This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
On Provision of Violence: (And some mild trauma processing).
I will try and avoid directly mentioning the Minnesota situation, but that’s obviously why I am writing.
I am not a police officer or active-duty military in a combat zone, despite that I have one of the few jobs that involves legalized provision of violence to individuals without their consent.
In healthcare this happens a few ways, one of which is treatment over objection, which happens for a variety of medical and psychiatric reasons and is in most settings a slow-motion problem that involves court and ethics committees. Emergency care absent consent is almost always adequately established retroactively without issue.
Far trickier is restraints.
Restraints happen for a lot of reasons. On the medical floors the classic example is delirious grandma flailing at the nurses. On psychiatric floors, well it should be obvious. In forensic (correctional) settings you have a variety of places where these becomes necessary because the patients are pretty much definitionally assholes. However, psychiatry and the ER are probably where this happens the most.
Fundamentally the reason for restraining patients is to protect the patient, the other patients, and staff. Plenty of people are a serious threat to themselves or others. Sometimes it is drugs. Sometimes it is delirium and confusion. Sometimes it is mental health, and sometimes it is pure personality.
People don’t usually appreciate being put in restraints. They fight back. Hard. Sometimes they attack unprovoked early which is a whole sperate problem. The impact of violence on healthcare workers is grossly underappreciated. It almost always goes unreported and unprosecuted. “The patient was sick” and it gets swept under the rug.
Nurses and techs are more risk than doctors, but it is a common way for careers in psychiatry and emergency medicine to end – tired of the threats and just giving up or injured and forced to bail out. Rarely people die, but it does happen.
During medical school I once got covered in my supervisor’s blood, and on another occasion, I had to carry away a chunk of somebody’s scalp. A guy I know from medical school once responded to a code in the middle of the night and found two patients and a nurse wrestling in the nursing station while another nurse slowly bled out from a neck wound.
I’ve been swept by a gun during a trauma (fucking search the bangers before, thanks), and handed a knife by a guy who was already searched while alone in a room. Yesterday, a nurse at another hospital in my region almost had their finger bitten off while restraining a patient, which is why I decided to write this.
And none of this occurred in the correction setting, which is far, far worse.
Below I have some lessons I’ve learned while dealing with this sort of thing.
-Violence is uniquely hard to deal with. At this point in my career, I can handle a medical code just fine. The risk of death is present, but the “enemy” is a disease. It fights back in predictable ways. Other people can get hurt (and I’ve seen it) but it doesn’t hit the same. Managing agitation is almost always far more uncontrolled and challenging. It is more likely to be different every time. It is enormously more stressful. And-
-It is hard to get used to safely managing violence. Training helps but very few people are actually dealing with situations that go pear shaped often enough to be calm, cool, collected, to learn lessons and get better next time. Most cops don’t deal with a serious incidence once. You can drill all you want but that isn’t enough real-world practice time to be actually good. It requires a lot.
-If you do get enough experience, being callous is nearly inevitable. The behavioral response team at a busy city hospital is going to be putting multiple patients in holds and restraints a week most of the time. They might get used to being punched in the face or nearly punched in the face. Some of their number may end up seriously injured. The fear is always there, but once you get used to it, you get used to it. You tune it out and it takes serious diligence to not blow things off and become blase. I don’t think I’m good at this. Someone with less training or dedication? Fuck no, it is an impossible task, anybody who could do it wouldn’t because inflicting violence sucks. You feel bad. You don't want to be in that position. You don't want to do it.
-Communication is hard. Restraining someone is like most police action. You have a large group overpowering and bum rushing one person. This should make things easy. I am also in charge, they can’t touch the patient without my explicit order, nor can they administer IM medication or put the patient in restraints. Everything runs through me. Clear communication. Should be easy, no? Fuck no. Everybody is shouting, the patient most of all. Uncontrolled things are happening. Somebody drops the keys. Somebody trips.
Tearing open the chest of a patient in a clamshell thoracotomy is a more controlled and clearer situation. A sub 90 second C-section is a more controlled situation. A “fight” hampers communication like nothing else. And that’s in a hospital with more than enough people and an experienced team.
-Everybody can’t breathe. Some patients who need to put in restraints are more “behavioral” (this means that instead of someone who thinks the doctors are leaches from Mars or is zonked on a UTI…. they are just an asshole). These patients almost always loudly shout they can’t breathe while being restrained. They say they can’t move their limbs while flipping you off. They'll claim racism no matter your race and their race. This goes double for forensic patients. You start to tune out these complaints since they are “always” lies. The connection to law enforcement is clear, I hope.
-We don’t like it. I’ve never seen staff bad enough that they enjoy restraining patients because they like the power, sometimes you see people who get disrespected and get some gross catharsis out of it. For the most part they hate it. The emotions afterwards can be hard to manage, even if you are a good person who didn’t like it. People say things. Stuff comes out.
-Lastly, violence isn’t safe. No form of violence is safe. Some are safer than others, but patients used to die in four-point restraints (now we have strict limitations on use and have to nanny patients, but bad shit still happens). Holds are dangerous to staff and patients. Chemical restraints have a risk of respiratory depression and other side effects. We minimize risks but if you do these things an appropriate number of times something wrong will happen eventually.
Restraints are a bad option, but they are a required option. In life that happens sometimes.
Okay, here is my hot take. Get rid of paternalistic involuntary commitment, and you will cut down the instances of violence by half. (Most of the remainder will probably be prisoners in forensic psychiatry, e.g. people who committed (mostly violent) crimes but were found not guilty for reasons of insanity. These are probably best considered prisoners first and patients second, just like normal, sane, sociopath serial killer serving life who also has a bad toothache is unlikely to be rendered less of a danger because of his medical condition.)
Specialties of medicine which respect patient autonomy presumably have a vastly lower incidence of patients turning violent. Take oncology. Breaking off a promising chemotherapy is probably among the treatment decisions which carry the highest QALY cost, outside of outright committing suicide while healthy. Yet for adult patients, society and healthcare professionals generally accept that it is the patients decision. Very few cancer patients will attack a nurse out of desperation, because if they want to leave, they are just one signature of their own death warrant ("leaving against medical advice") away from getting out.
Contrast with specialties which do not give a damn about patient's autonomy, psychiatry first and foremost. I wish I could say that a month in a psych ward had the same long term QALY gain associated with a month undergoing a promising chemotherapy, but while both treatments may share a similar quality of life during treatment (i.e. utter misery), the long term outcomes of these intervention are as different as different as a shot of rum and fentanyl are for pain management: in my experience, the main goal of psychiatry is to keep their patients alive for another day. A mostly functioning patient going into a locked ward for debatable psychotic symptoms might emerge a month later addicted to benzodiazepines (which effectively removes them as a further treatment option), prescribed some antipsychotic (which he will stop taking at the earliest opportunity), having experienced physical restraint (because people who mostly cope with life in freedom sometimes cope badly when put in very stressful situations) and a life-long conviction that anything related to the mental health system is utterly evil and terrible (which further limits their treatment options). (On reflection, likening this to rum for pain management seems optimistic, and it might be closer to chewing glass for pain management.)
(I am fine with people who attempt to kill themselves without success or are expressing the intend to commit suicide spending a few days locked up for their defection around social norms. There is no intrinsic right to fail to kill yourself or distress others with your plans. Just let them out after a few days, and hope that they have overcome their acute suicidality, learned their lesson either about threatening suicide, or the lesson about which way to cut and keeping their mouth shut -- suicide is a human right, after all.)
If a base jumper falls to his death, that is sad, but not particularly upsetting. After all, when he took on his hobby, he was perfectly aware that humans are ill-suited for gliding close to the ground.
If someone who has made it their profession to lock people up without them having violated criminal laws gets attacked by one of his prisoners, that is also sad (and generally wrong and evil on the part of their prisoners, because typically it will not lead to them escaping), but also not particularly upsetting. Treating people as unable to make decisions about their own life (which is why you lock them up, after all), while also expecting them to respect norms of polite society e.g. about not sticking a cake fork into through your eye socket seems to be both hypocritical and utterly foolish.
Further reading of my opinions.
On a broader level if anything it should be increased. Instead of releasing clearly schizo criminals 50 times in a row so they can finally set a lady on fire or kill some one and be put in jail, instead of the 3rd time they punched some one randomly on the street having them committed involuntarily in an asylum.
If you read my quote very carefully, you will notice that the fourth word is "paternalistic".
Putting someone into forensic psychiatry for crimes they committed is not paternalistic, it is clearly 'for the good of society', not 'for their own good'.
I have no problem with putting people into forensic psychiatry, provided that that get their day in criminal court, that their maximum stay duration is no longer than the penalty the law provides for their offense, and that they have the option to transfer to regular prison if they want to.
So if you jurisdiction allows for sentencing a sane person to life in prison for their third unqualified assault (which might set bad incentives on its own, however), I have no objection to you locking up a psychotic offender in forensic instead.
Of course, this also involves society being willing to pay the costs of keeping someone locked up in a psych ward long term, not only for patients who are naturally inclined towards violence, but also towards any patients which might prefer this to being left to their own devices, if they exist (because qualifying on purpose would be trivial).
That assumes they should be locked up after committing a crime, I think I'm proposing something you're completely against. I want the homeless and the violently insane institutionalized before they offend. Being homeless shouldn't be a crime, being homeless again after being supplied housing and a drug rehab program but then choosing nah, lets be homeless again and do drugs should get you involuntarily committed even before you start assaulting people.
Same for the randomly schizophrenic and psychotic roaming the streets without rap-sheets. Hell, you could have something like a cross between half-way houses and sanitoriums for the less pathological cases. Where the staff makes sure you take your meds while re-integrating into society in a structured environment.
Anything but the current status quo of dumping these disordered people on the streets we currently have going on.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I apologize if I missed something here, it's been a long day at work.
You are making two mistakes I think.
The first thing to note is that the vast majority of restraint encounters are in the ED with mostly undifferentiated agitation. That almost always ends up being drugs or medical illness.
Patients who end up in a psychiatric unit, well the vast majority of restraints are for violence towards others not the self.
If you are a reader here and you've been in a psych unit it's probably been for suicidal ideation and it was probably in a cushy unit. The majority of inpatient psych work involves violent criminals, drug users, and the severely mentally ill (ex: schizophrenia, bipolar) - not depression.
An untreated manic episode prior to modern medical care had a 20-25 percent fatality rate due to getting themselves killed in one way or another.
Even if we gave up on the suicidal it really wouldn't solve the problem.
Protecting other people from the crazy and foul tempered is important.
More options
Context Copy link
More options
Context Copy link
I'm counting the days till a patient socks me in the face. It'll save money on a nose-job.
Funnily enough, I've never seen restraints in use on the ward. Mostly because my placements have skewed geriatric, and there's only so much damage a delirious granny can do with a plastic spoon. That is not the same as that being the ideal level of usage for restraints, it boggles my mind how much shit UK doctors, nurses and hospitals put up with. I acknowledge that emergency sedation isn't perfectly safe, but neither is tolerating violence and agitation to the point where sedation is necessary. I haven't been offered any hazard pay, and I've had to patch up broken noses more than once.
From what I've heard the U.S. patient population is much more dangerous and violent than in other countries, in a variety of settings.
Doctors in other countries seem to pat themselves on the back for not really using restraints but it ain't for the reason they think it is.
Drugs use is probably a large part of this. So is safety social net.
How does a social safety net reduce patient violence?
This is more of a stereotypical lib left answer than my own but it keeps people away from drugs and homelessness and being super foul tempered.
More options
Context Copy link
More options
Context Copy link
We were patting themselves on the back about our social safety nets and how they lower criminality for decades. Then we imported 7 zillion Middle-Easterners and Africans. We don't pat ourselves on thr back so much anymore.
I would really like to talk to a non-woke doctor from say Germany about how that stuff goes.
I'd suspect that this side of things wouldn't be as bad as you think since shit hole countries may have a tendency to just kill or lock away forever patients with serious mental illness or drug use.
Baseline criminality and poor understanding of Western cultural norms is more of a traditional police problem and dodges (some of) these tensions.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
That sounds like a film script waiting to be written. I'm picturing Die Hard in an old people's home.
Die Hard meets Hobo With A Shotgun with a bit of From Dusk Till Dawn thrown in.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Violence is an inherently high-variance activity. Those who whine about the necessity of violence are fundamentally immature.
There's a common scene in street fights where a girl starts a fight, drags her man into it, then impedes him in the fight so he loses. This is the basic strategy of the political left, and the psychology that underwrites it is identical.
This does seem truly hard to grasp if you've only ever experienced physical violence in the abstract. i.e if you've never been punched in the face.
Even if you watch professional fights, the rulesets in those arenas are optimized to avoid the actions that can cause instant incapacitation or grievous harm/death, and the competitors are fighting with less than lethal intent.
Take away the refs, rules, and moral restraints... any given strike COULD be a life-changer or life-ender. Quadruple that if weapons are involved.
For me, and I think most 'right-thinking' humans, this means you avoid violence as long as possible because you mostly lose control of the outcomes once it comes to that.
And on the flipside, it means you don't let opponents implement violence unilaterally, both for the deterrent effect and to prevent your side from being the sole recipient of the the consequences.
But there is as you say a group of people who see this reluctance to get violent as an exploitable 'weakness'. Push the line to force some violent response and then hope for those fat-tailed outcomes to result. Then claim the fat-tailed outcome was SOLELY the fault of one side for acting out.
And it is a lot easier to implement this strategy if you can convince your low-agency ideological followers to become human fodder.
Even 'violence' against property carries this risk with it. One image that stuck with me from the BLM era is the protestor getting clobbered by a falling confederate statue.
Its a very, very stupid thing being done, on so many levels. This is fucking around with the laws of physics and finding out quite immediately. One second you're celebrating the fall of racism with your buddies... the next you're in a vegetative state.
But the human body is indeed resilient so he survived... for some definitions of that term.
Here's a terrifying line that I hope is never written about me:
In some very similar timelines that guy is just straight up dead. In some he's grievously injured but not traumatically brain damaged. And in a few he dodges fate by a few scant inches. High variance indeed.
Incidentally, this is why I think the saying "what doesn't kill you makes you stronger" is an extraordinarily bad sentiment to believe in the context of physical violence.
Humans can survive nearly anything, and die to nearly anything. But injury is fucking easy. People pretend that anything short of death isn't a big deal, but death isn't why violence is scary. Every violent situation contains a distinct possibility of major injury for someone, usually everyone involved. The sort of thing that changes your life forever.
Even without death, a simple fistfight will almost certainly require months of healing and rehab, if you win. More if you lose. It is rare that a real fight ends without both participants having broken bones. Fingers and toes the most common, of course. Add weapons/vehicles and this risk skyrockets. There are a world of outcomes from violent situations, but few of them are as good for either party as before the fight. Even winning without injury has its psychological and social costs.
Yeah. Its like, unless you're being paid pretty handsomely, or defending your life or a loved one against an unavoidable attacker... why do you ever want to fight?
Break a limb and now you've got a medical bill and lost work, and that's assuming no permanent complications. Concussions suck. Brain damage sucks worse. To not even talk about para or quadriplegia, which we aren't yet able to really treat.
I could curmudgeonly blame the movies that VASTLY understate how much damage it takes to incapacitate a human. But it really must come down to people RARELY encountering physical violence in their life unless they're in a profession or lifestyle that demands it.
Fewer people working in factories seeing dudes get dismembered by heavy machinery. Drunken bar brawls are rarer, I'd wager.
Cars are safer, too.
White collar/service jobs really insulate people from this particular facet of reality.
That said, some of us grew up with access to liveleak.
More options
Context Copy link
My mother and I recently visited a memorial to WWII submariners, and my mother looked at the list of lost ships and their crew numbers and said wow how on earth did you convince anyone to get on a submarine? And I pointed out that submarine service isn't SO bad, because for the most part you either sink or you don't.
You're much less likely to get grievously wounded, disfigured, crippled than you would be in the infantry. You aren't crouching in a trench in perpetual terror for months. Your moments of danger are intense but they last mere hours, and then generally you're dead or you aren't. Not a bad deal as war goes.
Though the WWI u-boats were pretty bad. But I guess so was the rest of WWI too. http://vlib.us/wwi/resources/archives/texts/uboatu9.html
Definitely pretty bad. In WWII, US Submarines were by far the worst deal in the US military for KIA. Worse than infantry, worse than bomber crews.
But in terms of the bravery required, it feels like it would be different and probably easier (for me) in nature. You get on the sub, and that's it, relatively little personal courage required after that. You'll have to act under pressure, of course, but no moreso than anywhere else in combat. Compared to sleeping in a foxhole under fire, day after day, seeing your friends wounded and killed and knowing you might be next. Jumping up to run into a bullet, over and over, seems much harder than "hope the ship doesn't sink."
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
To what extent do you (or legal or ethical theory) conflate or distinguish between force, and violence? Restraining someone is certainly forceful, but is it necessarily violent? If you had cheap, harmless sleep rays to aim at patients, would this be considered 'violence?' Such a technology "feels" unethical, even though it seems like it offers safety improvements.
People generally resist, because you wouldn't be restraining them unless you had to and you have to because they accidentally or intentionally want to do something dangerous, so they resist.
Restraining someone who is resisting involves them attempting to attack you, and you essentially attacking them. It is not safe. It is violent. It is dangerous.
People who do not have experience with these things can easily go "oh well it's a magic controlled situation" and underestimate how brutal it often is, which is one of the reasons I wrote this up.
Policing for similar reasons is inherently violent. The threshold for someone to resist the police is higher because of life long training to be scared of the police but people who do it present a threat to themselves, bystanders, the police.
And the left is training people to resist, violently or in a way that isn't distinguishable from violence in the moment.
That's why this woman died.
She didn't realize just how dangerous what she was doing was.
More options
Context Copy link
More options
Context Copy link
Do you think these situations would have been improved by you being armed with a gun? And given that many doctors suffer a...size disparity from your average trauma patient, and fists can easily be a deadly weapon, should the doctor have shot the patients in any of the stories you list above?
Where do the NRA and courts land on arming doctors/self-defense in hospitals, anyways?
With the exceptions of oversized atriums anything in a hospital is necessarily going to be CQB. Between that and the fact that incidents of violence are either totally unforeseen (or missed, anyway) or planned in advance....not likely to help. Most city hospitals will have some armed police onsite in some capacity and they have strict rules about what weaponry where.
Ultimately we are trained and "required" to accept being victimized instead of defending ourselves, this isn't always the wrongest thing in the world - delirious granny, well it's not her fault I'm not going to shoot her.
Incidents like the banger with a gun are rare, and almost always we have a damn large team and a million people in earshot, that lowers the risks.
Hospital policy is almost always going to ban people from bringing their own weapons but you definitely run into people who ignore that. It has been on occasion comical, some people will have capped syringes in their purse "just in case."
Coming to work armed is going to be more common in outpatient - you are more likely to be alone or semi alone, in the hospital someone can always hear you scream.
Sometimes that person is another patient - the second patient in the wrestling anecdote was actually helping restrain the stabber.
More options
Context Copy link
More options
Context Copy link
'Callousness' in medicine is unavoidable. End of the day most serious medical engagements are the worst thing to happen to the patient this year, decade or lifetime and it's Tuesday for the person treating them.
More options
Context Copy link
This is the core issue. Violence is easy. Minimal amount of violence necessary to achieve your goal, with the understanding your actions will be under the microscope in hindsight by others with all the time in the world is very difficult.
I have so much respect for healthcare security and medical staff for dealing with the worst of humanity.
Do you know what cops do when they assess that someone is out of their minds (either psychologically, or due to drugs)? They drop them off at the nearest ER, shrug, and say 'your problem now.' The worst types of criminals and mentally ill aren't dealt with by cops, but the healthcare system. The medical staff are meant to treat someone in a psychotic aggressive state without harming them or allowing themselves to come to harm. Imagine a George Floyd once a week except he's screaming and trying to bite your face off like a fast moving zombie from 28 Days Later.
Get it wrong and you've lost a digit, been stabbed with a junkie needle or are in fear of losing your job based on the outcome of an administrative panel review (that cares about the corporate image more than your wellbeing).
You couldn't pay me enough to do that.
All too true. Alas, this is pretty much SOP since a landmark Supreme Court ruling in 1975 set that specific standard. The system, such as it is, is working as intended. I work with folks that are responsible for doing the psychiatric screening end of this that get dispatched to the hospitals to determine whether or not these sorts of individuals are in such imminent danger to themselves or others or alternately cannot care for themselves that they need to be temporarily detained against their own will. It pretty much sucks for all liable parties, which is to say the hospitals, LEOs, and the screeners. The LEOs must regularly attend training on how to assess potential mental health issues with these sorts of folks and they could conceivably be put under the microscope for the decisions they make in these sorts of cases, so they're going to err on the side of taking folks to the hospital, where high-priced medical staff often need to basically wait for a drunk/drugged up patient to sober up, deal with the frequent fliers that are off their meds or worse still, decompensating but have to stay there until a bed opens up in a longer term care unit, or convince the depressed individual to just commit to a fucking safety plan already and Get Out of Dodge while they still can because they really don't want to have all of their things away and have to live in a padded room for a few days until they're judged safe from harming themselves, now do they? If a patient makes it to one of our people then we have to go through reams of paperwork to document the encounter with the client as well as the entire timeline from when the client hits to the hospital to when we leave, including when we first get the call, when we arrive at the hospital, what the disposition of the case was, whether or not the client was temporarily detained and if so, where were they sent, when was the ruling made, who ended up transporting the client, when did they arrive to collect the client, other various and sundry questions all revolving how long things took because detainment orders expire, and so if things go awry the bureaucracy can cover its ass and point the finger at the right party, which starts with our folks if they don't document everything to a T to begin with.
Somewhere, Moloch is smiling.
I sometimes feel like we over-medicalize things in modern society: we want to defer "hard" ethical decisions to "experts", and doctors are some of our favorite experts.
I noticed this acutely when I was called for jury duty a while back (I was not selected), and voir dire included some questions about considering about applying a legal label ("sexually violent predator") that does have a very loosely defined medical component, and I could tell a tangible number of potential jurors really wanted to hide behind "what does a/the doctor think?" in terms of something the legislature, in it's great wisdom, deserved a jury trial rather than a medical panel. Frankly, given the weight of the decision, I see why: there are plenty of horror stories of doctors involuntary committing people, and a jury seems a potentially-preferable way to evaluate such status.
There were also quite a few jurors that questioned their own fairness on the topic of heinous crimes. I didn't get selected (the defense busted the panel, as it turned out), but am I weird in thinking that sometimes "fair" is, after carefully weighing the evidence of guilt, "throw the book at them"?
Your last paragraph is the reason juries are rarely given much, if any, say in sentencing. The jury decides your guilt or innocence, and then the judge applies the appropriate standards and determines the sentence. This (in theory) lets the jury focus on the facts of the case without getting caught up in the emotions of also being responsible for punishing the convicted.
Though arguably this defeats the entire purpose of a jury trial in the first place by ceding too much decision-making power to unelected elites who can use their discretion over sentencing to usurp the jury's role in applying justice/mercy according to community values.
I think most Anglosphere jurisdictions now limit the discretion of local judges with some form of sentencing code produced by a body like the US Sentencing Commission (for federal crimes) or the English Sentencing Council.* Political supervision of the organisations that issue the code is possible, and would be a good idea. (Although the likely outcome of more political involvement in sentencing in today's degraded democratic culture is populists noisily passing longer sentences without spending the money to build the necessary prisons).
The real problem is that even judges have a limited say in sentencing if most cases are plea-bargained. Having sentencing decisions de facto made by prosecutors is good for democratic accountability in a system with elected DA's, but bad for the rule of law.
* I support mandatory tarring and feathering for everyone who registers a government domain on a .org, .org.uk or similar domain name, including the registrar. The government should be honest about what it is.
Right, I really should have mentioned sentencing guidelines and plea bargaining, since those probably have more of an impact on the criminal justice system than either judges or juries nowadays.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Yes absolutely, so many patients end up dumped in the ED who aren't really medical or psychiatric, they are just difficult enough that the cop figures it must be a healthcare problem.
Then we are left discharging this massive liability as soon as they sober up or whatever.
What options do the cops actually have otherwise?
Kinda sounds like buck-passing all around. How can society deal with low-grade socially corrosive people? Without offending the bleeding heart types who do nothing to help but condemn anything that might?
Here's the trick, you start with them.
How?
More options
Context Copy link
More options
Context Copy link
The answer is simple, but society refuses to accept it. Death. Life is not precious, it's cheap. Just execute these people. They don't add any value, they massively degrade the quality of life for all of society, they also take precious resources that could be allocated to more productive ends.
In the past, these people would have been outlaws, which means banishment and near certain death, and should an outlaw venture into civilisation it was legal to kill them.
More options
Context Copy link
You need us to make sure they don't die from intoxication or withdrawal? Fine. Cut themselves on a window breaking in, or got hypothermia? Fine. Need us to psychiatrically clear? Fine.
You'll see presentations that start this way though: "Patient brought in by police for threatening to push people onto the subway tracks while clearly high on a serious drug, two other incidents this week, and was brought to the hospital 14 times in the last 2 months for similar presentations but the police decline to press charges."
Probably not actually the police fault there but that's what the docs like to blame, but we see tons of dump jobs where we are just waiting for the guy to do something bad enough to not be caught and released and its an actuarial game. Seldom anything medical or psychiatric to do.
Big scandal in NYC recently after a state hospital cut someone loose and they immediately went and stabbed someone in a Macys. Doctor scuttlebutt is that the patient wasn't psychiatric - pure personality. Should have been a criminal matter front to back and now somebody is quite likely going to get sued out of the profession for something no physician has any control over.
In the US, this is a scandal; in Canada, this is Tuesday.
Oh no, released from police custody and does it? Def a Tuesday in the U.S.
Hospitals? Much rarer (in part because suing is an option).
More options
Context Copy link
More options
Context Copy link
How do you define this though? Not to cast aspersions on the doctors but the inherent nature of mental health diagnosis means that declaring somebody absolutely sane isn't the same as saying 'they don't currently have a broken leg'. The whole system is clearly creaking under an unwillingness/inability to actually handle whatever small % of genuine social defectors which then produces people rushing to palm them off on some other subsystem in order for them to no longer be their problem.
This means something very specific in a medical context, yes people can have personality problems in the sense that you mean outside of healthcare and end up in prison, but we have a specific suite of diagnostic identities called "personality disorders" (the most famous are probably: anti-social, borderline, and narcissistic) that represents a pattern of maladaptive personality features with a somewhat known cause that don't respond to medication and barely response to non-medical interventions like therapy.
Patients with these disease processes sometimes end up in a psychiatric hospital because of behaviors that are dangerous (towards themselves or others), but the purpose of a psychiatric hospital is to begin the acute stabilization process, if someone can't be helped by a psychiatric hospital and engages the in dangerous and illegal behavior than the correct location for them is prison, while in prison someone can try and treat comorbidities and begin loooooooooongitudinal therapy.
More options
Context Copy link
More options
Context Copy link
Yeah, I would guess this is a blue city soft on crime prosecutor problem. A crazy/drug-addled person threatening to kill people should actually not be left free to be a violent random encounter for the citizenry.
Exactly. The Modern West just struggles to deal with people who defect from polite society. Most of the punishments that can still be levied are more 'this derails you from polite society so don't do it' effects. Thus for committed defectors it quickly becomes a case of the latest fine simply adding to the pile.
More options
Context Copy link
Most of my work has been in blue locations but I'd wager that even red ones aren't great about this, I'd love to hear anecdotes or data to the contrary though.
You'd be shocked at how soft the legal system can be, even in red areas. You see this in stalking and DV cases - threats and implications are often not enough to do anything useful and things end up being too late.
The key word that twigged me there was "subway". Are there any places with both subways and Republican mayors? That actually seems like a good question for an LLM.
The Bing default search AI summary completely shit the bed:
Richard Riordan is real, but Pittsburg has not had a Republican mayor since 1934. Mike Mergner Bloomfield seems to have been entirely hallucinated (hilariously so - "Yeah, the last Republican mayor was old Johnny CityName). Jean Stothert was the Republican mayor of Omaha, Nebraska. Corey O'Connor is the mayor of Pittsburgh, but he took office last week, not 2021, and is a Democrat. David Bronson is real. 3/5 fake answers.
Copilot did better, listing
All of whom seem to be real.
Michael Bloomberg is real but a Republican in name only; he switched to the Democratic party partway through his mayorship and his most distinguishing feature was that he was all-in on government paternalism. Bloomfield, NJ is also real but lacks a subway, unless you mean the fast food chain, and has had only Democratic mayors in recent years.
More options
Context Copy link
This was an interesting exercise, actually kinda blows my mind.
More options
Context Copy link
More options
Context Copy link
True but you think those'd have more inherent grey areas than the litany of 'moderately violent homeless person is brought in 50 times until finally actually murdering somebody' if it's a defective relationship between two societally-functional people versus a person who is clearly just not beneficial whatsoever.
It's how our individual rights based system works. I'm usually okay with it but the problem is that many people have bought the progressive frame and never transition to actually managing the issue.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I'm just gonna register that I think everyone who is following this story should watch a random sample of police bodycam videos. Try Midwest Safety on Youtube. It may not change your view, but it will probably change your perception, because there appear to be many commonalities across a broad spectrum of situations.
Looked at the channel and one of their most popular videos seems to demonstrate the point quite well: https://youtube.com/watch?v=5FMtL7saNKE?si=5-UEv0w-P9KmYvtH
A woman's boyfriend gets mad at her for stripping and when the police intervene the man just absolutely refuses to be chill about it. Winds up needing to be manhandled quite severely. Dragging him into the police car without dislocating his shoulder was tough.
The woman being unable to enter the club legally under the age of 21 and therefore quickly signing up as a stripper in order to get in is a pretty insane sequence of events, I've got to say.
It's weird but it's a quirk based off of the strip club being a bar. It's state by state but it's not uncommon for employees to be allowed to be under 21. Beyond that there's the even more common carveout for "performers"; granted the law makers probably had musicians in mind.
I get why there'd be a workaround for professionals but the idea they've just got a pile of stripper signup forms and then she actually went up and danced instead of being 'observing Stripper intern' for the day
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I'm actually a paying subscriber to that channel. And one other. A dollar a month. Beats a Substack subscription on cost.
But it's a low status thing to admit to watching (much less paying for), even as it gives you a more realistic view as to what police are dealing with, at least relative to getting your information from scripted dramas and non-profit org stats and prog talking points. My more educated, higher income left-leaning friends will watch every last show on Apple TV before they waste their time on that "crime porn."
More options
Context Copy link
My friend calls it "exhibiting getting shot behavior", and it's remarkable how bad it is. There's definitely a selection effect because boring stops don't get posted. You've got your freak atrocity's like Daniel Shaver and Philando Castile (granted I've seen people claim they just needed to follow orders as well) but most of the time these people can just not sit still. Or like this guy "Let me reach deep into every pocket" while the cop has his gun drawn on me.
That's a crazy video. I can't believe that the cop kept his finger off the trigger (either for the taser or the pistol). I know all about trigger discipline, but I'm shocked that police would keep their finger off the trigger when a potentially armed suspect is digging through their pants like that. The extra couple hundred milliseconds to move the finger into the trigger guard could really make a difference.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link