Review of “My Brother Ron” by Clayton Cramer

Perhaps nothing better illustrates the modern notion of “freedom” better than an anecdote from the annals of deinstitutionalization:

Joyce Brown, aka Billy Boggs, a homeless person living on the streets of New York City in 1987, became something of a poster child for where this abstract theory of Constitutional rights led. Her behavior was clearly psychotic: “She urinated and defecated on the streets, . . . ran recklessly into heavily trafficked streets, and exposed herself when assistance was offered.” . . . Brown was sleeping on a steam grate in freezing weather, and the city authorities hospitalized her against her will. The New York Civil Liberties Union filed suit, arguing that her essential dignity [!!] as a human being was being denied by her involuntary hospitalization, and the she should not be forced to take psychiatric medications against her will. Rather than seeing her living conditions as a sign of mental illness, the NYCLU characterized it as “a fearless independent life style” and the courts agreed.

How free are you unless you can smear your own shit all over yourself in the middle of the city? What sort of human dignity is left if someone is prevented from doing this to herself?

Thankfully, Ms Boggs only hurt herself and caused minor inconvenience. Nevertheless, one can’t help but feel that a society which actively defends and seeks to perpetuate this sort of behavior is extremely ill.

In certain cases, the results are much worse:

Seung-Hui was allowed to “commit himself.” The next day, Seung-Hui left the hospital, and soon he was back on campus, living in a world of paranoid schizophrenia, culminating in the largest gun mass murder in U.S. history.

Clayton Cramer’s – an interesting guy in his own right – book is really split into two parts. Part of it is a history of the treatment of mental illness in the US. This part covers how patients are treated, what the medical profession thinks of mental illness, and how the courts have treated the mentally ill. This part is heavily footnoted and somewhat dry, but it’s a totally serviceable summary of some broad topics.

The other part of the book is about Cramer’s brother, Ron. Ron is a schizophrenic. Ron and his family have had to pay the price associated with changing views, policies, and legal restrictions associated with the mentally ill. This part of the book is really good. Some of Cramer’s anger slips out, but all in all, the personal story sucks the reader in.

A hundred years ago, mental illness was poorly classified and the mentally ill were institutionalized. Cramer shows that the stereotypes associated with institutionalization are not necessarily true. For example (to pick one of many), “A study of 15,000 patients admitted to Pennsylvania’s Warren State Hospital between 1916 and 1950 found that 42 percent of first admissions in the first period 1919-1925 were released within a year.”

This bias toward institutionalization changes to what amounts to a prohibition on institutionalization. This push for deinstitutionalization was led by social activists, civil libertarians, some doctors and the courts.

Here’s Cramer’s description of the views of the social activists who led the deinstitutionalization charge:

The CMHC (Community Mental Health Centers) movement believed that preventing mental illness meant preventing the environment that caused mental illness. This meant going after capitalism, poverty, and racism, which many of the CMHC advocates and activists had persuaded themselves caused the disproportionate mental illness of inner cities. . . . The mental health care system “must encompass some effort at changing the basic racist background.”

The charge was also led by groups like the ACLU, who used the courts to essentially make institutionalization prohibitively expensive. For example, Wyatt v. Stickney gave the mentally ill a “right to treatment” and specified how many employees different job classifications the state mental hospital had to have per patient (it’s right there in the Constitution, obviously).

The courts were happy to oblige even though it often led to terrible results:

In 1982, Rebecca Smith, who had been in a mental hospital, and refused to go back, lived in a cardboard box on the streets of New York. She refused all assistance. While New York City authorities were attempting to get a court order to bring her out of the cold, she froze to death.

The legal status of the mentally ill becomes quite confusing. “If a person accused of a crime was not sane enough to stand trial, could he be held indefinitely? Could he refuse treatment? What if, by refusing treatment, he would never be well enough to stand trial? If a mental patient had a right to treatment, but refused it, to avoid trial, did the state have the authority to continue holding him?” What if not guilty by reason of insanity? . . .

The result seems to be a situation in which only the mentally ill who are well enough to know that they’re not well actually get help.

The results of deinstitutionalization are not pretty. A 2000 study of rampage killers found that, “of the 100 rampage murderers, forty-seven ‘had a history of mental health problems.’” Another study found “an astonishingly strong negative correlation rate between the institutionalization rate, and the murder rate: -0.78.” Prisons suddenly became filled with mentally ill prisoners.

Less dramatically, there are lots of personal stories that are profoundly tragic. Including Cramer’s brother who leads a tragic and occasionally violent (including attacking his mother) life. He’s arrested multiple times, but never held. His brother manages to get help now and then, but policies change the few times that something seems to actually be working.

As time wears on, it becomes difficult to find doctors to treat patients on the outside. “As even a 1984 American Psychiatric Association report admitted, psychiatrists willing to work with the chronically mentally ill were in short supply.”

To cut to the chase, there seems to be a relatively readily identifiable group of people who need someone to take care of them. The choices are the state/community, family or nobody. We’ve chosen the nobody path (unless someone is lucky enough to have their family help, but in that case, the family’s efforts are often thwarted by the legal “rights” of the mentally ill).

The results are what they are, from mass killings, people starving themselves to death in subsidized apartments, or streets filled with people exercising their Constitutionally protected rights to piss in front of all of us. The future doesn’t look bright.

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8 Responses to Review of “My Brother Ron” by Clayton Cramer

  1. dearieme says:

    We have the same problem in Britain, having copied your idiocy. Here, however, The Left has the perfect get-out; if you raise the topic they blame it all on Margaret Thatcher.

    • Red says:

      The left does the same in American. Here the bogyman is Reagan.

      It amazing how people censor themselves on this topic. When you bring it up they engage crime think and change the subject.

  2. Federico says:

    The legal status of the mentally ill becomes quite confusing. “If a person accused of a crime was not sane enough to stand trial, could he be held indefinitely? Could he refuse treatment? What if, by refusing treatment, he would never be well enough to stand trial? If a mental patient had a right to treatment, but refused it, to avoid trial, did the state have the authority to continue holding him?” What if not guilty by reason of insanity? . . .

    Brilliant, Foseti.

    I wish there were a webcomic that lampoons these quandaries. If “insanity” is defined as “unusual, irrational and self-harming behaviour”, what crime of passion or perversity isn’t favourable to a plea of insanity?

    Also, I think “civil liberties activists” are highly selective. There’s always an outcry in Britain when e.g. the government threatens to detain terrorist suspects for 30 days, rather than 20. Not to be taken lightly, but hardly the advent of Robespierre. But when folks are arrested for posting racist messages on Twitter, the silence is deafening.

  3. Handle says:

    Dalrymple is an outstanding source of observation and wisdom on these matters.

    Nearly every time I see mental health issues mentioned on ordinary conservative or libertarian blogs when it becomes a current topic (e.g. the current discussion about mentally ill people and firearms) there will be someone who mentions Punitive Medicine (the term is the title of a book on the subject by Alexandr Podrabinek) and intemperately wonders aloud (trolls?) whether such a thing could happen here and, if so, whether it might not be in the interest of those likely to be classified as “dissidents” in the future to, ahem, back off their support for more involuntary institutionalization of crazy people.

    I used to think this was a true example of “The Paranoid Style in American Politics.” And then I heard classmates, on two separate occasions, sincerely diagnose the holders of certain taboo opinions as suffering from some form of mental illness. At some point it, I don’t remember whether it was with Bush or Palin or both, it became popular to start referencing sections of the DSM-IV-TR and doing snarky clinical analysis from a distance.

  4. patung says:

    “a society which actively defends and seeks to perpetuate this sort of behavior is extremely ill.”

    so society is ill, and minds are ill, and… can a metaphor be treated with drugs do you think? Do metaphors respond well to incarceration I wonder? Are you even aware that you are using the word ‘ill’ in a metaphorical sense in *both* instances above?

  5. Commodore says:

    Thing is, though, the Government and its agents would much rather institutionalize evil racist reactionaries than homeless urine-stained screamers. How likely do you think a pill to cure reaction is?

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