In the article Bioethics and the Marginalization of Mental Illness, Janet Nelson argues that bioethics needs to tackle the mental illness problem in America. Nelson explains how bioethics has mostly neglected the field of mental health in recent years, but the need to take care of people who are underrepresented and cannot stand up for themselves nonetheless falls within its scope. This is why it is imperative for Nelson that bioethics addresses mental health crisis.
Nelson holds that one of the main premises of bioethics is the principle of autonomy. The principle of autonomy asserts the self-sufficiency and rights of the individual. Being self-sufficient and having rights is what it means to be autonomous. It means to be an individual that can make their own choices and take responsibility for those choices. Nelson claims that it was the principle of autonomy that first got the bioethicists into the mental health field back in the 60s and 70s because of how patient’s rights were at that time so limited. Doctors were given wide latitude in their care of patients, for example, in ordering treatments and confinement, and because the principle of autonomy had not played a guiding role in the practice of mental health, the patient had little choice if they were to seek treatment or not. People were just committed to hospitals for life, and there could be all kinds of things done to them against their will such as electroshock therapies and lobotomies. She explains how it was the bioethicists that came to rescue of these patients. It was the bioethicists who were able establishing the principle of autonomy in the mental health field. Establishing the principle of autonomy gave patients their much-needed rights.
Nelson explains how the bioethicists have mostly stayed out of the mental illness debate since the deinstitutionalization of the mentally ill because the principle of autonomy was fully established giving patients more rights than they once had, but Nelson proposes that there is a solution to mental illness that bioethics to work on today. This solution is to take on the social aspect of mental illness through stigma and religion.
Mental illness is a serios crisis in America. Nelson explains how by the year 2020 the majority of people who will be on disability will be on it for mental illness. Her approach to solving this problem is how bioethicists will address mental health through social and cultural aspects. Nelson tells how there are stigmas in society, some brought by religion, and some brought by the uneducated public, that the bioethicists need to be the ones to address.
She writes how historically religion has played a big part in the stigma of mental illness as well, but through religion people can get some relief. She tells how when people were crazy, they were seen as possessed by evil spirits, or there was some curse from God. This was one of the only explanations people had for mental illness at certain times in human history; therefore, a mental illness was a punishment from God. This means that when it comes to religion, and the religious, if you are mentally ill, you are evil in some way. This is a big problem with society, and it goes to the stigma of the individual. God is punishing someone if they are mentally ill. This makes it so people who are religious do not seek treatment, and they are not able to have any type of acceptance of themselves because it goes to a direct challenge of self-worth if God is punishing them for who they are.
Nelson then goes onto propose how through the morality of religion people can get such things as love and acceptance. Nelson argues one of the answers the bioethicists should seek is a religious solution to the mental health crisis. All religions speak of universal principles that are about helping each other. They are about “Loving thy neighbor,” or doing such things like volunteering in the community and showing compassion for those who are less fortunate. This is one of the social aspects of the bioethical approach that Nelson says should be taken. Nelson is arguing how people who are mentally ill should seek some type of religious solution for their mental illness because of the universal principles that Christianity preaches.
The other social aspect that the bioethicists should take on is stigma according to Nelson. In society there are all kinds of misconceptions about what mental illness is, and such things as how dangerous mentally ill people are. Some people have the notion that they are going to be attached by people that are mentally ill, so people who are insane are dangerous. The overwhelming majority of people who are mentally ill are not violent. This is a total misconception, and no one wants to be labeled with this stigma. Misconceptions such as these give a direct threat to someone’s self-worth.
Nelson explains how these misconceptions of mental illness make it so people are less likely to seek treatment because of how society judges people who are taken as mentally ill. There is misinformation, and this misinformation gets people to not want to address the problems that they have. No one wants to think they are defective because that challenges their self-worth; therefore, people do not seek treatment, and when they do not seek treatment they suffer even more.
My problem with Nelson’s idea is having the bioethicist approach the individual suffering from mental illness and trying to relate to them through religious issues. I agree there is a stigma that needs to be overcome in the communities, but to have the bioethicists approach the individuals suffering from mental illness and have some type of proselytization would just make the situation worse. The sufferer’s relief cannot be contingent upon their spiritual beliefs. Making their relief contingent on their own spiritual beliefs just impose even more of a burden on the sufferer’s already trouble mind. They will be thinking there is a motive of the bioethicist besides just what is ethical, and what is truly ethical is for the bioethicists to do their very best to relieve the burden of the sufferer for no other reason than they are suffering. It is the bioethicist that needs to take the religious principles and apply them to themselves in a way that will abate the minds of the mentally ill people. The bioethicist will do this by practicing the principles of Christianity themselves.
The reason the bioethicists needs to be the ones the practice the Christian principles is because the bioethicists are the ones who are claiming to be virtuous, and as Socrates said, “Virtue is another branch of knowledge, to know is to do.” The bioethicists are the ones who are claiming to have the ethical solution, and the way the bioethicist should do this is by advocating for laws and political policies which will destigmatize mental illness and make such things as treatments more acceptable and more affordable through legislation.
The principles of any religion comes down to common sense. They are simple premises which just need to be practiced and fulfilled. The problem is getting people to truly understand what the scriptures say, and then practice and fulfill those scriptures. It is the virtuous who are the ones who will understand the true meaning of the scriptures and be willing to apply those principles to their life. Once they apply the true meaning to the foundations of their life, they will abate the suffering of the mentally ill. They will be able to apply those principles to the people’s lives around them. The bioethicists have a unique opportunity because they are the ones who claim to have the virtues and understanding of what actions are virtuous. They are the ones who have a true understanding of what is ethical, and by understanding what is ethical, they can take those religious principles of Christianity and help abate the sufferer’s mental illness.
Jesus states clearly in Mathew 25 36-40 how it is we should treat each other in any situation:
36 Naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me.
37 Then shall the righteous answer him, saying, Lord, when saw we thee an hungred, and fed thee? or thirsty, and gave thee drink?
38 When saw we thee a stranger, and took thee in? or naked, and clothed thee?
39 Or when saw we thee sick, or in prison, and came unto thee?
40 And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.
It is these verses which should be the guide of the bioethicists. It is these premises which tell us all how to treat each other. These verses clearly state that when someone is in need, it is our duty to help them. Nowhere in these verses does the King Jesus say the help we give one of our brothers depends upon their beliefs, or who’s God they are worshiping. Jesus does not say there is anything contingent our brothers need to be able to do in order for us to give them this help. It is up the bioethicists to practice these principles. It is up to the bioethicist to make sure their neighbor’s sickness is taken care of just like Jesus says should happen. For if we deny one of our brother’s help for their sickness, then we are denying Jesus! That is what it clearly states in this passage, and nowhere in these verses is the faith of one of our brothers brought up. That is why it is up to the bioethicists to practice these Christian principles, and the faith of the sufferer should not be a factor in any way!
If the faith of the sufferer is a factor, it will cause all kinds of complications. People who are mentally ill already have complications of perception, and if they feel as though the help they are going to be getting is dependent upon anything besides just the fact that they are suffering, it will trouble their minds even more. The best way to convert another to what a true solution is, is not proselytize, but just live by example. When people are known for doing the right thing, others will want what they have. If Nelson truly thinks Christianity is the solution, then just live by example! That example is to take on the problem of mental illness through the foundations of American society, which are the government policies!
The way the bioethicists should take on the mental health crisis in America is confronting the ones who have the capacity to fix the problem in the best and most efficient way. The ones who have this capacity are the politicians. The politicians can put forth legislation which will make mental health a priority in America. The politicians can even provide funding for treatments and make those treatments more affordable.
Regan was one of the main politicians that talked about the welfare Queen. This political myth made it so lots of funds were cut, and a lot those people who were in the institutions that the bioethicists played a role in getting rid of, are now homeless. If bioethics is going to make a dent in mental health crisis, they need to address the funding through politics. This is the main goal. The stigma is not just about the population’s misconception, but it is about the politicians and how they misinform the population about what it means to be mentally ill.
Regan clearly misinformed America when he created the myth of the Welfare Queen. This was a myth that goes directly against the verses in Mathew. To counter this myth means the bioethicists need to approach the monetary aspect through government policies. As is clearly stated in Timothy 6:10 in the Bible “The love of money is the root of all evil.” By demonizing the people on government assistance, people who truly did not have the ability to care for themselves completely, Regan was able to take those funds and turn them back into tax cuts of the 1%. Since Regan a lot of the stigma about illnesses of all kinds apply to someone’s sense of self-worth. Nelson explains about how with these stigmas we demonize other people. This is something Regan clearly did, and it is something all politicians have been willing to participate in since then because they saw how it worked. The bioethicists need to be the ones who take this on. They need to take it on in how Jesus commanded in Mathew. If Nelson wants to abate the stigma, and make it so mental health is treatable, she needs to see how it is the bioethicists who need to step up and be the chief advocates for laws and policies which will make treatments more affordable and more acceptable, and not to have that money redirected to other’s pockets, but put into funding which will abate the crisis.
It would be an impossible task for Nelson to get all the Christians in this country to practice what Christ taught. Let people go to church, but if we truly want change in the mental health field, it needs to be address through the politicians not the ethical standards of religion. The religious principles Nelson is writing about are universal but have never been practiced or understood all that well. What needs to happen is the bioethicists have to pressure the politicians on their political views. This can be done with things like laws that will lower the price of prescription drugs.
Another big part of the problem of treatment is the access to medications and the doctors which prescribe them. Saphris is a medication which is an anti-psychotic. It blocks the dopamine in the brain from getting to high. It is a D2 receptor site blocker. One of the problems with people who are psychotic is that their dopamine in their brain can be too high. It makes them delusional and can give them hallucinations. Saphris is a medication which keeps this from happening.
The problem with Saphris is how expensive it is, and most people who need a drug like Saphris are not autonomous individuals. They need the treatments, and the treatments are expensive. A 90-day prescription for Saphris without insurance is $2400.00 for the lowest dose, and the copayment with insurance for a three-month supply is approximately $300.00. In America we have an insurance system, even with the ACA, that is mainly employer based. That means in order for most people to get any type of medication, they need to be able to be self-supporting and autonomous to begin with.
If a patient is psychotic, they most likely will not be able to support themselves and hold down a job. Then we have medications, which are extremely cheap to make, whom the companies who make them do not do the research to create them, sell them for extremely high prices, and some of the medications that cost the most are medications which are for the mentally ill.
The bioethicists need to be the ones to advocate to the politicians in order to make drugs like Saphris more affordable. These drugs cost pennies to make yet are sold at an extremely unaffordable price. What could be done is just put taxes on the medications if they are sold at too high of a price. Congress has the power of taxation! “The power to tax is the power to destroy!” as the great Justice John Marshal said himself. There could be a law that makes so if the price is to high, then the company would not get any profit. The government would receive the full price! This would force the hand of the companies who make them to sell them at more affordable pricing. There could even be laws which would make it so all drugs are able to be sold as generic. This would reduce the pricing dramatically.
There also needs to be other legislation which opens up healthcare access to the mentally ill. It is not just the medication, but the clinics and the doctors which prescribe those treatments. The bioethicists need to be the chief advocators to get this type of funding passed through congress. These would be some of the first steps of what it would truly mean for the bioethicists to practice the virtues Jesus taught! “Or saw we thee sick, or in prison, and came unto thee.” This is what it truly means for the bioethicists to practice what is virtuous!
In the midterm elections of 2018 according to an article in Forbes written by Robert Pearl MD, Healthcare is the No. 1 Issue for Voters; A New Poll Reveals Which Issues Matter Most prescription drug prices are the number one issue. 58% of voters are more concerned with the ability to afford their medication. It is essential for the bioethicists to tackle this problem. The country is feeling it all around, and with the mentally ill, a lot of them do not have the advocacy for themselves that is necessary for them to live those autonomous lives. They need help. This help is something the virtuous cannot deny another who is suffering.
Nelson even explains about how the mentally ill are not really represented well in society, but the only way we are going to be able address this mental illness is through the funding and legislation. Stigma is a big problem, but the stigma is about being a self-supporting and self-sufficient individual. With appropriate treatments these people can become self-supporting and self-sufficient. That is what it means to truly have the principle of autonomy. With treatment people who are mentally ill can be autonomous, and they do not need to be institutionalized! But there needs to be legislation and funding which allows people who are mentally ill to afford treatment so that that autonomy can be reached for them.
No one enjoys government assistance. The government makes it so that if you are on it, you cannot do anything else. The minimum that people get is what they get just to survive, and with the mental health crisis the people truly have no choice. I was on SSDI for 15 year, and I was on it for mental health reasons. I did not get denied once with my disabilities. I was locked up and confined over and over, but today I am a productive member of society. They reason I am a productive member of society is because I have been able to overcome my disorders. What I truly want is anyone who is suffering from mental illness to the desperate point I was have the resources to overcome their mental illness and lead autonomous lives. This is what it truly means to be ethical. It means to love thy neighbor for no other reason than they are thy neighbor, and when one is sick and suffering, no matter who they are, they need to be helped. I was able to get help, and now I do accounting. I am autonomous in the bioethicist’s eyes. If we help people and give them a way out, they will be able to practice the principle of autonomy that Nelson holds so dear.
If the principle of autonomy is truly precious to the bioethicist, then they need to take on the politicians so that laws are passed for more affordable medications, and more types of treatment centers. Giving these people treatments is the only way they will be able to become autonomous in any way. The stigma Nelson is talking about is the problem, but she is saying it is just the misinformation of the social issue with the religious aspect. It is the politicians which have exploited these issues, and if bioethics is truly wanting to do something ethical, then the bioethicists need to take on the politicians, and have the politicians destigmatize mental illness. The bioethicists are the virtuous ones, and the only true way to be virtuous is to practice the principles that are laid out in Mathew, for when someone truly knows, then they will take the right action, and this is why the burden is on the bioethicists to be the chief advocator for the mentally ill in the American society, so the mentally ill will be able to live happy and autonomous lives.
Work Cited
Holy Bible – King James Version
Robbin, Leon, Greek Thought and the Origins of the Scientific Spirit
@1996 Routledge
Pearl, Robert, Healthcare is the No.1Issue for Voters; A New Poll Reveals Which Healthcare Issue Matter Most,
https://www.forbes.com/sites/robertpearl/2018/08/13/midterms/#7f25ab153667
Forbes 10/26/18
