Hacker News new | past | comments | ask | show | jobs | submit login
Shameful Profiling of the Mentally Ill (nytimes.com)
81 points by zzzeek on Dec 8, 2013 | hide | past | favorite | 49 comments



While I am sympathetic to the woman in the article, consider this: I am bipolar type one (the wilder type), ultra rapid cyclicity with psychotic features. I have had countless manic episodes complete with week-long total sleeplessness, hallucinations (visual and auditory) and delusions ranging from believing I was a CIA agent to thinking the CIA is out to get me. And I've done some really crazy, stupid things of.. questionable judgment, including sending very crazy faxes to the White House. Been hospitalized against my will more than once.

But now I take several drugs and am very well-treated, extremely "high-functioning" in the clinical sense. I've been married happily and nicely employed for years. While being manic is a lot of fun, I have no inclination to fall off the treatment wagon. I'm a success story basically.

But suppose I wanted a government job requiring security clearance to privileged information, should I be trusted given that I've been mentally healthy for several years, without incident?

I think the answer is no. Obviously.

Manic depressives are, relative to everybody else, prone to poor judgment, psychosis, run-ins with the law, suicide, not taking their medicines, unemployment, broken relationships and vices in general. Call me a self-hating nut but if I had a daughter (and parenthetically I do intend to have a kid, even though the kid has a fifty fifty chance of having the disease), would I want a bipolar boy to date my daughter, however well-treated he might be? Absolutely not.

So regarding my people, those with mood disorders (not just bipolar), while I appreciate the anti-discriminatory progressive stuff to make things easier for my people, between you and me, do yourself a favor, whether you are an employer, a money lender, an army recruiter, an immigration policy maker or a dad - or even a bipolar person yourself who's on the dating market, keep your distance from us manic depressives as too often we are bad news.

... Though we are more creative.


I'm glad your illness is well-managed. I had a bipolar friend who did not find a remedy.

At the same time, I wouldn't conflate "giving security clearance to bipolar person" with "allowing formerly depressed person to cross US borders."

Judging by the most-prescribed US drugs, depression is endemic in the US: http://www.rxlist.com/script/main/art.asp?articlekey=79509


I agree that some background checks need to be done for sensitive jobs, such as government jobs you describe. However the article is about a woman who was just crossing the border between Canada and US. This should have just been a formality, provided she wasn't carrying weapons or drugs, and the fact that the check was so thorough for this is what scares me the most in the article. Basically how long do we need to wait before the boarding agents scan our gmails and participation to any internet forum or social network to assert we are not gonna do crazy things once we have entered in the US?


I was writing more in response to whether or not "profiling the mentally ill" is a shameful thing or a good idea for society in general, not this woman trying to cross the border. Hers is a soft anecdote to use as context for an important question.


You don't become an 'officially mentally ill person' without serious profiling, anyway. The DSM-IV is nothing but a book of massive discrimination. One mans religion is another mans madness; and vice versa.

Make no mistake - we will never be rid of hatred and intolerance in the world for as long as we have industrialised mental health institutions producing their discriminating materials. Without discrimination, you can't "diagnose" someone as having a "mental disorder" that is "socially not accepted and therefore requires treatment".


Well, the answer to "is profiling the mentallly ill a bad thing to do?" would be: it depends of the circumstances. It can be legitimate for important things such as the ones you describe, and completely out of proportion for other things, such as crossing the Canada US border.


While I find your perspective to be insightful, I feel like you are doing a disservice to others with mental illness. I have Type II bipolar, and I am certainly prone to poor judgement and borderline delusional thought patterns in an untreated manic episode. However, I am on a medication regimen, that while not perfect, makes me effectively indistinguishable from a "normal" person in day-to-day interactions.

However, categorically suggesting that people should "keep [their] distance" from those with bipolar disorder seems like an extremely destructive message. As another commenter pointed out, there is a spectrum (as with any mental disorder), and I feel like sweeping generalizations of the societal risks of individuals with BP serve to exacerbate the issue of negative stigma surrounding the disease.

At what threshold of treatment efficacy should those with BP be allowed to participate equally and without stigma, in your opinion? Will it require some sort of brain stimulation to address the root cause? genetic engineering to attempt to prevent it? more advanced mood stablizers?

Treatment has progressed substantially from the heavily stigmatized 40s-80s already, and it's not unreasonable to assume that eventually it may become trivial to treat for the majority of cases. Were that to occur, should society still take your cautionary advice about these otherwise high-functioning individuals?


You are exactly the kind of crazy person that confounds America. (I say in jest, not meaning any offense)

In the wake of Newtown, a lot of states wanted to enact gun control measures, in my state, and in this example specifically, we wanted to enact gun control measures against the mentally ill.

As an advocate of the second amendment, I was initially for the idea, though against the majority of the bill, until I heard testimony from mental health professionals in the area who found the measures appalling, which was especially confusing to me, since they generally supported the bill, and specifically the ban on some semi-automatic rifles (referred to erroneously as assault rifles).

Through their testimony, I learned then that even of those diagnosed with potentially 'dangerous' mental disorders (mania, schizophrenia, etc.) that many of them were perfectly non-violent. Ultimately, my opinion was formed on the same grounds as most of my other opinions, which is that disorder or no, rights should not be curtailed without due process.

So, conceding that you shouldn't be eligible for top secret level positions, how do you feel about your second amendment rights? What about the right to vote? (And yes, I acknowledge that comparison often comes off as inflammatory, though I don't intend it to, and have had little good luck in explaining why it shouldn't.) -- And, so it's qualified up front, there's no wrong answer here.


Allowed to own a gun? Absolutely, positively not. Even if I were to assume a staunchly right wing position for myself for the sake of answering your question, no way should I be allowed to possess firearms. I don't have to decide to go off my meds to go crazy, I could simply be suddenly subjected to "stressors" (having a child, wife dying, losing a job) that spark up my serotonin faster than I can nuke it down with an extra few hits of Zyprexa. Suddenly in my beautiful mind the CIA is out to get me again, and in spite of what the founding fathers wanted for me, no, I shouldn't have a gun, and aggressive measures ought to be taken by society to try to ensure that.


So, assuming that we agree that people should be allowed to own guns, how do we, the other members of society, know which mentally ill persons should be allowed to and which shouldn't? Should your rights be suspended on involuntary commitment? Were you ever involuntarily committed? Was there ever a life event of yours that you would mark as the 'moment' that should have triggered to society that you shouldn't own a firearm?

Apologies if these questions are invasive, or even if they're just taken as rude. They feel rude of me to ask, and for that I apologize, but I've never had the luxury of speaking to someone so seemingly objective about their own situation before.

Edit: I redact the question. I don't know why, but it makes me feel dirty asking it, and I'd rather I hadn't. Thanks anyway.


Yes, involuntary commitment, at least a post-72 hour commitment imposed by a judge, should be a dealbreaker. Having filled a Klonopin prescription no, but having filled a lithium prescription yes. Unipolar depression isn't quite the softball mood disorder people may realize (in comparison to bipolar), I wouldn't want citizens prone to major depressive episodes to have guns either, and it's also noteworthy that those diagnosed with depression often turn out to have something more colorful, such as bipolar.

edit: As for bipolar CIA agents on Homeland, they should be restricted to carrying pistol-shaped tasers.


Now I'm trying to remember if I can recall any scenes in which Claire Danes' character enters a scene intentionally armed. My memory is failing me though.


... Though we are more creative. This is an example of positive discrimination, but it is still discrimination.

I'm not bipolar, I have a history of depression and anxiety. I would often hear others (including my folks) mention this to me to give me hope. I found it incredibly patronising, especially when in practically every other area in life the same people would just repeatedly kick my confidence in the teeth.


It was brave of you to post this comment and I'm happy you're having success with treatment. I come from a family with a history of bipolar symptoms. The only thing that keeps me hopeful about a certain sibling is the possibility that the condition will become much less severe in time. I dislike the treatment of the woman in this article because it's presumably a flat out denial of entry with no insight into her particular circumstance and because it brings to mind my brother being stigmatized for the rest of his life


You are a hateful asshole.

First of all, I grew up with someone who had exactly the same course of illness as you. So it isn't like I don't know. I lived with it for my whole childhood.

You also don't understand anything about getting a security clearance. Nothing.

Guideline I (Psychological Conditions) of the “Adjudicative Guidelines for Determining Eligibility for Access to Classified Information” states:

“No negative inference concerning the standards in this section may be raised solely on the basis of mental health counseling. . . . However, mental health counseling, where relevant to the adjudication of access to classified information, may justify further inquiry to determine whether the standards of subsection (b) of this section are satisfied, and mental health may be considered where it directly relates to those standards.”

When you apply for a clearance, I think they are redoing the forms, but the old ones there was a question:

Mental health counseling in and of itself is not a reason to revoke or deny a clearance. In the last 7 years, have you consulted with a health care professional regarding an emotional or mental health condition or were you hospitalized for such a condition? Answer “No” if the counseling was for any of the following reason and was not court-ordered:

1) strictly marital, family, grief not related to violence by you; or

2) strictly related to adjustments from service in a military combat environment.

If you answer yes you have to fill out "Authorization for the Release of Medical Information” with authorizes the following information from the mental health practitioner(s):

Does the person under investigation have a condition that could impair his or her judgement, reliability or ability to properly safeguard classified national security information?

If so, describe the nature of the condition and the extent and duration of the impairment or treatment.

What is the prognosis?

If the answer is yes, more paperwork is filled out, investigation, blah blah blah.

By the way:

Of the 150,000 security clearance applications processed each year by the Defense Industrial Security Clearance Office (DISCO) only 5 applicants were denied clearances in 2009 by Defense Office of Hearings and Appeals Administrative Judges because of Psychological Conditions. A July 2009 article at www.Army.mil reported that the US Army Central Clearance Facility’s “adjudicative history indicates that 99.98 percent of cases with psychological concerns obtained/retained their security clearance eligibility.”

Source: http://news.clearancejobs.com/2010/03/19/mental-health-and-f...

Your children don't have a "50%" chance of being bipolar. Nobody knows the odds. There is a genetic component but usually there is an environmental component as well.

And stigmatizing the mentally ill for life? That's just wonderful. Stigmatizing them doesn't allow them to get better and reintegrate into society and live and happy and fulfilling life.

It isn't like everyone is at the same level of "functioning" either. I hate that word, but there isn't any better I can think of.

You have some very hateful views.

I'm bipolar type II, I've spent years suicidal. I've spent years working (yes, it is HARD work) to improve my life and get better. Now you are saying I don't deserve my job and my spouse and all the work I did was useless because all people will see me for is "mood disorder" rather than the person I am?


I've known a lot of people with mental illness. People with bipolar run the gamut. For some, mania involves a psychotic break. Others just stay up till 5:00 am writing poetry and hurt no one. I know a few who can't hold a job, and many who are indistinguishable from "normal" people.

These people (like you) have biological issues that aren't their fault. Should they be given guns or be working for the CIA? In general, probably not. But they shouldn't be stigmatized and shut out of normal employment, either. These diseases are (for most people) quite treatable.

Also, "sane" people do dangerous, stupid, and unethical shit all the time. I know someone who just lost his license for drag racing, drunk, at 110 miles per hour. Although somewhat of a psychopath, I don't think he has a diagnosed mental illness. He is more of a danger to society than the average bipolar person.

On dating and mating, I think two mentally ill people being together is bad news. If one is grounded and they have a healthy relationship, and the person with the illness is principled and mature in managing the condition, then it's not so bad.


I appreciate that you've said this, thank you. But your advice cannot be helpful... I just cannot imagine that it is helpful.

We're talking about spectrum conditions here. You could run that same line of reasoning on autistics... when the environment (which includes people) is exactly the thing necessary to ensure productive and positive development.


This seems relevant to the thread about "should I use my real name online?" You just never know how information about you could be used against you, maybe ten or twenty years from now, maybe half a world away. You never know.

(I'm not too excited about Google dredging up 25-year-old Usenet posts from my college days.)


Side note: What about just consistently using a handle? And that handle being part of your "brand"? What if Jay-Z decided to become a web developer?

Primary note: African Americans could easily be labeled given the qualification of the nebulous "threat" clause, when it is in fact Old America (those likely to celebrate their licensed gun-ownership) that is going about shooting them in the face[0].

White supremicists, Men's Rights Advocates of many stripes, and the Tea Party are stridently making cases that African Americans are sub-human[1]; wherein it stands to reason they so too could be required to have "clearance" given their supposed "lack" of psychological integrity, etc.

There are many nets and dragnets being cast to categorize arbitrary lots of "unmentionable" society. There's a significant rate of undiagnosed depression in the African American community[2].

[0]: http://www.upworthy.com/she-knocked-on-his-door-to-ask-for-h...

[1]: http://whitelocust.wordpress.com/morality-and-abstract-think...

[2]: http://www.pbs.org/thisemotionallife/blogs/black-and-depress...


> "Side note: What about just consistently using a handle? And that handle being part of your "brand"?"

For me, there is too much cognitive overhead when you try to do this because you have to be constantly aware of what you have already said about yourself (going back years) and decide if additional information you are about to give could be used to disambiguate your identity by somebody who had access to the content of all your past online posts.

For example, say that mention that I am from a small town in Vermont. On another website, years later but with the same uncommon handle, I mention that my highschool class only had 27 people in it. On another site, I mention that I once swam a 100 meter freestyle in under 55 seconds. Just with those three things, each fairly reasonable things to mention in various online discussions, an obsessed stalker could probably narrow me down to one of a few dozen people. Now that is not too bad, but those are only three mundane facts, and if I am using the same handle for years or decades...

Handles that are hard to google without getting irrelevant results (such as my current handle) can certainly help, but that will only go so far. Counting on that is making assumptions about the capabilities of future web search technology.


I agree, I found it really not worth it for me to use a handle that was not my real name. I don't know about other people, but when I interact online, I don't act in a way that very different from how I act "IRL". Because who I am is the same online as it is in real life, obscuring just my name doesn't do me much benefit.

The only way I could obscure my information online would be if I maintained an entirely different persona/identity entirely, with totally separate lives. Since I can't or won't do that (I'd feel vaguely dishonest), I just use my real name anyway.


"Because who I am is the same online as it is in real life, obscuring just my name doesn't do me much benefit."

I operated like that for a few years, but then I realized that although my presentation of myself online is not that different from how I present myself in 'real life', there are examples in real life of situations where I present myself differently. For instance, I no longer discuss politics with family (in no small part out of respect for immediate family members who are now in the military. If I said to them what I am willing to say online, feelings would be hurt...)


Yeah, it really is a luxury that many people don't have, being able to not worry about who knows your views. I choose to not share most all my political or religious views in real life or online. But for many people who have views far outside the mainstream, or who would be otherwise persecuted for the things they think, I can totally understand why they wouldn't share many things.


Isn't this, like, the basic problem with our political system? Structural oppression? Disenfranchisement?

Hos does this not also apply to voting? I feel the same, now I am afraid to be in public for having the views that I have.

...


So then the follow-up is: Did "Batman" come before the rogue vigilante, or after ? (Chicken-or-egg.)


> Tea Party are stridently making cases that African Americans are sub-human[1];

Your reference [1] makes no reference to the Tea Party.


It saddens me that you destroyed my sentence.

http://www.rawstory.com/rs/2013/10/24/maddow-tea-party-appar...

That blog is an aggregation of Tea Party writers and commenters. Please... don't do what you're doing.



I appreciate that this is getting press on the American side of the border. This was in the Canadian news cycles a little while ago, but understandably the focus there was on how U.S. Border agents were able to access her medical history in the first place--with speculation that the Canadian government had some form of information sharing that involved medical history.

So it's great to see the focus on the other side of this issue as well, which is why the U.S. is profiling in this way in the first place.


The author of this article, Andrew Solomon, wrote a book entitled The Noonday Demon: An Atlas of Depression[1] that is based in part on his own struggles with depression.

[1] http://andrewsolomon.com/books/the-noonday-demon/


U.S. law (Citizenship and Immigration Services, Act 212) (http://www.uscis.gov/laws/act) states that aliens are inadmissible if they have:

a physical or mental disorder and behavior associated with the disorder that may pose, or has posed, a threat to the property, safety, or welfare of the alien or others, or

have had such a disorder and it is likely to recur.

It sounds as though this lady's condition does not meet these requirements, and hence she should have been admitted.

The issue, in this case, is that the immigration agents actually searched online for her medical/criminal history and found evidence of mental disorder[1].

Apparently, the agent in this case did not ascertain whether her condition presents a danger to herself or others currently. She states that it does not, and presumably she has a psychiatric sign-off to that effect.

Unfortunately, aliens have very little power to effect change in U.S. laws and abuse of those laws by the border guards. You just try to get past the border people, then breath a sigh of relief. If you can't get through, you are angry but your own government is unlikely to act.

This is just more fuel for the argument that our border control needs a major overhaul. Certainly we should be scrutinizing people coming in from other countries, especially ones who come from certain Middle Eastern and central Asian places who are interested in learning to fly jet planes and so forth. But the vast, overwhelming majority of visitors are good, honest people whom we should and must welcome. All I can think of to help solve this problem is to write to your Congressional delegation and get the issue onto the agenda.

[1] http://www.networkworld.com/community/blog/dhs-agent-cites-p...


It's almost hypocritical. Our lack of universal healthcare causes so many otherwise mildly ill people to become much sicker. (U.S. health insurers, who make much of their money by throwing red tape at people until they just give up on legit claims, are especially vicious toward those with mental illness, who are statistically more likely to give up easily.) Then the U.S. says, "no sick people! We've made too many of our own!"


Just to offer the anecdotal opposite: we left Canada precisely because the health care system harmed my son. Since living n the US, both of them have gotten help for far, far less than it would have cost in Canada to go the private route, and with a dramatically shorter wait time. This is without needing to use private insurance.


Having survived a childhood of OHIP, I find it hard to believe that your son received a significantly worse quality of care because you were in Canada. I don't doubt some doctors are better than others, but that happens everywhere.


It's not because we were in Canada, but because of the structure of Canada's Healthcare system, and specifically Quebec's.

> I find it hard to believe

Don't let my facts get in the way of your beliefs.

Edit: Better yet, let me treat you the same way. I doubt your story, liar. Fuck, you offer up a contradicting story, and people find it so hard to believe and immediately doubt you.

Seriously, if you think Canada's health care system is perfect, you are delusional.


edit: I get that this is a personal issue for you, and you got piled on for giving an anecdote that didn't fit people's expectations. I wasn't following the whole thread, so I didn't see you already answered my questions below. That said, you were kind of a jerk considering you gave no detail (not the province, not the illness, not the complaint, nothing but "Canadian healthcare sucks").

Was language a contributing factor? With the exception of Montral Quebec tends to be like a completely different country, and they definitely prioritize French language services. I could see getting an English-speaking specialist would be tough, especially in a smaller place.


> That said, you were kind of a jerk considering you gave no detail (not the province, not the illness, not the complaint, nothing but "Canadian healthcare sucks").

Considering the original comment I was replying to was "US healthcare sucks," I don't see why I need to pony up the proof. There are 50 states, all with different rules and regulations, all with different programs, and all that do things better in some areas than others. I'm tired of playing the game of having to explain it every time, so I limit my explanation to what I'm replying to.

As for being piled on, I'm used to it. But consider it's my kids, I feel it's worthwhile. If I can save someone else's child from suffering what my child had to suffer, it's worth it.

> Was language a contributing factor?

No.

First, this was several years ago, before the latest government went all crazy with the French language and French language police. It's worse now, but back than, it wasn't as bad.

Second, we lived and would have received services in Montreal.

Thirdly, we never prioritized English. My wife speaks French just fine, and we didn't care if it the service was in English or French.

Fourth, it was a result of regulations by the government saying that early intervention for children with Autism is not crucial. This was explained to us many times. This rule flies in the face of every doctor. Early intervention for children with autism is key.

Fifth, for the amount of money I was paying in taxes, I found it evil the amount that was being given to police the french language over Autism assistance. I will not ever stand to support that province again in any way, and have no qualms about fucking it over every chance I get.

Sixth, we were told on more than one occasion we should give up our son to a state run home. Now, this is the part that really gets people, and I'd love to say I was lying. I realize this isn't official policy, but still. It's the mentality. From what I'm told by others working up there in the medical field, this isn't uncommon for the French.

Anyways, that's more information than I intended to share, but point is, we did everything in our power. My wife worked this full time, submitting paperwork to every possible location to the point where our primary physician told us to stop sending out letters because she was tired of getting requests for information.

The straw that broke our back was being informed that we had finally gotten an appointment after 6 months of waiting, and we scheduled that appointment (which would take place 6 months later, mind you). This was with an service that our doctor from one of the children's hospitals in Montreal had recommended to us for our son. We got this appointment in the sprint of 2011, and we were finally happy that we were moving forward. That afternoon, we got a call back from the agency, and they cancelled the appointment, because they don't take children with autism. One moment we were happy! The next, horrified that all that work was for nothing. Over a year, and we had nothing to show for it, and our son was almost 2 1/2. Luckily, I am American, and we made the decision to move that day.

So yeah, I have a deep seeded hatred for Quebec, and the Canadian Healthcare system that allowed that to happen. Almost 10 years of living up there, and when we really needed the system, it failed us hard. It wasn't money, it wasn't lack of doctors, it wasn't even a lack of need.

It was purely a choice, political, and prioritizing a stupid language.


There's a misconception in the US that foreigners come to the US for healthcare and that somehow vindicates our shitty insurance/payment fuckuppery-industrial complex. In fact, (1) most of those foreigners come from the Third World, not W. Europe or Canada, and (2) to the extent that it is true, they come for specific doctors with global reputations, and would go to whatever countries those doctors lived in (and some are in the US, some are not).


Are you saying that you're getting better healthcare than in Canada, at much lower cost, while being uninsured in the US? That's hard to believe.

Healthcare is not free in the US, so someone is paying for the services your family is receiving. Perhaps you meant that you have high-quality employer-paid insurance. In that case, sure, once you're hooked up "within the system" it works. Don't lose your job!


> Are you saying that you're getting better healthcare than in Canada, at much lower cost, while being uninsured in the US?

No, that's not at all what I said. Not at all.

> That's hard to believe.

Oh, the problem is one where my facts are conflicting with your belief structure. I got it.

What part specifically? The part where I actually got care despite not getting any care after over a year waiting? That the cost is so much substantially lower that it's essentially free?

And what does my insurance have to do with it? Yes, I have insurance, but it doesn't cover the cost. The state does. My job has nothing to do with it.

I meant exactly what I said. Even the part about harming my son.


> Yes, I have insurance, but it doesn't cover the cost. The state does. My job has nothing to do with it.

Which state would that be? Did you come from Alberta or something?

Sorry if I come off as incredulous. But your story flies in the face of a lot more than just my own anecdotal experience.


While the quality of health care varies from province to province, and rural areas, the health care in Canada is very good. Is it perfect? No. Is it awesome? Yes.

Usually wait times aren't that terrible, and the quality of care is very good. I've had 2 surgeries. One of which would have been very expensiveness in the US.


Congrats on your surgeries.

We waited for more than a year to get any care (which we never got). In the US? We had appointments set up before we moved here.

> While the quality of health care varies from province to province

Quebec can rot.


Quebec is the worst. People who live in Hull (across the river from Ottawa) come over, pay, and then expense it to their province.


Could you elucidate this experience?


I've talked about it a million times it seems like. Short version: Quebec's health care system harms autistic children in Quebec. We were on waiting lists for years to get any care whatsoever. Going the private route meant north of $30k a year, none of it offset by the prices we already paid for care. This still required a 1+ year wait.

First 2 weeks in Pennsylvania resulted in more care than we got in the more than year up in Quebec fighting for anything for my son. My wife, a Canadian who was afraid of the US health care system before, loves it now. State/county helps to cover the cost of care for our children.


I suspected you were in Pennsylvania (but didn't want to say it, for I prefer not to speculate on others' health problems) based on your other posts. Yes, the state has an excellent MR/MH program (disclaimer: my father worked for the state government).

U.S. health insurance is not something to be proud of in general, but Pennsylvania's support for children with special needs is excellent.


ADHD is a much larger threat than all other mental illnesses combined. For every schizo with a rifle in a clock tower, there are 10,000 people with poor impulse control crashing cars.

As usual, FedGov is oblivious to statistics.


I'm very clumsy (I might have ADHD myself) but I have never accidentally killed someone.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: