Sunday, January 30, 2011

Rich Lowry's "The Madness Lobby": For all the craziness in the world, it's the craziness next door that scares us the most. We should seek to cure it, but first we have to get the government to stop subsidizing it.

The sturm und drang in Egypt might be dominating the news, but for most Americans, the sturm und drang that might be occurring inside the head of a neighbor is a lot scarier.   Earlier this month, on a Saturday in Arizona, we were reminded that our failure to grapple with mental health issues has tragic consequences: Six people dead, a Member of Congress seriously wounded.   For a few days, it seemed as if the murderous Jared Loughner would become yet another political football: Could his evil deeds be blamed on Rush Limbaugh?   Would gun control as an issue be revived?   But even before the Egypt unrest, the politics of Tucson had faded, because it became obvious that Loughner himself was not political--he was a lunatic schizophrenic.  And so his deeds couldn't be blamed on a political party or a communications medium.   Loughner was just another in a long line of crazy lone gunmen.

At that point, the politicos, and the chattering class, start to lose interest.   If it's no longer a political fight, well, find another political fight, such as taxes, spending, or the budget deficit.

Yet in view of the horrible carnage that Loughner caused, perhaps we shouldn't turn away from the mental-illness issue so quickly.    Perhaps we should realize that there are more Loughners out there--indeed, their numbers could be growing, relative to the population.  If so, then as a matter of self-defense, we need to think about how well we are dealing with mental health issues.

For decades, Dr. E. Fuller Torrey has been arguing that we have been badly mishandling mental illness, and that consequences of that mishandling have made all of us worse off.   He has argued that the de-institutionalization of the mentally ill--an effort that united liberals, libertarians, and budget-cutters--has in fact merely shifted the burden from institutions to the streets, and then to prisons.  That is, as the mentally ill were pushed onto the streets, they were "free" to hurt themselves and to hurt others.  The most casual observation--from a safe distance--of many homeless people should be enough to convince an honest observer that the homeless have problems greater than the lack of housing.  Indeed, after committing an unknown number of crimes, many of the homeless end up in prison.  It's almost hydraulic: Empty out the mental hospitals, fill up the prisons.

In addition, Dr. Torrey advances the theory that schizophrenia is the result of contagion--a virus.   This theory flies in the face of the received neo-Freudian wisdom, that schizophrenia is the result of bad parenting of some kind.  And it also flies in the face of received neo-Marxist wisdom, that schizophrenia, like all mental illness, is the result of unjust social conditions.  And in the face of received neo-Szaszian wisdom, which holds that much mental illness is simply an illusion concocted by bureaucrats and Nurse Ratched types.  And in the face of neo-Foucaultian wisdom, which holds that mental illness is at least in part the result of society-wide sexual compulsion and repression.  The common thread running through these four "neos" is the general sense that the mentally ill are victims, and that society, instead, is at fault.

And there are plenty of others, of course, who see mental illness deriving from dysfunctional brain chemistry, brought on by genetics, vaccines--although the argument about vaccines and autism has been thoroughly discredited--and the overall environment.

In other words, Torrey's work has plenty of enemies.   But it also has plenty of new allies, we might note, as more and more ailments are discovered to be the result of bacteria and viruses.  For example, the 2005 Nobel Prize in Medicine went to two Australians who confounded centuries of received scientific wisdom by demonstrating that peptic ulcers come from bacterium Heliobacter pylori, and not, say, onions or tabasco sauce.   Indeed, in 2009, The New Scientist published a pathbreaking piece, "Six Diseases You Never Knew You Could Catch--citing new research on the communicability of breast cancer, prostate cancer, obesity, diabetes, obsessive-compulsive disorder, and, yes, schizophrenia.  Many of these new insights can be traced back to the work of Paul Ewald, an evolutionary biologist at the University of Louisville, and Gregory Cochran, a physicist and anthropologist at the University of Utah.

In other words, we could be at the edge of a new precipice of discovery--a new dawning of realization that much of what we have thought about disease was wrong, or at least insufficient.   If so, surely there  should be more Nobel Prizes for this work--perhaps to Torrey, perhaps to Ewald and Cochran.

But in the meantime, as Loughner reminds us, we are still reeling from the consequences of wrong-headed decisions.  If schizophrenics have a virus, not only should they be kept under supervision for their own sake, but also for our sake, doubly.  That is, not only might they be dangerous, in terms of violence, but they might be dangerous in terms of contagion.

And so to Rich Lowry's brilliant piece in National Review Online, and in his syndicated column around the country, in which he took on those who have worked so sedulously for so long to prevent effective treatment for the Loughners of our world.  As Rich wrote, this "madness lobby" is not only working out of ideological zeal, it is working because it is getting paid to work--the madness lobby's efforts are subsidized by the taxpayers.  That's right: We have been paying to keep madmen, and madwomen, on the streets.   The whole piece is well worth reading, but here's an excerpt:

President Obama was too sweeping when he said we shouldn’t point fingers. Our ire should be directed at the mental-health “advocates,” federal bureaucrats, and crusading civil libertarians who fight to maintain a status quo that makes it hard to treat the mentally ill. They are the madness lobby.

They aren’t responsible for Jared Loughner or his crimes. They do deserve the blame for a system that willfully lets people fall through the cracks and pretends diseased minds can make rational decisions. At its best, this system is cruel in abandoning the ill to their suffering; in exceptional cases, it is reckless in leaving dangerous people to do harm to themselves or others. The madness lobby helps make the literally lunatic act of violence a routine part of the American landscape.

A group of “anti-psychiatrist” thinkers provided the philosophical impetus for emptying our mental institutions. Thomas Szasz, Michel Foucault, and others ably demonstrated the power of idiot ravings to increase the sum total of human misery. Szasz compared psychiatry to slavery, while idealistic lawyers who wanted to vindicate the civil rights of patients launched an assault on commitment laws.

In a combination of foolish budget-cutting and misconceived compassion (some of the institutions were indeed horrors), states began to dump people out of mental hospitals in the 1960s. In his book The Insanity Offense, Dr. Torrey documents how, as the numbers of mentally ill in institutions declined throughout the 1970s and 1980s, the numbers on the streets or in jails increased. For many of the mentally ill, deinstitutionalization was essentially a shuffle — from hospital to prison.

In the 1970s, a Wisconsin court struck down the state’s civil-commitment law in a decision that reverberated nationally. In writing his 2008 book, Dr. Torrey visited Alberta Lessard, the schizophrenic woman whose case prompted the decision. Still untreated, she had spent time homeless and had never held a job, had been charged with ten crimes, and lived with constant delusions of people persecuting her.

In the wake of Lessard and similar decisions, it became the rule in most states to wait until someone is on the very cusp of suicide or murder to commit him. And it nearly became impossible to force the mentally ill to take their medication, in or out of the hospital.

Today, even with the human wreckage of its handiwork all around us, the madness lobby persists. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) funds efforts to liberate the seriously ill from their treatment. Writing in The Weekly Standard, Sally Satel recounted a case in Maine where a SAMHSA-funded outfit got a patient out of the hospital over the objections of his parents; he killed his mother with a hatchet two months later.
Mental illness is the only disease that has an influential lobby devoted to not treating it.

So there we have it.  If the Loughner issue fades away, not only will it be a lost opportunity, in terms of doing justice for the Tucson victims, but it will also be a lost opportunity in terms of safety and security for the rest of us.  

No comments:

Post a Comment