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Is forced treatment for the mentally ill ever humane?

113 points by MoSattler 4y ago

kelseyfrog 4y ago
https://archive.vn/Togvj https://archive.vn/Togvj
hprotagonist 4y ago
Well, should you be allowed to stop a suicide?
- readthenotes1 4y ago
  I have a relative who had to be taken to the hospital after scraping invisible mites out of their eyes with a razor blade. They asked them if she would like some antipsychotic medication and of course they said no. As a result, my question is, is it ever humane to not force treatment on the mentally ill
  - ajb 4y ago
    Obviously it can be. See lobotomization and ECT just for starters (yes, I know ECT is supposed to be better now, don't really buy it)
    - gman2093 4y ago
      With respect, your statement about ECT is not aligned with reality. ECT is evidence-based and effective, with side effects that are less pronounced in many cases than drug-based therapies. It is approved for use in pregnant patients in the USA. One Flew over the Cuckoos Nest is not peer-reviewed.
      - deleted 4y ago
        [deleted]
      - generalizations 4y ago
        > There’s a risk of memory loss. Most people who undergo ECT have temporary memory loss and confusion. Most people's confusion clears up quickly, and memory loss usually goes away entirely within a few months. However, some people do have permanent memory problems. Using the right-unilateral electrode placement and shortening the electrical current duration can reduce the risk of this happening. https://my.clevelandclinic.org/health/treatments/9302-ect-electroconvulsive-therapy https://my.clevelandclinic.org/health/treatments/9302-ect-el...
      - cwillu 4y ago
        You agree to receive treatment, or you will not be released, and they get a court order rubber-stamped to say they can give you treatment without your consent. I don't remember what happened after. ECT has that effect.
      - ajb 4y ago
        Not aligned with current consensus, perhaps. But before you equate that to "reality", recall that the profession once had consensus about lobotomy. Evidence in psychological science is much more superficial than in, say, physics. I don't doubt that what you say is reflected in the literature, but I do doubt that it reflects the lived reality of those so treated.
  - raverbashing 4y ago
    You are asking the right questions A lot of homelessness is due to different mental illnesses (not discounting the societal issues, and of course the drugs then make it worse) I really feel society sucks at dealing with the action/inaction assymetries
    - brodouevencode 4y ago
      Most homeless is due to mental illness. Almost always men with addiction issues. Many veterans suffering from PTSD. It's rarely the "single mother of two that lost her job at the plant" trope.
      - mattzito 4y ago
        I think a better way to frame it is "most _chronically_ homeless is due to mental illness". However, most homeless people are not chronically homeless, and are homeless for <6 months. Those are the single mother of two who lost their job at the plant examples - or left an abusive relationship and is living in their car, or underemployed as a security guard and sleeping in a sheleter, etc. Unfortunately, and equally sad, many of these folks work, send their kids to school, and struggle to get themselves into a stable long-term situation.
        trynewideas 4y ago
        HUD data, for the US at least:[1] - 582,484 total homeless - 138,361 chronically homeless - 122,888 total homeless reporting severe mental illness - 48,373 total homeless victims of domestic violence - 33,129 total homeless veterans VA count of veteran homelessness was down 10% or more YoY in 2021 and 2022, and down 55% since 2010.[2] Veterans comprise about 10% of the total US population and 5.6% of the homeless population. Among veterans, PTSD was less of a risk factor than psychotic disorders, an equal factor to other mental health disorders, and mental illness in general was less of a risk factor than money mismanagement and could be mitigated by VA services, especially disability compensation.[3] 1: https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2022.pdf https://files.hudexchange.info/reports/published/CoC_PopSub_... 2: https://www.va.gov/homeless/pit_count.asp https://www.va.gov/homeless/pit_count.asp 3: https://doi.org/10.1093/epirev/mxu004 https://doi.org/10.1093/epirev/mxu004
- andrewclunn 4y ago
  When societies will intervene to stop suicide while simultaneously allowing for government sanctioned assisted suicide, it means that the morality or "rightness" of an act is only now defined by whether the proper paperwork was filled out.
  - polygamous_bat 4y ago
    > ... it means that the morality or "rightness" of an act is only now defined by whether the proper paperwork was filled out. I do not understand your point. How is that any different than, say, driving my car down the highway? The same act can be fine if I have a driving license and not fine if I do not.
  - kbenson 4y ago
    Sometimes, paperwork is there to force some other condition to have been met, such as time and review and notification of others. So, it it more "right" to make people that want to commit suicide take a bit of time to consider whether that's actually the decision they want, and not something being influenced by a temporary situation, whether external or internal (such as a hormone imbalance that ebbs and flows)? I think yes, generally, even if edge cases exist.
  - fellowniusmonk 4y ago
    It's moral to have an unsubscribe button, it isn't moral to require me to fax in an unsubscribe form after signing up with one click. It's moral to ensure charges go before a court quickly, it's immoral to allow a person to languish in jail for decades without trial. Time and effort are a components of everything including morality. To dismiss time and effort as trite or irrelevant in nearly any situation seems abusurd.
  - itishappy 4y ago
    I don't think those are fundamentally equivalent categories. Assisted suicide is (to my knowledge) aimed at end of life patients with terminal outlooks. People who have little chance of improving their outcome. Self inflicted suicide is a much broader category including bullied high schoolers and unlucky stock traders. People who's current situation might look grim but who could potentially change that situation. I won't comment on the morality of either, but there's more at play than just bureaucracy.
- shanebellone 4y ago
  Absolutely not. I believe there is a legal argument in favor of bodily autonomy which includes the right to death. "Life, Liberty and the pursuit of Happiness." Life is inextricably linked with death. If you have the right to live, you must also have the right to die. That belief is largely entrenched in our medical system too but stops short of doctor assisted suicide.
  - hprotagonist 4y ago
    Does your right to die permit you to inflict trauma on others by, say, stepping in front of a train in a moment of crisis? Eating a 12 gauge and leaving your family to discover your meat splattered on the floor? etc. Am I allowed to stop that suicide? "Whatever affects one directly, affects all indirectly."
    - shanebellone 4y ago
      This is such a selfish perspective. What about their trauma, pain, and sorrow?
      - hprotagonist 4y ago
        It's the exact opposite of selfish; I am pointing out that yes, people are individuals, but people are also inextricably communal as well. Choosing to end your life, like any other choice we made, is not solely about _you_ because it does not solely affect _you_. "No man is an island entire of itself; every man / is a piece of the continent, a part of the main;"
        shanebellone 4y ago
        Death is absolute. In no circumstance can you avoid its impact. Thus, your argument is predicated upon exerting control over another human in order to control the timing of your displeasure. Preferring a loved one to suffer, indefinitely, in order to spare your feelings... is the very definition of selfish.
- guerrilla 4y ago
  Absolutely not. The only possible justification for any of these authoritarian interventions is self-defense. Anything short of that is infringing on their autonomy over their body and not something you should be advocating for especially considering you could be in that exact situation. In addition, suicide is not necessarily irrational, so definitely not.
- sashenka 4y ago
mythrwy 4y ago
Looking around at insane and drugged up street people (for instance) intuitively I say "Yes definitely, and it should be more widely practiced!". Then I remember how the definition of mental illness has changed over the years and think how it might change in the future, and now I'm not so sure.
- TulliusCicero 4y ago
  Seems like the threshold should probably be whether it's substantially interfering with their ability to interface with the rest of society, especially in terms of breaking laws. Many people in the situation you describe no longer seem capable of regulating their own behavior.
- gernb 4y ago
  There's a mentally ill person who lives outside my apartment. Every day/night she screams at the top of her voice about random things. I feel very sorry for her but at some point she needs to be moved and taken somewhere. She has no right to subject the entire neighborhood to her rants. All of our collective santity outweights her issues. It's not that different than a repeat criminal. Reguardless of reasons, at some point they're too much of a net negative to society. Dealing with them in some humane way is ideal but those 2 things are separate concerns IMO. Meaning there are 2 issues (1) Save everyone else from someone's distruptive behavior (2) Deal with the person in the best possible way You can solve (1) and not solve (2). Being not able to solve (2) perfectly does not invalidate the need to solve (1)
  - horsawlarway 4y ago
    Yup - I think it's very important to point out that there are two different problems to solve here. 1) What sort of behaviors is a community willing to tolerate 2) What does that community do with people who are unable to stay within the confines of tolerated behavior The problem is that asymmetrical answers to the two questions can create a strange grey-zone, where problems linger. For example - if you murder someone, I don't think many people are going to argue against you spending some time in prison. The response is in line with the severity of the action. But... if you say, consistently piss in the elevators of your local metro (even though public bathrooms are available), most folks aren't sure prison is the right answer. Ideally - we'd just keep you out of the metro entirely - but setting up that system is very expensive when we're dealing with a very small number of bad actors. On the flip side - that small number of bad actors is doing considerable damage long term. They're making metro usage far less pleasant, driving down ridership, increasing cleaning costs, reducing public health, and requiring additional staff in attempts at monitoring. Each other member of society is only inconvenienced a relatively minor amount, but they're impacting a very large number of them by degrading a public and shared service. The same is true of those who camp/sleep outside of businesses, or scream & rant in public spaces, or do drugs in public spaces. They are actively harming the space they are using at large, and are unwilling to stop or unable regulate themselves. So what do we do with those people? What is a proportional action that we can take that prevents the damage this person is causing at scale? Prison/Jail rarely work - because the damage of each individual occurrence is small, they are usually out very quickly. Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Meds can definitely help - but the category of people creating these disturbances generally have trouble consistently taking meds (again - for a variety of reasons including access to services and payment, but not the least is active, personal resistance) So... if we've ruled out (as in - tried and failed) self medication + housing + prison... where do we go? Because at that point - I'm not really convinced that forced treatment and care are really unreasonable responses. It is far more cost effective to gather these folks in a single place and confine them there than it is to allow them to roam and attempt to stop their problem behavior at the place it occurs. It's the difference between 10 guards, a large facility home, and medical staff - versus thousands of required staff spread over a city.
bell-cot 4y ago
An old friend has a niece with a life-long, major mental illness. When off her medications (I've lost count of how many times, over the years), she goes "on the run", and phones home to various family members (often many times per day) with angry rants - which very often include threats of great bodily harm and/or death. Her grip on reality in that state is rather poor - asserting that Bugs Bunny and the CIA are conspiring to create a brain controlled army of polar bears with space lasers would not be unusual. When on her medications, she is a relatively pleasant & rational person, usually able to hold an entry-level job. Her family do not want to throw her in jail for all the threats (I'm not asserting that they could, if they wanted to), she really does not like the side effects of her medications, and (under the current system) neither confining her to a long-term mental health facility, nor reliably forcing her to take her medications seem to be available options. (Her family has talked to lawyers about their options more than once.) What would be the "humane" thing to do? In composing your answer, please recall that her family are also humans, and - barring a premature death - she is likely to outlive most of them. Edit: Thank you for all the replies, but my 4th-paragraph question was intended to be rhetorical. My point is that the case-by-case reality, even from the PoV of a well-to-do family that really seems to care about the mentally ill person, is often agonizingly difficult.
- deleted 4y ago
  [deleted]
- brodouevencode 4y ago
  It's certainly tough for sure. I think the ultimate question is what is considered "humane". Locked up in a straight jacket in a padded room for having slightly depressive thoughts is certainly not, but also allowing someone like in your story to spiral out of control and act out their trauma is arguably equally as inhumane. I wish I had a good answer for you.
- jimbob45 4y ago
  Assuming her threats and behavior would eventually result in her being tossed in jail, the choice seems to be between her imprisonment and her being forcibly medicated. I don't have an answer for you. I think you've come up with a potential plot for a very interesting Star Trek episode though.
yupis 4y ago
Thanks
p0pcult 4y ago
Surely some of the answer also depends on what constitutes the "treatment," no?
armchairhacker 4y ago
The way I see it: forced treatment is humane when the person being treated consents afterward. e.g. stopping someone in a bad mental state from suicide or anorexia, so that they thank you when they improve. Of course it’s not possible to know whether the person will consent beforehand, so you have to predict (and if you get it wrong, you messed up). In most cases this is what real-world suicide prevention leads to, because if a person is adamant on killing themselves they usually find a way. The exception is really sick people who want to kill themselves, but can’t because they have limited autonomy. That would be covered by euthanasia and is one of the reasons why it is very important ethically. For other mentally ill people, forced treatment is still only ok if they may actually get better and thank you later. If someone is dirty, homeless, and senile, but they don’t care, putting them into a retirement home does not make them happy so it does not actually benefit them. If someone acts sane only when they get medication but they hate it, giving them the medication does not benefit them, it benefits others. In these cases forced treatment may still be practically necessary and morally ok to benefit society (we don’t want dirty homeless people begging on the street, so we outlaw public indecency and soliciting, and some illnesses make a person dangerous). But I think that we need to understand that forced treatment is not to benefit the mentally ill themselves, but us, and also take their feelings into account. e.g. force homeless people out of the streets and into homes, but give them autonomy, and if their homes decay and they sit around all day and don’t care, let them. EDIT: Should also add that nursing and caregiving are jobs which give people power over other, vulnerable people. Many of the doctors which take care of mentally ill and disabled people are genuinely amazing people who honestly don’t deserve the bad connotation, but some apply to these jobs to take advantage of their power over others. So when forcing treatment on someone, we really need to ensure that those in charge of the treatment have said person’s best interests at heart, and need to be monitored and held accountable. This is something which is unfortunately lacking because the people who are exploited or in danger of being exploited and thus care the most can’t really advocate well, so the burden falls to beaurocracy which cannot adequately manage.
loeg 4y ago
Always nice to see a counterexample to Betteridge's law of headlines.
pcurve 4y ago
I guess it's a question of humane from whose perspective? If I were ever in a position where I'm not able to make sound decision ono my behalf and I don't have anyone around me to do so either, I would be OK with governmental entity intervening. "Democratic mayor of New York City, instructed police and first responders to hospitalise people with severe mental illness who are incapable of looking after themselves." I consider this humane and sound.
- AnimalMuppet 4y ago
  The problem comes with "incapable". What about marginally capable people? Where are you going to draw the line? The solution to that might be to not have a binary line. The less capable they are, the more we can choose for them, but it's not all or nothing. (No, I don't have any idea what the details look like...)
- lotsofpulp 4y ago
  In that quote, “hospitalise” might mean to drop them off in an understaffed hospital emergency room so that they can be temporarily sedated or whatever and then released within whatever timeframe protects the various entities from liability. I doubt “hospitalise” means to house them in a properly staffed psychiatric care facility under the care of qualified professionals.
- bell-cot 4y ago
  Like ~any government policy, the reality depends mostly upon the competence, honesty, good will, and resources of the people & agencies actually implementing the policy. (Vs. the Official Rules, as written down by politicians & bureaucrats.) Folks who really don't trust the government of NYC on the "competence, honesty, good will, and resources" angles may have plenty of evidence to support their distrust.
xyzelement 4y ago
The question feels very complex when framed like in the article. In reality I think it's two separate but connected questions that society should be able to answer based on its dominant values. 1. Do we have and enforce laws about things like people setting up tent cities in neighborhoods, open air drug use, public defecation and attacking pedestrians. Your politics can determine how you feel about this. My personal take is that yes we should have and enforce such laws. 2. What do we do when people are violating these laws due to mental illness? Do we just prosecute them and lock them up in regular jail or do we institutionalize and treat them like the mentally ill? To me it seems like treating mentally ill transgressors as such is right. The alternative to treat them like regular criminals seem worse. I think most people can follow this kind of argument. The real debate is around the first point, where do we draw the line about legal and illegal behavior.
- runnerup 4y ago
  Also, where should people be homeless? Literally I cannot pay rent next month and have no one willing to take me in. Where should I go? AFAIK there are zero legal options for me when I’m unable to pay for an apartment. I do not own a car. If I insist on being an upright citizen and following the law…do I just show up to a police station on January 1st and turn myself in for vagrancy and hope they throw me in jail?
  - pigeons 4y ago
    What part of the world do you live in.
    - runnerup 4y ago
      USA
  - Retric 4y ago
    Homeless shelters are a short term solution. Various housing programs are available depending on location, but tend to be really slow.
outside1234 4y ago
What about the rest of us that have to endure them shouting at us in the streets? Yes - it is humane for them AND for us.
- throwayyy479087 4y ago
  The general public isn't part of the Blessed Set of Protected Minorities so we don't count. What counts is the disadvantaged, and the more disadvantaged they are the more we're required to turn a blind eye to disruptive behavior. Homeless people, being at the bottom of the stack, are allowed to do basically anything and criticism of this fact will get you fired and cancelled. Ironically, this seems like true freedom to me - do whatever you want to whoever, with no fear of consequences. Just have to deal with the lack of dignity and resources.
kneebonian 4y ago
Interesting prespective on forced treatment for the mentally ill here: https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-prison-and-mental-illness/ https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p...
ravenstine 4y ago
No, but neither is allowing the mentally ill to remain ill. There's no win to pontificating over this issue. The only way to win is to get lucky when treating someone's mental illness and they happen to respond to it.
- blurri 4y ago
  To get lucky treating someone's mental illness if they allow you to treat them you mean?
zozbot234 4y ago
Tangentially related: ACX "in partial, grudging defense of the Hearing Voices movement": https://astralcodexten.substack.com/p/in-partial-grudging-defense-of-the https://astralcodexten.substack.com/p/in-partial-grudging-de... AIUI, the blog author points out that if you really want to comprehensively replace institutionalized, forced treatment, some sort of self-organized peer support is the best reasonable alternative - one that, arguably, has barely been tried. Related: Prison and mental illness https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-prison-and-mental-illness/ https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p... - My Brother Ron https://slatestarcodex.com/2016/03/31/book-review-my-brother-ron/ https://slatestarcodex.com/2016/03/31/book-review-my-brother...
djaouen 4y ago
As a mentally ill person myself, I don’t want to have to deal with being accosted when I go out just to buy food. If these policies get people off the streets, I think that is a good thing!
bnralt 4y ago
What's interesting is that once someone gets past a certain age, people almost universally agree that it's OK to confine them against their wishes if they are unable to take car of themselves. You don't hear many people saying that dementia patients should be able to leave whenever they want.
- trynewideas 4y ago
  As someone who's cared for someone with a declining mental state, dementia patients should be able to leave whenever they want. The problem is that the rest of the world doesn't want to - not can't, but finds it inconvenient - to deal with the ramifications of supervising or caring for people in public, strangers, who can't help themselves. It's much easier to detain inconvenient people than change the rest of the world around them such that it wants to share the burden of caring for them.
  - tacotime 4y ago
    Someone in my family, who is now in a memory care facility, has dementia. We tried to avoid it as long as possible, but when we got a call from the police saying that she was found wandering around barefoot in the snow next to a busy road in the middle of the night while hallucinating about “people coming to get her”, it felt like it was time to reconsider. She’s on meds that control the hallucinations now, but it would still be unsafe for her to leave unsupervised, no matter how much our culture changes. How do you help a stranger who doesn’t know where or who they are, and can’t hear too well to start with? She sure does still remember me and can dance to the Beatles, but I would not be comfortable trusting her welfare to a group of even the most compassionate strangers.
  - belval 4y ago
    This is a very emotional topic so I want to avoid being too critical of that opinion, but at the same time, it's much much deeper than "doesn't want to". Dementia patients depending on their state are a danger to others and themselves. Their limited ability to understand what's happening around them means that they can get aggressive. Even if not aggressive, they will just "get lost" and try to drive or "go for a walk" in the middle of the night in their pyjamas. I suppose from the way you phrased it that in your case it was mostly harmless and you just disliked getting weird looks, but a lot of dementia patients are actually incompatible with society and need to be detained or given anti-anxiety medications.
mullen 4y ago
This is why we can't have nice things in this country. It's always comes down to some rhetorical discussion about edge cases and possibilities of how a tiny fraction of people might be negatively impacted, so let's not do it. Let's frame it this way, "Is it humane to allow people be a slave to their mental illness and living on the streets?" The answer is clearly, "no". Allowing the mentally ill to live on the streets betters no ones life and causes many issues for everyone. If people with a mental health issue can not or will not take care of themselves, then someone else has to do it (IE: The Government). It is humane for everyone if the mentally ill are forced to get treatment or confined if they refuse it.
- guerrilla 4y ago
  > It is humane for everyone if the mentally ill are forced to get treatment or confined if they refuse it. Definitely not, unless they're actively harming you because self-defense is always justified. Short of that it's none of your business.
  - mixmastamyk 4y ago
    You may have misunderstood what humane means in this context. It is definitely society's business that our fellows don't live eating out of garbage cans while swearing obscenities at no one in particular on the sidewalk. Encampments also breed rats, disease, drugs, and prostitution. It was never acceptable to allow this and we no longer have the excuses of the old days—that we don't have the resources to help them. https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/ https://www.theatlantic.com/health/archive/2019/03/typhus-tu...
    - guerrilla 4y ago
      > You may have misunderstood what humane means in this context. It is definitely society's business that our fellows don't live eating out of garbage cans while swearing obscenities at no one in particular on the sidewalk. Encampments also breed rats, disease, drugs, and prostitution. You can offer as much help as you want, but you can't force it on anyone. I think we should give them all free housing, food and whatever else they may need, but we can't use violence and imprisonment on them in any other case than self-defense. That would be a violation of bodily autonomy and extremely illiberal.
WarOnPrivacy 4y ago
I was my ex's caregiver for decades. Today she lives in a local homeless community and her wellbeing is often at risk. Could she have had a different outcome through forced treatment? Yes and no. The technical answer is No because the treatment she needs doesn't exist here (extended-term, inpatient, safe). There's nothing to commit her to. If the treatment she needs existed, could I have committed her against her will? Probably not. It would require LEO assistance and (due to reality) husbands are generally considered to pose a heightened risk of gaslighting.
rr808 4y ago
Does anyone know of numbers of who used to be locked up in asylums etc? It seems to have been more common and I have no clue about how often it happens now. Reagan closed the mental hospitals?
jl6 4y ago
Implicit in the question is that we even understand what the right treatment should be. Once upon a time, doctors would have enthusiastically recommended lobotomies. Would we have nodded along? I think the ethical conundrum lessens if there actually is a clear, proven, effective treatment. We often make decisions on behalf of people who aren’t able to make the right choice for themselves, and I don’t think a pathological commitment to individual liberty should constrain us in cases where there is the possibility of dramatically improving someone’s wellbeing.
- mixmastamyk 4y ago
  It's 2022 not 1922 or earlier; no one is advocating medieval treatments.
trynewideas 4y ago
This is an imminent question in Portland, Oregon: the mayor wants to relax the requirements to civilly commit a person against their will despite a lack of hospitals that can receive or treat them,[1][2] another of his suite of tactics to address homelessness that's included perpetual weekly sweeps of dozens of homeless encampments,[3] asking for $27 million to build city-run open-air camps,[4][5] and trying but failing through those policies to secure additional state funding for city-run shelters.[6] None of these tactics have been strategic - housed and homeless people alike in Portland who want mental health resources can't access the limited inventory of them, so expanding involuntary commitment without funded services will only add to that resource stress. Sweeps without a variety of funded shelter options just move the problem of camps from one part of the city to another while destroying what little the campers own, at a contractor cost of $4.5 million per year. The city-run camp proposal has been derided as "concentration camps", and the $27 million price tag would pay for a year of stable housing for nearly 2,500. State legislators cited the sweeps and camp proposal as reasons why they were giving $25 million in funding to the separate county leadership instead of the city, and put conditions on the funding that explicitly prevented its use for sweeps or involuntary camps. All of this happened _before_ the proposal to expand involuntary commitment criteria, which would at worst facilitate abuse or harassment of people with mental illnesses - housed or not - and at best fail to solve the underlying lack of treatment resources available to anyone, much less the involuntarily committed.[7] 1: https://www.opb.org/article/2022/12/12/portland-mayor-ted-wheeler-suggests-easing-process-involuntarily-commit-mentally-ill/ https://www.opb.org/article/2022/12/12/portland-mayor-ted-wh... 2: https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-wants-to-forcibly-commit-more-people-with-mental-illness/ https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-want... 3: https://www.oregonlive.com/politics/2022/12/portland-has-dramatically-escalated-tent-sweeps.html https://www.oregonlive.com/politics/2022/12/portland-has-dra... 4: https://www.columbian.com/news/2022/nov/18/homeless-vote-in-portland-oregon-delayed-in-angry-meeting/ https://www.columbian.com/news/2022/nov/18/homeless-vote-in-... 5: https://www.kgw.com/article/news/local/homeless/multnomah-county-rent-assistance-wheeler-plan/283-7f1e75c8-8a1b-4dca-9362-344d859aaf9f https://www.kgw.com/article/news/local/homeless/multnomah-co... 6: https://www.oregonlive.com/politics/2022/02/no-direct-funding-for-portland-homeless-shelters-in-legislative-housing-plan.html https://www.oregonlive.com/politics/2022/02/no-direct-fundin... 7: https://www.themarshallproject.org/2020/11/08/when-going-to-the-hospital-is-just-as-bad-as-jail https://www.themarshallproject.org/2020/11/08/when-going-to-...
guerrilla 4y ago
It amazes me that this place gets a reputation of being libertarian when the vast majority of comments here (and on similar subjects) are extremely authoritarian. The libertarian stance is that if someone isn't harming you then you have absolutely no justification to impinge on their freedom. This is fundamental liberal and libertarian theory common to all branches of both.
- goatlover 4y ago
  So what does a libertarian society do with people who do the following in public: defecate, shoot up, litter, block sidewalks with tents, harass passerbies? Do you arrest them for breaking the law? Allow them to continue doing so? Or would there be no such laws because it’s not harming anyone under a libertarian view? How does a libertarian deal with the chronically homeless?
  - guerrilla 4y ago
    > How does a libertarian deal with the chronically homeless? Obviously you house them, feed them, offer them treatment, etc. with the least amount of friction possible. If they refuse and aren't literally hurting anyone, then nothing. You don't need to over-complicate this.
    - lostmsu 4y ago
      I think this is not a libertarian place then.
    - goatlover 4y ago
      So if they refuse assistance and continue breaking the law, you just let them? Do libertarians not have laws against littering, camping out on sidewalks or near schools, etc? I've seen enough public places trashed by the fraction of the homeless that are either too ill or don't care to pick up and walk a few feet to a trash receptacle. It can be unsanitary at times. Parks and coffee shops end up locking their bathrooms so they don't have to clean up the mess. If involuntary commitment is against your principles, what about relocation to designated areas where the homeless have access to services they need? They can leave and go wherever, they just can't camp outside those designated areas, or otherwise break the law, just like any other citizen.
qwerty456127 4y ago
Some times it is. It really depends on the condition, specific case and the way you treat them. To me it seems obvious that at least in some cases it is, even if not in many. May be hard to tell in advance though. There are cases when a person is not in the mood (to put it mildly) to accept help but really needs it and will sincerely appreciate it once a relief comes. The opposite question is also valid by the way: is it humane to leave the insane to struggle and roam the streets untreated?
_fol8 4y ago
[dead]
MopMop 4y ago
"Her grip on reality in that state is rather poor - asserting that Bugs Bunny and the CIA are conspiring to create a brain controlled army of polar bears with space lasers would not be unusual." The angry rants are a reaction to loss of bodily autonomy, spiritual wellbeing and mental liberation. If you are on these kind of antipsychotics for the most part of your adult life it's ordinary to not be in touch with your feelings or anyone elses and it's ok to be delusional cos if you don't ever know what it feels like to be mentally liberated then how else could you know how it feels to be free.
Tiktaalik 4y ago
Doctors don't support involuntary treatment because it's not effective. Effectively it trains people to distrust the health system, and to not seek medical care because they'll be locked up and bad things will happen to them. This leads to worsening health outcomes. We just passed through years of pandemic where everyone was eager to listen to the experts in the medical profession and that saved countless lives. It's sad and disturbing that when it comes to other health care issues, the politicians are now tuning out the same experts because they don't like what they're hearing.
- mullingitover 4y ago
  > Doctors don't support involuntary treatment because it's not effective. I think there's a difference between making an informed decision to decline treatment versus not being in a state of mind that allows you to make any rational decisions. People on the street with mental faculties in a state of failure are not really able to make that choice, and treating someone in that state as if they're making a voluntary choice is farcical.
- HDThoreaun 4y ago
  What other choice is there for people who have continuously refused treatment? Should we just accept that these people will live in tent encampments?
  - Tiktaalik 4y ago
    I'm sure we can concoct some elaborate edge edge edge case where there are no other options, but broadly I think the medical establishment much rather prefers the situation where some dysfunctional person is regularly coming to check in with a doctor, even if it means they have to handhold some person every step of the way through life as they make mistake after mistake. The alternative, where someone is whisked away to internment for a few months, bounces back right after into the same broken lifestyle, and subsequently never trusts the medical system ever again and never goes to see a doctor again is less desirable. With the former there remains always new opportunities for someone to take positive steps forward to recovery as they are always in contact with a system that can help them. With the latter we burn a bridge one and done.
LatteLazy 4y ago
Given the very low efficiency of most mental health "treatment" this remains a mostly theoretical question. Until psychology and physiatry sort themselves out and become sciences were really just talking about locking people up...
ThinkBeat 4y ago
We had asylums where we locked up mentally ill peopl. They were treated in a most horrible way in general. I have seen pictures and documentaries and a lot of them were nightmares. Then we tore down the asylums and set the inmates free. Good job. You are free. Live your lives in happiness. Nobody will force treatment up on you. In fact getting treatment is close to impossible in the US. Many people without treatment get progressively worse. A lot of start using alcohol or other drugs to try to manage their lives. For most people that does not turn out all that well over time. They had added a component that will give them even more problems. Now prison is full of people with mental illness who ought not to be there. They have become the new asylums. The prison cannot provide the care and treatment required. This is not progress. What was needed before, and is needed now is appropriate treatment for each person. Some can do well with speech therapy. Some need to be tied to a bed. A lot. Between those extremes there is a near infinite palette of mental problems. No two people are the same, even if they are given the same diagnosis. (Diagnosis in itself is a difficult thing to get right, and requires observation / follow up over a long period of time. Not just when they are having an episode. ) Treatment of mental illness is almost universally a part of healthcare with low funding.
- 77pt77 4y ago
  > I have seen pictures and documentaries and a lot of them were nightmares. Try reading the actual reports. Seriously, you can find that online.
  - selectodude 4y ago
    care to share?
DaniloDias 4y ago
at_a_remove 4y ago
Reframe the question in terms of what it really is: Is forced treatment for the mentally ill more humane or less humane than letting them "do their thing?" Is it more humane for the people who are forced to interact with them? A lot of ethical questions could use a "trolley-fy" process in which the status quo is simply presented as another track, and then another process by which that question is re-embedded within its actual context -- the mentally ill are not off wandering some other plane of existence, they may be screaming in your alley, tonight, around three a.m.
nitwit005 4y ago
The reality is, we provide (admittedly crappy) mental health care in prisons, so we already have a program of forced treatment. We just wait until a serious crime has happened. Almost any non-prison option would be better than the current way of doing things.
- LarryMullins 4y ago
  I think the prison-solution, as crappy as it is, is better than doing nothing at all. But it should certainly be possible to do better.
nimbius 4y ago
> Many liberals blame Ronald Reagan for the government’s abandonment of mentally ill Americans. Thats a fascinating stretch of the truth. Most sociologists, public health professionals, and public policy researchers can directly link "Reagans army" to the mans policies quantitatively. its less of a blame game and more of a fact of life the thatcher/reagan neoliberalist push essentially relegated the mentally ill to freeway underpasses and drug store parking lots. Those that didnt wind up screaming at stop signs or dancing nude through the streets instead have gone on to commit some of American societies most horrific mass shootings. > Many administrations in California have had opportunities to reverse Reagan in '67 sure, but by 1981 his federal cessation of funding for ANY state mental health services would have made the effort near Sisyphean. Alex Barnard doesnt do much to shore up the Gippers legacy outside of the prescriptive myopia that we should ignore the past and just look to the future now because $add_reason_later. Treat mental illness just like real illness and stop pretending its some special category of sorta-problem we cant do anything about because, surprise, we havent invested any money into its research, treatment, or cure since Dutch decided to gut funding 41 years ago before slipping into Dementia himself.
malcolmgreaves 4y ago
San Francisco is what happens if you answer “no” to this question.
someonewhocar3s 4y ago
smm11 4y ago
It's never humane, those who suffer mental illness rarely prefer treatment. But pit bull terriers who kill kids are put down.
faeriechangling 4y ago
Yes, obviously, I have seen a number of mentally ill children, all their treatment was forced as mentally ill children are not competent to make their own medical decisions. There is a huge body of ethics and law on the issue of forcing treatment upon others. As to this specific case, the forced treatment of homeless people with mental health problems, from what I've heard on the people with boots on the ground a lot of people have severe brain damage from things like fentanyl overdoses who simply can't take care of themselves, and I've heard tons of people who have been disturbed by people with mental health problems disrupting public order as people go about their day to day lives. How much should one value freedom, how much should one value order, and how much should one be a consequentialist? How cost-effective is forced treatment anyways?
77pt77 4y ago
Yes, because it's done by humans to humans. Is it moral? No.
jwatt 4y ago
On a related note, the interviews with homeless people on the YouTube channel Soft White Underbelly were a real eyeopener to me. I highly recommend it, but some of them are extremely hard to watch. https://www.youtube.com/@SoftWhiteUnderbelly/videos https://www.youtube.com/@SoftWhiteUnderbelly/videos
ineedasername 4y ago
It's a poorly formed question, and journalism in general is not a good venue for exploring the actual multiple questions that must be answered to get at the ostensible question in the title, much less the answers to those questions. An adequate addressing of the topic would need to start, at minimum, with defining with great specificity the following terms as applied to this problems: Force (which mechanisms, legal, physical, social, etc) Treatment (Chemical? Talk therapy & its many varieties? Simple protection from oneself, or others from the subject?) Mentally Ill (As classified by the DSM-V? Some other formal source? Who makes the diagnosis, what if there are competing diagnosis from different practitioners? Does the State get a say in this definition?) Humane (A vague concept whose specific definition, often also a bit vague, will vary by context: In the US it is considered humane to euthanize animals in pain that cannot be cured, or with terminal conditions, or some combination thereof. Doing so to humans, even with their consent, is highly controversial. And yet suicide hangs silently over many discussions of mental illness, and too often mental illness is resistant to treatment to the point of torture for the person experiencing it, even with their full & willing consent to any treatment that might help their cause. Further there is the same question of who decides what humane gets to mean, both in general and as applied in specific circumstances.) This barely scratches the surface, all I've done is identify items in a short headline that need defining, and each of those could take countless person-hours of discussion & debate and still not be settled in a meaningful way in which most parties agreed.
- black_13 4y ago
black_13 4y ago
StanislavPetrov 4y ago
Ultimately whether it is humane or not is irrelevant. If you are trapped on a lifeboat with a bunch of people, and one of them is mentally ill and threatening the safety and survival of the other people on the lifeboat because of an ability to regulate their own behavior, the people on that lifeboat are justified in taking whatever action necessary to ensure a safe environment. Society is that lifeboat. We should do everything possible to offer mentally ill people the resources they need to help themselves and to integrate themselves into society. But if that fails, and they are unwilling or unable to integrate into society, and their behavior causes a safety risk and/or a significant disruption to society, then society is completely justified in using whatever measures are necessary to ensure they aren't a danger to others. It is simply absurd to suggest (as many do today) that profoundly mentally ill people should be allowed to roam free and manifest their mental illness in ways that are harmful to other people because it it "inhumane" to stop them.
hackermeows 4y ago
One of the primary problems with this is who gets to decide what is metal illness ? Is being gay a mental illness , I’m sure there a whole subset of the population including some doctors who thinks it is. Is being overly religious a mental illness ? There is so much potential for abuse here it just doesn’t make sense to force anything on anyone, unless they are a direct threat to others
MissLaeti 4y ago
House them first, then treat them accordingly. It should be better for them. Of course it’s more expansive than just incarcerate them in psychiatric centers and feed them with nasty treatment just because they are a disgrace in our society. Maybe it’s time to think about them as humans, not as a social problem. Capitalism is more of a social problem than psychotic homeless people.
BrandoElFollito 4y ago
I was discussing about that topic some time ago and was left wondering what the proportions of various mentally ill people actually are in the rought 3 categories: - dangerous/"seriously impacting" for others (→ locking up in an asylum) - need to be forced to take some treatment / learning so that they can function in the community - the rest I genuinely do not know the ratios, but have the feeling that the 1st one is really marginal, the 2nd quite a lot and the 3rd the bulk of people
Konohamaru 4y ago
...is it just me or is the number of cases of severe mental illness growing in the U.S.A.?
niemal_dev 4y ago
It is truly unfortunate to see how ignorant and misinformed most of these answers are. First, to understand what is a mental illness we have to deduce strong neuro-biological evidence of the problem and after-so we can proceed with an effective measure, a treatment, that is actually a treatment. Currently, any kind of psychiatric label is equivalent to archaic prophecies. There's no credible scientific evidence to back up any kind of mental illness diagnostic. It is a facade. Each and every medication supplied by psychiatrists is not a treatment. It is an inhumane process of complete eradication. Dopamine is a product of hormones among others and it is the core fuel of the brain. Dopamine is the resource with which you anticipate time. Dopamine is the resource with which you can memorize and have a cognitive function as a human being. Dopamine is the reason you have an imagination. Dopamine is the resource that transforms into energy for you to move your body. Shutting it down is nothing but a legal modern euthanasia. You justify pills for an effective measure, when science itself tends to look towards the gut-microbiome and the inflammation reaching all the way up to the brain. Exact causes are still unknown, but: there are other things one should be treated with, and they are not pills. The ketogenic diet has completely cured people who have been diagnosed as schizo-affective (schizophrenia that is actually worse). People who have been diagnosed as bipolar have also seen tremendous benefits from the ketogenic diet and have been cured. There are many supplements one can use to optimize the overall neuro-biology along with daily routines that reinforce it. But guess what? No psychiatrist actually pursues those choices, the biggest majority of them are "Here's your pills, next. You don't want them? Let me call the police.". Seeing people treating family members like that is also disheartening. Ignorance got us blind, blind to the madness we as society reinforce and blind to the actual truth. Calling that a human process is completely ignorant, there's no way for you to know how it is like unless you have studied neuro-biology or you have been under the influence of a dopamine antagonist (commonly known as anti-psychotics). And let me tell you something, there's nothing worse from seeing your lifetime go by and you being completely unable to live because you got no brain fuel. The worst possible prison is in our brains. Sometimes we build it ourselves, and sometimes other people do. Anti-psychotics is other people. That's how the real trauma occurs. That's how many innocents get "treated" from the society and the psychiatric community.

113 points by MoSattler 4y ago

kelseyfrog 4y ago

https://archive.vn/Togvj https://archive.vn/Togvj

hprotagonist 4y ago

Well, should you be allowed to stop a suicide?

readthenotes1 4y ago
I have a relative who had to be taken to the hospital after scraping invisible mites out of their eyes with a razor blade. They asked them if she would like some antipsychotic medication and of course they said no. As a result, my question is, is it ever humane to not force treatment on the mentally ill
- ajb 4y ago
  Obviously it can be. See lobotomization and ECT just for starters (yes, I know ECT is supposed to be better now, don't really buy it)
  - gman2093 4y ago
    With respect, your statement about ECT is not aligned with reality. ECT is evidence-based and effective, with side effects that are less pronounced in many cases than drug-based therapies. It is approved for use in pregnant patients in the USA. One Flew over the Cuckoos Nest is not peer-reviewed.
    - deleted 4y ago
      [deleted]
    - generalizations 4y ago
      > There’s a risk of memory loss. Most people who undergo ECT have temporary memory loss and confusion. Most people's confusion clears up quickly, and memory loss usually goes away entirely within a few months. However, some people do have permanent memory problems. Using the right-unilateral electrode placement and shortening the electrical current duration can reduce the risk of this happening. https://my.clevelandclinic.org/health/treatments/9302-ect-electroconvulsive-therapy https://my.clevelandclinic.org/health/treatments/9302-ect-el...
    - cwillu 4y ago
      You agree to receive treatment, or you will not be released, and they get a court order rubber-stamped to say they can give you treatment without your consent. I don't remember what happened after. ECT has that effect.
    - ajb 4y ago
      Not aligned with current consensus, perhaps. But before you equate that to "reality", recall that the profession once had consensus about lobotomy. Evidence in psychological science is much more superficial than in, say, physics. I don't doubt that what you say is reflected in the literature, but I do doubt that it reflects the lived reality of those so treated.
- raverbashing 4y ago
  You are asking the right questions A lot of homelessness is due to different mental illnesses (not discounting the societal issues, and of course the drugs then make it worse) I really feel society sucks at dealing with the action/inaction assymetries
  - brodouevencode 4y ago
    Most homeless is due to mental illness. Almost always men with addiction issues. Many veterans suffering from PTSD. It's rarely the "single mother of two that lost her job at the plant" trope.
    - mattzito 4y ago
      I think a better way to frame it is "most _chronically_ homeless is due to mental illness". However, most homeless people are not chronically homeless, and are homeless for <6 months. Those are the single mother of two who lost their job at the plant examples - or left an abusive relationship and is living in their car, or underemployed as a security guard and sleeping in a sheleter, etc. Unfortunately, and equally sad, many of these folks work, send their kids to school, and struggle to get themselves into a stable long-term situation.
      - trynewideas 4y ago
        HUD data, for the US at least:[1] - 582,484 total homeless - 138,361 chronically homeless - 122,888 total homeless reporting severe mental illness - 48,373 total homeless victims of domestic violence - 33,129 total homeless veterans VA count of veteran homelessness was down 10% or more YoY in 2021 and 2022, and down 55% since 2010.[2] Veterans comprise about 10% of the total US population and 5.6% of the homeless population. Among veterans, PTSD was less of a risk factor than psychotic disorders, an equal factor to other mental health disorders, and mental illness in general was less of a risk factor than money mismanagement and could be mitigated by VA services, especially disability compensation.[3] 1: https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2022.pdf https://files.hudexchange.info/reports/published/CoC_PopSub_... 2: https://www.va.gov/homeless/pit_count.asp https://www.va.gov/homeless/pit_count.asp 3: https://doi.org/10.1093/epirev/mxu004 https://doi.org/10.1093/epirev/mxu004
andrewclunn 4y ago
When societies will intervene to stop suicide while simultaneously allowing for government sanctioned assisted suicide, it means that the morality or "rightness" of an act is only now defined by whether the proper paperwork was filled out.
- polygamous_bat 4y ago
  > ... it means that the morality or "rightness" of an act is only now defined by whether the proper paperwork was filled out. I do not understand your point. How is that any different than, say, driving my car down the highway? The same act can be fine if I have a driving license and not fine if I do not.
- kbenson 4y ago
  Sometimes, paperwork is there to force some other condition to have been met, such as time and review and notification of others. So, it it more "right" to make people that want to commit suicide take a bit of time to consider whether that's actually the decision they want, and not something being influenced by a temporary situation, whether external or internal (such as a hormone imbalance that ebbs and flows)? I think yes, generally, even if edge cases exist.
- fellowniusmonk 4y ago
  It's moral to have an unsubscribe button, it isn't moral to require me to fax in an unsubscribe form after signing up with one click. It's moral to ensure charges go before a court quickly, it's immoral to allow a person to languish in jail for decades without trial. Time and effort are a components of everything including morality. To dismiss time and effort as trite or irrelevant in nearly any situation seems abusurd.
- itishappy 4y ago
  I don't think those are fundamentally equivalent categories. Assisted suicide is (to my knowledge) aimed at end of life patients with terminal outlooks. People who have little chance of improving their outcome. Self inflicted suicide is a much broader category including bullied high schoolers and unlucky stock traders. People who's current situation might look grim but who could potentially change that situation. I won't comment on the morality of either, but there's more at play than just bureaucracy.
shanebellone 4y ago
Absolutely not. I believe there is a legal argument in favor of bodily autonomy which includes the right to death. "Life, Liberty and the pursuit of Happiness." Life is inextricably linked with death. If you have the right to live, you must also have the right to die. That belief is largely entrenched in our medical system too but stops short of doctor assisted suicide.
- hprotagonist 4y ago
  Does your right to die permit you to inflict trauma on others by, say, stepping in front of a train in a moment of crisis? Eating a 12 gauge and leaving your family to discover your meat splattered on the floor? etc. Am I allowed to stop that suicide? "Whatever affects one directly, affects all indirectly."
  - shanebellone 4y ago
    This is such a selfish perspective. What about their trauma, pain, and sorrow?
    - hprotagonist 4y ago
      It's the exact opposite of selfish; I am pointing out that yes, people are individuals, but people are also inextricably communal as well. Choosing to end your life, like any other choice we made, is not solely about _you_ because it does not solely affect _you_. "No man is an island entire of itself; every man / is a piece of the continent, a part of the main;"
      - shanebellone 4y ago
        Death is absolute. In no circumstance can you avoid its impact. Thus, your argument is predicated upon exerting control over another human in order to control the timing of your displeasure. Preferring a loved one to suffer, indefinitely, in order to spare your feelings... is the very definition of selfish.
guerrilla 4y ago
Absolutely not. The only possible justification for any of these authoritarian interventions is self-defense. Anything short of that is infringing on their autonomy over their body and not something you should be advocating for especially considering you could be in that exact situation. In addition, suicide is not necessarily irrational, so definitely not.
sashenka 4y ago

mythrwy 4y ago

Looking around at insane and drugged up street people (for instance) intuitively I say "Yes definitely, and it should be more widely practiced!". Then I remember how the definition of mental illness has changed over the years and think how it might change in the future, and now I'm not so sure.

TulliusCicero 4y ago
Seems like the threshold should probably be whether it's substantially interfering with their ability to interface with the rest of society, especially in terms of breaking laws. Many people in the situation you describe no longer seem capable of regulating their own behavior.
gernb 4y ago
There's a mentally ill person who lives outside my apartment. Every day/night she screams at the top of her voice about random things. I feel very sorry for her but at some point she needs to be moved and taken somewhere. She has no right to subject the entire neighborhood to her rants. All of our collective santity outweights her issues. It's not that different than a repeat criminal. Reguardless of reasons, at some point they're too much of a net negative to society. Dealing with them in some humane way is ideal but those 2 things are separate concerns IMO. Meaning there are 2 issues (1) Save everyone else from someone's distruptive behavior (2) Deal with the person in the best possible way You can solve (1) and not solve (2). Being not able to solve (2) perfectly does not invalidate the need to solve (1)
- horsawlarway 4y ago
  Yup - I think it's very important to point out that there are two different problems to solve here. 1) What sort of behaviors is a community willing to tolerate 2) What does that community do with people who are unable to stay within the confines of tolerated behavior The problem is that asymmetrical answers to the two questions can create a strange grey-zone, where problems linger. For example - if you murder someone, I don't think many people are going to argue against you spending some time in prison. The response is in line with the severity of the action. But... if you say, consistently piss in the elevators of your local metro (even though public bathrooms are available), most folks aren't sure prison is the right answer. Ideally - we'd just keep you out of the metro entirely - but setting up that system is very expensive when we're dealing with a very small number of bad actors. On the flip side - that small number of bad actors is doing considerable damage long term. They're making metro usage far less pleasant, driving down ridership, increasing cleaning costs, reducing public health, and requiring additional staff in attempts at monitoring. Each other member of society is only inconvenienced a relatively minor amount, but they're impacting a very large number of them by degrading a public and shared service. The same is true of those who camp/sleep outside of businesses, or scream & rant in public spaces, or do drugs in public spaces. They are actively harming the space they are using at large, and are unwilling to stop or unable regulate themselves. So what do we do with those people? What is a proportional action that we can take that prevents the damage this person is causing at scale? Prison/Jail rarely work - because the damage of each individual occurrence is small, they are usually out very quickly. Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Meds can definitely help - but the category of people creating these disturbances generally have trouble consistently taking meds (again - for a variety of reasons including access to services and payment, but not the least is active, personal resistance) So... if we've ruled out (as in - tried and failed) self medication + housing + prison... where do we go? Because at that point - I'm not really convinced that forced treatment and care are really unreasonable responses. It is far more cost effective to gather these folks in a single place and confine them there than it is to allow them to roam and attempt to stop their problem behavior at the place it occurs. It's the difference between 10 guards, a large facility home, and medical staff - versus thousands of required staff spread over a city.

bell-cot 4y ago

An old friend has a niece with a life-long, major mental illness. When off her medications (I've lost count of how many times, over the years), she goes "on the run", and phones home to various family members (often many times per day) with angry rants - which very often include threats of great bodily harm and/or death. Her grip on reality in that state is rather poor - asserting that Bugs Bunny and the CIA are conspiring to create a brain controlled army of polar bears with space lasers would not be unusual. When on her medications, she is a relatively pleasant & rational person, usually able to hold an entry-level job. Her family do not want to throw her in jail for all the threats (I'm not asserting that they could, if they wanted to), she really does not like the side effects of her medications, and (under the current system) neither confining her to a long-term mental health facility, nor reliably forcing her to take her medications seem to be available options. (Her family has talked to lawyers about their options more than once.) What would be the "humane" thing to do? In composing your answer, please recall that her family are also humans, and - barring a premature death - she is likely to outlive most of them. Edit: Thank you for all the replies, but my 4th-paragraph question was intended to be rhetorical. My point is that the case-by-case reality, even from the PoV of a well-to-do family that really seems to care about the mentally ill person, is often agonizingly difficult.

deleted 4y ago
[deleted]
brodouevencode 4y ago
It's certainly tough for sure. I think the ultimate question is what is considered "humane". Locked up in a straight jacket in a padded room for having slightly depressive thoughts is certainly not, but also allowing someone like in your story to spiral out of control and act out their trauma is arguably equally as inhumane. I wish I had a good answer for you.
jimbob45 4y ago
Assuming her threats and behavior would eventually result in her being tossed in jail, the choice seems to be between her imprisonment and her being forcibly medicated. I don't have an answer for you. I think you've come up with a potential plot for a very interesting Star Trek episode though.

yupis 4y ago

Thanks

p0pcult 4y ago

Surely some of the answer also depends on what constitutes the "treatment," no?

armchairhacker 4y ago

The way I see it: forced treatment is humane when the person being treated consents afterward. e.g. stopping someone in a bad mental state from suicide or anorexia, so that they thank you when they improve. Of course it’s not possible to know whether the person will consent beforehand, so you have to predict (and if you get it wrong, you messed up). In most cases this is what real-world suicide prevention leads to, because if a person is adamant on killing themselves they usually find a way. The exception is really sick people who want to kill themselves, but can’t because they have limited autonomy. That would be covered by euthanasia and is one of the reasons why it is very important ethically. For other mentally ill people, forced treatment is still only ok if they may actually get better and thank you later. If someone is dirty, homeless, and senile, but they don’t care, putting them into a retirement home does not make them happy so it does not actually benefit them. If someone acts sane only when they get medication but they hate it, giving them the medication does not benefit them, it benefits others. In these cases forced treatment may still be practically necessary and morally ok to benefit society (we don’t want dirty homeless people begging on the street, so we outlaw public indecency and soliciting, and some illnesses make a person dangerous). But I think that we need to understand that forced treatment is not to benefit the mentally ill themselves, but us, and also take their feelings into account. e.g. force homeless people out of the streets and into homes, but give them autonomy, and if their homes decay and they sit around all day and don’t care, let them. EDIT: Should also add that nursing and caregiving are jobs which give people power over other, vulnerable people. Many of the doctors which take care of mentally ill and disabled people are genuinely amazing people who honestly don’t deserve the bad connotation, but some apply to these jobs to take advantage of their power over others. So when forcing treatment on someone, we really need to ensure that those in charge of the treatment have said person’s best interests at heart, and need to be monitored and held accountable. This is something which is unfortunately lacking because the people who are exploited or in danger of being exploited and thus care the most can’t really advocate well, so the burden falls to beaurocracy which cannot adequately manage.

loeg 4y ago

Always nice to see a counterexample to Betteridge's law of headlines.

pcurve 4y ago

I guess it's a question of humane from whose perspective? If I were ever in a position where I'm not able to make sound decision ono my behalf and I don't have anyone around me to do so either, I would be OK with governmental entity intervening. "Democratic mayor of New York City, instructed police and first responders to hospitalise people with severe mental illness who are incapable of looking after themselves." I consider this humane and sound.

AnimalMuppet 4y ago
The problem comes with "incapable". What about marginally capable people? Where are you going to draw the line? The solution to that might be to not have a binary line. The less capable they are, the more we can choose for them, but it's not all or nothing. (No, I don't have any idea what the details look like...)
lotsofpulp 4y ago
In that quote, “hospitalise” might mean to drop them off in an understaffed hospital emergency room so that they can be temporarily sedated or whatever and then released within whatever timeframe protects the various entities from liability. I doubt “hospitalise” means to house them in a properly staffed psychiatric care facility under the care of qualified professionals.
bell-cot 4y ago
Like ~any government policy, the reality depends mostly upon the competence, honesty, good will, and resources of the people & agencies actually implementing the policy. (Vs. the Official Rules, as written down by politicians & bureaucrats.) Folks who really don't trust the government of NYC on the "competence, honesty, good will, and resources" angles may have plenty of evidence to support their distrust.

xyzelement 4y ago

The question feels very complex when framed like in the article. In reality I think it's two separate but connected questions that society should be able to answer based on its dominant values. 1. Do we have and enforce laws about things like people setting up tent cities in neighborhoods, open air drug use, public defecation and attacking pedestrians. Your politics can determine how you feel about this. My personal take is that yes we should have and enforce such laws. 2. What do we do when people are violating these laws due to mental illness? Do we just prosecute them and lock them up in regular jail or do we institutionalize and treat them like the mentally ill? To me it seems like treating mentally ill transgressors as such is right. The alternative to treat them like regular criminals seem worse. I think most people can follow this kind of argument. The real debate is around the first point, where do we draw the line about legal and illegal behavior.

runnerup 4y ago
Also, where should people be homeless? Literally I cannot pay rent next month and have no one willing to take me in. Where should I go? AFAIK there are zero legal options for me when I’m unable to pay for an apartment. I do not own a car. If I insist on being an upright citizen and following the law…do I just show up to a police station on January 1st and turn myself in for vagrancy and hope they throw me in jail?
- pigeons 4y ago
  What part of the world do you live in.
  - runnerup 4y ago
    USA
- Retric 4y ago
  Homeless shelters are a short term solution. Various housing programs are available depending on location, but tend to be really slow.

outside1234 4y ago

What about the rest of us that have to endure them shouting at us in the streets? Yes - it is humane for them AND for us.

throwayyy479087 4y ago
The general public isn't part of the Blessed Set of Protected Minorities so we don't count. What counts is the disadvantaged, and the more disadvantaged they are the more we're required to turn a blind eye to disruptive behavior. Homeless people, being at the bottom of the stack, are allowed to do basically anything and criticism of this fact will get you fired and cancelled. Ironically, this seems like true freedom to me - do whatever you want to whoever, with no fear of consequences. Just have to deal with the lack of dignity and resources.

kneebonian 4y ago

Interesting prespective on forced treatment for the mentally ill here: https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-prison-and-mental-illness/ https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p...

ravenstine 4y ago

No, but neither is allowing the mentally ill to remain ill. There's no win to pontificating over this issue. The only way to win is to get lucky when treating someone's mental illness and they happen to respond to it.

blurri 4y ago
To get lucky treating someone's mental illness if they allow you to treat them you mean?

zozbot234 4y ago

Tangentially related: ACX "in partial, grudging defense of the Hearing Voices movement": https://astralcodexten.substack.com/p/in-partial-grudging-defense-of-the https://astralcodexten.substack.com/p/in-partial-grudging-de... AIUI, the blog author points out that if you really want to comprehensively replace institutionalized, forced treatment, some sort of self-organized peer support is the best reasonable alternative - one that, arguably, has barely been tried. Related: Prison and mental illness https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-prison-and-mental-illness/ https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p... - My Brother Ron https://slatestarcodex.com/2016/03/31/book-review-my-brother-ron/ https://slatestarcodex.com/2016/03/31/book-review-my-brother...

djaouen 4y ago

As a mentally ill person myself, I don’t want to have to deal with being accosted when I go out just to buy food. If these policies get people off the streets, I think that is a good thing!

bnralt 4y ago

What's interesting is that once someone gets past a certain age, people almost universally agree that it's OK to confine them against their wishes if they are unable to take car of themselves. You don't hear many people saying that dementia patients should be able to leave whenever they want.

trynewideas 4y ago
As someone who's cared for someone with a declining mental state, dementia patients should be able to leave whenever they want. The problem is that the rest of the world doesn't want to - not can't, but finds it inconvenient - to deal with the ramifications of supervising or caring for people in public, strangers, who can't help themselves. It's much easier to detain inconvenient people than change the rest of the world around them such that it wants to share the burden of caring for them.
- tacotime 4y ago
  Someone in my family, who is now in a memory care facility, has dementia. We tried to avoid it as long as possible, but when we got a call from the police saying that she was found wandering around barefoot in the snow next to a busy road in the middle of the night while hallucinating about “people coming to get her”, it felt like it was time to reconsider. She’s on meds that control the hallucinations now, but it would still be unsafe for her to leave unsupervised, no matter how much our culture changes. How do you help a stranger who doesn’t know where or who they are, and can’t hear too well to start with? She sure does still remember me and can dance to the Beatles, but I would not be comfortable trusting her welfare to a group of even the most compassionate strangers.
- belval 4y ago
  This is a very emotional topic so I want to avoid being too critical of that opinion, but at the same time, it's much much deeper than "doesn't want to". Dementia patients depending on their state are a danger to others and themselves. Their limited ability to understand what's happening around them means that they can get aggressive. Even if not aggressive, they will just "get lost" and try to drive or "go for a walk" in the middle of the night in their pyjamas. I suppose from the way you phrased it that in your case it was mostly harmless and you just disliked getting weird looks, but a lot of dementia patients are actually incompatible with society and need to be detained or given anti-anxiety medications.

mullen 4y ago

This is why we can't have nice things in this country. It's always comes down to some rhetorical discussion about edge cases and possibilities of how a tiny fraction of people might be negatively impacted, so let's not do it. Let's frame it this way, "Is it humane to allow people be a slave to their mental illness and living on the streets?" The answer is clearly, "no". Allowing the mentally ill to live on the streets betters no ones life and causes many issues for everyone. If people with a mental health issue can not or will not take care of themselves, then someone else has to do it (IE: The Government). It is humane for everyone if the mentally ill are forced to get treatment or confined if they refuse it.

guerrilla 4y ago
> It is humane for everyone if the mentally ill are forced to get treatment or confined if they refuse it. Definitely not, unless they're actively harming you because self-defense is always justified. Short of that it's none of your business.
- mixmastamyk 4y ago
  You may have misunderstood what humane means in this context. It is definitely society's business that our fellows don't live eating out of garbage cans while swearing obscenities at no one in particular on the sidewalk. Encampments also breed rats, disease, drugs, and prostitution. It was never acceptable to allow this and we no longer have the excuses of the old days—that we don't have the resources to help them. https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/ https://www.theatlantic.com/health/archive/2019/03/typhus-tu...
  - guerrilla 4y ago
    > You may have misunderstood what humane means in this context. It is definitely society's business that our fellows don't live eating out of garbage cans while swearing obscenities at no one in particular on the sidewalk. Encampments also breed rats, disease, drugs, and prostitution. You can offer as much help as you want, but you can't force it on anyone. I think we should give them all free housing, food and whatever else they may need, but we can't use violence and imprisonment on them in any other case than self-defense. That would be a violation of bodily autonomy and extremely illiberal.

WarOnPrivacy 4y ago

I was my ex's caregiver for decades. Today she lives in a local homeless community and her wellbeing is often at risk. Could she have had a different outcome through forced treatment? Yes and no. The technical answer is No because the treatment she needs doesn't exist here (extended-term, inpatient, safe). There's nothing to commit her to. If the treatment she needs existed, could I have committed her against her will? Probably not. It would require LEO assistance and (due to reality) husbands are generally considered to pose a heightened risk of gaslighting.

rr808 4y ago

Does anyone know of numbers of who used to be locked up in asylums etc? It seems to have been more common and I have no clue about how often it happens now. Reagan closed the mental hospitals?

jl6 4y ago

Implicit in the question is that we even understand what the right treatment should be. Once upon a time, doctors would have enthusiastically recommended lobotomies. Would we have nodded along? I think the ethical conundrum lessens if there actually is a clear, proven, effective treatment. We often make decisions on behalf of people who aren’t able to make the right choice for themselves, and I don’t think a pathological commitment to individual liberty should constrain us in cases where there is the possibility of dramatically improving someone’s wellbeing.

mixmastamyk 4y ago
It's 2022 not 1922 or earlier; no one is advocating medieval treatments.

trynewideas 4y ago

This is an imminent question in Portland, Oregon: the mayor wants to relax the requirements to civilly commit a person against their will despite a lack of hospitals that can receive or treat them,[1][2] another of his suite of tactics to address homelessness that's included perpetual weekly sweeps of dozens of homeless encampments,[3] asking for $27 million to build city-run open-air camps,[4][5] and trying but failing through those policies to secure additional state funding for city-run shelters.[6] None of these tactics have been strategic - housed and homeless people alike in Portland who want mental health resources can't access the limited inventory of them, so expanding involuntary commitment without funded services will only add to that resource stress. Sweeps without a variety of funded shelter options just move the problem of camps from one part of the city to another while destroying what little the campers own, at a contractor cost of $4.5 million per year. The city-run camp proposal has been derided as "concentration camps", and the $27 million price tag would pay for a year of stable housing for nearly 2,500. State legislators cited the sweeps and camp proposal as reasons why they were giving $25 million in funding to the separate county leadership instead of the city, and put conditions on the funding that explicitly prevented its use for sweeps or involuntary camps. All of this happened _before_ the proposal to expand involuntary commitment criteria, which would at worst facilitate abuse or harassment of people with mental illnesses - housed or not - and at best fail to solve the underlying lack of treatment resources available to anyone, much less the involuntarily committed.[7] 1: https://www.opb.org/article/2022/12/12/portland-mayor-ted-wheeler-suggests-easing-process-involuntarily-commit-mentally-ill/ https://www.opb.org/article/2022/12/12/portland-mayor-ted-wh... 2: https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-wants-to-forcibly-commit-more-people-with-mental-illness/ https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-want... 3: https://www.oregonlive.com/politics/2022/12/portland-has-dramatically-escalated-tent-sweeps.html https://www.oregonlive.com/politics/2022/12/portland-has-dra... 4: https://www.columbian.com/news/2022/nov/18/homeless-vote-in-portland-oregon-delayed-in-angry-meeting/ https://www.columbian.com/news/2022/nov/18/homeless-vote-in-... 5: https://www.kgw.com/article/news/local/homeless/multnomah-county-rent-assistance-wheeler-plan/283-7f1e75c8-8a1b-4dca-9362-344d859aaf9f https://www.kgw.com/article/news/local/homeless/multnomah-co... 6: https://www.oregonlive.com/politics/2022/02/no-direct-funding-for-portland-homeless-shelters-in-legislative-housing-plan.html https://www.oregonlive.com/politics/2022/02/no-direct-fundin... 7: https://www.themarshallproject.org/2020/11/08/when-going-to-the-hospital-is-just-as-bad-as-jail https://www.themarshallproject.org/2020/11/08/when-going-to-...

guerrilla 4y ago

It amazes me that this place gets a reputation of being libertarian when the vast majority of comments here (and on similar subjects) are extremely authoritarian. The libertarian stance is that if someone isn't harming you then you have absolutely no justification to impinge on their freedom. This is fundamental liberal and libertarian theory common to all branches of both.

goatlover 4y ago
So what does a libertarian society do with people who do the following in public: defecate, shoot up, litter, block sidewalks with tents, harass passerbies? Do you arrest them for breaking the law? Allow them to continue doing so? Or would there be no such laws because it’s not harming anyone under a libertarian view? How does a libertarian deal with the chronically homeless?
- guerrilla 4y ago
  > How does a libertarian deal with the chronically homeless? Obviously you house them, feed them, offer them treatment, etc. with the least amount of friction possible. If they refuse and aren't literally hurting anyone, then nothing. You don't need to over-complicate this.
  - lostmsu 4y ago
    I think this is not a libertarian place then.
  - goatlover 4y ago
    So if they refuse assistance and continue breaking the law, you just let them? Do libertarians not have laws against littering, camping out on sidewalks or near schools, etc? I've seen enough public places trashed by the fraction of the homeless that are either too ill or don't care to pick up and walk a few feet to a trash receptacle. It can be unsanitary at times. Parks and coffee shops end up locking their bathrooms so they don't have to clean up the mess. If involuntary commitment is against your principles, what about relocation to designated areas where the homeless have access to services they need? They can leave and go wherever, they just can't camp outside those designated areas, or otherwise break the law, just like any other citizen.

qwerty456127 4y ago

Some times it is. It really depends on the condition, specific case and the way you treat them. To me it seems obvious that at least in some cases it is, even if not in many. May be hard to tell in advance though. There are cases when a person is not in the mood (to put it mildly) to accept help but really needs it and will sincerely appreciate it once a relief comes. The opposite question is also valid by the way: is it humane to leave the insane to struggle and roam the streets untreated?

_fol8 4y ago

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MopMop 4y ago

"Her grip on reality in that state is rather poor - asserting that Bugs Bunny and the CIA are conspiring to create a brain controlled army of polar bears with space lasers would not be unusual." The angry rants are a reaction to loss of bodily autonomy, spiritual wellbeing and mental liberation. If you are on these kind of antipsychotics for the most part of your adult life it's ordinary to not be in touch with your feelings or anyone elses and it's ok to be delusional cos if you don't ever know what it feels like to be mentally liberated then how else could you know how it feels to be free.

Tiktaalik 4y ago

Doctors don't support involuntary treatment because it's not effective. Effectively it trains people to distrust the health system, and to not seek medical care because they'll be locked up and bad things will happen to them. This leads to worsening health outcomes. We just passed through years of pandemic where everyone was eager to listen to the experts in the medical profession and that saved countless lives. It's sad and disturbing that when it comes to other health care issues, the politicians are now tuning out the same experts because they don't like what they're hearing.

mullingitover 4y ago
> Doctors don't support involuntary treatment because it's not effective. I think there's a difference between making an informed decision to decline treatment versus not being in a state of mind that allows you to make any rational decisions. People on the street with mental faculties in a state of failure are not really able to make that choice, and treating someone in that state as if they're making a voluntary choice is farcical.
HDThoreaun 4y ago
What other choice is there for people who have continuously refused treatment? Should we just accept that these people will live in tent encampments?
- Tiktaalik 4y ago
  I'm sure we can concoct some elaborate edge edge edge case where there are no other options, but broadly I think the medical establishment much rather prefers the situation where some dysfunctional person is regularly coming to check in with a doctor, even if it means they have to handhold some person every step of the way through life as they make mistake after mistake. The alternative, where someone is whisked away to internment for a few months, bounces back right after into the same broken lifestyle, and subsequently never trusts the medical system ever again and never goes to see a doctor again is less desirable. With the former there remains always new opportunities for someone to take positive steps forward to recovery as they are always in contact with a system that can help them. With the latter we burn a bridge one and done.

LatteLazy 4y ago

Given the very low efficiency of most mental health "treatment" this remains a mostly theoretical question. Until psychology and physiatry sort themselves out and become sciences were really just talking about locking people up...

ThinkBeat 4y ago

We had asylums where we locked up mentally ill peopl. They were treated in a most horrible way in general. I have seen pictures and documentaries and a lot of them were nightmares. Then we tore down the asylums and set the inmates free. Good job. You are free. Live your lives in happiness. Nobody will force treatment up on you. In fact getting treatment is close to impossible in the US. Many people without treatment get progressively worse. A lot of start using alcohol or other drugs to try to manage their lives. For most people that does not turn out all that well over time. They had added a component that will give them even more problems. Now prison is full of people with mental illness who ought not to be there. They have become the new asylums. The prison cannot provide the care and treatment required. This is not progress. What was needed before, and is needed now is appropriate treatment for each person. Some can do well with speech therapy. Some need to be tied to a bed. A lot. Between those extremes there is a near infinite palette of mental problems. No two people are the same, even if they are given the same diagnosis. (Diagnosis in itself is a difficult thing to get right, and requires observation / follow up over a long period of time. Not just when they are having an episode. ) Treatment of mental illness is almost universally a part of healthcare with low funding.

77pt77 4y ago
> I have seen pictures and documentaries and a lot of them were nightmares. Try reading the actual reports. Seriously, you can find that online.
- selectodude 4y ago
  care to share?

DaniloDias 4y ago

at_a_remove 4y ago

Reframe the question in terms of what it really is: Is forced treatment for the mentally ill more humane or less humane than letting them "do their thing?" Is it more humane for the people who are forced to interact with them? A lot of ethical questions could use a "trolley-fy" process in which the status quo is simply presented as another track, and then another process by which that question is re-embedded within its actual context -- the mentally ill are not off wandering some other plane of existence, they may be screaming in your alley, tonight, around three a.m.

nitwit005 4y ago

The reality is, we provide (admittedly crappy) mental health care in prisons, so we already have a program of forced treatment. We just wait until a serious crime has happened. Almost any non-prison option would be better than the current way of doing things.

LarryMullins 4y ago
I think the prison-solution, as crappy as it is, is better than doing nothing at all. But it should certainly be possible to do better.

nimbius 4y ago

> Many liberals blame Ronald Reagan for the government’s abandonment of mentally ill Americans. Thats a fascinating stretch of the truth. Most sociologists, public health professionals, and public policy researchers can directly link "Reagans army" to the mans policies quantitatively. its less of a blame game and more of a fact of life the thatcher/reagan neoliberalist push essentially relegated the mentally ill to freeway underpasses and drug store parking lots. Those that didnt wind up screaming at stop signs or dancing nude through the streets instead have gone on to commit some of American societies most horrific mass shootings. > Many administrations in California have had opportunities to reverse Reagan in '67 sure, but by 1981 his federal cessation of funding for ANY state mental health services would have made the effort near Sisyphean. Alex Barnard doesnt do much to shore up the Gippers legacy outside of the prescriptive myopia that we should ignore the past and just look to the future now because $add_reason_later. Treat mental illness just like real illness and stop pretending its some special category of sorta-problem we cant do anything about because, surprise, we havent invested any money into its research, treatment, or cure since Dutch decided to gut funding 41 years ago before slipping into Dementia himself.

malcolmgreaves 4y ago

San Francisco is what happens if you answer “no” to this question.

someonewhocar3s 4y ago

smm11 4y ago

It's never humane, those who suffer mental illness rarely prefer treatment. But pit bull terriers who kill kids are put down.

faeriechangling 4y ago

Yes, obviously, I have seen a number of mentally ill children, all their treatment was forced as mentally ill children are not competent to make their own medical decisions. There is a huge body of ethics and law on the issue of forcing treatment upon others. As to this specific case, the forced treatment of homeless people with mental health problems, from what I've heard on the people with boots on the ground a lot of people have severe brain damage from things like fentanyl overdoses who simply can't take care of themselves, and I've heard tons of people who have been disturbed by people with mental health problems disrupting public order as people go about their day to day lives. How much should one value freedom, how much should one value order, and how much should one be a consequentialist? How cost-effective is forced treatment anyways?

77pt77 4y ago

Yes, because it's done by humans to humans. Is it moral? No.

jwatt 4y ago

On a related note, the interviews with homeless people on the YouTube channel Soft White Underbelly were a real eyeopener to me. I highly recommend it, but some of them are extremely hard to watch. https://www.youtube.com/@SoftWhiteUnderbelly/videos https://www.youtube.com/@SoftWhiteUnderbelly/videos

ineedasername 4y ago

It's a poorly formed question, and journalism in general is not a good venue for exploring the actual multiple questions that must be answered to get at the ostensible question in the title, much less the answers to those questions. An adequate addressing of the topic would need to start, at minimum, with defining with great specificity the following terms as applied to this problems: Force (which mechanisms, legal, physical, social, etc) Treatment (Chemical? Talk therapy & its many varieties? Simple protection from oneself, or others from the subject?) Mentally Ill (As classified by the DSM-V? Some other formal source? Who makes the diagnosis, what if there are competing diagnosis from different practitioners? Does the State get a say in this definition?) Humane (A vague concept whose specific definition, often also a bit vague, will vary by context: In the US it is considered humane to euthanize animals in pain that cannot be cured, or with terminal conditions, or some combination thereof. Doing so to humans, even with their consent, is highly controversial. And yet suicide hangs silently over many discussions of mental illness, and too often mental illness is resistant to treatment to the point of torture for the person experiencing it, even with their full & willing consent to any treatment that might help their cause. Further there is the same question of who decides what humane gets to mean, both in general and as applied in specific circumstances.) This barely scratches the surface, all I've done is identify items in a short headline that need defining, and each of those could take countless person-hours of discussion & debate and still not be settled in a meaningful way in which most parties agreed.

black_13 4y ago

black_13 4y ago

StanislavPetrov 4y ago

Ultimately whether it is humane or not is irrelevant. If you are trapped on a lifeboat with a bunch of people, and one of them is mentally ill and threatening the safety and survival of the other people on the lifeboat because of an ability to regulate their own behavior, the people on that lifeboat are justified in taking whatever action necessary to ensure a safe environment. Society is that lifeboat. We should do everything possible to offer mentally ill people the resources they need to help themselves and to integrate themselves into society. But if that fails, and they are unwilling or unable to integrate into society, and their behavior causes a safety risk and/or a significant disruption to society, then society is completely justified in using whatever measures are necessary to ensure they aren't a danger to others. It is simply absurd to suggest (as many do today) that profoundly mentally ill people should be allowed to roam free and manifest their mental illness in ways that are harmful to other people because it it "inhumane" to stop them.

hackermeows 4y ago

One of the primary problems with this is who gets to decide what is metal illness ? Is being gay a mental illness , I’m sure there a whole subset of the population including some doctors who thinks it is. Is being overly religious a mental illness ? There is so much potential for abuse here it just doesn’t make sense to force anything on anyone, unless they are a direct threat to others

MissLaeti 4y ago

House them first, then treat them accordingly. It should be better for them. Of course it’s more expansive than just incarcerate them in psychiatric centers and feed them with nasty treatment just because they are a disgrace in our society. Maybe it’s time to think about them as humans, not as a social problem. Capitalism is more of a social problem than psychotic homeless people.

BrandoElFollito 4y ago

I was discussing about that topic some time ago and was left wondering what the proportions of various mentally ill people actually are in the rought 3 categories: - dangerous/"seriously impacting" for others (→ locking up in an asylum) - need to be forced to take some treatment / learning so that they can function in the community - the rest I genuinely do not know the ratios, but have the feeling that the 1st one is really marginal, the 2nd quite a lot and the 3rd the bulk of people

Konohamaru 4y ago

...is it just me or is the number of cases of severe mental illness growing in the U.S.A.?

niemal_dev 4y ago

It is truly unfortunate to see how ignorant and misinformed most of these answers are. First, to understand what is a mental illness we have to deduce strong neuro-biological evidence of the problem and after-so we can proceed with an effective measure, a treatment, that is actually a treatment. Currently, any kind of psychiatric label is equivalent to archaic prophecies. There's no credible scientific evidence to back up any kind of mental illness diagnostic. It is a facade. Each and every medication supplied by psychiatrists is not a treatment. It is an inhumane process of complete eradication. Dopamine is a product of hormones among others and it is the core fuel of the brain. Dopamine is the resource with which you anticipate time. Dopamine is the resource with which you can memorize and have a cognitive function as a human being. Dopamine is the reason you have an imagination. Dopamine is the resource that transforms into energy for you to move your body. Shutting it down is nothing but a legal modern euthanasia. You justify pills for an effective measure, when science itself tends to look towards the gut-microbiome and the inflammation reaching all the way up to the brain. Exact causes are still unknown, but: there are other things one should be treated with, and they are not pills. The ketogenic diet has completely cured people who have been diagnosed as schizo-affective (schizophrenia that is actually worse). People who have been diagnosed as bipolar have also seen tremendous benefits from the ketogenic diet and have been cured. There are many supplements one can use to optimize the overall neuro-biology along with daily routines that reinforce it. But guess what? No psychiatrist actually pursues those choices, the biggest majority of them are "Here's your pills, next. You don't want them? Let me call the police.". Seeing people treating family members like that is also disheartening. Ignorance got us blind, blind to the madness we as society reinforce and blind to the actual truth. Calling that a human process is completely ignorant, there's no way for you to know how it is like unless you have studied neuro-biology or you have been under the influence of a dopamine antagonist (commonly known as anti-psychotics). And let me tell you something, there's nothing worse from seeing your lifetime go by and you being completely unable to live because you got no brain fuel. The worst possible prison is in our brains. Sometimes we build it ourselves, and sometimes other people do. Anti-psychotics is other people. That's how the real trauma occurs. That's how many innocents get "treated" from the society and the psychiatric community.