Women at the understaffed Crownsville State Hospital in Maryland, circa 1955. Photo by Robert F. Kniesche/Baltimore Sun

Now is the time to talk about mental hospitals

Ben Lazar
Ben Lazar
Sep 2, 2018 · 9 min read

Two new stories have featured mental hospitalization promentaly in the past few weeks. First, the Associated Press reported that the culprit in the most recent brutally public shooting had two stays in a mental hospital years before killing two people and himself at a video game tournament. Second, a bill, number 1045 was sent to California Gov. Jerry Brown’s desk, backed by San Francisco mayor London Breed, that would allow homeless people suffering from addiction to be placed under involuntary holds, meaning the state would take conservatorship of them for 72 hours. This is a radical change from current policy, which currently only allows persons to be held if they pose a significant risk to themselves or others.

It is rare that we have opportunities to talk about mental illness, especially about the tricky and unpleasant scenarios of hospitalization. These two stories, and the reactions that they inspired are clear proof of this, because the webs of discussion around these stories demonstrate a clear lack of understanding about the issues that people staring down a mental hospital must contend with. The air must be cleared and the foul bitter realities of hospitalization and involuntary holds need to be addressed with an openness.

First and most basic: a hospital is not a “cure” if a cure is what we want. Even for illnesses of the body, a hospital is not the end. For a broken spine, treatment may involve months of physical therapy, operations, braces and medication, often continuing after the patient returns home . After a patient with a heart attack enters the hospital, they face hours of surgery, monitoring and a remaining life spent monitoring the heart and body.

The process is similar to the path of someone with a mental illness; just like with those physical ailments, anyone who wishes to treat a hospital like a mechanic will be disappointed. No one leaves a psychiatric hospitalization “cured”, whatever that term means. Because humans are complex and frustrating creatures, not one of them leaves the hospital and then re-enters society, another faceless autonoman. These things take time, and work. Some of that work can happen in the hospital, and this is what involuntary holds are intended for. These holds are meant to be the stabilizing work. A hold is a team of dedicated and brilliant doctors and nurses clinging to the legs of the patient and pulling them down as their head floats in the fog of madness. The hope is in that 72 hours, or longer if the patient consents, a plan can be set up to control the actions of the patient so that they are able to keep safe. This doesn’t always work (studies have put the rehospitalization rate within 90 days as high as 11%) but as a last resort, we as a society feel it must be done, especially in situations where the basic safety net of a home is absent.

This is the motivation behind the new bill on the governor’s desk. “You can either walk past them, watch them die on our doorsteps, or we can do something about it”, said state senator Henry Stern about people being helped by bill 1045, invoking the moral duty that we have to help those homeless living with mental illness and addiction. It is, on the first level, a noble goal; 72 hours in a clean environment, free from the pressures of life on the street, could in some cases be the clarity that those suffering need to recognize that their life does not need to be controlled by a substance. And though it is certainly not the end of anyone (except for those who die), the hospital is the best place to begin the journey for anyone with an illness. Indeed the inflation of the mentally ill homeless population came in the 1980s when Ronald Reagan slashed funding for state hospitals, sending thousands onto the streets or into prisons.

But as we learned in the news stories about murder in Jacksonville, just going to a hospital and entering treatment is not enough. For some people, staying safe is an uphill battle everyday. Just as walking after a spinal injury takes conscious thought and work with every step, for some of us being safe and sober requires effort that will never end, and this is the unpleasant truth that we don’t like to think about when we talk about hospitalization. These things take time, and for some of us 72 hours or two weeks or even two months isn’t enough time. Pretending otherwise would be folly, and it is that folly that California prepares itself for if they begin involuntary holds on those with addiction. An act of security theater, to make those ignorant about madness feel socially responsible. But this isn’t an open and shut door, healing never is.

Second: a hospital is not a place where bad people go, or even scary people. Because the world is a gruesome place, most of our conversations around mental health occur directly after murder or suicide, becoming colored with the blood of the dead and gun politics and discussions of the useless term “terrorism”. Humanity is lost with the first news story; the American news cycle immediately becomes an eighties action movie, filled with the exaggerated villains of Alex Jones, Marco Rubio, and evil corporations like the NRA and Big Pharma. So when the news comes out that a killer had spent time in a hospital, I feel a need to laugh because it is all so perfect. The idea of mental hospitalization was introduced to me by Arkham Asylum in Batman, it is only fitting that the lockup of the Joker would produce murders and suicides. Psychiatric hospitalization takes on a mythical and theatrical tone; those on the inside are on the outside of society, they are the fringes who scurry to their grimy prisons because it is the underground where they feel safe.

It’s not like this, certainly not now. A mental hospital is more than anything else a home for sad people. Mood disorders, such as depression and bipolar disorder, are the cause of most hospitalizations. The crazies all locked up in the loony bin are not dramatic or theatrical; like most people, they are in pain, and would simply like to be free from that pain for a little while. Even those with the more “dramatic” illnesses find themselves in this bind, one that is universal to the experience of conscious beings.

After you have been around them for a little while, or better yet felt what they feel, people with mental illness stop being scary. They almost stop being interesting. When we read the news about murders and suicides, we are reading about those with mental illness on their worst day, the day where they couldn’t say no to their impulses anymore. These are scary days, and ones that those who live in this world of insanity are all too familiar with. But most days, especially for those in the hospital, are days of boredom and work at keeping the demons at bay. They are quiet. Days at the hospital are not days where the villians of society plan their violence, they are days like any other, lived by people who are not altogether different. It helps our fragile super-ego to push the killers and suicides into Otherness, but doing so is inauthentic; perverted acts are committed by people, people that we may not know, but people. Certainly not the cartoonish villains created by the gun lobby as redharrings

Third, and essentially the same, and finally: a hospital is not a prison, the “ill” are not the villains. Earlier I mentioned that many of those in state care when the hospitals closed ended up in prisons. Early mental hospitals were like prisons, and films like Titicut Follies depict violations of the ill that would not be out of place in American prisons today. But if we further emphasize this reading of hospitalization, we doom ourselves to never getting better. If a hospital is where the bad people go, then why would any person who wants to be good ever go there? Our knowledge of the hospitalizations of the killer of Jacksonville is a deliberate attempt by the hegemonic ideal to remind us that those in hospital are dangerous lunatics, whose desires are not the desires of the moral upstanding member of society.

We of course have bought it, in a way that is very interesting. In the hours after a shooting occurred at a video game tournament for the comically violent sport of football, users of Twitter became a collection of little media theorists, acting as though they were the first to understand that news media is racist and represents killings differently depending on ideology. Regardless of race or religion or espoused motivation, desire for homicide is a sign of mental illness. The fact that news media makes racist labels of terrorism and “thug” for non-white killers does not remove the fact that anyone who kills is acting at the behest of some sickness that encourages them to forget their deep inherent empathy. Saying “the shooter had a history of mental illness” is not an excuse, it is an explanation. This explanation could inspire resentment and hatred or empathy for a killer, who like everyone dealt with demons, and unlike most of us was unable to deal with them any more. In a fascinating display ideological internalization, in certain circles the label has inspired the resentment instead of empathy. The ill person becomes the villain as an attempted rebellion against news media and NRA who use “the shooter had a history of mental illness” as an excuse. The million fragile white commenters will see this as an attack, not on the mentally ill, but the whites, and be sure to crow about “black on black crime.” None of this helps any one, least of all the “villain”, who is now dead, who was the one person whose actions needed to change. It certainly doesn’t dissuade the killers of the future.

Returning to to bill 1045, we see a link to a larger issue in America, which is the villainization of those who are useless. Those who could be held if 1045 passes are useless to the institutions of capitalism; addicts and the severely mentally ill don’t buy a variety of products (unless that is their illness) and they aren’t known for their reliable exploitable labor. Every spiked window sill and sit lie law communicates to homeless people that they are the villains of this society. Every failed attempt at Medicare for All, every tabloid rag “story” about addicted celebrities communicates to mentally ill people and addicts that they are the villains of society. We do not need to further communicate this dehumanization by locking up our sick as though they are animals.

I said earlier the goal of hospitalization is a noble goal on the first level. On this second, it is a despicable one, especially when it is driven at in concentrated efforts like with Bill 1045. This bill smells like the programs that load San Francisco’s homeless on busses to as far away as Indianapolis; it is another bid to move those on the outside of America to places less visible . Bills like this one are reactions to the devils that create sickness and poverty, but they are well crafted; knowing that the mental hospital in the American psyche is a prison for terrifying monsters, the backers of this bill know they will have safe careers locking up the troubling addicts in their districts for 72 hours. The NRA knows they will have safe careers villainizing the human beings in need of help instead of the tools used for murder. Life will carry on as normal, because the useless people are either dead or in their hospital-cum-jail.

My error in this entire piece was the assumption that anyone can go to the hospital if they need. This is certainly not the case. A week long stay in an American mental hospital can cost thousands, which could be a life changing amount for the millions without any insurance. One in five Americans say that they of a family member didn’t receive mental health services they needed, and of those Americans 25% say that they couldn’t afford the care or insurance wouldn’t cover it. Another 10% said that they were embarrassed to seek care. The city of San Francisco cut $40 million dollars out of the budget over six years that was allocated to behavioral health centers. And America has 6 vacant homes for every homeless American. The home and the hospital are apparently privileges, not rights, and as long as this is true we cannot expect to change our attitudes and ideologies.

These are the facts. We are a country that makes our mentally ill citizens feel like villians, that overcharges for our hospitals (which start to feel like prisons), that bars it’s citizens from houses. These are the unpleasant words that must be said when the words of “mental hospital” and “mental illness” appear in our headlines after death.

The National Suicide Hotline in the United States can be reached at 1–800–273–8255. Numbers for other countries can be found here.

Ben Lazar is a media student in San Francisco. He tweets here and also wrote about mass shootings after Parkland here.

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