Opinion - Saratoga Springs Politics

The below blog posts are written by John Kaufmann.
These opinions do not reflect the views of Saratoga TODAY newspaper.

Tuesday, 17 October 2023 10:50

Rethinking Mental Health and Homelessness

By John Kaufmann | Saratoga Springs Politics

[JK: this is a piece by Freddy DeBoer, who maintains an email list for subscribers. It addresses the thorny issue of dealing with mentally ill people who are a danger to others and/or to themselves. Legislative actions and legal decisions seeking reform of the mental health system have made the vulnerable more vulnerable, he argues.

DeBoer is critical of the advocates of the disabled whose ideology blinds them to the reality of mental illness.]

My hometown lies along the Connecticut River,  but you’d never know it by walking around. That’s because, in the 1960s, the American mania for building highways resulted in the construction of Route 9, which ran directly along the western bank of the river. Though there are two underpasses that one can use to reach the banks of the river (and the imaginatively named Riverside Park), both cut through grimier former industrial areas, and while I wouldn’t call them dangerous places, they are far from pleasant. Standing on most stretches of Middletown’s lovely and broad Main Street, you’d never know the park was there, much less how to get there, despite Main Street lying perhaps a couple hundred yards from the river at most. Once upon a time, the river was the economic heart of the town, and of the nearby region; at one point, Middletown looked like a rising powerhouse of commerce, as goods were shipped to and from Long Island Sound and New York via its waterways. But the creation of the country’s highway system did more than just divide Middletown from its waterfront; it robbed the town of the river’s commercial potential. The construction of America’s vast interstate highway system had already greatly reduced the salience of shipping via river. Thus our country’s automobile obsession hurt my hometown in two ways, first by rendering obsolete a key industry, then by physically separating it from the river and, in doing so, robbing it of natural beauty, public recreation space, and areas where shops and restaurants might have stood.

Not that the loss of the river as a jobs creator was the only economic problem. Though deindustrialization is typically presented as a Midwestern phenomenon, a problem of the Rust Belt, New England was in fact deeply damaged by the collapse of solid dependable jobs in manufacturing and industry, jobs that were often unionized and which gave a generation of men without college degrees the ability to own homes and raise families. By the time I was conscious enough to notice the outside world, in the mid-1980s, Connecticut was dotted with old mills, brick buildings that once housed productive labor but had since been gutted and turned into apartments, or else sat moldering, unused. I said that Main Street is lovely, and in many ways it is, particularly since the turn of the millennium and the coming of a wave of new economic fortune in the area. But Main Street has also been, in my lifetime, a site of economic collapse, full of boarded up businesses and empty buildings. The further north one went up the street, away from the town green, the more boarded-up doors you were likely to find, as the north end of Middletown is the “rough” part of town, or as rough as a mostly-quiet town of 45,000 residents in Connecticut is likely to be. Today, as I suggested, Main Street is a destination again, in part because the impossible happened – students from Wesleyan University, just up the hill on Washington Street, began to go downtown, bringing their wallets with them. But in the 80s and 90s, they stayed far away. And that had everything to do with Connecticut Valley Hospital, and with Jessica Short.

Wesleyan sits at the top of a hill overlooking the Connecticut River Valley. Its oldest and most picturesque buildings, known as College Row, are a series of brownstones that include the main administrative buildings and president’s office, the ’92 Theater building (that’s 1892) where my father often taught classes, the chapel in which I was baptized, and a building that now houses the Psychology department. From that hill you can look out and see another set of buildings, including some brownstones made with materials quarried from the same place - Portland, Connecticut, right across the bridge. That other collection of buildings also looks bucolic and collegiate from the outside, though looks can be deceiving. This other facility sits on the same side of the river as Wesleyan, but because of a bend in its path the buildings can appear to be on the other side. The divide between those facilities is more than geographic. For while the brownstones to the west are dedicated to the pursuit of knowledge and training a new generation of the ruling class, those to the east house those who, until very recently, would have been called insane. Today, we’re more likely to say that the patients at CVH suffer from mental illness. Either way, they live in a different world from the busy meritocrats who pursue degrees and their dreams.

Connecticut Valley Hospital is the state government’s major mental health facility; though there are private hospitals, like the labyrinthian Yale New Haven psychiatric ward, and a few much smaller state-run hospitals, CVH is the final destination for a large portion of anyone who receives state-directed care in Connecticut. (The state, after all, just isn’t very big.) There are addiction treatment centers and a few other sundry institutions that are state funded, but when it comes to housing the deeply disturbed under the government’s auspices, CVH is the place. Two other state psychiatric hospitals were closed and consolidated into CVH in the 1990s. The rich, as they always have, receive care in upscale facilities far beyond the reach of the average psychotic. The rest of us go to CVH, which is unremarkable, as far as these facilities go. It just so happens that the hospital lies in Middletown.

This reality, of state-governed care in Connecticut for the mentally ill being concentrated in one place, has created some issues for the people of Middletown. The experience of living next to a facility like CVH provides something of a lesson in the need for a robust social state and the ripple effects of not having one. Patients at CVH are often there on involuntary holds, compelled by the law to stay, particularly those housed in the Whiting Forensic ward – “forensic ward” being the psychiatric world’s euphemism for where they lock up patients who have committed or are likely to commit violent crimes. But involuntary holds, as opposed to treatment mandated by legal verdict, are temporary affairs. And when people are released from involuntary holds, the services available to them are often meager. You’d like to think that there would be a network of halfway houses and social workers who could shepherd the recently-committed mentally ill back into the world safely, but in most parts of this country, those resources are depressingly thin. Connecticut is little different; there’s some programs, out there, but not nearly enough. And so when people are released from CVH, whether formerly sectioned under an involuntary hold or because there’s no one to pay for their continued treatment or their stay simply ends, sometimes, they’re walked to the door and released, left to their own devices. The natural next step is to amble, down the hill, towards Main Street.

Which means that throughout my life Middletown has had a population of mentally ill homeless people that’s totally out of proportion with its overall size. Main Street is one of the major arteries in town, it’s home to several churches and charitable organizations that might help someone out with food or a bed, and unlike most of the city, it’s walkable. It becomes therefore a natural place for a mentally ill homeless people to roost. And roost they did; throughout my adolescence, I was aware of several regular characters among their number, most notoriously “the King,” a Black schizophrenic man who (legend holds) earned his title by spending a period with a paper Burger King crown permanently affixed to his head. He would, eventually, be killed in a horrific car accident after wandering into the flow of traffic on a nearby bridge. Before his death he had a habit of shouting racial slurs at Asian American people, but like most of them he was generally harmless – generally. Homeless people with serious mental illnesses are, indeed, more likely to commit violent crimes, just as they are more likely to be the victims of violent crimes. And even beyond their capacity for violence, such people can appear frightening to many. I’m not justifying repression of the mentally ill or the homeless. I am saying that it’s just statistically sensible to be a little more scared of them than of any random person. But this has become, somehow, controversial.

Anyway - you can understand the dilemma for my hometown. Whether being released directly from CVH, or from transitional housing nearby, people with serious mental illnesses would find themselves congregating in Middletown’s downtown. This has led people from neighboring towns to use the nickname “Mentaltown” for our city, which is ugly, but apt. This reputation, as a place for crazy people, was not the primary reason for Main Street’s decline in the last decades of the 20th century – that was surely the previously-mentioned deindustrialization that had killed many local jobs and the severing of the city from the river. People had less money and there were fewer reasons to go downtown. But being Mentaltown didn’t help. And, on July 28th, 1989, that reputation was sealed for years to come, in the most shocking of ways.

That day saw the annual Sidewalk Sale in Middletown, an event designed to get local people to travel down to Main Street and keep the businesses there afloat. Vendors would set up tables on the sidewalk in front of their storefronts and enjoy the chance to drum up a little more business. Various entertainments were held, like free balloons for children or the opportunity for kids to climb into a fire truck. Nine-year-old Middletown resident Jessica Short was enjoying the day with her mother. She would become the victim of a very bad mistake made worse by very bad timing.

In the years that followed, various investigations and a lawsuit would attempt to understand how, exactly, David Peterson had come to be released from Whiting Forensic Hospital in the CVH complex. Whiting is a medium-to-maximum security facility, after all; more importantly, Peterson had, at 37 years old, twice stabbed people while in the throes of schizophrenic psychosis. And yet somehow he was allowed to simply walk away from the hospital and board a bus downtown. Over the years that followed, there would be considerable confusion and debate about whether he was released due to a clerical error or whether he was knowingly set free for a day, in the manner that patients are sometimes allowed at psychiatric hospitals. (The New York Times piece the next day would say, cryptically, that he was released “on a pass,” but a follow-up article the next March said only that he had been “released.”) It appears some sort of formal choice to allow him to leave the grounds was made, but whether this decision was made based on miscommunication or bad information, or who made it, were never clear. Eventually, the civil case Jessica Short’s family brought against the hospital and the state would be settled, for $1.5 million, and whatever reason for continuing to pursue the question evaporated.

While exactly why Peterson was released will forever remain a mystery, nothing else about that day’s events is controversial. One way or another, he was released. He rode the bus down to Main Street. He bought a knife. And then, when he saw Jessica Short emerge from Woolworth’s general store, a Middletown institution that would close not that long after, he stabbed her more than thirty times, in front of her mother and dozens of witnesses. He was quickly wrestled to the ground by onlookers and subdued by the police; he would eventually make his way back to the very psychiatric hospital that had released him, where he remains to this day. (After he was found not guilty of Jessica Short’s murder by reason of insanity, a panel committed Peterson to Whiting for 70 years.) Locals, naturally, were horrified. Jessica Short’s family was left to mourn. And for almost two decades, downtown Middletown was finished. People had been afraid to go there because they thought the mentally ill population made it a dangerous place to go. After the sidewalk sale, how could you have told them that they were wrong?

In my adult lifetime, and especially in the past decade, I’ve watched as the discourse around mental health has changed. A cadre of disability activists, overwhelmingly made up of those with college educations and cultural capital, have been remarkably effective at changing what it means to be disabled. This change is epitomized by coming to see disabilities as identities, not negative attributes that individuals must navigate but totalizing and existential definitions of the self. And a corollary to the attitude of disability-as-identity is that disability therefore cannot be bad, that anyone that suggests that disabilities are negative is engaged in bigotry. This means that those with disabilities that result in outcomes that are indisputably bad - like, say, when someone’s schizophrenia leads them to habitually stab other people - must be marginalized, excluded, avoided, ignored. Because psychotic patients who kill people can’t be brightsided, can’t be swept up into some optimistic narrative of disabled people as proud and empowered agents who control their own destiny, they must therefore be sidelined in the discourse, locked away in a kind of discursive asylum, hidden from consideration, kept where they can’t be seen. 

Conveniently for activists, people like Peterson are too sick to participate in the debate about disability anyway, as are (for example) people whose cerebral palsy have rendered them nonverbal, those whose disabilities also can’t be spun off as a “superpower.” Anyone who is not disabled, even the families of those with severe disabilities, is told they may not participate in the conversation. So a group of educated professionals whose disabilities don’t hinder their participation in elite society, many self-diagnosed, dominate the debate. They insist that disability is only different, not damaging, demand special accommodations despite that contention, and when confronted with contrary information angrily dismiss it. So Jordan Neely, a profoundly disabled person who died a tragic death, is misrepresented as just a sweet and harmless Michael Jackson impersonator, the public concern for him based on a cheerful caricature rather than a full and adult accounting of all of his problems; so Kanye West, diagnosed with a psychotic disorder years ago, is written out of the community of the disabled, with many activists angrily insisting that his instability could never be the product of mental illness, as to allow for the possibility that it was would be to suggest that mental illness is something bad. And we can’t have that.

Were this all abstract, perhaps it would not matter much. But it’s not abstract. For one example, the question of involuntary commitment, of society being empowered to detain and treat people with severe mental illness without their consent, is deeply influenced by activist rhetoric. And despite what so many people think, it has gotten vastly harder over time to ensure treatment of treatment-resistant patients, in most contexts. The Community Mental Health Act of 1963, which made deinstitutionalization a federal policy, shrunk the number of facilities in which such patients could be housed and pushed many of them onto the streets - ostensibly to receive treatment at community mental healthcare centers, which were mostly never built. In 1965, the birth of Medicaid created fiscal incentives for states to push patients out of state-funded facilities and into private treatment, essentially moving those patients off of their own books and onto those of the federal government without any concern for actual treatment. The O’Connor v Donaldson Supreme Court decision in 1975 established the standard that a patient can only be involuntarily treated if they are at imminent risk of physically harming themselves or those around them, which perversely removed sickness itself from the equation. The Americans with Disabilities Act of 1990 further empowered patients to reject involuntary treatment. The Civil Rights of Institutionalized Persons Act provided a new range of restrictions on how doctors and facilities could handle patients held against their will and how long they could hold them. Again and again, our society has made involuntary treatment harder. That’s reality.

There are thousands of families that have experienced the profound helplessness of trying to force a loved one into care when they desperately need it. Like the family of Bailey Hamor, who fought for years to get him into inpatient treatment, were repeatedly denied, and then had to deal with the horrific fallout after he stuck a knife into another man’s head, ending the life of his victim and, for all intents and purposes, his own. You’re opposed to involuntary treatment of the deeply disturbed, OK. But you must count the costs.

Now, activists want to ban the practice of involuntary treatment altogether. Disability rights activists are joined by “anti-carceral” activists, the defund the police set, in insisting that no one should ever be forced into treatment, regardless of how dangerous they might be to themselves or those around them. Of course horrible crimes like the murder of Jessica Short are rare, but there are perfectly common outcomes that are profoundly tragic too - domestic violence, assault of others, self-injury, accidental overdose, suicide. Those few of us who oppose the disability activist agenda say that those patients who are liberated from involuntary treatment by means of the law and then promptly die because of their conditions “die with their rights on.” The term was coined by a psychiatrist in the 1970s, I believe, in reference to a patient with severe anorexia who battled for the right to be released from involuntary treatment, won a victory that was cheered by many activists, and then promptly starved to death. The same terms can be applied to the many, many people who have been sprung from involuntary commitment only to go on to kill themselves; they died with their rights on. 

That seems to me to be an obviously senseless outcome, but at least it’s something they’ve done to themselves. What are we to tell people who are physically threatened by those released from involuntary treatment, as the people at the sidewalk sale were threatened by Peterson, accidental though his release may have been? The activists have no answer; they simply quote dubious statistics about how the mentally ill are harmless, ignoring the fact that the National Institute of Mental Health’s numbers show that people with psychotic disorders are significantly more likely to commit violent crimes. (Which is of course perfectly sensible and predictable given what we know about insanity, paranoia, and violence.) Where do those who call for an end to all forced hospitalization think those who are a constant danger to themselves and others will go? What do they think people like Peterson will do when freed? I debate this stuff all the time, and I have no idea what their answers are. They have no pragmatic view of what dangerous mentally ill patients look like because their ideology prevents them from accepting the reality that such people exist in the first place. The more you press them for details about what should be done with those whose disorders render them violent, the more they escape into rhetoric. And given that their intellectual world is filled with people with ADHD and self-diagnosed autism, who declare themselves to be the face of disability, they’re almost never come face to face with these questions anyway.

It is right that David Peterson has spent his life in hospitals and not prisons. The legal accommodations that we give to the severely mentally ill (threatened, perversely, by the activist class that claims to speak for everyone who’s sick) are one of the only things this society can offer people like Peterson. It’s terrible that Whiting Forensic has been the site of a lot of abuse and mismanagement, and I’m glad that the state is finally ready to tear the place down and start over with something more modern and humane. I hope the new facility will be a place where people like Peterson can heal. The battle to preserve the ability to treat those whose disorders hijack their minds, destroy their impulse control, and render them unable to sort fantasy from reality - that battle is done for the good of the Jessica Shorts of the world, yes. But it’s also done to prevent other patients from facing the fate of Bailey Hamor or David Peterson. They will spend most of the rest of their lives confined to treatment facilities, which is the only responsible decision society can make. If we empower our society to be more proactive about treating profoundly sick people, maybe we can save not just future victims but also preserve the change that potentially violent patients can live free and normal lives.

I hope David Peterson isn’t suffering, at Whiting, and I hope the reforms to that place or the one that comes after leave him in more humane conditions. But I’m also glad he’s locked up in there. And I’m willing to bet that, though they would never admit it, deep down the activists are glad that he’s in there too.

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