20 ms·

People with severe mental illness have been failed by a dysfunctional system

281 points by fortran77 4y ago

kayodelycaon 4y ago
> Michael’s friends and family and his supporters at Yale had thought intelligence could save him, allow him to transcend the terrible disease that was causing his mind to detach from reality. This is such a bad misunderstanding of how schizophrenia works… intelligence does not help if the underlying hardware powering it breaks at a fundamental level.
- tokai 4y ago
  Premorbid IQ do predicted social function after the first schizophrenic episode. Here's some random papers, there are many more out there: https://www.sciencedirect.com/science/article/pii/S0924933815000723 https://www.sciencedirect.com/science/article/pii/S092493381... https://www.sciencedirect.com/science/article/pii/S0920996408003812 https://www.sciencedirect.com/science/article/pii/S092099640... https://www.nature.com/articles/npjschz201543 https://www.nature.com/articles/npjschz201543
  - qikInNdOutReply 4y ago
    https://de.wikipedia.org/wiki/John_Forbes_Nash_Jr https://de.wikipedia.org/wiki/John_Forbes_Nash_Jr. I would argue quite High IQ, still got nowhere regarding normal life due to the problem most of his adult life. Was kept on campus out of respect for his archivements. Finally returned to a state of being able to use his IQ with high age. The intelligence can do nothing once the hardware goes, except weave more elaborate conspiracies and paranoid fantasys.
    - tokai 4y ago
      I don't get your point. Nash outcome was very very good. He stayed out of hospitals and didn't take his medicine, after his initial stints with hospitalisation. >The intelligence can do nothing once the hardware goes, except weave more elaborate conspiracies and paranoid fantasys Why do you write this when I post evidence of the opposite? Do at least have some kind of backing to your statement.
      - qikInNdOutReply 4y ago
        Nashes work declined greatly with the full onset of the sickness and never fully recovered.
        tokai 4y ago
        That your only work declined is a very good outcome for an illness with as bad outcomes as schizophrenia. Like if you shattered both your legs, but ended up walking again while not able to compete in the olympics 100 meter sprint, would be a good outcome.
      - PurpleRamen 4y ago
        The linked german wikipedia descibe Nash's illness quite different from the english wikipedia. With the german article being less specific about the illness and outcome. Though, both are somewhat clear that the illness took him 20+ years of his life, which might be not a good proof for high IQ helps with mental illness.
        tokai 4y ago
        I wouldn't know, the link is dead. edit: No his outcome was good. He didn't die from it, he didn't spend his life locked up. It's absolutely ridiculous to argue the effect of IQ on outcomes from this one example tho. I posted several studies, that between them cites numerous studies, all based on data collected on 1000s of persons. A German wiki articles angle on Nash's illness is seriously a waste of everyone's time.
        PurpleRamen 4y ago
        The url has a dot at the end, which is missing in the link.
    - retrac 4y ago
      Schizophrenia is not an all or nothing. It's not like one resistor fries and suddenly they're hearing voices completely indistinguishable from reality. Some people have partial or even significant insight into their illness. That is to say, they are aware and appreciate that their thinking is disordered, or that the voices are actually internal, and they have coping methods. Some methods of coping like reality testing seem like they can be taught, and it does seem likely to me that having a lot of general intelligence would make such a thing more effective.
      - kayodelycaon 4y ago
        From my experience (and those on a bipolar discord server) coping mechanisms can definitely be taught. Most of them are rather simple in concept but almost all of them are absolutely exhausting to use. Trying to work full time while using coping mechanisms had me sitting in a chair, unable to function, after 5pm. I serious started to ask myself if living was worth living if that was all there was to it.
  - kayodelycaon 4y ago
    From personal experience, intelligence helps with self-awareness and finding strategies for dealing with mental illness. It does not help control it. Once psychosis take hold, it’s in the driver’s seat. I can be fully aware I’m trying to hurt someone and know that it’s wrong and be unable to stop myself from acting on my delusions. It feels like I’m outside my body, watching it do things I have no control over.
- fortran77 4y ago
  Isn’t that a one of the points of this article, that intelligence didn’t save him?
  - kayodelycaon 4y ago
    It does. It’s a very long (and very good) read. Most people aren’t going to finish it in time to comment. So I decided to start the discussion early for everyone else. :)
anon291 4y ago
Schizophrenia can be managed, not treated. Lost in all the talk about mental healthcare and drug addiction are two important topics. (1) Medicine does not have an answer for all mental illness. Many are incurable, and only manageable. (2) Sometimes even the management is not good enough. My uncle is extremely intelligent. Also has schizophrenia. Like Michael... extremely intelligent, PhD (received after diagnosis), etc. It's been many years. He has kids and grandchildren, etc. But... he still breaks from time to time. He's even attempted flat out murder. There's no answer really. His wife (my aunt) can get him to calm down, as can his children. But, it's still there, despite everyone's best efforts.In my view, short of completely numbing his personality and individualism, I can't see how anyone can 'fix' it. Further lost in our conversation as it pertains to drug abuse is the importance of not creating the problem to begin with. Schizophrenia is no joke. Several commonly available (some decriminalized) drugs can induce schizophrenia. We must do what is necessary to ensure this never happens. The mind is a terrible thing to lose. EDIT: Also, having also worked at Bain, I do not suggest anyone work in management consulting if they want their sanity.
- qikInNdOutReply 4y ago
  Another nuance lost is, that there are many millions for which the sickness is a gift. What becomes a conspiracy theory of the government following for one, becomes a thriller book for another, that switch to differentiate between hallucination and reality that artists have and patients dont have. My brother was quite the creative powerhouse, before the sickness took him.
  - anon291 4y ago
    My dad and his siblings are very smart (graduate degrees, doctors, all of them). However, the way my dad tells it, my uncle was exceptionally smart growing up, and I wonder if it was due to pre-schizophrenia traits (or pre-diagnosis... who knows). Despite being asian, my dad was always 'afraid' of smart children. In his mind, schizophrenia was caused by lack of rest and relaxation. He always encouraged my brother and I to relax, and not work too hard. Apparently, it is now known that schizophrenia is correlated with sleep disorders as well. I guess we are lucky in that my uncle has never been able to do anything wrong. He did attempt murder I suppose (in paranoid delusion), but luckily his brothers stopped him. I suppose it helps living near family and having a lot of siblings. Nowadays he's mostly limited (due to old age) to gathering apostles on the internet for his new religions. Probably the best outcome you can hope for. I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope. The 1950s and 60s saw the beginnings of the desire to eliminate asylums due to civil rights concerns. The 'solution' was a technology that at the time didn't exist, but which they hoped would exist after the law was passed. It is dangerous to create law while ignoring current reality, and depending on hope.
PuppyTailWags 4y ago
On one hand I want to be sympathetic to the author here, who has personal stake in preventing the severely mentally ill from murdering people. At the same time, the author doesn't at all go into the deeply personal and often traumatic reasons the mentally ill may resist being forcibly hospitalized in the way the author suggests should be done to them. The author doesn't go into cases like Brittney Spears's conservatorship, forced to take medication and have an IUD inserted and have her estate taken over by her parents under spurious claims of being unable to care for herself. The author doesn't go into how little oversight there is over ensuring the safety of patients once they're in the healthcare system, many of which go on to develop medical trauma due to rape, assault, etc. There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable.
- teeray 4y ago
  The judicial system should, ideally, serve this function since both arguments for and against compulsory care can be represented and a judgement can be made. The problem is that it is so costly financially and temporally that we can manage one judgement in years for a case rather than the greater re-evaluation frequency that is probably required for mental health.
  - jonhohle 4y ago
    Replacing one dysfunctional system for another doesn’t seem like the best option.
  - marcinzm 4y ago
    The judicial system is far from perfect even when the people involved are free to find their own representation or are able to freely do their own research. Someone who is not allowed to even access their own finances or sign legal contracts will naturally have a much harder time finding good legal representation. Someone in an institution even more so.
  - ada1981 4y ago
    The challenge is you then have someone whose specialty is law making psychological / spiritual / developmental determinations.
bjoli 4y ago
Isn't this the same old discussion that was recently ignited again by the Mr beast's glaucoma video? The US is a country where some people just can't afford not to be blind (or mentally ill). Their largest hope is for a millionaire influencer/Deus ex machina to appear and pay ther treatment.
- ixtli 4y ago
  the media apparatus regularly turns these into feel-good stories as well. its irresolvable imo
- giantg2 4y ago
  There are other options depending on the circumstances, such as Medicare, Medicaid, CHIP, pharmaceutical assistance programs, etc.
  - Broken_Hippo 4y ago
    Which are hard or stressful to get qualified for if you have your mental abilities with you, and you might not qualify for any of it (CHIP is for children, isn't it?). They can be almost impossible if you don't, and it isn't like someone is going to walk you through it. And most of these programs aren't going to do anything if you aren't already in crisis mode - disability might be the biggest offender here. You have a 24 month wait for medicare at that point, nevermind that you are obviously out of work at that point. You might qualify for medicaid, sure, but might not. And to be fair, most of my knowledge on this is personal: My ex was on disability for mental illness. I don't know how well he got along after we split.
    - giantg2 4y ago
      "and you might not qualify for any of it (CHIP is for children, isn't it?)." Which is why I said depending on the circumstances. "They can be almost impossible if you don't," The example give was glaucoma, so I was speaking to that. If one has mental issues, they could use an advocate (friend, family, or charity). If their impairment is too severe for that, they could have a guardian created by the court (still room for abuse here, but less so than acting without the extra step of a court). "and it isn't like someone is going to walk you through it." There are charities that do this very thing. Much of my knowledge also comes from personal experiences. The real point of discussion on this topic is somewhat hidden. The question is at what point should someone be considered a ward of the state - where they no longer have the capacity to decide things for themselves, and what restrictions the state should place on them (institutionalization, vs outpatient treatment, etc).
deleted 4y ago
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giantg2 4y ago
I find it hard to believe that expanding government power to put people in custody without a crime being committed is really the answer. Especially since the current laws would allow for a mandatory screening if the person commits a crime ("overt acts would almost always fall in that category or be rife for abuse). I think NY has already used mental health as an excuse to take away rights even when there was no danger to themself or others (retired NY police having firearms seized for having mild symptoms of depression with no risk of harm to themself or others). There's a ton of background in this story, but very little about what the solution is, at least in detail.
- lotsofpulp 4y ago
  The alternative to this is 3 (or whatever number) strikes type laws where successive crimes, even small ones, are punished more severely.
  - giantg2 4y ago
    That could be one option, but still has room for abuse. Maybe a homeless person shoplifts some candy three time. That's a felony in many states. Maybe they have a mental condition that causes them to shoplift, or maybe they were hungry. Now it's up to someone's opinion, who is likely overburdened, to decide which one it is. Either way, it's likely to result in custody, but one of those ways might involve mandated medication and a lifelong (mis)diagnosis. At least in this case it would be going through the court, and under the current laws should require some input on the part of the defendant to seek an insanity plea.
  - dionidium 4y ago
    We're quite literally to the point where something like a 20-strike law, which sounds like parody, would actually be quite useful.
  - Red_Leaves_Flyy 4y ago
    So you want to spend 60k/yr on prison times the homeless population of America? Because that’s what your comment suggests and there’s a litany of better options.
swayvil 4y ago
[flagged]
- justrealist 4y ago
  There is no obviously easy path from giving money to improving mental health given our current legal framework. You can sometimes fix around the edges, but the core constraint, for most people, is not one of resources. If someone is severely mentally ill and does not want treatment, you can't simply throw millions of dollars at them and make them want to be committed for treatment or rehab. Until they are on the brink of death, there is no legal recourse.
  - swayvil 4y ago
    It's safe to say that your average homeless maniac would lunge at the offer of free housing/food/cleaning-service. (which would vastly lower their stress level, which, in the majority of cases, converts non-functional to functional) It only takes a pile of money and an army of zero-skill workers. So yes, there is an easy path.
    - tristor 4y ago
      > It's safe to say that your average homeless maniac would lunge at the offer of free housing/food/cleaning-service. You say that it's "safe to say", except that it isn't true. There are many many services for the homeless, and these services legitimately help transitory homeless people, but those who are chronically homeless usually cannot stand (mentally/emotionally) or follow the strictures of these services, things like not engaging in drug and alcohol abuse, or being required to follow-through on mental health treatment. If your solution is basically paying people to care for mentally ill homeless people without /any/ restrictions on the behavior of said people (e.g. no required treatment, no restrictions on drugs/alcohol), then you're asking for people to literally risk their lives to care for people who do not have the mental capacity to even appreciate it, without any of the necessary power to help make the situation any better. It's a fruitless exercise. Those strictures are in place, because they must be in place to make it socially meaningful to help at all. As long as we expect that homeless people will undergo treatment in return for free housing/food/service, there are /many/ chronically homeless that will either refuse or relapse. They certainly are not "lunging at the offer". > an army of zero-skill workers. Dealing with mentally ill people and drug addicts in a safe manner is not "zero skill", even if the other base service you're doing may be. > So yes, there is an easy path. There is only an easy path if you can forcibly institutionalize people and forcibly treat them. Which... is kind of the point of the entire article.
jondwillis 4y ago
Replace “mental” with any other word and it would be true. Navigating the US healthcare system is perplexing and depressing for anything but the most trivial of conditions, for everyone but the most wealthy.
- swayvil 4y ago
  The role of USA healthcare is to fake it. To provide the appearance of healthcare without actually providing it. In collusion are a swarm of insurance and medical businesses. Parasites and illusionists.
  - mrguyorama 4y ago
    Strictly speaking the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition. But the way it is unavailable to many people and useless to many more means it should not be considered a functional system.
    - davidgay 4y ago
      > the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition. As the proud owner of several chronic conditions which are treated just fine(*) by US healthcare, I can infirm this statement (and I'm very, very far from being a fan of US healthcare...).
Hackbraten 4y ago
https://archive.is/bdOgl https://archive.is/bdOgl
cleandreams 4y ago
Living in SF for 30 years I am over, over, over severely mentally ill people killing themselves and harming others. No, they don't take their meds. The consequences mean they do need involuntary hospitalization. This has to be done with checks and balances but it has to be done.
- tiahura 4y ago
  If someone requires mental medication there should be a presumption that they shouldn’t be out loose.
  - loeg 4y ago
    > If someone requires mental medication there should be a presumption that they shouldn’t be out loose. This is obviously excessively reductive. I don't think my friends and colleagues on adderall and setraline should be locked up when they are perfectly functional members of society.
logicalmonster 4y ago
This is a field I don't know much about, but I think a part of the problem from an American perspective is that you can't easily force anybody to take medical treatment against their will. As a society, our values seem to be prioritizing personal freedom over safety and security. Personally I think that's the right choice, but your values will decide if that's the best possible tradeoff.
- hackernewds 4y ago
  if you are deemed a harm to society due to mental health concerns, you can totally be force admitted to a mental health institution in America, and denied basic guaranteed rights - if you have committed (or have the potential to) crimes - such as the right to bear arms (yes it does happen in America), and the "right" to privacy (registering in a sex offenders registry)
waynesonfire 4y ago
Reading or watching the news, you're sold the narrative that the world is doomed and falling apart. Some people are not equipped to deal with such a reality. Most are powerless to change the reality but instead internalize the message. Everyday, Lester Holt talks about how many tens of millions of people are under some weather distress due to severe climate. This is just but a sliver, one of countless examples, that contributes to a persons misery. And with sufficient resentment and misery, you awake the daemon within.
hoseja 4y ago
Freddie DeBoer writes a bit about this.
- kritiko 4y ago
  Yes, Freddie's review of the book that this article was excerpted from was previously discussed on HN.
calibas 4y ago
I watched as a schizophrenic friend of mine was teased and provoked by the local police. To me, it's common sense and common decency that you don't provoke someone who's mentally ill, but the police just treated him like an ordinary criminal. It's almost like they wanted him to act out so they'd have an excuse to arrest him. That's when I started to realize that crime, drug use and mental illness are closely connected.
LeonTheremin 4y ago
[flagged]
AtlasBarfed 4y ago
Our healthcare system is functioning as design,mental or physical. It is a cartel profit extraction system with impossible barriers to entry.
mxmbrb 4y ago
Hell, that's a damn book of an article. A short warning would have been apreciated.
- acuozzo 4y ago
  the warning == theatlantic.com Do they post any articles which are not the length of a novella? :-)
gitfan86 4y ago
I wonder what the right ratio of complainers to doers is in a society. If 100% of people were doers, there would be no accountability due to no one focused on critiquing systems. On the other hand if 100% of people were professional critics nothing would get done other than a brunch of people asking why nothing is getting done.
chaostheory 4y ago
This incident, others like it, and the homelessness problem squarely falls on Reagan and the Kennedy’s for making it near impossible to commit people to mental health care for those that need it.
deleted 4y ago
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starkparker 4y ago
This is just an ad for a political policy that doesn't address any of the problems, would not have helped the author's friend, and if it were the only policy enacted might not have saved the murder victim's life. Adams's proposal to involuntarily hospitalize people did nothing to address these problems that don't only affect New York City's chronically homeless: - Hospital staffing or capacity for triaging, assessing, treating, and making committal decisions on chronically mentally ill patients; police can't directly involuntarily commit people, a doctor has to do it[1] - Lack of training for first responders, and especially police, to compassionately handle people suffering from acute mental illness; his proposal added a video call hotline. It also leans on NYPD's existing specialized training section, which is only a four-day program, has a stated primary goal of handcuffing the person, and hasn't stopped police from following protocol instead of killing mentally ill people.[2] It also was apparently announced without any coordination with NYPD, who by their own admission found out about the new policy only when Adams publicly announced it.[2][3] NYPD in turn started implementing the policy without rolling out the training Adams mentioned, and directed officers to its legal team for advice instead of the hotline.[3] - An existing shortage of first responders, much less specially trained responders,[2] much less effectively trained responders.[4] - An existing shortage of in-patient beds and supportive housing, a shortfall that the state government is attempting to address independently of Adams. In-patient psychiatric hospital bed capacity dropped 20 percent from 2014 to 2022 with only 5,000 statewide, which left the handling of mentally ill people in places like NYC to understaffed and undertrained ERs.[5] Adams didn't respond to any of these fundamental shortfalls in his November proposal until three months later, with new proposals that didn't have budgets, didn't propose expanding fundamental mental health care infrastructure, and instead focused on clubhouse models for employing functionally mentally ill people without addressing the acute or chronic mental illness targeted by his involuntary hospitalization proposal. The only part of this new proposal that was even funded at the time it was announced was the other third of it, exclusively focused on substance abuse.[6] 1: https://www.washingtonpost.com/made-by-history/2023/03/13/new-york-mental-illness-homeless/ https://www.washingtonpost.com/made-by-history/2023/03/13/ne... 2: https://www.nytimes.com/2022/12/05/nyregion/mental-health-plan-nypd.html https://www.nytimes.com/2022/12/05/nyregion/mental-health-pl... 3: https://nypost.com/2022/12/08/nypd-moves-ahead-with-eric-adams-new-mental-illness-policy-despite-lack-of-training/ https://nypost.com/2022/12/08/nypd-moves-ahead-with-eric-ada... 4: https://www.npr.org/2021/07/23/1019704823/police-mental-health-crisis-calls-new-york-city https://www.npr.org/2021/07/23/1019704823/police-mental-heal... 5: https://www.nytimes.com/2023/01/10/nyregion/hochul-mental-health-plan.html https://www.nytimes.com/2023/01/10/nyregion/hochul-mental-he... 6: https://www.politico.com/news/2023/02/23/adams-mental-health-agenda-00084085 https://www.politico.com/news/2023/02/23/adams-mental-health...
goldforever 4y ago
[dead]
pyuser583 4y ago
I’ve personally seen people so mentally ill they don’t know where and who they are treated like customers buy a luxury yacht. Do you like this hospital? How would you rank the staff? Would you mind writing a review of our food? What’s your credit card number again?
cratermoon 4y ago
Let's not forget that during the Reagan era there was a big push to de-institutionalize the mentally ill, and that push came from mental health care providers who recognized that the hospitals for the mentally ill were terrible places. They pressed to move people in the smaller homes in communities where they could get support and care and still be near their families. President Reagan and his administration, of course, were fully behind closing the publicly-funded mental health institutions, but were also not about to spend money on anything to give the necessary care. As a result, untold numbers of people were turned out of hospitals and left to fend for themselves. There was no safety net, no place to go. Reagan demonized the homeless and came up with the myth of the welfare mom driving a Cadillac. And here we are today. Millions needing care but nowhere to go, living on the streets and unable to get stable enough to make a living or even afford their medications. The system is dysfunctional, yes. It was designed to be that way.
RecycledEle 4y ago
The US mental healthcare system has been weaponized against the alt-right. The is very dangerous. It is also a felony under US civil rights laws, but none of the leftists in federal law enforcement care. I doubt any of them understand the way the mental healthcare system was weaponized in the old Soviet Union or what the consequences of that were.

281 points by fortran77 4y ago

> Michael’s friends and family and his supporters at Yale had thought intelligence could save him, allow him to transcend the terrible disease that was causing his mind to detach from reality. This is such a bad misunderstanding of how schizophrenia works… intelligence does not help if the underlying hardware powering it breaks at a fundamental level.

tokai 4y ago
Premorbid IQ do predicted social function after the first schizophrenic episode. Here's some random papers, there are many more out there: https://www.sciencedirect.com/science/article/pii/S0924933815000723 https://www.sciencedirect.com/science/article/pii/S092493381... https://www.sciencedirect.com/science/article/pii/S0920996408003812 https://www.sciencedirect.com/science/article/pii/S092099640... https://www.nature.com/articles/npjschz201543 https://www.nature.com/articles/npjschz201543
- qikInNdOutReply 4y ago
  https://de.wikipedia.org/wiki/John_Forbes_Nash_Jr https://de.wikipedia.org/wiki/John_Forbes_Nash_Jr. I would argue quite High IQ, still got nowhere regarding normal life due to the problem most of his adult life. Was kept on campus out of respect for his archivements. Finally returned to a state of being able to use his IQ with high age. The intelligence can do nothing once the hardware goes, except weave more elaborate conspiracies and paranoid fantasys.
  - tokai 4y ago
    I don't get your point. Nash outcome was very very good. He stayed out of hospitals and didn't take his medicine, after his initial stints with hospitalisation. >The intelligence can do nothing once the hardware goes, except weave more elaborate conspiracies and paranoid fantasys Why do you write this when I post evidence of the opposite? Do at least have some kind of backing to your statement.
    - qikInNdOutReply 4y ago
      Nashes work declined greatly with the full onset of the sickness and never fully recovered.
      - tokai 4y ago
        That your only work declined is a very good outcome for an illness with as bad outcomes as schizophrenia. Like if you shattered both your legs, but ended up walking again while not able to compete in the olympics 100 meter sprint, would be a good outcome.
    - PurpleRamen 4y ago
      The linked german wikipedia descibe Nash's illness quite different from the english wikipedia. With the german article being less specific about the illness and outcome. Though, both are somewhat clear that the illness took him 20+ years of his life, which might be not a good proof for high IQ helps with mental illness.
      - tokai 4y ago
        I wouldn't know, the link is dead. edit: No his outcome was good. He didn't die from it, he didn't spend his life locked up. It's absolutely ridiculous to argue the effect of IQ on outcomes from this one example tho. I posted several studies, that between them cites numerous studies, all based on data collected on 1000s of persons. A German wiki articles angle on Nash's illness is seriously a waste of everyone's time.
        PurpleRamen 4y ago
        The url has a dot at the end, which is missing in the link.
  - retrac 4y ago
    Schizophrenia is not an all or nothing. It's not like one resistor fries and suddenly they're hearing voices completely indistinguishable from reality. Some people have partial or even significant insight into their illness. That is to say, they are aware and appreciate that their thinking is disordered, or that the voices are actually internal, and they have coping methods. Some methods of coping like reality testing seem like they can be taught, and it does seem likely to me that having a lot of general intelligence would make such a thing more effective.
    - kayodelycaon 4y ago
      From my experience (and those on a bipolar discord server) coping mechanisms can definitely be taught. Most of them are rather simple in concept but almost all of them are absolutely exhausting to use. Trying to work full time while using coping mechanisms had me sitting in a chair, unable to function, after 5pm. I serious started to ask myself if living was worth living if that was all there was to it.
- kayodelycaon 4y ago
  From personal experience, intelligence helps with self-awareness and finding strategies for dealing with mental illness. It does not help control it. Once psychosis take hold, it’s in the driver’s seat. I can be fully aware I’m trying to hurt someone and know that it’s wrong and be unable to stop myself from acting on my delusions. It feels like I’m outside my body, watching it do things I have no control over.
fortran77 4y ago
Isn’t that a one of the points of this article, that intelligence didn’t save him?
- kayodelycaon 4y ago
  It does. It’s a very long (and very good) read. Most people aren’t going to finish it in time to comment. So I decided to start the discussion early for everyone else. :)

anon291 4y ago

Schizophrenia can be managed, not treated. Lost in all the talk about mental healthcare and drug addiction are two important topics. (1) Medicine does not have an answer for all mental illness. Many are incurable, and only manageable. (2) Sometimes even the management is not good enough. My uncle is extremely intelligent. Also has schizophrenia. Like Michael... extremely intelligent, PhD (received after diagnosis), etc. It's been many years. He has kids and grandchildren, etc. But... he still breaks from time to time. He's even attempted flat out murder. There's no answer really. His wife (my aunt) can get him to calm down, as can his children. But, it's still there, despite everyone's best efforts.In my view, short of completely numbing his personality and individualism, I can't see how anyone can 'fix' it. Further lost in our conversation as it pertains to drug abuse is the importance of not creating the problem to begin with. Schizophrenia is no joke. Several commonly available (some decriminalized) drugs can induce schizophrenia. We must do what is necessary to ensure this never happens. The mind is a terrible thing to lose. EDIT: Also, having also worked at Bain, I do not suggest anyone work in management consulting if they want their sanity.

qikInNdOutReply 4y ago
Another nuance lost is, that there are many millions for which the sickness is a gift. What becomes a conspiracy theory of the government following for one, becomes a thriller book for another, that switch to differentiate between hallucination and reality that artists have and patients dont have. My brother was quite the creative powerhouse, before the sickness took him.
- anon291 4y ago
  My dad and his siblings are very smart (graduate degrees, doctors, all of them). However, the way my dad tells it, my uncle was exceptionally smart growing up, and I wonder if it was due to pre-schizophrenia traits (or pre-diagnosis... who knows). Despite being asian, my dad was always 'afraid' of smart children. In his mind, schizophrenia was caused by lack of rest and relaxation. He always encouraged my brother and I to relax, and not work too hard. Apparently, it is now known that schizophrenia is correlated with sleep disorders as well. I guess we are lucky in that my uncle has never been able to do anything wrong. He did attempt murder I suppose (in paranoid delusion), but luckily his brothers stopped him. I suppose it helps living near family and having a lot of siblings. Nowadays he's mostly limited (due to old age) to gathering apostles on the internet for his new religions. Probably the best outcome you can hope for. I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope. The 1950s and 60s saw the beginnings of the desire to eliminate asylums due to civil rights concerns. The 'solution' was a technology that at the time didn't exist, but which they hoped would exist after the law was passed. It is dangerous to create law while ignoring current reality, and depending on hope.

PuppyTailWags 4y ago

On one hand I want to be sympathetic to the author here, who has personal stake in preventing the severely mentally ill from murdering people. At the same time, the author doesn't at all go into the deeply personal and often traumatic reasons the mentally ill may resist being forcibly hospitalized in the way the author suggests should be done to them. The author doesn't go into cases like Brittney Spears's conservatorship, forced to take medication and have an IUD inserted and have her estate taken over by her parents under spurious claims of being unable to care for herself. The author doesn't go into how little oversight there is over ensuring the safety of patients once they're in the healthcare system, many of which go on to develop medical trauma due to rape, assault, etc. There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable.

teeray 4y ago
The judicial system should, ideally, serve this function since both arguments for and against compulsory care can be represented and a judgement can be made. The problem is that it is so costly financially and temporally that we can manage one judgement in years for a case rather than the greater re-evaluation frequency that is probably required for mental health.
- jonhohle 4y ago
  Replacing one dysfunctional system for another doesn’t seem like the best option.
- marcinzm 4y ago
  The judicial system is far from perfect even when the people involved are free to find their own representation or are able to freely do their own research. Someone who is not allowed to even access their own finances or sign legal contracts will naturally have a much harder time finding good legal representation. Someone in an institution even more so.
- ada1981 4y ago
  The challenge is you then have someone whose specialty is law making psychological / spiritual / developmental determinations.

bjoli 4y ago

Isn't this the same old discussion that was recently ignited again by the Mr beast's glaucoma video? The US is a country where some people just can't afford not to be blind (or mentally ill). Their largest hope is for a millionaire influencer/Deus ex machina to appear and pay ther treatment.

ixtli 4y ago
the media apparatus regularly turns these into feel-good stories as well. its irresolvable imo
giantg2 4y ago
There are other options depending on the circumstances, such as Medicare, Medicaid, CHIP, pharmaceutical assistance programs, etc.
- Broken_Hippo 4y ago
  Which are hard or stressful to get qualified for if you have your mental abilities with you, and you might not qualify for any of it (CHIP is for children, isn't it?). They can be almost impossible if you don't, and it isn't like someone is going to walk you through it. And most of these programs aren't going to do anything if you aren't already in crisis mode - disability might be the biggest offender here. You have a 24 month wait for medicare at that point, nevermind that you are obviously out of work at that point. You might qualify for medicaid, sure, but might not. And to be fair, most of my knowledge on this is personal: My ex was on disability for mental illness. I don't know how well he got along after we split.
  - giantg2 4y ago
    "and you might not qualify for any of it (CHIP is for children, isn't it?)." Which is why I said depending on the circumstances. "They can be almost impossible if you don't," The example give was glaucoma, so I was speaking to that. If one has mental issues, they could use an advocate (friend, family, or charity). If their impairment is too severe for that, they could have a guardian created by the court (still room for abuse here, but less so than acting without the extra step of a court). "and it isn't like someone is going to walk you through it." There are charities that do this very thing. Much of my knowledge also comes from personal experiences. The real point of discussion on this topic is somewhat hidden. The question is at what point should someone be considered a ward of the state - where they no longer have the capacity to decide things for themselves, and what restrictions the state should place on them (institutionalization, vs outpatient treatment, etc).

deleted 4y ago

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giantg2 4y ago

I find it hard to believe that expanding government power to put people in custody without a crime being committed is really the answer. Especially since the current laws would allow for a mandatory screening if the person commits a crime ("overt acts would almost always fall in that category or be rife for abuse). I think NY has already used mental health as an excuse to take away rights even when there was no danger to themself or others (retired NY police having firearms seized for having mild symptoms of depression with no risk of harm to themself or others). There's a ton of background in this story, but very little about what the solution is, at least in detail.

lotsofpulp 4y ago
The alternative to this is 3 (or whatever number) strikes type laws where successive crimes, even small ones, are punished more severely.
- giantg2 4y ago
  That could be one option, but still has room for abuse. Maybe a homeless person shoplifts some candy three time. That's a felony in many states. Maybe they have a mental condition that causes them to shoplift, or maybe they were hungry. Now it's up to someone's opinion, who is likely overburdened, to decide which one it is. Either way, it's likely to result in custody, but one of those ways might involve mandated medication and a lifelong (mis)diagnosis. At least in this case it would be going through the court, and under the current laws should require some input on the part of the defendant to seek an insanity plea.
- dionidium 4y ago
  We're quite literally to the point where something like a 20-strike law, which sounds like parody, would actually be quite useful.
- Red_Leaves_Flyy 4y ago
  So you want to spend 60k/yr on prison times the homeless population of America? Because that’s what your comment suggests and there’s a litany of better options.

swayvil 4y ago

[flagged]

justrealist 4y ago
There is no obviously easy path from giving money to improving mental health given our current legal framework. You can sometimes fix around the edges, but the core constraint, for most people, is not one of resources. If someone is severely mentally ill and does not want treatment, you can't simply throw millions of dollars at them and make them want to be committed for treatment or rehab. Until they are on the brink of death, there is no legal recourse.
- swayvil 4y ago
  It's safe to say that your average homeless maniac would lunge at the offer of free housing/food/cleaning-service. (which would vastly lower their stress level, which, in the majority of cases, converts non-functional to functional) It only takes a pile of money and an army of zero-skill workers. So yes, there is an easy path.
  - tristor 4y ago
    > It's safe to say that your average homeless maniac would lunge at the offer of free housing/food/cleaning-service. You say that it's "safe to say", except that it isn't true. There are many many services for the homeless, and these services legitimately help transitory homeless people, but those who are chronically homeless usually cannot stand (mentally/emotionally) or follow the strictures of these services, things like not engaging in drug and alcohol abuse, or being required to follow-through on mental health treatment. If your solution is basically paying people to care for mentally ill homeless people without /any/ restrictions on the behavior of said people (e.g. no required treatment, no restrictions on drugs/alcohol), then you're asking for people to literally risk their lives to care for people who do not have the mental capacity to even appreciate it, without any of the necessary power to help make the situation any better. It's a fruitless exercise. Those strictures are in place, because they must be in place to make it socially meaningful to help at all. As long as we expect that homeless people will undergo treatment in return for free housing/food/service, there are /many/ chronically homeless that will either refuse or relapse. They certainly are not "lunging at the offer". > an army of zero-skill workers. Dealing with mentally ill people and drug addicts in a safe manner is not "zero skill", even if the other base service you're doing may be. > So yes, there is an easy path. There is only an easy path if you can forcibly institutionalize people and forcibly treat them. Which... is kind of the point of the entire article.

jondwillis 4y ago

Replace “mental” with any other word and it would be true. Navigating the US healthcare system is perplexing and depressing for anything but the most trivial of conditions, for everyone but the most wealthy.

swayvil 4y ago
The role of USA healthcare is to fake it. To provide the appearance of healthcare without actually providing it. In collusion are a swarm of insurance and medical businesses. Parasites and illusionists.
- mrguyorama 4y ago
  Strictly speaking the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition. But the way it is unavailable to many people and useless to many more means it should not be considered a functional system.
  - davidgay 4y ago
    > the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition. As the proud owner of several chronic conditions which are treated just fine(*) by US healthcare, I can infirm this statement (and I'm very, very far from being a fan of US healthcare...).

Hackbraten 4y ago

https://archive.is/bdOgl https://archive.is/bdOgl

cleandreams 4y ago

Living in SF for 30 years I am over, over, over severely mentally ill people killing themselves and harming others. No, they don't take their meds. The consequences mean they do need involuntary hospitalization. This has to be done with checks and balances but it has to be done.

tiahura 4y ago
If someone requires mental medication there should be a presumption that they shouldn’t be out loose.
- loeg 4y ago
  > If someone requires mental medication there should be a presumption that they shouldn’t be out loose. This is obviously excessively reductive. I don't think my friends and colleagues on adderall and setraline should be locked up when they are perfectly functional members of society.

logicalmonster 4y ago

This is a field I don't know much about, but I think a part of the problem from an American perspective is that you can't easily force anybody to take medical treatment against their will. As a society, our values seem to be prioritizing personal freedom over safety and security. Personally I think that's the right choice, but your values will decide if that's the best possible tradeoff.

hackernewds 4y ago
if you are deemed a harm to society due to mental health concerns, you can totally be force admitted to a mental health institution in America, and denied basic guaranteed rights - if you have committed (or have the potential to) crimes - such as the right to bear arms (yes it does happen in America), and the "right" to privacy (registering in a sex offenders registry)

waynesonfire 4y ago

Reading or watching the news, you're sold the narrative that the world is doomed and falling apart. Some people are not equipped to deal with such a reality. Most are powerless to change the reality but instead internalize the message. Everyday, Lester Holt talks about how many tens of millions of people are under some weather distress due to severe climate. This is just but a sliver, one of countless examples, that contributes to a persons misery. And with sufficient resentment and misery, you awake the daemon within.

hoseja 4y ago

Freddie DeBoer writes a bit about this.

kritiko 4y ago
Yes, Freddie's review of the book that this article was excerpted from was previously discussed on HN.

calibas 4y ago

I watched as a schizophrenic friend of mine was teased and provoked by the local police. To me, it's common sense and common decency that you don't provoke someone who's mentally ill, but the police just treated him like an ordinary criminal. It's almost like they wanted him to act out so they'd have an excuse to arrest him. That's when I started to realize that crime, drug use and mental illness are closely connected.

LeonTheremin 4y ago

[flagged]

AtlasBarfed 4y ago

Our healthcare system is functioning as design,mental or physical. It is a cartel profit extraction system with impossible barriers to entry.

mxmbrb 4y ago

Hell, that's a damn book of an article. A short warning would have been apreciated.

acuozzo 4y ago
the warning == theatlantic.com Do they post any articles which are not the length of a novella? :-)

gitfan86 4y ago

I wonder what the right ratio of complainers to doers is in a society. If 100% of people were doers, there would be no accountability due to no one focused on critiquing systems. On the other hand if 100% of people were professional critics nothing would get done other than a brunch of people asking why nothing is getting done.

chaostheory 4y ago

This incident, others like it, and the homelessness problem squarely falls on Reagan and the Kennedy’s for making it near impossible to commit people to mental health care for those that need it.

deleted 4y ago

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starkparker 4y ago

This is just an ad for a political policy that doesn't address any of the problems, would not have helped the author's friend, and if it were the only policy enacted might not have saved the murder victim's life. Adams's proposal to involuntarily hospitalize people did nothing to address these problems that don't only affect New York City's chronically homeless: - Hospital staffing or capacity for triaging, assessing, treating, and making committal decisions on chronically mentally ill patients; police can't directly involuntarily commit people, a doctor has to do it[1] - Lack of training for first responders, and especially police, to compassionately handle people suffering from acute mental illness; his proposal added a video call hotline. It also leans on NYPD's existing specialized training section, which is only a four-day program, has a stated primary goal of handcuffing the person, and hasn't stopped police from following protocol instead of killing mentally ill people.[2] It also was apparently announced without any coordination with NYPD, who by their own admission found out about the new policy only when Adams publicly announced it.[2][3] NYPD in turn started implementing the policy without rolling out the training Adams mentioned, and directed officers to its legal team for advice instead of the hotline.[3] - An existing shortage of first responders, much less specially trained responders,[2] much less effectively trained responders.[4] - An existing shortage of in-patient beds and supportive housing, a shortfall that the state government is attempting to address independently of Adams. In-patient psychiatric hospital bed capacity dropped 20 percent from 2014 to 2022 with only 5,000 statewide, which left the handling of mentally ill people in places like NYC to understaffed and undertrained ERs.[5] Adams didn't respond to any of these fundamental shortfalls in his November proposal until three months later, with new proposals that didn't have budgets, didn't propose expanding fundamental mental health care infrastructure, and instead focused on clubhouse models for employing functionally mentally ill people without addressing the acute or chronic mental illness targeted by his involuntary hospitalization proposal. The only part of this new proposal that was even funded at the time it was announced was the other third of it, exclusively focused on substance abuse.[6] 1: https://www.washingtonpost.com/made-by-history/2023/03/13/new-york-mental-illness-homeless/ https://www.washingtonpost.com/made-by-history/2023/03/13/ne... 2: https://www.nytimes.com/2022/12/05/nyregion/mental-health-plan-nypd.html https://www.nytimes.com/2022/12/05/nyregion/mental-health-pl... 3: https://nypost.com/2022/12/08/nypd-moves-ahead-with-eric-adams-new-mental-illness-policy-despite-lack-of-training/ https://nypost.com/2022/12/08/nypd-moves-ahead-with-eric-ada... 4: https://www.npr.org/2021/07/23/1019704823/police-mental-health-crisis-calls-new-york-city https://www.npr.org/2021/07/23/1019704823/police-mental-heal... 5: https://www.nytimes.com/2023/01/10/nyregion/hochul-mental-health-plan.html https://www.nytimes.com/2023/01/10/nyregion/hochul-mental-he... 6: https://www.politico.com/news/2023/02/23/adams-mental-health-agenda-00084085 https://www.politico.com/news/2023/02/23/adams-mental-health...

goldforever 4y ago

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pyuser583 4y ago

I’ve personally seen people so mentally ill they don’t know where and who they are treated like customers buy a luxury yacht. Do you like this hospital? How would you rank the staff? Would you mind writing a review of our food? What’s your credit card number again?

cratermoon 4y ago

Let's not forget that during the Reagan era there was a big push to de-institutionalize the mentally ill, and that push came from mental health care providers who recognized that the hospitals for the mentally ill were terrible places. They pressed to move people in the smaller homes in communities where they could get support and care and still be near their families. President Reagan and his administration, of course, were fully behind closing the publicly-funded mental health institutions, but were also not about to spend money on anything to give the necessary care. As a result, untold numbers of people were turned out of hospitals and left to fend for themselves. There was no safety net, no place to go. Reagan demonized the homeless and came up with the myth of the welfare mom driving a Cadillac. And here we are today. Millions needing care but nowhere to go, living on the streets and unable to get stable enough to make a living or even afford their medications. The system is dysfunctional, yes. It was designed to be that way.

RecycledEle 4y ago

The US mental healthcare system has been weaponized against the alt-right. The is very dangerous. It is also a felony under US civil rights laws, but none of the leftists in federal law enforcement care. I doubt any of them understand the way the mental healthcare system was weaponized in the old Soviet Union or what the consequences of that were.