The Flaws of Murphy’s Law

Posted on June 14, 2015 in Accountability Courage & Activism Human Rights Stigma

I won’t say that Tim Murphy’s bill is completely without merit. That would ignore improvements such as eliminating the 190 days lifelong psychiatric care cap for Medicare/Medicaid and allow us to use Medicare at larger inpatient facilities. It makes it easier for psychiatrists to volunteer at mental health centers. It is about time that anti-psychiatrists stopped being in a position to make policy. Pete Early at The Mighty sings the praises of Murphy’s Law (where everything that can go wrong is guaranteed to happen). Here is my counter-list of why it is a bad law and why we need a better alternative.

1. Definition of caregivers which makes no provision to protect patients from abuse. You can have raped your daughter, beaten your son, or starved your wife, but if you pay the bills, you get access. Proponents think this is only fair. I think they are being disingenuous about the motives of some caretakers and their ability to serve in the capacity. In fact, there is no definition or itemization of what caregiving entails! “Primary responsibility” is the key phrase here and that goes without definition.
2. Too intrusive. Current HIPAA law allows caregivers access to all the medical information in a patient’s file. I suggest an alternative: They are allowed only that information which is necessary for them to give proper care. Gritty details such as whether the patient is gay, who the charge is having sex with, the names of their friends, what they say about the caretakers, etc. will be off limits. They will not have unbridled access to patient files, but may request information from psychiatrists. One more thing: this will not imply that they have the right to see you in the hospital. If the caretakers are upsetting to the patient during a bad episode, they will not promote recovery.
3. It would interfere in peer-to-peer programs. There is a paranoia about peer to peer programs and support groups among the proponents of Murphy’s Law. They think we encourage each other to avoid treatment. I have never been to such a support group. I have always been encouraged to keep taking my meds, to communicate with my psychiatrist, and educate myself about my disorder. But some of the things people do relate in support groups doesn’t sit well. Sometimes people have bad doctors who overmedicate them. We don’t tell them to adjust their meds on their own — we urge them to get a second opinion. Sometimes relatives are abusive. We advise them to surround themselves with caring people. It is NONE OF MURPHY’s BUSINESS who is labeled as a peer in our group. The First Amendment insists on a separation of Church and State. Likewise, it implies a separation of Government from the way that people wish to organize. I hope the ACLU takes this up and fights it if it passes.
4. Lack of accounting for recovery. So when does the caregiver stop having access? Murphy’s Law does not say. You can recover and live a meaningful, productive life, but it makes no provision for the sunset of the relationship.
5. No appeals process. What if things are being misrepresented by the caregiver? What if other psychiatrists dispute the first assessment? Murphy’s Law leaves patients no recourse. The legal programs that once helped them get just treatment have been defunded and barred from helping.
6. No penalties for caregivers who lie to psychiatrists about symptoms so that they can gain the upper hand. Joseph Kennedy had his sexually promiscuous daughter undergo a lobotomy. Do we want to deny people their rights based on the false words of a relative?
7. Lack of initiatives to provide meaningful housing. I don’t mean group homes, but a real place to call your own. Here in California, it takes years for people to get Section 8 housing! Studies show that this is the most important factor in securing stability. But Murphy’s Law does nothing to remedy the dire situation for the homeless.
8. Flimsy support for community health clinics. A pilot program in only ten states? Give me a break! Undoubtedly, the choice of which ten states get the grants will be politically driven. We need stronger funding here. If Murphy’s Law proponents really care about the mentally ill, they will insist on this. The money is there, given out as subsidies to profitable corporations. Let’s shift it around.
9. No assistance that lets patients take the medications that help them best. There’s a mean cycle that happens. You go to the hospital and they put you on a drug such as Abilify or Latuda. They work splendidly for you. But then you are discharged…. Guess what? You can’t afford the best medication for your condition. Where is Murphy here? He’s the Nowhere Man.
10. Lack of psychological and psychiatric care for caregivers. Caregiving is stressful. Sometimes it triggers episodes of mental illness. Caregivers who have “primary responsibility” for the patient should be required to visit medical professionals who can make a diagnosis (in California this means psychiatrists and psychologists) once a month (this should be billable to insurance). If they are given one, they must take their medication. If they are losing it, a better caregiver will be found. (The best caregivers do this. But several I have seen refuse to consider their own mental competence, suggesting to me unfitness.) Family therapy and couple’s counseling are other approaches that we would do well to promote. All of these should be billable to insurance companies.
11. Lack of power to opt out of ECT. I don’t believe in forced ECT, period. I know it helps some people, but not others. It is a treatment riddled with catastrophic side effects for some. Patients should always have the power to refuse this treatment as well as lobotomy and similar “great and desperate cures”.
12. Advanced directives are ignored. When we are in a stable place, it behooves us to write an advanced directive so that we can designate who can make medical decisions on our behalf and declare what treatments we would refuse in our right minds. Murphy’s Law scuttles this ship by giving advanced directives no role in patient care. Proponents argue that this is covered elsewhere, but I see an impending court case where a caregiver tries to override an advanced directive because he doesn’t like what the patient decided for himself. I am not confident that the courts will rule for the advanced directive.
13. It does nothing to curb police violence. OK, maybe this needs to be in another bill, but I think police officers are overworked, poorly trained, and poorly screened. Murphy’s Law could, however, promote the use of social workers to respond to psychiatric emergencies. Too many suicide attempters end up dead when police overreact and apply the militaristic training that they’ve taught works for any situation. Would we send out the police if someone was having an insulin overdose? This has to end.
14. Weak anti-stigma efforts. Right at the beginning of Tim Murphy’s summary of bill there is a statement to the effect that suggests that people in severe episode are potential mass murderers. This flies in the face of many studies which show that those of us who live with mental illness are less likely to commit acts of violence and eleven times more likely to be the victims of violent crime. The anti-stigma education program is weak: it says nothing about bullying; it only addresses schools; it does not ensure that families are educated on the damage that stigmatizing language can have on those attempting to recover. The words that come to mind are hypocritical and ineffective.
15. It doesn’t do a damn thing for the afflicted who don’t have families who care about them. The erroneous assumption is that there will always be someone will want to help you get treatment. But many of the homeless are there because no one does care.

I’ve been told that I don’t have to worry about Murphy’s Law because I am high functioning. But its prescriptions as to what constitutes a peer-to-peer program affect me directly. Our all volunteer groups can’t pay for a psychiatrist to be there at our every meeting. That will kill them which is what some lovers of Murphy’s Law want.

Furthermore, there is always the danger — no matter how stable I have been recently — of a breakthrough episode which might cause me to skitter and fall into Murphy’s “protections”. So, yes, I have every reason to be concerned about Murphy’s Law because it is waiting there for me in the event that I relapse.

There are better bills and better ideas for bills that aren’t backed by the National Rifle Association. Don’t be fooled. Without these changes, Murphy’s Law is not the friend of the patient or the caregiver.