Pondering Mental Illness in the Light of Arizona Shootings

An article Mona Charen (January 14, 2011) suggests that Americans need to re-consider treatment of the mentally ill in light of the shootings in Tucson, Arizona. She refers to Dr. E. Fuller Torrey, writing with a combination of compassion for the mentally ill and concern for the general public. He has analyzed the failure of our system for dealing with mental illness in The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens. She thinks anyone who is serious about preventing the next Tucson massacre should read this book.

In 1955, when the U.S. population stood at 164 million, 558,000 people were living in mental institutions. Over the course of the next 30 years, nearly all would be released as deinstitutionalization swept the nation. The mental hospitals were closed, leaving former residents to make do on the streets and (increasingly) in the prisons. I want to stress that today, roughly 4 million Americans suffer from serious mental illnesses and only about 1 percent of them, 40,000 individuals, are violent. Although that is a lot of people, we should not be afraid of every mentally ill person. 

He suggests that deinstitutionalization began not as a money-saving measure but as an idea. Psychiatrists like Thomas Szasz ("The Myth of Mental Illness") and sociologists like Erving Goffman ("Asylums") argued that symptoms of mental illness like raving, hearing voices, and paranoia were actually responses to being institutionalized. Asylums, claimed lawyer Bruce Ennis, were places "where sick people get sicker and sane people go mad." Szasz even denied that mental illness was real, preferring to see inmates as nonconformists.

Such were the '60s. Charen suggests that maybe now, when so many say they want bipartisanship, Democrats and Republicans can summon the humility to recognize that this disaster was a bipartisan one. Politicians of both parties agreed that subjecting people to psychiatric treatment against their will was immoral and un-American. The result was that a flood of deeply impaired human beings was loosed on American society. Numerous studies have found that about one-third of homeless men and two-thirds of homeless women have serious mental illnesses. Among the "hardcore homeless" or "permanent street dwellers," close to 100 percent are mentally ill.

As Charen points out, on the streets, the homeless have been granted the freedom to be assaulted, to "sleep under bridges," as Anatole France once mocked in another context, to freeze to death, to be robbed and raped, to be lit on fire, and killed. They rummage through trash bins for food and park their filthy shopping carts under highways.

Autonomy and individual liberty are cherished ideals -- achievements of Western civilization. But there can be no true autonomy for those with unsound minds. To insist upon the right of the mentally ill to refuse treatment is cruelty masquerading as respect.

Workable alternatives are available. Torrey recommends a national database that would track the most problematic patients, alerting emergency-room physicians and gun sellers. Programs to force compliance with treatment by withholding SSI payments, for example, or on pain of imprisonment, have been effective. Torrey's book overflows with common sense reforms.

The best that we could do to honor the memories of Christina Taylor Green and the other Tucson victims would be to address our shameful and disastrous mental health policies.