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
It’s really sad stuff. One thing Rosen’s book showed me is just how far back the rot goes when thinking about these issues on the left. His chapter on French Intellectuals and psychosis is so damning.
I plan to go to his neighborhood and screw every queen in heat as loudly as I can every night so FdB is good and mad and ready to write straight fire come morning.
"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. "
Good point.
Are prison abolitionists really prison abolitionists? Or do they really propose assigning guilt and innocence, depending on how many Wokemon points are allocated to perpetrator and victim, respectively?
"Howard clubbed Taylor to death with an aluminum baseball bat, but Howard is a Native American with one leg and Taylor listened to Rush Limbaugh for a while, but his maternal grandma had a drinking problem, but that's not enough so Howard gets off this time."
They're not actually abolitionists or opposed to vindictive "carceral" punishment. They have friends they want rewarded, like their classmates with sinecures, "friends" they want to ignore except when used as political pawns, like Neely, and foes they want to punish for bad vibes, like Penny. It's a staid con talking point, but if Neely had been White or Penny Black or had there been any narrative complicating factor (maybe if Neely was on a deranged antisemitic rant) this wouldn't have left the police blotter.
I had a friend back in the day (like when I was in high school) who was a pretty ideologically coherent left anarchist, in favor of prison abolitionism. Like, he went the whole nine yards and was even pen pals with convicted felons and the like - it wasn't just a punk pose. When I backed him into a corner, he admitted that after the revolution we would need some way to deal with criminals and the like, but he didn't want to call it prison.
I lost touch with him when I went away to college, but looking online, he works as a director of compliance at an investment bank now.
Folks change... at least she was ideologically coherent! It's the complete lack of ideological coherence that Freddie documents accurately... which is what happens when people who see themselves on the Left do not think structurally.
“Your brother killed my father; your family owes my family a weregild/20 camels/etc.” Or, “Your brother killed my father; it’s open season on anyone in your family! Vendetta time!”
He couldn’t break them without breaking half the Democratic hierarchy too. Frank, Dodd, about a hundred others who set up the rules, let the crooks loose, and gladly cashed the contributions.
A good friend of my brother-in-law actually did have a Kafka-esque time getting out of psychiatric treatment after voluntarily committing himself. Yes, I know, anecdotes aren't data. My point here is: he and his friends are not going to easily be swayed towards the "involuntary confinement is often necessary", because a visceral, ugly, and immediate story like that has a way of overshadowing other things. Including similarly visceral and ugly stories that happened to strangers who didn't get what they needed.
I wonder how many activists are spurred on by similar stories . The left* likes to believe trauma grants some kind of special wisdom and understanding the non-traumatized will never have, but it seems to me it has the opposite effect: if not properly treated, it is a blazing light that does not reveal, but obscures and blinds.
* EDIT: per Finster's point below, I should clarify I mean a particular activist, romanticist strain of it currently dominant in most nominally left-wing organizations and think tanks
"The left likes to believe trauma grants some kind of special wisdom and understanding the non-traumatized will never have, but it seems to me it has the opposite effect: if not properly treated, it is a blazing light that does not reveal, but obscures and blinds."
I see it is as not so much "the left" so much as romanticism, which is itself associated with a sort of lefty type.
As FdB Himself pointed out, the Soviet Union was not exactly loathe to administer involuntary commitment on those whom they thought would be benefitted by it.
This makes me think to some studies which were done of "political compass" type things in the Eastern Block and modern China. Essentially these states tend to have large numbers of people who are libertarian-esque (in favor of civil liberties and free markets) but basically no one who is economically left-wing and socially liberal (supporters of the communist status quo, once was established, tended to be social conservatives).
I bring this up because there have also been a good deal of studies on the extent to which our politics are in part formed by our genes, and they have suggested that while stances on economic issues are malleable, whether someone is attracted to social liberalism or conservativism seems to be partially innate - coming out of their personality traits, which are around 50% heritable. So you'll always get anti-establishment social liberals, but their stances on economics will be pretty much opposite of the status quo in whatever state they happen to be in. Within the U.S., they thus become coded as "left" because they're anti-authority, and capitalism is the dominant system of authority within our system (for obvious reasons).
I dunno, I run into plenty of goodthinkers who express a touching sensitivity to the plight of racial and sexual minorities, but their economic stance boils down to demanding more diverse exploiters.
Is the problem of "involuntarily-commitment is too difficult to undue" solve-able? It seems like it should be possible to make it both easier to be committed, and easier to be de-committed, but I don't want to be too glib.
It seems like the anti-commitment folks shouldn't be anti-commitment, they should just be helping to make de-commitment more fair and legible, unless this is truly not possible to do.
I have similar questions to yours. The fact is, we'll never hit the sweet spot, where involuntary commitment affects only those people who need to be committed and not people who don't need it. And de-commitment will be too easy for those for whom it shouldn't be as easy or will be too hard for those for whom it needs to be easier.
That's not a slam dunk reason not to make involuntary commitment, or de-commitment, easier. But we (as a society) really need to account for and balance the various interests at play. Freddie's articles have helped convince me to abandon my heretofore knee-jerk opposition to involuntary commitment, but I think it's fair to raise the tradeoffs of making commitment easier. And to be fair to Freddie, he recognizes there will be tradeoffs.
"I wonder how many activists are spurred on by similar stories."
Quite a few, I'd bet. Especially women. The number of women who've heard from The Powers That Be that what they're experiencing can't be real, and so the problem must be *women* who've lost touch with reality, rather than women no less disconnected from reality than average, but facing a real problem that simply hasn't been granted "social existence", is considerable.
People seized by kidney-stone pain act "irrational" – or what would be called irrational if they weren't recognized as having kidney-stone pain. But it's not the kind of "irrational" where they've lost touch with reality. Their behavior is simply socially unacceptable – it can be excused by the explanation of kidney stones, but the point is it needs excuse; it's not tolerable without an excuse that others accept. Moreover, while pain weakens moral fortitude, it doesn't remove it. In the face of overwhelming noxious sensation, your agency might feel puny, but it's not absent. You can still exercise it, though perhaps not to much effect.
Types of mental-health crisis aren't evenly distributed between the sexes. Women's psychological distress is usually less threatening to others, and the internalizing disorders women seem more prone to are arguably more like "kidney stones of the soul" than they are like losing touch with reality. To be treated as a threat to others when you're not ("What're you worried I'll do to others, officer, sir, cry at them?") is understandably alienating.
Perfect sorting of people in distress is impossible. Adequately treating the kind of "psychosis [that] obliterates true freedom through the imposition of delusion and hallucination", the kind that doesn't just weaken the effect of "authentic and undistorted will", but obliterates it entirely, seems like it'll inevitably involve wrongfully identifying and treating some people experiencing more-rational distress, who'll be justifiably exasperated by their wrongful treatment. Of course, every such wrongful identification and treatment diverts treatment resources away from those who really need it. So it's best for everyone if sorting of people in distress can at least improve. I'd expect even improved sorting to result in a fair number of those with experiences like your BIL's friend's. Accepting you've been collateral damage in the care of others more desperate than yourself is tough. It can be done, though. It should be done.
Sometimes some of us will suffer collateral damage from necessary things. We should minimize this collateral damage, of course. But also, I think, honor the sacrifice of it.
That reminds me of a psychotic episode my mom had when she got a horrible nose bleed (she was on blood thinners). After a few days in the hospital with repeated cauterizing attempts and zero sleep she started hallucinating and generally acting irrational (go figure). She was given anti-psychotics. Finally a doctor recognized that she just needed sleep and gave her enough of something to knock her out, and after a long sleep she woke up quite sane.
It’s very strange for me to go into bipolar support groups (which I am as well) and hear them talk about how they were “forced against their will” into involuntary commitment.
My mom can be roaming the streets telling people god wants her to die and there’s no help. She’s run a car into a wall because god says so and there’s no help. She’s been homeless and starving while ranting and there’s no help.
It’s a simple question, one that they ask the person with the mental illness, not witnesses. “Do you plan on harming yourself or others?” And when they say “no,” they take them at their word—bloody head and wrecked car in the back.
Even once admitted, you are given the same questions again, if no, back on the streets you go.
And if you ARE admitted, it’s a measly 72 hours, then where shall they put you? Oh, back on the streets.
I don’t trust the tales of involuntary commitment trauma. They had to answer yes multiple times. If you say “yes I plan to hurt myself” and then talk about the helium tank in your closet, that’s what inPatient is for, and what is more traumatic: a hospital stay while awake or a three month coma and explaining to your friends and family why you made a makeshift helium mask?
Fucking enrages me when these people try and make it even HARDER for people like my mom to get help. This is exactly why schizophrenics and the like commit violence. Before the act of violence, their loved ones had likely been begging for help for months or years. The system won’t help until violence has been committed, and that help is jail.
involuntary commitment is to the left what "being tested by the devil" is to the fundamentalist Christian. Its an in-group signifier, a shibboleth. Like you mention, if they truly believed it to be so awful they wouldn't have purposefully, repeatedly engaged in the behavior that results in their commitment. You said "yes" like 12 times, and you are a mental health advocate, im guessing you knew what was going to happen.
I have to come back to say I can thank you enough for this piece. This is what journalism is made for. I am on the verge of tears to have my reality even acknowledged.
I’ve had to leave support groups for bringing up having to get a court order for my mom to be injected with antipsychotics. She was extremely violent at the time and had already tried to burn our house down and murder one of our pets. But in the support group, although I had some supporters, there were quite a few that were very loudly calling me evil, a fascist, I’m sure you can imagine all of the words. Although there were mediators trying to calm everyone down, I never did feel okay going back, and I don’t feel okay going to such a place again.
I have tried to speak up when it’s brought up casually (as these bizarre verbal signifiers of social standing within the liberal hypocrites continue to be) again but I’m always met with people politely “educating me” on something they’ve never even been through.
These people use words like “gaslighting” about the most trivial shit yet completely warp reality so that there are never any hard questions without good answers. There must be a CORRECT ANSWER. It must be MORALLY PERFECT. If it’s not, they’ll just rewrite reality so that their weak minds don’t break.
Sorry for the rant but, again, i can’t reiterate enough how absolutely important this kind of work is for people like me and my mom. I will share it far and wide and I hope others will too.
> I don’t trust the tales of involuntary commitment trauma. They had to answer yes multiple times.
I wouldn't either, if I believed that "no, I'm not a threat to myself or others" worked like a magical incantation, preventing anyone from ever being held against their will. The patient doesn't get to decide. The physician uses their response to the question as one piece of data among many. The patient can't veto override a doctor's decision by insisting that they aren't at risk of hurting themselves. Trust me, I have tried really hard on several occasions. Taking what you are describing literally, you don't believe involuntary commitment occurs at all, that everyone effectively opts into it. I feel like you must know on some level that's not true, especially if you're well acquainted with the system yourself. Maybe you're confusing the process of committing at the hospital with the decision making process of an outpatient provider to send you to a hospital?
I do not know that is true, perhaps it is different states. The fact that my mom can be very clearly psychotic and state “no” is what informed my decision.
The fact that I have been outpatient and admitted I was suicidal but was asked if I had any specific plans in place and said “no” and it was left at that also informs my decision.
Do I think it is possible that it happens? Of course. From my anecdotal evidence, I would have to say it is very rare, and that often the people who are claiming such things (I am not saying this is you) answer “Yes” both to the initial question and to their follow up “do you have any plans in place.”
It's plenty common that someone who declares themselves safe is held regardless. I've been in both failure modes: declined to be held while floridly psychotic (twice), and held for no good reason. after recreational drug use gone awry and/or impulsive gestures were ascribed to actual suicidality. Regardless how many times I explained the truth of the situation and disavowed suicidal intent. I missed my high school graduation because of this. Some years later I would go deep into medical debt because of this. And it was in fact traumatizing when, as a 17 year old kid, I was told that I would be kept out of school, in a facility I'd never seen, to which I'd be taken directly, kept for an unknown length of time, given unknown treatments, and released on the grace of goodness knows who. But after losing such a fundamental battle as where your body is taken so many times you get used to it. You adopt a skillset designed to outdo the wills of the clipboard guys. There are ways to behave that greatly increase your chances of being allowed to leave the premises, but it's not at all as simple as saying "no" to the suicide/homicide questions. You learn to finesse them. You adapt quickly, because you'll do absolutely anything to stay out of the hospital.
It was also somewhat traumatizing when I spent an entire 72 hour hold alone in a tiny windowless room that seemed to be a repurposed broom closet. They had no space on the unit, you see, but they had to hold me by law--my mom went to see a judge about my very unfeminine tossing of furniture. There was a little ensuite toilet, and thus no reason to let me leave the dungeon. Once the 72 hours were up, though, you can bet I was affirmed to be safe in the community; if they determined otherwise, where on earth would they put me? The system is broken in complicated ways.
There is nothing about advancing your trenchant point that requires denying that harm occurs on the other side of the signal-detection line too. I've been psychotic and I've been involuntarily held and I can affirm that both are bad, and one being badder doesn't makes the other not bad. There's just no need to go the route of dismissing a bunch of people's deeply impactful experiences in your advocacy.
This is a great point and I apologize for my previous statements. What I would say is that the absolute vileness and hatred when you say something as simple as “involuntary commitment is sometimes necessary” is what likely drives me and others to the opposite extreme. There are infinite articles about involuntary commitment being the worst possible thing that can happen to a person, and a human rights violation. This is the first article that has said anything about the other side. Unfortunately the pendulum swings to the other side. I do agree there could be more nuance in the argument, but I also admit it was one of the most relieving things to read after having been shut out of the conversation amongst my own support groups for years.
I believe that involuntary commitment does happen, I also know for a fact that some people view it as a rite of passage, to be literally "certifiable" in the original sense.
I'm pretty sure it was just a typo, and that it was supposed to say "least* bad option." Am I right, Finster? If so, that is a perfectly reasonable thing to say, and in fact is true of countless situations in life, this one no exception.
Do you think leaving Neely untreated for a severe mental illness and living on the subway was a good option, JI? If so, I would say you are the one who doesn't actually care about the plight of people like him, as you're clearly not spending so much as 10 seconds imagining what their lives must be like.
You're avoiding the issue. The issue is not whether bad things happen to people but if there are ever any instances where it is necessary to forcible restrain someone or remove them from society due to antisocial actions.
Sure. We should have caged Neely’s family for not caring for him as well as his late mother had. We should have caged social services for not giving him housing, regardless of his “compliance” with psychiatric “treatment”. We should have caged police for criminalizing Neely’s homelessness (loitering, trespassing, etc.). We should have caged Neely’s foster family for ripping off the child welfare system (i.e. neglecting Neely as they lived off state money for his “care”).
What's your argument? You just keep repeating yourself. Neely had a hard life and bad things happen to him. The question is what you do in a situation where someone is having a psychotic episode and is harassing and threatening people. Do you believe this never happens? Do you believe that nothing should be done to control this person's behavior? Should they be free to attack and harass people, to even kill other people or themselves?
Is it more traumatic than leaving them homeless and untreated, subject to violence and drugs, eating out of garbage cans and wandering aimlessly in the streets until they meet an early and probably gruesome death?
Question to ask those defending the right of mentally I’ll people to live in squalor,drugs,and violence on the street until they die or are killed. “ Suppose you had a mentally I’ll child/loved one who refused treatment and lived like Mr. Neeley — riding the subways threatening and attacking people until his lifestyle resulted in death or severe injury. Would you really prefer life/death on the street to involuntary commitment?
One other thing I’d like to say is that due to Kennedy’s IMD exclusion and also the threat of litigation (you can thank trial attorneys for that ) inpatient psych hospitals ARE often shabbily designed and prioritize things like minimizing ligature risks over creating a therapeutic environment with free space and private rooms. That would go a long way. But the deficiencies with the way it is now still doesn’t make it any less necessary
It’s the perfect status game for the non-profit types. They get to profess to care about a group that cannot speak for themselves, generally speaking, and rail against the latest buzzword in their circles. They don’t even have to pretend to assist this group as they have defined down the seriousness of mental illness.
It would be a brilliant grift if it didn’t lead to untold suffering for the mentally ill, their loved ones, and anyone affected by it.
Throughout my early twenties I was exposed to a lot of anti-psychiatry politics and mad studies analysis. The liberal arts anarcho-leftism that I had immersed myself in had me blindly convinced that the correct way to think about “madness” was as an oppressive social construct designed to punish difference and deviance from bourgeois social norms. The completely ignorant and righteous adoption of these positions is deeply embarrassing to me now. And my heart races with anger when I continue to encounter these positions in left organizing spaces, publications, etc. These people do nothing to advance the changes to systems of care and treatment that are desperately needed to bring true relief to those who are suffering most. If anything they hinder them (especially the mad activist lawyer types).
While doing my nursing degree I was placed to complete my final practicum on a hospital-based Assertive Community Treatment team (in my program we had little choice over where we completed our practicums). I came into it with the totally deluded and righteous belief that it would only deepen my prior convictions - I couldn’t have been more wrong. I wound up working on the ACT team for many years and encountered so many people whose struggles mirrored those that Freddie so eloquently describes in this piece. People who refused life saving treatments owing to their delusions, people who engaged in dangerous and harmful behaviour (like eating glass or batteries) who did not want to die or harm themselves but acted upon psychotic beliefs that led to self-injury and personal neglect. I also experienced first hand how difficult it can be to get someone a hospital bed in a psych ward even when they are agreeable to going. I spent hours waiting in EDs with my clients advocating *with them* for an admission.
We need to remain critical of mainstream psychiatry while also advocating easier access to more humane treatment. You can do both. You can say: there’s lots that’s fucked up about our psychiatric and mental health systems now; and people are suffering and they need all of the medical care and socio-economic support we can offer. Psych wards can be horrible places, but also life saving ones. They can and should be more humanely designed - but we need them. We also need more R&D into psychiatric medications and we need this R&D to be government led and funded because pharmaceutical companies won’t take the risks required to develop novel treatments and, yes, there are real problems with their data. The material interests of the pharmaceutical industry severely compromises the quality and trustworthiness of the information they make public about their drugs. The fact that studies with pharmaceutical industry funding are far more likely to report positive findings has been well documented. But this is not just true for psychiatric drugs- this is a problem for basically all drugs. And acknowledgement of this problem doesn’t mean that we should abandon the project of investigating any and all treatments (pharmaceutical, psychotherapeutic, material, social, etc) that could bring some relief to the profound suffering that people with severe and persistent mental illness face.
I can’t tell you how much I appreciate your persistent voice on this topic, Freddie. I can barely bring myself to engage with it publicly because of the profound intellectual dishonesty that often animates it.
As an aside - would you consider reviewing Rachel Aviv’s book “Strangers to Ourselves”?
Pharma Bros are no longer convinced that anyone will “discover” a way to drug people into perfect submission to a deeply pathogenic and dysfunctional society. Shouldn’t that be a clue that it’s time to focus on rebuilding our society, or, at least, offer people more protection from it?
That’s right - nobody “has” to become a commodity of the Pharma Bros. It’s the fatal flaw in their business model. They go broke whenever a critical mass of people dedicate themselves to helping themselves and others. We’ve seen that happen over and over again: survivors of domestic abuse, LGBTQ, first-wave psychiatric survivors. Psychiatry has only as much power as we choose to let it have.
As a person with Bi-polar disorder, and growing up with a social worker mom who ran day treatment centers for the seriously mentally ill, and someone who had a bi-polar dad, I agree. Involuntary confinement/treatment has to be part of the picture. My dad, suffering from a severe bi-polar episode, was confined in a California jail for over a year, doing lovely things like smearing feces on the walls in protest. We confine now all the time, we just wait for the crime first, and then give substandard care. Some people need long-term confinement in healthy institutions, followed by supportive housing/care as they recover and stabilize. This need will not go away. My dad was actually at his healthiest when he was released from jail into a correctional mental institution, where he put his organizing skills to use in the library. He seemed happy. Years later, he was very unhappily confined to a crappy CA private nursing home, with substandard mental health care, where he eventually died.
So yes, I agree with your arguments, even if your essay had me thinking of that cartoon that says, "I can't go to bed yet, someone is wrong on the internet."
> We confine now all the time, we just wait for the crime first, and then give substandard care.
This is exactly right. Forensic psych admissions have been increasing throughout the country, particularly in localities that have pulled back on involuntary civil commitment.
frankly we need socialized healthcare to build public mental health facilities that look like passages malibu instead of the depressing and underfunded institutions we have today. nothing too good for the working class.
Not an American, but please explain to my upper middle class mother (RIP) and 0.1% former partner that in fact, their problem is poverty. Suppose a lot of it is that you can sue someone for involuntary commitment but not for... letting you practice your autonomy to do away with your life savings or even with your life itself. Suicide is a bigger cause of death than murder, last I checked, nearly everywhere.
Well said- and good luck to you as you pursue your college career and staring a family!
It’s really sad stuff. One thing Rosen’s book showed me is just how far back the rot goes when thinking about these issues on the left. His chapter on French Intellectuals and psychosis is so damning.
I also just want to say that this is a glorious, righteous, beautifully written piece. We thank you, from the trenches.
You haven’t seen a “trench” until you’ve endured 8 months in a psychiatric gulag, like Michael Laudor did BEFORE he broke any laws.
"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."
Romanticism is perhaps the ultimate Luxury Belief.
This is one of your best newsletter pieces recently. Bravo.
Gangsta comment. First Round Knockout.
The writing on the articles is great but oftentimes the comments are pretty good as well.
Ye shall know a truly great Substack by this Sure Sign, and that is when the comments are often as edifying as the article itself.
I’m stealing this: “people treating difficult social problems as opportunities for their own moral entrepreneurship.” Extremely well put.
Concur 🔥
Where can we get what you are inhaling?
Hear, hear. Bravo.
Very well put.
Love "moral entrepreneurship." Wonderful!
You have no idea how many people I know you can apply this to. Thank you for writing it.....and I am going to use it!
Yea, verily. FdB Delivereth The Goods in this instance.
Irate Freddie is a sight to behold
I plan to go to his neighborhood and screw every queen in heat as loudly as I can every night so FdB is good and mad and ready to write straight fire come morning.
Anyone in to buy this tomcat a plane ticket?
"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. "
Good point.
Are prison abolitionists really prison abolitionists? Or do they really propose assigning guilt and innocence, depending on how many Wokemon points are allocated to perpetrator and victim, respectively?
"Howard clubbed Taylor to death with an aluminum baseball bat, but Howard is a Native American with one leg and Taylor listened to Rush Limbaugh for a while, but his maternal grandma had a drinking problem, but that's not enough so Howard gets off this time."
They're not actually abolitionists or opposed to vindictive "carceral" punishment. They have friends they want rewarded, like their classmates with sinecures, "friends" they want to ignore except when used as political pawns, like Neely, and foes they want to punish for bad vibes, like Penny. It's a staid con talking point, but if Neely had been White or Penny Black or had there been any narrative complicating factor (maybe if Neely was on a deranged antisemitic rant) this wouldn't have left the police blotter.
Preach on, Brother!
VladTheInhaler described this bogus phenomenon as "moral entrepreneurship".
I had a friend back in the day (like when I was in high school) who was a pretty ideologically coherent left anarchist, in favor of prison abolitionism. Like, he went the whole nine yards and was even pen pals with convicted felons and the like - it wasn't just a punk pose. When I backed him into a corner, he admitted that after the revolution we would need some way to deal with criminals and the like, but he didn't want to call it prison.
I lost touch with him when I went away to college, but looking online, he works as a director of compliance at an investment bank now.
Folks change... at least she was ideologically coherent! It's the complete lack of ideological coherence that Freddie documents accurately... which is what happens when people who see themselves on the Left do not think structurally.
Traditional societies had ways of dealing with criminals that were not prison.
Those ways were not pretty.
Yep. Basically there are only three ways you can deal with transgression prior to civilization:
1. Ignore it
2. Shunning and social ostracization, which, when taken to its logical conclusion, was a death sentence.
3. Execution
Also 4. Collective guilt.
“Your brother killed my father; your family owes my family a weregild/20 camels/etc.” Or, “Your brother killed my father; it’s open season on anyone in your family! Vendetta time!”
I think the Irish variant was a complicated system of sureties - who could stand surety for whom and who had to do so.
Simply paying money was a common fourth option.
You need civilization to have fines. Though of course there were various ways to have "negotiated settlements."
Lol
"@Imissbarack1" on twitter is a fucking idiot? I'm shocked!
That’s uncalled for. You don’t have to love Barack Obama to recognize that many intelligent and thoughtful people supported him.
You could say that about 2008. By 2012, not so much.
Yeah. He failed to break the bankers who made such a mess in 2008. He was a complete waste. His pathetic Fat Elvis phase has been even sadder.
He couldn’t break them without breaking half the Democratic hierarchy too. Frank, Dodd, about a hundred others who set up the rules, let the crooks loose, and gladly cashed the contributions.
He is still a sad loser for failing to try.
There is no such thing as an intelligent and thoughtful twitter user.
A good friend of my brother-in-law actually did have a Kafka-esque time getting out of psychiatric treatment after voluntarily committing himself. Yes, I know, anecdotes aren't data. My point here is: he and his friends are not going to easily be swayed towards the "involuntary confinement is often necessary", because a visceral, ugly, and immediate story like that has a way of overshadowing other things. Including similarly visceral and ugly stories that happened to strangers who didn't get what they needed.
I wonder how many activists are spurred on by similar stories . The left* likes to believe trauma grants some kind of special wisdom and understanding the non-traumatized will never have, but it seems to me it has the opposite effect: if not properly treated, it is a blazing light that does not reveal, but obscures and blinds.
* EDIT: per Finster's point below, I should clarify I mean a particular activist, romanticist strain of it currently dominant in most nominally left-wing organizations and think tanks
"The left likes to believe trauma grants some kind of special wisdom and understanding the non-traumatized will never have, but it seems to me it has the opposite effect: if not properly treated, it is a blazing light that does not reveal, but obscures and blinds."
I see it is as not so much "the left" so much as romanticism, which is itself associated with a sort of lefty type.
As FdB Himself pointed out, the Soviet Union was not exactly loathe to administer involuntary commitment on those whom they thought would be benefitted by it.
This makes me think to some studies which were done of "political compass" type things in the Eastern Block and modern China. Essentially these states tend to have large numbers of people who are libertarian-esque (in favor of civil liberties and free markets) but basically no one who is economically left-wing and socially liberal (supporters of the communist status quo, once was established, tended to be social conservatives).
I bring this up because there have also been a good deal of studies on the extent to which our politics are in part formed by our genes, and they have suggested that while stances on economic issues are malleable, whether someone is attracted to social liberalism or conservativism seems to be partially innate - coming out of their personality traits, which are around 50% heritable. So you'll always get anti-establishment social liberals, but their stances on economics will be pretty much opposite of the status quo in whatever state they happen to be in. Within the U.S., they thus become coded as "left" because they're anti-authority, and capitalism is the dominant system of authority within our system (for obvious reasons).
I dunno, I run into plenty of goodthinkers who express a touching sensitivity to the plight of racial and sexual minorities, but their economic stance boils down to demanding more diverse exploiters.
"...but their economic stance boils down to demanding more diverse exploiters."
I like to call this the search for equitable inequality.
Is the problem of "involuntarily-commitment is too difficult to undue" solve-able? It seems like it should be possible to make it both easier to be committed, and easier to be de-committed, but I don't want to be too glib.
It seems like the anti-commitment folks shouldn't be anti-commitment, they should just be helping to make de-commitment more fair and legible, unless this is truly not possible to do.
I have similar questions to yours. The fact is, we'll never hit the sweet spot, where involuntary commitment affects only those people who need to be committed and not people who don't need it. And de-commitment will be too easy for those for whom it shouldn't be as easy or will be too hard for those for whom it needs to be easier.
That's not a slam dunk reason not to make involuntary commitment, or de-commitment, easier. But we (as a society) really need to account for and balance the various interests at play. Freddie's articles have helped convince me to abandon my heretofore knee-jerk opposition to involuntary commitment, but I think it's fair to raise the tradeoffs of making commitment easier. And to be fair to Freddie, he recognizes there will be tradeoffs.
"I wonder how many activists are spurred on by similar stories."
Quite a few, I'd bet. Especially women. The number of women who've heard from The Powers That Be that what they're experiencing can't be real, and so the problem must be *women* who've lost touch with reality, rather than women no less disconnected from reality than average, but facing a real problem that simply hasn't been granted "social existence", is considerable.
People seized by kidney-stone pain act "irrational" – or what would be called irrational if they weren't recognized as having kidney-stone pain. But it's not the kind of "irrational" where they've lost touch with reality. Their behavior is simply socially unacceptable – it can be excused by the explanation of kidney stones, but the point is it needs excuse; it's not tolerable without an excuse that others accept. Moreover, while pain weakens moral fortitude, it doesn't remove it. In the face of overwhelming noxious sensation, your agency might feel puny, but it's not absent. You can still exercise it, though perhaps not to much effect.
Types of mental-health crisis aren't evenly distributed between the sexes. Women's psychological distress is usually less threatening to others, and the internalizing disorders women seem more prone to are arguably more like "kidney stones of the soul" than they are like losing touch with reality. To be treated as a threat to others when you're not ("What're you worried I'll do to others, officer, sir, cry at them?") is understandably alienating.
Perfect sorting of people in distress is impossible. Adequately treating the kind of "psychosis [that] obliterates true freedom through the imposition of delusion and hallucination", the kind that doesn't just weaken the effect of "authentic and undistorted will", but obliterates it entirely, seems like it'll inevitably involve wrongfully identifying and treating some people experiencing more-rational distress, who'll be justifiably exasperated by their wrongful treatment. Of course, every such wrongful identification and treatment diverts treatment resources away from those who really need it. So it's best for everyone if sorting of people in distress can at least improve. I'd expect even improved sorting to result in a fair number of those with experiences like your BIL's friend's. Accepting you've been collateral damage in the care of others more desperate than yourself is tough. It can be done, though. It should be done.
Sometimes some of us will suffer collateral damage from necessary things. We should minimize this collateral damage, of course. But also, I think, honor the sacrifice of it.
That reminds me of a psychotic episode my mom had when she got a horrible nose bleed (she was on blood thinners). After a few days in the hospital with repeated cauterizing attempts and zero sleep she started hallucinating and generally acting irrational (go figure). She was given anti-psychotics. Finally a doctor recognized that she just needed sleep and gave her enough of something to knock her out, and after a long sleep she woke up quite sane.
My mom is schizoaffective.
It’s very strange for me to go into bipolar support groups (which I am as well) and hear them talk about how they were “forced against their will” into involuntary commitment.
My mom can be roaming the streets telling people god wants her to die and there’s no help. She’s run a car into a wall because god says so and there’s no help. She’s been homeless and starving while ranting and there’s no help.
It’s a simple question, one that they ask the person with the mental illness, not witnesses. “Do you plan on harming yourself or others?” And when they say “no,” they take them at their word—bloody head and wrecked car in the back.
Even once admitted, you are given the same questions again, if no, back on the streets you go.
And if you ARE admitted, it’s a measly 72 hours, then where shall they put you? Oh, back on the streets.
I don’t trust the tales of involuntary commitment trauma. They had to answer yes multiple times. If you say “yes I plan to hurt myself” and then talk about the helium tank in your closet, that’s what inPatient is for, and what is more traumatic: a hospital stay while awake or a three month coma and explaining to your friends and family why you made a makeshift helium mask?
Fucking enrages me when these people try and make it even HARDER for people like my mom to get help. This is exactly why schizophrenics and the like commit violence. Before the act of violence, their loved ones had likely been begging for help for months or years. The system won’t help until violence has been committed, and that help is jail.
Thank you for your piece.
involuntary commitment is to the left what "being tested by the devil" is to the fundamentalist Christian. Its an in-group signifier, a shibboleth. Like you mention, if they truly believed it to be so awful they wouldn't have purposefully, repeatedly engaged in the behavior that results in their commitment. You said "yes" like 12 times, and you are a mental health advocate, im guessing you knew what was going to happen.
I have to come back to say I can thank you enough for this piece. This is what journalism is made for. I am on the verge of tears to have my reality even acknowledged.
I’ve had to leave support groups for bringing up having to get a court order for my mom to be injected with antipsychotics. She was extremely violent at the time and had already tried to burn our house down and murder one of our pets. But in the support group, although I had some supporters, there were quite a few that were very loudly calling me evil, a fascist, I’m sure you can imagine all of the words. Although there were mediators trying to calm everyone down, I never did feel okay going back, and I don’t feel okay going to such a place again.
I have tried to speak up when it’s brought up casually (as these bizarre verbal signifiers of social standing within the liberal hypocrites continue to be) again but I’m always met with people politely “educating me” on something they’ve never even been through.
These people use words like “gaslighting” about the most trivial shit yet completely warp reality so that there are never any hard questions without good answers. There must be a CORRECT ANSWER. It must be MORALLY PERFECT. If it’s not, they’ll just rewrite reality so that their weak minds don’t break.
Sorry for the rant but, again, i can’t reiterate enough how absolutely important this kind of work is for people like me and my mom. I will share it far and wide and I hope others will too.
> I don’t trust the tales of involuntary commitment trauma. They had to answer yes multiple times.
I wouldn't either, if I believed that "no, I'm not a threat to myself or others" worked like a magical incantation, preventing anyone from ever being held against their will. The patient doesn't get to decide. The physician uses their response to the question as one piece of data among many. The patient can't veto override a doctor's decision by insisting that they aren't at risk of hurting themselves. Trust me, I have tried really hard on several occasions. Taking what you are describing literally, you don't believe involuntary commitment occurs at all, that everyone effectively opts into it. I feel like you must know on some level that's not true, especially if you're well acquainted with the system yourself. Maybe you're confusing the process of committing at the hospital with the decision making process of an outpatient provider to send you to a hospital?
I do not know that is true, perhaps it is different states. The fact that my mom can be very clearly psychotic and state “no” is what informed my decision.
The fact that I have been outpatient and admitted I was suicidal but was asked if I had any specific plans in place and said “no” and it was left at that also informs my decision.
Do I think it is possible that it happens? Of course. From my anecdotal evidence, I would have to say it is very rare, and that often the people who are claiming such things (I am not saying this is you) answer “Yes” both to the initial question and to their follow up “do you have any plans in place.”
My sister would have said no and not been lying. She truly believed she was not mentally ill (schizophrenic). That’s a problem.
It's plenty common that someone who declares themselves safe is held regardless. I've been in both failure modes: declined to be held while floridly psychotic (twice), and held for no good reason. after recreational drug use gone awry and/or impulsive gestures were ascribed to actual suicidality. Regardless how many times I explained the truth of the situation and disavowed suicidal intent. I missed my high school graduation because of this. Some years later I would go deep into medical debt because of this. And it was in fact traumatizing when, as a 17 year old kid, I was told that I would be kept out of school, in a facility I'd never seen, to which I'd be taken directly, kept for an unknown length of time, given unknown treatments, and released on the grace of goodness knows who. But after losing such a fundamental battle as where your body is taken so many times you get used to it. You adopt a skillset designed to outdo the wills of the clipboard guys. There are ways to behave that greatly increase your chances of being allowed to leave the premises, but it's not at all as simple as saying "no" to the suicide/homicide questions. You learn to finesse them. You adapt quickly, because you'll do absolutely anything to stay out of the hospital.
It was also somewhat traumatizing when I spent an entire 72 hour hold alone in a tiny windowless room that seemed to be a repurposed broom closet. They had no space on the unit, you see, but they had to hold me by law--my mom went to see a judge about my very unfeminine tossing of furniture. There was a little ensuite toilet, and thus no reason to let me leave the dungeon. Once the 72 hours were up, though, you can bet I was affirmed to be safe in the community; if they determined otherwise, where on earth would they put me? The system is broken in complicated ways.
There is nothing about advancing your trenchant point that requires denying that harm occurs on the other side of the signal-detection line too. I've been psychotic and I've been involuntarily held and I can affirm that both are bad, and one being badder doesn't makes the other not bad. There's just no need to go the route of dismissing a bunch of people's deeply impactful experiences in your advocacy.
This is a great point and I apologize for my previous statements. What I would say is that the absolute vileness and hatred when you say something as simple as “involuntary commitment is sometimes necessary” is what likely drives me and others to the opposite extreme. There are infinite articles about involuntary commitment being the worst possible thing that can happen to a person, and a human rights violation. This is the first article that has said anything about the other side. Unfortunately the pendulum swings to the other side. I do agree there could be more nuance in the argument, but I also admit it was one of the most relieving things to read after having been shut out of the conversation amongst my own support groups for years.
I believe that involuntary commitment does happen, I also know for a fact that some people view it as a rite of passage, to be literally "certifiable" in the original sense.
You won’t trust that involuntary commitment is traumatic until it happens to you.
I'm sure it is traumatic. It also may be the last bad option available at the time.
EDIT: LEAST bad option, not "last".
If you don’t give a fuck until the “last bad option” is all you have left, you never did intend to keep anyone safe.
LOL, because I'm just up in everyone's business at all times.
I'm pretty sure it was just a typo, and that it was supposed to say "least* bad option." Am I right, Finster? If so, that is a perfectly reasonable thing to say, and in fact is true of countless situations in life, this one no exception.
Do you think leaving Neely untreated for a severe mental illness and living on the subway was a good option, JI? If so, I would say you are the one who doesn't actually care about the plight of people like him, as you're clearly not spending so much as 10 seconds imagining what their lives must be like.
You are correct. Hard to type with my pads sometimes.
Good to hear it was only a typo, as it would've otherwise given me serious paws for concern.
Getting attacked by someone having a psychotic episode is also traumatic.
Being condemned to homelessness from ages 14-30 is also traumatic.
You're avoiding the issue. The issue is not whether bad things happen to people but if there are ever any instances where it is necessary to forcible restrain someone or remove them from society due to antisocial actions.
Sure. We should have caged Neely’s family for not caring for him as well as his late mother had. We should have caged social services for not giving him housing, regardless of his “compliance” with psychiatric “treatment”. We should have caged police for criminalizing Neely’s homelessness (loitering, trespassing, etc.). We should have caged Neely’s foster family for ripping off the child welfare system (i.e. neglecting Neely as they lived off state money for his “care”).
What's your argument? You just keep repeating yourself. Neely had a hard life and bad things happen to him. The question is what you do in a situation where someone is having a psychotic episode and is harassing and threatening people. Do you believe this never happens? Do you believe that nothing should be done to control this person's behavior? Should they be free to attack and harass people, to even kill other people or themselves?
Is it more traumatic than leaving them homeless and untreated, subject to violence and drugs, eating out of garbage cans and wandering aimlessly in the streets until they meet an early and probably gruesome death?
When the tales of under treatment vastly outnumber tales of over treatment it’s time to re-evaluate who gets treatment
Question to ask those defending the right of mentally I’ll people to live in squalor,drugs,and violence on the street until they die or are killed. “ Suppose you had a mentally I’ll child/loved one who refused treatment and lived like Mr. Neeley — riding the subways threatening and attacking people until his lifestyle resulted in death or severe injury. Would you really prefer life/death on the street to involuntary commitment?
One other thing I’d like to say is that due to Kennedy’s IMD exclusion and also the threat of litigation (you can thank trial attorneys for that ) inpatient psych hospitals ARE often shabbily designed and prioritize things like minimizing ligature risks over creating a therapeutic environment with free space and private rooms. That would go a long way. But the deficiencies with the way it is now still doesn’t make it any less necessary
Oh, so you want law-abiding people caged solely because they’re Mad AND to endure that brutal process with NO legal aid?
Fuck you!
It’s the perfect status game for the non-profit types. They get to profess to care about a group that cannot speak for themselves, generally speaking, and rail against the latest buzzword in their circles. They don’t even have to pretend to assist this group as they have defined down the seriousness of mental illness.
It would be a brilliant grift if it didn’t lead to untold suffering for the mentally ill, their loved ones, and anyone affected by it.
Throughout my early twenties I was exposed to a lot of anti-psychiatry politics and mad studies analysis. The liberal arts anarcho-leftism that I had immersed myself in had me blindly convinced that the correct way to think about “madness” was as an oppressive social construct designed to punish difference and deviance from bourgeois social norms. The completely ignorant and righteous adoption of these positions is deeply embarrassing to me now. And my heart races with anger when I continue to encounter these positions in left organizing spaces, publications, etc. These people do nothing to advance the changes to systems of care and treatment that are desperately needed to bring true relief to those who are suffering most. If anything they hinder them (especially the mad activist lawyer types).
While doing my nursing degree I was placed to complete my final practicum on a hospital-based Assertive Community Treatment team (in my program we had little choice over where we completed our practicums). I came into it with the totally deluded and righteous belief that it would only deepen my prior convictions - I couldn’t have been more wrong. I wound up working on the ACT team for many years and encountered so many people whose struggles mirrored those that Freddie so eloquently describes in this piece. People who refused life saving treatments owing to their delusions, people who engaged in dangerous and harmful behaviour (like eating glass or batteries) who did not want to die or harm themselves but acted upon psychotic beliefs that led to self-injury and personal neglect. I also experienced first hand how difficult it can be to get someone a hospital bed in a psych ward even when they are agreeable to going. I spent hours waiting in EDs with my clients advocating *with them* for an admission.
We need to remain critical of mainstream psychiatry while also advocating easier access to more humane treatment. You can do both. You can say: there’s lots that’s fucked up about our psychiatric and mental health systems now; and people are suffering and they need all of the medical care and socio-economic support we can offer. Psych wards can be horrible places, but also life saving ones. They can and should be more humanely designed - but we need them. We also need more R&D into psychiatric medications and we need this R&D to be government led and funded because pharmaceutical companies won’t take the risks required to develop novel treatments and, yes, there are real problems with their data. The material interests of the pharmaceutical industry severely compromises the quality and trustworthiness of the information they make public about their drugs. The fact that studies with pharmaceutical industry funding are far more likely to report positive findings has been well documented. But this is not just true for psychiatric drugs- this is a problem for basically all drugs. And acknowledgement of this problem doesn’t mean that we should abandon the project of investigating any and all treatments (pharmaceutical, psychotherapeutic, material, social, etc) that could bring some relief to the profound suffering that people with severe and persistent mental illness face.
I can’t tell you how much I appreciate your persistent voice on this topic, Freddie. I can barely bring myself to engage with it publicly because of the profound intellectual dishonesty that often animates it.
As an aside - would you consider reviewing Rachel Aviv’s book “Strangers to Ourselves”?
Amen
Pharma Bros are no longer convinced that anyone will “discover” a way to drug people into perfect submission to a deeply pathogenic and dysfunctional society. Shouldn’t that be a clue that it’s time to focus on rebuilding our society, or, at least, offer people more protection from it?
Oh please.
That’s right - nobody “has” to become a commodity of the Pharma Bros. It’s the fatal flaw in their business model. They go broke whenever a critical mass of people dedicate themselves to helping themselves and others. We’ve seen that happen over and over again: survivors of domestic abuse, LGBTQ, first-wave psychiatric survivors. Psychiatry has only as much power as we choose to let it have.
As a person with Bi-polar disorder, and growing up with a social worker mom who ran day treatment centers for the seriously mentally ill, and someone who had a bi-polar dad, I agree. Involuntary confinement/treatment has to be part of the picture. My dad, suffering from a severe bi-polar episode, was confined in a California jail for over a year, doing lovely things like smearing feces on the walls in protest. We confine now all the time, we just wait for the crime first, and then give substandard care. Some people need long-term confinement in healthy institutions, followed by supportive housing/care as they recover and stabilize. This need will not go away. My dad was actually at his healthiest when he was released from jail into a correctional mental institution, where he put his organizing skills to use in the library. He seemed happy. Years later, he was very unhappily confined to a crappy CA private nursing home, with substandard mental health care, where he eventually died.
So yes, I agree with your arguments, even if your essay had me thinking of that cartoon that says, "I can't go to bed yet, someone is wrong on the internet."
> We confine now all the time, we just wait for the crime first, and then give substandard care.
This is exactly right. Forensic psych admissions have been increasing throughout the country, particularly in localities that have pulled back on involuntary civil commitment.
frankly we need socialized healthcare to build public mental health facilities that look like passages malibu instead of the depressing and underfunded institutions we have today. nothing too good for the working class.
Not an American, but please explain to my upper middle class mother (RIP) and 0.1% former partner that in fact, their problem is poverty. Suppose a lot of it is that you can sue someone for involuntary commitment but not for... letting you practice your autonomy to do away with your life savings or even with your life itself. Suicide is a bigger cause of death than murder, last I checked, nearly everywhere.