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It's Time to Mandate Treatment of the Dangerously Mentally Ill

47 points by lxm 4y ago

jeffbee 4y ago
If the definition of insanity is doing the same thing repeatedly and expecting success, then a person who got trounced in the California gubernatorial election twice is clearly insane, therefore it’s time for mandatory treatment of Michael Shellenberger.
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blfr 4y ago
Most psychiatric treatments either don't work or have terrible side effects. People go off them not just because they're crazy. Which means that mandated treatment boils down to jailing many of these patients indefinitely. I can't find it right now but Freddie deBoer had a pretty good, and by good I mean harrowing, description of psychiatric medication, then medication for the side effects of psych meds, then... It's definitely not like taking antibiotics.
- notamy 4y ago
  Is it this? https://freddiedeboer.substack.com/p/the-weight https://freddiedeboer.substack.com/p/the-weight
  - blfr 4y ago
    Yes, that's the one. Thank you.
- biomcgary 4y ago
  Psychiatric treatments are largely shooting in the dark yet have always been popular among the elite. For example, the inventor of the lobotomy got the Nobel Prize in Medicine (https://en.wikipedia.org/wiki/Lobotomy https://en.wikipedia.org/wiki/Lobotomy). The biggest difference today is that drug companies get the money not the surgeons.
- denton-scratch 4y ago
  > Most psychiatric treatments either don't work or have terrible side effects. Well, yes; even talking therapy can have side-effects (and talking therapy often doesn't work). But I take it you're referring to treatment with anti-psychotic drugs. They have bad side-effects; but they work pretty consistently, in the sense that they suppress delusions and delusional behaviour. > jailing many of these patients indefinitely. That's never the right solution, unless you happen to be the owner of a private secure psychiatric clinic. You confine a patient while you medicate them, and release them a few months later, once they've convinced you they'll take their pills. Then you monitor them in the community, ideally indefinitely. > It's definitely not like taking antibiotics. It surely is not like taking antibiotics. Anti-psychotic drugs are very blunt instruments, including the more recent ones. If you had those side-effects, you'd correctly conclude that the drugs were making you ill.
- lamontcg 4y ago
  Murdering random people is a fairly terrible side effect of not taking psychiatric treatment.
sixhobbits 4y ago
> What’s needed is a single agency, let’s call it “New York Psych,” to address this growing crisis That... doesn't sound like a great idea. If you're all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives (people who get forced treatment while claiming that they are not ill and don't need it and then that turns out to be actually true). We could temporarily solve many of the world's problems if we had more authoritarianism, but it never ends well in fiction or in real life.
- whatshisface 4y ago
  Once the side effects of the medications kick in nobody will ever find out they didn't need them.
- throwawayacc2 4y ago
  I mean, you could say the same thing about jail sentences right? Presumably this forced treatment would be done via due process. Maybe in cases where a medical sentence is issued, half the jury are psychiatrists or neurologists or have some appropriate qualification.
  - LatteLazy 4y ago
    To be clear, are you saying people who commit crimes should (in some cases) face forced treatment. OR. That mental illness itself should mean forced treatment? Sentencing someone to a secure hospital rather than a prison for crimes is one thing. Sentencing them for not fitting in is another. Sorry if I have misunderstood
    - throwawayacc2 4y ago
      The case I was thinking about is something like, let's say there's a obviously mentally ill guy thratening to kill people. I'm talking hobo smeared with shit, reeking like all hell, tattered clothes, broken bottle in hand, screaming obscenities and frightening people with death threats in parking lots. You know, regulard tuesday evening in LA. I think the police should be allowed to arrest this man. A DA might decide to file this new mental health charge against him. Assuming the crazy person doesn't accept the plea deal he would be offered, voluntary commitment in a mental health facility, this goes to trial. If the trial finds the defendant guilty of being insane, he is forcefully commited to said mental health facilty. Are there issues? Sure. Is it somewhat ok because it's done via due process? Maybe. Is it better then letting potentially violent crazies in desperate need of mental health treatment run loose? Absolutely.
charlieyu1 4y ago
I am not sure these places are nice to the mentally ill. Are we going back to lock them in the madhouse like it is a century ago?
hoppyhoppy2 4y ago
>Common Sense: Honest news for sane people brought to you by Bari Weiss. Interesting branding. I don't think I've ever seen e.g. a newspaper or magazine marketed as "for sane people."
- ttpphd 4y ago
  This "I am sane I promise" t-shirt is causing people to ask me a lot of questions already answered by my t-shirt.
duxup 4y ago
Are we going to forcibly medicate them? I don't have a good answer to the problem here myself. But I'm pretty nervous about forcibly medicating folks...
- cvwright 4y ago
  Are you not also nervous about allowing them to continue assaulting and murdering random people?
  - duxup 4y ago
    Yes, but who then gets forcibly medicated? People who present a risk? That could be a lot of people... who picks what meds they are forced to take? How can you possibly ever get out of such a system?
  - LatteLazy 4y ago
    If you want to get into prevention, that's fine. But since most crime is committed by people without mental illnesses, you need to start by forcibly medicating the general population. Sound good?
    - vkou 4y ago
      I can't imagine that the people pushing this argument would be down with an involuntary mandate for a cheap, simple, safe, annual injection that would prevent tens and hundreds of thousands of deaths caused by a potentially deadly contagious respiratory disease, but I'm ready to be pleasantly surprised.
  - ttpphd 4y ago
    No, because I use my reasoning which includes taking in information about systems and balancing priorities. I am very opposed to broad reaching criminalization of mental illness. It will not stop violent crime, it will just stigmatize mental health and wellness. We should not set policy based on a knee-jerk, tunnel-vision, trauma/fear reaction. And anyway... Context is important: https://counciloncj.org/mid-year-2022-crime-pr/ https://counciloncj.org/mid-year-2022-crime-pr/
jimbob45 4y ago
I'm confused. Is the author not simply advocating for a federalized version of Florida's Baker Act[0]? [0] https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Baker_Act
- joshuamorton 4y ago
  No, they're advocating for forced medication of mentally ill people, so some firm of long term monitoring to ensure you take your pills every day.
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generalizations 4y ago
Reminds me of what happened to Alan Turing.
- mixmastamyk 4y ago
  It’s not the 50’s any longer. Mental illness is real.
  - NoraCodes 4y ago
    So is research that shows that mental illness has little link to violence. And, hell, so is homophobia! Let's say we make a law that says the state can black bag you and force you to take Abilify based on some arbitrary application of a psychology questionnaire by a state-employed psychologist; what's to say that a future administration doesn't reclassify homosexuality as a mental illness and do the exact same shit?
    - mixmastamyk 4y ago
      To conflate this with discrimination of the old days and use it as an excuse to prevent the ill from receiving care is contemptible. It's not like the government couldn't make you disappear if it wanted to badly enough already.
  - ttpphd 4y ago
    So is gun violence, the housing crisis, record levels of inequality, a deadly global pandemic, and anti-queer stochastic terror.
    - mixmastamyk 4y ago
      No comprendo.
  - ROTMetro 4y ago
    Right, in the DSM 5 they 'voted' that being gay is no longer deviant behavior. What a rigorous scientific system mental health professionals use to diagnose disorders.
phren0logy 4y ago
I'm a forensic psychiatrist. If there were an easy answer to this, we would have found it already, but I'll offer the following observation: I currently work in Oregon, where (in practice) it's more difficult than any other state or country where I have worked to admit someone involuntarily to the hospital. This has resulted in a greater number of mentally ill people staying untreated until the point that they do something that gets them arrested (which may or may not involve serious harm to someone else). In my opinion, this particular balance between individual autonomy vs involuntary treatment does not seem to be a net positive for either the community or individual rights.
- NoraCodes 4y ago
  In your experience, why do mentally ill people not seek treatment?
  - phren0logy 4y ago
    As a general rule of thumb, the more seriously ill someone is, the less likely they are to realize it. Like every "rule of thumb" there are many exceptions, but it's true enough. The other factor is that many medications for the treatment of psychotic disorders (psychotic meaning hallucinations, delusions, and disorganized thoughts - NOT meaning wanton violence) tend to have unpleasant side-effects. If you are convinced that you are not ill, you wouldn't want to take them either.
    - NoraCodes 4y ago
      Thank you, that makes sense. That said, though - doesn't that mean those people are making a pretty rational decision about avoiding treatment?
      - phren0logy 4y ago
        A rational decision is weighing the pros and cons. If you are blind to your illness (and the ramifications, for example having killed a family member you care about because you believed them to be a demon), then how can you weigh the pros of having those delusions resolve vs the cons of weight gain and potential diabetes? It's not always irrational to refuse, but a total absence of insight into illness precludes a rational decision.
ttpphd 4y ago
It's such a terrible, terrible idea to turn mental and behavioral health into arms of the police state. Horrible plan that will radically harm everyone regardless of any medical conditions they have.
mplewis 4y ago
Yeah, the thing we need is more policing and non-consensual treatment. What the hell is wrong with you?
rajeshp1986 4y ago
Leaving them out is inhumane to the rest of the society. Is the right of an individual greater than society? especially one who has been violent in the past towards other members of the society either through one's volition or not? The lawmakers and the public in American in general are not able to digest this correctly. There is no ethical dilemma here. One person who is/can harm another human being needs to be put in a place where they can't cause harm(This includes self-harm as well).
- NoraCodes 4y ago
  How do you propose we identify such individuals? How do you avoid false positives? And what will you do with them once you've done so? Antipsychotics? Electroshock? Just let people rot in prison for their whole lives because they answered a question wrong on a questionnaire?
giantg2 4y ago
I mean, there used to be assylums. Of course those had their own problems/abuses too (as the article points out). "including the right to avoid the consequences of their behavior." To me, this reeks of bias. They don't avoid consequences. The consequences are different (secure psychiatric facility vs prison). The main point of the punishment for a crime is to prevent it from happening again (and Gove the victim closure/recourse within the confines of the law). Stick a psychotic person in prison, they likely will be even worse when they come out. At least with treatment there's a chance at recovery and prevention. There needs to be a balance between mandating treatments and freedom. Can we mandate testing, treatment, and restrictions in freedoms for infectious diseases in the name of protecting society? It seems like there's a lot of conflicting precedent on that (STIs, vs covid, vs flu, etc). Also, if the state institutions shut down so long ago, is there any background information on the increase in the mentally ill in prison and on the street? Is there an overall increase in mental illness, or just a distribution issue? Or could it even be diagnostic sensitivity or scope creep of the definitions (likely what the ACLU and others are truly worried about, in addition to the Minority Report-esque pre-crime element)?
- orwin 4y ago
  When my country started removing asylums, it created at the same times community and youth/family centers where you can get pre-checked with certified nurses and mediators (i used that personally), and hospitals working as asylums for long-term treatments, but not as cut of society as asylums were. We also have psychologists available at 'formation centers' (messed up traduction : basically institutes mandated to find adapted formations to people on benefits (or stuck after their useless math bachelor degree... Hey, that's me again!) Granted, we probably the worse country in the world for that to happen, because most low-level mental healthcare workers are taught a lot of fraudulent and pseudoscientific theories like Young archetypes and other post-freud shenanigans, but it seems we are somehow better at taking care of our people than the country where most cutting-edge theories and treatments come from.
bezier-curve 4y ago
Perhaps in the US we could make healthcare affordable to just the "non-dangerously" mentally ill first before vilifying mental illness in general. Or perhaps, we could take a hard look at gun control laws that enable the danger instead of using mentally ill people as a scapegoat, which is what conservatives prefer to do any time there's a mass shooting.
- adventured 4y ago
  The biggest gun problem in the US is urban shootings via hand guns, by a drastic margin. I'd like to see a plan for removing all the illegally owned guns from US cities. I rarely see anybody talk about how to get those off the streets. Those guns are already illegal and nobody is doing anything about it, nothing that is making a dent in the problem anyway. The murders and shootings continue just as they have for decades, accounting for the majority of US murders by gun. Half of the major US cities are war zones because of illegal hand guns, and it has nothing to do with the mentally ill and mass shootings. And yes, we should still deal with the mental illness issue around gun access and ownership simultaneously.
  - tevon 4y ago
    The issue here isn't guns though, sadly. Most of the violence from homeless mentally ill folks isn't gun violence. Walking around SF, I (a regular looking guy) have been accosted multiple times. Its legitimately frightening, and would be so much worse if I was elderly or disabled or otherwise unable to defend myself.
akira2501 4y ago
This article itself highlights the absolute discomfort I have with this proposal, and why I think it's ultimately unethical. They completely switch from presenting a case about the "dangerously mentally ill with a propensity for murder" casually to just the "mentally ill." Even drawing a line between the two in the first place can be fraught with ethical difficulties, and all the "advocates" in this process are not duty-bound to the person who's mental health status is about to be "determined" by the state; and it's highly likely everyone else involved in the process will have some financial incentive to start as much treatment as is possible. It's easy to see the imputed process here making more errors than it prevents, since it seems to be a process that can be applied before any guilt is established.
jdlyga 4y ago
I knew this was New York before even reading this. It's getting bad out there, and we need to find a solution to address it.
- lotsofpulp 4y ago
  It is anyplace in the US with some combination of: -Temperate weather -Dense environment where travel by personal vehicle is not necessary -society does not imprison people for drug use/sleeping outside (trespassing)/other activities of people with severe mental illness NYC qualifies for the dense environment, western US cities contend with temperate weather and Martin v Boise ruling, plus other politics that prevent imprisoning mentally ill people. Hence suburbs that require personal cars are the best solution for those looking to minimize interactions, since the personal car serves as a credit check of sorts. And/or living in areas where weather does not permit living outdoors.
  - pyuser583 4y ago
    San Francisco
    - lotsofpulp 4y ago
      What about San Francisco?
chatterhead 4y ago
"It's Time to..." In my experience, these kinds of headlines are written by specific kinds of people for specific kinds of people and don't really have anything to do with the rest of us other than being forced to see it.
adventured 4y ago
No it's not. First you have to further pacify the policing and government systems of the US, which are far too often hyper violent and cruel. That process has only just barely begun as it is (starting with reducing sentencing, sane drug laws, reducing police brutality, etc). If you mandate X for the dangerously mentally ill (which ones are supposedly dangerously mentally ill?), what you'll get is terrifying abuse of the mentally ill broadly, in many different ways. The US is not Finland. The US is not Norway. The US is not Estonia. We're not some soft, cuddly European-style welfare state. The US has a very, very, very violent government, a superpower government that likes to abuse its power, one that often does not respect the rights of its citizens. Before you give the governments in the US (federal, state or local) such powers of treatment (which would include forced detainment against their will, instantly walking to the thin line of human rights violations) you better pacify it first, or you will not like the results. Then we'll be here 20 years from now and it'll be an avalanche of laments about all the horrific human rights violations that happened under the Treating Mentally Ill People With Respect Act. Who could have seen it coming?!? We didn't expect them to do such horrible things with those powers! And so on.
- pyuser583 4y ago
  I have had very, very, very good interactions with police regarding care for mentally I’ll relatives. Really above and beyond. Part of this is that our local police department has rigorous selections and training. All cops must have a graduate degree before receiving a permanent job offer.
throwhn83962 4y ago
Many people want treatment but cannot find it because it's stigmatized, too expensive and/or the waiting lists are too long. This seems like a bad but easy solution to a serious problem
sudden_dystopia 4y ago
Who exactly is doing the mandating though? And then it’s just a matter of time until the political party in power starts having their opposition committed for being “dangerously mentally ill”.
- kelseyfrog 4y ago
  What's stopping that from happening now? We already have the Baker Act and CA's 5x50s.
  - NoraCodes 4y ago
    And, indeed, when homosexuality and transness were considered mental illnesses, people were, in fact, abused using those laws. Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers.
    - Minor49er 4y ago
      > Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers Are you talking about the kids who are identified as trans and put into conversion therapy?
      - NoraCodes 4y ago
        Not only trans; many gay children and generally gender-nonconforming minors go through this.
        Minor49er 4y ago
        Oh, I was asking about the opposite, where kids are identified as being trans by adults, so they are put into conversion therapy which includes dangerous things like puberty blockers and hormone treatments. Also I don't think there's such a thing as gay children since kids aren't sexually active
A4ET8a8uTh0 4y ago
It is high time, we only allow one type of person to exist on this planet. I am comfortable that this type of person will not be me or anyone I personally care about so it is ok. Anyone who does not fit the mold must be identified, broken into malleable pieces and then, ideally, reset, but failing that removed from polite society. It is a hard read, but that is this article is arguing for. edit: Hell, I get freedom is scary. There are times I see and hear of people who use it in ways I would never think of considering thinking of dreaming about, but blanket convenient labeling, followed by drugging to ensure they can rendered docile is one of the more horrifying things a civilization can do to a person all the while proponent of the policy managing to feel warm and fuzzy about it. It certainly does not help ( and likely colors my thoughts ) that I regularly attend conferences where some well-meaning soul asks a seemingly benign question along the lines of 'We are already have data X; why are we not using it to do Y.'
kelseyfrog 4y ago
Strange that the article left out of the history the pivotal point where the Mental Health Systems Act of 1980 was about to go into effect and then was entirely repealed in The Omnibus Budget Reconciliation Act of 1981 because the new person in charge hailed from a part of the country where psychiatry was associated with Communism even though he was shot by a person with untreated schizophrenia six months before.
NoraCodes 4y ago
When people say that conservatism is fundamentally at odds with concepts like the human right to bodily autonomy, this kind of nonsense is what they mean. There is no authoritative or even moderately reliable way to diagnose "dangerous" mental illness. It is a fairly well established fact that mental illness is more associated with _victimization_ than perpetration of violence. This kind of scaremongering is entirely based in ableism, not actual "common sense."
- CodeSgt 4y ago
  Is there anything in the article indicating that this is some sort of conservative viewpoint or did you just decide to label it such because it seemed like an easy way for you to score a point? I consider myself to be more right-leaning and "conservative" but neither I nor any other conservatives I know would support this. Typically, though not always, people on the right want to take away power from the government - not enhance it as this would do.
  - NoraCodes 4y ago
    It's Bari Weiss's publication, and she describes it, and herself, as conservative.
    - CodeSgt 4y ago
      A publication having a political bias doesn't correlate to every product of that publication being one which broadly represents its political association. Nor can you in good faith generalize the ideas of a single person to be representative of all members of the political party that individual claims to be a part of.
      - NoraCodes 4y ago
        This is just textbook no true Scotsman. She's a conservative, and a prominent one.
        4y ago
1024core 4y ago
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souterrain 4y ago
Persons suffering from mental health conditions suffer them long before they warrant the "dangerous" moniker. The solution lies in substantive treatment of all mental health conditions. The disparity of care between mental health conditions and all other health conditions is laughable, including in New York State, despite "mental health parity" rules. For those with Medicaid (public health program for those meeting certain low-income or disability criteria), this disparity isn't as severe. However, many young adults with serious mental illness are covered by commercial health plans via their parents, and it is these plans that are relatively weak when it comes to mental health coverage. These plans do well when it comes to emergency, in-patient interventions, but fall short when it comes to ongoing outpatient support. Much of this is due to lack of participation by mental healthcare providers in the insurance reimbursement system, likely as a result of low reimbursement rates. Why see patients with serious mental illness reimbursed at $100 a session when one can see less complex patients paying cash at $150 or even $200 a session. This has been exacerbated by the prevalence of mobile app-based therapy arrangements, which, again, are suitable for someone who is reasonably healthy and needs some additional support, but may be completely inappropriate for those with a serious mental health condition. Mental health care parity laws need teeth. The free market will not solve this.
jacksnipe 4y ago
This article presents an absolutely DISTURBINGLY disingenuous view of the civil-rights-forward view here. > The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including a he right to avoid the consequences of their behavior. No, the ACLU believes that without strong protections against forced hospitalization and treatment, people will be abused and stripped of rights in the false name of community safety. The ACLU doesn’t just believe this on idealist grounds, they believe this because that is the legacy of asylums in the USA.
larvaetron 4y ago
I've been mostly a lurker on HN for over a decade. I never thought I'd see the day where a large portion of the userbase supports bringing back mental asylums and forced medication.
- ROTMetro 4y ago
  But the mental health providers voted to change the DSM 5 to not list being gay as a mental health disorder so we can trust them now. And hope they don't change their mind, sorry I mean take a rigorous scientific vote, and change it back in DSM 6. I'm sure gay people take comfort in knowing as of the 2013 DSM 5 there are no longer mental health categories based solely on sexual orientation.
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tevon 4y ago
We should be looking at models for how this system has worked elsewhere. If in fact the cause here is strictly biological (its likely a mix of biological and societal) factors, then there should be an even distributions in other populations. We should look to the Netherlands or similar to find models for effectively dealing with potentially violent mental illness.
kmeisthax 4y ago
Motte: Maybe deinstitutionalizing the mentally ill has gone too far Bailey: >The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including the right to avoid the consequences of their behavior.
devteambravo 4y ago
Define dangerously mentally ill please. I'm afraid that such definition might not be the same, depending on who you are, your religion, your sexual preference...etc Will the definition of dangerously mentally ill be the same in urban Vermont vs rural Mississippi? We have a lot of problems with racism in the US. How do we ensure that this won't become another tool of oppression? Maybe we start by not electing the dangerously mentally ill to the presidency instead.
pyuser583 4y ago
This already happens. Often plea bargains include “must receive mental health treatment.”
denton-scratch 4y ago
There's a reason people with serious mental illness don't take their medicines: they have unpleasant side-effects. The main type of medication is anti-psychotics. These drugs are also classed as "major tranquilizers" - drugs such as the notorious "chemical cosh" haloperidol are in this class. They suppress delusions, or at least delusional behaviour; but they make you gain weight, rock, tremble, mumble. The side-effects are progressive. Modern anti-psychotics have less side-effects than the old ones, but their effects are very marked. For people with bipolar, their illness sometimes makes them feel alive and cheerful, and the drugs take that away from them, depriving them of affect and zest for life. Basically the pills make them unhappy. So we're discussing forcing people to take pills that make them feel ill or unhappy. That's only justifiable if the compulsion regime is completely trustworthy. We have a compulsion regime in the UK (we tore down our asylums back in the 80s, just like the US). If you have an episode, you can be incarcerated for a few months on the say-so of two doctors. It seems to work alright - as far as I can see, they farm you out to some private secure clinic. But between the train-wreck of US law enforcement and the US reluctance to spend money on public health, along with the heavy, heavy politicization of everything in the USA, I think it would be dangerous to adopt the same model in the USA.
aaaaaaaaaaab 4y ago
Love how people in this topic keep arguing about the most strawman interpretation of the article. Noone is saying we should commit "neurodivergent" individuals with a minor Adderall addiction into mental asylums where they will be subjected to shock therapy... The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds. Sorry, but this is not some "on the spectrum" hippy bullshit - these people are seriously ill and need to be treated, and kept in check to make sure they stick to their treatment.
- denton-scratch 4y ago
  > The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds. You are suggesting that unmedicated people with schizophrenia are dangerous. That is mainly just wrong. The greatest danger that unmedicated schizophrenics pose is to themselves. And they are more likely to be murdered than to commit murder themselves.
seer-zig 4y ago
The first question that comes to mind is why has mental illness been substantially increasing recently over the past few decades? Something about our lifestyle definitely contributes to it.
Overtonwindow 4y ago
This alarms me considerably, as would anything that forces someone to do anything they do not want to do, whether it's for their own good or not. That said, however, I think there must be a system to treat those who are dangerous to themselves, or to society. I see the problem but once you go down that pathway where does it stop? Government does not back down, and I am deeply concerned that a system that mandates the treatment of someone for a disease could expand that definition, far beyond what anyone intended.

47 points by lxm 4y ago

If the definition of insanity is doing the same thing repeatedly and expecting success, then a person who got trounced in the California gubernatorial election twice is clearly insane, therefore it’s time for mandatory treatment of Michael Shellenberger.

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blfr 4y ago

Most psychiatric treatments either don't work or have terrible side effects. People go off them not just because they're crazy. Which means that mandated treatment boils down to jailing many of these patients indefinitely. I can't find it right now but Freddie deBoer had a pretty good, and by good I mean harrowing, description of psychiatric medication, then medication for the side effects of psych meds, then... It's definitely not like taking antibiotics.

notamy 4y ago
Is it this? https://freddiedeboer.substack.com/p/the-weight https://freddiedeboer.substack.com/p/the-weight
- blfr 4y ago
  Yes, that's the one. Thank you.
biomcgary 4y ago
Psychiatric treatments are largely shooting in the dark yet have always been popular among the elite. For example, the inventor of the lobotomy got the Nobel Prize in Medicine (https://en.wikipedia.org/wiki/Lobotomy https://en.wikipedia.org/wiki/Lobotomy). The biggest difference today is that drug companies get the money not the surgeons.
denton-scratch 4y ago
> Most psychiatric treatments either don't work or have terrible side effects. Well, yes; even talking therapy can have side-effects (and talking therapy often doesn't work). But I take it you're referring to treatment with anti-psychotic drugs. They have bad side-effects; but they work pretty consistently, in the sense that they suppress delusions and delusional behaviour. > jailing many of these patients indefinitely. That's never the right solution, unless you happen to be the owner of a private secure psychiatric clinic. You confine a patient while you medicate them, and release them a few months later, once they've convinced you they'll take their pills. Then you monitor them in the community, ideally indefinitely. > It's definitely not like taking antibiotics. It surely is not like taking antibiotics. Anti-psychotic drugs are very blunt instruments, including the more recent ones. If you had those side-effects, you'd correctly conclude that the drugs were making you ill.
lamontcg 4y ago
Murdering random people is a fairly terrible side effect of not taking psychiatric treatment.

sixhobbits 4y ago

> What’s needed is a single agency, let’s call it “New York Psych,” to address this growing crisis That... doesn't sound like a great idea. If you're all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives (people who get forced treatment while claiming that they are not ill and don't need it and then that turns out to be actually true). We could temporarily solve many of the world's problems if we had more authoritarianism, but it never ends well in fiction or in real life.

whatshisface 4y ago
Once the side effects of the medications kick in nobody will ever find out they didn't need them.
throwawayacc2 4y ago
I mean, you could say the same thing about jail sentences right? Presumably this forced treatment would be done via due process. Maybe in cases where a medical sentence is issued, half the jury are psychiatrists or neurologists or have some appropriate qualification.
- LatteLazy 4y ago
  To be clear, are you saying people who commit crimes should (in some cases) face forced treatment. OR. That mental illness itself should mean forced treatment? Sentencing someone to a secure hospital rather than a prison for crimes is one thing. Sentencing them for not fitting in is another. Sorry if I have misunderstood
  - throwawayacc2 4y ago
    The case I was thinking about is something like, let's say there's a obviously mentally ill guy thratening to kill people. I'm talking hobo smeared with shit, reeking like all hell, tattered clothes, broken bottle in hand, screaming obscenities and frightening people with death threats in parking lots. You know, regulard tuesday evening in LA. I think the police should be allowed to arrest this man. A DA might decide to file this new mental health charge against him. Assuming the crazy person doesn't accept the plea deal he would be offered, voluntary commitment in a mental health facility, this goes to trial. If the trial finds the defendant guilty of being insane, he is forcefully commited to said mental health facilty. Are there issues? Sure. Is it somewhat ok because it's done via due process? Maybe. Is it better then letting potentially violent crazies in desperate need of mental health treatment run loose? Absolutely.

charlieyu1 4y ago

I am not sure these places are nice to the mentally ill. Are we going back to lock them in the madhouse like it is a century ago?

hoppyhoppy2 4y ago

>Common Sense: Honest news for sane people brought to you by Bari Weiss. Interesting branding. I don't think I've ever seen e.g. a newspaper or magazine marketed as "for sane people."

ttpphd 4y ago
This "I am sane I promise" t-shirt is causing people to ask me a lot of questions already answered by my t-shirt.

duxup 4y ago

Are we going to forcibly medicate them? I don't have a good answer to the problem here myself. But I'm pretty nervous about forcibly medicating folks...

cvwright 4y ago
Are you not also nervous about allowing them to continue assaulting and murdering random people?
- duxup 4y ago
  Yes, but who then gets forcibly medicated? People who present a risk? That could be a lot of people... who picks what meds they are forced to take? How can you possibly ever get out of such a system?
- LatteLazy 4y ago
  If you want to get into prevention, that's fine. But since most crime is committed by people without mental illnesses, you need to start by forcibly medicating the general population. Sound good?
  - vkou 4y ago
    I can't imagine that the people pushing this argument would be down with an involuntary mandate for a cheap, simple, safe, annual injection that would prevent tens and hundreds of thousands of deaths caused by a potentially deadly contagious respiratory disease, but I'm ready to be pleasantly surprised.
- ttpphd 4y ago
  No, because I use my reasoning which includes taking in information about systems and balancing priorities. I am very opposed to broad reaching criminalization of mental illness. It will not stop violent crime, it will just stigmatize mental health and wellness. We should not set policy based on a knee-jerk, tunnel-vision, trauma/fear reaction. And anyway... Context is important: https://counciloncj.org/mid-year-2022-crime-pr/ https://counciloncj.org/mid-year-2022-crime-pr/

jimbob45 4y ago

I'm confused. Is the author not simply advocating for a federalized version of Florida's Baker Act[0]? [0] https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Baker_Act

joshuamorton 4y ago
No, they're advocating for forced medication of mentally ill people, so some firm of long term monitoring to ensure you take your pills every day.

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generalizations 4y ago

Reminds me of what happened to Alan Turing.

mixmastamyk 4y ago
It’s not the 50’s any longer. Mental illness is real.
- NoraCodes 4y ago
  So is research that shows that mental illness has little link to violence. And, hell, so is homophobia! Let's say we make a law that says the state can black bag you and force you to take Abilify based on some arbitrary application of a psychology questionnaire by a state-employed psychologist; what's to say that a future administration doesn't reclassify homosexuality as a mental illness and do the exact same shit?
  - mixmastamyk 4y ago
    To conflate this with discrimination of the old days and use it as an excuse to prevent the ill from receiving care is contemptible. It's not like the government couldn't make you disappear if it wanted to badly enough already.
- ttpphd 4y ago
  So is gun violence, the housing crisis, record levels of inequality, a deadly global pandemic, and anti-queer stochastic terror.
  - mixmastamyk 4y ago
    No comprendo.
- ROTMetro 4y ago
  Right, in the DSM 5 they 'voted' that being gay is no longer deviant behavior. What a rigorous scientific system mental health professionals use to diagnose disorders.

phren0logy 4y ago

I'm a forensic psychiatrist. If there were an easy answer to this, we would have found it already, but I'll offer the following observation: I currently work in Oregon, where (in practice) it's more difficult than any other state or country where I have worked to admit someone involuntarily to the hospital. This has resulted in a greater number of mentally ill people staying untreated until the point that they do something that gets them arrested (which may or may not involve serious harm to someone else). In my opinion, this particular balance between individual autonomy vs involuntary treatment does not seem to be a net positive for either the community or individual rights.

NoraCodes 4y ago
In your experience, why do mentally ill people not seek treatment?
- phren0logy 4y ago
  As a general rule of thumb, the more seriously ill someone is, the less likely they are to realize it. Like every "rule of thumb" there are many exceptions, but it's true enough. The other factor is that many medications for the treatment of psychotic disorders (psychotic meaning hallucinations, delusions, and disorganized thoughts - NOT meaning wanton violence) tend to have unpleasant side-effects. If you are convinced that you are not ill, you wouldn't want to take them either.
  - NoraCodes 4y ago
    Thank you, that makes sense. That said, though - doesn't that mean those people are making a pretty rational decision about avoiding treatment?
    - phren0logy 4y ago
      A rational decision is weighing the pros and cons. If you are blind to your illness (and the ramifications, for example having killed a family member you care about because you believed them to be a demon), then how can you weigh the pros of having those delusions resolve vs the cons of weight gain and potential diabetes? It's not always irrational to refuse, but a total absence of insight into illness precludes a rational decision.

ttpphd 4y ago

It's such a terrible, terrible idea to turn mental and behavioral health into arms of the police state. Horrible plan that will radically harm everyone regardless of any medical conditions they have.

mplewis 4y ago

Yeah, the thing we need is more policing and non-consensual treatment. What the hell is wrong with you?

rajeshp1986 4y ago

Leaving them out is inhumane to the rest of the society. Is the right of an individual greater than society? especially one who has been violent in the past towards other members of the society either through one's volition or not? The lawmakers and the public in American in general are not able to digest this correctly. There is no ethical dilemma here. One person who is/can harm another human being needs to be put in a place where they can't cause harm(This includes self-harm as well).

NoraCodes 4y ago
How do you propose we identify such individuals? How do you avoid false positives? And what will you do with them once you've done so? Antipsychotics? Electroshock? Just let people rot in prison for their whole lives because they answered a question wrong on a questionnaire?

giantg2 4y ago

I mean, there used to be assylums. Of course those had their own problems/abuses too (as the article points out). "including the right to avoid the consequences of their behavior." To me, this reeks of bias. They don't avoid consequences. The consequences are different (secure psychiatric facility vs prison). The main point of the punishment for a crime is to prevent it from happening again (and Gove the victim closure/recourse within the confines of the law). Stick a psychotic person in prison, they likely will be even worse when they come out. At least with treatment there's a chance at recovery and prevention. There needs to be a balance between mandating treatments and freedom. Can we mandate testing, treatment, and restrictions in freedoms for infectious diseases in the name of protecting society? It seems like there's a lot of conflicting precedent on that (STIs, vs covid, vs flu, etc). Also, if the state institutions shut down so long ago, is there any background information on the increase in the mentally ill in prison and on the street? Is there an overall increase in mental illness, or just a distribution issue? Or could it even be diagnostic sensitivity or scope creep of the definitions (likely what the ACLU and others are truly worried about, in addition to the Minority Report-esque pre-crime element)?

orwin 4y ago
When my country started removing asylums, it created at the same times community and youth/family centers where you can get pre-checked with certified nurses and mediators (i used that personally), and hospitals working as asylums for long-term treatments, but not as cut of society as asylums were. We also have psychologists available at 'formation centers' (messed up traduction : basically institutes mandated to find adapted formations to people on benefits (or stuck after their useless math bachelor degree... Hey, that's me again!) Granted, we probably the worse country in the world for that to happen, because most low-level mental healthcare workers are taught a lot of fraudulent and pseudoscientific theories like Young archetypes and other post-freud shenanigans, but it seems we are somehow better at taking care of our people than the country where most cutting-edge theories and treatments come from.

bezier-curve 4y ago

Perhaps in the US we could make healthcare affordable to just the "non-dangerously" mentally ill first before vilifying mental illness in general. Or perhaps, we could take a hard look at gun control laws that enable the danger instead of using mentally ill people as a scapegoat, which is what conservatives prefer to do any time there's a mass shooting.

adventured 4y ago
The biggest gun problem in the US is urban shootings via hand guns, by a drastic margin. I'd like to see a plan for removing all the illegally owned guns from US cities. I rarely see anybody talk about how to get those off the streets. Those guns are already illegal and nobody is doing anything about it, nothing that is making a dent in the problem anyway. The murders and shootings continue just as they have for decades, accounting for the majority of US murders by gun. Half of the major US cities are war zones because of illegal hand guns, and it has nothing to do with the mentally ill and mass shootings. And yes, we should still deal with the mental illness issue around gun access and ownership simultaneously.
- tevon 4y ago
  The issue here isn't guns though, sadly. Most of the violence from homeless mentally ill folks isn't gun violence. Walking around SF, I (a regular looking guy) have been accosted multiple times. Its legitimately frightening, and would be so much worse if I was elderly or disabled or otherwise unable to defend myself.

akira2501 4y ago

This article itself highlights the absolute discomfort I have with this proposal, and why I think it's ultimately unethical. They completely switch from presenting a case about the "dangerously mentally ill with a propensity for murder" casually to just the "mentally ill." Even drawing a line between the two in the first place can be fraught with ethical difficulties, and all the "advocates" in this process are not duty-bound to the person who's mental health status is about to be "determined" by the state; and it's highly likely everyone else involved in the process will have some financial incentive to start as much treatment as is possible. It's easy to see the imputed process here making more errors than it prevents, since it seems to be a process that can be applied before any guilt is established.

jdlyga 4y ago

I knew this was New York before even reading this. It's getting bad out there, and we need to find a solution to address it.

lotsofpulp 4y ago
It is anyplace in the US with some combination of: -Temperate weather -Dense environment where travel by personal vehicle is not necessary -society does not imprison people for drug use/sleeping outside (trespassing)/other activities of people with severe mental illness NYC qualifies for the dense environment, western US cities contend with temperate weather and Martin v Boise ruling, plus other politics that prevent imprisoning mentally ill people. Hence suburbs that require personal cars are the best solution for those looking to minimize interactions, since the personal car serves as a credit check of sorts. And/or living in areas where weather does not permit living outdoors.
- pyuser583 4y ago
  San Francisco
  - lotsofpulp 4y ago
    What about San Francisco?

chatterhead 4y ago

"It's Time to..." In my experience, these kinds of headlines are written by specific kinds of people for specific kinds of people and don't really have anything to do with the rest of us other than being forced to see it.

adventured 4y ago

No it's not. First you have to further pacify the policing and government systems of the US, which are far too often hyper violent and cruel. That process has only just barely begun as it is (starting with reducing sentencing, sane drug laws, reducing police brutality, etc). If you mandate X for the dangerously mentally ill (which ones are supposedly dangerously mentally ill?), what you'll get is terrifying abuse of the mentally ill broadly, in many different ways. The US is not Finland. The US is not Norway. The US is not Estonia. We're not some soft, cuddly European-style welfare state. The US has a very, very, very violent government, a superpower government that likes to abuse its power, one that often does not respect the rights of its citizens. Before you give the governments in the US (federal, state or local) such powers of treatment (which would include forced detainment against their will, instantly walking to the thin line of human rights violations) you better pacify it first, or you will not like the results. Then we'll be here 20 years from now and it'll be an avalanche of laments about all the horrific human rights violations that happened under the Treating Mentally Ill People With Respect Act. Who could have seen it coming?!? We didn't expect them to do such horrible things with those powers! And so on.

pyuser583 4y ago
I have had very, very, very good interactions with police regarding care for mentally I’ll relatives. Really above and beyond. Part of this is that our local police department has rigorous selections and training. All cops must have a graduate degree before receiving a permanent job offer.

throwhn83962 4y ago

Many people want treatment but cannot find it because it's stigmatized, too expensive and/or the waiting lists are too long. This seems like a bad but easy solution to a serious problem

sudden_dystopia 4y ago

Who exactly is doing the mandating though? And then it’s just a matter of time until the political party in power starts having their opposition committed for being “dangerously mentally ill”.

kelseyfrog 4y ago
What's stopping that from happening now? We already have the Baker Act and CA's 5x50s.
- NoraCodes 4y ago
  And, indeed, when homosexuality and transness were considered mental illnesses, people were, in fact, abused using those laws. Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers.
  - Minor49er 4y ago
    > Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers Are you talking about the kids who are identified as trans and put into conversion therapy?
    - NoraCodes 4y ago
      Not only trans; many gay children and generally gender-nonconforming minors go through this.
      - Minor49er 4y ago
        Oh, I was asking about the opposite, where kids are identified as being trans by adults, so they are put into conversion therapy which includes dangerous things like puberty blockers and hormone treatments. Also I don't think there's such a thing as gay children since kids aren't sexually active

A4ET8a8uTh0 4y ago

It is high time, we only allow one type of person to exist on this planet. I am comfortable that this type of person will not be me or anyone I personally care about so it is ok. Anyone who does not fit the mold must be identified, broken into malleable pieces and then, ideally, reset, but failing that removed from polite society. It is a hard read, but that is this article is arguing for. edit: Hell, I get freedom is scary. There are times I see and hear of people who use it in ways I would never think of considering thinking of dreaming about, but blanket convenient labeling, followed by drugging to ensure they can rendered docile is one of the more horrifying things a civilization can do to a person all the while proponent of the policy managing to feel warm and fuzzy about it. It certainly does not help ( and likely colors my thoughts ) that I regularly attend conferences where some well-meaning soul asks a seemingly benign question along the lines of 'We are already have data X; why are we not using it to do Y.'

kelseyfrog 4y ago

Strange that the article left out of the history the pivotal point where the Mental Health Systems Act of 1980 was about to go into effect and then was entirely repealed in The Omnibus Budget Reconciliation Act of 1981 because the new person in charge hailed from a part of the country where psychiatry was associated with Communism even though he was shot by a person with untreated schizophrenia six months before.

NoraCodes 4y ago

When people say that conservatism is fundamentally at odds with concepts like the human right to bodily autonomy, this kind of nonsense is what they mean. There is no authoritative or even moderately reliable way to diagnose "dangerous" mental illness. It is a fairly well established fact that mental illness is more associated with _victimization_ than perpetration of violence. This kind of scaremongering is entirely based in ableism, not actual "common sense."

CodeSgt 4y ago
Is there anything in the article indicating that this is some sort of conservative viewpoint or did you just decide to label it such because it seemed like an easy way for you to score a point? I consider myself to be more right-leaning and "conservative" but neither I nor any other conservatives I know would support this. Typically, though not always, people on the right want to take away power from the government - not enhance it as this would do.
- NoraCodes 4y ago
  It's Bari Weiss's publication, and she describes it, and herself, as conservative.
  - CodeSgt 4y ago
    A publication having a political bias doesn't correlate to every product of that publication being one which broadly represents its political association. Nor can you in good faith generalize the ideas of a single person to be representative of all members of the political party that individual claims to be a part of.
    - NoraCodes 4y ago
      This is just textbook no true Scotsman. She's a conservative, and a prominent one.
      - 4y ago

1024core 4y ago

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souterrain 4y ago

Persons suffering from mental health conditions suffer them long before they warrant the "dangerous" moniker. The solution lies in substantive treatment of all mental health conditions. The disparity of care between mental health conditions and all other health conditions is laughable, including in New York State, despite "mental health parity" rules. For those with Medicaid (public health program for those meeting certain low-income or disability criteria), this disparity isn't as severe. However, many young adults with serious mental illness are covered by commercial health plans via their parents, and it is these plans that are relatively weak when it comes to mental health coverage. These plans do well when it comes to emergency, in-patient interventions, but fall short when it comes to ongoing outpatient support. Much of this is due to lack of participation by mental healthcare providers in the insurance reimbursement system, likely as a result of low reimbursement rates. Why see patients with serious mental illness reimbursed at $100 a session when one can see less complex patients paying cash at $150 or even $200 a session. This has been exacerbated by the prevalence of mobile app-based therapy arrangements, which, again, are suitable for someone who is reasonably healthy and needs some additional support, but may be completely inappropriate for those with a serious mental health condition. Mental health care parity laws need teeth. The free market will not solve this.

jacksnipe 4y ago

This article presents an absolutely DISTURBINGLY disingenuous view of the civil-rights-forward view here. > The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including a he right to avoid the consequences of their behavior. No, the ACLU believes that without strong protections against forced hospitalization and treatment, people will be abused and stripped of rights in the false name of community safety. The ACLU doesn’t just believe this on idealist grounds, they believe this because that is the legacy of asylums in the USA.

larvaetron 4y ago

I've been mostly a lurker on HN for over a decade. I never thought I'd see the day where a large portion of the userbase supports bringing back mental asylums and forced medication.

ROTMetro 4y ago
But the mental health providers voted to change the DSM 5 to not list being gay as a mental health disorder so we can trust them now. And hope they don't change their mind, sorry I mean take a rigorous scientific vote, and change it back in DSM 6. I'm sure gay people take comfort in knowing as of the 2013 DSM 5 there are no longer mental health categories based solely on sexual orientation.
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tevon 4y ago

We should be looking at models for how this system has worked elsewhere. If in fact the cause here is strictly biological (its likely a mix of biological and societal) factors, then there should be an even distributions in other populations. We should look to the Netherlands or similar to find models for effectively dealing with potentially violent mental illness.

kmeisthax 4y ago

Motte: Maybe deinstitutionalizing the mentally ill has gone too far Bailey: >The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including the right to avoid the consequences of their behavior.

devteambravo 4y ago

Define dangerously mentally ill please. I'm afraid that such definition might not be the same, depending on who you are, your religion, your sexual preference...etc Will the definition of dangerously mentally ill be the same in urban Vermont vs rural Mississippi? We have a lot of problems with racism in the US. How do we ensure that this won't become another tool of oppression? Maybe we start by not electing the dangerously mentally ill to the presidency instead.

pyuser583 4y ago

This already happens. Often plea bargains include “must receive mental health treatment.”

denton-scratch 4y ago

There's a reason people with serious mental illness don't take their medicines: they have unpleasant side-effects. The main type of medication is anti-psychotics. These drugs are also classed as "major tranquilizers" - drugs such as the notorious "chemical cosh" haloperidol are in this class. They suppress delusions, or at least delusional behaviour; but they make you gain weight, rock, tremble, mumble. The side-effects are progressive. Modern anti-psychotics have less side-effects than the old ones, but their effects are very marked. For people with bipolar, their illness sometimes makes them feel alive and cheerful, and the drugs take that away from them, depriving them of affect and zest for life. Basically the pills make them unhappy. So we're discussing forcing people to take pills that make them feel ill or unhappy. That's only justifiable if the compulsion regime is completely trustworthy. We have a compulsion regime in the UK (we tore down our asylums back in the 80s, just like the US). If you have an episode, you can be incarcerated for a few months on the say-so of two doctors. It seems to work alright - as far as I can see, they farm you out to some private secure clinic. But between the train-wreck of US law enforcement and the US reluctance to spend money on public health, along with the heavy, heavy politicization of everything in the USA, I think it would be dangerous to adopt the same model in the USA.

aaaaaaaaaaab 4y ago

Love how people in this topic keep arguing about the most strawman interpretation of the article. Noone is saying we should commit "neurodivergent" individuals with a minor Adderall addiction into mental asylums where they will be subjected to shock therapy... The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds. Sorry, but this is not some "on the spectrum" hippy bullshit - these people are seriously ill and need to be treated, and kept in check to make sure they stick to their treatment.

denton-scratch 4y ago
> The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds. You are suggesting that unmedicated people with schizophrenia are dangerous. That is mainly just wrong. The greatest danger that unmedicated schizophrenics pose is to themselves. And they are more likely to be murdered than to commit murder themselves.

seer-zig 4y ago

The first question that comes to mind is why has mental illness been substantially increasing recently over the past few decades? Something about our lifestyle definitely contributes to it.

Overtonwindow 4y ago

This alarms me considerably, as would anything that forces someone to do anything they do not want to do, whether it's for their own good or not. That said, however, I think there must be a system to treat those who are dangerous to themselves, or to society. I see the problem but once you go down that pathway where does it stop? Government does not back down, and I am deeply concerned that a system that mandates the treatment of someone for a disease could expand that definition, far beyond what anyone intended.