"Normalgott"
by Rev. Kimi Riegel
November 9, 2003

Reading: Darkness Descending

The sun has set
But it does not bring
Respite.

Now comes the
Dark night of the
Soul.

Fear and trembling,
The sickness
Unto death.

Slugs slither through my
Dreams leaving trails of slime.

The sun rises again
But brings no
Light.

Darkness above my head.
Darkness beneath my feet.
Darkness behind me.
Darkness in front of me.
Darkness to the right of me.
Darkness to the left of me.

Everywhere,
I walk in darkness.

In darkness,
It is ended.

Sermon: “Normalgott”

It was a cold day in November several years back. A member of the congregation called because he needed to meet with me. He showed up looking tired and red eyed – he related a story of being an outcast, unable to sleep, work and maintain a home. He had been from hospital to hospital and tried many medications but still he suffered. Another day, this time a bright spring morning a high school student from the church youth group wanders into my office. I ask her why she isn’t in school. She answers that someone is chasing her and she wants me to protect her. One late night, a family calls – desperate. They have taken their son to the hospital because he has tried to kill himself. One after-church coffee hour turns into a crisis as one member of the congregation begins screaming at another who he believes has been spreading rumors about him. During Joys and Sorrows a family comes forward to light a candle for their daughter who has run away again. Because of the stigma attached to being mentally ill, I need to note here that the circumstances and the details of each of these has been changed. They are compilations of stories, real but altered to protect privacy.

Mental illness touches our church communities and our work places. Mental illness will touch 1 in every 4 families in America . Schizophrenia, manic depression (bipolar disorder), anxiety disorders, or severe depression affect more than 15 million Americans. In the United States , mental illness is the second leading cause of disability and premature mortality.
If this issue touches your life, know that you are not alone. Know that I care. Know that silence and shame will work against you. This sermon is about the struggles and difficulties of our society in dealing with mental illness, but that is nothing compared to the struggles of families and individuals. There are groups and people who can help. I encourage you to muster whatever hopes and faith you have left to keep trying to find the help you need.

The Surgeon General's report in May of 2000 makes two basic points. Mental illness is a national crisis and our treatment of the mentally ill is a national disgrace. [1] Stigma and fear compound the already difficult and complex problems faced by people who are ill and those who support them -- their families, friends, co-workers, neighbors, and service providers. Stigma, attitudes of fear, and discrimination against those with psychiatric disabilities have their roots in lack of information and lack of understanding.[2]
In his book, Mad In America, Robert Whitaker outlines well the history of care for the mentally ill in this country. It was a book recommended to me by one of the mentally ill people I have known. It is not a happy book, but in the end it is a hopeful book. I want to take most of the rest of this morning to talk about his research.

Mr. Whitaker first became interested in the topic of mental illness when, as a Boston Globe reporter, he reported on an unusual line of research in which “in order to study the biology of schizophrenia, American scientists were giving the mentally ill chemical agents expected to heighten their psychosis. This seemed an unusual thing to do, particularly since some of the people recruited into the experiments had come stumbling into emergency rooms seeking help. Equally striking was the response of the patients to the experiments. They were outraged, but not surprised.”[3] Not surprised that the very people from whom they sought help were making them sicker. Not surprised that experimentation was the only help they were offered.

In his research Mr. Whitaker came upon two other “facts”:
“In the past twenty-five years outcomes for people in the United States with schizophrenia are no better than they were in the first decades of the twentieth century, when the therapy of the day was to wrap the insane in wet sheets. Even more perplexing, schizophrenia outcomes in the United States and other developed countries today are much worse than in the poor countries of the world. The world Health Organization has looked at this question repeatedly – initially nobody could believe this disparity in outcomes – and each time it has come back with the same result. Suffer a psychotic break in a poor country like India and chances are that in a couple of years you will be doing fairly well. But suffer a similar break in the United States and it is likely that you will become chronically ill.”[4]

Mad in America traces three centuries of cures for mental illness that were mostly designed to silence the mentally ill and make them easier to manage. Whitaker’s data and research of this, our “modern era,” is most damaging. It seems instead of being motivated by ignorance or a desire to know and help we are now motivated by the dollar -- and eliminating that which doesn’t fit.
Near the turn of the previous century a movement, fed by the theories of evolution and genetics, became popular. Eugenics suggested that the weak of our species needed to be kept from breeding in order to create a more perfect society. We all know where this lead with Hitler, but perhaps we don’t know that it was the laws and procedures created to “handle” the mentally ill in this country to which the Germans turned. In 1935, a Nobel Prize winning physician, Alexis Carrel, wrote: “Gigantic sums are now required to maintain prisons and insane asylums. Why do we preserve these useless and harmful beings? Why should society not dispose of the criminals and insane in a more economical manner?”[5] He proposed that the insane or at least those who had committed a crime should be humanely and economically disposed of in small euthanasic institutions supplied with proper gases. In the United Sates the mentally ill were first separated from society, then sterilized. Nazi Germany began by killing its mentally ill with “proper gases” in January 1940.

And while this way of viewing the mentally ill was largely discredited, it set the stage for what followed. The sense that mental illness was a biological defect combined with “success” in the treatment of such illnesses as typhoid and diphtheria caused psychiatry to seek to remake itself as a true science. From the late 1800s to the 1930s and ‘40s, we see a rise in therapies that effect the body in a hope of changing the mind. Cold baths, scaldings, needle showers, surgeries, electroshock, induced comas, seizures, and terror were all used to create a change in the patient.
It was first “discovered” in the 1700 that convolutions caused a change in a person’s behavior often making them more infantile and manageable. This “going back” to the infantile state was considered better. Eventually, doctors came upon drugs that produced these convulsions. Metrazol was one of the first such drugs, producing violent seizures with a simple injection. Many patients were more cooperative and less likely to report hallucinations after a Metrazol seizure. Even though “studies didn’t provide evidence of any long-term benefit, Metrazol quickly became a staple of American medicine, with 70% of the nation’s hospitals using it by 1939.”

The most striking part of Mr. Whitaker’s book for me was how -- from the time of lobotomies and Metrazol forward -- each treatment and drug was compared to the one before, claiming to be more effective at doing the same thing. Brain damage became the miracle cure. Yet in many cases even the previous treatments showed no long-term benefits.
In 1954 the first antipsychotic medication was developed and marketed as Thorazine. First used as a substitute for anesthesia, Thorazine was prized for its ability to create the same infantile state in patients without the seizure or surgery of previous treatments.[6] Profits skyrocketed and drug companies competed with each other to create the next “new” drug that would do the job better.

By the 1980s and ‘90s drug companies were skewing their studies and employing charlatan scientists to carry them out in an effort to prove that their new drug was more effective than the old, [7] the old drugs having never been proven to be effective in the first place. Even the “facts” we have about brain function and chemistry are evolved from the notion that the brain controls the emotions through chemicals – something we have yet to prove. For instance: the once reliable fact that people diagnosed with schizophrenia are suffering from an overproduction of dopamine has been found questionable at best. While the drugs we use to treat schizophrenia do inhibit the production of dopamine they also produce pathology resulting from a lack of dopamine. Our perceptions of those who are ill with schizophrenia -- vacant facial expression, sleeplessness etc. -- are perceptions of people altered by medication not the illness itself. Patients who are medicated seem to develop more receptors for dopamine thus exacerbating the issue. In fact, patients who are never given the drugs seem to have fewer relapses than those that are medicated.

One piece of this history I found heartening was a story of the Quakers in 1796. When one of their own had died of neglect in a New York asylum they decided to build a retreat for their mentally ill. They reasoned: “if it be true that oppression makes a wise man mad, is it to be supposed that strikes and insults and injuries for which the receiver knows no cause are calculated to make a madman wise? Or would they not exasperate his disease?”[8] The Quaker retreat was a pleasant restful place with gardens, good food and activities. At the Quaker retreat there was no need to restrain the patients. No attendants were injured at the Retreat. This form of treatment became known as moral-treatment. Quaker Asylums were built in Boston , New York and Philadelphia . However moral treatment was at odds with the medical community, as it didn’t require the special services of a doctor to provide a restful environment. Finally, the combination of drug company profits, doctors and cost cutting measures brought the end of moral treatment.

Mental illness is an indescribable challenge for those who experience it and those who offer their support and care. It is clear we know too little about the brain, genetics and other factors of human development to even begin to have answers. Some people find relief from medication, some from therapy, some from time and support and still others from a combination of methods. One answer for the individual is to explore as many options as possible. Of course that means a medical system that encourages options and an insurance system that supports options. One answer for humanity seems to be to investigate what poor countries are doing right. In poorer countries they can’t afford to keep people regularly medicated. Is that the reason for their greater success rate or are there other secrets of their care?[9] What can we learn from the Quakers who would treat the ill with gentleness and respect?

Unitarian Universalist, Richard Baydin, a mental health consumer, writes in the World Magazine: “If America had an understanding and compassionate and loving heart, mental illness would disappear or wouldn’t matter. There is a powerful security in belonging. Imagine: beyond the invisible torment would be visible love! If we, the mentally ill, were viewed as precious, we could bend to the Light. We would not break off from life, we would join life!” [10] May it be so.