I have to agree with Ruth. Randomly speaking we've become a society of individuals who don't believe or take the consequences of their actions. It's someone else's fault. They cause me to..... "I'm fat because McDonalds' food is delicious and cheap and easy to get". Etc. State Hospitals had their purpose and fulfilled it, not always in the most humane or efficient way, but it was a place for people to be with others like them. Symptoms were treated. If I choose not to take my antihypertensives, statins, etc I can't blame the doctor for not forcing or explaining the consequences better. Take your meds people! As far as this case goes I'm not sure if anyone recognized his illness or encouraged him to seek therapy. (Pretty difficult to over look this type of behavior). If you aren't doing the right thing, taking medications, choosing to stop x or y or z, then you need to accept the consequences. I believe his illness was severe and when his behavior first came to light why wasn't he commanded to be treated?
I admire Dr. Satel's work, but I think in this case our sympathies have moved to much in favor of perpetrators of crime at the expense of the victims and their families. Even when a murderer is mentally ill, and assuming the mental illness actually plays a part in the murder (not always a clear cut case!), is there not something strange about first making sure we are not cruel to the murderer instead of making sure the victimized family receives some kind of resolution and peace?
We must consider the safety of society as well. While it is true that those with mental illness are often disproportionately victimized, it is also true that a sub-segment of severely mentally ill people are extremely dangerous, contrary to popular belief.
Edit: I keep thinking about the families of victims and the psychological price they pay knowing that someone who murdered their loved one is still out there somewhere. Perhaps I'm just a punitive guy, but in my book, if you murder someone, your life if basically forfeit.
While I absolutely appreciate seeing many sides of 'bio medicine' topics , and also having experience with persons with severe mental illness or those caring for those with MI (we have failed in so many ways in this area of medicine), to be included in the Sensible Medicine sub stack I would expect to find more bio-data shared. In this piece, I would have appreciated information not limited to but also including the criteria of how an MI diagnosis is determined outside of the courts, what resources are available for those with MI, statistics on MI in prisons versus outside, overall providing us readers with data so that we can understand better the opinion and how it is manifesting. Individual situations are very helpful in giving color to serious issues, medical or otherwise, but without more data it is hard to find grounding in the positions being posited.
I've never understood why we exempt people from prison or the death penalty on the basis of insanity unless their insanity is temporary and treatable. If a sane person would not have gotten the death penalty in their situation, I wouldn't push for it either, but permanent insanity is not an excuse to me.
The purpose of prison is two-fold:
1. To protect society and
2. To encourage repentance.
If someone was temporarily insane and, on the proper meds, is dedicated to living a non-violent life, I'm all for letting them free and making sure they take their meds. But if someone isn't treatable, I'm not sure how they can repent, and you have to keep them locked up (prison or asylum - your choice) to protect society.
The person you're describing is clearly a danger to others and themselves. They pulled out their own eyeball and ATE IT??? I don't believe in euthanasia and would not advocate for euthanasia, but I definitely don't think you're doing this person a favor by exempting them from the death penalty. For sure, you are increasing the risk of the guards and other inmates. If someone merits the death penalty based on their crimes, and doctors have tried everything possible to heal them, then the death penalty may actually be the least cruel punishment.
If we as a society say that a person should never be freed because they are too dangerous then we should execute them. You only prolong the suffering of the mentally ill and the taxpayer. It cost between $35,000 - $100,000 a year per prisoner depending on where they are housed. We kill nearly 800,000 innocent children via abortion but a mentally ill killer should be saved. I vote no and we should speed up the process. 10, 20, 30 years of taxpayer burden is such as waste of resources.
So how do we "fix" or even help a mentally ill person at this level? Society struggles with helping anxiety/depression and PTSD. We take someone so delusional that they kill their family, eat their own eye, and then lock them up forever? If that were me, I'd take the death penalty. Some things are worse than death. I also don't think "murder is murder". Life isn't black and white.
This is a tough question. How do you determine who is more mentally ill than another? To me, the death penalty was introduced not so much as to be a tit for tat outcome, but to dissuade others from committing criminal acts. But this would not apply to the mentally ill at all...many would not likely reason this out. Back to square one.
What determines cruel and unusual punishment? I would say mRNA substances injected into humans that leave them incapacitated highly qualifies, or even dead, more so. Are the perps of this operation going to feel the death needle? Murder is murder. Some get away scott free and others are taken out to the woodshed.
Actually reading the comments here has made me feel like that. Of course we shouldn’t execute the mentally ill, but I’m against executing anyone no matter their crime. How Christians square thou shalt not kill with being pro death penalty is beyond me.
Perhaps it’s more accurate to say our moral direction is less correct than ever. We fail to value life on a basic level, so it is no surprise that we have trouble with more complex moral issues.
I’m more sympathetic to the death penalty in this case than many other cases, in that, this person, while innocent of being born with severe mental illness, is a threat to society and he clearly could not survive on his own, apart from society on some island or otherwise. While tragic, taking his life is the greater good for society.
100%! it makes zero sense. in fact, im not sure thr even is a valid argument for the death penalty. eugenics is the *only* reason to argue for this kind of policy (that is valid.) in which case it should not just be Ltd to the "classically" severely mentally ill. gr8 piece. _JC
Rather than look at the small number of mentally ill people on death row, let's start with the bigger picture. Approximately 65% of people in jails/prisons are mentally ill. At some point in the 80s, lawyers thinking they were advocating for the mentally ill were successful in efforts to shut down many large facilities for MI adults and in the lawyers' utopian dreams, these people would be welcomed into the community in group homes. Many instead were welcomed by family members who were either looking to collect funds or just inadequate to care for their MI relative. Some have been used by criminal others to facilitate criminal activity, and some just languish with relatives unable or unwilling to advocate for them. The lawmakers who saw an opportunity to save a lot of money by closing MI institutions need to regroup and acknowledge that whether it's a prison or an MI facility, the money will be spent, and then open facilities where MI people aren't taken advantage of by criminally minded people. If there are safe placements that are secure for MI people to go when in crisis, and laws are restored that enable placement prior to a crisis without extreme legal proceedings, we will have a safer society and will hopefully have far less need to discuss MI persons on death row.
Is this really a question of medicine (sensible or otherwise)?
The death penalty is “an attack on the inviolability and dignity of the person” and should be deemed “inadmissible” in all cases, regardless of mental status.
I agree this is not the forum for random political advocacy and various world-improving missions.
Continuing down this path leads to lying about a pandemic to prevent the people from electing the wrong guy because he's a nazi. If you have power, audience, political agency, you are obligated to use it "for good," right?
No, you have a more complicated obligation, to stay within what you profess to your neighbors to be, so that they'll continue trusting you with the power you would not otherwise have.
I can understand there could be something uniquely offensive about the death penalty because of doctors' ethical self-conceptions, for example not making moral or personal judgements about who is more deserving of medical treatment, treating prisoners, so I was only a little surprised to see this posting. It's less disturbing if I imagine the intended audience to be only other doctors.
Thanks to both of you for the comments. This is the description of Sensible Medicine:
"Sensible Medicine is a shared substack featuring the voices of leading physicians, scientists and thinkers. We aim to showcase a range of ideas and opinions about all things bio-medicine.
The rules of Sensible Medicine are simple. If an article is signed -the Editors, then all of the people listed below, our editorial board, take ownership of it. If an article is signed by an individual, then they alone take ownership of it. Our goal is a showcase a range of ideas and opinions, and we may disagree with each other. Once upon a time, that was how progress occurred. We hope to return to a vigorous dialog."
This is an opinion piece, with an argument. Could have been written by a physician or not. I thought it fit as has to do with how we "treat" people with an illness. One could argue the other side (some are in comments and we would welcome an article).
This clearly falls under the broader scope of psychiatric medicine insofar as we are debating whether those with serious mental illness might be different enough from the normal population in some way that they warrant different legal treatment. Thoughtful psychiatrists are in a good position to talk about this issue given clinical experience. But of course anyone with sensible ideas could write the pro/con side of this topic since the ideas are what matter, not the credentials. This is a debatable topic, hence it is seems appropriate for Sensible Medicine.
So far, "Sensible Medicine" has given voice almost exclusively to medical practitioners. That is despite the recognition that groupthink in medicine is a serious problem. How will groupthink be recognized by insiders?
Absolutely true. I promise you we are not declining to publish dozens of essays written by non-physicians. We can only publish things that are submitted...
Would the same argument apply to pit bulls who disproportionately kill and maim members of society but of course suffer from lack of reasoning processes and understanding of the consequences of their actions? Should the dog in question be put down or housed in secure kennels for the rest of its natural life? I am not sure what is presented in this piece is an argument since it seems to not understand the problem from a substantive law basis or even philosophical basis. It also deeply confuses the nature of a fiduciary duty of licensed physicians when dealing with those unable to provide informed consent. No substantive argument exists either for or against the death penalty and claims of the moral high ground are empty posturing in this debate. The bizarre juridical idea that those who can show “by a preponderance of the evidence” standard that they are insane “enough” to escape the death penalty begs for abuse. There may be meaningful reasons that society chooses to exempt certain members from the death penalty but diminished capacity is not one of these. All one has to do is see how those who are evil can also be defined as “insane” and having a diminished capacity to differentiate right and wrong. Someone with high reasoning skills but lack of empathy or concern for the suffering of others is also “insane” but we do not say that they should escape the death penalty. The idea of “reason” is playing a very odd role here.
I have to agree with Ruth. Randomly speaking we've become a society of individuals who don't believe or take the consequences of their actions. It's someone else's fault. They cause me to..... "I'm fat because McDonalds' food is delicious and cheap and easy to get". Etc. State Hospitals had their purpose and fulfilled it, not always in the most humane or efficient way, but it was a place for people to be with others like them. Symptoms were treated. If I choose not to take my antihypertensives, statins, etc I can't blame the doctor for not forcing or explaining the consequences better. Take your meds people! As far as this case goes I'm not sure if anyone recognized his illness or encouraged him to seek therapy. (Pretty difficult to over look this type of behavior). If you aren't doing the right thing, taking medications, choosing to stop x or y or z, then you need to accept the consequences. I believe his illness was severe and when his behavior first came to light why wasn't he commanded to be treated?
I love the perspective of social topics from a psychiatric point of view by psychiatric providers. Thank you for the article.
I admire Dr. Satel's work, but I think in this case our sympathies have moved to much in favor of perpetrators of crime at the expense of the victims and their families. Even when a murderer is mentally ill, and assuming the mental illness actually plays a part in the murder (not always a clear cut case!), is there not something strange about first making sure we are not cruel to the murderer instead of making sure the victimized family receives some kind of resolution and peace?
We must consider the safety of society as well. While it is true that those with mental illness are often disproportionately victimized, it is also true that a sub-segment of severely mentally ill people are extremely dangerous, contrary to popular belief.
Edit: I keep thinking about the families of victims and the psychological price they pay knowing that someone who murdered their loved one is still out there somewhere. Perhaps I'm just a punitive guy, but in my book, if you murder someone, your life if basically forfeit.
While I absolutely appreciate seeing many sides of 'bio medicine' topics , and also having experience with persons with severe mental illness or those caring for those with MI (we have failed in so many ways in this area of medicine), to be included in the Sensible Medicine sub stack I would expect to find more bio-data shared. In this piece, I would have appreciated information not limited to but also including the criteria of how an MI diagnosis is determined outside of the courts, what resources are available for those with MI, statistics on MI in prisons versus outside, overall providing us readers with data so that we can understand better the opinion and how it is manifesting. Individual situations are very helpful in giving color to serious issues, medical or otherwise, but without more data it is hard to find grounding in the positions being posited.
Very interesting read.
I've never understood why we exempt people from prison or the death penalty on the basis of insanity unless their insanity is temporary and treatable. If a sane person would not have gotten the death penalty in their situation, I wouldn't push for it either, but permanent insanity is not an excuse to me.
The purpose of prison is two-fold:
1. To protect society and
2. To encourage repentance.
If someone was temporarily insane and, on the proper meds, is dedicated to living a non-violent life, I'm all for letting them free and making sure they take their meds. But if someone isn't treatable, I'm not sure how they can repent, and you have to keep them locked up (prison or asylum - your choice) to protect society.
The person you're describing is clearly a danger to others and themselves. They pulled out their own eyeball and ATE IT??? I don't believe in euthanasia and would not advocate for euthanasia, but I definitely don't think you're doing this person a favor by exempting them from the death penalty. For sure, you are increasing the risk of the guards and other inmates. If someone merits the death penalty based on their crimes, and doctors have tried everything possible to heal them, then the death penalty may actually be the least cruel punishment.
Not a medical question.
If we as a society say that a person should never be freed because they are too dangerous then we should execute them. You only prolong the suffering of the mentally ill and the taxpayer. It cost between $35,000 - $100,000 a year per prisoner depending on where they are housed. We kill nearly 800,000 innocent children via abortion but a mentally ill killer should be saved. I vote no and we should speed up the process. 10, 20, 30 years of taxpayer burden is such as waste of resources.
So how do we "fix" or even help a mentally ill person at this level? Society struggles with helping anxiety/depression and PTSD. We take someone so delusional that they kill their family, eat their own eye, and then lock them up forever? If that were me, I'd take the death penalty. Some things are worse than death. I also don't think "murder is murder". Life isn't black and white.
This is a tough question. How do you determine who is more mentally ill than another? To me, the death penalty was introduced not so much as to be a tit for tat outcome, but to dissuade others from committing criminal acts. But this would not apply to the mentally ill at all...many would not likely reason this out. Back to square one.
What determines cruel and unusual punishment? I would say mRNA substances injected into humans that leave them incapacitated highly qualifies, or even dead, more so. Are the perps of this operation going to feel the death needle? Murder is murder. Some get away scott free and others are taken out to the woodshed.
Functions of the death penalty other than deterrence:
1) Permanent removal of a highly dangerous person from society
2) The psychological resolution to the victim's family knowing that justice was served.
Pieces like this make me think that we have lost our moral compass in how we treat fellow human beings.
Actually reading the comments here has made me feel like that. Of course we shouldn’t execute the mentally ill, but I’m against executing anyone no matter their crime. How Christians square thou shalt not kill with being pro death penalty is beyond me.
Perhaps it’s more accurate to say our moral direction is less correct than ever. We fail to value life on a basic level, so it is no surprise that we have trouble with more complex moral issues.
I’m more sympathetic to the death penalty in this case than many other cases, in that, this person, while innocent of being born with severe mental illness, is a threat to society and he clearly could not survive on his own, apart from society on some island or otherwise. While tragic, taking his life is the greater good for society.
100%! it makes zero sense. in fact, im not sure thr even is a valid argument for the death penalty. eugenics is the *only* reason to argue for this kind of policy (that is valid.) in which case it should not just be Ltd to the "classically" severely mentally ill. gr8 piece. _JC
Rather than look at the small number of mentally ill people on death row, let's start with the bigger picture. Approximately 65% of people in jails/prisons are mentally ill. At some point in the 80s, lawyers thinking they were advocating for the mentally ill were successful in efforts to shut down many large facilities for MI adults and in the lawyers' utopian dreams, these people would be welcomed into the community in group homes. Many instead were welcomed by family members who were either looking to collect funds or just inadequate to care for their MI relative. Some have been used by criminal others to facilitate criminal activity, and some just languish with relatives unable or unwilling to advocate for them. The lawmakers who saw an opportunity to save a lot of money by closing MI institutions need to regroup and acknowledge that whether it's a prison or an MI facility, the money will be spent, and then open facilities where MI people aren't taken advantage of by criminally minded people. If there are safe placements that are secure for MI people to go when in crisis, and laws are restored that enable placement prior to a crisis without extreme legal proceedings, we will have a safer society and will hopefully have far less need to discuss MI persons on death row.
Disagree.
I can think of one purpose. This person will no longer be a threat to anyone ever.
Is this really a question of medicine (sensible or otherwise)?
The death penalty is “an attack on the inviolability and dignity of the person” and should be deemed “inadmissible” in all cases, regardless of mental status.
I agree this is not the forum for random political advocacy and various world-improving missions.
Continuing down this path leads to lying about a pandemic to prevent the people from electing the wrong guy because he's a nazi. If you have power, audience, political agency, you are obligated to use it "for good," right?
No, you have a more complicated obligation, to stay within what you profess to your neighbors to be, so that they'll continue trusting you with the power you would not otherwise have.
I can understand there could be something uniquely offensive about the death penalty because of doctors' ethical self-conceptions, for example not making moral or personal judgements about who is more deserving of medical treatment, treating prisoners, so I was only a little surprised to see this posting. It's less disturbing if I imagine the intended audience to be only other doctors.
Thanks to both of you for the comments. This is the description of Sensible Medicine:
"Sensible Medicine is a shared substack featuring the voices of leading physicians, scientists and thinkers. We aim to showcase a range of ideas and opinions about all things bio-medicine.
The rules of Sensible Medicine are simple. If an article is signed -the Editors, then all of the people listed below, our editorial board, take ownership of it. If an article is signed by an individual, then they alone take ownership of it. Our goal is a showcase a range of ideas and opinions, and we may disagree with each other. Once upon a time, that was how progress occurred. We hope to return to a vigorous dialog."
This is an opinion piece, with an argument. Could have been written by a physician or not. I thought it fit as has to do with how we "treat" people with an illness. One could argue the other side (some are in comments and we would welcome an article).
Thoughts?
This clearly falls under the broader scope of psychiatric medicine insofar as we are debating whether those with serious mental illness might be different enough from the normal population in some way that they warrant different legal treatment. Thoughtful psychiatrists are in a good position to talk about this issue given clinical experience. But of course anyone with sensible ideas could write the pro/con side of this topic since the ideas are what matter, not the credentials. This is a debatable topic, hence it is seems appropriate for Sensible Medicine.
"Sensible Medicine is a shared substack ... about all things bio-medicine."
how is this connected to biology or medicine?
It's purely a non medical issue. Strictly a legal and ethics issue, no matter which side we're on.
So far, "Sensible Medicine" has given voice almost exclusively to medical practitioners. That is despite the recognition that groupthink in medicine is a serious problem. How will groupthink be recognized by insiders?
Absolutely true. I promise you we are not declining to publish dozens of essays written by non-physicians. We can only publish things that are submitted...
A limiting factor could be small overlap between acceptable discourse and what outsiders care to discuss.
Would the same argument apply to pit bulls who disproportionately kill and maim members of society but of course suffer from lack of reasoning processes and understanding of the consequences of their actions? Should the dog in question be put down or housed in secure kennels for the rest of its natural life? I am not sure what is presented in this piece is an argument since it seems to not understand the problem from a substantive law basis or even philosophical basis. It also deeply confuses the nature of a fiduciary duty of licensed physicians when dealing with those unable to provide informed consent. No substantive argument exists either for or against the death penalty and claims of the moral high ground are empty posturing in this debate. The bizarre juridical idea that those who can show “by a preponderance of the evidence” standard that they are insane “enough” to escape the death penalty begs for abuse. There may be meaningful reasons that society chooses to exempt certain members from the death penalty but diminished capacity is not one of these. All one has to do is see how those who are evil can also be defined as “insane” and having a diminished capacity to differentiate right and wrong. Someone with high reasoning skills but lack of empathy or concern for the suffering of others is also “insane” but we do not say that they should escape the death penalty. The idea of “reason” is playing a very odd role here.
The obvious answer to your question is yes we should absolutely ban and remove pit bulls from our society.