http://www.claytoncramer.com/weblog/2007_04_22_archive.html#5017639412223685594

Mental Illness and Mass Murder

I’m glad that a few other people are prepared to say it. From today’s
/Wall Street Journal/
<http://www.opinionjournal.com/editorial/feature.html?id=110009977>;:

I was in graduate school, studying clinical psychology when they
began shutting down the asylums. The place was California, the time
was the early 1970s, and “they” were an unprecedented confederation
of progressives, libertarians and fiscal conservatives.

From the left marched battalions of self-styled mental health
“liberation activists” steeped in the writings of Scottish
psychiatrist R.D. Laing. Though he denied being opposed to his own
profession, Laing’s notion that madness could be a reasonable
reaction to an unjust society, or even a vehicle for spiritual
transformation, helped fuel the anti-psychiatry movement of the post
Love-In era. The most radical of Laingians carried revisionism one
step further: Not only wasn’t psychosis a bad thing, it was evidence
of a superior level of consciousness.

The libertarians were fueled by Thomas Szasz, an iconoclastic
psychiatrist who was, and remains, an outspoken foe of virtually
every aspect of his chosen specialty. Hungarian-born in 1920, and
witness to vicious state exploitation of medical practice by the
Nazis and the communists, Dr. Szasz pushed an absolutist dogma of
individual choice, finding ready converts among members of the
Do-Your-Own-Thing generation. Though his early essays offered
much-needed critiques of the Orwellian nightmares that can result
when autocracy corrupts health care, Dr. Szasz devolved into
something of a psychiatric Flat-Earther, insisting in the face of
mounting contrary evidence that mental illness simply does not
exist. Currently, he serves on a commission, cofounded with the
Church of Scientology, that purports to investigate human rights
violations perpetrated by mental health professionals.

Accepting the arguments of the liberationists and the libertarians
at face value led to the assertion that no matter how bizarre,
disabling or life-threatening a person’s hallucinations and
delusions, involuntary treatment was never called for. And to the
assertion that violation of that premise created yet another class
of political prisoners.

While moderate members of the anti-asylum movement were willing to
concede that psychosis might pose difficulties for a few
individuals, they insisted that society had no more right to force
psychoactive drugs upon mental patients than it did to hold down
diabetics for insulin injections. If treatment was to be offered, it
needed to be consensually contracted between caregivers and
care-recipients on an outpatient basis. That fit perfectly with the
sensibilities of conservative scrooges searching for ways to cut the
state budget, and all too happy to dismantle a massive state
hospital system denigrated as inefficient at best and inhumane at
worst. The replacement chosen was an untested, less costly treatment
model: the community mental center.

How nice that everyone agreed.

Everyone, that was, except for many families of hospitalized,
hopelessly-decompensated, often self-destructive and occasionally
violent psychotics. They’d lived with the reality of severe mental
illness and wondered what “freedom” would bring. But there weren’t
enough of these families to matter.

…

By the time I received my doctorate in 1974, the doors to many of
the locked wards had been flung open and the much vaunted community
mental health centers were being built–predominately in low-rent
neighborhoods. A few years later, government funding for these
allegedly humane treatment outposts had been cut, as yet more fiscal
belt-tightening was inspired by findings that they didn’t work.

Because crazy people rarely showed up for treatment voluntarily, and
when they did, the treatment milieu consisted of queuing up
interminably at Thorazine Kiosks.

And now we had a Homeless Problem.

And everyone was astonished.

Estimates vary but there’s no doubt that a significant percentage of
people living on heating vents, pushing their belongings in shopping
carts, squatting in city parks and immersed in the squalor of tent
cities suffer from severe mental disease. And their psychosis is
often exacerbated by drug and alcohol abuse–what is, essentially, a
regimen of self-medication that should make a Szaszian proud.

Many of these unfortunates end up as victims of violent crimes. A
few become victimizers and when they do, watch out. For though it is
true that schizophrenics are responsible for a proportionally lower
rate of violent offenses than the general population (because many
forms of the disease engender passivity and physical inactivity),
when crazy people do act out the results are often horrific: bloody
spree killings ignited by paranoid thinking and the angry urgings of
internal voices.

Which brings us to outrages such as the Virginia Tech massacre.

Diagnosis from afar is the purview of talk-shows hosts and other
charlatans, and I will not attempt to detail the psyche of the
Virginia Tech slaughterer. But I will hazard that much of what has
been reported about his pre-massacre behavior–prolonged periods of
asocial mutism and withdrawal, irrational anger and hatred, bizarre
writing and speech–is not at odds with the picture of a
fulminating, serious mental disease. And his age falls squarely
within the most common period when psychosis blossoms.

No one who knew him seems surprised by what he did. On the contrary,
dorm chatter characterized him explicitly as a future
school-shooter. One of his professors, the poet Nikki Giovanni, saw
him as a disruptive bully and kicked him out of her class. Other
teachers viewed him as disturbed and referred him for the ubiquitous
“counseling”–an outcome that is ambiguous to the point of
meaninglessness and akin to “treatment” for a patient with
metastasized cancer.

But even that minimal care wasn’t given. The shooter didn’t want it
and no one tried to force him to get it. While it’s been reported
that he was involuntarily committed to a “Behavioral Health Center”
in December 2005, those reports also say he was released the very
next morning. Even if the will to segregate an obvious menace had
been in place, the legal mechanisms to provide even temporary
“warehousing” were absent. The rest is terrible history.

This /Texas Law Review/ paper by Bernard Harcourt
<http://www.law.uchicago.edu/files/harcourt/institutionalized-final.pdf>;
examines institutionalization–as measured by both prison and mental
hospital inmates. He makes the shocking discovery that if you combine
both measures and plot them against U.S. murder rates for the period
1928-2000, there is an almost perfect negative correlation: as
institutionalization (in either prison or mental hospitals) goes up,
murder rates go down, and vice versa.

There’s a lot of evidence that many of those who are currently locked up
in prisons are mentally ill. It would appear that the great experiment
of the 1960s–deinstitutionalization–simply transferred violent
mentally ill people from mental hospitals to prisons, after a few
decades of suffering, both by those mental patients, and by the society
as a whole.