The Vanguard has a new home, please update your bookmarks to

Thursday, May 10, 2007

Fearmongering toward the Mentally Ill is not a Solution to a Broken System

Rich Rifkin's column on mental illness last week published in the Davis Enterprise, spawned an unusual amount of anger and backlash. This is not the first time that Mr. Rifkin has provoked this sort of response. However, I believe his writing suffers from some fatal fallacies that require a lengthy response. An examination of the complaints--three letters to the editor and a number of emails to myself shows that there are two basic problems with Mr. Rifkin's column. First, a fundamental misunderstanding of the nature of mental illness. And second, the use of insulting and demeaning jargon to describe mental illness.

The substance of Mr. Rifkin's column begins on solid ground but begins to devolve in the middle when it comes to the crux of his argument. He asks:
"Why was it that Cho was allowed to walk around freely after a court determined he was dangerous? Why didn't the authorities in Virginia put him in a mental hospital where he could be treated by psychiatrists?

Crazy people are not responsible for their behavior. The fault lies with the rest of us who treat the mentally ill as if they are normal adults who can freely make choices for themselves.

We should not only keep madmen from purchasing, we shouldn't let them walk the streets without supervision."
The problem he suggests goes back to deinstitutionalization of the 1960s. The problem with institutionalization was that it categorized people according to assumed characteristics and our limited understanding both for mental illness and how to best treat it. Moreover there have been increasing breakthroughs with medication that have allowed a number of previously institutionalized individuals to live mostly normal lives.

Furthermore, Mr. Rifkin is correct to point out flaws in the mental illness system as many of the individuals who wrote to the Davis Enterprise made quite clear.

Mr. Rifkin's opinion aside, he then supports his opinion by making sweeping assertions that are backward in terms of both causation and induction. In short, he commits a fundamental fallacy in his reasoning.
"Closing down the loony bins didn't get rid of psychotics. It largely has put them out on the streets, where many become homeless and others wind up in prisons."
His evidence?
The Department of Justice estimates that one in six inmates in the United States is mentally ill.

The National Resource and Training Center on Homelessness and Mental Illness has found that 20 to 25 percent of homeless people in America suffer from serious mental disorders."
What he has cited is evidence that a sizable but still minority percentage of individuals who are in jail and homeless suffer from mental illness. While that may be true, the inverse is not necessarily true--that a sizable percentage of mentally ill end up homeless or jail. The reasoning becomes flawed because he views the phenomena through the outcome of a specific deterministic behavioral feature rather than by examining the entire population of those who suffer from mental illness to determine whether they end up in jail or on the streets. In short, he commits what social scientists would call the problem of selecting on the dependent variable (the outcome) rather than the independent variable (a cause). He has reversed causation in his analysis by undertaking his reasoning in this manner.

What the letters to the editor cite are the statistics that demonstrate that those who are mentally ill are rarely either dangerous or criminals. As one writer suggests:
"Fewer than one in 500 people with significant mental illness display violent behavior. "
As a NAMI-Yolo member suggests in a letter to the Davis Enterprise Tuesday:
"Most people who suffer from serious mental illness hurt themselves or become victims of crime. They lose jobs, family and friends. Very few become violent like Cho. Locked facilities are not a permanent solution. Medical parity, community support and education of the public about the biological causes of these illnesses and treatment that works is the answer."
So it may be true that a sizable population in prisons suffer from mental illness that does not mean that most mentally ill people are dangerous. This is very poorly constructed logic on the part of Mr. Rifkin. And he uses this leap in logic to justify his very draconian policy approach.
"Many mental disorders are treatable. If a patient can function in society under medication, he should be allowed to do so. But, at the same time, he shouldn't be treated like a regular adult. He should be kept under the supervision of mental health professionals for the rest of his life. That is for the good of the patient and society."
Thus even for people who show no signs of actually being dangerous, they "shouldn't be treated like a regular" adult.

The final point which I almost do not want to bring up because it will strike some as political correctness, but his use of language is both inappropriate, insulting, and ultimately counterproductive.
"Crazy people are not responsible for their behavior."

"Closing down the loony bins didn't get rid of psychotics."
Such jargons indicate a prejudicial mindset that Rifkin in other writing so deplores. Why does he choose such language? Does he think about mentally ill people as somehow being less than full people? He certainly wants to throw away their rights without the due process of law and without much more than prejudicial evidence to back it up. Perhaps it is easier to do that after de-humanizing them by providing such dismissive labels to describe people who suffer from mental illness.

Everyone involved in this unfortunate incident realizes that our social services system has failed many individuals who suffer from mental illness. There are fundamental changes that need to occur in order to better diagnose and get help for those in need. What we do not need however is fearmongering and bigotry towards those who suffer from mental illness, because it is the last thing they need. Most of these people are no threat to anyone and are desperately in need of good quality care so that they can live as normal a quality of life as possible.

---Doug Paul Davis reporting