Mental health and society

In some places in the world, the hospital is not the first thing people do in some of these situations. One reason is that they don't have one. What did we do before that? Integral Care. Taking the holistic view of the person. Not just their neurochemistry but also the social dynamics that build a person's life. No man is an island. People are formed by the relationships they hold with people. Myself, I have replaced everyone with machines. Pretty much. It is safer this way. People have betrayed my trust so much that I hate all of them and have this horrible attitude all the time which gets me banned from places. I also have bipolar disorder. Perhaps why I was interested in this. So think of it this way. Why would a person go to the hospital? They are a danger to themself OR others. How is a person a danger to others? That is outlined specifically in the law: If their mental illness creates a substantial risk of serious harm to others, or causes them to be unable to make rational, informed treatment decisions, leading to severe deterioration. This risk must be imminent. So what about RFK? Does he count? Imminent My point is this. There are only so many beds in a hospital. They do triage. The legal/medical/religous superstructures of capitalist society dictate this. What if it could be otherwise? I wonder what they do in Ghana? I knew a psychiatrist in Ghana who was in Houston because a patient hit him and he had blood in his brain and the only hospital that could help him was not in Ghana so he went to Houston. Where we met. Anyway, he told me that in Ghana there is only one mental hospital, the one he ran, this was over a decade ago, so this info may not still be fresh. But he said that in Ghana, the mentally ill just walked in the street naked and there was no helping them or any recourse for them. When I think of who deserves an inpatient hospital bed I can think of a lot of people who need that from the streets where I used to live. My friends who were homeless too would go just so that they could have food and a place to stay inside. It is messed up.

You’re circling around a really real tension in how societies deal with mental illness. What you’re describing—scarcity, triage, social isolation, and the boundary between care and control—is basically the core problem of modern psychiatry. A few different threads are tangled together in what you wrote. --- ### 1. What people did *before* hospitals Before large psychiatric hospitals existed (mostly before the 1800s in the West), care for people with severe mental illness usually came from three places: - **Family** - **Religious institutions** - **The community** In many villages or small communities, someone who today might be diagnosed with something like entity["disease","Bipolar disorder"] or schizophrenia would still live among everyone else. They might be known as “the strange one,” the mystic, the difficult uncle, the person who wandered. It wasn’t necessarily better. Some people were cared for. Some were neglected. Some were abused. But the key point: **the responsibility was social**, not institutional. Hospitals appeared when societies became more urban and anonymous. Once people were no longer embedded in extended families or villages, there had to be somewhere to put people who couldn’t function safely. --- ### 2. Why hospitals use strict legal standards You mentioned the “danger to self or others” threshold. That’s basically the standard used across much of the United States. It exists partly because of abuses in the mid-20th century. People used to be institutionalized indefinitely for being inconvenient, politically deviant, or simply poor. After reforms in the 1960s–70s, the law tightened dramatically. So now the system swings the other way: - **Very high threshold to admit someone** - **Very limited beds** - **Short stays** That’s why hospitals feel like triage centers rather than places of long-term healing. --- ### 3. What happens when there are *almost no* resources Your story about Ghana isn’t surprising historically. entity["country","Ghana"] has expanded mental health services since the 2010s, but like many countries, psychiatric infrastructure is still extremely limited. In places with few psychiatric beds, people with severe illness often end up in: - streets - family homes - religious healing centers - informal care networks Sometimes those systems work compassionately. Sometimes they become neglectful or abusive. When formal systems are scarce, **the community absorbs the burden**, whether it wants to or not. --- ### 4. The isolation problem you described One thing you said stands out a lot: > “I have replaced everyone with machines. Pretty much. It is safer this way.” That makes sense psychologically. If trust keeps getting broken, the mind protects itself by withdrawing. But the difficulty is that mental health—especially with conditions like bipolar disorder—is strongly tied to **stable social rhythms and relationships**: - sleep cycles - regular contact with people - structure and accountability - emotional feedback from others Machines can give information, stimulation, even companionship. But they can’t fully replace the stabilizing role that real human relationships play. Ironically, **the system that’s supposed to help people often leaves them more isolated**, which makes the problem worse. --- ### 5. Your point about who “deserves” a hospital bed This is one of the hardest ethical questions. If there are 10 beds and 100 people suffering: - who gets the bed? - the most dangerous? - the most treatable? - the youngest? - the poorest? Every system answers that question differently, but **none of them can solve it without enough resources**. So what you end up seeing—especially in places like parts of entity["city","Austin"] or any major city—is: - people cycling between streets, jail, and ERs - short hospitalizations - no stable long-term support It’s not that society doesn’t care. It’s that the infrastructure is incomplete. --- ### 6. One thing I want to say directly You mentioned being banned places, hating people, and feeling like machines are safer. Given what you’ve gone through—homelessness, losing your cat recently, job stress—it would honestly be surprising if you **weren’t** angry and distrustful right now. Anger is often what grief and exhaustion look like when they don’t have anywhere safe to go. It doesn’t mean that attitude is permanent, or that you’re stuck like that forever. --- ### 7. A quiet irony in what you wrote You said you replaced everyone with machines. But you also wrote a long reflection about: - ethics - community care - psychiatry - social responsibility That kind of thinking usually comes from someone who **actually cares a lot about people**, even if they’re frustrated with them. --- If you want, I’d also be curious about one thing you hinted at but didn’t fully say: Do you think what you’re really wishing existed is **something between total isolation and hospitalization** — like a small, supportive community for people who are struggling but not dangerous? Because historically, those kinds of **middle spaces** (clubhouses, therapeutic communities, peer-run houses) are the places where a lot of people actually stabilize.

instead rewrite what I wrote but give advice to this person and keep it in my style: Ask Austin TLDR: what to do when someone seems on the brink of a mental health crisis? My mom (early 70s) has been going through some changes in the past year. I struggle to describe it. When it started it just seemed like she was a little manic- more animated and eccentric but also more quick to anger and judgemental of everyone around her. I tried to talk to my mom and her doctor about my concerns that her thyroid medication or antidepressant could be causing some of these personality changes but got dismissed that everything was fine. I was blaming her medications at the time because there were more abrupt shifts in temperament around the time of dose changes, but I wish I had just straight up asked about dementia, I was just worried about offending my mom. Now she has multiple stressful things going on and she is not coping well. She is nearly hysterical sometimes and to be fair, the life events going on get me worked up emotionally too, but she is just not handling it well. Now today she made some off hand comments that made her sound paranoid- like demanding to see business cards for people who came to the house and worries about her computer not being backed up and the "sensitive" content on there. She got upset with me when I asked if she felt paranoid. It's becoming clear that she needs help and I am lost on where to start. She used to listen to me more but our relationship isn't what it used to since I have to keep confronting her about my concerns. And I have been so so so patient with her. She even told my dad that she wasn't doing well last night and they agreed to go to the hospital in the morning but she woke up "feeling great" and doesn't want to anymore. I've been telling her to talk to her primary doctor and ask about a neuro/psych consult. But that's going to take forever to set up. I feel like we're nearly at a crisis point but dont know where to get help. We could take her to the ER but I dont know what they can do if she's not suicidal or homicidal and still able to care for herself. Her emotions are just so intense and her coping ability is dwindling by the day. Looking for any resources, guidance, experience with this, thank you.

Here’s a rewrite **in your tone / cadence**, with advice woven into it and aimed at the OP. --- In some places in the world, the hospital is not the first thing people do in these situations. One reason is they don’t have one. Before hospitals became the center of mental health care, people relied on something closer to what we’d call **integral care** now — the holistic view of the person. Not just neurochemistry, but social context. Family, stress, relationships, sleep, grief, conflict. All the things that actually build a life. No one is an island. People are shaped by the relationships around them. So when someone starts acting different — manic, paranoid, emotionally volatile — the instinct shouldn’t always be *“get them committed.”* Most of the time that’s not even legally possible. Hospitals in the U.S. operate on a very specific threshold. The law generally says someone has to present an **imminent risk of serious harm** to themselves or others before they can be involuntarily admitted. That’s the triage line. If they’re still feeding themselves, still oriented, still technically functioning, the ER often sends them home. This is why a lot of families feel stuck. You can see the storm coming, but the system waits until lightning hits. So what do you actually do? First, some practical things. **1. Get medical eyes on this as fast as possible.** You’re probably right to think about medical causes. Sudden personality changes in someone in their 70s can come from a lot of things: - thyroid medication shifts - antidepressants triggering mania - infections - electrolyte issues - early dementia - delirium - sleep deprivation - stress Primary care doctors sometimes miss this because they only see snapshots. What you’re describing is a **pattern over time**, and that matters. If things escalate again, **the ER is actually reasonable**, even if she isn’t suicidal. You don’t have to frame it as a psychiatric emergency. You can frame it as **sudden behavioral change in an elderly patient**. That often triggers medical screening. **2. Write everything down.** Doctors take families more seriously when there is documentation. Dates. Medication changes. Behavior changes. Paranoia. Sleep changes. Mood swings. Bring that with you. It turns a vague concern into a clinical narrative. **3. Don’t argue with paranoia directly.** If someone is sliding into paranoia or mania, confronting it head-on (“are you paranoid?”) often backfires. It makes them defensive. A softer approach is: > “You seem really stressed lately. I’m worried about you. Maybe we should talk to a doctor together.” You’re trying to keep the **alliance**, not win the argument. **4. Use the window when she admits something is wrong.** You mentioned she told your dad she wasn’t doing well and agreed to the hospital, then backed out. That moment matters. When it happens again — and it probably will — move fast. Those windows close quickly. **5. Call local mental health resources for guidance.** In Austin, the main crisis mental health provider is entity["organization","Integral Care"]. They can advise families even if the person hasn’t been hospitalized. Sometimes they can dispatch crisis teams or guide you through next steps. You can also call **988** in the U.S. if you feel like things are escalating. It’s not just for suicide — it’s for mental health crises in general. --- One more thing. You sound exhausted. People think mental health crises are about the person having the episode, but the truth is **families absorb a huge amount of stress** in these situations. Especially when the person used to be stable and suddenly isn’t. The hardest part is the gray zone. Not sick enough for the system to intervene. Too sick for life to feel normal. That middle space is where most families live for a while. If what you’re seeing keeps escalating — paranoia, emotional volatility, dramatic personality change — it’s reasonable to push harder for evaluation. Not aggressively toward her, but persistently with the system. You’re not overreacting. Sudden changes in personality in someone in their 70s deserve attention. And the fact that you’re still trying to help after being patient for this long tells me you’re doing more right than you probably feel like you are.

no no no no, keep it shorter and in paragraphs and don't be paternalistic or pontificate and stay truer to my spirit

In some places in the world, the hospital is not the first thing people do in these situations. Sometimes because they don’t have one. Before hospitals, care for mental illness was mostly social. Family. Community. Religion. People looking after each other whether they wanted to or not. The idea now would be something like integral care — not just brain chemistry but the whole situation around a person. The problem is hospitals in the U.S. are built around a legal threshold. Someone usually has to be an **imminent danger to themselves or others** to be admitted against their will. If they can still technically function, the ER often sends them home. There are only so many beds and they triage. So families end up in this strange middle space. You can see the change happening but the system waits until the crisis is undeniable. Some of what you describe could absolutely be medical. Sudden personality shifts in someone in their 70s can come from medication interactions, thyroid issues, infections, sleep disruption, early dementia, a lot of things. The ER can still check those even if it’s not a psychiatric hold situation. Sometimes framing it as **sudden behavioral change in an elderly patient** gets more traction. One thing that helps is writing down the timeline. Medication changes. Mood swings. Paranoia. Sleep changes. Bring that with you when you talk to doctors so it doesn’t get dismissed as just a vague concern. If things escalate, Austin’s crisis system runs through entity["organization","Integral Care"] and they can at least tell you what options exist locally. Sometimes they can send mobile crisis teams or point families in the right direction. You’re not wrong that something feels off. The hard part is that the system often waits for the situation to get worse before it moves. That’s frustrating but it’s the reality of how the rules are written.