[PaulHoule]

That's a wrong chronology. Before the 1950s we did not have effective treatments for schizophrenia other than incarceration.

In old books you read about

https://en.wikipedia.org/wiki/Catatonia

being intractable, now it usually clears up in 15-30 minutes with benzodiazepine medication. In the 1950s we got the Phenothiazines which were the first hope for many patients, there has been a huge amount of progress since then and managing most of these people outside the hospital is possible. People also came to see involuntary commitment as immoral as described by Thomas Szasz, depicted by the movie "One Flew out of the Cuckoo's Nest" and shown by this experiment

https://en.wikipedia.org/wiki/Rosenhan_experiment

The trouble isn't that we tore down the old system but that we didn't completely build a new system to replace it. There are deep issues involving people's agency. Right now we are in a society that thinks it is wrong to make people to take drugs they don't want to take, a different society (maybe even ours in N years) will think is it wrong to not make people take drugs for serious mental illness.

[gotoeleven]

I really don't understand society's attitudes here. Why is it more humane to give a psychotic person agency, resulting in them living in filth like an animal, dangerous to themselves and others, than to commit them to a mental hospital? If you let a baby or an old person wallow in their shit, it would be considered abuse. Why is this not abuse?

[jldugger]

Because the alternative was also abuse. Forced shock therapy. Lobotomizing children. Court ordered sterilization.

At least in the US, it's basically seen now as a violation of due process to be imprisoned like that without committing any crime. Psychiatric services are on offer, but can be refused.

[PaulHoule]

Part of it is the burden on the caregivers.

It can be exasperating to care for an elderly person with dementia, they can range from very agreeable to rather disagreeable but most of them have had enough experience with caring for people and being cared for that they can have some empathy with their caregiver -- even if they have a hard time remembering it.

People with serious mental illness have disturbances in those relationships (remember how Freud asked "tell me about your mother?") and are much harder. And if they want to kill you because they think you are something other than what you are they're more able to do it.

Communities that adopted "housing first" early on had great success with it. In the fentanyl age there's a lot of fear that a volunteer or someone who isn't paid nearly enough will open a door from time to time to discover a dead body.

[simoncion]

Another part of it is the (somewhat justified) worry that "inconvenient" people will declared mentally incompetent and effectively imprisoned in mental hospitals (or -worse- mental hospitals that know they're being used to jail "inconvenient" people, so they don't really bother to provide actual treatment).

IMO, I'd rather have to mitigate that hazard if it meant we got actual, effective treatment for folks with super fucked-up brains than have what we have today in the US... but I'm in no position to change the country's policies.

[PaulHoule]

The Soviet Union might be the only place where people were routinely diagnosed with schizotypy.

On the other hand I'm still a touch angry that it was missed in a psych eval I had in school that, I'm told, was a really superior psych eval for a kid in the 1970s. (Kohut's Analysis of the Self was a major discovery for me when I did a round of research trying to understand an crisis at work circa 2006 but I missed the literature connecting his work to schizotypy in the 1980s; a really good monograph came out in 2013 which fell into my hands a year ago... and I think "now it all makes sense" but "I lost so much time") It's hard to come out because (i) so much about it is offputting, and (ii) I find schizotypes on YouTube to be so annoying I can't stand to listen to them for more than 30 seconds. Those of you who think there's something weird about what I write here are right... It's what you get when you mix verbal intelligence too high to measure with a good measure of line noise. At least I find it easy to emphasize with people with schizophrenia and schizoaffective because "thought disorder" doesn't seem so strange to me.

I was at risk but dodged the bullet to get schizopherenia but I worry about psychotic dementia.