In the aftermath of the Virginia Tech shootings and the revelation that the culprit had been hospitalized in the past for profound depression, the conversation has turned to the various ways we treat mental illness. Some have called for draconian measures. Jill at Feministe provides this quote from someone named Beth:
If you ask me, if we are going to let these crazies run free, not forcing them to be institutionalized, then we need to goddamn well do a better job of protecting the public from them. There’s a reason why they used to be locked up, and it was to protect society. Virginia Tech totally dropped the goddamn ball with this guy; there’s no reason why they should have to educate dangerous people. I know, it’s all about wishy-washy liberal ideals–can’t deny someone with mental illness their “right†to a college education…
I have only occasionally touched on my own battles with mental illness. (See here, here, here, here).
I was first diagnosed with mental illness in college, back in the spring of 1987. After a very violent episode of “cutting”, I was placed on the first of what would be many “5150s”. A 5150 takes its name from the California code that allows 72-hour involuntary “holds” in locked psychiatric facilities for those who are considered a danger to themselves or others. I was 5150ed in April 1987, April 1990, June 1996 (two separate occasions) and June 1998. I was a voluntary admit in June 1989. It totals half-a-dozen stays in locked facilities. (My worst time of the year has always been spring; I tend to be at my lowest between the spring equinox and the summer solstice. I have many theories why, but this ain’t the time.)
I was lucky, so lucky: all the hospitals I was locked up in (both in Berkeley and Los Angeles) were private. They were good places, for the most part. In most I stayed only a few days, but in June 1996 (after two suicide attempts three weeks apart, the second nearly successful) I was placed on an “extended” fourteen-day hold. I talked about my various diagnoses in this post; as I said then I was usually described as having a heavy-duty case of “cluster B’ disorders: Narcissistic, Antisocial, and above all, Borderline Personality Disorder… Doctors frequently added phrases I remember vividly, like “with psychotic features or “prone to micro-psychotic episodes.”
At Feministe, a reader named Psyche wrote:
The real problem is that there aren’t really intermediate states between involuntary commitment (the experience of which, at least the way our mental health systems works now) is comparable to being arrested in terms of humiliation and unpleasantness. Perhaps worse in terms of the dehumanization and total loss of agency. And locked wards in mental hospitals, even the best ones that money can give you access to, are pretty much the last places you want to spend any time, especially if you’re a borderline functional person, you’re surrounded by people who are by and large incapable of sustained social interaction, in an environment with very few distractions, and with no privacy and no control over how you spend your time.
Well, yes and no. Mostly “no.” The locked wards I’ve been on (for, as I said, as long as a few weeks at a time) weren’t Club Med. But they weren’t prisons, either. I’ve spent time in five different locked facilities (I was only hospitalized in one place twice), and I was always thrilled to leave. But while I was there I generally felt safe, cared for. Each time I was locked up, it was after an episode where I had done something so self-destructive that it was obvious to me (and to everyone else) I couldn’t care for myself. Yes, these “psychotic episodes” were brief in my case; I was able to return to functioning (including working on a dissertation and teaching) within a short period of time after release. (I even wrote a paper in one psych ward.) Though I was fortunate in the sense that my illness was more episodic than chronic, I am also clear that all five of the locked wards on which I found myself were places where I got good, competent, even loving care.
I can still remember the faces of the various psych nurses who took care of me. I often ended up in the wards with physical injuries that needed attention (usually cuts or burns); once it seemed likely I had damaged my heart and my kidneys and my liver with one particularly nasty overdose that led to an extensive stay in the ICU before being “released” onto a 5150. (A whole lot of Ritalin and Anafranil and Klonipin, if you’re keeping tabs — quite a cocktail of about 100 pills. I’ve had my stomach pumped three times, and vomited up that charcoal stuff they give you another time or four.) The nurses who took care of me were sometimes loving, sometimes brisk, but always, always, they made me feel safe.
I ate a lot of fruit cocktail (always served in locked wards, it’s a staple.) I made moccasins in occupational therapy. I sat in community meetings with the paranoid schizophrenics and the bipolars in the full bloom of their manic episodes. I read back issues of Reader’s Digest and National Geographic. Two years apart, I watched England lose two heartbreaking matches (to Germany in Euro ’96 and Argentina in the ’98 World Cup); I was hospitalized for both. I was in a locked ward for Tiananmen Square in 1989, and watched the coverage of Khomeini’s funeral. (I was lucky — most of the wards had cable.) I read all of Davies’ “Deptford Trilogy”; even now, rereading it as I have a couple of times, it brings back those days. And oh my, did I smoke. I had my visitors load me up with packs of Parliaments and Marlboro Reds (and once, a few Djarums.) I haven’t smoked in years, but I puffed away with the best of them every time I went behind the locked doors.
I know I was lucky in many ways. I was a young white, not unattractive male with insurance. I was well-spoken and articulate, and tried always to be polite. (Once, when I was in restraints, I apologized profusely to the nurses who catheterized me, saying that I felt “dreadful” that they had to do this for me.) I was also obviously no danger to anyone other than myself. When I was in Northridge Hospital in 1998, I wandered the halls in Tigger slippers which the staff seemed to find cute and endearing. My illness often made me pathetic, but it rarely made me nasty when I was in the acute stages. (Outside the hospital, I could be very antisocial.)
I was lucky too, in a sense, that when I was “in an episode” my behavior was so bizarre and dangerous that I was instantly 5150ed. Had my illness been less obviously destructive, I might have resisted voluntary hospitalization (something I only consented to once). I know many people struggle with family members who refuse to seek help; I am so fortunate that my disease left me with no illusion that I could function or survive without treatment!
I am grateful that privacy laws kept my condition from Cal when I was an undergrad, UCLA when I was a grad student, and PCC when I was a professor. I can disclose my medical history now because I have been healthy for nigh on nine years, with little fear of the darkness returning. I am very concerned that the reaction to the Cho Seung-Hui situation may lead to calls to deprive those who seek treatment for mental illness of these basic and essential rights. What good would it have done to have me removed from school, fired from my teaching position, held longer than minimally necessary? Am I more of service here where I am or rotting in an institution? After eleven years and six hospitalizations, I might well have been considered a prime candidate for long-term commitment to a mental facility. Blessedly, the system allowed me to return to my life, to my family, to my duties as soon as I was able to do so. In my case, folks, the system really worked.
Medication, intensive therapy (including a couple years of analysis on a couch), growing older, and a Twelve Step program (or three): all of these played vital roles in my recovery. God’s grace allowed me to get still enough to make use of these tools. My story turned out very differently than that of Cho Seung-Hui. But if he is the face of where the system failed, let mine — for those who know me — be the face of where it worked.
Thanks for this – I wanted to post something in a similar vein, but didn’t really feel I had enough knowledge, either the book-learnin’ type or from experience.
I know from experiences with others that they don’t allow you to smoke on locked wards anymore. It’s the patch or nothing.
I had heard that, Auguste; I shudder to think about it. We weren’t allowed to smoke indoors, mind you, but every hospital I was in had a little patio area, enclosed with wire or walls or something, where we could puff for fifteen minutes at a time.
Therein lies the distinction: Cho was identified early on as a threat not only to himself, but also to others.
“I know from experiences with others that they don’t allow you to smoke on locked wards anymore. It’s the patch or nothing.”
I’ve gotten variable reports on that from patients who were in different hospitals at different times, actually. One hospital in our area a couple of years ago went with the patch or nothing approach, to the dismay of the smokers among the patients, but other hospitals were making provisions for smokers at the same time, and I’ve heard that the hospital that was not allowing smoking may since have changed its policy.
One thing that gets me is that when we talk about “where the system failed” we look only at the mental health system. No one says anything about the movies and the books and the video games which all promote violence. They want to blame it on anything ~except~ their own consumer choices.
Nice article, Hugo. I’ve written my own thoughts about why the bipolar/borderline community hasn’t touched this story.
Pingback: Pax Nortona - A Blog by Joel Sax » Blog Archive » The Minority Group Forbidden to Speak for Itself
Beowulf and Hamlet made me a killer.
Xrlq, I think the central contributing factor to the shooter’s evil actions is mental illness. I’m of the persuasion that the Korean / Asian cultural stigma against getting psychiatric care made it more than difficult and near impossible for someone like him to get the help he desperately needed, regardless of what mainstream society might have in place. That Asian cultural loyalty is too strong. So, if he had been strongly encouraged by both his immediate family, their Korean familial network, as well as societal and institutional communities, he would have had a much much better chance at wellness. (And we wouldn’t be having this conversation.)
As a Chinese American who also emigrated at age 8, and also went to Virginia Tech (1988 graduate), I know that I didn’t seek mental healthcare until much later in life. By the grace of God, I survived long enough to tell about it and didn’t harm people badly in the process. (If I could afford counseling, I’d love to have that kind of support throughout this thing called life.)
I have not read all the comments but wanted to post my own observations.
I work in special education as a coordinator of services; much of my work is in secondary schools. There are an amazingly large number of students with mental illness at this level of education. Everything from cutting, depression, other health impairment, etc. There is only so much that the “system” can do for students who demonstrate symptoms that are alarming, yet not endangering to themselves or others, can do. At this level, working with minors, it is up to the parent to follow-through and see that the student gets the help, medication, etc. needed. After that, parents must make sure the meds are taken and follow-up appointments with mental health professionals are kept. Once a student turns 18, then it is up to the student to take on these responsibilities. I think early and on-going education about disabilities and how to manage them are most important with anyone who has a disability; that being mental, physical or medical. (It is stunning to me the parents who do not want their children “labeled” or don’t want the students to know about the identification.)
Note, I am not talking about those who openly make threats or who play out their anger, etc. by acts of violence. They have options in the public school system other than a traditional school setting.
My heart goes out to all the families. But let us not forget the family of Cho; it could well be that they sought help but he refused or they did not know how to handle his behaviors. If you have never been confronted with mental health issues, you have no footprints to follow and it can be overwhelming to get answers or help.
I could go on and on about my knowledge and experiences, but I think I have given some insight to what I have experienced from the professional side.
My worst time of the year has always been spring; I tend to be at my lowest between the spring equinox and the summer solstice.
Random side note–the same is true for me. I have been at least mildly depressed every spring for as long as I can remember.
@Hugo:
(I’m always impressed with your work ethic under these circumstances and a little ashamed at how much I let my minor disappointments and neuroses interfere with my work life.)
What about Xlrq’s point about the difference between disturbed self-destructiveness and predatory actions which are harmful to others? I admire your compassion toward the mentally ill, but I think you are being inappropriate and dangerous to make a political solidarity statement, but it seems highly inappropriate.
It’s disturbing because it seems like you’re saying, “Before my conversion, I seduced a lot of women, so let’s not be so harsh on child rapists.â€
@djchuang:
News reports indicate that Cho’s family was very worried about him and asked the university for help, so I’m not sure that “Asian aversion to mental health care†is relevant to this case.
@Lou: the family does seem to have sought help.
I think that the family’s public statements have gone a long way toward diffusing any possible ethnic stereotyping and strife. Aside from the Kaczynskis, who turned in their brother to authorities, I don’t remember hearing from the families of a killer, except to defend their child (like the Hinkleys). It’s very easy identify with the Cho family after hearing how they tried to be good parents but were always very concerned about their son.
Hugo,
As always, eloquent and insightful. My own struggles with mental illness have been much less harrowing. I suffered from untreated and somewhat serious clinical depression as an adolescent and college student. My bouts with depression incresed in intensity until, in my late 20s, I finally was diagnosed and treated. Now 38, I haven’t had a bout of serious depression in almost 7 years. For me, it is the hottest months – July and August – that are most difficult.
On college campuses, I think it is easy to hide one’s mental illness. As a college student, my depression manifested itself in disrupted sleep and eating patterns. I had a dorm room more or less to myself so I could go without sleep without anyone noticing and I could usually get away with eating extremely small or large amounts. I might stay at a single meal for an hour but everyone else would come and go – no one knew if I’d just finished eating or was about to start. I could overeat or undereat without anyone noticing.
In a more structured environment, people notice – my office if I skip a meal my coworkers notice and ask. On a college campus where everyone is stressed and feeling overwhelmed, it was easy to be invisible – unless and until you actually become a threat to yourself or others. I was able to disguise the real nature of my mental health problems as creative eccentricity for years. The one person who caught one was actually significantly more mentally ill than I was and no one took her “diagnosis” that seriously.
In many ways, the system has protected and worked for me. As a well educated, white man I have and have always had access to tools to help myself and been given the presumption of health. It is one of the ways in which privilege functions almost invisibly.
K, we already have laws that allow people to be institutionalized that are actually a threat to others. If they didn’t get applied in Cho’s case, it’s certainly not because the ACLU is preventing people from getting locked up in the case where they really are a threat to others. When someone like Beth grumbles about letting these “crazies” run free, and wishy-washy liberals who don’t want to deny people with mental illness the right to a college education, she casts a much wider net than just those relatively few mentally ill people who are actually a threat to others. She’s also casting aspersions on the rights of people like my husband, who has never been the least threat to others. I know, through my husband’s support groups and through the family support group I attend, of a fair number of people who have needed a 5150, and a few who’ve needed a longer involuntary hold; the vast majority have been committed because they were a threat to themselves, not others. So, no, as long as we have such generalized rants about what a threat “crazies” are, I don’t think Hugo’s expression of political solidarity is at all inappropriate; I think it’s well said.
Thanks, Lynn. Indeed, California law, properly applied, always allows for the involuntary detention of those who are a threat to others. And most of those who are 5150ed are there, as Lynn says, because of threats to themselves.
I am not defending what Cho did; I am defending the rights of the mentally ill, who as a class pose chief danger primarily to themselves.
I have a friend who’s going through serious issues with bipolar and alcohol. I hope he makes it out of his problems alive like you did. Thanks.
K, from my perspective as an Asian American, and in my work as a researcher on Asian American churches, all the reports I’ve seen in the media about the Cho family resembles most others. And, as such, the cultural resistance and stigma to get mental care help is very difficult, and if attempted, often too late.
Granted, it’s speculation to know how much effort was made to get help in time, and how many creative avenues were tried for the person of our discussion. But, I do know that Asian stigma against counseling this is a major factor for most who need help but don’t get it, just as it was for me personally in my own family.
See this SF Chronicle article for more explanation about Asians being less likely to see therapy:
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/04/20/MNGHMPCDG41.DTL
At the time Cho could have been involuntarily committed he was seen to be a risk only to himself. Those doctors didn’t see his writings, etc. A better system for putting together the pieces of the puzzle would help.
Also, this was an unusual case of a very uncommunicative person–from childhood. I would guess that most people who are this mentally ill would say more alarming things. His roommate did report the one very alarming thing he said which indicated he might harm himself. That’s to be commended because many many such incidents don’t get reported.
Our son (while in college)was involuntarily put in a mental facility because police determined he was a threat to himself when he said he intended to collect money for a relative by panhandling. His friends had called 911 because he was talking a bit unusually over a few day period and they thought he needed to see a doctor.
The only other time he went to a mental facility he really only needed to see a doctor but was new in town and didn’t have his own. The emergency rooms are the only recourse. They gave him a sleeping pill, took him to the mental facility. When there he was asked to sign that he was there voluntarily (not true) for 5 days or be involuntarily committed for 30 days. (they exaggerated to threaten him–it would have been for 3 days.) We had to get a lawyer and fight them. He was not a threat to himself or others, just needed his medication adjusted so he could sleep.
The main point is that the whole system is very inconsistent and needs reform. If patients could get good care outside the facilities the spaces there could be reserved for those who really need them. If there were insurance parity, mental health issues (brain disease) would be covered like other physical diseases.
We need to use this case to sort out what would help many students and many situations rather than base our changes just on this one very very unusual case.
One of my major concerns in all of this is that in most areas of the country, and certainly for most people on regular health insurance (to say nothing of un- or underinsured folks), the mental health system is already strained to capacity. In Minneapolis in the 90s there was more than one case of a mentally ill person being turned away from involuntary (family-instigated) commitment, because there was no room at the facility, and then those people did go out and kill others. These were people whose families begged to have them committed and treated, but there was no room available. Part of the problem was that this was at the county hospital, which had so much traffic from people brought in and committed by police that they could not make space for people brought in by family. So if we’re already at (or past) the breaking point, and suddenly we’re to be institutionalizing more people, on the theory that they *might* be dangerous at some point, where are we going to put them? Where will the money and space come from, and at whose expense? Or will any remaining standards just become nonexistent, and mental hospitals become more akin to prisons, jam-packed with people who are there unnecessarily, under some mandatory sentencing scheme?
The other major issue that worries me is that it’s not been very long since being gay was a mental illness. Given the current political climate, it’s not unforeseeable that certain political opinions or expressions of protest could become classified as mental illness. Especially in a college setting, where the system is (in my experience) already somewhat fast and loose, this is a recipe for serious repression.
when you say it’s ove. Liesbeth Kiki.
Hi Hugo,
My overachiever and wonderful daughter 20 came home from Berkeley this Summer and had a major depression “melt-down”.
After much trial and error with doctors, we finally found a good one. She sat out one semester (and worked, instead) but plans to return to Berkeley this month/semester.
Your writings on your own bouts with mential illness have given me such positive hope and inspiration for my daughter’s potential positive future.
So much you read about mental illness is so negative.
You get the impression that once a person has a first episode, their life’s outcome will be horrible.
You remind me so much of her present doctor (who has really won her over); he is an optimist and upbeat.
Whenever I am feeling down about what my daughter has gone through these past six months, I read your writings and they make me feel good.
Thank you more than I can say!
My 10yo little girl is currently psychiatrically hospitalized for the fourth time in five months. Usually, she is a danger only to herself and me and my husband. This last time, she lunged at the baby. Her violent psychotic episodes last a day or two, we hospitalize her, they keep her and us safe, and then she’s fine and they send her home to start the cycle again. I have begged for help from everyone in the mental health and school system, and I am amazing at finding resources for my child. But most of the resources just don’t know what to do or don’t care. The vast majority of the time, my daughter is a happy, pleasant, gentle, creative, sweet, strange and wonderful child. She does NOT need to be locked up forever. She does need help. There just doesn’t seem to be anyone willing or able to help her. I am very scared of what she will do as she gets older and bigger, and I’m trying so hard to find the right therapy/meds/special school combo to prevent these episodes. But there is no set answer. Right now I feel like I don’t know if there is any answer. Other than to lock her in her room every night, be sure I”m always within arm’s reach of the baby, and to make sure she has an aide always within arm’s reach of her when she’s not at home. I am very worried for the future of my child. The resources just don’t seem to be there.
Cho should have never been in VT in the first place. He was too backward for that environment. He should have gone to a college for the mentally retarded. There just had to be a college for the mentally retarded in that town where he live, since every state in the country has one. Where was there one in Blacksberg, VA? He should have been enrolled at the Community College for Retards of Virginia. There probably was one there-he just wanted to be a darned fool, and be what he wasn’t-don’t know how he slipped through the cracks.