What do consumers really think about assisted outpatient treatment?
by J. Nelson Kull III
I would like to discuss two issues: political correctness and paternalism. These issues are on my mind as a result of the debate in Florida about outpatient commitment or as it is now called, assisted outpatient treatment.
I began responding to questions about this issue at least a year ago, maybe two. I spoke against it vehemently at a focus group of advocates and government officials, including state legislative staffers. I talked about all the usual reasons for opposing it. It was stated at that meeting that it would criminalize the mentally ill. It would interfere with trust between consumers and providers. It would clog up our system by giving priority to court-ordered patients so that they would displace people coming into the system from the traditional civil system. I went on to talk about constitutional rights. I may have even quoted one of the founding fathers:
"Those who would trade freedom for security deserve neither freedom nor
People present at some of those discussions accused me of using high rhetoric. Looking back at it, I may have.
I have now read in excess of 300 pages on the topic. Here are some of my observations: Many, if not most, states have some type of outpatient commitment law. Yet the problems predicted above do not seem to be apparent. Most people in most states never have cause to get involved in outpatient commitment. They probably do not even know what their state law says. I find it hard to understand how, if the above problems were true, why do we hear so little about them?
Another observation: When I began talking about this issue with my fellow Pathways' members and other consumers, it became apparent that they either believed that the law already existed, in some seldom-used form, or that it should.
I was so surprised that I took some informal polls. Pathways serves 50 to 60 consumers a day. On one day when 22 people were present, I explained the topic to the best of my ability and asked them to vote. Twelve people supported outpatient commitment, seven opposed, with the remainder abstaining. One of the abstainers said he wanted to change to pro, but he is not included in that category.
The next day I polled 10 consumers at People, Inc., a peer support group. All 10 voted for the pro position.
A couple of days later, I polled 43 consumers at Lakeside Alternatives, our local community provider. Twelve polled in favor, one opposed, and the rest chose not to vote.
Some more observations. This is an issue that people are having much difficulty sorting out. A lot of anger is already being expressed. It is sad when people start questioning one another's motives and integrity. This often comes in the form of attacking how the other side got their results and their motives.
I will note that both sides have been guilty of this. However, the traditional consumer advocates spend more of their time arguing against the other side's methodology and less giving examples of actual current events that result from the proposed policies. On the other hand, the supporters of outpatient commitment stress events in the news instead of scientific studies.
What I find really interesting is something that at first seems counterintuitive (science talk for "not what one expects," or different from what common sense would have one expect). What I am talking about is the difference between what people I call the "consumer elites or the consumer leadership" and the people whom they are supposed to serve and represent. It has often surprised me that people like this who are always talking about tolerance, diversity, and individualism, are often the most heavily invested in political correctness.
Some of these people have actually said to me that they will not allow the use of language that is not "person first." They seem to believe that they have the right to control speech as a method of controlling thought, and I assume reality. To me the best definition of an ideologue is a person who is determined to see reality in light of his/her ideology, instead of his/her ideology in light of reality.
What is offensive is censorship in American society, especially by people who wax eloquently about human rights and freedom of expression. These people claim to be protectors of diversity and the right to be different. They would no doubt describe themselves differently, but like all who support censorship as serving a special purpose. The first principle of censorship is that the ends justify the means. Most wrongs begin with this predicate.
Political correctness in its true and extreme form is a type of paternalism. That is, one American telling another what they can do or say for their, and hopefully others, good. Those who have the right to censor are often self-appointed, or appointed by like-minded who trade legitimacy for support.
I have attended national conferences in which I was disappointed by the lack of real diversity. There were people of different races, religions, national origin, and first languages present. However, too many people talked like tape recorders. They all seemed to be saying the same mantra. The professionals, families, government, and drug companies were all wrong and the consumers are always right, provided they conform to political correctness. There were no dissident views. There was very little debate about really serious issues where people would have legitimate and serious disagreements such as outpatient commitment.
I personally like a good disagreement. Many of my best friends introduced themselves by screaming at me. Hopefully, some of you will do the same. I find it suspicious when everyone sounds like the same tape recorder. It is not healthy. It reminds me of those old films about communist party meetings where everyone always voted unanimously.
Obviously, I am using an extreme example, but you get the idea. The forces of political correctness can never understand what the founding fathers intended. The founding fathers never intended to protect the truth. They were far too clever for that. What they intended was to create a free market of ideas where conflicting ideas could compete with free access to the media and the public. The ultimate predicate of democracy is that the average citizen is not a fool, and that if allowed to hear both or all sides of an argument will be able to discern the truth or the most truthful.
If you believe in freedom, you must first believe in free thought and that means no censorship. If you can be trusted with the truth, then so can everyone else. The market place of ideas works better when left open and unregulated by the politically correct or government. Finally, if you believe in your cause, then censorship works against you. You do not need its protection and it gets in the way of projecting your own message with independent credibility.
[Mr. Kull is President, Pathways Drop-In Center, Inc., and a nationally-recognized consumer advocate. He encourages people to respond and comment on his article by email at firstname.lastname@example.org <mailto:email@example.com>.]
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