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Tuesday, April 7. 2015
The old mental hospitals were far from perfect, but they served an important function.
If It Were Physical Pain, It Would Be Called Torture: A Story of Two Young Men
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This is what I do for a living. So.
How many more hospitals do we want? If you are going to keep patients longer, you will need more beds. To legally keep them longer, you will need to lower the threshold for admission and retention. Thus, we will have more false positives - people who are being deprived of their freedom because of their risk level for violence.
I'm not necessarily opposed to that - I think we have swung too far one way. But even slight changes are going to be very expensive. Most citizens simply have no idea how many folks we are talking about and how labor-intensive it is to treat them. We live among dangerous people. Most of the mentally ill are in more danger than are a danger, though.
When one of the primary symptoms of some expressions of illness is a lack of insight into having an illness at all, the system has to move increasingly toward force, locked doors, and deprivation of other normal rights. It ain't pretty.
The State of NH was one of 8 that just got sued to force communities to have more programs so that patients would not have to stay in hospital so long. It was one of those friendly lawsuits that the system mostly wanted to lose, in order to force the legislature to provide more funding.
So it will be difficult to administer fairly and judiciously and it will be or will become very expensive. Those of us who remember the days when the insane were locked up and we were not are of the opinion that those problems with the re-institution of widespread detention of the dangerously insane are an acceptable alternative to what we have. What might that be, you ask? Sandy Hook, Rep Gifford, that mess in Norway, the Navy Yard killings ... do I need to continue? I think not.
And how would you define who gets locked up indefinitely without their consent and without any form of legal process (yes, you heard it correct)?
Who'd get to define who's a "danger to society" because of their "mental state"?
Al Gore? He'd decide in a heartbeat that anyone who doesn't buy his "carbon credits" is dangerously insane and needs to be locked up to "protect the planet"...
Barry Obama? He'd do the same except he'd lock up anyone who didn't vote for him.
Mr. Holdren? Think about everyone who's not black ending life locked away in a mental assylum.
And on the other side of the political spectrum we'd find a plethora of people who are more than willing to remove anyone who's not a "proper Christian" from society for no other reason than that they don't go to church often enough, have the gall to do the laundry on sunday, or even because they wear the "wrong" kind of clothing. My parents live in a village full of such people, people who're adamant that The Lord demands people do no labour on sunday and consider even laying out clothes for the day to be labour (so they lay out clothes for monday on saturday), or making a sandwich for lunch (so all food for sunday gets prepared on saturday, put on plates and stored in the fridge a day in advance).
Mental assylums have and always will be an oubliette where you can very conveniently get rid of "undesirable elements", with the staff functioning as jailors who're not going to release any of the inmates because their budget depends on having as many as possible.
When in the last two centuries in America has anyone tried to put people in an asylum for not going to church? Make that three.
As to your hyperbole below, you simply have no idea what you are talking about. State institutions were neglectful places where bad things happened. Comparing them to Soviet gulags is ridiculous.
I don't know what state you're from, but state laws set the essential framework for mental health commitments. In Texas, an involuntary commitment requires - if the respondent aka the supposed mentally ill person demands it - a trial by jury of that issue of fact. Just as in other trials, the judge instructs the jury on what the law is that applies to the case and, at least in Texas, juries are not afraid to exercise what amounts to jury nullification and find for a respondent where the facts justify it. How do I know, you ask? Glad you asked. I was a court reporter in country courts-at-law and district courts here in Texas and practiced law for a total of over 35 years. About 25% of my work was defending indigent folks whose involuntary commitment was being sought either by the State of Texas or by their greedy children. You might be surprised by what a jury of folks who believe that they are actually in charge of the verdict will do to protect what they see as a person being railroaded. The use of a complete jury trial methodology will tend to produce - not assure; no assurances in the world I live in; don't know about you - tend to produce fair and just verdicts.
And I think that disposes of most of your objections based on "folks we don't agree with get locked up". As far as the rest, look up the meaning of the word, "asylum" - it refers to a place of safety for the people within it, safety from a world they are unable to deal with and in some cases unable to even comprehend. Why were they called that? Because before their introduction, the typical reaction to the insane by everyday people was to try to kill the insane because they were quite frightening. And they still are quite frightening, but they are in part isolated by intention and by untended consequences of police practices to specific areas of the towns and cities where they live, so all the "good" people and the "important" people don't see them much. The insane are still preyed upon by the ignorant and fearful; to that we add the ignorant and politically connected these days.
There are organizational and legal structures to reduce the "potato bin" consequences of asylums, we need to have them in the laws and have them enforced. Just like all the laws. This era, however, is one where the law is ignored by many when it is inconvenient or inconsistent with some idiotic ideology or another.
Well, that's my rejoinder. Due process by statue as in Texas with extra protections once detained and enough of a budget and small enough facilities so that detainee abuse - think of granny in the old folks home - is kept to a minimum. Groups of concerned citizens outside of the system who work to watchdog these places and their practices would work wonders, too.
Sorry Ike, once the regulations are in place that allows people to be locked up involuntarily on the word of a government official, no more courts are needed.
It becomes an administrative process, just like say a parking ticket.
And no, it's not a place to keep the inmates safe from society, it's a place to remove them from society.
Read up on the history of mental institutions and you'll realise they're not the rosy nice places you think they are.
They're worse than medieval prisons, "sanatoriums" where the inmates are locked naked in "airy halls" because "fresh air is good for them", drugged into a stupour to keep them pliant.
Gulag prisoners in Siberia have a better time than someone in the mental institutions (aka insane asylums) of the USA and Europe had before they were closed down.
As to due process? We now get courts convicting countless people to involuntary incarceration of indeterminate duration in mental hospitals in addition to prison sentences already, effectively turning half the prison sentences pronounced here into life sentences because once you're in one of those you're not coming out again seeing as the "hospital" gets funded depending on the number of "patients" (they're really inmates) and release depends on the "doctors" in charge declaring the "patient" "cured and fit for return to society", something they rarely if ever do.
Sorry, J.T., but mental health commitments are entirely within the state authority not the Federal. Forgive me that I don't have the citation right at hand, but it's true. Regulations do not overrule statutory law. Once the state passes civil commitment laws, the regulatory apparatus is out of the picture. The problem is to get any given state to pass a statute that provides protections from involuntary commitment.
Check your dictionary, as to the definition of the word, "asylum". It is certainly true that the historical classic asylums were hell holes. That doesn't require than any institutions we create now have to be the same. Nor do I think they are rosy places with bunnies and unicorns abounding. Careful oversight and requiring staff be screened for their own minor quirks and regular inspections from the legislature can reduce that sort of thing. There are not "countless people" being sentenced to mental hospitals instead of prisons; there are a relatively small number of such commitments, compared to the number of trials for major criminal offenses and as an absolute number it may appear large, but in a nation of over 320 million, it needs to be more than 2% I would think; otherwise using "countless" is simply rhetoric.
I seem to hear an undercurrent in your posts of a desire for a perfect solution to the problem. There is not any such thing to be found, but we can improve public safety as well as the lives of the many unfortunates who are compelled to live on the streets in a world in which they are incompetent to function. What I propose is to reduce the suffering all around, not to end the suffering. Ending it is a chimera, impossible to attain. In this instance, the perfect is the enemy of the good. We can make improvements and with careful and diligent supervision arrive at institutions for the insane which are well run and staffed by mostly compassionate folks. We cannot produce an institutional setting which is entirely free of abuse and mistreatment and even misdiagnosis, no more than we can create a judicial setting in which truth and justice always prevail. We are human and prone to error. That said, the nightmare you forsee is not a necessary result of the recreation of institutions to house those suffering from violent insanity or those who refuse to take their medications thereby putting the rest of us at risk of injury - directly or indirectly - from their inability to function in the real world.
We cannot abandon the search and effort to create a society which is as good as we can make it at this time, just because once there was the reality (which I freely acknowledge) illustrated by the Soviet misuse of psychiatric detentions as well as the horrors of the early years of institutional care for the insane. Why? Because the institutions don't have to be that way, nor do they have to become that way. The most horrible outcome imaginable will occur, if we abandon the method of applying intelligence and good will to the tasks we face as a society and as a nation.