The history of modern mental health treatment began with the often pressing need to dispose of troublesome relatives. Psychiatry evolved to fulfill the desires of wealthy families who could afford “treatment” of an unwanted relation. Psychiatry offered a less vulgar method to coerce the one’s we love. The “treatment” of the relative avoided assigning blame by labeling the identified patient as diseased. It avoided unpleasant legal terms and the lack of control even wealthy people suffer at the hands of the court. Society did not have to prove that someone actually came to harm; they could be jailed for behavior unbecoming to others. It should be noted that most legal systems keep people imprisoned for an inviolable length of time. In early psychiatry, as is often the case now, incarceration ended with the termination of payment.
Modern psychiatry has increasingly dovetailed with the legal system. The government often pays for incarceration (hospitalization), as well as third party insurance companies supported by the state. The length of incarceration is no longer directly related to the wealth of the family. At the same time, the criteria for incarceration has become more rigid and much less dependent on the wishes of the family. Even with this arguable progress, some psychiatric authors have railed against the coercive and legal aspects of psychiatry. They do not see the proper role of a medical doctor to be the control of behavior by manufacturing diseases of the mind. Psychoactive drugs may be considered the tools of choice to control unpleasant behavior. Those behaviors thought unpleasant will tend to change over time and locality. It is for this reason that many psychiatrists are uncomfortable functioning as the foot soldiers of government control. Within the last 100 years, masturbation and homosexuality were labeled as criminal behaviors, then diseased behaviors and now they are normal behaviors. Should psychiatric practice be the handmaiden of industry and government?
The dilemma of state behavioral control is complicated by practical considerations. To care for someone with a severe mental illness is a lifelong burden. Though the problems may stem from different sources, it is the caretaker’s burden to maintain a wary eye every waking second of their life. Sleep is often disturbed by the knowledge that harm befalls the afflicted at night even more than during the day. There is nowhere to run or hide from the caretaker’s responsibility. For example, it is not uncommon for parents of the mentally retarded to become tearful when their child is psychiatrically hospitalized. Part of the tears fall due to the pain of seeing their child suffer. The remainder of the tears fall over the guilt they experience. It is the guilt experienced from being relieved of their caretaking responsibility. A fairly typical example may further clarify the dilemma experienced by so many.
An elderly woman complained of the troubles she is having with her middle-aged son. She has a large happy family that is doing well, with the exception of this one child. About half the children have contributed both money and time towards the care of the one brother. Initially, the mother was seeking help to lower her anxiety over his welfare, and decrease the guilt over the possibility that she inflicted a psychological injury. Interviews with the other siblings were consistent regarding perceptions of their parents. They viewed the parents as loving, supportive, and overall good models of adult behavior. Both the mother and children, as mentioned, have given the middle-aged son money for food and shelter. For over ten years, this child squandered all the money on recreational drugs or get-rich-quick schemes, and was subsequently found homeless each time. Both the mother and children have paid for psychiatrists to prescribe medication, and they often believed he was better-even cured. These calm periods of effective functioning ended each time he discontinued the medications. He has confided to his mother that he views the medications as a “crutch,” it identifies him with being mentally ill, and lessens the high he experiences when manic. Even though he is homeless and completely dependent on others, the child has not made any effort to secure state funding; for example, Medicare, Medicaid and social security disability. Currently, the middle-aged son has another method to get rich, using the internet at his mother’s home. He markets himself as a sort of agent to foreign singers attempting to expand their American audience. These people fly to America at their own expense, and often with their whole families. What these people discover is a wild-eyed manic talking rapidly and nonsensically in his mother’s borrowed bedroom. If the family succeeds in removing him from the street and into a psychiatric facility, he becomes verbally abusive to his family. He accuses the mother and siblings of causing his mental illness, and even worse, incarcerating him at the cusp of realizing all his plans.
The preceding story, and millions like it, loudly begs the question whether this middle-aged child would be better managed by the legal system. Would it be better to let him bounce off the walls of a jail cell for the remainder of his life? Would it be better to psychiatrically hospitalize in order to stabilize medications and release him back into society? It is hoped that most people would choose the later rather than the former. To rid society of psychiatry might introduce new problems as well. The legal system would have to cross-train police to be ersatz social workers. Not only is the training widely divergent, the types of people who would perform well at either job is divergent as well. Additionally, most people with severe psychiatric disorders have difficulty with personal and social judgment. This psychiatric jail subgroup would be easy prey at the hands of the resident psychopaths. Society would be leading these lambs to slaughter. In effect, the jail would harden the attitudes of psychiatric patients and teach them psychopathic skills in order to survive. Once these hardened psychiatric patients are released back into society, without any support system, it is suspected they will not survive within the boundaries of the law.
It is a fact that good and kind people, with solid marriages, sire children with psychiatric and neuropsychologic disabilities. This article asked if the mental health system should separate itself entirely from the legal system. The answer is yes if society seeks to merely contain the dangerous and ignore the remainder. The answer is no if society seeks to manage the populace with some degree of humanism.