Saturday, February 20, 2010

Illinois nursing homes

A couple months ago I wrote about this tragic nursing home business in Illinois. I'm going to repeat some points, while trying to be less cynical out of respect for the hard work of the Nursing Home Safety Task Force, which just submitted its final report to the Governor.

Our problem remains that we want mental illness and deviant behavior to be a medical issue. Beyond the crude expedient of disabling bad guys with drugs, this is a very expensive and destructive intellectual error.

We do not have and will never find the pill to cure schizophrenia, depression, bipolar disorder, delusional disorder, anxiety disorder, post-partum psychosis, pre-menstrual syndrome, PTSD, ADHD, or QMRD (Quasitransorbital Malcognitive Revelatory Disorder: I made it up, but that's the same thing they do in the DSM, right? Maybe I'll expand on this new disease in a later post....)

As the psychs say, these things can only be treated, not cured. The fraud enters in by the pretentious definition of treat as giving (supposedly scientific) medical aid. Every culture has treated murder, for example - generally with public shaming, confiscation of property, exile, prison, execution, and so on. We try to treat murder with Risperdol, Paxil, Seroquel, ECT - to no improved effect whatsoever.

In his February 19 introductory letter to Governor Quinn, Chairman of the Nursing Home Safety Task Force, Michael Gelder, says a unique opportunity currently exists for fundamental changes in the system, to assure that the problems of violence and inadequate or harmful treatment of Illinois' most vulnerable citizens do not reoccur.

Reading the report itself, one might be struck by its concentration upon details of process - how to do this or that subsubsidiary task. This is all impressive work, and the recommendations are impressively detailed. Eleven separate workgroups are established to take it further. Target dates are set, things are defined, etc.

But fundamental? Not even close. Here's the tip-off.

While reading this basically well-written report, almost everyone, professional and non-professional alike, will begin to yawn or get slightly distracted or bored or go blank at certain points. The phenomenon results directly from a word in the text which, unbeknownst to the reader, is undefined or mistakenly defined. Now watch for the word resident.

The task force was supposedly in universal agreement right from the start, that nursing home residents are supposed to be old people who can't take care of themselves, not mental patients. Yet within the first few pages, we see repeated references to younger adult nursing home residents with mental illness who need to "receive the care and treatment essential to avoid anti-social behaviors." Now wait a minute...! Are these guys just another kind of resident, or are they a different breed of cat, or what? I don't get it.

There's a fundamental confusion here, and it's going to ruin any opportunity for positive change.

As I've written (many times) previously, I think the error is, very simply, calling people who behave badly "mentally ill" to begin with, and then presuming that they are the way they are because of some brain problem which ought to be dealt with as a medical issue.

I'm sorry, but we just don't know how to FIX people that way. Nursing homes can't do it, neither can state nuthouses. Nursing homes are places for old people to go when they need to be fed and sheltered and their families don't want to do it by themselves. Nuthouses are places for criminals to go when they need to be restrained and society doesn't have the stomach to discipline them in the traditional ways. When we lump these very different tasks together as "care" for "patients" we waste a lot of hard work.

Unfortunately, that's what's happening with the Illinois Governor's Nursing Home Safety Task Force. See whether their report is easier to read when you spot the fact that the word resident is causing some blankness.

1 comment:

  1. You hit the nail right on the head. It always gets me when I see young people in nursing homes. They don't belong in that particular setting - or at least they need to stop calling the facility a nursing home.

    Adult assisted care facility, group home, I understand. I hate it when those terms are used interchangeably with nursing home. It just clouds the discussion.