Anchorage Daily News
 

 

Alaskan tackles mental health care reform

GOTTSTEIN: Member of prominent family confronts psychiatric establishment.

By LISA DEMER
Anchorage Daily News

Published: November 6, 2005
Last Modified: November 6, 2005 at 03:39 AM

Jim Gottstein has an obsession that has gobbled up his legal practice, his energy and some of his family fortune.

He wants to upend what he sees as a flawed and dangerous mental health system, and the son of the grocery store family has turned agitator to get it done.

Like most people, you probably think the wide use of psychiatric drugs has cut the number of lives wrecked by mental illness.

Anything but, Gottstein says. In fact, the rate of people disabled by mental illness has swelled almost sixfold since 1955, according to a spring 2005 article in the journal Ethical Human Psychology and Psychiatry.

"Literally, the system is nuts," he says.

At 52, Gottstein is cultivating a national reputation in mental health reform. He has seen the system from the inside, as a psychiatric patient, and from the outside, as a lawyer for the mentally ill.

He can afford to immerse himself in the science and law of mental health because he's a son of the Gottstein grocery and real estate empire.

"His role has always been -- the word isn't really gadfly. He is more than a gadfly," said Nelson Page, a local lawyer who was the first board chairman of the Alaska Mental Health Trust Authority and now heads the finance committee. "That suggests annoyance. ... He is in the role of having to prod the system to make it go in the right direction."

"That doesn't mean that people are comfortable with him."

His goal? Pick apart the medical establishment's worship of psychiatric drugs and force the consideration of better treatments. Modern psychiatry is sold on chemicals as a way to help mental patients function in everyday society. Gottstein believes -- and some studies show -- these potent and heavily promoted drugs often do more harm than good.

Medicated patients talk to him about how drugs destroy their personality, their emotions, their thinking, their very sense of self.

"The scale of the harm that is being done is almost unimaginable," Gottstein said.

He has gone to court to stop the state from forcing drugs on people who don't want them and to protest the "sham" of mental hospital commitments. He has created organizations to help people "come back from the depths of insanity" without medication.

"We ought to at least have a system where the people that are helped by the drugs get the drugs and the ones that are not helped by the drugs have another choice," he said.

Gottstein is making the system justify how it treats people, said George Stone, an admirer and social worker at Spring Creek Correctional Center.

"He can go legal and hurt you," Stone said. "He's really a force. I think that's the kind of force it will take."

Mainstream psychiatry doesn't agree with Gottstein. But it's been wrong before.

BEHIND THE CLOSED DOOR

Gottstein's own fight with mental illness more than 20 years ago set him back as a lawyer but now gives him cachet as an advocate. He doesn't hide what happened.

His first breakdown came in 1982. He had finished an undergraduate degree in three years, went to Harvard Law School, thought of himself as the sort who could handle whatever a fast-track life might demand of him. He had just taken a big mental health case, one that would eventually result in the creation of an estimated billion-dollar trust of land and money to benefit Alaska's mentally ill. For days at a time he was too wired to sleep.

One night he jumped out of a second-story window in his underwear and was hauled away to Alaska Psychiatric Institute in a straitjacket, according to a story he posted online. He was medicated with a powerful psychiatric drug.

"I mainly needed sleep but API was so scary and noisy that I didn't sleep well," he wrote.

When he told the API staff he was a lawyer, some didn't believe him and others said he would never work again. He resisted at first but eventually did what he was told. Weave a pot holder? Sure. Take medication? Whatever.

After a month, he got out with a diagnosis of "atypical psychosis," meaning his symptoms didn't fall into one of the usual categories.

"His own personal experiences of being manhandled and denied personal rights and control of his care ... took him into a realm that only one who has experienced this sort of thing firsthand can truly know," his twin, Ruth Anne Faust, wrote in a recent e-mail exchange.

His family sent him to a private psychiatrist in New York who diagnosed him as bipolar. Back in Anchorage, Gottstein went into a major depression until another psychiatrist convinced him he could manage the situation and live a normal life. He returned to work, first for a law firm, then for his father's company.

In 1985, again overwhelmed with the mental health land trust case, he became delusional and, he said, ended up "in my own little world out there directing traffic in my bathrobe in March."

This time, his psychiatrist admitted him to Providence Alaska Medical Center and prescribed sleeping medicine, which he said quickly helped.

Since then, he said, he hasn't had another bad episode. When work is too much and his mind churns and he feels his control slipping, he forces himself to rest. If need be he takes sleeping medicine. He believes he's recovered.

"I consider myself an escapee from the system," he said.

THE BIG MOMENT

Gottstein was primed for the cause when a groundbreaking book radicalized him.

His father had long ago told him to give up the mental health lands case or find work elsewhere, Gottstein said. So he opened his own law office. He did routine land and business law for a while but spent 15 years, off and on, with the mental health case. He knew how the system worked and where it failed.

Over the years, he had pushed for mental patients to have more choices and especially the option of treatment without drugs. He co-founded a state association for, as they like to be called, consumers, a drop-in center and a Web site. He served on the advisory Alaska Mental Health Board.

The epiphany came in 2002 when he read "Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill," by former Boston Globe medical reporter Robert Whitaker.

"It was a litigation road map because he cited all these studies," Gottstein said.

The book traces the terrifying history of mental health treatment in the United States: water therapy involving intentional near drownings, electroshock, sterilization, surgical lobotomies.

Much of the book concerns modern-day drugs and includes studies that say they don't make people with mental illness much better.

Now Gottstein had a mission. He created a public interest law firm to take on strategic cases to reform mental health care. He started a Web site where he posted legal briefs and masses of studies.

That fall, Gottstein "crashed" a convention in Portland, Ore., of mental health activists called the National Association for Rights Protection and Advocacy.

There he met Whitaker and a leading national psychiatrist, Loren Mosher, the first chief of schizophrenia studies at the National Institute of Mental Health. Mosher, who died last year, made a big impression with work that showed schizophrenia could be treated without drugs in an intensive, structured and supportive setting.

Gottstein's legal filings and the smartly done Web site are bringing him national attention, Whitaker said.

The studies and articles on psychrights.org provide "a rational, intelligent critique," Whitaker said. "It's not an anti-psychiatry critique." Nor is it emotional. Someone struggling with whether to take medication might be helped by a trek through the Web site.

This fall Gottstein is zooming around the country to mental health conferences -- as an invited speaker. The International Center for the Study of Psychiatry and Psychology -- a group critical of conventional approaches -- gave Gottstein an award in October for his "consistent and conspicuous legal activism and accomplishment in the field of mental health." He's now on national boards. In December he goes to Ireland for an invitation-only gathering of the International Network of Treatment Alternatives for Recovery.

Gottstein hands out "Mad in America" to whoever he thinks needs educating, including news reporters; he bought about 250 copies. He also brought Whitaker to Alaska twice to talk to people on the other side of the medication issue including API staff and to put on a mental health seminar for public defenders, professionals with Anchorage Mental Health Court, and others.

"He is a brave human being," Whitaker said. "He has really confronted the psychiatric establishment and the medical establishment."

ONE OF FIVE

Gottstein grew up in a big, busy family where the kids scrambled for attention and sometimes felt unseen, said Faust, Jim's twin.

His mother drilled in the values of fairness and justice that made him want to help the underdog, said Terrie, his wife of 23 years. His dad was a businessman with vision and a player in Democratic politics. Barney Gottstein built the family fortune, combining food wholesaler J.B. Gottstein & Co. with Larry Carr's grocery stores and expanding into real estate.

In all there were five children including two sets of twins born within 20 months. A third set of twins didn't make it.

The parents split up when Jim was in high school. He chose to stay with his father, moving out of the big family house downtown.

"Divorce is never easy and it always feels personal, so we were all in our own private loneliness and sadness and space of loss," Faust, who now lives in Connecticut, wrote in an e-mail. Jim had " too many feelings trying to be hidden at a time when he was emerging into manhood and all the cultural demands that brings."

Jim was bright. Schoolwork came easy. He was always full of big thoughts.

As a teen he became a pilot and still gets in the air whenever he has good reason. Fishing, he said, is just an excuse to fly to a cool spot.

Jim and Terrie Gottstein live in a big house on the Hillside with their two kids. Their 17-year-old son is a champion high school debater who also performs in a local dance company and just earned his pilot's license. Their daughter, 12, is a competitive figure skater who can nail difficult jumps like double doubles.

Some nights, Gottstein tells his wife he's discouraged at how slow the mental health system is to change. "If he seems obsessed at times, imagine the frustration of having information that could prevent something horrible from happening and trying to get someone to listen," Terrie said.

The family lives mainly off Gottstein's share of the sale of the family grocery business in 1990. He said he didn't receive as much as people might think. "Not very many millions, but of course that's a ridiculously large amount," he said. Still it won't last forever.

"I'm going to run out of money if things don't change."

THE DRUG QUESTION

Gottstein believes his work is helping to shape the debate over how best to treat the mentally ill but he understand why psychiatrists are seduced by the idea of medication.

Psychiatrists still generally prescribe drugs for most patients and insist it is the right course. Gottstein stands with people on the edges who believe that presumption is a serious mistake.

He is finding growing acceptance of certain views: Some people who are seriously mentally ill can get well without drugs; drug studies that pushed the medications to market were flawed or even fraudulent.

"Let me tell you what Jim Gottstein is right about," said Ron Adler, chief executive officer of API, the state's only public mental hospital. "Big Pharma (nickname for drug manufacturers) really has some areas for improvement. He knows much more about this than I do."

Evidence is mounting that psychiatric drugs don't match pharmaceutical company hype. A new study paid for by NIMH found that newer expensive medicines for schizophrenia have dangerous side effects and that most patients stop taking them, just as they did the older cheaper drugs.

In an August column, the head of the American Psychiatric Association bemoaned "ugly" practices such as drug companies bribing doctors with cruises and fancy dinners, and urged reform of a system where treatment often amounts to a "quick fix" with a pill.

Still, "for every one person who tells you they are against medications, you'll find 25 that tell you their life is changed with the use of them," Adler said.

Studies show that most patients do best under a regimen of medication and counseling, said Anchorage psychiatrist Aron Wolf. He doesn't always agree with Gottstein but called him a "one-man dynamo."

"Jim and I have a wonderful detente," Wolf said.

Conflicts between the medical establishment and activists like Gottstein flourish because the causes of mental illness remain largely unknown.

"Medication may correct imbalances in brain chemistry that are thought to be involved in some mental disorders," the American Psychiatric Association says on its Web site. But what if there is no chemical imbalance?

What is proven, said Gottstein, is that the drugs themselves change the physiology of the brain, creating problems of their own.

Gottstein posts research on his Web site, including studies of schizophrenia by the World Health Organization cited in Mad in America. One found that about two-thirds of the people diagnosed with schizophrenia in poor countries recovered and about one-third didn't do well. For rich countries, the ratios flipped.

The difference, Whitaker concluded, was in the treatment: medication for the majority of patients in rich countries but not in poor ones.

THE BUSY LIFE OF A ZEALOT

When he's not on the road at conferences, Gottstein spends most workdays reading the latest on mental health, writing legal briefs and trying to recruit attorneys and psychiatrists around the country to fight forced drugging.

He works in the historic old Alaska Building at Fourth Avenue and G Street. It started as the Gottstein warehouse back in the 1910s. He bought it from his father to keep Barney from tearing it down. He's landlord to an eclectic mix of tenants that includes Suzi's Woolies and the World Affairs Council.

He installed a Web cam on the roof that gets about 5,500 visits a day from people wanting a peek at Fourth Avenue.

He also started and is majority owner of Touch N' Go Systems, a computer consulting company that operates the online Alaska Legal Resource Center for people who want to access case law, statutes and regulations for free.

He represents Alaska Natives from Alexander Creek in a fight over land allotments and a small company that owns royalty interests in Cook Inlet oil and gas leases. The latter case, against Conoco Phillips, is over production limits. If he wins it, he said, it could "loosen the stranglehold" of the big oil companies. And bring in some real money for him and his client.

He is vice president of Peer Properties Inc., a private agency that owns an experimental group house near downtown for people with mental illness.

He also started another agency, Choices Inc., that he hopes eventually will provide individualized, non-drug help.

Perhaps his riskiest idea is to open a place for people in psychiatric crisis to recover without drugs, outside a hospital. His mentor, the late Mosher, tried this with success in California.

His main work is through the Law Project for Psychiatric Rights. He's waiting for the state Supreme Court to rule on his appeal against forced drugging of an API patient. He also is working on a new case that challenges the nature of psychiatric commitment proceedings.

"All these coercive means have become what I call the path of least resistance," Gottstein said. "It is easier to drug these people so they are subdued than to deal with whatever is going on with them."

His work is making a difference, said Jeff Jessee, executive director of the Alaska Mental Health Trust Authority. At API, the number of patients forced by court order to take medication dropped 29 percent from fiscal year 2003 to 2005, according to hospital statistics.

"Ten years ago, there was no way you would get anyone on the medical staff of that hospital to even understand what Jim is talking about," Jessee said. "Now the issue is how will we get there."

"I wouldn't say the tide is turning," Gottstein said. "But I think there are some chinks in the armor."

Daily News reporter Lisa Demer can be reached at ldemer@adn.com and 257-4390.


Daily News reporter Lisa Demer can be reached at ldemer@adn.com and 257-4390.



 


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