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  • Trade-Offs

    Posted by Ginny on January 9th, 2011 (All posts by )

    This began as a comment and, given my extremely limited (nonexistent) expertise, it is rambling observations and questions – and if Michael & Madhu say I’ve got it wrong, well, I probably do.

    Mental hospitals dotted the landscape in the 50′s and 60′s. That was another time: some of us got through college pulling night shifts at them. Psychiatric counseling was a rite of passage among the artsy. (Note Girl Interrupted and Emily Fox Gordon’s Mockingbird Years. ) Gordon treats that particular perspective with irony. But such approaches were not always helpful and certainly those public wards filled with the less affluent were sad and lifeless.

    My understanding (Michael? Madhu?) was that a combination of many pressures cleared out those hospitals. The revolution in psychiatric drugs was one. Hospitals were expensive and shutting them down improved state budgets. A strong push from advocates for “patient’s rights” was one “cause” of 60’s empowerment. Making the choices voluntary meant few opted for such treatment. But those hospitals – better than they were decades before – were still awful.

    Then the adults read Freud & we just acted it out. Karl Shapiro taught creative writing in the mid-sixties in Lincoln; on the first class day he held up One Flew Over the Cuckoo’s Nest, telling us the book got it right – he knew about the one on the edge of Lincoln. Actually by then lobotomies were few, but we knew what they were. My own life was too much in shambles to argue – I was working nights at that hospital. And frankly I had no idea what was going on outside my pretty peculiar world at that time. But that book was a force. And as the sixties went on, the potential problems of isolated institutions where some had great power over the quite vulnerable remained. Forman ‘s interpretation is political: his vision was clearly influenced by the Soviet use of psychiatry, but that didn’t mean in the less politicized world of American hospitals excesses didn’t remain.

    The tension between individual & society’s rights are one of the great dilemmas: Should a community limit some because within them percolates a higher than average (if unpredictable) chance they pose harm? In the great dramas justice enters; but justice must involve the act and not the potential. Is stunting many lives because some might damage others fair? We think not. But the dilemma is no less real. We know that in our gut – Oedipus still has power because we understand the scapegoat story, we understand the restoration of order at the conclusion of classic tragedy with the banishment or sacrificial death of a flawed hero is stark. My friend teaches Ursula Le Guin’s “The Ones Who Walk Away from Omelas.” Remarkably responsive and loving, she says, why doesn’t someone scoop up the child and take it away. But it implies the tradeoffs are simpler than they generally are. When we see the slaughter at Safeway we remember that this particular tradeoff is not simple.

    In 2007 a series of posts on the Volokh Conspiracy analyzed incarceration rates, prmpted by Bernard Honcourt’s “An Institutional Effect,”. He notes rates were relatively stable if mental hospital and prison populations were factored together. Stuart Benjamin then did a series of posts. His was not (and could not rationally be) an argument of cause and effect nor that those in prison were really mentally ill. Teaching at a minimum security prison for a while, I felt thrown back on the gray misery of my work forty years earlier. The shiny buffed floors, gray & colorless, spread before quite different people. My anecdotal observation was reinforced: mental hospitals disproportionately held middle-aged white women while prisons house disproportionately ethnic young men. Perhaps it says something about the amount of unpredictability a society can contain (both add to society’s chaos). Or perhaps it says nothing.

    While some paranoids I know seem a bit edgier, they are also married & productive. Few are suicidal or homicidal. Deinstitutionalization may well be worth its costs. Or, perhaps, we could now diagnose more precisely. Or allow assessments prompted more often by others. If many are happier, others lead lives dramatically worse and more abused (as well as more abusive) than they would have in such facilities. And we don’t (can’t) isolate those who are truly (and obviously) homicidal.

    Charging such acts to political discourse distracts from the consequences of policy. I’m not sure failed policy, but if we protected the individual liberty of the deranged less, some would be alive in West Virginia, in Huntsville, Alabama, and in Tucson. But many might be much worse off. It would not be an easy task to total the pluses and minuses, but it might be an honest one.

    Political rhetoric? Well, this particular shooter appears as much loony left as loony right. If the left seems hypocritical in trying to make political gain, that is just what they do. But the truth is such a loon today when political discourse is important to us uses that vocabulary. Rants were often drawn from the Bible. Some use environmental terms & tropes. Loons become obsessed while others merely become interested. Among the Puritans such people killed others or committed suicide, quoting the Bible. But the Bible also pointed a way for many others to love one another. The Columbine massacre appeared to be acted out by teenagers using the rites and costumes of pop culture. It wasn’t that a Puritan ax-murderer like Jonathan Edwards’ uncle nor his other uncle who slit his own throat did so because they were Puritans. Because they were Puritans their fantasies were woven from Puritan tropes and vocabulary.

    Post ScriptL:
    While I was writing this, an e-mail discussion built among my friends. This isn’t surprising. We have been told that several people with significant problems are likely to appear in our classes. (A friend’s husband was getting quite violent threatening notes, but after he flunked the student at the big school he came over to our community college. There the student began to send threatening e-mails to one of my colleagues. The student’s sister is one of my daughter’s friends. They know their son has problems – but, they are also in a foreign country and don’t understand the system. Not that the rest of us do.) Not surprisingly, this is a problem we return to repeatedly at our division meetings and having guest speakers from counseling does little to reassure us. I suspect it is good we can’t arbitrarily throw such a student out, but some are (which one? we ask) ticking bombs. Here are the links my friends have been circulating: New York Times , Washington Post. I have my doubts that the mentally ill are a larger percentage of the student population than in our youth; we did, however, have a good deal fewer rights and a good deal less privacy.

     

    8 Responses to “Trade-Offs”

    1. Savings Bonds Rates Says:

      good article,,,,,,,,,,,,

    2. Jim Bennett Says:

      Clayton Cramer has an interesting article on that point:

      pajamasmedia.com/blog/mental-illness-and-mass-murder/?singlepage=true

      I think it is useful to promote an alternate course of action, as opposed to ineffective gun laws, in the face of these massacres. “Just suck it up” is not a response that people like to hear.

    3. Ginny Says:

      Thanks Jim
      I’ve thought about this often but am never sure how anecdotal my understanding is. Cramer’s writing a book and clearly feels it is an important issue. What strikes me as surprising is that publishers don’t think it has an audience. Surely that is becauwe they haven’t thought about it – or are too young to be able to see the changes that have come in the last fifty years. Ignoring problems doesn’t make them go away. Amd this change has led to less civil (even when not dangerous) exchanges at many retailers, on many street corners, and in many classrooms.

      The choices are not always easy nor always obvious. But we are making them blindly and ineffetively by pretending there is no dilemma. There is. And a civil society is likely to only contain so much chaos. We no longer have the frontier as a pressure valve, for one thing.

    4. sol vason Says:

      The question that is always asked is “Why should we wait for people to commit a crime before we hang them?”

      In Soviet Union and People’s Republic of (fill in name) people are hanged first and no one asks questions later. However, assassinations and terrorism still occur. People still live in terror – although mostly they fear Homeland Security.

      Conservatives argue that no one should be punished for evil thoughts except by God.

      Liberals argued that because there is not God and because there is not Evil, that abnormal thoughts should be punished by Our All Wise and All Seeing (fill in blank with proper title) or one of his agents.

    5. onparkstreet Says:

      Ginny,

      I’m afraid this is a topic of which I know next to nothing. I do wonder if increased urbanization and the polices you mentioned bring such souls into contact with more people and thus more chance of such horrific acts?

      Very sad events. Very sad indeed.

      Prayers for the victims and families.

      - Madhu

    6. Ginny Says:

      Thanks Madhu.

      Certainly “street people” (of whom the majority are mentally ill) are in constant contact with others. And not in very positive ways – either for themselves or others.

      Bennett said we won’t always be willing to “suck it up” – but I’m not sure that is what we are being told. It is more that these become a rallying call for peripheral (and sometimes irrelevant issues). The tragedy is people have died and the truth is that a pretty large percentage of people who do things like this aren’t just disturbed – they are obviously crazy and have been doing and saying much that would indicate they are.

      The logo for the memorial seems in bad taste – partially because it doesn’t say what you did – that this was sad and we need prayers for the victims and families.

    7. Michael Kennedy Says:

      Sorry I didn’t see this earlier. My personal experience was mostly at a VA hospital in west Los Angeles so the patents were all men. I had a summer job (when medical students still got the summer off) to do routine physicals on 200 psychotic men. The psychiatrists didn’t want to do them as it would” contaminate” their relationship with the patients. This was still the era of psychoanalysis. Fortunately, the chief of the service on that ward (It was its own building) was a terrific guy who was chiefly interested in psychosis. He was a full professor at UCLA. His name was George Harrington. His father had been a lay analyst and had moved to Austria to study under Freud. George had sat on Freud’s knee when a child. He said he had become an analyst at age 17 and a summer at the Kansas State Hospital (His father was then at Menninger) convinced him that analysis was useless in psychosis. He told me it was probably some unknown vitamin deficiency. At least he was convinced it was organic. I spent 8 hours a day talking to schizophrenics. It was fascinating but exhausting. At the same time, I was doing physical exams, including rectal exams. I actually found a prostate cancer in one patient. At that time, about 10% of patients who died in mental hospitals were found to have brain tumors. Of course, diagnostic measures were primitive and patients were very stoic and difficult to examine. I found a case of appendicitis on a patient who did not complain of pain but just looked “different: that day.

      I also spent a few days on the locked ward where dangerous patients were housed. One of them was a fascinating man. He had played football at USC and had married Den Acheson’s daughter, a very unusual story as he was black. He became psychotic and, because of threatening behavior, was in the locked ward. I was learning about psychological testing and saw his test. It was very odd but had signs that he might have been playing with the test. The psychologist told me that he wasn’t sure the guy was crazy. There were signs of joking and playing with the psychologist’s mind in the test. It was an eerie situation. This was 1962 and he had been there for years.

    8. Ginny Says:

      Thanks. 10% brain tumors and what’s happened since in terms of diagnosis surely must be a factor in the reduction of those truly needing institutionaizing.