Is There a Right to Be Mentally Ill? | National Review Online
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When responding to Dr. Torrey it is wise to start with the facts since he so frequently leaves them out. His post is about Alberta Lessard and the legal decision that he says gives the “mentally ill” the right to be “mentally ill.” What actually happened?
Ms. Lessard had become obsessed with getting a job back she had lost at a local university. She was calling the university hundreds of times a day. They called the police to get her to stop. When they got to her house she was delusional and thought they were “goons from Nixon’s administration coming to get her.” She tried to escape and went out a second story window. They caught her hanging onto the window sill and took her in. This occurred on October 29,1971. She was taken to a county psychiatric hospital. At that time in Wisconsin someone could be institutionalized with no hearing, with no rights on the testimony of three people.
On November 1 the police officers who had detained her went back before the court and the judge signed an order holding her for 10 more days. Ms. Lessard did not participate nor was she aware of this hearing.
On November 4 the psychiatrist from the hospital came before the judge and recommended permanent commitment. Ms. Lessard he said had paranoid schizophrenia. Ms. Lessard was not aware of this hearing either. The judge signed an order for 10 more days.
On November 10 Ms Lessard finally got a lawyer. None was ever offered. She got the lawyer based on her own initiative. If she had not acted she would have never been represented.
On November 15 she was told at 2:30 in the afternoon there would be a commitment hearing at 8:30 the next morning. Her lawyer got it postponed for one week and on November 24 the hearing was held and she was committed for 30 days. The judge’s rationale was that she was “mentally ill.” That was all….”mentally ill.” The order was extended each month after that for 30 days until she left.
At that time in Wisconsin being committed had a lot of reality consequences. For Ms. Lessard it meant that legally she could not vote, she could not enter into legal contracts or sue people, she could not hold a license to teach, she could not drive a car and she could not get married.
Her suit basically said she should have the same rights accorded to a criminal. Remember a psychiatrist who had known her for 3-4 days was recommending permanent commitment based on a simple diagnosis. If she hadn’t been pushy she would never have been given access to a lawyer and if she hadn’t been pushy how many other people would still be faced with permanent commitment based on a psychiatric diagnosis? How many lives did she save?
Her lawyers had a lot of arguments but two really stood out.
If you were going to commit someone for their own good you needed to prove it was for their own good. They pointed out clearly there was no proof that the state hospitals of the day did anyone any good. (Has it changed?) Their argument basically was that the burden of proof should be on the state.
One of Dr. Torrey’s favorite points is that people are being denied access to treatment (I will resist the impulse to talk about Rep Murphy’s fight against health care reform and the denial of access that means for people needing help.) He makes it sound like they are being denied choice. What he is really saying is that we make it way too hard to involuntarily treat people against their will. If you read his post he clearly seems to wish that Ms. Lessard had not stood up for her rights nearly so well.
The second argument was very simple. Statistics showed that the death rate in psychiatric hospitals was 10 times that in the general population. She didn’t deserve to be placed in a place for her own good that might result in her early death. Ms. Lessard died when she was 94. You gotta wonder if she would have come close to that in the hospital.
I apologize for the longest introduction in history but what exactly does Dr. Torrey say?
He starts off by saying she costed too much money. He figures she cost the state of Wisconsin close to $2 million dollars and little was gotten in return. We could have he believed used the money wiser. Suppose the suggestion of the original psychiatrist had been followed… permanent commitment. If you figure the hospital is $500 a day (I think it is twice that) what would it have cost to institutionalize Ms Lessard for 50 years? At $500 a day (and like I said I think it would be at least twice that) it comes to $9,125,000 to save the 2 million Dr. Torrey thinks we wasted on Ms. Lessard. Dr. Torrey closes the paragraph by asking “…who was really crazy here?” I don’t know but I know who can’t add or multiply.
But the point is more important than math. Dr. Torrey is saying that letting troublesome people live in the community isn’t worth it. Just cut your losses and put them where they can get “real help.” This is the kind of thinking we have come from. God help us all of this is where we are going. Ms. Lessard did not live a happy life. She was frequently a nuisance to other people. Much did not work out. But if we begin locking up all the nuisances and all the people someone thinks is a failure where do we stop? Where do we draw the lines and who draws the lines?
Ms. Lessard did not want to take medication. She says she tried it a couple of times and it made her sick. Could she not say no? Could she not say I would rather not be sick. Would it have made her less of a nuisance? I don’t know but neither does Dr. Torrey.
The woman who wrote her obituary describes Ms. Lessard as a brave woman. She struggled every day. That seems so true. But only a brave person fights so hard to make her own decisions for herself. If Alberta Lessard is Dr. Torrey’s poster child for involuntary treatment then I think he has it all wrong. I would wish her courage on more people.
He says her lawyers were intent on making “it as difficult as possible to involuntarily hospitalized a person.” Funny I just thought they wanted her to be treated as fairly as possible and that meant at least having the same rights as a criminal. Remember again a psychiatrist wanted to commit her forever based on a diagnosis he gave after knowing her for 4 days. Forever. Should it be made a little bit difficult to do such things. I think so.
This has already been a long post. Much that Dr. Torrey says is worthy of comment but I only want to touch on one more of his remarks. He says: “Because of her psychotic behavior she was briefly hospitalized more than 20 times, but, because of the new focus on immediate danger in commitment standards, she could never be held long enough to be properly treated….”
I have a lot of questions about this sentence. “Hospitalized more than 20 times…..never held long enough to be properly treated.” What does that mean? It is kind of a weird way of thinking a lot of psychiatrists fall prey to. “20 times….” She had a lot of involvement with the system. 20 times also tells me that it was never much of a help. 20 times makes me wonder what if any kind of community supports was she involved in after leaving. 20 times involuntarily makes me wonder why anyone is surprised she doesn’t voluntarily buy into anything from the system she sees as attacking her. Coercion does matter and doesn’t build investment. 20 times tells me that insurance companies probably got very tired of being asked to pay for the inpatient treatment of nuisance behavior. But the real important phrase is at the end of the sentence. It is the hallmark of psychiatric thinking. “20 times. That just proves we didn’t hold her long enough to make a difference….” Kind of failure proves that we could be successful if we just tried longer and harder thinking.
Alberta Lessard died at 94. Many people are better off for her fight. Her life was hard. Dr. Torrey thinks her life could have been cured. He thinks a lot of lives can be cured (whether the person wants to or not) but it is an easy faith. Every hard life for him is confirmation of “if they had just listened to me….” In the end, at least for me, her courage stands out. You know with all the problems she had and all the fights she fought and all the disappointments she had I suspect she was always glad that she stood up and said, “I am a person too and this is wrong.”