Friday, July 12, 2013

Cruelty and caring for the mentally ill...



If you Google the history of mental health treatment, you will find many articles detailing how we have struggled to come up with the “right” way to treat mental illness. Sometimes we have institutionalized the mentally ill.  And frequently those long-term inpatient hospitalizations were in institutions that were unsafe and inhumane. They also had nothing to do with real treatment.  Reading about Bedlam, which was one of the first mental institutions, it is clear that this is a pattern that has its roots deeply planted in history.  Bedlam used chains to control the inmates. The mentally ill have historically been treated as though they were less than human.

In thinking about that history, I am conscious that my family history has its own brush with institutionalization.  My maternal Grandmother spent years in a mental facility. At the time, I think that institutionalization was the primary treatment method for the mentally ill.  Did my Grandmother experience the type of inhumanity that characterized the types of long-term inpatient ‘treatment’ facilities of the time?  There is really no way for me to know.  But I doubt that my Mom’s birth family had the economic ability to pay for state of the art treatment.  So, it is pretty safe to make an ‘educated guess’ that her surroundings were less than stellar.  And what exactly was her mental illness?  Was she appropriately diagnosed? What kind of treatment did she get?  Did she really need to be institutionalized for the many years that she was?  I don’t know.  But I do know that we know a whole lot more today, and could probably more accurately determine her level of disability.  And we could also provide more useful treatment options.

At the time that my Mom was sick, there had been a push to deinstitutionalize the mentally ill.  Yet, mental illness wasn’t openly talked about.  Of course, there weren’t many options for treatment that didn’t involve having lots of money.  Or at least that’s what my family thought.  Additionally, when I questioned family members about why we couldn’t do something, I was told that unless Mom volunteered, there was no way to force her.  Since my Mom wasn’t suicidal or homicidal, at least as far as we knew, there seemed to be no way to get help.  The result was that we lived with an un-treated severely mentally ill woman for years.  As you have read in my blog, that was no walk in the park.  We really suffered.  So did my Mom.

So, fast forward to today.  I have considerably more experience with mental illness and mental health treatment personally.  In general, we have a great deal more knowledge about what mental illness is.  We better understand the biochemical basis for mental illness.  Medicines have progressed considerably.  We understand the importance of ongoing support to recovery.  We have knowledge of how other types of ‘tools’ can aid in recovery.  We know that the mentally ill really do have the capability of functioning with adequate supports in the community.  We have the knowledge to make this generation of the mentally ill the most productive and connected to society ever.  But access to treatment remains a problem. So does stigma. And so we don’t do what we are capable of doing.  In the whole convoluted and inhumane history of treating the mentally ill, that seems to me like the most egregious mistreatment of the mentally ill of all.  It was bad enough when we didn’t know better.  But to know and still not be willing to do something seems even crueler. It's time for us to do what's right.  What do you think?

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