The Ethics Of… Crazy People

You collapse into the train seat thankfully. It’s been a long day and while there’s a bit of a commute ahead of you, you’re happy to be heading home.

You’re just settling into the pink haze of a daydream about your couch when something catches you eye, and then your ear a few seats away – you glance over and see a guy hunched over a few seats behind you. He’s a bit of a sight; clothes all over the place, wild hair and crunched up posture like he’s hiding from something. You sneak another glance and realise he’s rocking backwards and forwards, clenching and sort of…flapping his hands around, all the while letting out small moans and staring at nothing.

You look away quickly and lock eyes with another passenger sitting near the strange guy. Neither of you says anything, but an understanding clearly passes between you; ‘that’s weird, hey?’. And it suddenly gets a lot weirder when the guy in question suddenly barks out a stream of gibberish to the entire carriage, causing everyone to turn and stare at him. Briefly. Something tells you (and everyone else) that you don’t want to get caught looking at this guy.

I’d be very surprised if we haven’t all been in this situation, or something like it once or twice – just another normal day on the train, in the park, at the shops, and then you run into this guy.

Be honest with yourself here: how did that make you feel? What was your first reaction? Did you stay and go about your business, or did you move elsewhere, change carriage, or try a different shop?

And did you maybe glance behind on the way out? Just in case?

Not to put too fine a point on it, metal illnesses suck. They suck big time. Whether we’re talking mood disorders like depression or anxiety, psychoses like bipolar or schizophrenia, or just good old alcohol or drug addiction, no one anywhere is going to argue that these conditions suck. They’re destructive emotionally, financially, socially and physically, not just for the sufferer, but for everyone around them as well. And as if it wasn’t bad enough for such a condition to make it impossible for you to function normally, mental illness actually manages to take the suffering to an entire extra level by screwing not just with your body, but also with your perceptions.

You break your leg. It sucks. It’s painful and it basically puts your life on hold until it heals. You’re forced to hang out at home, go to the doctor all the time and rely on others to help you until you recover.

But find yourself with a decent case of depression and things get a lot more messy. Your life is equally suspended as you struggle to function, but unlike a broken leg, there’s no clear signs what has happened to you – all you know if that you feel terrible and can’t raise the motivation to do anything at all, including going to the doctors. In this state you’re equally dependant on others for help until you recover, but without a clear sign of injury, who’s going to notice anything is wrong? And how long will they be sympathetic if they do? And when the very symptom of depression is a total lack of motivation, how would you raise the energy to ask for help in the first place?

Wind up with a psychosis like schizophrenia or bipolar and it only gets worse; now your condition not only ruins your own life, but actively drives people away from you – raging paranoia and unpredictable outbursts are not great ways of meeting people. And just imagine if you were born with a developmental condition like Downs Syndrome? You never even had a chance.

That’s the real bastard of mental illness that in many cases makes them worse than even the most severe physical conditions; they’re not socially acceptable. We as a society know how to deal with a physical injury. Hell we’ve been dealing with them before we were even human – they’re a natural risk for any living thing. Someone with a serious injury or illness may well be out of the ordinary for us, but we know what to do and we’re fine with that. Sign the cast, send them flowers, visit them in hospital, and in extreme cases, mourn for them at the funeral.

But mental illnesses? Most of us not only have no idea what to do about those, the very symptoms of the illness actively clashes with our social norms.

  • Someone who can’t get out of bed for weeks? We have a name for that: ‘lazy’.
  • Someone goes to pieces in stressful situations? They’re ‘weak’, ‘useless’, ‘cowardly’.
  • Someone muttering on the train or flying right off the handle for no reason? ‘Retarded’, ‘psycho’, ‘freak’.

It doesn’t matter that we know their conditions probably aren’t their fault, or that they’re probably not a danger to us personally – they’re behaving in ways that clash harshly with how we think people, even sick people, should behave. It’s unproductive, it’s not helping to fix their condition or heal their illness, and let’s be honest, it freaks us right out. How can you trust someone who isn’t in control of their own perceptions?

Is it any wonder then, that the first reaction most of us have to a clearly mentally ill person is to make ourselves scarce? To back away quietly so as not to draw attention and seek out slightly less depressing/distressing/potentially explosive company?

And can you really blame us?

The research shows that good social support structures (in tandem with professional care) are extremely important for a victim’s recovery and/or management of a mental illness. But when providing this support means hanging around someone who, practically by definition makes you uncomfortable, sad or even unsafe, is this a reasonable thing to ask of us?

This might sound callous, but consider the simple numbers of the situation: is it really reasonable to ask a group of people to lower their quality of life to support just one individual? An individual who, depending on the illness they suffer, may never actually be able to recover?

On a purely numbers basis, wouldn’t it be better overall to contain the suffering to just the one person?

Long-time readers will recognise Utilitarianism at work here: ‘the greatest good for the greatest number’ means that a minority, not matter how righteous, cannot be allowed to compromise the needs of the majority. Why should we allow the mentally ill to inflict suffering on the broader community, just to help them manage their conditions? Their illness may well not be their fault, but they certainly aren’t ours! Where is the justice in making us take responsibility and bear the burden of something we did not cause?

Why not simply leave them to look after themselves? Why pour good resources into broken people, rather than just focus on those we know will recover? Sure it’s pretty brutal, but it’s the same logic that makes us change carriages to get away from the crazy guy on the train: I don’t want to be part of this. I don’t want to be responsible for this. I don’t want this near me.

Make it go away.

Of course, long-time readers WHO WERE PAYING ATTENTION will know that this is a great example of bad Utilitarianism at work. Arguing for ‘the greater good’, only lead to justice if a superior alternative is not available. And if the option on the table is ‘abandon the mentally ill to look after themselves’, then yeah, you best believe there is a superior alternative.

As with most injuries of diseases, mental illnesses are best handled through prevention where possible, and early detection and treatment otherwise. Believe it or not, most psychological conditions can be effectively managed through a combination of therapies, medication and, yes, social support. Getting these conditions early lets us have our cake and eat it to, helping victims regain control of their lives and decreasing the burden on those around them at the same time.

But you know what doesn’t help with prevention and early detection? Stigma – specifically the same stigma that makes us move carriages on the train to get away from ‘the crazy guy’. Not so much because of how it makes the victims feel, but because it actively prevents the rest of us from seeking help before a lurking condition goes full blown, or admitting to it when it does.

Remember how uncomfortable you felt around the crazy guy on the train? How his very presence made you uncomfortable and wary? How you actually chose to move away from him rather than endure those feelings? Then how do you reckon you would react if you started to experience the same symptoms? What if you started hearing voices or seeing things? What if you suddenly started experiencing random mood swings or violent, explosive tempers? Or what if you just started feeling extremely anxious for no apparent reason?

Would you go and see a shrink? Discuss it with your partner, your family, your friends? Or would you just try to power through it? ‘Get over it’ and pretend it wasn’t happening? And if that didn’t work, would you seek professional help, or would you maybe try to manage it yourself? Maybe stay at home more often? Maybe have a few beers to calm down?

And if, despite everything you tried, it still kept getting worse, how long do you reckon it would take before you found yourself on a train, struggling desperately to keep the feelings under control – and you realised that someone just moved away from you?

There’s no denying that mental illness sucks. But hiding from it, in ourselves or others, just makes it suck all the harder.

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3 thoughts on “The Ethics Of… Crazy People

  1. Pingback: The Ethics Of… Circumcision | The Ethics Of

  2. Pingback: The Ethics Of… Ignoring the Homeless | The Ethics Of

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