Content note: mental illness, inpatient psychiatric treatment, gun violence
The worst experience of my life occurred during my fourth round of inpatient psychiatric treatment in 2016. Having used up all of my Medicare days at one of the country’s best psychiatric hospitals a month earlier, I was now in a Medicaid-funded public psych ward, hearing a voice that told me I had been condemned to Hell. My mind was filled with horrifying mental images of flames, worms, and vignettes of myself and my loved ones being tortured in eternal perdition. Bizarre cognitive changes had knocked out most of my ability to reason or speak, so I spent most of my time screaming uncontrollably and weeping instead. An older woman who had been in that place for months walked around wailing, “I’m dying and nobody cares! I’m dying and nobody cares!” over and over again. A third patient who had schizophrenia was convinced that she had AIDS and that the orderlies were poisoning her coffee. The unremitting, searing communal torment suggested to me that I was already in Hell. I prayed that I would die.
So, it angers me when instead of recognizing that tragedy is part of the human condition, politicians like President Trump and Governor Cuomo appropriate that kind of suffering whenever there’s a mass shooting. I have to believe that people who are calling for these misbegotten “mental health registries” don’t recognize the cold utilitarian logic of dealing with gun violence by going after people with mental illness. Instead of thinking of creative solutions, such people are framing mental illness as a substitute for the concept of evil.
Disabled people live in a society where the non-disabled majority feels entitled to rule the proverbial social roost. Institutionalizing disabled people is easy for those who wish to remove us from their midst, and gun violence is just a popular excuse. When viewed in a historical context, the desire to institutionalize people with mental illnesses isn’t really about violence; it’s a selfish human reaction to sharing one’s community with people who might have meltdowns or talk to themselves on the bus. That attitude is evil. It is the fruit of human avarice.
From my perspective, it seems as though people who are used to being able to go wherever and do whatever they want without encountering anything unseemly would like an excuse to warehouse mentally ill people. Apparently we should consent to live in dingy, whitewashed rooms and be told when we can eat, sleep, and go to the bathroom for the rest of our lives so that no one has to see us drooling, crying, or walking down the street next to their nice, manicured lawns. That is what is driving bipartisan scapegoating of mentally people whenever there’s a mass shooting.
Now that I’ve discussed the role that rapacity plays in public discussions about violence and mental illness, allow me to get to the point of this piece, which is to discuss positive mental health care reform. I suggest that rather than giving third parties more power to incarcerate psychiatric patients, psychiatric hospitalization could be significantly improved by giving mentally ill people more power to make that decision ourselves.
For instance, disabled people across America have shared reports of people being committed without any regard for their basic human rights, or of being denied admission to a hospital after they’ve asked for it. I personally was turned away at a hospital emergency room in 2015. I told the doctors that I felt as though there was another force in charge of my body that was going to force me to kill myself, that I couldn’t decide what was real and that I thought I might be a terrorist. “I can’t be walking around like this; you need to put me in the hospital right now,” I sobbed. Instead, the doctors sent me home alone on a bus without so much as a phone call to a relative. In contrast, other people have described being subject to wrist restraints and full body cavity searches because they walked into an emergency room crying and said, “I need counseling; I just feel like I wish I could get hit by a bus or something.” Rather than providing counseling, the doctors had them put them in straight-jackets.
This dichotomy is the result of making mental healthcare depend entirely on a physician’s subjective judgement rather than in tandem with our own instincts. The status quo is completely repressive, dehumanizing, and unnecessary. For instance, during one of my hospitalizations, I met a police officer who had given his service weapon to a friend weeks before admitting himself for treatment, because he knew that having a gun in the house was a suicide risk. Indeed, most of the people I met during my hospitalizations were there voluntarily because we wanted to get better. Because of those experiences, I believe that social policies about hospitalization should empower people with mental illnesses who want to seek comprehensive treatment, and that means giving third parties less power to veto our directives.
In the real world, people with mental illnesses generally know our own bodies. If a person with a mental illness asks for inpatient care, that should be arranged. If a person says that they need emergency counseling but not hospitalization, they should be able to make that decision too. That is the care and respect that innocent people living with mental illnesses deserve.
If there was evidence that one of the perpetrators of El Paso or Dayton pleaded for admission to a hospital prior to the shooting, was denied admission, and then grabbed a gun from a passerby and shot people because he thought he was stopping a martian invasion, then I might agree that mass shootings might be stopped by psychiatric hospitalization. However, that’s not what happened. Instead, the shooters obtained a gun, chose a public place, and mowed people down. Even if some of these individuals did experience symptoms of a mental health problem, it’s a fact that like cancer, mental illness strikes good and evil people equally.
Moreover, perhaps leaders who are currently jumping on the institutionalization bandwagon should consider the role that entropy plays in human affairs. Sometimes there is no logical explanation for why horrible things happen. Since the Enlightenment, people have believed that reason and science will solve all of our problems. Because our society puts so much emphasis on individual choice and control, people have swallowed the lie that we can create a perfect society by letting “benevolent” caretakers control people with mental illnesses. Some powerful people find it easier and more comforting to institutionalize people with mental illnesses than to accept that evil is real, that human intellect can’t save us or that human beings aren’t always in charge of our own destinies.
In short, politicians and talking heads need to stop using mentally ill people as pawns to obtain political power after a crisis and make themselves feel safer when they fail to solve the problem of unrepentant evil.
If Trump and Cuomo want to improve mental healthcare, they should support community-based, collaborative structures that allow us to choose hospitalization when we feel that it is necessary. We shouldn’t have to pay for the evil behavior of mass murderers, and our healthcare should lie more squarely in our own hands.