Insanity in Norway

In Norwegian psychiatric hospitals, the craziest thing isn't the patients.

I am an American who has lived in Norway for almost twenty years. I love Norway. There is much that is wonderful about it. But there are some aspects of it, generally institutional, that, when viewed through the eyes of an outsider, can seem, at best, bizarre and comical and, at worst, menacing and malignant.

This, as it happens, was the thrust of Lilyhammer, a terrific, hilarious TV series (2012-14) about Frank Tagliano, a New York mobster (played by Steven van Zandt), who is relocated by the Witness Protection Program to Lillehammer, Norway. In the series, which I reviewed three years ago, both Frank and the viewer are introduced to a wide range of Norwegian customs and cultural practices – ranging from the absurdly expensive and extensive preparation required to acquire a Norwegian driver's license to dugnad, the tradition whereby people who rent apartments are expected to maintain the public spaces of the building in which they live (as well as its grounds). 

Many of the practices Frank encounters come under the category of naive do-gooderism – such as the volunteer night patrols that are trained to respond to gangster criminality with “dialogue.” In one episode, the manager of a day-care center brainwashes small children with a puppet show about “Muriburiland,” an imaginary Communist utopia rich in solidarity and free of the evils of capitalism. As I wrote in my review, Frank “even spends a few days in a Norwegian prison, which he finds surprisingly cushy ('I should have been arrested a lot sooner!') and where he and other inmates – and guards – are taught to play the recorder by a hippie lady.”

One institution Frank doesn't experience is a Norwegian psychiatric ward – which is a shame, because Norway's approach to mental illness would have made for one of the series' more instructive episodes. In other countries, it's understood that if somebody's suffering from, say, bipolar disorder, he needs medication to keep from getting depressed (and potentially suicidal) as well as from becoming manic (which entails destructive conduct toward one's family, friends, and finances, and which can also lead to suicide). It's further understood in other countries that if a bipolar person goes off his meds and has a severe manic or depressive episode, he needs to be hospitalized, kept under lock and key, and medicated until he ceases to be a danger to himself and others. 

In this as in so many other ways, however, Norway is special. Among psychologically healthy people, Norwegian law is very clear about who counts as an individual's next of kin: for example, a spouse trumps a parent, an adult offspring trumps a sibling. But psychotics who are committed to psych wards are permitted to name their own “next of kin” – which has vital repercussions, because the persons treating a patient are only obliged to share information about his treatment and the current state of his health with the designated next of kin, and are prohibited by privacy laws from sharing such information with anyone else. So it is that a psychotic patient may, for example, name as his next of kin his mailman, his garbageman, some celebrity he's never met, or the self-styled fortune teller in the hospital room next to his – thereby leaving his real next of kin entirely in the dark about how his treatment and condition. 

Norway also has something called the “Control Commission” that wields immense power over the lives of mentally ill people and their loved ones. It is the commission, and only the commission, that can order a patient to be held against his will or to be released from commitment (calling “sectioning” in Britain). It also has the authority to determine the specific conditions of such patients' hospitalization. The commission tends to consist primarily of lawyers and doctors, with a sprinkling of persons in other professions. It is sort of a modern-day Star Chamber whose decisions can only be overruled by a court. 

It is also a secretive body. But if you poke around enough online, you will get a good idea of what kind of mentality reigns among its members. Its 2016 conference, held last November, featured a presentation by one Jan Magne Sørensen, head of a group called Hvite Ørn (White Eagle), that is premised on the idea that mental illness isn't necessarily a bad thing. Instead of calling it mental illness, the group calls it “psychic imbalance” and believes that it “can be a reminder that changes of course in life are necessary.” Indeed, psychic imbalance “can be a springboard to personal growth and positive life development....psychosis can be a positive transformational process.” Sørensen (in a recent article) has also put it this way: “psychic imbalance” can provide a patient with “room to play out something of the madness and achieve acceptance of the fact that one is furious at a world that doesn't function so well.” Does a patient hear voices? No big deal, says Sørensen: he's “seeing and believing in original things.” Cool, huh? Above all, argues Sørensen, psychiatrists, psychologists, and nurses shouldn't act as if they “know better” than the patient – instead, they should show respect for the patient's “picture of reality.” 

Another speaker at the 2016 conference, a professor named Lars Lien, agreed with most of Sørensen's dangerous drivel. In a Power Point presentation, he argued against forcing medication on patients, advocated for allowing patients to take part in determining how they should be medicated (or permitting them to refuse medication altogether), and encouraged replacing psychotropic drugs with treatments like cognitive therapy, dietary supplements or “natural preparations.” Under the words “Alternatives to Medication,” Lien presented several photographs, including one of a bare-chested guy playing guitar at the beach and another showing a group of people sitting around outside in a circle, apparently deep in meaningful conversation. 

Make no mistake about it: to view mental illness in the way that Sørensen and Lien do is Muriburiland medicine. It's Allen Ginsberg-style old-hippie thinking – you're not crazy, the world is. It's the ultimate in relativism – a psychotic's view of the real world is no less valid than a sane person's. Such obscene folderol is an insult not only to people who are bipolar but also to the people who love them – and who have been robbed for months or years at a time, or forever, of their ailing loved ones, who have turned into absolute lunatics and have remained that way far longer than necessary owing to misguided “treatments” such as the ones these vile quacks propose. (Among Sørensen's alternatives for psychotropic medication: yoga and canoeing.)

Also speaking at the2016 conference was law professor Aslak Syle, who framed the commitment of psychiatric patients as a human-rights violation. Syle cited with admiration Norwegian laws that protect an individual's rights, even when that individual is a psychiatric patient. Syle served up plenty of pretty language about the need to respect “personal integrity,” about the individual's right to “freedom of movement,” and about the wickedness of “deprivation of liberty” – all of which sounds just peachy until your totally out-to-lunch patient walks in front of a truck. In a nice postmodern touch, Syle even equated the restriction of psychotic patient's activity by mental-health professionals with that most odious of phenomena, “paternalism.” 

Syle also praised the “right to communication” enjoyed by patients in the Norwegian psychiatric-care system.  As a result of this right, I have discovered, even a patient in the depth of psychosis is allowed to have unlimited, unmonitored Internet and telephone access – and is thus able to send deranged e-mails or Facebook messages to, say, his own boss or landlord, even if those messages end up losing him his job or apartment. When I asked one hospital psychiatrist if there was any way to prohibit or at least limit this access, she told me that some degree of limitation by the Control Commission is possible only in the most extraordinary of circumstance – specifically, if evidence is adduced proving that the patient has been issuing serious and repeated threats to someone on the outside or has been sending inappropriate materials to children. 

When I asked whom such evidence might be sent to, the doctor provided me with an e-mail address at a particular hospital, but warned me that nobody in authority would be permitted under the law to examine any such evidence, because that would represent an invasion of a patient's privacy. My conversation with this doctor was in Norwegian, but after hearing this I was compelled to switch for a moment into English, because I do not know of any term in Norwegian that would cover what she had just told me: “Ser du ikke at det er en perfekt Catch-22?” I exclaimed. (“Don't you see that that's a perfect Catch-22?”) In the Kafkaesque manner that I have encountered over and over in my conversations with psychiatrists, psychologists, and psychiatric nurses about these issues, she merely tut-tutted and assured me that it was no such thing. 

Then there is the money issue. In a current case with which I am personally familiar, the brother and spouse of a bipolar individual who had experienced a psychotic break managed to confiscate his credit cards and bank cards, along with several thousand dollars in cash that he had withdrawn from ATMs and was carrying around in his backpack. They then took him to a psychiatric hospital, where he was diagnosed and committed on the spot. The brother and spouse thought they had nipped in the bud the possibility that the patient would empty his own bank account, spend his money profligately, and thereby incur a massive debt, as he had done during a previous psychotic episode. But no. Although the patient was supposedly confined to a “closed ward,” he was nonetheless permitted to go to a bank, open a new bank account, and acquire a bank card, which he then used to buy thousands of dollars' worth useless junk online.

Anyone who has had real-world experience with bipolar patients knows that all of these aspects of “treatment” that I have described are pie-in-the-sky nonsense. A human being in the grip of psychosis is in no position to make sensible decisions about anything. We are talking about people who are convinced they have magical powers, who think they have discovered the secrets of life and death, who believe the CIA is spying on them. We are talking about people who, when in good psychiatric health, are kind and peaceable, but who, when mentally ill, are capable of hurling at their loved ones the most disgusting obscenities and accusations, emptying their families' bank accounts, and even committing acts of violence. (Needless to say, daily long-term exposure to a psychotic spouse can do profound psychiatric damage to a mentally healthy partner.) We are talking about people who, given even a measure of unmediated and unmonitored contact with the outside world, can do untold harm to themselves and others. 

We are not talking here, in short, about mere “imbalance.” We are not talking about anything that is remotely positive or growth-inducing. We are talking about maladies that are as serious as cancer and that should be treated just as aggressively by intelligent professionals using the very best medical, psychiatric, and pharmacological approaches. But don't tell that to Norway's august Control Commission, which, like so many of the country's fatuously trendy official institutions, apparently prides itself on being a bastion of “progressive” thinking – thinking which, in this case, too often involves the championing of mental patients' “right” to decide to destroy their own lives while in the grip of utter madness.


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