Marching To The Beat Of A Different Reality

Thursday, August 27, 2015

In The Wake Of Recent Tragedy, Mental Health Reform Is A Must

Like many, I imagine, I've had a hard time reconciling the death of Labor Commissioner Mark Costello, because the sadness strikes on so many levels

Though it seems incalculable to ruminate on them all, one I hope will come to the forefront as a result of this tragedy, is the unbelievable hardship it has become to seek help for those with mental instability - a situation to which I've had a bit of exposure on both sides of the fence.

Back in the early 1990's David and I owned a small house in a little incorporated town called the Village inside the Oklahoma City limits. Our home was in a neighborhood of small, 1940's bungalows, and we spent a great deal of time (pre-second round of children) renovating it and enjoying our work.

Our neighbor to the south was a single black woman named Charlene whom we saw little of when we first moved in. One night about 6 months or so into our home ownership, the dogs started barking and we began to hear the most awful crashing outside. I ran to the window and there was Charlene taking a baseball bat to the car parked in her driveway. David quickly called the police. In minutes, there was a patrol car there, lights flashing, and in very little time at all, the woman was being put into the police car with another man.

Curious as to the nature of this kind of incident right next door, David went out to speak with the policeman. Charlene, he told us, suffered from schizophrenia. She also had a very long 'rap' sheet. Charlene had medicine, but rarely took it because she liked to smoke crack and it interfered with her high. Her family refused to have anything to do with her anymore, after trying for years to get her to take her medications and getting her into treatment only to have her check herself out and end up back on the streets. They had tried to have her committed, but they could never manage it. Consequently, she would go off her meds, cause some kind of trouble, get hauled into jail for 24 hours on a charge of some kind, and go home in the morning.

This was eye-opening to me. Why in the world was there a schizophrenic living next door to me who couldn't be counted on to take her medicine? What if it was our car she took out next time - or our daughter who stayed home in the afternoon after school until we got home from work?

Over the next several years, Charlene threatened to kill us while brandishing a hammer, burn down the house with us inside, kill our dogs, etc. - all from the other side of a 3 foot high chain link fence in our back yard, or from our front porch, or our front yard. We became exceptionally friendly with the Village Police department, many of the officers whom we grew to know on a first name basis.

One day, after Charlene stood on the front porch screaming epithets at us because we wouldn't open the door and pounding on it like she was going to break it down, I asked the officer who showed up to remove her why she hadn't been committed. He told me it was very hard to commit anyone because the person had to be a clear and present danger to himself or others before that could happen.

I was honestly aghast at his answer. At what point was the 'clear and present danger' characterization made, we wondered? She had threatened to kill us while holding what could be used as a weapon. At what point did that become a concern for someone? After we'd been found dead in our backyard pulverized with a hammer?  We'd purchased our home. We took care of it and our yard. We were good citizens and good neighbors, yet it was often impossible for us to enjoy the fruits of our labor because of the actions of a mentally ill next door neighbor. Why did she somehow have more right to be living next door threatening my life than I had to lawfully enjoy mine?

This situation was a near continual frustration until one day, some people (her family?) showed up, carted away her things and took her with them. Fortunately, we never saw her again, but what happened to her? Was she simply removed to another place to start her cycle of threats and violence all over again? Did she finally hurt herself or someone else? We never knew.

Many years later, we internationally adopted a child who - unbeknownst to us - had severe emotional issues. Sadly, she frequently made life in our house impossible due to outbursts of anger and disobedient behaviors. She ran away from the house several times - and once threatened her life. For years I tried to find help for her but to no avail. If I found something, it was so expensive we would have had to mortgage our home to pay for it, as insurance barely scratched the surface of the expense. I will never be able to adequately enumerate the number and hours of calls I made only to hear, "We're so sorry, have you tried ______. We can't help you."

After three years of trying to assimilate her into our family, the upheavals she caused became too hard for our family to withstand. By God's grace alone we were fortunate to find a family willing to take guardianship of her. This situation lasted a year before this family was also unable to care for her. She was then sent to an aunt in another state. That arrangement lasted six months before she was allowed to come back to our home where the cycle started all over again.

Eventually, our daughter ran away from a subsequent and third guardian family after being kicked out of her high school for behavioral issues. She took a bus to Dallas where she was found by police in a homeless shelter. That night we drove to Dallas in the middle of the night to pick her up because Texas DHS would have either taken her back to the shelter or another facility across town where her stay would have been billed directly to us. How does that happen? If a parent dumped a kid at a shelter, DHS would have a field day, yet a state agency would just put a run-away out on the street? We couldn't afford to pay for her to stay indefinitely in Texas or we would have arranged for live-in treatment long ago. We were truly doing the best we absolutely could for our family on our budget. None of this ever made any sense to me and compounded the frustration we felt at the situation. Eventually, without assistance and with no way to care for the child in a way helpful both to her and our family, she was sent back to her homeland to be cared for by her brother. I would much rather have had her living with our family - happily, stably - but the 'system' made that impossible for us.

When I was growing up in the 1960's, there were homes for the mentally ill and those in need of therapy for emotional issues. Though there are a few such places today in Oklahoma (and in states across the nation), they are called, "residential treatment centers" and they are excruciatingly hard to gain access to. After Mark's death, I began to think about my past personal experiences with mental/emotional/behavioral issues and did a bit of basic research, the results of which I would never have guessed.

Though the history of psychiatry and psychology in America are long and interesting, today's mental health policies and procedures appear to be taken from changes that occurred within the practices during the 1960's when the methods of Freud (mainly psychoanalysis) began to be challenged as 'repressive and controlling'.

During the 1960's, Hungarian/American psychiatrist Dr. Thomas Szasz (a libertarian) wrote a book called, "The Myth of Mental Illness." In the book, Dr. Szasz - who later became a professor at Syracuse University where he cast his theories - advocated against labeling individuals as mentally ill, arguing that there was, in fact, no such thing. Mental illness - including schizophrenia - was, essentially, a construct of physicians created to marginalize people out of society where they could then be used as guinea pigs for drug trials. Patients only really suffered, 'symptoms' because they refused to take responsibility for their own actions. Once a patient was able to exercise control over their irresponsibility, they would be cured.

The author of Dr. Szasz' website boiled his thoughts on mental illness down to 6 points:
  1. "The myth of mental illness". As far as Szasz is concerned, disease is defined as a physical lesion. Hence using the term 'mental illness' is a logical and semantic error. The reason the metaphor of mental illness is literalised by postulating it has a physical basis is so that it can serve as a justification for psychiatric interventions and institutions.
  2. Separation of psychiatry and the state. The state should not interfere with mental health practice, which ought to be an individual voluntary activity. Szasz was trained as a psychoanalyst and undertakes private work.
  3. Presumption of competence. Categorisation as a mental patient should not be understood as diminishing legal competence.
  4. Abolition of involuntary mental hospitalisation. Involuntary treatment is violence defined as beneficence. Detention should only take place under the criminal justice system.
  5. Abolition of the insanity defence. "Excusing a person of responsibility for an otherwise criminal act on the basis of inability to form conscious intent is an act of legal mercy masquerading as an act of medical science."
  6. "Americans are faced with the task of abolishing psychiatric slavery". As is apparent, Szasz is not afraid of polemical statements.
It is Dr. Szasz theories which are used predominantly throughout L. Ron Hubbard's creation, "Dianetics", the foundation of Scientology.

Not long after Dr. Szasz' theories were lauded, Dr. David Cooper's were as well. Cooper, who coined the term "Anti-Psychiatry" in his book, "Psychiatry and Anti-Psychiatry", was a Marxist who believed the concept of family to be 
"an ideological conditioning device that reinforces the power of the ruling class in an exploitative society". 
In 1967 he attempted to define 'anti-psychiatry' as 
"reversing the rules of the psychiatric game of labelling and then systematically destroying people by making them obedient robots." 
He believed that the roles of patient and doctor should be reversed and that a person should embrace and experience their own 'madness' rather than being treated or institutionalized.

Though there were many other players and events (such as the rise of the patient's rights movement) pushing the profound changes being made in psychiatry during the 1960's in America, Britain's 'anti-psychiatric' movement had begun a bit earlier in the 50's. 

In 1959, Britain passed the 1959 Mental Health Act in which involuntary treatment of the mentally ill was essentially abolished excepting in extreme cases, and institutional care was abandoned for care within the community. A practice called, "Care In The Community" rose up in response wherein, rather than institutionalizing those with mental health issues no one could be sure were actual or real, suffering people needed to be cared for in their own community where they would better assimilate a healthy lifestyle.

Looking to emulate Europe's response to the 'anti-psychiatry' movement, American President John F. Kennedy created the Community Mental Health Act in October of 1963. According to the National Council for Behavioral Health:
This law led to the establishment of comprehensive community mental health centers throughout the country. It helped people with mental illnesses who were “warehoused” in hospitals and institutions move back into their communities.
Along with this law, the development of more effective psychotropic medications and new approaches to psychotherapy made community-based care for people with mental illnesses a feasible solution. A growing body of evidence at that time demonstrated that mental illnesses could be treated more effectively and in a more cost-effective manner in community settings than in traditional psychiatric hospitals.
And there you have it. In the blink of an eye, the political machine was activated and public tax dollars went to the building of 'Community-Based Mental Health Centers' judged to be a better reaction to mental illness than any previous tactics because of the thoughts/ideas of a number of academics - not research from active psychiatric researchers (what little active research Cooper did, for example, failed miserably to prove his thesis) - and the creation of new drugs better able to help the mentally ill cope in society. Soon, Charlene's all across the United States were unleashed upon unsuspecting citizens in their 'community' with very little to keep them on track with their medications or their lives. 

In an article entitled, "When My Crazy Father Actually Lost His Mind", author Janeen Interlandi describes this situation well, and adds a quote, 
"But in the decades since, the sickest patients have begun turning up in jails and homeless shelters with a frequency that mirrors that of the late 1800s. “We’re protecting civil liberties at the expense of health and safety,” says Doris A. Fuller, the executive director of the Treatment Advocacy Center, a nonprofit group that lobbies for broader involuntary commitment standards. “Deinstitutionalization has gone way too far.”
The Treatment Advocacy Center provides information for legislators, lawyers and the lay community, lobbying for such issues as the addition of psychiatric beds and for removal of the incarcerated mentally ill to treatment centers. TAC also works hard to provide education of the current commitment laws in each state.  

Robert Davison, Executive Director of the Mental Health Association of Essex County in northern New Jersey (as cited in Interlandi's article) describes the circumstances of several individuals whom judges have refused to involuntarily commit due either to perceived civil rights violations or a lack of available treatment beds:
A man who was convinced that aliens were on the roof and that bugs were coming out of the walls and who would not sit on furniture but only lie on the floor was not committable. Neither was the man who refused medication and mutilated his own testicles. Nor the woman who wouldn’t eat because she believed the C.I.A. was trying to poison her.
Unfortunately, the changes to mental health treatment and commitment procedures have not only effected the mentally ill, but alcoholics and drug addicts as well. Without a commitment option available, families often have to wait so long before their loved one is able to seek treatment for drug or alcohol addiction, they injure others or themselves in the interim. 

In 2012, after the Sandy Hook Elementary shootings, the Washington Post published an article entitled "Seven Facts About America's Mental Health System" which delineated many of the concerns described herein, such as; 
  • costly treatment
  • tendency to treat with drugs rather than hospitalize
  • poor access to mental health care
  • lack of desire to accept treatment
Though mental health issues seemed to be gaining some inspection following this (and other) incidents of mass murder, today, as I finish this piece, yet another shooting has occurred - this time of a news reporter and her cameraman while on-air - by a man who appears to have been suffering from mental illness. 

Quite obviously, there needs to be less discussion and more actual reform of mental health care in America to uphold policies and procedures lying somewhere between the over-identifying, over-medicating psychiatric establishment and the treatment of the mentally ill as feral animals by the anti-psychiatric movement. 

It is beyond time for realist activists to engage on this issue, which, as with so many other American institutions has been overrun by ideologues. The mental health laws currently active in Oklahoma (substitute your own state if outside our borders) need to be researched and brought into the sunlight of the public square. It is absolute necessity to engage in the fight to make these laws protect the public as well as the mentally ill themselves - if for no other reason than this:
“Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world.For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’ “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?’“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’ (Matthew 25:34-40)