by Charles O'Meara
Most people would consider me a liberal. I fit the stereotype in many - though not all - ways. One way in which I fit the stereotype is in caring about 'the least among us,' - the poor, the indigent, the abused, the neglected, victims of injustice and so on. But liberals are not always right-headed in their approach to fixing things. Specifically, I'm talking about the half-assed and ineffective treatment of adults with chronic mental illness. In an attempt to help these folks, liberal social crusaders have, I think, done as much harm as good. Perhaps more, depending on your perspective. Let's rewind...you need some history to understand how the situation I'm going to discuss came to be. For millennia, the mentally ill were feared, ostracized, locked up, abused, or laughed at. Nobody had any idea whatsoever how to treat "lunatics," as they were most often called in English speaking countries. In many places and for many centuries the mentally ill were thought to be possessed by demons or evil spirits. But as long as they didn't commit a crime or scare the bejesus out of people, they were tolerated. If they couldn't behave, they were locked up. Not surprisingly, locking them up was the beginning and end of 'treatment'. Once inside an insane asylum (an outdated term), they might be beaten, raped, starved or neglected. Some of the abuses they suffered came from those entrusted to care for them and some of those abuses came from their fellow inmates. All in all, it was a grim and terrible existence that amounted to little more than incarceration. Then came the 20th century which marked the arrival of psychiatric medicine and psychology. The idea that the brain could malfunction and be corrected, that people were products of the way they were raised (vs. demonic possession and God's will) had arrived. Technically Freud was practicing psychiatric treatment in the late 19th century, but the study of the mind didn't really take root and spread till the 20th. And once it did, the floodgates opened. In the wake of Freud came Jung, Skinner, Piaget, Erikson, Wertheimer, Watson, Maslow and the amusingly named Karen Horney (well, amusing to me anyway) to name only a few. The brain and the mind were now being studied seriously. Scientifically based treatment and cures were being actively sought. By the 1950s drugs appeared. Haldol and Thorazine were the first drugs available to treat schizophrenics; lithium was brought into service to treat bipolar patients; MAOIs and tricyclics were applied to treat depression. Regardless of your opinion of these medications, they most certainly helped to control many of the symptoms experienced by patients who had previously spent their days and nights being openly - and sometimes dangerously - batshit crazy. For the first time, patients who had been expected to die at the asylum were now being tentatively returned to society. That's a key point. It marks the real turning point in my little tale. Coinciding with the arrival of drugs was a blossoming focus on social issues and human rights. In no particular order came the civil rights movement, black consciousness, black power, gay pride, feminism, women's liberation, latino rights, the war on poverty, the anti-war movement and a push for giving rights to the mentally ill. The state hospital where I began my career was opened around the time of the Civil War, and right up to the late 1960s it's sprawling grounds and various buildings contained a variety of enterprises that were staffed by patients (with supervision, of course). For decades, the hospital had horses, a stable, an icehouse, a slaughterhouse, gardens (for growing vegetables), a barber shop, a laundry, a carpentry shop and a theater where the patients put on shows and other forms of entertainment for their peers and the rest of the hospital. Patients who could do so, were expected to work at something. I don't mean to paint an idyllic picture or give you the idea that this was some sort of paradise where nothing ever went wrong and the mentally ill were happy and smiling all day long. But to some extent, patients were participating in a version of reality, a parallel version of daily life, doing the same sorts of things 'normal' people did outside the hospital. However, by the 1960s it was decided by well-intentioned liberals that having patients work was a human rights violation - abusive, degrading, and smacked of nazi work camps or prisons. So the work programs were undone, the laundry and food preparation was contracted out, the stables and gardens and theaters were shuttered, fell into disrepair and were eventually razed. And then everything was better because patients had rights, correct? Well, not necessarily. Patients still confined to the hospital now had no purpose whatsoever, no routine, nothing to do with their time. Instead of at least pretending to have a normal life, they now had fuck-all to do. And that is exactly what they did: fuck-all. Nothing. Here is what fuck-all means on a locked ward at a psychiatric hospital where two dozen seriously mentally ill people live: you smoke cigarettes, masturbate, watch TV, fight over the TV, walk up and down the halls, get into arguments with the staff and/or other patients, sleeping fifteen or twenty hours a day, overeating and not exercising. Oh sure, the same well meaning reformers tried to implement all sorts of educational programs and therapy groups and the like, but here's the thing: most of the patients didn't want to have anything to do with shit like that. Which brings us to an odd and ironic contradiction: since forcing patients to work is wrong, then forcing them to attend meaningful programs for their betterment is equally wrong. Checkmate! The people in charge of the asylum proved themselves as illogical as the patients. And so, for the most part, patients said 'no' to all the 'good' programs and did nothing of consequence. What most people who try to help the mentally ill fail to take into account is that they are...brace yourselves...mentally fucking ill. What this means in practical terms is that they may have symptoms that make it difficult or impossible to participate in a particular program. They might have neurological complications or damage that compounds their illness, thus making a remedial reading class pointless. Side effects of medication may make it difficult for them to stay awake. Voices in their head that make them paranoid might make them dangerous if you cram them to sit in a small room with ten other people for 40 minutes. And so on. Here's yet another irony (this piece is full of them). If you tell patients they have rights and can refuse to participate in things if they wish, why wouldn't they refuse? Here they are, essentially incarcerated, little chance of 'getting out,' cut off from the outside world following rules they didn't make and eating meals that someone else thought up and prepared for them. They're living in a dull, colorless world with few choices. Doesn't it make perfect sense that they would want to seize the few choices available to them? They have no say in when they can smoke, how the chicken they get for dinner is cooked, who their roommate is and so on. So when you give them the opportunity to say no to something, they'll take it. I probably would. Refusing treatment is an implied 'fuck you' to your captors. And so, in the name of patient rights and liberty and being forward thinking, patients who responded to pharmaceutical treatment were sent back out into the world. This was (and is) called something vaguely official like "mainstreaming" or "transitioning" or "community placement," but it always amounts to the same thing: don't let the door hit you in the ass on the way out. Patients discharged into the community, found - and still find - a world with lots of prejudice and little to offer. There are shops, but they have little or no money. There are bars but alcohol and medication don't mix. There used to be social programs, but over time those were trimmed and cut and chopped and reduced to the point where they disappeared or became worthless. So they filled the long, lonely hours doing the same things they did in the hospital plus wandering in and out of libraries and fast food joints and bus stations randomly hollering or screaming or swearing or masturbating. Or literally stinking up the joint (since nobody was allowed to force them to bathe), urinating publicly and offending the citizenry. It was just like the hospital except open to the public 24/7. And now, as private citizens, if they misbehaved they went to jail, not back to the hospital. And no matter what you think of psychiatric hospitals, I promise you, jail is worse, especially if you're mentally unglued. And so, my friends, this is why, in every city or large town, you see disheveled, smelly folks shuffling around being openly crazy and getting laughed at or annoying bus drivers or cashiers or scaring moms with little kids. Let's not be coy. You've seen it, the cops are well aware of it, all kinds of people are aware of it. Social workers and the staff at homeless shelters and hospital emergency rooms know a lot of these folks by name. We've reformed the asylums and created modern psychiatry and developed drugs and used all this to place the mentally ill in a situation in which they are 110% free to not get better, to not be happy and to be stigmatized from sunup to sundown. Behold, progress! Sorry, here's yet another bit of irony: the mentally ill are stigmatized as unsociable, withdrawn, verbally aggressive, unpredictable, foul mouthed and malodorous. And why are they stereotyped in this way? Because so many of them demonstrate unsociable, withdrawn, verbally aggressive, unpredictable, foul mouthed, malodorous behaviors. But it's not their fault. It's not that they're beyond hope. They need supportive treatment but if such treatment gets funded, you can't force people to accept it, so around and around we go. I'm not advocating forced treatment as a blanket policy. But clearly the alternative does nothing. When people with mental illness are discharged from hospitals, their only support system is a poorly funded, byzantine maze of bureaucratic bullshit that's understaffed and/or (in many cases) staffed by people of extremely mediocre intelligence who are taught to follow rules made up by some idiot with a PhD who has no concept of what life is like at ground zero. Daily life in the 'real world' for the mentally is one gigantic Catch-22: you can't do B until you do A, but A isn't available so you're out of luck. If we treated cancer patients and old ladies with broken hips the way we treat the mentally ill, there'd be an outcry the like of which you've never heard. From Snot City, Idaho to Melanoma Beach, Florida, people would be screaming. If you're a parent, you usually don't let your kid crap their pants and wander around with an unwashed face and a head full of lice. If you have aging parents, you don't want to see them eating out of a dumpster and crouching in the shadows of buildings muttering to themselves. So why do we think we're doing such a great thing by allowing people with untreated symptoms of mental illness do precisely those sorts of things? How is that an improvement over a hospital with a (hopefully) trained staff that affords them three meals and a safe, dry, warm place to sleep? Now, I said that this social problem was created by well intentioned liberals who had big ideas and no common sense and I'm sticking to that. But just to balance things out, let me say that the situation I've been writing about has been wholeheartedly embraced by conservatives, who immediately saw that it saved lots and lots of tax money. You could hear the gears in their heads turning from miles away. "Wait...you're saying that these new drugs mean the nuts can all go out and live on the streets or whatever and we can close hospitals and lay off tons of state workers? Sign me up!" The consequence of closing hospitals is the creation of a sub-class that the costs the public more to be out of the hospital than in it. Many mentally ill people, sadly, become entangled with cops or the legal system or unsympathetic landlords. They end up in jail. Or remanded back to a state psychiatric hospital. Or placed on the psych ward of a major hospital until they can be patched up and sent back out where they get into more trouble. Many of these patients go in and out of the hospital several times a year, which means continuously filling out reports and giving ambulance rides and doing admission paperwork on someone you discharged five days ago, etc. And all of this costs a ton of money. This is what went through my mind while sitting at a long stoplight recently. I watched as a patient well known to me shuffled back and forth on the sidewalk, smoking and shaking his long, tangled unwashed hair, talking to himself, ignored by people and utterly alone. Each day is the same for him. If he can get a cheeseburger or a pack of smokes, that's a great day. If he gets shooed away by the cops and his voices scare him more than usual, that's a worse day. Past that, nothing changes. Now I ask you, what kind of fucking existence is that? Addendum: the author had one biological brother, who was mentally ill and died as a direct result of being homeless. He was homeless as a direct result of being mentally ill. |
charles o'meara, r.n.I have worked as a registered nurse for more than two decades, ninety percent of that time as a psychiatric nurse. Archives
June 2017
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