What You Should Think About Mental Health Welfare

October 24, 2007

“The insane, on occasion, are not without their charms.”

–Kurt Vonnegut Jr.

There was a time when Western Civilization’s answer to obvious mental illness was to cram deranged individuals onto barges. In some ways this mode of thinking continued into the 20th century. One hundred years ago, it was thought that the most sensible thing to do with insane people was to lock them in asylums. Imprisonment without guilt is never a popular idea, but letting lunatics run wild is even less so.

Perhaps I should say, “was even less so.” As the politics of rugged individualism hijack so many debates about public policy, this one has also been turned upside down. All of the broad, and very real, consequences of depriving diagnosed psychotics of institutional support are waved away in order to focus on an absurd and bogus dichotomy between lower taxes on hardworking citizens or free benefits for do-nothing nut jobs.

Perhaps the public dialog has never been phrased in such stark terms. Yet public policy is clearly framed by such harsh thinking. Working hand in hand with majorities in Congress, President Bush was happy to make some progress in cutting spending not long after his inauguration. From coast to coast, residential mental health facilities were closed. Reduced funding also meant the most troubled patients would have less access to the most aggressive therapies. The warehousing approach to dealing with American mental illness had returned.

What makes this so objectionable is that the means exists today to achieve much better results. It is a penny-wise and pound-foolish approach that offers minimal institutional support in the most severe cases and none at all to garden variety schizophrenics. In the best cases, state and municipal governments act with foresight pick up the slack and maintain adequate services to meet the needs of, and minimized the harm caused by, mentally ill residents. In the worst cases, they pay a greater price dealing with these same individuals only after they have raised issues for emergency services and/or the criminal justice system.

Even as scholars, physicians, and chemical engineers continue to advance the human ability to treat psychological disorders; the role for America’s federal government in this process has been contracted. Humanitarian appeals often focus on the widespread use of prisons and criminal penalties as a means to deal with the problem of severe insanity. To be sure, there are few categories of tales more tragic than those of extremely troubled men and women, surrounded by brutality, denied any meaningful psychological support, essentially abandoned to the daily torments of their own madness.

Yet this is not merely a humanitarian issue. Many of these individuals could tend to some of their own needs in a different sort of institutional environment. Others could even lead healthy productive lives at liberty, requiring only the right sort of medication along with periodic oversight. A non-trivial amount of national productivity is frittered away in service to corrupt ideological nonsense taken from the “there ain’t no such thing as a free lunch” chestnut. Shortsighted public policy transforms a potential resource into an significant burden. Then there is the actual pain and suffering associated with the various crimes that abandoned psych patients commit as they transition from merely homeless to criminal convicts.

Of particular cause for concern at this point in history is the incredibly low amount of funding going into mental health care for returning veterans. Public figures and news reports have been going on for years now about the importance of readiness to deal with the psychological problems faced by soldiers returning to civilian life. Yet all this talk has been backed up by very little funding. In a good year these resources are still well less than 1% of spending on the war effort. Even worse, The Department of Veterans’ Affairs is apparently just plain incompetent when it comes to using what funds they do receive to upgrade mental health treatment capabilities.

The archetype of the homeless antisocial Viet Nam veteran, an angry beggar with visible injuries less shocking than the unmistakable damage to his pride, has strong resonance in our culture. This is not because of some sinister Hollywood plot to manipulate the American mindset. It is because Viet Nam was a particularly chaotic and pointless war, founded on lies, waged against savagely cunning enemies, and ultimately unsuccessful in the achieving the implausible objectives established by White House policies. In several crucial ways, it was more disturbing to its participants than typical wartime deployments.

Afghanistan presents a tricky case in that the war was launched with a clear purpose, some aspects of its management have been sensible, and the overall effort might yet be salvaged by more coherent policies of a future U.S. administration along with successes achieved by international partners in that effort. Yet it is still an occupation in which attacks could occur at any time from virtually anywhere. Suicide bombers, opportunistic snipers, convoy ambushes — combatants involved in action over there have more than a soldier’s usual reasons for coming back with nightmares.

Iraq creates a worst of both worlds situation. Insurgency tactics continue to involve surprise attacks, often with heavy civilian casualties. Participants in the original invasion force also must cope with the many civilian casualties inevitably resultant from Rumsfeld’s hasty plan of attack and barbaric rules of engagement. The Coalition Provisional Authority was more interested in placing control of Iraq’s oil fields in the hands of corporate profiteers than in restoring the basic institutions of civilized governance in that war-torn land. Regardless of however much soldiers in the field followed the politics of it all, they have been exposed to its consequences. It is impressive to see such dutifulness in the face the terrors they all must confront. Yet the unredeeming nature of the overall policy leaves them with no solace beyond that sense of duty in coping with the aftermath.

It would be excessively cynical to argue that the administration’s policy is, “let’s keep them in the fight over there so we don’t have to give them care over here.” Yet the interest in maintaining that fight is paired with a distinct lack of interest in providing that care. When it comes to the treatment of shellshocked warriors, minds and bodies forever scarred by acts of service to our nation, there is a convergence of moral imperatives.

Be it out of economic pragmatism, basic human decency, or a sense of obligation to those loyal in national service; there is no reason not to add much more funding and much more oversight to measures that will provide counseling and treatment to veterans deeply troubled by their experiences with asymmetrical warfare. Yet, setting aside the national service issue, the same arguments apply to all Americans with seeking treatment for some sort of mental disability. As a society we have the means to do much better than shove the lot onto itinerant barges. Why then would any national leader promote policies that regress the state of national mental health in such a downright medieval direction?