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.
"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."
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
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.
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”?
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."
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.
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.
"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.
Irate Freddie is a sight to behold
"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."
"@Imissbarack1" on twitter is a fucking idiot? I'm shocked!
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
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.
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”?
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."
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.