There are a number of reasons for this refusal, but my guess is that the mood stabilizers and anticonvulsants used (Lithium, Topamax etc.) take away the high manic feeling the person gets from the illness and they need it like a drug at times and go off their medication. The patient may also mistakenly feel that there is nothing wrong with them that warrants medication. The families of these patients suffer greatly. I have seen patients in the throes of mania commit some really screwed-up crimes. (Sorry for the lack of psychobabble here but if that is what you want--please consult one of the many Journals of Psychology where one can be bedazzled by the credentials/brillance of the authors while still having no freaking clue as to what the point of the study is).
Mentally ill people like Rigoberto Alpizar are four times more likely to be killed by law enforcement than the general public. Violent episodes of those with schizophrenia and manic depression account for 1000 homicides in the US each year despite what some psychologists and advocates tell us about the mentally ill not being dangerous. My question when I see violent episodes like the Miami one is to ask, "Why was this mentally ill man taking a plane without medication?" The answer, I am sure, is complex. We have 4.5 million people in the US with schizophrenia or manic depression (now called Bipolar Diorder). An estimated 40% of these are not receiving any treatment on any given day. This results in acts of violence, incarceration and homelessness.
The failure of deinstutionalization, civil liberty issues and economic factors have lead to a number of the mentally ill being out in our communities with little or no intervention. When Robert Kennedy called the state mental hospitals "snakepits," he must never have imagined the problems he would unleash into our communities. The community help that was to come from deinstitutionalization never materialized and hundreds of thousands of mentally ill have been left to fend for themselves. Now, instead of being in a hospital or a supervised setting, the severely mentally ill are in jails, nursing homes and homeless shelters -- often receiving services that are more expensive than the state hospitals that should have been equipped to provide them with psychiatric care in the first place.
Ever since Kennedy threw the baby out with the bath water, we have had more incidents of school shootings, mass shootings and just plain bizzare behavior like Alpizar's. No doubt we will see more of this in the future.
Update: Here is more information on the legislation that John Kennedy signed into law before he was assassinated:
The 1963 Community Mental Health Centers Act was the last major piece of legislation signed by President Kennedy prior to his assassination. It has become a symbol for how a well-meaning action can become a total and complete disaster.
The Act’s failure can be attributed to four flaws in its design and implementation. First, it was based on a number of failed assumptions about what was wrong with the severely mentally ill. Those responsible for the legislation did not fully understand brain diseases; assumed that if released from state institutions, the mentally ill could live happily ever after; and neglected to investigate a condition known as anosognosia. Anosognosia is an integral part of severe mental illness. As many as 50 percent of those with schizophrenia and 40 percent of those with bipolar are impaired to such an extent that they cannot recognize what is wrong with them. (See the fact sheet on anosognosia on page 11 of this issue.) So a significant portion of the severely mentally ill cannot live “happily ever after” without direct treatment and supervision.
Secondly, the Act suffered from flawed planning. It bypassed the states entirely and placed the burden of funding community mental health centers on the federal government. The National Institute of Mental Health failed to provide essential oversight of the centers. The community mental health centers were failed by a total unwillingness to take responsibility for center management at both the state and federal levels.
Thirdly, before the movement toward deinstitutionalization, the states covered 95 percent of the financing for care of the severely mentally ill. In the hopes of moving patients out of the state hospitals and into the community, the federal government made patients in state hospitals ineligible for aid while hospitalized, but eligible when discharged from the hospitals, thus providing the states with enormous incentive to empty out the hospitals. Deinstitutionalization quickly became the priority for state mental health agencies and there was no incentive to ask what happened to patients once they left the hospital.
Read the whole thing.
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