"(Involuntary Commitment) is Near and Dear to Powerful Institutions"
Psychiatrist Josef Witt-Doerring interviewed me--and shared his own experiences witnessing the harms of involuntary commitment
I first met Josef Witt-Doerring at a conference when he was still completing his university residency in psychiatry. He told me about discovering Robert Whitaker’s Anatomy of an Epidemic—on the verge of beginning his professional career as a psychiatrist, Witt-Doerring was unsettled by the book’s revelations.
Whitaker reviewed all of the scientific studies of long-term use of psychiatric drugs, and described how they showed generally poor outcomes—people who never took or eventually tapered off the medications seemed to fare better on quality-of-life indicators than people who stayed on the drugs for many years. These findings held even when adjusting for other possible confounding factors, such as severity of diagnosis.
Witt-Doerring told me that the findings went against his education and training—indeed, he said, most of those long-term studies, let alone Whitaker’s book, were not even included as part of his formal university education as a psychiatrist.
I appreciated his willingness to talk with me honestly, frankly, and respectfully, on both issues about which we agreed or disagreed. We kept in touch, and some years into his career as a psychiatrist, Witt-Doerring gave me an interview for Your Consent Is Not Required about his experiences in university and psychiatric residency, and then working in emergency departments and psychiatric wards. At that time, wary of the potential backlash for his career of speaking somewhat critically about involuntary commitment and psychiatric medications, he requested anonymity.
But those days are gone—Witt-Doerring decided to specialize in helping people taper safely off psychiatric medications, and he has been building an increasingly high-profile public presence through that work (not many psychiatrists openly offer tapering support) and by interviewing a wide range of people with different views of psychiatric issues.
Recently, he interviewed me, and within two weeks of release it’s already the most widely viewed talk I’ve ever done. Watch it here. And the comments below it on YouTube, already in the hundreds, are a shocking and all-too-real collection of testimonies to the havoc and pain involuntary commitment wreaks in many people’s lives—for themselves or for those they care about.
After listening to the discussion again myself, I found many aspects of it worthy of note. I still do most of the talking, but Witt-Doerring frequently brings in many of his own experiences and views from working in situations implementing—and witnessing colleagues implement—involuntary commitment and forced treatment. As a result, it’s all the more interesting, and in some respects all the more disturbing, to see where common ground between us emerges, where our perspectives strongly align, and where Witt-Doerring gives commentaries about involuntary commitment that are as critical as any in my own talks and writings.
For example, Witt-Doerring agrees with me that what actually happens in a typical psychiatric ward is often “not what people expect,” and describes the reality in terms as grim and harsh as I often use—the lack of non-drug options available in hospitals, the unsupportive atmosphere, brain damage caused by antipsychotics, and cognitive impairment caused by electroconvulsive shock therapy.
Witt-Doerring bluntly describes how involuntary commitment is often employed because it’s simply an “easy” way to take action and “shuttle someone along”—as compared to taking the time to really understand a person’s situation and collaborate with them on solving problems. He himself felt such tension and pressure — sometimes seeing clearly that what a particular patient really needed, for example, was someone to play a mediating role in helping deal with the manager of their school or group home. But then Witt-Doerring would look at “the line-up of patients” and just not feel able to take that time.
Continuing in this topic area, discussing the rising uses of mental health law powers in the management of schools, long-term care facilities, and group homes, Witt-Doerring says that hospitals have effectively become a “dumping ground for difficult people.” Meanwhile, psychiatrists are expected to use drugs to help make those people “so docile they can fit the mold” of what others around them want them to be and act like. He suggests many psychiatrists are often readily able to see when a patient actually has a “social” problem of this kind, yet will nevertheless reframe it as a “mental illness” issue for billing purposes.
We also discuss how, when news stories, politicians, or practitioners are justifying the “need” for involuntary commitment, they often describe especially “extreme” cases of people, say, enacting gruesome violence upon themselves. Yet Witt-Doerring says that, in fact, it’s not uncommon for medical staff to “give up on” trying to help some of these most seriously troubled patients—and will instead put them on a secret hospital “do not admit” list.
Conversely, Witt-Doerring describes the types of situations where he feels he’s seen involuntary commitment actually help people — and that leads to a discussion about the different ways in which commitment can play out in different situations, and what makes it more or less likely that some people may later feel it helped them in some way as opposed to feeling traumatized by it for the rest of their lives.
After I remark on how the mainstream mental health system’s educational and promotional activities never caution that their recommendations to “seek professional help” can bring risks of involuntary commitment and forced treatment, Witt-Doerring comments that such warnings aren’t provided because “it would be to openly acknowledge that the current system is quite dangerous and quite cruel.” He then discusses how psychiatry as an institution and its leaders are focused more on protecting psychiatry’s image and reputation than on being honest about some of the serious harms psychiatric treatments can cause—and he describes this as “an absolute betrayal of what the mission of medicine is.”
Let me know what you think!
Who Decides If You Are "Crazy" Enough To Be Locked Up? — A discussion between Dr. Josef Witt-Doerring and Rob Wipond
This was a really great, as well as distressing, interview- I would really love more psychiatrists to recognise that as long as they don’t speak out lives are being destroyed. It is only because the population they “treat” is so systematically silenced that this is enabled to continue behind closed doors. I appreciated how you kept the focus on rights and challenging the usual narratives.
I tried to watch the interview on youtube and it was full of adds, so I fell asleep, and when I woke up it was merely the interviewer?, psychiatrist just talking.
Nevertheless I came with a few impressions: first, those folks really are not suited to be physicians, they lack common sense and ability to do self study to guide them in the care they will be providing. Hence, it takes them, at best, years or decades to realize they were wrong, if at all.
Second, they pretend to present a milder alternative to care as usual, but they still hold the cherished beliefs mental disorders are real, when they are not, and on that, although impressionistic I saw more, in some contexts, of deceptive behavior, admitting top of my head I cannot point where specifically.
They display a lack of reasoning ability quite evident when the psychiatrist forgot what you asked, way at the beginning, when it was memorable and clear enough. In some contexts, such is a display of deceptive behavior: trying to set the script correct, hence requiring conscious effort to lie “correctly”.
In such contexts, there are others of course, involving precisely mental disorders and disabilities even if temporary, I would not trust whatever that guy says: he behaves deceptively, in some contexts, I need to clarify again.
Also, fear, anxiety and the need to show off, specially when facing “competent opposition” are valid, and relevant considerations, perhaps even correct.
Third, they are unable to see, as old physicians did from my personal and anecdotal experience, the severe side effects, lack of efficacy and worsening of some psychiatric treatments, evident in taking years to “see the light” so to say.
When I was a medical student, up to 1993-1996, around, surgeons could see benzodiazepines were worse for treating anxiety. We knew in México back then, opioids, even if for a few days led to addiction and dependence, hence they were rarely used, outside anesthesia practices, and probably private practices, I did my training in public hospitals.
Those physicians could see clearly in their patients, my guess both private and public, a lot of harm by some treatments, specially psychiatric. Before there was published evidence of its harms, hence they avoided them.
But, somehow, for the top psychiatrists, apparently, experience is worthless: they need some authoritative figure or newspaper headline to see what they do is wrong, and sometimes criminal.
As an example: I saw and read several articles arguing about covert medication as a medical ethics issue, well, no, in México, it is forbidden to give people psychotropics without authorization, it is a violation of the Federal Penal Code, and my guess, several State Penal Codes.
It is also a violation of the regulations regarding who picks which psychotropic at which drug store: the patient needs to go personally with an official ID and a prescription in his name to pick those up. No one else can pick those up, specially without the official ID.
And yet, those ignoramuses, proceed, as clinical psychologists, as if their practice somehow was absconded from Law, and merely guided by Ethical Codes, which sometimes are against the Law, as in the case of mandatory reporting of all crimes they are aware of: familial, psychological, and physiclal violence.
And yet, they do not disclose such to their patients or clients, and claim, erroneously whatever one tells them will be private, when law, at least in México, and I think France, obligates them to report it: all crimes, specially those which can be best or only be detected by professionals in so called “mental health”.
Professional secrecy does not apply to the obligation to report to District Attorneys, specially when it comes to minors or people with disabilities, or otherwise vulnerable.
And their lingo is all their patients are “struggling”, hence they have permanent or transient disabilities or vulnerabilities, therefore requiring a stricter abiding to the law of mandatory reporting to District Attorneys.
So, they are not alone in being incompetent, apparently, to know, not their “moral” or “ethical” obligations, but their legal ones…
And, as such, they are not trustworthy, at least to me.
And lacking common sense and limited working memory, I would not trust any physician displaying such characteristics.
But, as per usual, it might have been transitory, or explained in other benign ways…
Finally, they did not came clean with the wrongs they did or got involved in caring for vulnerable human beings during their training, hence their “change of mind” lacks efficacy if they don´t confess, probably under legal counsel: because effectively they show no remorse on the harm they did, covered up, or got involved in.
So, their rhetorics of changing and knowing better is, to me, no more than hot air…
Such might seem abstract: lack of remorse, but let me show a hypothetical although grounded example.
At a 2% risk of sudden death by antipsychotics per year, at a 5% false positive rate, let´s say 1,000 patients per year, different or new, we get:
50 non-psychotic “patients” dying at 2% per year is 1 wrongfully killed human being per year, who never had psychosis, at all, assuming Psychiatry was like the rest of medicine, which it is not.
Over a 30 yrs career, each psychiatrist at those rates killed 30 human beings wrongfully.
And such is just sudden death, mostly cardiac non-coronary arrhythmic.
Let´s add Diabetes, Hypertension, High Cholesterol and Lack of Excercise by anti-psychotics which, more or less, from memory increases the likelihood of dying by 2 fold, 6 fold, say 3 fold and who knows.
Such is a 36 fold increase in the risk of dying by anti-psychotics by just Diabetes, Hypertension and the rest.
It might be additive instead of multiplicative giving the “low”: 11 fold increase, who knows, it is not like they are researching on additive versus multiplicative death risk effects.
Still an 11 fold increase in dying on a wrongful diagnosis even if for a few, at a 5% rate false positive diagnosis is quite a lot, specially because treatments for Diabetes, Hypertension and High-Cholesterol give one person in around at least a hundred one more year of life, and hence, cannot correct for the increased risk of dying by those 3 new diseases alone, created by anti-psychotics treatment, no the original psychotic, so they say, disease.
And yet, they claim anti-psychotics are quite safe and life-saving.
And they hide or conceal the 5% per year rate of Tardive Dyskinesia caused by anti-psychotics that sometimes includes or cause Murderous Rampage Rage, not the so they say “original” psychotic disease.
And yet, I have not read of any psychiatrist showing remorse for killing people in a stochastic way, sometimes by proxy as Murderous Akathisia induced Murderous Rampage Rage: those akathisic victims can and probably do kill innocent by standers to psychiatric treatments, and sometimes kids, minors, along the way of Psychiatric Remorseless Beliefs.
And, again, it tells me, effectively, they are still remorseless, and whatever claim they make of knowing better, to me, lacks efficacy: it is just tokenization, more misleading and dishonesty, to keep their income flowing since they already committed to terminal specialization without ability to retrain…