Ask The Audience: Mental Health, Ctd

by Patrick Appel

A reader writes:

The Soloist author Steve Lopez writes about trying to help a homeless musician with schizophrenia: “What’s more humane,…to respect someone’s civil liberties to the point of allowing them to wither away on the street, or to intercede in the interest of their own welfare?” My relatives and I constantly asks the same question about a family member with schizophrenia, who for an entire year chose to be homeless because he thought it would help focus his poor mind. He also tries to self-medicate his symptoms –delusions, hallucinations, voices in his head – with beer. Members of my family divide pretty evenly on both sides of the debate about public policy relating to mental illness.

Laws started being changed to say that people couldn’t be hospitalized against their will right around the time when Ronald Reagan started closing the nation’s largest state mental asylums. Politicians promised outpatient clinics in every community to replace the big mental hospitals, but few clinics got built. You can see the results on the streets of every major American city.

Many people want to return to the days when people with diagnosed mental illnesses were medicated by force and in locked wards if necessary. Others, arguing that this approach arouses resentment and resistance that make clients throw away their meds once they’ve been stabilized and released, advocate a “recovery” model based on trustful long-term relations with individuals in their community. According to this model, clients must each have individuals in their lives who personally support their own illness-management efforts, as well as housing with services including counseling and employment training.
Whichever side of the debate you’re on, it's clear that recent science on the physiological benefits of friendship shows there’s a chemical basis to health. People with mental illnesses need the companionship of others with more stable, friend-rich lives – people outside what my son calls “the medical-pharmacological-military-industrial complex” – and outside the family. Inherent in even the most loving family relationships are authority issues that people with mental illness shrink from even when they need those relationships the most.  

My relative still suffers from untreated schizophrenia in miserable social isolation, though fortunately now has a small apartment in a building with a landlord who's tolerant of his “weird” behavior and periodic beer binges.

There's more on The Soloist and the treatment debate at Crosscut.

Also see Frontline’s online documentaries: Prisons: The New Asylums, about the horrendous treatment of prisoners with mental illnesses, and The Released, about the revolving door that offenders with mental illnesses get stuck in between prisons and untreated life on the streets.