Slipping Through The Cracks

``They did not listen, they did not know how. Perhaps they'll listen now.'' — Don McClean, Vincent.

THE TREATMENT OF THE MENTALLY ILL has historically been of mixed success and humanity. Historically, the dysfunctional behavior commonly associated with mental illness has been attributed to demonic possession or other mystical influences. Four hundred years before Christ, Hippocrates was one of the few to recognize mental illness as a disease comparable to the other diseases which afflict humans. However, it has only been in the last few decades that effective and powerful treatments for the mentally ill have emerged.

Perhaps the most despicable treatment of the mental ill occurred in Europe during the Middle Ages. While Muslim Arabs sequestered their mentally ill in asylums, in Europe the mentally ill were shunned and left to make due wandering through the countryside. Paul Stavis of George Mason University pointed out that in France before the 19th century, ``archers were posted at city gates to keep them [the mentally ill] out. Those who were allowed in the city were forced to labor in the sewers while chained in pairs.'' In England, ``the citizenry paid to see and ridicule the mentally ill in the government-sponsored correctional facilities.''

In the United States in the 19th and early 20th centuries confinement was the typical lot of the mentally ill. In the 1950s, the appearance of psychotropic drugs that for many controlled the most several behaviors improved the prognosis for many of the mentally ill. This treatment permitted the release of many formerly confined patients. The mentally ill population since then has largely been deinstitutionalized — and forgotten.

Unfortunately, many are left in a limbo between institutionalization and inadequate supervision. Medication only works if it is taken according to specific protocols. There is a class of chronically mentally ill individuals who are too functional to be placed in confinement, yet not sufficiently responsible to be counted on to remain on regular medication. There also remains a battle between single-minded civil libertarians whose excessive concern for the personal liberty of the mentally ill precludes compelling the mentally ill to take medication, while the true freedom of action of these individuals is radically constrained by their disability. Ultimately some find themselves incarcerated, not by the mental health community, but by the judicial system. A recent federal report indicated that 16% of those in nonfederal prisons were treated for severe emotional problems.

The only good fortune my nephew has experienced has been his adoption by my sister-in-law and her husband. Trauma at birth, coupled with chronic drug use by my nephew's biological mother conspired to produce severe emotional disorders. Despite the help and attention provided by his parents, when he reached adolescence it was clear that his emotional development and maturity would never keep pace with his physical growth. Now that my nephew is an adult, his parents are in a constant struggle to secure the right environment for their son.

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