6 ms·

Review: The Best Minds, by Jonathan Rosen

72 points by barry-cotter 4y ago

zafka 4y ago
Thanks for posting this. More than anything I think this is a conversation starter. The issue is complex, and it does not help to pretend that any mental health issue can blended in to a functional life style. We spend so much time celebrating the "high functioning" neuro-diversives that we defocus from those that need a lot more help.
- kspacewalk2 4y ago
  >We spend so much time celebrating the "high functioning" neuro-diversives that we defocus from those that need a lot more help. That's exactly the point DeBoer made on a podcast I listen to (forget which). All these very vocal and highly visible autism advocates with basically social awkwardness as the only externally visible symptom, while rightly wanting to combat stigma associated with their condition, also end up distorting the perception of just how debilitating and devastating the disorder can be. The severely autistic people who require lifelong round the clock care don't write books or go on podcasts. So when someone rails against the disorder "label" and wants us to see mental illness as "neurodivergence", people think of the mild cases they've been exposed to in the media and go "yeah, makes sense, it's just basically quirkiness or a different, equally valid perception of reality". But no, it isn't.
fzeroracer 4y ago
There are so many points in this review that I absolutely despise because this is less of a review and more of a soapbox, but I'll sum it up with these two points: > Consider deinstitutionalization. Few things could be less popular or esteemed in the public imagination than long-term mental healthcare facilities. People with no personal experience with mental illness themselves often have a visceral reaction to the very idea of institutions, assuming them to universally be houses of horror. And so deinstitutionalization, in a crude sense, is quite popular. This review ignores the incredibly sordid history of institutionalization in the US and why it's so strongly hated. Many crimes were committed on otherwise innocent people under the guise of curing their mental illnesses. Lobotomies were popular to 'cure' people. Cocktails of drugs, inhumane experiments. You can look at what was done at Willowbrook State School to understand why this rapidly took the case. And it was not that long ago that things like 'being gay' was considered a mental illness. > As Rosen unsparingly documents, the efforts to “destigmatize” mental illness have created a perverse scenario in which mental health advocates - who will tell you that their goal is to make mental illness more visible - push the darkest parts of mental illness deeper and deeper into the closet. You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill, so it must not be mentioned; that some mentally ill people commit sexual offenses could be said to stigmatize the mentally ill, so that must not be mentioned; that some people with mental illness commit hideously brutal acts of self-injury could be said to stigmatize the mentally ill, so it must not be mentioned; that some people with mental illness play with and eat their own excrement could be said to stigmatize the mentally ill, so it must not be mentioned. I shouldn't need to mention how absolutely stupid this whole paragraph is. But the point is that not all mental illness is equal, someone with different problems is going to be more prone to certain issues than others. That should be obvious, but the problem is when you conflate everyone and assume that 'well XYZ has ABC, so its obvious why he did [Thing]". Not only that, but in this paragraph the author cites a study [1] which they say "You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill". But the study they quote says nothing of the sort! In fact it says the exact opposite: It says and I quote: "The popular belief is that people with mental illness are more prone to commit acts of violence and aggression. The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as “crazy” individuals. A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator. This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population." and "Currently, there is scant evidence to suggest that mental illness can independently predict criminal behavior. On the contrary, there is ample evidence that shows that persons with mental illness are far more likely to be the victim of violent crime rather than the perpetrator.". They manage to somehow completely misread the study they cited in favor of their soapbox points. [1] https://www.ncbi.nlm.nih.gov/books/NBK537064/ https://www.ncbi.nlm.nih.gov/books/NBK537064/
- jhbadger 4y ago
  >This review ignores the incredibly sordid history of institutionalization in the US and why it's so strongly hated. Yes, the past of mental hospitals was bad. But that's true of the past of everything (nostalgia notwithstanding) The problem is that modern mental hospitals aren't like the hospital of "One Flew Over the Cuckoo's Nest" and yet that's what the public seem to think they are. Imagine if everyone's idea of a surgical hospital was that outdated -- nobody would be willing to get surgery. But people seem to understand that surgical science has advanced and yet seem to have a problem understanding that mental health treatments have advanced too.
  - fzeroracer 4y ago
    No, that's not true of the past of 'everything' and I highly recommend you actually looking into how the US used institutionalization to foster both inhumane experiments on people that had no say otherwise. Institutions supported only a fraction of the population dealing with mental illness and yet they frequently solved the problem by drugging people into a stupor, or turning them into a shell of who they were before. The people there knew what they were doing did not solve the problem or help the people.
    - jhbadger 4y ago
      Believe me, I'm well aware of that. But I'm also aware of the past of medical treatment in general which could also be presented as a horror show. Fortunately most people understand that they won't get their leg sawn off without anesthetic if they go to a hospital for treatment for a leg infection these days.
      - haswell 4y ago
        I’m trying to understand the point you’re trying to make here. This seems like a non-sequitur, but I could be misreading/fundamentally missing something. Yes, people generally understand that medical treatments are typically not unnecessarily barbaric these days (this is not always the case, even if we at least know that when painful treatments are required, they are actually useful). What does this say about the long-standing stigmas around mental health, both about the people who experience trouble and about the process of getting treatment? It seems like a vague analogy about progress over time, but to what end? How does knowing that I won’t feel a saw cutting through my leg change my understanding of mental health, either as a potential patient or as a curious person?
ar9av 4y ago
This was a good read, thank you. The whole destigmatization movement has never quite sat right with me. It's consequences seem glaringly obvious but noone cares, it's very frustrating. Pd: Found this after clicking on your username on a thread where someone was waiting for your Oscars opinions, lol. That's a swerve and a half
- criddell 4y ago
  Stigmatization has consequences as well. Reasonable people can disagree about which is worse.
- hummus_bae 4y ago
  [dead]
notShabu 4y ago
Something to note is that a large amount of individuals have "intrusive thoughts" that are typically only associated with the mentally ill. One example is the "call of the void", the "what if I jumped?" when looking from tall heights. However there are also many other violent or sexual thoughts that are suppressed and also difficult to talk about socially. What defines the "mentally ill" then is how prominent this voice is and how often it leaks into the "physical" world. These actions are usually controlled by threat of imprisonment/violence by the state, social punishment by the community, or controlled by being channeled into specific arenas and fantasies.(games/porns/sports/war/etc...) Behaviors that leak out of these boundaries are "eccentric" when they don't seem to do any harm and immoral when they disrupt the boundaries themselves (hacker) or the structures within the boundaries. Sometimes the boundaries are too restrictive like a straightjacket. They increase the internal pressure requiring stronger boundaries that increase the internal pressure until the whole thing explodes. Sometimes the structures themselves need to be updated and modernized. E.g. women showing their face in public or wearing a bikini shouldn't topple all of society. The pace of technology disrupts boundaries. This incentivizes and leads to more adaptable and resilient structures. The white-hat school prankster crosses into black-hat destruction territory only when others "can't keep up". The point is that maybe there isn't a specific mental "illness" like a bug or a virus that acts as an antagonistic external entity. It's just behavior relative to societal boundaries and outlets (which vary greatly across culture and time). Even a very black/white "illness" like schizophrenia seemingly used to have an social role as shaman-oracle but w/o this outlet can only express itself as axe murderer
barry-cotter 4y ago
> Near the end of the book, Rosen writes “Violence and mental illness have been legally entangled ever since dangerousness, rather than illness, became the necessary prerequisite for hospitalization.” And this really is the heart of it: in an effort to ensure the autonomy and rights of those with mental illness, we created a system where you have to be violent to be taken seriously, and where absent violence the people who love you most and know you best have no recourse for forcing you into treatment when you desperately need it. If ever there’s been a tragedy of good intentions, there it is. The Best Minds is a chronicle of that tragedy. I think it’s the best book about mental illness I’ve ever read.
- nordsieck 4y ago
  > And this really is the heart of it: in an effort to ensure the autonomy and rights of those with mental illness, we created a system where you have to be violent to be taken seriously, and where absent violence the people who love you most and know you best have no recourse for forcing you into treatment when you desperately need it. If ever there’s been a tragedy of good intentions, there it is. I suppose one could call it a tragedy, but I think a balancing act is a much more accurate way to describe it. It's a bit like the rules around convicting people of crimes. It's been pretty widely acknowledged that there are many people who escape punishment - particularly of intimate crimes - because a prosecutor probably couldn't meet the standard to convict them. But on the other hand, there are many innocent people who are currently being punished for crimes they didn't commit. The more we try to suppress type 1 errors, the more type 2 errors we get. And vice versa. In the case of mental health, sure - there are probably lots of people who desperately need care and can't get it because they can't be committed. But there's also a long history of people preying on others by getting them committed. I'm not going to pretend that I know if we have struck the correct balance; just that it is a balance. And moving the dial 100% in one direction or the other is the wrong answer.
  - GTP 4y ago
    But there's more to it. The writer points out that in the USA it's even hard to talk about the problem, because if you say things like that people with certain mental illnesses are more likely to be violent, some people will say that you're creating stigma. So it's more about how an healthy and balanced discourse about the topic would look like.

72 points by barry-cotter 4y ago

Thanks for posting this. More than anything I think this is a conversation starter. The issue is complex, and it does not help to pretend that any mental health issue can blended in to a functional life style. We spend so much time celebrating the "high functioning" neuro-diversives that we defocus from those that need a lot more help.

kspacewalk2 4y ago
>We spend so much time celebrating the "high functioning" neuro-diversives that we defocus from those that need a lot more help. That's exactly the point DeBoer made on a podcast I listen to (forget which). All these very vocal and highly visible autism advocates with basically social awkwardness as the only externally visible symptom, while rightly wanting to combat stigma associated with their condition, also end up distorting the perception of just how debilitating and devastating the disorder can be. The severely autistic people who require lifelong round the clock care don't write books or go on podcasts. So when someone rails against the disorder "label" and wants us to see mental illness as "neurodivergence", people think of the mild cases they've been exposed to in the media and go "yeah, makes sense, it's just basically quirkiness or a different, equally valid perception of reality". But no, it isn't.

fzeroracer 4y ago

There are so many points in this review that I absolutely despise because this is less of a review and more of a soapbox, but I'll sum it up with these two points: > Consider deinstitutionalization. Few things could be less popular or esteemed in the public imagination than long-term mental healthcare facilities. People with no personal experience with mental illness themselves often have a visceral reaction to the very idea of institutions, assuming them to universally be houses of horror. And so deinstitutionalization, in a crude sense, is quite popular. This review ignores the incredibly sordid history of institutionalization in the US and why it's so strongly hated. Many crimes were committed on otherwise innocent people under the guise of curing their mental illnesses. Lobotomies were popular to 'cure' people. Cocktails of drugs, inhumane experiments. You can look at what was done at Willowbrook State School to understand why this rapidly took the case. And it was not that long ago that things like 'being gay' was considered a mental illness. > As Rosen unsparingly documents, the efforts to “destigmatize” mental illness have created a perverse scenario in which mental health advocates - who will tell you that their goal is to make mental illness more visible - push the darkest parts of mental illness deeper and deeper into the closet. You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill, so it must not be mentioned; that some mentally ill people commit sexual offenses could be said to stigmatize the mentally ill, so that must not be mentioned; that some people with mental illness commit hideously brutal acts of self-injury could be said to stigmatize the mentally ill, so it must not be mentioned; that some people with mental illness play with and eat their own excrement could be said to stigmatize the mentally ill, so it must not be mentioned. I shouldn't need to mention how absolutely stupid this whole paragraph is. But the point is that not all mental illness is equal, someone with different problems is going to be more prone to certain issues than others. That should be obvious, but the problem is when you conflate everyone and assume that 'well XYZ has ABC, so its obvious why he did [Thing]". Not only that, but in this paragraph the author cites a study [1] which they say "You see, the fact that mental illness indisputably increases the odds of committing certain acts of violence could be said to stigmatize the mentally ill". But the study they quote says nothing of the sort! In fact it says the exact opposite: It says and I quote: "The popular belief is that people with mental illness are more prone to commit acts of violence and aggression. The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as “crazy” individuals. A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator. This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population." and "Currently, there is scant evidence to suggest that mental illness can independently predict criminal behavior. On the contrary, there is ample evidence that shows that persons with mental illness are far more likely to be the victim of violent crime rather than the perpetrator.". They manage to somehow completely misread the study they cited in favor of their soapbox points. [1] https://www.ncbi.nlm.nih.gov/books/NBK537064/ https://www.ncbi.nlm.nih.gov/books/NBK537064/

jhbadger 4y ago
>This review ignores the incredibly sordid history of institutionalization in the US and why it's so strongly hated. Yes, the past of mental hospitals was bad. But that's true of the past of everything (nostalgia notwithstanding) The problem is that modern mental hospitals aren't like the hospital of "One Flew Over the Cuckoo's Nest" and yet that's what the public seem to think they are. Imagine if everyone's idea of a surgical hospital was that outdated -- nobody would be willing to get surgery. But people seem to understand that surgical science has advanced and yet seem to have a problem understanding that mental health treatments have advanced too.
- fzeroracer 4y ago
  No, that's not true of the past of 'everything' and I highly recommend you actually looking into how the US used institutionalization to foster both inhumane experiments on people that had no say otherwise. Institutions supported only a fraction of the population dealing with mental illness and yet they frequently solved the problem by drugging people into a stupor, or turning them into a shell of who they were before. The people there knew what they were doing did not solve the problem or help the people.
  - jhbadger 4y ago
    Believe me, I'm well aware of that. But I'm also aware of the past of medical treatment in general which could also be presented as a horror show. Fortunately most people understand that they won't get their leg sawn off without anesthetic if they go to a hospital for treatment for a leg infection these days.
    - haswell 4y ago
      I’m trying to understand the point you’re trying to make here. This seems like a non-sequitur, but I could be misreading/fundamentally missing something. Yes, people generally understand that medical treatments are typically not unnecessarily barbaric these days (this is not always the case, even if we at least know that when painful treatments are required, they are actually useful). What does this say about the long-standing stigmas around mental health, both about the people who experience trouble and about the process of getting treatment? It seems like a vague analogy about progress over time, but to what end? How does knowing that I won’t feel a saw cutting through my leg change my understanding of mental health, either as a potential patient or as a curious person?

ar9av 4y ago

This was a good read, thank you. The whole destigmatization movement has never quite sat right with me. It's consequences seem glaringly obvious but noone cares, it's very frustrating. Pd: Found this after clicking on your username on a thread where someone was waiting for your Oscars opinions, lol. That's a swerve and a half

criddell 4y ago
Stigmatization has consequences as well. Reasonable people can disagree about which is worse.
hummus_bae 4y ago
[dead]

notShabu 4y ago

Something to note is that a large amount of individuals have "intrusive thoughts" that are typically only associated with the mentally ill. One example is the "call of the void", the "what if I jumped?" when looking from tall heights. However there are also many other violent or sexual thoughts that are suppressed and also difficult to talk about socially. What defines the "mentally ill" then is how prominent this voice is and how often it leaks into the "physical" world. These actions are usually controlled by threat of imprisonment/violence by the state, social punishment by the community, or controlled by being channeled into specific arenas and fantasies.(games/porns/sports/war/etc...) Behaviors that leak out of these boundaries are "eccentric" when they don't seem to do any harm and immoral when they disrupt the boundaries themselves (hacker) or the structures within the boundaries. Sometimes the boundaries are too restrictive like a straightjacket. They increase the internal pressure requiring stronger boundaries that increase the internal pressure until the whole thing explodes. Sometimes the structures themselves need to be updated and modernized. E.g. women showing their face in public or wearing a bikini shouldn't topple all of society. The pace of technology disrupts boundaries. This incentivizes and leads to more adaptable and resilient structures. The white-hat school prankster crosses into black-hat destruction territory only when others "can't keep up". The point is that maybe there isn't a specific mental "illness" like a bug or a virus that acts as an antagonistic external entity. It's just behavior relative to societal boundaries and outlets (which vary greatly across culture and time). Even a very black/white "illness" like schizophrenia seemingly used to have an social role as shaman-oracle but w/o this outlet can only express itself as axe murderer

barry-cotter 4y ago

> Near the end of the book, Rosen writes “Violence and mental illness have been legally entangled ever since dangerousness, rather than illness, became the necessary prerequisite for hospitalization.” And this really is the heart of it: in an effort to ensure the autonomy and rights of those with mental illness, we created a system where you have to be violent to be taken seriously, and where absent violence the people who love you most and know you best have no recourse for forcing you into treatment when you desperately need it. If ever there’s been a tragedy of good intentions, there it is. The Best Minds is a chronicle of that tragedy. I think it’s the best book about mental illness I’ve ever read.

nordsieck 4y ago
> And this really is the heart of it: in an effort to ensure the autonomy and rights of those with mental illness, we created a system where you have to be violent to be taken seriously, and where absent violence the people who love you most and know you best have no recourse for forcing you into treatment when you desperately need it. If ever there’s been a tragedy of good intentions, there it is. I suppose one could call it a tragedy, but I think a balancing act is a much more accurate way to describe it. It's a bit like the rules around convicting people of crimes. It's been pretty widely acknowledged that there are many people who escape punishment - particularly of intimate crimes - because a prosecutor probably couldn't meet the standard to convict them. But on the other hand, there are many innocent people who are currently being punished for crimes they didn't commit. The more we try to suppress type 1 errors, the more type 2 errors we get. And vice versa. In the case of mental health, sure - there are probably lots of people who desperately need care and can't get it because they can't be committed. But there's also a long history of people preying on others by getting them committed. I'm not going to pretend that I know if we have struck the correct balance; just that it is a balance. And moving the dial 100% in one direction or the other is the wrong answer.
- GTP 4y ago
  But there's more to it. The writer points out that in the USA it's even hard to talk about the problem, because if you say things like that people with certain mental illnesses are more likely to be violent, some people will say that you're creating stigma. So it's more about how an healthy and balanced discourse about the topic would look like.