Review: The Best Minds, by Jonathan Rosen
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I suppose one could call it a tragedy, but I think a balancing act is a much more accurate way to describe it.
It's a bit like the rules around convicting people of crimes. It's been pretty widely acknowledged that there are many people who escape punishment - particularly of intimate crimes - because a prosecutor probably couldn't meet the standard to convict them.
But on the other hand, there are many innocent people who are currently being punished for crimes they didn't commit.
The more we try to suppress type 1 errors, the more type 2 errors we get. And vice versa.
In the case of mental health, sure - there are probably lots of people who desperately need care and can't get it because they can't be committed. But there's also a long history of people preying on others by getting them committed.
I'm not going to pretend that I know if we have struck the correct balance; just that it is a balance. And moving the dial 100% in one direction or the other is the wrong answer.
The whole point of the article was that, to avoid creating stigma, it seems that in the USA they ended up with a situation where people with mental hillness are unlikely to receive the healthcare that they need.
So what’s the difference? Having foreign born parents does “impact” a persons likelihood to be violent in a statistical sense. Having schizophrenia has a similar “impact” on a statistical level. You may find it easier to see a causal relationship in the latter case, but there are plenty of people who see that causal relationship in the former case too.
Of course it’s wrong to deny people care for a serious illness. That unfortunately happens regularly in Sweden too.
Mental illness denial is the lefts version of climate change denial.
seems to me the balance, while being difficult to achieve, is not the problem, but the healthcare system in the US rears its ugly head again.
Apparently in the past, there might have been perverse incentives to keep mentally ill people institutionalized, which might have prevented some people from ever escaping the system. They were called "snake pits".
Eventually there was reform of the laws, and the mentally ill gained rights and some could get better and be released.
Unfortunately the real tragedy happened when then-governor Reagan cut mental health funding and most mentally ill people were released and could not get adequate care.
And that system survives, with the only way of getting care for mentally ill people is if they are "a danger to themselves or others". I suspect a good portion of the california homeless might be the fallout of this decision.
I (barely) knew a guy who had serious problems for years, nothing could be done until he started a major forest fire. People in the community knew he was a problem, and that it was only a matter of time until he did something beyond petty vandalizm and misbehavior. But couldn't really do anything about it until he set fire to a neighbors cabin over a petty feud and ended up burning (IIRC) ~23,000 acres at a cost of ~$23 million [1]. So, what to do before it happens? Earlier intervention? Childhood programs? Enforce future crimes? Benign neglect?
There has also been a huge amount of cost cutting and outright dishonesty regarding public health. In California, Ronald Regan was famous for cutting funding to the public mental health system, promising to fund community mental health. Then he renigged on his promise and refused fund community mental health. Mental health care has been a clear problem since then, at least.
I don't know the answer, and, given the whole US system, there might not be a good solution. That said, one idea towards a solution is for seriously mentally ill people to be able to sign away some of their rights. I know, it's a dangerous idea, but, assuming they can give informed consent when they are "sane". (Yes, it's a real problem to get right). Conceivably they sign a waiver such that, if their mental state deteriorates enough, then they can be forced to be institutionalized and medicated for a short term -- long enough to be stabilized. Right now that can't happen without their consent. Although there is an informal system where this is exactly what happens -- some of the larger jails have psych wards where patients are stabilized via meds or whatever. It's already happening, it's just done via the criminal justice system. I'm just suggesting that there should just be a system for the same that's done via the medical system, out in the open, with proper accountability and supervision.
> If ever there’s been a tragedy of good intentions, there it is. The Best Minds > is a chronicle of that tragedy. I think it’s the best book about mental > illness I’ve ever read. I haven't read the book, so take this with a grain of salt, please. I can't speak to the specific case of Michael Laudor. However, the parent comment is about "Violence and mental illness have been legally entangled" which is pretty general. It certainly is a tragedy. And it is partially a tragedy of good intentions, but it's not only a tragedy of good intentions. There are a lot of conflicting interests. For example, there are people don't want to pay taxes to support good programs, and acively work against public health programs. There were a lot of abuses of the mentally ill in the past via involuntary commitment, and that should not be repeated.
That's exactly the point DeBoer made on a podcast I listen to (forget which). All these very vocal and highly visible autism advocates with basically social awkwardness as the only externally visible symptom, while rightly wanting to combat stigma associated with their condition, also end up distorting the perception of just how debilitating and devastating the disorder can be. The severely autistic people who require lifelong round the clock care don't write books or go on podcasts. So when someone rails against the disorder "label" and wants us to see mental illness as "neurodivergence", people think of the mild cases they've been exposed to in the media and go "yeah, makes sense, it's just basically quirkiness or a different, equally valid perception of reality". But no, it isn't.
Pd: Found this after clicking on your username on a thread where someone was waiting for your Oscars opinions, lol. That's a swerve and a half
One example is the "call of the void", the "what if I jumped?" when looking from tall heights.
However there are also many other violent or sexual thoughts that are suppressed and also difficult to talk about socially. What defines the "mentally ill" then is how prominent this voice is and how often it leaks into the "physical" world.
These actions are usually controlled by threat of imprisonment/violence by the state, social punishment by the community, or controlled by being channeled into specific arenas and fantasies.(games/porns/sports/war/etc...)
Behaviors that leak out of these boundaries are "eccentric" when they don't seem to do any harm and immoral when they disrupt the boundaries themselves (hacker) or the structures within the boundaries.
Sometimes the boundaries are too restrictive like a straightjacket. They increase the internal pressure requiring stronger boundaries that increase the internal pressure until the whole thing explodes.
Sometimes the structures themselves need to be updated and modernized. E.g. women showing their face in public or wearing a bikini shouldn't topple all of society.
The pace of technology disrupts boundaries. This incentivizes and leads to more adaptable and resilient structures. The white-hat school prankster crosses into black-hat destruction territory only when others "can't keep up".
The point is that maybe there isn't a specific mental "illness" like a bug or a virus that acts as an antagonistic external entity. It's just behavior relative to societal boundaries and outlets (which vary greatly across culture and time).
Even a very black/white "illness" like schizophrenia seemingly used to have an social role as shaman-oracle but w/o this outlet can only express itself as axe murderer
> Consider deinstitutionalization. Few things could be less popular or esteemed in the public imagination than long-term mental healthcare facilities. People with no personal experience with mental illness themselves often have a visceral reaction to the very idea of institutions, assuming them to universally be houses of horror. And so deinstitutionalization, in a crude sense, is quite popular.
This review ignores the incredibly sordid history of institutionalization in the US and why it's so strongly hated. Many crimes were committed on otherwise innocent people under the guise of curing their mental illnesses. Lobotomies were popular to 'cure' people. Cocktails of drugs, inhumane experiments. You can look at what was done at Willowbrook State School to understand why this rapidly took the case. And it was not that long ago that things like 'being gay' was considered a mental illness.
> As Rosen unsparingly documents, the efforts to “destigmatize” mental illness have created a perverse scenario in which mental health advocates - who will tell you that their goal is to make mental illness more visible - push the darkest parts of mental illness deeper and deeper into the closet. You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill, so it must not be mentioned; that some mentally ill people commit sexual offenses could be said to stigmatize the mentally ill, so that must not be mentioned; that some people with mental illness commit hideously brutal acts of self-injury could be said to stigmatize the mentally ill, so it must not be mentioned; that some people with mental illness play with and eat their own excrement could be said to stigmatize the mentally ill, so it must not be mentioned.
I shouldn't need to mention how absolutely stupid this whole paragraph is. But the point is that not all mental illness is equal, someone with different problems is going to be more prone to certain issues than others. That should be obvious, but the problem is when you conflate everyone and assume that 'well XYZ has ABC, so its obvious why he did [Thing]". Not only that, but in this paragraph the author cites a study [1] which they say "You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill". But the study they quote says nothing of the sort! In fact it says the exact opposite: It says and I quote: "The popular belief is that people with mental illness are more prone to commit acts of violence and aggression. The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as “crazy” individuals. A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator. This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population." and "Currently, there is scant evidence to suggest that mental illness can independently predict criminal behavior. On the contrary, there is ample evidence that shows that persons with mental illness are far more likely to be the victim of violent crime rather than the perpetrator.". They manage to somehow completely misread the study they cited in favor of their soapbox points.
Yes, the past of mental hospitals was bad. But that's true of the past of everything (nostalgia notwithstanding) The problem is that modern mental hospitals aren't like the hospital of "One Flew Over the Cuckoo's Nest" and yet that's what the public seem to think they are. Imagine if everyone's idea of a surgical hospital was that outdated -- nobody would be willing to get surgery. But people seem to understand that surgical science has advanced and yet seem to have a problem understanding that mental health treatments have advanced too.
Yes, people generally understand that medical treatments are typically not unnecessarily barbaric these days (this is not always the case, even if we at least know that when painful treatments are required, they are actually useful).
What does this say about the long-standing stigmas around mental health, both about the people who experience trouble and about the process of getting treatment?
It seems like a vague analogy about progress over time, but to what end?
How does knowing that I won’t feel a saw cutting through my leg change my understanding of mental health, either as a potential patient or as a curious person?
The author addressed that in the article.
> Currently, there is scant evidence to suggest that mental illness can independently predict criminal behavior
Not all mental illness is the same, which I guess it's what the author of the article tried to explain in that long post of his. People affected by schizophrenia (which are mentally ill people) have bigger odds of being violent, against others or against themselves (this latter part hasn't been touched by the author).
Branding people affected by schizophrenia and people affected by severe ADHD (let's say) as basically the same, which is what the latest movement of putting mental disorders all in the same bucket does, is a very dangerous thing to do, again, as explained by the author. Because while it's ok not to institutionalise people affected by "light" mental disorders, is definitely not ok not to keep under a strong supervision and even to institutionalise people affected by debilitating mental disorders (such as schizophrenia), because, if you're not doing that, then those people have greater odds of doing very, very bad things.
Everyone knows why "institutionalization in the US is so strongly hated". The question is whether the pendulum swung back too far the other way.
The author is on a soapbox. But he isn't wrong: "destigmatization," pushed too far, is not without problems. It leads to a certain incoherence expressed well in the article.
It's less clear what we should do about this in terms of policy.
https://freddiedeboer.substack.com/p/i-would-like-closure-bu...