The best advice I ever received from a psychoanalyst concerned the son of a friend of mine (let's call him Joe). Joe kind of adopted me, and often came over seeking advice. The young man was unrealistically optimistic. If his boss complimented him on some job he carried out, Joe was sure he soon would receive a promotion. When none of this was forthcoming, far from being crushed, Joe would spin a new tale: he expected to be soon moved to a choice location. And when this move did not materialize, Joe assumed it was just being delayed.
The same with dating: a smile was interpreted as a sure sign of deep interest, and a long deep look meant a potential keeper. And there always was another tomorrow. Joe was never down -- except when I tried to call his attention to his poor reality testing. The therapist warned me not to take away Joe's defenses -- before I provided him with some other foundations on which to base his self-esteem. Sadly, I never found a way to help him find more realistic sources of contentment. Accordingly, I just listened sympathetically but tried not to reinforce his illusions.
I was reminded of this episode when I read in The New Yorker about a delusional woman named Linda, who believed that she was fighting off government spies and that God would provide whatever she needed. When she was hospitalized, she refused to accept that she was mentally ill. Therapists, The New Yorker reports, tend to see in such refusals -- exhibited by about half of mentally ill patients -- a sign of illness and insist that patients accept their conditions as a first step toward a cure. Such acceptance is also needed to encourage the patients to take their medication. However, for Linda -- and many others, it seems -- this meant great humiliation. In her case, she would have to give up on the heroic role she had spun for herself and accept that she was, in her words, "crazy" -- that is, give up on the narrative that kept her going before any new ones were formed. She left the hospital, moved into an abandoned house, lived on apples she collected at night, and eventually died from malnutrition.
The New Yorker -- writing about her and many other such patients -- implies that this is the life she wanted. It was her choice; to keep her hospitalized against her will, and make her recognize her illness, would have violated her autonomy. Many other physicians and therapists and even medical ethicists would agree. They tend to see the will of the patient as free will, which should take precedent over all other considerations unless the person poses even merely potential albeit plausible threats to others or to herself. (The fact that Linda might harm herself was not clearly evident when she was released.) Thus, it seems that a considerable number of therapists hold that one should not make or even unduly pressure mentally ill patients who refuse to take their medication, even if once they are on the meds they realize their benefits. The medical community wonders which is their "true" self -- the medicated or the un-medicated one? -- and whose preferences to follow.
As I see it, mental patients are like children who are not fully competent to make decisions. Adults, who are charged with their care, owe it to the community -- and above all to the children -- to second-guess and amend their decisions, if need be by use of force. As a parent I did not let my 2-year-old run into the street out of respect for his free will, nor drive when he was 16 and high -- even when I had to wrestle away the car keys. True, as children grow older, the range of decisions they can make on their own ought to be increased -- as and if their capacity grows. But even for, say, a 17-year-old, I would veto his decision to invest his savings, say, in a hedge fund, not to mention pork bellies.
The same goes for mental patients. True, they vary in their capacities, which hopefully can be made to grow, which in turn will require allowing them to make more decisions on their own and learn from their failures. However, at the end of the day, they should be medicated and, if need be, held if there are reasons to believe that may harm themselves or others. Protecting life takes precedent over respecting a will that is not free but distorted by mental and often genetic, chemical or other malfunctions.
Amitai Etizoni is a University Professor at The George Washington University and the author of New Common Ground (Potomac Books, 2009).
The nursing home admitted Paul only because his lungs got so bad. Then, Medicaid would cover him and because he was admitted due to his lungs, not his schizophrenia, the nursing home would not have a fear that they would be labeled an "Institute for Mental Disease", which would cause them to lose Medicaid coverage for all of their patients, whether they were mentally ill or not.
Because the feds won't help states pay for medically necessary long term care in a psychiatric facility, the states have balanced their budgets on the backs of the mentally ill, their families, and the communities into which they were released.
It is a national disgrace that our country has swung back to the 1800's and now our prisons again serve as our state hospitals. We have criminalized mental illness.
Please contact your members of Congress. Urge them to repeal the discriminatory Medicaid IMD Exclusion.
The tens years that followed Paul's release was a nightmare roller coaster ride with stops to local hospital emergency rooms and psych wards, and even back to the state hospital, only to be released again and again for the ride to start again and again. He went without for food for almost a month once when his food stamps card "didn't work". Paul's caseworker told us "well, we gave him the forms..." His need to renew his food stamps card wasn't on the caseworker's radar either since he was an "emancipated adult". Yeah, and everyone knew Paul thought he was James Bond...
Just as I was looking into getting guardianship of Paul to get him placed in a more secure facility, he was admitted to a nursing home due to his failing lungs. He was shortly diagnosed with cancer and died nine months later.
When 50% of all people with schizophrenia also lack insight into their own illness this means that probably only 50% of the millions of people with schizophrenia are getting the help they need, unless someone else steps in. I wish I had started the process sooner.
DJ Jaffe
http://mentalillnesspolicy.org
The society detrimentally subverts the human instinct at birth. Your living in a world of thought continually provided to you through a controlled mass media. Only a very small percentage of your brain do you even know how to use.
Those people on the streets are being used and you are told to deny that the government would put communication systems in human beings. Your supporting a government who purposely modify their population by genocidal methods and exist from the power to deprive the people of their needs.
Politics is a pure ruse, it only exist to instill the human id with thoughts that the government is the peoples choice and for the welfare of the people, where the people are cultivated for the use of governments.
Gods and science are used to create idols to deposit yourself worth, never to use ever. A delusion of constant absurdities are given you to never question and pursue fulfillment.
All types of subliminal persuasion exist. The magic bullets to take your free will and choice from you exist. Mind control is a exact science and that knowledge came from the destruction of a human mind.
I learned that mental illness is not a matter of degree, nor defined by who gets caught or doesn't. It is very real, and a professional who has seen a parade of such troubles is (hopefully) able to recognize what the rest of us struggle to understand.
We learned that the bumbling of the medical establishment and insurers, and the slightest yielding to notions of free will can steal away forever a sweet, promising life -- her loss still fills my eyes with tears, though it was many years ago.
Upon the surprisingly late arrival (30-something) of diagnosis #2, the young woman's mother took over with fierce determination. She quit her job, enlisted the husband, and created a veritable boot camp. She interviewed doctors and demanded thorough explanations and plans and milestones, holding them relentlessly to their word and firing any who faltered. Would that we each could have such an advocate. In the thick of it, the daughter was pleading with us midst hallucinations to aid her escape. She slowly shifted from resistance to advocating for herself in demanding the medication that finally returned her to us. The price is normally outside her reach, but she is persistent and finds those quiet sources that will help. It is a good story, nothing to do with child or adult. That's how I see it from my perspective.
Sometime in 1995, my other aunt revealed that her sister was thought to be illegitimate. Apparently, in the 1930s and 40s, this open secret in the family allowed her brothers to get away with physically and mentally abusing her as a child. Then I found out that in the 1950s my "crazy" aunt had been sexually assaulted by a man of another religion, who verbally abused her using religion as both a weapon and the reason for the assault. As I understand it, until that time she'd been "normal", but after the assault (given her unconventional birth and the attitude of those around her that she somehow deserved it) she became more and more paranoid and her refusal to be hospitalized came because she was assaulted - again - by another patient, and the staff did nothing.
Of course, no one ever spoke about the abuse or the assaults, nor would my aunt have done so in those days. So maybe there was a reason for Linda's behavior and forcibly holding her then shoving medication down her throat wasn't the answer. Maybe a little psychoanalysis and talk therapy that went beyond assuming she had no reason to feel paranoid might have helped.
What's so great about reality?
2. What constitutes being dangerous enough to have the State force you into a mental hospital?
Secondly, we have -- since around 1950 -- stopped making medications to cure illnesses. It's cheaper and more profitable to make medicines that merely treat the symptoms of a disease. Many of those medications have "side effects" that are far more harmful, if not outright deadly, than the disease being treated is to the human body.
Thirdly, the corporate administered "health care" we now receive has greaatly reduced the quality of the previously existing relationship between Physician and patient. Previously, the "family Doctor" actually CARED about the health and progress of the people who made up his/her practice. It has been transmuted into a "take a number and wait your turn for service" environment wherein the ones providing medical care are now more motivated by how many people they can push through their office on a given day. This type of "health care" is NOT sufficient to accurately determine the needs of anyones mental health care.
There are other points that I could make, but it's late and I'm off to bed, so these will have to be enough to explain my position.