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Break the Fall
April 21, 2010 5:24 AM   Subscribe

MINDS ON THE EDGE: Facing Mental Illness is a multi-platform media project that explores severe mental illness in America. The one-hour television program zeros in on wrenching and confounding situations that are playing out every day in homes and hospital ERs, on city streets and school campuses, in courtrooms and in jails, as Americans struggle with the challenges of severe mental illness. The distinguished panel includes U.S. Supreme Court Justice Stephen Breyer, Nobel Prize winning neurologist Eric Kandel, along with attorneys, doctors, legislators and other experts in the field. Several of the panelists have personal, as well as professional experience, in living with mental illness. A Fred Friendly Seminar.
posted by prefpara (19 comments total) 30 users marked this as a favorite

 
That looks pretty interesting. One of my friends has been locked up for several months now. I've just seen the movie the soloist, and both the movie and my friend's behaviour gave me the feeling that there was little hope that he will accept a diagnosis. but Elyn R. Saks is completely amazing and I'm sure that she has some very interesting points to make. So, thanks !
posted by nicolin at 6:01 AM on April 21, 2010


This looks great, I figured as soon as I saw Pathways prominently featured on the front page that it would be.
posted by The Straightener at 6:35 AM on April 21, 2010


as Americans struggle with the challenges of severe mental illness.

And just wait America: the new vets coming back from Iraq & Afghanistan are a very different breed from the Vietnam vets they saw decades ago.

"Also, back in the 60’s, we didn’t know a whole lot about PTSD and our Vietnam troops didn’t know what was happening to them. Based on what we knew from World War II, we tried to prevent them getting PTSD by limiting their time of service to a year (for Marines, it was 15 months). And, sure enough, they came back with a smaller incidence of PTS. But 2-3 years later, lo and behold, they developed delayed onset PTSD and the percentages were right back to being the same as WWII - somewhere between 22%-35%."

As compared to even WWII the tours of duty for the volunteers are much longer with some soldiers and marines having served as many as four or five tours in country.

We are seeing history repeat itself.
posted by three blind mice at 7:12 AM on April 21, 2010


One of the most horrible experiences you can have is watching someone become delusional and be powerless to help. The bar for getting help is high, as it should be, but the standard is sometimes unreasonable. In CA, the person must be an imminent danger to themselves or others. This typically means a threat of violence or suicide.

However, some delusions (e.g., paranoia) can be relatively specific and cause harmful behaviors that don't meet the 5150 Hold criteria. You can watch them spend thousands of dollars needlessly (changing locks, buying multiple phones, falling for security scams, etc.) and not be able to get them help. And if you do manage to get them some assistance, either psychological or medical, then HIPAA may prevent the doctors from sharing relevent information with you, even if you're a family member.

I understand the protections against abuse are necessary, but being in the situation has a distinctly Kafkaesque feel.
posted by CheeseDigestsAll at 7:31 AM on April 21, 2010


If you are the person experiencing mental illness, forced treatment and involuntary commitments to psychiatric facilities has a distinctly Kafkaesque feel.
posted by The Straightener at 7:35 AM on April 21, 2010 [2 favorites]


For those who can't watch the video, there is a full transcript available.
posted by prefpara at 7:38 AM on April 21, 2010


One of the most horrible experiences you can have is watching someone become delusional ... whilst being seated next to him on the bus with your kids.

Protections against abuse are no doubt necessary and respect for the rights of mentally ill people is not something to take lightly, but the public deserves some protection too.
posted by three blind mice at 7:48 AM on April 21, 2010


The public has protection in the criminal justice system which incarcerates the mentally ill in disproportionately high numbers.
posted by The Straightener at 8:00 AM on April 21, 2010 [1 favorite]


If my heart wasn't already broken it would be broken again by this.
posted by fuq at 8:01 AM on April 21, 2010


three blind mice: "One of the most horrible experiences you can have is watching someone become delusional ... whilst being seated next to him on the bus with your kids.

Protections against abuse are no doubt necessary and respect for the rights of mentally ill people is not something to take lightly, but the public deserves some protection too.
"

You're right, but the threat that people with mental illnesses represent is overestimated by the media : according to Dr Seena Fazel from Oxford’s Department of Psychiatry : ‘The figure of one in 20 is probably lower than most people would imagine. Many see those with serious psychiatric disorders as significantly contributing to the amount of violent crime in society. In many ways the most interesting aspect of our findings is that 19 out of 20 people committing violent crimes do so without having any severe mental health problems.’
Actually, "People with mental illness (are) more often crime victims".
posted by nicolin at 8:06 AM on April 21, 2010 [1 favorite]


Protections against abuse are no doubt necessary and respect for the rights of mentally ill people is not something to take lightly, but the public deserves some protection too.

Violence and mental illness: an overview

Violence and Mental Illness: The Facts

Dispelling the Myth of Violence and Mental Illness
posted by prefpara at 8:07 AM on April 21, 2010 [1 favorite]


"It is accepted as fact that persons with mental illnesses are over represented in the criminal justice system. Recent prevalence estimates suggest that approximately 25% of people in prison or jail suffer from a mental illness (1). Although the reasons for this over representation are debatable, it is not debated that the criminal justice system has become a primary service delivery setting for individuals with mental illnesses. In fact, over 15 years ago the Los Angeles County Jail system surpassed all state and private psychiatric specialty hospitals to become the nation’s largest provider of institutionally-based mental health services."

-- Center for Behavioral Health Services & Criminal Justice Research April 2010 Policy Brief
posted by The Straightener at 8:13 AM on April 21, 2010


Justice Breyer is a champion of the disability community. As has been Justice Stevens.
posted by ClaudiaCenter at 8:14 AM on April 21, 2010


The Straightener: ""It is accepted as fact that persons with mental illnesses are over represented in the criminal justice system. Recent prevalence estimates suggest that approximately 25% of people in prison or jail suffer from a mental illness (1). Although the reasons for this over representation are debatable, it is not debated that the criminal justice system has become a primary service delivery setting for individuals with mental illnesses. In fact, over 15 years ago the Los Angeles County Jail system surpassed all state and private psychiatric specialty hospitals to become the nation’s largest provider of institutionally-based mental health services."

-- Center for Behavioral Health Services & Criminal Justice Research April 2010 Policy Brief
"


Locking them up in a prison isn't the best move if you really want to spare people mental difficulties. But I do agree with the fact that prisons are more and more used as a substitute for a sensible treatment.
posted by nicolin at 8:23 AM on April 21, 2010


I had hoped for better from Metafilter than for a discussion on mental health to become a "lock 'em up, keep 'em out of sight and won't someone think of the children!".

I've seen the numbers above before,and if we apply that logic then I want all those 'sane' people locked up to protect people like me. They're scary.
posted by Coobeastie at 8:34 AM on April 21, 2010 [2 favorites]


Locking them up in a prison isn't the best move if you really want to spare people mental difficulties.

I am a social worker who works for a diversion program that keeps mentally ill drug offenders out of jail, I am not advocating incarcerating the mentally ill, simply supporting with a citation the assertion that the criminal justice system goes well above and beyond in terms of protecting public safety by over-incarcerating non-violent mentally ill offenders in extraordinary numbers.
posted by The Straightener at 8:37 AM on April 21, 2010


Absolutely, my first sentence wasn't really aiming at you (the "you" that I used was awkward) but rather at the people in charge.
posted by nicolin at 8:47 AM on April 21, 2010


I can't help but feel like if there was easier access to mental health care services -- both easier physical access, like you could walk up to a clinic and make an appointment without it costing an arm and a leg or having to wait two months, and easier social access, like it wasn't some weird stigmatized thing -- we'd have fewer people so absorbed by their illnesses that they are unable to take care of themselves.

Sure, by the time someone is critically affected by a delusional situation, of course they don't want to be committed into a hospital. But maybe, just maybe, they'd have been willing to voluntarily go see a counselor back when they started falling out of sync with consensual reality, if it had been easy to do so.
posted by KathrynT at 11:16 AM on April 21, 2010


"If you are the person experiencing mental illness, forced treatment and involuntary commitments to psychiatric facilities has a distinctly Kafkaesque feel."

If you are a close relative of a person experiencing (and acting out in the throes of) mental illness, forced treatment and involuntary commitments to psychiatric facilities feels like a serious blessing and anything less has a distinctly Dreiseresque feel (especially when your close loved one has a tendency towards violence only when nuts).

The sad reality is we let these people fall through the cracks and don't provide the kind of services until it's often too damned late and they go out, do something crazy, and have the boys in blue show up with revolvers drawn -- often letting the bullets fly free even sometimes when the psychotic has no weapon in their hands. Then it's all about punishment -- if the person isn't killed by the police.

My father spent the last twelve years of his life in a correctional facility for the criminally insane after committing homicide in the state of a delusion against a person he never met in his sixties with not even a speeding ticket to his name! Because of a goddamned voice in his head. Btw, the psychotics generally try to fight the voices but eventually succumb to their seductive strength. Anytime I hear somebody say, "Why don't they just ignore the voices?" I want to throw something. It's as bad as, "They just don't want to work. Those people on the street could work, but they're just lazy." Good God. All psychotics do all day is try to fight those voices in their heads. I have a friend I graduated high school with who was the classic schizophrenic. It hit him in college and he was out to lunch for a good ten years. He finally got on one of the more recent anti-psychotics and I got my old friend back. He tells me the voices never go away, but with the medication the noise sort of dies down a bit.

My mother spent the latter half of her marriage trying to keep the genie in the bottle (old school style -- no divorce, and reality: she loved the guy -- he wasn't a nut the first fifteen years of marriage). Sounds like denial. I've still got some of it, I can't lie. They tried different medications throughout the sixties, seventies and eighties with diagnoses that didn't cut the mustard which he would often break through (until about 2001 when he was diagnosed as an atypical schizophrenic and eventually got on I think -- was it Abilify?). He had psychotic breaks in prison, which really scared us because we figured any day something would happen and somebody would kill him there. Again, cold comfort for him and us, at least he wasn't going to ever kill again as long as he was inside. Thank God for his fellow prisoners, they watched his ass pretty well because most of them had their own issues on the same order. Thank God he was a likable old codger. I shudder to think otherwise. The guards loved him and my mom.

It sounds terrible but the classic schizophrenic who has the breakdown in late adolescence to my mind can be somewhat of a blessing. At least under those circumstances, the person is perhaps less likely to marry and have kids knowing in occasional moments of sanity that such a path could present serious problems. In my father's case the psychosis doesn't manifest until he was well into his late thirties by which time he had five kids to feed. But in either case, for the families there is NO ANSWER. NONE. NOT IN THE GOOD OLD USA.

When my dad went nuts, he went NUTS, with all the classic symptomology. Paranoia, CIA spying, the works. But as soon as we loaded my dad up with anti-psychotics, it only took a couple of days to a week before he was pretty much functioning like an ordinary citizen again. It got worse as he aged. He worried about his reading. He had a couple delusions when he would read books on astronomy and astrophysics which he loved so he feared reading those books after that. Man did he love his Carl Sagan. Total nerd. He thought going to the Basque restaurants in Bakersfield was a hoot. We would sit sometimes on Sunday nights and talk books. He loved Jussi Bjoerling and would play me the songs where Bjoerling hit like ten High C's in a row. He worried about the seduction of insanity -- that's what it feels like. He used to say it was like a conveyor belt into a waking nightmare. The psychiatrist never said, "Hey, check in forever," but I doubt he could have gotten in because most of the time he was normal and functioning. Friends, family, normal job, normal functioning. I know that must sound crazy and in denial, but honest to God, he was a pain in the ass, but a good deal of the time it was ordinary annoying parent stuff. My mother would insist he get to help me with my math homework. The old bird would have to explain calculus to convey an explanation of of simple addition. He didn't drink. He never laid a hand on any of us. He bitched about taxes, but voted Democrat. He was like the absent-minded professor.

BUT when he was nuts, it was like this faraway look would show up in his eyes. Eating his own feces, singing spirituals in the middle of the local jail because he thought if he didn't everybody there would be killed by Hitler. Getting pummeled by the police, misunderstanding the weirdo things that came out of his mouth in the fits of insanity. It was a mess.

They don't generally commit you UNLESS you are in the throes of insanity, which I can tell you is hard enough to pull off legally for relatives (except not as much in Florida for some reason, I don't know). They also have a habit of letting you out when you are back on solid ground, until, yet again, you break through the medication to be only watched over and protected by your family who simply don't have the training, skills, time, and financial wherewithal to constantly keep vigil. He was a good man, but boy was living under those circumstances a pain for him and us when insanity reared its ugly head. It was like growing up always wondering if lightning was going to suddenly strike.

When he was finally sentenced to life it was a cold sort of comfort for him and us. He hated prison. He was an educated man, a lover of culture, and books, and life, but on the other hand, he feared parole (and so did we). He felt enormous guilt over his actions he took on that fateful day. All the things he loved in this life, hiking in Yosemite, taking trips with his kids, hosting big Thanksgiving dinners with family and friends, all of it went in the shitter with all the magnitude of a hand grenade being dropped in the laps of innocent families, and our own. I would be lying if I said I felt as much for his victim as I did for us. I never knew the man, but I know he didn't deserve it. I know he was a good man who I learned was one of those guys you just ask "Why?" I was eighteen years old at the time in my second semester of college. Nobody recovered. Not the victim's family, not us. We just adjusted. Bourgeois whining on my part? You bet. His victim was just a goddamned stranger who didn't ask for it. A good man at the wrong place at the wrong time.

After twenty years of psychotherapy on my part, a lot of individuation, and knowledge that my parents should have somehow put him somewhere safe because he was so fucked up when insane, you'll have to forgive me if I still exhibit some denial, but some nights I still can't quite do the mechanical math on how they would have effectuated the whole thing and I've worked in social services and am a lawyer now who deals occasionally with this sort of thing. You want to talk denial? My mother still doesn't believe he would have ever harmed us in that state. Guess again. I'm not so sure. How is that for a pill to swallow? I don't think deep down he was so damned sure either, though after I had to check him into a hospital after the incident where he was wandering around for a couple of days, he assured me "It was all over, and nothing like that could possibly happen." About twenty minutes later he leapt up, jumped on me and tried to strangle me as I kicked at him trying to keep him off. PTSD? Baby, I'll never forget the look in his eyes at that moment. It was a fucking stranger. It was the first and last time he ever laid a hand on me to do anything but give me a hug.

AND THE SADDEST THING FOR AMERICANS WHO HAVE MENTAL ILLNESS IS HE WAS RELATIVELY LUCKY! Most psychotics can't even function enough to have a job. He did pretty well. How about Andrea Yates who killed her own children in the middle of a delusion? How about all the women who suffer from post-partum psychosis and wake up to find they did the same. Common as stopped up plumbing in this world. Many kill themselves once they come to sanity. I still shed a tear when "Sympathy for the Devil" comes on the radio.

I came to believe less in punishment and more in a not-so-punitive separation from society, but that's how it is here only a hundred or so years from public hangings.

Sartre's No Exit is right baby. He committed suicide after pulling an Andy Dufresne in the hoosegow for twelve years. I spent my early adult years getting to know him by letters. When I came out as a gay man, even though he was born in the Depression with an inveterate homophobe for his father, all he said was he was proud of me and that I had to make sure I wore a condom and didn't get gay bashed. I still get letters from guys who were in there with him telling me how much he helped them and what a good guy he was. He tutored one guy in Spanish grammar -- who was Guatemalan (my dad was just a non-Latin dude from the east coast). He helped another guy deal with the guilt of burning his own house down with his children in it while out of his gourd. Christ what an awful adventure life can lay in our laps. What the fuck is the answer to any psychotic let alone perennial? Especially when violence is a part of the pathology? He didn't know. I don't know. The dead don't know.
posted by CarsonDyle at 2:57 AM on April 30, 2010 [1 favorite]


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