American Psychosis Read Online Free PDF Page B

however, are managed by owners whose primary interest is in increasing profits, with consequent abysmal living conditions and victimization of residents, as described in previous chapters. This occurs because in most states there is little oversight of these homes; the state departments of mental health do not want to know about problems, because they would then have to close substandard facilities and find alternative living arrangements for the residents. The first rule of government is to not ask questions to which you do not want to know the answers.
Leaving nursing homes and board-and-care homes without adequate oversight has been a tragic mistake. These homes fall into the category of what are known as total institutions, which also include jails, prisons, mental hospitals, institutions for individuals with mental retardation, and orphanages. In such facilities, the staff has virtually complete power and authority over a captive and often vulnerable population. What usually happens in such total institutions was described by Philip Zimbardo in his well-known 1971 experiment with Stanford University students in which he had some students pretend to be prisoners and other students pretend to be prison guards. To the surprise of everyone, including Zimbardo, the pretend prison guards immediately began to devalue, depersonalize, dehumanize, and mistreat the pretend prisoners. Zimbardo summarized what is known about the phenomenon of total institutions in his book The Lucifer Effect: Understanding How Good People Turn Evil . “Dehumanization,” he noted, “is one of the central processes in the transformation of ordinary, normal people into indifferent or even wanton perpetrators of evil. Dehumanization is like a cortical cataract that clouds one’s thinking and fosters the perception that other people are less than human.” 29
The most effective way to counteract the natural tendency for staff to dehumanize mentally ill residents in total institutions such as nursing homes and board-and-care homes is through aggressive oversight and inspections. Such inspections are only effective if they are random and unannounced. Staff should be aware that inspectors may enter their facility at any time, day or night, and hold the staff accountable for conditions there. The original model for such oversight was the Lunacy Commission that operated in England from 1845 to 1890. Commissioners, including physicians, lawyers, and lay persons, carried out unannounced inspections of all public and private mental hospitals and had the authority to order the immediate closure of a facility. 30
In the United States, almost no unannounced inspections of nursing homes or board-and-care homes take place. The few inspections that do occur are announced well before the event, giving owners of the facility time to clean up everything. One of the few systems of unannounced inspections was implemented in 1977 in New York State as the Commission on Quality of Care for the Mentally Disabled. For two decades, members of this commission carried out unannounced inspections, publicly releasing reports resulting in headlines such as “Adult Home Abuse Found,” “Report Says Home Operators Misused Funds Meant to Feed Mentally Ill,” and “For Adult Homes This One Ranks among the Worst.” The commission reported directly to the governor, not to the state Office of Mental Health, thus shielding it in part from the agency that was not interested in finding anything wrong. 31
New York’s brief experiment with effective oversight and unannounced inspections was terminated by Governor George Pataki when he took office in 1995. Not coincidentally, nursing home and board-and-care home operators had been major contributors to the Pataki campaign. New York thus became like most states in preferring to hear no evil and see no evil in its nursing homes and board-and-care homes. Probably more typical than New York State is Pennsylvania, which, according to Andrew