The degree to which a society treats its most vulnerable citizens is a reflection of its level of decency.

A few months ago I wrote a column on depression. I received several emails regarding this and ended up in a good discussion with someone suffering from a longtime depression. This person explained how, after a series of stressful life events (a divorce, serious trouble with the law), he was not able to get back to a normal affective state. He described how he felt damaged. I explained that some illnesses are "states," which are brief, but others are "traits," which are persistent over time and across situations. But on rare occasions, states and traits converge.

Imagine that you put your body under a physically stressful situation - it causes you shortness of breath. Now imagine that you keep doing this to the point that you're permanently out of breath even when you are no longer physically stressing yourself. This can happen with some people with mental illness. The normal neurotransmitter level in your brain (i.e. serotonin) that partially regulates your mood is persistently off. Sometimes there is nothing that someone can do about this on one's own and medication may be helpful.

We see people being so seriously affected by stressful life events that some can't seem to get past this event. This is known as post-traumatic stress disorder. We often hear about this with returning war veterans or victims of sexual, physical or emotional abuse; the stress experienced can have such an impact that it essentially rewires someone's brain so that they continue to relive that stressful event.

After the introduction of psychotropic medications in the 1950s, it was determined that medication was cheaper than psychiatric hospitalization. Patients were discharged with a prescription and the belief that they would be fine. Hospitals were expensive to maintain, seemed antiquated, and subsequently closed. When many people on medication felt good and that they no longer needed medication, they stopped taking medication; relapse into aberrant behavior became common but there was no safety net. Since hospitals were closed, prisons became the new asylums and still are.

This is not just an anecdotal account. When I was working in corrections research, I examined this issue and I found that there is a very strong relationship between the numbers of times someone was incarcerated and the percent of inmates afflicted with a serious mental illness. For example, 5 percent of inmates who were incarcerated just once were afflicted with a serious mental illness. But nearly 50 percent of inmates who were incarcerated over 15 times were afflicted with a serious mental illness.

Imagine you have a son or a brother who suffers from a mental illness. You can see that this relative is not getting the help he needs despite your family's best efforts. Now imagine that he ends up in trouble with the law as a result of the illness, and subsequently is incarcerated. Is this the way you want our society to treat a segment of persons afflicted with a mental illness?

We hear about how ADHD and autism are common in children. PTSD and depression are common in persons subjected to trauma. The prevalence of schizophrenia is much higher in prison than the general population. According to the National Institute of Mental Health website, over a 12-month period of time, more than 26 percent of people may have suffered from a mental illness at one point or another. What is perhaps even more shocking is that more than 46 percent of people have suffered from a mental illness at least at one point in their life.

The most important thing to understand is that being afflicted with a mental illness is not the fault of the person afflicted. Equally important is that illness is not something that someone can "snap out of," pray away, or think it will go away by itself. Many mental illnesses have just as much a physical basis as diabetes, cancer or heart disease; each of these can be triggered or exacerbated by environmental circumstances, but they are physical issues. It is the same for many mental illnesses.

The next time you hear of someone afflicted with a mental illness, remember to be compassionate - they didn't ask to be afflicted with an illness any more than someone with asthma. And not only do they have to cope with normal everyday life just as your or I, but they have to cope with the complexity caused by the illness, and the stigma that is wrongly and needlessly associated with illness.

PAUL HEROUX of Attleboro is a contributing columnist. He has a bachelor's in psychology and neuroscience from the University of Southern California; he is not a clinician. He can be reached at PaulHeroux.MPA@gmail.com.

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