Sunday, January 23, 2011

On Mental Health Issues -- Final

The ostensible goal of most modern mental health care providers is for the mentally ill to be able to function at the highest possible level the individual is capable of and to live as rewarding and productive a life, preferably integrated within the general society, as possible.

In pursuit of this goal, many providers rely on medications that control or partially control symptoms of many mental illnesses. As a consequence, the United States is often called the "medicated nation." Such a large percentage of the population, starting at a very young age, is on some highly psychoactive drug or another, to control one or more symptoms of mental illness that it's not too much of a stretch to wonder if the whole damn country is bonkers.

This reliance on medications, in contrast to the previous reliance on an in-place system of custody and treatment, is partly the result of a belief that "mental illness isn't real." Instead, the manifest symptoms of mental illness in many if not most cases are the result of chemical/hormonal imbalances in the brain, and correcting those imbalances will correct the symptoms. From a purely physical perspective, there's a good deal of truth to the belief that many symptoms can be controlled or corrected with medication. The millions of Americans taking psychoactive medications and carrying on "normal" lives is testimony to that. The question then arises of how so many Americans became mentally ill enough to require constant medication.

When conformity was an important social value an entire mental health care infrastructure was built up in response. It was dismantled when conformity was no longer considered such an important social value. Now, instead, many more millions of ordinary Americans are medicated with chemical "re-balancers" than were ever served by the mental health care system that used to exist, and yet many of the mentally ill get little or no care or treatment at all but are left to fend for themselves on the streets or however they might, and if they act up, they're either jailed or summarily executed.

The goal of reintegrating mentally challenged and mentally ill individuals into the broader society was and is one of the more laudable goals of the dismantlers of the earlier system of custody, treatment and care. There was no reason, in many cases, to segregate mentally challenged and mentally ill individuals in out-of-the-way asylums. Segregation had long been the rule, however, so it didn't occur to the powers that be that there might be another way until it was forced on them.

There was and is no reason for a separate ("but not even close to equal") mental health care system distinct from the physical health care system. Mental health care should be available, just as physical health care should be available, to all, without the kinds of hurdles to access we have today.

So ultimately what the issue boils down to is accessible care, which is a problem for millions upon tens of millions of Americans, whatever their health care issue is, and it is a problem that would only be partially remedied by the Health Insurance Reform measures passed last year (and now under fierce assault from the Rightist Reactionaries).

Until we have a single-payer comprehensive health care system, together with the educational and other support systems necessary to keep it functioning -- the only kind of health care system that will provide universal care in a large and complex system like this one, the problem of access will continue, the problem of grossly disparate care for the mentally ill on the one hand, and over-medication on the other will get worse, and ultimately the concept of "care" itself will be inverted to mean its opposite.

We may not be able to control what our ruling class does about these matters, as they seem intent on governing contrary to the public interest at all times, but we can control what we do as individuals and in groups.

Never relent on advocating and doing what is right.

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