A few months ago MeTZelf subscribed to a Dutch quarterly called “Deviant - Magazine Between Psychiatry and Society.” It claims not to accept funding or advertising from the pharmaceutical industries. Pride aside, it is prohibited from doing so by Dutch law, as the magazine is aimed at lay readers as well as professionals, and Dutch law prohibits pharmaceutical advertising to a lay audience.

There are in fact no advertisements in Deviant. The writers and editors are volunteers. Yet I find it unlikely that the price covers the costs of printing, especially as it is high quality glossy paper. Who pays for it? It seems to be subsidized by our Mental Health Service.

Deviant has existed ten years, and in that time it has organized six conferences for its readers. I, as chairperson of MeTZelf, attended the sixth one on April 11, 2003, in Amsterdam.

As was the most recent issue of the Deviant, so was this conference, called a debate, dedicated to looking at psychiatry in Germany, which was implied to be somehow better than on our side of the border. I failed to find concrete examples. Nor was it really a debate.

The absence of pharmaceutical Euros was noticeable by the modest facilities. The building where the conference was held was old and in need of a new coat of paint and carpeting. It must have once been a church, as the auditorium contained a wooden pipe organ several stories high, probably built in the century after Columbus discovered America. At that time Holland was experiencing her “Golden Age” of wealth thanks to trade with the east. Most of the commodities brought back were exotic (at the time) foods such as oranges, almonds, and spices. I suspect the despicable trade in slaves also contributed to Holland’s wealth. To my amusement, two electronic speaker boxes stood on top of the museum-piece organ pipes.

Another sure sign of poverty was that lunch consisted of unimaginative sandwiches that had to be eaten standing up, though there were plenty of them. The missing luxury underscored how pharmaceutically funded conferences pamper and woo physicians.

The sponsors were six institutions belonging to the Dutch MHS. It surprised me that they have money to spare for sponsoring such a conference, particularly as that money comes from the taxpayer, who is always told about shortages. Or was pharmaceutical money behind this after all?

Only too late did it occur to me that if this conference was about psychiatry in Germany, there were bound to be German-speaking psychiatrists and others present. Indeed there were. Of the about 140 participants, 19 had come from across the border. Germans don’t speak Dutch (unless they [have] live[d] in the Netherlands), but Dutch people do speak German as it is a required subject in all Dutch middle and high schools. So guess which language the conference turned out to be in! Having received my education abroad (US) I never learned German. There were also two or three immigrants present who did not know German. The organizers had provided a translator, at least, that’s what they called her. Even when the speaker stopped after every sentence to give her time to translate, she began her translation by dancing behind the microphone, gesturing with her hands, and stuttering, “um, uh, he said, uh, I think he said, uh,” etc. the frustrated members of the audience wound up doing the translating for her, and eventually most efforts at translating were abandoned.

The conference was opened by Andrée van Es, who was introduced as the chairman of the MHS. Why the MHS should have a chairman I don’t know, nor does Van Es seem to have any affinity to the subject matter. She was once a member of parliament for the Socialist Party. I knew her six or seven years ago when she joined the board of a building society that I was on also. She clearly had no affinity for that either. She helped the director move to block members’ rights to the society’s property. When I warned the others of what was happening, I was removed from the board. So she has little credit with me.

Her speech was a lot of hot air about how important the MHS is, and how much it does. She joked that people used to think that all the MHS does is build camp sites with fences so that parents can take their autistic children camping. I found the joke to be in bad taste.

The next speaker was Detlef Petry, a psychiatrist working in Maastricht (of EU fame) although he is originally from Germany. Petry has a reputation of drugging less, though he is definitely pro-drugs. I once consulted him, and he disappointed me sorely, as I described in my book . There I called him Peterson.

Petry opened his speech by alluding to German psychiatry’s most infamous accomplishment: involuntarily sterilizing psychiatrized people and later, during WWII, mass murdering them. By putting his figures for the victims far lower than current historians’ estimates, he gave the impression of minimizing those events rather than coming to terms with them. He also mentioned the inmates of a Jewish institution in the Netherlands being transported to Auschwitz to be murdered. That only confused the issue, as the nazis intended, and pretty much succeeded, to murder all Dutch Jews, not just psychiatrized ones. Though these issues are related, they are not the same, as Daniel Jonah Golhagen points out in his book “Hitler’s Willing Executioners.”

German psychiatry continued after the war as though the mass murders had never been, Petry said. Psychiatry continued to be a totalitarian institution. At the same time, their history made them more open to improvements in psychiatry, according to him. In 1970-71 the (West?) German government investigated psychiatric institutions and came up with four recommendations: care in the community, care on the basis of individual needs, coordination of different types of care, and parity for mental and physical illness. After 25 years several publications demonstrate that some headway towards these goals has been made.

Ten years ago psychosis seminars were started in Hamburg for professionals, families, and patients, he said. Petry ended by extensively quoting the philosopher Gadamer.

Thank goodness there were no timers this time. Every speaker was able to finish. Only too bad they had so little to say. Petry inflated the above material into a twenty-minute speech. I seriously doubt his suggestion that Germany’s psychiatry is vastly better than in other countries due to coming to terms with past crimes. Germany’s psychiatry simply isn’t better. The crimes remain unatoned for to this day. See: In Memorium

The next speaker was Wilma Boevink, familiar to us from the Triptych. As usual her speech was well-received. She spoke about the need for peer support among psychiatric patients. I took few notes as I thought she would send me her speech again. However, she afterwards said she wouldn’t, as it will be published in full in the next issue of Deviant.

An interesting point about Wilma is that she is always introduced as affiliated with the Trimbos Institute, which does research on psychiatry and addiction. She works there, but her speeches are based on her own experiences as a mental patient, and do not reflect the opinions and values of the Trimbos Institute. Nevertheless her employment by that institution seems to give her the social status necessary to be taken seriously by professionals and invited to conferences.

Next was Wolfgang Werner, chief psychiatrist of an institution in Germany. He used the words politics, society, and responsibility a lot, suggesting his approval of massive government interference in (mental) health care. He then spoke at length about respect, discretion, and availability. The word “psychiatry” itself he seemed to avoid, except at the end, when he said that the most important social-political work is treating patients. It is marvelous how he was able to speak for twenty minutes without having said practically anything meaningful.

Later, just before lunch, Werner was ceremoniously given the first copy of a book written by himself and published by Deviant. On our way out of the auditorium, each participant received a copy. It’s called “The Psychiatric Alphabet.” I paged through it. It’s sort of poetic prose, a small passage per page. Although each passage is followed by a Dutch translation, for the life of me I can’t figure out what the book is about. I did find a glimmer of humor in it. The author’s URL: www.ww.de. Too bad he doesn’t have a middle name, like William.

Next the floor was taken by Gee de Wilde, who looked to me like some sort of professional. His name was overlooked on the list of participants, so I couldn’t check that out. He opened the floor to the audience, however, we were only to answer one question: What are we proud of?

A Dutch woman told us that she was proud to have set up peer support groups for women who were sexually abused in childhood.

Peter Lehmann told us of his pride, Runaway House in Berlin.

A woman who works for the assisted living organization (part of the MHS and a sponsor of the conference) spoke of her pride that they help so many people. I am not kindly disposed to her organization, as taking pills or depot injections is a condition to being allowed to live there. Most of their tenants would probably be able to live unassisted if only they weren’t kept drugged and our ridiculous housing laws didn’t block their access to the dwelling market

Lunch I already described above. I myself hopped on my bike and rushed to a nearby supermarket to do some urgent shopping for the weekend.

I was back in plenty of time, so browsed around the books offered for sale. Fortunately for my wallet, most were in German. But I couldn’t resist buying just one, a Dutch translation from the German of “Psychoses without Psychiatry” by Thomas Bock who spoke at the Triptych. In it Bock describes 34 people who live, according to him, in a chronic state of psychosis but are not treated for it or are treated only briefly. Again I was struck by how such a thick book could contain so little information. The descriptions are based on a single interview per person, and supplemented with Bock’s assumptions about them. They give little insight into what psychoses supposedly are, how these people cope, and how they manage to keep psychiatry away. Still, the idea of the book is interesting.

After lunch the audience was referred to one of the six workshops. They were: Socialization, Force and Pressure (in German more accurately called Force and Violence), Client/Patient Participation, Labor (whose?), Interculturalization (I think they mean the meeting of cultures), and View on Psychiatry and Psychiatric Suffering. I had chosen the workshop on Force, mainly because it was the only one coming close to having a concrete subject.

The workshop was chaired by Aart Jan Vrijlandt, a Dutch psychiatrist-manager who looked and talked like he ought to be bouncing a little blond-haired blue-eyed grandchild on his lap. He contended that force is always undesirable. It is better to persuade patients to take their drugs, and use force only when persuasion fails(!).

One of the guest speakers was Christa Rauwald, a youngish, attractive psychiatrist-manager from Bremen, Germany. Throughout she repeatedly smiled seductively as though she were in love. With whom I don’t know, surely not Grandpa Vrijlandt. I’m sure the patients in her institution have never seen that smile, if, indeed, they have ever seen her.

She said that in her institution solitary confinement is almost never used, because when you lock the door on someone, you break the contact. Instead, they use … four-point restraints! According to her, there’s always a staff member sitting next to the person. How would she know? I’m sure she doesn’t spend hours sitting next to such a person herself. In the Netherlands such a thing would be impossible because of the shortage of staff. I personally would prefer solitary confinement. Being chained to a bed is hardly a condition conducive to meaningful conversation. If I wanted to say something other than a curse, it would not be to the staff member sitting beside me.

The other speaker was a Dutch patient advocate, Paul Manni. His first experience of psychiatry, he told us, was when during the sixties he refused the draft and as a conscientious objector was assigned to work in an institution. He told us that current Dutch law requires each case of forced treatment to be registered with the regulating agency, which is to investigate it afterwards. In reality only few are registered, and of the ones that are, only about 5% are investigated (I suspect the real figure is 0). Although Dutch law is similar to German law, Dutch practice is more similar to British practice, he said.
The chairman, Vrijlandt, interjected that culture influences actual practice much more than law. With this I agree. Law is largely irrelevant to physicians in this country. They are above it. That is one reason why I consider efforts to “improve the quality” of psychiatry futile.

It is noteworthy that Vrijlandt and Rauwald, hot-shot psychiatrists, sat beside each other behind the table. Manni, the patient advocate, also sat with them. The audience, about 20 people, consisted of users, family members, and MHS employees of lesser status. After the coffee break, at the suggestion of one of the “lesser” participants, the workshop chairs were arranged in a circle, but it remained clear that Vrijlandt and Rauwald were the stars of this show.

The “users” (meaning [ex-] psychiatrized people) at the workshop stressed the importance of peer support, even during the height of a crisis. Peers are less threatening and therefore evoke less violence, one pointed out. People brought to institutions are often violent because they are resisting what is being done to them. They experience the forced commitment as traumatic.

Vijlandt pointed out that there is a lack in psychiatrists’ training. They are not taught how to force people. Rauwald confirmed that in Germany psychiatrists’ are not trained to force people either. They seemed to think they ought to be taught this as part of their medical training. This might improve “the quality of force and pressure.”

The psychiatric nurses and family members who were participating lamented that too little is done to “help” people who do not come to psychiatry of their own accord or do not take their drugs regularly. One person gave the example of a 75-year-old homeless woman who has been sleeping under trees all her life. They felt she should be brought into an institution against her will because she was too old to be living rough. I contributed that sleeping under a tree is not an illness unless it is added to the DSM (laughter), and that if the woman wanted help, it was probably not from psychiatry. Everybody seemed to agree that drugs are a good thing. I bit my tongue, as the workshop wasn’t about the efficacy or safety of drugs, and anyway this was not a crowd that was open to my opinions on the matter.

But when somebody mentioned that little had changed in the last 30 years, my tongue lost its patience. I said that little was going to change in the next 30 years as well. It’s all very cozy, what with psychiatrists sitting here paternalistically listening to family members and “users,” but what good is it? The amount of psychiatrists present at this conference is a drop in the bucket. When someone is admitted, or worse, committed, to an institution, his chances of being treated by one of the psychiatrists who supposedly believes in listening to patients is nil. There probably won’t be any psychiatrist around at all, and he’ll be carted off to solitary confinement and jabbed in the bottom by nurses. Nor can the psychiatrist do much to influence his staff to treat people more kindly. Dutch law makes firing a nurse practically impossible, particularly firing him for behavior which is considered normal in the field. And even if the psychiatrist did fire his nurse for abusive behavior, the next nurse he hires, if he finds one considering the shortage, will be the same. Only when there is a free market, and psychiatric institutions must compete with each other for patients’ patronage to survive, will there be any true improvement. At this, Vrijlandt looked at his watch and remembered that cocktails were already being served downstairs.

What was the point of this conference? It was clearly a tribute by certain Dutch psychiatrists to their German colleagues, the justification for which eludes me. The role of the other professionals, family, and “users” present was apparently to fill up the audience and reassure the psychiatrists that they are the good kind who listen to patients (even though they were all managers who hardly see patients). It was a medical mutual appreciation society, that revealed nothing new and accomplished nothing except bolstering up professional egos at the taxpayers’ expense.

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