Thin Lines Easily Crossed: On Individual Autonomy, Mental Illness, Engagement, and Danger
By Ken K. Gourdin
Author’s Note: Unfortunately, Salt Lake Police shot and killed a man who claimed to have an explosive device when he failed to obey officers’ commands September 26, 2012. This was cross-posted at SLTrib.com today, September 27, 2012 in response to another poster who said, “I think we need to work as a society to help the mentally ill before things like this happen.” The article, “Man killed by Salt Lake cops had explosives in backpack, long criminal history,” by Bob Mims, and the discussion which follows are available on line at http://www.m.sltrib.com/sltrib/mobile2/54985828-218/mayhew-criminal-officers-lake.html.csp#disqus_thread, last visited today.
I don’t deny that we should help as many of the mentally ill as we can, but there are at least two hurdles which are more difficult to overcome in real life than in the utopia you apparently envision where all of the mentally ill get all of the help they need: (1) they have to realize they need help; and (2) they have to want it. I applaud the steps forward we have taken to humanize our treatment of those with psychiatric diagnoses (and, for that matter, the steps we have taken to humanize our treatment of those with other disabilities). And I speak as someone who has both a physical disability and a psychiatric diagnosis.
Still, a couple of generations ago, society and law essentially decided that absent any imminent threat to self or others, mental illness simply is another way of perceiving and reacting to the world, no less valid than the myriad other ways of perceiving and reacting to the world in which mental illness isn’t implicated. So what if someone’s quality of life seemingly is affected by an apparent inability (or unwillingness) to engage the larger society in conventional ways? Even if someone has a mental illness, we decided, it’s not up to anyone else to be the arbiter of how that person “should” engage the world.
It doesn’t matter if everyone in the world without a psychiatric diagnosis believes that an ill person’s ways of engaging with the larger world are illegitimate … unless that person poses an imminent threat of danger to self or others, treatment cannot be forced upon him or her. That’s why “treatment” for so many people with such diagnoses involves interaction with emergency personnel while in the throes of the diagnosis, followed by a trip to the Emergency Room, followed by short-term stabilization of symptoms, followed by release … lather, rinse, and repeat. (Not to mention that once someone with a psychiatric diagnosis discovers how thin the line between apparent mental illness and apparent mental wellness can be, s/he often becomes adept at giving the appearance of having recrossed it, back into (apparent) normalcy).
Furthermore (while I am a layperson and you should weight my opinion accordingly) the zones marked “danger to self and/or to others” and “not a danger to self and/or others,” respectively, are separated by a line which is only a few nanometers in thickness. While it’s easy to tell that someone who is holding something s/he claims is an explosive device and threatening to detonate it has crossed that line, often, any movements toward that line also are measured in nanometers: often, each individual movement toward it is nearly imperceptible. It’s only when one considers the totality of all of those movements in retrospect that the danger becomes clear.
You and I might not think that someone with an active mental illness is capable of engaging the larger world in meaningful ways, but, for better or for worse, society has decided that it’s not up to us … or to anyone else who isn’t the person with a mental illness … to decide what constitutes meaningful engagement with the world: it’s up to that person. From where you and I sit, it might not seem that they have much of a life (e.g., living on the street, “dumpster-diving,” et cetera). We might not think that the person’s individual autonomony is the value most worth protecting. But again, for better or for worse, that decision is not ours to make. Society and law have made that decision for us, and they have left it to the individual, even when the individual has an active mental illness.