Why are mentally ill elderly treated better than mentally ill youth/young adults

Great Debates
1

I was thinking about this today, and our societies attitudes towards neurological diseases that affect cognition, emotions and social functioning seem to be treated far more humanely among the elderly than among youth or the middle aged.

An elderly person with alzheimer’s, dementia, parkinson’s, etc is probably going to be put into an assisted care facility when they can’t function in society or care for themselves.

A young adult with untreated schizophrenia, bipolar, severe PTSD, etc is probably going to be homeless and eventually end up in prison/jail if they can’t function or care for themselves if they do not have a strong family network.

I have seen tons of people 20-50 with illnesses like schizophrenia living on the street. Very few elderly with Alzheimer’s though. So that is confusing. There are even efforts to put out Silver alerts (similar to amber alerts, except for the elderly with dementia) when an elderly person with a severe mental illness wanders off. A young person with a severe mental illness who wanders off will likely just end up homeless and forgotten. An elderly person might have a statewide alert system designed to find them. In a lot of ways a young mentally ill person gets thrown in jail for acting erratically. An elderly mentally ill person has a silver alert system designed to help the police find them and get them to a hospital. So the police put the young mentally ill in prison but look for the old mentally ill so they can take them back to the hospital. I don’t get it.

Would Michael J Fox be considered so heroic or publicly lauded if he had schizoaffective disorder rather than parkinson’s (advanced parkinson’s affects your personality)? I seriously doubt it.

Talking openly about Alzheimer’s doesn’t seem (I could be wrong) to have the stigma an illness like schizophrenia or bipolar does. I do not see many celebrities or PSAs about bipolar or schizophrenia, people seem more ashamed of that disease than parkinsons or Alzheimers.
So my amateur impression is that when an elderly person gets a neurological illness they can count on less stigma and a stronger social safety net than a younger person. Better medical care, more social empathy, more public calls for research, etc.

So if that is true, why is that?

Is it because on some level we expect the elderly to show a physical decline, and as a result are more lenient on the elderly losing their minds? And as a counterpoint, we expect younger people to be healthier so if they are sick we unconsciously assume it must be because they ‘deserve’ it or did something wrong (whereas for the elderly we assume it is just part of life)?

Is it because the quality and access of health care among the elderly is better with medicare, whereas younger adults are likely to be uninsured?

Is there a difference in social attitudes towards the victims of these illnesses, the treatment they get and societies attitudes towards the diseases in general?

Is it because people feel more responsibility towards the elderly than towards middle aged and young people?

2

Part of that may be that the elderly situation could also happen to them as they grow old, while having such a ‘disorder’ at a young age is more of looking at it as a defective person.

3

I think you have explored most of the answers I would have provided – medicare and social security benefits and the permanent care insurance that the patient may have bought. Or maybe the children of the elderly feel more responsible for their care. Physically, they are more helpless as well as mentally. And they aren’t as likely to sue.

Some people may see the possibilities of their own futures in the elderly.

And there are young people who fight the mental health system tooth and nail – some of them with good reason and some of them because they aren’t thinking straight. It is not always easy to tell the difference. The mentally ill have rights too.

It’s a disgrace that we make homelessness a crime in some ways.

And maybe TPTB are more likely to suspect drugs as a cause in young people than they are in the elderly.

But there are some ways that society treats the elderly in much harsher ways that they do youth. That’s another can of worms though.

4

An elderly person who suffers a mental deterioration probably led a full and productive life - someone insane at twenty probably has not, therefore we owe them less.

Or something.

5

People with serious personality disorders tend to calm down with age. An antisocial person may commit crimes in their youth, but not so much at an old age. As such we have more sympathy for the one who isn’t doing harmful things.

6

you can’t tell the difference between mentally ill elderly people and elderly people, so it’s not very nice to mistakenly treat granny like shit.

7

Just hurry up and die so I can collect my inheritance and buy a moped.

8

  1. Mentally ill young people are physically stronger and more ambulatory than elderly people. It’s easier to institutionalize someone who can’t get off the toliet by themselves than it is someone who can run laps around a track.

  2. There’s also stigmitization associated with being institutionalized when you’re in the prime of your life. It halts your education and employment, and may screw up social relationships. When you’re elderly, these things aren’t that important and if you’re foregone enough, you may not have the awareness to know what’s going on anyway. But a delusional or manic 20- or 30-year-old isn’t just going to accept going to the hospital when, in their minds, everything is just fine and dandy. They might resist taking their meds (because they’ll make you fat! and everyone knows they don’t work anyway!) and rebel against any efforts to control them. They may find living as pale ghosts in parental basements or wild and crazy on the streets preferable to living in a place where their independence is limited. Even if they do acknowledge that they’re ill. A person with Alzheimer’s isn’t going to last very long on the streets, but a 20-something schizophrenic will, just because they’re young and more resilient. That both emboldens them to run away and makes people less worried about them when they do.

This is not to say every mentally ill young person fights the system. But I think that rebellious streak runs stronger in the young than it does in the elderly.

  1. We may be comparing apples and oranges here. It’s way easier to recognize and sympathize with someone who is mentally deficient than it is with someone who suffers from a mood, anxiety, or delusional disorder. Folks in the latter group have good days mixed with bad days–many days they can seem perfectly normal. So if you’re caring for someone who’s like this, then you might feel extra impatient and frustrated because you never know what to expect. There’s also that feeling that if only they took their meds, they’d be fine. We don’t have such expectations from someone with Alzheimer’s (or mental retardation or autism, for that matter). Also, people with Alzheimer’s or dementia tend to be more child-like. It’s easier to excuse their bad behavior with “Poor them. They don’t know what they’re doing”. Except in some cases of disorganized schizophrenia, there is no child-like “innocence” associated with mental illness. If a mentally ill person craps themselves, it’s not because they don’t know what they’re doing. It’s because they’re being spiteful and hateful. This is what an unenlightened person might think.

  2. We have come to expect old people to mentally turn the corner for the worst, eventually. But we expect young people to be of sound mind and we’re immediately suspicious when they act as if they aren’t. Like, yeah, they could be genuinely ill but they could also be malingering or exaggerating their symptoms just to get out of working or going to school. Or, behaviors which might actually be symptomatic of, say, bipolar disorder may come across as traits of a high-strung jerk or someone with an unlikeable personality. In other words, we have lowered expectations for the elderly and higher expectations for the young. It’s certainly unfair, but I don’t think it’s going to change anytime soon.

9

The OP is comparing “treated old people with families” and “untreated young people without families”. That seems to me like apples and watermelons (which have less in common than apples and oranges).

An old person who can’t take care of himself will be cared for (at home or not, directly or by proxy) by relatives; in many first world countries, if this person has no relatives who can do this, the government can not put them into a home without a lengthy judicial process.

10

Everything **monstro **said, especially point number 1.

People who are mentally ill and physically able can fulfil our stereotype of psychopath - can commit various heinous crimes that harm other people. Old dears who can’t physically do that are thought of as harmless.

May I add that frankly the mentally ill are treated appallingly whatever their age. (I work in mental health and I’ve seen some terrible practice).

11

This appears to be false, at least according to Wikipedia. Both apples and watermelons are part of the Magnoliophyta division and Magnoliopsida class, whereas the orange doesn’t seem to be. Maybe comparing apples and, uh, lobsters makes more sense?

12

This has already been touched upon, but an elderly person is more likely to have visual cues of things we associate with weakness (a cane, bad posture, wrinkles, hearing aids). If a young person, or even a middle-aged person, is mentally ill but can ‘pass’ physically, I think people tend to hold them to a higher standard because they assume a) They could be lying or exaggerating for attention, and b) They have a better chance at being able to re-enter ‘normal’ society (whereas no one is going to look down on someone in a wheelchair for not making the effort to walk).

I’m not this is so much a case of specifically stigmatizing youth so much as it is a case of stigmatizing mental illness in everyone except the elderly (at least to a lesser degree).

Sorry if this is too IMHO, but when a friend’s mom with MS had to use a wheelchair (not because of MS, because she caught her foot in a door) she said that, in some ways, she actually felt it made her more sympathetic to people because they ‘knew’ she was disabled rather than just drunk, ‘retarded’ – her words – or vaguely unhinged. People are simple, and they didn’t have to guess.

13

When our elderly relatives go crazy, we recognize that it isn’t “them” and we have lots of fond memories of the person they used to be. We take care of them for the sake of what they have been to us in the past.

But when someone is mentally ill at a young age, we don’t know who they are without the mental illness and we don’t have those fond memories. All we have is the crazy part. Often our only memories of them are bad memories.

When people who have been mentally ill for a long time get older, we don’t give them a pass. People have no problem saying “My borderline personality disorder grandma is a bitch from hell” or “My alcoholic sociopath grandfather can’t die a day too soon.”

14

I agree that the elderly deserve better treatment for having contributed to society, often for decades.

15

Most of us don’t see the elderly people who are incapable of taking care of themselves. If they lived on the streets, like some young mentally ill people, they wouldn’t live long.

While I think the OP has a point about they differences in the way we treat young vs. old I agree it is mostly apples vs. oranges. The elderly that he talks about are people who have lived productive lives and are now sliding into poor (mental) health. They have money, friends and probably kids. If not, they at least fit a pattern we know happens to most people.

There’s also the fact that the elderly in America, as a group, are some of the wealthiest people in the world. Lost of money to be made taking care of them. Not so much with the young street people.

16

you’re joking, right?

17

This is a big part of it. If I run into a schizophrenic twenty-something in a bad party of town at 2 in the morning - that’s a pretty dangerous situation. If I run into an Alzheimer’s patient at that same time and place, I’m more worried for that patient than my own safety - even if this person is violently aggressive, they just aren’t a threat.

18

Because when your 20 it’s malingering when you’re 60 it’s, “Hmmm…That could be me in a few years.”

:slight_smile:

Seriously as thelurkinghorror said, as you age, mental illness slows in progression and people who have it learn to cope. Look at an older diabetic versus a teen age diabetic. They both have a serious illness but the older one has had years to learn to cope and come to terms with their illness.

19

I’m sorry to say that the OP made some unwarranted assumptions here and everyone else went along with it. I have worked in eldercare for years. Some LTC facilities are lovely-- the more you pay, the better the care is likely to be, although the two don’t always correspond. But once you’ve worked in some bad ones… Medicare has a rating system for nursing homes, and Tennessee is one of the states always crowded into the bottom five. The state facilities are beyond belief at times. One of the state hospitals had its LTC facility wing closed down at one time because

(hmm, they’ve never had the option for spoiler tags here)

(don’t read this if you’re eating)

(I mean it)

Nobody seems to be exactly sure how it happened, but maggots somehow ended up breeding in residents’ Stage 4 pressure wounds. LOTS of residents.
The visceral terror engendered by severe dementia cannot really be matched by opinions about mental illness, IMHO (and I’ve worked in mental health too). A lot of it is ignorance-- too many people assume that Alzheimer’s and other dementias are “a natural part of aging”. (They are not; they are disease processes.) Older adults with these neurological diseases are warehoused and largely forgotten. Because these illnesses are progressive and are not steady or cyclical in nature like severe and persistent mental illness, warehousing does work. But these people are not treated “better.”