Deinstitutionalization

 

Starting in the 1960s and ’70s, roughly, there was a movement in America to empty mental institutions. There were a number of reasons for this. The practice of psychiatry was somewhat primitive, indeed barbaric, what with electroconvulsive treatments and lobotomies, and forcible sedation of inmates with potent drugs. Further, there was growing confidence (not always well grounded) in the ability of “Science” to provide better medications for mental illness, that would allow individuals hospitalized to return to the community to live.

There were costs to consider. Asylums were defunded, forcing their residents out of the institutions and into the community, often onto the streets. A number of events were contributory, not least Ken Kesey’s 1962 book, and the movie based on it, “One Flew Over the Cuckoo’s Nest,” and perhaps to a lesser extent, Foucault’s 1961 book “Madness and Civilization” that traced the approach to mental illness from Medieval times through the Enlightenment, from a time when the mentally ill roamed free (shipped about on “ships of fools” from town to town), to the time of establishment of asylums for control and management of the insane. Leftists in the last century argued for greater autonomy and freedom for the mentally ill. The right to refuse treatment for mental illness became a particular issue in the reform of psychiatric treatment and was enshrined in law.

Despite the development of a wide variety of psychotropic medications, and their very wide use, we have wound up, over the course of half a century, with a rather remarkable breakdown of society, with homelessness of individuals with mental illness and drug addiction crowding our cities. Attempts to provide housing and care for these individuals have been largely unsuccessful. The ethos of individual autonomy remains intact for these individuals, with other residents of cities now forced to tolerate the presence of the homeless and mentally ill on city streets. Accompanying crime reaches even into the homes of the elites, such as that of Nancy and Paul Pelosi.

Despite the intractability and severity of the problems of mental illness, homelessness, drug addiction, and crime, leftists seem to want to apply a similar approach to another realm of society, and that is to those committing crimes. Police departments are defunded, crime is redefined (or rather defined out of existence),  prisons are criticized, and inmates are increasingly released into the community. Criminals are viewed as needing greater autonomy, it seems.

Perhaps we will arrive at a point where we are told that the Ludovico cure always works. Perhaps we will arrive at a point in which incarceration can be refused, just as mental health treatment can be refused. Individual autonomy for the criminal, for the insane, certainly for the criminally insane. The John Hinkleys of the world need freedom. Never mind societal order or individual safety for those not afflicted with mental illness, nor displaying criminal behavior. They can fend for themselves.

The Utopian Vision of our Anointed seems to be a hellish dystopia. Perhaps we will reach a reverse King of Hearts moment. Who knows where madness lies?

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  1. Jim McConnell Member
    Jim McConnell
    @JimMcConnell

    Yes, at the time, I thought it was somewhat barbaric. The “do-gooders” wanted to de-institutionalize those poor mentally ill persons. What they did was dump them out onto the street when they had no way of coping on their own. 

    • #1
  2. kedavis Coolidge
    kedavis
    @kedavis

    Jim McConnell (View Comment):

    Yes, at the time, I thought it was somewhat barbaric. The “do-gooders” wanted to de-institutionalize those poor mentally ill persons. What they did was dump them out onto the street when they had no way of coping on their own.

    But at least they had their “dignity” back.

    • #2
  3. Sandy Member
    Sandy
    @Sandy

    As the dystopia approaches the state of the war of all against all, complete control from on high will look not only good but essential.  Problem solved.

     

    • #3
  4. Dunstaple Coolidge
    Dunstaple
    @Dunstaple

    Good post, but I have one quibble. 

    Electroconvulsive therapy (ECT) may seem barbaric (especially the way it was practiced back in the day; without anesthesia and paralyzing agents) but it is the single most effective known therapy for a number of debilitating mental disorders. People whose lives have been absolutely devastated by refractory depression are freed from that burden within a couple of weeks. And the side effects really are minimal, for almost all patients. I’m a big believer.

    Just as an aside: recent studies using ketamine and other dissassociating agents suggest they may work as well on depression as ECT, when utilized properly. And also with minimal side effects.

    kedavis (View Comment):

    Jim McConnell (View Comment):

    Yes, at the time, I thought it was somewhat barbaric. The “do-gooders” wanted to de-institutionalize those poor mentally ill persons. What they did was dump them out onto the street when they had no way of coping on their own.

    But at least they had their “dignity” back.

    Your sarcasm is warranted. Is there anyone with less dignity than a homeless schizophrenic (oh excuse me, “person struggling with schizophrenia and a lack of reliable housing”) raving on the street corner?

    • #4
  5. Flicker Coolidge
    Flicker
    @Flicker

    Sandy (View Comment):

    As the dystopia approaches the state of the war of all against all, complete control from on high will look not only good but essential. Problem solved.

    That is the goal being worked toward, isn’t it?

    • #5
  6. kedavis Coolidge
    kedavis
    @kedavis

    Dunstaple (View Comment):

    Good post, but I have one quibble.

    Electroconvulsive therapy (ECT) may seem barbaric (especially the way it was practiced back in the day; without anesthesia and paralyzing agents) but it is the single most effective known therapy for a number of debilitating mental disorders. People whose lives have been absolutely devastated by refractory depression are freed from that burden within a couple of weeks. And the side effects really are minimal, for almost all patients. I’m a big believer.

    Just as an aside: recent studies using ketamine and other dissassociating agents suggest they may work as well on depression as ECT, when utilized properly. And also with minimal side effects.

    kedavis (View Comment):

    Jim McConnell (View Comment):

    Yes, at the time, I thought it was somewhat barbaric. The “do-gooders” wanted to de-institutionalize those poor mentally ill persons. What they did was dump them out onto the street when they had no way of coping on their own.

    But at least they had their “dignity” back.

    Your sarcasm is warranted. Is there anyone with less dignity than a homeless schizophrenic (oh excuse me, “person struggling with schizophrenia and a lack of reliable housing”) raving on the street corner?

    Aren’t we supposed to say “neurodivergent” now, or something?

    • #6
  7. Flicker Coolidge
    Flicker
    @Flicker

    kedavis (View Comment):

    Dunstaple (View Comment):

    Good post, but I have one quibble.

    Electroconvulsive therapy (ECT) may seem barbaric (especially the way it was practiced back in the day; without anesthesia and paralyzing agents) but it is the single most effective known therapy for a number of debilitating mental disorders. People whose lives have been absolutely devastated by refractory depression are freed from that burden within a couple of weeks. And the side effects really are minimal, for almost all patients. I’m a big believer.

    Just as an aside: recent studies using ketamine and other dissassociating agents suggest they may work as well on depression as ECT, when utilized properly. And also with minimal side effects.

    kedavis (View Comment):

    Jim McConnell (View Comment):

    Yes, at the time, I thought it was somewhat barbaric. The “do-gooders” wanted to de-institutionalize those poor mentally ill persons. What they did was dump them out onto the street when they had no way of coping on their own.

    But at least they had their “dignity” back.

    Your sarcasm is warranted. Is there anyone with less dignity than a homeless schizophrenic (oh excuse me, “person struggling with schizophrenia and a lack of reliable housing”) raving on the street corner?

    Aren’t we supposed to say “neurodivergent” now, or something?

    Neurodivergent is a new word that I haven’t paid attention to.  Neuro- means the physical, the brain and nerves, not the mind; though the two overlap, they are two different things.  And divergent means, from what I can tell, simply abnormal.  Neurodivergent is a word intended to frame a mental abnormality as “normal” and neurophysiological, isn’t it?

    • #7
  8. Tex929rr Coolidge
    Tex929rr
    @Tex929rr

    Working in emergency services I know how much time police and EMS spend dealing with the mentally ill, but your post got me to thinking.  In a county of about 50,000 people we have two full time mental health deputies and one full time officer in the police department of the only incorporated city. (They are all sworn officers).   All the other deputies and police officers receive extensive training on dealing with mental health issues.  It’s been a very successful program, but think about those numbers.  Those services previously provided in institutional settings are now outpatient care (and sometime inpatient care) courtesy of law enforcement.  I was talking to the sheriff a while back about health care in the jail (I teach CPR to the jail staff).  We typically have at least one pregnant inmate at any time.  They generally get more prenatal care than they were getting  in the outside.  Sometimes being in jail is the only reason they get any prenatal care at all. So a non-trivial portion of health care is now provided by one institution to which progressives are implacably and uniformly opposed. 

    • #8
  9. DonG (CAGW is a Scam) Coolidge
    DonG (CAGW is a Scam)
    @DonG

    I am a gadget guy.   I would like to see widespread use of implanted drug delivery devices for people that have proven themselves unable to stay on medications.  I don’t mean a fancy insulin pump, something like Norplant ($400) but for anti-schizophrenia.  There needs to be solutions between institutionalization and roaming the streets.

    Speaking of roaming the streets, Schellenberger says the newest meth formulation causes schizophrenia.  Gone are the days of the functional meth addict.   Another reason to bomb the drug cartels.

    • #9
  10. GrannyDude Member
    GrannyDude
    @GrannyDude

    Dunstaple (View Comment):
    Electroconvulsive therapy (ECT) may seem barbaric (especially the way it was practiced back in the day; without anesthesia and paralyzing agents) but it is the single most effective known therapy for a number of debilitating mental disorders. People whose lives have been absolutely devastated by refractory depression are freed from that burden within a couple of weeks. And the side effects really are minimal, for almost all patients. I’m a big believer.

    I agree—in fact, I read (somewhere) that but for its negative associations (thanks, Ken Kersey!) it would and should be the first rather than last resort for treating severe depression,  in particular for pregnant women and the elderly because the side-effects are negligible.  

    • #10
  11. GrannyDude Member
    GrannyDude
    @GrannyDude

    Tex929rr (View Comment):

    Working in emergency services I know how much time police and EMS spend dealing with the mentally ill, but your post got me to thinking. In a county of about 50,000 people we have two full time mental health deputies and one full time officer in the police department of the only incorporated city. (They are all sworn officers). All the other deputies and police officers receive extensive training on dealing with mental health issues. It’s been a very successful program, but think about those numbers. Those services previously provided in institutional settings are now outpatient care (and sometime inpatient care) courtesy of law enforcement. I was talking to the sheriff a while back about health care in the jail (I teach CPR to the jail staff). We typically have at least one pregnant inmate at any time. They generally get more prenatal care than they were getting in the outside. Sometimes being in jail is the only reason they get any prenatal care at all. So a non-trivial portion of health care is now provided by one institution to which progressives are implacably and uniformly opposed.

    Exactly. We’re institutionalizing mentally-ill people, just not in actual mental hospitals. And, unfortunately, the mentally ill (and/or pregnant) have to commit a crime before they can have the benefits of institutionalization. Which do exist—rich people “institutionalize” their acutely mentally-ill or drug addicted children: They pay for in-patient treatment programs because these work. Hunter Biden being the obvious, though not most positive, example.

    • #11
  12. MarciN Member
    MarciN
    @MarciN

    I always wonder about what people envision for mentally ill people had deinstitutionalization not occurred. All it did was close down old decrepit buildings. That the states never replaced them with decent assisted-living housing is on the states, not on the courts who ordered these decayed buildings closed. It was a good movement. We closed a lot of bad institutions–those for severely disabled children as well. That was followed by the inclusion movement in schools–the “mainstreaming” of children with disabilities so they could have a normal home-based childhood. And the closing of a lot of bad nursing homes so the elderly could live at home.

    These institutions had become local closets where towns and cities had put anyone who didn’t fit in. When Massachusetts surveyed the populations of their institutions, they found many people who didn’t belong there. When relatives can put someone “away” who bothers them, all kinds of horrible things can happen.

    This is a local issue, like police, fire, and education. How a city or town cares for its poor and vulnerable is up to them. A good friend of mine works in city government in Vermont, and he is making great progress in developing housing options for mentally ill and destitute residents.

    There are lots of humane and constructive actions that can be taken to address these growing problems.

    • #12
  13. GLDIII Purveyor of Splendid Malpropisms Reagan
    GLDIII Purveyor of Splendid Malpropisms
    @GLDIII

    You mention the power of a movie to help push the cultural zeitgeist, and how bad the resultant effects are on society. My mind wonders how we would be if the movie The China Syndrome had not come on the heels of the Three Mile Island power plant incident, where we would be with respect to our national energy grid. (I’m looking at you California and Texas, the two largest grids after the combined Middle and NE sections of the country).

    It will be something I keep in mind as I freeze my butt off in my blacked out home along with no any more propane gas access in the coming years…

    All in the name of some hyped up mass cult delusion of global climate warming change.

    • #13
  14. Paul Stinchfield Member
    Paul Stinchfield
    @PaulStinchfield

    GrannyDude (View Comment):
    And, unfortunately, the mentally ill (and/or pregnant) have to commit a crime before they can have the benefits of institutionalization.

    Generally, they don’t get institutionalized until they have committed multiple serious crimes. There was a recent case of a former child soldier, diagnosed as schizophrenic, with multiple prior crimes of violence, who is only being institutionalized now because he finally killed someone.

    • #14
  15. Nanocelt TheContrarian Member
    Nanocelt TheContrarian
    @NanoceltTheContrarian

    GrannyDude (View Comment):

    Tex929rr (View Comment):

    Working in emergency services I know how much time police and EMS spend dealing with the mentally ill, but your post got me to thinking. In a county of about 50,000 people we have two full time mental health deputies and one full time officer in the police department of the only incorporated city. (They are all sworn officers). All the other deputies and police officers receive extensive training on dealing with mental health issues. It’s been a very successful program, but think about those numbers. Those services previously provided in institutional settings are now outpatient care (and sometime inpatient care) courtesy of law enforcement. I was talking to the sheriff a while back about health care in the jail (I teach CPR to the jail staff). We typically have at least one pregnant inmate at any time. They generally get more prenatal care than they were getting in the outside. Sometimes being in jail is the only reason they get any prenatal care at all. So a non-trivial portion of health care is now provided by one institution to which progressives are implacably and uniformly opposed.

    Exactly. We’re institutionalizing mentally-ill people, just not in actual mental hospitals. And, unfortunately, the mentally ill (and/or pregnant) have to commit a crime before they can have the benefits of institutionalization. Which do exist—rich people “institutionalize” their acutely mentally-ill or drug addicted children: They pay for in-patient treatment programs because these work. Hunter Biden being the obvious, though not most positive, example.

    I am told, though I can’t confirm, that women on Medicaid in California, who get pregnant to get a larger welfare check, will commit a petty crime to get jailed, as they get better prenatal care in jail than under Medicaid out of jail (that was in the past–maybe that doesn’t work any longer). When they deliver, they are strongly encouraged to have tubal ligation, which most refuse in order to have another child if and when they need another government check for childcare. And that California has actually continued to sterilize such women without their consent or knowledge (Buck v Bell remains in force, at least at a national if not state level, permitting forced Eugenic sterilization) if they deliver via C section. We have created a strange society. 

    • #15
  16. kedavis Coolidge
    kedavis
    @kedavis

    MarciN (View Comment):

    I always wonder about what people envision for mentally ill people had deinstitutionalization not occurred. All it did was close down old decrepit buildings. That the states never replaced them with decent assisted-living housing is on the states, not on the courts who ordered these decayed buildings closed. It was a good movement. We closed a lot of bad institutions–those for severely disabled children as well. That was followed by the inclusion movement in schools–the “mainstreaming” of children with disabilities so they could have a normal home-based childhood. And the closing of a lot of bad nursing homes so the elderly could live at home.

    Not could.  Had to.  Or somewhere else, anyway.  Is there evidence that the elderly who had decent children etc, weren’t already being taken care of at home, usually?  Did they have to be FORCED to, because there was no other option?

    I’m thinking that people who didn’t want anything to do with their parents, for whatever reason, probably didn’t have them come into their homes just because the bad nursing homes were closed by the government.

     

    • #16
  17. CarolJoy, Not So Easy To Kill Coolidge
    CarolJoy, Not So Easy To Kill
    @CarolJoy

    kedavis (View Comment):

    MarciN (View Comment):

    I always wonder about what people envision for mentally ill people had deinstitutionalization not occurred. All it did was close down old decrepit buildings. That the states never replaced them with decent assisted-living housing is on the states, not on the courts who ordered these decayed buildings closed. It was a good movement. We closed a lot of bad institutions–those for severely disabled children as well. That was followed by the inclusion movement in schools–the “mainstreaming” of children with disabilities so they could have a normal home-based childhood. And the closing of a lot of bad nursing homes so the elderly could live at home.

    Not could. Had to. Or somewhere else, anyway. Is there evidence that the elderly who had decent children etc, weren’t already being taken care of at home, usually? Did they have to be FORCED to, because there was no other option?

    I’m thinking that people who didn’t want anything to do with their parents, for whatever reason, probably didn’t have them come into their homes just because the bad nursing homes were closed by the government.

    Many elderly outlive the relatives.

    I had a 102 year old client, living in a private home with 4 other elderly women. Very capable even at that age. A taxi came and picked her up once a week, to drive her over to do shopping at a major shopping mall.

    Once in a while I was assigned to go with her, but on days I wasn’t around, she often went on her own.

    After commenting on what a delight she was, I expressed my sorrow that none of her relatives visited.

    “They are all with God now honey. My husband of course. But my 2 kids and the 3 grandsons as well.”

    She was one of the lucky ones, as the pension her spouse left her had provided for payments to this assisted living style home.

    Many women outlive their provisions for the future. When a woman is fifty, being told by a financial adviser that “This program you have chosen will keep you going should you live to be 95” sounds like a godsend.

    But that is true only if you die before turning 96.

     

    • #17
  18. Washington Square Member
    Washington Square
    @WashingtonSquare

    When the day comes that “wrong think” is defined as criminal, then all of us wrong thinkers will be institutionalized.

    • #18
  19. Paul Stinchfield Member
    Paul Stinchfield
    @PaulStinchfield

    kedavis (View Comment):

    MarciN (View Comment):

    I always wonder about what people envision for mentally ill people had deinstitutionalization not occurred. All it did was close down old decrepit buildings. That the states never replaced them with decent assisted-living housing is on the states, not on the courts who ordered these decayed buildings closed. It was a good movement. We closed a lot of bad institutions–those for severely disabled children as well. That was followed by the inclusion movement in schools–the “mainstreaming” of children with disabilities so they could have a normal home-based childhood. And the closing of a lot of bad nursing homes so the elderly could live at home.

    Not could. Had to. Or somewhere else, anyway. Is there evidence that the elderly who had decent children etc, weren’t already being taken care of at home, usually? Did they have to be FORCED to, because there was no other option?

    I’m thinking that people who didn’t want anything to do with their parents, for whatever reason, probably didn’t have them come into their homes just because the bad nursing homes were closed by the government.

    Another occasional possibility: the kids scatter across the country pursuing careers, and the parents, when they begin to have trouble caring for themselves, resist moving away from the neighborhoods where they lived their whole lives. I’ve seen evidence of that a few times.

    • #19
  20. kedavis Coolidge
    kedavis
    @kedavis

    Paul Stinchfield (View Comment):

    kedavis (View Comment):

    MarciN (View Comment):

    I always wonder about what people envision for mentally ill people had deinstitutionalization not occurred. All it did was close down old decrepit buildings. That the states never replaced them with decent assisted-living housing is on the states, not on the courts who ordered these decayed buildings closed. It was a good movement. We closed a lot of bad institutions–those for severely disabled children as well. That was followed by the inclusion movement in schools–the “mainstreaming” of children with disabilities so they could have a normal home-based childhood. And the closing of a lot of bad nursing homes so the elderly could live at home.

    Not could. Had to. Or somewhere else, anyway. Is there evidence that the elderly who had decent children etc, weren’t already being taken care of at home, usually? Did they have to be FORCED to, because there was no other option?

    I’m thinking that people who didn’t want anything to do with their parents, for whatever reason, probably didn’t have them come into their homes just because the bad nursing homes were closed by the government.

    Another occasional possibility: the kids scatter across the country pursuing careers, and the parents, when they begin to have trouble caring for themselves, resist moving away from the neighborhoods where they lived their whole lives. I’ve seen evidence of that a few times.

    That can happen, but considering the likelihood that most or all of the people the parents remember have also left the neighborhood, what is there to really keep them there?  Nostalgia doesn’t really seem like enough.

    • #20
  21. Nanocelt TheContrarian Member
    Nanocelt TheContrarian
    @NanoceltTheContrarian

    Tex929rr (View Comment):

    Working in emergency services I know how much time police and EMS spend dealing with the mentally ill, but your post got me to thinking. In a county of about 50,000 people we have two full time mental health deputies and one full time officer in the police department of the only incorporated city. (They are all sworn officers). All the other deputies and police officers receive extensive training on dealing with mental health issues. It’s been a very successful program, but think about those numbers. Those services previously provided in institutional settings are now outpatient care (and sometime inpatient care) courtesy of law enforcement. I was talking to the sheriff a while back about health care in the jail (I teach CPR to the jail staff). We typically have at least one pregnant inmate at any time. They generally get more prenatal care than they were getting in the outside. Sometimes being in jail is the only reason they get any prenatal care at all. So a non-trivial portion of health care is now provided by one institution to which progressives are implacably and uniformly opposed.

    Very interesting perspective. Thank you.

     

    • #21
  22. davenr321 Coolidge
    davenr321
    @davenr321

    The problem with Ludovico is that those treated had difficult holding jobs and functioning in general; anything requiring the most remote hint of aggression or violence (like reading Old Testament stories) would send them into suicidal disparities, creating a cycle of permanent dependence. Choice, choice…

    my theory, developed and published 30 years ago or so, is that liberal Democrats who were duped into letting dangerous, mentally-ill persons into the populace in the name of dignity or civil rights – fell into the communist’s plan regarding chaos in the streets. Combined with do-nothing, care-less Republicans who “realized” these public facilities cost money… so they’re in agreement that we close ‘em and here we are. Same thing happened to the public schools. Even some police departments.

    I want the garbage picked up, and I don’t want crazy people on the public streets. It probably would cost less to do it right than lots of things our taxes otherwise go to. 

     

     

    • #22
  23. Jerry Giordano (Arizona Patriot) Member
    Jerry Giordano (Arizona Patriot)
    @ArizonaPatriot

    It seems to me that the argument about mental institutions being “barbaric” is pretty much the same argument applied to defunding the police.

    From my point of view, the fundamental problem is a failure to face reality.  There are people who behave dreadfully, sometimes in a criminal way, sometimes in the sort of antisocial way that we now call “mental illness.”  There’s no easy and gentle way to deal with them.  So, practical solutions are harsh.

    Many people seem unable to accept this.  They can always believe, in the face of experience and evidence, that gentle ways will solve the problems.

    • #23
  24. Idahoklahoman Member
    Idahoklahoman
    @Idahoklahoman

    Jerry Giordano (Arizona Patrio… (View Comment):

    It seems to me that the argument about mental institutions being “barbaric” is pretty much the same argument applied to defunding the police.

    From my point of view, the fundamental problem is a failure to face reality. There are people who behave dreadfully, sometimes in a criminal way, sometimes in the sort of antisocial way that we now call “mental illness.” There’s no easy and gentle way to deal with them. So, practical solutions are harsh.

    Many people seem unable to accept this. They can always believe, in the face of experience and evidence, that gentle ways will solve the problems.

    Right. And if you think it’s harsh now, wait until we defund the police departments and leave it all up to private citizens. People forget that we created laws and courts and police as much to protect criminals as to protect their victims.

    • #24
  25. kedavis Coolidge
    kedavis
    @kedavis

    Idahoklahoman (View Comment):

    Jerry Giordano (Arizona Patrio… (View Comment):

    It seems to me that the argument about mental institutions being “barbaric” is pretty much the same argument applied to defunding the police.

    From my point of view, the fundamental problem is a failure to face reality. There are people who behave dreadfully, sometimes in a criminal way, sometimes in the sort of antisocial way that we now call “mental illness.” There’s no easy and gentle way to deal with them. So, practical solutions are harsh.

    Many people seem unable to accept this. They can always believe, in the face of experience and evidence, that gentle ways will solve the problems.

    Right. And if you think it’s harsh now, wait until we defund the police departments and leave it all up to private citizens. People forget that we created laws and courts and police as much to protect criminals as to protect their victims.

    But the left will make sure there are always enough police and courts etc to punish the victims.

    • #25
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