“If everybody had good mental health, then all the other problems could be solved.

Because in order to take care of mechanical and practical problems, you have to have good mental health in order to attack those problems…if people were just in a position to have their minds functioning right, then everything else would fall into line.” –Frank Zappa

Where does the sovereign right of the individual to refuse mental health treatment fall below the need for public safety? Does it ever? And if so, what do we do about it?

Kelly Thomas would have been 50 years old this week. I would recapitulate the horrible circumstances of his death, except that I did that at this time last year, and all the gory details are easily available with a couple of clicks to anyone with computer access. Wikipedia has the most accurate account, and it is chilling in its completeness. I don’t recommend watching the video unless you have a cast-iron stomach.

https://en.wikipedia.org/wiki/ Killing_of_Kelly_Thomas

This time out, in light of what happened to Mr. Thomas on July 5, 2011, as well as the incident on March 6, 2024, involving the fatality of a homeless, mentally disordered man at the hands of the Fullerton PD (I’m willing to bet that the “less lethal kinetic energy projectile” was a rubber bullet), it’s past time to re-examine where we are with the twinned issues of mental dis- orders and homelessness.

Last month, Prop 1 squeaked through, which will negatively impact mental health resources at the county and state level, as well as lead to involuntary hospitalizations of the mentally disordered. And I still haven’t forgotten or forgiven Douglas Cox for his abrasive comments printed in the early February issue. For those whose memory needs refreshing or who have no idea who I’m talking about, this is the most salient passage from Mr. Cox’s statement:

“(Governor) Gavin Newsom just signed bill SB43 in October (2023) that expanded forced medical treatment. Start by arresting severely ill homeless people to get them into the system where they can get mental services.”

If you think Cox represents the minority here, you must look at the voting results for Prop 1. Anyone alive during the Vietnam War is familiar with the edicts “bomb them back to the Stone Age” and “destroy the village to save it.” That’s exactly the sort of blinkered thinking that is on display here, that gave us My Lai and the carpet bombing of Laos and Cambodia. It’s using the tired, contraindicated military-industrial law enforcement model to deal with mental health issues. It’s been a disaster in the War on People with Drugs; why would it work here? Answer: It wouldn’t, but remember the informal definition of insanity–doing the same thing repeatedly while expecting different results.

But even the most ardent civil libertarians need to recognize that while the mentally disordered must retain their Constitutional rights, including the right to refuse and resist forced treatment, there is the counter issue of how people with untreated and grave mental health disorders are supposed to function in a society that doesn’t really understand what bipolar disorder is, or schizophrenia, or multiple- personality disorder, and simply isn’t geared to handle untreated and unmedicated persons diagnosed with these disorders.

It would be wonderful if all people diagnosed with mental disorders could acknowledge them and voluntarily receive treatment. Unfortunately, it is in the very nature of these disorders that the mind lies to itself: it often refuses to acknowledge any dysfunction, displacing it onto others. Even when treatment is accepted, assuming that it can be found and at a low cost, there are continuous issues such as side effects from medication and the unfortunate tendency of patients to decide that, once a medication begins to work, it no longer needs to be taken.

I understand this last problem all too well. I’ve gone off psychiatric meds “cold turkey” when I thought they had done their job and, therefore, weren’t needed anymore. This usually occurs within two weeks of a new psych med regimen once the levels of serotonin in the blood and brain reach optimum levels. The person starts to feel more like themselves–the self that was before the mental aberration took hold–and it feels like you’ve been cured. And if you’re cured, the illogic runs, then why do you need to keep taking the medication? That’s when you need to learn about withdrawal, downregulation, and other physical phenomena that occur in the mind and body when a medication is abruptly withdrawn.

None of this makes for easy solutions, neither the “lock ‘em up to get ‘em treatment” nor “medicate up the wazoo” approaches. So what is the solution? I would argue there never is one solution, no magic bullet. But the one area that does show distinct promise is psychedelic-assisted therapy, that orphan child of 1960s-era psychiatric research that has experienced a welcome resurgence in the last two decades. That’s where we’ll pick up next time.