On The Need For Mental Health Reform

So, back in 2008, a guy named Vince Li got on a Greyhound bus and, seemingly out of nowhere, started stabbing the young man sleeping next to him, 22-year-old Tim McLean.  Li would go on to sever his victim’s head, show it to the horrified passengers who were huddled on the side of the highway, and then not only remove other parts of McLean’s body, but eat them, as well.

In court, Li was found not criminially responsible for the crime, and sent to a high security psychiatric ward.

Less than 8 years later, he has legally changed his name and is preparing to live on his own again.

I have to say, I am really struggling with this whole thing. On the one hand, I understand that mental illness is a legitimate reason to not be held responsible for committing a crime. On the other hand, this man took the life of another, and while he may be feeling better now, the other passengers, the bus driver, the trucker who stopped to help, the police on the scene (one of whom has since taken his own life) and most of all, the friends and family of Tim McLean, will carry this horror and loss with them for the rest of their lives. I’m just not sure how I feel about someone causing – deliberately or not – so much pain and suffering to others, being able to just move on and live out the rest of his life.

I think this whole scenario serves to highlight the many issues and problems with the way mental health is handled, both in this country and possibly around the world. I think, even though great strides have been made, at its heart, we still don’t really know what to do, what to think, or how to feel. We can couch our thoughts into PC wording, or spread clever memes and hashtags on social media, but I am not sure anyone actually has any real understanding of how best to deal with mental health issues. I’m not sure it’s even possible to really understand, not for those suffering, and not for anyone who is not.

It’s not that people aren’t trying hard enough. I think it’s just such a vast and complex issue overall, and the fact that mental health is completely intangible, and invisible – we can’t touch or see the problem itself, only the external effects of it – that all makes it even more impossible to truly get a grasp on. In addition, actual focus on mental health – in terms of the wider public, at least – has really only come about in recent years, comparatively speaking. We hear horror stories of drilling holes in skulls to release the demons within whenever someone had a headache (along with pretty much anything that happened in asylums around the turn of the 20th century or so), we shake our heads in dismay at tales of electroshock therapy and the mishandling of postpartum depression. Even the effects of addiction and withdrawl haven’t been fully investigated and treated as of yet. There’s still so much more we don’t know or understand than we can claim to have a handle on, and that’s kind of terrifying, if you think about it.

We have procedures and punishments for those who break the law outright, deliberately and knowingly. Those have changed a lot over the years, too, as we learn more about incarceration and rehabilitation. We aren’t sure what to do with the criminally insane – those who seemingly can’t be rehabilitated and released back into the wild (aka civilization), so we keep them locked up indefinitely, for the safety of themselves and others.

But we have a very vague line drawn where accountability and responsibility is concerned, and that is part of the problem. We agree that some people shouldn’t be punished for crimes that they can not be found criminally responsible for. But…what can be done, instead? Can justice still be served if the offender can’t ever be held accountable for his or her actions?

Li claimed he’d been hearing the voice of God for a good 4 years before “God” told him to kill Tim McLean. There’s zero point in trying to find the logic in it. Like, God also said “Thou shalt not kill” – there was no caveat in that statement. And did God also tell Li to eat parts of the guy he’d been instructed to kill? To defile the body and cut pieces from it to put in his pockets? To show the head of his victim to the other passengers on the bus once he’d removed it? Did God create the aliens that he wanted Li to save the rest of us from?

Did God tell him to carry a big-ass knife around with him, just in case?

We’ll never know any of that, because we weren’t inside Vince Li’s head, and if we were, everything would make sense to us, because that’s how mental illness works. You see one thing; the rest of the world sees something else entirely. Everything you see is real, whether it’s actually there, or not.

In that way, reality is subjective.

So, basically, to Vince Li’s mind, he did nothing wrong. He was a hero, in fact, saving us from aliens, or whatever.

At the time.

But what about now? What does he think and feel abuot what he’s done now that he’s medicated and doesn’t hear voices anymore? His condition is currently not curable, so he must remain medicated for the remainder of his life. And there’s nothing to say that his treatment won’t need to be adjusted in the future to remain effective, so hopefully he’ll be closely monitored for the rest of his life, too, since he won’t be able to determine on his own if his reality is slipping again.

And that’s the thing, really, because who can tell? In the days and weeks leading up to the murder, no one noticed anything wrong or different about him. He’d been hearing God’s voice for 4 years, and apparently no one could tell anything was amiss. So how do we, as a society, know that we’ll still be safe even when he’s back out in the world, living on his own?

We don’t.

Maybe it’ll be fine, and he’ll never do anything like that again. But guaranteed there’s more people out there listening to the voice of God speaking to them and only them, every day. And no one around them can tell. There will always be more people slipping, and breaking from reality. There will always be crimes committed for which the perpetrators are not criminally responsible.

I realize that we can’t just lock everyone up and throw away the key, or hospitalize them until they die. I understand that, in this case as in many others, Li is and will continue to be closely monitored, even when he’s on his own.

But I think we need to find a better way. Some way to not only research and find new methods of treatment, but to also see that a better sense of justice is served. What Li did may never seem real to him, but it’ll never be anything but real to those who suffered as a result of his actions. There needs to be some form of punishment, some price to pay. Some attempt at atonement for crimes committed.

And not just in this case, nor just in cases where there is an added criminal element. We need to do better for mental health issues overall. Even something that seems simple from the outside – depression = sad, so therefore sunshine, laughter and hugs are the cure – is more complex to the person living with it, and to those around them who are affected by it. Hugs can sometimes be the cure for sad, but being sad isn’t the same as being depressed. Being sad is a mood. Being depressed is a condition. Hugs won’t cure depression any more than they cure a broken arm or a ruptured spleen. And that’s how we have to start thinking about mental illness in general. We need to treat it the same way we treat physical illnesses – as something that’s actually not all in our heads.

Even though it technically is in our heads, but not in a way that can be brushed off as irrelevant or easily remedied. It’s not something that can be quantified nor understood, even by the sufferer.

It’s a physical ailment of the mind.

As for when there is a criminal element involved…I just don’t know. There needs to be something in between institutionalization and rehabilitation/release. At least for the length of time a mentally competent person who’d committed a similar crime would receive in a court of law. Something that would allow for closer monitoring of the individual, as well as further research into the disease, the hopefully both understand and treat it better. Like a halfway house, but with stricter controls, medical and therapeutic monitors and less tangible access to the outside world. We don’t allow murderers out on unaccompanied day trips and the like while they are serving their sentence; the same should really hold true for those who kill while suffering a break from reality. The act is the same, the accountability is different, the punishment should be somewhere in between.

I think that might make it easier to determine what punishments would best suit others, too, like those who commit crimes of passion, or while under the influence of drugs and/or alcohol. Addiction is itself a mental illness, and while someone may commit a crime while they weren’t entirely in control of themselves as a result, there is still a price to be paid.

They always say the punishment should fit the crime. I think the real problem is that we’re slowly realizing that the issue is not nearly that clear-cut; not so black and white. It’s a series of complex layers that we’re only beginning to dig into.

So maybe the way we deal with it should have several layers to it, as well.

Know What’s Crazy? ‘Cause I Don’t…

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So, I stumbled across this list on Tumblr a couple of weeks ago, and it’s still kind of on my mind. It consists of reasons why someone would be admitted to an insane asylum – in the late 1800’s.

First, insane asylums are creepy as all heck to me. Especially old school ones, but really, no matter what name you give them, they are filled with unpredictability. And that is one thing that bothers me most. I mean, a lot of things get under my skin, but that is a huge one. I still occasionally check under my bed to ensure the psycho killer isn’t waiting for me to feel safe enough to sleep before he stabs me, or whatever. It’s the feeling that everything is fine until it isn’t – the sense that anything could happen at any time and for NO DISCERNABLE REASON. Like, the sane (or sane-ish) can’t predict what the insane will do at any given moment, because even they don’t know until they do it.

Also, asylums are scary and full of ghosts, especially after they’ve been abandonned. Not to mention all the tools. What the hell are doctors and scientists thinking sometimes?

I think part of it is also – like, I’m pretty sure even a sane person, under similar circumstances, would begin to exhibit insane-like behaviour after awhile. In many cases, even now, prison would be better. It’s called an asylum, but it’s not really to keep the sick safe from society. It’s to protect society from the sick. For so many, there’s no coming back from that. And I feel like even for the “sane-est” person alive, trying to prove you’re NOT insane would be like trying to prove you’re not drunk. Evidence can be found to prove the case against you quite easily once someone is looking for it, and from that point on, the frustration at not being able to prove your truth to the world – that you are sane and/or sober – that alone would begin to make matters much, much worse.

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Now, I of course know that things are very different now than they were in the 1800’s. We have made incredible advances in the mental health field along with everything else. Looking at this list is almost laughable, really. Like, WTF does “time of life” even mean? It’s your time to be a lunatic? Fell from horse in war is a reason for admission? What if you fell from a horse at home, and not anywhere near the war?

I’m not even going to get into the sexist, ignorant reasons, because as you can see, they make up the majority of the list. I wonder how many of these were acted upon by a person checking themselves in, versus being checked in against their will. I wonder how many were women or gay or not-white.

Novel reading?! Seriously?!

Funny how priorities change. Back then they seem to have been obsessed with masturbation, the expression of any emotion (grief is on there), and anything possibly related to a fever and/or the imagination.

To my eyes, all of those reasons seem insane in and of themselves.

Possibly because I would have been locked up for several of them, myself.

Sometimes I actually have to wonder how far we’ve really come. Attitudes and stigma surrounding mental health are still – I mean, I feel like they’ve been getting a bit better in recent years, but I almost feel like it’s going too far in the other direction. We’ve gone from having no real understanding of most mental health issues and not really talking about it in any kind of meaningful discourse, to still having no real understanding, yet talking about it all the time. Just on the surface, though. Everyone jumps on the #BellLetsTalk bandwagon one day a year, which is great, but it doesn’t seem like very many people actually talk. We’re all very good at nodding in sympathy and telling people to just talk about whattever’s bothering them, that we’re here to listen.

I just don’t think many of us know how to really talk about it. Because none of us really understand any of it.

On a logic level, we can grasp that being sad and being depressed are not the same thing. But sometimes it looks the same. And sometimes it looks completely different. Sometimes it doesn’t look a thing like what we think depression should look like, and so we might not even notice.

Even when it’s happening to you.

That sense of not being able to understand your own self, of not knowing why you do some of the things you do – it can feel very disconnecting. And so we bury it, because we don’t want anyone else to see us becoming more disconnected and risk having them think we’re a freak.

Or insane.

Because once someone has that thought about you, it’s very difficult – if not impossible – to get them to see you any other way.

We all want to be normal, yet unique and special. And the definition of normal has never been anything but a slippery slope. Whoever invented the concept of normal should be put in an asylum, were they still alive, because that concept is completely crazy. We want to stand out as individuals, but for good things. Inspiring or heroic things. Not for telling squirrels to be careful when they cross the street when you’re on your way to work in the morning.

Hypothetically speaking, of course.

So as much as we all want to talk about our thoughts and feelings, and let our freak flags fly, we’re also terrified that it’ll reveal too much, and that there will be no coming back from that. Once we are too real, and too exposed, we’re doomed. It feels like it could actually drive people further away, especially since we have no idea why we think and feel some of the things we think and feel. We can’t explain it because we don’t understand it ourselves.  Human beings have a need to dissect and understand everything – we’ve been testing theories and hypotheses since we crawled out of the primordial ooze.  But I think mental health is perhaps the one true bane of our existence, because it’s not something that can be quantified or studied with any degree of accuracy.  It not only changes from person to person, but also within the same person, from moment to moment and day to day.  It’s unpredictable, and that’s what makes it scary.

Like, maybe we have a great life – not just appear to have – actually have everything that should make us happy. A spouse, children, pets, job satisfaction, comfortable salary, a boatload of friends, an in-home theatre, a cottage in Greece, sunshine, rainbows and a unicorn. From the outside, we have everything. From our own perspective, we want for nothing. Yet for no discernable reason, we feel unhappy. How can one who has so much to make them feel complete still have a sense of disconnect and actually suffer from depression? How do you fight something when you have no idea what it is, why it is, or what might actually help make it go away? How do you live with it? And how on earth would you ever, ever tell anyone about it? What would they think? How would they react? Is it worth the risk of potentially making it even more difficult to get through the day, if the conversation goes south?

Often times, no, it is not.

And so we remain silent, for better or for worse, and wait for the next storm to pass.

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