If This Isn’t Danger, Then WHAT THE HECK IS?!? or Loosening the (Nearly) Impossible Standard-by Alpheus Madsen.

This Guest Blog Post started off its life as a comment to Sarah’s previous post from a few days ago, But! It’s Madness! – According to Hoyt, where she expresses the conflict between two very important, and very valid concerns:
(1) the need to help the obviously mental ill who are on the streets, and who are obviously impacting society in harmful ways, and
(2) the need to protect mostly-sane people (to the extent that any of us are sane, to be sure!) from being committed, when the reason for that commitment isn’t really mental health, but disagreements over politics, religion, inheritances, and so forth.
While it’s true that many mental institutions were abusive to their patients, they nonetheless served an important role in providing a places where the severely mentally ill could be helped, and while it’s true that it was Soviets who locked up and drugged anyone they disagreed with, we unfortunately have plenty of stories where, in our America, of individuals who were able to do the same thing. So, without further ado …
This has been something that has been on my mind for several years now — both because I have read “My Brother Ron”, and also because well before that book was finished, my sister was diagnosed schizophrenic.
One of the biggest take-aways from that book is the “Danger to self or others” — and about how pretty much the only way you could be deemed a “danger” if if you’ve just stabbed or killed someone.
That woman who believes she is dead and is slowly starving herself? (An example given in “My Brother Ron”.) According to the current “standard” she’s not a danger somehow. In the case of this woman, she starved herself to death. (This is something particularly relevant to me, because that’s how my sister started out with her diagnosis — fortunately she got to a point where she voluntarily accepted treatment!)
That homeless guy who rants at passers-by, who threatens them, and who occasionally punches someone? Somehow it is justifiable to periodically put him in jail for a few days, and then release him, over and over again — until he goes and pushes a young woman onto the tracks of an incoming train.
That guy who can’t stay in a homeless shelter, even though it’s freezing (and heck, even though he has an apartment that, between social security and auto-payment, remains paid for even when empty, but isn’t used because he’s convinced it’s bugged — another example from “My Brother Ron”) either because he’s paranoid to go inside, or between drug use and angry tirades, he has to be kicked out — how is this not a danger to self, even putting aside others? How many homeless froze to death because of this?
So I would propose that a simple starting point for fixing the homeless problem, helping the mentally ill, and preventing the system from getting out of hand, is to expand “Danger to self or others” to include people who are, indeed, a danger to self or others! But it doesn’t have to be expanded greatly to have an enormous effect in both reducing homelessness and helping the mentally ill.
I would propose that being homeless and not able to hold a job should be a necessary, but not sufficient, condition for committing people against their will. If someone can wander the streets without accosting strangers, and can stay in shelters without getting kicked out (whether for using drugs or for being actively hostile to others), then that person shouldn’t be committed. A homeless, jobless person who does start doing these things — particularly if they’re getting arrested for these things, is a danger to self or others, and thus needs intervention.
Now, for purposes of removing people off the street, I kind of don’t care whether the individual is mentally unstable because of insanity, or due to a drug-addled brain — but the first step for treating someone committed should be to check for underlying physical conditions. As Sarah has pointed out, the mind is connected to the body in funny ways. I recently encountered a story of a meth addict who had been used for “before” and “after” pictures to show how awful meth can be … only to have her appearance continue to deteriorate, even after a year of sobriety … because it turned out that she had Lupus, and her meth addiction may have been partly self-medication for that. Whether the person has schizophrenia, is drug-addled, or just has other issues, it should be considered important to find and try to treat underlying conditions first, because other treatments won’t work as well without that!
Also, another random thought: commitment rooms should be comfortable to live in, should be “homey”, and inmates should be treated kindly. I can’t remember where I saw it, but I recently saw a study that suggests that, regardless of the mental issue, it’s far better to treat the patient in a nice environment than it is to put the person in a small, sterile, white room, which is apparently the current standard practice.
Should someone be forced into treatment? I’m not entirely sure I can say for sure — however, I will say this: if someone is belligerent, treatment should be a requirement for transfer to a half-way house — and if the person can stop taking medication (maybe he’s come to terms with his schizophrenia, for example, and has learned what his hallucinations are, and could learn to ignore them) and still function reasonably well, then I doubt it would be productive to force the individual to continue medication. But if the person goes back to being a danger, whether or not the person is still on meds, the person should be re-committed.
If someone is living in a home, and maybe even holding down a job, and is starting fights with strangers or making threats, that person should be considered sane, and should be charged with assault in these cases. It might be a good idea to check for underlying conditions for that individual too, though, particularly if it’s a clear personality change. But commitment should be off the table completely, unless an underlying mental illness has been clearly identified and it’s to the point where his new aggression is both related to the disease and is rising to the danger of self or others.
Now, this is by no means a perfect solution — in particular, the people on the boundary of insanity and intelligence, who are far enough gone to decide to kill people in crowds, but still have enough sanity to plot, plan, and acquire the means to do so, will inevitably fall through the cracks — because they will usually be just outside this strengthened standard of danger of self or others.
This is also going to miss people who lose their mind and go crazy, but don’t do so at a level to qualify as a danger to self or others — and may even refuse treatment that would be extremely helpful. Such individuals, so long as they are being cared for and have a place to stay, and aren’t hurting other people, will almost certainly slip through the cracks.
Perhaps there is a way to forcibly treat such an individual without going down a route that would be easily hijacked by evil people to drug innocents — whether it’s forced by family or by bureaucrats, it’s easy to see how such can be abused by greedy and/or power-hungry people — but it may very well be the case that these people would be a “sacrifice” we have to make, to be able to commit people who clearly need committing and to leave unmolested people who are clearly sane.
Thank you for coming to my Ted Talk! I am just a lone mathematician pretending to be a software engineer, so I don’t expect this proposal to reach the halls where it needs to be heard, but I figured that if I vented here, this proposal could at least get into a few more minds.
And come to think of it, this post was a lot longer than I expected. Heck, if anyone else thinks this would be a good blog post, don’t bother to ask me for permission, just use it: I think this is an important enough idea that it should be spread as far and wide as possible. Perhaps it’s not the best solution to both helping our mentally ill and preventing our psychiatric institutions from being hijacked by evil people, but I think it’s at least a good starting point!












































































































































































