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I've been following this story on the terrible shooting at Northern Illinois University. It sounds like the shooter is a schizo who stopped taking his meds. From all available information it sounds like as long as he stayed on his medication he would never hurt anybody. But then, once he's off, well...bang.

What are the ethics of this? Can people who are convicted of a crime but placed in a health facility instead of prison due to reasons of mental defect be forced to take their medication as a condition of their release? Please note that I am restricting this question to a very specific subset of people, those who have been convicted of hurting others as a result of their mental illness. I do not intend to discuss people who may be LIKELY to hurt others were they off their meds but have never actually done so. I believe that is a separate issue and I would not find it justified to force those (innocent) people to do anything.

I'm interested in this topic for a few reasons. I think it encompasses the intersection of ideas like choosing to be rational or not, responsibility for one's actions, guilt or innocence and when "permanent" punishment is justified.

Oh, and although I understand others may not agree, it is my opinion that there are valid, rational reasons for not taking medication for a mental illness. They do have serious side effects and can also radically alter your personality (as any Objectivist who rejects the mind-body dichotomy can accept, the physiological condition of your body can and does affect your mind and mental states).

Discuss.

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Can people who are convicted of a crime but placed in a health facility instead of prison due to reasons of mental defect be forced to take their medication as a condition of their release?
No, not in a system of objective law where specific crimes have specific punishments. If a person is sentences to 5 years in prison, then when their 5 years is up, they are to be released, period.

However, a system of objective law could allow a concept of parole, which could allow a person to be released if the facts warrant it, and this could be subject to conditions. Thus a reasonable term of parole is not associating with other convicted criminals, or reporting to a supervising officer every month or week. In that kind of case, a requirement to take the drugs would be wise and just as a condition of parole. A person not willing to comply with that condition can serve the full term. Note though that this is entirely irrelevant to Kazmierczak, who was not arrested, imprinoned, or anything.

Discuss.
Is that an order?
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I think the prior question is whether someone who is insane and dangerous can be forced into some type of asylum. (i.e. they have not committed a crime, they're just insane).
I agree, and taking people who may be LIKELY to hurt others but have not off the discussion table is an error. Threats are threats, whether they come from an evil person or an insane person, and since threatening people sanely is justifiably a basis for incarceration, I can't see how the threats of an insane person should be disregarded as, well, the harmless ravings of a lunatic.
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I agree, and taking people who may be LIKELY to hurt others but have not off the discussion table is an error. Threats are threats, whether they come from an evil person or an insane person, and since threatening people sanely is justifiably a basis for incarceration, I can't see how the threats of an insane person should be disregarded as, well, the harmless ravings of a lunatic.

You're talking about communication of a threat, which is a crime, regardless of the mental capacity of the perp. The more general, and difficult question is the non-communicated threat, that is, the potential threat that we correlate to the clinical diagnosis of an individual. This raises the question of whether we should restrain people who have not committed a violent act in the past, based on a similarity they have with people who have committed violence. Recognizing that clinically defined conditions are only a subset of the possible correlative traits of violent persons reveals a danger in the diagnosis (i.e., preventive) approach to threats, v. the criminal justice (i.e., reactive) approach.

Should the definition of "dangerous" be extended beyond the clinical insanity definitions to include behavioral indicators of potential violence? For instance, if it was shown than membership in a street gang had a stronger correlation to violence than clinical schizophrenia had, would we be justified in chemically or physically restraining gang members?

Are we more comfortable with restraining people who are dangerous and irrational, than we are with people who are just dangerous? (dangerous, in the statistical sense)

In other words, is irrationality a crime?

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You're talking about communication of a threat, which is a crime, regardless of the mental capacity of the perp.
Specifically, I am talking of "acts which a reasonable man would understand as threatening harm", regardless of any communicative intent. If a person runs around naked in the village square, brandishing an axe and a shotgun, not saying a word and just gesturing at a person with his weapons, he has threatened the person. Before complicating the question with a distinction between "communicated threats" and "non-communicated threats", I suggest figuring out what it means to "communicate". I'm saying that something along the lines of "communication" is an essential part of "threat".
This raises the question of whether we should restrain people who have not committed a violent act in the past, based on a similarity they have with people who have committed violence.
I think the question that it raises is whether a blunt instrument like the diagnosis "is anti-social" or "is schizophrenic" is an accurate enough predictor of violence. I am skeptical that our current knowledge of mental disorders is sufficient to correctly predict those who are likely to harm others. Time (perhaps a week) will tell, but it doesn't seem that there is any way to have predicted that Kazmierczak would have snapped. Cho Seung-Hui, on the other hand, seems to have been predictable. The proper basis for restraining such people is their acts, not a statistical analysis of their test results.
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I don't know the statistics right off hand, but there are a lot of people out there who have serious mental disabilities, such as schizophrenia, and especially on medication can go on to live more or less normal lives and be an active part of humanity. And it is important to understand the difference between schizophrenia and insanity. Schizophrenics have not lost touch with reality, as someone who is insane has, what normally happens is that the subconscious of a schizophrenic acts up such that he has psychological triggers to a wide range of observations. He might hear someone say, "You'll never get rid of it!" and think it is directed at him, instead of just overhearing something, and then his subconscious will bring up something to his mind that he thinks he will never get rid of, like maybe he is trying to sell his car or something. Or he might be watching television and hear someone say, "I can still see you!" and think that someone is in the television watching him, even though it was part of a movie. With training and medication, they can learn to live with the triggers until they subside, which they often do with medication. Since medication helps so much, without the need for psychotherapy, I'm inclined to think that schizophrenia is more of a neurological disorder rather than a strictly psychological disorder, but this type of reaction can be brought on with psychological stress -- like their brains get sprained due to not knowing how to deal with a psychologically stressful situation -- especially if it goes on for a long time.

This is one reason Ayn Rand considered it to be evil to taunt someone who has psychological problems -- she considered it to be evil, because their condition would probably get worse, and because someone is not morally responsible for having a psychological problem, since it is something going wrong with the subconscious which is not under direct volitional control. Being taunted is a nuisance to someone of normal psychology, but it may lead to getting punched in the nose; for someone with a psychological problem, the reaction to being taunted could be much worse -- not only for the person being taunted, but to those taunting him about it.

I'm not trying to say that those two school shootings that occurred recently were necessary brought on by taunting, but there are a lot of people who don't understand the nature of psychological disorders, and will taunt people who are known schizophrenics. At any rate, the fact of having schizophrenia is no excuse to go around shooting people, even if one is being taunted about it. Get even, yes, I could see that; but shooting people at random just because they happen to be around when one gets triggered is inexcusable. Venting anger at them, OK; and then report them to the authorities; because harassment is a crime, and it ought to be.

In any case, I don't think it would be moral to forcibly treat someone for a mental disorder with medication. But if it can be shown that they are a danger to others, then they could be forcibly restrained, just like anyone else. In other words, I think the law ought to be neutral with respect to someone's mental disorder -- in other words a mental disorder by itself is not sufficient grounds for locking someone up against their will or forcing them to take medication -- but they ought to know that if they do not learn to handle their disability around others and show signs of being violent, then the law will be there to protect the innocent from them if necessary.

Edited by Thomas M. Miovas Jr.
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... I don't think it would be moral to forcibly treat someone for a mental disorder with medication.
Well, "mental disorder" is very broad. Surely some segment of insane people are adults but nevertheless incompetent to make decisions about their medication etc. They are like young children in this sense: even if they do not pose a threat, it can still be moral for some guardian to take decisions on their behalf. Indeed, if someone were the guardian, it would be immoral to let the insane person make the call on what medications to take.
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Well, "mental disorder" is very broad.

You are right. What I meant to say is that if someone has a psychological problem or neurological problem such that they still have the capacity to function on an adult level, then they cannot be forced to take medication. I don't think the state has the moral authority to force someone to take medication, if they choose not to take it.

The truly insane would be in a different category, similar to the mentally retarded. They are more or less completely incapable of taking care of themselves, and therefore would need a guardian, but I don't think the state should be that guardian, especially if it is being charged to the tax payer. Someone who is truly insane could be morally kept out of the general public, because of his break with reality. He wouldn't know how to deal with ordinary everyday events, and might be a danger just by being out there -- say while trying to drive.

But people with severe psychological disorders, such as schizophrenia, are not necessarily incapable of taking care of themselves or making decisions for themselves, especially while on medication. They may function on a very confused level, but they are not insane.

Unfortunately, denial of themselves having a problem goes along with some psychological disorders, and so they may not think that medication is necessary; but so long as they are sane, the choice is up to them. If they want to live in a constant state of confusion without medication, that is their right.

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  • 6 months later...

Here is a follow-up story for this thread. Evidently, this person had some sort of severe mental disorder after his house burned down (according to his mom) and refused any kind of mental disorder treatment. Well, something set him off, though the details are vague, and he went on a shooting spree. He is now in custody after turning himself in.

http://www.foxnews.com/story/0,2933,416584,00.html

Unfortunately, the fact that this makes news gets everyone to think that the mentally disturbed or mentally ill people are all going to become shooters or murderers, because you rarely hear about the guy who had a problem and got the proper treatment and went on to live his life happily without shooting anyone.

I still think one cannot be forced to take mental illness medication, and supposedly there were no warning signs that this guy was about to flip out and go on his rampage, but I have to wonder if there were no warning signs at all and why someone didn't alert the police. Someone with a mental illness cannot be force to take medication and cannot be forced to stay at home, but he certainly has no right to go on a shooting spree, and I'm going to be curious if this guy will get some sort of reduced sentence because he is mentally ill.

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No - especially since it is not my responsibility to pay a tax in order to fund drugs for lunatics. If they have some way of staying on drugs, throuhgh family or friends or whatever, then so be it. But if they can't do it, and that means they kill someone, then tough luck - punishment applies - it is not an excuse.

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No - especially since it is not my responsibility to pay a tax in order to fund drugs for lunatics. If they have some way of staying on drugs, throuhgh family or friends or whatever, then so be it. But if they can't do it, and that means they kill someone, then tough luck - punishment applies - it is not an excuse.
The question is not whether free mood-enhancing drugs should be provided by the state, at taxpayers' expense, the question is whether a mentally ill person who has harmed others due to his illness can be forced to take his meds, in order to be released from custody.
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The question is not whether free mood-enhancing drugs should be provided by the state, at taxpayers' expense, the question is whether a mentally ill person who has harmed others due to his illness can be forced to take his meds, in order to be released from custody.

How can you force someone to take drugs without them first existing? If as a condition of parole they must supply and use their own drugs, then I see nothing wrong with that, but they aren't being forced. They must first have been arrested, and therefore initiated force.

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They must first have been arrested, and therefore initiated force.
However, if we assume they are lunatics, then they "initiated force" mostly in the sense that a volcano "initiates force" when it erupts. Edited by softwareNerd
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Yes - that is true I suppose, they are not rational beings. At least, not entirely rational.

No, one cannot say that just because someone did something that "was crazy" that they are not responsible for what they did. So long as a person retains control of their mind, then they are responsible for what they say and what they do. The only exception is if they have gone psychotic, but even at that others have the right to be protected from them. In this story and the one's preceding it, there is no indication that these guys "lost total control", in fact, they all seem to be premeditate in that they deliberately went out and got a gun for the purpose of shooting someone.

Perhaps a re-read of "The Psychology of Psychologizing" is in order. For my OPAR Study Group, I have come up with quite a few study questions, because I think this essay is not very well understood.

http://groups.yahoo.com/group/opar/message/757

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It's interesting that the continued story does not mention what religion his is with, but the person involved in that most recent shooting spree said: "I kill for God. I listen to God," a man accused of a Washington shooting rampage earlier this week that left six people dead and four injured said at his court hearing Friday.

This certainly implies that it was premeditated and not based on anything being done to him, though the sheriff shot did try to get him to a mental ward several times in the past.

To make a claim that he was psychotic because God spoke directly to him would put quite a few people in the psychotic line.

It will be interesting what the defense comes up with in this case.

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In fact I read somewhere that there is a theory that until very recently (a few thousand years ago) most people's brains were bifurcated in some funky way that resulted in their hearing voices in their head (really just one part of their brain "talking" to the other); some people still have this and of course they think it's God talking to them.

I don't think I give it very much credence.

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In fact I read somewhere that there is a theory that until very recently (a few thousand years ago) most people's brains were bifurcated in some funky way that resulted in their hearing voices in their head (really just one part of their brain "talking" to the other); some people still have this and of course they think it's God talking to them.

There actually is a medical condition where this can happen, though I forget what it is called. Basically, if I remember correctly, that brain processing that take place that makes it possible to "hear" one's own thoughts gets short circuited to the hearing center of the brain, and the person with this affliction actually hears his own mind as if with his ears, but cannot identify that it is his own mind due to the short circuit.

Nonetheless, hearing voices, real, imagined, or short circuited, does not give him an excuse to shoot someone just because a little voice or a loud voice told him to do it. Though, I imagine that a constant voice booming in your ears would be difficult to ignore, rather like wearing earphones and having someone constantly talking in your ear and you can't turn it off. People in the past have actually been driven mad with this condition, before modern times and modern medication was there to correct it. Unfortunately, those afflicted with this condition can come to believe it is normal and therefore do not seek medical attention, even after it is offered to them.

Edited by Thomas M. Miovas Jr.
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In fact I read somewhere that there is a theory that until very recently (a few thousand years ago) most people's brains were bifurcated in some funky way that resulted in their hearing voices in their head (really just one part of their brain "talking" to the other); some people still have this and of course they think it's God talking to them.

sounds like Schizophrenia (schism mind), and it's a real, chemically proven, disease, in which the brain produces too much dopamine, though I can't figure out how "most people's brains" had it. ¿?

And there's surely medication that lowers the dopamine levels, but again, there's no correlation between schizophrenia and criminal activity.... and even if it were.....

Edited by volco
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sounds like Schizophrenia (schism mind), and it's a real, chemically proven, disease, in which the brain produces too much dopamine, though I can't figure out how "most people's brains" had it.

I don't think it is true that "most people" in the past had schizophrenia, but it is possible that at certain times in the past "environmental" impacts could have led to a higher incidence of schizophrenia than in modern times. Believe it or not, there is actually a schizophrenia.com that goes into quite a bit of detail about the disorder and what factors can lead to someone getting schizophrenia, included in these is undue psychological stress, genetics, and starvation. Also, there were certainly times in the past when not only was there chaotic social interactions (i.e raids, gangs, mysticism, harassments, threats, etc.) but there was also a great deal of confusion as to the nature of the human mind. In other words, a lack of introspection and of identifying one's own thought processes as being one's own, could lead to a higher incidence of people susceptible to getting schizophrenia of actually getting the illness.

I was unable to locate the particular disorder that I thought I was talking about previously, but maybe it has been incorporated into the general disorder of schizophrenia. In other words, not all schizophrenics "hear voices" and maybe this was once considered a separate disorder.

Fortunately, medication and self-cognitive training can bring someone with this disorder up to a more or less normal mode of functioning. The prescribing of medication is very controversial in some circles, psychiatry versus psychology, in that some psychologists think that the problem is not one of brain disfunction, but rather of undiscovered psychological ills.

However, brain scans have shown that the brain of a schizophrenic not on medication isn't functioning correctly, and with medication returns to normal states. But this leads to the whole mind / brain interaction, such as does a person who is not thinking correctly actually able to shut down some of the functioning of his brain. Even for something like Pavlov's dogs*, it can be shown that a being with a consciousness can become so confused with environmental stresses that the brain actually begins to not work correctly. Of course, doing something like that to a human being is evil, since even with medication and self-cognitive therapy, he may not be able to return to normal functioning.

*The particular experiment I am thinking of is when it was found that giving a small electric shot to a dog before feeding him eventually led to him starving to death, because the negative input countered the feeling of hunger. If not handled correctively, there is some evidence that the brain actually re-routes pathways, leading to a kind of permanent negative response in the long-run. In other words, there is evidence that undue psychological or physiological stresses can re-wire the brain, in effect; though it is unclear how this works on the neurological level.

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  • 3 months later...

*** Mod's note: merged with an earlier thread. -sN ***

I'd like to know what members of the Objectivist community think about the practice of involuntary psychiatric commitment. If you are in favor of it, does your support extend to forced medication, or merely to confinement in a mental institution?

Edited by softwareNerd
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If you were found guilty of an actual crime (violation of another person's rights), and if during your due process it was found that you are not sane, involuntary confinement to a psychiatric facility is an alternative to incarceration in a prison. Only if you committed (or were apprehended during commission of) a crime against another man are you the dangerous kind of nutjob. Otherwise, you're just excentric.

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