Monthly Archives: September 2011

Mental Health Misunderstood. Again.

According to yesterday’s Globe and Mail, a report from the Vancouver Police Department identifies the deinstitutionalization of the mentally ill as a major problem for police, who have become de facto mental health workers.

“We certainly have identified individuals that we wonder whether it would be healthier – both for themselves and the community – if they were in institutional care,” Vancouver Police Department Inspector Scott Thompson is quoted as saying at a press conference. “The difficulty,” he added, “is that [that] is a medical question. That’s not within the realm of policing.”

Ah, but there’s the rub. It’s not a medical question or medical issue or even a medical decision. It’s a political and economic and sociocultural one.

When the decision was made to – for all intents and purposes – shut down the single major institution this province had for the mentally ill, Riverview, it had nothing to do with the doctors and nurses and social workers; it was a decision made at the Ministry of Health and provincial and federal level. It had to do with the general tenor of the times, notions of autonomy and individual rights  – not to mention a way to save cold, hard cash.

Riverview, once upon a time

To some extent it was in reaction to the authoritarian, pseudo eugenics-type of position taken in earlier decades where the mentally ill were forcibly sterilized, forced to undergo horrible procedures (like frontal lobotomies – driven by the enthusiasm of a single nutty doctor incidentally) and unethical experiments on prisoners and others considered somehow lesser human than the rest of us.

Now the chickens have come home to roost. The downtown east side is a morass of misery and it is the police and the justice system who increasingly have to deal with people who are incapable of making rational choices for themselves. People who live next door to drug addicts and pushers and pimps.

Yes, it is a disgrace and yes, many of the people are sick and would do far better in the wooded confines of Riverview Hospital. But we’re closing Riverview (the scuttlebutt is that the land is worth a mint and that plays a major role as well)

Many years ago I wrote a document for and on Riverview; I spent a few days wandering the grounds and halls, talking to psych nurses and doctors and patients and all kinds of people. I watched as mentally ill individuals happily wandered through the garden and attended art therapy and crafts workshops. If they had a bad episode there were medical professionals on hand to help.


As a society we decided a long time ago that we couldn’t afford it, that it wasn’t a viable alternative, that it wasn’t the way to do things.

Now the police are unhappy about how it’s all unfolded and most of us don’t like it much either. But it’s not a medical decision. Or even a personal one – talk to the families of schizophrenics or people who feel fine on meds and decide they don’t need them any more, become psychotic and head for the hills. Even if the hills are only in their mind.

Mental illness is complex and misunderstood – but it’s not medicine that’s let us down. It’s ourselves.

9/11 revisited, again and again

Many years ago when I was young, idealistic and – not to put too fine a point on it – an idiot, I truly believed that ideas, beliefs (like democracy) could drive action, states, life. I thought that if you had the right attitude then, by golly, the right institutions and governments would follow. As I said, I was an idiot. Most 17-year-olds are.

I now know that it is lives and who we are, how we are, how we live that drives the systems we adhere to. What does that mean? Well, it means that the Bush Doctrine of heading into Iraq post 9-11 to bring democracy into the region – democracy deprived as those poor Iraqis were – then all would fall into place, like a jigsaw puzzle opening up into its full splendour of a sunset over the Rockies.

But it’s not like that.

People’s lives, whether they have enough to eat, a place to live; whether their children can go to school, safely, and come home after without being blown up; it is having decent work under reasonable conditions, living in a place where you can make a life for yourself: it is these that then give rise to political and moral beliefs.

Years ago a psychologist by the name of Kohler (I think that was his name, my lamentable memory) spoke of the slow process through which true moral understanding develops. Another psychologist, Maslowe, spoke of the hierarchy of needs and how it is only after the fundamentals are satisfied is one able to concern oneself with abstract concepts like ethical societies or an ecological metaphor for life. One can only become a person with genuine global, ecological concerns required living in a world where one’s other more basic needs like food and shelter are met.

But we don’t talk much of development or developmental processes these days. Early education is under attack (no matter how much the school day is extended) and our reverence is focused on the gene and its so-called blueprint. Well, if you believe that it’s all there, ready to go, in your genes then why the hell would you even think about development, learning, the ways in which an individual evolves into that wonderful Jewish notion of a mensch?

To care about things larger than oneself one needs to have the basics and the knowledge that more is out there if one applies oneself. This is what the Arab Spring is about and this is what the guardians of terror and nitpickers at airports do not get. As long as entire regions of the globe only see the good life in movies downloaded from the internet or from satellite television – never in their own lives – there will be terrorism and people willing to die because they have nothing to lose.

That was the real lesson of 9/11. Or ought to have been.