Ignoring Mentally Ill Is Plain Crazy

When I was living and reporting in India, I saw things that hurt my eyes. I saw them every day for years - twisted bodies, rotting bodies, mutilated bodies dragging through the streets.

Faces were attached to the bodies but usually you did not look at them peering up from the sidewalk or the gutter. That way, it was possible to keep walking past the broken people and their hands.

For all my love and hope for India, I could never escape a sense of anger that any community would allow such degradation. At least, pick them up, pick them up.

Pick them up and tend to them - shouldn’t Americans think that as we pass our own broken people in the streets, the men and women who scream or cry as they lie there or try to run from themselves, down the sidewalks and into the roads?

If a person breaks a leg in the street, civil help tends to him quickly - ambulance, doctors, police.

Break your mind and you lie there, unless you can show you need help by getting up and pushing somebody into a subway train.

How can this be so? Money, for one thing. Treat them with pills, then discharge them from the hospitals, tell them to take the medicine themselves, close the hospitals. That is why in New York state alone, patients in state mental hospitals have dropped from about 93,000 in the ‘50s to about 9,000 today.

But one patient in three does not take the pills after his release. He is too mentally ill, too alone - or too many care centers supposed to provide help have been closed.

The American community finds money for taking care of tens of millions - the poor, the aged, the physically ill. Why are there so many mentally ill people cut off from help - at least 10,000 just in New York City’s streets?

One reason is that everybody knows physical pain, but the pain that mental disorder can bring is literally unutterable by the suffering and unknown to most of humanity.

A couple of months ago, I had a long cardiac bypass operation. The doctors had said that when I recovered consciousness almost a full day later I might be disoriented by the heavy doses of anesthetics and drugs. I was, for some hours.

I did not understand why all these people around my bed were hurting me, why nobody stopped them. I was not just frightened but in total, enveloping terror. I felt it not as emotion but as overriding, bottomless pain. The particular agony was that since I did not know why I was being made to suffer so, I could not conceive of the end of suffering.

I catch my breath at the memory of those hours. I will never forget them, I hope, because they gave me a brief taste of the anguish of people who cry in the street because they do not know where their pain is coming from.

Some remain neglected because of the tangle of law and civil liberties that troubles judges, doctors, patients and their families. Under New York state law, a patient has to have an illness that can inflict “serious harm to self or others” before he can be committed.

In the new issue of City Journal, a sophisticated and useful publication of the Manhattan Institute, Prof. Sally Satel, a psychiatrist at the University of Pennsylvania on leave from Yale, says that lawyers and judges often see commitment hearings as a criminal rather than medical proceeding. The goal becomes to avoid incarceration, “not to look out for the person’s best interest.”

But mental patients and their families particularly need the protection of law. New York’s standard of “dangerousness,” however, permits severely disturbed people who have not attempted suicide or attacked somebody else to remain in the streets weeping, unfed, without medicine. Professor Satel suggests New York follow 39 other states and adopt a standard of “grave disability” rather than “dangerousness.”

That may bring help to some people on the streets but it won’t prevent thousands of others joining them there. One essential, for any state, is enough centers to sustain and guide patients who need medicines. Another: for patients who have shown they cannot continue medical treatment voluntarily, a return to hospitalization until they can.

When all that happens, we will no longer have to pass the bodies of people with broken minds, or avert our eyes not to see their faces.

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