In reading Ginny’s post below as well as the posts and comments of the sites she links to, I note a strong presumption among most that in the case of mental illness we should err on the side of under-treating rather than risk over-treating someone. Dr. Jonathan Kellerman makes this observation:
Talk to anyone who’s tried to commit a dangerously violent child or parent for even a few days: A stranger with a law degree will show up at the hearing and paint you as a fascist. So it’s far too much to expect anything resembling a decisive approach to those whose level of threat remains at the verbal level.
The presumption of minimal or no treatment doesn’t exist in the rest of medicine. We expect that if our wishes are not otherwise known medical professionals will do all in their power to treat us. Yet in the case of mental illness, we all seem to imagine that we would rather not be treated than to receive treatment we do not at the time think we need.
Why the difference? I think the major reason is quite simple: Most of us simply cannot image that we will even go truly insane.
We can easily imagine that we might suffer from accident or disease of the body and be rendered unconscious or incoherent, so we support a public policy creating a presumption of treatment but we cannot really imagine that we might develop a severe disease of the mind that would have the same effect.
In part, this is a reasonable assumption. Today, if a person makes it to 25 without developing a severe organic mental illness, chances are they never will. They might get some kind of dementia very late in life but otherwise not. For the age group that creates and implements public policy, the chances they will go crazy or even know a peer who does so is very,very low.
Neither do we give a lot of thought to the risk that one of our children will develop a serious organic mental illness. Perhaps the prospect is just too damned frightening. Few people today know someone who is institutionalized. Due to the stigma of mental illness, many do not inform even close family of the true extent of a loved one’s illness. Most of us will spend out lives without directly experiencing the reality of severe mental illness.
Few artistic works realistically portray mental illness. This leaves us with little but our imaginations to inform us about mental illness. I think we find it much easier to imagine ourselves being wrongly or maliciously diagnosed as mentally ill than we do to image that we might really need treatment but be so impaired that we do not realize it. When we sit down to make public policy, we unconsciously start from the presumption that a mental health misdiagnosis is more likely to be wrong than to be right, because we generalize from our own ego-experience. We imagine that we would prefer to remain untreated than risk being over-treated or mistreated.
Sadly, severe mental illness tends to strike first in the age range of 18-24 years of age. It strikes young adults who have just left their parents’ oversight but have not yet established their own mature support networks or resources. Unsupported, they can degenerate with frightening rapidity. Yet, our current legal system presupposes that they can make decisions of such difficulty as to challenge the mentally fit and more mature. We do this, I think, because we intuitively believe that we ourselves could make good decisions in the same circumstances.
Well, you could not and would not have. The person standing mumbling on the street corner is proof of that.
Howl & Reality
One of Those Things We Forget About the 50’s & 60’s