The Public Conversation on Mental Health and Dangerous Legislation: Part One
content note: voluntary admission to a psych ward, medication, suicidal ideation, ableism, institutionalization, abusive treatments
The gown was too big and I had to hold it in place. Later I changed into thin scrubs, and skid-proof socks. I cried hysterically upon arriving on the ward. They handed me pills and a paper cup of water. I somehow still asked if they had made sure the medications didn’t interact with the ones I was on, despite having a not-subtle death wish in my head.
One person, later in my stay, lay down on the floor, doing no harm to anyone. They picked them up and medicated them. The staff made noises of pity. I wondered what was so wrong about the floor. Then again, I am autistic and mentally ill. Of course the floor might make sense to me.
I thought a lot about my blog, and other social media I was not allowed to be on. I thought of the things I was supposed to write for work and ended up writing poetry on printer paper instead.
The psychiatrist only saw me once a day; one of the therapists really wanted me to go to groups. They unhooked the phones during groups. I only had two phone numbers to call anyway. Someone brought me books on disability to read in the psychiatric ward. It would have been more ironic if they’d brought me Mad in America to read.
My roommate liked looking at the skyline at sunset and I turned and watched the light falter into darkness much the same way my words became staccato-like between tears. I didn’t get to know other people or their stories. Already I got attached to some of them without knowing them. I wanted to go back and talk to them after I left, but I never did.
I was a mental patient, and occasionally I wonder if the hospital stay will be one of more to come. I left within a few days, insistent on leaving so I did not develop a dependency on the hospital to keep me safe. I proceeded to blog about my hospital stay and the executive order passed down by Obama.
I had sent myself to the ER; voice shaking, I explained in a dull voice through tears what plans and impulses had formed in my head. With no one to sit with me and keep me safe and avoid the hospital, I had few options available to me.
There is a need for reform. It seems to be the only thing anyone can agree on — but on how to enact reform, there are split ideas. The public conversation on mental health tends to push toward forced treatment and stigmatization, throughout history and now. Mental patients like me, many disability rights groups, and some LGBTQ+ groups have different opinions. Mental health care should be accessible for those who want it, safe to get, and destigmatized.
There is no current 24/7 system for care that is not a hospital if it’s needed. You either work with someone who has a 9–5 job, go during the day during a partial hospitalization, or stay several days or more in a psychiatric ward of a hospital. It would be wrong to deny the need for better community care and alternatives to the sterile wards of hospitals. Some of these were converted from the same state hospitals that so many psychiatric survivors organized movements en masse in the 1960s to close.
The funding promised in the Kennedy administrative era for community living has never been put to proper use. The current incentive for state Medicaid programs prioritizes nursing homes for people with disabilities instead of at-home care. The alternatives for many places we end up, like hospitals— peer support and respite centers — get a sideways glance. The state hospital doors began to close in the 1960s and 1970s, and the doors to the community never swung open.
Congress is tackling the issue, right? Not really. In 2013, just after the media ran their usual rounds of calling the Sandy Hook Elementary school shooter mentally ill and disturbed, Rep. Tim Murphy (R-PA) introduced legislation that is currently known as the Helping Families in Mental Health Crisis Act (H.R. 2646).
To some, it seemed like a solution to the country’s “mental health problem.” It seemed like a godsend from the name alone. The Murphy Bill, as it is known among many organizations, has received its support from a country desperate to find a solution to the growing issue of incarceration and hospitalization of people with mental health needs, and those who believe that mental health should be inextricably linked to gun control policy and/or forced treatment.
The Murphy Bill has been met with sharp criticism from mental health self-advocates and disability rights groups, myself included. In its current form, the bill would:
- strip HIPAA rights for anyone in treatment with a doctor or therapist for mental health needs,
- strip a great deal of funding for and place restrictions on the portion of protection and advocacy agencies (P&As) that serve people with mental illness (this program is called PAIMI)
- provide more federal funds for institutionalization. This will mean less focus on community-based services.
- This includes cutting the budget for the Substance Abuse and Mental Health Services Administration (SAMHSA)’s community integration projects.
- encourage states to allow forced-medication programs by providing financial incentives to do so. These would be through court systems.
The people affected only need have a DSM diagnosis that “substantially impairs” function. This could include gender dysphoria, which, while not a requirement for being transgender, is common in transgender individuals. In addition, as several organizations put it: “LGBT individuals are disproportionately affected by mental illness, face pervasive discrimination in health care settings and can experience unique vulnerabilities when denied privacy or decision-making power in their treatments.”
Throughout history, there has never been question that people with mental illness belong in the care of doctors and need to be contained. It was clear following the theories behind what could have caused our “madness” and “lunacy” that in turn followed the treatments of bloodletting, electroshock, lobotomies, and neuroleptic drugs, that for all the supposition, few thought to talk us through our crises and treat us as human.
It was clear when in the 1800s, the “mad trade” flourished and we were treated as commodities to be placed in “madhouses” and treated by “mad doctors,” passed around from one location to another and gawked at by the public. They were safe from us, but we weren’t safe from them.
It was clear with the albeit altruistic intent of asylums to keep people safe with the rush of asylum-building in the 1840s, and care turned more and more to the custodial warehousing that is still common in placing people with disabilities in nursing homes today. The public was safe from us, but we weren’t safe from institutional abuse.
It was clear in the 1920s and 30s, when the eugenics movement took its grip, and states created laws to keep those with developmental, intellectual, and psychiatric disabilities from marrying — as well as laws to sterilize them, especially those in institutions.
It was clear in the 1960s, when the Parkinson’s-like symptoms of neuroleptic drugs were systemically ignored by doctors, and they chemically restrained us to shuffling gaits in the halls and staring at TVs for eight years, their minds feeling like cotton, as some patients reported their experiences in the hospitals.
It is hard to think about where I would have been with each of those stages. Among other things, I have severe depressive episodes and bouts of generalized anxiety. My gender identity and sexual orientation would be fodder for symptoms, as it was for a person who expressed themselves by dressing in men’s clothing after the death of their husband instead of the “appropriate” women’s clothing, one of the reasons for their subsequent commitment.
It is clear now, in 2016, that if the Murphy Bill passes, the means to contain us once more in various fashions will be at hand and the funds for community care will trickle further away.
The public conversation is something of a dangerous curiosity. It believes the best course of action for mental health needs is treatment with hospitals and drugs and therapy, even if forced. It professes to want us to seek help on our own and demands to know why we haven’t gotten help yet. Then, after most mass shootings, it raises the stigma higher and higher by blaming us, people with mental illness, for the shooting. It affects lawmakers and the President and solidifies their opinion of us into the thought that we are a public health threat and in desperate need of containment and treatment. It then shames us with stigma for being a mental patient once we have entered the system.
It doesn’t factor in the many other reasons why people might not seek care, including personal autonomy, previous bad experiences, and racism, sexism, homophobia, ableism, and transphobia in health care. Medical professionals are not exempt from casual or blatant forms of bigotry.
What probably should not happen is the Murphy Bill passing, a product of the public conversation on mental illness. This public conversation on mental illness has resulted in dangerous legislation, a push for modern asylums by ethicists and some psychiatrists, and a blatant call to keep us from exercising our rights.