I was fortunate enough to be included in Isabelle Kenyon’s new poetry anthology supporting the mental health charity, UK MIND. I was happy to participate in the project because I think any effort to remove stigma around mental illness and to provide support for those suffering is a good and necessary thing to do. I don’t think I am unusual, really, but I’ve had my bouts with depression, anxiety, avoidance and attendant health problems. The more open we can be about our struggles, the easier it will be for us, collectively, to cope. I’m very grateful to Isabelle Kenyon for her efforts, which she describes below.
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Isabelle Kenyon is a Surrey based poet and a graduate in Theatre: Writing, Directing and Performance from the University of York. She is the author of poetry anthology, This is not a Spectacle and micro chapbook, The Trees Whispered, published by Origami Poetry Press. She is also the editor of MIND Poetry Anthology ‘Please Hear What I’m Not Saying’. You can read more about Isabelle and see her work at www.flyonthewallpoetry.co.uk
Thank you to Randall Horton for letting me guest blog today! I wanted to spread the word about the MIND Poetry Anthology, which I have compiled and edited. ‘Please Hear What I’m Not Saying’ will be out in early February, expected date of release to be Thursday the 8th, on Amazon. The Anthology consists of poems from 116 poets (if I include myself!) and the book details a whole range of mental health experiences. The profits of the book with go to UK charity, MIND.
The book came about through my desire to do a collaborative project with other poets and my desire to raise money for a charity desperately seeking donations to cope with the rising need for its work. I received over 600 poems and have narrowed this down to 180.
As an editor, I have not been afraid to shy away from the ugly or the abstract, but I believe that the anthology as a whole is a journey – with each section the perspective changes. I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
‘Please Hear What I’m Not Saying’ is a poetry anthology, the profits of which will go to UK charity, MIND. The book consists of 116 poets (I’m happy to be one of them) from around the world and details a whole range of mental health experiences. The expected date of release is Thursday 8th, on Amazon.
Editor Isabelle Kenyon answers questions about the project.
Question: How did this project begin?
Isabelle: I knew I wanted to work collaboratively with other poets and it was actually the theme of mental health for a collection, which came to me before the idea of donating the profits to charity MIND. This was because I knew how strongly people felt about the subject and that it is often through writing that the most difficult of feelings can be expressed. I think that is why the project received the sheer number of submissions that it did.
Question: How did you select the poems – was there a process?
Isabelle: In some cases of course personal taste came into my selection, but I tried to be as objective as I could and consider the collection as whole. I wanted the book to have as many different personal experiences and perspectives as I could find. Because of this, I have not been afraid to shy away from the ugly or the abstract, but I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
Question: Why should people buy this book?
Isabelle: Easy – to support the fantastic work which MIND does and to support the fantastic poets involved. Rave about their work because I believe the poets involved are both talented and dedicated.
Reid Ewing of Modern Family fame recently wrote publicly about his struggle with body dysmorphia in a personal essay on the Huffington Post. Ewing revealed that his dysmorphia led him to seek and receive several surgeries. He feels his surgeons should have recognized his mental illness and refused to perform surgery. He wrote, “Of the four doctors who worked on me, not one had mental health screenings in place for their patients, except for asking if I had a history of depression.”
The principle of autonomy is by far the most discussed principle of bioethics. Discussions typically focus on the rights of patients to refuse treatments, not to seek them. On either side, the issues can be thorny. If a depressed and suicidal patient refuses life-prolonging treatment, is it ethical to respect the patient’s autonomy or should mental health services be provided first? As in Ewing’s case, the ethical problem arises from the claim that the decision is driven by mental illness and not reason. If someone is mentally ill, they are not fully autonomous agents as they are not fully rational.
This is a problem with autonomy in general. Our ideas of autonomy come largely from Immanuel Kant, who claimed that all rational beings, operating under full autonomy, would choose the same universal moral laws. If someone thinks it is okay to kill or lie, the person is either not rational or lacks a good will. How do we determine whether someone is rational? Usually, most of us assume people who agree with our decisions are rational and those who do not are not rational. If they are not rational, they are not autonomous, so it is ethical to intervene to care for and protect them.
Earlier this year, a woman named Jewel Shuping claimed a psychologist helped her blind herself. She says she has always suffered from Body Integrity Identity Disorder (although able-bodied, she identified as a person with a disability). Most doctors, understandably, refuse to help people damage their healthy bodies to become disabled, which can lead clients to desperate measures to destroy limbs or other body parts, sometimes possibly endangering others.
Jewel Shuping never named the psychologist who may have helped her, so it is impossible to check the story. It is possible to imagine, however, that some doctors would help someone with BIID in the hopes of preventing further damage to themselves or others. Shuping says she feels she should be living as a blind person, and she appreciates the help she received to become blind. In contrast, Ewing feels he should have undergone a mental health screening before he was able to obtain his surgery and that his wishes should not have been respected.
Plastic surgeons are often vilified as greedy and unscrupulous doctors who will destroy clients’ self-esteem only to profit from their self-loathing. On the other hand, these same plastic surgeons are hailed as heroes when they are able to restore beauty to someone who has been disfigured in an accident or by disease. Unfortunately, we do not have bright lines to separate needless surgery to enhance someone’s self image and restorative surgery to spare someone from a life of social isolation and shame. Some would argue the decision should not be up to the doctors in the first place but should be left in the autonomous hands of clients.
Many have similarly argued that doctors should refuse gender confirmation surgery to transgender men and women. As with BIID, many assume that transgender individuals are mentally ill and should see a mental health professional, not a surgeon. Transgender activists (and I) argue that transgender individuals need empowerment to live as the gender that best fits what they actually are. If surgery helps them along that path, they should have access.
All this leaves us with the question of when to respect autonomy and when to take the role of caregiver, which may involve a degree of paternalism (or maternalism for that matter). Is it more important for doctors who ensure the patient’s rights to seek whatever treatment they see fit, or is it more important to provide a caring and guiding hand to resolve underlying mental health issues before offering any treatment at all?
One of Ewing’s complaints is that he was offered plastic surgery on demand with no screening at all. The process for people seeking gender confirmation surgery, by contrast, is arduous. Before surgery, transgender people go through counseling and live as their true gender for an extended period of time. At the far end of the spectrum, people with BIID rarely find doctors willing to help them destroy parts of their bodies and resort to self-harm. These three cases are not the same, but make similar demands on the distinctions between respect for autonomy and a commitment to compassionate care.
It seems reasonable to accept Ewing’s claim that mental health screenings should be a part of body modification surgery, especially when someone has no obvious flaws that need to be repaired. In all these cases (dysmorphia, gender identity, and BIID), mental health support is necessary. In each case, patients describe depression, emotional turmoil, and, too often, thoughts or attempts of suicide. Mental health care does not require a violation of autonomy, but it may help a person’s autonomous decisions to form more clearly from deliberation and not desperation.
Imagine you and a friend go to see a documentary (or even fictional film) about the plight of victims of famine, war, disease, or oppression, and you bawl uncontrollably throughout the film as your friend sits next to you unmoved and indifferent to everything happening on the screen. You think anyone who isn’t moved by the extreme suffering you’ve just seen must be some kind of monster (or a sociopath at the least). You feel, in short, that crying is more moral than just sitting there.
You will admit, of course, that your crying through the movie didn’t help the victims any and your friend’s indifference didn’t really hurt anyone. Still, it seems that a moral person should have feelings for those who are suffering, even if you can’t find any real benefit for these strong feelings for strangers who get no benefit from your tears, heartfelt as they are.
In fact, your friend might point out that you are getting all worked up for no reason, and it might be better to keep your emotions in check. Your wailing for these strangers won’t change anything for them, but it might impair your ability to attend to problems you can change. What good are you to your children, for example, if your mind is on the poor souls in some far corner of the world? You should get your head together, friend, and get on with the business of life.
But, you counter, if you learn to be indifferent and unmoved by the pain of strangers, you may become indifferent to the pain of others, including friends and, yes, your own children. You don’t want to become the kind of monster you now suspect your friend of being. You want to be the kind of person who is moved by the suffering of others. You may not be able to help in every situation, but you do not want to become callous and cold. You want to be a caring individual. It isn’t about what you can do but about what you are.
And now your friend points out that not only did you cry during the movie, but you seemed, in some sense, to enjoy it. In fact, you apparently went to the movie with the prior intention of being moved to tears. You chose the movie because it was described as “moving” and “emotionally riveting.” Will you be happy when your children fall ill because it will satisfy your need to “let it all out”? Perhaps you are the monster, after all?
You didn’t enjoy the pain, you object, but you enjoyed the high quality of the film and its ability to elicit the pain. It was beautiful in its ability to enlarge compassion and trigger a caring response. The film will help, if nothing else, audiences develop a greater sense of concern for others, even if it doesn’t affect everyone (with a sly and disapproving nod to your friend).
And your friend now points out that people had to suffer in order to expand compassion and develop a greater caring response, so the suffering of others is used as a means to your own ends. You are actually acting selfishly after all, and the film makers are also exploiting the suffering of these people in order to teach a moral lesson and even to make a profit and perhaps sit in the spotlight after receiving coveted awards. You can just imagine the director’s teary expressions of gratitude and exhortations for a more acts of compassion at the ceremony.
In 2012, comedian Anthony Griffith told the story of his daughter’s cancer in a moving performance for The Moth. The video quickly went viral. You can see the video here:
The video on YouTube now has more than 1.8 million views. It is almost impossible to watch the video without sobbing, and people shared it by promising that anyone watching should have some tissues on hand. For reasons that aren’t entirely clear, we enjoy experiencing his grief with him. It might be objected that we are emotional voyeurs watching a sort of grief porn. By watching, we are not helping his daughter, we are not preventing future cancer deaths, we are not improving medical care, and it isn’t clear how we might be improving ourselves.
Paradoxically, we simultaneously want to avoid our own pain but glom onto the pain of others. Watching the story enables us to experience the pain without having to actually experience the loss of child. Doing this while watching a fictional account of loss seems justifiable in many ways, but to seek out a chance to cry and experience this kind of pseudo-grief that is provided by the actual grief of another person certainly raises an ethical concern.
We might say that Anthony Griffith needed to talk about his loss, and we are providing him with an audience. We are doing him a great favor by listening. We are honoring his loss. And he may agree with us. In this case, he is using us to help him along his healing journey, but this doesn’t seem to be what is going on. We want to see and hear his story. We want to be part of his grief story without having to do any heavy lifting ourselves. We watch the video, feel emotional excitement, hug our loved ones because one never knows when they will be gone, and then we are done with it.
We might say that we want to hear the story because it is well written and well performed. Griffith is extremely talented as a story teller, and we appreciate his talent and courage to share such a personal story. When we watch the video, we are paying tribute to his writing and his acting. The only problem is that he really doesn’t seem to be acting. He has merely put his pain on view for the world. He is certainly talented, and the story is well-written, but most people will be moved by anyone’s story of a lost child. It is relatively easy to evoke strong emotions with a story of intense pain and grief.
It may be that we want to hear his story so we can prepare ourselves for the times our story might be the main event. Someday we will have to do the heavy lifting. If we can live through Griffith’s pain, maybe we can face our own. By experiencing Griffith’s grief, we see that we can also face it and live through it just as he has done. We finish the video feeling somehow more prepared.
Or we may be drawn to the stories of others because it provides an evolutionary advantage. By hearing stories of others, we develop compassion and care. Other than providing an audience, we may not be helping Griffith directly, but we may be better able to empathize with others in the future. We are preparing not only for how to face our own struggles but to help others through theirs. If this is true, then we are actually doing something noble and beneficial by watching such videos.
Or, maybe we are just seeking the thrill of an emotional roller coaster ride.
Comments are welcome below. I appreciate corrections to typos and so forth (randall@ethicsbeyondcompliance.com).
We are offering a workshop on the ethics of grief on Friday, Dec. 4, from 9 a.m. till noon. We will be exploring proper responses to grieving clients. Most therapists accept the dictum that “There is no wrong way to grieve,” but we will look at extreme cases such as homicide and self-destruction and search for the “bright line” between good and bad grief. We will then ask whether “bad grief” is unethical or merely unhealthy. We will examine the ethical response to “bad grief” and explore whether men and women should respond to grief differently.
The workshop is open to anyone, but we offer 3 Continuing Education Units (CEUs) to Licensed Professional Counselors, Licensed Marriage and Family Therapists, and Licensed Clinical Social Workers.
The cost is $25.00.
For more information, write randall@ethicsbeyondcompliance.com
When Charles Dickens wrote Oliver Twist, he never bothered to make mention of the race or religion of any of the characters, except one. Throughout most of the novel, Fagin is referred to as “The Jew” with occasional variations on the theme. You may think his choice of words was simply standard at the time, but he was challenged on this choice. When criticized, he seemed surprised, and said, “It unfortunately was true, of the time to which the story refers, that the class of criminal almost invariably was a Jew”. He said he wasn’t biased against the Jews but was merely reflecting a simple truth about the nature of certain criminals. He even exclaimed, “I have no feeling towards the Jews but a friendly one. I always speak well of them, whether in public or private, and bear my testimony (as I ought to do) to their perfect good faith in such transactions as I have ever had with them…”
He really couldn’t see that any of this was his fault, but he eventually did change his ways. He did have actual Jewish friends, and as hard as it was for him to see the problem, he didn’t want to offend them. He explained, “There is nothing but good will left between me and a People for whom I have a real regard and to whom I would not willfully have given an offence.” In the last chapters of the book and in subsequent readings, he deleted the offending appellation in the way you might finally discard a favored but hopelessly stained garment.
Dickens wasn’t unique by any means. We all have biases that we feel certain are nothing but statements of fact, supported by our frequent observations. In my interactions with therapists, I often hear the phrase “usually the man” sprinkling their descriptions of couples with marriage difficulties. Something like this: “When one partner has difficult expressing emotion (usually the man) . . .).” Or, “When one partner struggles with monogamy (usually the man . . .). Or, “When one person is addicted to porn (usually the man . . .). I’ve asked a few therapists about this construction, and the response is always some variation of, “What am I supposed to say when I’ve observed this time after time in my office?”
The fact is, of course, when we believe something is true, we tend only to take note of that occurrence in our observations. Even when we are aware of our own confirmation bias, it is exceedingly difficult to diagnose our own blind spots.
Some examples:
Dr. Gerald Stein, listing several kinds of unhealthy sexual activities, describes “selfish sex” as “a cousin to Obligatory Sex. However, in this example, it is usually the man who satisfies himself quickly, not out of duty, but simply because his needs are all that matter to him.” Note that it is usually the woman who has sex out of a sense of obligation, or so Dr. Stein believes.
In a paper by Barry McCarthy on marital sex, he says, “A realistic expectation is forty to fifty percent of sexual experiences will be satisfying for both people, twenty to twenty-five percent are very good for one partner (usually the man) and good for the other.” He begins the paragraph by saying the data is empirical, but only cites a study on sexual dysfunction that occurs before the statistics about satisfaction, which is not cited. I’m sure his experience confirms his claims to his satisfaction.
An article on domestic violence in Psychology Today by Neil S. Jacobson and John M. Gottman says, “In many unhappy marriages, when one partner (usually the woman) requests change, the other one (usually the man) resists change, and eventually the woman’s requests become demands, and the man’s avoidance becomes withdrawal.” Again, if asked, I am sure these therapists/researchers would insist that their statements are supported by many hours of clinical observation, and they probably are; however, it is likely that men who are victims of domestic violence are much less inclined to seek therapy because they know they will not be taken seriously as victims or because they also refuse to see themselves as victims.
I could go on and on with examples, but you can do it yourself. If you want to see how pervasive this phrase is, just Google “psychotherapy” and “usually the man” or “marriage counseling” and “usually the man.” I promise, you will have plenty of examples.
What I would like to point out is that these “empirical” claims about what men do in relationships always conform to negative stereotypes about men. Men are selfish lovers. Men are abusive partners. Men are kinky. Men are more easily satisfied sexually than women. This thinking eliminates the opportunity for men to be abused, neglected, unloved, and unfulfilled. It denies women the opportunity to be the partner who is more sexual, more liberated, or more powerful. I once sat through a panel discussion by three male therapists, and one of them admitted that his sympathy just naturally went to the women when he saw heterosexual couples.
A couple of things to consider:
First, it may be correct that in some cases men are more likely to exhibit certain behaviors or attributes than women, but assuming they do makes it extremely difficult for you to see the men who are atypical. Second, it may be that men and women are not as you perceive them to be at all. Rather than interpreting data as it appears, you may be constructing data from your own biases.
A final note:
If you wonder whether your statements may reflect a bias or stereotype, try the Dickens test: Substitute “usually the Jew” or other racial term for “usually the man,” and see how it sounds. If you aren’t comfortable with the racial term, consider revising both your words and your expectations of your clients.
On March 14, I learned of a new holiday known as Steak and BJ Day. Known as a humorous response to Valentine’s Day, the idea behind Steak and BJ Day is that women get all the attention on Valentine’s Day (men spend about twice as much as women) and there should be day for men to get what they enjoy, which is, obvious to the creators and celebrants of this day, steaks and blow jobs. It’s just a joke. It’s all in fun. If you don’t like it, don’t participate.
Many women seem to feel this is a fair way to compensate men for being so generous on Valentine’s Day, apparently having no qualms describing their romantic relationships as blatant prostitution. (“After all the trouble he went to for Valentine’s Day, I owe him something. Teehee.”) If people want to live their lives exchanging gifts for sexual favors and cooking services, I have no problem with it, so long as everyone knows what is going on and feels comfortable commodifying relationships. I have a different problem with this holiday.
Steak and BJ Day is based on a crude masculine stereotype that is inoffensive to men who live for their next steak and treat of oral sexual gratification. All men are supposed to want this. Any man who doesn’t love and know how to prepare steak, in fact, should turn in his man card, according to this web site. Again, it is just a joke. If you don’t love steak, you are just a girl. Hilarious. I mean, who would want to be a girl? It isn’t meant to offend anyone. Any man who objects to this stereotype is himself at risk of being told he is too sensitive or not a “real man” or a “typical man.” People who are less kind will tell him he is a sissy, wimp, girl, or any number of nastier anti-gay slurs.
So, men who don’t want these things should turn in their man cards (see this site for an uproariously funny rendition of this ). “Turn in your man card” is the functional equivalent of “you throw like a girl.” As much as people insist this is all just a joke, the consequences of masculine stereotypes are severe. Children who fail to express their gender in expected ways are more likely to be bullied and abused and suffer from depression and PTSD (see a study on the risk here). You may have heard what happened to a boy who liked My Little Pony. Further, anti-gay attacks are typically in reaction not to sexual activity but to perceived non-conformity to gender stereotypes (a 1982 study by Joseph Harry found that “effeminate” men are twice as likely to be victims of gay bashing than gender conforming men), which means gay-bashing victims include many heterosexuals or children with no obvious sexual orientation or identity at all.
This bias against unmanly men is nothing new. Through an essay by Elizabeth V. Spelman, I found a passage in Plato‘s Republic describing what kinds of men would be inappropriate for a decent society:
We will not then allow our charges, whom we expect to prove good men, being men, to play the parts of women and imitate a woman young or old wrangling with her husband, defying heaven, loudly boasting, fortunate in her own conceit, or involved in misfortune and possessed by grief and lamentation—still less a woman that is sick, in love, or in labor.
People sometimes want to credit Plato with an early form of feminism, because he felt women should be trained in the mode of men. Like many today, he felt it was quite admirable for women to strive to “achieve” masculine traits. Men being the highest form of human perfection, Plato thought it made sense for women to strive for the masculine ideal. The man who would follow the lead of women, however, would be lowering himself below his station and be pathetic at best. His view persists as we encourage girls in sports, mathematics, and leadership, but forbid boys from nurturing, crying, creativity, and careers related to care and empathy. It seems odd to me that eating meat is considered particularly masculine, but vegetarian men are portrayed as being the least manly of all. The hatred and devaluation of “feminine” men is an extension of the oppression of women. Feminist philosopher Jean Grimshaw points out that the conception of a feminine ideal depends on “the sort of polarization between ‘masculine’ and ‘feminine’ which has itself been so closely related to the subordination of women.”
The hatred of “effeminate” men is an extension of the devaluing of the feminine, but it leads to violence and oppression of both men and women. In order to be free, we must assign equal value to all human activities and emotional dispositions. Leadership and assertiveness have their value, but we will not last long in a society devoid of nurturing, care, and concern. Another feminist philosopher, Genevieve Lloyd, puts it this way:
If the full range of human activities–both the nurturing tasks traditionally associated with the private domain and the activities which have hitherto occupied public space–were freely available to all, the exploration of sexual difference would be less fraught with the dangers of perpetuating norms and stereotypes that mutilated men and women alike.
I added the emphasis on the word “mutilated,” because I am grateful to her for using such strong language to describe accurately what sexist stereotypes have done to us. I often hear women struggle to describe how sexism hurts men. Some say it discourages men from working hard or from caring for others, but they miss the fact that sexism destroys men from the inside out. Very few men escape childhood without having their masculinity questioned and challenged. And too many men have responded violently to a woman who has taunted them with, “If you were a real man, you’d . . . !” The constant demand that a boy or man prove his resilience, indifference to pain and fear, and lack of compassion rends men from their humanity. Those who resist are often trampled under foot and left with depression, addiction, anxiety, and self-loathing. Too often, it ends in self-destruction through addiction, isolation, or suicide.
You may be thinking I take things a little too seriously. No one would kill himself over Steak and BJ Day. I agree, but I am asking you to consider the good of masculine stereotypes, and I tell you they serve no purpose and provide no benefit. The cumulative effect of such stereotypes is to prevent men from being whole and to destroy those who are uninterested or unable to fulfill the social expectations such stereotypes are designed to enforce.
I seem to remember Jon Stewart once playing a clip of a politician declaring that sunshine is the best disinfectant. After the clip, Stewart warned viewers that using sunshine as a disinfectant could lead to a nasty infection. In response to the Sunshine (Open Payments) Act, bioethicist Mark Wilson sounds a similar alarm in a recent paper.
For years, many people, including myself, have argued that industry payments to physicians should be disclosed to the public, so that we will all be aware of possible financial conflicts of interest (FCOI). My hope was that disclosing conflicts of interest might help actually reduce corruption or even simple bias in medical practice, but Wilson points to our experience of Wall Street before and after the 2008 financial collapse to show that knowledge of conflicts of interest does not prevent them. Rather, disclosure only shifts the burden for reducing FCOI to patients, who are least empowered to eliminate them. Rather than fixing the problem, Wilson claims the Sunshine Act only “mythologizes transparency.”
Wilson pointed me to a paper (“Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5”) in Psychotherapy and Psychosomatics that illustrates the problem. If you want the details, you can read the paper yourself, but I will skip right to the conclusion, which I admit is how I read most papers anyway:
[I]t is critical that the APA recognize that transparency alone is an insufficient response for mitigating implicit bias in diagnostic and treatment decision-making. Specifically, and in keeping with the Institute of Medicine’s most recent standards, we recommend that DSM panel members be free of FCOI.
Telling people about FCOI does not reduce bias and corruption; it only offers an opportunity for people to be aware that bias and corruption exist. I think it is valuable that the Sunshine Act is making people aware of FCOI. In response, though, I hope we will take steps to reduce FCOI. Unfortunately, the burden is indeed shifted to voters and consumers. The most disturbing and obviously true statement Wilson makes in his paper is this: “Until politicians end their own commercial COIs, the Sunshine Act will likely remain the governance order of the day.”
We can’t hope the experts will solve this problem. We must demand that FCOI are eliminated.
Last week I tweeted a link to a Texas Observer article by Emily DePrang about sexual assaults in Harris County jails. DePrang had written about two Bureau of Justice Statistics studies that showed the Harris County Jail on Baker Street had sexual assaults that are higher than national averages.
One survey reported rates of sexual victimization as reported by inmates, and found that inmates reported higher than average rates of victimization from other inmates. The other survey was based on official reports of sexual violence in jails and also reported higher than average rates for the Baker Street jail. DePrang did not discuss, in her short post, all the statistical and methodological limitations of the studies in question.
To my surprise, Alan Bernstein, the director for public affairs at the sheriff’s office tweeted me, saying he hoped someone would fact-check DePrang’s article as it had many mistakes, so I asked him what the mistakes were, and he sent me a list of items he felt were misleading. Later, the Texas Observer agreed to publish his response to the article (his published response was slightly different from what he sent me).
For the most part, his response pointed out the limitations of the study. Also, he noted that only one of four jails in Harris County had a higher incidence of sexual assault, and he also noted that jail had a high percentage of inmates who are under treatment for mental illness. In his note to me, Bernstein asked, “Is touching a clothed inmate’s thigh sexual violence? Maybe so. But this is one of the actions considered sexual victimization in the study.” I will just say that I consider any unwanted touching of my upper thigh over or under clothing to be sexual assault, even if the “violence” seems minor.
In trying to separate the signal from noise, though, what interested me most was not the definition of sexual violence or even the limitations of the study but the fact that the jail had so many inmates on medications. The Houston Chronicle quoted Sheriff Adrian Garcia saying, “The Harris County Jail has been referred to as the largest psychiatric facility in the state of Texas” and “More than 2,000 inmates … are on psychotropic medications on a daily basis.” And in Bernstein’s response, posted on the Texas Observer site, he said:
That building houses the jail system’s inmates with acute mental illness. In fact the statistician who worked on the 2011 study tells us that two-thirds of the surveyed inmates in the so-called “high” rate building had “psychological stress disorders.” We don’t know how that was determined, and we would never allege that people with mental illness fabricate allegations more often than anyone else.
I’m not sure what “acute” means in this context, but I suspect anyone on medication is assumed to have an acute mental illness. Given the number of prescriptions written for antidepressants and anti-anxiety medications these days, I suspect a fairly high percentage of the general population is acutely mentally ill, according to these assumptions. Even someone being treated for mild depression, though, will experience unpleasant side-effects if doses are missed, as they are likely to be missed inside a jail. We should be concerned both about lack of treatment for mental health and the over-prescription of drugs for depression and anxiety. Withdrawal sometimes leads to aggressive behavior and could account for some problems. On the other hand, mental illness is also stigmatized, and those receiving treatment may become targets for abuse at the hands of other inmates.
Fortunately, I found more information on treatment of the mentally ill in Harris Country jails in excellent article by DePrang titled “Barred Care.” According to the article, the jail “treats more psychiatric patients than all 10 of Texas’ state-run public mental hospitals combined.” And why is that? Because no one else is treating those patients. Again from the article: “Harris County has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending.” Some people get so desperate for relief, that they break the law just so they can go to jail and get treatment.
The program in the jail is commendable. The funding priorities of our state government are not. In 2003, the Texas legislature slashed funding for mental health services in Texas. According to DePrang’s article, “In Harris County, the number of law enforcement calls about people in psychiatric crisis jumped from fewer than 11,000 in 2003 to more than 27,000 in 2012.” So, the Harris County jail has a high number of mentally ill as a result of deliberate action of our state’s lawmakers. This should make us all angry. Cutting funding for mental health services only to force the mentally ill into jails is cruel and expensive. No matter what sends people to jail, many will never really recover from the stigma and the trauma of the experience.
What should be done? We should lobby our lawmakers to restore funding for mental health services in Texas. We should stop blaming the mentally ill for their problems. We should resist the temptation to treat even minor difficulties with powerful and addicting drugs. We should insist that Texas expand Medicaid as part of the Affordable Care Act (this would cost the state nothing) so that people can receive basic medical care and avoid crisis.
In short, we should learn to heal each other. The person with a mental health crisis tomorrow could be you.
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us, collectively, to cope. I’m very grateful to Isabelle Kenyon for her efforts, which she describes below.
rational or lacks a good will. How do we determine whether someone is rational? Usually, most of us assume people who agree with our decisions are rational and those who do not are not rational. If they are not rational, they are not autonomous, so it is ethical to intervene to care for and protect them.
