When I was young, mental hospitals sprinkled the countryside. My parents read Freud in hypochondriac mode and neuroses were part of growing up – indeed, nurtured in certain groups (say among drama majors & yes, creative writers). I don’t know what percentage of the population was housed on those wards, but considerably more than today.
Update: Jonathan Kellerman, a man who went through med school as these changes were taking place, describes the arguments for de-institutionalization by doctors & ideologues such as R. D. Laing and Thomas Szasz. That in this case even those of us on this blog, non-experts, could see the problem indicates how extreme are the problems in contemporary treatment. As Kellerman notes
That is not to say that anyone who pens violence-laden poetry or lets slip the occasional hostile remark should be protectively incarcerated. But when the level of threat rises to college freshmen and faculty prophesying accurately, perhaps we should err on the side of public safety rather than protect individual liberty at all costs.
De-institutionalization was the effect of many causes. I’m no expert, but having lived through those years, I know some: better and more specific medications; patients’ rights groups, especially the ACLU, argued decisions (which were sometimes at a family’s or community’s convenience) should rest with the patient; better and more numerous half-way houses; more clinics specifically aimed at drug & alcohol dependency. I suspect more prisons have a mental health wing; in those days some mental hospitals had prison wings. No matter how minimal the psychiatric help and spartan the conditions, these institutions were expensive. They had few defenders & have disappeared across the country. But homeless street waifs and thirty-two dead in Blacksburg may indicate the need, if on a smaller scale, remains; some then housed on those wards are vulnerable – as are those of us living beside them. (Two blogs with repeated posts on the illness of the shooter are neo-neocon’s and Dr. Helen‘s; the latter links to an article on de-institutionalization.)
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Related posts:
Howl & Reality
Imagine Insanity
Again
Its a more fundamental problem than an issue of institutionalization. Mental health, like the rest of the medical industry, is administered and run by people who are overwhelming of a liberal-arts background. The people comprising the field lack the necessary technical background necessary to do the needed research to understand fundamental principles of neuro-chemistry and molecular biology that lie at the basis of mental health problems. Hense, there is very little effort going into understanding basic bio-chemistry of neuro-physiology (if you doubt me, spend time on PUBMED looking up papers on mental health).
This is the basic problem with medicine, in general, in this country and much of the world. Very little of the so-called research is focused on the fundamental bio-chemical principles underlying all biological processes, those that govern all physical and mental health. This is especially true for effective anti-aging research. It is no accident that the most significant proponent of research into understanding and curing the aging process itself is on the part of computer scientists, not medical researchers. Like the development of effective cure for aging, I strongly believe that the solutions to mental illness will also come from innovators outside the medical field itself.
Institutionalization does nothing to solve these problems.
Trying to cure mental illness without a comprehensive understanding of neuro-chemistry and neuro-biology is as stupid as trying to build airliners without a solid understanding of aerodynamics. I work in semiconductor industry. It is impossible to manufacture computer chips without a solid understanding of the chemistry and materials science that is the basic science underlying semiconductor manufacture. Likewise, people cannot be cured of medical problems by “experts” who lack an understand of the fundamental priciples of bio-chemistry and molecular biology that is the basic science underlying biological systems.
The fact that MDs do not understand or use these scientific priciples, nor that these priciples are used by the pharmaceutical companies to develop new therapies, makes it clear as daylight that the entire industry and everyone in it are complete parasites. Both the FDA and the AMA are criminal organizations that should be abolished.
The entire medical field is completely parasitical. Real advances, both in anti-aging medicine as well as mental health, can only come from innovators outside the field.
Several changes drove deinstitutionalization:
During WWII & Korea many conscientious objects did their equivalent service in the mental institutions and came away horrified. Many of these people went on to positions of prominence especially in the northeast. By the 60’s, they were quite ripe for any kind of an alternative. The near eradication of tertiary syphilis significantly changed the composition of the patient population. Advances in neuropharmacology made many patients more manageable with less infrastructure. Pilot programs showed that many patients did better in group homes and similar small scale settings than they did in large institutions.
However, I think politics screwed everything up. Firstly, a counter-reaction against Fascist beliefs drove far to many to the opposite extreme of the Blank Slate (the idea that environment ultimately determines all human behavior). It reached its pinnacle of influence in the 60’s. In the area of mental health, the Blank Slate created the dominate view of the times that environmental causes created all mental illness. Diseases and conditions that today that are recognized as organic in origin such as manic-depression, schizophrenia and autism were blamed on bad environment. (Autism was blamed on “cold” mothers for example) The obvious public policy response to such a view was to treat the mentally ill by normalizing their environment. Proponents argued that the mentally ill just needed talk therapy and resocialization. (This idea died out in the 80’s because (1) it obviously failed and (2) science improved to the point it demonstrate microscopic and functional diseases of the brain.)
Activist judges in the 60’s also changed the traditional definition of legal insanity effectively destroying the states ability to involuntarily commit people. The zeitgeist of the time led them to question if any individual or group had the right to declare someone else insane. The judges instead chose to invest the decision about when and how to treat mental illness in the hands of the mentally ill themselves. Legally, the inmates ARE running the asylum. This judicial fiat led to the uniquely modern problem of having people who are obviously mentally ill to the point of disfunction wandering around unprotected on the street.
Ever since the 60’s we can’t seem to separate public policy and law about mental illness from broader political philosophies. Everybody seems to have an axe to grind and they use the mentally ill as pawns. We need a return to practicality. We need to focus on making the mentally ill functional whenwe can and protecting them when we cannot.
While it will not be an easy goal to achieve, surely Shannon’s last paragraph sums up our society’s goal: practicality. Practicality, as so often, is also the most sensitive approach. This was not true of the 60’s, when, like the Romantics of 150 years before, society tended to valorize rather than marginalize mental problems.
After widespread abuses were exposed in the mental heatlh system, reformers won changes that made it harder to involuntarily treat the mentally ill.
The plan was to shut down large hospitals that functioned mores as prisons than health facilities and replace them with “halfway houses” sprinkled through neighborhoods. The benefits would be greater socialization and less opportunity for abuse, along with lower costs.
But before this grand scheme could take root, Reagan was elected and massive cuts in social programs left no money for “halfway houses.” Thusly, America’s army of homeless was born. The country had always had its hobos, winos and vagrants, but the widespread presence of mentally ill people in public places was little known before the Reagan era.
Funding for halfway houses has yet to be restored to the originally envisioned levels and even if it were, most American communities are now political organized well enough to prevent the establishment of halfway houses in their neighborhoods. If you want to see the heighth of liberal hypocrisy, try building a home for the mentally ill in a high-income liberal neighborhood. You’ll hear ad nauseum: I want to help the homeless/mentally ill, but this is the wrong neighborhood for it.
It’s not clear to me, either, whether most mentally ill are better off institutionalized or not. I’m certain some are and some are not, but government policy is always aimed at a common denominator and that’s an elusive target in the realm of mental health.
Clive Bartley,
This is myth for two reasons: (1) Public funding for treating the mentally ill has always come primarily from state and local governments. (2) Most federal support comes in the form of entitlements such as SSI and medicade that attach to individuals. (3) Reagan didn’t actually succeed in cutting spending on social programs. (4) The mentally ill have been one of the populations that everyone believes deserves the support of the broader society. Finding money for treating the mentally ill has never been a big political problem.
Group homes didn’t fail due to a lack of Federal money. Group homes failed because:(1) The idea didn’t scale. Managing and staffing a half dozen group homes was easy. It turned out that managing and staffing hundreds was not. Working in a group home is far more taxing on the staff than working in an institution, for example and there is less oversight. (2) Group homes need to be in safe neighborhoods away from crime and drugs. That proved much more difficult and far more expensive than the pilot programs suggested.
But by far the biggest factor was (3)Legal changes made it impossible to require all but the immediately dangerous to remain under medical supervision. The vast majority of mentally ill today cannot be legally compelled to take medication or visit therapist. This creates the “yo-yo’s” mentally ill people who are taken into the system, treated until they are minimally functional and then released until they deteriorate to the point that they again pose a danger to themselves or others. Lather. Rinse Repeat
It doesn’t matter if you spend enough to make every mental health facility in the nation as tricked out as Bill Gate’s mansion if you do not have the legal authority to make people comply with the treatment. The same goes for the drug addicts that comprise the vast majority of the “homeless.”
There is some confusion here. My brother was confined to a state mental hospital. At the time, Freud was the big approach to “understanding” insanity. Later, pharmaceuticals became much more available for treating patients–not curing them but making them easier to work with. Later, many patients released to halfway houses where they could have better and more nearly home-like housing, but still have meds available. But many released and took to the streets, not taking available meds and becoming a part of the homeless population. I recall that a doctor told me when I visited the hospital to see my brother than had they had the meds when he had entered rather than later–and after so many shock treatments–he would not have to have been confined as he then was.
It was not “activist judges” but the psychological profession who detailed as to what insanity consisted of. I have seen no evidence that ‘activist judges” dismissed the professionals and decided what to do. As for the rant against the medical profession and FDA et al posted as a comment above: stay away from all doctors and take any pills you want, wherever you can find them, and dismiss out of hand any warnings from professionals since they all seem criminal to you.
A few facts:
The Carter administration wrote and approved the Mental Health Systems Act of 1980. The act limited involuntary commitment and called for establishing Community Mental Health Centers and continued federal government support for such programs. Reagan rescinded the act on August 13, 1981, saying it cost too much and that mental health should be the responsibility of state, not federal, government.
Cuts in funding for mental health services continued throughout the 1980s, with the emphasis being on the provision of services via the private sector. Overall, the number of beds available to the mentally ill in public and private hospitals dropped more than 40 percent between 1970 and 1984 (Reamer, 1989). Most of this decline was due to cuts in public hospitals.
Private hospitals did increase the number of mental health care beds available to take up some of the slack, but not nearly enough.
The privatization of mental health care meant that low-income people had less access, thus the surge in homelessness.
[Last paragraph deleted by admin. FYI, “Clive Bartley” appears to be the same person as “Wes Turner” and “bunkerbuster” and appears to be sliding quickly into his characteristic anti-American trolling mode. I did not delete his comments so far, because they are still germane to the discussion at hand, but any future comments from him will be deleted unless they bring something new and productive to the conversation. JG]
In my town, a mentally ill man attacked an old lady in her home with a knife and cut off her nose. She had the misfortune to live near a halfway house.
Prisons have become insane asylums and their staff and buildings are not suited to it.
We should rebuild our mental institutions and give decent care to the insane. They should not be walking around loose, a danger to themselves and the public.
Clive Bartley,
You little story would hold more water if the homeless problem had not begun sometime around 1975. Time ran its first cover story on homelessness (IIRC) sometime in 1977. If public spending decisions drive homelessness, how could we have a homeless problem after nearly 10 years of unprecedented increases in public spending? Even if you wanted to blame the problems post-1982 on Reagan, how do you explain the fact that their were far more homeless of all kinds in 1980 than in 1960 even though social spending across the board increased during the era?
Why do we have a much larger homeless problem today than we did 50 years ago even though we are a much richer society with a much larger welfare state? Even more telling, how to millions of illegal immigrants move into this country without education, skills or even knowing the language and yet manage to keep themselves off the street.
The real explanation for homelessness is that people remain persistently homeless not due to a lack of resources but due to individual dysfunction caused primarily by drug addiction or mental illness. These dysfunctional people cannot keep a roof over their heads even if they are given everything they need. They cannot self-manage.
Traditional law recognized that and required individuals to either maintain at least a minimal household or go to jail(for drug addicts) or the hospital (for the mentally ill). Legal and conceptual changes in the late-60’s and early-70’s changed that standard and the “homeless” problem was born.
The Left has ruthless exploited a problem that they themselves helped to create. They have frustrated every attempt to address the homeless problem with practical and empirical methods and instead tried to exploit the suffering of the homeless to justify their vote buying scheme du jour. I have come to think that they actually like having the homeless around because they let Leftist feel morally superior. They get to chastise the rest of society for being so cruel while all the time proclaiming that if they were in charge they would fix everything.
Its pathetic.
Note: updated link to Jonathan Kellerman’s Bedlam Revisited in WSJ. I wish Shannon were being too cynical, but Kellerman’s argument reinforces it. Of course, I can’t imagine states weren’t happy to close down some of those hospitals, which were expensive as well as increasingly vulnerable to law suits (some deserved, some brought on by the crack-pot ideas Kellerman describes). Â