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by Marvin Ross
The issue that jumps out at me in this poignant depiction of Margaret is that of trying to force someone who does not accept that they are ill to take treatment. So many of the homeless that we see in our cities are suffering from schizophrenia or other serious mental illnesses. They refuse treatment and live in horrific conditions. Every time I go into Toronto, I am amazed at the number of homeless sleeping in their blankets in the middle of sidewalks in the financial capital of as wealthy a country as Canada. The crowds rushing to their offices from the commuter trains simply walk around them as if they were not human beings at all but rather garbage cans that had been blown there by the wind.
One morning, sitting in Toronto's stalled rush hour traffic, I noticed a homeless person on the sidewalk in his sleeping blanket. A van pulled up to the curb beside him, the driver got out, went to the back and opened the door. After rummaging around for a time, he brought out a tray, took it over to the sleeping gent, nudged him awake and gave him his breakfast. A wake-up call and breakfast in bed. Maybe not a five star luxury hotel but................
There is some kindness shown towards the homeless as the story above illustrates but is that really all that is required of us? As my book, “Schizophrenia: Medicine's Mystery – Society's Shame” points out, so many people with serious mental illnesses live on the streets untreated in the wealthiest countries in the world. Are we being fair to allow them to go untreated? Should we not be doing more for them than providing occasional handouts?
Many do say that we should respect their right to reject treatment. Our laws, for the most part, give these people the option to choose not to be treated and the right to remain psychotic and to live on the street, in homeless shelters, or in jail.
Most family members, in contrast, would agree that they need to be treated and that they have the right to be free of psychosis. If that means convincing them to be treated and even forcing that treatment then that needs to be done. These issues are also discussed in my book but an interesting analogy is that of Alzheimer's Disease. We all accept that the elderly with advanced dementia are not capable of making treatment decisions. We provide very compassionate care and protection to our elderly when they do suffer from Alzheimer's. There are no treatments that can alter the course of that disease but we make them as comfortable and as secure as possible. We do not allow them to wander or to be put in a position where they may harm themselves.
However, there are some reasonably effective treatments for schizophrenia but we do not treat these ill people with the same compassion that we show the elderly. We allow them to live on the streets, to forage for food in dumpsters, to be estranged from their families and, at times, to frighten ordinary citizens. The nature of the disease often robs them of the ability to make rational treatment decisions but the laws of our society accept these irrational decisions as rational.
What happens when we do take the time to treat was illustrated to me a few years ago by a psychiatrist. A homeless bag lady was picked up by the police when she smashed a shop window late one night. The police, who were quite familiar with the woman, decided to take her to the local psychiatric hospital instead of to jail this time. At the hospital, a compassionate nurse worked with her to gradually gain her trust and get her to take anti-psychotic medication.
Eventually, she became well enough to be discharged to a supported housing situation. As she progressed and her illness subsided, she began to do regular volunteer work in the community and became reconciled with her family whom she had not seen for many years.
If we have the will, we can accomplish far more for these ill citizens than we do now. But, whether it is indifference or stigma, we do not take the time or make the effort to help those with serious mental illness to recover. Before we can call ourselves a civilized people, we need to provide better care.
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