Cuckoos out of the nest

Over the past week, the consistently best op-eds on the VT shooting have come out of the Wall Street Journal, which is no surprise as it’s one of the few center-right editorial pages out there. Today, there is a beautiful essay by Dr. Jonathan Kellerman, clinical psychologist and bestselling crime fiction writer, on how the focus on the individual rights of the mentally ill led at least indirectly to what happened last week. Some tidbits:

Were the state hospitals wretched nightmare-palaces straight out of “One Flew Over the Cuckoo’s Nest”?

A few were. But many were well-run institutions for patients in wretched circumstances, providing optimal care within the limitations of what constituted psychiatric treatment at that time: a handful of poorly understood psychotropic drugs and supportive talk-therapy. Perhaps more important, they offered clean beds and three squares a day, which led to them being belittled as warehouses. But the protective environment of the best state hospitals has yet to be improved upon, or even matched.

No matter, this was baby-and-bathwater time.

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.

Read it all.


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