I do hope Daniel and the readers of this blog will indulge me yet one more mention of some articles, and once again from the Los Angeles Times. I well realize everyone is pressed for time these days, but I'd rather err on the side of abundance (of information) rather than the converse (after all, that's one of the better pedagogical functions of blogs such as this).
The articles in question are part of a series called "Breakdown," which is described as follows: "For California's estimated one million people with mental illness, life is a daily struggle. Times reporters Scott Gold, Lee Romney and others are chronicling their lives and the strained system meant to serve them."
While I suspect these stories are representative of the state of mental health care in much of the country, they are moving enough on their own, painting a deeply human portrait of what individuals face day-to-day in dealing with various forms of mental illness. Of course one needs to keep in mind that "the set of instances available to us might form a very biased sample of the set to which we wish to generalize when we make our frequency estimates," in short, what is termed the "availability bias," and described by Robyn M. Dawes as "quite common and robust"(See his wonderful book, Everyday Irrationality, 2001). Inasmuch as this series consists of "good stories," they can be the vehicle for an availability bias.
Permit me a powerful illustration of the kind of problems associated with undue reliance on the availability heuristic (such heuristics, as mental 'short-cuts,' are in themselves neither good nor bad), one not unrelated to the subject matter of the Times series. It is from a book by Dawes and Reid Hastie titled Rational Choice in an Uncertain World: The Psychology of Judgment and Decision Making (2001):
"[C]onsider the current widespread belief that much of the 'homelessness problem' in the United States is due to the 'deinstitutionalization' of mental patients, which simply releases them into the streets without the ability to obtain or hold jobs. This belief was expounded in a 1986 cover story of Newsweek magazine, which began with the provocative headline "Abandoned" (and subsequently failed to recount a single instance of an emotionally disturbed individual requesting psychiatric hospitalization and being denied it). The homeless are 'America's cast-offs--turned away from mental institutions and into the streets. Who will care for them?' The story continues by quoting from a number of eminent psychiatrists and mental health workers: 'It is true that up to 65% of the liberated mental patients have successfully adapted to life outside, but as any psychiatrist can testify, "success" among the long-term mentally ill is a very sometimes thing.' (Our own observation is that 'success' for all of us is a 'sometimes thing').
What do actual surveys of the homeless show? Estimates of the proportion who are mentally ill vary from locality to locality, but the average is about one third, with the criterion for categorizing someone as 'mentally ill' being either current mental distress or a history of psychiatric hospitalization. The vast majority of the homeless are poor, just plain poor. Why do so many people accept the conclusion that homelessness is due to deinstitutionalization of mental patients? Search your memory for the homeless people you saw most recently. What were they like? The unobtrusive homeless person is easily forgotten. We tend to remember the person who sings on the bus, who intrudes on passersby, who is drunk, or who is obviously high on some drug. Moreover, we prepare ourselves to behave in certain ways if such a person approaches us, such preparation being exactly the type of ancillary event that--as Willem Wagenaar points out--enhances recall of the event leading to it. Hence our view of 'the homeless' is based on the memorable homeless, people whose emotional and physical debilitation is so severe that it suggests poverty alone cannot be the cause of their problems. The judgment quoted earlier of 'any psychiatrist' is also subject to a memory selection bias. Unlike family doctors, psychiatrists do not see their patients for periodic check-ups. They see their former patients, if at all, only when subsequent emotional problems develop. This selective sampling is particularly severe for psychiatrists who work in mental institutions, because discharged patients tend to be very disturbed when a former psychiatrist sees them on readmission." [Please do not infer that Dawes and Hasties are not concerned about those who are both mentally ill and homeless, as they simply want to make the point that too many people believe mental illness is the primary causal reason in accounting for the sheer number of homeless individuals, thereby refusing to admit the realities of poverty in this country. Homelessness is difficult enough, being homeless and mentally ill is terrible testimony to the often 'unbearable heaviness of being.']
So, without further ado, here is the link to the Times series (11 articles up to this point): http://www.latimes.com/news/science/la-me-breakdown-sg,1,1610997.storygallery
Patrick S. O'Donnell
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