[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.

[SpaghettiCat]

And there have been at least as many cases of political abuse of the police force, should we also cut down on that just because there is a potential for abuse? Many instutions that are intended to good can be abused or used as political weapons under a totallitarian government, but I think the potential for abuse is much reduced under a more benevolent political system.

[bzbarsky]

Police abuse in a "benevolent political system" generally reads to things like bills of rights and restrictions on when the police can arrest people. Sometimes that means criminals go free.

That's precisely what happened with psychiatric institutionalization: abuses (not just in totalitation regimes) led to restrictions on when it can happen. Sometimes that means that people who maybe should be institutionalized are not.

[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.