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Wednesday, July 22. 2020
Is there a role for asylums today?
Furthermore, many patients do not like to take medicine. You can't force them to, under ordinary conditions.
The other category of severe mental illness, Bipolar Disorder, is thankfully readily medically and psychotherapeutically managed now in people who are willing to follow a treatment program.
I do not agree with several points made in this piece, but I do not feel that jails and homeless tents are good approaches to severe mental illness.
Posted by Dr. Joy Bliss in Psychology, and Dr. Bliss at 12:41 | Comments (24) | Trackbacks (0)
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I think it is cruel for the mentally ill to end up in jails. Isn't this the same thing as putting them in an asylum and locking them up? There has to be a better solution and some of it might not be what people want to accept.
Maybe a combination of 'accepted' medication and living a separate life in a safe place (safe to them, safe to public). Make the place a desirable one to live where someone gets much freedom and autonomy, but accepts the medication and therapy that goes with it.
Just spitballing. I don't know the answer. But we need to do better than what we have now.
Watched an interesting documentary on Amazon Prime the other day about the violently mentally ill in France. Was fascinating to see what their laws are, how people are treated, etc.
That's the original meaning of "asylum"--somewhere people who can't control themselves can live free from the threat of retaliation from their outraged neighbors.
Please a link or title to the referenced Amazon documentary on French care?
The title is "Unit of Difficult Patients: What Future for the Criminally Insane?"
Mentally ill or not they should face the same justice as a mentally balanced individual. If they commit the crime they do the time.
I see no reason not to re-establish "dorms" for the mentally ill. They clearly need a safe place where they can function and their basic needs met. The asylums of the past are just that, the past. They were built on Victorian principles and that just no longer works. Assisted living for the aged is a good model; private rooms, doctor oversight, proper medication, communal rooms, and a garden for those that can to enjoy. And they should not house hundreds at a time. There should be a number of them in each state, thus easing the burden on the care givers. I would have no problem with my tax dollars going to these "homes", using the money we are currently throwing at the problem. But I am just a lay person.
This is a reality in most neighborhoods. They're called "care homes," and they house the controllable mentally ill. There are two near me, both constantly causing trouble for the neighbors. It's not the patients, who are largely medicated, it's the low-wage workers who have relationship problems, substance-abuse problems, and their own self-control problems. Turns out the people who are willing to work there aren't typically so great.
Working in true nursing homes is different because you're caring for people's grandparents. The mentally ill often have no one who loves them or wants them and their paid care-takers can barely tolerate them.
Yes, it's very sad.
There are a lot of people that have mild symptoms of bipolar disorder who are prescribed powerful drugs for treatment. The few that I've known never follow up with therapy. They usually drink on top of the meds, which makes the difference between having some problems and being dangerously crazy. Severe bipolar disorder makes having a normal life nearly impossible in the long run, but it is wildly over-diagnosed and over-medicated.
Years after the mentally ill were distributed to the streets Human Resources a my trade school called me in to the office. "Have you seen your student Margret lately?" she asked. "No." I replied, " She has been absent for three days straight." I noted the pained look on the administrators face as she said, "If you see her, avoid all contact and call the police immediately."
There was a pause and I replied, "Let me guess, she is off her medication and she is considered to be dangerous?"
I had another student who was permanently paralyzed with a steel bar by a mental patient who should have been separated from his future victims.
The asylums were not perfect, but they kept millions safe who are now in danger every single day.
There is a role for asylums today. In the early 1970’s I volunteered at the Dane Co. home in Madison Wi. The place was clean and safe. All the residents were clean and properly fed. There were activities for stimulation and entertainment. The place was locked so no one could wander off. I was allowed to take the person I volunteered to visit out for shopping. She almost never wanted to go anywhere. I was appalled when the place was closed a short time later.
My cousin is bi-polar. He's done well on meds for years and has psychiatrist since the old one retired.
They had him on lithium at one point. It caused his kidneys to start to fail so he is on dialysis and also on the list for a transplant. And the old psychiatrist stopped his prescription for valium. He has been taking it three times a day for years. No reason given, no instructions on how to taper off, just cold turkey. That has caused some health issues too.
My mother was an RN and worked the Cook County (Chicago) Hospital psych ward before I was born. It was a whole wing of the hospital.
In later years when we would see people living under the interstate she would say those are the people who would of been her patients if they hadn't shut everything down in the name of "mainstreaming".
Of course, if she were alive today she would say the same thing about protestors lol.
The asylums clearly need to reopen.
the entire city of Chicago is an insane asylum.
Same with Mineapolis, Portland, Los Angeles, Philadelphia, Seattle, New York, and others...
Yes there is, although thanks to modern medicine and psychiatry and other institutional alternatives, the need is greatly reduced compared to the 80's. But there will always be a need for those who can't look after themselves reliably, from those who could live in the low-grade security of Memory Care-style facilities up to those who are further up the extreme scale and either purely vulnerable or criminally insane and violent.
I would think that states could nominally maintain a single facility or two to concentrate expertise and purpose. It would be good to hear from AVI and his well-informed perspective. Crazy violent homeless people is never a good solution for anybody.
I used to pickup hitchhikers if they didn't look too sketchy but stopped when it became apparent most were mentally ill. (The stories started to get weird after a while). I mentioned this to a truck driver on her plane to another load and she agreed with me.
I classify them as part of the "walkers". These seem to be mental patients who walk all day along the road. While the hitchhikers are at a higher functioning level, the regular route seems to keep them somewhat stable.
I think as long as they have a place to end up at night, they are not a hazard, but there is usually just enough paranoia to make this possible. If the numbers are low in any one area I think this is manageable, but not perhaps in the bigger cities. Local cops seem to keep a pretty good informal list of these people and watch out for them. Maybe you can tack on a mental health surveillance as well.
Yikes, Dr. Bliss. Bipolar disorder is not “readily medicated” in the sense of good long term outcomes. Indeed, it very well be the iatrogenic result of “readily medicating” depression. It’s really scary that you don’t know that. I commend to you Robert Whitaker’s Anatomy of an Epidemic.
Re: The role of Mental Institutions
"Roughly 140,000 seriously mentally ill people are now homeless on city streets, while 350,000 others are serving time in prisons and jails, where their illnesses get little treatment."
Most people have a very idealized concept of a "Mental Institution". They think of shiny floors, and big orderlies, and patients walking around, perhaps going to the cafeteria. Everyone is being patiently cared for, by loving nurses and doctors. How nice. Here's the reality: Screaming insane people are forcibly given huge doses of Oxycontin. As a result, they lay on the floor all day in a coma. That's reality, and nothing is going to change it.
Keeping the mentally ill alive is pointless. The only result is a great deal of unnecessary suffering. None of them are ever going to get better. They just get older and more miserable. We've got about half a million people who are categorized as mentally ill, and probably about another half a million who will develop mental illness in the future. That's an even million. The best thing to do is face reality: We've got one million people to euthanize in the shortest time frame. It should be possible to do the whole job in about six months. The logistics are the hard part; personally I would transport them to a central facility, where they can be euthanized and cremated quickly. Some people will complain; all we can do is explain that there's nowhere to put crazy homeless people; and we can't let them commit crimes, or freeze to death on the sidewalk. One thing is sure: When the job is done, many Americans will silently thank God that the streets are safe again. We have a responsibility to keep America clean, and a good place to live for both adults and children. That means taking hard action. Some men are courageous enough to to that job, and some are not.
Is this a spoof response? If so, it is almost too well done.
No, we pretty much get the "euthanasia" message from Ron every week here. It's one of those answers that grows until it covers all problems.
Deinstitutionalization was a perverse side-effect of Erving Goffman's "Asylums," a very good study of behavior in total institutions, using asylums as the object.
The result was that people in asylums don't do what they say they're doing.
Rather than taking it as intended as a feature of human behavior in general, it was taken as proof that asylums were frauds and they were all closed.
The simplest sociological view of the individual and his self is that he is to himself what his place in an organization defines him to be. When pressed, a sociologist modifies this model by granting certain complications : the self may be not yet formed or may exhibit conflicting dedications. Perhaps we should further complicate the construct by elevating these qualifications to a central place, initially defining the individual, for sociological purposes, as a stance-taking entity, a something that takes up a position somewhere between identificaiton with an organization and opposition to it, and is ready at the slightest pressure to regain its balance by shifting its involvement to either direction. It is thus against something that the self can emerge. This has been appreciated by students of totalitarianism ...
I have argued the same case in regard to total institutions. May this not be the situation, however, in free society, too?
Without something to belong to, we have no stable self, and yet total commitment and attachment to any social unit implies a kind of selflessness. Our sense of being a person can come from being drawn into a wider social unit ; our sense of selfhood can arise through the little ways in which we resist the pull. Our status is backed by the solid buildings of the world, while our sense of personality identity often resides in the cracks.
Goffman Asylums ``The Underlife of a Public Institution'' p.320
In Denver about 10 years ago a serial killer was murdering a couple of homeless a month. It went on for almost a year. Never caught...
You can't tell me living under a bridge, being randomly murdered, living in filth, being assaulted and freezing to death in the winter is less cruel than State Mental Hospitals.
While I certainly appreciate the sentiment that we can do better than jail or the streets for the mentally ill (and I speak from experience as someone who works in the field albeit tangentially) I find the (perhaps) well-intentioned ignorance displayed by Mr. Braslow to be sadly typical. The diagnosis is the usual combination of hackneyed cliches (who knew that drugs alone weren't the answer?) and canards (deinstitutionalization was all Reagan and Thatcher's fault or something) and the fix is, when stripped of its buzzwords, empty nonsense. We cannot simply wish away the complexity of psychiatric disease, indeed.
Unfortunately, we cannot simply wish away the complexity of the current state of case law around psychiatric disease either. O'Connor v. Donaldson (1975) held that in short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends (emphasis added). Mental illness, no matter the severity, is not in itself enough for incarceration and homelessness does not necessarily parse out to the individual not being capable of surviving safely in freedom. To be sure, there are things that could be changed or done differently that would, to a (usually small) extent, improve how we as a society deal with mental illness. The bureaucracy that my State alone has built around it is utterly appalling and though I am not as intimately familiar with our neighbor States, the interactions that I've had with them suggest that they are similar. However, as bad as jails, homeless shelters and the like (including assisted living facilities, which is a rabbit hole worthy of its own discussion) can be, we simply don't have better options within our current legal framework.
They are broken. Most of them you can't help. You can medicate some, lock up some but you can't talk them into being functional. At best they will understand what you are doing and use you. your desire to help them, to their advantage. You will see some "success" as long as you are useful to them and then they will revert to their true self, whatever that is. They may kill you, they may just run away, they could do anything... except be normal. They are broken and you cannot put them back together again.