depression

You shouldn’t have to go to jail for mental health treatment

R. Horton

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.

Why I Am Afraid To Die

R. Horton5 Comments
Ben Jonson's Lucretius
Ben Jonson’s Lucretius (Photo credit: Catablogger)

My interest in the topic of this blog arose several years ago from a conversation with a scholar visiting from China. She had studied Christianity in China and was interested in meeting Christians in the United States and learning more about their beliefs and culture. She admitted to me that she felt some disappointment to learn that a promise of a blissful eternity did not seem to decrease the fear of death for most American Christians. If life is filled with pain and challenges, why would Christians not welcome a release to a joy of eternity?

Lucretius would not be surprised by their fear. He noted that those who boast of fearlessness in the face of death will react to death in pretty much the same way everyone else does. He says:

“These same men, exiled from their country and banished far from the sight of their countrymen, stained with some foul crime, beset with disease heralding approaching death, keep going all the same. To whatever situation they come in their misery, in spite all their talk, they sacrifice to the dead, slaughter black cattle, and lay out offerings to the gods of the dead.”

Of course, we also know some turn to suicide, which may or may not reflect a loss of fear of death. It may only mean a fear of the misery of life has overtaken a fear of death, but I will return to that idea later.

On the other side, I can remember discussions with Christians describing the attitude of suicide bombers in armed conflict. I have heard at least a few people who equate a willingness to die for a cause with a lack of respect for the value of life rather than a lack of fear in the face of death. If we value our lives, must we fear death? Is there a greater moral advantage to reducing the fear of death or to emphasizing death as a loss of something of great value, life?

Epicurus
Epicurus (Photo credit: Ian W Scott)

Epicurus, who inspired Lucretius, felt our lives would be enhanced if we could extinguish, or greatly reduce, our fear of death. Epicurus said, “Death, the most dreaded of evils, is nothing to us, because when we exist, death is not present, and when death is present, we do not exist.”  Death is a harm because it robs us of the good of life, but it is a harm that is impossible to experience. Some will say that they don’t fear being dead but fear the process of dying, but Thomas Nagel points out succinctly and convincingly that we “should not really object to dying if it were not followed by death.” Both Nagel and Epicurus argue that death is bad because it deprives us of life, but no amount of life is sufficient to eliminate the harm. No matter how long we extend life expectancy, we will view death as a harm to us.

S. Collings Boswell & Johnson 448
S. Collings Boswell & Johnson 448 (Photo credit: Wikipedia)

Of course, some of us face death with more equanimity than others. Scottish author James Boswell visited Scottish philosopher David Hume on his deathbed and was impressed by Hume’s serenity. Boswell mentioned Hume’s calm to Samuel Johnson, but Johnson refused to believe Hume was not covering his fear. In response, Boswell tells us, “The horror of death which I had always observed in Dr. Johnson, appeared strong tonight. I ventured to tell him, that I had been, for moments in my life, not afraid of death; therefore I could suppose another man in that state of mind for a considerable space of time.” Johnson responded, “The better a man is, the more afraid of death he is, having a clearer view of infinite purity.” Our fear of death may, indeed, aid our moral development.

Brush drawing of German philospher Martin Heid...
Brush drawing of German philospher Martin Heidegger, made by Herbert Wetterauer, after a photo by Fritz Eschen (Photo credit: Wikipedia)

While he doesn’t have much in common with Samuel Johnson, German philosopher Martin Heidegger also sees some advantages to our uneasiness with death. When we contemplate our own annihilation, he says, we are filled with dread, which forces us to confront what is authentic. When we are projected into Nothing, we are transcendent. If we were not “projected from the start into Nothing,” we could not relate to “what-is” or have any self-relationship. Only through confronting annihilation do we have any hope for authentic existence.

It may be that our dread gives both our life and our actions meaning. Suicide, which is often seen as a failure to negotiate life, is not necessarily so. Indeed, Simone de Beauvoir sees suicide a possible way to will ourselves free, even in the most horrific situations. She says, “Freedom can always save itself, for it is realized as a disclosure of existence through its very failures, and it can again confirm itself by a death freely chosen.”  If we do not fear our own death, however, this act of defiance and control has little meaning. Willing ourselves free through suicide is only meaningful if it is a triumph over something, and this is not to be taken lightly.

Simone de Beauvoir (9 January 1908 – 14 April,...
Simone de Beauvoir (9 January 1908 – 14 April, 1986) was a French author and philosopher. (Photo credit: Wikipedia)

Fear of death propels us forward through life, even in the face of injury, disease, and extreme hardship, and as it propels us forward it also gives meaning to our struggle. By working to overcome our fear, we establish ourselves as free beings capable of making meaning of our own suffering. And if we will ourselves free and full of meaning, we will strive for others’ freedom as well. Indeed, Beauvoir says we extend our own freedom through the freedom of others.

As a final note, let me say that part of willing freedom for others is an effort to remove obstacles that make suicide seem like a triumph. It is for this reason we should work to promote human capabilities and, specifically, to relieve the pain and suffering of depression.

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The Ethics of Caring and Seasonal Depression

R. Horton2 Comments

I don’t know if it is the changes in the weather, the length of the days, or what, but we

The suicide
The suicide (Photo credit: Wikipedia)

sometimes find the world slipping away from us. As we reach, objects, people, and activities seem to continuously recede into the distance just beyond our grasp. We forget how to be engaged with even the most basic tasks. Seasonal changes can leave us feeling depressed and melancholy. As the poet Phillip Larken put it:

The trees are coming into leaf
Like something almost being said;
The recent buds relax and spread,
Their greenness is a kind of grief.

For reasons that aren’t completely understood, spring seems to bring a surge of depression and suicides, but winter gets all the attention for warnings about seasonal depression. Some researchers have noticed that suicide spikes coincide with increased pollen production.  Apparently, allergies release cytokines, which affect appetite, activity, sex drive, and social engagement. There may be a philosophical question in there as to the difference between having “depression” and having a response to allergies that looks a heck of a lot like depression. Sufferers of either will probably not worry the distinction too much.

Some theorists suggest that suicide peaks in spring because of a “broken promise effect.” When spring doesn’t bring the joy and energy it generally promises, the depressed are moved to suicide. Others have suggested that springtime brings more energy and agitation (and a corresponding drop in melatonin), especially to people with bipolar disorder, that moves them to act against their own lives.  Still others speculate that springtime increases in serotonin give people the energy to kill themselves.

I don’t want us to turn away from people who are depressed during the holidays. Rather, I just hope we can remember that some of us occasionally feel depressed and hopeless throughout the year. The extra effort we make through the holidays may be worth making year round.

Still, I know it is true that many of us mourn with greater intensity during the holidays as we count all those who are no longer with us and grieve for our losses, so maybe we should be a little extra careful during December. A little care can go a long way to avoiding a holiday crisis. But we should remember to keep caring and reaching out during the new year, into spring, and for the rest of the year. When we help each other, we are all stronger.

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