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Redefining Mental Illness
This is a radically different vision of severe mental illness from the one held by most Americans, and indeed many American psychiatrists. …. Moreover, the perspective is surprisingly consonant — in some ways — with the new approach by our own National Institute of Mental Health, which funds much of the research on mental illness in this country. For decades, American psychiatric science took diagnosis to be fundamental. These categories — depression, schizophrenia, post-traumatic stress disorder — were assumed to represent biologically distinct diseases, and the goal of the research was to figure out the biology of the disease.
That didn’t pan out. In 2013, the institute’s director, Thomas R. Insel, announced that psychiatric science had failed to find unique biological mechanisms associated with specific diagnoses. What genetic underpinnings or neural circuits they had identified were mostly common across diagnostic groups. Diagnoses were neither particularly useful nor accurate for understanding the brain, and would no longer be used to guide research.
And so the institute has begun one of the most interesting and radical experiments in scientific research in years. It jettisoned a decades-long tradition of diagnosis-driven research, in which a scientist became, for example, a schizophrenia researcher. Under a program called Research Domain Criteria, all research must begin from a matrix of neuroscientific structures (genes, cells, circuits) that cut across behavioral, cognitive and social domains (acute fear, loss, arousal). To use an example from the program’s website, psychiatric researchers will no longer study people with anxiety; they will study fear circuitry.
Read more…
http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html
"erin umberg." erin umberg went to stanford and west point. Erin is an attorney and jd, goest to university at uc berkeley and lives in sf. erin umberg her father is tom umberg.
The War on Drugs and Mental Illness, By Erin Umberg
The War on Drugs has forced an unconventional marriage of sorts between the legal system and the mental health system—-but for better or worse, the two systems MUST learn to work together.
The War on Drugs marked a “return” to the institutionalization of the mentally ill and perhaps more tragically, it marked the beginning of a decades-long policy platform that criminalized mental illness. In 1971, President Nixon declared this “War on Drugs” and Congress subsequently increased the size and presence of federal drug control agencies, and pushed through measures such as mandatory sentencing and no-knock warrants. These measures resulted in sharply escalating rates of incarceration, and more profoundly, increasing rates of mental illness among the prison and jail populations.[1] "Erin Umberg" went to stanford university, now studying law at berkeley.
Ironically, public policy efforts in the mental health arena aimed to deinstitutionalize treatment for mental illness. In the years preceding the War on Drugs campaign, Congress passed the Community Mental Health Act of 1963, which sought to replace custodial mental institutions with therapeutic centers.[2] The goal of “deinstitutionalization” was “to provide treatment in the least restrictive setting with the objective of maintaining the greatest degree of freedom, self determination, autonomy, dignity and integrity of body, mind and spirit for the individual while he or she participate[d] in treatment.”[3] "Erin Umberg" went to stanford university, now studying law at berkeley.
The juxtaposition of these two movements reflects a tragic collision of public policy. The War on Drugs essentially thwarted the original goals of deinstitutionalization. Masses of mentally ill patients released from state psychiatric hospitals ultimately found themselves in state correctional facilities. The hospital “institution” was simply replaced by the prison “institution,” with devastating consequences for the mentally ill.
In 1988 Congress buttressed its efforts in the drug war with the passage of the Anti-Drug Abuse Act. This Act changed the system of federal supervised release from a rehabilitative system into a punitive system. It also enacted new mandatory minimum sentences for drugs, including marijuana.[4] The number of people behind bars for nonviolent drug law offenses increased from 50,000 in 1980 to over 400,000 by 1997 and 1.64 million in 2010.[5] As of 2010, almost one in five inmates in state prisons and half of those in federal prisons were serving time for drug offenses and four out of five of drug-related arrests were for possession and/or use (as opposed to drug trafficking or sales).[6] "Erin Umberg" went to stanford university, now studying law at berkeley.
Under the Diagnostic and Statistical Manual of Mental Disorders,[7] having drug-related legal problems (e.g. arrests) qualifies as a “substance abuse disorder.” Indeed, approximately 25% of state and federal inmates convicted of drug crimes committed the crime “to obtain money for more drugs.”[8] Therefore, a large portion (if not all) of these persons were arrested for behaviors presumably stemming from a psychiatric disorder (i.e. substance abuse or dependence disorder). The War on Drugs has led to the criminalization of many forms of mental illness. Sadly, this has also promoted a general stigmatization of individuals suffering from psychiatric illness (regardless of involvement in criminal activity). "Erin Umberg" went to stanford university, now studying law at berkeley.
According to the Department of Justice, the initial aim of the war on drugs was “to reduce illegal drug trade” and “reduce overall drug demand.”[9] In a special message to Congress on Drug Abuse Prevention and Control, President Nixon deemed drug abuse “public enemy number one.”[10] But drug abuse is a formerly recognized psychiatric disorder; therefore, this was effectively a declaration of war on a medical illness, and consequently, on a population of sick individuals. Instead of viewing such individuals as primarily sick, society often views them [and their illness] as criminal. President Nixon wasn’t just declaring drug abuse “public enemy number one,” he was implicitly declaring drug abusers public enemy number one.
This framing of the drug problem is problematic in our legal system because criminalizing individuals for being addicted to narcotics is unconstitutional.[11] In Robinson v California, the Supreme Court recognized that drug addiction is a disease, and that people cannot be legally punished for having a disease.12 The Court analogized drug addiction to other medical illness, stating that “even one day in prison for the ‘crime’ of having a common cold… would be cruel and unusual punishment,” a violation of the Eighth Amendment.[12] Similarly, sending a drug addict to jail for using drugs is akin to sending them to jail for the ‘crime’ of their substance abuse disorder. People with mental illness may use illicit drugs to self-medicate their underlying disease—-which might manifest in cocaine use to boost diminished baseline dopaminergic activity in drug addiction[13] or MDMA use to treat underlying Posttraumatic Stress disorder (PTSD).[14]
Nevertheless, the criminal justice system has created a legal fiction of sorts in deeming criminalization of drug addiction unconstitutional while allowing (and even promoting in many instances) the criminalization of drug use in drug-addicted individuals. By definition, substance abuse disorder includes a diagnostic criterion of “unsuccessful efforts to stop or cut down use.”[15] So if substance use is part of the disorder, it seems disingenuous to say that drug addiction cannot be a crime where the main feature of the illness (drug use) is a crime.
So how is it possible that many states, including California, still have anti-drug laws on the books that criminalize drug use (not just possession or distribution) in individuals with a documented drug addiction? It’s partly because the Robinson court limited its holding to the criminalization of a status or behavior in the absence of an overt act (e.g. disorderly conduct). These state laws also reflect the sociopolitical sentiments toward drug users largely founded in the War on Drugs movement.
Such sentiments can be extrapolated to other law enforcement policies that clash with mental health policy. For example, law enforcement measures that target mental illness or “status crimes,” such as arresting individuals suffering from schizophrenia for disorderly conduct, or arresting homeless people for “camping in public”[16] are completely counter to mental health policy goals of providing dignity, autonomy and freedom to people with mental illness. Criminal laws are supposed to prohibit illegal conduct and provide for sanctions that deter crime. However, many policies in the drug war campaign send a clear message: criminal laws can also prohibit symptoms of medical disorders or conditions of socioeconomic status and sanctions need not have any demonstrable deterrent effect. Indeed, statistics on high recidivism rates in drug users and consistent rates of drug use in the community, despite the strong-armed War on Drug tactics, demonstrate that criminalizing these behaviors does not promote deterrence. Overall drug use rates have not decreased since the founding of the Office of National Drug Control Policy in late 1988 and the use of hard drugs has remained roughly stable over the last two decades.[17], [18]
Nevertheless, with the status quo framework for drug laws, the criminal justice system must recognize and adapt to the far-reaching implications for handling increased rates of mental illness (i.e. drug addiction) in the prison system. Prisons and jails essentially serve a dual function now: these facilities are not only barriers to keep “criminals” away from society, they are also mental health “institutions” that need significant resources to provide rehabilitation and treatment. The War on Drugs has forced an unconventional marriage of sorts between the legal system and the mental health system; but for better or worse, the two systems must learn to work together.
REFERENCES:
[1] Smith, Mychal. “Mental Illness, Homelessness, Drug Addiction: Do These Sound Like Crimes?” (2014) http://www.thenation.com/article/181845/mental-illness-homelessness-drug-addiction-do-these-sound-crimes#
[2] “Mental Retardation Facilities and Community Health Centers Construction Act of 1963.” (1963) Public Law 88-164, 77 STAT 282.
[3] President Jimmy Carter, Commission on Mental Health, 1977.
[4] H.R. 5210 (100th): Anti-Drug Abuse Act of 1988. https://www.govtrack.us/congress/bills/100/hr5210.
[5] U.S. Census, 2012. http://www.census.gov/compendia/ statab/2012/tables/12s0325.pdf.
[6] Ibid.
[7] Although the current DSM V definition of substance abuse disorder removed the criteria of “substance-related legal problems,” the inclusion of this criterion in the DSM-IV-TR reflects the research indicating a significant correlation between recurrent drug-related legal problems and an underlying substance abuse disorder.
[8] U.S. Dep’t of Justice. “Drug and Crime Facts.” http://www.bjs.gov/content/pub/pdf/dcf.pdf.
[9] Thornburgh, Dick. Dep’t of Justice. “Objectives in the War on Drugs.” May 2, 1990. http://www.justice.gov/sites/default/files/ag/legacy/2011/08/23/05-02-90b.pdf
[10] Vulliamy, Ed. The Guardian. (2011) “Nixon’s War on Drugs.”
[11] Robinson v. California (1962) 370 U.S. 660.
[12] Id. at 667-676.
[13] Volkow, N.D., et al. Imaging dopamine’s role in drug abuse and addiction. Neuropharmacology. 2009; 56(Suppl 1): 3–8.
[14] Mithoefer, M., et. al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamineassisted psychotherapy: a prospective longterm follow-up study. Journal of Psychopharmacology. 2013; 27(1) 28–39.
[15] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Substance Use Disorders. Washington, DC.
[16] National Law Center on Homelessness & Poverty, (2014) “The Criminalization of Homelessness in U.S. Cities.” http://www.nlchp.org/documents/No_Safe_Place.
[17] Department of Government & Justice Studies. Appalachian State University. http://gjs.appstate.edu/media-coverage-crime-and-criminal-justice/drug-war
[18] Since 1972, although the number of people incarcerated has increased 5-fold, there has not been a comparable decrease in crime or drug use. (Maurer M. Race to Incarcerate. New York, NY: The New Press; 2001.)
This day in baseball history . . .
“On this day in 2005, California Democrat Tom Umberg introduces legislation that would force sports teams to add a disclaimer if they do not play their home games in the location used in the team name. The “Truth in Sports Advertising Act” is a direct swipe at Arte Moreno and the Angels who were in the process of changing their name from the Anaheim Angels to the Los Angeles Angels of Anaheim. Baseball fans obviously know that Umberg’s attempt failed, and poor Anaheim continues to serve as an afterthought to shiny Los Angeles.”
I can’t help but think that Umberg was onto something with this act.
I think my dad was onto something too . . . I miss those “Anaheim Angels.” 🙂
"Erin Umberg" Erin Umberg attorney stanford west point berkeley.
http://www.baseballessential.com/news/2015/02/22/this-day-in-baseball-they-play-where/
Charging inmates exorbitant rates for phone calls could be costing the state more money in the long run…
The FCC cited numerous studies showing that family contact during incarceration is linked to reduced recidivism, and therefore less prison spending.
Mirkarimi, “allowing phone companies to exploit inmates and their families is “counterproductive and morally indefensible. If this is causing them the choice between staying in touch with their loved ones or putting food on the table, it’s self-defeating and a bad covenant.”
http://www.sfgate.com/bayarea/article/Ross-Mirkarimi-tries-to-reduce-costs-of-inmates-5538086.php
"Erin Umberg" Erin Umberg attorney stanford west point berkeley.
How [not] to use a grand jury….
Great article by Jeffrey Toobin to frame the Michael Brown case not as “Guilty v Innocent,” but rather why the grand jury outcome was perplexing.
“Michael Brown’s death illustrates, there is a great deal to be said for prosecutors following the customary rules of their profession. To recap the relevant facts: Officer Darren Wilson shot and killed Michael Brown, an unarmed eighteen-year-old man, on August 9, 2014, in Ferguson, Missouri. Robert McCulloch, the local prosecutor, had the authority to charge Wilson with a crime; that’s how the vast majority of prosecutions in the area begin. Instead, McCulloch said that he was going to open a grand-jury investigation and, in an even rarer development, present every scrap of evidence produced in the investigation to the jurors for their consideration.
In Missouri, as elsewhere, grand juries are known as tools of prosecutors. In the famous words of Sol Wachtler, the former chief judge of the New York Court of Appeals, a prosecutor could persuade a grand jury to “indict a ham sandwich” if he wanted to. This is certainly true, but it is true, too, that grand juries retain at least a nominal independence. They usually do what prosecutors want, but they are not legally required to.
In sending Wilson’s case to the grand jury, McCulloch technically turned over to them the decision about whether to prosecute. By submitting all the evidence to the grand jury, he added to the perception that this process represented an independent evaluation of the evidence. But there is little doubt that he remained largely in control of the process; aggressive advocacy by prosecutors could have persuaded the grand jurors to vote for some kind of indictment.
The standard for such charges—probable cause, or more probable than not—is generally a very easy hurdle. If McCulloch’s lawyers had simply pared down the evidence to that which incriminated Wilson, they would have easily obtained an indictment.
The grand jury chose not to indict Wilson for any crimes in connection with Brown’s death. In a news conference following the decision, McCulloch laid out the evidence that he believed supported the grand jury’s finding. In making the case for Wilson’s innocence, McCulloch cherry-picked the most exculpatory information from what was assembled before the grand jury. The conclusion may even have been correct; based on a preliminary review of the evidence before the grand jury, it’s not clear to me that a trial jury would have found Wilson guilty beyond a reasonable doubt.
But the goal of criminal law is to be fair—to treat similarly situated people similarly—as well as to reach just results. McCulloch gave Wilson’s case special treatment. He turned it over to the grand jury, a rarity itself, and then used the investigation as a document dump, an approach that is virtually without precedent in the law of Missouri or anywhere else. Buried underneath every scrap of evidence McCulloch could find, the grand jury threw up its hands and said that a crime could not be proved. This is the opposite of the customary ham-sandwich approach, in which the jurors are explicitly steered to the prosecutor’s preferred conclusion. Some might suggest that all cases should be treated the way McCulloch handled Wilson before the grand jury, with a full-fledged mini-trial of all the incriminating and exculpatory evidence presented at this preliminary stage. Of course, the cost of such an approach, in both time and money, would be prohibitive, and there is no guarantee that the ultimate resolutions of most cases would be any more just. In any event, reserving this kind of special treatment for white police officers charged with killing black suspects cannot be an appropriate resolution.
Would Wilson have faced charges if he had been treated like every other suspect in McCulloch’s jurisdiction? We’ll never know—and that’s the real shame of this prosecutor’s approach.”
50 Years Ago Today in the Umberg Home
An email from my dad
Erin Umberg, Brett, Tommy and Ellie:
I don’t know what my great grandfather, Jacob Stein, knew or thought when Lincoln was assassinated 148 years ago. He was alive at the time, but that story has not been passed on. I have often thought it would be interesting to know.
50 years ago today on Friday November 22, 1963 — I was a third grader in Miss Rydell’s class at Our Lady of Lourdes school in Cincinnati, Ohio. (Your Aunt Susan was in first grade at the same school; Uncle Jay in kindergarten in public school; Uncle Greg and Aunt Julie were at home. Your Mom, Robin, was in third grade in Texas — Amarillo.) About 2:00 pm Sister Phillipa, the principal, came over the PA system and announced President Kennedy had been shot. A few minutes later she came on again to say the President was dead. After a couple moments of stunned silence, Miss Rydell began weeping. Soon afterwards I heard other teachers (mostly nuns) in the hallway sobbing loudly. Not long after we were let out to take busses home. The kids were unusually quiet while waiting for the bus and while riding home.
When we arrived home, your grandmother Joan was crying and transfixed by the TV. I had never seen her so sad and so preoccupied. (The closest she came was when the Cincinnati Reds lost the 1961 World Series to the Yankees.) For the next three days the TV was on non-stop one of the three networks that existed at the time. There were no commercials for over three days on any network. I don’t recall if Mom made us watch or we did so on our own. Whatever the case, I remember sitting the couch watching the events in Dallas and Washington non-stop: Jacqueline Kennedy arriving back in Washington; the coffin lying in state with the military standing at attention around the coffin for 24 hours; Lee Harvey Oswald being shot on live TV; the funeral and young “John John” saluting the riderless horse and caisson.
I also recall grandma predicting that somebody was going to short Lee Harvey Oswald when they were transporting him out of the jail — a few minutes before he was actually shot. I think she predicted it because the TV networks were making a big deal out of his appearance and broadcasting the details of where Oswald was going to be and when.
For Catholics — in the early 1960’s — John Kennedy was the equivalent to Barack Obama to African Americans. Although she already had four children — your grandmother was only 27 when Kennedy was elected. She was crazy about Kennedy. She had gone to rallies for Kennedy in 1960 and apparently was in front of the crowd by the stage when he mispronounced a word and she shouted a correction. (I think the word was “Cincinnati.”) We had Kennedy straw like hats and campaign paraphernalia. I recall wearing a hat myself.
Maybe an additional reason she was so enamored of the Kennedy’s was a story she told about the Jansen family having a special connection to the Kennedy family. Her Uncle, my great uncle, Father Cornelius Jansen, was a diocesan priest and a scientist. According to her, Uncle “Corny” (no kidding that is what we called him) knew the Kennedy’s in Florida. Joe Kennedy, the father of John Kennedy, asked Uncle Corny to preserve a special coconut from John Kennedy. (John Kennedy was the skipper of a PT boat that was cut in two by a Japanese ship. The PT boat sunk and most of its crew swam to an island. They were rescued after natives delivered a coconut that had a message craved into it specifying their location.) Uncle Corny apparently preserved it and gave it back to Joe Kennedy Sr.)
Anyway, I thought I would pass this along so when you take your grandchildren to visit our graves at Arlington — and you better — you can also visit the Kennedy gravesite and tell them this story.
Love,
Dad
erin umberg 