Mental Illness in America
To the editor:
James Panero insufficiently emphasizes the awful treatment that many people with mental illness received in institutions and the fact that many people were committed simply because they didnt fit the normal view of behavior in society [A New Moral Treatment, Spring 2013]. He does not mention that many people with disabilities advocated for their own liberation from warehousing and torture in institutions. He neglects the influence of civil rights laws—such as Section 504 of the Rehabilitation Act of 1973—that prohibit discrimination on the basis of disability by recipients of federal financial assistance. And he doesnt sufficiently mention the lack of community mental health services available today.
To the editor:
This is a biased, antihuman rights hit piece on the rights of people labeled mentally ill, calling for us to be rounded up like dogs. We will continue to fight for our human rights in the face of demagogues. No other minority in society is subjected to calls for wide-scale internment just because some in the minority commit crimes. Shame on you: it is not moral to institute a system of pre-crime imprisonment.
To the editor:
I know firsthand how disconnected the system is when one has a family member in crisis. With the new HIPAA rules, unless you have a medical-care directive, you are not allowed even to know if your loved one is admitted to the facility, much less to be able to participate in his or her care. Patients are usually stabilized and discharged with no comprehensive look at their underlying problems and no attempt to ensure that the treatment will work in the long term. On the other hand, I did not see Paneros article as advocacy for indiscriminate warehousing of psychiatric patients.
James Panero responds:
I am encouraged by the range of responses that have greeted my article. The time has come for a new national conversation on mental illness. A century and a half ago, a similar conversation lifted the severely mentally ill from the margins of society and gave them refuge in state-of-the-art institutions. This moral treatment, through its innovative network of mental asylums, recognized the immorality of subjecting those with severe cognitive diseases to society, as well as subjecting society to them. While the conditions of these facilities had gravely deteriorated by the mid-twentieth century, the ideals behind them—and the concept of treating the chronically ill in separate, therapeutic communities—deserve to be revisited. Our current system of expecting a helpless population to get by with a bottle of pills and a welfare check is an abrogation of the social contract. The effects of this annulment will continue until we face it head-on.
Just how a new moral treatment would take shape is a question that I left open, but it must begin by removing the stigma of providing asylum for the mentally ill. The states must again get the financial resources to make their own care decisions by letting federal funds support state-run facilities. Private philanthropy and medical research should focus on diseases of the brain as much as on other severe illnesses. Finally, we must recognize that a system that allows defendants to be held not responsible for their actions by reasons of mental illness—but doesnt give the state powers to take responsibility for them—is flawed.