I don't have an answer for you. I think you've come up with a potential plot for a very interesting Star Trek episode though.
(Star Trek: My guess is that such an episode, if it had any serious depth, would be vetoed in the script stage - due to being an extremely painful subject for too many viewers.)
In Scifi: Real bad people exist. Real people who need help exist. Real people who just need some time to talk out their problems with the ship's / a local counselor exist.
Real people who can't be helped don't exist, they reductively condense into one of the three classes above because society and tech are advanced enough. (Except in cases of extreme breakdowns; E.G. Voyager wasn't the only ship mostly sucked to the delta quadrant.)
The poorly written second season of Star Trek Picard had a character who was suicidal and refused treatment, then killed herself.
I think people refuse treatment in real life because the drugs don't work too well, not because they don't want to feel better, and at any rate you can't have a utopias if people choose to due horrible things to themselves or each other, you just have real life, so I think it went against the tradition of Star Trek being utopian fiction.
Star Trek alone had countless plot lines surrounding incurable medical conditions. Worf broke his spine, Picard has some kind of syndrome which will cause cognitive decline, La Forge had to settle for a visor for most of the franchise, and so forth.
Even under utopean circumstances, ethical considerations abound, as in "The Schizoid Man," an exploration of both rights for artificial life and transhumanism. Sisko's father ignored medical advice because he chose to, and in VOY's "Scientific Method" we find aliens desperate to develop lifesaving technology, even at the cost of agency for Federation staff.
These mental illnesses break the ability of an individual to choose to do what’s best in terms of medication, treatment, and lifestyle. The illness makes one not want to be properly medicated.
Someone can be consistent with their treatment and lifestyle for many months, but it just takes one trigger and a couple days off medications to lose all progress.
While I agree with the rest of your comment, I want to gently challenge this specific statement, as someone who has to take a powerful med (lithium) to avoid relapsing into mania with psychosis.
I was so extremely reluctant to regularly take meds, and lapsed in and out of mania for a few years. The main thing that got me to stick with lithium, and a major driver in me staying on them today, is grokking how deeply destructive mania is to all the relationships and other good things in my life.
I'm not saying we should shame mentally ill people, but part of treatment should be helping them understand & agree that permanent treatment is in their own best interest. Easier said than done, of course... it took years for me.
The medications do that too. The side-effects are horrific.
1. Justify what they did.
2. Dismiss it.
3. Ignore it.
4. Deny it happened.
Note that change their behavior isn't on that list. :(
I'm bipolar I, and I take lithium for it. Being confronted with my actions over and over and over and over again was a big part of what got me to start taking meds.
And yup, there's some newer research about the long term benefits such as lowering alzheimer's risk, which is a nice silver lining :) My doctors have mentioned it, so probably not pseudoscience.
You mean the opposite of that?
I worry that one day he'll end up being shot by police or something. It's awful.
I'm on antipsychotics. They are nasty drugs. Absolutely brutal. The worst of the side-effects for me are the sexual side-effects and motor-control issues. If I get dehydrated or my blood sugar gets low, I can lose the ability to walk.
Within the first hour of taking my meds, I can't stand without losing my balance. I lose both my inner ear and kinesthetic senses. I don't know where my feet or hands are. I can only walk by having my eyes open to see if I'm level and feeling where the pressure is on my feet.
During the day, I have medication that helps this but I still trip on uneven surfaces or drop things.
The sexual side effects, I can't orgasm. Combined with the hypersexuality a manic episode creates, it is unbearable. Fortunately, I'm on yet another drug that makes this less of an issue.
The only reason I can tolerate this is the alternative of going crazy is so terrifying, I'll do anything to prevent that from happening. If anyone wonders why people don't stay on their meds... this is a big reason.
Growing up he would tell me how terrible the medications were. I believed him, and still do to an extent. However he also identified with his illness and thought the drugs were taking away his special powers. That was a symptom. For those reading who have less experience, they sometimes call that anosognosia or lack of awareness.
In the end it's a very existential thing. It's easy to wonder about identity. I had a few people in my life with this sort of illness. I developed a model where medicated, treated, and stable, that is the "normal" them, their identity. However, these people got offended by this, and engaged in behavior I would describe as identifying with symptoms. Acknowledging symptoms, no matter how evident, was tantamount to personal attacks.
I think we all have issues with this in our lives. Self awareness and identity is a difficult problem. It's only when it falls far outside of norms, into extremes, that we call it a disorder. It can be very tricky to draw those lines.
What I had to realize is that even if "me without meds" was an existentially truer version of myself, people did not like me without meds, they did not want to be my friend, nor did they want to give me a job. That's what got me on meds, and yes, it felt really shitty at the time.
Years later, I don't feel that way any more. "Me with meds" feels like me, more than ever actually. And, lots of those things I valued about "me without meds" (wit, spontaneity, high energy, creativity) came back over time as I adjusted to being medicated.
Unfortunately, not everyone is able to find a med that allows them to get to that happy point. It took good healthcare, several tries, a support network, and (I assume) luck.
In another time, I would have been a shaman. My entire life, I had a deep spiritual connection with wolves. That's gone. All that's left of it is blank wall and confusion.
This hurt deeply. I can't even begin to describe how it felt to have everything I knew about myself destroyed.
I'm fortunate to have been raised Christian. That hasn't changed and it's been a welcome grounding while I work things out.
I feel like I'm fundamentally a different person. Like I was dropped into someone else's body. Someone else was here before me and left a bunch of furniture I keep bumping into. :)
But, I know I'm a kinder person than the person before me. Is this spiritual enlightenment? If it is, I might want a refund. :D
I’m not psychotic so it’s of course easier to be reasonable about the situation, but it’s never fun to be on drugs like these.
I chose to live without mania. I want to slow down and work on things I want to do, not be driven to do things, no matter how amazing they turned out.
> For those reading who have less experience, they sometimes call that anosognosia or lack of awareness.
I'm fascinated to learn of this and to read more, thank you.
These mental illnesses are adaptions/optimizations to the rise and fall of violence that was normal human history for the longest time.
A armed paranoid hobo maybe looking like a maladjusted human being to you now, but in stalingrad, sebreniza or bhakmut, he would be very adapted to his surroundings. All those stress triggered changes had their spoke on the wheel of time.
My opinion is that people should be force treated, but only until they reach "sentience" and can decide for themselves, not under any influence.
They also should be able to make sentient "wills", specifying condition under which the state is allowed to step in and help them.
If somebody wants to return to his mental state, nobody should be allowed to stop them. Human lifes value is not there to be useful, aesthetic pleasing or comfortable for society. Its value is only defined by the person living it..
But then again, i view optimists as mentally sick..
I don't think this works well when clear-cut, unambiguous delusions cause somebody to act on them and harm themselves and others.
I do acknowledge it's very hard to know when that is, and people can disagree.
At least he won’t be stabbing someone in an alley in 10 years - probably.
You know, I believe that Kanye may have significant mental illness, but...
An argument primarily from an economic angle makes me uncomfortable. On paper, I am not maximizing economic value right now-- but I'm pretty sure I'm well adjusted and happy with my (seemingly economically irrational) choices.
I think what you describe is completely orthogonal to what we were discussing-- whether seemingly acting in one's economic interest can be a measure on one's mental well being and used to judge whether someone is using their autonomy appropriately.
If we use outside economic tests, we become pretty fascist and authoritarian really-quick-like.
Eg. A lot of people can have symptoms of a psychotic disorder but they are still "productive" and functioning.
On the other hand a lot of people with bipolar disorder go through "manic spending sprees" which leaves them in huge debt. Or, people start to be unable to hold a job or keep up with studies. They might quit their job impulsively persuing a delusion, or make unwise investments while manic. This can be a proxy for how they are doing with the illness.
Someone with this type of issue who is very wealthy kind of makes that kind of argument fall apart. Kanye can blow a lot of money and still survive. A more normal person with bipolar disorder would hit rock bottom from a financial standpoint much sooner.
Yes, and Kanye may have various financial and business problems, but by any sane metric is able to support himself.
> Kanye can blow a lot of money and still survive.
Yes, which makes the behavior less obviously irrational.
This is why diagnostic criteria have phrases like "cause marked impairment in social or occupational functioning" --- and meeting diagnostic criteria alone is not generally sufficient for involuntary commitment. There, we reach the legal system, and definitions that generally include a pretty strict definition of danger-to-self-or-others-or-gravely-disabled, which wouldn't include this kind of thing.
I agree, though it’s not clear if you’re talking 5150 or conservatorship.
IMO, a pretty clear argument could be made (if someone had standing and wanted to do so) for conservatorship, at least of the estate, and possibly for him individually, in Kanye’s case.
I don’t see anything even hinting at a justification for 5150 WIC, even without considering the de-facto loosening of when it’s applied, which is I’m guessing what you’re referring to.
Hell, even if you’re lunging at someone with knife while talking about killing your self, it seems like most jurisdictions won’t do it. (Especially SF). If particularly public safety minded at the moment, they might take away your knife if they don’t shoot you first.
Budget reasons.
As to where it would go, god knows.
Plenty of poor people say messed up things, alienate people around them, and screw up their employment. They generally don't end up with involuntary mental treatment. Even if the root cause is because of mania or something.
> I don’t see anything even hinting at a justification for 5150 WIC, even without considering the de-facto loosening of when it’s applied, which is I’m guessing what you’re referring to.
Well, the whole context we're talking about things in is in the context of involuntary treatment.
Budget has a big part to play in this.
I disagree with this assertion, too, BTW, but it's so far from what I set out to discuss that I'm not too interested in responding further.
It’s quite common for folks in entertainment and sports for people to accrue large ‘fixed’ expenses (property, debt, child support, etc), on a variable future income.
He’s earned a lot of money, but he’s also spent a lot of money, and he nuked his major source of income and wealth not that long ago.
The divorce clearly is setting up even more cashflow issues. That kind of thing has ruined many normal/objectively mentally stable men.
Unless he’s been carefully squirreling away something, or setting up trusts carefully to protect his ass - not something that seems characteristic for him - it’s possible he’s defacto negative cashflow and bankrupt right now, and just doesn’t know it. Or maybe he does, and that’s feeding the mania.
Not disagreeing with you. Noting that such a system does exist, is currently active, alive, and ‘doing well’, and applicable when someone’s decisions impact the economic well-being of others in a certain situation.
And similar for being sane enough to be so intent upon staying that way.
I've known three people one directly and two indirectly that were lunatic level if they were off meds and all refused meds consistantly.
1. Was a guy I worked in the same dept during an early job. His thing was to start telling people that government agents were in the elevator to control your mind or something and ending out emails about it and corning people to warn them. Funny thing was it was a government job so there were government agents in the elevator pretty much anytime someone was in the elevator. He resisted because he didn't like the meds.
2. My friends brother in his 30's would not take his meds and his parents had to sneak them in his food. If he missed enough doses he would eventually go raving mad into the woods and eventually be found passed out somewhere by emergency responders usually naked and injured. He resisted because he didn't like the meds.
3. My brother in laws brother was paralyzed and brain damaged from a car wreck. Yet when off meds he would run off in his wheelchair into dangerous traffic or be found passed out(and injured) from exhaustion of crawling because he went somewhere a wheelchair couldn't go and just crawled for miles. Again he didn't like the drugs.
I doubt in each of these cases people are making the rational choice to ditch the meds in favor of a state of "pure madness". Instead they probably get fed up with side effects, and decide that "this time won't be as bad", or "I'll just stop taking them for a day".
I had to learn to be a different person. (Discussed in another comment.)
This is an extreme example, but imagine smashing into an artist’s home, breaking their tools, and telling them they’ll be working in a warehouse for the rest of their life.
Maybe they’ll be happier working in a warehouse, but they don’t know that. Change is hard.
It’s not as simple as they didn’t like the drugs.
I’m fortunate to have kept my creativity. If I had lost that, I’d prefer being crazy, even knowing it would end badly.
Lots of people voluntarily take substances that make them think much less clearly but also make them feel good: it's just a matter of scale
50 mg of Zoloft later I am 100% panic attack free. But even 50mg of Zoloft (which is essentially the lowest dose of a very safe drug, and I am a large male) has side effects I dislike, and accidentally missing a dose makes me feel absolutely awful.
I can hardly imagine what serious drugs do to you and the implications of them.
Sometimes there simply is no solution to a problem, a very hard concept to grapple with as participants in a community, society, or civilization.
However … eventually she’s going to make contact with the criminal justice system. This can very productive. Authorities can make plea deals/pre-prosecution agreements that require medical compliance.
I’d advise the family to move to a jurisdiction with lots of resources. A wealthy suburb should work.
Then wait for her to commit a crime and make report it.
I too have a relative who has psychotic episodes. I’ve had wonderful experiences with the criminal justice system (in rich suburbs).
Depends on the law enforcement. My aunt would ocassionally get arrested, but they'd never charge her with anything, just bring her to the hospital for an involuntary psych hold, and she'd find her way back home after that. I don't think they ever found meds that worked for her and that she'd take consistently for more than a couple weeks. (This was in San Pedro, CA, which doesn't fit your suggestion of a wealthy suburb)
Seems like the side effects of a lot of these harsh meds might be tempered by a slow release vs all at once with a pill. I am not a medical professional though so I could be completely wrong here.
Sure. The problem is that most (probably all) of these drugs give severe withdrawal symptoms when abruptly discontinued by a patient. You'd have to spend a lot of time to slowly wean her off all(!) drugs to know if they're helping or harming. Nobody does that.
When on her medications, she is a relatively pleasant & rational person, usually able to hold an entry-level job.
Her family do not want to throw her in jail for all the threats (I'm not asserting that they could, if they wanted to), she really does not like the side effects of her medications, and (under the current system) neither confining her to a long-term mental health facility, nor reliably forcing her to take her medications seem to be available options. (Her family has talked to lawyers about their options more than once.)
What would be the "humane" thing to do? In composing your answer, please recall that her family are also humans, and - barring a premature death - she is likely to outlive most of them.