Insanity and Guilt

 

When I was an undergraduate, I took my meals at Yale’s “kosher kitchen” in a basement on the periphery of campus. Dinners were popular, but lunch was… intimate. Depending on the day of the week, lunch could be a gathering of a dozen, or just three or four. One semester during my sophomore year, I got to know a third-year law student named Michael. Our schedules overlapped on one of those weekdays when lunch was sparsely attended. Michael was a little older than most law students, and his gravitas was enhanced by his quiet confidence and his full beard. But there was also something else about Michael. It was a kind of heroic intensity, similar to the vibe I get from ex-military guys.

Over the course of the semester, I learned a little of Michael’s story. He had some condition that caused periodic blindness. The law school provided him a reader, when necessary, to read textbooks aloud to him. Fortunately, Michael had a remarkable memory and could recall all the material. Michael was well-informed, intelligent, and reasonable. He had seen something of the world between his undergraduate days and law school, and was an engaging conversationalist. He was someone I often turned to for advice.

After that semester, we lost touch. Michael graduated; I spent a semester abroad. Michael moved to New York City. I heard how he was doing from time to time through a common acquaintance.

A year later, Michael dropped his bombshell.

Michael published his story in the New York Times. It turns out that he was seriously mentally ill, suffering from severe schizophrenia. With the intense effort of family, friends, and psychiatric professionals, he brought it under control. And Guido Calabresi, the dean of Yale Law School, made it possible for Michael to attend, and graduate. As Michael said, “I went to the most supportive mental health care facility that exists in America: the Yale Law School.” Those episodes of blindness had been side effects from some powerful psychotropic medications.

After Michael went public, things continued to go very well for him. He got a book deal. Ron Howard even optioned his story for a movie.

And then, one day, our mutual acquaintance called in tears and told me to check the news. Michael Laudor had stabbed his fiancee, Caroline Costello, to death.

Laudor’s mother, Ruth, telephoned the police in Hudson saying she had received an especially frightening call from her son in the morning. She feared for the welfare of both him and Carrie, who had taken the day off for “personal emergency” reasons from her job at the Edison Project, a private education company that runs public schools in some states. Mrs Laudor begged the police to send a cruiser to the apartment.

A police officer was dispatched and let in by the superintendent of the building. The bloody scene inside, Carrie in a pool of her own blood, confirmed the mother’s worst fears.

As in the case of so many other schizophrenics, Michael was feeling well and had gone off his meds. And, as in the case of so many other schizophrenics, tragedy followed.

When Jared Laughner’s attack on Gabby Giffords prompted a gun control frenzy, all I could think of was Michael. When James Holmes shot up a theater in Aurora, Colorado, all I could think of was Michael. And after the Sandy Hook Elementary School shooting in Newtown, not far from my home, all I could think of was Michael. To me, the story of these murders was not about guns. It was about serious mental illness and people who desperately needed treatment.

One and a half years later, after the Newtown gun control hysteria has been beaten back, there is finally an opportunity to address the real problem. It has taken that long because the issue is complicated. Mind-bogglingly complicated. There are real tradeoffs of individual liberty vs. personal (and public) safety. And the mental health system has many, many moving pieces.

The opportunity comes in the form of a bipartisan bill authored by Republican Representative Tim Murphy, a practicing psychologist from Pennsylvania. As Ramesh Ponnuru explains at Bloomberg View:

Murphy thinks that existing government policies and bureaucracies don’t place enough emphasis on the severely mentally ill, instead catering to those with milder problems and the “worried well.” He also thinks they’re too solicitous of the “right to refuse treatment” when it is asserted by people who are too mentally ill to have a meaningfully free will. An inability to see that one has a severe mental illness can, he says, be a symptom of it.

So Murphy would prod states to set up mental-health courts that could order treatment for people with a history of arrests, violence or repeated hospitalizations. He would clarify federal law so that doctors could more easily share information about people in an acute mental-health crisis with their parents and caregivers. He would change Medicaid payment policies so that they no longer discourage long-term hospitalization for people with severe mental illnesses. He’d also make federal mental-health bureaucracies show evidence that they’re spending money in ways that work.

And he would cut spending for a federal program called Protection and Advocacy for Individuals with Mental Illness, which funds state agencies that often sue and lobby to stop the sorts of mental-health policies Murphy backs. Opponents of the Protection and Advocacy program often bring up the case of William Bruce, who got out of a psychiatric facility over the objections of doctors thanks to such legal advocacy — and later killed his mother.

Murphy developed his bill over more than a year, in consultation with professionals, mental health advocates, and families. One third of the Murphy bill’s 77 co-sponsors are Democrats. However, another bill was recently introduced by Democratic Representative Ron Barber of Arizona, who used to work for Gabby Giffords and was injured in the Loughner shooting.

Barber’s bill includes none of these provisions. He thinks what’s most important is not to reform the existing programs — although he allows that they could do a better job — but to give them more money. His emphasis is on increasing awareness and early treatment of mental illnesses. He would fund bullying counseling at schools, for example, because bullying often leads to mental illness. That’s very far from Murphy’s focus on the worst cases.

Barber also rejects Murphy’s approach to the Protection and Advocacy program, saying the Republican’s bill “would basically abolish a very important part of our mental health system.”

Ponnuru is evenhanded in discussing both proposals, describing them as different good-faith approaches to the problem. He concludes that the Barber approach is more-of-the-same and should be rejected on the merits.

And it should. But there is more going on here. This is, as Kimberly Strassel wrote in the Wall Street Journal, “a raw partisan exercise in killing mental-health reform, shoring up midterm election prospects and protecting Democratic constituencies—all at the expense of the most seriously ill.”

Despite all the bipartisan consultation, Murphy’s Democratic co-sponsors are under pressure to walk away.

Mr. Murphy … had solicited Mr. Barber’s thoughts and was even working recently with his committee counterpart, Colorado’s Diana DeGette, in the expectation that she would come on board. All that ended when [Nancy] Pelosi decided that Republicans couldn’t be allowed any victory that might present them as bipartisan, compassionate and leaders on health issues. Mr. Barber and Ms. DeGette received new marching orders.

While Mr. Barber presented the bill (Ms. DeGette is a co-sponsor), the Hill reported late last week that Ms. Pelosi and Rep. Henry Waxman (D., Calif.) were “deeply involved in crafting” it. A lobbyist told the paper that “Pelosi and Waxman hope this legislation will blow up any kind of continuing dialogue with Murphy.”

What is the political motivation?

Liberals have been unhappy that Mr. Murphy has so successfully focused attention on mental illness, since it messes with their story line that the only issue is guns. In this warped universe, a bipartisan vote for a Murphy bill —an acknowledgment that mental illness plays a primary role in shooting tragedies—is a surrender on gun control, and potentially an excuse for some Democrats to drop that politically dangerous issue.

The Barber bill is no threat to these liberals, since it won’t be heard, and is simply another Democratic spending blowout. Pelosi-Barber strips out every consequential reform from the Murphy bill—outpatient treatment, privacy rules, commitment standards, Samhsa reforms—and settles for throwing yet more federal dollars at “mental health awareness.”

As such, Pelosi-Barber also protects Democratic lobbies that are currently feeding from the federal trough and want to continue doing so. That includes federally funded lawyers who fight to keep the seriously mental ill out of treatment, as well as to a huge array of Samhsa-funded anti-psychiatry groups, such as the National Coalition for Mental Health Recovery, that oppose treatment for those most sick.

This is crass political opportunism. It is also cruel and evil.

If Nancy Pelosi succeeds in killing the Murphy bill, there will be more shootings and more stabbings and more broken lives. And I will continue to think of Michael Laudor and Carrie Costello. But all of us should now also think of Nancy Pelosi, and the responsibility she and her caucus bear.

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  1. Arahant Member
    Arahant
    @Arahant

    MarciN: (That said, I’ve met a lot of people who should not be in this business of helping the mentally ill.)

    Some folks go into psychology and psychiatry to find out what’s wrong with them.  Not all, by any means, but there are examples.

    • #31
  2. MarciN Member
    MarciN
    @MarciN

    Arahant:

    MarciN: (That said, I’ve met a lot of people who should not be in this business of helping the mentally ill.)

    Some folks go into psychology and psychiatry to find out what’s wrong with them. Not all, by any means, but there are examples.

     Too many words of agreement to write!  I went through twenty psychiatrists to get to a really good one for my mom.  
    Someday I’ll get a podium so I can yell at the rest of them.  :)

    I’m sitting here realizing that this is still too emotional for me to speak coherently on.  I guess all I can do is what I did, and tell people that there is hope.  But I really understand the hot emotions on all sides of this issue.  

    I once saw a “group home” someone thought would be good for my mom.  It was so terrible, and I was so upset I pounded a hole in the dashboard of my car!  The pain in families dealing with this is horrific.  

    • #32
  3. Instugator Thatcher
    Instugator
    @Instugator

    While SOS’ explanation is sufficient, if you require further information, I would recommend Clayton Cramer’s book, My Brother Ron
    for a more complete history of the deinstitutionalization movement and the consequences thereof. I think it explains the history of mental health care in the US very well, as well as highlighting the problems SOS points out.

    The kindle version is $1.49 but please use the link from the Ricochet main page if you choose to buy.

    • #33
  4. Mark Coolidge
    Mark
    @GumbyMark

    Instugator:

    While SOS’ explanation is sufficient, if you require further information, I would recommend Clayton Cramer’s book, My Brother Ron for a more complete history of the deinstitutionalization movement and the consequences thereof. I think it explains the history of mental health care in the US very well, as well as highlighting the problems SOS points out.

    The kindle version is $1.49 but please use the link from the Ricochet main page if you choose to buy.

     My Brother Ron is a wonderful book for anyone wanting to understand how we got where we are on institutionalization v noninstitutionalization and the parts about his family must have been tough for Cramer to write about.

    • #34
  5. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Martial Resources?  OK, have you taken one of the pills you hand out?  Have you changed someones prescription several times?
    Your own experience is all the resources I need if you stop making pretty pictures.

    • #35
  6. Mark Coolidge
    Mark
    @GumbyMark

    MarciN:

    Bryan G. Stephens:

    People with SPMI die 20-25 years sooner than the rest of the population. They do not get medical care, they live hard lives, and mostly are a danger to themselves. Americans, Christians, have a duty to their brothers and sisters who cannot care for themselves. As a culture, as a society, we have not care much at all.

    Having my mom committed was the hardest thing I ever did–my knees literally buckled under me. The social worker said, “Things will get better.”

    And they did. For twenty years.

    You are right, Mr. Stephens. And you are helping a lot of families.

    (That said, I’ve met a lot of people who should not be in this business of helping the mentally ill.)

    I agree with both Bryan and Marci.  My experience began in the late 1960s and I saw the problems with commitment laws that were too loose and terrible facilities.  I supported reform and then saw the pendulum swing so it became almost impossible to get treatment for the severely mentally ill.

    • #36
  7. user_240173 Member
    user_240173
    @FrankSoto

    Hydrogia:

    Martial Resources? OK, have you taken one of the pills you hand out? Have you changed someones prescription several times? Your own experience is all the resources I need if you stop making pretty pictures.

    I’m not sure what you are expecting from people.  That medications react somewhat differently in different people, is an unsurprising fact, that in no way invalidates their usefulness.

    It is impossible for any doctor or psychiatrist to know with certainty which drugs or combination of them will solve a given persons problems.  They have to be tried.  There is nothing barbaric about the process.

    Is your suggestion that the severely mentally ill and society at large are better off without attempts to treat their problems medically?  

    • #37
  8. Mark Coolidge
    Mark
    @GumbyMark

    Interesting article on this topic just went up on NRO
    http://www.nationalreview.com/corner/377920/americas-mentally-ill-have-nowhere-go-patrick-brennan

    On a related note while the US prison population has increased greatly over the past 30 years it is (as a % of total population) about where prisons plus mental hospitals were in the 1960s.

    • #38
  9. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Hydrogia:

    Martial Resources? OK, have you taken one of the pills you hand out? Have you changed someones prescription several times? Your own experience is all the resources I need if you stop making pretty pictures.

     You really are pretty insulting. I have spent 22 years working with these populations, trying to care for people as best we can without the resources that we have. I resent your implication.

    • #39
  10. MarciN Member
    MarciN
    @MarciN

    I know the medications help people when they are given correctly.  But they are not always administered correctly.

    At one point, my mother was at Bournwood Hospital, a very upscale private mental hospital.  (The other hospitals were full, so, thankfully, she ended up there.)  But even there, conditions were not good.  She was so neglected, it was really appalling.  But the worst thing was that she visibly overmedicated.  She could not lift her head off the pillow.  It was frightening.  When I saw her doctor, he said, “Yeah, we’ll have a look.”  Seriously?  Postsurgical patients are not treated that way.  

    I understand the public’s desire to see reinstitutionalization. But I hope no one is deluding themselves thinking this is a fantastic thing.  Human nature being what it is, if you put ten people and a warden in a locked-ward situation, you get a prison.  

    When I visited my mother at Danvers State Hospital, the other patients would grab me and say, “Please get me out of here.”  Locked-ward institutions are not good.  If the community would stay involved and visit these places, maybe they could work.  But I don’t think that’s going to happen. 

    • #40
  11. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    If you follow the link I posted, it is clear I am not for warehousing people in big central hospitals. I want to give brief stays to stabilize acute crisis, and then have services in the community. It is what we do.

    • #41
  12. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Mark:

    Interesting article on this topic just went up on NRO

    http://www.nationalreview.com/corner/377920/americas-mentally-ill-have-nowhere-go-patrick-brennan

    On a related note while the US prison population has increased greatly over the past 30 years it is (as a % of total population) about where prisons plus mental hospitals were in the 1960s.

     We serve 4000 people a year in the County Jail. As incarceration rates go down, the numbers we serve stay steady. If we had more staff we would serve more.

    We still lock up the Mentally Ill. We just use Jail.

    • #42
  13. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Thank You for verifying my well meaning charlatan label. 
     Do you want the Police bringing you people who you force to take drugs?
    Would you act peculiar if the police dragged you off to a cage?

    • #43
  14. user_240173 Member
    user_240173
    @FrankSoto

    Hydrogia:

    Thank You for verifying my well meaning charlatan label. Do you want the Police bringing you people who you force to take drugs? Would you act peculiar if the police dragged you off to a cage?

    Is your argument that no one is severely mentally impaired, or that such conditions never make them a danger to all around them?

    I’m having a hard time understanding your position if you don’t believe one of those two things.

    • #44
  15. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    I worked in the system and did my best too. That is not the point. The point is different tiers of rights for an arbitrarily decided 
    condition and abuse of power. You must know mentally ill people are severely oppressed, how is that improved by having less rights?
    As a Ricochet member you must also be aware of the culture of government over-reach in the age of Obama. How could I not not harshly insult and criticize the culture of cretins handing out pills and wishing to incarcerate?

    • #45
  16. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Frank, What I said, that is my argument, I have no idea what you are talking about.

    • #46
  17. user_240173 Member
    user_240173
    @FrankSoto

    Hydrogia:

    Frank, What I said, that is my argument, I have no idea what you are talking about.

    You have dismissed the entire notion of forcing the insane to take medication that would mitigate their insanity.  

    I must assume that you either don’t believe the insane exist, or that you don’t believe they are ever dangerous.

    If neither of those statements describe you, you cannot reasonably oppose the premise of forcing the insane to take medication.  If you are concerned with abuses and over reach, your focus should be there, not against the very concept of forcing treatment in such cases.

    • #47
  18. 10 cents Member
    10 cents
    @

    Hydrogia:

    Martial Resources? OK, have you taken one of the pills you hand out? Have you changed someones prescription several times? Your own experience is all the resources I need if you stop making pretty pictures.

     Hydrogia,

    Please respond to a good faith question. If you don’t have resources please tell us. If you want to ask a further question, ask it without being snide. If you have a story to tell of how someone has suffered by bad treatment, please tell us. This is the Ricochet way of debate.

    • #48
  19. Arahant Member
    Arahant
    @Arahant

    Hydrogia: I worked in the system and did my best too. That is not the point. The point is different tiers of rights for an arbitrarily decided condition and abuse of power. You must know mentally ill people are severely oppressed, how is that improved by having less rights?

    So, we don’t lock them up.  We don’t force the medication.  Do we wait for them to kill someone and then execute them?  Do we make the police go into a situation where it is shoot or be shot?  Do we just tell the relatives, “Hey, he’s your responsibility.  If you don’t control him, we’ll prosecute you and people can sue you for the damage done?”  Do we just let them kill people?  “Sorry about your sister, but Hydrogia was off his meds again.  We wouldn’t want to interfere with his rights.”

    While I am very favorable with libertarian arguments, part of it is that rights convey responsibilities.  Some of these folks, by definition, are not responsible for their actions.  If one is incapable of being responsible for one’s actions, it is hard to argue they should have full rights.

    What is your solution?

    • #49
  20. 10 cents Member
    10 cents
    @

    Hydrogia,

    I wrote #48 before I read your current comments.

    There definitely needs to be a balance. What do you suggest for people who are a harm to themselves and others? What guidelines do you suggest for making those decisions?

    • #50
  21. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    I am for liberty and freedom. But when someone is no longer a rational actor (i.e. they are hearing voices that tell them to kill themselves or others, or they sleep in the woods because they are too paranoid for treatment), I do not think it is right or proper to do nothing. It is not oppression to move someone from under a bridge to a safe place where he can get food and shelter.

    You appear to have one version of how things work that is all about forced medication.I can tell you that forced medication is rare, and used only in extreme circumstances in GA. We do not do it in our SU. Maybe 4 people a year of the people we see (75ish a month) refuse meds at all. They get better in the 3-6 days we have them. They don’t stay locked up forever.

    So, where do you get off calling me names? My staff do damn fine work in a hard situation. They work for less monthly than they could make in the private sector because they believe in the mission. None of use are “charlatans”.

    • #51
  22. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    So why support less rights for your patients?
    My solution is equal rights. Mental illness is not an indicator of criminality.
    Wake up sheeple.

    • #52
  23. user_240173 Member
    user_240173
    @FrankSoto

    Hydrogia:

    So why support less rights for your patients? My solution is equal rights. Mental illness is not an indicator of criminality. Wake up sheeple.

    Your solution appears to be to ignore the hard cases.  This makes debates easier as you don’t have to consider them, but is problematic in the real world.

    • #53
  24. Arahant Member
    Arahant
    @Arahant

    Hydrogia: My solution is equal rights. Mental illness is not an indicator of criminality. Wake up sheeple.

    Because we have differing opinions does not make us “sheeple.”  Isn’t that a term used by disaffected teenagers with Ché t-shirts?

    None of us are arguing that any and all mental illness qualifies a person for the special treatment that should be reserved for those who are truly dangerous to themselves or others.  We are speaking of things done on a case by case basis.  Some cases of mental illness do lead to criminality.  The highly publicized multiple-murder cases are the tip of the iceberg.  You’ll never hear about 99% of the incidents unless they are local.  “Local Woman Found on College Campus with Knife” might be all that the police blotter on page D4 of the paper says, because her husband is very prominent and the police know her and know that she got off her meds again.  They take her home and file a report.  Her husband gets her to take her meds, takes her to the doctor the next day, and life goes on quietly until the next time.

    • #54
  25. douglaswatt25@yahoo.com Member
    douglaswatt25@yahoo.com
    @DougWatt

    As such, Pelosi-Barber also protects Democratic lobbies that are currently feeding from the federal trough and want to continue doing so. That includes federally funded lawyers who fight to keep the seriously mental ill out of treatment, as well as to a huge array of Samhsa-funded anti-psychiatry groups, such as the National Coalition for Mental Health Recovery, that oppose treatment for those most sick.

    Thank you for a great article. As a former police officer I have been on calls involving paranoid schizophrenic individuals. One of the calls was a disturbance and when we entered the motel room we found out that we were dealing with a homicide. Our suspect had stabbed his roommate to death. A mental health agency found our suspect housing and nothing else. No follow up on meds or treatment. I’ll be contacting my representative.  Thanks again for the article. 

    • #55
  26. user_240173 Member
    user_240173
    @FrankSoto

    Hydrogia:

    So why support less rights for your patients? My solution is equal rights. Mental illness is not an indicator of criminality. Wake up sheeple.

     Hydrogia,

    Let’s try this a different way.  There are approximately 300,000 incidents of drunk driving per day in the U.S.  Yet only about 30 drunk driving related deaths per day.

    As you can see, it is an incredibly low percentage of drunk drivers that end up causing fatal crashes.  Clearly Drunk driving isn’t an indicator of dangerous driving…right?

    Are we violating peoples rights when tell them they can’t drive drunk?  The correlation between mental illness and violence is small, but substantially larger then the correlation between drunk driving and fatal crashes.

    Is society allowed no preventative measures, or when a persons faculties are by definition impaired, may it take steps to protect people?

    • #56
  27. Arahant Member
    Arahant
    @Arahant

    I’m suddenly wanting to see The Ruling Class again for some reason.

    • #57
  28. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Frank Soto:

    Hydrogia:

    So why support less rights for your patients? My solution is equal rights. Mental illness is not an indicator of criminality. Wake up sheeple.

    Your solution appears to be to ignore the hard cases. This makes debates easier as you don’t have to consider them, but is problematic in the real world.

    What do you mean “hard cases” ?  
    The center right has  to get behind equal rights,  calling for more arbitrary government power to 
    forcibly imprison and pummel more people with dubious poisons is sheer lunacy no matter how many nice things you hope to achieve. The question remains, why support lesser rights for “them”.? 

    • #58
  29. 10 cents Member
    10 cents
    @

    Hydrogia,

    Why use the derogatory term “sheeple”? It can be used toward you to. Do you really think your ideas are original? Maybe you need to wake up and have some answers to give to a mother of a dead daughter because your ideas of “freedom” were followed. Remember respect goes both ways. I am beginning to feel that you don’t want to honestly engage the argument but name call. This is common and boring.

    • #59
  30. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Hydrogia:

    So why support less rights for your patients? My solution is equal rights. Mental illness is not an indicator of criminality. Wake up sheeple.

     I have not advocated treating people with mental illness as criminals. In fact, far from it. However, I do not think it is humane to let someone who’s rational mind is not working to suffer a great deal of misery, and to cause their loved ones to suffer a great deal of misery, because “freedom”.

    Someone in the throes of mental illness is not “Free”.

    • #60
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