In summary, published research strongly points to underlying medical problems, rather than environmental or psychosocial factors, as the primary cause of delirium in the ICU.
In the past, this neurological symptom used to called “ICU Psychosis”. The “What is Serious Mental Illness” page stresses that it is important to look at other medical conditions that are typically classified as ‘medical’ vs psychiatric as a means of breaking down erroneous patterns of thinking about what is known as serious “mental” illness.
Schizophrenia, Bipolar, Clinical Depression and other Ideopathic Psychosis Spectrum Disorders (IPSDs) that severely afflict mentation, cognition, consciousness, and sensory processing are in fact medical disorders.
Some advocates are calling for these disorders to be reclassified out of the mental health system. The way people conceptualize these illnesses has to change, beginning with the medical community itself. Misunderstanding of these diseases and disorders is the root of so many of the mistakes legislators, policy makers, and the criminal justice system are making. These are mistakes that have life and death consequences.
The criminal justice system tends to downplay the dangerousness of psychosis because acknowledging that it robs human beings of regulatory control interferes with the drive that so many prosecutors and judges have to see people convicted and incarcerated. Many of these actors have the cognitive capacity to learn about these illnesses, but they do not care to learn – they are too angry, too much driven by emotion over reason. Unfortunately, there are too many “forensic” psychiatrists (and psychologists who should be barred from clinical engagement with people who have IPSDs) who have insight problems that lead them to cooperate with criminalization.
There are a lot of informative articles on the web about Delirium (which really is a psychosis with unstable consciousness) and many of these sources bluntly describe this neurological state as acutely dangerous. Were it not for the inherent restraints on motor activities imposed by acute illness, many Delirium patients might physically harm themselves or treatment staff – just as in the so-called behavioral health ward. This blogger has described psychosis as a medical emergency but that assertion is not taken seriously by policy makers and legislators. Consider this excerpted statement from the following article:
“Delirium is an emergency. It is a serious medical problem,”
We have people across this country who have manifested the most catastrophic behavioral consequences of psychosis sitting in jails for weeks and months untreated awaiting so-called competency restoration. Many of them have died in jail, others have been conducted through the courts to the living death – in prison.
Yet, there are factions of the mental health industry that continue to peddle the notion that serious “mental” illness is a very small risk factor for violence:
…Having a mood or psychotic disorder carries only a small increased risk of violence compared with the general population but when combined with a history of substance abuse, personal victimization, or exposure to violence in the surrounding environment, the likelihood of violence increases. Risk factors for violence include a history of violence or arrests, psychopathy or antisocial personality disorder, substance abuse, young age, male gender, unemployment, and relationship losses.
This is the standard disclaimer deployed by the credentialed, authoritative class (the academics and clinicians) of the mental health industry. There is no reason to conclude that their belief in this orthodoxy is not absolute. However, the “research studies” that are cited to support these assertions are highly suspect. There are vested interests ( e.g the criminal justice regime and negligent state governments) who may find the conclusions derived from these spurious “research studies” to be complimentary to their objectives. These assertions undergird criminalization of hundreds of thousands of human beings who should be getting medical care instead of conviction and punishment. Dr. E. Fuller Torrey expounded upon this pernicious dissociation of serious “mental” illness from goal-directed and paroxysmal type violence in his book, The Insanity Offense.
What disclaimers are attached to the reality that acute care patients suffering from Delirium have a grave risk of violence, if not for the physical incapacity imposed by their physical frailty?