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> Looks like we are back to that situation again. The promise of big Pharma that medication would magically make mental illness able to be treated completely in

> Looks like we are back to that situation again. The promise of big Pharma that medication would magically make mental illness able to be treated completely in an outpatient manner has failed spectacularly. We shut down a lot of these mental asylums without providing a replacement. Big Pharma had nothing to do with the decision to get rid of mental hospitals. That was part of the generalized 70s breakdown of trust in authority and belief that community can do everything if you just believe hard enough. Care in the community never happened and if your entire strategy, insofar as you have one, relies on that, you just get deinstitutionalisation of the mentally ill. The same period saw quadrupling of crime rates. All part of the same phenomenon of social change.

dbcooper 4y ago
One of the worst aspects of this forum is the completely ignorant blaming of "big pharma" for any and all short-comings of health systems.
anovikov 4y ago
Well, since 70s, crime rates have significantly reduced. Their increase is a new thing, only in the last 5 years or so.
- barry-cotter 4y ago
  Yes, crime rates are much higher than the 60s but still a lot lower than the 70s. Much older population, drugs are a well known phenomenon not a new one, flight to the suburbs has happened once already in living memory. All the coping mechanisms are known and in large part still in place.
giraffe_lady 4y ago
Mmm there's more to it than that, and simplifying it that way is just as much an error as blaming "big pharma." The mental hospitals were horrific; unambiguous human rights violations were the norm and ubiquitous in them. The core of the deinstitutionalization movement was a legitimate reaction to that. It's also true that rapid developments, and growing (over) confidence, in psychiatric medicines were a major part of presenting an alternative that people could generally accept. And it fit well into the Reagony zeitgeist of the time, of removing large-scale institutions of social support. Deinstitutionalization was supposed to have two steps: first was to remove the large generalized asylums. The second was to be replacing them with smaller, community support-based, specialized institutions more aligned with the needs of the individuals. Obviously the second never happened, and you can argue that it was never meaningfully intended to by the people with the power to do it. But it wasn't even mostly a "breakdown in trust" in general, and actually displays a level of trust in large-scale commitment to social efforts that we rarely see anymore. It wasn't naiveté either, the institutions were genuinely horrific! They needed to be replaced with something, instead they were replaced with nothing. The fault is in the followthrough rather than the original impetus to deinstitutionalize.
- barry-cotter 4y ago
  > And it fit well into the Reagony zeitgeist of the time, of removing large-scale institutions of social support. Yes, if you don’t trust the social institutions because they’ve visibly failed you don’t support them. More or less everyone who was voting in the 80s would know that they were living in a society that was much higher crime than it had been. This is after huge expansions in social programmes. To see the modern version of this calculus > low density is a bet on institutional failure https://twitter.com/RogueWPA/status/1530298502382661634?s=20&t=XkwPfc4hQxvD9G07OAsITQ https://twitter.com/RogueWPA/status/1530298502382661634?s=20... A comment on this tweet > The reason people don't care about about "walkable cities" and the urbanism push in general is because basically every public space in America ends up becoming the territory of mentally unstable and drug addicted vagrants. People don't feel safe in them. Its a hard truth. https://twitter.com/river_is_nice/status/1530182991766507520?s=20&t=XkwPfc4hQxvD9G07OAsITQ https://twitter.com/river_is_nice/status/1530182991766507520...

dbcooper 4y ago

One of the worst aspects of this forum is the completely ignorant blaming of "big pharma" for any and all short-comings of health systems.

anovikov 4y ago

Well, since 70s, crime rates have significantly reduced. Their increase is a new thing, only in the last 5 years or so.

barry-cotter 4y ago
Yes, crime rates are much higher than the 60s but still a lot lower than the 70s. Much older population, drugs are a well known phenomenon not a new one, flight to the suburbs has happened once already in living memory. All the coping mechanisms are known and in large part still in place.

giraffe_lady 4y ago

Mmm there's more to it than that, and simplifying it that way is just as much an error as blaming "big pharma." The mental hospitals were horrific; unambiguous human rights violations were the norm and ubiquitous in them. The core of the deinstitutionalization movement was a legitimate reaction to that. It's also true that rapid developments, and growing (over) confidence, in psychiatric medicines were a major part of presenting an alternative that people could generally accept. And it fit well into the Reagony zeitgeist of the time, of removing large-scale institutions of social support. Deinstitutionalization was supposed to have two steps: first was to remove the large generalized asylums. The second was to be replacing them with smaller, community support-based, specialized institutions more aligned with the needs of the individuals. Obviously the second never happened, and you can argue that it was never meaningfully intended to by the people with the power to do it. But it wasn't even mostly a "breakdown in trust" in general, and actually displays a level of trust in large-scale commitment to social efforts that we rarely see anymore. It wasn't naiveté either, the institutions were genuinely horrific! They needed to be replaced with something, instead they were replaced with nothing. The fault is in the followthrough rather than the original impetus to deinstitutionalize.

barry-cotter 4y ago
> And it fit well into the Reagony zeitgeist of the time, of removing large-scale institutions of social support. Yes, if you don’t trust the social institutions because they’ve visibly failed you don’t support them. More or less everyone who was voting in the 80s would know that they were living in a society that was much higher crime than it had been. This is after huge expansions in social programmes. To see the modern version of this calculus > low density is a bet on institutional failure https://twitter.com/RogueWPA/status/1530298502382661634?s=20&t=XkwPfc4hQxvD9G07OAsITQ https://twitter.com/RogueWPA/status/1530298502382661634?s=20... A comment on this tweet > The reason people don't care about about "walkable cities" and the urbanism push in general is because basically every public space in America ends up becoming the territory of mentally unstable and drug addicted vagrants. People don't feel safe in them. Its a hard truth. https://twitter.com/river_is_nice/status/1530182991766507520?s=20&t=XkwPfc4hQxvD9G07OAsITQ https://twitter.com/river_is_nice/status/1530182991766507520...