Posts Tagged ‘schizophrenia’

Into The Darkness: America’s Mental Health Problems

February 17, 2018

Into The Darkness: America’s Mental Health Problems

The following is an important re-blog from 10/30/09.

She had walked about three miles in the dark and was lost before she found my office. It was cold and raining 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 almost every week.

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 recessed into the protection of the jacket’s 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 She had withdrawn from the world around her.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. The hood made 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 and hated them. She said that she is always nervous and cannot come out of her house during the day. She reported that she gets confused and scared and wanted 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 a psychotic state. I said that I could not help her through counseling until she was on antipsychotic 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 counseling to her for a condition that required medication before counseling would be of any benefit. I told her I could not participate in prolonging her illness that was harming her.  I did my best to comfort her and softly spoke of my desire to help her get better. She began to mumble about cutting herself and she fumbled in her purse for something. For a moment I feared she was looking for a knife.

She finally found the tattered intake form that she had meticulously filled out and brought to give to our receptionist. She didn’t say anything more as she slowly stood to slouch within her hooded sweat shirt and shuffled slowly from my office. She lingered near the reception desk for a time and finally moved slowly out the front door into the dark, cold, and rainy night. I imagined what she must feel like as she walked her long way back to wherever she came from.

I normally do not loose sleep over my client’s problems. I could not do that and remain in practice for over 30 years.  However, I did not sleep well that night and I cannot forget that lost and pathetic young woman who walked out of my office and into the dark.

Both the poor lady and I were caught in the results of a terrible mistake that our American culture made following the discovery of antipsychotic medications in the 1950’s.

At that time close to six hundred thousand patients, daily,  were confined in our public mental institutions. The new neuroleptic medications frequently ( but not always) helped to control the active symptoms of many forms of psychosis. However, the medications did not cure the symptoms, which were prone to return when the patients encountered stressful conditions, especially 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 mental hospitals. This process was 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 enacted forbidding the hospitalization of mental patients against their will, unless they were a clear and present danger to themselves or others. This led to the bizarre practice of giving severely and profoundly mentally ill citizens the choice as to whether they should be hospitalized or not.

In other words, people who clearly were not in contact with reality were (and still are)  asked to make rational decisions about accepting treatment, which most often would improve their condition. Tragically their answer was and still is, very often: No!

This indefensible policy has contributed to the increase in social horrors  such as mass murders in our schools, killings and attempted killings of high profile entertainers, politicians, U.S. presidents and others: All too frequently by people who are very severely mentally ill and  who cannot control their actions.

It is also painful to see the severely mentally ill who are cold and starving in the streets, who seek shelter under bridges and train trestles or in cardboard boxes and other make-shift shelters all across America.

I will never forget a documentary that I watched of mental health workers putting sandwiches on a bench in a city park and hiding in bushes waiting to see if a starving psychotic man would eat them. The man thought that people were trying to poison him so he would not eat the food left for him. He ran away from the well-intentioned mental health workers. No one had the power to take him to a safe hospital environment where he could have been medicated and cared for. My perception was of a cultural practice that was just as psychotic as was the starving man it was designed to help.

There is yet another concern that has not been addressed. The psychotic woman, who I could not help, told me she had two children.

Think about this: schizophrenia is a bio-genetically-based mental disease that is heritable. After deinstitutionalization in America, the reproductive rate of schizophrenics increased to approximate that of the rest of our population.

The truth is that there is nothing humane about the way we treat our severely and profoundly mentally ill citizens…or their children. Our treatment of these suffering people is abusive.

The real motive, hidden behind false ideas of personal freedom and humane treatment, is primarily financial. Deinstitutionalization saves money in the short-term, pure and simple. But, in the long-term, as America is now learning, it has been a disastrous mistake.

This is another example of America’s avoidance of short-term expenses and trouble, at the cost of long-term cultural self-abuse and self-destruction.

V. Thomas Mawhinney, Ph.D., 10/30/09, 2/17/09

Revise Civil Commitment Laws II

January 13, 2011

Revise Civil Commitment Laws II

A few days ago I presented the educated assumption that the man who shot and killed six people and wounded Congresswoman  Giffords along with 12 others, was suffering from Paranoid Schizophrenia. I reviewed the deinstitutionalizing/community mental health initiative of the early 1960’s and also the change in our civil commitment laws that made it almost impossible to get psychiatric and psychological help to those who are in psychotic states and who refuse to seek or accept help for their condition.

Many facts are now available that were not then. Professionals interviewed on the media have tentatively diagnosed his condition as paranoid psychosis. Neighbors had seen symptoms of psychosis in this young man for a long time, high school classmates and friends reported his increasing symptoms of psychosis, college classmates and a math professor reported their fear of this man in their class. The students feared he would bring a gun to class and the professor was afraid to turn his back to do math problems on the blackboard for fear that the actively psychotic person  might shoot him in the back. These fears were present despite the fact that no one reported ever seeing him bring a gun to class. Also, the man’s  disturbed and and forboding ramblings were publicly posted on the internet.

This tragedy could have been, and should have been, avoided.

Once again,  America has hog-tied itself with our laws and we see the inhumane outcomes of our attempts to be humane. It is a sad truth that mental patients were once locked away and many were never released. It is a happy truth that, with the discovery of antipsychotic medications, many were able to benefit and lead more normal lives. It is a sad truth that a large proportion of hundreds of thousands of mental patients who were once released from hospitals did not get medications, or refused to take them, or were ones for whom the medications did not work very well.  A great many of these former mental patients joined the legions of our mentally ill homeless and those in our prisons.

So I ask, what is humane about this outcome for nonviolent psychotic? And what is humane about America allowing an obviously dangerous paranoid psychotic to wander freely amongst our citizens who were fearfully trying to get help for this individual, while our mental health systems and our legal systems were unable to provide the help and protection needed?  So now a man is a mass murderer who likely never would have hurt anyone. All of thishappened because of his untreated paranoid psychosis. So now a congresswoman has been brain damaged,  twelve more have been wounded and nine other citizens have been killed.

In response, our government predictably swings into frenetic and futile action. It proposes that we limit the capacity of firearm magazines (use two guns, or poison, or several knives and a sword). It proposes that we limit the zone around a public official in which citizens may possess a gun to 1000 feet.  What does it matter?  How would such a law be enforced and how likely is the law to control the behavior of a dedicated sane assassin or someone in a murderous  psychotic rage? Finally, the grand absurdity emerges among these lesser ones: it was Sara Palin, Fox News, Rush Limbaugh, etc., who need to be silenced!

No, dear friends, what really needs to happen is a revision of our civil commitment laws.

 Although murderous attacks by paranoid psychotics can never be prevented 100% of the time, the probability of it happening again can be cut dramatically, if we will only behave rationally.

It is essential that our licensed doctoral level mental health care providers (psychiatrists and Ph.D. clinical psychologists) once again be given the authority to commit actively psychotic citizens, who refuse help,  to mental health care facilities.  This new commitment procedure can be much more humane than the previous ones. The new commitment procedure would be for evaluation and medication assistance (remember medication for psychosis was once unavailable). The first goals of this intervention would be to quell the ongoing psychotic episode, educate the patient as to their particular mental disease, and teach them how to effectively cope with it through medication and stress management.  The final goal of this commitment would be discharge the patient as soon as possible with mandatory supportive follow-up.

It should be understood that such a treatment approach would need to be refined through outcome analyses and further revisions, to the point that it reflects our best efforts to protect the rights of all citizens concerned, including the patient under treatment.

V. Thomas Mawhinney, Ph.D.       1/13/11

P.S. You will note that I have omitted the paranoid psychotic murderer’s name. I did so because that person did not do the killing. Rather, it was a dangerous mental disease (paranoid schizophrenia) that America allowed to wander freely amongst its citizens that did the killing.

To those who ask: What about individual freedom? I will ask: What about the individual freedoms of those students and the professor terrified  in the classroom? What about the freedoms of the professionals who were called to help, but who were restricted from providing help? What about the individual freedoms of those killed and injured by a paranoid schizophrenic’s murderous attack? What about the individual freedoms of all of the victims?

 The list of victims includes the paranoid schizophrenic who did the shooting, those who were killed and injured, and all of their friends and relatives and the rest of us who have been traumatized by this and similar tragedies.

Some say that this suffering is “the cost of freedom”. I say it is the cost of our own cultural design mistake and a loss of freedom that must now be repaired.

Into The Darkness

October 30, 2009

Into The Darkness

She had walked about three miles in the dark and was lost before she found my office. It was cold and raining 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 almost every week.

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 recessed into the protection of the jacket’s 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. The hood made 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 and hated them. She said that she is always nervous and cannot come out of her house during the day. She reported that she gets confused and scared and wanted 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 a psychotic state. I said that I could not help her through counseling until she was on antipsychotic 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 counseling to her for a condition that required medication before counseling would be of any benefit. I told her I could not participate in prolonging her illness that was harming her.  I did my best to comfort her and softly spoke of my desire to help her get better. She began to mumble about cutting herself and she fumbled in her purse for something. For a moment I feared she was looking for a knife.

She finally found the tattered intake form that she had meticulously filled out and brought to give to our receptionist. She didn’t say anything more as she slowly stood to slouch within her hooded sweat shirt and shuffled slowly from my office. She lingered near the reception desk for a time and finally moved slowly out the front door into the dark, cold, and rainy night. I imagined what she must feel like as she walked her long way back to wherever she came from.

I normally do not loose sleep over my client’s problems. I could not do that and remain in practice for over 30 years.  However, I did not sleep well that night and I cannot forget that lost and pathetic young woman who walked out of my office and into the dark.

Both the poor lady and I were caught in the results of a terrible mistake that our American culture made following the discovery of antipsychotic medications in the 1950’s.

At that time close to six hundred thousand patients, daily,  were confined in our public mental institutions. The new neuroleptic medications frequently ( but not always) helped to control the active symptoms of many forms of psychosis. However, the medications did not cure the symptoms, which were prone to return when the patients encountered stressful conditions, especially 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 mental hospitals. This process was 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 enacted forbidding the hospitalization of mental patients against their will, unless they were a clear and present danger to themselves or others. This led to the bizarre practice of giving severely and profoundly mentally ill citizens the choice as to whether they should be hospitalized or not.

In other words, people who clearly were not in contact with reality were (and still are)  asked to make rational decisions about accepting treatment, which most often would improve their condition. Tragically their answer was and still is, very often: No!

This indefensible policy has contributed to the increase in social horrors  such as mass murders in our schools, killings and attempted killings of high profile entertainers, politicians, U.S. presidents and others: All too frequently by people who are very severely mentally ill and  who cannot control their actions.

It is also painful to see the severely mentally ill who are cold and starving in the streets, who seek shelter under bridges and train trestles or in cardboard boxes and other make-shift shelters all across America.

I will never forget a documentary that I watched of mental health workers putting sandwiches on a bench in a city park and hiding in bushes waiting to see if a starving psychotic man would eat them. The man thought that people were trying to poison him so he would not eat the food left for him. He ran away from the well-intentioned mental health workers. No one had the power to take him to a safe hospital environment where he could have been medicated and cared for. My perception was of a cultural practice that was just as psychotic as was the starving man it was designed to help.

There is yet another concern that has not been addressed. The psychotic woman, who I could not help, told me she had two children.

Think about this: schizophrenia is a bio-genetically-based mental disease that is heritable. After deinstitutionalization in America, the reproductive rate of schizophrenics increased to approximate that of the rest of our population.

The truth is that there is nothing humane about the way we treat our severely and profoundly mentally ill citizens…or their children. Our treatment of these suffering people is abusive.

The real motive, hidden behind false ideas of personal freedom and humane treatment, is primarily financial. Deinstitutionalization saves money in the short-term, pure and simple. But, in the long-term, as America is now learning, it has been a disastrous mistake.

This is another example of America’s avoidance of short-term expenses and trouble, at the cost of long-term cultural self-abuse and self-destruction.

V. Thomas Mawhinney, Ph.D., 10/30/09


%d bloggers like this: