Involuntary commitment: it needs to be on the table

There is a great, blunt editorial by a man named Tom Zoellner published, “Reforms shouldn’t protect ‘Big Mental Health“. Though the issue is contentious in the mental health community and among those living with mental illness, Zoellner is absolutely right: involuntary commitment could save lives if it could be used more. This is both in more public situations (mass shooters with obvious symptoms and warning signs), and to save the lives of individuals who will otherwise kill themselves.

Charles Krauthammer is wrong about most things (he’s just a more intellectual-sounding Rush Limbaugh), but his experience as a psychiatrist and his work with mania is extensive and undeniable. Thus even in a column where most of his logic is shaky, like this work after Newtown, his point on mental illness is correct. Several social problems persist due to inadequate resources to treat those who suffer from psychosis, major depression, and mania. And if involuntary commitment was a possible option in more states and situations, some prominent shootings would likely not have happened. Jared Loughner and Seung-Hui Cho (the Virginia Tech shooter) had plenty of warning signs that teachers and friends recognized, but this didn’t filter up to the relevant authorities, and even then their hands can be tied by personal rights and privacy.

This is a balancing act, which is par for the course with mental health. People shouldn’t be locked away like in the days of the massive mental facilities, but they shouldn’t be left to rot when they reach the point where they can’t help themselves. People should be entitled to their privacy and autonomy, but there are times when an imminent threat exists, towards self-harm or harm of others. People should be treated with empathy, but should recognize that involuntary commitment can be an expression of that empathy. The heartless thing is to nothing when nothing is not the best option.

The opening point of the oped, that Republicans currently have a better understanding of what needs to be changed than Democrats do, is correct. Though given the Republican interest in reducing healthcare spending, that basic good idea shouldn’t mean they get the keys on overhauling the system. It points to a need to look at American mental health policy and figure out what works and what does not. Zoellner is right that services may have no track record of success. It’s true that services are redundant and mismanaged- I’ve volunteered at the county level and it’s a complete mess. Even experienced people are finding new groups and services year after year they didn’t know about. The uniting factor is that most of these places get government grants and subsidies; transparency about where this money goes and whether it is overlapping is key.

There are two ways to look at mental illness, where neither is full right nor wrong. One is that anyone with a diagnosis is incapable of living independently and needs to be locked up. The other is that someone with a diagnosis should be given full privacy and any suicidal or dangerous statements shouldn’t be communicated to relevant authorities. It’s key to see involuntary commitment as a tool that shouldn’t be used carelessly (like in the past), but it shouldn’t be ruled out entirely. There have been points where I was in a dangerous place, and the last thing I wanted was a culture of silence where nobody felt obligated to get me more direct help.

Crisis: sometimes you gotta hit a brick wall

As I’ve said before on this website, I am a member of Stamp Out Stigma. It’s a speakers’ bureau dedicated to putting a human face on mental illness, and countering negative stereotypes that stigmatize those who deal with their disease.

Today we spoke at a training for a crisis line. The work that these organizations do is incredible; even though I have bipolar disorder, dealing with the pain of others in my community can be overwhelming. Just because I can understand doesn’t mean I can handle other people’s desperation. I am glad there is something I can help them with, because I can’t do what they do. It would be a serious threat to my present stability.

What our conversation eventually led to is how those in crisis can feel trapped when looking for help. What is important to know is that overcoming the fear of stigma and seeking professional help is only the first step in treatment. There is the fear of powerful, sometimes dangerous medication. Therapy is now commonplace, but it can still be a point of alienation. And when you ‘come out’ to family or friends about what you go through, you have to educate each one – because what mental illness is and is not are just not taught or discussed about.

So when someone calls a crisis line, it may not come from a lack of resources. Yes, a person may not know where or how to get help, but they may also fear the help they get. Unmedicated you can end up in crisis, but also after months or years of trying treatment and finding it only partially effective.

A friend of mine was diagnosed as bipolar not that long ago. She was older than me, so she got the news 12 years later in life than I did. She, like me, feared the side-effects and power of the medication. Ultimately it took a crisis to remove that psychological barrier and embrace treatment.

In the end, it’s a series of difficult choices. Mental illness evolves, and people are at different points in the process of understanding, denial, anger, and acceptance. Crisis can be necessary for transition, but not everyone lives through a crisis. That’s why crisis lines and trained staff is so important. The way forward is blocked by a sense of desperation and isolation, both physical and psychological.

Mental illness is a maze, but sometimes you need to bust through some walls to get out. My crisis in 2012 led to me hitting a brick wall – a massive increase in antipsychotic dosage that slowed me down to a crawl. But with that collision the chaos stopped, and a new, better life could be put together from the pieces.

Sometimes you gotta hit a wall. And there need to be people to make sure you get out safe on the other side.

The consequences of a drugged society

This will be the first of a few posts about mental health- from a philosophical, political, and personal viewpoint. I think the issue of mental health is often ignored in parts of Western society- the mentally ill have been marginalized in one way or another.

In 2002, a film featuring Christian Bale was released, called Equilibrium. In short, it’s a terrible movie. However, its premise raises some interesting notions about mental health, and the attempts to keep humans from being self-destructive.

The decades preceding the setting of the film are wracked with large-scale war, racial hatred, and a deterioration of global society. It is determined by the new ruling class that the cause of these tragedies was human emotion. A perfectly rationally constructed society is only as good as the humans themselves. Humans, therefore, are the weak point in the structure, and need to be strengthened.

Continue reading “The consequences of a drugged society”