DON'T THROW OUT THE BABY WITH THE BATHWATER

Victor Bloom, M.D.

Grosse Pointe Park

Psychiatrist and Psychoanalyst

Three decades ago Michigan had a modern and progressive state hospital system for the custodial care of chronically ill mental patients. Mostly they were schizophrenics, manic-depressives and senile dementias (Altzheimers). Research was ongoing to find the cause and cure of these dread illnesses. Federal and state money was amply available, attracting the top minds in research and teaching. As a result, patients were well cared for.

For some strange reason, the small pockets called 'snake-pits' were dramatized in the media, while the vast majority of good care went unnoticed and unappreciated. Well-intentioned liberal, civil-rights attorneys brought suits to restrict commitment, research and therapy. The new drugs controlled the more extreme behaviors and awful feelings suffered by the mentally ill. Locked doors became open doors and revolving doors. Politicians had a heyday cutting funds and dreaming that the family and community could absorb these people, with the rare exception of a legislator who had a mentally ill person in the family.

Funds were cut so low and expectations were so high, that the CMH's (Community Mental Health Centers) were staffed with relatively low-payed and inexperienced people. If a 'therapist' came from the 'inner-city', he or she was assumed to be 'experienced', and so ex-alcoholics treated alcoholics and ex-junkies treated substance abusers. The recidivism rate was high in therapists and patients alike, while some good was accomplished. But it was a pie-in-the-sky 'utopia' that fizzled, and as a consequence, our mentally ill relatives (they all come from a family) are on the streets and in the jails.

At least fifty per cent of prison inmates and the homeless are mentally ill. The practice of psychiatry in the public sector has shifted from the state hospital to the state prison and the streets. In a nation as affluent as ours, where there is money for roads and rockets, our situation is a well-known, worldwide disgrace. Chinese diplomats can barely hide their snickers as we deign to criticize them for violation of human rights.

At a time when costs are being cut and priorities re-aligned, we must consider the plight of the mentally ill. It was cheaper and more humane for the chronically ill to be cared for in state hospitals, rather than the streets and the jails. We are beyond warehousing and snake-pits. We can provide for humane custodial care and selective psychotherapy where indicated in a revamped, restored state hospital system. The newer medicines are more effective than ever, and research into the workings of the brain is promising. Even more promising are psychoanalytic insights into the variety and complexity of the human condition. Each human being deserves compassionate care and understanding, and this could be accomplished without waste or excess, learning from mistakes of the past.

In the past, when we focussed on the few snake-pits, rather than the many caring facilities, we in effect threw out the baby with the bathwater. The babies are now grown and languishing on the streets and in the jails, and it is time to take care of them again. It will cost money, of course, but it will at least be well spent.