescribing excessive doses,’ says Svend Hartling , vice president of Metro Mental Health.
He describes the Amager incident as ‘highly irregular’ and will now ask the executive board of Metro Mental Health whether enough has been done to prevent this from happening again.
The Patient Safety Commission’s report is also being sent to the National Board of Health and to chief medical officers in Copenhagen, who will address the issues at a meeting next week.
‘We are discussing whether there should be consequences, so other patients are not put at risk,’ said National Health Board oversight manager Anne Mette Dons. She is generally satisfied that the Metro region has taken effective action against overmedication. ‘There really a has been a paradigm shift.’
Clinic Manager Inger Merete Terp says that the overmedication case has resulted in a ‘culture change.’
‘We need to focus not only on medication but also on patients’ daily lives. We must look at patients’ daily life, see that they can wash dishes or take a walk and do things that contribute to quality of life,’ she says.
The Commission’s ruling will now be taken up with doctors at Amager Psychiatric Center and with other mental health center managers in the Metro Area.