How Does Mental Illness Fit into the Equation?

Part I

In the next several days, I want to discuss the now “hot topic” of mental illness, especially as it relates to numerous cases of mass shootings. Guns and mental illness are significant topics now bandied about in the political world. While I do no know very much about guns, other than that there are more guns than people in the United States, I do know about mental illness. Therefore, I will talk about what I know…

Since the scourge of COVID-19 began in 2020, more attention has been paid to the effects of mental illness in our society. COVID has been blamed, with some accuracy, with ratcheting up stress, anxiety, and depression rates. Further, the recent spate of mass shootings, inordinately an American phenomenon, has drawn more attention to the state of our collective mental health. I have worked in the field of mental health since 1973, and I have some observations about the provision of mental health services in this country in the past 50 years.

Some History…

When I started work at the Dayton Mental Health Center in 1973, I was a social worker on three wards of patients from a three-county area- Darke, Miami, and Shelby counties in southwest Ohio. We had approximately 90 patients on those wards on any given day. Many of these patients were highly institutionalized, meaning that they had been in the relative sanctuary of a state mental hospital for years. In some cases, it had been decades. These were people diagnosed with a significant and profound mental illness which required hospitalization.

The treatment in those days consisted of rather harsh first-generation anti-psychotic medications which were generally effective in subduing the most devastating symptoms the patients faced. The trade-off, if that is the right word, was often equally devastating side effects, such as extreme lethargy, involuntary muscle movements, facial tics, and a gait impairment commonly known as the “Thorazine Shuffle”. Thorazine, of course, was one of those first-generation medications used to treat psychosis. As one of my patients told me, “For you all these are ‘side-effects’, but for me they are primary effects!”

Nonetheless, such medications reduced some florid symptoms such as visual and auditory hallucinations, aggressive behaviors, deeply paranoid thinking, and serious agitation which caused immense disturbance to those suffering from uncontrolled thoughts.

Further, these medications spared some patients the practice of a frontal lobotomy. Yes, that procedure did happen, and some of my patients were survivors of such treatment. The hope and belief of the time was that releasing patients back into society with proper medication and community supports would allow them to function in the world despite a serious mental illness.

Sometimes, it worked.

As medications became better, with fewer side-effects, more patients were able to be released into a community that often was not accepting of them. Part of my job was to make sure that those services (and medications) followed those patients into the community.

In coming days, I will expand on the history, the successes and failures of mental health treatment in the United States.

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