It should not be dangerous to be “mentally ill”: the battle for the soul of the mental health system

It should not be dangerous to carry the label of “mental illness.”

It is.

It affects your life in countless ways.  The preceding post links to an article by Pete Earley.  He talks about a mentally ill person who was beaten to death by police basically because he could be.  It shouldnt be, but was and still is.  The people who did this were legally judged as innocent.  To be “mentally ill” means to be less than a person.  It is told to you in a thousand ways a day, in ways both spoken and unspoken.  We use words like stigma, but I am beginning to wonder if that is not too antiseptic a word.  It is discrimination, prejudice, victimization, and dehumanization.  It is nastiness times nastiness.  It is wrong.  But every person labeled “mentally ill” knows it is real.

Let me be clear in what I am saying.  Mental health issues, mental health disorders, mental health challenges (whatever political flavor of word you prefer) impact life.  They affect everyday how you live, what you do, and how you get along with others.  For some it is a challenging impact.  For some it is a crushing impact.  But that is not what I am talking about here.

The most dangerous thing for too many is not the issues they struggle with, but the label they carry.  It is not a morally neutral scientific/medical label.  Anyone who believe that is simply naive.  It is a political act, a statement that disempowers one group of people and empowers another and then dismisses/justifies anything the second group does as being for the good of the first group.  It is an act that in the wider culture becomes an excuse for every form of prejudice and discrimination you can imagine.

We are in a battle for the soul of the mental health system.  We are in a battle to decide what it means to need care and what it means to provide care.  We are in a battle to decide how we should treat each other and whether or not people who have difficulty in life can ever, or should ever expect, to find a path to a better life.

Robert Whitaker in his book “Mad in America” told the history of what it has meant to be “mentally ill” in America.  It is not a proud history.  For the longest time mental health treatment was segregation.  It meant locking up people for a lifetime because they were different.  Mental hospitals were cities literally.  When I was 22 years old I got my first job in a psychiatric hospital working in a gym.  I will never forget my first piece of advice from a veteran co-worker.  “What you do is make friends with the biggest and meanest one.  He will get the rest to do whatever you say….”

We put people in the community finally and made all kinds of promises about what we would do.  We just didnt keep the promises.  We abandoned a whole generation of people and justified our actions by talking about how hard they were to reach, to motivate, and how so many of them just didnt want a better life.  We lied to people who depended upon us and then lied to ourselves so we wouldnt have to look.

Meanwhile psychiatry prospered.  Pharmaceutical companies could produce pills and they had to produce the diseases they might cure and they did.  The life saving help that medication gave for some was lost in the lies, the cheating, and the misrepresentations that tried to convince an entire culture that problems in living were all basically mental illnesses.  They tried to define us as what was wrong with us and told us not to worry because they got the pill.

Out of all this a notion of recovery started to take place.  People started to share their stories and a truth was discovered that had always been there.  People do get past difficulty.  Human beings have an amazing resilency.  They can learn the things, do the things and come to care for the things that enable them to transform their lives.  People could and indeed should make the decisions about their own life.  Life was never so hard for anyone that they were less than a human being.  Hope came to places and to people who had never had it before.

Now a new front has opened.  A campaign of anecdote and fear has tried to convince us that we are wrong.  The “mentally ill” are dangerous.  They are unpredictable.  And fear is just realism long discounted.  We are told that a responsible system is ultimately based on making people do what is good for them whether they want to or not.  If people say perhaps this is not good for me that must be proof of brain damage on their part.  We are told 50% of the “mentally ill”  dont know they need help and it is our job to see they get it.  Maybe 50% of the “mentally ill” just dont believe the help really helps.

The new battle is not being fought in scientific or medical circles.  They are not trying to convince psychiatrists of their wisdom.  It is not about studies or proof.  It is being fought in the arena of public policy.  It is being fought in newspapers, magazines and on the internet.  It is being fought most surely in the legislative arena.  What they cant convince people to do they are trying to compel them to do.  It is not about building a consensus for coercion and force.  It is about making them the most legal thing.

They will tell you they come to only build.  But basically they want to put the genie back in the bottle.  They talk about the minimum they need as 50 psychiatric beds per one hundred thousand people.  In Tennessee that would mean increasing the psychiatric beds 4 or 5 fold.  At over 100,000 a bed psychiatric hospitals would soon cost more than medicaid.  It is a salvation we cant afford.  And it is a salvation that in the end could only mean the destruction of the community mental health system we do have.  The money has to come from somewhere.  And so those with mental health issues would once again find themselves deserted.

Mental health advocacy should not be about arguments for a bigger piece of the pie.  They should not be about power and influence.  They should not be about what we get, but how we might more effectively and productively give.  It should be about honesty and helping those who need help.

Share your story.  Share your experience.  Share your hope.  Policy makers need to hear from you.  They need to hear your hope.  Many, way too many simply dont know.

Speak.  For all of us.





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