“The Real Navy Yard Scandal”

As was the case in the Tucson shooting — instantly politicized into a gun-control and (fabricated) tea-party-climate-of-violence issue — the origin of this crime lies not in any politically expedient externality but in the nature of the shooter.

On August 7, that same Alexis had called police from a Newport, R.I., Marriott. He was hearing voices. Three people were following him, he told the cops. They were sending microwaves through walls, making his skin vibrate and preventing him from sleeping. He had already twice changed hotels to escape the men, the radiation, the voices.

Delusions, paranoid ideation, auditory (and somatic) hallucinations: the classic symptoms of schizophrenia.

So here is this panic-stricken soul, psychotic and in terrible distress. And what does modern policing do for him? The cops tell him to “stay away from the individuals that are following him.” Then they leave.

But the three “individuals” were imaginary, for God’s sake. This is how a civilized society deals with a man in such a state of terror?

Had this happened 35 years ago in Boston, Alexis would have been brought to me as the psychiatrist on duty at the ER of the Massachusetts General Hospital. Were he as agitated and distressed as in the police report, I probably would have administered an immediate dose of Haldol, the most powerful fast-acting antipsychotic of the time.

This would generally relieve the hallucinations and delusions, a blessing not only in itself, but also for the lucidity it brings on that would allow him to give us important diagnostic details — psychiatric history, family history, social history, medical history, etc. If I thought he could be sufficiently cared for by family or friends to help him receive regular oral medication, therapy, and follow-up, I would have discharged him. Otherwise, I’d have admitted him. And if he refused, I’d have ordered a 14-day involuntary commitment.

Sounds cruel? On the contrary. For many people living on park benches, commitment means a warm bed, shelter, and three hot meals a day. For Alexis, it would have meant the beginning of a treatment regimen designed to bring him back to himself before discharging him to a world heretofore madly radioactive.

That’s what a compassionate society does.

via National Review Online.

I agree that in this situation, administering the appropriate drug(s) would have been the correct solution.

The larger argument, though, is troubling to me.The question of when and whether to treat someone who does not want treatment is a very difficult question, because throughout the 20th century there is a history of mental health being used as an excuse to incarcerate political dissenters, criminals (without trial), and troublesome patients who couldn’t be cured honestly.

The history of mental health treatment is a history of abuse for a reason. How to resolve this particular issue is genuinely problematic. It’s not a simply matter in the way that setting a broken bone is simple. Most mental illness has no direct cure; much of it is subjective – a cultural decision that a particular situation is “abnormal” rather than “healthy”. The word “healthy” refers to a value judgment, not a scientific fact; we have to define what constitutes healthy before we can apply the label.

Who gets to decide when to intervene? Who gets to decide what interventions are appropriate? Based on what?

It is an incredible power that replaces rule of law with elite opinion. Experts acting under the guise of “we know what’s good for you better than you do” are allowed to override your right to self-governance. Their opinion replaces due process. If they say you’re crazy, then you’re crazy. Who has the authority to tell them they’re wrong, if they should decide to abuse that power – or even if they are just plain mistaken?

I remember reading some article awhile back that claimed caretakers of autistic people at a particular site, in essence, got a bit burned out and started enjoying controlling and even inflicting pain on their charges. I don’t know if this is true or not, but it is plausible. I could see scenarios like this happening. Burnout is a serious problem for people dealing with cognitive disabilities – and every other type of mental health disorder.

Even when we don’t have impaired or corrupt decision makers, there’s still the fact that involuntary treatment has an ugly history. We used to lobotomize people against their will, and/or for dubious reasons. We used to use electric shock therapy on people against their will, and/or for dubious reasons. In some places, shock and pain are still used to control special needs kids.

Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient.” – Ernest Hemingway, Nobel Prize-winning author who killed himself after complaining that psychiatric electric shocks had ruined his career by destroying his memory.

quote lifted from one of many sites questioning the efficacy – and even the motives – of psychology

I agree that we need to treat mentally ill people but the problem is that mentally ill people have good reason to fear the people who would treat them. This community really does have a history of abuse, control issues, and insensitivity toward the feelings of those whom they treat. The community has not fostered trust. It dehumanizes people. Worst of all: it does not have a track record of proven results. It does not turn sick people into healthy, happy people. It turns sick people into drugged, “treated”, controlled people. In some cases these people might be happier, might be better off – but we don’t really know for sure.

These are serious problems and it needs/deserves serious issues.