The Republic of T.

Black. Gay. Father. Vegetarian. Buddhist. Liberal.

I Think You’re Crazy. Just Like Me.

I actually went all day without hearing about the hostage situation at Hillary Clinton’s campaign headquarters. By the time I got the full story, it was all over but the post-hostage-crisis analysis, which basically boiled down to this: the guy was crazy. His lawyer said he heard voices telling him to “sacrifice himself” to bring awareness to mental health issues. Maybe the voices were on to something, because he appears to have done just what they said.

As I listened to the reports, I couldn’t help shaking my head and asking “What was a guy with obvious problems like this just roaming around? Why wasn’t he somewhere getting help?” Of course I knew the answer. In a way, the hostage situation in Hillary’s office is just like any number of other events, like the disastrous non-response to Katrina, or the tidal wave of toxic toys and poisonous food that’s washed up on U.S. shores. It’s the result of a very simple political philosophy, one that’s often mistakenly paraphrased as “government doesn’t work, when a more accurate description would be “government shouldn’t work, mustn’t work, and if it is working it must be stopped.”

I remember the one time my parents came to visit me in D.C., they were amazed — appalled, really — at the number of homeless people in the nation’s capitol. I don’t know if they realized that many of them were mentally ill, and had no place to go. Not anymore anyway. Jay at Feministe pointed out this post by Richard Kim, over at The Nation, recognizing Ronald Reagan as the president who turned out the mentally ill.

The gutting of public mental health services began with Reagan, first in California where he closed state-funded mental health facilities. As president he cut aid for federally-funded community-run mental health programs. The result: thousands of more homeless people in California and nationwide and a spike in the prison population. The New York Times recently reported that despite a rapid rise in the suicide rate in New Orleans in the aftermath of Hurricane Katrina, the city has half of its psychiatrists, social workers and mental health care workers.

…Without appearing to capitalize on the situation, Clinton, and all elected officials, can and should take this incident as an opportunity to emphasize the importance of mental health services in any health care package, criminal justice reform, and indeed, in any vision of what a more caring, safer America looks like.

Jay elaborates further.

What happened is that funding for mental health at every level, public and private, has been consistently reduced over the last 25 years. No insurance, public or private, covers psychiatric meds or talk therapy at the same level that it covers physical illness. I’m not saying meds are the solution to everything – far from it – but people with insurance can access medications far more easily than they can talk therapy. For most emotional illnesses (save schizophrenia), talk therapy is just as effective as meds, but it’s far more expensive and insurances just don’t pay for it.

In fact, if you need — really need — inpatient mental health care, you’re unlikely to be able to get it, or at least get enough of it, because whatever can’t be treated in 10 days or so, isn’t going to be treated period. Not unless you kill someone, or at least take a few hostages. After his
arrest, he war ordered to undergo evaluation.

A judge ordered a mental evaluation Monday for a man accused of taking workers hostage at a Hillary Rodham Clinton campaign office, and his attorney said the man saw visions directing him to “sacrifice himself” to bring awareness to mental health issues.

…”I want to make sure that this man doesn’t go anywhere until he is dealt with properly,” Rochester District Court Judge Daniel Cappiello said.

Eisenberg’s defense attorney, Randy Hawkes, said in court that Eisenberg heard voices and saw a “movie in his head” last week telling him he had to “sacrifice himself to bring the issue forward.”

The sad part is that Eisenberg tried to get help earlier, and couldn’t.

The man accused of taking five people hostage at a Hillary Rodham Clinton campaign office desperately wanted help with a drinking problem, but lacked insurance and money to pay for it, his family said Monday.

Leeland Eisenberg, 46, is accused of walking into the Clinton office on Friday afternoon with what appeared to be explosives strapped to his body, demanding to speak to Clinton about mental health care, authorities said.

“It was an act of desperation to try and get help,” his stepson, Ben Warren, told ABC’s “Good Morning America” Monday.

Let’s just hope that everyone who needs mental health care and can’t get it doesn’t follow Eisenberg’s example. Both worldwide and in the United states, there most people who need mental health treatmenr don’t get it.

Most people in the world with mental illness get no treatment at all, and scarce mental health resources are not reaching the people who need them most, U.S. researchers said on Thursday.

…”Even in the United States, which is by far the most resourced country, it is by no means adequate. In our country, folks who meet the criteria for the most serious illness, only about half get anything,” Wang said in a telephone interview.

“Many aren’t receiving healthcare at all. The situation is concerning,” he said.

Patients who were male, married, less-educated and at the extremes of age or income got the least amount of care, the researchers found.

The question, at least to me, is why are resources so scarce? Well, there are a couple of answers. As the Washington Post piece points out, part of the problem is the notion that mental health issues are not as “real” as other health problems.

Q Why are my mental health benefits less generous than those that my insurance policy provides for other conditions?

A When mental health coverage was first added to benefits packages a few decades ago, there was still a persistent belief that a condition like depression was not as real as heart disease or cancer. There also were few medications or other therapies that offered significant improvement. Many employers did not offer rich coverage because they assumed the government would eventually pay for treatment of serious mental illnesses such as schizophrenia or bipolar disease.

Mental health problem are instead treated as moral or character failures.

Why do mental illnesses continue to be stigmatized? For one thing, the term “mental illness” itself implies a distinction from “physical” illness, although the two are intimately entwined. In fact, neuroimaging studies show physical changes in the brain associated with mental disorders, suggesting a biological basis. Some mental health advocates propose switching to less stigmatized terms, such as behavioral health or brain disorders or brain illnesses.

To some, “mental” suggests not a legitimate medical condition but rather something that results from your own doing and your own choices. People may blame you and think your condition is “all in your head.” They may think that mental illness is an indication of weakness or laziness. That you’re a “moral failure” or simply “can’t cut it.” That you should just “get over it.”

That’s probably why it’s also one of the legacies of Reaganism, founded on a bedrock belief that the government shouldn’t be in the business of helping people, or helping people get help; especially if those people are moral failures.

When Ronald Reagan was governor of California he systematically began closing down mental hospitals, later as president he would cut aid for federally-funded community mental health programs. It is not a coincidence that the homeless populations in the state of California grew in the seventies and eighties. The people were put out on the street when mental hospitals started to close all over the state.

California put a stop to at least some of Reagan’s madness. But the rest of America wasn’t.

Seeing an increase in crime, and brutal murders by Herb Mullin, a mental hospital patient, the state legislature passed a law that would stop Reagan from closing even more state-funded mental health hospitals. But Reagan would not be outdone. In 1980, congress proposed new legislation (PL 96-398) called the community mental health systems act (crafted by Ted Kennedy), but the program was killed by newly-elected President Ronald Reagan. This action ended the federal community mental health centers (see timeline on this link) program and its funding.

And that probably because too many people see mental health problems as moral or character failings, and Americans have a almost pathological desire to separate the “lambs” from the “goats”; the people deserving of help from the people who are not deserving of help, and the mentally ill — who didn’t ask for or create the brain chemistries that are often the source of their difficulties — fall in that last category.

Of course, making treatment available has to be balanced with protecting the rights of those needing mental health care. One one hand, some people think our current system coddles the mentally ill.

The attitudes and techniques of the therapeutic culture–non-judgmental toward behavior (moral neutrality), empathic, understanding–have only one useful and proper place–a treatment venue: a consulting room or hospital. There is no place for these in schools or in any other life situations. Their use outside of clinical situations can only result in a perversion of normal guidelines for social behavior, confusion for teachers and students, and ultimately resentment and mischief.

These attitudes and the clinical techniques based on them emerged out of the practice of psychoanalysis in the early part of the century to deal with clinical problems unique to analysis but with no other application outside of analytic therapy. This came to be misunderstood by those who fell under the influence of psychoanalysis either as patients or students in schools of education and social work. Aping their analysts or teachers, they came to believe that these attitudes were in and of themselves therapeutic. And over the years these misunderstandings have gained ground and replaced reality–and common sense–as the guiding principles of education and social work.

It would be highly desirable to change the laws that stress the “civil rights” of the mentally ill in schools and that encourage the view that the privacy of the mentally ill individual trumps his health and well-being to laws that support early recognition of severe mental illness so that he may be helped to treatment and management of his psychosis in a timely way, and prevented from doing serious harm to the innocent.

On the other hand the mentally ill do have rights that must be protected.

The mentally ill are not treated well in our society. Mental illness is horribly stigmatized, and posts like Beth’s are part of the reason why many people are hesitant to seek help. Further, it’s not a matter of “some people are sane, others are crazy.” Metal illness is wide-ranging, and is a term that encompasses everything from depression to schizophrenia to obsessive-compulsive disorder. The kind of depression and mental illness that Cho faced was extreme; it does not follow that every other person with depression should be locked up against their will. It does not follow that every schizophrenic should be locked up against their will. It does not follow that every mentally ill person should be locked up against their will — even if they’re obviously ill, and even if their illness makes us uncomfortable.

What mentally ill people do need is treatment and access to medical care. People who don’t have insurance don’t usually have the luxury of seeing a therapist; even if they manage to do that, paying out-of-pocket for medications is not easy. People need to be able to see a therapist without being branded “crazy.” Those who are severely mentally ill and who also lack resources need help and empathy, not scorn. Mental illness needs to be seen as it is — a continuum in which there is no clear line between “mentally ill” and not, and where many (even most) types of mental illness are treatable and manageable. The face of mental illness is the ranting homeless man on the corner, but it’s also a member of your family, a friend, a co-worker. If people like Beth actually want to combat mental illness, they wouldn’t promote locking up any person who showed signs of it — they’d promote a universal health care system that would give all people the medical care they need, and they’d make efforts to de-stigmatize mental illness so that people would actually be receptive to that care.

But who is mentally ill? In my brief 38 years I’ve been treated for depression and am currently being treated for ADD, both of which NIMH lists as “mental disorders”. If I qualify, then so do a lot more Americans. and the cost for not treating them (us?) is pretty high.

One-quarter of all Americans met the criteria for having a mental illness within the past year, and fully a quarter of those had a “serious” disorder that significantly disrupted their ability to function day to day, according to the largest and most detailed survey of the nation’s mental health, published yesterday.

Although parallel studies in 27 other countries are not yet complete, the new numbers suggest that the United States is poised to rank No. 1 globally for mental illness, researchers said.

…Less than half of those in need get treated. Those who seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. And the treatment they receive is usually inadequate.

Younger sufferers are especially overlooked, the survey found, even though mental illness is very much a disease of youth. Half of those who will ever be diagnosed with a mental disorder show signs of the disease by age 14, and three-quarters by age 24. But few get help.

Many factors contribute to these failings, the reports conclude, including inattention to early warning signs, inadequate health insurance and the lingering stigma that surrounds mental illness.

It’s just a matter of whether that price gets paid up front or later, and with considerable interest added. In cases like the Clinton hostage crisis, the cost is the trauma and mental health consequences experienced by the victims. In the case of incidents like Virginia Tech, the cost is measured in human lives.

For the rest of it’s a cost that’s measured in increments and “mental health days” away from work, and doesn’t make good news content, but it adds up to a lot eventually.

An NIMH-funded study finds that more than half of U.S. adults have a mental or physical condition that prevents them from working or conducting their usual duties (e.g., role disability) for several days each year, and a large portion of those days can be attributed to mental disorders. The study, published in the October 2007 issue of the Archives of General Psychiatry, is based on data from the National Comorbidity Survey Replication (NCS-R), a nationwide survey among 9,282 Americans ages 18 and older.

Role disability is increasingly recognized as a major source of the societal costs of illness, but these indirect costs—the result of impaired functioning and lost productivity—are not easily measured, making it difficult to estimate the total costs of illness. To help quantify these costs, NIMH researcher Kathleen Merikangas, PhD., Ronald Kessler, PhD., of Harvard University, and colleagues analyzed data from 5,962 respondents of the NCS-R to determine the rate and frequency of role disability. They asked respondents how many days they were completely unable to work or carry out their usual activities as a result of a mental or chronic physical condition, such as an anxiety or mood disorder, substance or alcohol dependence, cancer, cardiovascular illness, musculoskeletal conditions, or others.

They found that over a one-year period, 53 percent of U.S. adults have one or more mental or physical conditions that result in role disability. Among those adults, each experienced an average of 32 days of disability per year. Nationwide, about 2.4 billion disability days resulted from physical conditions, and about 1.3 billion disability days resulted from mental conditions. “These figures suggest an enormous burden on the people who have one or more of these conditions, their families and their employers,” said Dr. Merikangas.

I’m fortunate enough to have health insurance through my job, that makes it easier for me to get the treatment I need. But there are a lot more people like me who don’t. We just don’t think of them until we see them in the news, even though some of them are just in the next cubicle, the house next door, or just in the next room.

We’re about to enter a campaign season where health care will be one of the big topics. All the major candidates either have or will present at least some vague proposals for improving health care. From where I sit, anyone who doesn’t include significant support for mental health treatment is, well, crazy.


  1. Obama or Hillary are in danger of their lives–we all need to get that

  2. Forget the mentally-ill homeless folks! Let’s first treat the mental illnesses that plaques the oval office… but then again, is there a treatment for stupid?

  3. such is what we have always known, ask DeToqville(sp). nice blog chk me out sometimes

  4. Part of the issue, is indeed, language. We all continue to contribute to the ongoing problem too. For example, in your own post, you open with:

    By the time I got the full story, it was all over but the post-hostage-crisis analysis, which basically boiled down to this: the guy was crazy.

    The connotation there is negative. You could easily have said he was “ill,” “sick,” or “psychotic.” And at the end you confirm the negative connotation by saying

    From where I sit, anyone who doesn’t include significant support for mental health treatment is, well, crazy.

    I realize that you meant this to go with your title – which isn’t negative – “I Think You’re Crazy. Just Like Me.” As a complete piece, I can see your intent isn’t to castigate the mentally ill. I just found it interesting that the word choice inadvertently helped to continue the stigma unintentionally.

    Sadly, I do it in my own speech and writing too. It’s a vicious cycle that ingrained in our culture. Thanks for highlighting this, Terrance.