Friday, February 20, 2015

Standing up for "Disposable" People

Standing up for "Disposable" People

By Erik Roskes

Well, after six weeks, our Iraqi visitors have returned home. During their visit, they told us that things were becoming more difficult at home, and one of them was considering relocating to the US, if possible, even knowing that he likely would never be able to practice psychiatry here.
During their visit, we became close colleagues and friends.  It was amazing to me how easy it was to get close to them, how much more alike we all are than one would think.  As the psychiatrist and psychoanalyst Harry Stack Sullivan said over a half-century ago, “We are all more human than otherwise.”
Think about the lesson this teaches us.  We who choose to work within the criminal justice system have chosen to work with those whom society has deemed “disposable” people.  I’m not saying that some—maybe many—incarcerated people have done quite horrible things.  The recent case in Connecticut reminds us that there are, in fact, evil people in the world.
But, many people with mental illness are unfortunates who suffer with serious impairments in their decision-making capacities, their insight, at times even their volitional control.  For many of these individuals, jail is the only place that doesn’t say no.  I have already described a woman arrested for “being mentally ill in public.”
Here’s another case: 20 year old Ryan is arrested after seriously assaulting his mother.  He is a talented student athlete, home from college for winter break.  After describing his actions as “I had to do it – she was possessed,” he is referred for a psychiatric evaluation and found to be suffering with a psychotic illness rendering him severely delusional.  He denied drug use, and his urine and blood are clean.  He is admitted to a hospital, treated with medications and therapy, and within 2 weeks has become asymptomatic.  Profoundly remorseful over what he has done, he becomes severely depressed.
What should happen to Ryan, who is so similar to you, reading this blog, and to me, writing it?  Should he be charged with assault?  Should he be diverted for treatment?  Both?
In our country, we struggle mightily with issues of liberty and personal autonomy, and conversely with holding people accountable for their choices.  But accountability assumes the freedom to make choices – and Ryan’s case, can we truly conclude that he made a free choice while struggling with a new-onset psychosis?
Back to my opening: We are all more human than otherwise.  Cases like Ryan, so similar to me when I was a student – except, of course, for the psychosis and the athletic skills – make me ever grateful that I have not developed a serious mental illness.  Meeting my new friends from Iraq, where psychiatrists are held hostage for ransom, or even occasionally assassinated, make me ever grateful that I was born here in the US.   But at the end of the day, we are all pretty much the same, but for the random nature of where we were born, what genes we are born with, and what our early life experiences are.
Finally, if you are losing faith in the positive impact you can have on those you serve, read Phil Taylor’s latest column in Sports Illustrated.
Erik Roskes is a forensic psychiatrist and currently the Director of Forensic Services at the Springfield Hospital Center in Maryland. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes’ employers or consultees, including the Maryland Department of Health and Mental Hygiene. He can be found at

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