People have an incentive to find what they are looking for when finding that whatever it is increases their control, their power, their social status. It is even a larger incentive when finding what they are looking for means money in their pocket. People have an incentive to see things that make them matter or that lead to them getting things that matter. If what they are looking to find is the distress of other people and the way that distress is framed or explained results in some type of positive payoff for them then you might say they have a perverse incentive to profit from the misery or unhappiness of other people.
All this was triggered by a phone conversation. I was part of a group call and listened to some people from New York discuss their experience with AOT. What stood out for me was that if those people had lived in Tennessee none of this would have happened. It is not just that there is no AOT. I have never heard a professional in Tennessee bemoan the fate of all the poor people with anosognosia. If someone did not buy into treatment that would be viewed as their decision and if anything happened it would be some kind of effort to connect with the person they thought needed help in a more effective manner. I wonder if anosognosia is not less of an issue in Tennessee because their is less incentive to see people in that way.
I wonder in particular if perverse incentives don’t operate at their strongest when what must be justified is the coercion or forcing someone to do something they might otherwise choose not to do. At one time it was common wisdom that drug people needed to be put in prison for a long time. What was wise once is now seen as foolish and the cause of an epidemic of mass incarceration that has crippled this country.
The last year I could statistics about AOT in New York had one startling one. Well over 90% of the petitions filed were judged founded. Either New York has some extremely perceptive people filing these petitions or the courts see what they have an incentive to see.
I can remember when it was easy to see and justify the need for long term psychiatric hospitalization and the hospitals were filled with long term patients that everyone just knew couldn’t make it in the real world. There is no longer an incentive to justify the idea that some people can’t make it in the real world ever and people who once would never be given the chance to make it in the community are regularly successful.
Follow the money. Follow the power. Follow the control. Follow the status and professional standing. Follow who is defending whose territory from what. Follow all these and it will be much easier to see why things are the way they are and seem so resistant to change.