I agree with the criticism of this ‘blame the victim’ tone. There is truth here but the lens is distorting it. First- Richard Lewis here makes good points- biology matters. And biology cannot be separated from the greater environmental context that puts neurotoxins in the meds and in the food and water in the form of pesticide or lead contamination. Social matters too – we are after all social creatures. There is a challenge here because it’s not just meds that have negative impacts. PTSD and other impairments also cause cognitive problems- I don’t think we’ll ever have the data we need to parse it all with any strong authority. We can all probably agree though that patients in crisis have different needs than when they are functioning fully and we need more good ways to get from one to the other. Patients need help de-institutionalizing no matter whether it is inside or outside of a building. They will never totally be free of the need for some structure, order and connection whether this comes from friends and family and community or from healthcare providers. How does a person go from being told what to do and when to do it to making good choices on their own? From what I’ve seen, it occurs when a person feels safe and secure (#1) with no threats of being cut off from the roof over their heads, the meds that get them to sleep at night, or the resources that keep them from begging for food); once that’s settled, they need daily contact with people who really care about them- they need walks in the park, phone calls, grocery trips, trips to the movies- and everything that passes as normal life. They need opportunities to exercise their decision making legs- and they need a safety net that allows them to be imperfect and not be punished for it. The fact that our culture has succeeded in isolating, compartmentalizing, and separating so many from their community is one of the biggest problems. Until we acknowledge that we are all in this together, pushing people into the ‘other’ category will continue to harm us all.