On February 4, 2002, I became aware of the work of Dr. Sally Satel, a very prominent psychiatrist, lecturer, and conservative ideologue. I received a message on the ACTMAD mailing list from Joseph Rogers of the National Mental Health Consumers' Self-Help Clearinghouse stating that Dr. Satel had "managed to get President Bush's Budget to say that the Federal Center for Mental Health Services will not fund any new consumer/survivor efforts." Concerned and somewhat shocked, I contacted Dr. Satel and arranged a brief email interview. I reviewed her work quickly and sent her an email containing six questions:
(Dr. Satel's latest book PC, M.D.: How Political Correctness is Corrupting Medicine was available at my local library as were her recent articles)
EFHM: As you illustrate in PC, M.D. the consumer/survivor movement has many viewpoints represented. But do you believe the consumer movement as a whole attempts to make the argument that mental illness is caused by political oppression? And do you still believe, as was implied in the book, that consumers as a group believe that redistribution of wealth will be the answer to mental illness? Please describe your current thinking on these topics.
Dr. Satel: The consumer movement is diverse but the consumer-survivor-ex-patient movement seems to be predicated on the belief that the mental health profession either caused or exacerbated the illnesses of its members. I have no idea whether they believe redistribution of resources is the answer. Instead, control of mental health services seems more the goal of the most radical among them. (In PC, M.D., Chapter 2, I document my sources for these statements)
EFHM: Your disagreement with the consumer/survivor movement appears to be in its extremism more than anything else. Isn't it natural that in the dawning of political awareness the most active members of a group, in this case the millions of Americans with mental illness, will tend to be radical?
Dr. Satel: Yes, the most active members in most movements are typically the most extreme. In the case of the C-S-X movement that is precisely why they do not represent the most severely ill and debilitated. The latter are too psychotic and disorganized to be part of a political movement. They need to be protected and taken care of. The goals of the most radical C-S-X-ers -- antimedication, anti-involuntary care -- will prevent them from getting crucial help.
EFHM: My organization, Empowerment for Healthy Minds, has started teaching consumers computer skills free of charge with technical assistance from the National Mental Health Consumers' Self-Help Clearinghouse. The Clearinghouse does at times act on a political agenda--we ask it to forward our interests among decision makers at the highest levels. But in so many ways the Clearinghouse serves our community's educational and social needs. Must federal funding to the Clearinghouse and other consumer technical assistance centers be discontinued? Do you at this point support any federal funding of any consumer-run activities?
Dr. Satel: If localities want to use federal money for club-houses for the severely mentally ill, that is fine. No federal money should be going to any groups with a political agenda or to groups that themselves largely exist to lobby for more money. These funds should go mostly to direct care for the sickest.
EFHM: In your book PC, M.D. you associate the notion of mental illness as a transformative experience with ideas such as the rejection of psychiatric medication. Yet you don't critique transformation directly. What are the problems in viewing mental illness as a transformative experience?
Dr. Satel: Individuals who are ill will understand their conditions in myriad ways, some constructive some not. That is intensely personal. I am simply against third parties encouraging sick people to view their illness in ways that lead them to reject help and thus prolong their misery.
EFHM: At EFHM we emphasize personal responsibility, in the sense that we believe consumers need to be educated regarding the medicines they are prescribed and the treatment they undergo, assertive with their service providers, self-reliant, open about their conditions, responsible for getting the best help they can, and responsible for making wise personal decisions. How does our vision of personal responsibility mesh with yours?
Dr. Satel: That's fine. Pursue that with private money, though. Federal dollars should be going for direct care.
EFHM: Do you know of anyone among the psychiatric practitioners who'd like to present the argument to the consumer community that mental illness has some biological determinants?
Dr. Satel: Not sure what you mean. Of course certain illnesses, like schizophrenia and bipolar, have biological determinants.
EFHM: Wouldn't such an outreach result in greater consumer compliance?
Dr. Satel: Not necessarily. It might be useful for families but C-S-X-ers, in my experience, prefer to see themselves as sick because of what has "been done to them."
EFHM: What are your views regarding dialogue-building between the consumer and service provider communities?
Dr. Satel: It's already going on. Perfectly fine for professionals to elicit advice on how to make the system better.
EFHM: Thank you, Dr. Satel.
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