Geography for Americans: The MicroRepublics of Central Asia

What used to be represented by a blur in our collective consciousness, Central Asia, is now emerging from the geographical fog of the American mind. As our forces have been stomping the kebabs out of Afghans, Tajiks, Uzbeks and all kinds of other folks over there in that craggy and dusty part of the world, they have come home and regaled us with tales of unpronounceable peoples and places. It seems that the stories of our soldier sons and daughters have to some extent ignited the flame of curiosity in us about these ancient cultures. No longer content to live in an isolationist torpor, we at home now yearn to know about all of the inhabitants of these faraway lands, that we might understand them, learn from them and eventually annihilate them, too. The greater countries, like Iraq and Afghanistan, are by now well known to us. But we have come to learn that there are scores of small principalities and regions that are much more obscure. The more we know others, as men of wisdom say, the more we know ourselves, so let us introduce ourselves to the three "MicroRepublics" of Central Asia: Turdistan, Nerdistan and Jerkistan.

Figure 1. The Lands of Gonzonia 

Brief History. This part of the world, Gonzonia, is thought to be one of the places where the Caucasian race first appears beyond the veil of history; this can be determined by the archaeological discovery of khaki pants at the Gongoozle site. It was originally inhabited by a branch of the Hittites called the Borborygms; later the Scythians, Persians and Greeks engulfed the region within their imperial borders. The Mongols as well came through these valleys as they cut their swath through Asia and Eastern Europe, but they left no major settlements or outposts. Turkic peoples left a durable mark, particularly the Tatars and the Seljuks. The British subjugated almost all of Gonzonia in the 19th Century, dividing it into the three great territories largely along ethnic lines. Russia and later the Soviet Union dominated the region until the latter part of the 20th Century.

Although they are distinctive peoples, their cultures, languages and religions bear the mark of almost all of the foreign influences of their conquerors. The Turks brought Islam, for example, but frustrated Muslim scholars complained that the inhabitants could not be made to understand the fundamental beliefs. Anglican and Protestant Christianity fared little better under the British. Orthodox Christianity under the Russian Empire had modest success, as it was not well understood even by the conquering Russians, but the official Atheism of the Communist Party caused what little discernible religion was left to atrophy into almost unrecognizable vestigial beliefs.

With the 21st Century we have seen a resurgence of nationalism and ethnic identity and even a renewed interest in religion. While under the Seljuks Gonzonia was a unified Khanate, and it had retained a sense of geographical identity for several centuries, recent years have seen the three regions, now called "MicroRepublics," devolve into almost continuous conflict.

 I. Turdistan. 

Figure 2. The Flag of the Democratic Republic of Turdistan. The people of Turdistan identify with the camel, as it is a beast of burden in Central Asia. This is somewhat ironic because the Turds are not thought to be very industrious. They excel, however, in telling others what to do, and especially what to think. 

The Westernmost part of Gonzonia is known as "The Democratic Republic of Turdistan." Of the three MicroRepublics, Turdistan was the most influenced by Communism. Although most Turds are atheist or agnostic, those who attend worship generally go the Church of Turdistan, believe it or not a branch of the Church of England. Of interest, a recent poll conducted by UN Committe on Religious NGOs determined that most of the members of the Church of Turdistan were surprised to learn of the existence of a God. Most believed that the purpose of attending church is to receive instructions on social consciousness.

 Figure 3. The Reverend Mohammed Wembish, rector at the Cathedral of St. Ahmet in Berq. 

Demographics, Culture and Geography. Turdistan has a total population of approximately 3 million, about a third of whom live in the capitol, Squirn. There is an official policy of population reduction in Turdistan, which has at its root the strange Turdi belief that human beings are a represent a kind of contamination of the earth; the population was 4 million as recently as 1975. More than 95% of the population is Caucasian, although most of them appear to wish they were not, as there is a cultural mandate that they dye their hair dark colors and spend hours per week tanning themselves. There are important but oppressed minorities from Nerdistan and Jerkistan, despite the official policy of ethnic tolerance.

Figure 4. Turds celebrate Equality Day, a National Holiday. 

Lake Bollox in the southern part of the country is the largest lake in Gonzonia and is home to a fish known as the Gonzonian Crappie.  It is the favorite source of animal protein to the Turds; otherwise the Turdi diet is almost exclusively vegetarian, consisting especially of bitter greens.

The Turds are highly educated, with a literacy rate close to 90%. Of interest, almost all of the universities teach exclusively the humanities, so there has been a gradual decline in technology. Almost half of the population are teachers. National pastimes include reciting poetry, foreign cinema (particularly French), and the consumption of wine.  They also enjoy the theater, and Lacrosse, the national sport.

 Figure 5. Mustafis Furbish, Left Attack Wing and star of the Turdi National Lacrosse Team. 

French culture is very popular in Turdistan. All things French represent, in the Turdi imagination, that which is of the highest quality. Almost no Turds speak French, but many of them pretend to do so, affecting nasal vowels, puckering their lips and brandishing crusty baguettes.

Politics. The Democratic Republic of Turdistan has two legislative houses, the upper house or Gobnob and a lower house, the Karnov. There is a judiciary branch but it functions more like a legislature in that it generates laws and legal standards. The highest court is the Exalted People's Court; it abolished the Constitution in 1988, declaring it "an obstacle to progress." The Executive of the Country since 1993 is the president, Mehmety Govnov; it is anticipated that he will remain president until his death. Term limits exists but they are consistently ignored.

All of the nation's media outlets are strictly controlled by the State. The most important newspaper is The Squirn Post, with a circulation of 500,000. There is only one television network, TurdTV, and programming consists almost exclusively of political orientation, Lacrosse matches, and low-key dramas with indiscernible themes. There is also only one radio corporation, Turd Public Broadcasting.

The ruling class of Turdistan, or the Stroonz (the "Enlightened Ones"), are the most highly educated and wealthiest 1% of the population. They believe it is their burden to hoard the wealth of the nation, so the common people will not be corrupted by its influence. They believe themselves immune to the moral dilemma of wealth by virtue of their high level of education. Virtually all of the politicians, judges and important people of Turdistan are from the Stroonz class.

Officially a pacifist state, Turdistan is nevertheless in an almost constant state of war. Their hatred of Jerkistan is almost without limits and skirmishes and conflicts between the Turds and the Jerks are commonplace. It is widely believed in Turdistan that the Jerks are born literally without brains, that they are greedy and gratuitously violent. Much of the content of the newspapers, television and radio programming is propaganda against Jerkistan.

Turdistan made frequent raids into Nerdistan until the 21st Century to plunder wealth and to capture "technical" slaves. "It is necessary to secure slave labor," wrote President Govnov, "to have sufficient manpower to operate an enlightened, egalitarian society like that of Turdistan. One cannot expect a people like ours to toil, particularly when so many have forgotten how."

Economics. Despite a relatively high educational level, most Turds are relatively poor. Fortunately all social services are free, including healthcare. On the other hand, there are only ten hospitals in Turdistan, and very few doctors, so the healthcare system is run by chiropractors and naturopaths. There are no Magnetic Resonance Imaging (MRI) machines in Turdistan and only one CT scanner. The average life expectancy is 60 for men and 65 for women.

Exports from Turdistan include apples, fish, opium and tobacco (even though tobacco is highly illegal in Turdistan). Turdistan and Jerkistan together produce 85% of the world's bat guano, mined from the extensive mountain ranges.

II. Jerkistan.

Figure 6. The Flag of the Islamic Republic of Jerkistan. The Jerks' symbol is the Asian Rhinoceros, which they believe accurately captures their national spirit of belligerence. It is ironic because the Asian Rhinoceros is actually rather cowardly. 

To the East we find the Islamic Republic of Jerkistan. It is officially a theocracy, although the Jerki sect of Islam is essentially unrecognizable to Sunnis or to Shia Muslims. For example, Jerki Muslims believe that Jesus, Mohammed and Charles Spurgeon were the same person. They abstain from vegetables, subsisting primarily on fatty meats and cornbread; salads and stir-fry dishes are forbidden. Pork is permitted, but only if it is fried (Jerkov Porqi).  Islamic scholars elsewhere in the world have issued a fatwah against Jerki Islam, noting that it is "foolishness."

Figure 7. The Mosque of Jonikash, in Az'holabad. 

Demographics. Culture and Geography. The population of Jerkistan is approximately 4 million. The capitol is Az'holabad, with a population of 500,000, but the largest city is Sqrotoum, population 800,000. The Jerks are a fair-skinned people and they have a suspicious attitude toward other ethnic and religious groups. Therefore almost all of the population of Jerkistan are Jerks. There are small but isolated and oppressed populations of Turds and Nerds, functioning in essentially servile roles.

Jerkistan is the largest of the MicroRepublics, with an area of approximately 3,000 square miles. The second largest lake in Gonzonia is Lake Kraq, considered by the Jerki Muslims to be the holiest body of water in the world. It is precisely at Lake Kraq where the Prophet Mar'jin is said to have relieved himself and the Jerks make pilgrimages there to bathe and be healed of infirmities by the salty warm waters.

The Turds are vehemently hated by the Jerks. It is accepted as fact in Jerkistan that all Turdi men have vaginas and the Turdi women have penises.

The national sport of Jerkistan is rifle marksmanship. Education is despised in Jerkistan; school only goes to the eighth grade and there is only one university: Az'holabad College of Exalted Business Adminstration. Jerks believe that everything they need to know is in their Holy Book, Dianetics.

Figure 8. Bloz Kabela, winner of the 2010 National Jerkistani Marksmanship Medal. 

Politics. As an Islamic Republic, the Supreme Ruler is an Imam named Ali Wakbarov. Wakbarov has been in office since 1988. He must approve all of the legislation of the elected parliament, The Diet of Phat, before it can be enacted as law. The Grand Imam also has the sole power of veto; if he believes the laws do not conform to Sharía they will not be implemented. He may also create laws as he sees fit to support or enforce the Holy Islamic Republic.

Jerk Sharía, then, is the law of the land. For example homosexuality is punishable by death for common people. Of interest, however, it is accepted and widely practiced among the ruling class, or Pedez. Similarly the average citizen of Jerkistan must bathe daily; if they are perceived as having a body odor by the Jerki Kulturi Polizi they are beaten but the Pedez rarely bathe. Making use of a woman of ill-repute, or Snooki, is punishable by stoning but the Pedez have entire paddocks of male and female Snookis at their disposal. 

Jerkistan has effectively been under a state of martial law since 2002. At that time Ali Wakbarov established the Sekuritatni Stat "in order to protect our freedoms." It is ruthlessly enforced by the Sekuritatni Polizi, who can arrest without a warrant, detain indefinitely without charges and torture arrested suspects. Most Jerks have suffered under the current system, but as Prime Minister Kolboz Bobo said in 2010, "It is a small price to pay to be free."

Economics. The Jerki economy is dominated by the three great Korporazi, or dominant industries. The largest is Kakaboli, the company that mines guano in the mountain region. The second largest is Agrinaz, an agribusiness conglomerate and then there is Smerzikon, manufacturer of weapons. The vast majority of Jerks work for one of these organizations. The chairmen of each of these Korporazi are members of the Pedez and have seats in the Parliament. As such they function under the direction of the Supreme Leader. The standard of living is somewhat higher than in Turdistan, a fact that enrages the Turds. The Jerks do not pay taxes, but the state's operating costs come from confiscations by the Sekuritatni Polizi.

The major exports of Jerkistan are weapons, apples, honey and guano. About 30% of the guano produced in Jerkistan is fashioned by artisans into pottery and vessels for food and beverages and most of those are exported.

III. Nerdistan 

Figure 9. The Flag of the Confederation of Nerdistan. The image of the two-headed eagle was imported by the Seljuks, but to the Nerds it represents constant vigilance against the Turds to the West and the Jerks to the East. 

Uncomfortably situated between Turdistan and Jerkistan is Nerdistan, population 3.5 million. The population of Nerdistan has not grown since 2009. This is thought to be for two reasons: The history of the kidnapping of Nerds for technical servant labor by Turdistan and Jerkistan and also because for some reason, the women of Nerdistan prefer to marry Jerks and Turds.

Demographics, Culture and Geography. The population of Nerdistan is more diverse than the other MicroRepublics. Most of the population are Caucasians, but approximately 20% are ethnically Chinese, 10% are ethnically Hindi and 10% are Khazar Jews. A significant number of the population are refugees from Turdistan and Jerkistan. It turns out that the ability to work quadratic equations is grounds for expulsion from those two countries as it is forbidden for citizens, but fortunately it is a qualification for citizenship in Nerdistan.

The capital of Nerdistan is Da'weeb, with 500,000 inhabitants. Other important cities include Dorqov (300,000), Wangi (250,000) and Putzov (100,000). There is no official state religion in Nerdistan, but many are practiced. The largest church is the Church of the Subgenius, with approximately one half million adherents.

Figure 10. The Reverend Ivan Stangolov, Minister of Religion of the Confederation of Nerdistan and Solemn and Serene Patriarch of the Church of the Subgenius. 

Figure 11. The Cathedral of St. Nikolai Tesla in Da'weeb. A significant percentage of the Caucasians in Nerdistan are Slavs, who immigrated here to play chess. The Orthodox Church of Nerdistan has 300,000 adherents. 

Nerds dislike the Turds and the Jerks because of the history of frequent raids by those countries into Jerkistan for the importation of technical servant labor. Science and Mathematics are considered taboo in Jerkistan and Turdistan; nevertheless skilled scientists, mathematicians and engineers are needed in those lands to run factories, machines and utilities. The raids were successfully halted by the Nerds in 1990 by biological warfare. The gene for lactose intolerance was inserted by Nerdi scientists into the chromosome of the highly infectious schizobacillus. The germ was introduced into and spread throughout Turdistan and Jerkistan and those populations were paralyzed by flatus, abdominal pain and severe diarrhea. The Nerds were immune, as they are already lactose intolerant. Since then the Turds and the Jerks are suspicious of and intimidated by the Nerds, fearful of their sorcery, and they have for the most part left them alone.

The national sport of Nerdistan is paintball. The Cup of Nerdistan is held every three years in Putzov and it is a Federal Holiday so everyone might participate. The crowds consume fried lactose-free cheese and kwos (a dark, sweet, carbonated beverage) and advocate for their champions with spirited words of encouragement. The most common pastimes are computer games and board games.

Figure 12. Zorki Borzagis commands a Q-21.2 "Zhukov" Paintball Tank during the championship in Putzov. 

Nerdistan is one of the most tolerant of the Republics of Central Asia. There are Freedom of Speech, Freedom of Religion, and the Right to Bear Electronics. All kinds of lifestyles are sanctioned as long as there is not a lot of noisy moaning and whatnot. The Confederation is libertarian in orientation but not so much philosophically as by a desire not to be bothered with meaningless details.

There are 23 universities of Nerdistan, all awarding degrees exclusively in the sciences, mathematics and history. 18% of the population are physicists. Almost ten percent of the country are doctors, mostly internists and psychiatrists. Nerdistan has more dermatologists and dentists per capita than any other country.

Politics. Nerdistan is a confederation of its fourteen Departments (regions). Each department is headed by a Dean, who reports to the most powerful executive in the country, the Chancellor (Dr. Borb Weebis, an engineer by training, since 2008). The Deans are popularly elected by the Faculty Senates of the Departments, and they in turn form the Council of Da'weeb, also called the Nerdokratia, who elect the Chancellor.

There are over 100 political parties in Nerdistan, but the largest are the Particle Theory Party, the String Theory Party, and the Assembly of Fractals. Anyone with an IQ higher than the averages of those in Turdistan (90) or Jerkistan (89) may vote, regardless of age.

Economics. The economy of Nerdistan is based on the manufacture and exportation of silicone chips. The Nerds were the first to develop the robotic girlfriend prototype J-19 and approximately 5000 are produced at the factory in Dorqov every year. A glitch in the software code was found in the J-16 through 18 models, resulting in the units wandering off into Turdistan and Jerkistan when the owners were at work or at the board game or comic book stores. The latest model, the Kuoko, sells for $10,000 US and while many are sold within the country, most are exported to Japan and the Netherlands.

While the standard of living is high in Nerdistan, there are nevertheless serious problems. None of the Nerds are willing to do manual labor; guest workers from Jerkistan come into the country to perform these functions on two-year visas. There has also been a serious decline in productivity since World of Warcraft was introduced in 2006.

Conclusion. We hope this has been an interesting journey into Central Asia and that you have learned a great deal. It is truly enlightening when we realize that no matter how strange or exotic a culture may be, they are really not so different from us.

(c) Copyright 2011 Robert Albanese

The Defense of Insanity

The Idaho Correctional Institution at Orofino.  It was once a psychiatric hospital.

I learned from a story in the Idaho Statesman yesterday that Idaho has no Insanity Defense.  It seems there is an individual named John Delling who, seized by an acute psychosis due to schizophrenia, shot and killed two men and injured a third.  Although there was agreement across both defense and prosecution that his actions took place under the influence of mental illness, he was apparently tried and convicted as if he were not mentally ill.  According to the article in the Statesman, three other states have eliminated the Insanity Defense:  Utah, Montana and Kansas.   

There will be an impulse from the Northeast Corridor to view the absence of this legal pathway as a flannel-shirt-and-bushy-beard kind of frontier justice.  In the Statesman, a somewhat liberal newspaper trying to bring light to the conservative darkness of Idaho, it is detailed that the insanity defense was "banned" in these four states as a reaction to John Hinckley's use of the insanity legal loophole to avoid accountability for shooting Ronald Reagan.   I believe this issue is being unnecessarily politicized.  It may be that the issue of how mentally ill individuals are found culpable of crimes is not a simple matter of compassion or retribution.   

In my mind at least, I've been an advocate for the mentally ill for twenty years.  I've received a "Helper Friend Award" from a local chapter of the National Alliance on Mental Illness (NAMI), and several years ago I spoke at their national meeting in San Diego.  It may seem inconsistent with advocacy in the minds of some, but over the years I have leaned increasingly in the direction of full accountability of the mentally ill for crimes they may commit.   

My clinical experience is unambiguous.  When mentally ill individuals become dangerous to person and property, at least one of two elements is virtually always present.  The first is a refusal to take medications.  Typically these patients are well-compensated and organized but for whatever reason, and many reasons are given such as side effects, they decide to stop taking their medications and then undergo a marked deterioration.  Paranoia takes hold, and the patient begins to perceive threats all around, leading to what they may see as "preemptive" strikes of violence.  

The second element is use of illegal drugs.  This behavior is astonishingly common among the mentally ill, and although one theory is that these patients are "self-medicating," they virtually always destabilize, even with relatively benign substances like cannabis.  Their internal neurochemical environment is much more prone to disarray than those of people without mental illnesses, and many of these drugs can produce paranoia and violence even in people without a diagnosis of mental illness.  While patients who stop taking their medications do not always use illegal substances, those who use illegal substances virtually always stop taking their medications, either before the drug use starts or after it is under way.   

So while the decision to shoot someone may occur under the impairment of decompensated insanity, the decision to stop taking medications and that to use illegal drugs usually happen while the individual is in a much more stabilized state.  Since the outcome is relatively predictable, especially in patients who have previously become violent, it does not seem reasonable to ignore or soft-peddle the decision not to adhere to treatment. 

With the Insanity Defense, we are teaching individuals with mental illnesses that they are at times not responsible for their behavior.  But what concerns me even more is that we may be conveying to them that, as victims of mental illnesses, they are unable to be in control of their behavior in general.  If that is the case, the consequences will be more decompensation and violence and poorer self esteem and hopelessness in the mentally ill.   

The case of Paul Harrington is instructive in this regard.  He was a Viet Nam combat veteran and heroin abuser who murdered his wife and two daughters in 1975.  Because of his Posttraumatic Stress Disorder diagnosis, he was found Not Guilty by Reason of Insanity in 1977 and spent two months in a psychiatric hospital, then was released.  He later remarried and in 1999 killed his wife and 3 year old son.  This unspeakable tragedy recurred because he was given the rather clear message that he was not responsible for his behavior and probably also that there was no point in trying to control himself.  While the second murders would likely have been prevented had he been held accountable for the first, I wonder if Harrington had already internalized an ambiguous set of standards of responsibility in 1975.   

Experience has also taught me that the connection between mental illness per se and dangerous behavior is not as direct as is portrayed in popular media.  Most of the severely mentally ill people I have known are considerate of the rights of others, and many of them have a completely intact sense of humor.  To say that they are dangerous by virtue of their mental illness is to do them a grave injustice.  Most of them are people who are struggling as best they can against internal strife, social isolation and economic desolation; that we project evil onto them as well may explain why there seems to be so little compassion for them in contemporary society.   

To take the point a bit further, almost every disease state is manifested differently in different people.  Tuberculosis might represent a good analogy.  Most people who contract tuberculosis contain the disease within their immunity; they can eradicate the infection with antibiotics but even without antituberculine drugs they are not infectious.  They pose no threat to anyone.  Other patients, however, have "active" tuberculosis, coughing and spreading the bacilli throughout their contacts.  When these patients do not follow treatment instructions closely, they pose a significant risk to others, and sometimes they have to be quarantined under the authority of the state.  I would argue that mental illnesses are exactly the same in that the character of the affliction varies from individual to individual and it is only the minority who are potentially dangerous. 

Of all the reasons I favor accountability for the mentally ill, however, one far surpasses the rest.  Some years ago I was listening to a story on National Public Radio; it was a feature precisely on this topic.  A nurse who identified himself as having bipolar disorder was interviewed.  "We can't have it both ways," he said.  He observed that if people with mental illnesses demand full integration into society, they will have to assume the same accountability for their behavior as those who do not have mental illnesses.  One cannot demand to be accepted and assimilated into a collective society or culture on one's own strictly individual terms.  That would be kind of like saying:  "Henceforth I shall be considered by all to be a black American, despite the fact that I have no African heritage."   

One fact threatens to obscure my point, though.  It is widely believed that as the state psychiatric hospitals have closed since the 1950s, the mentally ill have streamed into the prisons.  In fact a Department of Justice report from 2006 details that over half of the inmates in state prisons have mental illnesses.  So how can it be true that we do not hold mentally ill people accountable enough, at the same time unfairly holding them too accountable?   

While some people think that the purpose of incarceration is punishment and others think that it is rehabilitation, the fact is that the prisons serve one function:  Quarantine.  Individuals who believe that they are not responsible for their behaviors eventually wind up in prison, generally after an escalating pattern of serious crimes.  In my experience this concept applies to three groups of inmates:  The criminals per se, the nonviolent drug offenders, and the mentally ill.   

The first group, who are sometimes called sociopaths, tend to blame others for the crimes they commit.  They lack compassion for their victims and they have no conscience, so there is almost no psychological obstacle to violence against person and property.  They do not take responsibility for their actions, so they are quarantined.  Similarly, those who become addicted to heroin or crack cocaine come to the realization that their desire to obtain and use drugs surpasses every other drive or instinct, occasionally provoking monstrous behaviors.  Therefore they, too, are quarantined.   

The mentally ill, however, contend with a more complex set of circumstances.  They are frequently homeless, often victims of assault themselves, and sometimes afflicted with superimposed substance use disorders.  They do not always have access to mental health care, let alone general medical care.  Generally it begins with misdemeanors like trespassing, progresses to illegal drugs use and assault, eventually sometimes culminating in violent crimes.  It is possible that because a compassionate court excuses minor crimes on the grounds of mental illness, the perpetrator acquires the sense that he or she is not responsible.  Released therefore from the accountability constraints of civil society, their infractions become progressively more serious, advancing to crimes so violent the jury is no longer inclined toward mercy.  Had we held them accountable at an earlier time and given them access to adequate care, their behaviors might not have progressed to the level of felonies.   

There is a more rational, and in my opinion, less expensive way.  We could build state psychiatric hospitals, as we did a century ago, and make available to patients long-term treatment for substance use and mental illness.  We could make outpatient treatment of mental illness and addiction available in a meaningful way, and in the former case implementation of real case management.  With case managed, when a schizophrenic patient with a history of violence stops coming to his appointments, he is at least in theory quickly located and treatment reinitiated. 

We have closed the mental hospitals and opened the prisons.  It is often said that of all the nations in the world, the U.S. has the highest absolute number, and the greatest percentage of her population in jail or in prison.  If it is true, this statistic is a dramatic challenge to the notion that we are a "free" country.  It might not gratify the emotional need, as Bill Clinton said, to "send a message" to drug users and those who commit crimes.  But we would be safer, freer, and less fiscally strained if we closed the prisons and opened the mental hospitals.   

Everyone, including the mentally ill, should be accountable for his or her behavior.  Reason and compassion dictate, however, that we not expose mentally ill individuals to inhumane conditions; that they not be held accountable under such a different set of circumstances than society at large.  Even those not motivated by moral consciousness will probably concede that since contraction of mental health care was followed by an explosion in homelessness and dramatic increases in prison populations, a reciprocal effect could be induced by investing in mental health care.  If it is true as the NAMI has suggested that the prison system is the new mental health system, it would be cold reason itself to replace it with a more effective and yet also less expensive one.    


Update:   On 12/7/2011 I had a conversation with my colleague Dr. John Hubbard.  We co-authored a textbook some years ago:  "Primary Care Medicine for Specialists and Subspecialists:  A Practitioner's Guide."  We were discussing this topic, that of culpability of the mentally ill.  He made an interesting observation.  He said that people should not be found Not Guilty by Reason of Insanity but rather Guilty by Reason of Insanity.  Such a legal finding would, it seems to me, make it possible to hold patients accountable but also emphasize quarantine and treatment over quarantine and punishment. 

(c) copyright 2011 Robert Albanese

Update:  On 4/20/16 I attended Baylor College of Medicine Grand Rounds.  The speaker, Christina Treece MD, an expert on postpartum psychiatric disorders, noted that Andrea Yates had discontinued her haloperidol (an antipsychotic) without consulting with her psychiatrist not long before the horrific murders of her five children.