Thursday, April 19, 2007

The Virginia Tech Incident Is About Mental Health

Less than seventy-two hours have passed and we now know that thirty people are dead because a mentally ill person, diagnosed and returned to society repeatedly, was able to plan, document and execute a nightmare conceived in his damaged brain.

This is not about guns.

This is not about evil.

This is not about politics.

This is not about religion.

This is not about immigration.

This is not about the media.

And most of all, it is not about comparing the magnitude of tragedies. (Fred Clark has an excellent, link-filled commentary worth reading and drilling into. Go there when you finish here.)

What we are witnessing, not only with this high-profile event but every day of our lives, is the consequence of a trend set in motion about fifty years ago to change the manner by which we as a society handle (or not handle) those of us who are mentally ill. It seemed like a good idea at the time. Some of the darkest stories of history are about mental hospitals as places of torment and neglect, repositories of human wreckage that also doubled as places to hide political prisoners, abused family members of all ages and connections, and just about anyone without the social skills, political connections, family prestige or financial resources to defend himself.

Mental hospitals were not just hospitals. They also doubled as jails, poor houses, work houses, and closets for those whose public appearance, harmless though it might be, might embarrass or make others uncomfortable. The stories about them are truly horrible (One Flew Over the Cuckoo's Nest comes to mind) as well as the manner in which patient were treated. The words patient and treatment took on twisted meanings that seem inappropriate now. My post a few weeks ago about one man's experience with having been lobotomized in his younger years is a case in point.

One of my closest friends from high school went crazy at the time and had to be institutionalized, but thanks to the trend to releasing such people, however well-intended it may have been, he was left to wander the streets in a mad state, disoriented by what was clearly a mental disorder, having been subjected to ECT more than once, probably medicated and unrealistically expected to self-medicate, drifting from one friend to another in what proved to be a fruitless search for help. His family was not in any position to help him because his father, already a stroke victim, was going to die soon, and his mother had already died. There were no siblings and part of his problem, aside from drug usage and a stint in a monastery from which he was expelled (it was the Sixties, you know), was learning after his mother's death that he had been an adopted child and would never be able to find out who his biological parents were.

But his was only one case. The larger picture was that large repositories of mentally ill people, whatever the reasons, were being dismantled. Cases judged to be worse than his were taking up space in a shrinking pool of available facilities. As I said, this was all done with the best of good intentions, but you know what they say about the road to Hell being paved with good intentions.

Wikipedia has stimulating reading about Psychiatric Hospitals, with an even more provocative link to another article entitled "Anti-Psychiatry."

This morning I have no solutions to the problems we now face with the management and treatment of people with mental disorders. All I know is that when I was a student in college about forty-five years ago I went on a field-trip with a group of other students pursuing courses in Music Therapy. I was studying music ed. at the time , now MT, but I was along for the experience. We spent a day at Georgia's Central State Hospital, once known (together with another one in New York) as one of the world's biggest and worst of its kind.

We were told that thanks to the efforts of a former first lady (it may have been the wife of Governor Vandiver) a large fund had been raised for the renovation and upgrading of the hospital. We saw two large facilities that looked more like hotels than hospitals, new, comfortable-looking, with amenities that even included a place that resembled a lounge or bar, but without the alcohol. It was the first time I had seen an atrium-styled large building with an overhead roof with skylights several stories overhead. It was very impressive.

We were also told that there were places in the hospital where visitors were not permitted to go because conditions were so bad, not only the barbed-wire enclosure pointed out as the place for the criminally insane, but other places that were systematically being renovated and reviewed for updating. I recall an interesting statistic: the "inpatient daily census" (the taxonomy sounded so clinical) was said to be in the thirty-thousand range. That number was larger than the number of students I knew were attending the university where I was studying and it struck me as unbelievable. The facility covered hundred of acres, including a farm where food was grown that was also being used to feed patients. Patients worked on the farm as well. Chickens and eggs from the farm were used in the food facilities.

Sometime between then and now, everything changed. When I checked the website yesterday, that same hospital is now reduced to about five hundred inpatients. Sometime over the last forty years a rolling number in the vicinity of some thirty-thousands have been released to care for themselves or rely on the resources of others. I'm sure some of them did not need to be there. I am personally aware of one woman who worked for me put there as a child because she was judged to be mentally retarded and was not released until a re-evaluation in her twenties revealed that she was entirely "normal" (whatever that means). She was later "released." I don't know the details, but "put out" would probably be a better term. She may be better off because her teeth, which had turned brown from years of over-medication, had to be replaced by dentures. As a middle-aged woman with no education, poor social development and little to serve her by way of personality or looks, the best she could find to support herself was a job in a cafeteria serving line.

As I said, I don't have the solution, but I do know this: Something in the way we handle deranged people has gone badly wrong and the incident at Virginia Tech should be a wake-up call. Finger-pointing is out of order. So, too, is all this yelling about politics, gun-control and other issues that are nothing but distractions from the main problem. My own instinct is that Big Pharma and Big Insurance have a lot to do with this trend. I have known for years that both of these mammoth interests have powerful friends in high places and they quietly keep those friends happy with obscene amounts of money euphemistically called "lobbying" which in reality are nothing more than bribes.

But that's just an old guy bitching this morning. My most heartfelt appeal is not to the politicians but to everyday people who need to back away from events of the last three days and try to see a bigger picture. That picture is one of homeless people and poor people whose numbers are swollen beyond what should be the case if they are expected to contribute to the gross national product. Too many people cannot and will not make any meaningful contribution unless and until they are either appropriately treated or taken off the streets. The real challenge is how best to accomplish that goal.

1 comment:

Tina said...

We still need the hospitals, but they need to be HAVENS and not hell-holes. People with severe mental illness need a place of rest retreat and treatment where they can be maintained long enough for the treatment to do some good. Sending people to a hospital for two or three days and then turning them out is no where near a therapeutic procedure. These days what have is not's reSHOVEry, which is pushing them out on their own to sink or swim in order to save money for the state and their insurance buddies.