In Volume 38 we highlighted journalist Terrence McCoy’s work chronicling three vivid stories of downward mobility in contemporary America. Our claim was that while Americans are quite interested in stories (mythic or otherwise) reinforcing the sense that America is a land of opportunity—a place where those interested in bettering their plight can do so with relative ease—stories chronicling the ease with which those who have made it up can fall back down again are less well-known. When we pay attention to these stories, we see that a just and well-ordered society is committed to providing not only opportunity for the capable, but also protection for the vulnerable.
Readers of McCoy’s accounts will notice common features across the three stories. In addition to the fact that all three people profiled—Debi Thomas, Schuye LaRue, and Alfred Postell—are African Americans, they each suffer, to some degree, from some form of mental illness.
Studies by the World Health Organization have shown that the United States has the highest rate of mental health disorders in the world, at over one in four. According to the latest statistics from the National Institute of Mental Health, in 2014, there were an estimated 9.8 million adults aged 18 or older in the United States—4.2% of the population—suffering from “Serious Mental Illness,” which is described as “a mental, behavioral, or emotional disorder” that results in “serious functional impairment, which substantially interferes with or limits one or more major life activities.” Just this week, the University of Virginia announced that the number of students seeking appointments at the university’s center for counseling and psychological services rose 25% in the past year.
This week we bring you two pieces on mental health in America. The first is a brief interview with Christopher Payne, a New York-based photographer who has recently published a book called Asylum: Inside the Closed World of State Mental Hospitals. Payne, a practicing architect before becoming a photographer, chronicles America’s abandoned industrial architecture, and in this work, he turns his attention to the state hospitals for the mentally ill that are now all-too-frequently “objects of derision.” As Payne says, “the asylums were [once] sources of great civic pride, built with noble intentions by leading architects and physicians, who envisioned the asylums as places of refuge, therapy, and healing.” Real and deplorable abuses took place in these facilities; nevertheless, Payne writes that “buildings of such grandeur, detail, and beauty will never be seen again.”
Payne’s photographs capture a moment in our history when substantial civic resources were committed to providing care and respite for people suffering from mental illness. If someone’s illness rendered normal social interaction too difficult, alternative communities would have to be created, and, as Payne’s photographs show, many of the state mental hospitals were designed to be elegant, stately, and above all, humane.
The public backlash to the very real abuses of state institutions produced a social and political movement (sometimes referred to as “deinstitutionalization”) whose purpose was to reintegrate those suffering from mental illness into the mainstream society. Advances in pharmacological treatments of common disorders and public support for community-based mental health services worked hand in hand to provide the necessary support structure for both patients and their families.
Writing for Vox, German Lopez has recently argued that we have traded one kind of institutionalization for another. Instead of local services or asylum, all too often, the only thing we now offer people with mental illness is a run-in with the criminal justice system. Consider, for example, Lopez’s account of a father’s call to an emergency health unit about his son (Kevin) in Fairfax, Virginia:
I said, "My son is off his meds. He's starting to slip. Please come over."
They said, "Is he dangerous?"
I said, "No, not yet. But here's what happened before…"
They said, "That's not fair. You can't judge him based on what happened in his past. Please call if he's dangerous."
Well, at night he became violent—the night I didn't have to lie. I called the same dispatcher and said, "My son's violent. Please come."
They said, "Wait a minute. Is he dangerous, or is he violent?"
I said, "He's violent."
They said, "We don't come if he's violent. Call the police."
Once again, the response came only after a crisis, and police had to get involved.
This story (and others like it) illustrates the ways in which the criminal justice system has filled in the gap left by divestment in institutions like state hospitals and the underfunded mandate community based mental health institutions live with every day. The result has been an increase in arrest rates as well as uses of force. To take one example, though most people with mental illness are not violent, according to the Treatment Advocacy Center, “someone with an untreated mental illness is 16 times more likely to be killed by police than other civilians approached or stopped by law enforcement.” Moreover, once incarcerated, people with serious mental illness are often insufficiently treated and released without the necessary tools to re-enter society.
At a minimum, a just and well-ordered society does not exploit the vulnerabilities of fellow citizens. Sadly, in the case of mental health, exploitation often comes by way of inattention. Whether our collective attention is mediated through outpatient care in community-based clinics or publicly funded institutions of refuge, the objective should be care, treatment, and grace, not punishment.