[bsder]

> What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover?

What gives you the authority to institutionalize him?

This isn't a snide question. It's a very difficult question that leads to a whole raft of difficult questions.

How do you force a person to take their medication? Why should you do it for this particular person but not that particular person? Who is responsible for the cost of doing so?

[SpaghettiCat]

> What gives you the authority to institutionalize him?

A government has the duty to provide for the welfare of their people. It's every government's goal to make their people healthier.

> How do you force a person to take their medication?

In a psychiatric institution you could for example inject the medicine into them.

> Why should you do it for this particular person but not that particular person?

If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control.

> Who is responsible for the cost of doing so?

Taxpayer

[chris_wot]

I once had a very bad episode where I didn't take my medication as I ran out. It's an anti-depressant, not an anti-psychotic or anything like that as I just have depression.

I felt restless that night, and I'd just been made redundant, so I drove my car to an all-night diner. For whatever reason, I somehow managed to go through a red light and a cop pulled me over and issued me with a $500 ticket.

I basically felt destroyed inside. I'd just lost my job, I was hungry, and I felt I'd just let down my family - and I was suffering from withdrawal from the anti-depressants. I freaked out, left my car and wandered the streets. I honestly can't recall much, but I do know it started raining on me and I do know I was thinking about death. The police came and put me in an ambulance. I arrived in the ED, and was placed in a mental health ward.

It was the worst experience of my life. I have never been treated so badly, or had my rights and dignity stripped away so thoroughly and systematically. They didn't chart my medication properly, they put me in a freezing room overnight with not enough bedsheets, the building leaked everywhere (even the light sockets had water going through it), there were people having psychotic episodes or hearing voices, it was terrible food and no staff gave me any counselling or even asked how I was. What's worse was that I recovered very, very quickly so I was fully cognizant of what was happening. When I asked for my correct medication, I was told I was being unreasonable and "You don't get anywhere here by being demanding you know!" was the answer given to me by the nurse on duty (I put in a complaint and then admitted they had made a major mistake in charting my medication).

So THAT'S why we don't institutionalise people. I don't care what facility it is, if the person isn't harming themselves, that's the wrong place for them. I can assure you, if I ever have thoughts of suicide, I will never admit it to the police or any health worker in case they put me back in that place. One night in that place was more than enough. I will either commit the act (God, I hope it never gets that bad!) or I'll suffer in silence.

[chrisseaton]

But people have rights. They have a right to not live in an institution if they don't want to. You want to disregard that right, because you think you know better for them than they do. Many of these people aren't dangerous and don't have infectious diseases, so there's no public health need to lock them up as you're suggesting.

[SpaghettiCat]

These people don't have control over their mental faculties; they aren't competent enough to make a choice for what is best for them in the same way that minors aren't allowed to go truant or to consent to sex with an adult.

If you are all there in the head, by all means live on the streets, stay filthy, don't eat and ignore people, but this man has a brain disease that makes him lose control of his mind.

If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me."

If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).

[vidarh]

Who are "these people"?

How do you decide which ones amongst them are "all there in the head"?

How do you distinguish between someone sane but eccentric that refuses to speak to you, and is filthy and lives rough vs. someone with a mental illness without applying force?

> If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me!

Some would. Others, as I mentioned in an anecdote elsewhere in this thread, would sue you, appeal the case all the way to the supreme court, and win.

> If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).

I would too. The problem is that not everyone living like this have mental disorders that make them incompetent to make their own decisions, and separating the ones with real medical needs from the eccentrics is not straightforward.

A large problem is also that often while the official motivation is to help, the impetus for the "help" is that others take offence at their presence or attribute moral failings to them and want them gone, and don't so much care whether or not it helps the person in question.

[herbert_cassidy]

I think this is the problem left-wing/liberal/socialist thinking. It sounds great - nobody should be on the streets - we have enough resources to house everyone. And then a little while later it's some kind of totalitarian nightmare with people forced to live in institutions as you think you know better for them, and anyone who doesn't agree with your way of life must be insane.

[vidarh]

As a left-wing/liberal/socialist, I both believe nobody should need to be on the street, and that it's totally unacceptable for the state to use force to put people in institutions without very strict checks on mental competence.

I find your notion that there's some slippery slope where we'll suddenly want to force people into institutions quite bizarre.

A lot of socialist thinking, on the contrary justifies the need for a welfare system and redistribution with arguments that true liberty is only possible once there are protections in place which ensures that you do not just have the legal opportunity to make your own choices, but also the means to realistically be able to make choices.

On that basis, the argument both for giving people help to get off the street and restricting the states ability to interfere if you chose untraditional lifestyles is the same: Maximizing liberty.

Now, given the old socialist joke that if you put two socialists in a room, you'll get three incompatible definitions of socialism, there may be socialists out there more gung-ho about institutionalizing as many people as possible, but I've not met any.

Conversely I'd hesitate to say it's a right wing issue, despite the fact that historically a lot of right wing governments have been very gung-ho about using draconian measures to force people off the streets and into institutions, including the use of police to remove them coupled with work-houses or even prison next to mental institutions, as many have had a long tradition of seeing homelessness or poverty in general as a sign of moral failings that need to be treated harshly.

[chris_wot]

Enough with plotting some sort of opinion on a simplistic and inadequate two-dimemsional political axis! It's almost never helpful.

[ashworth]

But who decides who has control over their mental faculties? Who decides who is competent? The state? The family? The physician?

Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.

This isn't a hypothetical for me... like the author of the article we're discussing, I've had close friends suffer from schizophrenia and depression, and seen one of them involuntarily institutionalized. I wish it was so clear cut SpaghettiCat, but I think the majority of mental health cases are not so black and white as the one in the article.

[SpaghettiCat]

> But who decides who has control over their mental faculties? Who decides who is competent? The state? The family? The physician?

Who is the most competent to make this decision? The medical professional. Of course government (advised by medical professionals) will set the policy which will constrain the possible decisions.

> Can you imagine scenarios where the state, or the family, or the physician are incompetent, selfish, or malicious in determining the competence of a person? I believe there are MANY such scenarios.

This could apply to absolutely everything: evil police officers taking bribes and releasing criminals, doctors not prescribing expensive medicine to save their hospital money, etc. Does that mean we do away with police protection and hospital services entirely? No, as in this case, we have to accept the risk of the person in authority to make the good decision.

I agree this issue is not black and white.

[duggan]

> Who is the most competent to make this decision? The medical professional. Of course government (advised by medical professionals) will set the policy which will constrain the possible decisions.

This has gone poorly quite often throughout history, which is why it's a tough question. Homosexually was officially considered a mental illness in America until 1974.

[bzbarsky]

Note that countries used to do a lot more forced institutionalization than they do now. There were lots of abuses (even in the West, to say nothing of the way it worked in the Soviet Union: https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_... should be a must-read for anyone arguing for government involvement in institutionalization decisions) and people have backed away from that sort of thing.

It's possible that Europe and the US have swung too much to the other extreme now, of course. But as you say this is very much not black and white.

[dragonwriter]

> These people don't have control over their mental faculties; they aren't competent enough to make a choice for what is best for them in the same way that minors aren't allowed to go truant or to consent to sex with an adult.

Which people? "Mentally ill" people aren't a homogenous group, and the fact that someone is mentally ill and living on the street does not imply that they are incompetent to make personal decisions due to their mental illness. The relation between mental illness, poverty, physical illness, etc. is complex.

There aren't simple answers, and this person isn't these people.

> If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me."

Would he? He was medicated, functional from the point of view of the broader society, and living in an apartment and stopped taking his medication. Was it because the medication wasn't the best medical science could identify and he was still incompetent though he would be better off with other medication? Did he accidentally stop taking medication and start a downward spiral where he became out of control? Or was he, as he seemed, competent -- but voluntarily decided to discontinue the medication?

> If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).

And that's great, but its a mistake to project what you think you would want onto other people as their preferences.

[SpaghettiCat]

> Which people? "Mentally ill" people aren't a homogenous group, and the fact that someone is mentally ill and living on the street does not imply that they are incompetent to make personal decisions due to their mental illness. The relation between mental illness, poverty, physical illness, etc. is complex.

I was referring to patients who lack control over their mental faculties at least to the degree of the man on which the article was written.

> There aren't simple answers, and this person isn't these people.

Yes, this person belongs to the general collective I described above. Clearly when I said "these people" I meant people like the man in the article I was talking about.

> Or was he, as he seemed, competent -- but voluntarily decided to discontinue the medication?

He may have been in the driving seat when he hypothetically decided to stop taking medication, but ultimately he lost control of the wheel. If a person is not taking care of themself and so out of your wits that you stand for hours at road junctions staring blankly forward, they need to be saved. The authorities must assume that though the decision to stop taking medication was voluntary, because the person lost control of their mind, maybe that person's decision was misinformed (or as you suggest, accidental). By analogy, ust because the driver of a car intentionally didn't buckle themselves in (maybe they wanted to die, or like the risk, or were just eccentric), doesn't mean that when they crash and their body flies out, that we shouldn't hospitalise them.

> And that's great, but its a mistake to project what you think you would want onto other people as their preferences.

Actually there is no mistake here: it's a fact that there are other people like me who want this protection from the state.

[ufmace]

Your very insistence that you have the only right point of view on this makes me even more against ever allowing anybody who thinks like you the power to involuntarily commit anybody.

The USA, for all it's flaws, is supposed to be based on the idea that the people are not subservient to the Government's goals, but instead, the Government is subservient to the peoples' rights. That they can only be deprived of their rights through due process of law, as passed by elected legislature. Not a "scientific" book written by people who have no accountability to the population as a whole.

I fear you would not understand how important this is unless you yourself were involuntarily committed. It may well already be true that a malicious individual with enough knowledge could look at your current lifestyle and find a justification for committing you and injecting you with things against your will. I'm sure that such a thing could happen under the rules that you seem to advocate. I hope such a thing never happens to you, but I fear that there are many people who would not see the importance until it does.

It's as much a part of the human condition that power corrupts as it is that we are subject to mental illnesses at times. Many say that it will never happen here. I say that (to quote a line from Battlestar Galactica) all of this has happened before, and all of this will happen again.

[SpaghettiCat]

> Your very insistence that you have the only right point of view on this makes me even more against ever allowing anybody who thinks like you the power to involuntarily commit anybody.

I don't know what made you think that I have the only right opinion. I'm advocating a view, and actually part of developing a well-rounded view is challenging beliefs you yourself hold--playing devil's advocate.

> That they can only be deprived of their rights through due process of law, as passed by elected legislature. Not a "scientific" book written by people who have no accountability to the population as a whole.

The part of the government that deals with health sets the policy on who should be institutionalised, and they are the ones that give executive power to do so to doctors. Actually, doctors and psychiatrists hold an immense amount of responsibility over the welfare of patients; they may not personally hold accountability, but the hospital or other medical instution does, because of the great potential for lawsuits in the case of mistakes (AFAIK).

> It may well already be true that a malicious individual with enough knowledge could look at your current lifestyle and find a justification for committing you and injecting you with things against your will. I'm sure that such a thing could happen under the rules that you seem to advocate.

This is rather unplausible; there is a mountain of a difference between my behaviour and of an unwashed, malnourished man who fails to communicate even basically with other people, standing for hours at road crossrods like a zombie.

[DanBC]

What you're asking for is that people who have the ability to chose (where to live; what medical treatment to have) are denied that choice.

> In a psychiatric institution you could for example inject the medicine into them.

Schizophrenia is a lifelong illness. Do you keep someone imprisoned for the rest of their life so that you can forcibly medicate them against their will?

[dredmorbius]

There are, to change the domain somewhat, other lifelong illnesses, which arent mental disorders. TDR-TB -- totally drug resistant tuberculosis -- is one of these. Worse, unlike schizophrenia, it's contagious.

And the only viable public health responses are either a total quarantine of infected populations, or killing them.

If you reject the latter, and i hope that you do, you're left with a situation not much different from that posed by schizophrenia: the prospect of institutionalisation, but under terms and conditions in which the afflicted will prefer and seek out that option. Or at the very least not resist it.

I'll also note that lifelong imprisonment is not necessarily the only option, you're appealing to the extreme here. Though sometimes, yes, that _is_ what society must do.

[SpaghettiCat]

> Schizophrenia is a lifelong illness. Do you keep someone imprisoned for the rest of their life so that you can forcibly medicate them against their will?

No, until the mental disorder is controlled. After all avenues of curing are exhausted, and it's still not under control, then they can be released, provided there's no significant risk that they'll harm others or themselves.

[DanBC]

Schizophrenia is not cured, but treated.

So you risk getting into "revolving door" admissions to hospital. A person with a psychosis becomes ill, rejects medication, is detained against their will in hospital and given medication against their will (sometimes by force) until they "become well" enough to be let out of hospital. At which point they're free to decide to stop taking the medication.

I'm not sure that this style of revolving door admission is better for the person than just letting them be homeless. (Although preventing people getting into that situation would be a good idea).

[SpaghettiCat]

This already happens with homeless people: they become diseased, malnourished, get drunk and hurt themselves. Once the trauma has reached a certain degree that they require hospitalisation, they end up in hospital and released once they've recovered. Are you proposing we not help them at all and just let them fester and die on the streets?

Surely not. The "revolving door" concept, as you call it, is the middle-ground between not helping at all, thus letting a mentally ill person reach trauma more severe, and permanently confining those with incurable mental disorders (but those which can be controlled, and the patient able to live healthily outside the ward), which is both wildly expensive and harder to justify overruling the patient's will and freedom.

[DanBC]

No, I'm saying that you can't force people to take medication against their will apart from a few situations.

If you want to provide MH treatment to people it's much better to start with children and young people and better drug and alcohol services, both of which would reduce the amount of homeless people, and also to provide better voluntary MH treatment for homeless people.

People aren't arguing with you because you want to provide MH treatment. People are arguing with you because you want to force that treatment on people against their will.

[chris_wot]

There is no cure for schizophrenia. I wish there was, but there isn't.

[reverend_gonzo]

> If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control.

This is a very fine line. What if someone refuses to eat food, or communicate, as part of a protest or a religious fast or any other personal reason? Who are you do to decide what they're doing is wrong?

If they are not endangering anyone else, it gives you no right to interfere.

[SpaghettiCat]

The difference is he has a genuine medical problem: a mental disorder, i.e. it's in the DSM.

[leroy_masochist]

Homosexuality was listed as a mental disorder in the DSM until the mid-1970s.

The understanding of relatively highly-occurring afflictions such as PTS and schizophrenia is evolving to this day and it's a near-certainty that the DSM will be a different document 10 years from now.

I don't think we should be so cavalier about taking freedom away from people whose main transgression against the rest of society is making us feel uncomfortable when we look at them.

[SpaghettiCat]

>Homosexuality was listed as a mental disorder in the DSM until the mid-1970s. The understanding of relatively highly-occurring afflictions such as PTS and schizophrenia is evolving to this day and it's a near-certainty that the DSM will be a different document 10 years from now.

Just because it had errors before doesn't discredit the document in its current state; it's the product of scientific investigation. By it's very nature it will make mistakes and then update the conclusions as time goes by. Yes, of course it will be different in 10 years, but currently it is our best understanding of mental ailments and the knowledgebase has come a long way.

> main transgression against the rest of society is making us feel uncomfortable when we look at them.

The main transgression is that the victims are trapped in a cycle of suffering because their brains are malfunctioning and are preventing them from recovering or seeking help to recover.

[leroy_masochist]

I don't think the word "transgression" means what you think it means.

[chris_wot]

The DSM? Don't make me laugh. The DSM has plenty of things in it that you can't say would require someone to be institutionalised. I'll bet there is something I could find in the DSM that you would fit into. I'm not about to commit you though.

[SpaghettiCat]

Not every mental disorder warrants institutionalisation; I never said that. My point was to clarify that a medically diagnosed person who does some crazy action should be institutionalised, whereas a person who does the exact same crazy action but has no mental disorders should not be.

[chris_wot]

Define "crazy action"? And under what mental disorder should someone be institutionalised? All you've referred to is the DSM, so it's very unclear which illnesses and disorders you are referring to.

Incidentally, are you aware that there is a difference between a mental disorder and a mental illness?

[DominikR]

> A government has the duty to provide for the welfare of their people.

You state this as if it is an universal principle. It is not. Why don't you and everybody else provide for your own welfare?

> In a psychiatric institution you could for example inject the medicine into them.

Some countries deem persons with certain sexual preferences as mentally ill. (homosexuals) How would you feel about imprisoning them in a psychiatric ward and injecting some "medicine" against their will to "treat" them.

You may find this example not applicable because it is obviously wrong to do that but I can tell you this much:

No matter how much you feel that you are sitting on the moral high horse and know it all, in a hundred years people will analyze how we acted this very moment and conclude we were a bunch of backward barbarians.

Let's not revert back to the backwards behavior our precursors deemed morally right a hundred years ago.

> If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control.

Which could be translated for many into: Imprisonment for life.

>> Who is responsible for the cost of doing so? > Taxpayer

And if it's not sufficient we'll just raise taxes and steal even more. Simple solution.

[mcphage]

I was with you 100% until you referred to taxes as "stealing".

[DominikR]

I overreacted here, I don't believe that taxing equals stealing.

It's just how quickly people that have this wish for the nanny state will claim they have a right to your resources for their very well thought out plans.

Plans like imprisoning every mentally ill person and injecting them with some compound against their will.

[mcphage]

> Plans like imprisoning every mentally ill person and injecting them with some compound against their will.

Yeah that's legit horrifying.