perspective, it may be necessary to capitalize on the fear of violence
to get the law passed."
These words, written by D. J. Jaffe in 1993, launched a campaign by
what is now the Treatment Advocacy Center in Arlington,
Virginia to toughen involuntary outpatient commitment laws throughout
Mr. Jaffe explained the strategy at a
NAMI conference in 1999, "Laws change for a single reason, in reaction to
highly publicized incidents of violence. I am not saying it is
right, I am saying this is the reality ... it means you have to take
the debate out of the mental health arena and put it in the criminal
justice/public safety arena.
The items below are examples of how the Treatment Advocacy Center
capitalizes on fear. These items were selected from many others.
The list has not been updated since 2010 and needs work.
21, 2010 - News
of the Week
THE 'TREATMENT ADVOCACY CENTER' HELP OR HARM?
Law, New York's
controversial statute permitting compulsory medication of psychiatric
outpatients, is due to expire at the end of June, 2010.
we are seeing
efforts to make it permanent by the law's chief proponent, the
Treatment Advocacy Center in Arlington, VA. Recent quotes by key
spokespeople suggest that a new wave of fearmongering may be in the
years ago, D.J. Jaffe, an
advertising executive, advised mental health advocates that "from a
marketing perspective it may be necessary to capitalize on the fear of violence" to
pass laws compelling psychiatric outpatients to take psychotropic
medication. Soon Jaffe joined forces with Dr. E. Fuller Torrey, a
psychiatrist who shared Jaffe's compulsory medication agenda. Thus was
launched an intensive public relations campaign linking mental illness
with violence. Since then, factoid-laced, sensationalistic articles,
op-eds and television features have appeared with depressing frequency
in the national media. For an example, see "Will
The Damage Be Doubled?" , a repeat of "Breaking
Point," an infomercial for involuntary outpatient commitment on
CBS's 48 Hours.
What's a financially-strapped advocacy movement
to do? Advocates'
protests requesting fairness fall on deaf ears at "60 MINUTES," "48
HOURS," "The Washington Post," and other national media. For nearly 20
years the Torrey/Jaffe team, unimpeded, has relied on a scare strategy
to win public support for compulsory medication.
The fact is that there are no violence studies that focus on people
with untreated schizophrenia and bipolar disorders, the Torrey/Jaffe
team's target population. The Treatment Advocacy Center copes with this
problem by lifting phrases out of context from work by others. The
result is self-serving misinformation with respectable citations.
Does this twisted form of advocacy help or harm those it purports to
assist ? Could this be a reason researchers are finding the public to
be less tolerant toward people with psychiatric disabilities and
decreasingly willing to accept housing and community support programs?
"Study Finds Fear Tactics Win Public Support for Coercion"
Below are some examples of *factoids
circulated by the Treatment
Advocacy Center. These items have been selected from the
archives of the
Anti-Stigma Home Page, http://www.stigmanet.org
team wrongly interpreted conclusions
concerning stigma in the Surgeon
General's Report on Mental Health
(1999). See "Torrey
Twists Meaning of Surgeon General's Report"
team distorted research concerning the
effect of the news media on public opinion. See "Selective
Reporting of News Skews Views"
Most Important Cause of Stigma?"
team selectively reported violence
estimates (in research based on a study investigating medication
effectiveness) to inflate the result. See Treatment
Advocacy Center Reduces Research on Violence to a Stigmatizing
team added incorrect interpretations
to findings of a U.S. Department of Justice report on homicide. See "Just
the Facts, Please!"
team summarized research involving 49
subway pushings and attempted pushings over a 17-year period
(1975-1991). The researchers (Martell & Deitz) chose to gather
only on assailants who were psychotic at the time of the offense (20
individuals - 1 of these rejected ). Torrey's 1-sentence summary of
this study is nonsensical:
"Among 20 individuals who pushed or tried to push another person in
front of the subway in New York, all except one was severely mentally
ill and offered motives directly related to their untreated psychotic
symptoms." Such rewriting of research findings is
outrageous. And no reader would guess that such pushings occurred
only once or
year in a city of (then) 7 million people.
team mislabeled Andrew Goldstein (of
Kendra's Law fame) a "treatment refuser" even after his psychiatric
records proved he had repeatedly tried to get treatment from a
downsizing mental health system. See "More
About Kendra's Law"
respected research organizations,
The Lewin Group, the U. S. Department of Justice, the National Advisory
Mental Health Council (NIMH), and the MacArthur Foundation on Mental
Health and the Law have confirmed that their work does not support
findings attributed to them by the Torrey team. See "Just
the Facts, Please!" and "Ten
Top Stories of 2007 Continue Fearmongering"
Law expiration date draws near (June,
2010), the Torrey/Jaffe team has doubled its earlier 5% estimate of
homicides committed by people with "untreated schizophrenia and bipolor
disorders" to a frightening 10% of all homicides in the U.S. The
doubled (10%) figure, however, misuses research and homicide numbers
from data spanning 1990-2002.
Torrey Doubles Bogus Homicide Estimate
*Editor's note: "A
factoid is a questionable or
- unverified, incorrect, or fabricated - statement formed and asserted
as a fact but with no veracity. The word appears in the Oxford
English Dictionary as 'something
which becomes accepted as fact,
although it may not be true.' "
is from Wikipedia, the free
A FACTOID IN THE MAKING
In an ABC News interview
on March 4, 2010, Dr. E. Fuller Torrey stated: "The
most recent data would suggest
that about 10 percent of the homicides in the United States are
committed by people who are bipolar or schizophrenia -- when they are
not on medication."
Where's the evidence?
The Treatment Advocacy Center's most recent briefing paper on violence
(updated April 2009) states that Individuals
with severe mental
illnesses are probably responsible for approximately 10 percent of
homicides in the United States.
They cite the following study.
researchers examined the records of 518 individuals in
prison who had been convicted of homicide between 1990 and 2002. Among
the 518, 53 (or 10.2 percent) had been diagnosed with schizophrenia
(n=27), bipolar disorder (n=12), or other psychotic disorders not
associated with drug abuse (n=14). An additional 42 individuals had
been diagnosed with mania or major depressive disorder. It should be
emphasized that the study included only those who had been sentenced to
prison and did not include those individuals who had committed
homicides and were subsequently found to be incompetent to stand trial
or not guilty by reason of insanity and therefore sent to a psychiatric
facility instead of prison. Thus, the 10.2 percent is an undercount.
The authors also noted that 80 percent of the mentally ill individuals
who committed homicides had received past psychiatric treatment but
that "many of the offenders were not receiving treatment" at the time
of the homicide." Matejkowski JC,
Cullen SW, Solomon PL. Characteristics of persons with severe mental
illness who have been incarcerated for murder. Journal of the American
Academy of Psychiatry and the Law 2008;36:74â€"86
Quoting Dr. Torrey: "In 2007, there were 16,929 homicides in the United
States. If individuals with severe psychiatric disorders were
responsible for only 10 percent of these, that would be approximately
What's Wrong With
Picture? Torrey is either deceptive
or very careless.
In fact, the quote above does not
state there were 53 people with untreated
schizophrenia and bipolar -- 27 people with schizophrenia and
12 people with bipolar = 39 people. Further, their
medication status is not known. Torrey's "preventable tragedies" file
news clippings suggests that as many as 1/3 of homicides comitted by a
mentally ill individuals may have been on medication.
An analysis of a 6-month sample of Dr. Torrey's
clipping summaries ("Preventable Tragedies") of homicides showed
1) At least 8 of the 66 news articles summarized, from Jul-Dec 2004,
involved an assailant who had been discharged prematurely from a
psychiatric facility or was turned away when he asked for help. (Oddly,
a later printout of Torreys files shows only 9 clippings summaries for
that time period, not the 66 we found in 2006.)
2) 25 of the 66 news article summaries give medication status.
These 25 summaries say that 9 assailants were on medication, 16
3) 27 of the 66 assailants had histories that included one or more
red-flag behaviors: brutal assaults, drug and alcohol disorders, child
abuse, and restraining orders.
Torry has included 14 people with "other psychotic disorders" to bring
his total number to 53. He can't do that and then apply the figure to
"untreated people with schizophrenia and bipolar."
Torrey can't assume that none of the 39 assailants with schizophrenia
and bipolar were on meds.. Our analysis of
his "preventable tragedies" showed 1/3 of homicide assailants were on
meds at the
time of the crime. (Also, some years ago in a NYTimes article about
rampage killers, of 24 assailants who were prescribed meds,10 were
taking them at the time of their rampage murders.) If we speculate that
13 of the 39 assailants could have been on meds, then Torrey's estimate
is reduced to 4.4%.
Torrey uses an outdated figure for total homicides in the U.S, 16,929
(2007). The most recent figure is 14,180 (2008). This lowers his
already unsubstantiated estimate of homicides committed annually by
with untreated schizophrenia and bipolar illness
News of the Week
! DR. TORREY
HIS BOGUS HOMICIDE ESTIMATE !
Torrey's obsession with homicide figures dates back to the 1990s when
the media were quick to accept his unsubstantiated estimate that "1,000
homicides are committed annually" by an unmedicated group of people
with schizophrenia or bipolar illness. Last week, in a startling claim
in an ABC News feature, Torrey raised the estimate to 1,690 annually--
that would be 36 per week every week committed by an extremely small
group of individuals.
'discovery' about homicides is clearly
as bogus as his previous guesstimates. The new number (10% of all
homicides!) doubles his earlier estimate (5%), a figure based on six
clippings from the Washington Post and some deceptive tinkering with
research done by others. (Note: authors of the studies have confirmed
that their work does not support Torrey's conclusions.)
the 10% figure, which he projects to
1,690 homicides annually, seems even more shakey. Oddly, Torrey's
website file of "Preventable Tragedies" showed only 179 homicides
during the peak year of 2003.
It is alarming
that the most visible, articulate, and
engaging psychiatrist in the business has successfully promoted facts
and figures tailored to suit his narrow agenda of coerced medication.
Continuous repeated references to violence by the Treatment Advocacy
Center can't fail to affect public attitudes. And this is after all the
Torrey/Jaffe team's goal
December 30, 2007 - News of the Week
TAC'S "TOP 10 STORIES OF 2007"
PATTERN OF FEARMONGERING
Last week, the Treatment Advocacy Center, the nation's leading
proponent of compulsory neuroleptic medication, issued a list of ten
"under-reported stories of 2007." Seven of the ten stories involve
crime or dangerousness. Clearly, http://www.treatmentadvocacycenter.org
intends to continue its pattern of fanning fear to win public support
for its controversial agenda.
Also troubling are errors of fact. For example, by lifting a phrase out
of a research study published by Jeffrey Swanson et.al. (Archives of
General Psychiatry, May 2006), TAC created an astounding rate of
violence for patients with schizophrenia, 10 times greater than the
general public, (or 19.1% vs 2%).
Acts considered violent by TAC range from a brief threatening gesture
to a physical assault causing injury. TAC fails to mention that the
Swanson team found two levels of violence: only 3.6% of research
participants were involved in serious violence. This rate is similar to
the general population rate of 2% (ECA data circa 1980).
For the public, violence means danger. But Swanson's research team uses
the word to mean involvment in a fight whether or not the respondent
was the aggressor or defending himself. The researchers called such
fights assaults by the respondents. The fights involving 15.5% were
called "minor violence" (no injury and no use of threat or knife). The
remaining 3.6% were called "serious violence" (a weapon was used or
there was some injury, at least a bruise.) Quoting from Heathcote
W. Wales, Georgetown U., letter to the Washington Post, "Hype Won't
Help The Mentally Ill," 6/4/06.
The Treatment Advocacy Center also ignored the Swanson team's finding
that the odds of violent behavior varied with factors other than
Further, the data used for the Swanson study was designed for a
different project, the Catie study on medications. This raises
questions about the data's findings.
Read an interesting comments by John Grohol, psychologist and founder
of PsychCentral about pitfalls and
variations that plague research on violence. Go to
September 10, 2006 - News of the Week
CAN PSYCHLAWS.ORG REWRITE HISTORY?
Let Andrew Goldstein's Record Speak
The background of Kendra's Law, now under intense scrutiny in New
Mexico, is well documented. For this reason, attempts by Psychlaws.org
to rewrite the psychiatric history of Andrew Goldstein are easy to
refute. For those unfamiliar with the case, Goldstein acquired
notoriety as a "treatment refuser" after he pushed Kendra Webdale to
her death in a New York City subway on January 3, 1999.
In for/against commentaries in the Albuquerque Tribune,
2006, critics of Kendra's Law contended that if there had been adequate
resources, including stable housing, treatment, and case management,
the subway tragedy would not have occurred. The reports cited above
confirm that view, showing that Andrew Goldstein knew he needed help
and committed himself to psychiatric hospitals 13 times, perhaps
expecting to be stabilized and discharged to a supervised setting where
he had done well for 4 years.
Posted online are reports by impartial investigators:
REPORT #1: "Bedlam on the Streets," by
Michael Winerip, New York Times Magazine, May 23, 1999.
Magazine cover blurb: "Long Before Andrew Goldstein pushed a woman in
front of a train, he pleaded for help. He couldn't get it. The Crisis
of the Mentally Ill" . Click http://nytimes.com
and enter search for Michael Winerip Bedlam on the Streets.
(If you don't have access to the NYTimes archive, we'll send a hard
copy. Email firstname.lastname@example.org
and give us your postal mailing address.)
REPORT #2: "In the Matter of David Dix
(pseudonym)," A Report by the New York State Commission on Quality of
Care for the Mentally Disabled, November 1999. Click http://www.cqcapd.state.ny.us/publications/dix.htm
(Tihis 'page' may have been removed)
In a recent blog, the Treatment Advocacy Center ignores these positive
instead accuses the Albuquerque advocates of "recycling an old fallacy"
about Goldstein's search for supervised treatment. Psychlaws also
dismisses the premature hospital discharges, dead-end waiting lists,
administrative mixups, and endless broken promises that plagued this
former honor student.
Three weeks before Kendra Webdale's death, Goldstein was prematurely
discharged from a hospital with a one-week supply of medication.
Although the Treatment Advocacy Center made Goldstein the
poster boy for compulsory
treatment, he more fittingly symbolizes the dangerous gaps in an
uncoordinated underfunded mental health system. Of the few homicides
commited by people diagnosed with psychiatric disabilities, 1 in 8
follows an assailant's premature discharge from or refused entry to a
treatment facility (See "Preventable Tragedies,
12, 2006 - News
of the Week
TEETERS ON FALSE PREMISE
Requires High Quality Programs, Not
The guru of forced psychotropic medication for outpatients, Dr. E.
Fuller Torrey, recently acknowledged in a National Public Radio
interview that although 42 states have court-ordered treatment laws,
they are rarely used. Why? Perhaps Torrey's organization, the Treatment
Advocacy Center (psychlaws.org), is itself at fault.
Psychlaws has linked coercion laws to much-publicized deaths, winning
their passage in the glare of highly emotional media coverage. When the
full facts emerge, however, they often reveal a trail of negligence by
budget-squeezed poorly-coordinated mental health facilities.
"Bad case, bad law," is a cliche that may explain states' caution in
applying their court-ordered treatment laws.
Psychlaws perfected its "public safety" approach to legislation in
1999, after the fatal encounter of Kendra Webdale and Andrew Goldstein
in a Manhattan subway station.
Under Psychlaws' guidance, a family's overwhelming loss came to
symbolize a menace to every New Yorker.
To launch "Kendra's Law," the Torrey group first shoehorned Goldstein
into the role of a "medication refuser" who lacked insight into his
Several months of intense publicity overwhelmed the actual facts of
Goldstein's record, including findings by the New York Times that he
had tried in vain to get the help he knew he needed. As the truth
emerged, Goldstein's psychiatric history is an appalling account of
mistakes made and opportunities missed by the psychiatric facilities he
turned to, often voluntarily, for help. In spite of all this, a
vengeful tone at his trials helped put him in prison, and his
mislabeling continues to re-surface in the press.
Innovative states are proving that high quality programs are successful
without a law enforcement approach. The appeal of Psychlaws' coercion
campaign will fade further as states shift to treatments developed in
consultation with people with first-hand knowlege of psychiatric
conditions. These programs are promoted by the Bazelon Center for
Mental Health Law, The Presidents' Commission on Mental Health, and
Are forced treatment laws redundant? Has the Treatment Advocacy
Center's aggressive and fearmongering stance on forced medication
hindered system reform?
Here are two critics' views on the law's redundancy:
1999 - "The focus
of coercion upon the patient is, I
submit, a misdirection of energy. Coercion is needed, but to enforce
the laws already on the books that are routinely disregarded with
impunity, either because of the scarcity of resources or because of
Source: Clarence J.
Sundram, former Chairman (for 20 years), NYS Commission on Quality of
Care. "Misdiaagnosis and Non-Solutions," May 20, 1999, a statement in
opposition to the then-proposed Kendra's Law.
2006 - " 'Kevin's
Law' [Michigan's forced-treatment
law] is unnecessary because we judges already had the authority to
order medication on an outpatient basis."
The quote is from Judge
Patrick J. McGraw, Saginaw County Circuit Court Family Division.
The article notes that "Mr.
McGraw, who handles nearly all mentally
ill committments in the county, says he occasionally orders outpatient
medication but has yet to use 'Kevin's Law' for any person."
Source: "Forced Drugging," by Scott Davis, The
Saginaw News, March 1, 2006.
A Comment on the Treatment Advocacy
Center's Inflation of Kendra's Law Outcomes:
In March 2005, the New York State Office of Mental Health released an
analysis of outcome data on 2,745 recipients of New York's outpatient
commitment program, Kendra's Law.
Psychlaws, led by E. Fuller Torrey, has selected data out of context
and is using it to win support for similar laws in other states.
The Torrey group is publicizing high rates of improvement without
explaining that only a modest number of the program's 2,745 recipients
improved significantly between the time they entered the program and 6
For example, Psychlaws reports that IOC recipients experienced 87% less
incarceration after 6 months in the program.
What the Treatment Advocacy Center
doesn't explain is that prior to
entering the program, 23% of recipients experienced incarceration, and
after 6 months in the program, 3% experienced incarceration. The
state's official report describes this as an 87% improvement for 23% of
2,745 program recipients. (To complicate matters, some data analysts
would consider this a 20% improvement.)
How does this' skewing of outcomes poison the IOC debate? Consider
the preposterous claims of a forced treatment proponent in Maine:
York, 91% of those who were not
taking medications began taking them, just because that law was on the
books" and "arrests for petty and violent crimes involving people with
mental illness dropped 78% and millions of dollars in hospital costs
were freed up for community services." Source: Maine Times
Record, March 10, 2005
We welcome readers' comments. Email email@example.com
17, 2002 - News of the Week
IS TAC CHANGING
CAN YEARS OF DAMAGE BE UNDONE?
For years, the Treatment Advocacy Center (TAC) has used fear tactics to
win support for coerced antipsychotic medication. Is TAC toning down
its message? Additions and deletions on its website click here
suggest this may be the
case. For some examples of TAC's fear tactics, read the postings on
this web page. Also see "Mindless
and Deadly: Media Hype on Mental Illness and Violence,"
Phyllis Vine (FAIR-Fairness & Accuracy In Reporting).
In a switch, the TAC home page now gives site visitors a few options
that are non-proselytizing and unrelated to violence. A TAC briefing
paper, "How Many Homicides Per Year Are Commited By Individuals With
Severe Psychiatric Disorders?" appears to have been dropped.
Sensationalistic statements to the press and article titles are less
melodramatic. Some fear-mongering articles have been dropped or buried
But still, the site continues to be a minefield of misleading
statements and half-truths.
Looking back, it was in October 1993 that E. Fuller Torrey, at a
psychiatrists' meeting in Baltimore, unveiled his now-familiar idea
that "the public stereotype that links mental illness to violence is
based on reality and not merely on stigma."
But the shift to emphasize and exaggerate violence had emerged much
earlier. In November 1991, a fear-mongering feature in the Toronto Star
stated that "100,000 schizophrenics and manic-depressives roam the
urban jungle [New York City]. The article said, "Their presence is not
merely harrowing. It is dangerous." It went on to quote D. J. Jaffe,
who had recently joined forces with Dr. Torrey. It appears that
Patricia Pearson, the Toronto Star's reporter, had relied on Jaffe for
her information, since no other source was mentioned.
By 1994, the Torrey-Jaffe team was creating the Treatment Advocacy
Center and proposing stiff new state commitment laws. A briefing paper
circulated by Jaffe in 1994 stated: "According to a just released
report by my friend, Dr. E. Fuller Torrey, individuals with
neurobiological disorders (NBD, formerly known as 'mental illness') as
a group are more violent than the general population. There are more
people with these disorders in jails and prisons than their presence in
the population would indicate. In other words, public fears of violence
by individuals with NBD are not unfounded." Before long, editorials by
Jaffe or Torrey (such as one titled "Mental Illness, Public Safety,"
New York Times, December 1995), began to appear in the news media.
We rehash this history because it is unclear whether TAC is moving to
reverse its decade-long reliance on bloated and repetitive claims about
homicide to win public support for its agenda. Although TAC may be
adding some broader information to its website, it continues to tailor
the research findings of others to agree with its views. It is nearly
impossible for readers to detect the errors that result.
Take for example a new briefing paper called "Stigma and Violence." TAC
uses a series of New York Times articles concerning 50 years of
multiple murders (April 2000) to support its contention that homicide
by individuals with severe psychiatic disorders is a root-cause of
stigma. TAC cites the Times' finding that nearly half the "rampage
killers" had a psychiatric diagnosis (a hindsight decision in half the
cases). But TAC neglected to mention the death toll: 17 deaths in a
peak year. This is not a big public safety issue; the figure is
imperceptible compared to other accidental deaths. Medical mistakes are
said to account for 44,000-98,000 deaths each year. There are over
40,000 highway deaths annually, 1,400 accidental gun deaths, 800
fatalities from running red lights, 16,000 fatal falls, 4,000
drownings, 8,000 deaths from accidental poisoning, and on and on.
Furthermore, TAC chose to ignore the fact that among the 24 slayers in
the Times articles who had been prescribed medication, nearly half (10)
were taking it at the time of the murders. This is significant because
TAC's fundamental message has been that homicides are commited by
When TAC states that stigma stems from violent crimes, it implies that
the media report these crimes like any other. Not true! TAC ignores the
conclusions of prominent researchers who found that the news media over-report
psychiatric crimes, position them more prominently than other crimes,
and keep them in the public eye longer. These practices help to explain
TAC's success with the media.
A TAC briefing paper says that "people with a history of severe mental
illness" commit 1,000 homicides annually. But to support this claim,
TAC cites a 1994 Department of Justice study whose author has confirmed
to us that the study contains nothing about diagnosis, severity of
illness, or treatment. TAC also inserts the word "severe" to suit its
purpose. (Actually, the 1,000 figure looks like the work of a math
Another briefing paper says that "1,000 homicides are commited each
year by people with untreated
schizophrenia or manic-depression".
Again, this is a guesstimate. But if true, it would mean that members
of this small segment of the population commit 20
week, year after year. Where's
the hard evidence?
Unfortunately, the mental health community lacks concrete information
about violence and mental illnesses. TAC has filled in the blanks with
self-serving numbers, harped repeatedly on any homicides that occur
and, in our view, fueled the prejudice that hampers advocacy efforts.
What's your view? E-mail firstname.lastname@example.org
9, 2001 - News of the Week
FEAR IS EASY
vastly easier to amplify fear than it
is to assuage it." (From an editorial, "The Statistical Shark,"
NYTimes, September 6, 2001)
The Treatment Advocacy Center (TAC) maintains that the public's fear of
people with mental illnesses stems from violence, mainly homicide. TAC
proposes to eliminate these "stigmatizing" acts with tougher
court-ordered-treatment laws. To get such laws passed, TAC focuses
attention on rare violent acts, not only at the time they occur but
with repeated reminders long afterward.
This fear strategy reinforces existing stereotypes. On prime time
television drama, for example, "mentally ill" characters are violent in
60 percent of their roles. Such distortion makes people with mental
illnesses seem the most dangerous of all demographic groups -- three to
four times more violent than other character groups on TV. (Numerous
studies show that significantly higher rates of violence are found in
abuse of alcohol and other substances, not mental illnesses.)
The TAC's tactics are questioned in September's Psychiatric
in an article analyzing mandated community treatment. The article, by
John Monahan, et. al., states that "Advocates of outpatient commitment
have explicitly 'sold' the approach largely by playing on public fears
of violence." The authors conclude that involuntary outpatient
commitment may be won at the cost of increasing prejudice, and with no
certainty of reducing community violence.
It is time for the National Alliance for the Mentally Ill, the American
Psychiatric Association, and the National Mental Health Association to
publicly denounce the Treatment Advocacy Center's fear tactics.
"The Statistical Shark" may be downloaded free
until Thursday, September 13. Click http://www.nytimes.com/
, then enter "The Statistical Shark" in Search box.
24, 2001 - News of the Week
MORE NEBULOUS NUMBERS FROM TAC
The Treatment Advocacy Center (TAC) has issued a new Briefing Paper.
Its title is, "How Many Homicides Per Year Are Committed By Individuals
with Severe Psychiatric Disorders?" Homicide is a prominent theme in
TAC's campaign to expand court-ordered psychotropic medication.
For years, TAC has plied the public with virtually baseless homicide
numbers. The new Briefing Paper continues to promote TAC's convictions
and assumptions about homicide using nebulous numbers, quoting
selective studies, and misusing information from research done by
others. Some material in the paper is new, however.
For the first time, TAC admits to using estimates
crime" to arrive at an estimate
of "homicides." Using this
logic, if an identified group is said to commit 2% of the nation's
violent crimes, TAC assumes the same group commits 2% of the nation's
homicides. This frees TAC from needing data (currently unavailable)
about the actual number of homicides committed by whatever group they
say requires court-ordered psychiatric medication.
In another oddity, TAC lists European homicide studies despite vastly
different homicide patterns in Europe. It is misleading to suggest that
European data applies to the U.S.
TAC has expanded its focus from "people with untreated schizophrenia
and manic-depression" (estimated at 1.4 million people) to a much
larger category: "individuals with severe psychiatric disorders." We
need to know if this newly-created group includes people with
antisocial personality disorders, which are generally ranked higher
than other psychiatric conditions in violence-risk studies and are
considered unresponsive to medication. The public should know if
"psychopathic" personality disorder is part of TAC's new group.
Also new, the paper acknowledges that alcohol and other drugs
contribute to the majority of homicides committed by people with
psychiatric diagnoses. This may mean that TAC will address the nation's
dire need for integrated mental health and substance abuse treatment
The Briefing Paper says studies "suggest" (!) that in "almost all"
homicides attributable to individuals with severe psychiatric
disorders, the individuals who committed these homicides were not
taking medication for their illness at the time. Readers should note
that this is another TAC "guesstimate," and is unsubstantiated.
TAC's struggle with math continues (4.3% is not 0.43, but 0.043). A
pleasant surprise: the paper drops an earlier TAC statement about
"untreated" mental illnesses. TAC had wrongly reported that a 1994
Justice Department analysis of 1988 homicides, "Murder in Families,"
referred to untreated mental illnesses in their analysis of homicide,
when in fact the report made no
reference to diagnosis or to
READ MORE ABOUT THIS TOPIC:
For the Treatment Advocacy Center's briefing paper, "How Many Homicides
Per Year Are Committed By Individuals With Severe Psychiatric
For a related article, "Mindless and Deadly: Media Hype on Mental
Illness and Violence."
For National Stigma Clearinghouse Archives on Involuntary Outpatient
Commitment (under construction)
For more about
TAC's nebulous numbers, ask for "Just
The Facts, Please." E-mail your request, with your mailing address, to email@example.com
1-page leaflet has a chart and cannot be posted on Webtv.)
April 1, 2001 -
News of the Week
TAC TAKES FEAR TACTICS TO MARYLAND
The Treatment Advocacy Center (TAC) has written an opinion piece,
"Courts Must Be Able to Order Help," which appeared in the Baltimore
Sun on March 1st. The article recommends a forced-treatment law for
Maryland similar to New York's Kendra's Law.
The article opens in capital letters with 'IT IS SHOCKING," followed by
six sentences using "dead," "killed," "violent," "shock," tragedies,"
"bludgeoned," "stabbed," "shot," "tragic," and "violence."
The article goes on to perpetuate the lie that Kendra Webale's subway
assailant in New York, Andrew Goldstein, was "medication noncompliant"
and required court-ordered treatment. In fact, Mr. Goldstein (now in
prison) had repeatedly asked for treatment and was repeatedly denied
the help he knew he needed.
No one condones violence. Neither should we condone fear-mongering.
Research at Duke University found that individuals with severe mental
illnesses who were not taking medication were no more violent than
other individuals in the study, as long as they were not abusing
substances. (Am J Psychiatry,
155:2, p.230, February 1998.)
When rare acts of violence occur, often (as in the case of Andrew
Goldstein) they are the results of program cost-cutting and treatment
diversion policies. Maryland would do well to look beyond New York's
flawed example for ways to improve the state's mental health system.
to the Editor
"Torrey accused of dangerous and fuzzy math"
Monday, March 12, 2001
Reprinted with permission of Manisses Communcations Group
More should be said about E. Fuller Torrey, M.D.'s homicide estimates,
which were a factor in NAMI California's differences with Dan Weisburd,
publisher of The JOURNAL
Feb. 19). There is
no scientific basis for Torrey to say that a lack of psychotropic
medication is responsible for 1,000 homicides annually.
Torrey's often-repeated statement that "people who have untreated
schizophrenia and manic-depression commit 1,000 homicides each year"
has a ring that appeals to the news media. The Wall Street Journal
featured it as a blurb in a Torrey opinion piece titled "Why
Deinstitutionalization Turned Deadly." Lesley Stahl of "60 Minutes"
used a shortened version, "The mentally ill are responsible for as many
as 1,000 homicides each year," to introduce a segment on coercive
treatment, "A Right That Could Be Wrong." The figure is becoming
accepted as fact (much like a now firmly rooted fiction that the man
who triggered New York's Kendra's Law expanding court-ordered treatment
was a noncompliant patient who refused to take medication.)
But there is no scientific study to substantiate Torrey's numbers. He
has cited as his sources his personal estimate (!) based on six
Washington Post news articles about 13 homicides in the Washington,
D.C. area; a report by the U.S. Department of Justice, and a report
done for the National Institute of Mental Health (NIMH) by The Lewin
Group. None of these sources verifies Torrey's assertion that absence
of medication is responsible for 1,000 homicides annually.
Torrey himself admits that the six newspaper articles (from 1992, a
peak year for homicides) provide only a rough estimate. After
extrapolating the 13 "local" homicides to the national population and
getting 770, he rounds off the figure to 1,000. Interestingly, although
total U.S. homicide figures have dropped sharply since 1992 (from
roughly 23,000 to 16,000), Torrey's "1,000 homicides" does not vary.
The cited Department of Justice study done in 1994, "Murder in
Families," (using data from 1988), does not include psychiatric
diagnosis or treatment status. It refers to people with "a history of
mental illness," a category that is both broad and vague. When Torrey
applies the department's findings to people who have "untreated
schizophrenia and manic depression" he cloaks his opinion with a
scientific basis that does not exist.
The Lewin Group's report, "The Economic Cost of Mental Illness, 1992,"
cautions that "conclusions about the magnitude of the relationship
between mental illness and violent behavior based on studies of
psychiatric populations should be avoided or at least interpreted with
caution." Despite this caveat, and despite a mismatch between the
Torrey statement and the Lewin analysis, Torrey has used the Lewin
report to validate his statement.
Jean Arnold, Chair
National Stigma Clearinghouse
3, 2000 - News of the Week
FEAR TACTICS ACCEPTABLE?
The controversy over involuntary outpatient commitment continues, state
by state, as the Treatment Advocacy Center pushes legislatures to
change state laws. Florida is a present target.
WILL FLORIDA LEGISLATORS REALIZE THAT
BEING PSYCHOTIC IS MINDLESS AND DEADLY?" (Op-ed Headline, Orlando
Sentinel, October 27, 2000))
The above heads an op-ed article by E. Fuller Torrey in the Orlando
Sentinel is titled, "Not Treating Mental Illness is Dangerous and
Deadly." The piece is an attack on Florida's Baker Act, a hard-won law
intended to protect people diagnosed with mental illnesses from
The article uses two violent incidents that occurred this Fall in
Melbourne, Florida -- resulting in a homicide, a critical injury, and a
suicide -- to advocate for stiffer laws that expand the grounds for
Torrey, who heads the Treatment Advocacy Center (TAC) in Arlington,
Virginia, seeks to frighten the public into supporting his ideas. But
scaring the public has far-reaching consequences. In New York we are
seeing the fallout from a fear campaign in 1999 for forced-treatment
legislation (Kendra's Law). "The Railroading of Andrew Goldstein," by
Patricia Warburg Cliff, is an article in the latest issue of The
Journal of NAMI California
("Mental Illness and the Law"). Ms.
Cliff, a NAMI board member, is dismayed that Kendra Webdale's mentally
ill subway assailant, Andrew Goldstein, has been sentenced to state
prison. She asks,"Has the 'justice system' reverted to a witch hunt to punish
the violent mentally ill whom the public system has dismally failed?"
It's a good question.
Advocates must carefuly examine what is happening. The bedrock issues
in TAC's crusade for more forced treatment are "lack of insight" and
"medication noncompliance." But in fact, it is alcohol and
substance-abuse disorders that push violence rates above the rates
found in the general population. Ironically, substance-abuse and
mental-health policymakers feel little pressure from advocates or the
public as they argue endlessly over who is to provide the crucial
Clarence Sundram, who for 20 years chaired the New York State Commision
on Quality of Care, points out the futility of passing harsher laws:
"The focus of coercion upon the patient is, I submit, a misdirection of
energy. Coercion is needed, but to enforce the laws already on the
books that are routinely disregarded with impunity, either because of
the scarcity of resources or because of conflicting pressures."
Advocates should question the wisdom of supporting divisive new laws
that have not improved conditions in states where they were tried.
Letter to the Orlando Sentinel from Harold A. Maio, Director, The
Mental Health Clearing House, Fort Myers, Florida. E-mail: firstname.lastname@example.org
Dear Letters Editor:
E. Fuller Torrey states that "1,000 homicides in the United States are
committed each year by people who have untreated mental illness."
According to recent statistics for murders in the U.S., about 20,000
people are murdered each year. That would mean that I, a person with
severe depression, am 20 times more likely to be murdered by E. Fuller
Torrey than he is by me, and that I should fear him 20 times more than
he should fear me.
I do fear him.
I do for several reasons: First, it is his goal to instill fear into
the public - with the help of the media - about people like myself.
Second, he employs the term "mental illness" as a catch-all for every
mental illness. There are many mental illnesses, just as there are many
physical illnesses; and I assure you there are physical illnesses we
fear, and many we do not.
Third, history has continually revealed the abuses that abound in the
area of mental health "treatment" and each state has fought ways to
interdict this abuse without succes. This pattern has persisted since
the "Discovery of the Asylum" in the 1820's (a book by David Rothman
which I highly recommend) to the present day. Florida recently
contracted its South Florida institution to a private company because
it was not able to contain the abuses - by employees - of people
supposedly there for treatment. The state is in the process of closing
another, coldly isolated institution in a cattle pasture outside a
small town in Central Florida for similar reasons.
Florida, like many other states, is beginning to step into the 21st
century and realize that for the vast majority of mental illnesses, the
best treatment is in integrated settings. That does not mean that we,
as the rest of the public, will all succeed, or even succeed to the
same degree. But we will have a better chance in an integrated setting.
For a real-life illustration, I have been married for 28 years. I have
2 children, a girl 21, and son 15. I have taught throughout my life,
from university level to public and private school. I have been
"treated" in the worst institutions and in the best. I am not the
"unusual success," but the general rule.
Harold A. Maio, Director, The Mental Health Clearing House, Fort Myers,
Florida. E-mail: email@example.com
Dr. Torrey's estimate of "1,000 homicides" is not substantiated by
scientific research. And in another calculation, he equates "violence"
with "homicide." These and other distortions of fact are hard to spot
and unfortunately even more difficult to undo.
13, 2000 - News of the Week
JUST THE FACTS,
The statement, "There are 1,000 murders each year by people with
untreated schizophrenia and manic-depression," has appeared in a number
of major publications and national news broadcasts.
If true, this would mean that a minuscule segment of the U.S.
population (.5 of 1 percent) is committing over 6 percent of the
But this statement is not substantiated. A Department of Justice study
cited as the source of the statement does not provide data about
diagnosis or treatment, according to its author, Dr. Patrick Langan.
The statement is part of a national push for court-ordered medication
led by E. Fuller Torrey and D. J. Jaffe, founders of the Treatment
Advocacy Center. At the 1999 convention of the National Alliance for
the Mentally Ill, Mr. Jaffe, an advertising executive, advised
forced-treatment advocates to use the argument that stronger commitment
laws are necessary to protect the public from "dangerous" mentally ill
This is a new wrinkle in advocacy. No other disability group has
exaggerated the violence of its members in order to pass coercive laws
against them. Not advocates for people with diabetes, who may harm
themselves or others when insulin shock causes blackout. Not advocates
for people with Alzheimers', whose behavior may be threatening. Not the
advocates for people with AIDS dementia or Huntington's disease or
autism or developmental disabilities. Only advocates for people with
mental illness, it seems, frame their arguments in terms of danger to
There is some objective data that may help establish the truth about
violence. Uniform Crime Reports are issued annually by the Department
of Justice in an effort to improve the training and safety programs of
law enforcement officers nationwide. According to the DOJ's latest
report (1998), murder and assault by "mentally deranged" people are at
the bottom of the dangerous-situation list. They rank just above "civil
disorders," posing a negligible danger to police officers.
Over 10 years (1989-1998), "mentally deranged" individuals accounted
for only 1.6 percent of all homicides of police officers, and only 1.5
percent of all assaults. Furthermore, in the period from 1989-1998,
there was no escalation in violence by "mentally deranged" individuals
against police officers.
We welcome your
comments. E-mail firstname.lastname@example.org
6, 2000 - News of the Week
TREATMENT FACES CREDIBILITY GAP
With familiar eloquence, a Washington Post opinion piece by E. Fuller
Torrey and Mary T. Zdanowicz capitalizes on a widely-publicized
homicide to promote court-ordered psychotropic medication (August 1).
Veteran advocates may remember Dr. Torrey's equally impassioned pleas,
in 1986, for "passage in each state of a bill of rights that guarantees
minimum standards of care." Since then, Torrey's position has swiveled
180 degrees. Now he calls for stiff laws that punish patients for
decades of neglect by a dysfunctional system.
Involuntary outpatient commitment deserves examination. But research on
the issue to date has not found that court-ordered treatment works
better than high-quality programs. Yet for the past decade, based on
their assumptions and convictions, the forced-treatment advocates have
worked hard for policies that are unproven, divisive, and potentially
Clarence J. Sundram, who for 20 years chaired the New York State
Commission on Quality of Care, a mental health watchdog agency, made
this assessment: "The focus of coercion upon the patient is, I submit,
a misdirection of energy. Coercion is needed, but to enforce the laws
already on the books that are routinely disregarded with impunity,
either because of the scarcity of resources or because of conflicting
23, 2000 - News of the Week
THE MOST IMPORTANT CAUSE OF STIGMA?
An oddly sweeping and emphatic statement by Dr. E. Fuller Torrey about
the "single most important" cause of stigma, in a letter to Behavioral
Healthcare Tomorrow (December
issue), raised our curiosity.
Torrey's letter asserts that "studies in Germany and the United States
have shown that the single most important cause of public stigma
against individuals with mental illness is episodes of violence,
including highly publicized homicides, committed by them."
We have read the researchers' conclusions; Dr. Torrey misses the point.
The research concerns how selective
reporting affects public
attitudes. It is exactly this selective coverage that Dr. Torrey's
Treatment Advocacy Center plays upon to market forced-treatment
The German and American studies Torrey refers to are attempts to
understand the cause of the public's fear of people with mental
illness. These studies, by Matthias C. Angermeyer and his colleagues at
the University of Leipzig, and Jo Phelan, Bruce Link, and colleagues at
Columbia University, span more than five years. What the researchers
have found is that exaggerated media attention to violence (to the
exclusion of other images of mental illness) has a lasting negative
effect upon the public.
Episodes of violence are rare. It is not the episodes, but the
sensational press coverage, that causes the stigma.
5, 1999 - News of the Week
MEETS STIFF OPPOSITION IN ST. LOUIS
TAC'S FEAR TACTICS STIR UP BAD WILL
In its nationwide push for stiffer laws to compel psychotropic
medication, the Treatment Advocacy Center (TAC) of Arlington, Virginia,
has met angry resistance in St. Louis from MadNation, a St. Louis-based
cyber-network of psychiatric survivors.
TAC's use of inaccurate information and statistics has raised the wrath
of Vicki Fox Wieselthier, MadNation's founder, who is leading a
David-and-Goliath battle against TAC's forced-treatment campaign in
TAC first tested its strategy in New York, where it "capitalized on the
fear of violence" (their words) to win a forced-treatment law in
August. (See News Archive for August).
By playing the public-safety card, TAC won a tough law that nearly
everyone finds fault with. Still needed are housing, community support
services, and medical care for thousands of mentally ill people who are
living with elderly parents, and thousands more who are already
destitute on the streets of New York.
TAC's fear campaign left a poisonous aftermath which has fueled
hysterical accusations and acts of violence against "the mentally ill"
of New York City. MadNation is determined to prevent such a dismal
setback in St. Louis.
28, 1999 - News of the Week
LET'S STOP THE
SPREAD OF INACCURATE, INFLAMMATORY
TAC's Numbers on Homicide Rates in U.S. Are Misleading and
On Monday, in St. Louis, Vicki Wieselthier of www.MadNation.org
alerted us to a
television news promo that blasted KSDK's daytime viewers throughout
the day with the bogus statement, "1,000 homicides are committed
annually by mentally ill people." Working fast, Vicki alerted St. Louis
advocates and the ad was later pulled.
Missouri psychiatrists quickly faxed their objections to KSDK (excerpt
below, from www.MadNation.org
I wish to
convey our great concern about the
portrayal of psychiatric patients in the upcoming report. The promotion
I saw this morning spoke about the "1,000 murders committed each year
by persons with mental illness." No reputable scientific data supports
the assertion about 1,000 murders, and this inflammatory language does
a disservice to a vulnerable population who are much more likely to be
the victims than the perpetrators of crime and violence. The fear of
people with mental illness engendered by this inaccurate portrayal
leads to stigma and makes it harder for people in recovery to obtain
housing, employment, and develop relationships with their neighbors.
Unfortunately, murders by people believed to be mentally ill make news,
while murders by people who are not mentally ill often don't make news.
Think about a frightening comparison: if every time a murder was
committed by a young African American male, would you emphasize the
race and gender of the assailant in your reports? If you did, there
would be justified cries of public outrage from every civil rights
organization in the country. Wilson
M, Compton, M.D., President,
Eastern Missouri Psychiatric Association.
The statement, "1,000 homicides..." was created by the Treatment
Advocacy Center (TAC) in Arlington, Virginia, to win support for forced
psychotropic medication. TAC postulates that people with untreated
schizophrenia and manic-depression (1.4 million people -- less than 1%
of the U.S. adult population) commit 5% of the nation's murders. The
frequent use of the quote is part of TAC's strategy to "capitalize on
fear" to attain stiffer forced-treatment laws.
TAC cites the U.S. Department of Justice as the source of its homicide
information. This is incorrect.
The DOJ, in a 1994 study using 1988 homicide data from 33 urban
counties in 20 states, tried to assess histories of individuals who had
committed homicide. The data indicated some history of mental illness
in 4.3% of those homicides. But contrary to TAC's explicit claims, the
study makes no mention of "untreated" mental illness; neither does it
mention schizophrenia, manic-depression, or any diagnosis. Furthermore,
the data is limited to large urban counties. Also, the DOJ study found
that 44% of the homicide victims
had criminal records, which
seems surprising. Clearly, TAC has invented findings not warranted by
the study's data.
TAC arbitrarily raised the DOJ's homicide estimate from 4.3% to 5%.
Then they arbitrarily attributed these homicides to less than 1% of the
U.S. population, the number TAC says have "untreated schizophrenia and
manic-depression." In another error: 4.3% of 16,914 (the total
homicides in 1998) is 727, not 1,000 as TAC claims. And DOJ's
predictions for 1999 will lower the figure still further to 645.
We could use TAC's method of mismatching research data to prove an
opposite conclusion from theirs. The National Institute of Mental
Health estimates that 22% of the U.S. population has a diagnosable
mental illness. If we speculate that mentally ill people do commit 4.3%
of the nation's homicides, it follows that 22% of the adult population
is responsible for 4.3% of homicides, and 78% of the population is
responsible for 95.7% of homicides. In other words, "mentally ill"
people are much less homicidal than "non-mentally ill" people.
14, 1999 - News of the Week
WAKE OF ANDREW GOLDSTEIN CASE, EXPERTS
OUTLINE HARD WORK AHEAD TO RE-SHAPE AND COORDINATE MENTAL HEALTH SYSTEM
Appearing in today's New York Times (11/14) is an excellent report by
Erica Goode on the dysfunctional mental health system in New York. In
"Experts Say State Mental Health System Defies Easy Repair," Goode
reports a common concern among experts that "...it will take much more
than money and some additional beds to turn a chaotic, vastly
overburdened system into a system that works."
The article identifies an even more formidable problem -- public
opinion -- and states that what is required is "a basic attitudinal
shift in a society that has long stigmatized mental illness: to treat
patients as real prospects for recovery, and to offer attractive, high
quality services that patients actually want and will accept."
The story of Andrew Goldstein and thousands like him, exposed by Times
staffers Michael Winerip, Erica Goode, Nina Bernstein, and others, may
initiate a turning point in public awareness and official negligence.
Unfortunately, damage done by forced-treatment advocates, who falsely
labeled Goldstein "treatment-resistent" in a fear campaign to win
passage of Kendra's Law, leaves a lasting mark.
For a copy of "Experts Say State Mental Health System Defies Easy
Repair," e-mail your request to the National Stigma Clearinghouse,
Remember to give us your mailing address.
7, 1999 - News of the Week
Joseph A. Rogers sums up a
costly, pain-filled Mental Health Failure.
Joe Rogers points out misguided expenditures on Kendra's Law in a
letter to the New York Times on November 6. (Consider also the Webdale
family's $70 million lawsuit against the system's hospitals that
withheld mental health care.)
"Re 'Report Faults Care of Man Who Pushed Woman Onto Tracks' " (New
York Times news article, Nov. 5):
The tragedy of Andrew Goldstein and Kendra Webdale is compounded by the
fact that Mr. Goldstein could have lived in a group home in the
community for a fraction of the amount that New York State spent on his
repeated short stays in the hospital.
Mr. Goldstein had done well in such a place, and he had taken his
medication. He wanted to go back there, but there was no room.
It is unfortunate that Gov. George E. Pataki, who had cut New York's
budget for community-based mental health services, has signed Kendra's
Law, which will further drain resources that could have been put to
better use in the new and innovative mental health initiatives that he
is said to be planning.
is executive director of the National
Mental Health Consumers' Self-Help Clearinghouse, Philadelphia,
5, 1999 - News of the Week
STEREOTYPING IN NEW YORK: 12 Police
Bullets Kill Mentally Ill Man
On August 30, a mentally ill man armed only with a hammer was slain in
the street by a 12-bullet barrage from six policemen.
Outrage at the slaying may signal that New Yorkers will no longer
tolerate a makeshift community mental health system.
Letters to the New York Times (9/6/99), triggered by an editorial by
Bob Herbert (9/2/99), cited as culprits an underfunded and overburdened
mental health system and an unprepared police force, creating
"dangerously false stereotypes about people with serious mental
A recent violence-based campaign conducted by the Treatment Advocacy
Center (TAC), which misrepresented a mentally ill man to win
forced-treatment legislation, may influence actions of undertrained
8, 1999 - News of the Week
STIGMATIZING CAMPAIGN WINS
The New York State Legislature has passed one of the most extreme
involuntary outpatient commitment laws in the nation,"Kendra's Law."
The law's main proponent, the Treatment Advocacy Center (TAC), framed
forced medication as a public safety issue after a mentally ill man
pushed a woman to her death in the New York subway. The fact that the
assailant had literally begged for treatment -- but was repeatedly
turned away by an underfunded mental health system -- was buried in a
flood of public outrage at the tragic death.
But as Assemblywoman Deborah Glick pointed out, "We've had too many
bills with names that carry an emotionalism that dissuade proper public
1, 1999 - News of the Week
MARKETING STRATEGY CREATES STIGMA
TAC campaign capitalizes on fear -- and misinformation --to promote
court-ordered psychotropic medication
The Treatment Advocacy Center (TAC) in Arlington,Virginia has persuaded
the New York State Legislature to consider a sweeping law ("Kendra's
Law") that puts psychiatric patients in New York at risk of
court-ordered commitment and forced medication. The new law would
empower a variety of complainants to seek court orders based on their
belief of need.
The marketing strategy for "Kendra's Law" is based on the premise that
a subway assailant with mental illness had refused to accept treatment
and required coercion. In fact, the man had tried in vain to get
treatment. He voluntarily committed himself to psychiatric care 13
times, only to be dismissed and abandoned by an underfunded mental
health system. To support their argument,TAC similarly misrepresents a
number of other cases and research findings.
To its credit, the New York legislature has withheld its approval of
the proposed bill and is exploring non-repressive alternatives that
show good treatment outcomes.
End of archive
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