Ok, I apologize. I guess I did read too much into, at least for your post. I don’t understand however, why people in this thread are calling for “changes” when the same or similar processes that already exist.
The change would consist of legislation putting an end to involuntary holding & treatment of non-incompetent people.
ambushed:
Hi again, ambushed! I know that at various times in the history of the world innocent people have been brutally murdered by people diagnosed mentally ill. I know from you relating your own back-story that you lost someone personally in this fashion.
But yes, I think we deserve the same consideration as other members of the general population, specifically including the right to not be arrested for what you think we might do and the right to decide what brain-altering chemicals do and do not get put into our bodies (along with other medical decisions).
Do you have any statistical evidence that shows schizophrenics are more likely to commit violent crimes than a comparable non-schizophrenic control group? (Controlling for socio-economic status and gender and so on?)
We don’t lock up males despite overwhelming evidence that correlates maleness with violence. There’s no denying that if all males were either locked up or incapacitated with drugs, there’d be far less violence. I suppose you could argue that the only reason we don’t do it is because of the sheer numbers involved. (Would it be ethicaly OK to do it if our species was 85% female?)
How about if you couldn’t really tell for sure who is male and who isn’t? Suppose the identification was made only on the basis of opinion that was statistically only slightly more reliable than sheer guesswork? (i.e., in double-blind tests the experts were only mildly more likely to pick the same persons out as “male” as previous experts)?
I’m suggesting a little more- that someone with a psychiatric diagnosis who is not “insane” (and therefore still faces conviction and punishment) should be treated the same as someone without a diagnosis.
I think the reason for this is pretty simple to comprehend: We have yet to contrive an authoritative governing body that can decide with infallibility what is the the best interests of individuals and society. Given that, severe limitations on the power of governing bodies must be put in place to protect individuals and society from tyranny. One way a government could impose unjust will on the people is to compel them to undergo medical treatment. Since there’s no perfectly reliable way to determine who should and should not be treated, there must be mechanisms in place to resist efforts to impose treatment except under the direst circumstances, where harm to an individual or society can be demonstrated with a high degree of confidence.
You know, Brave New Word, and all that.
Yes, that’s exactly why we never have court judgements about scientific or technical matters. It’s a shame we don’t have some way of bringing in experts to give their opinions in these cases, thus providing the judge with a framework for evaluating the matter…
Okay, Shagnasty, let me point out right from the start that my trying to answer such questions is fairly foolish. I’m entirely out of my depth. I have insufficient qualifications to lend my views on such matters any authority. I expressed an opinion as carefully and as honestly as I could, but it’s only an opinion. I don’t presume to be able to answer such questions on my own, without the resources of many thousands of learned professionals at my disposal. There are countless ways to discredit my personal opinions which are admittedly lacking such resources.
With respect, it’s not justified to expect me to be able to answer them. Your challenge, then, is essentially unfair and my failure to answer authoritatively and completely must not be taken as an indication that my opinion lacks merit or are unsound. It’s a bit like asking me how to find bin Laden or strengthen the economy and then mocking me when I can’t do so.
But if you’ll grant all that, I’ll throw out a few personal, off-the-cuff, unauthoritative ideas for you to chew on…
I don’t know whether that is a regional law or what, but I was assured by this very friend in Utah (possibly mistakenly) that the law provides no such protection, at least in his mother’s case. According to him, this was never claimed by anyone, at trial or at any other time. According to the family, the police insisted that there was nothing the law allowed them to do.
That’s a damned difficult and thought-provoking question, to which I am unable to provide any hint of a final answer. But don’t we already keep people who present physical danger to society in institutions for life? (But I would never advocate putting non-criminal mentally ill patients in jails or prisons.)
Sure I can! No one is obligated to provide full, final, authoritative solutions to every problem they legitimately recognize. I can recognize that terrorism is a real danger without being able to know how to solve the problem, can’t I?
If I had the powers of a king?
I would first supply considerable funds to medical schools, law schools, respected universities, research institutions, and other reputable professionals to perform (and endeavor to repeat) extensive, peer-reviewed epidemiological studies based on actual case histories, as well as truly extensive co-analysis employing the best neuroscientific, psychological, and psychiatric science available, to develop legal and medical methodologies and modes of treatment and detailed psycho-neuro testing and instruments such as extremely detailed analytic profiles.
I’d emplace strict, formal policies that would guarantee that parties expressing safety concerns about a person that might reasonably involve mental illness be at least initially examined in person by well-trained personnel within 24 hours. There should be serious penalties for making false or spurious reports, of course.
At all times, the civil rights of the potentially dangerous, potentially mentally ill person must be upheld with significantly greater caution and respect than is afforded alleged criminals. They shouldn’t even be in the same systems. Incarceration in a medical facility before a thorough analysis is completed must be the last option pursued, and it should be used only if the person’s behavior conforms to medical precedent that corresponds to a significant threat profile. If such last-ditch measures becomes common, the entire system should be automatically challenged by medical and legal ombudsmen and patient advocates.
If it is determined after an extensive and exhaustive medical and professional analysis that the person in question suffers from a mental illness which, if not treated with medication or other medical treatment would be consistent with medical precedent that corresponds to a significant threat to others, that person must agree to either: (1) compulsory treatment that is as compassionate and low-risk as possible, or (2) confinement in a locked medical institution (where they are not compelled to take such medication or treatment) that guarantees just and compassionate care and is subject to completely transparent public review as well as to the automatic challenges described above.
Just note once again, please, that there is no rational justification for expecting me to be able to solve this difficult problem or provide authoritative suggestions.
You asked:
In my previous reply, I mistakenly thought you were asking about people who did NOT respond to treatment. People who DO respond to treatment should not be committed at all if they aren’t dangerous or if they agree to be compulsorily medicated (what I have in mind is a medically implanted shunt containing a multi-month or year drip of medication).
Good, peer-reviewed science, including good epidemiology.
I don’t, and I’m a regular L&O watcher.
But portraying such a case on L&O does not mean that my friend’s family didn’t actually go through such horrors. This isn’t a FOAF story, my friend.
I’m sorry to hear about your sister’s misfortune and mistreatment. As in all other professions, there are good doctors and bad doctors. It’s sad that she had some bad ones before she found a good one. The bad ones were seriously deficient in following their training and the APA’s treatment guidelines. So deficient that I believe you and/or your sister have a clear duty to report their possibly criminal misbehavior to the APA.
But look at what you are suggesting: In the end, you are saying that nothing should be done at all to protect people from the dangerous mentally ill until medical science reaches complete perfection, which of course will never happen.
Please note that every single solution in the world to every single problem in the world is imperfect. Why must this issue be the only one that has to be perfect?
Well, I feel chastened at how my idea has been shown to be somewhat lacking. This is why I stay out of Great Debates.
Thank you all for contributing. Special thanks to: Ranchoth, for contributing the phrase "inept bunglers” (although I’m surprised there hasn’t been a “band name!” post yet); The Scrivener, for the information about Dr. Szasz, and to ambushed for defending the idea that people can raise an issue without having The Perfect Solution TM at hand.
One disclaimer: I hadn’t thought of people trying to get out of criminal charges by claiming mental incompetence. I see very little of that in my job.
I remain appalled at the conditions under which many people with mental illness live. Many legitimate concerns have been raised here about dangers possible (inherent?) in trying to address this. However, are those sufficient reason to do nothing?
AZRob
Hello, yourself, AHunter3. As always (at least to my recollection), you’ve acquitted yourself well here. You make sound observations that make genuine sense. Your concerns are rational, and sensibly put. And I certainly share your concerns over unreasonably denying anyone their civil rights, let alone their physical freedom.
The problem is, I find that your proposal that insists that we make it even harder for people to defend themselves from the dangerous mentally ill is not sensible or fair in the end. Your views are far too heavily biased toward protecting the dangerous mentally ill than protecting society.
There’s no question that life for the potentially dangerous mentally ill is manifestly unfair. They certainly didn’t do anything that resulted in what they are; it’s no fault of theirs!
But I liken their plight to plague (or to put it in more modern terms, SARS) victims. Is it their own fault that they must be secured in locked medical institutions in order to protect society from their potential actions? Of course not! Does this incarceration result in their civil rights and physical freedoms being effectively denied to a very serious extent? Yes, of course.
Yet, is it necessary? Absolutely!
It would be appallingly unjust – even criminal – to let them free!
It is a matter of competing rights. At some extremely carefully and scientifically determined point, the rights of society to be protected overrules the rights of the potentially dangerous. That’s just the way it HAS to be; there is no possible alternative.
I don’t like it either, but that’s the way is has to be.
As to exactly where that point is drawn, please see my earlier response to Shagnasty
Well, yes, but I’ve heard that the vast majority of people with schizophrenia and bipolar disorder and other common mental disorders are not violent. Are there any mental illnesses that do seem to cause violence? Or are mentally ill people violent at about the same rate as people who aren’t mentally ill? (Assuming that you don’t define violence itself as a sign of mental illness.)
And even if mentally ill people are more violent, how much more violent do they have to be, statistically, before they should be locked up just in case?
If, say, 3% of normal people will become violent throughout the year, and 6% of people with Mental Illness X will, is that enough to justify locking up the innocent 94%?
I would think that there are certain characteristics of an individual that will predict future violent behavior – probably the most blatant being “a record of past violent behavior.” (Assuming the violent behavior was unjustified, of course, and wasn’t reasonable.) But other behavior is probably indicative as well. That whole “triad of sociopathy” thing, which IIRC is wetting the bed, lighting fires, and torturing animals, is supposed to be a good indicator of whether a kid will become a serial killer… and maybe there’s more.
Should a competent psychologist / psychiatrist be able to tell if a mentally ill person will become violent?
But I thought that being incapable of distinguishing right from wrong was the entire basis of the insanity defense? Surely you’re not saying that there are NO mental illnesses that render someone incapable, at a particular moment, of distinguishing right from wrong?
Instead of an insanity defense there could be an incompetency defense, I suppose. If the 11 month old baby picks up Dad’s pistol and shoots his sister, if the Alzheimer’s patient who knows neither her own name nor where she’s being kept climbs into an open automobile, drives off, and slaughters some people with the car, it’s tragic but I think we don’t blame them, do we?
But the whole grey thing area, the “where do you draw the line” question —people are better off being accorded the authority to behave as adults, and then held responsible for what they do, than they are being infantilized and protected from that kind of responsibility. And there’s always going to be that tradeoff — no one wants a class of people who have the full range of freedom but who aren’t held accountable for their actions.
ambushed, you’re still assuming that we, as a class, are more likely to be violent than the typical person is. You don’t know that, or at least you haven’t shown us any reason why we should accept that as an assertion. (Mostly we are not). I think you need to address the questions raised by chorpler above.
are we not permitting ourselves to be backed into a corner where a hobson’s choice between physical and chemical incarceration becomes the universe of discourse?
If the money freed up by deinstitutionalization were really utilized for any of the supported living alternatives that are simultaneously cheaper, more human, and more humane, there would be almost not problem of violent decompensation, the level of supportive interaction being such as to perceive long before acting out occurred, the impending neurochemical crisis.
Of course, if you close the nuthouses, and then rob the insane by diverting the money saved to tax cuts,what the fuck can you hope for?
It may not have been the stated hope or even the conscious hope, but I have long suspected that the unconscious hope of those who made those changes was that those mentally ill who were too far gone to function without cost to the state would just die. There is no other explanation as the number of people and their needs were too great for the slack to be picked up by charities. Thanks to do-gooders like AZRob and a string of mild winters this die-off has not happened.
My interpretation of how things went down was more like this:
Deinstitutionalization becomes policy. It will save money and enough people are convinced that The Crazies aren’t going to lay waste to the lands and eat the citizens and so on.
In the beginning, they take up cheap residences which are available in many big cities as “flophouse hotels” or, to clean that up and PC it a bit, “single-room occupancy hotels” or “SROs”. In many places and cases that’s a misnomer — I can speak from personal experience of one in the Greenpoint area between Queens & Brooklyn where “single-room occupancy” meant a big long room with a dozen or more cheap cots and we would be sleeping there in the same room together. (I didn’t go for it). But regardless of how wonderful they were or were not, they existed and as they had soaked up the bottom tier of people who wanted to be indoors previously, they soaked up the newly deinstitutionalized refugees from mental hospitals. Lots of them rented by the night / by the bed, i.e., it wasn’t permanent housing, but it was always there (and if one place filled up there was always another). For a bit more, you could snag a place that would be yours, with an address and storage space for your stuff, a permanent abode as long as you could pay the paltry rent.
Then after the 70s, the big cities started changing. Young professional types started wanting to live in the cities and were willing to pay fairly well to do so, and to live there somewhat comfortably. Politically, rent controls and subsidies fell into disfavor. Property that had existed as cheap housing got gentrified. Rental apartments all across the economic spectrum gave way to a considerable degree to condos and coops, and the remaining rental apartments became more expensive and more tied to longer-term tenants who could put down a substantial damage deposit. The dingier ones were often razed and new hi-rise residential space went up where they had stood. Housing became tight and the folks on the bottom, most vulnerable, lost the struggle to find and keep it and became the new phenomenon “America’s Homelessness Problem”. And yeah, lots of 'em were the psychiatric refugees.
The housing problem manifested itself in a second-tier way: in the old days, if you were picked up for observation by a police officer who thinks you’re not wrapped too tight but they let you go after awhile, you’d go back and find a flophouse or a cheap apartment, but now getting “psychiatrized” meant you’d lose your housing and on release you weren’t getting back indoors without first month and last month and half again as damage deposit and maybe some references.
Homeless people are visible. You run into them as you head to work, maybe having to step over the ones sleeping on your building’s steps if your neighborhood tends to have them around. Meanwhile, homelessness is itself crazy-making, alienating as hell. It can reduce you to the rawest kind of essential survivalism, which means that you look far less together to observing folks than you would if you had a week’s worth of opportunity to not have to chase down each next meal and sleeping-place in desperation, and had people to talk to like a human being and so on. So because of homelessness people have this pervasive sense that we’re up to our eyeballs in crazy folks and that the reason we didn’t see them everywhere like this before is that they were safely locked up in locked wards at large psychiatric facilities.
What’s the qualitative difference between an Alzheimers patient who wrongly believes himself competent to drive a car, and say, a schizoprenic who wrongly believes that a federal agent ordered him to crash his car, for example? Why should one get off the hook and not the other?
If you are unfamiliar with the kinds of questions that would be posed to a person to determine whether or not that person is competent, you can probably Google it or perhaps a psychology grad student will post, but in my post above I stipulated an Alzheimer’s patient who doesn’t know her own name.
Let’s assume that individuals (schizophrenic, Alzheimerish, and otherwise) get asked some variant of the following kinds of questions —
• What is your name?
• When were you born?
• What year is this?
• How did you get here?
• Where do you live?
• Where did you live before that?
• How would you get home from here?
• How would you get home from Cincinnati?
• How would you get home from Johannesburg, South Africa?
• Why are you here?
• What does “competent” mean to you?
• In your own words, why should this court consider you to be competent?
If your answers look like this, I’d lean towards considering you incompetent in the absense of mitigating circumstances (e.g., reason to think you weren’t understanding the questions) —
• What is your name? “Sometimes” <repeat Q> “Joe”
• When were you born? “I was born in Boston.” <repeat Q> “1935”
• What year is this? “1935” <repeat Q> “Oh, I don’t know then, maybe 1960”
• How did you get here? “We drove from Philadelphia when I was a little boy”
• Where do you live? “::looks around and points” <repeat Q> “I have a room”
• Where did you live before that? "<doesn’t answer> <repeat Q> “I have a room, it has blue…blue windows”
• How would you get home from here? "<doesn’t answer> <repeat Q> ::points to door:: “I have a room…Tom lives there too, do you know Tom?”
• How would you get home from Cincinnati? "<doesn’t answer> <repeat Q> <doesn’t answer>
• How would you get home from Johannesburg, South Africa? “I know those people, they don’t bother me none.” <repeat Q> <doesn’t answer>
• Why are you here? "<laughs> <repeat Q> “I want to go home, they won’t let me go home”. <repeat Q w/request for elaboration> “I don’t know”
• What does “competent” mean to you? “I’m Joe” <repeats Q> <doesn’t answer>
• In your own words, why should this court consider you to be competent? “I came here with this guy ::points to court officer:: and I live in a room”
Whereas this person is clearly competent:
• What is your name? “It’s a couple of syllables that people use to refer to the real me” <repeats Q> “You want me to tell you what my name is? I can do that. You don’t know? Why are you asking me this?” <confirms that the request is to tell what the name is> “Joe Schmoe. As if you didn’t know. Ho ho ho! I’m a poet and I didn’t know!”
• When were you born? “January 11th 1973 at 14 minutes after midnight and my Mom said my timing sucked because it was raining”
• What year is this? “9012” <repeats Q> “It’s been about 9012 years since the dawn of agriculture. I don’t use A.D. because I don’t believe in Jesus Christ, the Church is just trying to poison people’s minds. No one baptized me.” <repeats Q requesting date A.D.> “2004”
• How did you get here? “These people who think I ought to be locked up in a cage like some fucking animal made it necessary for me to come here”
• Where do you live? “I have a room, with blue windows”
• Where did you live before that? “Shelter. The Homeless Hilton at Fort Washington. Roach Motel”
• How would you get home from here? “Take the bus”
• How would you get home from Cincinnati? “Hitchhike”
• How would you get home from Johannesburg, South Africa? “I’d hijack a plane, man”
• Why are you here? “I told you, they’re trying to say I’m fucked up in the head, they’re trying to put poison in my brain because they know I’m not like them”
• What does “competent” mean to you? “That’s where you see things, maybe not everyone sees the same things but they’re your things, you know? And, well, if you’re competent you don’t let things get away. I mean, you deal with stuff and take care of what you have to.”
• In your own words, why should this court consider you to be competent? "<25 minute rambling exposition on why he is able to deal with stuff and take care of what he has to, and why the people who allege him to be incompetent, the ones “who say he ought to be locked up in a cage like an animal” are wrong.>
In the latter case, the person’s mental processes may be off a bit, but there is a clear recognition of the meaning of the questions and an ability to process them and make use of information, utilize memory, and so on. Competent.