Mental Illness and Mass Murder

I'm glad that a few other people are prepared to say it. From today's Wall Street Journal:

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 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.