Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Pelosi, DePape, and the Politics of Mental Illness
The news has come out that Paul Pelosi’s assailant DePape has admitted it was political. That he admitted he was indeed there to force Nancy to tell the truth. For most of the Twit-punditry, this has meant a spiked football for them. The Right’s narrative is destroyed! The Right encourages violence and they need to pay!
However comma…
I see it more damaging to D’Souza’s narrative, of which I’ve already been skeptical. I don’t want to give this more print than has already been given, but it makes a rather salacious story. There are indeed questions that remain unanswered about the entire progression of events, but this narrative only partially answers any of those questions while raising even more.
More importantly, though, DePape’s confession does nothing to change the idea that he’s most likely suffering from psychosis of some sort, and here’s the thing with people who are psychotic: just about everything they do makes perfect sense to themselves. There’s no recognition that, say, breaking into the Pelosi house and threatening bodily harm to Nancy Pelosi until she admits her malfeasance might actually be downright insane. It makes perfect sense to them. Michael Schellenberger discusses this situation in a bit more detail here:
The media are portraying the suspect in the attack on Nancy Pelosi's husband as a man fundamentally driven by right-wing ideology. But it's obvious to anyone who looks that what drove David DePape to violence was drug-induced paranoid psychosis.https://t.co/qfs5zHokni
— Michael Shellenberger (@ShellenbergerMD) October 29, 2022
I’m speaking with a bit of experience here. We have a family member who’s suffering from serious mental illness. So things like, “I don’t like what this church has done in the past, so I’m going to attempt to burn down this church building” didn’t come off as downright bad decisions to them. They just went ahead and started the process. And that’s just a part of the things they’ve done that most would consider alarming and crazy. There’s nothing in them that says, “Hey, don’t do that — that’s crazy!” And it’s hard to get them help, because as far as they perceive, they are completely rational individuals.
And here’s the other thing: If those who are dangerously mentally ill aren’t properly cared for, the Pelosi situation, our family situation, these things aren’t avoidable. Because the psychosis will just grasp on something as an excuse and just go with it.
There’s a lot more detail on this latter problem in Insane Consequences by D. J. Jaffe, which details just how bad it is for those suffering from serious and dangerous mental illness and how the socio-political situation leaves them (and those who happen to be around them) out on a limb to fend for themselves. The fact that the Democrats jumped on a chance to politicize this against their opponents right out the gate speaks volumes of their character. The fact a lot of Republicans clung to the salacious rumor a day or two afterward also speaks volumes of their character.
I highly recommend this book to understand the politics of mental illness in America and how damaging it is at present.
Meanwhile, there’s a man suffering psychosis who’s shown he’s willing to hurt others and he’s getting little help. There are plenty more like him on the streets with the same potential for violence of some sort and it’s all swept under the rug. And the fact that we can’t make headway to help him, to help our family member, because the system wants to score easy points, angers me the most. And I won’t say more, because I’m honestly about to go into a rather blue-worded rant if I continue.
Published in Politics
Haldol really, really, sucks.
It helped thousands of people. It was a major breakthrough in the field. What was interesting to me about it was that the psychiatrist who wrote about this history said that it helped largely because doctors could learn then from the patients who did respond to it and could actually talk about what they were experiencing. That was a huge move forward.
It didn’t help everyone, however. And the knowledge and breakthroughs didn’t come fast enough to help Sam. I am extremely sorry for She and Sam.
Thank you.
Haldol was a first-generation anti-psychotic. Sam never took Haldol. He was–however–over the course of about 35 years, and during numerous episodes, breaks, and cycles, prescribed several of the second -generation drugs, as well as the only third-generation example to this point, aripiprazole. Sometimes, he was prescribed more than one at a time.
But my point isn’t “what drugs did Sam take?” and, “are the drugs effective?” The drugs can, if they are the right drugs for the symptoms, and if they are titrated properly for the patient, render him–for the time that he takes them, and, to a casual acquaintance–fairly rational and sane. That is, indeed, a relief and a seeming miracle for those who love him. But the insidious nature of very serious mental illness–and I am talking here only about real, very serious, mental illness–is that its sufferers know that the tamped-down, quiet, version of themselves, the one which very often comes along with unpleasant side effects such as–among others and in various degrees–weight gain, brain fog, tardive dyskenisia, and reduced interest in sex, isn’t the real them, and that somewhere inside themselves is the real, creative, spontaneous version of themselves that they’d like to set free again.
Many (perhaps the great majority) of the very seriously mentally ill cannot manage this dichotomy and the struggle inside themselves, and so they go off their meds. Our society allows them to do so. And then, because it is almost impossible to enforce medication compliance, no matter the strenuous efforts of those in the patient’s life who are willing to try every means available, including, sometimes, very expensive and life-altering ones, the cycle begins again.
I think that is the point of the OP–made most explicitly in the last paragraph–that’s been missed in many of the comments. Arguing about whether or not there are enough drugs, and if they are effective to treat the symptoms is merely whistling in the wind if there’s no way to insure that the patients who must take them to function relatively normally are compelled to do so. (And before someone brings up the magic of “long-lasting” injectable antipsychotics, they’re no panacea either, because the situation I’ve described above, the battle inside the patient, is still the controlling factor in his decision to stay on them as well.)
These problems, as you so well describe, exist in every long-term-healthcare situation. Diabetics don’t want to keep up the regimen, cancer patients don’t want to finish the course of radiation or chemotherapy treatments, and dialysis patients stop. Alcoholics continue to drink.
This is the challenge of medicine: the cure has to work for the patient whose motivation wanes.
The patients need to get something in exchange for taking the medicine. That’s what we need to work on.
And we will get there. That much I am sure of.
We do not yet have a good solution for schizophrenia or substance addiction
I hope so. I do think there’s a qualitative difference between the situations you’re describing and what I’m talking about, though. Diabetic patients and cancer patients aren’t (usually) making their decisions to continue or discontinue treatment based on faulty brain-wiring. They may be weak-willed, or they may have decided that the lengths to which they have to go to stay alive are simply cases of the book not being worth the candle. But they’re usually not insane when they make those choices, and whatever those choices are, I should think the likelihood of their leading to violent or criminal behavior are vanishingly small.
Alcoholism is a little closer to the mark, as–while it’s going on–it can mess up the pathways and chemical balances in the brain. My father-in-law, who died with Korsakoff syndrome, was a pretty extreme case. But it is possible to reverse much of the damage of alcoholism by abstaining from what causes it, and to make oneself “better” by simply living a life without it. And that’s why twelve-step programs are so effective–because people come to understand that they feel “better” when they stop drinking, find comfort in the company of others, and face their problems.
There’s a difference between doing that–hard as it is–and embracing a lifetime of drug-dependency which alters your natural state, often in ways you don’t like, and which often makes you feel “worse” while you are taking it. I’m afraid that we are nowhere near to squaring that circle at the moment. Since we can only go to metaphorical war with the metaphorical army that we have, I think we need to figure out a more immediate solution. Or if not a solution, at least an improvement in what we’re currently doing.
Agreed.
But I am very hopeful about the future. Answers will come.
You and I and Bryan have billions of ideas just among the three of us. Multiply that by the families and friends of the thousands of sufferers, and I know there will be breakthroughs.