By Dr David Laing Dawson
Years ago driving along a busy residential street in Hamilton with my then teenage son in the passenger seat we passed a disheveled bearded man standing alone on a street corner gesticulating and shouting at the clouds above.
“Shit!” I said.
“What’s the matter?” my son asked.
“That man on the street corner. He was my patient years ago. When he wasn’t much older than you are now. He’s off his meds. They’ve let him go off his medications.”
“Dad,” said my son. “It isn’t your fault.”
I have always remembered that moment as one of those rare and heartwarming times when a parent discovers that his otherwise indolent and careless teenage son is actually an intuitive, sensitive, caring human being.
But it was my fault. Or at least our fault. We have allowed our asylums, our mental hospitals, our psychiatric hospitals to be reduced or closed and the responsibility for our most vulnerable citizens to shift from the Province (in the US from the State) to the cities, municipalities, and charities.
It seemed like a good idea at the time. Under State and Provincial responsibility the physical structure and accommodation in those hospitals was stuck circa 1940 – large day rooms, dormitory wards, shared washrooms and showers, acute wards and chronic wards. Meanwhile our general hospitals had marched ahead to private rooms with ensuite, or at least seldom more than 4 beds to a room, with all possible medical specialties and equipment available. And transferring psychiatric care to our General Medical Hospitals would reduce stigma, or so we thought. Besides, we now had, but only since 1960, effective treatments.
With shorter treatment times and medications to prevent relapse, we wouldn’t need those spacious grounds and workshops and gyms and six month hospitalizations.
But as is often the case we were forgetting our history. There was a time the seriously mentally ill were simply punished and expelled from their communities, to wander as aliens until they died or found asylum within a religious order. (a current day parallel may be the closing of homeless encampments). But as our western countries developed, became wealthier, and a broader communal sense of responsibility for others evolved, the state (the crown) assumed responsibility for the most vulnerable of its citizens. Villages, cities, municipalities did not have the resources, financial or attitudinal, to take on this responsibility. The provincial and state asylums were born, and then grew as our populations grew and urbanized.
Who would have guessed that as our understanding of the neurological basis of serious mental illnesses grew, along with effective treatment, that an anti-psychiatry movement would develop, along with a spate of euphemisms? But then it is a law of nature, I think, that every force generates a counter force, and we humans have always been adept at developing language that can obscure or hide an undesirable reality.
Where does that leave us? I think these lessons of history tell us that the state and province must resume some responsibility for the most vulnerable of its citizens. I doubt this can or should take the form of rebuilding the asylum or psychiatric hospital. But I think it does mean taking direct responsibility and not simply handing money to various self promoting charities. It should also mean avoiding all the euphemisms, in fact ignoring all agencies or factions asking for money for “mental health” or “mental health issues” and rather looking seriously at the resources and processes needed to ensure adequate acute and long term treatment for those of our citizens suffering from serious mental illness. Oh, and please drop the word “prevention” until and unless we actually know how to prevent these illnesses from occurring.