Thursday, January 20, 2011

Madness vs Evil

I think this article makes some really good points we should all keep in mind:
My morale, however, is not lifted by this conflation of the terms "mad" and "evil." On the contrary, I find it depressing that so many smart people choose to see mental illness as a moral failing.

"What ever happened to evil?" wonders Politico's Roger Simon, as though that word had not been applied to Loughner by everyone from Perez Hilton to John Podhoretz. "[I]n our modern times,'' Simon asks, "are we embarrassed by the term 'evil'? To some, it seems too primitive or too religious or both. And we would much rather believe that all sick people can be cured by medical intervention.''

To which this deeply Catholic primitive replies: Who doesn't believe in evil? Sometimes, evil is political, as per the remote-control detonation of mentally disabled women strapped with explosives and sent into crowded Baghdad markets. More often, it's less murderous and messy than that, and sometimes it's very well dressed.

One of my favorite references to everyday evil comes from the Albert Brooks character in the movie "Broadcast News," who says of his substance-free rival for Holly Hunter's affections, "Please don't take it wrong when I tell you that I believe that Tom, while a very nice guy, is the Devil. What do you think the Devil is going to look like if he's around? Nobody is going to be taken in if he has a long, red, pointy tail. No. I'm semi-serious here. He will look attractive and he will be nice and helpful and he will get a job where he influences a great God-fearing nation and . . . he will just bit by little bit lower standards where they are important.''

Yet it's the Christian underpinnings of my view of evil, in a world in which we do have free will, and sin, which in all cases involves a choice, that makes it impossible for me to ever see those who suffer from schizophrenia as an embodiment of moral evil. We don't know for sure that Loughner has schizophrenia, though his paranoia and references to "mind control" are classic markers. But those who are so afflicted haven't chosen their delusions and hallucinations; a stand-out even in the pantheon of dreadful diseases, theirs is an illness no one would choose.


Serious mental illness regularly leads to self-medication and homelessness, though as David Brooks has pointed out, it only rarely leads to violence. Yet persistent as these related problems are, frustratingly little has changed since I covered mental health issues in the mid-'80s. Even then, the seriously mentally ill were no longer being warehoused in inhumane institutions. But most still aren't getting sufficient treatment in their communities, either.

An even knottier challenge than the chronic under-funding of community mental health services is that one symptom of schizophrenia is that the sufferer truly believes he isn't ill and that those who are trying to treat him are involved in a plot to hurt him. Then as now, there is no way a loved one can get an adult involuntarily committed unless he is deemed a threat to himself or others – a standard that is often impossible to meet until it's too late; I've seen some incredibly sick people pull it together long enough to fool a judge in a commitment hearing, and if you think that's the "evil" criminal mind at work, well, you should see them when they fall apart. Also then as now, even if the person is hospitalized, it's only briefly, until he is "stabilized" on medication, at which point he's released to "the community" to go off his meds and get sick all over again.

Roger Simon writes that we "medicalize" evil so we can pretend it doesn't exist, but I see us doing just the opposite -- writing illness off as "evil" to justify our inaction. "Madness can be treated,'' he says. "All we need is early intervention and clinics and more resources devoted to the problem. And we would much rather believe that all sick people can be cured by medical intervention.'' Only they can't be, unfortunately. Schizophrenia can be treated -- and with great difficulty, managed -- but not cured, or not yet, anyway. And as long as we confuse mental illness with wickedness, I'm not sure how that's going to change. Decades after deinstitutionalization, we have barely started the conversation.

No comments: