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Ditto, from a fellow shrink - doing my MD gig since 1984 and the shrink sub-gig since 1988, Boarded in ‘93.

Having spent sizable portions of my career working at both state hospitals and at public mental health clinics, I could go on and on confirming and elaborating upon your points, but instead, I’ll just offer up a few skewed insights that have fascinated me over the years:

1. The do-gooder involvement of federal and state governments have done nothing to lessen the suffering for most patients with serious mental illnesses, and have often enabled a worsening. The emptying of the state hospitals, and the stultifying politicization of what remains of them is but one example. Despite what should have been game-changing advances in pharmacological treatments for mental illness, and vast armies of people devoted to helping them live outside an institution, the experiment has failed dramatically. Liberally politicized professional organizations, courts and patient advocate groups, playing out compassionate fantasies based on statist ideologies, have insured the mess we have now.

2. The general erosion and breakdown of the traditional, cohesive family and societal institutions, ushered in by the Marxist changes initiated in the 60s, have been devastating to those with enough remaining ego strengths to prosper in a more orderly society. The bulk of the patients I have seen over the years would probably never have needed my services before those changes.

3. The drug epidemic, facilitated by the failed “War on Drugs” and the failed “War on Poverty,” with all their attendant corrupting influences, has caused unimaginable damage to the most vulnerable.

When I was awarded a Mead Johnson Fellowship in Public Sector Psychiatry towards the end of my residency, they sent me to the APA convention in Chicago to hob nob with others like me and with the movers and shakers in that field. My interest in the field was based on a perceived need to turn back the failed de-instituionalization movement, revamp the old private or state hospital system into a truly therapeutic force that would end the suffering and the maltreatment of the severely mentally ill now living on the streets and in the jails and prisons. How naive.

I was treated there like a leper or a naive little kid for challenging the outpatient system that had provided such lucre, prestige and power to these people. I recall my final moment of involvement in that charade, in the penthouse of some uber-plush hotel along the waterfront, quite dressed up, waiters and waitresses coming around constantly to the little cliques of movers and shakers, and the promising young fellows like me, handing us as much champagne, caviar, goose liver pate and other delicacies as we wanted. I was standing - drink and caviar in hand - with a little group of luminaries, listening to them discuss the latest legislative proposals they were backing, when I raised my glass, made an overly gleeful and loud toast to “all those homeless mentally ill,” downed the entire glass of champagne, and left, never to return. I’ve never regretted closing that door behind me.