Wednesday, March 16, 2011

My Own Private Siberia

An extremely senior (age-wise, at least) New Hampshire lawmaker has resigned after having offhandedly suggested (supposedly in jest) that mental patients be shipped to Siberia. Well... the Siberia of today is not the “Siberia” of old, in any case; I understand it can be quite pleasant at certain times of the year – not unlike the Northern Plains of this country, as far as that goes. But as to the suggestion, whether in jest or not – he was clearly and willfully ignoring the far more humane solution that we have to the problem of the mentally ill – namely, to just set them loose in the streets of our large cities. Yes, let them fend for themselves, because they have “rights”, after all – including the right to eat, sleep, urinate, etc. wherever and whenever they please. That's the ticket – treat them as equals, even if they're somewhat challenged when it comes to returning the favor.

And furthermore... well, first let me indulge in a bit of nostalgia. I entered upon formal training in the psychology “biz” at the beginning of the end of an era -- the old institutionalization model for mental patients. There were still, at that time, mental hospitals dotting the landscape... but the bloodless term “mental hospitals” doesn't really do them justice. These were insane asylums, by gosh – nut houses, loony bins... places in which to abandon all hope. They were invariably high on a hill and built like ancient fortresses or castles, complete with towers and crenelations... with ample grounds, ancient trees, pathways, stone walls, the occasional flower garden... but scary in the best of times. They always seemed to be enveloped in the black and white twilight of a “B” movie, with bare, windblown trees and large black birds cawing and cackling in the gnarled branches... with the occasional muffled scream emanating from a high, barred window. Oh yeah – these places were the real thing. And on the inside, they weren't much more warm and fuzzy. High ceilings, everything painted the same color of pale green or yellowish tan... grossly overheated in the winter and stagnant in the summer... questionable odors wafting about... bland food... TV sets blaring... staff and patients shuffling around with equal energy (i.e. not much). And, above all, the resident psychiatrists, who invariably had paneled offices with floor-to-ceiling bookshelves, large windows looking out over well-manicured grounds... who smoked a pipe... and wore white coats over their wool three-piece suits. This was their empire, their fiefdom... and they were, by and large, benevolent dictators, who seemed to, at least on occasion, recognize the residual, faintly-glimmering sparks of humanity in their patients. They were, to a man, enlightened humanists, big on “ethics” but indifferent to morals. It was, let's admit, a somewhat patronizing attitude... but on the other hand, when you're the only arguably sane person in a building full of madmen (and women), it's hard not to be a bit patronizing at times. Better to act like the kindly father – who could be stern if absolutely necessary – with the patients as your not-quite-right, perpetually needy children. This was a model that, for good or ill, persisted for many decades. But then came the revolution.

And I don't know exactly how or why it happened, and I don't have time to research it at this point. I suspect the words "lawsuit" and "advocate" would enter in. But it most definitely did happen, and I saw it with my own eyes. Almost overnight, all across the country, mental hospitals flung open their doors and disgorged an army of... former patients, now cured and whole? Well, not exactly. Most of them were no better off than they'd been when they entered. But now the model had changed, and, besides, they had “rights”, just as the homeless who were that way for other than mental health reasons had rights. No more vagrancy laws, no more picking people up off the street just because they were living there and creating an unsanitary condition – no, now they were full-fledged citizens will all of the same rights and privileges as anyone else... whether they wanted them or not.

This was, let's say, “Step Number One” of the “solution”. Step Number Two was to then take the ones who couldn't stay out of trouble and throw them in jail – i.e. the more active, violent, feisty (and probably less insane) types. The more passive, depressed, and plain psychotic were left in the streets, parks, and public places. The result? Our prisons are bursting at the seams, and in many cases it's because they include people who, in the old days, would have been behind other bars – in mental hospitals, with a much lower “unit cost”. And, our cities are graced by the presence of the homeless, with public officials helpless to do anything about it, since those homeless have powerful and politically-active advocates. And let's face it, it's a sign of the times... of the evolving culture... of evolving “values”... of a hesitancy to ever, under any circumstances, “judge” anyone, because “there but for the grace of God go I”, etc.

So yeah, those old red-brick or stone fortresses on the hill are gone – or turned into condos – but the problems they were built to deal with are still with us, and are in fact more immediate, visible, and “in your face” than they were when the mentally disturbed could be locked up, safe and out of sight, and not able to cause scandal, especially when they came from a middle-class background. Ah yes, the “shame” of mental illness – something that seems downright quaint in our day and age, when everyone who is anyone has been through regimens of group therapy, couples therapy, individual therapy, drugs of all sorts (legal and otherwise), New Age gimmicks of all sorts... and when people who are arguably mental cases dominate daytime television (both as hosts and guests). It all started – as so much else did – back in the hippie era, when it was suddenly cool to be crazy. Well, I guess it had some prefigurings in the beatnik era... and the Roaring Twenties... and the Romantic Age... and so on. I mean, it's always been cool to be a little bit crazy, as long as you were also highly verbal, clever, and “artistic”... but the mental patients of the Fifties and early Sixties were anything but fashionable. The notorious “back wards” were places of despair – not so much for the patients, who hardly realized where they were (or even _if_ they were), and were totally drugged up besides, but for anyone witnessing the scene who had a spark of humanity. The word that comes most readily to mind is “waste”. After all, each of these creatures had only one life to live, just as we all do... and this was the way they had to live it? It just seemed to be too bad, even if they were “happy” (or at least “content”... or “cooperative”, as the expression went, which meant too far gone to protest). And who knows, maybe their inner world was glorious beyond compare, and if we only knew we would be insanely (ahem) jealous. But I'll leave that romantic assumption up to the radical fringe of psychiatry, like R. D. Laing.

All I'm saying is that, while it's easy to get all huffy about a jest like that of the New Hampshire lawmaker, at least part of that reaction is sheer defensiveness, and – dare it say it? -- guilt. Because we don't know “what to do about” the mentally ill either. The old fortresses weren't all that great (although they beat the heck out of what came before), but are jail and the street any better? And after all, doesn't it depend to a great extent on how we define mental illness (or whatever we choose to call it), and how we define it in relation to the rest of society? I don't think we've settled on that issue yet either. After all, political parties and politicians are fond of calling their opponents “insane” -- which is not far removed from the familiar tactics of those who were in power in the Soviet Union. And yet, if politics is based on reality, and there is only one reality, then shouldn't there be only one valid political position... all the rest being based on something other than reality, i.e. insane? Is there, in fact, any room for “opinion” at all, or can only one point of view be right? I'm asking these questions without answering them, because I'm not sure I know the answers. Some writers have questioned the very concept of “mental health” -- and yet we remain faced with hordes of people who simply can't function in a “normal” way, i.e. they can't hold their own in society as it is currently configured. Maybe they're all misunderstood saints... but that has yet to be proven. All I can say for certain is that the current model doesn't work, and it's probably because the metaphysical and psychological premises behind it don't work, either because they've been contaminated by politics or because they're just plain wrong.

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