Shrinking Responsibility: Providing mental health treatment in a profit driven system
by Dallas M. Ducar • What does it mean to be mentally ill?
We generally define mental illness as a condition which affects one’s psyche so intensely that it impairs function. Specifically, many claim that a mental state becomes disorderly when it becomes maladaptive to one’s environment.
The late Oliver Sacks wrote about an island wherein the majority of the people are color-blind. On this island, the activities and norms reflect the needs of the majority. In this case, the people of this island are most active during the du and dawn as both those times provide the best vision. In this case, non-color-blindness has become maladaptive as the social practices revolve around color-blindness.
In this case, illness has become normative, that is to say, the definition of an illness is determined by the interpretation of a change from the norm. In the case of mental illness, the normative factor is usually more difficult to identify.
Some may argue that social perceptions are directly influencing the perception of the illness, however the illness still exists. For example, one schizophrenic may be considered a shaman; however he still exhibits the signs and symptoms of schizophrenia and has simply not been detected within his culture. This argument becomes less obvious when we look to cases of Joan of Arc who claimed she heard voices of God, or Claire of Assisi who spent the last 27 years of her life in bed, too weak to move, and venerated as a saint.
The point is not to say that mental illness is not real, but rather to highlight the very real fact that it is a normative endeavor. The implications of the normative basis of the definitions of mental illness are resounding when one analyzes the connection between the practitioners and both political and corporate agencies.
Texas is just one example of many states where a corporation is contracted by the government to jail juvenile offenders, including those whom are deemed mentally unwell. Moreover, if the level of care needed increases, more compensation is also required per prisoner. The sentencing system in Texas works by assigning an indeterminate term to offenders with release only possible when a vague set of treatment programs have been fulfilled. Assessing whether a prisoner is ready for release is usually up to a mental health clinician, or team.
The legal precedent to allow mental health clinicians to testify in the courtroom about the presence of mental illness is due to the 1962 U.S. Court of Appeals decision Jenkins v. U.S. Since then, the use of mental health clinicians within the judicial system has skyrocketed. A study in Virginia discovered that mental health experts will side with the prosecution 80 percent of the time.[i]
Not only do these mental health clinicians have the capability to diagnose and justify detention of offenders, but also retain the offenders within privately contracted prisons. This level of responsibility becomes more dubious when it is in the best interest of the corporation to keep profitable offenders for as long as possible.
When the DSM-5 was released discussions ensued about the power it held as a definitive mental health manual, especially in the court room. Hypersexuality, binge eating, paraphalic coercive disorder, and other dubious disorders were almost available for use in trial at this time, allowing for a greater range of civil commitment. Ultimately, this becomes quite dangerous when the institutions’ interests encourage detainment.
When we rely on the government to certify practitioners and definitions, diagnoses, and prescriptions become beholden to political and corporate agencies, there is an inexorable drift towards treatment as punishment.
Currently, 7 million Americans are under law-enforcement supervision and the demand for mental health services has never been greater. However, the goals of mental healthcare have been abandoned in favor of lucrative contracts and corporate models. This compromise fails to reduce recidivism, fails to alleviate incarceration rates, and fails to promote public safety.
If we fail to acknowledge that the definitions for what constitutes as a mental illness are normative, we fail to accept the tenuousness of our own conclusions as a society and truly fail those who suffer.
[i] Murrie, D. C., Boccaccini, M. T., Guarnera, L. A., & Rufino, K. A. (2013). Are forensic experts biased by the side that retained them?. Psychological science, 0956797613481812.