Posts Tagged ‘mental illness’

Into The Darkness

March 6, 2020

Into The Darkness

She had walked about three miles in the dark and was lost for a time before she found my office. It was cold and sprinkling rain as she walked through the “wrong side of town” to seek my help. Her journey took her through tough streets where rapes, robberies and gang shootings happen all too often.

She was a very slight waif of a young woman and she hid in an over-sized hooded sweat shirt, her head and face were well recessed into the protection of that dark hood. She had withdrawn from the world around her.

I expressed my concern that she had walked at night through a dangerous area of our city. She said that she wasn’t afraid because when she “walks at night no one can see her”. She sat in my room with her head bent down and the hood making it impossible for me to see her face, unless I bent low from my chair to look into its recesses. There I saw an expressionless mask with wide eyes that gazed at the floor.

With my hearing aids on their highest setting, I strained to hear her voice. At times she made sense, but often she did not. She said that she wanted to get better and to be normal. She said that she used to cut herself and that she had tried suicide many times. She said that she had been in mental hospitals frequently and that she was afraid of those places.  She said that she is always nervous and can not come out of her house during the day and that she gets confused and scared and wants to feel better. At times she was whispering. I asked if she was hearing voices: She said “yes, but there are many voices talking at the same time and I can’t make out what they are saying”.

My heart sunk and I felt a little sick as I told the lady that she appeared to be suffering from schizophrenia. I said that I could not help her through counseling until she was on anti-psychotic medication. Her voice became louder and very firm as she stated that she was not crazy and did not need any medication: “I just needed someone to talk to”.

I tried to explain that it would be unethical for me to provide-long term counseling to her for a condition that required medication before counseling would be any benefit. I told her I could not participate in prolonging her illness that was harming her. She began to mumble about cutting herself and she fumbled in her purse for something: I was fearful she was looking for a knife.

It was a tattered intake form that she had meticulously filled out and brought to give to our receptionist. She continued to slouch within her hooded sweat shirt as she shuffled slowly from my office. She lingered near the reception desk for a time and finally walked out the front door into the dark, cold, and rainy night.

I normally do not loose sleep over my client’s problems. However, I did not sleep well that night and I cannot get visions of this poor and pathetic young woman of my mind.

Both the poor lady and I were caught in the results of a terrible mistake that America made following the discovery of anti-psychotic medications in the 1950’s. At that time close to six hundred thousand patients were confined in public mental institutions. The new anti-psychotic medications frequently ( but not always) helped to control the active symptoms of many forms of psychosis. However, the medications did not cure the conditions, which were prone to return when the patients encountered stressful conditions, and  with near certainty if they had stopped taking their medications.

During the 1960’s, in the name of “humane treatment of mental patients”, the U.S and other nations began the process of letting these patients out of hospitals. This process has been called deinstitutionalization. By the year 2001 there were less than 60,000 patients confined to mental hospitals on any one day. Also, strict patient’s rights laws were past by our federal government forbidding the hospitalization of mental patients against their will, unless they were a clear a danger to themselves or others. This led to the insane practice of letting severely mentally ill citizens being given the choice to be hospitalized or not.  In other words, people who were not in contact with reality were (and are) being asked if they think they need to be hospitalized: tragically their answer is very often: No!

This has led to the increase in the social horrors which we all plainly see, such as mass murders in our schools, or killings and attempted killings of high profile entertainers and even U.S. presidents and others, by people who are very severely mentally ill.

Just as painful to see,  are the severely mentally ill who are cold and starving in the streets, who seek shelter under bridges and train trestles, or in boxes and other make-shift shelters all over America.

I will never forget a documentary I watched showing mental health workers putting sandwiches on a bench in a city park hoping that a starving psychotic man, who thought people were trying to poison him, would finally eat. As often is the case, the man ran away from them and would not talk to them. No one had the power take him to a safe environment where he could have been medicated, and cared for. My perception was of a cultural practice, which is as psychotic as the starving man who though it was t“trying to poison” him.

One final thought. The psychotic woman who I could not help and who walked out into the darkness from my office, had told me she had two children.

Think about this: schizophrenia is a biogentically-based mental disease that is heritable. After deinstitutionalization in America, the reproductive rate of schizophrenics came to approximate that of the rest of the population. Therefore, we should realize that serious mental illness has been growing in proportion within our population. This sector of our population has exponentially increased America’s homelessness problem. Furthermore, the children of schizophrenics are at greater risk of that and other psychological disorders.  

The truth is that there is nothing humane about the way we treat hour severely mentally ill citizens–and/or their children. I see our treatment of these suffering people as being negligent and abusive and I see the true motive for this abuse as being financial in nature. Deinstitutionalization saves money in the short-term, pure and simple.

This is another example of America’s short-term avoidance of short-term expenses and trouble, at the expense of long-term self-abusive and destructive outcomes.

V. Thomas Mawhinney, 10/30/09, now 3/6/20

P.S. I am republishing this writing now, in 2020, as countless hundreds of thousands of people are living in boxes and make-shift tents on the streets of America’s formerly great and beautiful cities, now bastions of grotesquely liberal-leftist administrations.

It is estimated that there are approximately 500,000 thousand of people in America homeless each night. How many are actually living on the our streets is very hard to estimate. 



Revise Civil Committment Laws!

January 9, 2011

The following is a republication of a blog that I did on 1/9/11. My reference to a recent mass shooting, at that time, will certainly date this blog. However, nothing has changed with the many mass shootings in America since then. These are almost to painful for us to bear. The school shootings are even, somehow, even more gut-wrenching.

Nothing has changed and so neither has the contents of this post.

Revise Civil Commitment Laws!

It is true, as I taught for 36 years as a professor of psychology, and as I validated during 40 years as a psychotherapist; people with mental illnesses are generally no more dangerous than people without these afflictions. However, there are some exceptions. 

Those who are severely depressed are prone to suicide and in rare cases, also homocide. Those who suffer from Bi-Polar disorder can be prone to suicide while severely depressed, or other dangerous behaviors when in high manic phases.

Instances of bizarre and senseless violence, such as the recent case of Congresswoman Gabrielle Giffords and the others who were gunned down with her, a severe mental illness (probably Paranoid Schizophrenia) was the cause. A person suffering from paranoid schizophrenia, a more dangerous form of mental illness, was allowed to wander free among us, and it was this (or possibly another psychotic mental illness) that repeatedly pulled the trigger on our innocent and precious citizens.

Paranoid Schizophrenia is a specific and sometimes dangerous form of mental illness, especially when delusions of persecution are prominent. This should make sense to anyone. Delusions of persecution are false beliefs, often bizarre in nature, that others are “out to get me”, “spying on me”, “taking my property”, or “trying to harm or kill me”.

Of course, many “normally functioning” people would become very angry and tempted to “defend” themselves by attacking the “perpetrators” if they really believed that someone, or some people (perhaps the government, the next door neighbor, etc.), were trying to harm them or destroy their lives. But those in a paranoid psychotic state with with this psychotic mind-set can be very dangerous and no amount of security will protect the innocent from their unpredictable violent psychotic aggression.

The deinstitutionalization movement culminated in 1963 when the Federal Government ordered that mental patients be freed from mental hospitals and be treated within their communities. Congress passed the Community Mental Health Act which provided funding for the construction of community-based facilities to treat mental patients on an outpatient basis. With cases of acute mental states, patients could be admitted for short terms, evaluated, medicated, stabilized and released back into the community. They were oftentimes referred to out-patient therapists within their community for continuing therapy and support. 

All of this happened shortly after the discovery of anti-psychotic medications. In 1955 there were around 600,000 mental patients in state institutions. By the year 2001, there were only about 60,000 in state institutions. Where did the rest of the 500,400 mental patients go? These individuals with severe and sometimes dangerous mental problems went back to living free withing all of our comminities.

Following 1963, if hospitalization was necessary, patients were to be admitted on a short-term basis, medicated, stabilized and then released. This led to a “revolving door policy”, in which patients frequently were admitted, medicated, stabilized, and released, but, then stopped taking their medication and again became actively psychotic and were likely to be re-hospitalized for the same course of treatment.

Also, in the name of  civil rights and humane treatment, the criteria for “civil commitment” (commitment to mental hospitals against one’s will) were narrowed to the point that only those who were a clear and present danger to themselves or the public, could be committed without their permission. This meant that even those who were actively hallucinating, ranting and raving, homeless, filthy, or in some cases starving could not be hospitalized against their will. 

These criteria are far too restrictive and great suffering among the mentally ill,  as well as the rest of us, continues as a result.

It is pure stupidity to insist that an actively psychotic individual make a rational decision about what is best for themselves to do about their psychotic condition.

Once again an over-reaction in the name of personal freedom and humane treatment has gone too far. In doing so it predictably has resulted in more social chaos and tragedy, with a net loss of personal freedoms for all.

Once again, I must judge that the true governmental motivation for extending the definition of “personal freedom” ( in this case for mental patients) was largely revenue savings.

It is true that those patients who seek help at Community Mental Health Centers tend to benefit. But on a yearly basis, 40 to 60 percent of all people suffering from schizophrenia “and other severe mental disorders receive no treatment at all”. While poor coordination, or a shortage of available services, are frequently named as the cause for this shortfall, no one is willing to face the other obvious fact.  Giving an active psychotic and potentially dangerous the right to refuse treatment is an absurdly self-destructive big part of our problem!

While institutions may become more effective in their treatment, there is no happy feel-good remedy for psychotics who are unable to make rational decisions in their own best interests, who do not seek treatment, or who refuse treatment when it is offered.

New Laws with  more nuanced civil commitment capabilities,  intensive medication and psychological treatment strategies are essential.  Mandatory close follow-up with streamlined recommitment capabilities are essential.

Also glaringly clear, and most costly, is the need to increase America’s mental hospitals, once shut-down, in order to provide long-term care for those who simply cannot be stabilized and returned to open society.

Wake-up America!  Advocate for a Revision of our Civil Commitment Rules!

V. Thomas Mawhinney, Ph.D.   1/9/11

P.S. (I).  The history and statistics of the Community Mental Health Movement and its failings are based upon the college textbook Abnormal psychology, by Ronald J. Comer.

P.S. (II).  Schizophrenia is a life-long mental disease with strong heritability. There is no cure for schizophrenia, though medication can imperfectly help to control its most bizarre and incapacitating symptoms.

P.S. (III). A factor in our social decline is that since deinstitutionalization, the reproductive rates of people with schizophrenia and other severe mental illnesses have naturally increased and are thought to now approximate that of the “normal” population. I believe this has led to a growth of a variety of genetically-based schizophrenic spectrum and other serious mental problems within our population. 

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