What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover?
That is not a straightforward choice, and choosing to let people do things that are bad for them doesn't mean there's anything wrong with the society. It may mean that bad things happen, but the converse, where society steps in when you're deemed 'incapable', might be worse if it's not managed exceptionally well.
As an example, consider whether should someone who is depressed to the point of needing medication be banned from buying alcohol (which is a depressant) because it'll make their situation worse, or should society let depressed people use alcohol as an escape from their illness? Does being ill mean you have to give up your right to decide how to live your life?
And no matter what (sensible) tradeoffs you make, it will always be agonizing around the margin.
I thought a depressant in the context of drugs means "central nervous system depressant", not "causes depression"?
You want them to keep fighting.
and choosing to let people do things that are bad for them doesn't mean there's anything wrong with the society.
In Oslo, near the university, there used by a "cave dweller". A by all accounts bright student who at 25 decided to stop washing himself. He was soon thrown out of his student accommodation because of the smell. He then decided to take up residence under a tarp in a makeshift "cave" in a hillside next to the university where he stayed for the following two and half decades. In 1987, he was refused the opportunity to take his astrophysics exam because of the smell, and later given a blanket restriction on participating in any exams unless he washed first.
He was repeatedly institutionalised against his will, but in 1988 he won a supreme court decision that made it clear that his unorthodox lifestyle was insufficient grounds for forcing him into mental health institutions. He later sued the University of Oslo over lost income due to the exam ban, but lost.
It may seem obvious that this guy had mental problems. The problem is that in court and during psychological examinations he was fully coherent and defended his choices with references to traditions of asceticism and spiritual beliefs. He understood what he was doing. (EDIT: This does not mean that he necessarily didn't have mental problems, but that he was coherent enough to be able to justify his decisions sufficiently that the court found he was competent to make his own decisions about whether or not he needed treatment)
This poses a challenge, because it can be superficially extremely hard to distinguish actual mental illness from "crazy" lifestyle choices that the person making them are perfectly happy with.
The guy mentioned above was very bright and able to get the resources he needed to protect what he saw as his own best interests in court (all the way to the supreme court 3 times, with one win), but most don't.
Many of these people are mentally ill and need treatment, but we also need to protect those who aren't, and especially those who aren't yet are not resourceful enough to mount vigorous legal campaigns to protect their choices.
At the same time setting the bar high means there are potential high costs and lots of resources involved in helping people that makes it harder to help those who need it out of a concern for e.g. distinguishing resistance and refusals grounded in mental illness from resistance and refusals from people who are mentally competent.
Getting the balance right is hard.
That's sort of understandable - if you are around people all day who hear Satan, or have obsessive compulsions, complaining that you don't have enough bedclothes or the food is bad is just seen as part of your condition. If you get given the wrong medication, it's assumed you are wrong and you'll be ignored. If you get mad about being ignored, you can't just walk out as they wont let you. In all likelihood you'll be tranquillised to keep you quiet.
How do I know this? Everything except the sedation happened to me!
He had made some self-destructive statements and a mutual friend reached out to me for help. Several of us scheduled an intervention to try to convince him to go get help and the day before the intervention, he made some more self-destructive statements so that same mutual friend called me and I went to his apartment. He looked like death warmed over. He hadn't been taking care of himself and was extremely thin and pale.
When I asked him to go to a hospital for help, he refused. I told him that I wasn't going to take no for an answer. He had been talking about harming himself and that's all we needed to have him involuntarily committed for 72 hours. He still didn't want to go so I called the police and explained that my friend had been talking about hurting himself and I thought he needed to be committed.
He even threatened that if I followed this course of action, it would mean the end of our friendship. I said that I would prefer to be able to drive past the place where I was no longer welcome than to drive past the place where my friend died because I didn't help him.
The police and paramedics came and the officers explained to me that because of his talk of self-harming, he could be involuntarily committed if he didn't go of his own volition. If he was right and there was "nothing" wrong with him, he could be out of the hospital in the morning.
Their argument persuaded him and he went voluntarily.
He was in the hospital for over a week. Long story short, his problem was caused by the side effect of a medication he was taking for a medical condition. They were able to find a different medicine that helped his condition without producing the side effect of depression. He's doing well today and we're still friends.
Frankly, I find it kind of disturbing that you can have anyone you know committed for several days just by lying to the police.
Yes, I approve of it. Without the ability to compel him to receive medical attention, my friend would have died.
But I don't.
It wasn't a lie.
We can play that game all day.
Even if the cops had heard him, the doctors who treated him wouldn't know if the cops were lying.
The judge, who had the final say about extending his observation beyond three days couldn't have known if I, the other friend, the cops, the paramedics and the doctors were lying.
There is often more nuance to real-life situations than "I contend that I didn't say that. He can't prove that I did say it."
Namely, my friend needed help. It was obvious to everyone, except him.
Where is the difference between this guy and the one who risks their lives and their childrens' lives by being a missionary in some place where their work can be punished by death? If anything, this man is more sane as he isn't risk his life and the lives of those close to him.
P.S. I'm a religious guy myself, but I am seriously asking this. In many ways religion itself can seem to be a mental illness if it weren't so popular.
Look up delusion in the DSM. The definition is more accurate without a special exemption. A close examination of the entire manual will reveal a careful wording to prevent religious people from being diagnosed with any sort of condition.
Simply the fact that this approach is taken says volumes. A rose by any other name...
(If missionary activities were frowned upon in their communities it wouldn't surprise me if the prevalence was close to that of not washing yourself.)
As long as a person didn't commit any crime and is no risk to society or oneself you cannot institutionalize him or her.
In any case I would refrain from making such broad generalizations about a society. Some societies prefer strong individual rights and others prefer a strong state that tells them what to do.
Often persons will be categorized as mentally ill just because they deviate in their beliefs or lifestyle from the mainstream culture.
And yes, mentally ill persons HAVE a free will, don't tell me they don't as this would be equal to declaring that they are not human beings but just a lump of meat.
They have feelings, desires and goals like anyone else, it's just that these in some cases may be very different from yours or mine.
[1] https://en.wikipedia.org/wiki/Thomas_Szasz#.22Myth_of_mental...
But I must say that I agree with many points he makes although I disagree with some.
In my naive view (this is not my profession) many persons that are just to some degree different are labeled as mentally ill and medicated starting with children that aren't docile enough.
Psychiatry surely has its uses helping people to improve and overcome fears / tragic events or to evaluate if someone can be dangerous but it can't be right to forcefully medicate everyone that doesn't fit our society into submission.
Often persons will be categorized as mentally ill just because they deviate in their beliefs or lifestyle from the mainstream culture.
Reminds me of this quote:
A question that sometimes drives me hazy: am I or are the others crazy?
-- Albert Einstein
Simply being unconventional can be dangerous. Lots of people who were the wrong sexual orientation, skin color, you name it, have been classified in an ugly manner as an excuse to justify mistreatment of them.
(Example: https://en.wikipedia.org/wiki/Drapetomania)
When does this become a problem such that your naive views makes it impossible for people like me to integrate ourselves into society? Putting up in a soft version of prison isn't going to help us.
I can personally tell you that I have plenty of agency and I understand my situation. Please stop generalizing your naive views, okay?
A friend of my family studied medicine, and during his studies there was apparently a course where the lecturer used to bring in a mental patient each year.
This specific mental patient suffered from severe delusions. He by all accounts genuinely believed he was the rightful heir of Kaiser Wilhelm II, and had constructed an elaborate fantasy world around his childhood and how he came to grow up in a suburb of Oslo, with a Norwegian family.
But here's the thing: He was in full work (I don't remember as what - a plumber or electrician or something), and lived a seemingly normal, happy life. He functioned fully as a normal member of society in every way.
He had learned and understood that, while he still believed fully in his delusions, people around him thought they were totally crazy. And so he'd accepted he had to live "undercover". He enjoyed showing up in the lecture once a year because it gave him his an opportunity to talk about what he saw as his real self.
He would debate the students at length and expand on details the asked him about with ease.
Did he not have free will?
The point of inviting him was exactly for the lecturer to point out that many forms of mental illness does not remove the patients ability to reason or their ability to function, and that often it can be hard to determine if they are mentally ill at all. What if this man was right? Nobody other than him believed so, but that doesn't prove anything. We assume he was mentally ill, but for many forms of mental illness, the line between ill or not is a fuzzy line that boils down to subjective judgement, and where the more interesting question is whether or not the patient feels there is a problem they want help with.
Of course there are mental illness where the decision is clear-cut too. But mental illness is not a binary. It's not a matter of declaring you "crazy" or "sane".
Capacity is narrowly defined. I might be able to chose where to live, but not chose how to spend my money. I might have capacity for everything apart from what food I eat.
The relevant laws are the Mental Capacity Act (can I chose what I do; what happens if I lose that ability;) and the Mental Health Act (can I be detained against my will; can I be transported to a place of safety for assessment; can I be medicated against my will).
If you live in the UK it's worth having a quick look at the guides for this. You probably won't need it, but it's a good idea to be prepared for the worst. (EG parent gets a dementia illness and starts giving money to telephone "microsoft repair" scammers; your adult child develops a psychosis illness; your co-founder torpedos your business by burying the product on a beach)
In general if you aren't a risk to other people and you're not in danger of killing yourself it's hard for them to hospitalise you against your will. (At least in UK). But it's important that if you have the choice between an informal admission (you go in voluntarily) or section (they detain you against your will) that you go in voluntarily.
My brother-in-law has very bad schizophrenia. I can assure you, he has free will.
You speak about mentally ill people like they are subhuman. They aren't - they are people with the capacity for agency and they have rights. And they should be treated with more respect.
Coercing someone into psychiatric treatment in some facility until the person "is better" is open ended in nature that it might effectively mean imprisonment for life.
That's why there is (or should be) such a high barrier for this.
Don't get me wrong, I'm really happy for the family in this article and if I knew 100% for sure that (reasonable) action X and Y would have this positive outcome - I would do it.
But the problem is that more often than not you cannot know because we all can't read the minds of others.
There are cases of people living in (for us) unimaginable conditions by their own choice. And some of them are even willing to fight for their right to live in such a way.
Some societies prefer strong individual rights and others prefer a strong state that tells them what to do.
I didn't say that it is a binary choice of either forcing them into a psychiatric ward or letting them rot on the streets.
One can offer persons in such situations help in different ways, which they are of course free to reject.
> Whether private or public, the choices made on this spectrum absolutely do reflect on the society making them.
No, it does not reflect in an _absolute_ or _general_ way on the society, it is only one specific feature.
That's why I cite the strong individual rights in the next sentence.
If a person rejects any help and is no threat to anyone then it is none of your or anyone else's business if he ruins his life.
There's no psychiatric ward, jail or Gulag awaiting such a person to "mentally correct" him.
In our fiction we describe whole worlds where the Damned are left to shamble around and fend for themselves, cut off from the warmth of humanity. We depict hell as a plane of the existence where the Lost are cut off from all that is right and good in the world, pitched overboard into un-ending darkness and despair.
It's hard not to draw parallels.
Luckily dark days are few and far between, and I get help. Medication helps, and when it occurs I tell myself it's not reality because, well, it isn't.
You can leave any time you're willing to stop calling us nasty names and accept our help. Or hell, even stop calling each-other nasty names and accept each-other's help. It's not like you're actually damned in any strictly metaphysical sense. It's just that you've got two primary tools, your intellects and your social abilities, your brains and your hearts, and you vilify the fuck out of both of them in favor of fists and fire!
Sincerely,
The Other Place
In the USA it's estimated that one third of the homeless people suffer a serious mental illness.
I live in the Netherlands and I think the numbers are the same here. Ofcourse there is help but most homeless people move around a lot so it can be difficult to track them and help them.
Also: having worked with homeless people I know for sure they will get some kind of mental illness sooner or later.
It's probably significant that a lot of the US is a lot warmer year-round.
[1] https://www.homelessworldcup.org/homelessness-statistics/#eu...
Yup, exactly this. It's why there are so many homeless folks in Hawaii: it's easy to live there without shelter. Living in a part of the world where the weather gets cold forces people to make decisions.
In the USA there are apparently 633,782 homeless [2] per night out of 319 million people, or 1,987 per million people.
But that's heavily influenced by the way homeless people are counted. The US number is explicitly the number of people homeless on any given night. Estimates of the number of people in the US that will be homeless for some period each year ranges from 2.3 - 3.5 million [3] (7,210 and 10,972 per million resp.) This is estimated from shelter occupancy.
I couldn't figure out if the Dutch statistics agency were counting number of people homeless in a year, or number on any particular night, but [4] hints to me that they're estimating the annual population, so I think the best comparison is:
Netherlands: ~1,700 homeless per million USA: 9,000 +/- 2000 homeless per million
[1] http://www.cbs.nl/en-GB/menu/themas/bevolking/publicaties/ar...
[2] https://www.hudexchange.info/resources/documents/2012AHAR_PI...
[3] http://www.familyhomelessness.org/media/306.pdf
[4] http://www.cbs.nl/en-GB/menu/methoden/toelichtingen/alfabet/...
80% of the homeless in the Netherlands suffer from mental illnesses. Source (in Dutch): http://www.ontmoeting.org/dak_thuislozen I guess the explanation for the difference is that the social security system in the Netherlands is better, so there's less chance for ending up in the street when you lose your job.
What gives you the authority to institutionalize him?
This isn't a snide question. It's a very difficult question that leads to a whole raft of difficult questions.
How do you force a person to take their medication? Why should you do it for this particular person but not that particular person? Who is responsible for the cost of doing so?
A government has the duty to provide for the welfare of their people. It's every government's goal to make their people healthier.
> How do you force a person to take their medication?
In a psychiatric institution you could for example inject the medicine into them.
> Why should you do it for this particular person but not that particular person?
If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control.
> Who is responsible for the cost of doing so?
Taxpayer
If you are all there in the head, by all means live on the streets, stay filthy, don't eat and ignore people, but this man has a brain disease that makes him lose control of his mind.
If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me."
If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).
I find your notion that there's some slippery slope where we'll suddenly want to force people into institutions quite bizarre.
A lot of socialist thinking, on the contrary justifies the need for a welfare system and redistribution with arguments that true liberty is only possible once there are protections in place which ensures that you do not just have the legal opportunity to make your own choices, but also the means to realistically be able to make choices.
On that basis, the argument both for giving people help to get off the street and restricting the states ability to interfere if you chose untraditional lifestyles is the same: Maximizing liberty.
Now, given the old socialist joke that if you put two socialists in a room, you'll get three incompatible definitions of socialism, there may be socialists out there more gung-ho about institutionalizing as many people as possible, but I've not met any.
Conversely I'd hesitate to say it's a right wing issue, despite the fact that historically a lot of right wing governments have been very gung-ho about using draconian measures to force people off the streets and into institutions, including the use of police to remove them coupled with work-houses or even prison next to mental institutions, as many have had a long tradition of seeing homelessness or poverty in general as a sign of moral failings that need to be treated harshly.
Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.
This isn't a hypothetical for me... like the author of the article we're discussing, I've had close friends suffer from schizophrenia and depression, and seen one of them involuntarily institutionalized. I wish it was so clear cut SpaghettiCat, but I think the majority of mental health cases are not so black and white as the one in the article.
Who is the most competent to make this decision? The medical professional. Of course government (advised by medical professionals) will set the policy which will constrain the possible decisions.
> Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.
This could apply to absolutely everything: evil police officers taking bribes and releasing criminals, doctors not prescribing expensive medicine to save their hospital money, etc. Does that mean we do away with police protection and hospital services entirely? No, as in this case, we have to accept the risk of the person in authority to make the good decision.
I agree this issue is not black and white.
This has gone poorly quite often throughout history, which is why it's a tough question. Homosexually was officially considered a mental illness in America until 1974.
It's possible that Europe and the US have swung too much to the other extreme now, of course. But as you say this is very much not black and white.
That's precisely what happened with psychiatric institutionalization: abuses (not just in totalitation regimes) led to restrictions on when it can happen. Sometimes that means that people who maybe should be institutionalized are not.
How do you decide which ones amongst them are "all there in the head"?
How do you distinguish between someone sane but eccentric that refuses to speak to you, and is filthy and lives rough vs. someone with a mental illness without applying force?
> If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me!
Some would. Others, as I mentioned in an anecdote elsewhere in this thread, would sue you, appeal the case all the way to the supreme court, and win.
> If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).
I would too. The problem is that not everyone living like this have mental disorders that make them incompetent to make their own decisions, and separating the ones with real medical needs from the eccentrics is not straightforward.
A large problem is also that often while the official motivation is to help, the impetus for the "help" is that others take offence at their presence or attribute moral failings to them and want them gone, and don't so much care whether or not it helps the person in question.
Which people? "Mentally ill" people aren't a homogenous group, and the fact that someone is mentally ill and living on the street does not imply that they are incompetent to make personal decisions due to their mental illness. The relation between mental illness, poverty, physical illness, etc. is complex.
There aren't simple answers, and this person isn't these people.
> If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me."
Would he? He was medicated, functional from the point of view of the broader society, and living in an apartment and stopped taking his medication. Was it because the medication wasn't the best medical science could identify and he was still incompetent though he would be better off with other medication? Did he accidentally stop taking medication and start a downward spiral where he became out of control? Or was he, as he seemed, competent -- but voluntarily decided to discontinue the medication?
> If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).
And that's great, but its a mistake to project what you think you would want onto other people as their preferences.
I was referring to patients who lack control over their mental faculties at least to the degree of the man on which the article was written.
> There aren't simple answers, and this person isn't these people.
Yes, this person belongs to the general collective I described above. Clearly when I said "these people" I meant people like the man in the article I was talking about.
> Or was he, as he seemed, competent -- but voluntarily decided to discontinue the medication?
He may have been in the driving seat when he hypothetically decided to stop taking medication, but ultimately he lost control of the wheel. If a person is not taking care of themself and so out of your wits that you stand for hours at road junctions staring blankly forward, they need to be saved. The authorities must assume that though the decision to stop taking medication was voluntary, because the person lost control of their mind, maybe that person's decision was misinformed (or as you suggest, accidental). By analogy, ust because the driver of a car intentionally didn't buckle themselves in (maybe they wanted to die, or like the risk, or were just eccentric), doesn't mean that when they crash and their body flies out, that we shouldn't hospitalise them.
> And that's great, but its a mistake to project what you think you would want onto other people as their preferences.
Actually there is no mistake here: it's a fact that there are other people like me who want this protection from the state.
> In a psychiatric institution you could for example inject the medicine into them.
Schizophrenia is a lifelong illness. Do you keep someone imprisoned for the rest of their life so that you can forcibly medicate them against their will?
No, until the mental disorder is controlled. After all avenues of curing are exhausted, and it's still not under control, then they can be released, provided there's no significant risk that they'll harm others or themselves.
So you risk getting into "revolving door" admissions to hospital. A person with a psychosis becomes ill, rejects medication, is detained against their will in hospital and given medication against their will (sometimes by force) until they "become well" enough to be let out of hospital. At which point they're free to decide to stop taking the medication.
I'm not sure that this style of revolving door admission is better for the person than just letting them be homeless. (Although preventing people getting into that situation would be a good idea).
Surely not. The "revolving door" concept, as you call it, is the middle-ground between not helping at all, thus letting a mentally ill person reach trauma more severe, and permanently confining those with incurable mental disorders (but those which can be controlled, and the patient able to live healthily outside the ward), which is both wildly expensive and harder to justify overruling the patient's will and freedom.
If you want to provide MH treatment to people it's much better to start with children and young people and better drug and alcohol services, both of which would reduce the amount of homeless people, and also to provide better voluntary MH treatment for homeless people.
People aren't arguing with you because you want to provide MH treatment. People are arguing with you because you want to force that treatment on people against their will.
And the only viable public health responses are either a total quarantine of infected populations, or killing them.
If you reject the latter, and i hope that you do, you're left with a situation not much different from that posed by schizophrenia: the prospect of institutionalisation, but under terms and conditions in which the afflicted will prefer and seek out that option. Or at the very least not resist it.
I'll also note that lifelong imprisonment is not necessarily the only option, you're appealing to the extreme here. Though sometimes, yes, that _is_ what society must do.
You state this as if it is an universal principle. It is not. Why don't you and everybody else provide for your own welfare?
> In a psychiatric institution you could for example inject the medicine into them.
Some countries deem persons with certain sexual preferences as mentally ill. (homosexuals) How would you feel about imprisoning them in a psychiatric ward and injecting some "medicine" against their will to "treat" them.
You may find this example not applicable because it is obviously wrong to do that but I can tell you this much:
No matter how much you feel that you are sitting on the moral high horse and know it all, in a hundred years people will analyze how we acted this very moment and conclude we were a bunch of backward barbarians.
Let's not revert back to the backwards behavior our precursors deemed morally right a hundred years ago.
> If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control.
Which could be translated for many into: Imprisonment for life.
>> Who is responsible for the cost of doing so? > Taxpayer
And if it's not sufficient we'll just raise taxes and steal even more. Simple solution.
It's just how quickly people that have this wish for the nanny state will claim they have a right to your resources for their very well thought out plans.
Plans like imprisoning every mentally ill person and injecting them with some compound against their will.
Yeah that's legit horrifying.
This is a very fine line. What if someone refuses to eat food, or communicate, as part of a protest or a religious fast or any other personal reason? Who are you do to decide what they're doing is wrong?
If they are not endangering anyone else, it gives you no right to interfere.
The understanding of relatively highly-occurring afflictions such as PTS and schizophrenia is evolving to this day and it's a near-certainty that the DSM will be a different document 10 years from now.
I don't think we should be so cavalier about taking freedom away from people whose main transgression against the rest of society is making us feel uncomfortable when we look at them.
Just because it had errors before doesn't discredit the document in its current state; it's the product of scientific investigation. By it's very nature it will make mistakes and then update the conclusions as time goes by. Yes, of course it will be different in 10 years, but currently it is our best understanding of mental ailments and the knowledgebase has come a long way.
> main transgression against the rest of society is making us feel uncomfortable when we look at them.
The main transgression is that the victims are trapped in a cycle of suffering because their brains are malfunctioning and are preventing them from recovering or seeking help to recover.
Incidentally, are you aware that there is a difference between a mental disorder and a mental illness?
>And under what mental disorder should someone be institutionalised?
Under those that are responsible for causing a person to suffer and damage their own health and fail to try to recover, or seek help with recovery, as in the example above.
>All you've referred to is the DSM, so it's very unclear which illnesses and disorders you are referring to.
You've taken this comment thread on a totally different tangent. We're arguing a wholly different point now.
> Incidentally, are you aware that there is a difference between a mental disorder and a mental illness?
No, wasn't aware. I use them interchangeably.
There are a group of people in Australia called Ferals. They don't eat well, and they never bathe. They do it out of choice. I'm sure some of them are mentally ill. I wouldn't be locking them up in an institution!
I felt restless that night, and I'd just been made redundant, so I drove my car to an all-night diner. For whatever reason, I somehow managed to go through a red light and a cop pulled me over and issued me with a $500 ticket.
I basically felt destroyed inside. I'd just lost my job, I was hungry, and I felt I'd just let down my family - and I was suffering from withdrawal from the anti-depressants. I freaked out, left my car and wandered the streets. I honestly can't recall much, but I do know it started raining on me and I do know I was thinking about death. The police came and put me in an ambulance. I arrived in the ED, and was placed in a mental health ward.
It was the worst experience of my life. I have never been treated so badly, or had my rights and dignity stripped away so thoroughly and systematically. They didn't chart my medication properly, they put me in a freezing room overnight with not enough bedsheets, the building leaked everywhere (even the light sockets had water going through it), there were people having psychotic episodes or hearing voices, it was terrible food and no staff gave me any counselling or even asked how I was. What's worse was that I recovered very, very quickly so I was fully cognizant of what was happening. When I asked for my correct medication, I was told I was being unreasonable and "You don't get anywhere here by being demanding you know!" was the answer given to me by the nurse on duty (I put in a complaint and then admitted they had made a major mistake in charting my medication).
So THAT'S why we don't institutionalise people. I don't care what facility it is, if the person isn't harming themselves, that's the wrong place for them. I can assure you, if I ever have thoughts of suicide, I will never admit it to the police or any health worker in case they put me back in that place. One night in that place was more than enough. I will either commit the act (God, I hope it never gets that bad!) or I'll suffer in silence.
The USA, for all it's flaws, is supposed to be based on the idea that the people are not subservient to the Government's goals, but instead, the Government is subservient to the peoples' rights. That they can only be deprived of their rights through due process of law, as passed by elected legislature. Not a "scientific" book written by people who have no accountability to the population as a whole.
I fear you would not understand how important this is unless you yourself were involuntarily committed. It may well already be true that a malicious individual with enough knowledge could look at your current lifestyle and find a justification for committing you and injecting you with things against your will. I'm sure that such a thing could happen under the rules that you seem to advocate. I hope such a thing never happens to you, but I fear that there are many people who would not see the importance until it does.
It's as much a part of the human condition that power corrupts as it is that we are subject to mental illnesses at times. Many say that it will never happen here. I say that (to quote a line from Battlestar Galactica) all of this has happened before, and all of this will happen again.
I don't know what made you think that I have the only right opinion. I'm advocating a view, and actually part of developing a well-rounded view is challenging beliefs you yourself hold--playing devil's advocate.
> That they can only be deprived of their rights through due process of law, as passed by elected legislature. Not a "scientific" book written by people who have no accountability to the population as a whole.
The part of the government that deals with health sets the policy on who should be institutionalised, and they are the ones that give executive power to do so to doctors. Actually, doctors and psychiatrists hold an immense amount of responsibility over the welfare of patients; they may not personally hold accountability, but the hospital or other medical instution does, because of the great potential for lawsuits in the case of mistakes (AFAIK).
> It may well already be true that a malicious individual with enough knowledge could look at your current lifestyle and find a justification for committing you and injecting you with things against your will. I'm sure that such a thing could happen under the rules that you seem to advocate.
This is rather unplausible; there is a mountain of a difference between my behaviour and of an unwashed, malnourished man who fails to communicate even basically with other people, standing for hours at road crossrods like a zombie.
I'm not saying I know what the answer should be, and this sits on legally and ethically tricky ground all over the world. The mentally ill have been treated pretty badly through history, and I'm not sure that benign neglect is the worst of these options but I do think there should be some formal system of checking on them (informally, there are any number of NGOs and religious groups who tend to keep tabs on the homeless, funding permitting).
But if you're talking about the USA and want to understand why so many are not institutionalized see the single-page summary:
"A Brief History of Mental Illness and the U.S. Mental Health Care System":
http://www.uniteforsight.org/mental-health/module2
From that page:
"...the deinstitutionalization movement has been widespread, dramatically changing the nature of modern psychiatric care.(7) The closure of state psychiatric hospitals in the United States was codified by the Community Mental Health Centers Act of 1963, and strict standards were passed so that only individuals “who posed an imminent danger to themselves or someone else” could be committed to state psychiatric hospitals."
FTA: >He wasn't a danger to himself or to others, he wasn't threatening anyone, he just didn't look very respectable.
This is the missing condition required to withdraw a patient's liberty in a secure hospital. Even if he presents with severe enough problems to become a voluntary inpatient, he may still wander off and be difficult to find. Due to the nature of this kind of illness, you are likely to cease seeking care when your problems become that severe, and need someone else to push you into it.
Although he had medication that he wasn't taking, it sounds like he was living on his own when his problems became that severe, so he probably had no one to push him to the doctor.
All that said, there should be people looking out for the homeless and making sure they get the medical treatment they need, and maybe the definition of "danger to self" needs looking at, as choosing to sleep rough during a hurricane sounds pretty dangerous to me.
It's a crying shame to let yet another mentally ill person end up in crisis. He could have easily died or been severely injured.
A society pathologically obsessed with markets, blind to the priceless.
If he were to have been hospitalized, not institutionalized, I wonder if the outcome were the same.
Our society assumes mental illness is totally different from physical illness, but in cases like schizophrenia the treatment ends up being very similar. You take your pills and see a doctor. If he had the flu and had suddenly taken a turn for the worse, the discussion wouldn't have been about institutionalization. He would have received treatment in a hospital and then been discharged as soon as possible.