From Straitjacket to Supreme Court: The Fight for Psychiatric Justice

Interview with Jim Gottstein

In 1982, when Jim Gottstein was forcibly hospitalized, restrained in a straitjacket, and told his brain was defective, requiring lifelong neuroleptic drugs, the psychiatric establishment claimed authority over his mind and future. This was not an isolated incident but part of a decades-long pattern, stretching back to the 1950s when neuroleptics—originally called “major tranquilizers” for their brain-suppressing effects—were heralded as psychiatry’s salvation. As I explored in Toxic Psychiatry, Dr. Peter Breggin reveals how these drugs, far from curing, shrink frontal lobes and slash life expectancy, a truth echoed in Gottstein’s Report on Improving Mental Health Outcomes, which documents a 20–25-year reduction in lifespan for those diagnosed with serious mental illness. Yet, as Toby Rogers noted, “The entire field of psychiatry saw ‘antidepressants’ destroy their patients and said, yep, sounds good.” The chemical imbalance myth, debunked in Is Psychiatry a Crime Against Humanity? by Peter C. Gøtzsche, was a marketing ploy, not medicine, entrenching a corrupt alliance between psychiatry and Big Pharma that prioritized profit over lives.

This systemic deception, rooted in the post-World War II rise of psychopharmacology, has compounded harm through forced drugging and incarceration, stripping patients of agency. In Anxiety Uncovered and Talking Back to Prozac, AMD and Breggin detail how SSRIs, prescribed to millions, induce mania, suicidality, and dependency, often misdiagnosed as worsening illness, a point Gottstein underscores when noting antidepressants drive patients toward “persistent serious mental illness.” Worse, Mass Shootings: The Untold Link to Psychiatric Drugs connects psychotropics to violent impulses, with akathisia and emotional blunting implicated in tragedies like Columbine. Gottstein’s legal victories, such as Myers v. Alaska Psychiatric Institute, challenged this coercion, asserting that forced drugging violates constitutional rights unless proven in the patient’s best interest—a standard rarely met given neuroleptics’ catastrophic reduction of recovery rates from 80% to 5%. Yet, as Gøtzsche argues, psychiatry’s disease model ignores social causes like poverty or trauma, which Gottstein’s “People, Place, and Purpose” framework seeks to address. The system’s inertia, however, dismisses patient voices. “Denying one is mentally ill,” Gottstein notes, citing Alaska’s Catch-22-like statute, “is considered proof that one is mentally ill.”

I write this introduction not merely to expose psychiatry’s historical corruption but to empower readers to reclaim agency and demand change. Gottstein’s work, from founding PsychRights to exposing Eli Lilly’s Zyprexa cover-up in The Zyprexa Papers, embodies this revolution, advocating for psychosocial alternatives like Soteria Houses and Peer Respites that honor human dignity. As we delve into this interview with Jim Gottstein, I invite you to question a system that has long betrayed its patients and to envision a future where mental health care restores, rather than destroys, lives. The evidence is clear; the choice is ours.

With thanks to Jim Gottstein.

1. Jim, for those that don’t know you, can you please tell us a bit about your background and the journey that led you to become an advocate for psychiatric patients' rights?

A. I grew up in Anchorage, Alaska in a prominent family. As a result of sleep deprivation I had what is clinically called a psychotic break in 1982 when I was 29. I like to say I went crazy. Up until then I had been quite successful, having graduated from Harvard Law School in 1978 and then practicing law. I was hauled into the psych hospital in a straightjacket, drugged, and told I was mentally ill, would have to take the drugs for the rest of my life, and the best I could hope for was to minimize my time in psych wards. Those who believed I was a lawyer said I would never do that again and when I told them I had gone to Harvard Law School that confirmed I was delusional.

I was very lucky to have escaped being made permanently "mentally ill" by the mental health system as I have learned happens to so many. This changed the direction of my life in that it made me want to help other people escape from being made permanently mentally ill by the system.

I mainly advocated in Alaska, including serving on the Alaska Mental Health Board for a number of years. I generally knew the drugs were harmful and counterproductive, but didn't think I had anything special to contribute in addition to what the great people around the country working on the problem were doing. Then, in 2002, I read the new book Mad in America by Robert Whitaker and in addition to it being a great read, to me it was a litigation roadmap for how to challenge forced drugging based not so much on the civil rights aspect of it, but that it was not in people's best interests; that they are very harmful and counterproductive.

No one else was doing that so I formed the Law Project for Psychiatric Rights (PsychRights) as a public interest law firm. I went to the annual conference of the National Association for Rights Protection and Advocacy (NARPA) that November in Portland, Oregon, because three key people were speaking there: Robert Whitaker, Loren Mosher, the founder of Soteria House which was discussed in Mad in America, and Michael Perlin, who the Anchorage judge who later established one of the first Mental Health Courts in the country, described as the "icon of mental health law." I was able to establish relationships with all of them.

I was way late to make a proposal to give a talk at the conference, so I rented a meeting room, passed out flyers, and brought a bunch of copies of Mad in America to give away. That could have been awkward because MindFreedom International was selling them, but it worked out great because my presentation was at the end of the conference and everybody who wanted a copy and could afford it bought it from MindFreedom and those who wanted one and couldn't afford it got it from me.

Anyway, PsychRights' mission is to mount a strategic litigation campaign against forced psychiatric drugging and electroshock and I started doing forced drugging cases in Alaska, which necessarily also includes psychiatric imprisonment cases, euphemistically called involuntary commitment. I won five Alaska Supreme Court cases ruling various aspects of Alaska's psychiatric commitment and forced drugging regimes unconstitutional or otherwise illegal.

2. In your book, The Zyprexa Papers, you detail how you exposed Eli Lilly's cover-up of the harmful side effects of their antipsychotic drug Zyprexa. What motivated you to take on such a powerful pharmaceutical company?

A. Well, it was dropped into my lap. Dr. David Egilman, an expert witness in the massive litigation over Zyprexa causing diabetes and other metabolic problems in a large percentage of people taking it, called me because he wanted to get information out to the public about that and about Eli Lilly (Lilly), Zyprexa's manufacturer, illegally marketing it to children and the elderly. The information was subject to a secrecy order, which provided that if he was subpoenaed in another case, before he complied with the subpoena he had to give Lilly notice and a reasonable opportunity to object. He found out about an expert report I had posted on the Internet about Zyprexa, titled An Analysis of the Olanzapine Clinical Trials--Dangerous Drug, Dubious Efficacy, by Dr. Grace Jackson and hoped I would be willing to subpoena him. Olanzapine is the chemical name for Zyprexa. I was very interested and we were off to the races. I knew Lilly would be vengeful, but felt it was worth it because Zyprexa was killing thousands of people.

By the way, I prefer calling this class of drugs, "neuroleptics," which means "seize the brain," because it is more accurate than "antipsychotic". Neuroleptic was one of the original names for this class of drugs, along with "major tranquilizer" which differentiated them from benzodiazepines, the "minor tranquilizers," such as Valium and Klonopin. The neuroleptics don't have much of an antipsychotic effect for most people. What they do is disable people's brains so much that they are not so disturbing—at least for a while. "Antipsychotic" is marketing masked as science.

3. How did the case of Bill Bigley serve as the basis for accessing the Zyprexa papers, and what did his story reveal about the practice of forced drugging?

A. You can't just subpoena people. Typically, you have a case and subpoena people whom you believe have relevant information. This was different; I wanted to subpoena Dr. Egilman and I needed an appropriate case to do so. Finding such a case was a drama in itself (which I write about in The Zyprexa Papers) and I found Bill. He was locked up and being drugged against his will. He had a guardian and the guardianship case ended up being the case from which I had the subpoena issued.

Bill's life was utterly destroyed by psychiatry. He had a good job as a heavy equipment operator, a wife and two daughters. In 1980, his wife left him, taking his two beloved little girls and he was saddled with alimony and child support he couldn't handle. He had what we used to call a nervous breakdown and ended up in the psychiatric hospital. He was noted as friendly and cooperative and voluntarily took what he was prescribed. The psychiatrist at the hospital noted when he was discharged that his prognosis was guarded depending on how much help he was given dealing with the divorce and loss of his girls.

Bill was just a couple of months older than me and was hospitalized just two years before I was, and the doctor who gave that prognosis was the same psychiatrist who saved me from being made permanently mentally ill by the system. Bill didn't get to keep that psychiatrist, wasn't given any help, and when he started resisting the drugs because of their negative effects and he didn't find them helpful they forced them on him. When I met him in late 2006, he had been hospitalized around 70 times.

I would say the forced drugging of Bill mainly revealed doctors don't know the legal requirements for drugging someone against their will, are ignorant about the drugs they are forcing on people or lie about them, and the judges don't care.

4. In 2002, you founded the Law Project for Psychiatric Rights (PsychRights). What were the primary goals of this organization, and how has it evolved over the years?

PsychRights' mission is to mount a strategic litigation campaign against forced psychiatric drugging and electroshock, and to educate the public about how extremely counterproductive and harmful these drugs and electroshock are. The psychiatric drugging of children and youth is particularly troubling and a priority.

In short, the drugs reduce the recovery rate from a possible 80% to 5% and shorten lives by 20-25 years on average, while catastrophically diminishing most people's quality of life. See, Report on Improving Mental Health Outcomes.

I was in a financial situation where I could devote the bulk of my time to PsychRights without getting paid. I never felt PsychRights was a good prospect for foundation funding because we had two major strikes against us. The first is most mental health funders believe what is needed is more mental health services, which primarily means the drugs, and PsychRights was fighting against that. The second is few foundations are interested in funding litigation. One that is, the Open Society Institute, almost gave us some funding, but that got derailed by the Zyprexa Papers situation.

So, rather than spend my time on what I thought would be a futile effort to build up PsychRights' capacity I just litigated cases on my own. I primarily represented people facing psychiatric incarceration, euphemistically called "involuntary commitment" and forced drugging proceedings. We usually lost at the trial court level because the judges don't follow the law. My take is they don't want to be blamed if anything goes wrong so they go along with the hospital psychiatrists. I made what is called "a good record," meaning I presented evidence and arguments, to take up on appeal. The appellate courts, in this case, the Alaska Supreme Court, tend to follow the law more and vindicate people's rights.

With respect to the psychiatric drugging of children and youth, we filed Law Project for Psychiatric Rights v. State of Alaska, et al., which sought declaratory and injunctive relief that Alaskan children and youth have the right not to be administered psychotropic drugs by the State of Alaska or the State pay for them (through Medicaid, mainly) unless and until:

(i) evidence-based psychosocial interventions have been exhausted,

(ii) rationally anticipated benefits of psychotropic drug treatment outweigh the risks,

(iii) the person or entity authorizing administration of the drug(s) is fully informed, and,

(iv) close monitoring of, and appropriate means of responding to, treatment emergent effects are in place, and that all children and youth currently receiving such drugs be evaluated and brought into compliance with the above. Unfortunately, during the pendency of this case, the Alaska Supreme Court changed its standing rules and we were thrown out of court as not being allowed to bring such a lawsuit.

We then developed PsychRights' Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth based on many, if not most, of the psychiatric drugs given to children and youth in the United States not being properly reimbursable under Medicaid, and the federal False Claims Act providing that anyone can sue on behalf of the government for fraud and share in the recovery, if any. Each offending prescription is a false claim and the minimum penalty was $5,500. Since any prescriber is likely to have prescribed at least 1,000 of these within the 6-year statute of limitations, that is $5.5 million and the idea is to bankrupt one or more of these prescribers to scare the others into stopping. I won on the basic legal argument that prescriptions that are not for a "medically accepted indication," is Medicaid Fraud in the United States Court of Appeals for the Seventh Circuit, but we haven't gotten to the finish line with any of the cases. Especially while Robert F. Kennedy, Jr., is the Secretary of the United States Department of Health and Human Services this has great potential. I am retired from litigation, but would come out of retirement to do one of these cases with someone else.

In late 2016, due to the collapse of my financial situation, I had to go on hiatus from much PsychRights work, and tried to reinvigorate my private practice. However, before I did, I wrote a $5.5 million funding proposal for PsychRights, called Getting to the Next Level. I didn't really expect to have it funded, but I figured I might as well put it out there. My financial situation recovered in late 2019.

5. Through PsychRights, you've won several landmark cases in the Alaska Supreme Court and the Seventh United States Circuit Court of Appeals. Can you discuss the significance of these victories and their impact on psychiatric patients' rights?

A. I have won five Alaska Supreme Court cases holding various aspects of Alaska's psychiatric incarceration (euphemistically called "involuntary commitment") and forced drugging regime unconstitutional or otherwise illegal. In terms of actual changes, in my more cynical moments, I feel like the only thing that has been accomplished is the forms used to lock people up and drug them against their will have been changed.

My first case, Myers v. Alaska Psychiatric Institute, established in 2006 that the state cannot drug someone against their will unless the court finds by clear and convincing evidence that the drugging is in the person's best interest and there are no less intrusive alternatives available. These requirements can never be legitimately met because of the counterproductive nature and great harm these drugs cause. The statute ruled unconstitutional said that if the court found the person incompetent to decline the drug(s), the hospital could drug them any way it wanted. Myers has been called "the most important State Supreme Court decision" on forced drugging in 20 years.

My second case, Wetherhorn v. Alaska Psychiatric Institute, established in 2007 that the state cannot psychiatrically imprison someone for being "gravely disabled, unless the person is so incapacitated they are incapable of surviving safely in freedom. Under the statute ruled unconstitutional a person could be psychiatrically incarcerated if their previous ability to function independently was predicted to substantially deteriorate.

The third case, Wayne B. v. Alaska Psychiatric Institute, decided in 2008, ruled the State could not dispense with the requirement of a transcript when involuntary commitment and forced drugging cases are referred to a master for hearing and recommendations.

The fourth case, Bigley v. Alaska Psychiatric Institute, building on the Myers decision, held on constitutional grounds in 2009 that (a) if there is a less intrusive alternative that is "feasible" for the state to provide, it must provide it or let the person go, (b) a petition for forced drugging must include information about the patient’s symptoms and diagnosis; the medication to be used; the method of administration; the likely dosage; possible side effects, risks and expected benefits; and the risks and benefits of alternative treatments and nontreatment, and (c) the hospital must give the person's lawyer their medical chart sufficiently in advance to allow for adequate preparation.

The last Alaska Supreme Court case I won, in January of 2016, the Alaska Supreme Court decided In the Matter of Heather R., holding, based on statute, it was improper to order Heather to be picked up for an involuntary psychiatric evaluation without the Court first interviewing Heather if it was reasonably possible.

There is little to no doubt, these rulings are being flouted by the State and the trial courts. With respect to forced drugging, there was a study published by Gail Tasch, MD, and Peter C Gøtzsche, MD, in the peer reviewed journal, Psychosis, Systematic violations of patients' rights and safety: Forced medication of a cohort of 30 patients in Alaska whose title says it all. There is a free version available on the Institute for Scientific Freedom website.

United States and the State of Wisconsin ex rel. Dr. Toby Watson v. Jennifer King-Vassel agreed with the analysis of PsychRights' Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth that most psych drugs prescribed to children and youth on Medicaid constitutes Medicaid Fraud

6. The Report on Improving Mental Health Outcomes describes the current mental health system's standard treatments as counterproductive and harmful. Can you outline the scope of the problem and what are some of the approaches that should be used instead?

A. First, I would like to say the Report is meticulously referenced with links to the sources. Second, our current system is so bad it is hard to believe. The primary problem is the almost universal use of psychiatric drugs as the mode of dealing with people who have "mental issues."

People diagnosed with serious mental illness in the public mental health system are now dying 20-25 years earlier than the rest of the population; they had normal life spans before the introduction of the drugs in the 1950's. That there is not a public uproar about this demonstrates how little society values people considered mentally ill.

People who are put on the neuroleptics, such as Zyprexa, Abilify, Risperdal and Seroquel and maintained on them have a five percent recovery rate, while we know that if we try to help people without using these drugs if possible, we can achieve an 80% recovery rate. People who get off these drugs after they have been on them for a while have a 40% recovery rate. This is eight times better than 5%, but half of the possible 80%. This shows how important it is to avoid putting people on these drugs in the first place. These drugs are marketed as "antipsychotics" but I use the original word, "neuroleptic," which means "seize the brain". They don't have antipsychotic properties for most; they just suppress people so much they are not as troubling to other people. At least for a while.

The "antidepressants" cause a significant percentage of people to become manic and then instead of stopping the drug, they are diagnosed as having bipolar disorder and more drugs are added, usually starting with a neuroleptic. They then go down the path to being "persistently seriously mentally ill" and disabled by the drugs. The "antidepressants" also cause some people commit suicide and others murder. Not to mention often permanent sexual dysfunction in an astoundingly large percentage of both men and women.

The stimulants given to children for so-called Attention Deficit Hyperactivity Disorder (ADHD) also cause a significant percentage to become manic and go down that path. They also permanently stunt growth and increase cocaine use.

There are similar problems with the other classes of psychiatric drugs, such as the so-called "mood stabilizers."

People are locked up to prevent them from harming themselves, but psychiatric incarceration, euphemistically called "involuntary commitment," is associated with a massive increase in suicide.

These are reasons why I say the current system is massively harmful and counterproductive.

In contrast to this very harmful and counterproductive system, there are other approaches that are known to be helpful without the harm or coercion. These approaches include Peer Respites, Soteria Houses, Open Dialogue, Drug-Free Hospitals, Housing First, Employment, Warm Lines, Hearing Voices Network, Non-Police Community Response Teams, and emotional CPR (eCPR). These, and others, are briefly described in the Report.

7. The Report states that the most important elements for improving patients' lives are People, Place, and Purpose. Can you elaborate on this concept and how it can be implemented in practice?

That this even needs to be said demonstrates how off-track and harmful the mental health system is. Everyone needs People, Place, and Purpose and those diagnosed or labelled mentally ill are no different.

We are social beings, need meaningful relationships and to interact with others (People). Social isolation is usually harmful and detrimental to one's mental state. The mental illness system is very isolating. Of course being locked up is isolating, but so is stigma. In other words, the very act of giving someone a serious psychiatric diagnosis can, by itself, be very isolating. Friends are lost. Jobs are lost. People just don't want to associate any more. This has been called "Social Death."

Everyone also needs a safe place to live, especially to sleep. There is a huge problem with people not having housing in the U.S. and the latest fad is to round them up, lock them up, and make them take drugs, rather than just provide affordable housing. As Dr. Loren Mosher's affidavit stated in the Myers case, "Without adequate housing, mental health “treatment” is mostly a waste of time and money." The solution to homelessness is simple; homes. Currently, the vast majority of housing for people in "the system" is conditioned on taking psychiatric drugs and/or not using alcohol or street drugs. Leaving aside the irony of requiring people to take prescribed mind-altering drugs, while prohibiting street drugs and alcohol which, as a general rule, make people feel better and very well may be less harmful, many people would rather be homeless than take harmful and counterproductive psychiatric drugs. Housing First is a proven program where housing is provided without strings but in which services that people want are available.

Similarly, everyone, including people diagnosed with serious mental illness need purpose or meaning in their life. It is typical for mental health workers to discourage people diagnosed with serious mental illness from working unless or until they are functioning better, but working is often a very big help in people getting better. Volunteering is also good, but gainful employment is especially good for dramatically improving someone's self-esteem. And has been proven to help people recover. This is discussed in the Report.

That People, Place and Purpose is not recognized by the mental illness system as keys to the well-being of people who have been diagnosed with mental illustrates how clueless the system is. That cluelessness is very harmful.

8. You've co-founded several organizations to help psychiatric patients, such as CHOICES, Inc., and Soteria-Alaska. How have these organizations contributed to the well-being of psychiatric patients in your community?

A. We actually set up a kind of counter mini-mental health program, with CHOICES, Inc., being the community piece, Soteria-Alaska being a substitute for psychiatric imprisonment, and Peer Properties providing peer-run housing. CHOICES, Inc., and Soteria-Alaska were founded to provide other choices than psychiatric drugs. Peer Properties was strictly a landlord, but it did not require people to be taking psych drugs to live there, unlike virtually all of the other housing programs. I wrote about these efforts in the Report on Multi-Faceted Grass-Roots Efforts To Bring About Meaningful Change To Alaska's Mental Health Program.

Unfortunately, this all fell apart in 2015, which I wrote about in Lessons from Soteria-Alaska. CHOICES, Inc., is still technically in existence, but my understanding is it has strayed from its founding vision and is fairly mainstream.

I was unsuccessful in having these organizations stay true to their founding vision following my departure. Loren Mosher once told me maintaining the vision is a common problem, which he had not solved. It is just too easy to acquiesce to the pressure to conform, especially because it is far easier to obtain funding. This is what happened to CHOICES, Inc.

While they were in existence, they had profound positive effects on many of the people they served. At times, it was magical. In my Lessons from Soteria-Alaska article, I quote a former staff member who wrote in part:

Recently I was asked about Soteria by those with the power to invoke change here…and I highlighted the self-actualization of choice, humane experiences, whole health…and most especially; that Soteria did something in my eyes that I have never seen done before; a community absent of power and control; dominance and defeat. For me, as a person with lived experience, it is the most surreal gift and what “treatment” never gave me; It is a gift for which I have no adequate words.

There is great resistance from the mental health establishment to such programs that even when one gets something going and it is successful, it is hard to keep it going. Or, at least, I had a hard time with it. The one program I co-founded that is still going is the Alaska Mental Health Consumer Web drop-in center.

9. The Report highlights the tragic consequences of psychiatric incarceration and drugging of children and youth. What steps can be taken to address this issue and provide better support for young people facing mental health challenges?

A. When I first started in mental health advocacy children and youth were not even diagnosed with mental illness because it was recognized children and youth go through a developmental process and things can resolve. They called it "Serious Emotional Disturbance" instead. This has completely changed and children are told they have something wrong with their brain, and as a result, not responsible for their actions. This is exactly the wrong message. One of the primary responsibility of parents, and other adults in children's and youths' lives is to teach them how to control their emotions and behave in a way that is considered acceptable. Children "act out" because of things going on in their lives and should be taught how to deal with them in ways that don't get them into trouble. And, maybe address the things that are causing the behaviour. What a concept.

The problem is most starkly illustrated by what is done to children and youth placed in foster care. The legal reason a child or youth is placed in foster care is because there has been a determination they have been subjected to abuse or neglect. Leaving aside for the moment that the determination may be incorrect (for example, children are often taken away from parents who refuse to consent to psychiatric drugs on the grounds that this is neglect) if the child or youth has been subjected to abuse or neglect that will cause them to act out. While some children and youth are glad to be withdrawn from such situations, for most it is traumatic to be yanked out of one's home and can cause them to act out. Finally, many foster placements are pretty horrific in different ways and that can cause children and youth to act out. We tell these children and youth they have something wrong with their brains, which is incorrect, they are not responsible for their behaviour because of it, they will need life diminishing drugs for the rest of their lives and, by the way, don't expect to have much of a life.

This is all wrong. We should be helping parents be better parents and help children and youth to be successful, including taking responsibility for their actions and not letting their emotions drive actions that cause trouble for them. Part C, Empirically-supported psychosocial interventions for children and adolescents, in Module 8 of the Critical ThinkRx Curriculum outlines a number of successful strategies. There is a 20-minute video as well. One of the approaches I particularly like is mentoring. It can be very helpful to have a caring adult in a child or youth's life that will be there for them, giving advice, sure, but mainly a steady presence in their life, over a long period of time. Many children and youth diagnosed with mental illness don't have such a figure (and role model) in their life.

10. In your opinion, what are the most significant barriers to achieving the 80% possible recovery rate mentioned in the Report, and how can these barriers be overcome?

A. Psychiatry and its meretricious alliance with Big Pharma are the biggest barriers. Psychiatrists have the extraordinary power to have people locked up and drug them against their will with the drugs that are reducing the recovery rate. In order to overcome these barriers, I have fashioned a strategy that I call the Transformation Triangle. It consists of three spheres that reinforce each other to bring about system change. The most important element is changing Public Attitudes because if the public understood how harmful and counterproductive the current system is, change would be demanded. The second most important element is having other choices or alternatives. The way these two reinforce each other is to the extent the public understands these other choices are far more effective and safe, the public will insist on them being available and to the extent these other choices demonstrate far better outcomes without the harm, the public's attitude will change in their favor.

Down at the bottom, people have the right to the least restrictive alternative with respect to psychiatric imprisonment and the least intrusive alternative with respect to forced drugging and electroshock. This is regardless of whether they are actually available, although the Alaska Supreme Court has gotten this wrong. To the extent the state cannot get an order to lock someone up because they could go to, say, a Peer Respite instead and therefore denies the petition to psychiatrically imprison the person even though there is no Peer Respite to which the person can go, that will put pressure on the state to have such peer respites. However, judges are reluctant to deny a psychiatric imprisonment petition because of a non-existent less restrictive alternative, so to the extent there are such alternatives, people's right to not be locked up are more likely to be honored.

On the right side, to the extent the public understands that what the state wants to do is so counterproductive and harmful, it will support honoring people's rights not to be psychiatrically imprisoned and drugged or electroshocked against their will. Right now one of the things people say against this is "dying with their rights on" as a justification for ignoring their rights. But the truth is the violation of people's rights is killing them. It is harder to see how honoring rights can impact public attitudes, but the best example I know is legal segregation in the United States. Before Brown v. Board of Education, a pretty wide swath of the public believed segregation was acceptable; after all the United States Supreme Court had ruled it was constitutional in Plessy v. Ferguson. However, after Brown, virtually no one would say it was okay.

I have written and talked about this extensively.

11. The Report emphasizes the importance of voluntary approaches that improve people's lives. How can mental health professionals and policymakers work together to promote these approaches and reduce the reliance on forced treatment?

A. The vast majority of psychiatrists are misguided, at best, and not interested in taking these approaches. Other mental health workers are more likely to be supportive, but they tend to have no power and put their jobs at risk if they challenge the system. Realistically, the policy makers through what they fund, can drive the change. The Report is specifically written for policy makers and potential funders, although it has other uses as well, such as being an evidentiary roadmap to challenging psychiatric imprisonment, forced drugging and forced electroshock. I do think mental health professionals from Trieste, Italy, for example can also help because psychiatric imprisonment, forced drugging and forced electroshock were banned there decades ago. It has totally changed their attitude. They say, for example, "Our patients would never trust us if we forced them." Also, the true peer support community can guide policymakers and funders.

12. The Zyprexa Papers highlights the obligation of doctors to become fully informed about the harms of antipsychotic drugs. How do you think this can be achieved, and what role can patients play in this process?

A. I try not to ascribe bad motives to people, but that has gotten increasingly untenable. In 2009, I adapted a Peanuts cartoon, which illustrated this, based on a prominent University of Minnesota psychiatrist in the pay of Astra Zeneca, the manufacturer of Seroquel, who was touting Seroquel as significantly superior to other drugs despite evidence to the contrary. That psychiatrist's name was Charles Schulz, which is also the name of the creator of Peanuts. The last line of the article about this is, "Was Schulz fooled or was he complicit?" I couldn't resist.

The evidence has just piled up even more since then, so "fooled" is no longer a credible excuse. Psychiatrists' power derives from their prescribing privileges and assumed knowledge—and their willingness to testify falsely in court in order to get troubled and troubling people locked up and drugged into a stupor. Around the 1970's, psychiatry, which had primarily been a psychological based endeavor, i.e., psychoanalysis, faced competition from therapists who were not MDs, so they combined with the pharmaceutical industry to make it a medical issue and therefore preserve their predominant role.

I just don't think it is a question of being informed. I think it is a question of preserving their position through dishonesty.

Patients and ex-patients have been showing what works for 50 years. There is perhaps a little more acceptance of what we have been saying, but there is also even more pervasive oppressive measures being implemented. Again, I think the only thing that can change the dynamic is for the public to get up in arms about the horrifically harmful and counterproductive system that has been created by the psychiatric/pharmaceutical juggernaut.

13. Your work has often put you at odds with powerful interests in the pharmaceutical industry and the psychiatric establishment. How have you navigated these challenges, and what advice would you give to others who wish to advocate for change in the mental health system?

A. Sadly, with the exception of subpoenaing and disseminating the documents resulting in the series of New York Times articles I write about in The Zyprexa Papers, nothing I have done has been threatening enough to the pharmaceutical industry and psychiatric establishment for them to go after me. For that situation I knew going in that there was a good chance I would be subjected to the wrath of Eli Lilly, but there was so much potential benefit that it was worth it to me. Dr. Peter Gøtzsche from Denmark, who is one of the top medical researchers in the world, and one of the authors of the Report on Improving Mental Health Outcomes, has estimated Zyprexa had already killed over 200,000 people by that time.

Advocacy doesn't usually involve such risk, although civil disobedience is designed to get oneself arrested in order to emphasize the importance of whatever issue is being advocated. Frankly, though, I think it is hard to get much attention drawn to even civil disobedience these days so I question how much it is worth to engage in it. To me, drawing the ire of powerful interests in the psychiatric/pharmaceutical establishment is a sign of effectiveness. There is that famous saying Gandhi never uttered, "First they ignore you, then they laugh at you, then they fight you, then you win." I think we are still largely at the ignore stage with some at the laugh stage and we have to get to the fight stage to win.

We need to take the types of information contained in the Report on Improving Mental Health Outcomes to all sorts of advocacy opportunities. There are situations, such as when doing so might put one's job in jeopardy, and one has to determine for oneself if the risk is worth it, but by and large, I think there are many advocacy opportunities without much risk, if any.

14. Looking back on your experiences as a psychiatric patient and as an advocate, what are some of the most important lessons you've learned, and how have they shaped your perspective on mental health and human rights?

A. Denial that one is mentally ill and noncompliance in taking psychiatric drugs are two of the most helpful things for reclaiming one's life after a diagnosis of serious mental illness. I am not denying people's thinking and perception gets screwed up in a way that is fairly characterized as being crazy, but refusing to accept that there is something fundamentally wrong with one's brain is key to getting through it. This can bring on psychiatric retaliation because denying one is mentally ill is considered proof that one is mentally ill. There is even an Alaska statute that provides denying one is mentally ill when there is evidence one is is evidence that one is mentally ill. Did you read Catch 22? This is literally the reverse of the actual Catch 22 which is that bomber crew members were excused from flying very dangerous bombing missions in World War II if they were crazy, but they had to ask to be excused, and if they asked to get out of these very deadly missions they weren't crazy. Catch 22.

Similarly, declining to take psych drugs, especially on an ongoing basis, which is very harmful and, for most people, counterproductive, is both usually a good decision and cited as proof that one is incompetent and therefore not allowed to make that choice. Now, I will say I know people who find the drugs helpful, even the neuroleptics, and they should be able to have access to them. Not children, though. Children should never be given psych drugs. No one should ever be forced to take the drugs against their will.

Every day I am confronted with the reality that unwanted psychiatric interventions are done in wholesale violation of law and inflicting great harm.

I have had a policy of accepting every speaking invitation I can. I am not traveling because of health reasons these days and Zoom has really proven to be a tremendous vehicle for such speaking.

15. What are you currently focusing on in your work, and how can people stay informed about your ongoing efforts to improve mental health outcomes and protect patients' rights?

A. I am glad you asked. I believe the PAIMI Advisory Council Empowerment Project has the possibility of being the most impactful thing I have ever done. The Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act funds an army of lawyers to "ensure that the rights of individuals with mental illness are protected." It does this through Protection and Advocacy (P&A) agencies in every state and other U.S. jurisdictions. The PAIMI Advisory Councils, comprising at least 60% of people who are receiving or have received mental health services or family members, are to jointly determine the annual PAIMI priorities with their P&A.

No more than 10% of the people who are psychiatrically incarcerated actually meet the legal criteria for doing so and no one can be legitimately drugged or electroshocked against their will under the United States Constitution because it has to be proven the forced drugging is in the person's best interest and there are no less intrusive alternatives. Since the result of these rights violations is lowering the recovery rate from a possible 80% to 5% and reducing life spans by 20-25 years on average, it seems obvious this should be a top priority of the P&As. Except for a couple of states, however, it isn't and the PAIMI Advisory Council Empowerment Project is designed to leverage the Advisory Council's joint priority making authority, and other tools they have, to make this a high priority and then fashion strategies for ensuring that the rights of individuals with mental illness not to be psychiatrically incarcerated or drugged or electroshocked against their will are protected (enforced).

The PAIMI Advisory Council Empowerment Project was the subject of a recent Mad in America article, The Fight Against Involuntary Commitment: Are Protection & Advocacy Organizations Fulfilling Their Mission?

As I write this, though, the status of PAIMI funding is pretty unclear because of the chainsaw type cuts to spending by the U.S. government.

I am also on the board of MindFreedom International, whose mission statement reads:

MindFreedom leads a nonviolent transformation, championing human rights and options in mental health care, uniting psychiatric survivors, consumers and allies with movements for justice everywhere.

One of MindFreedom's flagship programs is its Shield Program, which is a mutual aid, one-for-all, all-for-one approach to try and help people who are locked up and/or drugged or electroshocked against their will to get it stopped, by giving the people doing it hell. We have had some notable successes although right now we are suffering under a lack of resources situation.

Another flagship program is Judi's Room, named after the iconic psychiatric survivor who wrote On our own : patient-controlled alternatives to the mental health system, originally published in 1979. On Our Own was the call to action for the modern psychiatric survivor movement. Judi's Room is a monthly educational program with discussions that is well-regarded.

To stay informed about my efforts, people can sign up for the PsychRights e-mail list and/or join MindFreedom International.

I appreciate you being here.

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