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Source: (consider it)
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Thread: Failing Those Suffering From Psychosis and the Public Who MIght Be Hurt By Them
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Niteowl
Hopeless Insomniac
# 15841
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Posted
This editorial in the New York Times written by psychiatrist Paul Steinberg discusses the change in attitudes, treatment and availability of treatment for those suffering from psychosis like schizophrenia.
" Too many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.
Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls. "
He explains psychosis and the changes in the brain that occur and discusses how treatments have changed, what treatments are effective and what he thinks should be done to prevent some of the violent attacks like the Virginia Tech shooting - including bringing back involuntary commitment. In his opinion:
"It takes a village to stop a rampage. We need reasonable controls on semiautomatic weapons; criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists (and other mental health professionals) to treat the disorder, rather than less dangerous conditions. "
I've been wondering what balance can be struck between the rights of the inidvidual suffering from psychosis such as schizophrenia to refuse medical treatment and the rights of those around them who may be harmed by them down the road - especially since it is a minority of those suffering from such illness who become violent. There would definitely have to be stronger safeguards protecting individuals in such situations from abuse of the commitment process and the abuses that may occur during any long term stay in an inpatient facility. The question of to pay for expanded treatment and hospital space is also a concern. Comments?
[ 26. December 2012, 10:01: Message edited by: Niteowl ]
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Macrina
Shipmate
# 8807
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Posted
I think good mental health care is an absolutely fundamental partof any decent and well functioning healthcare system. From my limited knowledge of the US system I'd say it was broken on a lot of levels.
Where I disagree with people like the professor is labelling psychosis into boxes and stating it is caused in a reductionist and biologically driven way. If we see psychosis like this then we often respond not with compassion but control. Institutions are not a good idea, we've done all that before and it results only in abuses and lack of freedom.
Psychosis is rarely chronic and does respond well to treatment in the community. If you institutionalize someone you take away the ability of the village to ever recognise or seek to stop any rampage and thus perpetuate it. You might also paint yourself into a corner of locking someone up out of fear for what they might do.
People with psychosis are often frightening to others and are themselves frightened by what they experience. But if we allow ourselves and our response to mental health to be driven by fear and control we will never get it right. We need to step back and rationally consider how to support people with care and compassion, this may involve short term control but it should never be the long term answer. We need better ongoing compassionate systems that see a person, not a label.
Posts: 535 | From: Christchurch, New Zealand | Registered: Nov 2004
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Gwai
Shipmate
# 11076
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Posted
It's hard, because one on hand I am reminded of the mother of the shooter last year(?) who heard that there had been a shooting and immediately said that her son had done it then, they'd come to the right house. She knew he was likely to do that. Why on earth wasn't there more help given to him? I doubt she wanted that to happen, so it seems likely she would have availed herself of help, if she knew how to get it.
On the other hand, even the most mild mental health adjustment is stigmatized such that I would never advise a friend to tell their coworkers. If we can't trust society with mental illnesses, how can we trust it to take more extreme measures to control mental illnesses?
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A master of men was the Goodly Fere,
A mate of the wind and sea.
If they think they ha’ slain our Goodly Fere
They are fools eternally.
Posts: 11914 | From: Chicago | Registered: Feb 2006
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North East Quine
Curious beastie
# 13049
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Posted
Someone very close and dear to me has a psychotic illness. Her medication has worked well for the past eight years, and there are enough people around her who love her to spot if she started to slide. She has never been a danger to anyone but herself; when she is delusional she self-harms.
She is one of the kindest, most generous, most selfless people I have ever known. Being in her company makes me happy and relaxed.
Thirty years ago she'd have been institutionalised for life, with medication she is married to an adoring husband, raising happy children.
The label "psychotic" is a problem for her; she is quite open about having a mental illness and being on medication, but "psychotic" is a word that people recoil from.
Psychiatric treatment, including medication, has worked miracles for her.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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Niteowl
Hopeless Insomniac
# 15841
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Posted
What can the family or community do when someone they know/love refuses to take their medication? I know there have been amazing advances, but side effects from medications remains a problem. Someone I know who had schizophrenia refused to take their medication for just about all the years from his diagnosis in his early twenties to on the other side of middle age. Even the most recent medications made him feel bad. He died because of his illness. He lived on the streets because facilities/homes he stayed in insisted he take his medication in order to stay there. He HATED how he felt when he did. He was one of the most peaceful and kind men I've known and he saved a life, didn't take one. But what about those where there is concern they could be a time bomb? Do we force medication if they've not yet broken any law? How do we balance the patient's right to refuse treatment or medication with keeping the community and them safe?
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Niteowl:
How do we balance the patient's right to refuse treatment or medication with keeping the community and them safe?
The right to refuse treatment is a toughie. On the one hand, there are folks with terminal illness who wish not to prolong the process of dying, especially if the treatment may entail as much suffering as the terminal process. I wouldn't want to see a cancer patient deprived of choice when s/he was ready to accept death instead of another round of treatment that left her/him exhausted, nauseated, debilitated, etc. and when death was the certain outcome in any case.
We do (or at least once did) restrict the rights of (some) people with diseases which can readily spread to others, in order to protect public health. Time was in the U.S. when someone diagnosed with TB was hustled off to a sanitarium without so much as stopping at home first for a change of underwear. Yet these days we trust to the good faith/good sense of people with HIV to inform potential partners and take precautionary measures to avoid infecting others. It doesn't always happen, though.
Mental illness, of course, isn't "catching," nor does any particular form of MI predictably produce dangerous behavior.
Frankly, I think that "public" has shrunk in meaning from the term "public health." Individualism as a driving force in US culture has, IMO, taken several steps too far toward its last illogical extreme.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Boogie
Boogie on down!
# 13538
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Posted
This is what happens in the UK.
It worked well for my friend's daughter - who is back home and doing well now.
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Squirrel
Shipmate
# 3040
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Posted
That sounds similar to the Mental Hygiene laws in New York State, with its provisions to involuntarily commit a person to a hospital. The laws look good on the books, but the reality is that many seriously disturbed people get put back out on the streets quite quickly. Put a person in a controlled environment; give them potent medications and they often "get better" quickly. Once back out on the street, with limited follow-up services and the freedom to not take their medication, such a person often finds him/herself homeless, in prison or a horrible burden upon an overwhelmed family. I see it all the time in my work.
The 800-pound gorilla in the room is that many of the most seriously disturbed (and potentially dangerous) of the mentally ill simply can't be left to their own devices. They won't take their meds, and, even if outpatient therapy is available, they often don't show up for their appointments. They NEED to be institutionalized.
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"The moral is to the physical as three is to one."
- Napoleon
"Five to one."
- George S. Patton
Posts: 1014 | From: Gotham City - Brain of the Great Satan | Registered: Jul 2002
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Eleanor Jane
Shipmate
# 13102
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Posted
quote:
Originally posted by Boogie:
This is what happens in the UK.
It worked well for my friend's daughter - who is back home and doing well now.
Sadly it doesn't always work even in the UK. My husband's Aunt has been battling to get help for her son for years. He's clearly very mentally ill, but also very clever at spotting medical people and avoiding them when they come to the house or if necessary bluffing his way through. He mostly refuses to take his medication. He's lost his job, been through periods of living rough, has been so unpleasant, obsessive and hyper that my aunt couldn't have people visiting her house. He is currently awol (i.e. no-one knows where he is or what he's doing). It's really sad for all concerned.
Posts: 556 | From: Now in the UK! | Registered: Oct 2007
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
quote:
Originally posted by Squirrel:
That sounds similar to the Mental Hygiene laws in New York State, with its provisions to involuntarily commit a person to a hospital. The laws look good on the books, but the reality is that many seriously disturbed people get put back out on the streets quite quickly. Put a person in a controlled environment; give them potent medications and they often "get better" quickly. Once back out on the street, with limited follow-up services and the freedom to not take their medication, such a person often finds him/herself homeless, in prison or a horrible burden upon an overwhelmed family. I see it all the time in my work.
The 800-pound gorilla in the room is that many of the most seriously disturbed (and potentially dangerous) of the mentally ill simply can't be left to their own devices. They won't take their meds, and, even if outpatient therapy is available, they often don't show up for their appointments. They NEED to be institutionalized.
We have guardianship orders and Community Treatment Orders to try to manage that in the community - it does work to keep most people safe.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Martin60
Shipmate
# 368
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Posted
What a sick joke we are.
This UK case made me snort in derision.
The enquiry, the great and the good wringing their hands and saying what went wrong and how we all failed and what must be done about it.
NOTHING. We get what what we vote for. NOTHING.
I work briefly once a week or so with street people. Paranoid schizophrenes, bi-polar sufferers, addicted to drink, drugs, gambling: 'self-medicating' on base, cannabis. I've sat with them in A&E, in secure mental units.
And even if we voted for Scandinavian levels of support, it would still lack. Communal, relational support.
I.e. Christian support.
Once again, it's all OUR fault.
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Love wins
Posts: 17586 | From: Never Dobunni after all. Corieltauvi after all. Just moved to the capital. | Registered: Jun 2001
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Niteowl
Hopeless Insomniac
# 15841
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Posted
quote:
Originally posted by Martin PC not & Ship's Biohazard:
I work briefly once a week or so with street people. Paranoid schizophrenes, bi-polar sufferers, addicted to drink, drugs, gambling: 'self-medicating' on base, cannabis. I've sat with them in A&E, in secure mental units.
And even if we voted for Scandinavian levels of support, it would still lack. Communal, relational support.
I.e. Christian support.
Once again, it's all OUR fault.
A majority of us have voted for the dolts who have cut funding for mental health care and many have ignored the problem of those with severe mental health issues who live among us - especially those who are living on the streets. We all have a responsibility to be part of the solution. So my question to you is what constitutes communal, relational support. Yes, sitting with those in need, trying to get them the health care they need as well as trying to ensure the rest of their needs are met. But what are the specifics of that for those with severe psychosis? Are we to ensure (with force) they take their medication so they can become a fully functioning part of the community and lead happier lives for the most part? Do we force them into institutions when all else fails out of concern for their well being and the well being of the community? - being there for them when they are ready to be released? It's all well and fine to say we are all to blame, but unless you state specifics of what we need to do that is an utterly useless statement.
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Martin60
Shipmate
# 368
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Posted
Aye Niteowl. But note the sequence of events. We obtain Scandinavian levels of support AND in the meantime, now and until then (HA!), we visit the sick. Befriend the unbefriendable. And yes I've been found wanting, love-less in that regard.
What happens in Nepal ? Mali ?
HYes, how do we make a difference at both ends of the spectrum of power ?
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Love wins
Posts: 17586 | From: Never Dobunni after all. Corieltauvi after all. Just moved to the capital. | Registered: Jun 2001
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Niteowl
Hopeless Insomniac
# 15841
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Posted
quote:
Originally posted by Martin PC not & Ship's Biohazard:
Aye Niteowl. But note the sequence of events. We obtain Scandinavian levels of support AND in the meantime, now and until then (HA!), we visit the sick. Befriend the unbefriendable. And yes I've been found wanting, love-less in that regard.
What happens in Nepal ? Mali ?
HYes, how do we make a difference at both ends of the spectrum of power ?
I can do nothing about Mali or Napal, but I can try to make a difference here in my country, especially where there is at least a conversation and a possibility of spurring action as a result of Newtown. I admit it's far to easy to do nothing but we do so at our own peril.
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Martin60
Shipmate
# 368
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Posted
Absolutely agreed. I ask about those 'backward' countries because I suspect they're a LOT better at it than we are.
Hopefully our technology will give us a semblance of village life. We'll know who among us needs serving and do it.
Which is absurd I realise. It won't happen. And the answer has been staring us in the face of Christ for two thousand years. That we hold ALL things in common serve one another according to need and ability.
Which is absurd I realise ...
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Love wins
Posts: 17586 | From: Never Dobunni after all. Corieltauvi after all. Just moved to the capital. | Registered: Jun 2001
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Porridge
Shipmate
# 15405
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Posted
Apologies for a loo-o-oong post.
In my own country (US), I've had frequent occasion in the line of work to visit common rooms in county jails, the state prison system, the state hospital, and (when we used to have one) the state institution for what we then called "the retarded."
Except for details of architecture & furnishings, I'm unable to discern any significant differences among the groups of people (including guards/attendants) normally found in these rooms. Despite having set up separate "systems" for dealing with folk who are behaviorally challenged, functionally challenged, and/or perceptually challenged, all three sets of challenges loom large in the populations of all three systems. Our society currently attempts to deal with the problem of non-conformity to major societal expectations by segregating non-conformists for the most severe and most dangerous of their noncomforming behaviors.
What determines which system a challenged person ends up in, assuming s/he eventually enters some system? The actions which bring him/her to the attention of a societal "guardian." Criminal actions usually lead to being segregated into the criminal justice system. Functional abnormality leads to segregation within the physical/sensory/cognitive disabilities system(s). Perceptual abnormality (where the individual's perceptions of what's going on around him/her, &/or of how s/he is interacting with others do not match the majoritarian view of these interactions) leads to segregation within the mental health system.
In short, we've set up systems to treat discrete types of non-conformity. We've done this on the basis of assumptions that, IMO, don't hold water. For example, we seem to assume that "criminals" are actively choosing not to conform (they could and should behave better, but refuse to do so), so we "punish" them and "protect" society by segregating them, usually within actual physical buildings.
We seem to assume that the functionally non-conforming cannot conform even if they want and try to do so. (Blind people cannot choose to see, spinal-cord-injured people cannot decide to walk, brain-injured people cannot will themselves into greater reasoning capacities, etc.) We have further assumed, at least historically, that this means these individuals also cannot work. Thus, we've developed support systems which segregate these non-conformists economically.
In an effort to prevent the assumed "natural" desire to avoid work (note that in basic Christian theology, work-toil-labor-pain forms part of humanity's punishment in the banishment from Eden), quite low levels of comensation are offered, along with fairly steep threshholds to "qualify" the functionally-challenged for disability compensation. Practically speaking, most applications for Social Security Disability payments are now routinely denied on first attempt, and ultimate qualification, once achieved, can take a year or more, often considerably longer (during which time the applicant cannot work at all for fear of being denied. What s/he is supposed to live on in the meantime remains a mystery.)
And so we come to the perceptually non-conforming. Current US standards for officially segregating these people (dangerousness to self or others) pretty much guarantees that many of them, if brought into any system at all, will be brought into the one originally intended for criminals, not for people with mental illness.
In actual practice, though, many people, regardless of the "type" of nonconformity they exhibit, enter into none of these systems, because they don't get "caught." Petty criminals (behavioral non-conformists) are low on stretched-thin CJ systems' priority lists. Though serious crimes, rape and incest (perpetrated by behavioral non-conformists -- or are they actually functionally or perceptually impaired?) are significantly under-reported; the typical sex offender has committed an average of 12 crimes before being arrested.
The functional non-conformists are often (and are now routinely expected to be, where I live) cared for by their families of origin. They may receive systemic attention when entering public school, but there's no guarantee of this; school resources are also stretched thin, and most school systems actively resist officially labeling and then becoming financially responsible for providing needed services. Depending on the functional impairment and the family's social and economic resources, some of these individuals only enter into the appropriate "system(s)" when the parents become too elderly or frail to manage their care. Fairly often, this means that these non-conformists also enter into a system (the behaviorally-oriented CJ one) not set up for their needs.
Perceptual non-conformists, as already noted, have to become dangerous to get systemic care, and this too often funnels them into the "wrong" system.
Both functional and perceptual non-conformists experience a high degree of social and economic segregation, along with some degree of physical segregation when actually institutionalized.
Personally, I'm not persuaded that our assumptive underpinnings work. I doubt that sex offenders and petty criminals (for example) can be changed with our current understanding of the etiologies of these behaviors. I'm not convinced that these actions are necessarily "willed" by criminals in the same way that others "decide" to go to college or attend hair-dressing school. Clearly, prison does NOT "reform" (change the behavior of) most criminals; recidivism is notoriously high. Until we decide, as a society, that we're more interested in rehabilitation than in punishment, and until we put real resources into discovering what produces (and is ikely to correct) such non-conformity, we remain mostly helpless to address such behavior in ways that can lead to successful (that is, safe) re-integration into society.
It seems to me that, as a society, we have four options when it comes to people who (in whatever ways, and for whatever reasons) do not conform to societal expectations for functionality, behavior, and perception.
1. Accept such people as they are and accommodate their living as non-conformists among the rest of society.
This is a pretty tall order, and would take a very long, very arduous, and likely never-terribly-successful campaign to re-educate society itself, and a sweeping reform of societal expectations. The mainstream (whoever THEY are) would have to adopt a brand-new and much broader definition of "normal," with different standards for public and private behavior. We'd have to adjust to and expect a higher level of petty crime, inconvenience, unpleasantness, and possibly higher level of violence (although that's hard to imagine in the already-quite violent US).
2. Change non-conformists into conformists, but with far greater levels of success than we currently experience.
Again, sweeping reforms would be needed. We would have to allocate undreamed-of resources into researching and developing technologies likely to produce significant and durable change.
3. Segregate non-conformists.
This, one way or another, is what we currently do -- primarily only when the non-conformity becomes extreme enough to result in dangerousness.
4. Prevent non-conformity.
Given that our entire society appears to function on a reactive basis -- we respond primarily to emergent problems, rather than attempting to identify and prevent potential problems, either on an individual or a societal level, I see little hope for this one. We do not actually know (though we have theories) why some people's brain chemistry changes and begins to produce perceptual non-conformity. We have theories about behavioral non-conformity, but remain unable to predict why person A becomes a career criminal, petty thief, or sex offender, while person B, from similar background and upbringing, becomes a successful professional or entrepreneur or artist. We have a fair amount of knowledge about some factors that affect pre-natal functional development, but zero agreement about how, when, or whether to intervene in efforts to prevent these.
Meanwhile, we muddle bumblingly along. We attempt to divide the issues up in an effort to cope with the sometimes devastating effects of their non-conformity. Have we really divided these non-conformists up correctly? I doubt it. Have we divided up these issues in ways that help either the non-conformists or the society in which they live? It doesn't appear so. Are we actually prepared -- that is, willing and able -- to do anything about the resulting mess, economicaly, politically, morally?
It's hard to see how.
Martin PC's proposed solution of "simply" (this is seldom simple) sitting with people offers this hope: if we could persuade more of our population to engage in this activity, it would certainly raise general awareness of the enormity and complexity of the issues. If there's a start, that probably has to be it.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
quote:
Originally posted by Martin PC not & Ship's Biohazard:
Absolutely agreed. I ask about those 'backward' countries because I suspect they're a LOT better at it than we are.
As a matter of fact, they are. WHO research has found that outcomes for people with schizophrenia are better in the developing world than in "advanced" societies: What Did the WHO Studies Find?
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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Niteowl
Hopeless Insomniac
# 15841
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Posted
Disgraceful that the countries that have the most riches do worse than those that have far less. Especially those that are known as Christian nations...
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
It is important not to over sentimentalise:
quote:
The outcome of patients in the developing countries was not uniformly better, as compared to the outcome in developed countries. While high rates of complete clinical remission were significantly more common in developing country areas (37%) than in developed countries (15.5%), the proportions of continuous unremitting illness (11.1% and 17.4%) did not differ significantly across the 2 types of setting.
I have seen people shackled so they do not wander, and heard of people simply being tied to a tree when the psychosis was acute in order to keep them safe.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Niteowl
Hopeless Insomniac
# 15841
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Posted
quote:
Originally posted by Doublethink:
It is important not to over sentimentalise:
quote:
The outcome of patients in the developing countries was not uniformly better, as compared to the outcome in developed countries. While high rates of complete clinical remission were significantly more common in developing country areas (37%) than in developed countries (15.5%), the proportions of continuous unremitting illness (11.1% and 17.4%) did not differ significantly across the 2 types of setting.
I have seen people shackled so they do not wander, and heard of people simply being tied to a tree when the psychosis was acute in order to keep them safe.
In that event, we are more civilized - but we have a severe problem and are ignoring it and the suffering of those afflicted until numbers of people are hurt and/or killed by those afflicted.
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Doublethink:
It is important not to over sentimentalise:
I have seen people shackled so they do not wander, and heard of people simply being tied to a tree when the psychosis was acute in order to keep them safe.
Exactly. This is precisely the dynamic which produced the era of wide-spread institutionalization in Western societies (or at least in the US): families chaining, tying, or caging (and sometimes beating) family members who did not and apparently could not conform to major social expectations re: behaving, learning, & functioning. Institutions were originally introduced as a humane alternative to what families were reduced to doing; that's why they were once called "asylums."
Asylums originally offered refuge for their inmates from the treatment inflicted on them by families without resources to assist the challenged individual.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Niteowl
Hopeless Insomniac
# 15841
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Posted
Another person has been shoved to their death off a subway platform in New York by a person displaying symptoms of schizophrenia. This is a problem that is not going away.
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"love all, trust few, do wrong to no one"
Wm. Shakespeare
Posts: 2437 | From: U.S. | Registered: Aug 2010
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Martin60
Shipmate
# 368
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Posted
No dichotomy there Doublethink.
What is the Church to do ? Are we SO thin on the ground ? I know I am. I've had a guy's secure ward address in my wallet for months. I just fished it out of the waste bin where I'd finally thrown it yesterday.
I have my excuses ...
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Love wins
Posts: 17586 | From: Never Dobunni after all. Corieltauvi after all. Just moved to the capital. | Registered: Jun 2001
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Olde Sea Dog
Shipmate
# 13061
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Posted
I think tying them to trees is only during the acute phase of the illness, if there are severe "positive" symptoms.
I suppose the reason thirdworld schizos have better rates of remission is because they tend to live in extended families, where they are gradually given things to do as part of the unending chores. There's always someone around to talk to. It's a lot better than being stuck in a room staring at the TV, as often happens in advanced industrialized societies ..... or even being abandoned to homelessness.
In the usa, it's so difficult to get help even when it's wanted. I don't suppose that will change, it's often a result of Supreme Court decisions about privacy and civil liberties that are unlikely to be reversed. No amount of legislating would stand up to court challenges.
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Even a stopped clock is right twice a day.
Posts: 67 | From: The C of Consciousness - California | Registered: Oct 2007
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Olde Sea Dog:
No amount of legislating would stand up to court challenges.
I'm not so sure. Legislating actually brought us to the state we're currently in. I think many people are slowly coming to recognize that individual liberty can impinge heavily on the public health, safety, and good of other individuals and their freedoms, pendulums will start swining back t'other way.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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churchgeek
Have candles, will pray
# 5557
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Posted
I'm in an HMO that's supposed to be pretty good, but from what I hear, there's a shortage of beds for psych patients, and people who need ongoing intensive treatment have to settle for an amount of time that's less than what they need.
I worry sometimes, too, about what availing oneself of these services entails. For example, short of committing yourself to hospitalization, you can go to something called the Intensive Outpatient Program, which as I understand is about 3-5 hours Monday-Friday (or maybe 3x a week, probably depends on how bad you're doing), and is basically just group therapy. Now, take your pick: Let's say I had to do either one, IOP or hospitalization. What will that do to the degree program I'm in, let alone my job? I would get behind on my degree. I could get a medical leave of absence, and I understand my school would still let me buy into the health insurance - but then how would I have money to live on? I rely on financial aid, which I wouldn't be getting during a leave of absence.
What this means is that I'm highly unlikely to avail myself of any of these services, even if they're available, because of those worries.
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I reserve the right to change my mind.
My article on the Virgin of Vladimir
Posts: 7773 | From: Detroit | Registered: Feb 2004
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Gramps49
Shipmate
# 16378
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Posted
Speaking as a former mental health worker, I do not think the problem is with any psychosis or bipolar disorder per se. I think the major problem is, rather, with the lack of empathy. These people have no sense of feel for another human being. They actually have Axis II disorders: Antisocial; Narcissistic; and Sadistic as well as pyschopathy. Psychothy, in particular, is characterized by: shallow emotions (including reduced fear, a lack of empathy, and stress tolerance), coldheartedness, egocentricity, superficial charm, manipulativeness, irresponsibility, impulsivity, criminality, antisocial behavior, a lack of remorse, and a parasitic lifestyle.
I used to work with these people and I can say they are scary.
Used to be such people were put into mental health institutions with little hope of discharge. Then Ronald Reagan did away with that system. Maybe we need to go back to it.
Posts: 2193 | From: Pullman WA | Registered: Apr 2011
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Gramps49:
Then Ronald Reagan did away with that system. Maybe we need to go back to it.
There are serious problems with any institutional "solution" involving this population.
1. Precisely because of their characteristics, these patients are often very abusive to one another. Congregating them multiplies the in-house problems of caring for them. (Of course, de-institutionalizing them multiplies other problems.)
2. Their care, as a result, becomes very expensive -- more attendants are needed, hazard pay is often needed (sometimes as an incentive to acquire staff willing to work with them), special training is often needed; the alternatives -- restraints, drugging folks into torpor -- pose legal issues.
3. There's little hope of improvement in congregate settings. If the people around you are all behaving badly, you have neither incentives nor models to modify your own behavior.
In my state, these are the folks most apt to end up in the Secure Psychiatric Unit, which is run by Corrections rather than by Mental Health. In other words, 24/7 incarceration, often in isolation, and absolutely zero treatment.
I think what we actually need is some sort of national push for research into treating psychiatric disorders, and I don't just mean more drugs. Don't get me wrong; some drugs can turn some people's lives around in ways that seem almost miraculous. But no drugs work until or unless patients can be persuaded to take them and to keep taking them, and to get (i.e. afford) regular psychiatric care to monitor for changes, as well as to develop new drugs that don't have such devastating long-term side effects.
Unfortunately, folks with chronic mental illness are not a well-heeled "market." Because these illnesses tend to disrupt lives economically as well as socially, we are talking about folks who are generally impoverished. Even if willing to shell out all their tiny (if any) disposable income on meds, they often can't; they have none. Going off the rails usually means loss of job, then loss of domicile, then disruptions to disability payments and other benefits due to loss of address, etc.
There's little or no financial incentive in our alleged "free market" system for for-profit drug companies to develop new, better drugs; there's no funding for this and no money to be made from it.
And drugs alone, for all the reasons mentioned above, are definitely not the answer. Affordable, steady, frequent monitoring/guidance/care is essential.
Frankly, we are barely out of the Dark Ages when it comes to handling chronic mental disorders.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Gramps49
Shipmate
# 16378
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Posted
I think you are missing my point. The people who are the problem have Axis II disorders which are very hard to treat. I am saying if they will not respond to treatment, we have to find a way of keeping them safe, and society safe from them.
Axis one disorders can be treated and are not usually violent.
It is estimated over half of all people in American prisons have mental health problems. I would argue that the American prison population exploded shortly after Ronald Reagan did away with mental health institutions.
Posts: 2193 | From: Pullman WA | Registered: Apr 2011
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Gramps49:
I think you are missing my point. The people who are the problem have Axis II disorders which are very hard to treat.
I think I understood your point. The point I am making in response is that Axis II disorders are hard to treat because (A) we don't currently have appropriate treatments for them, and (B) neither are we putting significant effort into developing same.
The fact that we don't now have useful treatments for some disorders/patients does not necessarily equate to "these disorders/patients can't be treated (or are "too expensive/too difficult/are too rare/have too low a success rate") to treat. Yet the latter premise(s) rapidly become(s) the default position which in turn obviates/disincentivizes research into new drugs and treatment options.
I grant you that, in the meantime, institutionalization appears to be the only option capable of protecting the general public frmo these individuals. But institutionalization + drugs to keep patients quiet should not be mistaken for "treatment." It's the policy which may offer greater protection for the public for now, but it offers neither relief nor hope for those suffering from the illnesses.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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