The Rehabilitation of Abuse

Over more than a half-century, Rob Reiner's legacy achieved icon status. His body of work assure him of a place in the pantheon of great cinematic artists. 

But now, because of the same ghoulish propensity that causes "rubbernecking" in both directions on highways after major crashes, most people's immediate association with the image of the actor in that pioneering sitcom masterpiece of social commentary All In the Family and director of classics like When Harry Met Sally, will be of his throat being slit, (allegedly, we are constrained to say) by his own son during a  meth-driven rage.

The son reportedly had been to "rehab" 18 times, at a monthly cost of $70,000, reminiscent of the Pentagon's $10,000 toilet seat. Many of us knew all along that money cannot buy serenity, even though it can help defray guilt trips. 

At least in the short term, for those who can afford it.  In the end, both the rich and the poor are ill-served by the rehabilitation industry, although there are many exceptions. 

Rehabilitation for drug addiction is a worthy and equally elusive goal. It's a cash cow with a moo that roars.  

A better business than stealing cars and deporting them to Cuba or Qatar.

No doubt many of the clinicians and support personnel are credentialed and highly motivated. But when a single cycle of rehabilitation does the trick, it's as likely due to coincidence as their protocols. 

And relapses are extremely common. This is attributable to the profound complexities of addiction disease, which may be accentuated by the economic incentive for a revolving door until the insurance money runs out.

Being a patient at a "rehab" should carry neither stigma nor bragging rights. 

But narcissistic celebrities and their press agents vie for media space and free publicity by volunteering colorful descriptions of their stint in rehab, making the facility sound like a pleasure trip to their chalet in St. Tropez. That distracts from the reality that they are often the last resort for people at their wit's end, who are caught in a mortal battle against self-destruction.

Rehabilitation centers should not conjure imagery of solitary confinement.  But neither should they be glamorized and made de rigueur like destination weddings.

That fantasy must be deromanticized.  

The protocols of rehab must be revised so that the failure rate can be whittled down. That will require scrutiny of the connections and "co-dependencies" among rehab businesses and referring pharmaceutical-oriented  clinicians.

A person who is ordinarily responsible and rational, becomes, in terms of judgement and impulse, literally a different person when crazed by drugs like meth. Their psyche is commandeered by a supernatural mania and irresistible power, with authority so potent that it will propel them to atrocities of which they would otherwise be incapable.

To what extent, if any, should the law take this into account during criminal trials?  And to what degree should a person, subject to, or in the throes of the violent dictation of drugs, retain their civil liberties, including the refusal of intervention?

In life-or-death physical emergencies, extraordinary measures can and should be taken which would otherwise be prohibited. While doing chest compressions on patients during cardiac arrest, their breastbone may be broken. Survival sometimes allows and often demands collateral pain. 

In cases of severe cases of recidivism among drug addicts, that pain may need to take the form of temporarily diminished rights, with regard to the Health Insurance Portability and Accountability Act (HIPAA).

The HIPAA is a double-edged sword. It protects confidentiality and prevents intrusion. 

But it also bolts the door to keep out potential rescuers whose first-hand knowledge and personal intercession could be decisive.  Some of the Act's provisions should be relaxed and suspended. 

Grounds for involuntarily placement, and duration of therapy must be expanded and tightened, even at the expense of  the patient's autonomy and freedom of volition.

This is not incarceration. It is a merciful form of protective custody.   There is no detention more virulent than the arresting restraints and paralysis of a person's ability to thrive or even cope with everyday life. 

Judicial oversight should still be embedded in the process, but more circumspectly invoked. 

When customary "rehabilitation" has proven to be a fool's errand and hopeless quest, there must be mandatory options, such as "tough love" bootcamps that include a graduated tapering down and weaning patients off of psychotropic drugs that often perpetuate or aggravate underlying conditions. 

Many of these "medications" simply make patients more pliant, stuck and enslaved. Indeed, that is commonly the practitioner's objective and part of the design of the industry of "care."

Almost a million Americans died of drug overdoses since 1999. Over the last four years, as many people in the US died of them as American soldiers who perished during all of World War II.  

Let's viscerally bear this in mind as remedies are contemplated and enacted by various role-players in our afflicted country.

The absolutist belief that government is inherently either the cause of, or the solution to the problems that plague society has got to be nuanced if we are to make progress.

The hitch is not how much, but how ignorant its influence has been. It's not the philosophy, but the folly of those in whom we have placed our trust. 

Some laws, such as HIPAA, need to be somewhat neutralized. Others, such as New York State's "Anti-Harassment in Reporting Act," should be doubled-down upon.

In late December, Governor Kathy Hochul made New York the third state in the country to pass a law that removes the option of anonymity when reporting allegations of child abuse to the state hotline. The identity of callers will still be held in confidence and not shared with the subject of the allegation but must be on record. 

Deliberate false complaints have been made by disgruntled neighbors, landlords, spouses in custody disputes, malicious pranksters or anyone else who wanted for any reason to terrorize parents and guardians. By doing so they gained satisfaction, and sometimes leverage in relationships, and had nothing to lose by sounding the alarm.

Because all claims had to be investigated, it would hamstring caseworkers and jam up the system. Children would be traumatized by visits to their homes and school, and sometimes invasively searched. There would be lingering biases from irrepressible rumor mills and permanent records. 

With the new law, the state will still, however, diligently collect data and, hopefully, revisit policy where indicated.

The new year is already unfolding. What new manifestations of abuse will entertain our bloodied sensibilities?