Our ‘War on Drugs’: Eugenics Without Surgery?
By Erik Roskes
Blogger Erik Roskes asks, 'Is incarceration addiction is tantamount to eugenics without surgery?'
Erik Roskes
How Good Intentions Can Go Wrong
By Erik Roskes
Therapeutic courts may have consequences not intended by their leaders and participants. Most of these courts begin with noble motives. That said, good intentions can lead in many directions if unchecked by objective reviewers or evaluators.
An Optimistic Counterpoint for the Holidays
By Erik Roskes
During this holiday season, I thought I would take a break from my usual criticisms to point out how well things can go when people simply refuse to give up and accept the “inevitable.”
Mental Health Courts: The Law (and Irony) of Unintended Consequences
By Erik Roskes
Growing from the garden of therapeutic jurisprudence, mental health courts have been developed in numerous jurisdictions across the US. One of the key elements of these courts includes the defendant’s exercise of voluntary choice to participate in the diversion, which is often predicated on a guilty plea or on the waiving of the defendant’s Sixth Amendment right to a speedy trial.
Involuntary Treatment is Not Enough
By Erik Roskes
In a recent article, researchers from the University of South Florida correlated arrest rates with recent histories of involuntary commitment. They found that people who underwent an involuntary psychiatric evaluation were 12 percent more likely to be arrested in the three months after that evaluation than people who had not been involuntarily evaluated.
Vacations: Who Needs Them?
By Erik Roskes
In a recent blog, my friend and colleague...
The Importance of Sharing Medical Records
By Erik Roskes
Josie is a 29-year-old woman who has a long...
The Canary In The Coal Mine
By Erik Roskes
Prior to the introduction of ventilation...
The Long Shadow of a Criminal Record
By Erik Roskes
I have a patient who carries a conviction for a very serious...
Standing up for "Disposable" People
By Erik Roskes
Well, after six weeks, our Iraqi visitors have returned home. During their visit, they told us that things were becoming more difficult at home, and one of them was considering relocating to the US, if possible, even knowing that he likely would never be able to practice psychiatry here.
During their visit, we became close colleagues and friends. It was amazing to me how easy it was to get close to them, how much more alike we all are than one would think. As the psychiatrist and psychoanalyst Harry Stack Sullivan said over a half-century ago, “We are all more human than otherwise.”
Think about the lesson this teaches us. We who choose to work within the criminal justice system have chosen to work with those whom society has deemed “disposable” people. I’m not saying that some—maybe many—incarcerated people have done quite horrible things. The recent case in Connecticut reminds us that there are, in fact, evil people in the world.
But, many people with mental illness are unfortunates who suffer with serious impairments in their decision-making capacities, their insight, at times even their volitional control. For many of these individuals, jail is the only place that doesn’t say no. I have already described a woman arrested for “being mentally ill in public.”
Here’s another case: 20 year old Ryan is arrested after seriously assaulting his mother. He is a talented student athlete, home from college for winter break. After describing his actions as “I had to do it – she was possessed,” he is referred for a psychiatric evaluation and found to be suffering with a psychotic illness rendering him severely delusional. He denied drug use, and his urine and blood are clean. He is admitted to a hospital, treated with medications and therapy, and within 2 weeks has become asymptomatic. Profoundly remorseful over what he has done, he becomes severely depressed.
What should happen to Ryan, who is so similar to you, reading this blog, and to me, writing it? Should he be charged with assault? Should he be diverted for treatment? Both?
In our country, we struggle mightily with issues of liberty and personal autonomy, and conversely with holding people accountable for their choices. But accountability assumes the freedom to make choices – and Ryan’s case, can we truly conclude that he made a free choice while struggling with a new-onset psychosis?
Back to my opening: We are all more human than otherwise. Cases like Ryan, so similar to me when I was a student – except, of course, for the psychosis and the athletic skills – make me ever grateful that I have not developed a serious mental illness. Meeting my new friends from Iraq, where psychiatrists are held hostage for ransom, or even occasionally assassinated, make me ever grateful that I was born here in the US. But at the end of the day, we are all pretty much the same, but for the random nature of where we were born, what genes we are born with, and what our early life experiences are.
Finally, if you are losing faith in the positive impact you can have on those you serve, read Phil Taylor’s latest column in Sports Illustrated.
Erik Roskes is a forensic psychiatrist and currently the Director of Forensic Services at the Springfield Hospital Center in Maryland. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes’ employers or consultees, including the Maryland Department of Health and Mental Hygiene. He can be found at http://mysite.verizon.net/eroskes/
TCR at a Glance
Waiting for 'Smart' Guns
new & notable June 19, 2013
A new report — called for by President Barack Obama in response to the Newtown rampage — examines efforts to develop new gun ...
Marrying Police Craft to Science
new & notable June 18, 2013
Law enforcement needs to resolve the long-running dispute between supporters of evidence-based policing and practitioners of experiential...
Smile, You’re Under Arrest
June 17, 2013
U.S. cops are increasingly using micro cameras to record their daily activities—and defend themselves, if necessary, against charge...
Fracture Clinics Reveal International Scourge of Domestic Violence
new & notable June 14, 2013
Intimate partner violence found to be leading cause worldwide of non fatal injuries to women, according to an international study of orth...
Violence in Juvenile Justice Facilities
new & notable June 13, 2013
Nearly half of youths in containment experience theft and almost a third are threatened or beaten, according to the Office of Juvenile Ju...
New York's Rising Tide of Judicial Diversion
new & notable June 12, 2013
In the year after the Rockefeller drug laws were repealed, the rate of felony offenders sent to drug treatment rose sharply, reports the ...
When Love Hurts
June 11, 2013
A few states—such as New York—are expanding orders of civil protection and establishing special courts for teens at risk from...