Robert Kennedy's Legacy
Today is the 25th anniversary of the day that John Lenon was killed by mentally ill Mark David Chapman. And then I heard the news yesterday that a man by the name of Rigoberto Alpizar had been shot and killed by air marshals at a Miami airport; it did not suprise me to hear that he was also mentally ill. The wife of the man shot said that he was Bipolar and not on his medication. This refusal to take medication is typical for those who have Bipolar Disorder, in my experience.
There are a number of reasons for this refusal, but my guess is that the mood stabilizers and anticonvulsants used (Lithium, Topamax etc.) take away the high manic feeling the person gets from the illness and they need it like a drug at times and go off their medication. The patient may also mistakenly feel that there is nothing wrong with them that warrants medication. The families of these patients suffer greatly. I have seen patients in the throes of mania commit some really screwed-up crimes. (Sorry for the lack of psychobabble here but if that is what you want--please consult one of the many Journals of Psychology where one can be bedazzled by the credentials/brillance of the authors while still having no freaking clue as to what the point of the study is).
Mentally ill people like Rigoberto Alpizar are four times more likely to be killed by law enforcement than the general public. Violent episodes of those with schizophrenia and manic depression account for 1000 homicides in the US each year despite what some psychologists and advocates tell us about the mentally ill not being dangerous. My question when I see violent episodes like the Miami one is to ask, "Why was this mentally ill man taking a plane without medication?" The answer, I am sure, is complex. We have 4.5 million people in the US with schizophrenia or manic depression (now called Bipolar Diorder). An estimated 40% of these are not receiving any treatment on any given day. This results in acts of violence, incarceration and homelessness.
The failure of deinstutionalization, civil liberty issues and economic factors have lead to a number of the mentally ill being out in our communities with little or no intervention. When Robert Kennedy called the state mental hospitals "snakepits," he must never have imagined the problems he would unleash into our communities. The community help that was to come from deinstitutionalization never materialized and hundreds of thousands of mentally ill have been left to fend for themselves. Now, instead of being in a hospital or a supervised setting, the severely mentally ill are in jails, nursing homes and homeless shelters -- often receiving services that are more expensive than the state hospitals that should have been equipped to provide them with psychiatric care in the first place.
Ever since Kennedy threw the baby out with the bath water, we have had more incidents of school shootings, mass shootings and just plain bizzare behavior like Alpizar's. No doubt we will see more of this in the future.
Update: Here is more information on the legislation that John Kennedy signed into law before he was assassinated:
Read the whole thing.
There are a number of reasons for this refusal, but my guess is that the mood stabilizers and anticonvulsants used (Lithium, Topamax etc.) take away the high manic feeling the person gets from the illness and they need it like a drug at times and go off their medication. The patient may also mistakenly feel that there is nothing wrong with them that warrants medication. The families of these patients suffer greatly. I have seen patients in the throes of mania commit some really screwed-up crimes. (Sorry for the lack of psychobabble here but if that is what you want--please consult one of the many Journals of Psychology where one can be bedazzled by the credentials/brillance of the authors while still having no freaking clue as to what the point of the study is).
Mentally ill people like Rigoberto Alpizar are four times more likely to be killed by law enforcement than the general public. Violent episodes of those with schizophrenia and manic depression account for 1000 homicides in the US each year despite what some psychologists and advocates tell us about the mentally ill not being dangerous. My question when I see violent episodes like the Miami one is to ask, "Why was this mentally ill man taking a plane without medication?" The answer, I am sure, is complex. We have 4.5 million people in the US with schizophrenia or manic depression (now called Bipolar Diorder). An estimated 40% of these are not receiving any treatment on any given day. This results in acts of violence, incarceration and homelessness.
The failure of deinstutionalization, civil liberty issues and economic factors have lead to a number of the mentally ill being out in our communities with little or no intervention. When Robert Kennedy called the state mental hospitals "snakepits," he must never have imagined the problems he would unleash into our communities. The community help that was to come from deinstitutionalization never materialized and hundreds of thousands of mentally ill have been left to fend for themselves. Now, instead of being in a hospital or a supervised setting, the severely mentally ill are in jails, nursing homes and homeless shelters -- often receiving services that are more expensive than the state hospitals that should have been equipped to provide them with psychiatric care in the first place.
Ever since Kennedy threw the baby out with the bath water, we have had more incidents of school shootings, mass shootings and just plain bizzare behavior like Alpizar's. No doubt we will see more of this in the future.
Update: Here is more information on the legislation that John Kennedy signed into law before he was assassinated:
The 1963 Community Mental Health Centers Act was the last major piece of legislation signed by President Kennedy prior to his assassination. It has become a symbol for how a well-meaning action can become a total and complete disaster.
The Act’s failure can be attributed to four flaws in its design and implementation. First, it was based on a number of failed assumptions about what was wrong with the severely mentally ill. Those responsible for the legislation did not fully understand brain diseases; assumed that if released from state institutions, the mentally ill could live happily ever after; and neglected to investigate a condition known as anosognosia. Anosognosia is an integral part of severe mental illness. As many as 50 percent of those with schizophrenia and 40 percent of those with bipolar are impaired to such an extent that they cannot recognize what is wrong with them. (See the fact sheet on anosognosia on page 11 of this issue.) So a significant portion of the severely mentally ill cannot live “happily ever after” without direct treatment and supervision.
Secondly, the Act suffered from flawed planning. It bypassed the states entirely and placed the burden of funding community mental health centers on the federal government. The National Institute of Mental Health failed to provide essential oversight of the centers. The community mental health centers were failed by a total unwillingness to take responsibility for center management at both the state and federal levels.
Thirdly, before the movement toward deinstitutionalization, the states covered 95 percent of the financing for care of the severely mentally ill. In the hopes of moving patients out of the state hospitals and into the community, the federal government made patients in state hospitals ineligible for aid while hospitalized, but eligible when discharged from the hospitals, thus providing the states with enormous incentive to empty out the hospitals. Deinstitutionalization quickly became the priority for state mental health agencies and there was no incentive to ask what happened to patients once they left the hospital.
Read the whole thing.
posted by Helen at 11:15 AM
37 Comments:
so let me get this straight. robert kennedy calling mental hospitals "snakepits" has resulted in school shootings, mass shootings, and just plain bizarre behaviour? surely there was someone else involved?
Yes, you have that straight. Robert Kennedy closing down state hospitals out of compassion for the mentally ill meant that there are people in our communities who are sick and in need of treatment. He wanted there to be be community services but those were never put in place and people fell through the cracks. Some mentally ill are now sick and some violent without supervision and we are all paying the price for Kennedy's inability to think through the consequences of his actions.
Was it Kennedy's inability to to think through consequences, or ours? After all, Robert Kennedy was assassinated in 1968. We've had 37 years to change course.
It's not hard to see where Kennedy was coming from. His own sister was destroyed by quack psychiatrists.
For that matter, the Alpizar case is a little different because his wife was with him. If he had medication and a caring spouse, then that could well have been as good for him as a mental institution. I don't know whether Mrs. Alpizar was a caring spouse, but she might have been. The ones who didn't care about him were the air marshals.
His sister was lobotomized on her father's orders.
During the mid-80's I worked at a mental health center in Tennessee. De-institutionalization was in full swing at that time. Long term, chronic patients were being moved into group homes, independent living, and other community settings.
These patients included paranoid schizophrenics, bipolars, and others. Most had minimal daily living skills. Some of the group homes were terrible. But, legally these patients were emancipated adults and could not be committed to a mental hospital except under the most extreme circumstances.
During this time two patients I worked with were murdered by another patient, one over a cigarette.
Sure some people in mental hospitals didn't need to be there but many did. Much suffering has occurred due to de-institutionalization.
Great post, and you're absolutely right. (My family suffered terribly trying to get help for a family member.) I think the egalitarian mindset that schizophrenia is really no different from things like shyness (anxiety disorder) and that "we're all mentally ill in one way or another" have contributed to the problem. So has the idea that a raving, unmedicated, hallucinating man should be primarily seen as "homeless."
I'll go even farther out on a limb and blame Geraldo. Journalists like him made their name during the sixties and seventies with exposes on mental hospitals. Politicians were then all too happy to shut them down, saving money while looking like reformers at the same time. Left us with a big mess on our hands.
Being mentally ill and having a bomb are not necessarily mutually exclusive. His wife yelling that he was mentally ill as he ran off the plane did not give him a pass if the air marshalls saw him as a serious threat.
Every time someone who is mentally ill is shot by law enforcement, a family member can be counted on to say "they should have done more to help him." Doesn't matter if he had just (real examples) murdered someone, or was waving a gun or a knife and threatening to kill everyone in sight, someone will say more should have been done to help him. My question is: If helping him was that easy, why didn't you get him help while there was still time?
The air marshals did the only thing they could--they had a split second to make a decision that could affect many people. Law enforcement often have to make these decisions and it is hard to distinguish who is mentally ill--and Mr. Small is right--being mentally ill and having a bomb are not mutually exclusive. That said, it would have been better if the mentally ill were taking their medication--particularly those who have a tendency towards violence--then maybe some of these problems could be reduced.
I work with violent people, have been threatened by them and understand that they are not safe when they are not complying with treatment. I am not saying this as a "quack psychologist" as Greg likes to think of all of us who think some people belong in the hospital. Yes, it would be great to have a caring spouse and medication but sometimes that is not enough.
I believe there are people in our society who are too sick and mentally ill to live on their own--the hospitals were better places for them, but now that is rarely an option. We used to have a terrific state run hospital for adolescents but they slowly stopped taking in patients over the years and shut down a few years ago. There are few options for kids who are quite sick and they rarely get the help they need until they harm someone and end up in trouble. Same with some adults I see. Help is not easy, and sometimes is impossible to get for those with mentally ill family members. Many are left on their own to deal with a violent or suicidal person. However, it was extremely poor judgement to let this man get on a plane.
I blame "One Flew Over the Cukoo's Nest"!
PS- The Air Marshalls cared- about everyone else on the plane.
Under Supreme Court precedent, a person must be released from a mental hospital to a less restrictive environment once the person reaches a stable point and is no longer improving. The idea is the person goes to a group home rather than stay in the hospital, and can be integrated into society. The problem is there is not necessarily enough funding for group homes, or the patients do not follow the rules of the home (often substance abuse) and end up on the street. This is the revolving door. Many patients become stable on meds, are released, go off the meds, and wind up back in the hospital. The intention was that the mentally ill not be warehoused in mental institutions. But the reality is that many end up on the street and could be better and more efficently cared for in an institution.
Great comments, including greg's up until the last line. Eric and anonymous 817 raise important points.
I have been doing this for a living for 25 years, working acute psychiatric emergencies and trying to find some sort of stable housing, income, treatment, etc for the mentally ill and would-be mentally ill. A 200-bed hospital, 1800 admissions a year -- you do the math -- they don't stay long.
Deinstitutionalization is usually blamed, correctly; lack of community services is usually added in as a culprit, incorrectly. With the freedom to miss medications and abuse substances, a large percentage of the mentally ill are not fully containable with any amount of outreach and support. As noted above, even group homes do not always offer enough containment. We have a Conditional Discharge statute in NH, which allows a patient to remain outside of hospital if s/he follows certain conditions, most usually including medication, appointments, and refraining from substance abuse. It is moderately successful.
The difficulty is in identifying in advance who is going to be dangerous. Any method which successfully identifies those who need to remain contained also identifies many more false positives. Do we as a society lock up the five identified as equally dangerous, even though four of them will live out their life spans without dangerousness? I tend to be outraged at the civil libertarians who insure that many sick people have the freedom to die with their rights on, but I also see their point.
All this only to note that the solutions aren't simple.
I'm bipolar, and I wouldn't blame anyone for shooting me in the head if I started a spooky ruckus on an airplane.
I'll also vouch for how pleasant hypomania (mania lite) is, but just because I'm getting intoxicated off my own brain chemistry doesn't mean I should be held blameless for my actions -- an endogenous binge is a binge nonetheless.
My uncle has a mental illness , he is on medication ,when not on medication , he thinks he is like a god and can control the world . my memories of him as a child , he was the nicest , kindest person , of all our uncles he was the best , until this sickness took hold of him , what could happen to someone that would turn him into something that would literally scare his family to death ... I have read studies on how or why , but still sometimes you still ponder , why ?
There are numerous reasons why a person who is bipolar might be off their medication. Mild mania can feel pleasant but it also can feel agitated and unpleasant.
Patients often go off their medication because of side effects. Lithium causes weight gain, heat intolerance, and trembling hands. Topamax is sometimes referred to by mental health professionals as "stupimax". It can create noticable and troubling cogitive impairment, as well as an unpleasant tingling feeling in and and changes in taste perception. Lamictal can cause a life-threatening rash.
Patients may also go off their medication because the drugs can be extremely expensive. Even with insurance coverage bipolar medication can cost hundreds of dollars a month.
This man and his wife were robbed while on their missions trip. It's possible his drugs were taken as well. Or they could have been lost, left in checked baggage, or he may have run out of them while traveling.
Its was,nt the gun that killed KENNEDY or LENON it was the person with the gun but too many time we have these liberal nit wits who want to blame a inanimate object rather than the person holding it
The most loving and caring spouse in the world can do absolutely nothing if the mentally ill person won't take their meds. The next of kin can not legally force an adult to take medication - even if everyone knows that the medication would work and would keep that person from becoming a danger.
I can see someone now saying - well... just slip them the meds on the sly...
From what I understand - bipolar also causes accute paranoia... meaning they might not eat or drink anything they didn't make themselves because they think you might "poison" them.
Also, if you think someone is a danger and try to get them institutionalized... it's nearly impossible until after they have committed some heinous act. So, as a family, you have to sit and watch the person deteriorate and there's not a single thing you can do about it.
I'm hoping this shooting draws some attention to the problem... but I doubt it. So far as I can tell - the air marshall did the only thing possible under the circumstances. Especially when a wrong decision could cost hundreds or even thousands of lives... depending on the chain reaction of a bomb going off.
Last of all, I lived in Elgin Illinois for 13 years... home of one of the state's large mental hospitals. There was a constant revolving door of people in and out all the time. After a couple of years you even recognize most of the regulars when they end up back on the street corners while they wait until the hospital will let them back in... or they commit a crime.
All right, the air marshals had little choice but to shoot the guy. It wasn't to save people on the plane, though, because he had already run off the plane. I think that I was behind everyone else on this story. As I said, I have no television, and I suppose that this story would be all over the TV.
When I said that Rosemary Kennedy was destroyed by quack psychiatrists, I did not mean that all psychiatrists are quacks. I meant that those psychiatrists (or more precisely neurosurgeons) were quacks. She was lobotomized. Yes, it was done with her father's irresponsible and unilateral approval. He had been told that lobotomy was a miracle cure for her mood swings. I have to admit that this is a tangential point. The relevance of it is that the Kennedys were familiar with mental institutions since their sister had to be in one. If they said that many mental institutions were "snake pits", they probably knew what they were talking about.
The stronger point is that it is just scapegoating to blame Robert Kennedy for decades of mental health practice after he was assassinated. Cuts in public funding are not in any way a consequence of his advice. The cuts would have come anyway, whether mental health patients were in institutions or not. If the institutions were "snake pits" before, then they would have stayed bad. You see exactly the same thing with public housing and public defenders.
For that matter, Robert Kennedy never supported the philosophy that taxation is theft. "Taxation is theft, but public spending is our due." That's the way that the country is run these days.
A minor point, Greg
I'm not yet sure exactly where he was when he was shot, if he was moving, or in what direction. If he was still in the proximity of the aircraft, if the marshals reasonably believed he had a 'bomb' the'd have no way to assess the danger and would assume the worst.
Imagine a long, narrow building with very, very few exits jammed with people. Oh, and we'll store 90,000 pounds of kerosene in the basement. And I'm standing outside with a 'bomb' and threatening to detonate it. In most (maybe all) states, shooting me would be justified -- I pose an imminent danger to everyone in the building. The closest analogy is I'm threatening to commit Arson 1, setting fire to a structure I know to be occupied, and deadly force is authorized in most jurisdictions.
Even if he's off by himself, is he moving toward a crowded area ? This is what homicide bombers do before they cook off their explosives.
In a perfect world, he's all by himself, 250 yards from anyone, and not running towards anyone or away from the marshals (who are charged as law enforcement to protect the public at large, so they can't let him simply escape with a possible bomb). Under that circumstance, talking to him and trying to persuade him to surrender would be the best avenue. "Waiting him out" might work. Getting impatient -- like Reno got at Waco -- can have consequences more drastic than necessary.
I don't really know enough about the tactical situation in this case to form an opinion against the officers. Absent conclusive evidence they screwed the pooch, I will not question their motives or their actions.
I'm serious about "One Flew Over the Cukoo's Nest".
The lefty, new-agey feelgood idea that the mentally/emotionally ill are just "seeing things as they really are"
or are just nonconformists brutalised by the system was a consistent theme of the late 60's-early 70's. Just liike the evergreen, "children have a lot to teach adults" that has destroyed the public schools.
Net result: untreated, homeless crazy people; and an ever rising tide of functionally illiterate Americans. Now that's "progressive"!
Jeff,
Many of the mentally ill are living in hell and some of the drugs we have now are miracles. I also get frustrated when others who probably have never lived with someone who is psychotic etc. are telling us that the mentally ill just think differently. It's like saying someone without a leg just walks differently. We need to take a more moderate approach and not go from the extreme of warehousing people in "snakepits" to letting them all go with little supervision and calling it progress.
me,
We are paying anyway--it is much more expensive to keep someone in jail than in a mental hospital. I do not think we need to pay more to treat the mentally ill--we need to reallocate our resources from the jails and administrators etc. to hospitals--and of couse, there should be some decent staff, not the high school grad with no training (although some of these types are better than the therapists). And many citizens do not trust the staff at hospitals to decide when a patient is ready to go--at least jails can't just open the doors and let people out without the courts etc. intervening.
Mental insitutions, or long-term mental health facilities and state hospitals, serve the severely chronically mentally ill. The mentally ill who are not presently high-functioning. The mentally ill who are either noncompliant with their medication regimen or who are treatment resistent. And despite public opinion, there are many, many high-functioning mentally ill persons who do not need to spend time in a mental institution. The deinstitutionalization movement served the philosophy that the mentally ill were being treated poorly within these institutions, and that greater society should learn more about mental illness to be able to better serve that segment of the population. Current estimates now show that 4.3% of the population is bipolar, moving it from 2.7 million people to 12,750,000 in the United States alone. As it seems thus far, Mr Alpizar was among the high functioning mentally ill, and most likely would not have needed institutionalization had he remained on his medication regimen. Of course, speculation is unfair, and I hope the private details of his case never go public. My thoughts and sympathies are with Mr Alpizar's family.
This incident, if nothing else, has only begun to shine the spotlight on the stigma of mental health, specifically bipolar disorder. I think we will be seeing the repercussions of this tragedy for a long time. Should the air marshalls have acted differently? I wasn't there and can't make that call. Did they behave correctly if Mr Alpizar shouted he had a bomb and ran about like a terrorist? I would say in that incident that they did their job. There is still a lot of information to come from this incident. Witnesses are now saying that Mr Alpizar never mentioned a bomb and simply ran off the plane as if he had boarded the wrong plane. What's done is done, and all I can hope is that we learn from whatever conclusions are made from this incident.
Greg..my true love!
Precisely what did Kennedy do except make a public statement? Did he write the legislation? Make the regulations?
Oh, and I am pretty sure Kennedy's statement related to the institutionalization of the severely retarded, and not the mentally ill.
For all of our talk about the problems of the metally ill in our society, the fact is that drunks and druggies cause 1000's of times more problems and, like the metally ill, there really is no way to effectively treat them. I really believe that if there was a pill or a treatment that worked half as well for alcoholism as the meds listed do for bipolar disorder the crime rate in this country would drop noticably as would the number of panhandlers and homeless.
I used to live next door to a halfway house for those who had been hospitalized by the state of Virginia for mental health reasons. One of my neighbors was a schizophrenic, I believe. He was a gentle man in his late 30's who looked much older. He seemed to be carrying an immense burden but was consistently kind and sociable.
He hated being institutionalized but also feared "mind control" by his roommate when he was at home. He lived on SS disability of some kind, I think. He was truly ill and I have no idea in what capacity he might have been able to be a productive member of society. I guess he was lucky to receive some treatment and support but he wasn't very happy with the cycle of his life.
I think of him everytime I see a homeless person who looks out of it. I also think of him every time I try to assess wheter or not I was permantly damaged by my youthful substance abuse. I might have come closer to being like him than I care to admit.
One of my best friends, a man as intelligent and talented as anyoneI have ever met, is in rehab right now.
He is an alchoholic and cocaine addict, and has been commiting suicide in slow-motion for the last dozen years. He has emotional problems stemming from sexual abuse at the hands of his psychiatrist, which began when he was 12 and lasted for several years.
He is mostly a danger to himself but may eventually hurt someone else, most likley in a DUI situation. WHich is not including the damage that he ahas done to his family, friends, and his former fiance. How you treat someone like him is beyond me. How you prevent him from harming himself and others in the future is the real question.
I don't think that it's quite fair to pass on accusations of sexual abuse from severe drug abusers. If the man fell off the wagon that badly, then you can't take what he says at face value. He could be misrepresenting his experiences with his psychiatrist in a thousand different ways. Besides, any psychiatrist who can properly deal with a cocaine addict who has betrayed every last friend and relative deserves a medal.
In fact, I think that people cavil too much here about their friends and acquaintances. So-and-so is a hypocrite, so-and-so is sanctimonious, so-and-so committed sexual abuse. I can't say that I am innocent of this behavior, and I hope to keep it to a minimum. As it applies to my friends and acquaintances, that is. Specific viewpoints are still fair targets, as are the world's powerful people.
Actually, the cocaine abuse happened as an adult, the sexual abuse happened as a 12 year old.
And the DA in his city is taking it seriously. About 50 other former victims have come forward with similar accusations. They've been building a case for two or three years now and the prosecution will go to trial if the psychiatrist in question doesn't die of health problems first.
My friend had some issues prior to his abuse, of course, or he wouldn't have been taken to see a psychiatrist when he was 12. Whatever the ultimate origins of his emotional problems are, the outcome is clear. I've never seen anyone more uncmfortable in their own skin. Self-medication was his solution but it just gave him even more problems. Despite which he has had a steady stream of offers to help from friends and family, so it can't be said that he had nowhere to turn when he needed help, which was every single day.
You updated the post to mention a piece of legislation John Kennedy signed into law, but your original post was about Robert Kennedy. What was the connection between Robert Kennedy's comment about the institutionalization of the mentally retarded and the legislation you mention? Who wrote the legislation, and who pushed it through Congress?
anonymous;
Thank you for pointing out my mistake--it was John Kennedy who signed the legislation into law.
Note that lobotomy was state of the art treatment in the 1930s through 1950s, along with electroshock therapy -- there were no drugs for these conditions. There have been other stories of famous lobotomized persons -- there was a movie a few years ago about actress Frances Farmer, who was lobotomized. Barbaric, perhaps, but the best that medicine had to offer as a treatment. There has been much criticism of Joe Kennedy for having Rosemary lobotomized, and he's certainly not one of my personal favorites in history -- whether he was truly trying to help his daughter or simply control her, who knows. The psychiatrists were 'quacks'? Given the standards of the time, there's a good argument that they were not.
On another note, I see in the UK papers that the London police who shot the (apparently nonterrorist) Brazilian plumber on the tube shortly after the July bombings may face charges. Never mind the plumber ran from police and jumped the turnstile -- and he wasn't even bipolar. Split second decisions on which others' welfare depends is a terrible burden, but I can't blame the London police or the US air marshals. Note to self: take meds, and pay the fare.
Good on ya pointing out the Kennedys role in de-institutionalization. I'm from California, and, for years and years now, I've heard the libs pull out of their big bag of lies the canard that Reagan was responsible for putting the mentally ill on the streets. Kennedy and de-institutionalization always just seems to slip down the memory hole.
Best regards from NY! » » »
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