When I was a young fella growing up in Nashville, Tennessee, I vividly remember the Victorian-era mental hospital that operated across the highway from the old Berry Field. Of course many things have changed a lot from the 1960’s through today and most people no longer call the airport in Nashville – “Berry Field”. Now, the airport is most appropriately referred to as the Nashville International Airport and the location across Murfreesboro Pike where the old Asylum we affectionately called “Central State” used to sit is currently the Nashville campus for Dell Computers. If you were a kid living near or around “Central State” back then, your parents probably threatened you just like mine did with a short stay there when we were acting a little too rambunctious.
In my late teen’s, my cousin David White (DNA You Can Count On) worked security there. I don’t guess that I ever fully realized back then that the buildings were so old. I later learned, by means of an after-hours non-sanctioned midnight tour with my older cousin that the buildings were actually built during the mid 1800’s. When I was about 19 or 20, David and I jumped a fence and snuck onto the grounds late at night and we played pranks on the night-shift security guards to scare them. We actually did a pretty good job of it at that. But one of the things that struck me then that I still vividly remember were these old subterranean dungeon-type cells in the basement of one of the main buildings.
When we toured the old basement by flashlight, the hallways were mostly obstructed with modern HVAC ducting, water and sewer pipes and electrical conduit. The remnants of prison-esque cells along both sides of the long concrete corridor – many of which still had iron wall-shackles ominously hanging from cell walls – reminded me that the treatment for our mentally Ill was pretty barbaric in 1852 when Central State first opened. This, of course, fueled my imagination with torturous and sadistic imagery, forced-lobotomies and electric-shock therapy, stuff that would excite the imaginations of any teenager.
I cannot imagine that those features were still being used when that institution closed for good in 1995. Lets say, I’m confident that they were not. But Central State Mental Hospital and many other psychiatric treatment centers like it were systematically closed in the 1980’s and 1990’s due mostly with a paradigm shift in public perception where such facilities were widely viewed as inhumane. But a political backlash between the Carter and Reagan administrations over institutional government waste also found the perfect expensive government program ripe for dismantling. Lastly, medical and psycho-pharmacological drug advances and other alternative psycho-medical treatments all contributed to the logic of shutting these dinosaurs down for good.
When you’re young, it’s difficult to relate to an object, place or story like that. It just seemed interesting or funny or pitiful or whatever. You can comprehend what it is, no problem, it’s just not relative to anything personal. But life eventually happens to every single one of us. Our lives become ever fuller, more complex and entrenched with the lives of hundreds or even thousands of other people. One of these days, no matter where your story begins, you’re going to have gobs and gobs of conversational experience to share when your crazy uncle starts bringing up uncomfortable subjects at the Christmas dinner table. You’ll just have to trust me on that!
At that time, I could have never imagined that a member of my own immediate family, my brother who was 13 months my senior, would end up with a serious psychiatric disorder. Until then, that old building meant nothing. Now, at the precipice of 50, a father, a husband and the brother of a victim of a serious psychological illness that resulted in his suicide, my perspectives on life in general and of course my views on institutional treatment for the mentally-ill have percolated. I am at a place in my life where a person has to challenge him/herself politically as well because there are always going to be valid arguments over certain social welfare programs which challenge even the most conservative minds of our time.
People who’ve never had to rely on welfare, obviously cannot find a profoundly positive reason to have it. The negatives, in their minds, out-weigh the positives. Similarly, those of you who’ve never been challenged to care for a mentally vulnerable family member who you love but whom also challenges your definition of the word “unconditionally”, its impossible to know how valuable an in-patient mental care facility really is. These are people you love but people who scare you as much for what they could do to others but also of themselves and your family. These, in some cases, are loved one’s who are not only broken, but who oftentimes break everyone around them.
What happened to in-patient mental treatment? It’s mostly all disappeared except for a few temporary hospital wards and the VA Hospitals. The institutions which had been once hailed as a safe refuge for society’s most vulnerable men and women had, in reality, earned a reputation as becoming dehumanizing and prison-like. Before the 1980’s and 1990’s, pharmacology for mental illness was pretty much non-existent. We and the rest of the civilized world had been institutionalizing our mentally hopeless for many centuries as we knew well that regardless of the love we have for these people, they can and do cause great harm to others if we don’t take some sort of preemptive measures to control their accesses and ability to act on their impulses.
Before asylums, the burden of keeping vulnerable individuals rested entirely on family. ‘Mad’ people, as they were often referred, who could not be kept at home wandered free, begging for food and shelter often finding neither. Families cannot be counted on to care for them because they often put so much stress on their family that it forced them to free themselves of the responsibility or suffer harm themselves. One must often choose between their spouse and children or a family member who, by no choice of his/her own, introduces instability, irrationality and fear into an otherwise happy home.
All that said, the de-institutionalization of our seriously mentally-ill has gone terribly wrong. There has been a steady decades-long push to move mentally-ill patients out of mental hospitals and into community-based care facilities or no structured facility at all. This push coincides with a steady increase in the percentage of mentally-ill prison inmates nationwide. Likewise, the rise of homelessness in America began to skyrocket in the 1980’s, ironically the same time mental hospitals nationwide began to close.
As psychiatric hospitals continue to close and our government leaders keep choosing to inadequately finance exploitative entrepreneurs in community-care and residential programs where no medical psychiatry exists, where are our mentally-ill going to be getting their much needed treatments? Just recently, the Obama administration’s Eric Holder began cracking down on states who still have psychiatric treatment centers. This continued attempt to move vulnerable people to community care programs where they have little or no access to any form of treatment other than massive cocktails of pills prescribed by general physicians who have no training whatsoever in mental illnesses is a prime example that our government still isn’t getting it.
Prisons & Jails are the new de facto asylums’ in the United States. Is it really fair to jail our mentally-ill instead of just caring for them so they’re not in a position to commit crime in the first place? What’s worse, real prison with real bad people or a prison-esque asylum? 65% of the populations of local, state and federal prisons are people with serious mental health issues. In 1970, it was reported that 5% of inmates were seriously mentally-ill. Studies from the 1920’s reported that only 2% of inmates were seriously mentally-ill. In Philadelphia, for example, mental-illness related incidents increased 227.6% from 1975 to 1979, whereas felonies increased only 5.6%. The mentally-ill are 3 times more likely to be arrested than the average citizen.
My own brother followed these same statistical patterns. He would drift away from medication because the medication brought about undesired side effects, then he would fall into a state of manic mental decline and depression. Just like the movie Groundhog Day, he would again and again do something incredibly scary to some innocent person with whom he would fixate his attentions, which would bring in the police and justice system. Then, we as a family, would attempt to speak with his VA case worker and/or physicians which resulted in complete incompetence, apathy, denial or forced acknowledgment of the HIPAA privacy law which was/is an excuse not to do anything at all.
After inaction on the part of non-existent medical healthcare and his VA social workers, he would be re-arrested for whatever scary thing he was doing to undeserving people, then we would work with the District Attorney’s office to seek a more appropriate legal remedy which might or might not result in court-ordered treatment at the VA Hospital psyche-ward for a few months where he would be forcibly required to medicate. After a few weeks of treatment, he would slowly regain whatever equilibrium available to him through the use of undesirable psyche medications, then summarily released back to his own care which would begin the cycle over and over again. When that system failed, he’d spend months in the county jail with predatory room mates and guards that treated him horribly, instead of humanely.
The only thing that would change was that each time he entered and exited the system, he would become increasingly more difficult to deal with. My brother would further and further push the boundaries of his fixations when he was off his meds, and his jail sentences would become ever longer because his record of arrest was becoming ever more impressive. His experiences in jail and in forced-treatment were also systematically crossing the fragile thresholds of inhumanity as his own bizarre behaviors, not understood by simple jail guards, invited such a response, not just from workers in the system but also by other inmates and VA patients.
Jail/Prison staff and police officers are not properly trained in crisis intervention for the mentally-ill. It is no more fair to incarcerate mental-ill persons alongside committed criminals as it is to ask untrained and unprepared jailers to appropriately care for them in a place which is not designed to render such care. Likewise, we as taxpayers are having to foot the bill for their expensive incarceration and hold our noses while our mentally-ill loved ones are being treated like criminals when many of them do get their prescribed medicines while incarcerated and are completely lucid and fully functional once they’ve been inside for a week. But, we’re afraid to let them come home. You end up feeling incredibly guilty because you don’t want them in a jail but you don’t want them staring into your refrigerator with glassy eyes either.
Our current approach is way more archaic in some ways than the asylums of our past. Instead of questionable accommodations and horrible surgical procedures, we just lock them in jail with hardened criminals, expose them to prison rape, inmate assault and bullying on a daily basis along with an environment which exacerbates paranoia and distrust – the very thing that most of them live in fear of and try to avoid. In mental illnesses, it is difficult to draw a line between what is treatable and what is without hope. Confinement may be necessary for some to protect the patient and society from bizarre, irrational behavior but that incarceration should not be a prison cell with a rapist for a bunk mate and predators around every corner.
Hospitals won’t keep them due to demands of patient advocacy groups. They sometimes assault other patients and staff, which unfairly exposes them to libelous actions. However, such patients should be treated the same as anyone else with any illness. Physicians have the same obligations of care to the mentally-ill as they do to anyone who is ill in any other way. The complicated part rests in the physician’s responsibility to the patient versus his/her responsibility to society. But, that’s only because they have no options available to them otherwise. Our government has closed them all down.
Regardless of the position of a hospital or a particular physician, society’s principle loyalty and duty should be held in the best interests of any vulnerable American (i.e., infant, child, elderly, or physically or mentally handicapped). As a country, we can’t continue to ignore the needs of our country’s most vulnerable while subsidizing the lifestyles of citizens who can take care of themselves but refuse to do so. We must draw a line in the sand somewhere. If money is the issue, we must do what is necessary to care for our vulnerable first, then take what is left to divide among the bottom feeders. If that statement offends you, read a different blog.
The formal mental health care institution was among the earliest fruits of the American social welfare programs of the nineteenth century. Contemporary medicine and ideologies have allowed us to outsmart ourselves and take the self-aggrandizing bait believing that we can create pills that will eradicate mental illness. But instead of solving the problem we’ve just created a new demographic of society called “public mass murderers”. These are kids and adults who’s insurance companies require them to forgo any real psychiatric treatment for mental illness, get psyche pills from a general practitioner and pain meds from a licensed drug dealer (pain clinic), neither of which know a single thing about mental illness, then after living a miserable existence for weeks, months or years, decide to take a gun to school, a movie theater or mall and put as many people out of their perceived misery as they can before taking their own lives or being gunned down by cops.
I’m not suggesting the return of lobotomies or electric shock therapy, I’m suggesting the return of common smarts and a sense of loyalty to our most vulnerable population. We can’t afford not to care for them because they are killing us and themselves while we are loving them to death. Prisons are far more expensive to build than humane hospitals yet 65% of the incarcerated are now considered seriously mentally ill. How many new jails and prisons could communities forgo the construction of if we just did one smart thing and built a place to properly care for our sick with real psychiatrists and psychologists? We don’t have a gun problem, we have a crisis-level of incompetence and lack of common sense in our capitols who’d rather blame the other team than do the hard work to solve real problems.
I find it so ironic today that as a young guy, I tried so hard to get into one of these places when decades later my brother worked so hard to stay out of one. But, he’s gone now, another victim of a failed political policy and a broken bureaucracy. Yes, he was broken too, but that should have just amplified our responsibility to help him, not become an excuse to ignore him. Now, what?
Update – February 2018
The recent school shooting in Broward County Florida reminded me of this blog I wrote a few years ago. Once again, politicians are using victims as pawn in a political argument and once again, people are focused on the tool of a mad man instead of the mad man himself. Our police tell us, “See Something, Say Something”. But, didn’t people say something and didn’t they say it pretty often?
The problem was not the gun, the problem was not apathy on the part of the public. Nope, people did get involved and they reported him time after time. The problem was that the police had no options available to them. The man was obviously mentally disturbed but he’d committed no crime that allowed them to remove him from the public. If the police had been able to arrest him for something long-term, would that have helped? No, because that’s not what this man needed and the police are not the people who we need to solve these kinds of problems. We need mental institutions that are geared for long-term in-patient mental medical treatment and care.
If you see something then say something, what next? Well, uh, nothing is next unless what you saw was a serious crime. If what you saw was a warning sign of something terrible about to happen, what in the hell can the police do about a warning sign? Nothing people! Not one damn thing. So stop with the “See Something, Say Something” mantra. It’s not ever going to work.
This man should have been picked up and transported to a mental care facility and hospitalized, diagnosed properly, treated for his illness and cared for indefinitely until such time as he was safe to live among the rest of us. His physician should have been able to enter his name onto a HIPPA compliant Mental-Illness registry that is integrated into the NCIC Database that is searched when a person makes a gun purchase. And when he attempted to buy that weapon, that HIPPA compliant registry would have triggered an automated response that wouldn’t tell the gun store clerk what he was diagnosed with, but would deny the gun store the ability to sell that weapon to him – just like it would if he’d been a felon.
But that automated registry doesn’t currently exist and that treatment hospital doesn’t exist. Nothing exists but jails and prisons and police but jails and prisons and police can’t do anything until after the murders occur. So, “see something, do nothing” is perhaps a more appropriate jingle don’t you think? What’s horrible too is that disturbed young man will live out his life in a prison that will never treat him for his mental illness. Instead, he will live a hellish life of chaos and fear in a place he really doesn’t deserve to live in and children are dead that should be going to school and dating and taking their driving tests and fulfilling and enriching the lives of their parents and siblings and communities. None of this should have happened and it all could have been prevented.
President Obama, in his first term, had control of both houses of congress and the white house…if he had thought gun control would have solved this problem, he could have certainly tried it. But instead, he put all his political capital in passing a health care bill that still ignored the mentally-ill. He totally ignored gun control and was the only president in recent history who had the power to modify the way we buy guns.
I personally don’t think gun control is the answer because it can’t address the way criminals buy guns and statistics prove that the number of guns in the hands of a country’s citizens has zero correlation to the amount of violent crimes committed. So gun control is really an ignorant argument that is entirely predicated on political activism and not the greater good.
What we need to focus on are two things: What we’re doing with our most vulnerable populations; and, how to keep that population from legally purchasing firearms. We desperately need places that know how to care mentally vulnerable people – long term, and we need a national registry of those people that is integrated in our NCIC database that alerts gun sellers that the buyer is either ineligible for his/her criminal past or because their name is on a mental health registry. The sellers have no idea why a person is denied now, except that it must be criminal, so what would be the difference if we added another layer?
We need to do whatever we can to keep our mentally-ill out of jails and prisons, and instead inside places that know how to properly care for them, and we need to keep them from buying guns without restricting lawful purchases of guns by law-abiding citizens. That’s it. There’s nothing political about it. It’s the right thing to do for the greater good of everyone.