While it's well known that "homeless" is often code language for mentally ill people with bad hygiene, a lot of people don't realize the amount of money which is wasted on people in need of longterm care, but who instead tax society's resources by consuming piecemeal emergency "treatment."
Especially ambulances. Just ask San Francisco paramedic Niels Tangherlini:
"...I don't want to get into a war with the advocates, but I strongly disagree. We get some of these guys into supportive housing and they can't handle it."
And most of all, Tangherlini thinks that the current system of support, where a 911 call sends an ambulance rushing out to treat someone who is likely to be a "chronic inebriant," is an ongoing disaster. Some of those who call clearly need medical care, but many are using the ambulance and the Fire Department as a personal taxi to the emergency room. He says it is stressing the system, the care providers and the city's financial well-being.
So who is Tangherlini, and how can he say these things?
On one hand, Tangherlini is a local success story. A paramedic with the Fire Department, Tangherlini went back to school for a degree in social work, then pitched the city on his idea that, instead of an ambulance and fire truck, "what a lot of these people need is a van with a paramedic and a social worker."
Here's Cramer's conclusion:
The pleasant little theory about deinstitutionalization was that the severely mentally ill would end up back in their communities, receiving community-based psychiatric treatment. It didn't happen, because many of the mentally ill are not sufficiently well--or at least, not consistently so--to hunt up all the social services that they need to keep from freezing to death, or dying of pneumonia, or getting murdered by either other mentally ill homeless people, or common thugs looking for a thrill. As much as the mental hospitals of the 1950s were denigrated as horrible institutions, they at least simplified the providing of basic services to many of the most seriously disturbed parts of our society. What we are doing today in places like San Francisco is not only cost inefficient, it is profoundly inhumane.
Inhumane is exactly what it is. I remember riding the New York subway once and being overcome by the stench of a man who was sleeping on five or six seats. The car was nearly empty, and people kept moving out of it and into other cars simply because the foul smell of rotten vomit and fecal material was strong enough to make a normal person wretch. (Really, the people leaving looked like they were going to get sick if they stayed.)
"We'd never treat a dog that way!" I remember thinking at the time.
And we wouldn't. Because, to our enlightened way of thinking, dogs have the right to be cared for when they are clearly unable to care for themselves, whereas humans don't. In the name of some perversion of "rights" theory, humans are allowed to rot away in public places, because society has no right to help people who are clearly unable to take care of themselves if they are unwilling to accept help.
Hmmm....
I'm wondering why the animal rights people don't make the same argument about dogs. Why isn't the argument made that they have just as much right to live in squalor and disease in the streets as people do? Don't "rights" work that way? Or is it the old "some animals are more equal" thing?
(I don't have the answer. It's just one of life's many contradictions.)
posted by Eric on 12.22.07 at 04:52 PM
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The pleasant little theory about deinstitutionalization was that the severely mentally ill would end up back in their communities....
I don't necessary disagree with Cramer's conclusion, at least superficially. However, I doubt that the "pleasant little theory" actually included the deinstitutionalization of the severely mentally ill. As I recall, back in the late sixties and early seventies, there were a good number of patients who were suffering from cerebral palsy, Down syndrome, early-stage ALS, and other such conditions who were just "dumped" into these places. Of course, such patients do much better -- physically, emotionally, and mentally -- when placed in assisted-living arrangements.
I honestly don't know how, when, or why the deinstitutionalization of the moderately disabled to smaller assisted-care places -- especially as better physical and pharmacological treatments became available -- abruptly expanded into the wholesale discharge of the severely mentally ill, but I'm willing to bet that someone, somewhere, someway is making money on it.
The real problem is the people in the middle. Those who are in reasonable shape one week and terrible the next.
A lot of them won't take the drugs. Why? Because if you look at the contraindications on many of those drugs they are flat out poisons. Some cause uncontrollable muscle tics that don't go away when the drugs are stopped. They cause permanent liver damage. And to top it all off they have warnings that long term use is not advised.
Andrew Dawson - please explain how some one semi-permanently not in their right mind can be held responsible. It is folks like you who give libertarianism a bad name.
Sociologist Erving Goffman wrote _Asylums_ in 1961, using mental institutions as an example of how any institution works, as to motivations of various participants and their views of what they were doing.
It was taken as proving that mental institutions were frauds, rather than his actual discovery, that any institution's accounts of itself are far from accounts of what is happening ; mental institions might or might not still be valuable and desireable.
It is such a great and readable book that it got wide circulation, and so had this unintended effect in the end, of eliminating mental institutions.
"However, I doubt that the "pleasant little theory" actually included the deinstitutionalization of the severely mentally ill."
Actually, it did. Several movements collided in the 1950s and 1960s. The most foolish was the conclusion that because World War II soldiers suffering from combat fatigue (men who had been healthy entering the service) responded so well to psychiatric first aid stations, that the same approach--community-based mental health care--would work for psychotics in civilian life.
The antipsychiatric movement of the 1960s built on Goffman's book _Asylums_, but also on the emerging delusions of Thomas Szasz, R.D. Laing, and Michael Foucault, that psychosis did not exist; it was just a mechanism for social control. While Szasz was pro-capitalism, Foucault claimed that capitalism invented the concept of mental illness as an instrument of economic control (ignoring that non-capitalist systems have always recognized mental illness).
Ken Kesey's _One Flew Over the Cuckoo's Nest_--written after Kesey dropped LSD before going to work in a mental hospital--profoundly influenced a generation of thinkers. And it was as accurate and meaningful as something written while taking LSD.
The Anti-Idiotarian Rottweiler
Don?t bang your head!
The pleasant little theory about deinstitutionalization was that the severely mentally ill would end up back in their communities....
I don't necessary disagree with Cramer's conclusion, at least superficially. However, I doubt that the "pleasant little theory" actually included the deinstitutionalization of the severely mentally ill. As I recall, back in the late sixties and early seventies, there were a good number of patients who were suffering from cerebral palsy, Down syndrome, early-stage ALS, and other such conditions who were just "dumped" into these places. Of course, such patients do much better -- physically, emotionally, and mentally -- when placed in assisted-living arrangements.
I honestly don't know how, when, or why the deinstitutionalization of the moderately disabled to smaller assisted-care places -- especially as better physical and pharmacological treatments became available -- abruptly expanded into the wholesale discharge of the severely mentally ill, but I'm willing to bet that someone, somewhere, someway is making money on it.