[HN Gopher] Is forced treatment for the mentally ill ever humane?
___________________________________________________________________
Is forced treatment for the mentally ill ever humane?
Author : MoSattler
Score : 61 points
Date : 2022-12-20 19:33 UTC (3 hours ago)
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(TXT) w3m dump (www.economist.com)
| mythrwy wrote:
| Looking around at insane and drugged up street people (for
| instance) intuitively I say "Yes definitely, and it should be
| more widely practiced!".
|
| Then I remember how the definition of mental illness has changed
| over the years and think how it might change in the future, and
| now I'm not so sure.
| Baeocystin wrote:
| I fully agree that this is a genuinely difficult, multi-factor
| problem with no easy answers.
|
| I also think that there are _a lot_ of 'low-hanging fruit'
| level of options available, that seem to be disregarded in
| today's all-or-nothing environment. Specific example: During my
| short, ~10-block drive to the 101, I pass a good half-dozen
| regulars who are either screaming at the aether, wandering
| erratically through traffic, flinging things at passing
| people/cars, or in one case literally rolling around on the
| onramp between cars. This is not an exaggeration, or hyperbole.
|
| These people need to be in an institution. Maybe with
| treatment, they can recover. Maybe they will be there for the
| rest of their lives. Maybe some form of halfway-house works
| best. But I can't think of any good-faith argument that leads
| to the status quo being the best choice for either them or
| society at large. Surely we can come to a societal agreement
| about what to do for this level of dysfunction?
| LexGray wrote:
| That question would be is forced denial of treatment for the
| mentally ill ever humane. I question how many mentally ill
| people on the street are there because they were given a choice
| to avoid treatment or if they were driven there by
| circumstances. The cognitive disruption of most mental health
| treatments would make most any sane person question their value
| versus quality of life.
|
| I do agree that mental illness definitions are a problem. Even
| forcing treatment on just those who are a danger to society
| makes me leery given that hostile social posts are now a social
| danger.
| TulliusCicero wrote:
| Seems like the threshold should probably be whether it's
| substantially interfering with their ability to interface with
| the rest of society, especially in terms of breaking laws. Many
| people in the situation you describe no longer seem capable of
| regulating their own behavior.
| gernb wrote:
| There's a mentally ill person who lives outside my apartment.
| Every day/night she screams at the top of her voice about
| random things. I feel very sorry for her but at some point she
| needs to be moved and taken somewhere. She has no right to
| subject the entire neighborhood to her rants. All of our
| collective santity outweights her issues. It's not that
| different than a repeat criminal. Reguardless of reasons, at
| some point they're too much of a net negative to society.
| Dealing with them in some humane way is ideal but those 2
| things are separate concerns IMO.
|
| Meaning there are 2 issues
|
| (1) Save everyone else from someone's distruptive behavior
|
| (2) Deal with the person in the best possible way
|
| You can solve (1) and not solve (2). Being not able to solve
| (2) perfectly does not invalidate the need to solve (1)
| horsawlarway wrote:
| Yup - I think it's very important to point out that there are
| two different problems to solve here.
|
| 1) What sort of behaviors is a community willing to tolerate
|
| 2) What does that community do with people who are unable to
| stay within the confines of tolerated behavior
|
| The problem is that asymmetrical answers to the two questions
| can create a strange grey-zone, where problems linger.
|
| For example - if you murder someone, I don't think many
| people are going to argue against you spending some time in
| prison. The response is in line with the severity of the
| action.
|
| But... if you say, consistently piss in the elevators of your
| local metro (even though public bathrooms are available),
| most folks aren't sure prison is the right answer. Ideally -
| we'd just keep you out of the metro entirely - but setting up
| that system is very expensive when we're dealing with a very
| small number of bad actors.
|
| On the flip side - that small number of bad actors is doing
| _considerable_ damage long term. They 're making metro usage
| far less pleasant, driving down ridership, increasing
| cleaning costs, reducing public health, and requiring
| additional staff in attempts at monitoring. Each other member
| of society is only inconvenienced a relatively minor amount,
| but they're impacting a very large number of them by
| degrading a public and shared service.
|
| The same is true of those who camp/sleep outside of
| businesses, or scream & rant in public spaces, or do drugs in
| public spaces. They are actively harming the space they are
| using at large, and are unwilling to stop or unable regulate
| themselves.
|
| So what do we do with those people? What is a proportional
| action that we can take that prevents the damage this person
| is causing at scale?
|
| Prison/Jail rarely work - because the damage of each
| individual occurrence is small, they are usually out very
| quickly.
|
| Providing housing can resolve problems in some cases, but
| there are people who are actively unwilling to stay in
| publicly provided housing (for a variety of reasons -
| although the most common I see is consistent drug use,
| closely followed by serious mental illness).
|
| Meds can definitely help - but the category of people
| creating these disturbances generally have trouble
| consistently taking meds (again - for a variety of reasons
| including access to services and payment, but not the least
| is active, personal resistance)
|
| So... if we've ruled out (as in - tried and failed) self
| medication + housing + prison... where do we go?
|
| Because at that point - I'm not really convinced that forced
| treatment and care are really unreasonable responses. It is
| far more cost effective to gather these folks in a single
| place and confine them there than it is to allow them to roam
| and attempt to stop their problem behavior at the place it
| occurs. It's the difference between 10 guards, a large
| facility home, and medical staff - versus thousands of
| required staff spread over a city.
| tracerbulletx wrote:
| We need to do the best we can with the information and morality
| we have, we've become paralyzed into inaction by fear of doing
| anything wrong and the ghosts of atrocities past.
| ThinkBeat wrote:
| We had asylums where we locked up mentally ill peopl. They were
| treated in a most horrible way in general. I have seen pictures
| and documentaries and a lot of them were nightmares.
|
| Then we tore down the asylums and set the inmates free. Good job.
|
| You are free. Live your lives in happiness. Nobody will force
| treatment up on you.
|
| In fact getting treatment is close to impossible in the US.
|
| Many people without treatment get progressively worse.
|
| A lot of start using alcohol or other drugs to try to manage
| their lives. For most people that does not turn out all that well
| over time. They had added a component that will give them even
| more problems.
|
| Now prison is full of people with mental illness who ought not to
| be there. They have become the new asylums.
|
| The prison cannot provide the care and treatment required.
|
| This is not progress.
|
| What was needed before, and is needed now is appropriate
| treatment for each person.
|
| Some can do well with speech therapy. Some need to be tied to a
| bed. A lot.
|
| Between those extremes there is a near infinite palette of mental
| problems. No two people are the same, even if they are given the
| same diagnosis.
|
| (Diagnosis in itself is a difficult thing to get right, and
| requires observation / follow up over a long period of time. Not
| just when they are having an episode. )
|
| Treatment of mental illness is almost universally a part of
| healthcare with low funding.
| outside1234 wrote:
| What about the rest of us that have to endure them shouting at us
| in the streets?
|
| Yes - it is humane for them AND for us.
| throwayyy479087 wrote:
| The general public isn't part of the Blessed Set of Protected
| Minorities so we don't count. What counts is the disadvantaged,
| and the more disadvantaged they are the more we're required to
| turn a blind eye to disruptive behavior. Homeless people, being
| at the bottom of the stack, are allowed to do basically
| anything and criticism of this fact will get you fired and
| cancelled.
|
| Ironically, this seems like true freedom to me - do whatever
| you want to whoever, with no fear of consequences. Just have to
| deal with the lack of dignity and resources.
| mullen wrote:
| This is why we can't have nice things in this country. It's
| always comes down to some rhetorical discussion about edge cases
| and possibilities of how a tiny fraction of people might be
| negatively impacted, so let's not do it.
|
| Let's frame it this way, "Is it humane to allow people be a slave
| to their mental illness and living on the streets?" The answer is
| clearly, "no". Allowing the mentally ill to live on the streets
| betters no ones life and causes many issues for everyone. If
| people with a mental health issue can not or will not take care
| of themselves, then someone else has to do it (IE: The
| Government).
|
| It is humane for everyone if the mentally ill are forced to get
| treatment or confined if they refuse it.
| guerrilla wrote:
| > It is humane for everyone if the mentally ill are forced to
| get treatment or confined if they refuse it.
|
| Definitely not, unless they're actively harming you because
| self-defense is always justified. Short of that it's none of
| your business.
| mixmastamyk wrote:
| You may have misunderstood what humane means in this context.
| It is definitely society's business that our fellows don't
| live eating out of garbage cans while swearing obscenities at
| no one in particular on the sidewalk. Encampments also breed
| rats, disease, drugs, and prostitution.
|
| It was never acceptable to allow this and we no longer have
| the excuses of the old days--that we don't have the resources
| to help them.
|
| https://www.theatlantic.com/health/archive/2019/03/typhus-
| tu...
| guerrilla wrote:
| > You may have misunderstood what humane means in this
| context. It is definitely society's business that our
| fellows don't live eating out of garbage cans while
| swearing obscenities at no one in particular on the
| sidewalk. Encampments also breed rats, disease, drugs, and
| prostitution.
|
| You can offer as much help as you want, but you can't force
| it on anyone. I think we should give them all free housing,
| food and whatever else they may need, but we can't use
| violence and imprisonment on them in any other case than
| self-defense. That would be a violation of bodily autonomy
| and extremely illiberal.
| mixmastamyk wrote:
| Oh definitely we can, and society often does and should
| limit the autonomy of individuals for the greater good,
| e.g.: Driving is a "privilege" not a right. You may be
| placed in a conservatorship or similar if not capable of
| taking care of yourself. Your right to throw punches ends
| at other people's noses. Folks with dementia often have
| mobility limits placed on them.
|
| Either these folks are deemed competent or they are not.
|
| Also, you've used the word violence here to give the
| appearance that this is the same as assault, but it not.
| It is humane care for those who need it.
| progman32 wrote:
| Your example of driving privilege is inapt. My
| hypothetical privilege to drive is not rejected based on
| my ability to take care of myself. It is rejected on my
| ability to take care of others around me.
| WarOnPrivacy wrote:
| I was my ex's caregiver for decades. Today she lives in a local
| homeless community and her wellbeing is often at risk.
|
| Could she have had a different outcome through forced treatment?
| Yes and no.
|
| The technical answer is No because the treatment she needs
| doesn't exist here (extended-term, inpatient, safe). There's
| nothing to commit her to.
|
| If the treatment she needs existed, could I have committed her
| against her will? Probably not. It would require LEO assistance
| and (due to reality) husbands are generally considered to pose a
| heightened risk of gaslighting.
| kneebonian wrote:
| Interesting prespective on forced treatment for the mentally ill
| here:
|
| https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p...
| DaniloDias wrote:
| nimbius wrote:
| > Many liberals blame Ronald Reagan for the government's
| abandonment of mentally ill Americans.
|
| Thats a fascinating stretch of the truth. Most sociologists,
| public health professionals, and public policy researchers can
| directly link "Reagans army" to the mans policies quantitatively.
| its less of a blame game and more of a fact of life the
| thatcher/reagan neoliberalist push essentially relegated the
| mentally ill to freeway underpasses and drug store parking lots.
| Those that didnt wind up screaming at stop signs or dancing nude
| through the streets instead have gone on to commit some of
| American societies most horrific mass shootings.
|
| > Many administrations in California have had opportunities to
| reverse Reagan
|
| in '67 sure, but by 1981 his federal cessation of funding for ANY
| state mental health services would have made the effort near
| Sisyphean. Alex Barnard doesnt do much to shore up the Gippers
| legacy outside of the prescriptive myopia that we should ignore
| the past and just look to the future now because
| $add_reason_later.
|
| Treat mental illness just like real illness and stop pretending
| its some special category of sorta-problem we cant do anything
| about because, surprise, we havent invested any money into its
| research, treatment, or cure since Dutch decided to gut funding
| 41 years ago before slipping into Dementia himself.
| patientplatypus wrote:
| kelseyfrog wrote:
| https://archive.vn/Togvj
| ravenstine wrote:
| No, but neither is allowing the mentally ill to remain ill.
| There's no win to pontificating over this issue. The only way to
| win is to get lucky when treating someone's mental illness and
| they happen to respond to it.
| blurri wrote:
| To get lucky treating someone's mental illness if they allow
| you to treat them you mean?
| zozbot234 wrote:
| Tangentially related: ACX "in partial, grudging defense of the
| Hearing Voices movement":
| https://astralcodexten.substack.com/p/in-partial-grudging-de...
|
| AIUI, the blog author points out that if you really want to
| comprehensively replace institutionalized, forced treatment, some
| sort of self-organized peer support is the best reasonable
| alternative - one that, arguably, has barely been tried. Related:
| Prison and mental illness
| https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p... -
| _My Brother Ron_ https://slatestarcodex.com/2016/03/31/book-
| review-my-brother...
| rr808 wrote:
| Does anyone know of numbers of who used to be locked up in
| asylums etc? It seems to have been more common and I have no clue
| about how often it happens now. Reagan closed the mental
| hospitals?
| malcolmgreaves wrote:
| San Francisco is what happens if you answer "no" to this
| question.
| jl6 wrote:
| Implicit in the question is that we even understand what the
| right treatment should be. Once upon a time, doctors would have
| enthusiastically recommended lobotomies. Would we have nodded
| along?
|
| I think the ethical conundrum lessens if there actually is a
| clear, proven, effective treatment. We often make decisions on
| behalf of people who aren't able to make the right choice for
| themselves, and I don't think a pathological commitment to
| individual liberty should constrain us in cases where there is
| the possibility of dramatically improving someone's wellbeing.
| mixmastamyk wrote:
| It's 2022 not 1922 or earlier; no one is advocating medieval
| treatments.
| bell-cot wrote:
| An old friend has a niece with a life-long, major mental illness.
| When off her medications (I've lost count of how many times, over
| the years), she goes "on the run", and phones home to various
| family members (often many times per day) with angry rants -
| which very often include threats of great bodily harm and/or
| death. Her grip on reality in that state is rather poor -
| asserting that Bugs Bunny and the CIA are conspiring to create a
| brain controlled army of polar bears with space lasers would not
| be unusual.
|
| When on her medications, she is a relatively pleasant & rational
| person, usually able to hold an entry-level job.
|
| Her family do not want to throw her in jail for all the threats
| (I'm not asserting that they could, if they wanted to), she
| _really_ does not like the side effects of her medications, and
| (under the current system) neither confining her to a long-term
| mental health facility, nor reliably forcing her to take her
| medications seem to be available options. (Her family has talked
| to lawyers about their options more than once.)
|
| What would be the "humane" thing to do? In composing your answer,
| please recall that her family are also humans, and - barring a
| premature death - she is likely to outlive most of them.
|
| Edit: Thank you for all the replies, but my 4th-paragraph
| question was intended to be rhetorical. My point is that the
| case-by-case reality, even from the PoV of a well-to-do family
| that really seems to care about the mentally ill person, is often
| agonizingly difficult.
| tensor wrote:
| I have a high school friend who is the same way. It's beyond
| traumatizing for his friends and family. Many of them live in
| fear. Same story, neither confining him nor forcibly medicating
| him are options, so he roams around, unable to hold jobs,
| randomly threatening various people.
|
| I worry that one day he'll end up being shot by police or
| something. It's awful.
| kayodelycaon wrote:
| I don't have any answers here, but I want to provide some
| context for the drugs in question.
|
| I'm on antipsychotics. They are nasty drugs. Absolutely brutal.
| The worst of the side-effects for me are the sexual side-
| effects and motor-control issues. If I get dehydrated or my
| blood sugar gets low, I can lose the ability to walk.
|
| Within the first hour of taking my meds, I can't stand without
| losing my balance. I lose both my inner ear and kinesthetic
| senses. I don't know where my feet or hands are. I can only
| walk by having my eyes open to see if I'm level and feeling
| where the pressure is on my feet.
|
| During the day, I have medication that helps this but I still
| trip on uneven surfaces or drop things.
|
| The sexual side effects, I can't orgasm. Combined with the
| hypersexuality a manic episode creates, it is unbearable.
| Fortunately, I'm on yet another drug that makes this less of an
| issue.
|
| The only reason I can tolerate this is the alternative of going
| crazy is so terrifying, I'll do anything to prevent that from
| happening. If anyone wonders why people don't stay on their
| meds... this is a big reason.
| citizenpaul wrote:
| I've often been confused by reports like the OP that the
| person refuses meds then proceeds to descend into some sort
| of pure madness. How can that madness be better than the
| meds? Why do you think they prefer the madness? You seem to
| resist it do you know any reason why?
|
| I've known three people one directly and two indirectly that
| were lunatic level if they were off meds and all refused meds
| consistantly.
|
| 1. Was a guy I worked in the same dept during an early job.
| His thing was to start telling people that government agents
| were in the elevator to control your mind or something and
| ending out emails about it and corning people to warn them.
| Funny thing was it was a government job so there were
| government agents in the elevator pretty much anytime someone
| was in the elevator. He resisted because he didn't like the
| meds.
|
| 2. My friends brother in his 30's would not take his meds and
| his parents had to sneak them in his food. If he missed
| enough doses he would eventually go raving mad into the woods
| and eventually be found passed out somewhere by emergency
| responders usually naked and injured. He resisted because he
| didn't like the meds.
|
| 3. My brother in laws brother was paralyzed and brain damaged
| from a car wreck. Yet when off meds he would run off in his
| wheelchair into dangerous traffic or be found passed out(and
| injured) from exhaustion of crawling because he went
| somewhere a wheelchair couldn't go and just crawled for
| miles. Again he didn't like the drugs.
| themanmaran wrote:
| For all of these, I assume it's a lack of awareness of the
| manic state. By it's definition, the individual is going to
| be less cognizant/aware of their surroundings. Likely they
| don't have the best memory of these lapses either.
|
| I doubt in each of these cases people are making the
| rational choice to ditch the meds in favor of a state of
| "pure madness". Instead they probably get fed up with side
| effects, and decide that "this time won't be as bad", or
| "I'll just stop taking them for a day".
| dsego wrote:
| You can get intramuscular depot injections monthly
| nowadays.
| bell-cot wrote:
| +100 (if I could).
|
| And similar for being sane enough to be so intent upon
| staying that way.
| sieabahlpark wrote:
| asveikau wrote:
| My brother was on antipsychotics for about 20 years. His
| compliance was poor. He is homeless now and without
| treatment.
|
| Growing up he would tell me how terrible the medications
| were. I believed him, and still do to an extent. However he
| also identified with his illness and thought the drugs were
| taking away his special powers. That was a symptom. For those
| reading who have less experience, they sometimes call that
| anosognosia or lack of awareness.
|
| In the end it's a very existential thing. It's easy to wonder
| about identity. I had a few people in my life with this sort
| of illness. I developed a model where medicated, treated, and
| stable, _that is the "normal" them, their identity._ However,
| these people got offended by this, and engaged in behavior I
| would describe as identifying with symptoms. Acknowledging
| symptoms, no matter how evident, was tantamount to personal
| attacks.
|
| I think we all have issues with this in our lives. Self
| awareness and identity is a difficult problem. It's only when
| it falls far outside of norms, into extremes, that we call it
| a disorder. It can be very tricky to draw those lines.
| bell-cot wrote:
| From years of second-hand accounts, my impression is that
| my friend's niece finds the in-the-moment experience of
| life _off_ her meds to be somewhat more emotionally
| rewarding / rich / "genuine" than life _on_ her meds. (On
| top of the nasty side-effects of the latter.)
| selectodude wrote:
| I can empathize to a lesser extent. I'm on pretty high
| doses of antidepressants to keep myself alive. The world
| feels dead. I'm not sure that I prefer that to me being
| dead. But I do it for the people who give a shit about
| me. Am I going to live past 65? Probably not. But for
| now, it just the way things are.
|
| I'm not psychotic so it's of course easier to be
| reasonable about the situation, but it's never fun to be
| on drugs like these.
| kayodelycaon wrote:
| Mania is a hell of a drug. I've done so many amazing
| things because of it. Life feels dull and slow without
| it. At the same time, the cost was high.
|
| I chose to live without mania. I want to slow down and
| work on things I want to do, not be driven to do things,
| no matter how amazing they turned out.
| jimkleiber wrote:
| I read this and I start to think about how our identities
| may just be stories to which we've attached, often
| shortcuts to summarize characteristics of behaviors. I'm
| thinking of it more in the romantic "friend" vs "lover"
| buckets, but I think it plays out a lot in the health space
| as well.
|
| > For those reading who have less experience, they
| sometimes call that anosognosia or lack of awareness.
|
| I'm fascinated to learn of this and to read more, thank
| you.
| kdmccormick wrote:
| Yes, this is a big thing I struggled with when I was off
| meds. Me without meds felt so much more... "me-like" than
| me on meds. So when someone referred to medicated me as
| "normal me", it was extremely hurtful.
|
| What I had to realize is that even if "me without meds" was
| an existentially truer version of myself, people did not
| _like_ me without meds, they did not want to be my friend,
| nor did they want to give me a job. That 's what got me on
| meds, and yes, it felt really shitty at the time.
|
| Years later, I don't feel that way any more. "Me with meds"
| feels like me, more than ever actually. And, lots of those
| things I valued about "me without meds" (wit, spontaneity,
| high energy, creativity) came back over time as I adjusted
| to being medicated.
|
| Unfortunately, not everyone is able to find a med that
| allows them to get to that happy point. It took good
| healthcare, several tries, a support network, and (I
| assume) luck.
| kayodelycaon wrote:
| My treatment caused a complete loss of self-identity.
|
| In another time, I would have been a shaman. My entire
| life, I had a deep spiritual connection with wolves. That's
| gone. All that's left of it is blank wall and confusion.
|
| This hurt deeply. I can't even begin to describe how it
| felt to have everything I knew about myself destroyed.
|
| I'm fortunate to have been raised Christian. That hasn't
| changed and it's been a welcome grounding while I work
| things out.
| Biganon wrote:
| You sound extremely brave. Thank you for sharing your
| story, and merry Christmas in advance
| asveikau wrote:
| I know a lot of spiritual traditions, especially in the
| east, talk about loss of self identity as progress. So
| hard as it was (and it sounds hard!), I hope you are able
| to have deeper understanding that you might not have had
| exposure to otherwise.
| kayodelycaon wrote:
| Not sure.
|
| I feel like I'm fundamentally a different person. Like I
| was dropped into someone else's body. Someone else was
| here before me and left a bunch of furniture I keep
| bumping into. :)
|
| But, I know I'm a kinder person than the person before
| me. Is this spiritual enlightenment? If it is, I might
| want a refund. :D
| PicassoCTs wrote:
| One of the symptoms can be tremendous creativity. Would you
| recommend to force treatment upon an artist, because she/he
| suffers from other side effects?
|
| These mental illnesses are adaptions/optimizations to the
| rise and fall of violence that was normal human history for
| the longest time.
|
| A armed paranoid hobo maybe looking like a maladjusted
| human being to you now, but in stalingrad, sebreniza or
| bhakmut, he would be very adapted to his surroundings. All
| those stress triggered changes had their spoke on the wheel
| of time.
|
| My opinion is that people should be force treated, but only
| until they reach "sentience" and can decide for themselves,
| not under any influence.
|
| They also should be able to make sentient "wills",
| specifying condition under which the state is allowed to
| step in and help them.
|
| If somebody wants to return to his mental state, nobody
| should be allowed to stop them. Human lifes value is not
| there to be useful, aesthetic pleasing or comfortable for
| society. Its value is only defined by the person living
| it..
|
| But then again, i view optimists as mentally sick..
| asveikau wrote:
| > If somebody wants to return to his mental state, nobody
| should be allowed to stop them
|
| I don't think this works well when clear-cut, unambiguous
| delusions cause somebody to act on them and harm
| themselves and others.
|
| I do acknowledge it's very hard to know when that is, and
| people can disagree.
| [deleted]
| 23B1 wrote:
| I think what's really important about your comment is that
| there might not be an answer to some problems. This is
| something that most people struggle with - and certainly
| publications (even the respectable Economist) love these sorts
| of conundrums because they pluck at the tragedy-strings of most
| humans.
|
| Sometimes there simply is no solution to a problem, a very hard
| concept to grapple with as participants in a community,
| society, or civilization.
| squirrel wrote:
| Read books on schizophrenia by Dr Xavier Amador for an
| interesting perspective on gaining compliance without
| necessarily agreeing on what the problem is. Excellent videos
| on YouTube also.
| [deleted]
| brodouevencode wrote:
| It's certainly tough for sure. I think the ultimate question is
| what is considered "humane". Locked up in a straight jacket in
| a padded room for having slightly depressive thoughts is
| certainly not, but also allowing someone like in your story to
| spiral out of control and act out their trauma is arguably
| equally as inhumane. I wish I had a good answer for you.
| pyuser583 wrote:
| The side effects of medications can be horrific. I'd rather be
| dead than deal with extreme nausea.
|
| However ... eventually she's going to make contact with the
| criminal justice system. This can very productive. Authorities
| can make plea deals/pre-prosecution agreements that require
| medical compliance.
|
| I'd advise the family to move to a jurisdiction with lots of
| resources. A wealthy suburb should work.
|
| Then wait for her to commit a crime and make report it.
|
| I too have a relative who has psychotic episodes. I've had
| wonderful experiences with the criminal justice system (in rich
| suburbs).
| sheusndudn wrote:
| Dma54rhs wrote:
| I've been forced to be on antipsychotics. They are nasty and I
| compare it to sexual conversion therapy. I totally understand
| the society is not ready for that discussion but it does irk me
| the supposedly compassionate people are quick to mentally
| sterilize you.
| sshine wrote:
| It's a controversial topic that the side effects are so bad
| that some choose to go psychotic instead. But it doesn't
| change the picture that all the stories on this page tells
| you how much each side sucks and how much the other side
| sucks more.
| Melatonic wrote:
| I am hoping these kinds of things are the perfect candidate for
| future biotech implants. Having to take ap ill everyday can be
| difficult to regularly remember even for the totally sane. What
| if we had some type of implant that could somehow recognize
| when someone was going through a major mental episode and then
| dispense some medication to help them? Or even one that simply
| regularly released the medication throughout the day and then
| periodically had to be refilled?
|
| Seems like the side effects of a lot of these harsh meds might
| be tempered by a slow release vs all at once with a pill. I am
| not a medical professional though so I could be completely
| wrong here.
| jimbob45 wrote:
| Assuming her threats and behavior would eventually result in
| her being tossed in jail, the choice seems to be between her
| imprisonment and her being forcibly medicated.
|
| I don't have an answer for you. I think you've come up with a
| potential plot for a very interesting Star Trek episode though.
| bell-cot wrote:
| Her family's guess is that she'll be killed in some violent
| altercation while "on the run". Probably one for which she
| bears most of the "responsibility". And they pray that she
| won't get any innocents maimed or killed before that happens.
|
| (Star Trek: My guess is that such an episode, if it had any
| serious depth, would be vetoed in the script stage - due to
| being an extremely painful subject for too many viewers.)
| mjevans wrote:
| Star Trek and the like also have utopia levels of medical
| tech. Physical level problems are all solvable with their
| level of technology.
|
| In Scifi: Real bad people exist. Real people who need help
| exist. Real people who just need some time to talk out
| their problems with the ship's / a local counselor exist.
|
| Real people who can't be helped don't exist, they
| reductively condense into one of the three classes above
| because society and tech are advanced enough. (Except in
| cases of extreme breakdowns; E.G. Voyager wasn't the only
| ship mostly sucked to the delta quadrant.)
| stonogo wrote:
| Ethical dilemmas persist: Voyager's "Lon Suder" character
| had violent tendencies which he struggled to control. The
| Next Generation episode "The Outcast" replaced dangerous,
| violent tendencies with romantic love; the character in
| question was forced to undergo treatment _and then
| afterward was grateful_ for them, which raises questions
| whether informed consent is even possible under those
| circumstances.
|
| Star Trek alone had countless plot lines surrounding
| incurable medical conditions. Worf broke his spine,
| Picard has some kind of syndrome which will cause
| cognitive decline, La Forge had to settle for a visor for
| most of the franchise, and so forth.
|
| Even under utopean circumstances, ethical considerations
| abound, as in "The Schizoid Man," an exploration of both
| rights for artificial life and transhumanism. Sisko's
| father ignored medical advice because he chose to, and in
| VOY's "Scientific Method" we find aliens desperate to
| develop lifesaving technology, even at the cost of agency
| for Federation staff.
| anotherman554 wrote:
| "Star Trek and the like also have utopia levels of
| medical tech. Physical level problems are all solvable
| with their level of technology."
|
| The poorly written second season of Star Trek Picard had
| a character who was suicidal and refused treatment, then
| killed herself.
|
| I think people refuse treatment in real life because the
| drugs don't work too well, not because they don't want to
| feel better, and at any rate you can't have a utopias if
| people choose to due horrible things to themselves or
| each other, you just have real life, so I think it went
| against the tradition of Star Trek being utopian fiction.
| Pxtl wrote:
| I've already read a science fiction story or two about this
| scenario - a dangerously schizophrenic guy goes off his meds
| and then murders someone during mania. He gets charged with
| criminal negligence because he knew how dangerous he would be
| without his meds. One of Niven's short stories, he loved to
| write about the ethics of schizophrenia.
| bell-cot wrote:
| FWIW: Larry Niven, "The Ethics of Madness", first published
| in _Worlds of IF_ 's April'67 issue. (And available on
| archive.org, if you can't yet rationalize buying dead-tree
| copies of all of Niven's _Known Space_ stories.)
| pcurve wrote:
| What a dilemma. Is she aware of how she acts when she's off
| medication? Has she seen herself act this way on video?
| runnerup wrote:
| That won't help. There's hundreds of thousands (nearing or
| exceeding a million) people like this in the USA alone. If
| that worked, it would be widely practiced.
|
| These mental illnesses break the ability of an individual to
| choose to do what's best in terms of medication, treatment,
| and lifestyle. The illness makes one not want to be properly
| medicated.
|
| Someone can be consistent with their treatment and lifestyle
| for many months, but it just takes one trigger and a couple
| days off medications to lose all progress.
| kdmccormick wrote:
| > That won't help.
|
| While I agree with the rest of your comment, I want to
| gently challenge this specific statement, as someone who
| has to take a powerful med (lithium) to avoid relapsing
| into mania with psychosis.
|
| I was so extremely reluctant to regularly take meds, and
| lapsed in and out of mania for a few years. The main thing
| that got me to stick with lithium, and a major driver in me
| staying on them today, is grokking how deeply destructive
| mania is to all the relationships and other good things in
| my life.
|
| I'm not saying we should shame mentally ill people, but
| part of treatment should be helping them understand & agree
| that permanent treatment is in their own best interest.
| Easier said than done, of course... it took years for me.
| guerrilla wrote:
| > The illness makes one not want to be properly medicated.
|
| The medications do that too. The side-effects are horrific.
| bell-cot wrote:
| My understanding is that she is relatively aware. I don't
| know about the video part.
| kayodelycaon wrote:
| I doubt this would work. When a neurotypical person is
| confronted with their actions, you usually get one of four
| results:
|
| 1. Justify what they did.
|
| 2. Dismiss it.
|
| 3. Ignore it.
|
| 4. Deny it happened.
|
| Note that change their behavior isn't on that list. :(
| kbelder wrote:
| >neurotypical
|
| You mean the opposite of that?
| kayodelycaon wrote:
| No, I meant neurotypical. I guess I could have said
| "normal" or "average". It's also culturally dependent, so
| maybe I should have just said Americans.
| kdmccormick wrote:
| This is such a defeatist attitude.
|
| I'm bipolar I, and I take lithium for it. Being confronted
| with my actions over and over and over and over again was a
| big part of what got me to start taking meds.
| kayodelycaon wrote:
| The over and over is important. A lot of people do get
| the hint eventually. It's hardly as simple as showing a
| video.
| kdmccormick wrote:
| True. Fair enough.
| Melatonic wrote:
| What kind of lithium do you take? I have heard that the
| prescribed doses can be pretty sedating or brutal but
| there are also people advocating for very tiny doses of
| lithium in a different form that is similar to what is
| found in some natural wells. Could be completely
| pseudoscience but it seemed interesting
| MopMop wrote:
| "Her grip on reality in that state is rather poor - asserting
| that Bugs Bunny and the CIA are conspiring to create a brain
| controlled army of polar bears with space lasers would not be
| unusual."
|
| The angry rants are a reaction to loss of bodily autonomy,
| spiritual wellbeing and mental liberation. If you are on these
| kind of antipsychotics for the most part of your adult life it's
| ordinary to not be in touch with your feelings or anyone elses
| and it's ok to be delusional cos if you don't ever know what it
| feels like to be mentally liberated then how else could you know
| how it feels to be free.
| trynewideas wrote:
| This is an imminent question in Portland, Oregon: the mayor wants
| to relax the requirements to civilly commit a person against
| their will despite a lack of hospitals that can receive or treat
| them,[1][2] another of his suite of tactics to address
| homelessness that's included perpetual weekly sweeps of dozens of
| homeless encampments,[3] asking for $27 million to build city-run
| open-air camps,[4][5] and trying but failing through those
| policies to secure additional state funding for city-run
| shelters.[6]
|
| None of these tactics have been strategic - housed and homeless
| people alike in Portland who want mental health resources can't
| access the limited inventory of them, so expanding involuntary
| commitment without funded services will only add to that resource
| stress. Sweeps without a variety of funded shelter options just
| move the problem of camps from one part of the city to another
| while destroying what little the campers own, at a contractor
| cost of $4.5 million per year. The city-run camp proposal has
| been derided as "concentration camps", and the $27 million price
| tag would pay for a year of stable housing for nearly 2,500.
| State legislators cited the sweeps and camp proposal as reasons
| why they were giving $25 million in funding to the separate
| county leadership instead of the city, and put conditions on the
| funding that explicitly prevented its use for sweeps or
| involuntary camps.
|
| All of this happened _before_ the proposal to expand involuntary
| commitment criteria, which would at worst facilitate abuse or
| harassment of people with mental illnesses - housed or not - and
| at best fail to solve the underlying lack of treatment resources
| available to anyone, much less the involuntarily committed.[7]
|
| 1: https://www.opb.org/article/2022/12/12/portland-mayor-ted-
| wh...
|
| 2: https://www.wweek.com/news/2022/12/07/mayor-ted-wheeler-
| want...
|
| 3: https://www.oregonlive.com/politics/2022/12/portland-has-
| dra...
|
| 4: https://www.columbian.com/news/2022/nov/18/homeless-vote-
| in-...
|
| 5: https://www.kgw.com/article/news/local/homeless/multnomah-
| co...
|
| 6: https://www.oregonlive.com/politics/2022/02/no-direct-
| fundin...
|
| 7: https://www.themarshallproject.org/2020/11/08/when-going-
| to-...
| yupis wrote:
| Thanks
| djaouen wrote:
| As a mentally ill person myself, I don't want to have to deal
| with being accosted when I go out just to buy food. If these
| policies get people off the streets, I think that is a good
| thing!
| someonewhocar3s wrote:
| Tiktaalik wrote:
| Doctors don't support involuntary treatment because it's not
| effective.
|
| Effectively it trains people to distrust the health system, and
| to not seek medical care because they'll be locked up and bad
| things will happen to them. This leads to worsening health
| outcomes.
|
| We just passed through years of pandemic where everyone was eager
| to listen to the experts in the medical profession and that saved
| countless lives. It's sad and disturbing that when it comes to
| other health care issues, the politicians are now tuning out the
| same experts because they don't like what they're hearing.
| at_a_remove wrote:
| Reframe the question in terms of what it really is: Is forced
| treatment for the mentally ill more humane or less humane than
| letting them "do their thing?" Is it more humane for the people
| who are forced to interact with them?
|
| A lot of ethical questions could use a "trolley-fy" process in
| which the status quo is simply presented as another track, and
| then another process by which that question is re-embedded within
| its actual context -- the mentally ill are not off wandering some
| other plane of existence, they may be screaming in _your_ alley,
| tonight, around three a.m.
| hprotagonist wrote:
| Well, should you be allowed to stop a suicide?
| guerrilla wrote:
| Absolutely not. The only possible justification for any of
| these authoritarian interventions is self-defense. Anything
| short of that is infringing on their autonomy over their body
| and not something you should be advocating for especially
| considering you could be in that exact situation. In addition,
| suicide is not necessarily irrational, so definitely not.
| readthenotes1 wrote:
| I have a relative who had to be taken to the hospital after
| scraping invisible mites out of their eyes with a razor blade.
| They asked them if she would like some antipsychotic medication
| and of course they said no.
|
| As a result, my question is, is it ever humane to not force
| treatment on the mentally ill
| ajb wrote:
| Obviously it can be. See lobotomization and ECT just for
| starters (yes, I know ECT is supposed to be better now, don't
| really buy it)
| gman2093 wrote:
| With respect, your statement about ECT is not aligned with
| reality. ECT is evidence-based and effective, with side
| effects that are less pronounced in many cases than drug-
| based therapies. It is approved for use in pregnant
| patients in the USA. One Flew over the Cuckoos Nest is not
| peer-reviewed.
| [deleted]
| generalizations wrote:
| > There's a risk of memory loss. Most people who undergo
| ECT have temporary memory loss and confusion. Most
| people's confusion clears up quickly, and memory loss
| usually goes away entirely within a few months. However,
| some people do have permanent memory problems. Using the
| right-unilateral electrode placement and shortening the
| electrical current duration can reduce the risk of this
| happening.
|
| https://my.clevelandclinic.org/health/treatments/9302-ect
| -el...
| raverbashing wrote:
| You are asking the right questions
|
| A lot of homelessness is due to different mental illnesses
| (not discounting the societal issues, and of course the drugs
| then make it worse)
|
| I really feel society sucks at dealing with the
| action/inaction assymetries
| brodouevencode wrote:
| Most homeless is due to mental illness. Almost always men
| with addiction issues. Many veterans suffering from PTSD.
| It's rarely the "single mother of two that lost her job at
| the plant" trope.
| mattzito wrote:
| I think a better way to frame it is "most _chronically_
| homeless is due to mental illness". However, most
| homeless people are not chronically homeless, and are
| homeless for <6 months. Those are the single mother of
| two who lost their job at the plant examples - or left an
| abusive relationship and is living in their car, or
| underemployed as a security guard and sleeping in a
| sheleter, etc.
|
| Unfortunately, and equally sad, many of these folks work,
| send their kids to school, and struggle to get themselves
| into a stable long-term situation.
| trynewideas wrote:
| HUD data, for the US at least:[1]
|
| - 582,484 total homeless
|
| - 138,361 chronically homeless
|
| - 122,888 total homeless reporting severe mental illness
|
| - 48,373 total homeless victims of domestic violence
|
| - 33,129 total homeless veterans
|
| VA count of veteran homelessness was down 10% or more YoY
| in 2021 and 2022, and down 55% since 2010.[2] Veterans
| comprise about 10% of the total US population and 5.6% of
| the homeless population. Among veterans, PTSD was less of
| a risk factor than psychotic disorders, an equal factor
| to other mental health disorders, and mental illness in
| general was less of a risk factor than money
| mismanagement and could be mitigated by VA services,
| especially disability compensation.[3]
|
| 1: https://files.hudexchange.info/reports/published/CoC_P
| opSub_...
|
| 2: https://www.va.gov/homeless/pit_count.asp
|
| 3: https://doi.org/10.1093/epirev/mxu004
| [deleted]
| shanebellone wrote:
| Absolutely not. I believe there is a legal argument in favor of
| bodily autonomy which includes the right to death.
|
| "Life, Liberty and the pursuit of Happiness."
|
| Life is inextricably linked with death. If you have the right
| to live, you must also have the right to die. That belief is
| largely entrenched in our medical system too but stops short of
| doctor assisted suicide.
| anon291 wrote:
| > Life is inextricably linked with death.
|
| Sure
|
| > If you have the right to live, you must also have the right
| to die.
|
| This is a non-sequitur. In fact, in so far as all human
| rights descend from the one in question being alive in the
| first place (since the dead have no rights), it makes no
| sense of a right to die. In the same way a right to liberty
| involves no right to sell one's liberty. Just like your
| freedom, you do not own your life. We know this because you
| cannot sell either your life or your freedom, thus you don't
| own it. Thus, despite having a right to it, you don't have
| the right to rid yourself of it.
|
| Here's another example. My children have a right to live in
| my house and receive support from me. They have no right to
| either sell my house or not receive support from me. Although
| they have a legal right to my money and protection, they
| cannot dispose themselves of it.
|
| Life and freedom are similar. They are something we enjoy and
| have a right to, but not something we own.
|
| > That belief is largely entrenched in our medical system too
| but stops short of doctor assisted suicide.
|
| Choosing to not undergo therapies that may or may not
| lengthen your life is not morally equivalent to actively
| choosing death.
| shanebellone wrote:
| Straw man.
| anon291 wrote:
| You claim a right to life implies a right to death,
| without any reasoning. I've pointed out why that doesn't
| follow (namely, the notion that one has a right to live
| is predicated on one being alive. You don't have rights
| after death). I've also pointed out that we have other
| rights that you cannot dispose yourself of to show that
| the right to life is of the same nature. What is your
| rebuttal?
| shanebellone wrote:
| You're comparing property law to bodily autonomy. How can
| I take you seriously?
| hprotagonist wrote:
| Does your right to die permit you to inflict trauma on others
| by, say, stepping in front of a train in a moment of crisis?
| Eating a 12 gauge and leaving your family to discover your
| meat splattered on the floor? etc.
|
| Am I allowed to stop that suicide? "Whatever affects one
| directly, affects all indirectly."
| runnerup wrote:
| Language for these discussions is important. We should
| always put "should I be allowed" rather than "am I
| allowed".
|
| I generally feel there is an inalienable right to suicide.
| Similar to other rights in the Declaration of Independence,
| this is a right that people will exercise regardless of
| whether it is outlawed or not and no one _can_ stop those
| who wish to exercise it. It's functionally impossible to
| prevent someone from committing suicide -- there are
| countless cases where people in mental wards have a
| watcher-person with them 24 hours a day, less than 3 feet
| away at all times. And the patient will do something like
| suddenly sprint full speed into a wall headfirst and kill
| themselves.
|
| But I also believe that the person committing suicide has
| the duty to cause the least amount of property damage and
| additional overhead for others in the wake of their death.
| Similarly, those who survive them have the duty to process
| the persons death to the best of their ability.
|
| I would say that the gruesome suicides you asked about
| should be legal to stop, given a situation where the
| interruptor has a reasonable belief that:
|
| 1) there are more humane ways to commit the suicide which
| do less collateral damage, and 2) that the person
| committing suicide is not in such extreme pain that these
| options will take too long and cause the intervention to be
| a particularly cruel intermission.
|
| For example, if someone has been suffering greatly from a
| very bad exposure to the gympie-gympie tree and they truly
| need the most expedient death to relieve the pain...perhaps
| the train really is their best option. And it's up to the
| rest of society to understand and be thankful that this
| person found relief from their unimaginable pain and that
| it is now our duty to clean up and process the aftermath.
| itishappy wrote:
| > Similar to other rights in the Declaration of
| Independence, this is a right that people will exercise
| regardless of whether it is outlawed or not and no one
| can stop those who wish to exercise it.
|
| I don't understand this argument. Should we also have an
| inalienable right to recreational opiates?
|
| > If someone has been suffering greatly from a very bad
| exposure to the gympie-gympie tree and they truly need
| the most expedient death to relieve the pain...
|
| This example is also confusing to me. It sounds horrific,
| but it's temporary and non-terminal. Not what I'd
| classify as a "true need for the most expedient death." I
| can be understanding of the desire to die in this
| situation, but I cannot see how this should grant
| everyone the right to die in the manner of their
| choosing. If you truly need an expedient death, as you
| say, the law won't stop you.
|
| Reducto ad absurdum: If I get poison ivy and can't sleep
| for a few nights, should I be legally allowed to swerve
| headlong into traffic?
|
| If we should have a right to suicide, the only way I can
| see it enacted is through doctor assisted suicide
| clinics, otherwise we open the door to even greater harm
| from public or botched attempts.
| shanebellone wrote:
| This is such a selfish perspective. What about their
| trauma, pain, and sorrow?
| hprotagonist wrote:
| It's the exact opposite of selfish; I am pointing out
| that yes, people are individuals, but people are also
| inextricably communal as well. Choosing to end your life,
| like any other choice we made, is not solely about _you_
| because it does not solely affect _you_.
|
| "No man is an island entire of itself; every man / is a
| piece of the continent, a part of the main;"
| shanebellone wrote:
| Death is absolute. In no circumstance can you avoid its
| impact. Thus, your argument is predicated upon exerting
| control over another human in order to control the timing
| of your displeasure.
|
| Preferring a loved one to suffer, indefinitely, in order
| to spare your feelings... is the very definition of
| selfish.
| hprotagonist wrote:
| > Preferring a loved one to suffer, indefinitely, in
| order to spare your feelings... is the very definition of
| selfish.
|
| If by this you mean "don't blow your brains out", then,
| yes, i agree, and i wonder if you're misreading me
| somehow in a way that suggests that I think you ought to
| be able to without interruption.
|
| Otherwise, i'm having a hard time making heads or tails
| of what you're saying here.
| shanebellone wrote:
| I refuse to argue with stupid.
| tshaddox wrote:
| Should you be allowed to treat someone who is unconscious?
| Forcibly remove someone from a burning building or vehicle?
| andrewclunn wrote:
| When societies will intervene to stop suicide while
| simultaneously allowing for government sanctioned assisted
| suicide, it means that the morality or "rightness" of an act is
| only now defined by whether the proper paperwork was filled
| out.
| itishappy wrote:
| I don't think those are fundamentally equivalent categories.
|
| Assisted suicide is (to my knowledge) aimed at end of life
| patients with terminal outlooks. People who have little
| chance of improving their outcome.
|
| Self inflicted suicide is a much broader category including
| bullied high schoolers and unlucky stock traders. People
| who's current situation might look grim but who could
| potentially change that situation.
|
| I won't comment on the morality of either, but there's more
| at play than just bureaucracy.
| polygamous_bat wrote:
| > ... it means that the morality or "rightness" of an act is
| only now defined by whether the proper paperwork was filled
| out.
|
| I do not understand your point. How is that any different
| than, say, driving my car down the highway? The same act can
| be fine if I have a driving license and not fine if I do not.
| kbenson wrote:
| Sometimes, paperwork is there to force some other condition
| to have been met, such as time and review and notification of
| others. So, it it more "right" to make people that want to
| commit suicide take a bit of time to consider whether that's
| actually the decision they want, and not something being
| influenced by a temporary situation, whether external or
| internal (such as a hormone imbalance that ebbs and flows)? I
| think yes, generally, even if edge cases exist.
| fellowniusmonk wrote:
| It's moral to have an unsubscribe button, it isn't moral to
| require me to fax in an unsubscribe form after signing up
| with one click.
|
| It's moral to ensure charges go before a court quickly, it's
| immoral to allow a person to languish in jail for decades
| without trial.
|
| Time and effort are a components of everything including
| morality. To dismiss time and effort as trite or irrelevant
| in nearly any situation seems abusurd.
| sashenka wrote:
| guerrilla wrote:
| It amazes me that this place gets a reputation of being
| libertarian when the vast majority of comments here (and on
| similar subjects) are extremely authoritarian. The libertarian
| stance is that if someone isn't harming you then you have
| absolutely no justification to impinge on their freedom. This is
| fundamental liberal and libertarian theory common to all branches
| of both.
| bnralt wrote:
| What's interesting is that once someone gets past a certain age,
| people almost universally agree that it's OK to confine them
| against their wishes if they are unable to take car of
| themselves. You don't hear many people saying that dementia
| patients should be able to leave whenever they want.
| trynewideas wrote:
| As someone who's cared for someone with a declining mental
| state, dementia patients should be able to leave whenever they
| want.
|
| The problem is that the rest of the world doesn't want to - not
| can't, but finds it inconvenient - to deal with the
| ramifications of supervising or caring for people in public,
| strangers, who can't help themselves.
|
| It's much easier to detain inconvenient people than change the
| rest of the world around them such that it _wants_ to share the
| burden of caring for them.
| belval wrote:
| This is a very emotional topic so I want to avoid being too
| critical of that opinion, but at the same time, it's much
| much deeper than "doesn't want to". Dementia patients
| depending on their state are a danger to others and
| themselves. Their limited ability to understand what's
| happening around them means that they can get aggressive.
|
| Even if not aggressive, they will just "get lost" and try to
| drive or "go for a walk" in the middle of the night in their
| pyjamas. I suppose from the way you phrased it that in your
| case it was mostly harmless and you just disliked getting
| weird looks, but a lot of dementia patients are actually
| incompatible with society and need to be detained or given
| anti-anxiety medications.
| tacotime wrote:
| Someone in my family, who is now in a memory care facility,
| has dementia. We tried to avoid it as long as possible, but
| when we got a call from the police saying that she was found
| wandering around barefoot in the snow next to a busy road in
| the middle of the night while hallucinating about "people
| coming to get her", it felt like it was time to reconsider.
| She's on meds that control the hallucinations now, but it
| would still be unsafe for her to leave unsupervised, no
| matter how much our culture changes. How do you help a
| stranger who doesn't know where or who they are, and can't
| hear too well to start with? She sure does still remember me
| and can dance to the Beatles, but I would not be comfortable
| trusting her welfare to a group of even the most
| compassionate strangers.
| mixmastamyk wrote:
| Many folks fully don't believe mental illness among younger
| people is as serious as it is. Maybe they have never seen it up
| close. Somehow the frailty of old age legitimizes it.
| p0pcult wrote:
| Surely some of the answer also depends on what constitutes the
| "treatment," no?
| armchairhacker wrote:
| The way I see it: forced treatment is humane when the person
| being treated consents afterward. e.g. stopping someone in a bad
| mental state from suicide or anorexia, so that they thank you
| when they improve. Of course it's not possible to know whether
| the person will consent beforehand, so you have to predict (and
| if you get it wrong, you messed up).
|
| In most cases this is what real-world suicide prevention leads
| to, because if a person is adamant on killing themselves they
| usually find a way. The exception is really sick people who want
| to kill themselves, but can't because they have limited autonomy.
| That would be covered by euthanasia and is one of the reasons why
| it is very important ethically.
|
| For other mentally ill people, forced treatment is still only ok
| if they may actually get better and thank you later. If someone
| is dirty, homeless, and senile, but they don't care, putting them
| into a retirement home does not make them happy so it does not
| actually benefit them. If someone acts sane only when they get
| medication but they hate it, giving them the medication does not
| benefit _them_ , it benefits others.
|
| In these cases forced treatment may still be practically
| necessary and morally ok to benefit society (we don't want dirty
| homeless people begging on the street, so we outlaw public
| indecency and soliciting, and some illnesses make a person
| dangerous). But I think that we need to understand that forced
| treatment is not to benefit the mentally ill themselves, but us,
| and also take their feelings into account. e.g. force homeless
| people out of the streets and into homes, but give them autonomy,
| and if their homes decay and they sit around all day and don't
| care, let them.
|
| EDIT: Should also add that nursing and caregiving are jobs which
| give people power over other, vulnerable people. Many of the
| doctors which take care of mentally ill and disabled people are
| _genuinely amazing people_ who honestly don't deserve the bad
| connotation, but some apply to these jobs to take advantage of
| their power over others. So when forcing treatment on someone, we
| really need to ensure that those in charge of the treatment have
| said person's best interests at heart, and need to be monitored
| and held accountable. This is something which is unfortunately
| lacking because the people who are exploited or in danger of
| being exploited and thus care the most can't really advocate
| well, so the burden falls to beaurocracy which cannot adequately
| manage.
| nitwit005 wrote:
| The reality is, we provide (admittedly crappy) mental health care
| in prisons, so we already have a program of forced treatment. We
| just wait until a serious, crime has happened.
|
| Almost any non-prison option would be better than the current way
| of doing things.
| LarryMullins wrote:
| I think the prison-solution, as crappy as it is, is better than
| doing nothing at all. But it should certainly be possible to do
| better.
| qwerty456127 wrote:
| Some times it is. It really depends on the condition, specific
| case and the way you treat them. To me it seems obvious that at
| least in some cases it is, even if not in many. May be hard to
| tell in advance though.
|
| There are cases when a person is not in the mood (to put it
| mildly) to accept help but really needs it and will sincerely
| appreciate it once a relief comes.
|
| The opposite question is also valid by the way: is it humane to
| leave the insane to struggle and roam the streets untreated?
| loeg wrote:
| Always nice to see a counterexample to Betteridge's law of
| headlines.
| pcurve wrote:
| I guess it's a question of humane from whose perspective? If I
| were ever in a position where I'm not able to make sound decision
| ono my behalf and I don't have anyone around me to do so either,
| I would be OK with governmental entity intervening.
|
| "Democratic mayor of New York City, instructed police and first
| responders to hospitalise people with severe mental illness who
| are incapable of looking after themselves."
|
| I consider this humane and sound.
| bell-cot wrote:
| Like ~any government policy, the reality depends mostly upon
| the competence, honesty, good will, and resources of the people
| & agencies actually implementing the policy. (Vs. the Official
| Rules, as written down by politicians & bureaucrats.)
|
| Folks who really don't trust the government of NYC on the
| "competence, honesty, good will, and resources" angles may have
| plenty of evidence to support their distrust.
| lotsofpulp wrote:
| In that quote, "hospitalise" might mean to drop them off in an
| understaffed hospital emergency room so that they can be
| temporarily sedated or whatever and then released within
| whatever timeframe protects the various entities from
| liability.
|
| I doubt "hospitalise" means to house them in a properly staffed
| psychiatric care facility under the care of qualified
| professionals.
| AnimalMuppet wrote:
| The problem comes with "incapable". What about marginally
| capable people? Where are you going to draw the line?
|
| The solution to that might be to not have a binary line. The
| less capable they are, the more we can choose for them, but
| it's not all or nothing. (No, I don't have any idea what the
| details look like...)
| xyzelement wrote:
| The question feels very complex when framed like in the article.
| In reality I think it's two separate but connected questions that
| society should be able to answer based on its dominant values.
|
| 1. Do we have and enforce laws about things like people setting
| up tent cities in neighborhoods, open air drug use, public
| defecation and attacking pedestrians.
|
| Your politics can determine how you feel about this. My personal
| take is that yes we should have and enforce such laws.
|
| 2. What do we do when people are violating these laws due to
| mental illness? Do we just prosecute them and lock them up in
| regular jail or do we institutionalize and treat them like the
| mentally ill?
|
| To me it seems like treating mentally ill transgressors as such
| is right. The alternative to treat them like regular criminals
| seem worse.
|
| I think most people can follow this kind of argument. The real
| debate is around the first point, where do we draw the line about
| legal and illegal behavior.
| nonameiguess wrote:
| I happen to live in downtown Dallas, near enough to homeless
| encampments to walk past them pretty frequently. Tents all over
| the place near highway overpasses. There was a tent set up
| behind the Dallas Police Memorial across the street from city
| hall for about six months. The exact same tent, which never
| moved. The main branch public library, also across the street
| from city hall, and a bridge near me where there is a large bus
| depot, are nearly refugee camps. You can't walk six feet
| without stepping on someone if you try to go by them when it's
| dark.
|
| My take on this is what else are they supposed to do? Unless
| they're all killed, they have to live somewhere, and if they
| can't hold jobs and/or can't obtain real housing, what option
| is there other than to live on the street? I don't see how this
| can be made illegal. You're arresting people simply for
| existing and not being able to pay rent. What is this supposed
| to help? These are at least thousands of people in one city,
| hell, one neighborhood. If they were all sent to prison,
| there'd be no space left for real criminals.
|
| As for shitting on the street, again, what else are they
| supposed to do? If there aren't public toilets available to use
| anywhere, that doesn't change the fact that they're animals
| with digestive systems that require them to defecate on a
| regular basis. Hell, with all the walks I go for early in the
| morning, I have three times in the past six months had to shit
| on a sidewalk, not because I'm some belligerent lawbreaker or
| even because I don't have a toilet, but simply because I
| couldn't get home fast enough when it came on and there was
| nowhere else to go. It's not even a matter of whether
| businesses with toilets will let you use them. There aren't
| even any businesses open at 4:30 in the morning.
|
| I don't even see how this is a matter of politics so much as
| practicality. There are simply so many people that having the
| police, courts, and prisons try to deal with all of them would
| leave them unable to effectively do anything else they're
| supposed to do. I doubt it even works as a deterrent. Prison
| isn't any worse than how they're already living and the
| inability to reintegrate into society means nothing if they
| were already unable to integrate into society in the first
| place.
|
| As it stands, sleeping in public and setting up camp in these
| places is illegal, but they may as well pass a law saying
| eating is illegal. How can it possibly be enforced? People
| can't just not sleep and shit, and if they don't have the right
| to occupy any private space, public space is the only space
| left.
|
| Edit: I can see someone else already said something similar and
| got immediately downvoted with the response that they should go
| to a shelter. Okay, as far as I can tell, the people are
| sleeping where they are right now because it's within walking
| distance of aid facilities that are all located downtown. This
| includes shelters. But these shelters don't have anywhere near
| enough room for all of these people, and they aren't faced with
| a "temporary" problem. I've lived here long enough to see the
| same people and recognize them over the course of years. Some
| of them have clearly lived on the street for decades.
| anon291 wrote:
| In olden times, people used to be sent to poor farms, where
| they were given shelter, labor, and food. Yes, there were
| abuses. But these are fixable ones that we should have tried
| to solve, rather than get rid of the program entirely. Such
| situations help people get back on their feet by providing
| meaningful employment, training in labor, stability, an
| address, etc. I don't see why this is so verboten to mention
| these days.
|
| I'm thoroughly unconvinced this is a problem of shelter
| space. I don't know about Dallas, but in Portland, OR we have
| hundreds of beds going unused every night, and despite best
| efforts to fill them... we still have tons of street campers.
| runnerup wrote:
| Also, where should people be homeless? Literally I cannot pay
| rent next month and have no one willing to take me in.
|
| Where should I go? AFAIK there are zero legal options for me
| when I'm unable to pay for an apartment. I do not own a car.
|
| If I insist on being an upright citizen and following the
| law...do I just show up to a police station on January 1st and
| turn myself in for vagrancy and hope they throw me in jail?
| Retric wrote:
| Homeless shelters are a short term solution. Various housing
| programs are available depending on location, but tend to be
| really slow.
| runnerup wrote:
| There are widespread reports that there is no shelter
| availability for single men in my metro area. I suspect
| that multiple times per week I'll be unable to find a cot
| in a shelter. Not sure what the legal thing to do then is.
|
| https://www.houstonchronicle.com/news/houston-
| texas/houston/...
|
| I'm also a bit concerned about the safety and conditions in
| the shelters, being that close to unpredictable strangers.
| But I'd prefer that over doing anything illegal.
| TylerE wrote:
| Any chance you'd qualify for Section 8?
|
| https://hchatexas.org/housing-choice-voucher-
| program/voucher...
|
| It can take a while to go through all that, though.
|
| You can see available inventory here:
|
| https://www.myhousingsearch.com/dbh/SearchHousingSubmit.h
| tml...
|
| (Disclaimer: My day gig, speaking on behalf of meself
| only, etc. We are sponsored by the HCHA as their housing
| search provider.)
| bittercynic wrote:
| From a friend's experience with shelters in NorCal,
| you're mostly safe from crime inside the shelters (except
| for theft) but at high risk of being a victim of crime
| and harassment when you're nearby/outside. You will be
| perpetually ill with coughs and colds if you stay in
| shelters.
|
| edit to add: I don't know of any solutions. Sorry for
| sounding so hopeless.
| dilap wrote:
| I think you meant this as a rhetorical question, but I'll go
| ahead and answer it anyway.
|
| The practical answer is you do become homeless, but not out
| in the open -- you'll set up a tent somewhere somewhat hidden
| (maybe in the middle of a park, for example), and hope nobody
| notices it. Every so often your camp will get discovered and
| cleared out, which will be inconvenient.
|
| It certainly seems pretty mean-spirited to harrass the
| homeless in this way, but it does have the benefit of
| (mostly) preserving the beauty and safety of public space.
| runnerup wrote:
| That seems illegal? I'd like to follow the laws. I am in
| the USA.
| dilap wrote:
| Hard to follow the law without a certain amount of cash,
| unfortunately.
|
| If it comes down to it, I'd definitely recommend trying
| to get your hands on a van before going full homeless.
| p0pcult wrote:
| Do you have a cryptocurrency address? Can I help?
| runnerup wrote:
| I'm not suffering that much and we shouldn't make HN a
| place to spin a yarn for cash, or we'll lose what makes HN
| great.
|
| The story is largely truthful, except for the character who
| has a pathological need to follow every rule. In reality,
| I'll be late on my rent, my various credit scores will take
| a hit, but I'm not going to get evicted _that_ quickly and
| should be on my feet again before the end of January.
|
| The lack of employment is entirely my fault, with the
| peripheral assistance of crippling anxiety and self-doubt.
| But I can choose to make ends meet bagging groceries, etc
| for $15-17/hour. I'm also a reasonably median performance
| programmer in C++ and Python so I should be able to find
| salaried work in the next month or so!
|
| If I was actually post-eviction / move-out negotiation with
| my apartment I'd probably sleep in a car if I owned one or
| set up a very hidden tent far away from other homeless
| people near a $10/mo gym with showers and lockers.
|
| Those plans may be illegal currently, but they are also
| still probably the best choices for a homeless person
| looking for work. Done properly, this doesn't result in
| harm, inconvenience, or cost to the public. IMO, if someone
| can notice me enough to complain about me...I'm not being
| safe.
| chaostheory wrote:
| Homeless shelters exist for this purpose.
|
| There's also HUD or similar entities if you're not in the US.
| There are also private nonprofits like churches that help
| with homelessness
| kayodelycaon wrote:
| My uncle was homeless for a while. One of the church run
| shelters required everyone staying there to attend the
| religious services at the shelter.
| mullingitover wrote:
| > There are also private nonprofits like churches that help
| with homelessness
|
| It's honestly shocking that the US has _absurdly_ wealthy
| churches and we have greater than zero homeless people on
| the streets. Helping the poor is _the_ core tenet of the
| christian faith. If they practiced what they preach, it
| should be impossible to lay down on the street for more
| than five minutes and not be swarmed with offers for help.
| RobertRoberts wrote:
| Many people _refuse_ housing for these reasons: (I've
| been directly told these, or have seen them reported)
|
| * Housing is dangerous/scary (robbery, rape, physical
| violence, etc...)
|
| * Housing is a conspiracy (to control people or other
| irrational ideas)
|
| * The rules of housing are too restricting. (can't have a
| pet, visitors, noise rules, cleanliness rules, curfew
| rules, behavior rules, etc...)
|
| There are others as well, but can't recall immediately.
|
| A church can't fix these problems, no matter how rich.
| runnerup wrote:
| There are widespread reports that there is no shelter
| availability for single men in my metro area. I think I'll
| be able to get a cot some nights, but I suspect that
| multiple times per week I'll be unable to find a cot in a
| shelter within a 4-hour walk of city center. It's hard to
| go around and ask at each shelter every night...there's a
| limited time window for checkin so if my first two tries
| are full I probably won't make it to a third option before
| they lock up for the night. Not sure what the legal thing
| to do then is.
|
| https://www.houstonchronicle.com/news/houston-
| texas/houston/...
|
| I'm also a bit concerned about the safety and conditions in
| the shelters, being that close to unpredictable strangers.
| But I'd prefer that over doing anything illegal.
| naet wrote:
| Shelters are often worse than being outside in my past
| experience.
|
| People in shelters use lots of hard hard drug and fight or
| sexually assault each other, shelters are full of tons of
| illness (physical and mental), rampant theft, you'll end up
| with awful pests like bedbugs, body lice, scabies, fleas...
| and you aren't even guaranteed to be let in, after hours of
| waiting in line, due to lack of availability.
|
| They aren't well funded enough, aren't taken care of, don't
| have enough staff to keep you safe, and have too many
| troubled people in too close quarters. The ones sponsored
| by religious organizations are usually just as bad and add
| an extra layer of judgement and religious propaganda on top
| of it all, rudely implying that all your problems are
| because you don't follow their faith.
|
| I'm not saying I have a good alternative in mind; being
| outside can also (obviously) suck for different reasons,
| but there are tons of legitimate reasons to avoid shelters
| even when you're homeless.
| anon291 wrote:
| > Literally I cannot pay rent next month and have no one
| willing to take me in.
|
| Well in most cities in the United States, there are numerous
| open spots in rent assistance or shelter programs. For
| example, in my city of Portland, there is a lot of money
| spent tackling this problem. In fact, each night, the city
| has empty rooms available for anyone, but they go unused.
| Unfortunately, part of the problem is the narrative pushed by
| the media that America has no social welfare. We have quite a
| lot. Unfortunately, the narrative we don't prevents people
| from seeking it out.
|
| This is similar to how narratives about COVID swamping
| hospitals led to so many people not seeking medical
| intervention that they died or let a preventable illness go
| untreated. And it's what caused so many hospital closures.
|
| Moreover, if you cannot pay the rent next month, you can
| contact your local st vincent de paul, and they will often
| cover it for you: https://www.svdphouston.org/
|
| Below you said you are simply going to be late, and able to
| resume making payments in January. If that is the case, there
| are numerous programs available that will help you to make
| your rent so you don't take the credit hit. Again, if you
| lived in my city of Portland, I know several charities that
| will simply pay your rent no questions asked, not even
| expecting the money back. Please contact your local social
| services agency or one of these charities. Many have funds
| that go unused each month.
| pigeons wrote:
| What part of the world do you live in.
| runnerup wrote:
| USA
| LarryMullins wrote:
| Such laws should be enforced, they are good laws that benefit
| _almost_ everybody. If somebody has a mental illness that
| renders them unable to comply, they should be permitted to
| receive treatment in lieu of legal punishment. If they prefer
| not to be treated, treatment should not be forced on them but
| they should instead face the normal legal punishment for their
| crimes.
|
| And of course, funding/supporting programs and regulations that
| reduce the scope of the problem is a good investment. This
| likely entails providing housing to people to preempt the issue
| of those people trashing up public parks. But the laws against
| that sort of behavior will still be necessary because some
| people will choose not to avail themselves of those programs
| and will behave antisocially no matter how much help you try to
| give them.
| Tiktaalik wrote:
| The laws themselves are unjust.
|
| In NA we don't build the housing we badly need, making it
| arduous and illegal to build in most places, which has spiked
| the price of having a home, making it unaffordable to many, and
| then we've turned around and made it illegal to not have a
| home.
|
| That there are so many people "breaking the law" is a self
| created problem by refusing to build homes for people to live
| in.
| LatteLazy wrote:
| Given the very low efficiency of most mental health "treatment"
| this remains a mostly theoretical question. Until psychology and
| physiatry sort themselves out and become sciences were really
| just talking about locking people up...
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