Is forced treatment for the mentally ill ever humane?
economist.com
economist.com
When on her medications, she is a relatively pleasant & rational person, usually able to hold an entry-level job.
Her family do not want to throw her in jail for all the threats (I'm not asserting that they could, if they wanted to), she really does not like the side effects of her medications, and (under the current system) neither confining her to a long-term mental health facility, nor reliably forcing her to take her medications seem to be available options. (Her family has talked to lawyers about their options more than once.)
What would be the "humane" thing to do? In composing your answer, please recall that her family are also humans, and - barring a premature death - she is likely to outlive most of them.
Edit: Thank you for all the replies, but my 4th-paragraph question was intended to be rhetorical. My point is that the case-by-case reality, even from the PoV of a well-to-do family that really seems to care about the mentally ill person, is often agonizingly difficult.
I don't have an answer for you. I think you've come up with a potential plot for a very interesting Star Trek episode though.
(Star Trek: My guess is that such an episode, if it had any serious depth, would be vetoed in the script stage - due to being an extremely painful subject for too many viewers.)
In Scifi: Real bad people exist. Real people who need help exist. Real people who just need some time to talk out their problems with the ship's / a local counselor exist.
Real people who can't be helped don't exist, they reductively condense into one of the three classes above because society and tech are advanced enough. (Except in cases of extreme breakdowns; E.G. Voyager wasn't the only ship mostly sucked to the delta quadrant.)
The poorly written second season of Star Trek Picard had a character who was suicidal and refused treatment, then killed herself.
I think people refuse treatment in real life because the drugs don't work too well, not because they don't want to feel better, and at any rate you can't have a utopias if people choose to due horrible things to themselves or each other, you just have real life, so I think it went against the tradition of Star Trek being utopian fiction.
Star Trek alone had countless plot lines surrounding incurable medical conditions. Worf broke his spine, Picard has some kind of syndrome which will cause cognitive decline, La Forge had to settle for a visor for most of the franchise, and so forth.
Even under utopean circumstances, ethical considerations abound, as in "The Schizoid Man," an exploration of both rights for artificial life and transhumanism. Sisko's father ignored medical advice because he chose to, and in VOY's "Scientific Method" we find aliens desperate to develop lifesaving technology, even at the cost of agency for Federation staff.
These mental illnesses break the ability of an individual to choose to do what’s best in terms of medication, treatment, and lifestyle. The illness makes one not want to be properly medicated.
Someone can be consistent with their treatment and lifestyle for many months, but it just takes one trigger and a couple days off medications to lose all progress.
While I agree with the rest of your comment, I want to gently challenge this specific statement, as someone who has to take a powerful med (lithium) to avoid relapsing into mania with psychosis.
I was so extremely reluctant to regularly take meds, and lapsed in and out of mania for a few years. The main thing that got me to stick with lithium, and a major driver in me staying on them today, is grokking how deeply destructive mania is to all the relationships and other good things in my life.
I'm not saying we should shame mentally ill people, but part of treatment should be helping them understand & agree that permanent treatment is in their own best interest. Easier said than done, of course... it took years for me.
The medications do that too. The side-effects are horrific.
1. Justify what they did.
2. Dismiss it.
3. Ignore it.
4. Deny it happened.
Note that change their behavior isn't on that list. :(
I'm bipolar I, and I take lithium for it. Being confronted with my actions over and over and over and over again was a big part of what got me to start taking meds.
And yup, there's some newer research about the long term benefits such as lowering alzheimer's risk, which is a nice silver lining :) My doctors have mentioned it, so probably not pseudoscience.
You mean the opposite of that?
I worry that one day he'll end up being shot by police or something. It's awful.
I'm on antipsychotics. They are nasty drugs. Absolutely brutal. The worst of the side-effects for me are the sexual side-effects and motor-control issues. If I get dehydrated or my blood sugar gets low, I can lose the ability to walk.
Within the first hour of taking my meds, I can't stand without losing my balance. I lose both my inner ear and kinesthetic senses. I don't know where my feet or hands are. I can only walk by having my eyes open to see if I'm level and feeling where the pressure is on my feet.
During the day, I have medication that helps this but I still trip on uneven surfaces or drop things.
The sexual side effects, I can't orgasm. Combined with the hypersexuality a manic episode creates, it is unbearable. Fortunately, I'm on yet another drug that makes this less of an issue.
The only reason I can tolerate this is the alternative of going crazy is so terrifying, I'll do anything to prevent that from happening. If anyone wonders why people don't stay on their meds... this is a big reason.
Growing up he would tell me how terrible the medications were. I believed him, and still do to an extent. However he also identified with his illness and thought the drugs were taking away his special powers. That was a symptom. For those reading who have less experience, they sometimes call that anosognosia or lack of awareness.
In the end it's a very existential thing. It's easy to wonder about identity. I had a few people in my life with this sort of illness. I developed a model where medicated, treated, and stable, that is the "normal" them, their identity. However, these people got offended by this, and engaged in behavior I would describe as identifying with symptoms. Acknowledging symptoms, no matter how evident, was tantamount to personal attacks.
I think we all have issues with this in our lives. Self awareness and identity is a difficult problem. It's only when it falls far outside of norms, into extremes, that we call it a disorder. It can be very tricky to draw those lines.
> For those reading who have less experience, they sometimes call that anosognosia or lack of awareness.
I'm fascinated to learn of this and to read more, thank you.
What I had to realize is that even if "me without meds" was an existentially truer version of myself, people did not like me without meds, they did not want to be my friend, nor did they want to give me a job. That's what got me on meds, and yes, it felt really shitty at the time.
Years later, I don't feel that way any more. "Me with meds" feels like me, more than ever actually. And, lots of those things I valued about "me without meds" (wit, spontaneity, high energy, creativity) came back over time as I adjusted to being medicated.
Unfortunately, not everyone is able to find a med that allows them to get to that happy point. It took good healthcare, several tries, a support network, and (I assume) luck.
In another time, I would have been a shaman. My entire life, I had a deep spiritual connection with wolves. That's gone. All that's left of it is blank wall and confusion.
This hurt deeply. I can't even begin to describe how it felt to have everything I knew about myself destroyed.
I'm fortunate to have been raised Christian. That hasn't changed and it's been a welcome grounding while I work things out.
I feel like I'm fundamentally a different person. Like I was dropped into someone else's body. Someone else was here before me and left a bunch of furniture I keep bumping into. :)
But, I know I'm a kinder person than the person before me. Is this spiritual enlightenment? If it is, I might want a refund. :D
I’m not psychotic so it’s of course easier to be reasonable about the situation, but it’s never fun to be on drugs like these.
I chose to live without mania. I want to slow down and work on things I want to do, not be driven to do things, no matter how amazing they turned out.
These mental illnesses are adaptions/optimizations to the rise and fall of violence that was normal human history for the longest time.
A armed paranoid hobo maybe looking like a maladjusted human being to you now, but in stalingrad, sebreniza or bhakmut, he would be very adapted to his surroundings. All those stress triggered changes had their spoke on the wheel of time.
My opinion is that people should be force treated, but only until they reach "sentience" and can decide for themselves, not under any influence.
They also should be able to make sentient "wills", specifying condition under which the state is allowed to step in and help them.
If somebody wants to return to his mental state, nobody should be allowed to stop them. Human lifes value is not there to be useful, aesthetic pleasing or comfortable for society. Its value is only defined by the person living it..
But then again, i view optimists as mentally sick..
I don't think this works well when clear-cut, unambiguous delusions cause somebody to act on them and harm themselves and others.
I do acknowledge it's very hard to know when that is, and people can disagree.
At least he won’t be stabbing someone in an alley in 10 years - probably.
You know, I believe that Kanye may have significant mental illness, but...
An argument primarily from an economic angle makes me uncomfortable. On paper, I am not maximizing economic value right now-- but I'm pretty sure I'm well adjusted and happy with my (seemingly economically irrational) choices.
It’s from case law where someone quit their highly lucrative (but stressful) job to become a priest. The court ruled, ‘nah bro, you’re still on the hook’.
One could argue having a mental breakdown and destroying your career is not voluntary - but if it is not voluntary, then the whole argument about personal freedom goes out the window doesn’t it?
I think what you describe is completely orthogonal to what we were discussing-- whether seemingly acting in one's economic interest can be a measure on one's mental well being and used to judge whether someone is using their autonomy appropriately.
If we use outside economic tests, we become pretty fascist and authoritarian really-quick-like.
Eg. A lot of people can have symptoms of a psychotic disorder but they are still "productive" and functioning.
On the other hand a lot of people with bipolar disorder go through "manic spending sprees" which leaves them in huge debt. Or, people start to be unable to hold a job or keep up with studies. They might quit their job impulsively persuing a delusion, or make unwise investments while manic. This can be a proxy for how they are doing with the illness.
Someone with this type of issue who is very wealthy kind of makes that kind of argument fall apart. Kanye can blow a lot of money and still survive. A more normal person with bipolar disorder would hit rock bottom from a financial standpoint much sooner.
Yes, and Kanye may have various financial and business problems, but by any sane metric is able to support himself.
> Kanye can blow a lot of money and still survive.
Yes, which makes the behavior less obviously irrational.
This is why diagnostic criteria have phrases like "cause marked impairment in social or occupational functioning" --- and meeting diagnostic criteria alone is not generally sufficient for involuntary commitment. There, we reach the legal system, and definitions that generally include a pretty strict definition of danger-to-self-or-others-or-gravely-disabled, which wouldn't include this kind of thing.
I agree, though it’s not clear if you’re talking 5150 or conservatorship.
IMO, a pretty clear argument could be made (if someone had standing and wanted to do so) for conservatorship, at least of the estate, and possibly for him individually, in Kanye’s case.
I don’t see anything even hinting at a justification for 5150 WIC, even without considering the de-facto loosening of when it’s applied, which is I’m guessing what you’re referring to.
Hell, even if you’re lunging at someone with knife while talking about killing your self, it seems like most jurisdictions won’t do it. (Especially SF). If particularly public safety minded at the moment, they might take away your knife if they don’t shoot you first.
Budget reasons.
As to where it would go, god knows.
Plenty of poor people say messed up things, alienate people around them, and screw up their employment. They generally don't end up with involuntary mental treatment. Even if the root cause is because of mania or something.
> I don’t see anything even hinting at a justification for 5150 WIC, even without considering the de-facto loosening of when it’s applied, which is I’m guessing what you’re referring to.
Well, the whole context we're talking about things in is in the context of involuntary treatment.
Budget has a big part to play in this.
I disagree with this assertion, too, BTW, but it's so far from what I set out to discuss that I'm not too interested in responding further.
It’s quite common for folks in entertainment and sports for people to accrue large ‘fixed’ expenses (property, debt, child support, etc), on a variable future income.
He’s earned a lot of money, but he’s also spent a lot of money, and he nuked his major source of income and wealth not that long ago.
The divorce clearly is setting up even more cashflow issues. That kind of thing has ruined many normal/objectively mentally stable men.
Unless he’s been carefully squirreling away something, or setting up trusts carefully to protect his ass - not something that seems characteristic for him - it’s possible he’s defacto negative cashflow and bankrupt right now, and just doesn’t know it. Or maybe he does, and that’s feeding the mania.
Not disagreeing with you. Noting that such a system does exist, is currently active, alive, and ‘doing well’, and applicable when someone’s decisions impact the economic well-being of others in a certain situation.
And similar for being sane enough to be so intent upon staying that way.
I've known three people one directly and two indirectly that were lunatic level if they were off meds and all refused meds consistantly.
1. Was a guy I worked in the same dept during an early job. His thing was to start telling people that government agents were in the elevator to control your mind or something and ending out emails about it and corning people to warn them. Funny thing was it was a government job so there were government agents in the elevator pretty much anytime someone was in the elevator. He resisted because he didn't like the meds.
2. My friends brother in his 30's would not take his meds and his parents had to sneak them in his food. If he missed enough doses he would eventually go raving mad into the woods and eventually be found passed out somewhere by emergency responders usually naked and injured. He resisted because he didn't like the meds.
3. My brother in laws brother was paralyzed and brain damaged from a car wreck. Yet when off meds he would run off in his wheelchair into dangerous traffic or be found passed out(and injured) from exhaustion of crawling because he went somewhere a wheelchair couldn't go and just crawled for miles. Again he didn't like the drugs.
I doubt in each of these cases people are making the rational choice to ditch the meds in favor of a state of "pure madness". Instead they probably get fed up with side effects, and decide that "this time won't be as bad", or "I'll just stop taking them for a day".
I had to learn to be a different person. (Discussed in another comment.)
This is an extreme example, but imagine smashing into an artist’s home, breaking their tools, and telling them they’ll be working in a warehouse for the rest of their life.
Maybe they’ll be happier working in a warehouse, but they don’t know that. Change is hard.
It’s not as simple as they didn’t like the drugs.
I’m fortunate to have kept my creativity. If I had lost that, I’d prefer being crazy, even knowing it would end badly.
Lots of people voluntarily take substances that make them think much less clearly but also make them feel good: it's just a matter of scale
50 mg of Zoloft later I am 100% panic attack free. But even 50mg of Zoloft (which is essentially the lowest dose of a very safe drug, and I am a large male) has side effects I dislike, and accidentally missing a dose makes me feel absolutely awful.
I can hardly imagine what serious drugs do to you and the implications of them.
Sometimes there simply is no solution to a problem, a very hard concept to grapple with as participants in a community, society, or civilization.
However … eventually she’s going to make contact with the criminal justice system. This can very productive. Authorities can make plea deals/pre-prosecution agreements that require medical compliance.
I’d advise the family to move to a jurisdiction with lots of resources. A wealthy suburb should work.
Then wait for her to commit a crime and make report it.
I too have a relative who has psychotic episodes. I’ve had wonderful experiences with the criminal justice system (in rich suburbs).
Depends on the law enforcement. My aunt would ocassionally get arrested, but they'd never charge her with anything, just bring her to the hospital for an involuntary psych hold, and she'd find her way back home after that. I don't think they ever found meds that worked for her and that she'd take consistently for more than a couple weeks. (This was in San Pedro, CA, which doesn't fit your suggestion of a wealthy suburb)
Seems like the side effects of a lot of these harsh meds might be tempered by a slow release vs all at once with a pill. I am not a medical professional though so I could be completely wrong here.
Sure. The problem is that most (probably all) of these drugs give severe withdrawal symptoms when abruptly discontinued by a patient. You'd have to spend a lot of time to slowly wean her off all(!) drugs to know if they're helping or harming. Nobody does that.
1. Do we have and enforce laws about things like people setting up tent cities in neighborhoods, open air drug use, public defecation and attacking pedestrians.
Your politics can determine how you feel about this. My personal take is that yes we should have and enforce such laws.
2. What do we do when people are violating these laws due to mental illness? Do we just prosecute them and lock them up in regular jail or do we institutionalize and treat them like the mentally ill?
To me it seems like treating mentally ill transgressors as such is right. The alternative to treat them like regular criminals seem worse.
I think most people can follow this kind of argument. The real debate is around the first point, where do we draw the line about legal and illegal behavior.
Where should I go? AFAIK there are zero legal options for me when I’m unable to pay for an apartment. I do not own a car.
If I insist on being an upright citizen and following the law…do I just show up to a police station on January 1st and turn myself in for vagrancy and hope they throw me in jail?
https://www.houstonchronicle.com/news/houston-texas/houston/...
I’m also a bit concerned about the safety and conditions in the shelters, being that close to unpredictable strangers. But I’d prefer that over doing anything illegal.
https://hchatexas.org/housing-choice-voucher-program/voucher...
It can take a while to go through all that, though.
You can see available inventory here:
https://www.myhousingsearch.com/dbh/SearchHousingSubmit.html...
(Disclaimer: My day gig, speaking on behalf of meself only, etc. We are sponsored by the HCHA as their housing search provider.)
Is section 8 fast anywhere?
If it takes 3 years to get through.. that means now is the time to apply!
edit to add: I don't know of any solutions. Sorry for sounding so hopeless.
The practical answer is you do become homeless, but not out in the open -- you'll set up a tent somewhere somewhat hidden (maybe in the middle of a park, for example), and hope nobody notices it. Every so often your camp will get discovered and cleared out, which will be inconvenient.
It certainly seems pretty mean-spirited to harrass the homeless in this way, but it does have the benefit of (mostly) preserving the beauty and safety of public space.
If it comes down to it, I'd definitely recommend trying to get your hands on a van before going full homeless.
There’s also HUD or similar entities if you’re not in the US. There are also private nonprofits like churches that help with homelessness
https://www.houstonchronicle.com/news/houston-texas/houston/...
I’m also a bit concerned about the safety and conditions in the shelters, being that close to unpredictable strangers. But I’d prefer that over doing anything illegal.
It's honestly shocking that the US has absurdly wealthy churches and we have greater than zero homeless people on the streets. Helping the poor is the core tenet of the christian faith. If they practiced what they preach, it should be impossible to lay down on the street for more than five minutes and not be swarmed with offers for help.
* Housing is dangerous/scary (robbery, rape, physical violence, etc...)
* Housing is a conspiracy (to control people or other irrational ideas)
* The rules of housing are too restricting. (can't have a pet, visitors, noise rules, cleanliness rules, curfew rules, behavior rules, etc...)
There are others as well, but can't recall immediately.
A church can't fix these problems, no matter how rich.
While some churches do physical charity, that’s not the nominal function of a church in the general sense (it may implicitly be part of why churches are legally treated as charities in the US, getting not merely tax exemption but deductibility of donations for donors, but that is more an indictment of that policy than anything else.)
People in shelters use lots of hard hard drug and fight or sexually assault each other, shelters are full of tons of illness (physical and mental), rampant theft, you'll end up with awful pests like bedbugs, body lice, scabies, fleas... and you aren't even guaranteed to be let in, after hours of waiting in line, due to lack of availability.
They aren't well funded enough, aren't taken care of, don't have enough staff to keep you safe, and have too many troubled people in too close quarters. The ones sponsored by religious organizations are usually just as bad and add an extra layer of judgement and religious propaganda on top of it all, rudely implying that all your problems are because you don't follow their faith.
I'm not saying I have a good alternative in mind; being outside can also (obviously) suck for different reasons, but there are tons of legitimate reasons to avoid shelters even when you're homeless.
The story is largely truthful, except for the character who has a pathological need to follow every rule. In reality, I’ll be late on my rent, my various credit scores will take a hit, but I’m not going to get evicted that quickly and should be on my feet again before the end of January.
The lack of employment is entirely my fault, with the peripheral assistance of crippling anxiety and self-doubt. But I can choose to make ends meet bagging groceries, etc for $15-17/hour. I’m also a reasonably median performance programmer in C++ and Python so I should be able to find salaried work in the next month or so!
If I was actually post-eviction / move-out negotiation with my apartment I’d probably sleep in a car if I owned one or set up a very hidden tent far away from other homeless people near a $10/mo gym with showers and lockers.
Those plans may be illegal currently, but they are also still probably the best choices for a homeless person looking for work. Done properly, this doesn’t result in harm, inconvenience, or cost to the public. IMO, if someone can notice me enough to complain about me…I’m not being safe.
Well in most cities in the United States, there are numerous open spots in rent assistance or shelter programs. For example, in my city of Portland, there is a lot of money spent tackling this problem. In fact, each night, the city has empty rooms available for anyone, but they go unused. Unfortunately, part of the problem is the narrative pushed by the media that America has no social welfare. We have quite a lot. Unfortunately, the narrative we don't prevents people from seeking it out.
This is similar to how narratives about COVID swamping hospitals led to so many people not seeking medical intervention that they died or let a preventable illness go untreated. And it's what caused so many hospital closures.
Moreover, if you cannot pay the rent next month, you can contact your local st vincent de paul, and they will often cover it for you: https://www.svdphouston.org/
Below you said you are simply going to be late, and able to resume making payments in January. If that is the case, there are numerous programs available that will help you to make your rent so you don't take the credit hit. Again, if you lived in my city of Portland, I know several charities that will simply pay your rent no questions asked, not even expecting the money back. Please contact your local social services agency or one of these charities. Many have funds that go unused each month.
My take on this is what else are they supposed to do? Unless they're all killed, they have to live somewhere, and if they can't hold jobs and/or can't obtain real housing, what option is there other than to live on the street? I don't see how this can be made illegal. You're arresting people simply for existing and not being able to pay rent. What is this supposed to help? These are at least thousands of people in one city, hell, one neighborhood. If they were all sent to prison, there'd be no space left for real criminals.
As for shitting on the street, again, what else are they supposed to do? If there aren't public toilets available to use anywhere, that doesn't change the fact that they're animals with digestive systems that require them to defecate on a regular basis. Hell, with all the walks I go for early in the morning, I have three times in the past six months had to shit on a sidewalk, not because I'm some belligerent lawbreaker or even because I don't have a toilet, but simply because I couldn't get home fast enough when it came on and there was nowhere else to go. It's not even a matter of whether businesses with toilets will let you use them. There aren't even any businesses open at 4:30 in the morning.
I don't even see how this is a matter of politics so much as practicality. There are simply so many people that having the police, courts, and prisons try to deal with all of them would leave them unable to effectively do anything else they're supposed to do. I doubt it even works as a deterrent. Prison isn't any worse than how they're already living and the inability to reintegrate into society means nothing if they were already unable to integrate into society in the first place.
As it stands, sleeping in public and setting up camp in these places is illegal, but they may as well pass a law saying eating is illegal. How can it possibly be enforced? People can't just not sleep and shit, and if they don't have the right to occupy any private space, public space is the only space left.
Edit: I can see someone else already said something similar and got immediately downvoted with the response that they should go to a shelter. Okay, as far as I can tell, the people are sleeping where they are right now because it's within walking distance of aid facilities that are all located downtown. This includes shelters. But these shelters don't have anywhere near enough room for all of these people, and they aren't faced with a "temporary" problem. I've lived here long enough to see the same people and recognize them over the course of years. Some of them have clearly lived on the street for decades.
I'm thoroughly unconvinced this is a problem of shelter space. I don't know about Dallas, but in Portland, OR we have hundreds of beds going unused every night, and despite best efforts to fill them... we still have tons of street campers.
In NA we don't build the housing we badly need, making it arduous and illegal to build in most places, which has spiked the price of having a home, making it unaffordable to many, and then we've turned around and made it illegal to not have a home.
That there are so many people "breaking the law" is a self created problem by refusing to build homes for people to live in.
There is not enough housing available that is affordable to people whose only income is whatever the minimums the government can provide.
Accordingly they're homeless. There's also not enough temporary shelters for people who are homeless, so the only option is to sleep in a tent outdoors.
Sleeping in a tent outdoors is against the law.
So in effect there is no real alternative for these persons but to break the law.
Supreme Courts in Canada (unsure on the USA) have noted this fact, that people have literally no choice but to break the law, and have accordingly ruled that cities are not legally able to stop people from setting up tents in public land (parks) if there is no other housing options available. (Cities are however able to put time limits on tenting in parks)
Washington State Supreme Court has ruled similarly.
As a capitalist who believes that everything is driven by supply and demand, I agree that enabling more build would drive down prices.
But that's completely irrelevant to the topic here. We're talking about people so severely mentally ill that "forced treatment" is a consideration. These aren't the people who are going to be buying/renting houses in a normal way regardless of availability and cost.
We're talking about people where the options are street life, incarceration, or institutionalization.
Politicians seem to be going "we've tried nothing and we're all out of ideas" shrug and leaping to "lets institutionalize everyone" before they've done any basic things that would improve the mental health and wellbeing of people. It's very depressing to see.
And of course, funding/supporting programs and regulations that reduce the scope of the problem is a good investment. This likely entails providing housing to people to preempt the issue of those people trashing up public parks. But the laws against that sort of behavior will still be necessary because some people will choose not to avail themselves of those programs and will behave antisocially no matter how much help you try to give them.
Let's frame it this way, "Is it humane to allow people be a slave to their mental illness and living on the streets?" The answer is clearly, "no". Allowing the mentally ill to live on the streets betters no ones life and causes many issues for everyone. If people with a mental health issue can not or will not take care of themselves, then someone else has to do it (IE: The Government).
It is humane for everyone if the mentally ill are forced to get treatment or confined if they refuse it.
Definitely not, unless they're actively harming you because self-defense is always justified. Short of that it's none of your business.
It was never acceptable to allow this and we no longer have the excuses of the old days—that we don't have the resources to help them.
https://www.theatlantic.com/health/archive/2019/03/typhus-tu...
You can offer as much help as you want, but you can't force it on anyone. I think we should give them all free housing, food and whatever else they may need, but we can't use violence and imprisonment on them in any other case than self-defense. That would be a violation of bodily autonomy and extremely illiberal.
Either these folks are deemed competent or they are not.
Also, you've used the word violence here to give the appearance that this is the same as assault, but it not. It is humane care for those who need it.
Obviously there's a difference between defecating on the sidewalk and recklessly injuring someone with a car, so the question becomes how we define harm.
No, it's to prevent the person from doing harm to others, not "for the greater good" or else you've entered into fascist territory. It has nothing to do with competence either but harm reduction. That's why someone can't drive without a license because they would be at a high risk of hurting others (you can drive on your own property.) It's self-defense.
> Also, you've used the word violence here
I used the word violence because it's literally violence. It has nothing to do with connotation, the definition of a state is the monopoly on violence over a particular territory; so wielding the state to force people to do things is nothing less than using violence or the threat of violence. This isn't remotely controversial.
As a non-US reader, I have never encountered this definition where I live. I understand what is meant, but it seems very much like a fear inducing frame; state = violence.
Maybe this is because where I live we have a different relationship with our government and law enforcement than the U.S., but to me it’s not at all “not remotely controversial”, at least in the way it’s phrased.
Now, if you are crazy and live on a deserted island it’s not a problem. On my doorstep is another story; the other 98% of us have a right to peace that overrides yours. We live in society and lose a few rights, the bargain is that we get more in return than we lost. The ill could be free to try to survive on their own if they don’t want to submit, but again we know they are not competent to make the decision by definition.
Are there any other situations when we can forcibly act to protect you from yourself, or is mental illness the only situation where this is permitted? Should society be allowed to forcibly restrict you from engaging in other forms of self-damaging behaviour? Smoking, drinking, gambling, being stoned all day erry day, riding an ATV without a helmet..? Not getting vaccinated against a deadly, contagious respiratory disease, because you think the vaccine[1] is a 5g chip created by Bill Gates as part of a secret mass eugenics program? Not allowing a doctor to operate on you or your child, because you believe that a blood transfusion is a sin?
There's a wide, wide spectrum of a gray zone here, and that's why drawing a hard line through it is not the clear-cut easy moral answer that you think it is. It's precisely why society tends to draw soft lines through it, leans towards encouraging and discouraging over compelling, and why it won't intervene in response to most forms of self-harm.
[1] That's a pretty big one. If we're going to forcibly medicate people for their own good, universal vaccination seems to be a much more obvious place to start. Debilitating side effects of vaccines are negligible compared to those of brain pills, and the overall ROI, both personally, and to the people around you is fantastic.
The problem is that the rest of the world doesn't want to - not can't, but finds it inconvenient - to deal with the ramifications of supervising or caring for people in public, strangers, who can't help themselves.
It's much easier to detain inconvenient people than change the rest of the world around them such that it wants to share the burden of caring for them.
Even if not aggressive, they will just "get lost" and try to drive or "go for a walk" in the middle of the night in their pyjamas. I suppose from the way you phrased it that in your case it was mostly harmless and you just disliked getting weird looks, but a lot of dementia patients are actually incompatible with society and need to be detained or given anti-anxiety medications.
Effectively it trains people to distrust the health system, and to not seek medical care because they'll be locked up and bad things will happen to them. This leads to worsening health outcomes.
We just passed through years of pandemic where everyone was eager to listen to the experts in the medical profession and that saved countless lives. It's sad and disturbing that when it comes to other health care issues, the politicians are now tuning out the same experts because they don't like what they're hearing.
I think there's a difference between making an informed decision to decline treatment versus not being in a state of mind that allows you to make any rational decisions. People on the street with mental faculties in a state of failure are not really able to make that choice, and treating someone in that state as if they're making a voluntary choice is farcical.
The alternative, where someone is whisked away to internment for a few months, bounces back right after into the same broken lifestyle, and subsequently never trusts the medical system ever again and never goes to see a doctor again is less desirable.
With the former there remains always new opportunities for someone to take positive steps forward to recovery as they are always in contact with a system that can help them.
With the latter we burn a bridge one and done.
A lot of ethical questions could use a "trolley-fy" process in which the status quo is simply presented as another track, and then another process by which that question is re-embedded within its actual context -- the mentally ill are not off wandering some other plane of existence, they may be screaming in your alley, tonight, around three a.m.
There are cases when a person is not in the mood (to put it mildly) to accept help but really needs it and will sincerely appreciate it once a relief comes.
The opposite question is also valid by the way: is it humane to leave the insane to struggle and roam the streets untreated?
"Democratic mayor of New York City, instructed police and first responders to hospitalise people with severe mental illness who are incapable of looking after themselves."
I consider this humane and sound.
The solution to that might be to not have a binary line. The less capable they are, the more we can choose for them, but it's not all or nothing. (No, I don't have any idea what the details look like...)
I doubt “hospitalise” means to house them in a properly staffed psychiatric care facility under the care of qualified professionals.
Folks who really don't trust the government of NYC on the "competence, honesty, good will, and resources" angles may have plenty of evidence to support their distrust.
Then we tore down the asylums and set the inmates free. Good job.
You are free. Live your lives in happiness. Nobody will force treatment up on you.
In fact getting treatment is close to impossible in the US.
Many people without treatment get progressively worse.
A lot of start using alcohol or other drugs to try to manage their lives. For most people that does not turn out all that well over time. They had added a component that will give them even more problems.
Now prison is full of people with mental illness who ought not to be there. They have become the new asylums.
The prison cannot provide the care and treatment required.
This is not progress.
What was needed before, and is needed now is appropriate treatment for each person.
Some can do well with speech therapy. Some need to be tied to a bed. A lot.
Between those extremes there is a near infinite palette of mental problems. No two people are the same, even if they are given the same diagnosis.
(Diagnosis in itself is a difficult thing to get right, and requires observation / follow up over a long period of time. Not just when they are having an episode. )
Treatment of mental illness is almost universally a part of healthcare with low funding.
Try reading the actual reports. Seriously, you can find that online.
In most cases this is what real-world suicide prevention leads to, because if a person is adamant on killing themselves they usually find a way. The exception is really sick people who want to kill themselves, but can’t because they have limited autonomy. That would be covered by euthanasia and is one of the reasons why it is very important ethically.
For other mentally ill people, forced treatment is still only ok if they may actually get better and thank you later. If someone is dirty, homeless, and senile, but they don’t care, putting them into a retirement home does not make them happy so it does not actually benefit them. If someone acts sane only when they get medication but they hate it, giving them the medication does not benefit them, it benefits others.
In these cases forced treatment may still be practically necessary and morally ok to benefit society (we don’t want dirty homeless people begging on the street, so we outlaw public indecency and soliciting, and some illnesses make a person dangerous). But I think that we need to understand that forced treatment is not to benefit the mentally ill themselves, but us, and also take their feelings into account. e.g. force homeless people out of the streets and into homes, but give them autonomy, and if their homes decay and they sit around all day and don’t care, let them.
EDIT: Should also add that nursing and caregiving are jobs which give people power over other, vulnerable people. Many of the doctors which take care of mentally ill and disabled people are genuinely amazing people who honestly don’t deserve the bad connotation, but some apply to these jobs to take advantage of their power over others. So when forcing treatment on someone, we really need to ensure that those in charge of the treatment have said person’s best interests at heart, and need to be monitored and held accountable. This is something which is unfortunately lacking because the people who are exploited or in danger of being exploited and thus care the most can’t really advocate well, so the burden falls to beaurocracy which cannot adequately manage.
Almost any non-prison option would be better than the current way of doing things.
As a result, my question is, is it ever humane to not force treatment on the mentally ill
https://my.clevelandclinic.org/health/treatments/9302-ect-el...
I don't remember what happened after. ECT has that effect.
Evidence in psychological science is much more superficial than in, say, physics. I don't doubt that what you say is reflected in the literature, but I do doubt that it reflects the lived reality of those so treated.
A lot of homelessness is due to different mental illnesses (not discounting the societal issues, and of course the drugs then make it worse)
I really feel society sucks at dealing with the action/inaction assymetries
Unfortunately, and equally sad, many of these folks work, send their kids to school, and struggle to get themselves into a stable long-term situation.
- 582,484 total homeless
- 138,361 chronically homeless
- 122,888 total homeless reporting severe mental illness
- 48,373 total homeless victims of domestic violence
- 33,129 total homeless veterans
VA count of veteran homelessness was down 10% or more YoY in 2021 and 2022, and down 55% since 2010.[2] Veterans comprise about 10% of the total US population and 5.6% of the homeless population. Among veterans, PTSD was less of a risk factor than psychotic disorders, an equal factor to other mental health disorders, and mental illness in general was less of a risk factor than money mismanagement and could be mitigated by VA services, especially disability compensation.[3]
1: https://files.hudexchange.info/reports/published/CoC_PopSub_...
I do not understand your point. How is that any different than, say, driving my car down the highway? The same act can be fine if I have a driving license and not fine if I do not.
It's moral to ensure charges go before a court quickly, it's immoral to allow a person to languish in jail for decades without trial.
Time and effort are a components of everything including morality. To dismiss time and effort as trite or irrelevant in nearly any situation seems abusurd.
Assisted suicide is (to my knowledge) aimed at end of life patients with terminal outlooks. People who have little chance of improving their outcome.
Self inflicted suicide is a much broader category including bullied high schoolers and unlucky stock traders. People who's current situation might look grim but who could potentially change that situation.
I won't comment on the morality of either, but there's more at play than just bureaucracy.
"Life, Liberty and the pursuit of Happiness."
Life is inextricably linked with death. If you have the right to live, you must also have the right to die. That belief is largely entrenched in our medical system too but stops short of doctor assisted suicide.
Am I allowed to stop that suicide? "Whatever affects one directly, affects all indirectly."
"No man is an island entire of itself; every man / is a piece of the continent, a part of the main;"
Preferring a loved one to suffer, indefinitely, in order to spare your feelings... is the very definition of selfish.
If by this you mean "don't blow your brains out", then, yes, i agree, and i wonder if you're misreading me somehow in a way that suggests that I think you ought to be able to without interruption.
Otherwise, i'm having a hard time making heads or tails of what you're saying here.
If jumping in front of a train isn't clear enough for you, should we be allowed to swerve headlong into traffic?
I generally feel there is an inalienable right to suicide. Similar to other rights in the Declaration of Independence, this is a right that people will exercise regardless of whether it is outlawed or not and no one can stop those who wish to exercise it. It’s functionally impossible to prevent someone from committing suicide — there are countless cases where people in mental wards have a watcher-person with them 24 hours a day, less than 3 feet away at all times. And the patient will do something like suddenly sprint full speed into a wall headfirst and kill themselves.
But I also believe that the person committing suicide has the duty to cause the least amount of property damage and additional overhead for others in the wake of their death. Similarly, those who survive them have the duty to process the persons death to the best of their ability.
I would say that the gruesome suicides you asked about should be legal to stop, given a situation where the interruptor has a reasonable belief that:
1) there are more humane ways to commit the suicide which do less collateral damage, and 2) that the person committing suicide is not in such extreme pain that these options will take too long and cause the intervention to be a particularly cruel intermission.
For example, if someone has been suffering greatly from a very bad exposure to the gympie-gympie tree and they truly need the most expedient death to relieve the pain…perhaps the train really is their best option. And it’s up to the rest of society to understand and be thankful that this person found relief from their unimaginable pain and that it is now our duty to clean up and process the aftermath.
I don't understand this argument. Should we also have an inalienable right to recreational opiates?
> If someone has been suffering greatly from a very bad exposure to the gympie-gympie tree and they truly need the most expedient death to relieve the pain...
This example is also confusing to me. It sounds horrific, but it's temporary and non-terminal. Not what I'd classify as a "true need for the most expedient death." I can be understanding of the desire to die in this situation, but I cannot see how this should grant everyone the right to die in the manner of their choosing. If you truly need an expedient death, as you say, the law won't stop you.
Reducto ad absurdum: If I get poison ivy and can't sleep for a few nights, should I be legally allowed to swerve headlong into traffic?
If we should have a right to suicide, the only way I can see it enacted is through doctor assisted suicide clinics, otherwise we open the door to even greater harm from public or botched attempts.
I mean, you correctly labeled the fallacy here. Yours is a plainly terrible example. The pain of poison Ivy would clearly not be so great as to require immediate relief.
Returning to clarity: I think most reasonable people would agree that there exists pain which is severe enough to require immediate relief in the form of death. You might not, but I don’t think that’s reasonable. You say anything that’s “temporary and non-terminal” should not qualify for the right to die. I’m incredulous that you cannot imagine ANY torture so great that someone should be allowed to die rather than endure it for some indefinite amount of time.
Instead I pose a reductio ad absurdum to you: Lets say I create a machine which causes you more pain than any human has ever experienced, but does not otherwise harm you. I connect you to this machine with a button you can press to kill yourself but it will also cause 30 seconds of pain to a random person in another room. Other prisoners in your room share your beliefs and tie your hand so that you cannot press that button. You will be connected to this machine until the final year of your life, at which point you will get one final year without this pain. Should the other prisoners let you press the button?
The point here is to acknowledge that there exists a spectrum. And that somewhere on that spectrum, a person should be allowed to kill themselves even if it causes some discomfort to others. We might disagree where that point lies but my goal is for us to agree that it exists.
> Should we also have an inalienable right to recreational opiates?
This doesn’t fit my example at all. It’s possible to remove opiates from society if you spend enough on the project. Whereas inalienable rights like protesting the government, finding shelter, finding food, etc cannot be prevented before they occur, only punished after. A better counter example would be murder if you’d like to use that instead.
Instead, I’d like to ask you what your concept of an “inalienable right” is and how “finding relief for unendurable pain” doesnt fit in your definition.
An interesting corollary would be the right to self-defense. If someone unjustly attacks me and I believe the attack threatens to break my arm but does not threaten to kill me, I am allowed to use a similar degree of force to defend myself. And if, in the course of defending myself, I accidentally knock over an old lady to the ground and she dies…the attacker gets blamed for that, not me. I had a right to protect myself from the pain of a broken arm, even though it would get better eventually.
If I’m a bystander, should I prevent the person from defending themself because someone else might get hurt in the frenzy and it’s only a temporary pain of a broken arm?
Why do you blame the person who is being threatened with more pain, rather than the attacker (the gympie gympie tree)?
You bring up excellent points regarding my absurd example, but I'm actually not sure I agree there exists a pain severe enough to require the release of death. My example was meant to highlight that such threshold is quite arbitrary. Should we be allowed to kill ourselves over a shattered bone? A breakup? A hangover? A bad test score? Most people survive their encounters even with the gympie-gympie tree. Now, my opinion changes completely if the condition is terminal, but for temporary pain I'm uncertain there's an obvious answer. We haven't even considered that there may be alternatives also able to reduce suffering like painkillers (or, in the context of this thread, mental health treatment).
Another terrible example (can there be any other type on this topic?) is car crash victims. I vividly remember drivers ed, and I expect EMTs are occasionally met with pleas for death while brutally triaging their patient. I also expect a good number go on to have partial or even full recoveries and lead happy productive lives. Should EMTs abide by this wish in that moment? Should the patients prognosis influence this decision? These questions are hard for me even ignoring the affect on others. Should it affect anything if the patient has kids or is pregnant?
I think we’ll fundamentally disagree as a result of this. Like, based on each of our personal fundamental beliefs, our own ideal social rules make sense, but will not make sense to the other.
To me, if you believe a uniquely unfortunate hypothetical person should be forced by society (to the best of society’s abilities) to endure the worst torture imaginable for their entire life just because it won’t be “their ultimate cause of death”…
…that you probably are worried about something other than that persons life. Perhaps you are more concerned with their soul than their life? This is valid and given certain beliefs in afterlife/heaven/god it is the overwhelmingly more important outcome to consider! Nearly any infinite Earthly pain would be worth saving a soul from eternal suffering away from Heaven.
But I will say that I’d also like not to live in a Theocracy, where government rules are decided based on the sincere beliefs of the dominant religion. Some people do though! And it may be that’s another point where we’ll permanently be unable to see eye-to-eye despite our best efforts and intentions.
I do think it might be important to consider, acknowledge, and announce where the foundational beliefs come from which are likely to lead to radically different conclusions, even given best intentions from all involved parties.
If you are not religious, or your feelings on this topic don’t stem from your religion, I apologize for my assumptions!
To answer all your specific questions based on my personal value system:
> Should we be allowed to kill ourselves over a shattered bone? A breakup? A hangover? A bad test score?
Yes to all. But again the one ending their own life has a duty to do it in the most considerate and responsible way possible, not harming others in the process to the best of their ability.
In all these cases, it wouldn’t be the one event that causes the suicide, rather that event would be the straw that broke the camels back. A lifetime of pain and trauma would precede it.
> We haven't even considered that there may be alternatives also able to reduce suffering like painkillers (or, in the context of this thread, mental health treatment).
Given the reality that people will commit suicide whenever they want anyways, if we accept that fact as normal, it will lead society to understand that it is society’s responsibility to advertise these options and make them easily available. We should make them automatic first-line options in the minds of those who may be suffering, so that they choose those options over suicide. When society denies that suicide (or worse) is a default option for people who are suffering, we lose some of our incentive to implement the best possible remedies.
> Should EMTs abide by this wish in that moment? Should the patients prognosis influence this decision? These questions are hard for me even ignoring the affect on others. Should it affect anything if the patient has kids or is pregnant?
My value system does not lead to a conclusion where an EMT has to do anything to assist a person in their quest to end their own life. The EMT would never ever have to kill anyone who begged for death — I’m not even sure my value system would allow them to outside of a highly regulated and mildly Byzantine euthanasia process.
In general, parents have a right to suicide as well (although the state does not have to assist). What is wrong with our society that so many people feel that suicide is their best option?
Can we focus on fixing THAT?
Instead of worrying whether the person who commits suicide is selfish VS. the people of society are selfish who insist that sufferers should forever persist in their suffering for the benefit of society?
I believe if we accept in our hearts that suicide as an inalienable right, we’ll start building a better society as we accept the conclusions of the belief.
It's not people's lives I worry about so much as their agency. Suffering shrinks one's horizon. If someone's suffering can only be ended with death, then I see no reason they should be prevented from ending their life. I just think that's not often the case. A lot of things get better and a lot of things can be treated. Suicide attempt survivors rarely try again.
If someone has Issues like bad gympie gympie tree sting or radiation burns or something and they're not responding to treatment then I certainly would not prevent them from suicide. I don't think a government should either. But if a someone gets a bad grade and climbs up on the roof or has a bad breakup and tries to jump in front of a train, I'd hope a parent or friend could restrain them. I'd hope a stranger could too.
> What is wrong with our society that so many people feel that suicide is their best option?
> Can we focus on fixing THAT?
I think we should all agree on that.
Aren't the walls cushioned for exactly this reason?
Sure
> If you have the right to live, you must also have the right to die.
This is a non-sequitur. In fact, in so far as all human rights descend from the one in question being alive in the first place (since the dead have no rights), it makes no sense of a right to die. In the same way a right to liberty involves no right to sell one's liberty. Just like your freedom, you do not own your life. We know this because you cannot sell either your life or your freedom, thus you don't own it. Thus, despite having a right to it, you don't have the right to rid yourself of it.
Here's another example. My children have a right to live in my house and receive support from me. They have no right to either sell my house or not receive support from me. Although they have a legal right to my money and protection, they cannot dispose themselves of it.
Life and freedom are similar. They are something we enjoy and have a right to, but not something we own.
> That belief is largely entrenched in our medical system too but stops short of doctor assisted suicide.
Choosing to not undergo therapies that may or may not lengthen your life is not morally equivalent to actively choosing death.
- You can also opt out of treatment and receive terminal care.
Your superstitions should not impact my life. I will not respond again.
An adequate addressing of the topic would need to start, at minimum, with defining with great specificity the following terms as applied to this problems:
Force (which mechanisms, legal, physical, social, etc)
Treatment (Chemical? Talk therapy & its many varieties? Simple protection from oneself, or others from the subject?)
Mentally Ill (As classified by the DSM-V? Some other formal source? Who makes the diagnosis, what if there are competing diagnosis from different practitioners? Does the State get a say in this definition?)
Humane (A vague concept whose specific definition, often also a bit vague, will vary by context: In the US it is considered humane to euthanize animals in pain that cannot be cured, or with terminal conditions, or some combination thereof. Doing so to humans, even with their consent, is highly controversial. And yet suicide hangs silently over many discussions of mental illness, and too often mental illness is resistant to treatment to the point of torture for the person experiencing it, even with their full & willing consent to any treatment that might help their cause. Further there is the same question of who decides what humane gets to mean, both in general and as applied in specific circumstances.)
This barely scratches the surface, all I've done is identify items in a short headline that need defining, and each of those could take countless person-hours of discussion & debate and still not be settled in a meaningful way in which most parties agreed.
As to this specific case, the forced treatment of homeless people with mental health problems, from what I've heard on the people with boots on the ground a lot of people have severe brain damage from things like fentanyl overdoses who simply can't take care of themselves, and I've heard tons of people who have been disturbed by people with mental health problems disrupting public order as people go about their day to day lives. How much should one value freedom, how much should one value order, and how much should one be a consequentialist? How cost-effective is forced treatment anyways?
I think the ethical conundrum lessens if there actually is a clear, proven, effective treatment. We often make decisions on behalf of people who aren’t able to make the right choice for themselves, and I don’t think a pathological commitment to individual liberty should constrain us in cases where there is the possibility of dramatically improving someone’s wellbeing.
Could she have had a different outcome through forced treatment? Yes and no.
The technical answer is No because the treatment she needs doesn't exist here (extended-term, inpatient, safe). There's nothing to commit her to.
If the treatment she needs existed, could I have committed her against her will? Probably not. It would require LEO assistance and (due to reality) husbands are generally considered to pose a heightened risk of gaslighting.
- dangerous/"seriously impacting" for others (→ locking up in an asylum)
- need to be forced to take some treatment / learning so that they can function in the community
- the rest
I genuinely do not know the ratios, but have the feeling that the 1st one is really marginal, the 2nd quite a lot and the 3rd the bulk of people
Capitalism is more of a social problem than psychotic homeless people.
Then I remember how the definition of mental illness has changed over the years and think how it might change in the future, and now I'm not so sure.
Meaning there are 2 issues
(1) Save everyone else from someone's distruptive behavior
(2) Deal with the person in the best possible way
You can solve (1) and not solve (2). Being not able to solve (2) perfectly does not invalidate the need to solve (1)
1) What sort of behaviors is a community willing to tolerate
2) What does that community do with people who are unable to stay within the confines of tolerated behavior
The problem is that asymmetrical answers to the two questions can create a strange grey-zone, where problems linger.
For example - if you murder someone, I don't think many people are going to argue against you spending some time in prison. The response is in line with the severity of the action.
But... if you say, consistently piss in the elevators of your local metro (even though public bathrooms are available), most folks aren't sure prison is the right answer. Ideally - we'd just keep you out of the metro entirely - but setting up that system is very expensive when we're dealing with a very small number of bad actors.
On the flip side - that small number of bad actors is doing considerable damage long term. They're making metro usage far less pleasant, driving down ridership, increasing cleaning costs, reducing public health, and requiring additional staff in attempts at monitoring. Each other member of society is only inconvenienced a relatively minor amount, but they're impacting a very large number of them by degrading a public and shared service.
The same is true of those who camp/sleep outside of businesses, or scream & rant in public spaces, or do drugs in public spaces. They are actively harming the space they are using at large, and are unwilling to stop or unable regulate themselves.
So what do we do with those people? What is a proportional action that we can take that prevents the damage this person is causing at scale?
Prison/Jail rarely work - because the damage of each individual occurrence is small, they are usually out very quickly.
Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness).
Meds can definitely help - but the category of people creating these disturbances generally have trouble consistently taking meds (again - for a variety of reasons including access to services and payment, but not the least is active, personal resistance)
So... if we've ruled out (as in - tried and failed) self medication + housing + prison... where do we go?
Because at that point - I'm not really convinced that forced treatment and care are really unreasonable responses. It is far more cost effective to gather these folks in a single place and confine them there than it is to allow them to roam and attempt to stop their problem behavior at the place it occurs. It's the difference between 10 guards, a large facility home, and medical staff - versus thousands of required staff spread over a city.
Why don't we see what happens when we max out this intervention? Data seem to show that it would free up a lot of resources, and maybe some of those whom you're assuming will be recalcitrant won't be if housing options are ample.
I think it's likely this would address 80% of the problem, and then we can see what the remaining 20% looks like qualitatively and quantitatively.
I also think that there are a lot of 'low-hanging fruit' level of options available, that seem to be disregarded in today's all-or-nothing environment. Specific example: During my short, ~10-block drive to the 101, I pass a good half-dozen regulars who are either screaming at the aether, wandering erratically through traffic, flinging things at passing people/cars, or in one case literally rolling around on the onramp between cars. This is not an exaggeration, or hyperbole.
These people need to be in an institution. Maybe with treatment, they can recover. Maybe they will be there for the rest of their lives. Maybe some form of halfway-house works best. But I can't think of any good-faith argument that leads to the status quo being the best choice for either them or society at large. Surely we can come to a societal agreement about what to do for this level of dysfunction?
I do agree that mental illness definitions are a problem. Even forcing treatment on just those who are a danger to society makes me leery given that hostile social posts are now a social danger.
Yes - it is humane for them AND for us.
Ironically, this seems like true freedom to me - do whatever you want to whoever, with no fear of consequences. Just have to deal with the lack of dignity and resources.
Thats a fascinating stretch of the truth. Most sociologists, public health professionals, and public policy researchers can directly link "Reagans army" to the mans policies quantitatively. its less of a blame game and more of a fact of life the thatcher/reagan neoliberalist push essentially relegated the mentally ill to freeway underpasses and drug store parking lots. Those that didnt wind up screaming at stop signs or dancing nude through the streets instead have gone on to commit some of American societies most horrific mass shootings.
> Many administrations in California have had opportunities to reverse Reagan
in '67 sure, but by 1981 his federal cessation of funding for ANY state mental health services would have made the effort near Sisyphean. Alex Barnard doesnt do much to shore up the Gippers legacy outside of the prescriptive myopia that we should ignore the past and just look to the future now because $add_reason_later.
Treat mental illness just like real illness and stop pretending its some special category of sorta-problem we cant do anything about because, surprise, we havent invested any money into its research, treatment, or cure since Dutch decided to gut funding 41 years ago before slipping into Dementia himself.
How does a libertarian deal with the chronically homeless?
Obviously you house them, feed them, offer them treatment, etc. with the least amount of friction possible. If they refuse and aren't literally hurting anyone, then nothing.
You don't need to over-complicate this.
If involuntary commitment is against your principles, what about relocation to designated areas where the homeless have access to services they need? They can leave and go wherever, they just can't camp outside those designated areas, or otherwise break the law, just like any other citizen.
> I've seen enough public places trashed by the fraction of the homeless that are either too ill or don't care to pick up and walk a few feet to a trash receptacle.
I mostly see non-homeless people do that. I'd say they're responsible for the majority. Look at the side of highways, for example.
> Parks and coffee shops end up locking their bathrooms so they don't have to clean up the mess.
Provide them bathrooms.
Even so libertarianism has to take the real world into account at some point to be a useful -ism. That means your freedom ends where mine begins.
None of these tactics have been strategic - housed and homeless people alike in Portland who want mental health resources can't access the limited inventory of them, so expanding involuntary commitment without funded services will only add to that resource stress. Sweeps without a variety of funded shelter options just move the problem of camps from one part of the city to another while destroying what little the campers own, at a contractor cost of $4.5 million per year. The city-run camp proposal has been derided as "concentration camps", and the $27 million price tag would pay for a year of stable housing for nearly 2,500. State legislators cited the sweeps and camp proposal as reasons why they were giving $25 million in funding to the separate county leadership instead of the city, and put conditions on the funding that explicitly prevented its use for sweeps or involuntary camps.
All of this happened _before_ the proposal to expand involuntary commitment criteria, which would at worst facilitate abuse or harassment of people with mental illnesses - housed or not - and at best fail to solve the underlying lack of treatment resources available to anyone, much less the involuntarily committed.[7]
1: https://www.opb.org/article/2022/12/12/portland-mayor-ted-wh...
2: https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-want...
3: https://www.oregonlive.com/politics/2022/12/portland-has-dra...
4: https://www.columbian.com/news/2022/nov/18/homeless-vote-in-...
5: https://www.kgw.com/article/news/local/homeless/multnomah-co...
6: https://www.oregonlive.com/politics/2022/02/no-direct-fundin...
7: https://www.themarshallproject.org/2020/11/08/when-going-to-...
Is it moral? No.
https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p...
AIUI, the blog author points out that if you really want to comprehensively replace institutionalized, forced treatment, some sort of self-organized peer support is the best reasonable alternative - one that, arguably, has barely been tried. Related: Prison and mental illness https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p... - My Brother Ron https://slatestarcodex.com/2016/03/31/book-review-my-brother...
Currently, any kind of psychiatric label is equivalent to archaic prophecies. There's no credible scientific evidence to back up any kind of mental illness diagnostic. It is a facade.
Each and every medication supplied by psychiatrists is not a treatment. It is an inhumane process of complete eradication. Dopamine is a product of hormones among others and it is the core fuel of the brain. Dopamine is the resource with which you anticipate time. Dopamine is the resource with which you can memorize and have a cognitive function as a human being. Dopamine is the reason you have an imagination. Dopamine is the resource that transforms into energy for you to move your body. Shutting it down is nothing but a legal modern euthanasia.
You justify pills for an effective measure, when science itself tends to look towards the gut-microbiome and the inflammation reaching all the way up to the brain. Exact causes are still unknown, but: there are other things one should be treated with, and they are not pills. The ketogenic diet has completely cured people who have been diagnosed as schizo-affective (schizophrenia that is actually worse). People who have been diagnosed as bipolar have also seen tremendous benefits from the ketogenic diet and have been cured. There are many supplements one can use to optimize the overall neuro-biology along with daily routines that reinforce it.
But guess what? No psychiatrist actually pursues those choices, the biggest majority of them are "Here's your pills, next. You don't want them? Let me call the police.". Seeing people treating family members like that is also disheartening. Ignorance got us blind, blind to the madness we as society reinforce and blind to the actual truth.
Calling that a human process is completely ignorant, there's no way for you to know how it is like unless you have studied neuro-biology or you have been under the influence of a dopamine antagonist (commonly known as anti-psychotics).
And let me tell you something, there's nothing worse from seeing your lifetime go by and you being completely unable to live because you got no brain fuel. The worst possible prison is in our brains. Sometimes we build it ourselves, and sometimes other people do. Anti-psychotics is other people. That's how the real trauma occurs. That's how many innocents get "treated" from the society and the psychiatric community.
The angry rants are a reaction to loss of bodily autonomy, spiritual wellbeing and mental liberation. If you are on these kind of antipsychotics for the most part of your adult life it's ordinary to not be in touch with your feelings or anyone elses and it's ok to be delusional cos if you don't ever know what it feels like to be mentally liberated then how else could you know how it feels to be free.