Jail and the mentally ill

Bridget O'Shea's article on yesterday's NY Times Health page featured Sheriff Tom Dart and others, complaining about Cook County Jail being the biggest mental health provider in Illinois. I never quite know what to say to people who seem to think this is so pathetic.

The presumption of course, is that individuals who are sick belong in hospitals, not jails. But there's a highly ironic and eery similarity between mental "hospitals" and jails. The people of Illinois should notice, just for example, that these hospitals have locked doors and guards to make sure the "patients" don't escape.

I would love to walk around the cell blocks at 26th and California with Tom Dart, and say, "OK Sheriff, point out one guy here who's mentally ill as opposed to just a bad guy, and explain to me how you yourself can tell." My guess is, he'd only be able to reliably distinguish between the regular criminals and the mentally ill in his own jail by looking at a file or a record, or asking somebody else who had looked in a file or record, which might include pronouncements by psychiatrists or other so-called mental health professionals.

These pronouncements are called diagnoses. But the people who make them are completely confused these days about whether and in what sense they are valid at all. There's is never any objective test, and DSM-5 intends to define mental illness of every kind on an unbroken continuum with normal behavior. In other words, nobody knows exactly where to draw a line between the guys who are sick and the guys who are bad at Cook County Jail.

For ten years, I've worked with "patients" in this system who were found not guilty of violent crimes by reason of insanity. I'm down at 26th & Cal almost every week. Some of my clients have been basket cases who didn't brush their teeth or bathe; others have been smart, totally symptom-free, unmedicated murderers. Sometimes their doctors have insisted that they had to take psychotropic drugs, or even threatened to get court orders to force them; other times the clinical team has carefully contrived to change a diagnosis so a non-drug treatment plan could be justified to a true-believing judge.

The one thing that's always obvious is, it's not medicine or science in any sense that the public could ever recognize. It's a tortured attempt at a giant social control machine which can run on automatic without any responsibility by any individual human being, so nobody ever has to be punished, or blamed, or wrong. People can just get their brains fine-tuned by the experts, and we can all live happily ever after.

This is the probably most destructive social delusion in history. Maybe it's easy for Sheriff Dart to pretend he's being humane and scientific and medical, when he moans about too few state nuthouses to relieve his crowded prison. The truth is he's just passing the buck like all the other helpless, wasted bureaucrats we pay.

And ultimately, the New York Times reporter has no excuse not to know that. Nor do any of the rest us.