I have been asleep at the switch on the story of Linda Bishop, who was a patient at my hospital in the 2000’s, refusing treatment and eventually being discharged, after which she moved into an abandoned farmhouse and eventually starved to death. It was written up well in the New Yorker in 2011 and I recalled reading that. Since that time it was made into an award-winning documentary in 2016, “God Knows Where I Am,” which I had not known about. I’m not sure how I missed that. Asleep at the switch, apparently. I knew nothing about the case at the time, but her entire treatment team were all people known to me. I worked that unit at other times. I think they are all gone from the hospital by now. The discussions they had are ones I have had repeatedly through the years as well. A person is psychotic, but displays no measurable dangerousness. In the protected environment of the hospital they are able to eat, stay clean, and clothe themselves. They go to a cooking group, make food, and answer a nutritionist’s questions intelligently. Whatever we suspect, we are hard pressed to offer much evidence they won’t be able to care for themselves. We might apply for a guardianship, but the standard for proving that a person is unable to make decisions on their own behalf is high. It is not enough to demonstrate they make bad decisions. Half the state of NH makes bad decisions but we don’t lock them up and get them a guardian. The bar is high because we want it to be high.
Her story is poignant, and provoking, but all the commentary in all such stories seems to say the same ridiculous things over and over. She fell through the cracks of the mental health system. No she didn’t. The story/film calls into question a system where a person who doesn’t believe they are sick can make decisions for themselves. No it doesn’t, not really, neither the legal nor the mental health system. The hospital refused to notify the family because of HIPAA laws. What’s this word “refused” in there? Do we say that the sheriff “refused” to tear down a building because of zoning laws? As in my post three years ago about the word “systemic,” we use that word system as an evasion. Systemic racism means we can’t actually define what we’re talking about, but we want bad things to stop happening so we start kicking the machine in random places. Someone will pay, dammit!
Tangent: When it’s New Hampshire, people from other places always have to work in the “Live Free Or Die” angle too. NH actually has more protective (and intrusive) mental health laws than nearly all other states. Try to get someone committed to a hospital in Vermont or Massachusetts sometime. The magazine writer and the filmmaker are from New York City, where you actually can die on the street without many people noticing. But it’s fun to pretend it’s one of those backward other states instead.
So…You are fifty years old. If you get admitted to a hospital do you want your mother notified without your permission? Your sister? We have privacy laws for a reason, and when we pass them we generally intuit the plusses and minuses pretty clearly. This is also true of laws committing someone to a hospital against their will, or appointing a guardian over their decisions. We set a bar that must be reached before we take rights away from people. These are not made in ignorance of what will result. Changing mental health law even a little bit is very difficult, I can assure you. The idea that all these problems are new, and no one really ever thought about them before, but now this new story comes up to awaken us to the idea that OMG, something might go wrong here, and maybe this will inspire people to action so that she didn’t have to die in vain…it’s all hogwash. This story came to the fore because she was white, well-educated, a mother, gentle, had an artistic streak, chose an environment that had some elements of beauty (Farmhouse! Orchard! Brook!) and wrote things in a diary expecting a lover to rescue her, a very old-fashioned attitude like women in books. People who are less white and educated, with less romanticism or in uglier places have this happen all the time. It’s not some failure of any system. It’s exactly what we thought it was when we passed those laws. We just want to have things both ways, that’s all.
I rail against arguing from anecdote. That’s all this is. It just happens to be an anecdote that hits closer to home, and told particularly well. Sad for the family. Sad for lots of families. If you want to change commitment or guardianship laws, go for it.