February 22, 2005
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Mysteries of the Mind
U.S. News & World Report; 2/28/2005; Marianne Szegedy-Maszak; ; Marianne Szegedy-Maszak
The snap judgment. The song that constantly runs through your head whenever you close your office door. The desire to drink Coke rather than Pepsi or to drive a Mustang rather than a Prius. The expression on your spouse's face that inexplicably makes you feel either amorous or enraged. Or how about the now incomprehensible reasons you married your spouse in the first place?
Welcome to evidence of your robust unconscious at work.
While these events are all superficially unrelated, each reveals an .phpect of a rich inner life that is not a part of conscious, much less rational, thought. Today, long after Sigmund Freud introduced the world to the fact that much of what we do is determined by mysterious memories and emotional forces, the depths of the mind and the brain are being explored anew. "Most of what we do every minute of every day is unconscious, " says University of Wisconsin neuroscientist Paul Whelan. "Life would be chaos if everything were on the forefront of our consciousness."
Fueled by powerful neuroimaging technology, questions about how we make snap decisions, why we feel uncomfortable without any obvious causes, what motivates us, and what satisfies us are being answered not through lying on a couch and exploring individual childhood miseries but by looking at neurons firing in particular parts of our brains. Hardly a week passes without the release of the results of a new study on these kinds of processes. And popular culture is so fascinated by neuroscience that Blink, journalist Malcolm Gladwell's exploration of "thinking without thinking," has remained on the bestseller lists for four weeks.
Most of us can appreciate the fact that we make up our minds about things based on thinking that takes place somewhere just out of our reach. But today, scientists are finding neural correlates to those processes, parts of the brain that we never gave their due, communicating with other parts, triggering neurotransmitters, and driving our actions. Says Clinton Kilts, a professor in the department of psychiatry and behavioral sciences at Emory, "There is nothing that you do, there is no thought that you have, there is no awareness, there is no lack of awareness, there is nothing that marks your daily existence that doesn't have a neural code. The greatest challenge for us is to figure out how to design the study that will reveal these codes."
Burgeoning understanding of our unconscious has deeply personal and also fascinating medical implications. The realization that our actions may not be the pristine results of our high-level reasoning can shake our faith in the strength of such cherished values as free will, a capacity to choose, and a sense of responsibility over those choices. We will never be able to control the rhythm of our heartbeats or the choreography of our limbic system. And yet, Gladwell writes that "our snap judgments and first impressions can be educated and controlled . . . [and] the task of making sense of ourselves and our behavior requires that we acknowledge there can be as much value in the blink of an eye as in months of rational analysis."
Mental health. But unconscious processing is not just the stuff of compelling personal insight. For those with emotional disorders like anxiety, bipolar disorder, and schizophrenia, and others who suffer from traumatic brain injuries either from a stroke or an accident, peeling away the behavioral layers of their dysfunction has revealed fascinating activity out of conscious awareness that may eventually provide clues to more effective treatments. Recent research on minimally conscious patients, for example, shows language centers on fire when they hear personal stories recounted by a family member. Research on schizophrenia reveals that most who are afflicted have an impaired ability to smell, which researchers think may provide some clue to understanding why they have such difficulty perceiving social cues. Or consider the case of Sarah Scantlin, who was hit by a drunk driver and lay mute at the Golden Plains Health Care Center in Hutchinson, Kan., for 20 years. After the Sept. 22, 1984, crash, the doctor told her parents that it was a miracle she was even alive but that she would never talk or move again on her own. Last month she began to speak--a simple "OK" at first, then more words, even short sentences.
How does this happen? What was going on all that time? How do we get some access to this thing called the unconscious?
According to cognitive neuroscientists, we are conscious of only about 5 percent of our cognitive activity, so most of our decisions, actions, emotions, and behavior depends on the 95 percent of brain activity that goes beyond our conscious awareness. From the beating of our hearts to pushing the grocery cart and not smashing into the kitty litter, we rely on something that is called the adaptive unconscious, which is all the ways that our brains understand the world that the mind and the body must negotiate. The adaptive unconscious makes it possible for us to, say, turn a corner in our car without having to go through elaborate calculations to determine the precise angle of the turn, the velocity of the automobile, the steering radius of the car. It is what can make us understand the correct meaning of statements like "prostitutes appeal to pope" or "children make nourishing snacks" without believing that they mean that the pope has an illicit life and cannibals are munching on children.
Consuming thoughts. Gerald Zaltman uses examples like these in many of his conversations. He may be an emeritus professor from the Harvard Business School, but he thinks about layers of consciousness like a neuroscientist. He is also a founding partner in Olson Zaltman Associates, a consulting firm that provides guidance to businesses seeking to better understand the minds--and in this case it is quite literally the minds--of consumers. As a professor of marketing, Zaltman obviously was very interested in figuring out what made people buy one thing and not the other. In the world of neuroscience, this goes to the heart of the profound questions of motivation. In the world of business, this goes to the bottom line.
When trying to probe the minds of consumers, Zaltman wondered if there was a way to move beyond the often-unreliable focus group to get at the true desires of consumers, unencumbered by other noise, which would finally result in more effective sales and marketing.
His solution became U.S. Patent No. 5,436,830, also known as the Zaltman Metaphor Elicitation Technique, which is, according to the patent, "a technique for eliciting interconnected constructs that influence thought and behavior." From Hallmark cards to Broadway plays, from Nestle's Crunch bars to the design for the new Children's Hospital of Pittsburgh, ZMET has been used to figure out how to craft a message so that consumers will respond with the important 95 percent of their brains that motivates many of their choices. How? Through accessing the deep metaphors that people, even without knowing it, associate with a particular product or feeling or place.
Language is limited, Zaltman says, "and it can't be confused with the thought itself." Images, however, move a bit closer to capturing fragments of the rich and contradictory areas of unconscious feelings. Participants in his studies cut out pictures that represent their thoughts and feelings about a particular subject, even if they can't explain why. He discovered that when people do this, they often discover "a core, a deep metaphor simultaneously embedded in a unique setting." They are drawn to seasonal or heroic myths, for example, or images like blood and fire and mother. They are also drawn into deep concepts like journey and transformation. His work around the world has convinced him that the menu of these unconscious metaphors is limited and universal, in the manner of human emotions like hope and grief.
And Zaltman has found that even grand metaphors have their practical applications. The architectural firm Astorino and the design firm Fathom asked Zaltman for help in designing a new children's hospital that would make a difficult experience somehow easier for children, their parents, and the people who work there. With the classic ZMET technique, children, parents, and staff members cut out pictures they somehow associated with the hospital and were then interviewed for nearly two hours about these pictures, exploring the thoughts, feelings, and associations that they triggered. A stream of metaphors emerged in the conversation. A child brought in a picture of a mournful-looking pug, which she colored blue "because he's kind of sad, and that's the way I feel when I'm in the ICU or just can't get out of my room."
After each picture was thoroughly analyzed by the participants, the images were scanned, and another interviewer with a computer and a talent for the Photoshop program sat with the parent, child, or staff member and created a collage, a personal Rorschach test of the images (box, Page 60). This snapshot of the participant's unconscious associations with the hospital was then enlarged to include personal narratives using the collage. The process is painstaking, but after the transcripts of these sessions are reviewed, even in all the enormous variety of human expression and emotion, core themes emerge. In the case of Children's Hospital, says Christine Astorino Del Sole of the Fathom firm, "the main metaphor was transformation, and the supporting metaphors were control, connection, and energy."
So how does that translate into the physical space? When patients and their families walk into the new hospital, which will be completed in 2008, they will be surrounded by images of butterflies, the ultimate symbol of transformation. Patient rooms will be more like home, and children will be able to exercise some control over their personal space. A huge garden, embodying transformation as well as energy and connection, will be visible from all rooms and accessible to children and their families. "Before, design was a guessing game; it was hit or miss," says Del Sole. "But we know now that at the deepest level this hospital has to be about transformation." So when a sick child, or a worried parent, or a harassed nurse walks into this hospital, a deep and reassuring recognition of the potential beauties of transformation will resonate unconsciously.
Waves of cola. Zaltman, obviously, is not the only person peering into the mind of the consumer. In a neuroscientific take on the time-honored blind taste test, Coke and Pepsi once again squared off. In Blink, Gladwell describes how the Coca-Cola Co. made a costly mistake in using data from blind taste tests between Coke and Pepsi--in which Pepsi was emphatically preferred by most cola drinkers--to change the recipe and create the marketing debacle that was New Coke. Still, even with a less preferred taste, Coke remains No. 1 in the soft-drink world. More recent research that was published after Gladwell's book was finished may explain why.
Researchers at Baylor College of Medicine offered 67 committed Coke and Pepsi drinkers a choice, and in blind testing, they preferred Pepsi. When they were shown the company logos before they drank, however, 3 out of 4 preferred Coke. The researchers scanned the brains of the participants during the test and discovered that the Coke label created wild activity in the part of the brain associated with memories and self-image, while Pepsi, though tasting better to most, did little to these feel-good centers in the brain. P. Reed Montague, director of the Brown Foundation Human Neuroimaging laboratory at Baylor, explained when the study was released last October: "There's a huge effect of the Coke label on brain activity related to the control of actions, the dredging up of memories and self-image." The mere red-and-white image of Coke made the hippocampus, our brain's vault of memories, and the dorsolateral prefrontal cortex, which is responsible for many of our higher human brain functions like working memory and what is called executive function or control of behavior, light up. The point, says Montague, is that "there is a response in the brain which leads to a behavioral effect." And curiously, it has nothing to do with conscious preference.
The dog comes up and begins to sniff. If it remembers you, and you were a nice person, then instantly it wags its tail, perhaps even deigns to lick your wrist. It may avoid you. It may associate you with food or with a swift kick. And all those images, all those associations are evoked by one healthy whiff.
Aside from the basic inhibition against walking up to someone and sniffing, humans are no different. "An odor is not just a name--it is a whole context," says psychiatrist Dolores Ma.phpina of the New York State Psychiatric Institute and the Columbia University Medical Center. Olfactory information is "privileged," Ma.phpina explains, since it is the only one of our five senses that does not make a brief stop at the brain's relay station, the thalamus, before going to the ever so intellectual prefrontal cortex. Smell is unmediated, unfiltered, and it hits the prefrontal cortex with a wallop of intensity. Researchers have found that smell plays a strong role in our mating choices, even without our knowing it. And when female roommates synchronize their menstrual cycles, it is because the unconscious perception of odor sets off the endocrine system. Our brains, says Ma.phpina, "beginning with fetal development, are laid out to give precedence to olfactory perception."
But what happens if olfactory perception doesn't work properly? Ma.phpina and other researchers are looking at the olfactory sense in emotional disorders and have found some intriguing results. While schizophrenia is seen as a disorder of hallucinations and delusions, a more compelling and disruptive element of the disorder is social impairment. Some people with schizophrenia can't seem to read social cues, or manage social relationships, or summon a social context for whatever encounter they are experiencing. And while hallucinations and delusions can be controlled often through medication, these basic social impairments cause far more difficulty in dealing with the daily demands of life.
Research has shown that many people with schizophrenia can also suffer from "clinically meaningful olfactory impairment," which includes dysfunction in higher brain centers such as the parietal lobes--the part of the brain that's responsible for integrating sensory output so as to understand something, like reading social cues or contextualizing those cues. Just as a smell can elicit an immediate image of a particular time and place, lacking that ability can deprive someone of a basic social and emotional anchor in life. "What we are learning is that smell is a good window into the unconscious basis for sociability and social interest," says Ma.phpina. "There is a tremendous explosion of interest in this forgotten sense. And it was under our noses all the time."
The scenario occurs in hospital rooms throughout the world, thousands of times every day. A brain-damaged father or mother or child lies in bed, not completely unconscious, not in a coma, but demonstrating only flickering consciousness, small behaviors that show there is some evidence of the person who once was there, some evidence that this person perhaps knows friends and family members are near by. Medically, these patients are categorized as existing in a minimally conscious state of awareness; it is estimated that there are 100,000 to 300,000 Americans in such a state right now. Sometimes these patients are able to actually utter the name of an object or to follow a very simple command. But for friends and family, they are no longer themselves. And because they find language so difficult, it is also assumed that they are unlikely to follow conversations.
The eye of the mind? But in a stunning study published this month in the journal Neurology, researchers used functional magnetic resonance imaging to study the brains of two minimally conscious patients and compared them with the brains of seven healthy men and woman. The scans revealed that the minimally conscious patients had less than half of the brain activity of the others. But then all the subjects were played a tape made by a family member or friend, recounting happy memories and shared experiences. One minimally conscious man listened to his sister reminiscing about her wedding and about the toast that he made. The result was astonishing: All those who were scanned, including the minimally conscious patients, shared similar brain activity, some with activation in the visual cortex. "This shows that there is a life of the mind beyond what is apparent," says Joseph Fins, chief of the medical ethics division of New York-Presbyterian Hospital-Weill Cornell Medical Center. But Fins, who was not involved in the study, points out that philosophical questions also emerge. "Does this mean that they are seeing words? Visualizing semantic concepts? Does this in some way conceptualize consciousness?" As Zaltman points out, language is only the narrowest determination of our thoughts. This study shows that our brains, even damaged brains, are exquisitely attuned to that fact.
For the brain damaged and for the healthy, despite the evidence of the prevalence of the unconscious in our daily lives, even as fervent a believer as Zaltman urges a bit of caution. "I don't think we know what the batting average is for purely rational reasons or reasons dressed up that way, or reasons dressed up as purely intuition. Both can get us into trouble--often do. And both serve us well." It is that great tension between the two, the intermingling of the known and the unknown, the conscious and the unconscious, the 5 percent and the 95 percent, that the pioneers exploring this vast and intricate universe of our minds will continue to probe. But there will most likely never be a complete understanding. After all, the enigmas of the mind, and the mechanics of the brain, will forever define the ultimate mystery of simply being human.
Copyright © 2005 U.S. News & World Report, All Rights Reserved.
When care is needed, not incarceration
The Record (Bergen County, NJ); 2/21/2005; TOM DAVIS, STAFF WRITER
For Ron Troche, life was never "normal."
Just about 5 feet 4 inches, he barely spoke above a whisper. His small eyes seemed to disappear in his round face. He looked scared and nervous, like he was about to cry.
He didn't have much of a past. He had played saxophone in the school band and learned to be a locksmith. He became a father when he was 19 and dreamed of having a tight-knit family. But that was only a dream.
He was mentally ill, and he got into trouble. He ended up behind bars eight times, usually for stealing money for the heroin that made him feel better. Police would find him lying in the street. Eventually, he landed in a 2,000-square-foot cell in the mental health unit of the Bergen County Jail, with bunk beds packed close together, sharing space with guys who, he said, "don't play with a full deck."
They would sleep, even snore.
He'd sit there for hours, beneath a light that never went off, scraping his bottom lip against his teeth. He was taking Zoloft for depression, but the real problem was anxiety. Every night was the same. The light that never went off, the pills in the middle of the night, the derisive laughter of the others.
When the news came that Ron was getting out, they didn't get it.
They watched in amazement as he packed.
That day was the start of something new.
Ron's chance came through "jail diversion," a program that provides alternatives for inmates with mental illness. The idea is to stop cycling people like Ron in and out of jail continuously. Instead, they are treated for psychological problems, and supported as they try to get established with a job and a place to live.
The new approach holds the promise of a better life for the participants, and removes them from the prison system. Some even hope that by reducing jail populations, it may save taxpayers money.
"We need to stop the bleeding," said Bergen County Prosecutor John Molinelli.
Thanks primarily to Molinelli, the state a year ago awarded a two-year, $250,000 grant to Bergen County to establish New Jersey's very first jail diversion program. Care Plus NJ, a private mental health care agency in Paramus, manages the service and provides guidance to inmates who qualify.
Other jail diversion programs nationwide serve hundreds of mentally ill inmates at a time, usually beginning when they are arrested. With limited funding, Care Plus doesn't intervene until a few months or so before an inmate's court date. It had 17 active cases by the end of December.
Those who qualify may get a lighter sentence, or even avoid prison altogether. Some are transferred to a treatment program. All get something that's rare in a steel-and-concrete jailhouse: extensive care and support.
Care Plus' case managers help pay participants' fines, accompany them to court and serve as a liaison to their families and lawyers. They contact counseling and drug treatment programs. Once the inmates are on the outside, case managers drive them to doctors' appointments and help make sure they have housing, benefits and the ability to pay their rent. Along the way, the agency's staff - a supervisor, two case managers and an intern - plays a big-brother/big-sister role.
Every Tuesday morning, case manager Mike Lang chats with inmates who are interested in Care Plus in a small, pale room at the county jail in Hackensack. The inmates are dressed in bright orange jumpsuits, their feet in sandals or high-tops with Velcro straps. The television is off. The books are stacked neatly in cases. As inmates lumber in for his weekly meeting, Lang assesses their moods. He's trying to determine who among them has the will to change.
"Sometimes that's their only outlet, to talk to me," said Lang.
A moment of uneasy silence starts things off. The inmates slouch in their chairs, arms folded. But once the ice is broken, they unload big-time. Curses and complaints pour out - about the food, their fellow inmates, their frustration with confinement. Lawyers aren't calling them back. Family members won't accept collect calls. They don't get enough medication. They get too much.
Most believe there is nothing wrong with them.
They were framed, they say.
Most can't meet the strict conditions for the diversion program. Only non-violent offenders from Bergen County can participate. But Lang listens to them all.
Each has his story.
About 16 percent of the nation's jail population suffers from severe mental illness, according to the U.S. Department of Justice. And that number is growing.
Over the past decade, nearly a third of the nation's jails have held mentally ill people who haven't been charged with a crime, said Ron Honberg, legal director for the National Alliance for Mentally Ill. There is no place else to put them, he said.
"The folks who are served by the jail diversion programs, they've committed low-level crimes," Honberg said. "These are, by and large, not hardened criminals."
Some critics deride diversion programs as "get-out-of-jail-free cards" that don't deter crime. But advocates say they can prevent certain people from ever entering the justice system in the first place. Besides the individual benefit, they say, the approach helps society at large - easing court caseloads, making streets safer and relieving overcrowded jails and prisons, which saves tax dollars.
"There are lots of people with mental illness in jail who don't need to be in jail," said Michelle Naples, of the TAPA Center for Jail Diversion, a national organization that helps coordinate jail-related mental health services. "They need a program that allows them to link with the right services in the community."
Authorities in Florida, Texas, Georgia and Alaska are bragging about programs that have steered hundreds away from jail and into treatment programs and other services. Many of those treated have avoided getting into trouble again, they say.
Bexar County, Texas, identifies people with mental illness at the point of their arrest and immediately gets them into treatment. In some cases, the charges may be dropped.
If any of them ends up in jail, "we've failed," said Gilbert R. Gonzales, the mental health care director of jail diversion in Bexar County.
"Once you're in jail, you're dealing with red tape, lawyers and judges. It becomes much harder to divert this person from incarceration to treatment."
Donald Cardinali illustrates some of these problems.
He once dreamed of being a photographer. He dreamed of playing in a rock band. Heroin helped him dream. He'd inhale the chemicals he used while fixing roofs and they helped him dream. Eventually he was diagnosed with bipolar disorder. He spiraled down all the way. In July, he was jailed on charges of threatening to rob a Ridgefield bank.
Jail diversion seemed a perfect way out. Don followed the program's rules and attended the weekly group meetings.
Guarding his food
Don would carry honey buns in a pillow sack. Another inmate had tried to steal his food, he said. He had his ground coffee in a plastic bag that he rolled up and stuck in his sock. At one meeting, he clutched his arm and slouched in his chair. His long blond hair needed a combing.
That was the week someone threw his underwear behind the washing machine.
"I lost my job. I lost everything," Don said at the meeting. "I feel like I hit a brick wall on a motorcycle going 100 miles an hour. No wonder I'm mentally ill. I feel like I've been beaten to a pulp."
As Don's October court date approached, his attorney began working on a deal with prosecutors: He'd plead guilty to fourth-degree public alarm. Maybe he'd get a quick release, with probation.
The Care Plus staff was preparing a safe landing. The program would help pay Don's bills and try to get him in touch with his family. All he needed to do was get into treatment, find a job and make a genuine effort at rehabilitation.
It's a decision all participants in the Care Plus program face: Follow the rules or stay in jail.
After years of living on the streets, Don's fingers are now scarred. Yet he will pick up a guitar and play a song by Quicksilver Messenger Service. He'll play a number by The Who on the piano. Don is 53.
He thought he could go back to work at a music store in Palisades Park. He once taught drums there. Once, he had offers to be a disc jockey. Maybe if he cleaned up, he could get behind the microphone.
Hope got the better of him.
He didn't want to do the rehabilitation.
Care Plus said it couldn't help him.
"Right now, I'm 76 days clean. I don't need to go back to these street drugs. We've gotten beyond the point of fairness," Don said. "I can't allow this to keep going on."
Don remained at the jail another three months. When he showed up in court on Jan. 28, he had cut his hair. He told his lawyer he had potential jobs lined up, a place to live, transportation. His family would help him, he said. After pleading guilty to causing a public alarm, he was sentenced to two years' probation.
Later that day, Don walked out of the jail into the 20-degree weather. He went to Faith Foundation, a Hackensack homeless advocacy group. There, he revealed the truth. He had no job, no place to live. Family members were keeping a safe distance.
Since then, what little sleep Don gets is at a Hackensack "sit-up" shelter. Life is just a "mess," he said.
"I wish to God I didn't grow up to be this way."
Going along to get along
Ron Troche pushed a guy out of the way while stealing a car in Carlstadt. Forty years old, he was staring at a five-year term in state prison. He knew he had some serious problems.
He'd go to his lockers and constantly rearrange his clothes. He'd fold and refold his three orange jumpsuits, socks, underwear and long johns.
"I was constantly moving my cosmetics from one locker to the other," Ron said. "People used to watch me and make fun of me doing it."
But he had something going for him.
His mother and 21-year-old son were worried sick about him. If being with them again meant he had to swallow his pride and comply with the terms set by Care Plus, so be it. Instead of fighting a second-degree robbery charge, Ron agreed to plead guilty to a reduced charge of third-degree burglary. Instead of five years in state prison, he got five years' probation - provided he agreed to undergo treatment for substance abuse.
In the months before his release, Ron followed the Care Plus plan to the letter, becoming a model participant.
"If you had some goals," Lang asked him at one meeting, "what would they be?"
"My father's got no tombstone on his grave," Ron said. "I want to put that on."
The right thing to do
A few years ago, Prosecutor Molinelli served as chairman of Care Plus' Board of Trustees. He heard stories from people who struggled to survive in lockups that lack counseling, medical and rehabilitation services. He now believes that, in the long run, jail diversion will reduce the court caseload and save the county money.
But more important, he says, it's the right thing to do.
As it stands, Bergen County's pilot program is a relatively modest venture. For instance, it receives about 10 percent of the funding that goes to Bexar County, whose population is comparable. Molinelli hopes the program will expand to assist people with mental illness at an earlier point in the process - when they first come to court.
"We just took a baby step," Molinelli said. "I will never see the benefits of this program. This is a 10- to 20-year program. I'd like to think by then, jail diversion will become the norm."
A fresh start
Ronald Troche walked out of the Bergen County Jail on Dec. 2 with just the clothes on his back. He went home to his mother in Carlstadt. He began a course of treatment that would take several months. He hoped to get a job at Friendship House, an agency that serves the poor and disabled. He was looking forward to a different kind of future.
"I've just had enough," he said. "It's time to make something of my life."
*-About 16 percent of the nation's jail population suffers from severe mental illness.
*-A year ago, the state awarded a two-year, $250,000 grant to Bergen County officials and a mental health care agency, Care Plus NJ of Paramus, to establish jail diversion. The group manages the program and provides guidance to inmates who qualify.
*-Eligibility standards are strict. Care Plus had about 17 active cases by the end of December; the Bergen County Jail typically holds more than 700 inmates.
*-The program usually begins when the inmate is within three months of release, and continues after the inmate leaves.
About the series
Turning Point - a continuing series on a New Jersey program designed to divert mentally ill people from incarceration - was funded by a $10,000 fellowship from the Carter Center Mental Health Program, headed by former first lady Rosalynn Carter.
Tom Davis, an award-winning reporter for The Record, was one of 10 recipients from an international field of journalists who received grants to study a particular mental health issue for a year. Davis and the others met with Carter in Atlanta and receive support from the program's staff.
"Informed journalists can have a significant impact on public understanding of mental health issues, as they shape debate and trends with the words and pictures they convey," Carter said. "They influence their peers and stimulate discussion among the general public, and an informed public can reduce stigma and discrimination."
Future installments of Turning Point will follow the progress of participants in the program and explore successful jail diversion programs elsewhere in the country.
Copyright © 2005 Bergen Record Corp. All rights reserved.
Cornelia caught in the Aussie detention policy
New Straits Times; 2/20/2005; K.C. Boey
THE outcry started out innocuously enough. A schizophrenic had slipped out of a Sydney psychiatric hospital. A missing persons notice was posted, soon to be forgotten.
Former Qantas flight attendant Cornelia Rau was found 10 months later
in an immigration detention centre, setting off debates that go beyond
scrutiny of Australia's mandatory detention policy on illegal immigrants
and asylum seekers.
Allegations of her mistreatment have refocused attention on conditions in migrant detention centres that critics have likened to gulags.
Since Rau's family picked her out of a newspaper report of a German- speaking detainee in the Baxter detention centre in South Australia, debate has raged not only about immigration handling of her but also on a whole range of issues.
Rau's case goes beyond bureaucratic bungling, as one editorial comment has it.
It brings together many strands of public debate in recent years, The Age contends: "...on human rights and civil liberties; on institutional and political accountability; on the neglect of people with mental illness; on damaging mindsets that have taken hold in Australia."
There are those e.phperated with criticism of a system in the face of a woman bent on misrepresenting her identity: what were the authorities to do?
Others question the mental health system; the rigour with which it challenges the security and immigration authorities on the effects of mandatory detention on mental health. Questions are raised on public attitude towards mental health.
The continued need for mandatory detention as deterrence against illegal immigration has come under renewed scrutiny. Members on the Government's side of politics have broken ranks on this.
More fundamentally, the core of Australian compassion has come under challenge.
Questions about double standards are raised about Australian compassion towards its own - such as Rau - and to others such as asylum seekers. Generosity in the wake of the Asian tsunami has come into the discussion on "comfortable" compassion and "hard" compassion.
Rau, now in hospital in Adelaide, continues to insist she is a German backpacker who has overstayed her visa. Should she be left to her devices, or does society have a duty of care to her?
The German-born Rau, who moved to Australia with her parents and sister when she was 15 months old, was diagnosed with bipolar disorder in 1998, which deteriorated into schizophrenia.
Over the next six years, there have been documented incidents of bizarre behaviour, in Australia and overseas, including her turning up in Germany disheveled and injured after having hitchhiked through Malaysia.
Once she was hospitalised after jumping from a moving train near Rome.
Rau became caught up in a system that psychiatrists said put detainees at risk of mental illness, and made things worse for those who were ill.
The Rau case has given fresh impetus to criticism of an immigration policy that split the nation in August 2001 with the Government turning away the Norwegian container ship Tampa that had picked up a boatload of asylum seekers in distress in international waters.
Illegal immigration is no longer a problem, critics maintain. Among them are well-regarded members of the Liberal-National coalition in Government, who have called for the policy to be abolished.
The Government says it is vindication of its policy of deterrence. Others say it is because of improved conditions in previous source countries that illegal immigration has trickled to a stop.
Still, the "fortress mentality" remains, to tragic consequences, in the view of refugee advocate Peter Mares, a journalist who is senior research fellow at the Institute for Social Research at Swinburne University in Melbourne.
"The crucial point is that the Rau tragedy does not represent a failure of the system of immigration detention; it is a product of the system," Mares wrote in a commentary calling for change.
Mares' argument goes to the heart of compassion, which has come in for some airing.
Over claims that Australians do have compassion for each other - and for their neighbours - distinctions have been drawn in response, on "comfortable" compassion and "hard" compassion.
Australia's response to and treatment of refugees is seen as a prime example of "hard" compassion.
"Australians are compassionate and caring - our response to the tsunami disaster demonstrates that fact," one letter to the editor acknowledged.
"But our inclination as a society is towards that form of compassion that costs us little, which doesn't involve risk or exposure and which, in essence, represents the line of least resistance.
"And this must change: for if we are incapable of exercising `hard' compassion towards others, eventually we will lose the capacity to engage in the `comfortable' compassion we daily demonstrate towards ourselves."