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July 30, 2014

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Guns and mental illness

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Many years ago, when I was a young reporter at Texas Monthly magazine, I spent the better part of six months in the company of a man who suffered from schizophrenia. His name was Fred Thomas; he was 23 years old, and he had been steadily deteriorating since high school, which is when most men first show symptoms of the disease.

I watched Fred as he was shuttled in and out of the state hospital in Austin, Texas — one of the few that had not been closed down by the mid-1980s — where he was wildly overmedicated, and then released to either his mother’s home, which was invariably disastrous, or a halfway house ill-equipped to help someone as delusional as he was.

I learned about the group homes that had sprung up after the closure of the mental hospitals. They were so gruesome that one outplacement worker told me she had never been to one “because I don’t want to know where I am sending them.” I spent time at a homeless shelter that had become, in effect, a mental institution without doctors or aides. Ultimately, the article I wrote was about how the “deinstitutionalization movement” of the 1960s and early 1970s — a movement prompted by the same liberal impulses that gave us civil rights and women’s rights — had become a national disgrace.

What spurs this recollection are two things. The first is Nina Bernstein’s powerful report in The New York Times last week about the plight of the mentally ill in New York. Although the article was pegged to the loss of services after Hurricane Sandy, in truth, Sandy only exacerbated a situation that was already terrible. With the mentally ill rarely institutionalized for any length of time — on the theory that their lives will be better if they are not confined in a hospital — other institutions have sprung up to take their place.

Prisons, for instance. According to E. Fuller Torrey, a psychiatrist who founded the Treatment Advocacy Center, a staggering 20 percent of the prison population is seriously mentally ill. Around a third of the homeless are mentally ill.

And one more statistic: “Ten percent of homicides are committed by seriously mentally ill people who are not being treated,” Torrey said.

In the wake of the massacres in Aurora, Colo., and Newtown, Conn., there have been essentially two central arguments about the cause. Liberals have stressed the need for new gun regulations that would make it more difficult for the likes of James Holmes and Adam Lanza to get hold of killing machines such as semi-automatics. There is no lack of sensible ideas: background checks for all gun purchasers, a national registry that would allow guns to be traced, an assault weapons ban, controls on ammunition and so on. Nouriel Roubini, an economist, wrote in a Twitter message that gun owners should be required to have liability insurance, an intriguing idea. Some legislators who once blindly followed the bidding of the National Rifle Association now are saying they are reconsidering in the wake of Newtown.

Many conservatives, however, have placed the blame for the recent rash of mass shootings not on the proliferation of guns but on the fact that Holmes and Lanza were allowed to go about their business unfettered despite their obvious mental illness. The editorial writers at The Wall Street Journal recently wrote that changing the way we treat the mentally ill “strikes us as a more promising path” for reducing mass killings than a fight over gun control.

In truth, both are necessary. If conservatives need to face the need for gun regulations — controls that will make guns less ubiquitous while still staying on the right side of the Second Amendment — liberals need to acknowledge that untreated mental illness also is an important part of the reason mass killings take place. Yes, it is true, as has been noted in recent weeks, that most mentally ill people don’t commit crimes. But it is equally true that anyone who goes into a school with a semi-automatic and kills 20 children and six adults is, by definition, mentally ill.

The state and federal rules around mental illness are built upon a delusion: that the sickest among us should always be in control of their own treatment and that deinstitutionalization is the more humane route. That is not always the case. Torrey told me that Connecticut’s laws are so restrictive in terms of the proof required to get someone committed that Lanza’s mother would probably not have been able to get him help even if she had tried.

“Mentally ill street people shame the society that lets them live as they do,” I wrote toward the end of that article in Texas Monthly. It has been 50 years since deinstitutionalization became the way we dealt with the mentally ill.

How much more proof do we need that it hasn’t worked?

Joe Nocera is a columnist for The New York Times.

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  1. When I last toured California's Porterville State Hospital one last time, back in the 1970s, I had serious concerns about the trend of "deinstitutionalizing" vulnerable, sick, mentally ill and mentally incapacitated individuals.

    As the author of this article writes about deinstitutionalization, in 50 years now, "How much more proof do we need that it hasn't worked?" my question begs, "How morally bankrupt is the Americans society to allow this to continue?" As the saying goes, "We are only as strong as our weakest link," and it is past time for us, as compassionate Americans, to reevaluate our mental health care system and address what is not working.

    Blessings and Peace,
    Star