Deinstitutionalization didn’t happen, it just shifted locations, journalist argues

Written By Keith Norbury

Book Review

Your Consent Is Not Required, The Rise in Psychiatric Detentions, Forced Treatment, And Abusive Guardianships
By Rob Wipond

Just as B.C.’s lawmakers are pondering involuntary mental health treatments, along comes a book by Victoria journalist Rob Wipond that argues strongly against the idea.

In Your Consent Is Not Required, Wipond presents the case that more people in Canada and the U.S. are now being involuntarily committed than ever before. 

Along the way, the book exposes myths about mental illness, such as the now discredited notion that schizophrenia is caused by chemical imbalances in the brain. Moreover, Wipond argues, the drugs used to treat those conditions often fail to work or have deleterious effects and lead to addiction.

Although, he does allow that biochemical phenomena does happen during “unusual or intense mental experiences — it’s just that what happens is complex, difficult to discern, widely varying, and usually proves nothing about cause and effect or disorder versus natural response.” 

Wipond’s many horror stories about survivors of the mental health system are enough to make a person wonder why anyone would ever seek psychiatric help.

Beware of wellness checks

“Wellness checks are by far the single largest funnel into psychiatric detentions,” Wipond writes. 

None of the cases he presents are of people who’ve received successful forced treatment for mental illness. He found some who said they were glad they were detained but when he delved deeper into their stories, he concluded they were treated well and were rarely forcibly confined for long.

“The fact that they regularly administer forced treatment naturally biases many psychiatric professionals toward feeling and hoping it’s helping.”

Rob Wipond

Research on the “Thank-You Theory” is scant. However, he does cite a Duke University study that found only 28 per cent of patients receiving forced treatment felt they’d benefited.

“The fact that they regularly administer forced treatment naturally biases many psychiatric professionals toward feeling and hoping it’s helping—a kind of placebo effect on the medical staff themselves,” Wipond writes.

Hearing voices OK, just don’t do what they say

An underlying theme of the book is that much of what is considered mental illness is just eccentricity — folks marching to a different drumbeat, although he doesn’t use that turn of phrase. It’s fine for people to hear voices or even have suicidal thoughts, he writes, so long as they don’t act on them.

Simply asking for help will likely result in your involuntary commitment, and make your life worse, forms the subtext of many of the stories he relates.

“Ultimately, family conflicts form another major funnel into psychiatric detentions and forced treatment,” he writes.

Wipond himself first became immersed in this world after his father was diagnosed with “major depression with psychotic features.” 

“Family conflicts form another major funnel into psychiatric detentions and forced treatment.”

Rob Wipond

The drugs his father received made his condition worse, he wrote. It worsened further after electroconvulsive therapy, which initially caused a brief improvement but ultimately left him with huge memory gaps. His father had feebly objected to the ECT but the psychiatrist had swayed Wipond’s mother and brother to consent. 

Not long after his father’s experiences, Wipond started interviewing other people who recounted their own unpleasant brushes with coercive and forced psychiatric treatment. They weren’t the clichéd chronically insane and dangerous as often characterized. Most were like his father and lived largely ordinary lives.

Even good intentions can make illness worse

While Wipond doesn’t use the word “normal,” he makes the case that symptoms of mental illness look like just the usual crap that happens to everyone now and then. 

“In truth, American psychiatry’s own diagnostic manual shows that there are no consensus-based, scientifically testable, known biological aspects to most mental disorders,” Wipond writes, establishing firm footing on that point. 

But that doesn’t mean mental illnesses aren’t real. 

Things are happening that are causing not only great pain and discomfort for those experiencing mental illness but also for those around them, who can see their loved ones descend into the thrall of a mysterious and debilitating illness and desperate for help.

Wipond’s book does a great service by illustrating how even well-intentioned treatment efforts can make mental illness worse. Where the author veers off course is when he conflates such illnesses with the vagaries of healthy minds (or brains).

“Characterizing bouts of ‘madness’ as in any potentially valuable, natural, healing, or transformative is anathema to biological psychiatry,” Wipond writes.

Every story needs a villain

Every story needs a villain and this book’s is E. Fuller Torrey, whom Wipond describes a “prominent pro-force psychiatrist.” Chiefly, Torrey’s widely cited numbers about the steep drop in state psychiatric hospital beds since the 1950s “aren’t technically incorrect— but they disguise the truth,” Wipond writes. 

However, in his effort to nail down the numbers, Wipond also displays willful blindness. 

For instance, he cites a 2017 report from the NRI research arm of the US National Association of State Mental Program Directors. On his website, Wipond provides annotated links to his source material, including that report.

A graph in the NRI report reveals how state psychiatric hospital bed numbers declined sharply — from 369,969 in 1970 to 39,907 in 2014 — supporting Torrey’s technically correct claim that psychiatric commitments dropped following deinstitutionalization. 

According to Wipond, Torrey neglects to mention the number of patients in private psychiatric beds increased about two-and-half times, while residential treatment beds tripled. The trouble is Wipond didn’t present those figures in the aggregate. 

The total numbers for psychiatric inpatient and residential care dropped from 471,451 in 1970 to 170,200 in 2014. Significantly, patients in psychiatric inpatient and residential care declined from 236.8 patients per 100,000 population to 54 patients in beds per 100,000 population. Wipond does cite the 54 patients per 100,000 figure to bolster his case about Torrey fudging the numbers but fails to note the much higher rate in 1970.

Riverview report disputed

From there, Wipond argues that the figures in that NRI report don’t capture many other people now receiving psychiatric treatment in other settings, such as hospital emergency rooms, jails, prisons, and groups homes “large and small.”

By his rough tally, the number today exceeds 600 or 700 per 100,000 in psychiatric beds, “several times the per capita number of beds in the 1950s.” That includes smaller facilities, which he says are less regulated.

For example, he cites a report that tracked 189 people who were discharged from Riverview, B.C.’s largest asylum, between 2001 and 2004, most of whom “had been moved into these smaller, coercive, long-term institutions.” 

However, the cited report doesn’t describe those “smaller” institutions, which provided most of those former Riverview patients with 24-hour care, as “coercive.” 


The Long walk: Front entrance to the now closed Riverview Mental Hospital in Coquitlam, B.C. [Photo Fran Yanor]

Rather, as the report’s abstract notes, “Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.”

Nevertheless, Wipond cites that report to back his assertion that “psychiatric ‘deinstitutionalization’ not only didn’t ‘fail’— it never really happened.” 

“Psychiatric ‘deinstitutionalization’ not only didn’t ‘fail’— it never really happened.” 

National Association of State Mental Health Program Directors

His book doesn’t just slam large insane asylums, it slams just about any kind of psychiatric institutional care, of any size, whether voluntary or involuntary.

“Many people I spoke with said they’d indeed been unwilling ‘voluntary’ patients,” Wipond writes.

The biggest data set he references confirms his observation of diagnostic inflating of mental illness. 

“According to the most recent lifetime-prevalence rates from 2005, more than half of Americans at some point have a diagnosable mental disorder,” he writes. Those numbers are rising, to 60 or 70 per cent or more, Wipond estimates.

Harrowing tales in the world of psychiatry

Even if policy makers will take Wipond’s statistical interpretations with a dose of salt, he presents a lot of compelling evidence that things are terribly amiss in the world of psychiatry. And, really, for a book bursting with statistics, it’s a breezy read. 

Wipond sprinkles numbers like so much seasoning into the personal stories that form much of the backbone of the narrative. Those stories range from ones of intrigue, like the family of an 82-year-old who hid her from the authorities, to the poetically sad, such as of a mother who would just wander off “and be difficult to find.”

Among the experts Wipond interviewed was Maureen Clark, who is completing a PhD on civil commitment and teaches at Westfield State University. Wipond reports that America has a “veritable army” of more than 650,000 social workers, whom Clark said are “employed in many institutions where the function is more as an agent of social control than as an agent of social change.” 

“A diagnostic label … makes people more vulnerable to forced hospitalizing forever after.”

Rob Wipond

Continuing that line of reasoning, Wipond states that “a diagnostic label also starts a documented psychiatric history that becomes widely accessible in social service systems and makes people more vulnerable to forced hospitalizing forever after,” which he follows with this quote from Clark: “If you started a fire at any point in your life, you’re always potentially going to start a fire.”

That was just one of many jarring examples in the book. Leaving aside the possibility that Clark is referring to a Boy Scout igniting a campfire, is a penchant for starting fires not worrisome?

Then again, it’s easy to see how someone being evaluated by a mental health professional can waltz into a Catch 22 situation. “If you’re too vocal, if you’re not vocal enough, if you cry, if you don’t cry, if you say you’re getting lawyers, if you ask to read the paperwork too much—any of it confirms your mental health diagnosis,” Wipond quotes Clark.

Talk of stigma is ‘Sanist bigotry’

Another of Wipond’s sources is Jennifer Poole, a social work and “Mad Studies” professor in Toronto “who identifies as mad.”

Poole’s biography on the University of Toronto website says she “is interested in sanism, oppression and critical approaches to ‘mental/health’ and madness; critical theory and methodologies including discourse analysis; pedagogies that push back on settler colonialism as well as grief and death.”

Wipond himself picks up on that sanism theme, writing that “public talk about the ‘stigma’ of mental disorders puts a genteel face on what’s more accurately described as widespread, entrenched, sanist bigotry.”

“The odds of getting killed by someone with schizophrenia are barely higher than … getting struck by lightning.” 

Rob Wipond

Wipond also points out that “the odds of getting killed by someone with schizophrenia are still barely higher than the odds of getting struck by lightning.” 

The same could be said about homicides generally. That people fret so much about such statistical improbabilities is because of a cognitive bias that psychologists call the availability heuristic

It doesn’t mean people shouldn’t be concerned. B.C. news was recently aflutter with questions about why a man who, while in a psychotic episode years earlier had killed his daughter, was recently granted an unescorted pass and is now accused of stabbing three people in Vancouver’s Chinatown.

Concerns about connections between Pharma and psychiatry

The book isn’t entirely about psychiatric villainy. 

Wipond points to Loren Mosher, who while chief of the Center for Studies of Schizophrenia at the National Institutes of Mental Health in the 1970s, “openly expressed his concerns about psychiatry’s increasingly cozy relationship with the pharmaceutical industry and intensifying fixation on biological treatments.”

With NIMH funding, Mosher launched his own pilot, Solteria House, “a home in California where people were diverted from the psychiatric hospital to live in a collaborative, non-coercive, supportive environment.” 

Despite its success, Mosher, who died in 2004, “was forever after ‘marginalized’ from mainstream psychiatry,” writes Wipond.

Trauma-informed approach needed, says author

Wipond advocates a “trauma informed” perspective that would include peer support from people who have previously been patients in psychiatric hospitals. Even having “better food than typical hospital slop,” more exercise, outdoor activities and “passably warm and friendly” staff “would’ve revolutionized their experience,” he writes.

What Wipond makes most obvious is that modern psychiatry has a tendency to pathologize just about every tic of human behaviour. What the book doesn’t explore are the qualitative differences among those tics. 

If you’re hearing a disembodied voice, it’s one thing if the voice is Jordan Peterson ordering you to clean your room, and quite another if it’s God directing you to kill your daughter.

Most worrisome is that not even the most experienced mental health professionals, or even the most dedicated journalists and activists, can easily tell the difference between a pathology and a tic. 

If policy makers can read Wipond’s book from that perspective, perhaps it can inspire them to work out ways to improve the lives of people with mental illnesses and those who love them. It just won’t be easy.