Psychotic Disorders Do Not Respect Autonomy, Independence, Agency, or Freedom

tell me more Susan

All political debates are subject to the imposition of emotion and the distortion of bullying, but I know of none where that is more true than with the issue of involuntary commitment. I never think of myself as a contrarian or try to be divisive for divisiveness’s sake, but I have a lot of positions on which I’m out on a lonely hill. Somehow, though, no corner is lonelier than this one. As I’ve said before, most people continue to allow their perception of mental healthcare to be dictated by One Flew Over the Cuckoo’s Nest and other pop-culture fantasies that have nothing to do with reality; they assume that it’s very easy to fall into “the system” when in fact we’ve had 60 straight years of involuntary treatment getting harder and harder; and they bend the public perception of mental illness further and further in the direction of “mental illness is just adorable personality quirks!” and in so doing ultimately hurt the most vulnerable. Every step we take towards seeing the severely mentally ill as inherently harmless and “valid” is a step we take away from fully and compassionately understanding the depths of their problems. Real severe mental illness is constantly painful, periodically debilitating, always ugly, and sometimes violent. If you aren’t willing to admit to those things you will never be a friend to the severely mentally ill.

I have a friend who’s a front-line social worker, someone who tries very hard to provide the kind of voluntary mental health services that nobody has any issues with. It’s hard, dispiriting, low-paying work, and it’s the kind of role that’s increasingly disrespected by the activist class - you see, to be a government social worker is still “carceral,” whatever the ever-loving fuck that means, and anyway there’s nothing wrong with the mentally ill, they’re fine and have no problems and it’s stigmatizing to suggest that they need help. My friend was telling me about a homeless man who had a ghastly wound on his arm that was clearly gangrenous. Her colleague told her that if they didn’t get him into care immediately he would lose the limb. This information was relayed to him. And he refused care. Sitting there with an arm that was literally rotting off of his body, at incredible risk of spreading infection and death, he shrugged off the possibility of getting help. And do you want to know why? Was it because he was rationally exercising his personal freedom, expressing his individual choice, luxuriating in his adult autonomy? No, it was because he was very very sick, and the illness he was suffering from prevented him from understanding reality.

And this is where fantasies of totally and permanently non-coercive mental healthcare collapse, will always collapse, must collapse: there is no such thing as autonomy or freedom or personal choice under the grips of a mental illness that hijacks the mind. You think involuntary treatment obstructs freedom? Schizophrenia obstructs freedom. You think involuntary treatment tramples on autonomy? Bipolar disorder tramples on autonomy. You think involuntary treatment denies personal choice? Schizoaffective disorder denies personal choice. It’s nonsensical to speak about preserving the freedom of a psychotic person! A psychotic person cannot be free because psychosis obliterates true freedom through the imposition of delusion and hallucination. If you drug me and make me sign a contract, no one sees that as an expression of my personal freedom because my action was not the expression of my authentic and undistorted will. If you deceive someone in an effort to get their money, you can be arrested for fraud even though the person whose money you took explicitly said you could have it. Because that person wasn’t actually expressing autonomous behavior thanks to the deception! To be psychotic is also to be deceived. To be severely mentally ill is to be held hostage by internal forces that are not you. This destroys every argument about personal freedom and choice, permanently and totally. Opponents of involuntary commitment never talk about this point or even attempt to rebut it because they know they can’t. They just get mad about it.

Now. Let’s meet Emma Williams. She has thoughts about my essay on Jordan Neely and involuntary commitment. Click through to expand the thread to get her full thoughts. Don’t worry, it won’t take long; you won’t encounter any complexity there. Only thoughtless, unthinking, dismissive righteousness. She and everyone I’m going to quote here is an adult voluntarily engaging on a public forum. Remember that.

Ms. Williams, a self-described “student of Black abolitionist feminism” - truly, a brave stand in the world of urban nonprofit organizations - is a policy analyst for Cabrini Green Legal Aid and for the “Prison Policy Initiative,” which is a dispatch from some future Star Trek series where prison abolitionists actually think they’re going to live to see an end to prisons. (As opposed to here on planet Earth, where they’re B-tier liberal arts college grads looking for a cush job where no one expects results.) What does she know about involuntary commitment? I don’t know; in all of those tweets, she advances no sense whatsoever that there are reasons why involuntary commitment exists, refuses to ask if sometimes it’s necessary, demonstrates no knowledge that it’s gotten much harder rather than easier to get people into involuntary treatment over time, and certainly not even the slightest hint that there’s something that she could learn from me or my piece, that there’s anything she doesn’t already know. Involuntary commitment, you see, is like prison, sort of, if that’s your thing, and so it just is prison, and all we need to do is fart out the same tired cliches that have done precisely nothing to improve the world for the marginalized and the incarcerated in three years of bleating about them. All she knows is that an idea flitted across her consciousness that she didn’t absorb in some utterly pointless meeting in a stuffy nonprofit meeting room that “the marginalized” wouldn’t be caught dead in or from a C-tier CRT paper she didn’t really read in college. So she was against it.

Here we have a think tank apparatchik who cannot be bothered to actually think, shrugging off an issue of the most exquisite complexity imaginable with a diffident and unconcerned smirk. Well, Jessica, let’s talk about James Holmes. I understand that it’s gauche to talk about the victims of the severely mentally ill - it’s in fact unpopular to suggest that the mentally ill could ever have victims - so let’s ignore the massacre he committed and focus on Holmes’s life itself. Holmes was flagged by multiple people as a potentially dangerous person, displaying clear signs of incipient paranoid schizophrenia, and these fears triggered a psychological evaluation. But since the professional and cultural and social incentives in mental healthcare point directly away from involuntary commitment, despite the assumptions of people who don’t know anything about the subject (like Jessica Pishko), Holmes was not held, and instead went on to soak the floor of a movie theater with blood. The result of that action was that Holmes was permanently incarcerated. Had he been forced into compulsory treatment, he might have lived a stable and healthy life as a neuroscientist when he emerged. We don’t know for sure. We do know for sure that, in this world where he wasn’t sectioned, he’ll die in prison. So, Jessica, from the point of view of incarceration: should James Holmes have been involuntarily committed?

Incidentally, someone from the New America Foundation - the fucking New America Foundation - complaining that other people are “center-left” produces a level of irony so great it defies evaluation. Who do you think you work for?

I agree - we should always do exactly what people who have been involuntarily committed say we should do when it comes to mental healthcare. I’m sure that will never result in any obvious and glaring contradiction.

For the record “to be in this work” means “to be in the business of glad-handing donors so that I can file reports justifying my salary in a nonprofit system that has been repeatedly and conclusively demonstrated to be in the business of perpetuating problems rather than solving them.”

Really? That was his only problem? A man who suffered from schizophrenia, depression, PTSD, suicidality, use of dangerous substances like synthetic cannabinoids, hearing voices, transitory body numbness, and a host of other medical problems brought on by mental illness? Poverty was his only problem? Why do the vast majority of people in poverty not suffer from those conditions? This is the nadir of a certain liberal attitude towards “underlying conditions” or “the environment,” the kind that compels people to imagine that severe mental illness just isn’t real, that if you could just give people envelopes of cash, suddenly they wouldn’t be paranoid, wouldn’t suffer from delusions, wouldn’t be at dramatically higher risk of self-harm, wouldn’t have psychotic breaks. It’s a good example of progressive sympathy for the mentally ill that leads them eventually to ignore and minimize the mental illness itself and leave the severely ill worse off. For the record if you click around in the replies and the quote tweets you’ll find that there’s a loooooot of straight up anti-psychiatry cult stuff - not just “involuntary treatment is bad” but “psychiatry and all psychiatric medications are bad and it should be totally abolished.” Does Emma Williams like rubbing shoulders with those people? I kind of doubt she’s even thought about it.

(Are there very wealthy people who are very mentally ill? Yeah, of course.)

I have not, in fact, scoffed at the idea of paying for people to have homes, have advocated for socialized housing for my entire adult life, and have worked in local housing activism for the past six years. In this person’s defense, it would be very convenient for them if I was in fact opposed to funding for housing, which is just about the same thing as me actually being so opposed, right? Right?

(psst having the hammer & sickle and anarchist A right next to each other is completely intellectually incoherent if you take either philosophy seriously and makes you look like a know-nothing edgelord)

Your wit is sparkling, Sarah. Quick question: what does “saving Jordan Neely’s life” entail? I’ve already written, multiple times, about my feelings towards Neely’s murder, the injustice of it, its profound and peculiarly American tragedy. I’ve also seen Sarah’s sentiments here represented as some sort of checkmate. Which is bizarre when you consider that, had Neely not been killed, absent real and sustained involuntary treatment he would be right back where he was - sleeping on the subway and on park benches, hungry and emaciated, subject to debilitating paranoia and terror, at the mercy of the violent tendencies of his psychosis and vulnerable to the violence of others. Is that “saving his life”? All of these “just don’t choke him to death!” bromides, formulated to receive social media clout rather than to help the mentally ill, have absolutely nothing to say about how to actually help someone like Neely live a healthy and happy life. We know for a fact that he was offered voluntary treatment many times and that he went off meds when he took it or else declined care entirely. We know he was offered many kinds of social services. We know he was involuntarily committed, but because it’s even harder to keep someone in treatment than it is to pull them into treatment in the first place, he was released unready to take care of himself. And that’s how he was left, eating out of trashcans and babbling to himself on the subway. Would you call that saving his life, Dr. Sarah? I wouldn’t. (Fixed it!)

Well, yes, it’s true: if Neely had received prolonged and sustained treatment, instead of the too-brief holds that did not afford him nearly the time necessary to get better, then perhaps he would have been able to avoid having to live on the subway, which then would have kept him out of the range of Penny. The suggestion that this means that Penny is not responsible for Neely’s death - well, if I said “that woman who got beaten by her husband should have had better resources for escaping him,” would that be excusing the husband? Well, no! No it wouldn’t be! And you’d have to be an absolute fucking dullard, just an immense gaping failure of a human intellect who’s just trying to fling shit online and hasn’t spent five minutes thinking about any of this, to make that leap of logic.

Hey, “Michael,” since you’re a self-described tankie: ever read a book about what the USSR did to the mentally ill?

Yes, Jordan Neely needed a home. But a home is a lot more than a place to sleep. He had, for awhile, the opportunity to stay with his grandparents. Unfortunately, Neely’s illness made him too unstable to take advantage of this home. If someone had walked up to him the day before his killing and handed him the deed to a house, he would still be a profoundly, profoundly sick and vulnerable person. A neighbor of the Neelys was interviewed and said

“They wouldn’t let him inside sometimes at night because they were afraid of him,” Berry told The Post. “I never saw him violent myself, but I saw him sleeping in the hallway in front of the [grandparent’s] door a lot.”

“My wife would fix him a plate of food sometimes, and I’d give him a couple dollars,” Berry said. “There was something a little mentally off about him, but we all knew what happened to his mother. It’s a sad situation.”

“Jordan didn’t deserve to die,” Berry said. “I hope some justice comes out of this situation.”

What prevented Neely from having a place to live was not just poverty, or our perennial lack of housing, or discrimination. What also prevented Neely from having a home was his illness itself, which these people refuse to take seriously. The illness itself was a problem. The illness itself was an injustice. The illness itself was tragic, ugly, painful, and ultimately deadly. Why so many have decided that the way to take mental illness seriously is to absolve the illness itself, I’ll never know. I’ll never understand. And I don’t want to.

Jordan Neely didn’t deserve to die. I don’t know what a prison abolitionist like those in this Twitter thread does with Daniel Penny, but I’m happy to say he should go to prison. Call me crazy! For Berry’s larger hopes, hopes for justice, I’m afraid I have little optimism. No justice will be forthcoming because we refuse to have a serious and difficult adult conversation about what tools are actually available to society to help the most vulnerable. And we can’t have that because of people like Emma Williams, who crowd 501(c)3s and earn their living writing donor newsletters about “stigma” and refuse to consider the possibility that sometimes in life we are compelled to choose. Sometimes we are compelled to choose between bad options. Sometimes there is no perfect solution. Sometimes we have to stumble along the best we can in an inherently broken world. What strikes me about Williams’s thread and the dozens of comments and quote tweets is the absolute absence of doubt, complication, uncertainty, pause, or humility. Could it possibly be the case that I know something of what I speak? Could it possibly be the case that this issue deserves more than a hand-waving tweeted dismissal? Could it possibly be the case that the untold thousands of family members who struggle to get their loved ones into care want more involuntary commitment for a reason - like the parents of Bailey Hamor, whose inability to receive care led to him stabbing another man in the head? Could the dozens and dozens of mentally ill people I know personally who credit involuntary commitment with saving their lives have any point at all? I guess not. I guess not.

There are victims of involuntary commitment. No doubt. But there are victims of refusing to involuntarily treat people, too - people dead from suicide, overdose, preventable illness, neglect, violence. Emma Williams and the rest of the people I’m responding to here will never shed a tear for any of those victims; in fact, they’ll never have to think about them at all. They're too pure for such things. Joyce Brown was a schizophrenic New York woman who ran into and out of traffic, defecated in the street and in her pants, and constantly harangued passers-by with racist comments despite being Black herself. She was correctly identified as a threat to herself and involuntarily committed. But the valiant, heroic, camera-ready attorneys of the New York ACLU sprung into action and got her out. There was a great fanfare. Tons of publications wrote laudatory stories. She was invited to speak at Harvard Law! Everybody clapped. Everybody loved the story. It was such a feel-good tale. Except for Joyce Brown’s sisters. They were the people who loved her the most, and they had fought hard against her release, to no avail. They insisted that to release her was cruel and, ultimately, racist, as the result would be a life of instability and pain. And guess who was right, in the long run? Two weeks after the Harvard event, Brown was back on the street, panhandling, deluded, filthy. I’m guessing the ACLU lost interest; certainly the press did. She spent the rest of her life in and out of treatment, impoverished, resisting treatment, refusing services, periodically using heroin, and died at 58 years old.

But, hey. At least she had her freedom.

Ms. Williams will go on pursuing her busy little career for a nonprofit that will, like almost all nonprofits, do essentially no material good in the world. She’ll sit there full of that uniquely white self-satisfaction that you find only in the white person who wants you to know how much they love Black people, smiling that beatific smile. And it will never, ever occur to her to ask - was there something that Freddie deBoer knew, that maybe I didn’t know? Was there something that he had to say, that I could have heard? Is there something about the world that I didn’t want to understand, and so never understood?