Thursday, June 28, 2007

"You Can't Make An Omelet Without Breaking Some Eggs"

In the 1930s, intellectuals making excuses for censorship, police state, show trials, and mass murder, would use this expression as a jocular way of distracting attention from the Soviet Union's little...failings.

I think that I have found the modern equivalent.

Albert Brooks’ 1974 compendium of legal issues associated with mental illness speculated that if civil commitment went away as a mechanism for dealing with those who were everything from murderers to public disorder problems, that something else would take its place. His prediction turned out to be remarkably accurate:

It is assumed that if coercive commitment were abolished, most of the persons presently confined would not be confined, and would be either treated on an outpatient basis or simply left alone. It is more likely, however, that a probable consequence of abolishing civil commitment would be that persons who engage in undesirable behaviors now controlled by the civil process would become subject to our already overloaded criminal justice system, and would be treated as “criminals”…. [Brooks, Law, Psychiatry and the Mental Health System, 606.]

Two years earlier, M. F. Abramson, a psychiatrist who consulted “to a county jail system, county courts, and the adult division of a county probation department,” described the effects of California’s cutting edge Lanterman-Petris-Short Act (1969). While acknowledging that some of the effects were positive, “There may be a limit to society’s tolerance of mentally disordered behavior. … [M]entally disordered persons are being increasingly subjected to arrest and criminal prosecution.” Because so many of these deinstitutionalized or never-institutionalized mental patients were using illegal drugs, when they came to the attention of police, drug possession was likely the basis for processing them—but as criminals, not as persons in need of care. The state prison system was suddenly awash in mentally ill prisoners.[M.F. Abramson, “The Criminalization Of Mentally Disordered Behavior: Possible Side-Effect Of A New Mental Health Law,” Hospital and Community Psychiatry, 23[1972]:101-105.]\

Unsurprisingly, Abramson’s concerns were soon met with a response by a J. Monahan that argued that forcing mentally ill people into the criminal justice system was actually a good thing:

But the criminal justice system forces society to confront its tolerance level, to think out, evaluate, and agree upon exactly what behaviors are so deviant that their perpetrators should be incarcerated. By holding up for public debate in the courts and the legislature such issues as homosexuality, prostitution, abortion, and marijuana use—all of which have mental health aspects—the system forces society to come face to face with its norms and values.

Perhaps most disturbing is how this wonderful confrontation of society to deviance was couched not in terms of concern for the mentally ill offender—for Monahan admitted that “on a purely humane level mental hospitals may be preferable to jails in many jurisdictions”—but that the mental patients would bear the costs of confronting what Monahan clearly saw as a hypocritical and rigid society: “the current paradigm clash between criminal justice and mental health may be a portent of true progress, a sign that revolutionary advances in our ways of conceptualizing and responding to antisocial behavior are in the offing.” [J. Monahan, “The Psychiatrization Of Criminal Behavior: A Reply,” Hospital & Community Psychiatry, 24[1973]:105-107.]

And what a tragedy this wonderful theory has produced.

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