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. user_1029039 Inactive
    user_1029039
    @JasonRudert

    Any attempt to bring back forced confinement needs to answer a basic question, which we should also apply to a lot of schemes the left dreams up: Why is it going to be different this time? A lot of people support the idea of giving the state back the power to confine the chronically mentally ill, but they are imagining that this will be done in the sort of facility that they themselves would run for, say, their loved ones. But these people are going to be confined in the sort of facility that the state would actually run.
    Another question that needs to be tackled is how do you hold a person captive and still respect his rights? We throw away prisoners’ rights for the term of their sentences, and some of them for life, but they have committed a crime, and the mentally ill, by and large, have not.

    • #61
  2. user_1029039 Inactive
    user_1029039
    @JasonRudert

    Another point, as has been mentioned, is that these people do not form a constituency with any real political power. The sad thing is that if you removed the problems of homeless people ranting in the streets, and the school shooters, by and large the public would not care what had been done to those people to make the problems go away. You could implement a truly inhuman solution and it would be tolerated by the majority in exchange for making the surface-level problem disappear.
    My thinking is that this is one area where the government should be involved, and it should be in terms of doing research into how to manage these diseases. If there were a technological solution, something like a slow time-release drug delivery device, coupled with remote observation or tracking of the blood levels, you could conceivably achieve the public safety goals while at the same time minimizing the boot print impressed in these citizens’ faces.

    • #62
  3. user_240173 Member
    user_240173
    @FrankSoto

    Jason Rudert:

     If there were a technological solution, something like a slow time-release drug delivery device, coupled with remote observation or tracking of the blood levels, you could conceivably achieve the public safety goals while at the same time minimizing the boot print impressed in these citizens’ faces.

     This type of thing is not as far off as you might think.

    • #63
  4. user_1029039 Inactive
    user_1029039
    @JasonRudert

    Frank Soto: This type of thing is not as far off as you might think.

     No, and I suppose it would probably end up  being the cause of its own set of miseries and injustices. But you have a basic principal-agent problem in handing your loved ones over to the state, and if your state’s facility isn’t convenient, it becomes a great burden to keep an eye on them. Ideally, the monitoring would be done by the state and the family in parallel.

    • #64
  5. MJBubba Member
    MJBubba
    @

    Son of Spengler,  thanks for the post.    MarciN,  thanks for your comments.

    If anyone wants more information about House Bill 3717, there is a ton of stuff at Congressman Murphy’s page:

    http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact

    • #65
  6. Arahant Member
    Arahant
    @Arahant

    Jason Rudert: You could implement a truly inhuman solution and it would be tolerated by the majority in exchange for making the surface-level problem disappear.

    I’m not so sure.  All of these people have mothers and fathers.  Many also have siblings, aunts and uncles, some have children, etc.  When one starts adding it all up, it becomes a larger constituency than you may think.

    • #66
  7. MarciN Member
    MarciN
    @MarciN

    Jason Rudert:

    Any attempt to bring back forced confinement needs to answer a basic question, which we should also apply to a lot of schemes the left dreams up: Why is it going to be different this time?  . . . 

     Yup.  Exactly what I’m seeing.  I can’t imagine how this can work better than it did forty years ago.  

    But I also wonder if it will undo itself anyway.  After three to six weeks on forced medication, the patient will be too lucid to confine.  The doctor will release the patient, and the drugs will stay effective, for some people, as long as three months. The patient will stop taking the drugs because of the side-effects, of which there are many like weight gain, loss of energy, diabetes in many cases, and just feeling groggy.  And then the decompensation will start (not always–actually, there have been cases where the person didn’t need the medication beyond the first round!), and within a year, the patient will be right back where he or she started.  So I’m not sure how the Murphy Bill actions will help anyway, in the long run, in terms of keeping violent schizophrenics confined. 

    • #67
  8. user_1029039 Inactive
    user_1029039
    @JasonRudert

    Arahant:

    Jason Rudert: You could implement a truly inhuman solution and it would be tolerated by the majority in exchange for making the surface-level problem disappear.

    I’m not so sure. All of these people have mothers and fathers. Many also have siblings, aunts and uncles, some have children, etc. When one starts adding it all up, it becomes a larger constituency than you may think.

     Yes, but the reason the lawsuits were filed on behalf of those people in confinement back in the Seventies was because all those family members handed their kin over to the state, and a lot of them never looked back. Or they felt powerless to change the conditions. 

    • #68
  9. Son of Spengler Member
    Son of Spengler
    @SonofSpengler

    Jason Rudert: Any attempt to bring back forced confinement needs to answer a basic question, which we should also apply to a lot of schemes the left dreams up: Why is it going to be different this time?

     As PychLynn points out in #15, we’ve learned a lot in 40 years, through experience and research. Murphy’s bill is based on these lessons, not some abstract theory.

    Not all of the bill promotes confinement. Some aspects — like relaxation of privacy laws — are so that familial support structures can function and obviate unnecessary confinement. Special mental-health courts are proposed to give patients the kind of individual advocacy they lacked under the old system.

    This is not a shotgun approach to the problem. It’s not perfect, as no perfect solution exists, and there must be some tradeoffs. But it is a careful, humane, sensitive, respectful approach, an improvement over both the current system and what was in place before deinstitutionalization. If you have the time, I would encourage you to look at the link MJBubba posted at #65. It details the year’s worth of research and discussion that went into this bill.

    • #69
  10. Instugator Thatcher
    Instugator
    @Instugator

    Jason Rudert:  Any attempt to bring back forced confinement needs to answer a basic question, which we should also apply to a lot of schemes the left dreams up: Why is it going to be different this time? A lot of people support the idea of giving the state back the power to confine the chronically mentally ill, but they are imagining that this will be done in the sort of facility that they themselves would run for, say, their loved ones. But these people are going to be confined in the sort of facility that the state would actually run. Another question that needs to be tackled is how do you hold a person captive and still respect his rights? We throw away prisoners’ rights for the term of their sentences, and some of them for life, but they have committed a crime, and the mentally ill, by and large, have not.

    Read Cramer’s book. The problems started 40 years ago with the de-institutionalization movement. One thing Cramer points out was that the movement argued largely from hypothetical, not actual abuses in the system.
    In short, the present is worse then the previous system.

    • #70
  11. user_1029039 Inactive
    user_1029039
    @JasonRudert

    Son of Spengler: If you have the time, I would encourage you to look at the link MJBubba posted at #65. It details the year’s worth of research and discussion that went into this bill.

     Went and read the summary, and yes, I can see why you support this. But what I mostly hear about in public discussions of this is compulsory inpatient confinement.

    • #71
  12. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Jason Rudert:

    Son of Spengler: If you have the time, I would encourage you to look at the link MJBubba posted at #65. It details the year’s worth of research and discussion that went into this bill.

    Went and read the summary, and yes, I can see why you support this. But what I mostly hear about in public discussions of this is compulsory inpatient confinement.

     Treating the mentally ill has to be about more than sound bites. It is a complex issue that requires a sober response. It is clear we have moved from hospitals to homlessness and inpatient to incarceration.

    I cannot see how it is better for someone to be in jail than a hospital bed, or freezing in a tent instead of in a warm, safe place.

    The chronically homeless do not have the skills they need to live independently. We should try to help them live in the least restrictive location possible, like a supportive apartment, group home, or if they need it, a facility of some sort that is not jail.

    • #72
  13. Grendel Member
    Grendel
    @Grendel

    The Pelosi-Barber initiative continues 100 years of Progressive policies that destroy society, waste money, kill people, and usually fail at their ostensible purpose.

    • #73
  14. Grendel Member
    Grendel
    @Grendel

    Jason Rudert:

    Another question that needs to be tackled is how do you hold a person captive and still respect his rights? We throw away prisoners’ rights for the term of their sentences, and some of them for life, but they have committed a crime, and the mentally ill, by and large, have not.

    Imprisonment is often used as a punishment, but it also serves the purpose of reforming, and more to the point, of protecting society.  That is the purpose of the state, and confining the violent, whether criminal or mentally ill, is part of that purpose.

    • #74
  15. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Grendel:

    Jason Rudert:

    Another question that needs to be tackled is how do you hold a person captive and still respect his rights? We throw away prisoners’ rights for the term of their sentences, and some of them for life, but they have committed a crime, and the mentally ill, by and large, have not.

    Imprisonment is often used as a punishment, but it also serves the purpose of reforming, and more to the point, of protecting society. That is the purpose of the state, and confining the violent, whether criminal or mentally ill, is part of that purpose.

    So I suppose every single person on meds in America is mentally ill and sbject to a lesser regime of rights than the good normal people who want to help them.  It is the purpose of the state to protect society.?   

    • #75
  16. Arahant Member
    Arahant
    @Arahant

    Hydrogia: So I suppose every single person on meds in America is mentally ill and sbject to a lesser regime of rights than the good normal people who want to help them. It is the purpose of the state to protect society.?

    Who, besides you, is arguing for that?  The rest of us are talking about special cases.  Not everyone on meds is likely to be violent.  Part of that is the specific disease and part is the case history. 

    Your attempts at rational argument fall below the standard here.  Maybe it works for Facebook or wherever else you hang out, but we expect better of you here than calling people sheeple and twisting what people say about special cases into generic treatment for everyone.  Following your logic, a med is any medication, therefore, we are all advocating that people who take a pill for high blood pressure should be locked away.  You are not making sense.  All that you’ve left out from standard Internet practices is comparison to that Austrian guy.

    • #76
  17. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Hydrogia:

    It is the purpose of the state to protect society.?

     Well, I happen to have made a post on the purpose of the state. Feel free to read it and make arguments there. (It will even open in a new window)

    • #77
  18. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Who said I advocate that? Where were you when it was suggested I don’t want people treated or want dangerous people on the street? Who was here to say, who is advocating that? The question remains, why have less rights for people deemed to be mentally ill? This is a good question and there is no basis for such and if that makes no sense to you than that is your problem. I will continue to make this this point which hasn’t been refuted and can’t be refuted and saying I make no sense doesn’t refute it.

    • #78
  19. Arahant Member
    Arahant
    @Arahant

    Hydrogia: I will continue to make this this point which hasn’t been refuted and can’t be refuted and saying I make no sense doesn’t refute it.

    If it can’t be refuted, then what are you arguing against?  There’s no reason to argue against something that can’t be refuted.  I think it is irrefutable that you are wasting your time, arguing the irrefutable.

    • #79
  20. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Cute, ahahahah….. Next

    • #80
  21. Son of Spengler Member
    Son of Spengler
    @SonofSpengler

    Hydrogia:

    …The question remains, why have less rights for people deemed to be mentally ill?

     A child does not have full rights, because the child is assumed to lack sufficient capacity to make decisions for himself or herself. Instead, a parent exercises those rights on behalf of the child, and can limit the child’s freedom. When the parent fails in those responsibilities, the child can become a ward of the state.

    Similarly, when a person hears voices, hallucinates, and otherwise suffers from mental illness that prevents him or her from making capable decisions for himself or herself, someone else needs to assume that responsibility. The person may cede that freedom to a guardian (parent, sibling, or child), but if not, the person may become a ward of the state.

    Maintenance of rights requires a “sound mind” (that’s why legal documents, such as wills, may require testimony to that effect). What’s tough is that we need mechanisms to determine objectively whether a person has lost his or her capacity.

    • #81
  22. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    That is exactly right. It is hard to determine where to draw the line. It is easy to lock someone up if they are threatening to kill someone else. But what do we do when they refuse to take meds and live in the woods?

    • #82
  23. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    A child is not an arbitrary distinction like “mental illness” and enjoys Constitutional protection.

    The problem there is that the medications are so variable and powerful,  can cause the symptoms you mention and much 
    worse,  are dispensed in experimental fashion, and are going obsolete continually. The question remains like all my questions here, would you act peculiar if you were dragged off and thrown in a cage by brutal thugs?

    We have a mechanism for “Special Cases” and If All men are created equal, that includes the mentally ill. Not much controversy here.

    • #83
  24. douglaswatt25@yahoo.com Member
    douglaswatt25@yahoo.com
    @DougWatt

    Here is something worth reading. It takes the discussion from the theoretical to what I call the real world.

    • #84
  25. Son of Spengler Member
    Son of Spengler
    @SonofSpengler

    Hydrogia: The question remains like all my questions here, would you act peculiar if you were dragged off and thrown in a cage by brutal thugs?

    I encourage you to read Michael Laudor’s story in the link I included in the original post. Michael Laudor suffered without having been dragged anywhere or thrown anywhere. Can you offer any evidence of people developing symptoms only after being preemptively treated or confined?

    • #85
  26. Son of Spengler Member
    Son of Spengler
    @SonofSpengler

    Hydrogia: A child is not an arbitrary distinction like “mental illness” and enjoys Constitutional protection.

     If someone hears voices and hallucinates, is that an arbitrary distinction?

    • #86
  27. douglaswatt25@yahoo.com Member
    douglaswatt25@yahoo.com
    @DougWatt

    Hydrogia:

    A child is not an arbitrary distinction like “mental illness” and enjoys Constitutional protection.

    The problem there is that the medications are so variable and powerful, can cause the symptoms you mention and much worse, are dispensed in experimental fashion, and are going obsolete continually. The question remains like all my questions here, would you act peculiar if you were dragged off and thrown in a cage by brutal thugs?

    We have a mechanism for “Special Cases” and If All men are created equal, that includes the mentally ill. Not much controversy here.

    I was one of those brutal thugs. Right after roll call I would hit the lights and siren, you can never get to that cup of coffee fast enough after all. Nothing like having a sip of coffee while hoping for that call that gives you the opportunity to put the boots to someone. That about sums up everything I saw and did as a police officer. Thanks for giving me another chance to stroll down memory lane.  

    • #87
  28. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Hydrogia:

    A child is not an arbitrary distinction like “mental illness” and enjoys Constitutional protection.

    The problem there is that the medications are so variable and powerful, can cause the symptoms you mention and much worse, are dispensed in experimental fashion, and are going obsolete continually. The question remains like all my questions here, would you act peculiar if you were dragged off and thrown in a cage by brutal thugs?

    We have a mechanism for “Special Cases” and If All men are created equal, that includes the mentally ill. Not much controversy here.

    You continue to ignore case after case put forth by me and everyone else, and continue to present a single straw man argument. Clearly, you are not wanting to discuss or debate, but bang the one drum you have. You are unwilling to see any good faith in others points of view, and throw around names.

    In short, you argue like a leftist.

    • #88
  29. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Son of Spengler:

    Hydrogia: A child is not an arbitrary distinction like “mental illness” and enjoys Constitutional protection.

    If someone hears voices and hallucinates, is that an arbitrary distinction?

    Son of Spengler:

    Hydrogia: The question remains like all my questions here, would you act peculiar if you were dragged off and thrown in a cage by brutal thugs?

    I encourage you to read Michael Laudor’s story in the link I included in the original post. Michael Laudor suffered without having been dragged anywhere or thrown anywhere. Can you offer any evidence of people developing symptoms only after being preemptively treated or confined?

     
    There are going to be borderline tragedies even with a very effective benevolent system.  Building such a system does not require lesser tiers of rights.  We are already to far down that road. 

     That is too narrowly constructed, don’t get me started.  

    • #89
  30. Hydrogia Inactive
    Hydrogia
    @Hydrogia

    Hey Bryan, Why  ignore the principles which include all the cases?. You already said it is rare to forcibly do your business so why do need more power to do that?  Do you want it to be more frequent? What is precluding you from being more effective that can’t be done by more sensible use of the means you have? Straw Man? I just said there is little controversy here and have acknowledged your good faith efforts and see no reason not to exhort the people to wake up because of what I have seen and know. No straw man here, just a man who has seen things that shouldn’t be seen.

    • #90
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