Friday, December 03, 2010

Post 2700 - Disabilities Rights Center

Every state has one - a nonprofit dedicated to protecting the rights of people with various disabilities. This is New Hampshire's. You'd think that for a civil libertarian type such as myself, they would have a good reputation with me. I grudgingly have a mildly positive view of them in general. They do very good work badgering, cajoling, advising, threatening, or suing other agencies on behalf of people with other types of disabilities to receive more services.

But in mental health, they reverse field. They badger, cajole, advise, threaten, and sue mental health agencies to provide fewer services. That's not how they would describe it, but that is the practical effect. Mental health services are seen as an intrusion and burden that should not be placed on people who don't want them. And I will not be dissuaded from the belief that such is exactly their opinion of mental health services, however much they deny it. I have observed them and interacted with them for decades. Ultimately, they think that people really don't need these services, and that the evil MH system goes around trying to force ourselves on people who could just as well be left alone.

I get the civil liberties part. I get the concept that people have the right of self-determination, and the state does not have the right to interfere with a person unless the state can show a necessity for doing so. But that principle fails to take into account that lack of insight is one of the symptoms of several major mental illnesses. Depressed or anxious people seek services. They want relief, and are sometimes only too willing to try treatments that are more risky than they would otherwise entertain. The personality disorders are mixed, sometimes demanding services, sometimes evading them, and often both: help-seeking and help-rejecting at the same time. But those with schizophrenia and other psychotic disorders, or those with affective disorders on the manic side, often think that they're doing just fine, and it is everyone else who doesn't get it. Lack of insight is a symptom, and there are detectable brain-reasons why this is so.

I testified at a very complicated hearing on one patient today and cleaned up the legal confusion on another who was discharged back to jail yesterday. In both cases, the procedures put in place to protect them from receiving treatment because they think they don't need it, have resulted in both patients having miserable, isolated lives, rejected by friends and family and frequently in trouble with the law, because we are not allowed to give them the treatment they need. And the DRC is dead-center in this. Our current policies are based around the idea that someone's artsy and eccentric wife is going to get locked up for years because the fascist overbearing System is going to squeeze all the life out of her by giving her mind-numbing chemicals and make her into a zombie, depriving the world of the next great advance in sculpture. Or something. And to effect this protection for women in Birkenstocks, as if they are in constant danger of being silenced, we willingly sacrifice the lives of hundreds of intelligent, decent people, putting them on the altar of pretended dignity and slicing their throats.

They are stuck at the college bull-session "What is reality?" stage of philosophical understanding, selectively quoting Thomas Szasz. (I dare them to take his whole philosophy seriously.) They would not for half a second entertain the idea that brain injury or paraplegia were merely alternate ways of experiencing reality, but they willingly grant that to schizophrenics, who by definition misunderstand reality.

Okay, I'm done now. Rant over. Tomorrow I go back to explaining NH's RSA 135:C to people who believe that the vent over the cat litter box has made the air in their house dangerous and caused silica to clog up their veins, and that's why they drew a gun on their daughter who didn't believe them and wanted them to go to the hospital; or that the government has implanted a chip in their brain that makes them hear voices.


Michael said...

One of the first times I was appointed to represent someone that was mentally ill, I was appalled when Judge Cloutier said words to this effect:

"OK, so she's on her meds and she feels better and we release her back into the community where she thinks she is fine and then stops taking her meds and next thing you know she is back here in front of me. Involuntary commitment granted."

As a young lawyer, I was appalled at his lack of consideration for her "civil liberties". After I represented a few more of these types of clients, I realized he was spot on. I don't do much of that work any more, but I think the NH judiciary misses that type of practical approach in the judiciary.

Dubbahdee said...

"Protection for women in Birkenstock..."

Brilliant turn of phrase.

Oh, and your main point is good too. It's just that I have nothing really useful to add other than applaud.

Retriever said...

Amen. A relative has this lack of insight into their illness. Year after year, dozens of hospitalizations, but it is still the Evil husband (1, 2 and 3), the stressful job, the uncaring neighbors, the fascist police, the FBI listening on the phones, the cruel world, etc. that are to blame...The person, when manic, has thought processes as bizarre as any schizophrenic. And violent. Mercifully, lives far away. God forgive me for being relieved. At least in England you used to be able to section a person for months at a time. It didn't cure them but it kept them (and others) fairly safe until (hopefully) meds took effect or the episode ran its course.

The current "care in the community" is BS. Some people whose conditions do not respond to meds (even when they are willing to take them) need time in hospital (and their families need somewhere safe for them to be or the family members are at risk and/or lose jobs while keeping the person alive).

But I will cut my rant short...

Donna B. said...

A minor quibble, but living with physical disabilities IS in some respect an alternate way of experiencing reality. Or, at least dealing with reality.

Brain injuries definitely change the ways in which one thinks also, but not in the way "defined" mental illness does. Lack of insight is often present, but the cause is different and so is the result.

There is often little worse that can happen to one suffering "mental" problems due to a physical brain injury than to be "dumped" into the mental health system.

Neither the patient nor the system can cope.

Assistant Village Idiot said...

Donna, I did think of this while writing that line, but thought the additional explanation too lengthy. Downs Syndrome is certainly an alternate way of experiencing reality, too, but I was thinking of the phrase in the sense of "lifestyle choice" or "mere eccentricity."