Catch 22, Chapter 2

Back in 2015 I wrote about the 'Catch 22' of seeking disability benefits:

""You mean there's a catch?"
"Sure there's a catch", Doc Daneeka replied.  "Catch-22.  Anyone who wants to get out of combat duty isn't really crazy."
There was only one catch and that was Catch-22, which specified that a concern for one's own safety in the face of dangers that were real and immediate was the process of a rational mind.  Orr was crazy and could be grounded.  All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions.  ("Catch-22 (logic), Wikipedia)

I love that.  Twisted logic.  It's fun until you are faced with it.

As I look at appealing the insurance carrier's denial of my disability benefits I was reminded of the "Catch-22" that is often at play.

If someone has a mental illness that results in a disability then they are entitled to disability benefits.  If denied, they have the right to appeal the decision.  However, if they are capable of appealing the decision they demonstrate that they are not disabled.  Catch-22.

Or to put it differently, appealing the decision of the insurance company to deny disability is an overwhelming task.  The more disabled, the more overwhelming the thought of formulating an appeal.  Hence, the least likely to be able to appeal the decision are the one's who most need it to be overturned.  Makes sense, doesn't it?"

There is another, more troubling Catch 22 -- or perhaps it would be Catch 23.  It relates to receiving treatment as a mentally ill person.

This is the thing.  Treatment is available to those who need it.  All one has to do is ask.  However, if one is psychotic and unable to maintain a firm grasp on reality and recognize one's need for mental health care, you won't ask.  Hence those who need mental health intervention don't receive it because they are not sane enough to recognize their need for it and request it or consent to it. 

The young person I've been concerned about has been in and out of the hospital this last week.  The psychotic behaviors continue, in fact appear to be escalating.  But the treatment offered was not desired.  The only diagnosis so far has been psychosis, which is a symptom, not a disease.  One hopes that additional help will be forthcoming, but its effectiveness will depend on the person's willingness to participate and ability to see the need. 

The thing about psychosis is it is very real to the person experiencing it.  Their reality is reality.  Perhaps the only one they know.  It's very hard to reason with a person that has lost their grip on reality.  And yet you know that anyone who is mentally ill, and subsequently treated to the point of becoming healthy, will be deeply grateful for having received the treatment.  Its just that when they need it they can't see it.

In the case of this individual that I'm concerned about, the primary criteria for involuntary treatment is that they must exhibit behaviors that put themselves or others at risk.  Simply being in another reality is not to be homicidal or suicidal.  They may have lost all contact with reality but-- they appear harmless, so the disease goes on untreated.

We've got a long way to go with mental health care.  One size doesn't fit all.  It is good to respect the rights of the mentally ill.  Yet it is necessary to get them the treatment they need.  Psychotic people are not competent to make that decision on their own. 

Their wellbeing might be dependent on the courts recognizing this.

In the meantime we hope and pray.