This is a powerful and moving piece by Shaheen E. Lakhan,M.D., Ph.D. It’s a personal plea for a more effective approach to treating serious mental illness, drawing on his dual experience as a medical professional and a family member.
Hear’s a breakdown of teh key themes and arguments presented:
the Core Problem:
Deinstitutionalization’s Failure: The author argues that the Reagan-era deinstitutionalization of psychiatric hospitals was flawed. While the intention was to provide community care, the necessary infrastructure and resources were never built. This has led to a crisis of untreated psychosis on the streets.
Ineffective Current Solutions: He criticizes existing civil solutions like California’s CARE Court as being “legal choreography without teeth.” They lack enforceable treatment, dedicated resources, and the ability to intervene effectively, creating an “illusion of reform without actual care.”
The “Unwilling” vs. the “Vulnerable”: A central argument is that current systems often only treat those who are willing to seek help. However, serious mental illnesses, particularly psychosis, can impair insight and the ability to recognize one’s own need for treatment. This leaves the “vulnerable” untreated.
The Proposed Solution and its Rationale:
A Shift in Approach: The author sees potential in Trump’s executive order as a signal to reverse course. However, he emphasizes that this must be about healing, not just removing people from public view.
Commitment to Care, Not just Laws: He calls for “commitment to care” over “commitment laws.” This means:
Real Facilities and Trained Staff: Investing in actual treatment facilities with qualified professionals, not just more jail beds.
Long-Term Housing and Structured Treatment: Providing long-term psychiatric housing with evidence-based treatment, rather then short-term crisis beds that lead to recidivism.
Early Intervention and Family Empowerment: Enabling families and clinicians to intervene early, before tragedies occur, while protecting individual rights and focusing on recovery. Addressing Coercion: The author directly confronts the criticism of coercion by arguing that untreated brain disease is inherently coercive. He uses his brother’s experience to illustrate how illness traps individuals, stripping them of their freedom and ability to make choices.
Parallels to Other Brain Diseases: He draws parallels to how society treats other brain diseases like stroke and Alzheimer’s, where intervention is accepted even without explicit consent due to impaired autonomy. He argues psychiatry should have the same clarity and urgency.The personal Connection and Hope:
Brother’s Story: The piece is deeply personal, using the author’s brother’s struggle with psychosis as a powerful illustration of the problem and the potential for recovery with treatment.The anecdote of his brother briefly regaining insight is particularly poignant.
Optimism for the Future: Despite the criticisms of past failures, the author expresses optimism that the Trump administration will provide the necessary resources and policy changes. He believes this is an opportunity to address a humanitarian crisis.
* Moral Responsibility: he frames the issue as a matter of moral responsibility, urging action based on reason, compassion, and a commitment to not abandoning those who cannot advocate for themselves.
In essence, Dr. Lakhan is advocating for a paradigm shift in how society addresses severe mental illness. He believes that a compassionate and effective system requires not only legal frameworks but also substantial investment in infrastructure, treatment, and early intervention, even for those who lack the insight to seek help themselves.
