In the last week, as the nation has taken stock about what to do in response to the recent attack on schoolchildren in Connecticut, two major ideas appear to be more attention to gun control and "mental health." (It is interesting how we speak of mental "health" and not mental illness, another reflection perhaps of the stigma against admitting the reality of mental illness.) One most commonly hears a call for more funding for "mental health" treatment, but also, in an increasing number of places, there is awareness of a need not just for more money in a broken system, but a need to fix that system.
One place psychiatric care clearly is broken is the extreme resistance to requiring treatment for severe and potentially dangerous cases of clear mental illnesses, especially schizophrenia and severe bipolar disorder.
I noted in my last blog post that this approach has some political problems, in that it will be opposed by the far right and the far left, for different reasons. Some will always defend civil liberties - they did it with vaccinations and fluoride and cigarette smoking too (and some still oppose these ideas) - until cultural forces led society to accept the need for some restrictions on extreme liberties. Some will oppose involuntary treatment of mental illness, simply because they reject the idea of mental illness, for various ideological reasons.
Examples of recent calls for greater attention to the need for involuntary community-based treatment of severe mental illnesses include a Boston Globe editorial, a recent column by the conservative journalist (and former psychiatrist) Charles Krauthammer, and commentary by Dr. Oz on CNN. Clearly, these persons represent a range of political views, but they are able to see realistically the problem of untreated severe mental illness, and the fallacies of the extremism, whether on the right or left, on this matter.
Much attention has recently been given to the blogger known as Anarchist Soccer Mom, who described how she had to criminialize her adolescent with autism to get psychiatric treatment ordered by a court for him. She had to put her son in jail to get appropriate psychiatric care. This is what extreme civil libertarianism produces: the loss of liberty when medical care is provided. Not to mention the loss of innocent life.
The debate will continue, but one can hope that, in addition to honestly revisiting gun control (as seems to be happening), we also start to have an honest discussion - despite the predictable attacks of critics of psychiatry - about the need to treat severe mental illnesses, sometimes involuntarily, and the need for a change in our laws to allow for such treatment.