Tuesday, January 11, 2011


I am only one of thousands in the US who help to treat people with mental illness, but we could all probably say the same thing. There is a dearth of treatment options for the unfortunate among us who are tormented by a severe mental illness such as paranoid schizophrenia.

Historically, they seem to have always been a drain on society one way or another, but around two hundred years ago, individual states decided to do something positive for them. South Carolina began building state of the art facilities to treat “lunatics” who could stay and receive treatment for as long as they needed. Sometimes that would be for their entire lives. It worked pretty well for many generations.

Over twenty years ago, the states started shutting down these facilities for the mentally ill in a program euphemistically titled “Toward Local Care.” I suppose keeping the hospitals up and running was just too expensive. These patients, some of whom had been dependent on the safety of institutions for much of their lives, in truth had no good place to go. Outpatient treatment facilities expanded purportedly to tend to them, but many eventually ended up on the streets or in jail.

I have seen so many distressed psychotic people over the past twenty-five years, people who hear horrific and degrading voices and whose heads are filled with thoughts of violence. The day before the Tucson shootings, I talked with an incoming young adult patient who was besieged by voices commanding him to harm his parents. Weeping, he said he didn’t want to do what they say. When something like this happens locally to average people, it is not as appealing to the media.

The amazing thing is that these violent acts do not occur more frequently. We do what we can to prevent them. However, hospitals are businesses and must stay in business, and mental health centers must work within certain parameters. We can only treat those who somehow (often through aggressive acts) find their way to us. We cannot keep people who effectively lie. We do not track down every “nut job” out there.

Those among us who are free from a tormented mind cannot understand the tragedy and potential for further tragedy unless they have witnessed it firsthand. They try to make sense of a senseless situation, from whatever bias they have, still not getting it. People with mental illnesses can be scary, weird and annoying, and we had rather deny that they are out there. If we must assign blame, which I do not recommend, we must point the finger at all of us.

I am reminded of John Donne's words:

"No man is an island, entire of itself; every
man is a piece of the continent, a part of the
main. If a clod be washed away by the sea,
Europe is the less, as well as if a promontory
were, as well as if a manor of thy friend's or
of thine own were: any man's death diminishes
me, because I am involved in mankind, and
therefore never send to know for whom the bells
tolls; it tolls for thee."

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