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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by juniper on June 17, 2001, at 19:58:10
I used to frequent this board more, at times when things were going pretty poorly. I'm now in grad. school and (as many who have psychological problems tend to do) studying mental health, and am back to where I received lots of information and support, though now for a different reason. I've been studying about the future of mental health, and wondering specifically about the future of asylums...obviously, our mental health policy is not working (jails are the largest "inpatient" facilities, the many with mental disorders who live on the street). Where is the best place for individuals who have chronic and debilitating mental disorders? Do asylums have a place in America?
I'm curious as to what the psychobabble community thinks....Blessings to everyone on the journey,
Juniper
Posted by kazoo on June 18, 2001, at 1:01:33
In reply to future of asylums, posted by juniper on June 17, 2001, at 19:58:10
> I used to frequent this board more, at times when things were going pretty poorly. I'm now in grad. school and (as many who have psychological problems tend to do) studying mental health, and am back to where I received lots of information and support, though now for a different reason. I've been studying about the future of mental health, and wondering specifically about the future of asylums...obviously, our mental health policy is not working (jails are the largest "inpatient" facilities, the many with mental disorders who live on the street). Where is the best place for individuals who have chronic and debilitating mental disorders? Do asylums have a place in America?
> I'm curious as to what the psychobabble community thinks....
>
> Blessings to everyone on the journey,
> Juniper^^^^^^^^^^^^^^
Juniper, my dear ...
The world's largest, open-air lunatic "asylum" in America is called "LOS ANGELES, CALIFORNIA" where the art of folding road maps is deemed a thought-provoking, transcendental and viable occupation. I can highly recommend LA for all walking, talking Looney Tunes, thank you Jack Warner.
Actually, the word "asylum" is considered politically and socially incorrect here in the States. One must not be offensive when talking about, or to, the insane, you know. This might hurt their feelings. I'm trying to think of a good euphemism ... "please stay on the line and a service representative will be with you shortly, before you die..."
In answering your question re. the future of "asylums," this is dependent on your bank account (as always). If you're rich, you go to "spas" or "retreats" or "celebrity clinics." If you're broke, you're stuck in a government run institution where you would be lucky to get out alive, not to mention cured.
"Oh, the humanity ..."
You hit the nail on the head with your statement about jails. In America, they send the mentally ill (or retarded) to jail, or execute them (although this is changing). See! Hope *is* a thing with feathers, sniff, sniff, Emily, I love you so ...
Now about that euphemism ...
kazoo
Posted by Anna Laura on June 18, 2001, at 1:02:11
In reply to future of asylums, posted by juniper on June 17, 2001, at 19:58:10
> I used to frequent this board more, at times when things were going pretty poorly. I'm now in grad. school and (as many who have psychological problems tend to do) studying mental health, and am back to where I received lots of information and support, though now for a different reason. I've been studying about the future of mental health, and wondering specifically about the future of asylums...obviously, our mental health policy is not working (jails are the largest "inpatient" facilities, the many with mental disorders who live on the street). Where is the best place for individuals who have chronic and debilitating mental disorders? Do asylums have a place in America?
> I'm curious as to what the psychobabble community thinks....
>
> Blessings to everyone on the journey,
> JuniperHi juniper,
I'm glad you're doing better. I'm trying to graduate in Psychology also. I've been interested in those studies since my first depression episode of depression took place.(looong time ago).
O.K., i don't want to talk about myself: let's go in the core of the issue instead.
This is might sound weird or crazy, but i believe that the best thing to do with those people is making them interact with others, ("normal" people) even if they apparently can't cope. I think they gotta get used step by step to a life the more normal as possible.
I don't think they should stay in the asylum 'cause it tends to grow them more chronic/ not-reacting/passive and so on.
I'm quite sure of this cause i've been mad also (ever heard about the Coutard Syndrome? ).
I noticed that the more i was between people/in the "real " world, the more i grew better, even if it was far more painful then sitting at home doing little (small jobs) or nothing at all. Ihad a pdoc forcing me to get out in the "real" world: it was scary, but i managed to do that with his help.
The world scared me, it's true; it made my anxiety worse, but i did grow better in the long run.
As far as Asylums are concerned i think it's important for those people having a shelter, a cozy, peaceful place to rest and to feel protected, but i don't think it should be a compulsory thing: no one should be forced, it should be a personal choice instead.
I'm thinking about "open" asylums, places where you can go to or leaving if you wish.
The situation here in Europe it's quite contradictory, apparently asylum being a free-choice, but substantially being some sort of prisons. Here in Italy the situation improved when the "Basaglia law" was passed back in 1980. Basaglia was an italian pdoc who set all the mad people free in the seventies: he discovered terrible situations: people being given ECT as a punishment, tied to their beds FOR YEARS or laying in cage as animals in a zoo and so on. I don't agree with some passages of his philosophical theory though: he believed that mental illness was 100% induced from social/family events. I don't believe that's always true. Even if it was socially induced when the illness developes it's actually physical so that one needs medication. My analogy is the following: if i get ulcer because Mr. X drove me nervous, i won't get cured if manage to get along with Mr. X: i would still have ulcer. Got it?
O.K. this is my humble opinion so far.Good luck for your studies
Anna Laura
Posted by ChrisK on June 18, 2001, at 5:30:23
In reply to future of asylums, posted by juniper on June 17, 2001, at 19:58:10
I work in a day program for our county ARC ( Assoc. for Retarded Citizens .. and yes retarded is till used in this day of political correctness). Our clients have varying degrees of mental illness but all are able to live in group homes. They are integrated into the community as opportunities exsist and do quite well. I work with people that can be anywhere on the spectrum. Some are highly functional, some autistic, some nonverbal, some just pace in circles all day and some just want to listen to the radio and do nothing else. We try to initiate projects with them - anything from arts and crafts to keep their hands and minds busy to community outings where they can go bowling or to the park or grocery shopping.
My point is that these are the people who were formerly in asylums and gov't run hospitals. They can function with a lot of staff assistance in homes. Unfortunately the money isn't always there to staff enough homes. I see our system of handling the mentally ill heading more and more in this direction. Some of our clients came from Willowbrook which was a hospital in NY that was featured in a Geraldo expose on the decline of care for the mentally ill. These people are scarred for life but are able to make adjustments and assimilate within their own community.
I think that large gov't run hospitals or assylums will only be used as stop gaps for people that need temporary help. We don't pretend that these people are going to ever be fully integrated into the community (and end up on the streets). They will always need to live in a supervised community. I just see that our future will be in more small homes and not in the asylum type structures that exsisted in the past.
All of that said, I still don't know what needs to be done with the mentally ill who are a threat to harm themselves and others. Too many will end up in jail when they should be getting medical care. My own experience is that most forms of psychosis can be treated medically and the people who are a threat to others can be, for lack of a better word, brought under control.
Interesting subject, thanks for bringing it up.
Posted by Ted on June 18, 2001, at 10:33:44
In reply to Re: future of asylums, posted by ChrisK on June 18, 2001, at 5:30:23
ChrisK,
Even if those who are a threat to othersreceived treatment, should they be free to live their lives "on the outside"? What if they have already committed violent crimes? Even if they are successfully treated and released, do you really believe they will continue to take their meds and stay mentally healthy, or not and fall back into the cycle of crime? I *think* I support prisons specifically for the mentally ill and provide treatment & occupational therapy, but still keep them locked up. The one problem is cost.
Ted
> All of that said, I still don't know what needs to be done with the mentally ill who are a threat to harm themselves and others. Too many will end up in jail when they should be getting medical care. My own experience is that most forms of psychosis can be treated medically and the people who are a threat to others can be, for lack of a better word, brought under control.
>
Posted by Dr. Bob on June 18, 2001, at 13:20:19
In reply to future of asylums, posted by juniper on June 17, 2001, at 19:58:10
> I used to frequent this board more...
Just wanted to say welcome back! :-)
Bob
Posted by ChrisK on June 18, 2001, at 15:51:44
In reply to Re: future of asylums, posted by Ted on June 18, 2001, at 10:33:44
Ted,
I don't believe that those who are in a position or nature to harm others should ever be "on the Outside" without constant supervision. All of the people I work with have constant supervision and in many cases certain restraints becuase of their behavior. I have numerous scars on my arms thanks to an autistic client who grabs and digs his nails into your arms. He has special mitts that he has to wear when he gets aggressive of self abusive. He also has a special jacket in his group home that comes just short of being a straight jacket. Others wear harnesses when on their busses because they can get out of their seats and cause a disruption while on the bus ride in.
These are definitely not examples of people who are criminal but people who can't function on their own. We average 3 staff per 10 clients. The houses average a little more.
As you state the big thing is money. If we can find the staffing a avst majority og the mentally ill could find some form of mainstreaming. Those with criminal backgrounds are still the ones that I don't have a gut feel as to what might be appropriate. It's a tough call but I think the days of asylum type treatment are behind us.
Chris
> ChrisK,
>
> Even if those who are a threat to othersreceived treatment, should they be free to live their lives "on the outside"? What if they have already committed violent crimes? Even if they are successfully treated and released, do you really believe they will continue to take their meds and stay mentally healthy, or not and fall back into the cycle of crime? I *think* I support prisons specifically for the mentally ill and provide treatment & occupational therapy, but still keep them locked up. The one problem is cost.
>
> Ted
>
>
Posted by Jane D on June 18, 2001, at 19:43:08
In reply to Re: future of asylums » Ted, posted by ChrisK on June 18, 2001, at 15:51:44
> Ted,
>
> I don't believe that those who are in a position or nature to harm others should ever be "on the Outside" without constant supervision. All of the people I work with have constant supervision and in many cases certain restraints becuase of their behavior. I have numerous scars on my arms thanks to an autistic client who grabs and digs his nails into your arms. He has special mitts that he has to wear when he gets aggressive of self abusive. He also has a special jacket in his group home that comes just short of being a straight jacket. Others wear harnesses when on their busses because they can get out of their seats and cause a disruption while on the bus ride in.
>
> These are definitely not examples of people who are criminal but people who can't function on their own. We average 3 staff per 10 clients. The houses average a little more.
>
> As you state the big thing is money. If we can find the staffing a avst majority og the mentally ill could find some form of mainstreaming. Those with criminal backgrounds are still the ones that I don't have a gut feel as to what might be appropriate. It's a tough call but I think the days of asylum type treatment are behind us.
>
> ChrisChris-
You've got a tough job. Congratulations and thank you. Most of your clients are much better off than they would have been under the old system. I do think there may be a few exceptions that the current system doesn't well serve. Specifically, some of the people who need constant supervision to be out in the community might actually have more freedom in an institutional setting. The whole idea has been to put people in as normal an environment as possible but wearing a straight jacket in a group home may be less normal then being unrestrained behind a locked door on an institutional ward. And I would rather walk from building to building, never leaving an institution's grounds, then by tied to my seat on the bus.
I've been using your example of the developmentally disabled but I think that sometimes the mentally ill might benefit but for different reasons. It is one thing to be pushing yourself to go out and hold a job - perhaps with supportive services. Here you are being forced into a role of competency. If you go out only in someone elses custody you are being pushed into the other role - that of a dependant. If you do need to be taken care of by someone else I think limiting it to one environment, such as hospital or institution, makes sense. Once you leave the hospital you don't have those associations of helplessness in everything you do. This doesn't address the problems of the continously ill of course. Those are probably more like the developmentally disabled.
This also ignores the difficulty of monitoring conditions in institutions. The public is more likely to take an interest in how the group home next door treats its residents. If this prevents the kind of abuses that shut the institutions down it may be worthwhile for that alone.
Jane
Posted by Diane J. on June 18, 2001, at 22:11:06
In reply to Re:future of asylums-LA is a great big freeway... » juniper, posted by kazoo on June 18, 2001, at 1:01:33
Gee, another California joke. How original. How insightful. Did you actually read Juniper's post?
> > I used to frequent this board more, at times when things were going pretty poorly. I'm now in grad. school and (as many who have psychological problems tend to do) studying mental health, and am back to where I received lots of information and support, though now for a different reason. I've been studying about the future of mental health, and wondering specifically about the future of asylums...obviously, our mental health policy is not working (jails are the largest "inpatient" facilities, the many with mental disorders who live on the street). Where is the best place for individuals who have chronic and debilitating mental disorders? Do asylums have a place in America?
> > I'm curious as to what the psychobabble community thinks....
> >
> > Blessings to everyone on the journey,
> > Juniper
>
> ^^^^^^^^^^^^^^
>
> Juniper, my dear ...
>
> The world's largest, open-air lunatic "asylum" in America is called "LOS ANGELES, CALIFORNIA" where the art of folding road maps is deemed a thought-provoking, transcendental and viable occupation. I can highly recommend LA for all walking, talking Looney Tunes, thank you Jack Warner.
>
> Actually, the word "asylum" is considered politically and socially incorrect here in the States. One must not be offensive when talking about, or to, the insane, you know. This might hurt their feelings. I'm trying to think of a good euphemism ... "please stay on the line and a service representative will be with you shortly, before you die..."
>
> In answering your question re. the future of "asylums," this is dependent on your bank account (as always). If you're rich, you go to "spas" or "retreats" or "celebrity clinics." If you're broke, you're stuck in a government run institution where you would be lucky to get out alive, not to mention cured.
>
> "Oh, the humanity ..."
>
> You hit the nail on the head with your statement about jails. In America, they send the mentally ill (or retarded) to jail, or execute them (although this is changing). See! Hope *is* a thing with feathers, sniff, sniff, Emily, I love you so ...
>
> Now about that euphemism ...
>
> kazoo
Posted by kazoo on June 19, 2001, at 0:09:04
In reply to Re:future of asylums-LA is a great big freeway..., posted by Diane J. on June 18, 2001, at 22:11:06
> Gee, another California joke. How original. How insightful. Did you actually read Juniper's post?
^^^^^^^^^^
Did you say something, honey?
Posted by Ted on June 19, 2001, at 10:39:02
In reply to Re: future of asylums » ChrisK, posted by Jane D on June 18, 2001, at 19:43:08
Chris & Jane,
I agree 100%. Chris, you do have a *very* tough job, one that I could never do. And thank you for taking it seriously.
Jane's point of keeping some patients institutionalized for their own freedom makes sense -- I couldn't have said it better.
t.
> > Ted,
> >
> > I don't believe that those who are in a position or nature to harm others should ever be "on the Outside" without constant supervision. All of the people I work with have constant supervision and in many cases certain restraints becuase of their behavior. I have numerous scars on my arms thanks to an autistic client who grabs and digs his nails into your arms. He has special mitts that he has to wear when he gets aggressive of self abusive. He also has a special jacket in his group home that comes just short of being a straight jacket. Others wear harnesses when on their busses because they can get out of their seats and cause a disruption while on the bus ride in.
> >
> > These are definitely not examples of people who are criminal but people who can't function on their own. We average 3 staff per 10 clients. The houses average a little more.
> >
> > As you state the big thing is money. If we can find the staffing a avst majority og the mentally ill could find some form of mainstreaming. Those with criminal backgrounds are still the ones that I don't have a gut feel as to what might be appropriate. It's a tough call but I think the days of asylum type treatment are behind us.
> >
> > Chris
>
> Chris-
>
> You've got a tough job. Congratulations and thank you. Most of your clients are much better off than they would have been under the old system. I do think there may be a few exceptions that the current system doesn't well serve. Specifically, some of the people who need constant supervision to be out in the community might actually have more freedom in an institutional setting. The whole idea has been to put people in as normal an environment as possible but wearing a straight jacket in a group home may be less normal then being unrestrained behind a locked door on an institutional ward. And I would rather walk from building to building, never leaving an institution's grounds, then by tied to my seat on the bus.
>
> I've been using your example of the developmentally disabled but I think that sometimes the mentally ill might benefit but for different reasons. It is one thing to be pushing yourself to go out and hold a job - perhaps with supportive services. Here you are being forced into a role of competency. If you go out only in someone elses custody you are being pushed into the other role - that of a dependant. If you do need to be taken care of by someone else I think limiting it to one environment, such as hospital or institution, makes sense. Once you leave the hospital you don't have those associations of helplessness in everything you do. This doesn't address the problems of the continously ill of course. Those are probably more like the developmentally disabled.
>
> This also ignores the difficulty of monitoring conditions in institutions. The public is more likely to take an interest in how the group home next door treats its residents. If this prevents the kind of abuses that shut the institutions down it may be worthwhile for that alone.
>
> Jane
Posted by Diane J. on June 19, 2001, at 21:18:13
In reply to Now posting from an asylum, posted by kazoo on June 19, 2001, at 0:09:04
That's MRS. honey to you, Mr. Inmate. Thank you.
> > Gee, another California joke. How original. How insightful. Did you actually read Juniper's post?
>
> ^^^^^^^^^^
>
> Did you say something, honey?
Posted by kazoo on June 20, 2001, at 1:55:07
In reply to Re: Now posting from an asylum » kazoo, posted by Diane J. on June 19, 2001, at 21:18:13
> That's MRS. honey to you, Mr. Inmate. Thank you.
^^^^^^^^
Does that mean I get a little kiss, Mrs. Honey, on the "Boulevard of Broken Dreams," no less?(a sweet) kazoo
Posted by Diane J. on June 20, 2001, at 23:26:45
In reply to Re: Now posting from Cielo Drive » Diane J., posted by kazoo on June 20, 2001, at 1:55:07
Hmmm...well, it would mean a commute. I live in Orange County, not L. A. County. Would it be worth it? You know, what with the price of gas and all...Diane J.
> > That's MRS. honey to you, Mr. Inmate. Thank you.
>
> ^^^^^^^^
> Does that mean I get a little kiss, Mrs. Honey, on the "Boulevard of Broken Dreams," no less?
>
> (a sweet) kazoo
Posted by juniper on June 22, 2001, at 16:43:23
In reply to future of asylums, posted by juniper on June 17, 2001, at 19:58:10
Thank-you to everyone who thought about this whole asylum question. The word itself is tricky because it has connotations and history attatched to it. If "asylums" were to be reinstated, they certainly could not be like ones of old. My idealistic view would be more along the lines of a co-op, where those who lived could work as they were able: farming, carpentry, cooking, cleaning...It does not make sense to me to have institutions (nursing homes included) where individuals reside for the long term, with no purpose but to pass time. I think it is important for all people to be as much part of a community as possible. Unfortunately, it does all seem to filter down to funding, and in the U.S. at least, mental illness is still so stigmatized, and priorities so backwards...
> > > >Thank-you Anna Laura for your take on things, it's always interesting to learn how things are in other countries, and too easy to get caught in our own narrow perspective. I'm glad that you are now studying the field and helping others to understand how mental illness affects a life.happy days to all,
Juniper
Posted by medlib on June 22, 2001, at 20:40:38
In reply to Re:thanks to all the asylum folk , posted by juniper on June 22, 2001, at 16:43:23
My idealistic view would be more along the lines of a co-op, where those who lived could work as they were able: farming, carpentry, cooking, cleaning... > Juniper
Juniper--
One example of your ideal therapeutic community exists somewhere in New England--wish I could remember the name. I saw a profile of it on PBS some time ago. Professional staff members and their families live and work alongside mentally ill patients on a large farm/commune. There's a communal dining hall, but separate living quarters of various sizes and shapes. The enterprise is at least partially self-supporting; since I missed part of the program, I don't know funding details. The camraderie seemed genuine and the environment appealing.
Good luck on your coursework---medlib
Posted by Jane D on June 22, 2001, at 23:29:58
In reply to Re:Therapeutic environments » juniper, posted by medlib on June 22, 2001, at 20:40:38
> My idealistic view would be more along the lines of a co-op, where those who lived could work as they were able: farming, carpentry, cooking, cleaning... > Juniper
>
> Juniper--
>
> One example of your ideal therapeutic community exists somewhere in New England--wish I could remember the name. I saw a profile of it on PBS some time ago. Professional staff members and their families live and work alongside mentally ill patients on a large farm/commune. There's a communal dining hall, but separate living quarters of various sizes and shapes. The enterprise is at least partially self-supporting; since I missed part of the program, I don't know funding details. The camraderie seemed genuine and the environment appealing.
>
> Good luck on your coursework---medlibMedlib -
I think you may be thinking of Camphill Village in Copake, NY. It was based on an English program also called Camphill and if you look at their web site they mention a number of affiliated programs.
http://www.camphillvillage.orgThere are also some other programs that were inspired by the Camphill model. These programs were designed for the developmentally disabled rather than the mentally ill. I know of a couple for autistic people also.
Ironically these programs are threatened by advocates for the handicapped who insist that everyone must integrate with the larger community. They point to the scandals of the old institutions as justification. I think they overlook the fact that some people cannot integrate with the greater community even if you put them into a house next door. It may be too confusing for them or perhaps the neighbors just don't want to integrate with them. These smaller "sub communities" like Camphill may end up providing a far more normal life for some people.
Jane
This is the end of the thread.
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