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> Near the end of the book, Rosen writes “Violence and mental illness have been legally entangled ever since dangerousness, rather than illness, became the nece

> 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.
  - bjornsing 4y ago
    It’s a complex topic though. For example, where I live (in Sweden) people with schizophrenia have about the same overrepresentation among violent criminals as people with foreign born parents. I don’t think you’d be okay with a system where you could have “immigrants” and their kids locked up preemptively on the suspicion that they might commit violent crimes in the future.
    - GTP 4y ago
      But I'm not ok with preemptively locking mental hill people as well. I see the discussion more about taking into account that a mental hill person is more likely to have a violent behavior, and thus evaluating on a case-by-case basis if such a person needs to stay in a specialized health care facility (for their own good first, so they can receive the help they need) vs negating this fact and saying that mental illness doesn't impact on a person's behavior. The whole point of the article was that, to avoid creating stigma, it seems that in the USA they ended up with a situation where people with mental hillness are unlikely to receive the healthcare that they need.
      - bjornsing 4y ago
        > taking into account that a mental hill person is more likely to have a violent behavior, and thus evaluating on a case-by-case basis if such a person needs to stay in a specialized health care facility (for their own good first, so they can receive the help they need) vs negating this fact and saying that mental illness doesn't impact on a person's behavior. So what’s the difference? Having foreign born parents does “impact” a persons likelihood to be violent in a statistical sense. Having schizophrenia has a similar “impact” on a statistical level. You may find it easier to see a causal relationship in the latter case, but there are plenty of people who see that causal relationship in the former case too. Of course it’s wrong to deny people care for a serious illness. That unfortunately happens regularly in Sweden too.
- xthrown1 4y ago
  The only people who call it a balancing act are the ones who have never seen disruptive mental illness first hand. It's not cute, quirky or a choice. It's one step away from murder at the best of times. You're welcome to move to an insane asylum if you want to prove me wrong, you're not welcome to turn my back yard into one to make yourself feel better. Mental illness denial is the lefts version of climate change denial.
  - bjornsing 4y ago
    If you don’t think it’s a balancing act to strip people of their right to liberty then I don’t know where on the political spectrum you’re from. But you’re certainly not a republican in the classical sense, that’s for sure.
    - xthrown1 4y ago
      Ones right to liberty ends when they start throwing feces at me.
      - mold_aid 4y ago
        Maybe you are a Republican in the classical sense
        xthrown1 4y ago
        Or maybe I'm a communist and want to follow the example of the USSR when dealing with mental illness.
        barry-cotter 4y ago
        The Republicans welcome your aid in helping them get elected.
- em-bee 4y ago
  why can't they be committed though? because they themselves refuse to, or because without a forced commitment they can't afford to, or even if they can pay, they can't get a space? seems to me the balance, while being difficult to achieve, is not the problem, but the healthcare system in the US rears its ugly head again.
m463 4y ago
I think of the mess of mental health in california. Apparently in the past, there might have been perverse incentives to keep mentally ill people institutionalized, which might have prevented some people from ever escaping the system. They were called "snake pits". Eventually there was reform of the laws, and the mentally ill gained rights and some could get better and be released. Unfortunately the real tragedy happened when then-governor Reagan cut mental health funding and most mentally ill people were released and could not get adequate care. And that system survives, with the only way of getting care for mentally ill people is if they are "a danger to themselves or others". I suspect a good portion of the california homeless might be the fallout of this decision.
webnrrd2k 4y ago
> 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. That's the thing -- it's not against the law to be crazy. And, crazy or not, people have rights. I (barely) knew a guy who had serious problems for years, nothing could be done until he started a major forest fire. People in the community knew he was a problem, and that it was only a matter of time until he did something beyond petty vandalizm and misbehavior. But couldn't really do anything about it until he set fire to a neighbors cabin over a petty feud and ended up burning (IIRC) ~23,000 acres at a cost of ~$23 million [1]. So, what to do before it happens? Earlier intervention? Childhood programs? Enforce future crimes? Benign neglect? There has also been a huge amount of cost cutting and outright dishonesty regarding public health. In California, Ronald Regan was famous for cutting funding to the public mental health system, promising to fund community mental health. Then he renigged on his promise and refused fund community mental health. Mental health care has been a clear problem since then, at least. I don't know the answer, and, given the whole US system, there might not be a good solution. That said, one idea towards a solution is for seriously mentally ill people to be able to sign away some of their rights. I know, it's a dangerous idea, but, assuming they can give informed consent when they are "sane". (Yes, it's a real problem to get right). Conceivably they sign a waiver such that, if their mental state deteriorates enough, then they can be forced to be institutionalized and medicated for a short term -- long enough to be stabilized. Right now that can't happen without their consent. Although there is an informal system where this is exactly what happens -- some of the larger jails have psych wards where patients are stabilized via meds or whatever. It's already happening, it's just done via the criminal justice system. I'm just suggesting that there should just be a system for the same that's done via the medical system, out in the open, with proper accountability and supervision. > 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. I haven't read the book, so take this with a grain of salt, please. I can't speak to the specific case of Michael Laudor. However, the parent comment is about "Violence and mental illness have been legally entangled" which is pretty general. It certainly is a tragedy. And it is partially a tragedy of good intentions, but it's not only a tragedy of good intentions. There are a lot of conflicting interests. For example, there are people don't want to pay taxes to support good programs, and acively work against public health programs. There were a lot of abuses of the mentally ill in the past via involuntary commitment, and that should not be repeated. [1] https://en.wikipedia.org/wiki/Holy_Fire_(2018) https://en.wikipedia.org/wiki/Holy_Fire_(2018)

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.
- bjornsing 4y ago
  It’s a complex topic though. For example, where I live (in Sweden) people with schizophrenia have about the same overrepresentation among violent criminals as people with foreign born parents. I don’t think you’d be okay with a system where you could have “immigrants” and their kids locked up preemptively on the suspicion that they might commit violent crimes in the future.
  - GTP 4y ago
    But I'm not ok with preemptively locking mental hill people as well. I see the discussion more about taking into account that a mental hill person is more likely to have a violent behavior, and thus evaluating on a case-by-case basis if such a person needs to stay in a specialized health care facility (for their own good first, so they can receive the help they need) vs negating this fact and saying that mental illness doesn't impact on a person's behavior. The whole point of the article was that, to avoid creating stigma, it seems that in the USA they ended up with a situation where people with mental hillness are unlikely to receive the healthcare that they need.
    - bjornsing 4y ago
      > taking into account that a mental hill person is more likely to have a violent behavior, and thus evaluating on a case-by-case basis if such a person needs to stay in a specialized health care facility (for their own good first, so they can receive the help they need) vs negating this fact and saying that mental illness doesn't impact on a person's behavior. So what’s the difference? Having foreign born parents does “impact” a persons likelihood to be violent in a statistical sense. Having schizophrenia has a similar “impact” on a statistical level. You may find it easier to see a causal relationship in the latter case, but there are plenty of people who see that causal relationship in the former case too. Of course it’s wrong to deny people care for a serious illness. That unfortunately happens regularly in Sweden too.
xthrown1 4y ago
The only people who call it a balancing act are the ones who have never seen disruptive mental illness first hand. It's not cute, quirky or a choice. It's one step away from murder at the best of times. You're welcome to move to an insane asylum if you want to prove me wrong, you're not welcome to turn my back yard into one to make yourself feel better. Mental illness denial is the lefts version of climate change denial.
- bjornsing 4y ago
  If you don’t think it’s a balancing act to strip people of their right to liberty then I don’t know where on the political spectrum you’re from. But you’re certainly not a republican in the classical sense, that’s for sure.
  - xthrown1 4y ago
    Ones right to liberty ends when they start throwing feces at me.
    - mold_aid 4y ago
      Maybe you are a Republican in the classical sense
      - xthrown1 4y ago
        Or maybe I'm a communist and want to follow the example of the USSR when dealing with mental illness.
      - barry-cotter 4y ago
        The Republicans welcome your aid in helping them get elected.
em-bee 4y ago
why can't they be committed though? because they themselves refuse to, or because without a forced commitment they can't afford to, or even if they can pay, they can't get a space? seems to me the balance, while being difficult to achieve, is not the problem, but the healthcare system in the US rears its ugly head again.

m463 4y ago

I think of the mess of mental health in california. Apparently in the past, there might have been perverse incentives to keep mentally ill people institutionalized, which might have prevented some people from ever escaping the system. They were called "snake pits". Eventually there was reform of the laws, and the mentally ill gained rights and some could get better and be released. Unfortunately the real tragedy happened when then-governor Reagan cut mental health funding and most mentally ill people were released and could not get adequate care. And that system survives, with the only way of getting care for mentally ill people is if they are "a danger to themselves or others". I suspect a good portion of the california homeless might be the fallout of this decision.

webnrrd2k 4y ago

> 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. That's the thing -- it's not against the law to be crazy. And, crazy or not, people have rights. I (barely) knew a guy who had serious problems for years, nothing could be done until he started a major forest fire. People in the community knew he was a problem, and that it was only a matter of time until he did something beyond petty vandalizm and misbehavior. But couldn't really do anything about it until he set fire to a neighbors cabin over a petty feud and ended up burning (IIRC) ~23,000 acres at a cost of ~$23 million [1]. So, what to do before it happens? Earlier intervention? Childhood programs? Enforce future crimes? Benign neglect? There has also been a huge amount of cost cutting and outright dishonesty regarding public health. In California, Ronald Regan was famous for cutting funding to the public mental health system, promising to fund community mental health. Then he renigged on his promise and refused fund community mental health. Mental health care has been a clear problem since then, at least. I don't know the answer, and, given the whole US system, there might not be a good solution. That said, one idea towards a solution is for seriously mentally ill people to be able to sign away some of their rights. I know, it's a dangerous idea, but, assuming they can give informed consent when they are "sane". (Yes, it's a real problem to get right). Conceivably they sign a waiver such that, if their mental state deteriorates enough, then they can be forced to be institutionalized and medicated for a short term -- long enough to be stabilized. Right now that can't happen without their consent. Although there is an informal system where this is exactly what happens -- some of the larger jails have psych wards where patients are stabilized via meds or whatever. It's already happening, it's just done via the criminal justice system. I'm just suggesting that there should just be a system for the same that's done via the medical system, out in the open, with proper accountability and supervision. > 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. I haven't read the book, so take this with a grain of salt, please. I can't speak to the specific case of Michael Laudor. However, the parent comment is about "Violence and mental illness have been legally entangled" which is pretty general. It certainly is a tragedy. And it is partially a tragedy of good intentions, but it's not only a tragedy of good intentions. There are a lot of conflicting interests. For example, there are people don't want to pay taxes to support good programs, and acively work against public health programs. There were a lot of abuses of the mentally ill in the past via involuntary commitment, and that should not be repeated. [1] https://en.wikipedia.org/wiki/Holy_Fire_(2018) https://en.wikipedia.org/wiki/Holy_Fire_(2018)