First, thank you all again for sharing your stories and taking part in the discussion. A topic as complex as mental health and our justice system is difficult to fully explore in such a short period of time, but I am glad we were able to brush over a couple of different areas. I don’t have so much a couple of specific questions here as I do a general idea and theme, so freely respond with how you feel, and to whatever most jumps out at you.
For this blog I wanted to extend our discussion to current events, the media, and communication of a cause. Mental health cuts (as shown by the Huff Post article) have been on the rise for decades. In recent news—and as a result of recent gun violence—there have been cries for increased mental health support and services. It almost seems as if criminal behavior and mental illness have become so enmeshed that the discussion has to begin there. But, it raises important questions…
Don’t get me wrong: It is great to talk about mental health and advocate for more treatment and services. With that said, the framework on which we argue for such services is of equal importance (my view). As we’ve seen in class, the “criminalization of mental illness” is a multifaceted issue. How do we assess the independent pieces of the puzzle? How does government balance public fears and research and facts in creating new policies? Does the way we portray a cause (i.e. “criminalization of mental illness”) evoke emotional responses? Given the narrative we’ve built—and the multiple perspectives we have explored in class—what do you make of these recent calls for more treatment and the general societal stance?
Further, how do we attempt to alleviate the vexing problems of our times without compromising the main goals? Then again, what even are the “main goals” here? Is there some give and take that we just have to deal with? Can you ever advocate in favor of something… but for the wrong reason?
This small debate presented on the NY Times may be helpful in guiding the discussion. Listed as one of the experts is my mentor from the Vera Institute— Jim Parsons. Also provided is an interesting perspective from Dr. E. Fuller Torrey again, author of our deinstitutionalization article for class.
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14 comments:
Hi Joseph, thanks for a great class discussion. I am going to start by saying that I agree with the NY Times article you posted because I think we really need to take a closer look at the laws which are already in existence and enforce them rather than start making new laws to criminalize people for crimes they have not committed.
I believe the Arizona law which allows for involuntary treatment for those mentally ill individuals who refuse to take medication and who show signs of being a danger to themselves and others, is a good law and a practical solution for a lot of the issues involving mentally ill people. I think most individuals who have a mental illness can function normally (whatever that might be) if they get the proper treatment. I do not necessarily believe treatment involves medication but when it is necessary, those who refuse to take the proper medication should be forced to comply in order that they, along with the rest of society, can be safe.
I also agree that most violent individuals who commit horrific crimes are not mentally ill. However, so much attention has been focused on the subject, due to the recent rash of violence perpetrated by mentally ill individuals, that it is a very important subject to discuss.
My personal opinion on the matter is that if we pay attention to individual who are suffering from any kind of mental or emotional problem we might learn to recognize patterns that can help prevent violence. I also believe that it is our lack of understanding and our stigmatizing of mentally ill individuals that generates violence. Like the saying goes, “violence begets violence”, therefore if we shut out people, place stigmas on their conditions or behavior and we separate them because we do not want to, or do not know how to deal with them, then we will create a violent and neglectful atmosphere.
I'm going to jump onto the blog now, Sunday at 4pm, though I was really waiting for more than one Veron to get going on the discussion.
But I don't want to wait anymore because I'm feeling a heavy heart right now, having just gone through the past week or so of NY Times articles (in addition to what Joe posted). One was a front page article titled "Drowned in a Stream of Prescriptions" (Feb 03, 2013) about a young man whose addiction to prescription drugs for attention deficit disorder led to his suicide. That's the outline of the story. As with our discussion in class, the story is revealed to be multi-layered, involving the dominance of the pharmaceutical model in psychiatry (diagnosis + prescriptions), the production, distribution and consumption of "legal" and illegal drugs, intense pressures put on young people to perform, alienation, law, powerlessness (the parents had no recourse though they fought against what they saw was happening to their child right before their eyes, but to no avail), and more...
Then a sign of hope: in today's paper, there's an article titled "A Guide in the Darkness" about an attorney (yes, an attorney!) who seems to have developed a model for helping families navigate (and negotiate within) the clearly inadequate mental health system in order to offer some reprieve for sufferers--the person and their loved ones. Hers seems to be a somewhat holistic, teamwork-like approach (NOTE: only people who can afford her and her recommendations can benefit; but I wonder if we can learn about "what works" from her model and adopt it to the public sector).
Joe asks us to think about goals--what those might be as we think about this seemingly intractable issue. Facing such a complex topic, I think it's important not to imagine that the whole thing will be "fixed," but that it might be worthwhile to examine what helps (and what are the necessary ingredients for maximizing what helps), and what hurts, harms or hinders.
I do think the conflation between guns, violence and mental illness needs to go. In terms of addressing mental illness issues and in terms of addressing gun violence, I think that conflation gets us nowhere.
In terms of the issue of guns/ assault weapons in the US, I wonder if it might be useful to reframe the discussion altogether. To understand "guns in America" don't we need to more fully understand the social life of these dangerous things? Why are they here? What's the larger social context for their existence? What does their existence have to do with the "military normal," the condition within which now live? Who benefits and who loses by their being here? What are the social relations behind their production, distribution and consumption, and our ideas and ideologies in relation to them? Questions like these take us away from the "neat" nexus of guns/mental illness that seems to be dominating much of the public discourse.
Joe,
What a great class! Lively discussion and I got to learn so much. So, right to it.
When it comes to thinking about what we should do to change the public discourse, especially when it comes to the criminalization of the mentally ill, is to focus on a narrative that strays from the outlets of information that mental health issues get their voice. The news, often times, is extremely biased when it comes to mental health, and whip out quick statistics that are often times wrong or very misleading. For me, the way the narrative can change is through non-conventional means, and that is fiction, literature, and even cinema. We spoke briefly of the movie “Silver Linings Playbook”, and while I do think the movie romanticized mental illness, it did a good job of giving it a positive portrayal as well as not portraying the stereotypical idea of mental illness (akin to the use of terms like “retarded”) that we see in moves like “I am Sam”. Not to say this is problematic, but it cane be used to shift the discourse in a more positive direction.
I also believe that part of this burden falls upon Academics. Those who engage in this research, at least in my view, do to little to reach out to the families and communities that are dealing with mental illness on a daily basis. Who read academic journals and publications on the latest research? First, the access to such information is limited to Universities and Research Institutes, and second, it isn’t “reader friendly”. Researchers needs to have a revolution when it comes to the distribution of knowledge, not only for the people who are affected by mental illness, but by politicians who work and vote on policy initiatives that effect mental illness.
When it comes to dealing with problems and complexities of issues of funding, policy, and resources, it seems that some of the issues are purely games of money and politics. Not to say that certain initiatives haven’t done any good, many have, but there seems to be a lack of clarity in Washington. Furthermore, there is a serious conflict of interest when it comes to the pharmaceutical companies – the profit that comes out of the manufacturing of medicine. Quick thought, has anyone ever tried to start up a manufacturing company that is “not-for-profit”? Wonder how that would work.
I was so excited that Joe was going this week since I see access to mental services as central to the issue of mass incarceration. Expanding prison populations are not just about low level drug arrests but about jail being the “(mental health) treatment of last resort”, as noted by some of the authors we read, especially for the poor and people of color. The article Prof. Waterston mentioned, A guide in the darkness (http://www.nytimes.com/2013/02/10/nyregion/for-families-struggling-with-mental-illness-carolyn-wolf-is-a-guide-in-the-darkness.html?emc=eta1&_r=0), portrays the complications of navigating within the current system and the enormous number of resources it takes to rescue one mentally person from the jaws of the criminal justice system.
So, a chorus: MORE TREATMENT! However, as I thought more thoroughly about the implications of an expanded and empowered psychiatric system, I was ready to go get my own prescription for anti-depressants. My favorite psychiatrist, Harry Stack Sullivan, remarked about 70 years ago that many psychiatrists had “found for themselves a useful function: sheltering society from those whom it had destroyed”. Sullivan was observing that psychiatric “care” might also be a kind of prison. That is still true today. Another article, Successful and schizophrenic (http://www.nytimes.com/2013/01/27/opinion/sunday/schizophrenic-not-stupid.html), takes the psychiatric profession to task for channeling the mentally ill into dead end lives, whether it is through the criminal justice or mental health systems.
It seems that once any promising avenue for reform become bureaucratized and institutionalized, the ability to help people sours. Given this, Nico’s argument in class that we should focus more on community based interventions sounds right. I have no idea, however, what exactly a community based treatment tends to consist of or whether there is empirical evidence of efficacy. Like Nico mentions in the blog, research is spotty. I think one of the problems, and maybe it is insurmountable, is that mental problems do not have the “one size fits all” solution that systems need to develop to work with large numbers of people in our current model. The model stinks.
Hey Joe,
Thanks for a great class!
To begin, I wholeheartedly agree with Minerva’s point that we need to have a closer examination of our current laws, rather than creating new laws and finding new ways to criminalize people who have no committed crimes. I think one of the central issues with mental health laws is that there are no “one size fits all” policy that can be created, but the policy makers don’t realize this. There are so many different layers and extents to different mental illnesses. I believe there is a disconnect between policy makers and the individuals who actually suffer from mental illnesses. The policy makers don’t necessary realize and though their intentions of helping are good, they don’t realize the reality of how the individual is feeling by implementing all these rules and restrictions. As Professor Waterston states, it is important to assess not on what will “fix” the issues, but rather, base it on what helps, what hurts, what harms and what hinders. Instead of focusing on a central goal of “fixing,” we need to take a more holistic look from an outside perspective and consider all the factors, costs and benefits.
I also believe that society does play a role in creating the problem of what the perceived image of an individual with the mental illness and how we react to them. The first creation of this problem is primarily through media, literature and even cinema. This image of the “mentally ill” is created for us even and we hold on to those interpretations without challenging them. In some instances, we do contribute to the pattern of violence because, as Minerva stated, our lack of understanding and stigmatization of these individuals. Because we don’t understand, we make assumptions and create labels.
In addition to the labeling, I believe that to a certain extent, society also forces the individual to believe the stigmas placed upon him/her. Sometimes, society tries to make a problem out of nothing. The first supporting detail is the diagnosis of NOS (Not Otherwise Specified) as a mental illness. I’m not saying that NOS means nothing. However, I believe that sometimes, doctors or society does exaggerate (to some extent) and dramatizes an issue in a way that forces the individual to believe there is something wrong with him/her. The next supporting detail is the story that Andre shared with the class about his brother. It is almost as if doctors WANTED his brother to believe something was wrong with him by constantly imploring the idea into him and forcing him to take such-and-such medication.
When a mentally ill individual commits a crime, there is a lot of attention placed on the individual for their mental illness and having that be the reason for committing… However, what society doesn’t realize is that “we” actually may be part of one of the reasons why they turned to violent (to an extent). Now, this is in no way justifying a mentally ill individual’s actions when they do commit a violent crime on their own will. However, I am just asking to look at this situation from a different perspective for when society does force someone to turn to violence. This is such a complex topic and either way, there will be costs and benefits, what ifs, etc.
I want to start with your last question you posed Joe. It appears that you can advocate for good and change but be misguided in your advocacy. For example, if I am a police officer and I advocate in favor of stop and frisk laws to maintain my job, my reason may be sound but in the broader scheme of things my reason is wrong. This is relevant to the class discussion and readings this past week. Sometimes in the criminal justice system we are told to "settle" with the minute changes being brought forth in the status quo when the truth is there is an economic reason that these short comings are present in the first place. It would make sense if we did not have the funds to change problems such as psychiatric wards or jail cells but the truth is, we do. In the end, the only real solution to these broader issues would be a conscious shift that starts with people with influence (i.e, wealthy people willing to sacrifice what they have for the people at the bottom) and allow the revolutionary sentiment to trickle down. A bottom up approach would be preferable but when thinking of change in our real world, what I propose seems to be the only option...
First and foremost, I would like to thank Joe for setting such a high standard for the semester on Thursday. I would also like to thank the class for sharing some personal struggles they had with family members who had trouble dealing with mental illness. It is always great and helpful to connect stories with societal issues, especially since and Professor Reitz said “The personal is political.”
Since I had little background knowledge on mental illness and the intersection with the criminal justice system, this class was quite helpful. The New York Times articles highlighted a number of powerful proposals for dealing with the mentally ill. Rather than locking individuals with mental illnesses without linking them to treatments, there needs to be a system that identifies mental illness prior to arraignment and a support system to help them cope. Moreover, there needs to be emphasis that these vulnerable populations are protected and not neglected. I am so glad the class had the chance to read Grendel right before Joe’s class. In some ways, Grendel provided an example for what a “bad” guy may look like. More importantly, the experiences and circumstances surrounding his childhood revealed the influence these experiences had shaping his personality and view, correlating some of the same influence a mental illness could have on an individual.
The discussion regarding mental illnesses also brought to light an issue that complicates treatment: civil liberties. On the one hand, there are numerous benefits for individuals to attend hospitalized treatment. Yet, at the same time, admitting individuals involuntary may have negative benefits. For example, the law in Arizona poses a problem for me to agree with or not. What’s makes putting individuals involuntarily in a system right? Unfortunately my experiences limit my imagination and my ability to put myself in the shoes of individuals who experience difficulties with mental illness.
Another point I’d like to raise deals with Professor Waterston’s comment on prescription drugs. The pharmaceutical industry depends on individuals to having certain diseases and illnesses, including mental illnesses. These companies create so many prescriptions drugs, which, in turn, creates dependency. Why is the first thought to get a prescription to deal with any illness or disease? This is particularly important for individuals who have ADD or ADHD and the rise of doctors and medicine created to treat this mental illness. Too often, parents are unaware of the side effects while doctors receive money for prescribing these drugs without alternatives. Natural remedies provide certain cures without the side effects and dependency. There is a show on tonight where Robert Whitetaker will speak about this you can catch it on: http://radioboston.wbur.org/2011/01/19/mental-diagnoses
Thanks, Joe, for the class and the blog -- and particularly the link to the discussion of this issue from a range of experts in the field. While I don't think they represent "multiple perspectives" (there was a surprising if persuasive amount of agreement) those pieces did represent fine examples of concise argumentation. Good models!
I wonder to what extent part of our conflation of crime and mental illness -- particularly in these cases of exceptional and unthinkable violence, such as the mass shootings -- is at heart rhetorical. This is a separate issue from those raised here in the blog discussion: I am convinced by the experts that very little violence to others is done by folks diagnosed with mental illness and that we absolutely need greater understanding and access to treatment. I am thinking more of that moment when you hear about violence and think -- or maybe it is even happening pre-thinking, maybe the rhetorical expression comes first -- that is "crazy." On some level the unthinkable is expressed as a craziness.
Have I lost you? I'm sure you all had a conversation in the wake of the Aurora and/or Newtown incidents -- if you were even able to put the soul-crushing bewilderment into language and not just weep or close your eyes -- where you said "that's crazy,"
"he must be really sick," "nuts." "Crazy" is sort of a placeholder for that which we cannot understand. And once we have placeholders -- forms of expression disconnected from any real thought -- we stop seeking to understand. At that point, we start turning assumptions about culture (for me, the "military normal" that Professor Waterston mentions comes closest to what I think is going on) into assumptions about nature (someone's faulty brain).
And yes, I am still talking about George Orwell.
I am going to start by saying that I agree with the NY Times article you posted because I think we really need to take a closer look at the laws which are already in place, there need to be a tinkering to the laws in place to address the problems we discussed in class. I agree with Minerva that it is way more productive to serve the needs of the community than to persecute the community. I myself also have little background knowledge on mental illness so I’m not too sure what the exact solutions if there even one although I agree there is more that can be done. Based on the article that Joseph provided I agree like Minerva already previously mentioned that much attention has been given though the few individuals who are mentally ill who have committed horrendous crimes such as the sandy hook shooting. However more discussion needs to occur in media on the national stage on how to help the mentally ill. I also agree with Michelle point as well there is a “disconnect between policy makers and the individuals who actually suffer from mental illnesses”. I also agree think Andre has a viable option when it comes to solutions “only real solution to these broader issues would be a conscious shift that starts with people with influence” and use such resources to provide better programs for those in the mental health community.
Thanks for the responses! This is a topic I’m passionate about, so it’s great to hear that you all learned something. More importantly, I’m glad to see the critical thinking employed when considering these issues.
Minerva: Your last point really hit me. It’s a difficult stigma to break. Society has a history of associating characteristics to certain groups, which can then be believed and acted upon by those groups (known as projective identification in psych). Prof Stein has written a great article on this in relation to sex offenders. Talk about Grendling! Michelle, you also speak so clearly to this grendling issue. You bring up again the important point of diagnoses and the notorious “NOS.” Unfortunately, for many programs and also for government benefits and insurance purposes, an individual must have a confirmed psychiatric diagnosis to be eligible. Just from my experience working with these individuals who have been diagnosed, there is usually a pervasive feeling of internalized stigma—fear of who will see these records; how this will affect them in the future; how this will affect employment—which translated into these individuals actually believing the stereotypes purported against them.
Prof Waterston: That article highlights just how much of a maze the mental health care system is. It is sad that the system relies so heavily on mental health professionals—namely social workers, and even lawyers as we see here, to navigate the immense bureaucracy. When I think of goals, I think of the big picture, but there are so many points in-between that need to be addressed, as we’ve talked about. There is no cure-all solution, and discussion and public discourse has to reflect that complexity. It is all about finding the pieces to a puzzle that we don’t quite know what it should exactly look like.
The aptly titled “Crazy…” is a great book on this topic, and our discussion in general, if anyone’s interested: http://www.amazon.com/Crazy-Fathers-Through-Americas-Madness/dp/0425213897/ref=sr_1_1?ie=UTF8&qid=1360682659&sr=8-1&keywords=crazy
Nico: I may be biased here, but I would say that clinical psych researchers are less ivory-towerish than other professions (maybe a strong statement, but hear me out). What I mean is that most (well, the ones I’ve worked with) are actively involved in academia and the community. One Prof who I work with (Prof Yanos) teaches undergrad, grad, and doctoral students, and is also actively involved in several community organizations as a psychologist and researcher for individuals diagnosed with serious mental illness. His research directly reflects (and sometimes involves) the individuals and organizations he works with. Again, this is just my small sample of knowledge and personal experience; it may be different from the sample I’ve worked with. On that note and to your point, we do need more services for low-income communities, in particular. Further, the dissemination of research is always of utmost important. There are too many “reactionary policies” in Washington (i.e. gun laws, mental health, etc.) I too am a proponent for more empirically-guided policy, and this again falls into the theme of really working out the complexities and intricacies of these issues… I would again recommend another short article—this one from a research analyst I work with at Vera: http://www.vera.org/blog/after-tucson-rethinking-mental-illness-and-violence
Her blog post here was posted two years ago after the Tucson shootings, but is still so relevant.
Prof Stein: I think that will always be one of the huge challenges to understanding mental illness. As you know, its idiosyncrasies are better understood on a spectrum, not a “you have it or you don’t” medical model. So much legislation and good intentioned policies can enter sticky areas when defining what “mental illness” actually is. I also really liked Nico’s community focused theory, but how well that would translate into practice is contingent on so many factors. In terms of community-based treatment, the most analogous example I can think of is assertive community treatment (ACT). It’s a multidisciplinary team of professionals who cater specifically to those diagnosed with serious mental illness in the community. These professionals work in the communities and very closely with these individuals. Research on its efficacy has also been pretty promising. http://bi.omh.ny.gov/act/index
Andre: it’s a tough dilemma. Personal and broader societal concerns conflict, and the Warren Buffets and Bill Gates would surely help financially. On this point, I always think to Prof Waterston’s point that we don’t have the funds is a myth. We do have the funds, but they are misappropriated. For me, views on mental illness are also a deeply entrenched cultural view that we need to mend. Finally, I do honestly think small, focused changes can combine to result in effective change. Supportive and competent “big guns” at the top certainly will assist this.
Sally: Your thoughts on civil liberties echo many important points. What is the state’s role here? Can individuals diagnosed with a mental illness refuse treatment competently? Moreover, the very idea of “competency” brings us into a whole ‘nother philosophical dimension of thought. Medication is always a contentious issue, and we got a brief view of this in class—for example: Patient perspective: yeah, the voices/anxiety/depression goes away, but I have XYZ side effect. Doc perspective: but how will you function in society? Do the pros outweigh the cons? Family perspective: you are more under control now/no longer a burden.
Prof Reitz: I think language is huge, so thank you for bringing Mr. Orwell into this discussion. I think that the words we use to describe such incidents can carry unintended, potentially stigmatizing undertones. This again ties into creating a healthier dialogue about mental health and mental illness. The very words we use to describe such concepts should not encompass unpredictable, wary, and fearful emotions. Hence, education and advocacy is definitely one of the “goals” I see here.
In a way, it is disturbing that it takes mass violence like the Newtown tragedy for the public to spare their attention to the issue of mental illness. However, I believe that we still have not learned to address the core issue in the right way and continue to allow political popularity to dictate mental health policies. Public discourses, including media and political debates, tend to exaggerate the danger impose by a small portion of mentally ill and at the same time overlook the bulk of folks are sick in less interesting ways, say mentally ill people who do not threaten others’ safety. It is not say that violence and criminality is not an important segment in the discussion of mental health, but the point is there are other parts to it as well. Maybe before we talk about barring them from purchasing firearms and other lethal weapons, maybe we should also talk about shelter, food, and emotional support. I know that I might seem being a bit too idealistic for saying this, but my interoperation of the movie Silver Linings Playbook makes me appreciate the message it conveys. Some might see it as another Hollywood film that romanticize a serious and challenging social problem, but what I saw in it is an alternative to the unbending mental health system—creative art (dance) therapy, community and family support, self-enrichment (reading), and physical exercise. Although the protagonist’s road to recovery was not free of obstacles, he had to fought his way out of the mental health institution; he wife withdrew her emotional support for him; his formal employer viewed him as nothing other than a dangerous nut case (which is something that most of us are guilty of doing); but the combination of other effective method seem to have overcame these negative impacts. I dare to ask us to imagine, if we shift our attention away from those politically motivated discussion, violence and criminality, to focus on searching for a less institutional and more humanized approach to mental health problem, maybe we will see unexpected positive changes.
Sylvie, I love that you said that we become caught up in the fusion of mental illness and violence, forgetting that most "folks are sick in less interesting ways". Most people with serious mental illnesses struggle quietly to attend school, hold a job, have a romantic relationship. (Probably, Silver Linings Playbook appealed to you because, although the view of mental illness presented was a bit romanticized, it wasn’t sensationalized.)
The same holds true all across the spectrum of social ills. Books about tracking serial killers sell better than books about low level drug busts. Starving toddlers make more compelling commercials than food insecure adolescents. Assault rifles worry us more than handguns even though the latter cause most of the damage.
We have to be vigilant about not getting distracted.
Well said, Prof. Stein! <3
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