‘Deinstitutionalization’: Mass Murder and Untreated Madness
We do not yet have all the data on James Holmes, the accused killer in the Aurora case, but he fits a pattern that I have found common when I was researching my new book: very, very intelligent, and yet when Holmes’ mother was contacted by the news media, she did not for a second question the possibility that her son was the killer.
When you watch a relative spiral down into severe mental illness, you know that there is something terribly wrong, but our legal system has made it nearly impossible to provide help to those who are insane. In late May, a mentally ill man named Ian Stawicki committed mass murder in the Café Racer in Seattle — read his father’s anguished description of watching this disaster in preparation, and being unable to prevent it.
The mainstream media, of course, are using this tragedy in Aurora as an argument for restrictive gun control. But the core problem — the deinstitutionalization of the mentally ill — is simply being ignored.
One major factor in the de-instititionalization of the mentally a half-century ago was the development of drugs that helped control major psychotic disorders. Of course, the drugs do no good if you don’t take them, and they’re not perfect.
When I practiced medicine in Texas in 1985, if I had reason to believe someone was an imminent danger to themselves or others due to mental disease, I could call the sheriff’s deputies. They’d respond and usually take the person against his will for a psychiatric evaluation. I doubt it’s that easy these days.
-Steve
This is quite true. I cannot count all of the clients I had who truly needed to be “Pink-Slipped.” Of all of them, I can recollect only one who was involuntarily committed for Observation. That’s out of thousands of clients over the years.
And of all of those clients who I personally believed should be closely scrutinized and were not, one later attacked a group of guards in a local Federal building; one murdered his wife; another killed another person with a knife in broad daylight, smack in the middle of a heavily-trafficked tourist area. Several others committed suicide.
Dr. Parker, I am Administrator for a small town in Ohio. There is a woman in town who the police regularly 2 or 3 times per year take to our stress center at the local hospital. They get her back on her meds, keep her for a week and send her her home. The police, the docs, and her family all agree that sooner or later she will hurt someone, but the docs and the police can do nothing until she actually commits a crime.
What percentage of the homeless in any big city would have been fed, clothed, and medicated in a psychiatric hospital 50 years ago? True, modern psychiatric drugs would reduce the number of rooms needed from that day and age, but IMHO our current practice is false compassion at its worst.
A very high percentage, OCS.
Reagan was blamed for the jump in numbers of homeless people that occurred during his administration, but it was the result of the Democrat Congress, under Carter, passing laws that made it nearly impossible to keep these people in hospitals.
Being wacko, they couldn’t hold jobs, and they wound up in the streets. NOT because of economic conditions.
A bit more complicated than that. My book goes into great detail on this. There are multiple factors, and not any single legislative or judicial action that made this happen. There is plenty of blame to go around.
His point is they called them Reagan Ranches (they were tent “cities”) and they blamed Reagan for making people homeless when he had nothing to do with it (he had only been in office a couple of months). It WAS the result of democrat policies under Jimmy Carter that lost those people their jobs and their homes.
No question that Reagan got the blame, and undeservedly so. The media was prepared to oversimplify everything that went wrong to a single focus of evil, rather than actually learn what happened.
Indeed, it was under Reagan that the now cliched tradition began that there is always a terrible homelessness problem in America that magically vanishes whenever a Democrat takes the Oval Office.
Haven’t read your book; but the linked article is nothing more than a disjointed amalgam of appeals to belief, biased samples, circular reasoning, and hasty generalizations.
It amounts to “Everybody knows that the mentally ill are violent; therefore it is so.”
A brief perusal of your footnotes makes it abundantly clear that most of what you cite was taken either out of context, or in exact opposition to the context of the item cited.
You’re a damned software engineer. How can you expect to be taken seriously on matters of psychology and psychiatry.
In addition, it’s clear that you advocate the institutionalization of ALL mentally ill persons, regardless of either acts committed or actual psychologicaly assessed propensity for violence.
Frankly, I think that YOU are insane. In addition to being a monster who cannot understand right from wrong — that is, btw, one legal definition of insanity.
The permanent imprisonment of HUMAN BEINGS who have committed no crime is WRONG.
The idea that you, and so many others here, need to have that explained to you is terrifying.
Your alleged “logic” is that because some mentally ill persons commit violent crimes, ALL mentally ill persons should be imprisoned.
What if I told you that some “SANE” persons commit violent crimes? Would you have the same conclusion? i.e., that ALL sane persons should be imprisoned? (I filled in the blank there for you because I doubted that you had the IQ to fill it in for yourself)
Suppose you have someone taken in for evaluation, but they’re not held or treated. Now you have not only a crazy but a crafty and quite angry person on the loose and with animus toward you. It’s risky all the way around.
Evaluation is still pretty easy. As an example, California Welfare & Institutions Code sec. 5150 allows a peace officer, physician, and a few other professionals to have someone held for 72 hours for observation, and an additional 14 days for intensive treatment. But beyond those 17 days, involuntary commitment is a much harder thing to do.
I had a schizophrenic relative who would regularly be taken in for observation. Once there, he’d be quite sane for the 72 hours, and then get out and get crazy again. If he hadn’t died relatively young, he would have killed someone. He certainly injured people.
BTW, when he was on anti-psychotics, he was quite normal and very intelligent.
My mother has suffered from mental illness for as long as I can remember but never would get help. As the years went by her condition became worse. She started to threaten people living near her. After a LOT of work by a deputy gathering statements from people in her life, she was finally institutionalized for a couple weeks. The experience scared her enough that she doesn’t want to go through it again and has stayed on her medication. The family knew she needed help, but there was very little we could do other than to urge her to do so. There has to be a better way to get help to the people who need it.
Interesting. Not a single word about WHY we started deinstitutionalization.
No mention of the abuse of patients, not a single peep on various state run places that had long track records of inadequate care (Even for the standards of the time), or the long history of doctors using the mentally ill for their own personal pet experiments (Google the history of lobotomies and electro-shock therapy).
One has to wonder WHY not a peep is mentioned about this while calling for the lowering of standards. Definitely interesting.
No word on the “why” because the reasons given by you are invalid and false. It was a civil liberties issue pushed from the political left (as always). Patient abuse? Undoubtedly some occurred. Unethical experimentation, lobotomies–not in decades. Electroshock treatments–a valid psychiatric tool even today. There is no legitimate reason that a practice of long term institutionalization couldn’t be constructed embracing both individual mental health care as well as public health and safety.
That is correct, Doc, as I recall. We went through a period in this country when the law was “liberalized” in many respects, standards for involuntary commitment being one of them, with seemingly no thought for the real world consequences.
That said, however, the notion of depriving someone of their liberty without a stringent process is offensive to many civil libertarians. And it was about that same time that the use of “mental hospitals” and powerful anti-psychotic drugs in the USSR and other totalitarian states to deal with dissidents became widely know in the West.
Where we are now on this issue is not a good place, IMHO, but it is understandable how we got here.
“… the notion of depriving someone of their liberty without a stringent process is offensive to many civil libertarians.”
But when you ask them to apply the concept to a civil liberty they themselves do not value, such as the right to keep and bear arms, they respond with insults and abuse. One more reason why I hold most so-called “civil libertarians in contempt.
the plan in place when patients were deinstitutionalized was the small group home plan with on-site monitoring by professional “caregivers”. it was not until the process was complete and mentally ill were living on the streets that it became known that the budget considerations for the small group homes was lacking in every regard. there was no genuine commitment to it by the politicians. only the psychiatric community and the non-profits were involved in helping psychotics with monitoring medications, bringing them food to eat, caring for them with professional services through the city hospitals on a “triage” basis.
it is true, however, that families who were unable to cope with the onset of psychosis got no help with hospitalization and had to go in front of a judge, often ruling against committed treatment.
the kind of society we get is what we want, and we prioritize. we are a free society. that is what we wanted. do we want something else?
The “group homes” may have been workable in theory but in practice were a dinner bell for corruption and abuse. Throughout the 1980′s and 1990′s in nearby Washington, D.C. there were regular stories in the local media about awful neglect and abuse, as well as outright exploitation (as a source of labor and sex) went on in these privately-contracted group homes. The people who won these contracts were, of course, politically connected and were almost exclusively interested in turning a buck out of their operations so inevitably the quality of care was abysmal and lowlifes were hired to to run the places. Patient care was abysmal, molestation was rife, inspections were few and far between and damning reports were swept under the carpet. Inevitably, deaths and scandals became routine.
It should be rather obvious that it is far cheaper and easier to monitor conditions and care under one large roof than a whole lot of little ones.
There were a variety of motivations, civil liberties being one of them. My book examines all the beautiful theories and how they interacted.
See front page article from The Star Ledger (NJ) dated Saturday, July 28, 2012: “Administrative charges follow alleged reserch on disabled clients.” “State Human Services officials filed administrative charges against a physician and a nurse practicioner at the Hunterdon Development Center in connection with an unauthorized bone study the doctor is accused of conducting on people with intellectual disabilities…”
Baby. Bath water.
Did de-institutionalizing also have something to do with legislatures wishing to cut spending for large mental hospitals?
Bugs, that was certainly the main reason for doing so here, back around 1990. I remember the debates about it, not to mention when all of the Mass. Mental facilities just dumped their clients onto the streets to fend for themselves.
As I dug through the sources on this, it was apparent that saving money was a secondary motivation, at least in the 1960s and 1970s. There were all sorts of wonderful theories about how much better it was going to be for the mentally ill to be cared for in a community setting.
Nope. O’Connor v. Donaldson (1975 US Supreme Court ruling) held that involuntary hospitalization violates an individual’s civil rights.
Nothing to do with saving money.
I should mention that the movement was already well under way when Donaldson v. O’Connor (1975) was decided. There were many strands that came together on this.
Thanks! I looked up the decision. Interesting summary:
“In short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”
On the one hand, it’s quite just. It’s not right to lock people up just because they act weird. On the other hand, it seems to set the bar pretty low – at the level of mere survival, seemingly without regard to quality of life and health. I’m also not sure it was wise to make a decision affecting a very diverse class of people based on the experience and competence of only one.
But it is the law, for better or worse.
Make sure you read the concurring opinion by the chief justice. He agreed with the result, but pointed out where this could (and did) lead. The gravest result of this decision was to make a mental hospital director personally liable for what appears to have been a well-meaning and otherwise lawful commitment. The patient was not have been immediately dangerous to others, but I can see why the paranoia exhibited, especially in light of his previous mental illness history, would lead a reasonable judge to decide that he needed hospitalization.
Yo Tristan! You must think that Medicare & Medicaid aren’t cruel & unusual. Wherever government bureaucrats intrude into the private affairs of U.S. citizens expenses go up and the overall quality of life goes down.
My book examines how Medicare caused the movement of vast numbers of senile elderly from state mental hospitals to private, generally for-profit facilities. Death rates rose.
I had an uncle who was institutionalized in the bad old days. There may well have been problems associated with the way things were done but as far as we could tell when we visited him, his state hospital was clean, decent and pleasant. I have a hard time thinking he was really better off after deinstitutionalization in the street culture to which he undoubtedly drifted before he died at an underpass.
These lives are each a sad situation and there is no perfect solution. I think involuntary institutionalization should be hard but the pendulum has swung too far. And everyone is suffering for it.
My book examines the various problems to which you allude (some of which were already history, and some of which were still current, depending on the state).
Mr. Philips: there were some very serious problems with state mental hospitals into the 1960s. Part of the problem was states that simply refused to fund the programs (such as Alabama) which leads to Wyatt v. Stickney. Many states during the Great Depression and World War II were suffering serious financial problems, and mental hospitals were at the back of the bus for funding. But there was great progress made in the 1950s in many states.
The introduction of penicillin after World War II eventually caused about 15% of state mental hospital inmates to disappear: those suffering syphilitic insanity. Medicare caused a great movement of the senile elderly from state mental hospitals to private nursing care. Both of these substantially reduced crowding in state mental hospitals. The introduction of chlorpromazine also substantially helped, by making some patients able to operate outside an institutional setting.
But along with genuine problems in state mental hospitals (which I examine in detail) there were also some ideological motivations for deinstitutionalization that were simply laughable. Goffman’s Asylums (1961) created an intellectually fashionable idea that mental hospitals caused madness–not that insane people were hospitalized because they were insane. Thomas Szasz, among others, for ideological reasons denied that illnesses like schizophrenia even existed.
This was a more complex problem than just overcrowded and often neglectful (and sometimes abusive) mental hospitals.
Tristan, you are unnecessarily accusatory. There’s no suppression of facts or discussion here.
Heather MacDonald has done good work on the recent history of the politics of homelessness.
http://www.city-journal.org/html/13_4_sndgs02.html
In Atlanta, for decades, the political activists (Task Force for the Homeless) have used damaged, confused, drug and alcohol addicted souls to advance their parade of causes and gripes — on their backs and on our dime. The activist classes care not one whit for the mentally ill people they exploit. We saw the consequences of their politics on the repeat customers at the rape crisis centers. I blame Geraldo Rivera for inventing the template for this sort of evil political exploitation.
One of the problems with the “medication of the deinstitutionalized” is indeed getting them to take the meds. In this area, the SOP of Ohio Job and Family Services (according to a friend of mine who works there) is that on the first day of the month, the client is supposed to come in to the office and receive a packet of medication for the entire month. If they don’t, a caseworker goes out to find them and give it to them, and remind them to take the medication as per the schedule.
That’s it.
Considering that;
1. Paranoids generally regard meds as attempts to poison them;
2. Most indigent, mentally challenged people either don’t have an actual time sense, or even wear watches; and
3. Many of the above have “no permanent abode”; therefore
4. The chances of them taking their “meds” as scheduled are about as good as my chances of being elected President.
If they take them at all, they tend to take them either only when they “don’t feel right”, or all at once. Neither one works very well.
What I would like to ask our enlightened thinkers, who told us that this was the “compassionate” way to handle the insane, is exactly what their definition of “compassion” actually is.
clear ether
eon
In Italy the laws prevent to charge people for crimes committed when they were not imputable. And only people able to will and understand is imputable.
“Nessuno può essere punito per un fatto previsto dalla legge come reato se, al momento in cui lo ha commesso, non era imputabile. E’ imputabile chi ha la capacità di intendere e di volere” (art. 85 c.p.).
And can not be imputed who was mentally impaired by some infirmity making him unable to will and understand.
“Non è imputabile chi, nel momento in cui ha commesso il fatto, era, per infermità, in tale stato di mente da escludere la capacità di intendere o di volere” (art. 88 c.p.)
The difference from the US is, here, these laws open the doors of the OPG (Judiciary Psychiatric Hospitals) where the patient can be committed for a minimum time period (ordered by the judge) and kept there if he is deemed “socially dangerous”.
E.G.
A patient stopped to tale medications as prescribed and lost contact with the Psychiatric Services for 10-12 years. It was forcefully committed in psychiatric ward of a General Hospital when he ripped off the home heating natural gas tube from his kitchen in his apartment (because he was pissed off with his neighbors). Firefighter come, closed the gas connections, local police took him when he returned home. The episode notified to a prosecutor (In Italy they are in the judiciary body, not the lawyer body). Short story, he was released, but continued to behave as before (not taking his medication, harassing the neighbors, not allowing psychiatric service to follow him).
In few days he was forcefully committed again in the same hospital ward.
The third time (a couple of weeks later) the judge signed to send him to the OPG.
Note, every time a patient is forcefully committed there is the need of two physicians (at least one a psychiatrist of the Health Service) to sign the request, the major (or legal representative) must approve it (as higher local health authority) and it go to be review to a judge (and often it will send some police to check and ask the patient after the commitment for details).
In another episode, a patient being denied the certification needed for the driving license paid a visit to the psychiatrist at the local psychiatric ward with an axe. They talked it in putting down the axe (and signed the certification). Then the police took him in custody and the judge sent him to the OPG without further delay.
The OPG is an hospital, not a jail, so the people there is there forcefully but for their sake. And they will stay there for a minimum period decided by the judge but can be kept the for all the time needed to make them no more “socially dangerous”. And for many is all their life.
That makes WAY too much sense, Mirco!
We could never do that here!
We did, for more than a century.
Some kind of systematic reform is clearly necessary.
I’ve seen some gruesome programs on the subject on the cable channels. Up close and personal shows about how the mentally ill cycle between the street, the E.R. and the jails. Until they finally die an untimely death.
They showed how the prisons are now the de facto warehouse for the insane and how this is the worst possible place to put them. There is no way in the world anyone can convince me that this monstrous approach as it has evolved is remotely cheaper for the taxpayer than the state mental institution.
Off the top of my head it will require a movement with some brave political leadership to take on the civil liberties/homeless-industrial complex. I think the American public is ripe for it.
Actually, the report that Holmes’ mother “did not for a second question the possibility that her son was the killer” turns out to have been incorrect:
What! ABC mischaracterizing or intentionally misrepresenting her statements for their own purposes!?!?! I am SHOCKED! Simply SHOCKED!
Yes, this came out after I wrote the article. A fellow student of Holmes, at the medical school, however, has described him as having a break from reality.
I am somewhat appalled to see the tired old link between genius and mental illness. It is ideological and directed against the individual who diverged from censorious families and social norms. I wrote about that stereotype here: http://clarespark.com/2012/07/24/the-cracked-and-cracking-loner-as-mass-murderer/. As for the Unabomber, I took issue with Alston Chase’s book here: http://clarespark.com/2009/09/25/on-mobs-teaching-and-jungians/. The author, a Harvard grad, blamed Henry Murray for creating the monstrous Unabomber.
There’s a big distance between “break from reality” and mass murder, and also a distance between fellow student and mother in another state. I don’t see how the student’s observation justifies leaving in place the counterfactual claim that Mrs. Holmes was unsurprised that her son perpetrated a massacre — unless PJM doesn’t allow adding a footnote or a parenthetical correction.
It isn’t terribly easy to get these articles changed once they are up, but your comment and my agreement are effectively an errata slip. The detailed statement of plans that Holmes mailed to a psychiatrist at his medical school (and which the mail room apparently mislaid) are going to make his defense attorney’s job that much harder, but also demonstrates pretty serious mental illness.
The usual flurry of back-and-forth arguing of what constitutes mental illness in incidents such as these has so far only confused the issue further. I’ve known a few schizophrenics and there is no way in hell they could get it together to carefully plan a monstrous crime such as this.
Of course, the likes of Ted Kaczinscky, Seung-Hui Cho, and James Holmes could all qualify as not-right-in-the-head but they don’t seem to fit into any category I’ve ever heard of. They sure as hell knew what they were doing. Most of them had been a little “off” all their lives but none of them showed the proper behavioral symptoms of schizophrenia or psychopathy.
sinanju;
This is why the classification “sociopathic disorder” was created in the 1950s (IIRC). It describes someone who has normal, in fact sometimes higher-than-average, planning abilities, but is afflicted with a worldview in which they are either all-important (megalomaniac pattern), or see themselves as on a “sacred mission” to save the world, usually “from itself”.
Kazcynski was out to save the planet Earth from what he saw as the evils of technology, a mindset common on the deep-ecology left, notably in academia. Which is the reason his potential for violence went unremarked; when everyone is chanting “Save The Whales, Destroy Civilization”, the guy who actually sets out to do it by blowing things up is apt to pass unnoticed. Especially if, like Kazcynski, he “goes bush” as a hermit living without modern technology; deep-eco fan(atics) admire that.
To take it a higher (and even more lethal) level, most people today accept that Pol Pot, the leader of the Khmer Rouge, was a homicidal lunatic who dreamed of universal annihilation. But few could fault his skills in planning; he managed to plan and carry out one of the largest genocides in human history. I believe he is in fifth place behind Mao, He Who Must Not Be Named For Fear Of Godwin, Stalin, and Genghis Khan.
BTW, Genghis is now acclaimed as a guru on the deep-eco side because he killed enough people in Asia to keep it “pristine” by Greenpeace standards for a couple of centuries longer than it would have been otherwise. Massacring about 40 million people when the world’s total population is under 250 million can do that.
The major reason that such individuals are often not recognized as insane until after they have caused mass destruction is that they tend to sign on to- or start- mass movements with similar goals. Which generally mask their desire for blood under pious protestations of their “love” for… something that would-be intellectuals approve of. As with the Unabomber.
Sociopaths are manipulators by nature, and regard killing somebody (or a lot of somebodies) as the ultimate manipulation; the ultimate proof of their own superiority. The “logic” being, if they weren’t superior, it wouldn’t have worked.
On reflection, we’re probably lucky that Kazcynski decided to live in a hut and build bombs. As opposed to, say, running for President. He might have succeeded in killing a lot more people, that way.
clear ether
eon
Yes, it’s probably a cardinal error to trust the “news” reporting in the mainstream media. However, that now means we have a he said/she said situation.
Was Ms. Holmes misquoted, or did an attorney suggest she needed to walk back that statement?
Did the reporter hear what he wanted to hear, rather the way another person wanted to see Holmes’ name on a Tea Party roster?
I guess we’ll have to wait for more data.
This concerns me. There is a very seriously mentally ill young man that lives nearby. We have had to call and go speak to the police regarding his odd, concerning, and frankly very frightening behaviors. He suffers from paranoid schizophrenia according to his guardian. The police say, as long as he’s not doing anything illegal, we can’t do anything about him.
/wonderful
He may never commit a serious crime against another; the odds are against it. But the risks are much higher than for a person who is not psychotic.
My sister came out of hospitalization and then a clubhouse to be a functioning mentally ill person; my wife’s brother was a genius, successful at work but known to the family as depressed who went to one or two therapy sessions and quit, took no meds had no hospitalization and shot himself, shocking coworkers but not the family. Our daughter came out of hospitalization went to college and career. Sister and daughter take meds under psych supervision. I recall as a grad student attending a de-institutionalization meeting in the mid 70s led by one of our professors where I argued for keeping some patients and improving conditions she alleged. She refused to consider anything other than absolute closing of all the hospitals.
Not mentioned is the fact that some proportion of those deinstitutionalized are not able to care for themselves enough to remain alive.
My new book explores that. Hypothermia death rates more than doubled 1974-84, and characteristics of those who die match well with the deinstitutionalized mentally ill.
“One Flew Over the Cuckoo’s Nest” probably had a lot to do with it.
Mr. Abrams, your remark entails much more than you might realize. Below in Comment#11 I relate a bit about my bi-polar life, which includes stays in pychiatric clinics in more than one country. If a patient is totally “out of it”, a clinic helps and I mean really helps. But, once a certain self-control returns and the clinic of “Cuckoo Nest” begins, oppresively so. Alas, I have had the same repeated experience in a few clinics. There is a pattern: The patient can do no wrong. The presumption is that his illness has robbed him of autonomy. The docs and nurses and therapists all show understanding, compassion, willingness to help, and, being the knowers they are, demand control, thereby leaving the patient in heterotomy — this was the clinical situation in the movie. If the patient cooperates, he will be given ever more autonomy. What do I mean here? If I were thirsty, a nurse would go down the hall and get me a class of water. But, I wanted to do that for myself. Well, I at times was not cooperative. So, I was served and served until my failed automony became so clear to me that I started being healed (i.e., fooling my “caretakers”). That was the rule of the game! So, I started cooperating, saying all the right words, participating in all the right therapies, simply obeying and agreeing. Then, and only then, I was allowed to go down the hall (some 20 yds) and get a glass of water FOR MYSELF on my own volition. I prostrated myself just to have a “self” which freely acts. I can honestly say that I would prefer a year or two in a prison (where I might be seen as dangerous person, but as a PERSON) to the same period against my will in a clinic, where “my” will is no longer “mine”. Such a stay would make me incredibly aggressive.
I do not wish to be misunderstood here. Those who indicate mental difficulties with probable criminal (if allowed as a categorization by the courts) acts. In one country where I have stayed in Europe the state was forced by the EU to let loose some convicted rapists of CHILDREN who then, and with rapidity, raped again. The EU found that the state concerned had violated “human rights” with forced retention. Lawmakers scrambled to change the law such that indefinite preventive retention is possible. This would mean confinement in a mental clinic which, willy/nilly, means placing the person in a “Cuckoo Nest” without limits. Was not that a problem in the movie?
There is a problematic here. Dangerous persons must be confined. I hold that such a societal need should structure the confinement, i.e. it should not be first and foremost viewed as a therapeutic retention. Within the confinement the person of danger should be afforded therapy, but not forced to it or dehumanized to the point that his autonomy is erased. The first “moral” point is to get the individual to recognize the danger he (why do I write “he” when occasionally a “she” qualifies) is. At least autonomy is recognized in a type of forced retention where criminal law and punishment has nothing more to say. I am not sufficiently informed as to the legal and medical regulations for taking the dangerous off the street. I only suggest that a type of danger is entailed in such street cleaning. In more than one EU nation in the past (and in the Soviet Union), forced medical incarceration has been used to surpress dissidents. I only caution care and reflection. There is no easy solution.
One difficulty is that while the U.S. did not have a history of political repression by mental institution, the assumption that the U.S. had to be morally equivalent to the Soviet Union caused many civil liberties advocates to make this assumption.
And this is now embedded in popular culture. I just watched an episode of TV’s Perception, where a college prof, a “functioning” schizophrenic is smart and beloved. All he needs is his student assistant to keep him in reality, and he is fine! No meds, of course. IOW he’s just different, not sick.
This episode dealt with the long term hospitalization of a girl traumatized by a rape who then supposedly had a psychotic break. But our brilliant prof discovered she was administered the wrong drug for what was a head injury and this wiped out her memory. Of course, the huge health corporation that owned the hospital did it probably to keep her in the hospital. He saves her from the clutches of the corporation their hack doctor, takes her off her meds and returned her, damaged but alive, to her mother.
Reprehensible.
There are functioning schizophrenics–those whose hallucinations have not broken their connection to reality, or who manage to stay on their antipsychotic medications. Unfortunately, many people watch TV and think that it has something to do with the real world. That’s unfortunate.
There was a period in which mental institutions were “demonized” by popular media: Snakepit, One flew Over the Cookoo’s Nest,etc. The public probably thought these situations were indicative of what went on in mental howspitals. There were always tales of ‘nutty psychiatrists’ also. That, added to the pressure for civil rights, probably helped push the legislation through.
Well done, b.
Thanks for the “insider’s” viewpoint. You’re right,there are no easy solutions.
It is indeed a fine balance between the need to protect society and get treatment for the mentally ill but at the same time, to ensure that people who are not ill end up being committed for whatever reason. Those under 40 may have heard of “they’re coming to take me away” and “the men in white coats are coming for me” and not really understand why that was considered such a terrible thing. This was outlined in movies such as One Flew Over the Cuckoo’s nest and in the horrible connetations that people associate with asylums whch may seem a little outdated now. This was a real threat, once you were put away – to get out could prove incredibly difficult if not in some cases impossible. Certainly your chances of coming out unharmed or changed by drug therapy and other abuses were significant.
There are quite a number of cases where recalcitrant teenages – especially girls, ended up in an institution for disobeying their parents, being sexually active or going out with the wrong people. So although there is a need to strike a balance, I do not want to see us go back to that situation – no way.
I kept looking for examples of sane people hospitalized against their wills. Everyone knew that it happened–but actually finding documented examples was like chasing swamp gas. Can you give me some actual examples, with names, dates, places?
This reply will probably not be of any help to you, but FWIW here goes : Way back in the dark ages of the early 1980s, I read a book which even then was ‘older’, ie, probably already outdated. (I found the book in my high school library.)The book detailed abuses people had been subjected to through the centuries via the law, governments, other forms of authority including religious bodies. The book had a chapter on abuses of the involuntary committal process. It discussed a woman who had been committed solely on her wealthy husband’s say-so, a teenage girl committed when she became depressed after she had been involved in a sexual relationship with a much older, married man, a man who (his account) was depressed but NOT suicidal, but was forced into IC by his psychiatrist upon the psychiatrist going on vacation “just in case”…The book IIRC was EITHER Clifford Crawley’s 1969 The Right to Live, OR G Rothman’s 1971 The Riddle of Cruelty.
Neither book appears to be available online. Even though whichever book it was had detailed case histories presented, it is unlikely the accounts would use the person’s true names-surely the author would have used pseudonyms to protect his sources from the embarrassment their committal would have caused them in those days (and still today?) . After all these years, I cannot recall if both or either book had an index or bibliography listing newspaper accounts of (e.g.) cases where an involuntarily committed person who had regained freedom sued the person they believed had made a false report causing the committal.
(So how did I remember the author and title of these books? I began keeping a log of every book I read, starting in the first Reagan administration. I have kept this log ever since. Few things are more aggravating then wanting to re read a book, but not being able to remember the title or author. Sometimes even the font can be seen in the minds’ eye-but not anything to enable one to identify the book . That happened one time too many, hence the log.)
I will see if I can find them. One of the difficulties is that indeed, those writing such books were often using pseudonyms, making it difficult to verify the accuracy of the accounts. Even books such as Prisoners of Psychiatry, which made similar claims, often failed not only internal consistency checks, but checks against external documents.
You see, I don’t doubt that there were abuses. It’s part of human nature. But if this was common, you would expect it to leave more tracks in court decisions.
I would doubt that many people who were wrongfully institutionalized would have had access to any form of legal help, especially if family members were to blame for keeping them there.
I don’t have documentation at hand, but when I was taking Psychology 101 for my General Ed requirements, I read of a case where a researcher had a few graduate students present themselves for admission to a mental hospital. They were to claim to have heard voices saying “Empty, hollow, and thud”, and otherwise behave normally.
The researcher thought none of the students would be admitted, or if they were, they would be spotted as normal in short order and released.
Allegedly, all were admitted, and none were spotted as actually normal. Their behavior was interpreted through the filter of being pathological. Keeping a journal was described in charts as “writing behavior”, strange because none of the other patients did it. It is alleged that in a couple of cases, the researcher had to intercede to get the students released.
If true, it’s an example of “when your only tool is a hammer, every problem becomes a nail”.
And none were involuntarily committed, were they? Hospitals have serious problems with von Munchhausen Syndrome with physical illnesses, too.
IIRC, the article you’re talking about (graduate students reporting voices saying “empty,” “hollow” and “thud”) was On Being Sane in Insane Places, author Thomas Szasz.
Thomas Szasz: right there is a credibility problem. I quote passages in my book from some of Szasz’s writings on the subject of schizophrenia. It is hard to imagine why anyone took him seriously.
There’s a musician of whom I am fan who was put into an asylum. From what I gather, it was not willingly. Her name is Emilie Autumn, and she has written a book about her experiences there and many songs as well. Some of her interviews are also quite interesting; those can be found on YouTube.
I haven’t read the book but I’m fairly sure it would be an interesting read on the subject.
http://www.usatoday.com/news/nation/story/2012-07-24/john-holmes-smart-academics/56467518/1
Hey Cramer, according to this article Holmes was described as a ‘dolt’ and ‘mediocre’…maybe you might want to revisit you meme about the violently mentally ill and intelligence…either that or wait until all the facts of the case finally come out instead of engaging in knee jerk reporting like the rest of the media.
Honors graduate of UC Riverside. PhD programs in the sciences are not generally open to idiots. Sorry, I don’t think I buy the USA Today article.
I think I concur with Clayton.
“Not an elite neuroscientist” is not that low a bar. I don’t know what the average is like in the graduate program, but if he was an average student there, I don’t think “dolt” really applies.
Something is uncanny here. The murderous student comes from my hometown, studied at a uni. in California where I taught, started to attend a Colo. uni. where I taught and killed people in a town where one son of mine lives. Beyond that he is intelligent and that I also am. Not only does this “accidental” parellel strike me as unnerving, it also recalls my own bi-polar life, the echoes of which still resonate. Perhaps I can say something of interest, including for the med. doctors, psychiatrists, and psychologists who might find me to be an interesting speciem of research.
Just a note of preface here. Long ago I came to the conclusion that at least two of my children, quite brilliant, suffer from the same malaise as I. My parents saw a problematic in me when I was still a baby. I have collected some academic and professional medallions that dwarf Mr. Holmes’s career to present (who knows what accomplishments that brilliant young man could have achieved–so I limit my narcism). Legally retired early as “nuts” (not the exact words of the Soc. Sec. judge, but close enough), career gone, family no more, I cruise about the world observing the insanity of normal healthy humans. At any rate, I can certify that some of the most brilliantly imaginative people I have known frequented the clinics that have dotted my life, though I never met a Van Gogh.
What causes all this “insanity” in the mind of some intelligent persons? Pardon, me, let me offer a more sophisticate term, namely the etiology of madness. It is important to note that trials and tribulations of bi-polars do not have to have violent expression. They just ruin life and lead one to seek socially unacceptable substitutes for vitality. Ernest Becker, in the most revealing book on psychology I have ever read–and I have read many, many–writes in his “The Denial of Death” the following: “I believe that those who speculate that a full appreciation of the human condition would drive [the individual] insane are right, quite literally right”. Becker even suggested that the “intelligently” insane might be justly so. Paradoxically, one can be sanely insane. The problem is that most insane people are “dumb”, whatever IQ is present. Becker’s thesis –and with my “full appreciation”–is, of course, no more than a generalization. It is up to the treating psychologist to uncover the specifics of the “dumbness” behind the maleadjusted patient. (I do note that if a clever patient reads enough than s/he needs but find out the treating psychiatist’s school, and than manipulate him/her–fascinating sport. Is this hubris on my part, do my words suggest illusion of grandeur? I think not! Just empirical experience.) A cure is not to learn to deny all disturbing factors in one’s personality, i.e. a return to vital lies, all of which are necessary and now in effect in me as I write this very second, rather to learn how to integrate the “appreciated” human condition into a life style that allows for social functioning. A healthy person is not free from the human condition, he just can cope with it (denying, as Becker would say, the mendacity of “vitality”). What is the point of my comments?
My public self-analysis has been made to express my pleasure at such an incisive article as Dr. Cramer has written. Any attempt to politize the truely tragic “maladjustment” of such a brilliant killer, be it on the left or right, is to render totally senseless the terrible deaths of so many. From the point of view of etiology, politicizing blocks any attempt to gaze into the human condition and to see oneself. Gun laws are secondary, though no guns at all do not abolish the difficulties of mental suffering. I still gaze at my appreciated insanity every morning and worry that the effects will linger through out the day. They do not and I remain “sane”. I have concluded that the ultimate solution, totally out of touch with our modern secular times, requires a religious dimension. The psychiatrist can use religion in therapeutic treatment, but he does not, God knows, have it to offer. The appreciation of the human condition that haunted Becker is a structural difficulty for which man has no answer. The cure for my sane insanity is not of this world! If someone thinks that one does possess the cure, there is always the insight of Becker, namely: We humans kill in order to liberate ourselves from the (bearers of) death. (Personally, I suspect that Hitler killed so richly and joyously to save the “Herrenrasse” from death, and when that raced failed him, he wanted to destroy it too. An extreme parallel to Colorado???) At any rate, maybe such audacity was the unconscious motivation behind the murderer in Colorado. What do you “quacks” think?
Let me emphasize that while people with bipolar disorder sometimes get themselves into trouble (search for Clinkingbeard), the most serious problem from a public safety standpoint is schizophrenia.
You are right. An extremely intense and intelligent friend of mine what picked up roaming the streets with a 45 in his hands. He was paranoic and schizo. But, in my opinion, neither of those features are necessary for the bi-polar sufferer to become violent. There are some “existentialist” reasons for aggressivity. Neat categories are not available, though that is about all we apparent have.
Kaye Redfield Jamison, herself a bipolar patient, has written numerous books about mental illness. She was going to become an MD but, because of her illness, dropped out. She is currently a professor at Johns Hopkins. One of her most interesting books takes on many artists, writers, and musicians and their mental illnesses.
b, having just read William Davis, M.D.’s “Wheatbelly” I can’t help but wonder what might happen if you tried the “paleolithic diet”. T’would sure be funny if a few dietary changes were all that is required to clear out the fog. If it did, we’d all feel kind of silly and regret all the lost years, but it would be worth trying for a month or two. I’d try it as well, but unfortunately I don’t have two nickels to rub together…
Mr. Cramer: At this point we do not seem to know enough about James Holmes’ state of mind prior to his madness to know whether any of the recommendations you make would have the prevented the tragedy from having occurred. But I should note that others have killed many more, although slowly over a period of time, so it was no so spectacular. To name only two, there was John Wayne Gacy and Jeffery Dahmer, and yet no one detected their madness until many, many had died.
I think we have to live with the fact that there cannot be perfect certainty in this world: cars crash and people die, planes crash and people die, hospitals make mistakes and people die, etc. That is the human condition, and we should accept it as such. While we want to make the world a better place, we cannot make it perfect and we should accept that.
Utopia is not an option. There are many others, as my books documents, who gave plenty of advance warning. The guy who killed six at Cafe Racer in Seattle in May. The guy who shot up the U.S. Capitol in 1999 killing two police officers. The Virginia Tech killer. The killer at the Jewish Community Center in Los Angeles. And many more.
The deinstitutionalization of mental hospitals came at the very same time that they (liberals) did away with orphanages. The result in the 80′s was an INSANE rise in violent crime. Thanks to that and the publics cry to “DO SOMETHING!!!” we now have the police state we currently live in.
Mostly agree with this statement.
Add to this: (a) movement to decriminalize and in some countries legalize, marijuana possession and use; (b) invention of so called non-invasive monitoring devices of the population like CCTV and the tracking capability of cellular phones; (c) increases in the building density in the big cities (so called “smart growth”) to increase the property tax revenue and support social services expenses; (d) an increase in the lack of toleration for individualism encouraged by the prevalent mass media culture & the PC movement.
When I was growing up Sylvia Seegrist killed three people (including a two year old) and wounded more at the nearby Springfield Mall (outside Philly)
She wore combat fatigues and would walk around talking about how cool other mass killings were. She was so visibly disturbed that she was actually denied a gun when she tried to buy one (the store clerk claimed he was “out”)
Sadly her mother had taken her to psychiatric care- Sylvia was a paranoid schizophrenic- her mother even warned the police that she was becoming violent-
The police told her mother that nothing could be done until she attacked someone.
Flashback: 1970′s. The star student of 11th/12th grade, sterling AAA grades etc. developed adult onset schizophrenia, could not manage university, wouldn’t stay on medications, would disappear and be found months later across the continent in a homeless shelter.
I last spoke to her about 10 years after high school. She told me things about myself and what I should be doing with my life that were tremendously perceptive. Thirty years later, I value that insight.
Surely there has to be a middle ground for someone like this that does not involve locking them up, someone who has tremendous capacities but needs attention too.
Sure there’s a middle ground.
But first the powers that be must be made to accept the inevitability of the opposite pole from what now obtains–there are people who should be committed for life before they hurt someone.
Our society can’t afford to do long-term hospitalization of everyone with mental illness, and in many cases, it is neither necessary nor useful. But the current system is too far the other direction. In 1938, about half the psychotics in the U.S. were institutionalized. Now it’s about 5%.
Yeah, and the rest vote Democrat.
Not clear how many even vote.
Clayton, you missed it.
That was a gratuitious slam of Democrats, implying that they are psychotics, not a serious comments on the number of psychotics voting.
But, as I tell my children, a joke explained is a joke ruined.
I caught the joke. I didn’t find it funny. This is a very serious problem, and one that many Democrats will agree needs fixing.
I’ve come across a few articles that mention a not-so-surprisingly effective middle-of-the-road approach. Programs where the mentally ill have to regularly take their meds in the presence of a social worker or their government benefits are cut off.
Seems like nobody’s too crazy to reason that one through.
For many years now, the mentally ill have been forced to live on the streets of major cities, like New York and San Francisco. These people not only commit crimes, but they also have the potential of killing people as well. Some do murder innocent people and then they are simply stashed away in prison with other inmates who are not mentally ill, which doesn’t really help the people in prison at all. At the very least we should be looking at the homeless people in our major cities and seeing why they are homeless. Is it because they can’t find a job, or because they are mentally ill. There is a huge difference between the two and it’s about time we start to acknowledge that.
There’s a flipside to that as well. A lot of these folks are extremly vulnerable. Many are middle-aged or older. They have no money or anything else anyone would want, but there are people in my city who would beat them to death just for fun. So even if they’re not a danger to society, society can be a danger to them.
Yes. At one time Santa Cruz had a problem with “bum bashing.” Some young people there decided that beating up homeless people (many of whom are mentally ill) was both fun and useful for driving them out of town. Homeless mentally ill people are also disproportionately victims of violent crime. The paranoid are less likely to trust police.
A sad commentary on one contemporary American town reminiscent of the Nazi treatment of psychiatric patients. Nazi comparisons are made too much (and as the child of survivors I am careful not to make them) but in this case, if the shoe fits…..
And a completely inappropriate commentary. that was not policy.
It was young thud being thugs.
Have to agree with tom. Big different between bum bashing and Aktion T4.
Interesting item on Wikipedia’s page about Aktion T4. There’s a poster put out by the Nazis showing a mentally ill/handicapped man an his caretaker. The translation of the poster’s text reads: “60,000 Reichsmarks is what this person suffering from a hereditary defect costs the People’s community during his lifetime. Fellow citizen, that is your money too. Read ‘A New People,’ the monthly magazine of the Office of Racial Policy of the NSDAP.”
The beliefs and assumptions that appear to underlie this ad seem familiar, but I’m not sure why.
While de-institutionalization certainly has caused problems, I’m not sure that society, as a whole, would be better off under the prior situation, where you could be institutionalized with a lesser burden-of-proof.
The potential for abuse in such a setting would be huge. Yes, every so often, a crazy person erupts and kills a dozen people, whether by driving in to a bus stop, or opening fire in a theater, but my guess is that under the old lower burden-of-proof system, FAR more people were involuntarily committed, drugged, abused, and surgically mutilated every month in mental institutions.
If you think about how vicious people are, in terms of filing false claims of rape, robbery, murder, tax-evasion, child-abuse, spousal-abuse, and pretty much everything else, you’d have to assume that people would falsely accuse someone they didn’t like of being schizophrenic, hearing voices, etc. on a regular basis. The false commitment rate must have been tremendous.
And let’s not forget the potential for government abuse: remember how the Soviet Union treated dissidents. Do you really want to live in a system where you can be hauled away by force, and be institutionalized (and forcibly medicated) after a session with a state-employed psychiatrist who decides that you are insane because you protested the President? Because you’re a member of the NRA? Because you attended a Tea Party rally?
If this had been a problem in the U.S., where is the evidence for it?
Where’s the evidence, hmmmm
http://www.law.virginia.edu/html/news/2006_spr/perlin.htm
http://www.nytimes.com/2009/02/06/nyregion/06kings.html
http://www.pbs.org/wgbh/americanexperience/features/primary-resources/lobotomist-bedlam-1946/
http://www.ajc.com/services/content/metro/stories/2009/01/16/georgia_mental_care.html
Google is your friend.
You are the one asking for the initiation of force – therefore it is your job to prove the government is failsafe.
http://www.amazon.com/Mad-In-America-Medicine-Mistreatment/dp/0738203858
Utopia is not an option. Were there abuses? Any system with people in it has mistakes and abuses. But scrapping the old system created a different set of problems: homelessness; increased murder rates; people dying of exposure.
What impresses me is how few clear-cut examples I can find of sane people being institutionalized.
No system involving human beings is failsafe. If failsafe were our standard, we wouldn’t have a government at all.
Hell, we’d never do anything, if failsafe was the standard.
Having done no research I cannot give you examples. I can give you an example of how a volutary commitment became an involuntary one. That example is, of course, myself. I freely entered a clinic at one point. After initial improvement I wanted out. The chief psychiatrist thought otherwise. I overheard said doctor inform my wife of his wish to retain me. He even mentioned that, should I resist, he had burly male nurses who would retain and restrain me. So, I remained for more time. Actually, not a bad idea and I wish now I had stayed longer. Whatever, I am an example that voluntary entry can become a blocked exit. I wonder how many other times such things happen. The danger is there. The patient, even if only a bit wobbly, is no match for a psychiatrist and his/her dictates. I felt cowed. Maybe I was the only person in the entire history of the US of A to have such an experience. But I did have it and I felt defenseless. In my unique case I would want to have legal defense easily accessible and right of exit. Tyranny is, well, tyranny. So, your points are well taken. I do demur a bit because of dangers entailed. I am not liberal and am aware of violent rapists be let go in a EU country which had no legal way of retention.
The question that I asked was an example of someone held against their will in the U.S. because of their political beliefs. It does not sound like that was the reason that you were held.
What state was this? There are state-to-state differences on when someone can be held against their will, but in nearly all states, there must be imminent danger to self or others before involuntary commitment. Did the psychatrist believe that you were likely to commit suicide in the near future?
In light of the uncanny parallels with which I started my comments, what other state could it be in my case than in Colorado. I spent three periods at that clinic, only the first time did I feel aided. My innate problems were intensified by some personal ones resulting in a flood of depression. I entered a second clinic in another Colorado town for the last ditch treatment of 9x/electro-shock treatments. All though freely there I had the impression that just walking out needed permission or no leave. The electro-shock treatments worked in one sense and one marvelous sense only. They gave me back a desire to try again. And so I did. This reactivated the energy side of my personality and I have achieved some things. But, what remains is a tenusous balance from bi-polar ups and downs and the sense that the damn could break. I do think the inward directed energy of self-destruction of extreme depression can suddenly be redirect such aggression outwards and there a bi-polar non-schizo can become aggressive,maybe even violent. I felt that, but channelled violence into Martial Arts and remaining energy into creativity. All to the good, but a hell bubbles in the depths and enters consciousness everyday. I hope you understand that I do not wish to give the exact clinic. The date was, I believe, 1985. I thank you for your article. Someone needs to keep watch over society’s treatment of the mentally ill, specially of a pathological type. (Aside: What creativity for good was in that violent young man? Maybe he might have made discoveries in neuroscience offering help for sick mind. If only he had been caught in time! And that hope brings me full circle to your efforts. At the moment, his appearance in court give me a slight impression that he is “playing” with the system. If so, he is as “crazy” as ever.
P.S.: There is one political postion that should bring with it forced clinical retention. If a citizen longs for his individual liberty to be responsible for himself and announces that he will campaign or our current president, we have prima facie evidence of insanity, OR???
The false commitment rate must have been tremendous.
It was. The combined imprisonment and institutional rate in the 1950′s was actually higher than similar rates today, despite the huge increase in imprisonment in recent years(due largly to drug prohibition).
1. You are assuming false commitment based on numbers institutionalized.
2. Mental hospital populations were very high into the 1960s partly because of high numbers of syphilitic insane (we don’t have much of that at all anymore) and elderly senile (who started to move to private facilities once Medicare started to pay for such care).
Uh, no. The dramatic expansion of prison populations in the 1990s was because of increasingly severe sentences for a bunch of felonies, especially violent and economic felonies. Libertarians like to believe that marijuana possession sends a lot of people to prison. That’s simply false. Meth and crack certainly sent people to prison in larger numbers, but this oversimplification of prison population expansion to War on Drugs doesn’t fly.
Look to Kesey’s One Flew Over The Cuckoo’s Nest to see the beginnings of a movement to see commitment as a civil rights matter rather than a medical matter. This put lawyers between the patient/family and the physician. Rather than providing a safe, consistent environment for the chronically mentally ill, we have legions of advocates who get paid to maintain a miserable system.
I have talked to a number of psychiatrists over the years who tell me that this film is the single biggest reason for judges to refuse to commit. Apparently, many judges didn’t realize that it wasn’t a documentary.
You and I sparred a bit over this in an earlier post; I know from first hand experience that “…Cuckoo’s Nest” was entirely too realistic. Not all big mental hospitals were like that, but enough were. I know – very well – someone who was judicially committed for a psychiatric evaluation over a SPEEDING TICKET in a Southern state in ’69, couldn’t have had anything to do with the length of his hair, could it? A judicial committment, even for an evaluation, in those days was a life sentence with right of habeas corpus.
That said, we have thrown the baby out with the bathwater, but we can’t go back to the whim of a judge or a couple of family members – and “whim” is what a preponderance standard is. I’m not naive enough to get into the vagaries of the various standards of proof; they all boil down to does the trier of fact believe it, but there must be a reasonable check against error and that check shouldn’t depend on the connections and financial resources of the person asserting error.
Proofread, dammit!
“in those days was a life sentence with right of habeas corpus.”
Should be: in those days was a life sentence withOUT right of habeas corpus.
Lifetime involuntary commitment was certainly unnecessary. Some states did require periodic renewal of commitment orders, and any revision of our current system needs to make sure that this is not just a rubber stamp action.
A speeding ticket? You sure that there wasn’t something else involved, such as inappropriate comments or behavior when pulled over?
Sure there was something else involved; long hair, a reputation in the community, and a belief by some in political authority that the subject might have been f**king their daughters and giving the holy little virgin Dixie Darlins’ drugs. Nothing happens in a vacuum. If you believe in law and order, you don’t know anything about law and order. My solution was to become one of the a**holes who understood law and order and I’ve lived very well as the result.
How long was this guy hospitalized? When was he released. Do you have a name for him? (I realize that this was a long time ago.)
He was “hospitalized” for most of a year. He was never released; he walked away, got the Hell out of the jurisdiction, and only returned many years later when people had died and times had changed.
Different states had different rules on this. Many states required two doctors and a judge; some required a coroner’s inquest. Some used commissions of lunacy (usually a lawyer and a couple of psychiatrists) to determine whether commitment was appropriate or not.
A lot of people have trouble distinguishing between Hollywood and reality. I think it’s a by-product of too little education and too much time watching the idiot box.
This shows up in the jury room, too, to the detriment of justice.
Of course, when fiction is so often presented as documentary, it doesn’t help matters. Think Al Gore and Michael Moore.
An old theory is that art represents life, sort of a focus. Whatever general value such an old-fashioned theory has, it catches artistically a “Nest” experience that I have had several times in more than one country. This is no place for a detailed cinema critique. If so, I would bring in the aspect of women dominating men in the praxis and the wiseman chief psychiatrist in the highup background. The point of the movie that I can attest to is the de-autonomization of the patient. I grovelled for some automony, be it not more than the permission to go get a class of water for myself. Dangerous people must be retained. But the legal structures and governmental means of “detaining” portend dangers. That is all!
It seems obvious: the old system didn’t work, the current system doesn’t work, so we need a new system. Does anyone ever propose a different way to deal with the mentally ill? Or do too many people have too much invested in the current system that they don’t want to change it? Or are they afraid to change it?
Involuntary outpatient commitment is one of the newer strategies. And obviously, we aren’t going back to 1960. But we can improve the situation considerably over the current mess.
Actual treatment should be tried! (Drugs are not treatment of emotional/psychological problems.) As someone who never had trouble with ‘mental illness’ before my husband mentally abused me for 10 years, and I was hit with several tragedies, and as someone who has read plenty on both sides of the psychiatric drug issue, I resent the fact that it is assumed that so called ‘mental illness’ just happens in a vacuum and has nothing to do with abuse or horrible life tragedies like divorce, loss of children, or serving in a war. The studies they try to use to prove a genetic component for mental illness often take no account of henious abuse or tragedy in people’s lives that account for their depression and breaks from reality. Common sense looks at what some people have gone thru and is amazed that they are still sane at all. It’s been known throughout history that extreme circumstances can drive a person insane. WE are not surprised that veterans come home ‘shell-shocked.’ But now it’s called a ‘chemical imbalance’ (that can’t be medically tested for, hence is totally unproven and not a scientific statement) and people are given drugs for it that drive many, many people over the edge. Antidepressants and other drugs have been proven to contribute to violence and suicide. I can attest to the horrible body-raping, insanity inducing agitation these drugs cause — and how innocuous sounding ones like “Abilify” can rob you of your eyesight, ability to read, concentrate, and function. If you are agitated they say it is your ‘disease,’ not a side effect of the drugs, but you know better when it ends as soon as they remove that drug. If you can’t function or concentrate, they say it is your ‘disease,’ and not the drugs, but when you get your ability to read and do your homework back as soon as they remove that drug, you know better.
The drugs are extremely dangerous when going on them, changing the dosage, or going off of them (NO ONE should go off or switch any psychoactive drugs suddenly — even if the doctor says it’s ok — you must wean off slowly!) THese drugs are as addictive as street drugs and work exactly the same way. Some people do ‘feel better’ on them, but they are not curing or helping anything — they are just medicating personal problems that need to be dealt with. When people medicate their emotional pain with alcohol, they are called alcoholics, or drunks. If they use marijuana, they are called stoners or potheads. If they use ‘hard stuff’ they are called drug addicts or junkies.IF they use sex, they are called whores or sex addicts. But if they use psych meds they are called good patients.
I know others struggling with emotional issues/mental illness, and they have all been either abused or experienced terrible gut wrenching tragedy — which when combined with high intelligence and a sensitive nature DOES lead to problems functioning in a society where almost no one gets enough emotional support anymore to survive daily life, let alone tragedy. Most therapists and family doctors now push drugs, and when you are high on drugs you can’t always deal with the real issues as well, or you ‘feel better’ so you refuse to deal with them, or you are told you are not responsible for truly getting better — you just have an illness like diabetes for which you just need to take your medicine forever. Stupid! Deinstitutionalization happened about the same time as family therapy began to make real progress in addressing how family dynamics contributed to psychological problems, yet the psychiatric profession turned to more and more supposedly new and better drugs each decade and more away from any semblence of therapy, now lip service is paid to therapy, but most of it is drug follow up, and there is no real therapy going on in even the ‘best’ community mental hospitals. Other than at your intake, no one even asks you why you are unhappy, upset, etc. (I’ve seen women shaking with terror, crying, and none of the counselors or nurses would touch them to reassure them because of rules, they were being ignored until I, a patient, went to them to calm then down by speaking softly and reassuringly to them, and secretly holding their hand!) Nothing you say matters anyway — everyone gets drugs. No one thinks you can get better without drugs. The only way to get released is to play the game — take all your meds, act ‘normal’ which means among other things — don’t act too happy, and go to all the ‘groups’ which are either just some basic educational topics on how to deal with stress, or lessons on “don’t go off your meds.” The people I know who have dealt with their problems, believe in God, and take little or no medication are all doing great adn are contibuting members of society (including me — I work full time and have raised 8 responsible kids). The ones I know who strongly believe in their diagnosis and take whatever meds their doctors suggest have constant struggles in their emotions, daily lives, and relationships with their families that is pretty easy to trace to their unwillingness to ‘deal with their baggage.’ THey are not truly ‘functional’ at all even though they may be successfully surviving in a passable modern lifestyle. What really helps people emotionally are support, hugs, listening ears, good advice (friends or counselors that don’t just agree with whatever you say), and trusting God to help you deal with loss, and RESPECT for your personhood (something you will never get from most mental health professionals.) The only thing helpful about a hospitalization is the break from taking care of everyone else and making friends with other people in there who understand what you are going through and treat you like a real person with something valuable to say – we counselled and consoled each other–We even ‘tamed’ a real raging psychotic with kindness, enticing him outside into the sunshine, etc. until we got him relating to people normally again– but we got almost nothing from the staff — and this was a really nice hospital with otherwise nice people staffing it — it reflects their conscious decisions on proper ‘treatment’. (A real vacation would work just as well. But this is the only vacation a poor working single parent is likely to get.)THe heartbreaking part is now your family can blame you for being mentally ill, and refuse to take responsiblity for how badly they behave or their lack of emotional support. I have dealt with this even though I have a very ‘nice’ family! I can’t imagine what it must be like for those with a seriously dysfunctional or abusive family — especially if they don’t understand how dysfunctional it is. Not that I believe in playing victim and blaming others for your problems instead of dealing with them as best you can, but we need to look realistically at what causes people to be depressed or even psychotic — circumstances can have a lot to do with it. Anyone who feels trapped to the point of hopelessness will become ‘mentally ill.’ This whole discussion is ignoring people like psychiatrist Peter Breggin and other therapists who have ‘cured’ hundreds of people diagnosed with psychosis or schizophrenia with their empathy and attention instead of drugs. THis is not to say that all can be helped that way — some people are filled with hate and anger and don’t want to get better — but many will if treated appropriately as persons with free will — not as incurable life-long mental ‘patients.’
Depression isn’t schizophrenia.
I would also include the med student who killed several women in the New England area. There are probably many others. Many authors and artists have had various forms of mental illness. Sometimes that is only revealed after their death.
A psychiatrist who practiced in the Washington, DC area pushed for closing mental hospitals and wrote frequently about it. Strange, I read little about him AFTER the hospitals were closed and former patients appeared on the streets.
When I was volunteering at a homeless shelter, many of the occupants were mentally ill who did not take their medications. Unless there is a responsible person to check, I think this often happens. It is a stressful position for anyone to be in but it must be done,
This is an obvious topic for more investigation and I hope someone takes the results seriously.
Two flaws in this argument:
1) I’m not convinced that schizophrenia is genetic. It certainly does not follow the Mendalian rules of inheratence. It is more likely caaused by an infectuous agent during embryonic development. Toxoplasma is one possible infectious agent that may cause schizophrenia.
2) I am also skeptical of claims that mental illness correlates with intelligence. I think this cunard is promulaged by those promoting a “leveling” political agenda who seek to denegrate the more intelligent.
While de-institutionalization certainly has caused problems, I’m not sure that society, as a whole, would be better off under the prior situation, where you could be institutionalized with a lesser burden-of-proof.
The potential for abuse in such a setting would be huge. Yes, every so often, a crazy person erupts and kills a dozen people, whether by driving in to a bus stop, or opening fire in a theater, but my guess is that under the old lower burden-of-proof system, FAR more people were involuntarily committed, drugged, abused, and surgically mutilated every month in mental institutions.
3) I agree with this 100%! People have been institutionalized in the U.S. for ideological reason under the old system. This kind of abuse was not only in the former Soviet Union. Also, psychiatry is not a real science. Neuroscience is a real science. The diagnostic catagories of psychiatry do not correlate with any etiology, what so ever. Additionally, a patient diagnosed with one condition today will be diagnosed with a completely different condition 6 months later. That psychiatric conditions do not correlate with any etiology, not to mention any changes in neurobiology, makes clear that psychiatry is not (yet) a legitimate science.
People should not be deprived of due process on the basis of a bogus science in the absense of any criminal acts.
There is obviously more than simple inheritance involved. Toxoplasmosis as the infectious agent is one possible cause. Alcohol, marijuana, and LSD are also apparently causal factors (likely for those with the genetic predisposition).
Don’t confuse psychodynamic psychiatry with the whole field of psychiatry. The psychodynamic school sort of took over what was a more biologically based field in the mid-20th century, and exercised enormous influence through their control of the NIMH.
“People have been institutionalized in the U.S. for ideological reason under the old system.” Examples?
i suppose you have a study showing causation as opposed to correlation?
Attempts to self medicate are equally well supported by what you’ve said so far.
Yup. A bunch of different studies published over the last 15 years have controlled for pre-existing signs of mental problems, and demonstrated that people with no pre-existing difficulties were at increased risk from regular marijuana use. What amazes me is how many people don’t find that alcohol and LSD use increases mental illness risk but get absolutely insistent that pot is different.
You have citations??
Of course I have citations. The book has a somewhat longer list of citations in the chapter “What is Mental Illness?” But http://claytonecramer.blogspot.com/2010/11/marijuana-and-mental-illness.html gives you a number of the studies. This isn’t all that buried. Even CBS News reported on one of these studies when it came out.
This is actually a hot topic in scientific research right now. Go to scholar.google.com and search for “marijuana schizophrenia”.
The skepticism is warranted with them claiming to have statistically proven a negative.
What do you mean “statistically proved a negative”? Because they identified that subjects did not have mental illness symptoms different from the rest of the study group before they started smoking marijuana?
There’s also a study that suggests schizophrenia may be a disease trapped in our genes, and that we have certain genetic structures that prevent it from being expressed. If something interferes with those structures–an illness in early infancy may do so, for example–then that person may gradually develop schizophrenia.
The study also suggests that Multiple Sclerosis may be expressed in a similar way.
Longitudinal studies have appeared in the USA and UK equating long time use of marijuana with the late onset of various psychiatric maladies in people over 50. The studies I’ve seen are from reputable institutions and can no way be labeled scare tactics.
How does this trend (if it is indeed a trend) correspond to the inevitable COSTS to a public health care system? The Brits have had their NHS the longest and were the first I believe to posit this trend.
Yup. My book points this out. Alcohol and LSD are also causally connected. The risk seems to be highest the younger you become a regular user.
I make no such assumptions. I do see the weakness in EU countries. I am basically in accord with you. I mention “civilized” and not so civilized EU countries and their past as a warning, as something to think about. I did not seek to refute you. So, please, no guilt by similar thoughts pushed on me. I sought to suggest a point of reflection, because I have experienced the American way of the “Cuckcoo Nest”. I have read articles in PJ Media that indicate that some psychiatrists hold “sorrow” for longer than a couple of weeks to be an indication of mental disorder. I do not wish to be retained should I be confronted with such sorrow. Your case is solid! The US is not Europe or the Soviet Union of the past. There are, alas, indications that not preferred emotional behavior is being considered in America as a sign of mental disorder. Before I would let myself be put into a mental clinic in the US or in Europe (where the Europeans copycat American methods), I would fake sanity–and I know how to do so. Again, I am not arguing against removing dangerous people, mentally disturbed in a significant and dangerous manner. I am worried about pychologists (specially government financed and controlled “quacks”) floating about seeking the “disturbed”, particularly with the current administration and its desire to take care of us all. Wait tell HHS Mandates appear mandating “mental” health criteria. In other words, I am worried about simply putting the “disturbed” into a mental clinic structurally run according to the main features of the “Cuckoo Nest”. In some case, a prison-like atmosphere is preferrable to an endless Nurse Ratchit (or whatever her name was). They are per method there. So, please, reflect upon the unintended consequences that forced instituionlization could produce. That is all! Does that wish make me a leftist?
The comment by myself immediately above was supposed to be attached to Cramer’s response to my resonse to Comment #8 by Asher Abrams. It is out of place and rings silly as such.
The psychodynamic school’s desire to see almost everyone as “not well adjusted” is part of what discredited psychiatry in the 1960s. The more biologically based psychiatric establishment recognized a clear dividing line between psychosis and mood disorders, and that only a small fraction of the population was seriously mentally ill.
The psychodynamicists did tremendous damage. It started with the Freudian cult and after too long a time, morphed into less cultish but still foolish systems.
Patients were harmed. Society was harmed. The field of psychiatry was largely discredited, resulting in a decades long period where insurance would pay little or nothing for psychiatric care.
Even now, Hollywood’s plot lines are loaded with silly psychodynamic interpretations of behavior. Government policies are still frequently influenced by this nonsense – especially on the left, where these ideas were most popular.
A friend’s father was a Viennese psychiatrist who emigrated to the US in the 60′s. He failed his first attempt at the credentialing boards because Freudian psychology was all they would accept, and ironically, Vienna had already abandoned that nonsense.
Today there seems to be more of a balance between biological and psychological theories and treatments, since plenty of studies have shown most psychotherapies to be useless, but some evidence based techniques to be helpful (such as cognitive therapy).
The current standards for making people simply disappear for days or weeks are already frightening loose. I entirely agree with those who have pointed out the appalling potential for abuse that without doubt *was* realized in the bad old days of the flimsiest possible legal grounds for violently kidnapping and imprisoning innocent people for years against their wills. Hysterically making monkey motions at a few obviously ill individuals does not in any sense justify mass contempt for civil rights by state actors.
“One Flew Over the Cuckoo’s Nest” actually portrayed a much gentler scenario than that met by rebellious teenage girls, hippies who made the mistake of traveling through the Deep South and others who simply annoyed the powerful. I frankly and bluntly spit on the arrogant filth who would return to those days.
Give me some evidence for your claim. Book titles? Legal decisions? Something?
I’m curious: what do you think are the current standards? And when you say “simply disappear”? Do you think that a person held for observation is not allowed to call family or friends?
I can well understand your dislike of communities that do not accept the “stranger”. But, please, do read your words. They bespeak a proto-violent attitude. When does “spitting at” because “hitting at”. I repeat that I have some understanding of your feelings. But feelings can have their own augmenting logic. I suggest “disdaining” is better than “spitting at”. I am fearful of violence and what might lead to it.
I read author/screenwriter/movie reviewer/conservative cultural critic Michael Medved’s autobiography “Right Turns” when it came out in 2005. I hate to pop your self-righteous culturally-bigoted bubble but he wrote several chapters about how he spent his college years in the 1960′s hitch-hiking around the country during his summer vacations and he spent plenty of time roaming through the South–an obvious long-haired Eastern jewboy–and he wrote of encountering nothing but politeness and courtesy.
He recalled being gravely offended when the movie “Easy Rider” came out during this time and his fashionable liberal college buds (including, at the time, one Hillary Rodham) raved about it. He went to considerable lengths telling anyone who would listen that bigoted, violent depiction of the American South did not in any way resemble what he had seen.
Between 1 and 2 percent of the population has schizophrenia and another 1-2% is bipolar. About 25% of the population will have depression will have psychosis with it. You want to lock up the mentally ill? Which ones? While a small percentage of people with bipolar disorder pr schizophrenia cannot keep housing without assistance, and a much smaller percent commits unprovoked violence (please do not include self-defense), which ones do you want to lock up? It is generally the undiagnosed who go on rampages. Anti-depressives can cause the individual to kill, either self or others. Antipsychotics can deaden thinking and feeling.
Also, I was dealing with a psychiatrist while a member of NAMI (National Alliance on Mentally Illness) who thought anyone who believed in God to be psychotic and did not use accepted definitions of the illnesses before telling family members to dump their loved ones into adult living facilities, just forget them!
Depressed people aren’t out of touch with reality. With a few exceptions, neither are people with bipolar disorder.
The psychiatrist that you are describing may hold peculiar ideas, but they are not a basis for involuntary commitment. They are sufficiently outside the mainstream that I suspect that it would get him in some trouble with the rest of the profession.
Yeah, and polio vaccines can make your kid autistic. Gimme a break.
Antidepressants saved my life, my marriage, my job – and, oh yes, my sanity. You can have my Paxil when you pry it out of my cold, dead fingers.
Bipolar is a broad spectrum, and the incidence you cite is too low.
Some bipolars are frankly psychotic – with either or both psychotic mania or psychotic depression.
Most are Type II – non-psychotic – and often with little hypomania and mostly recurrent depression as symptoms. Even type II’s may need to be hospitalized due to suicide risk.
If I remember correctly, de-institutionalization was to be a two step process. Step one was to be de-institutionalization but then, step two was to be the creation of a myriad of small group homes/treatment centers in residential neighborhoods all over the country to “reintegrate” as many as possible of the de-institutionalized into normal society, and part two–for a number of obvious reasons–just never happened.
Community treatment happened, somewhat, but for schizophrenics who refused to take their medicines, it did not happen at all. Costs were part of the problem, but the lack of authority to require mentally ill persons to take the medications that make the zombies go away was the bigger problem.
Just another perspective. I worked in a psychiatric hospital in Philadelphia. There it was very easy to get someone evaluated and committed for 3 days to a week. The police would pick them up and if a psychiatrist and judge agreed you could commit them. The judge almost always agreed with the psychiatrist, but that was usually because the patient was so irrational that they could not even contribute to their defense. I don’t know what would happen if someone more sane came in. The problem was that there were very few long term spots available, and barely enough short term beds so the long term spots had to be saved for only the very most abnormal and untreatable patients. Antipsychotic medications worked well on ALMOST everyone, but for reasons stated above people did not stay on them. About half of our patients had very severe mental illness and about half had mild mental illness exacerbated by drugs and alcohol. The most frustrating patients ironically was mild mental illness with only marijuana abuse because there were not outpatient programs for them. If you said you did heroin you could get a lot more resources and programs. Just to end on a positive note, there was a minority of patients who, after cycling through the clinic dozens of times over many years, eventually quit drugs took their meds and became productive successful citizens. So it is possible. In Pennsylvania I think we mainly need more resources (even acknowledging that as with any government program many will be wasted.) It is possible to do long term commitment. There just aren’t enough beds. There are a couple of pilot programs of intensive outpatient treatment, that are moderately successful at keeping people, medicated, out of the hospital and occasionally in minimal wage jobs. But there’s not enough resources to expand them. I know I sound like a typical government worker saying we just need more money, but in this particular case I think that psychiatric treatment has been starved of resources for a long time and a little more money could go a long way.
There’s no question that shortages of beds is a problem–and a study just released this weekend shows that we now have the same number of mental hospital beds, per capita, as we did in 1850.
I’m curious how many people with serious problems were not brought to your hospital because police had learned that the chances of getting a commitment were low unless they were an imminent danger to self or others.
I forgot to add. We did get a significant number of sane people come in, to try and get prescriptions for psychiatric meds. I could understand the people who wanted xanax. I never quite understood the ones who wanted risperdal or other antipsychotics. To my knowledge, all of them were easily eliminated after seeing a psychiatrist because they really did not know how a typical schizophrenic acted or couldn’t keep it up for more than 5 minuts. Of course, if they were particularly good at acting we wouldn’t have detected them anyway and would never know. So in that system there seemed to be a very low chance of committing someone who didn’t have a serious problem. But of course all it would take was a combination of one unethical/incompetent psychiatrist and unethical/incompetent judge to change that.
What’s the incentive for psychiatrist and judge to commit people who are sane?
All the usual motives to common a crime of course.
Why did those two judges in PA send innocent and undeserving youths to juvie? money.
They got kickbacks from the detention facility operators, the operators got state cash on a per filled bed basis.
State mental hospitals are non-profit institutions. Where do they get the money to bribe judges and psychiatrists? Now, you make a good argument against private for-profit operations working with the coercive arm of the government. But that wasn’t the situation for most of our history.
No. it isn’t a good argument for state run institutions of any sort. Its an argument for assuming the imperfectability of men.
It should be easier to commit the insane, without necessarily waiting for them to commit a crime. this is true even though there well be abuses.
Will, not well.
I may turn this autocorrect off.
Mr. Perkins: You may a good case that it isn’t drugs that are addictive, but ideologies, too.
Governments abuse power. They need to be watched and restrained for that reason.
Businesses abuse power when they are allowed to–and need to restrained first by the free market, second by consumer boycott and action, and third by governmental power.
When businesses and government work together, boy do you have a lot to worry about: generally accepted legal authority combined with the profit motive gives an enormous risk.
If commitment meant that someone was going to a for-profit operation, it would be very worrisome indeed, for precisely the reason that you mention: the government judges taking kickbacks from for-profit juvenile jails.
Clayton & tom – I think you’ve discovered the real culprits behind this whole issue: people.
Objectively, there’s nothing wrong with a nice, safe, comfortable hospital where mentally ill people can receive treatment and recover OR receive lifetime care if they have nowhere else to go. That was supposed to be the purpose of every modern mental institution. The horrors described by some inmates, the abuses depicted in “One Flew Over the Cuckoo’s Nest,” and the terrible errors revealed in court cases like O’Connor vs. Donaldson, were not the fault of “the system.” The people running “the system” were responsible for all those things.
If I were mentally ill, I might not mind spending time in a modern facility staffed by friendly, knowledgeable, compassionate people who paid attention to my needs, didn’t treat me like a child, and believed me when I said I was feeling better or worse. Evidently, those are NOT the kind of people who normally work in mental hospitals. The ones in the horror stories seem to be petty bureaucrats, low-level sadists, or just plain assholes. Jobs that give them a little authority and a lot of power over helpless people bring out the worst in them. They’re the kind of people who are now creating all new horror stories as TSA inspectors.
Admittedly, the nature of the work – caring for people who are sometimes strange, uncooperative, unclean, untruthful, and violent – can turn well-intentioned workers into cynical time-servers. But it shouldn’t turn them into actual brutes.
Would the “old” system have been better if it had been run by better people? Do such people even exist? Is it possible for such people to function in an institutional environment without losing their humanity?
The “autocorrect” made commit into common. FYI
I am a family member of a person who has been diagnosed as paranoid schizophrenic (although the name for the condition may have now become something else–there are fads) and who is currently not taking his medication. That person was placed “in the care of family” meaning my 90 year old, extremely frail and mentally failing, mother with supposed oversight by another family member who does not live with them, I must say that follow-up to community placement is appallingly absent. My mother was not ever told by anyone (including family) why it was that her child was committed for 2 weeks; nor was the “placement” ever evaluated by a mental health professional. My sibling was dumped.
But there is nothing I can do about it, except visit my mother often to try to judge her physical safety.
Antipsychotic medication is awful and uncomfortable, and for 40 years my relative was able to function out in the world, holding jobs, living in own apartment and generally being “independent” through taking it (couple of episodes when medication was altered to the latest versions). This person was my children’s favorite relative, once.
My mother is in failing health, and because my sibling is falling into believing in persecution, stupidity of everyone else in the world, and the need to escape threats from people who are actually oblivious to his existence, it appears he will, within the next few years, either be dead or end his days in an institution.
I don’t accept your definition of “intelligent” as it seems to encompass only ability to perform adequately in academic institutions. I’ve worked in academic institutions, and their focus now is keeping the money coming in, they really don’t care about the “health” or “fitness” of students, in any aspect. Those college students who “pretended” to be insane–did anyone ever follow up the ones the psychiatrists wanted to keep?
My family is in this situation because the psychiatrist did NOT want to lock my sibling up, as they would have had to do had my mother not been willing to take her child in. Mental health professionals are NOT eager to commit anyone to an institution, as far as we have experienced.
Psychiatrists are not eager to commit people, this is true. That’s a good thing, I think. Commitment should be a last resort.
Many folks taking psychotropics smoke pot because it is not toxic with most of their meds. Over 10,000 case studies I personally read never referred to pot as causal. As a telephone crisis worker we were trained to rate lethality based on a number of factors including alchohol consumption. No one got nervous when a caller said they were high on pot, but a drunk was another matter entirely. Pot may or may not cause schizophrenia, but alchohol absolutely causes brain damage, especially during withdrawal (DTs). Alchohol figures in approximately half of all homicides and is toxic with common OTM meds like tylenol. When I worked as a bouncer, I noticed violent drunks who went out and smoked pot were no longer as aggresive and dangerous.
Yet pot is illegal and selling it puts you in jail.
Many people I encountered while working with the mentally ill were in it for the power. Absolute control over another person. Same with “social workers”. Piss them off and there go your kids.
In my experience, the vast majority of upper level mental health professionals believe all gun owners are wannabe mass murderers. Juan Williams discovered the hard way that Liberals think all dissenters are mad and must be dealt with. My local paper had a recent letter to the editor by a psychiatrist who said her Republican clients were all crazy because they were obsessed with wealth, as well as just generally being reprehensible people. If you don’t think liberallized commitment laws will be used against dissenters, you must be smoking pot.
You are in the wrong thread to arguing for pot legalization.
“Over 10,000 case studies I personally read never referred to pot as causal.”
If you mean that you have read 10,000 studies on this subject, I don’t believe you, because that many do not exist. (Put the doobie down before posting.) If you mean that you have read 10,000 files on people with mental illness problems and never seen marijuana listed as causal, I suspect that you need to understand why they won’t say that–you can’t determine that for any single individual.
Your “vast majority” claim sounds pretty laughable. But you do make a good anecdotal case that marijuana isn’t useful for relieving paranoia.
So, what about all of those reports over the last few years that say that “pot”–love the use of this term, which makes marijuana seem almost like a friendly and harmless little Disney character–contains more cancer causing carcinogens than tobacco (and if you get your not exactly regulated by the Department of Agriculture “pot” from some guy who grows it in, say, some secluded area of a State Park or in Mexico, you get the added bonus of the extra carcinogens that are added by all of the toxic pesticides and other things he probably sprayed on his plants to increase crop yields) and leads to far more lung damage than smoking cigarettes?
How about recent reports of scientific studies showing permanent brain damage and reductions in cognitive functioning that result from long term/heavy pot smoking?
Orange juice has high fraction of carcinogens in it, and pot smokers have a lower incidence of lung cancer. What’s your point?
Yuh, pot is more cancerous than tobacco. And joints are never rolled with filters.
So, the common sense conclusion is to try to do 20 or fewer J’s a day.
By chance I just discovered this morning (July 26) an interesting confirmation of your complaints. On Fox News, “The Reilly Factor” of July 25 (here in Europe I can view clips from Fox one day later), DR. Krauthammer was interviewed. Krauthammer, when a practicing psychiatrist, could as a doctor at a emergency ward commit without difficulty individuals he considered dangerous for themselves or for others. Dr. Krauthammer went on to complain that it is no longer so easy, indeed, entailing insufferable problems. O’Reilly quickly chimed in noting that there are always a slew of lawyers waiting in the background to find new clients to sue for. Interestingly, O’Reilly blamed the hord of lawyers hovering about on the influence of the ACLU. Is that true? At any rate, the problematic you have brought up received confirmation from an excellent source.
The ACLU is certainly part of the problem, although my book shows that they were a late arrival at the party. They remain a major part of the problem. When New York passed an involuntary outpatient commitment law (Kendra’s Law), ACLU fought it vigorously. One criticism of it was that it didn’t allocate enough money for lawyers to challenge commitments.
I’ll argue that mental institutions do cause illness for the psychologically sensitive-James Holmes had to live in a majority Hispanic immigrant neighborhood, which is great for people who like drinking themselves blind and playing loud music after work and terrible for anyone interested in catching up on a highly abstract and rigorous field of study after easily passing dumbed-down non-rigorous public school classes.
(Hint: Half Sigma and his commenters have been the most commandingly comprehensive analysis on his life situation as I’ve seen over the past couple of days.)
News reports indicate that he lived in a very quiet apartment building.
I’ve spent quite a few years living in overwhelmingly Hispanic immigrant neighborhoods in Santa Ana and Buena Park, California. In fact, I was the first person to call 911 on the first drive by killing in Buena Park (early ’90).
Other than the New Year’s Eve gunfire, and the aforementioned drive-by entertainment (we moved after the drive-by), it was pretty quiet. There was an occasional drunk, but in the 8 or 9 years I spent in those neighborhoods, I could count those problems on one hand.
Methinks your stereotyping needs a tune-up.
Mr. Cramer:
I have had 7 psychotic episodes in the last 20 years, starting at age 30. I am a successful business person with a family. Most people who know me consider me to be sort of a genius.
I have been diagnosed as bipolar, though I don’t have depressive episodes. Several days of several psychotic episodes have been so severe that I have absolutely no memory of where I was or what I did.
To my knowledge, I have never been violent during an episode other than tearing all the paper signs off the walls in a mental ward. In your view, am I a candidate for institutionalization? And where do you draw that line?
Hard to say. Were you ever locked up for an observational hold (which in most states is pretty easy)? If not, it suggests that you didn’t scare anyone.
Nobody should be able to have another citizen arrested on suspicions of any sort. There is no such thing as a thought crime. Only actions are criminal. How about arresting P-shrinks on suspicion of thinking about violating civil rights? You say, ‘But that’s different!’ No, it’s not.
God gave All of us free will. Nobody has a right to take that away. Murderous nutters like the Aurora shooter have always walked among us. Free will. The solution lies not in repressing free will or trying to but in having the nutters decide of their own free will to not open fire in target rich environments.
I have read that no mass murder has been attempted in a local that allowed concealed carry.
That well could be part of the answer. If our Aurora shooter had been meet with a fusillade as soon as he popped smoke, he would be dead and his victims alive.
Considering a fairly large percentage of the population has a few screws loose, we do pretty good. Some people want perfection when good enough is already here. If that isn’t a disorder, it should be.
This is incorrect. Mass murders do happen in places that allow concealed carry. Arizona, last year. In the church in Colorado Springs that Jeanne Assam stopped with a pistol.
Try defining your terms first, Clayton.
“Intelligence” is just speed of thought and memory; smarts – what used to be called “wisdom” – is how you use that. Rationality or mental health is simply to acknowledge cause and effect and personal responsibility, while irrationality or mental illness is the (most often) self-inflicted criminal desire to disbelieve in cause and effect in order to avoid personal responsibility by blaming one’s victims.
People can be really intelligent, yet use that speed to run headfirst into the metaphorical wall, while unintelligent yet smart folks will plod on to the correct conclusions.
Mental illness is any combination of from one to three things: 1. either confusion over terms (believing the salesmen who use abstracted/context-free verbs as pretended nouns to promote a lack of thinking in favor of easy, idolatrous mimicry of real thinking: ‘speed,’ ‘freedom,’ ‘honor,’ etc;) 2. a secret desire to reverse cause and effect by acting as criminal salesmen to lie, first to them selves and then to others, by pretending effects are their own causes, in order to avoid the fear of fear in stead of the fear of the mistakes which cause pain, in order to maintain a pretended right to remain irresponsibly wrong, and to cover up their own mistakes by blaming their victims; &/or: 3. actual physical brain damage.
The first two, people can be educated out of, or arrested for if they choose to persist in using it as an excuse for their anti-social, criminal behaviours. Even the third cause (actual physical brain damage, which is more correctly the jurisdiction of neurologists) can be overcome because the brain can repair itself with the correct stimulation (see the case of hydrocephalics, whose brain functions are forced to relocate and rebuild all the time).
Otherwise, it’s just an excuse for immoral behavior; i.e:
“I didn’t do it – ONLY my BRAIN did it!”
Whee!
PS: As for “schizophrenia” itself, it has absolutely NO valid medical nor legal definitions. They’ve just bundled a bunch of disparate symptoms under one all-inclusive title, in order to pretend the symptoms are their own cause.
Further, (as Dr. Thomas Szasz has noted) the “mental-health” INDUSTRY that grew up around all this, selling victimology, just pretends that:
“NOBODY SHOULD EVER BE PUNISHED FOR COMMITTING THEIR CRIMES, BECAUSE WE’RE ALL VICTIMS ANYWAY! BOO HOO HOO!”
As for “schizophrenia” itself, it has absolutely NO valid medical nor legal definitions. They’ve just bundled a bunch of disparate symptoms under one all-inclusive title, in order to pretend the symptoms are their own cause.
And it’s a cause they are quite willing to endlessly exploit. While no problem was ever actually solved by ignoring it, their creed has always been, in stead:
“There’s no money in solutions! So Please Give Generously – AGAIN!
“Schizophrenia” is only a description of a host of symptoms – some caused by self-indulgent spoiled brats’ own desires to get attention, to claim a right to be irresponsible, and/or by some others, caused by a host of real but unrelated physical reasons (from parasites to viruses to genetic defects to physical damage).
It’s only an excuse for not acceptinig personal responsibility for one’s own actions. All “mental illness” (irrationality) only stems from refusing to accept cause and effect – and by pretending that, “Since all facts are really only opinions anyway, my fact-free, subjective opinions are the diversely-opposite “equals” to all the real objective facts! Whee!”
And, as for ‘BI-POLARITY’ (aka “Manic-Depression”):
Everyone and everything in the universe is “bi-polar!”
Humans are animals, period. And animals are machines. All are directly controlled by the stick-and-carrot (pain/no pain) binary of behavioural conditioning, from bacteria and viruses to amoebas, plants, fungi, insects, birds, reptiles (including lawyers) and mammals – exactly the same as the I/O or 1/0 of computers. There is nowhere to regress to, nor evolve to, either. What some call “spiritual” or “ethical” attitudes are really only communication confusions (irrational reversals of situational causes and effects, or “insanities,” exactly like homosexuality) where they pretend effects and symptoms are their own causes. These are usually used to attempt to avoid pain, rather than to observe and correct the mistakes which cause the pain: for instance, a rational conservative will say: “That jerk was going too fast, and his car hit that tree!” while a liberal would say: “Speed kills” &/or “that tree hit my car!”
“Schizophrenia” is a lie, but there is a cure for ALL kinds of mental defects: binary, behavioural conditioning (the carrot and stick approach). It’s too bad society is too squeamish to endorse and enable this simple and 100% effective cure.
http://unclevladdi.posterous.com/defining-mental-illness
Someone who quotes Szasz is already not worth debating.
Those who pretend to care more about WHO said something, than about WHAT was said, have already conceded they have no facts with which to continue the discussion.
i.e: FAIL.
All Dr. Szasz has said (and since he’s been there since the beginning of the ‘science’ one might want to take note) is that if ‘mental illness’ is a physical problem, then it should be considered as part of neurology, and, if not, then it can be corrected by educational training. It’s either hardware OR software. With what part of his simple and valid assessment do you so dismissively disagree, Clayton? Or is it just that you’re so intent on selling your brother’s sad tale of victimology?
We can start by blaming the Kennedy family for the “deinstitutionalization” push. Apparently their sister was in one and they chose to play Doctor and decide people would be better off in group homes or other scenarios. As a psychiatric RN who has worked in a state hospital, there is a great need for places like this. Some people are unable to live in society and are either a danger to themselves or others. While we may not choose, ourselves, to live an insitutionalized life, there are many people who can live no other way. My patients received excellent care and I was proud to work with those like-minded individuals who tried to make our patients lives just a little better.
Kennedy went along with this, but there is no evidence that he was the instigator. This was already a movement well under way when Kennedy came to office.
It’s a fact that mentally ill people who are NOT in treatment (whether that’s medication, therapy or both) DO have higher incidences of violence – towards other and, more likely, against themselves. Those same people IN treatment are no greater a risk to the public than the norm. Interestingly, people with mental illnesses are often recipients of violence in higher percentages due to homelessness, etc.
Those who taking their medications for psychosis are certainly far less dangerous, no question about it.
My book discusses the high risk to the mentally ill because of homelessness.
Mr Cramer,
Dr Clinkingbeard, a frequent flier for aberrant behavior, just got 5 years suspended with probation. In light of her obvious inability to control her behavior, a person who had been institutionalized previously in possession of a firearm, and the Aurora massacre do you feel this is a reasonable sentence?
BTW, I bought a read your book. Thanks for writing. An important contribution to the literature of the treatment of mental illness.