(re)commitments to mental health

     I've been thinking a lot about deinstitutionalization lately and what the communities that the mentally ill and intellectually challenged were released to have actually done in the aftermath. Access to care is a complication of our community mental health system today; cost, stigma and lack of providers are all major contributing factors here. My online discussion forum research on psychiatric patients has shown that this lack of care has driven some to seek admittance in institutions rather than have an aversion toward them and with the significant amount of foresight needed to accord with insurance guidelines. This is of course a dynamic phenomenon among this patient group and fear of hospitalization is still very salient in the discussions. 

    Almost 50 years ago, JFK addressed Congress in a message on mental illness and mental retardation (intellectually challenged). He stressed prevention and alleviation and was eager to propose 'cure' as an expected outcome of better mental health care, a view that would be considered rather chimerical today. In the contemporary, 'cure' is a much more precarious concept in the discourse on mental illness and neurodiversity at large. Positing institutional care as 'cold' and the community model as 'warm', JFK was right to see that a radical change of attitude, as well as policy, was in order but without the insight that 50 years of semi-effective initiatives on mental health have brought us, he lacked the sobriety toward therapeutic efficacy we now have. 

     At the time, this "problem unpleasant to mention, easy to postpone, and despairing of solution" was well due for national action but with a clear objective. Today, we know cure doesn't hold as an end goal and ideals are truly individualized. The hopes for today's mentally ill and intellectually challenged are the best possible alleviation of symptoms and a life with the least amount of disruptions and the most fulfilling. These are graduated rather than polarizing; successes include better employment prospects, a drug with less side effects and an overall better understanding of the brain to lessen stigma. These are goals I see as reasonable and better adapted to increase social integration rather than the elimination of these afflictions. Curative philosophies seem to miss what is so important in our approach to any measure of diversity; acceptance of difference to better face the challenges of today rather than trying to avoid difference altogether. The neurodiverse movement would abhor this exclusionary attitude and argue this is part of why stigma is so persistent. Some would argue that mental diversity is a gift and one should appreciate coming into contact with it (this is a more radical stance). What JFK said, however, was brave. He was brave to make it a priority within that sociopolitical moment and brave to point out the failings of the system as it stood.

     Last August, Barack Obama signed an executive order that outlined a strategy to alleviate mental health issues among military service members. His order addresses mental illness in a comprehensive manner and acknowledges, in many ways, the unique social circumstances PTSD and TBI (traumatic brain injury) patients face. Military service is truly a self-sacrifice that couples with an emotional burden civilians sometimes escape. Obama too has been brave for his actions in this sociopolitical climate. In the aftermath of the major shootings under his administration he has called for an attention to mental health access at a time when the link between mental illness and violence is contested at best and national anxiety clouds around the more tangible harm done by guns and physical violence rather than the internal harm these shooters have undoubtedly endured.  It requires a certain boldness to address such a disruption to our evolutionarily adaptive bulwark of emotional defense. It is, perhaps, an acknowledgment of a failing of society, the recognition of which can be dangerous. For now, the danger remains unseen, hidden in the cortical layers and incredibly versatile nuclei of the human brain. Now is the time to unearth that danger and confront the crisis with collaboration from the mentally ill and policy makers alike. Mental illness is a complicated experience, one that remains vague in its causation and obscure in its phenotype so let us proceed with the caution and sensitivity required to face such uncertainty.

References:

Barack H. Obama
      2012    Executive Order: Improving Access to Mental Health Services for Veterans, Service             Members and Military Families, August 31.

John F. Kennedy
     1963     Special Message to the Congress on Mental Illness and Mental Retardation., February 5.

AboutFace photo courtesy of National Center for PTSD