Extra Credit Post: Three Strikes, You’re Out!

Recently, Professor Lindsay Smith sent me an article from the New York Times about California’s controversial three strikes sentencing law. In case you have not heard of this law before, the three strikes law significantly increases the prison sentences of persons convicted of a felony who have been previously convicted of two or more violent crimes or serious felonies, and limits the ability of these offenders to receive a punishment other than a life sentence. The law, approved by a ballot initiative in 1994, was implemented after the brutal kidnapping and murder of a little girl by a parolee. The three strikes law was seen as a way of getting killers, rapists and child molesters off the streets forever. While the law had good intentions, it also had unexpected and dire consequences for some. For example, under the statue, the third offense can be any number of low level felony convictions ( passing a bad check, shoplifting low priced items). Perhaps unintentionally, this statue has  disproportionately subjected African American’s to life sentences. In addition, and directly related to my paper topic, mentally ill inmates are nearly always jailed for behaviors related to their mental illness. These are often low level petty crimes like the ones described above. In California, the three strikers are higher among those with mental illness. A substantial number of mentally ill persons have been sentenced to multiple, low level offenses, leaving a substantial number of them with life sentences.

The three strikes law, like many laws, ignore persons with mental illness. California is just an example of the injustice that has been inflicted on a vulnerable population that more than often presents no harm or danger to the rest of society. California, and the rest of the United States needs to reassess who we want in our jails and prisons. Do we want people we are afraid of? (i.e. violent murderers, rapists and child molesters) Or do we want people that we’re kind of mad at? (i.e. substance users, shop lifters, drunks, etc). It’s clear that these types of people are not the same and do not commit the same kinds of crimes. But, under our justice system we make laws that say these people are the same and thus should be punished the same. I don’t think an individual, (especially one who is mentally ill), should be serving a life sentence for three petty crimes while some other violent offenders often serve less time on a plea deal.

Sorry California, three strikes your out belongs in a baseball game, not in our justice system.

Mental Health Reform: It starts and ends with Me

In my first blog post I wrote about the Declaration of Human Rights and the passing of the Affordable Health Care Act in the United States under President Barack Obama. Health Care is a form of social change with the underlying premises that health care is a human right, not a privilege. The act acknowledges that we are “free and equal in dignity and rights.” In my last blog post I will continue to talk about health care reform and the relationship between mental health, human rights and the law. Roslyn Solomon’s article “Global goes local: Integrating human rights principles into a county health care reform project” influenced me to do some research on current mental health campaigns aimed at the relationship between the individual and the community. A number of approaches have been used to address this relationship such as increasing mental health awareness, efforts to reduce the stigma associated with mental illness, and encouraging those who suffer from a psychological issue to seek help and share their story. While, promising, none of these campaigns have proven to be relatively effective. I almost lost hope in my search for an approach that is integrative enough to produce real change. I came across a group called The International Council of Nurses. 

The ICN is a group of nurses from 130 different countries who, amongst other health issues, acknowledges that mental health is a crucial aspect of well being that remains sorely neglected, under-resourced and plagued by stigma in most societies. The International Council of Nurses deplores the fact that stigma, discrimination, treatment gaps, and lack of access to services and to continuity of care continue to exist globally. Through their own code of ethics, they call on government to set policy, including legislation, to protect and improve mental health and supply effective, integrated, community-based mental health services. Together they call on health professionals to combat the stigma and discrimination associated with mental health problems.

I think that the ICN is a great example of how the United States can best help vulnerable individuals with mental illness and prevent them from being incarcerated. Society, as well as government and the corrections system play important roles in the outcome of individuals with mental illness. There has to be more efforts to make sure these outcomes do not result in a jail or prison sentence.

As a result of this course, I have been extremely interested in studying public health policy and mental health. In particular,  I am interested in changing the U.S. corrections system’s role in mental health. Everyone has a passion, and this is one of mine. There is a need for social change and it starts and ends with me.

 

Reality Check

A banned book is a book that had something important to say; something that others found so obsence, so grotesque, so objectionable, that they had to ban others from reading it, from engrossing in the hideousness of the text. Mrs. Meghan Gurdon, in her article, “Darkness too visible,” criticizes today’s young adult fiction for being too dark, too explicit, too violent and too depraving.  Sherman Alexie comes to the defense of his young adult book The Absolutely True Story of a Part-Time Indian, and books like his by explaining why it is necessary to write about the experiences that kids have today.

I completely agree with Alexie. In essence, Mrs. Gurdon is criticizing contemporary young adult fiction because it is “too realistic.” I think Mrs. Gurdon needs a reality check. She is naive to think that writers should change what they write about and that we should protect these children from books that she claims are “too dark” and “disturbing.” She is especially naive to assume that adolescents will engage in doing drugs, violence, self-harming behavior etc, because they read Go Ask Alice, Crank, or Wasted. If I know anything about Adolescent Psychology it’s this: Adolescents are more likely to not engage in these behaviors if they are exposed to them in a realistic, fact based manner. If anything, it will inform them about the realities of the world and open them to understanding others. Sheltering adolescents and censoring what they read is not the answer to solving our worlds problems. It’s the exact opposite. We have to expose them to it!

I’ve spoken a lot about the stigma of mental illness in this blog. It is something that I am obviously very passionate about because I suffer from one. I know that many authors have written about their own experiences with mental illness, drug addiction, anorexia, etc. However, I have yet to read one that accurately describes what I go through every day in my struggle with Obsessive-Compulsive Disorder (OCD). I recently read an article reviewing J.K. Rowling’s new adult novel, The Casual Vacancy. One of the main characters has Obsessive- Compulsive Disorder, and according to the reviewer, Bella Mackle, she portrays it as an illness that is to be taken seriously – not just the stereotypical Monk or Jack Nicholson in “As Good As it Gets.” As a long time sufferer from OCD, I greatly appreciate this. Sure, I enjoy poking fun at myself and finding humor in illness, but I wish others could walk in my shoes, experience what I experience and understand that I am not just “crazy.” OCD is a debilitating brain disorder that affects millions of people, men and women equally. It is definitely not just washing hands and checking and rechecking locks. It’s so much more than that.

I once hid my mental illness. I was once extremely ashamed of it and hid it from the people I loved most. Now that I am older, and a little braver, I have become a lot more comfortable talking about it and educating others about mental illness in general. It is my hope that someday I can write a semi-autobiographical novel like Sherman Alexie, and maybe, just maybe, make a difference in someone else’s life.

P.S. If you want a good portrayal of what OCD looks like (untreated and undiagnosed), watch Leonardo Dicaprio as Howard Hughes in “The Aviator.” Read the book Brain Lock by Dr Jeffrey Schwartz. (Changed my life). I have a lot more recommendations if you are interested.

A Tale of Two Identities

For the second to last week of the course, I have been assigned to read Sherman Alexie’s beautifully written novel, The Absolutely True Diary of a Part-Time Indian. I am an avid reader, and this is one of the most quotable novels I have ever read. This is my second time reading this novel, but given all that I have learned from this class, my perspective has changed since the first time around. In case you haven’t read it, the novel is about a 14 year old American-Indian boy named Arnold Spirit, aka Junior, whom is a budding cartoonist. Arnold lives on the poverty stricken Spokane reservation but transfers to a wealthy white school 22 miles away. It’s a tale of two identities; one white and wealthy, the other, poor and indian. At the heart of the book is his struggle to survive between the indian world and the white world. It is a tale of a struggle with identity, both self and tribal. What I love most about this book is Alexie’s ability to portray the harsh realities of oppression, poverty, alcoholism, violence and death in explicit realistic language that helps me understand something about what it’s like to be an American Indian in a white world.

This novel has brought me back to my questions about the struggles that persons with  mental illness face in terms of self-identity. There is a large difference between seeing oneself has a person who’s mental illness is only a part, compared to someone who sees their mental illness as their overarching identity. What happens when a person with mental illness becomes too identified with their diagnosis? Once a person is labeled as mentally ill, everything else about them becomes suspect – even to themselves. This is evident when we see the difference between descriptions – mentally ill person or person with a mental illness. How we describe others has a huge impact on how they describe themselves. Thus, there is with out a doubt, a power that exist in each of these labels on self-identity- some of which have potentially negative consequences for the person labeled.

One of my favorite quotes from the novel:

– “I realized that, sure, I was a Spokane Indian. I belonged to that tribe. But I also belonged to the tribe of American immigrants. And to the tribe of basketball players. And to the tribe of bookworms.

And the tribe of cartoonists.

And the tribe of chronic masturbators.

And the tribe of teenage boys.

And the tribe of small-town kids.

And the tribe of Pacific Northwesterners.

And the tribe of tortilla chips-and-salsa lovers.

And the tribe of poverty.

And the tribe of funeral-goers.

And the tribe of beloved sons.

And the tribe of boys who really miss their best friends.

It was a huge realization.”

The Paradox of Mental Heath Disparities

“It’s impossible to understand what good psychological health means if we don’t understand the economic, social, biological and physical context in which people live.” – Dr. James S. Jackson PhD.

The article “All I Eat is ARVs” written by Ippolytos Andreas Kalofonos, refers to the paradox of aids treatment interventions in central Mozambique. This article is a critique of the AIDS treatment programs because even while they save lives, they can paradoxically have dehumanizing effects such as the coexistence of hunger and competition for food while being given treatment for a deadly disease. Kalofono’s points to a particular kind of paradox that I think is relative to a lot of health disparities not only in the world but in the United States as well. In our efforts to treat diseases and illnesses, we concentrate on treating the symptoms, not by, according to Kalofonos, “targeting the biological conditions, political conditions, political and economic concerns and local forms of solidarity.” In other words, we have to understand the underlying causes to effectively address a problem.

The quote above was stated by Dr. James S Jackson, a psychologist at the University of Michigan. Dr. Jackson is referring to a paradox that many African American’s face when it comes to their mental health. Several national studies have indicated that African Americans are at greater risk for many health problems than their white counterparts. Despite large disparities in access to and utilization of mental health services, the prevalence of certain mental illnesses ( major depression, panic disorder, generalized anxiety disorder, etc) is no greater among African Americans than among whites. Dr. Jackson believes that the answer behind this paradox rests in black American’s strategies for coping with discrimination, racism and social inequality. He suggests that these coping strategies are often self-medicating efforts such as drinking, smoking, eating “comfort foods” may be effective in preserving black mental health but may contribute to health disparities. I think that Dr. James S Jackson is right in his suggestions. It is only through understanding of the diversity of the minority experience that we can begin to eliminate the health disparities that African American’s face.

Police Perspectives on Mentally Ill Persons in Crisis

In the United States, police officers are usually the first to respond to a mentally ill person in crisis. Every law enforcement officer is trained on how to intervene in situations where a person or persons suffering from a mental illness is in crisis. However, there is no national consensus on how to deal with persons of mental illness and thus each law enforcement agency has a different response to mentally ill persons in crisis. Police perspectives on how the situation is carried out are drastically different from persons with mental illness. The large amount of mentally ill persons in jails and prisons is a cause for policy concern in all domains of the justice system. Police practice, the way the police interact with mentally ill persons is crucial in the decision to whether these people will be involved in the justice system or whether they are diverted to mental health services. From my previous posts it is obvious that sending a mentally ill persons has serious negative consequences. The article “Sterilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon” by Pamela Feldman-Savelsberg et al, analyzes the history of vaccinations misconceptions in Cameroon by using the case study of a 1990 incident where girls jumped out of windows in fear that they would be sterilized. Pamela and the rest of the authors suggest that this misconception derived from a long history of rumors and social stigma reproductive health and fertility. Pamela’s case study reveals how fast rumors and stigmas spread like wild fire. With this said, perhaps the gaps in perspectives of law enforcement have to due with the long history of social stigma against mentally ill persons as dangerous and unpredictable. Thus, police are more likely to send a mentally ill person to jail because they perceive and react differently to suspects with a possible mental illness than suspects with no mental illness. This indicates that there is not only a need for better training of police officers but also a better understanding of the history and etiology of mental illness.

Bioethics of testing on Mentally Ill Persons and Prisoners

Believe it or not, the U.S. government once thought it was fine to test on mentally disabled persons and prison inmates. In a previous blog post, I wrote about several cases where medical experiments were performed on these two vulnerable populations. For example, in Connecticut, hepatitis C was purposefully injected into mental patients and in Maryland, the pandemic flu was squirted up the noses of prison inmates. Both of these cases are not only inhumane, they are a reflection of the need to further the development of bioethics and human rights in the United States. Paul Farmer and Nicole Campos, in their article “New Malaise: Bioethics and Human Rights in the Global Era,” discuss how to make human rights a global doctrine and thus a reality for every person. Recently, there has been a focus on bioethics for the medical testing of mentally ill persons and prisoners. In 2011, a committee in Washington gathered together for a presidential bioethics commission. The meeting was triggered by the governments apology for federal doctors infecting prisoners and mentally ill persons in Gautemala with syphilis 65 years ago. During this meeting, they also acknowledged the U.S.’s involvement in dozens of other similar experiments in the U.S. This meeting, while not extremely progressive, is a step towards better medial research and ethics in the United States. It is the duty of the United States government to not only protect its most vulnerable citizens but value them as human beings entitled to dignity, respect and health care.

NOTE: Click on picture for link

The Incarcerated Mentally Ill: Vulnerable & Invisible

Vulnerability is defined as the susceptibility to harm that results from an interaction between the resources available to individuals and communities and the life challenges they face. Vulnerability can result for numerous reasons; developmental problems, personal incapacities, disadvantaged social status, disadvantaged neighborhoods, inadequate social and economic support and networks, etc. All these reasons could lead to the vulnerability of specific populations. Eric Klinenberg’s article “Denaturalizing Disaster: A Social Autopsy of the 1995 Chicago Heat Wave” speaks about the 5,379 deaths  that occurred between 1979 and 1992 in Chicago Illinois. He argues that not only were the deaths preventable, but they were also not directly due to excessive heat. Rather, it is most likely attributed to some features of the sociospatial and political structure of Chicago that created the unprecedented death toll. In his analyses of the heat wave, he offers a framework that uses environmental events as revealers of social conditions that are less visible but present in every day life. While the incarceration of the mentally ill is not an environmental disaster, (I argue that it is a form of structural violence) it does speak of the underlying social conditions that exist in American society. As I mentioned numerous times, the societal shift from long term institutionalization to short term hospitalization has had unintended but unjust consequences to one of our nations most vulnerable populations. Deinstitutionalization, originally seen as liberating and humane, has actually created health policy reforms that are associated with the gradual demise of mental health care because it is dependent on large, state-supported hospitals. It is attributed to decreased need for hospital care for mentally ill persons. Using Klinenberg’s model, I argue that the mentally ill’s incarceration is not because they are mentally ill per se, but due to the social and political structure of the United States (capitalism) that allow them to be so vulnerable.

Physical Vs. Mental Pain and Suffering

The article “When Wounds and Corpses Fail to Speak: Narratives of Violence and Rape in the Congo,” discusses the limitations that exist among the human rights discourse and the need to examine the rhetoric, styles, and genres of the discourse to determine which forces have stifled violence like that seen of the Congolese people during the Rwanadan Genocide. The Congolese have suffered great atrocities – rapes, massacres, assassinations, displacements of population, Hutu genocide, in silence because of the Rwandan genocide.

The author of this article, Ngwarsungu Chiwengolaine, “examines how the rhetoric and genre of human rights discourse along with political manipulation stifle the narratives of the violence of Congo.” This article brought to light some ideas as to why the mentally ill are subjected to so much stigma in the United States. In part, it could be due to the internal pain and suffering that they endure, often in silence. As Chiwengolaine points out, some narratives of violence receive empathetic identification, political advocacy, and calls for redress others receive apathy. Like in the case of violence suffered by the Congolese, I feel that the incarcerated mentally ill have been afflicted by pain and suffering that is not viewed as a cause for real concern in American society, and thus are punished for their behavior.

When we think of pain and suffering in America, we tend to think about those whose wounds are visible, (handicap, amputee, blind, etc). These persons have been subject to a political movement known as the Americans with Disabilities Act of 1990. (scroll down for full PDF document). In short, the ADA is a civil rights law that prohibits, under certain circumstances, discrimination based on disability. Under this law, persons with disabilities cannot be discriminated against by employers in hiring, procedures, advancements, training, etc,  and have to be given access to public entities, public transportation, public accommodations and telecommunications. This act has made great strides in the rights of individuals suffering from physical disabilities that make them unable to function in society. However, this Act has failed to address those that suffer from mental disabilities. Due to the stigma associated with mental illness, persons who suffer are not seen as disabled, but rather as “crazy,” and “insane.” They are not seen as being able to function within society and are seen as needing to be isolated from the rest of society. Why is there such a difference between the pain and suffering of persons with physical disabilities but not with those with mental disabilities? This is an important question to ask because it directly affects how persons with mental illness are viewed not only by society but how they are treated by medical professionals, police officers and corrections officers. If persons with mental disabilities were treated the same as persons with physical disabilities, they may not be subjected to such structural violence like being incarcerated.

Mental Health Consequences of War

The article “Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq” discusses one of the most pressing concerns in America today: the long-term effects of returned U.S. soldiers with PTSD and other psychiatric symptoms. Their study found that out of the 124 soldiers who reported a loss of consciousness, 43.9% percent met criteria for post-traumatic stress disorder (PTSD). Their study concluded that mild traumatic brain injury (concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD 3 to 4 months after they return home. In their discussion, the authors suggest that significant changes to health policy changes need to be made in order to design better intervention strategies. While I agree with this suggestion, it is also important to note that violence that is associated with war has traumatic consequences, not only physically, but also mentally. In fact, The World Health Organization estimated that, in the situations of armed conflicts throughout the world, “10% of the people who experience traumatic events will have serious mental health problems and another 10% will develop behavior that will hinder their ability to function effectively. The most common conditions are depression, anxiety and psychosomatic problems.

In my paper, I discuss the history of psychiatric care in the United States as a means to understand why the incarceration of the mentally ill has become a form of structural violence. War has had an important part in psychiatric history in the U.S. For example, it was the psychological impact of the world wars in the form of shell shock that supported the effectiveness of psychological interventions during the first half of the 20th century. It was the recognition of a proportion of the population not suitable for army recruitment during the Second World War that spurred the setting up of the National Institute of Mental Health in USA. War is an important indication on the health and well being of nations such as the United States. While research on PTSD has increased significantly, the findings are not fully understood and thus we cannot produce effective strategies for dealing with such problems. As a nation, we need to carefully assess the consequences before declaring war. Death from war is just the tip of the iceberg- some soldiers suffer a lifetime of physical and mental symptoms. If we send our people to war, our nation has a responsibility to care for them after they return.