CBC did an interesting set of stories on "The Current" last week dealing with mental health. Some of the things I heard were really interesting and at times, downright bizarre. One thing I did hear from a psychiatrist was something along the lines of, "only 2 - 5 % of schizophrenics are violent and can be dangerous". Only??? He may be comfortable with those odds but I am not. I am not saying, in any way, that schizophrenics all need to be locked away but surely the risk that those who are not being treated or effectively managed means that we need to address the issue, not only for our own safety but even more for theirs.
Another thing that really grabbed me, and again, I see this as the crux of the issue, is around the ability of schizophrenics to accurately perceive their own level of illness. A doctor (again, I can't remember who) said that schizophrenia is a disease of the brain that effects the very part of the brain that is aware of the individual's own mental state - with a broken thermostat, how can you possibly judge the temperature accurately?
I realise that these issues are not as clear cut as they seem. Yes, the easy answer would seem to be to just force these people to take meds but it isn't that easy. Who is the judge of what beliefs are "crazy" and what are just different or divergent or creative? Will turning off the disease always necessitate suppression of the individual? Can medicating be an easy way to shut down someone whose ideas we don't like? Obviously, there are issues of personal freedom that would need to be wrestled through but, based on what Margaret Sommerville of McGill University, a prominent bio-ethicist said on CBC, there are court rulings that do lay down some guidelines and we are working to develop more.
I wish I thought that these issues stem from our desire to respect the personal freedom of those suffering from these mental illnesses but sadly, I don't think that is what it is really about. More basically, I think it is about money and it's about shame. Providing medical care, especially for chronic conditions that need ongoing monitoring, is expensive and these days, we are already trying to deny the fact that our society has to pay if we want to be healthy. We shut down all the psych wards as being inhumane (which may well be true) and emergency psych beds are almost impossibly hard to come by. In the meantime, we did nothing to increase accessibility to community based care and when families are dealing with a family member in crisis, other than calling the police, there is little that can be done to help. On the other hand, we just don't like to talk about this. It's scary, it's embarrassing and there are no easy answers. It's easy to blame the behaviour on drugs and bad choices and ignore the fact that these people are ill, no differently that a diabetic or someone with chronic heart disease. We wouldn't try and ignore people with those chronic conditions. I think one of the hardest parts of mental illness for most of us to understand is that it can't be measured clearly by ultrasounds or MRIs, it's manifestations are almost entirely behavioural.
On Saturday mornings, a group of us used to get together to do field training with our dogs. There was one couple who always came from VERY far away to train. I always wondered why they would bother. The wife and I got talking and I discovered that they had a schizophrenic son in his twenties at university and the training was their way of getting a break from the anxiety. I know that this woman and her husband went through hell. Their son had been in all kinds of trouble and his doctors refused to talk to them. She knew that one day, someone was going to be hurt and, to be honest, we all worried that one day, we would read in the paper that he had killed them in the night. Sadly, in the end, he killed himself. I will never forget my conversation with her after that - her grief, her guilt at feeling relief that it was over and the way the two of them fell apart. It was one of the most upsetting things I have ever watched.
So, today, we bury yet another victim. Another child is without a father, another family is destroyed by our fear and our denial. How much more does this have to happen before we face it head on?