COMMENTARY

The Return of the Alienist

James L. Knoll IV, MD

Disclosures

May 10, 2013

In This Article

An Alienist Reincarnated

A national public opinion survey conducted in the wake of the Newtown shootings found that almost 50% of respondents believed that "people with serious mental illness are more dangerous than members of the general population," and more than 70% said they "were unwilling to have a person with a serious mental illness as a coworker or a neighbor."[20]

One possible consequence of linking gun violence with mental illness in the public and political arena is that society will naturally want to achieve greater distance from persons with severe mental illness, and possibly from those with less severe forms of mental illness as well. Indeed, this sentiment would seem to be entirely in accord with the public surveys. To paraphrase the survey outcome: "Treat them, but keep them away from us." Whereas homelessness is still too near and within sight, prisons are typically far away, and their inhabitants virtually invisible.

Is not the increasing influx of persons with severe mental illness into correctional facilities a clarion call to psychiatry to improve its treatments, methods, and advocacy efforts? Does it not suggest a regressive trend? The reshackling and alienating of patients– not the present media-driven, politicized, and specious association of gun violence with mental illness -- should serve as the stimulus for our efforts to improve mental healthcare.

At this point, it becomes difficult to escape the conclusion that society has chosen to achieve social distance by recreating the mental health system behind bars. Correctional facilities have and will continue to be forced to transform themselves into our new asylums.[21,22] I say this as just one of an entire new generation of psychiatrists who have been specifically trained to practice in prisons. I'm an echo from the past, sending a message into the future. I'm an alienist reincarnated.

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