Friday, 3 August 2012

My Brother Ron

Ron has suffered from schizophrenia for most of his adult life. My Brother Ron is his story, a book written by his brother - blogger Clayton E Cramer. Schizophrenia is a dreadful thing to happen to anyone, but Cramer weaves another story around Ron and his personal disaster.

On a wider scale the book is an analysis of the deinstitutionalization of mental health care in America, in particular the way patients with serious mental illness were let out into the community. Much the same happened here in the UK and although this is an American story, Cramer draws a few parallels with the UK.

Obviously this isn’t an easy subject for anyone who holds dear the liberty of the individual. Some individuals can’t handle personal liberty through no fault of their own. Cramer is talking of serious mental illness here, mostly schizophrenia and psychosis, biochemical brain illnesses therapy can’t touch. He is not discussing the emotional kind.

Cramer’s book is a remarkably cool, dispassionate and meticulously researched analysis of how mental hospitals in the USA were closed down over a few decades, sometimes for the best of intentions, but certainly with some horrific results.

It isn’t a simple story though, because some people undoubtedly were better off outside mental hospitals and some mental hospitals were inadequate or worse than inadequate. But freezing to death on the streets dressed in urine-soaked rags has been just one consequence of closing mental hospitals. Killing sprees another.

It’s a complex and a morally and legally difficult subject. Cramer’s impressive book surely does an excellent job of telling the story. Available in paperback and Kindle format, it is a very sobering story, but a great read too.


Sam Vega said...

America certainly does seem to have increasing numbers of totally bewildered mentally ill people on the streets. I'm not familiar with their health-care system, but something similar has happened in the UK. The reason here is that there has been a horrible conjunction of left-liberal and monetarist ideology. The conservative bean-counters like "Community Care" because it is cheaper than running the total institutional care that some individuals obviously require. They are aided and abetted by the softies who think that all institutions are repressive, and that patients ought to have freedom of choice. But choice when you don't understand the options is a heavy burden at best...

A K Haart said...

Sam - yes, much as it goes against our desire for personal liberty, some people need involuntary treatment. A very difficult issue which doesn't seem well suited to rule-based solutions either.

Anonymous said...

Tricky indeed and something that speaks to an unattractive part of our natures. Certainly the institutions were bad. Trouble is to do a good job costs and the question is who pays? Politicos were very open to the notion of 'care in the community' being quick to see that everyone's responsibility would instantly become no-one's responsibility. But right at the heart of this is the unpleasant fact that most of us will walk right on by a distressed mentally ill person because we don't like them.

Institutions are needed, but I remember a local institution (ex workhouse) with old ladies who had been put inside for having a babe out of wedlock. A doctor friend told me it was not so long ago that mentally ill females gave birth by caesarian because it was a handy chance to 'tie their tubes'. Careful what you wish for.

Demetrius said...

This is another area where there are no "right decisions" only options each of which have moral or practical difficulties. In such cases you need to take a good hard look and try for the "least worst". Incidentally, the same sort of situation applies to those of the very old who have lost capability are never going to reclaim it. It is questionable though how far "Community Care" is a saving. It depends how you cost it. If a very ill person is in an ordinary home this is a cost. If they are impacting on others and are a major call on services as well these need to be added in.

A K Haart said...

Roger - yes, institutions are needed, but we may need them to be staffed by saints. I can't imagine doing such work day after day.

Demetrius - I'm not sure about community care savings for the elderly either.

In my limited experience they usually need far more than they get and presumably that gap is at least some of the supposed saving.