"His name was R.P. McMurphy. They said he was crazy." I still remember the trailer for the film One Flew Over the Cuckoo's Nest. And the movie was even better, one of the dozen of so truly great movies that Hollywood has produced in the last few decades. But now I realize that the message of the film--that insanity is nothing more than social nonconformity, and that attempts to institutionalize the insane are a form of fascism--is foolish and destructive. In fact, precisely this sort of thinking prevented the Virginia Tech shooter from being institutionalized. If that had happened, all those victims would be alive today. Even Cho could have gotten the help he surely needed.
I'm not saying Jack Nicholson, or even his character, is personally to blame. But the movie was part of a larger cultural movement pioneered by such thinkers as Michel Foucault and Thomas Szasz. Foucault is dead but Szasz remains a kind of libertarian hero. These gurus have gone much to establish the notion that "social deviancy" is mostly harmless and should not result in confinement against one's will. In the 1980s, you may recall, the ACLU and other civil liberties groups filed lawsuits that forced asylums to open their doors and let the lunatics out. They weren't crazy, you see, they were merely unconventional. And to hold them against their will! What about their constitutional rights? In Washington DC I would pass homeless people every day who had a dazed look in their eye and didn't seem to know which planet they were living on. Even as I handed them a dollar, I knew that what they needed was treatment, and this they were not getting, courtesy of our constitutional guardians at the ACLU.
The question to ask in connection with the Virginia Tech tragedy is, quite simply, why was Cho not committed? Pediatrician Jonathan Kellerman asks this question in the April 23 issue of the Wall Street Journal and comes up with the right answer. "No one who knew him seems surprised by what he did," Kellerman writes. From what we know Cho showed all the signs of "a fulminating, serious mental disease." Despite this, "Minimal care wasn't given." The reason? "The shooter didn't want it and no one tried to force him to get it." On one occasion in December 2005 he was sent to a behavioral health center, but he was out the same day.
Kellerman concedes that, yes there is a danger of making a mistake but "if the Virginia Tech shooter had been locked up for careful observation in a humane mental hospital, the worst-case scenario would have been a minor league civil liberties goof: an unpleasant semester break for an odd and hostile young misanthrope who might even have learned to be more polite." Instead Cho's civil liberties were assiduously protected, and more than 30 people are dead. I don't think I'll see One Flew Over the Cuckoo's Nest in quite the same way again.
Reader Comments ( Page 1 of 2)
1. Your comments are not only intelligent and insightful but also timely and compelling. What I find most disconcerting; however, is the paucity of comments your essay has received. As a member of NAMI and a father who has a seriously ill son who is seeking public support to put a stop to HIPPA (the law that guards the privacy of thos with mental illness while leaving the remainder of society vulnerable), I'd ask that you read a newly published book entitled, "Crazy...A Father's Search Through America's Mental Health Madness" by Pete Earley (himself a father whose son is also ill). Mr. Earley is a Journalist writing for the Washington Post for the past thirty years.
Once again, thank you on behalf of families and friends of the mentally ill across the US.
drbehavior at 3:13AM on May 1st 2007
2. When the Catholic church splits over gay marriage and whether priests should have sex, Red-State Pope will saint Reagan. Then you can pray to Reagan and ask him why he was so excited to close down those mental hospitals. I'm sure he'll have a good reason.
lil_turk at 3:18AM on May 1st 2007
3. Good article Dinesh. I understand that the Virginia Governor signed an executive order to make sure that mental cases are reported properly to the authorities to help keep guns out of their hands, but the further issue of getting them help is a lot to digest!
lil_turk would like to raise Reagan from the dead just to bury him all over again.
dalosophy at 4:47AM on May 1st 2007
4. You might be interested in a review in the March 23 issue of the Times Literary Supplement by Andrew Scull. It is entitled "Foucault's Fictions" and discusses the new edition of Foucault's "History of Madness," detailing as well the marketing of Foucault's ideas in the U.S. and England. More important, however, is its deconstruction of Foucault's work and research. The lesson: "the ease with which history can be distorted, facts ignored, the claims of human reason disparaged and dismissed, by someone sufficiently cycnial and shameless, and willing to trust in the ignorance and the credulity of his customers."
goethegirl at 9:50AM on May 1st 2007
5. DD' wails - "In the 1980s, you may recall, the ACLU and other civil liberties groups filed lawsuits that forced asylums to open their doors and let the lunatics out. "
"Combined with a sharp rise in homelessness during the 1980s, Ronald Reagan pursued a policy toward the treatment of mental illness that satisfied special interest groups and the demands of the business community, but failed to address the issue: the treatment of mental illness"
http://www.sociology.org/content/vol003.004/thomas.html
Raygun closed the mental hospitals, and threw mentaly ill people out on the street to become homeless. He structurally dissassembled the "safety net" system by withdrawing funding from Public Hospitals (resulting in massive closures) - shifting the system to one operated for profit.
The fact that whackos like Cho wander the streets with no alternatives to get them treatment is directly a legacy of Raygun.
How fitting that Raygun got shot by one of the people he put on the street.
Bushthwak at 10:00AM on May 1st 2007
6. It is not surprising how Bushwak and lil turk trot out the old and misleading, but narrowly correct charge that "Reagan closed the hospitals".
Reagan was governor of California and - mistakenly in my opinion - presided over closing many mental hospitals in California. That was in the late 1960's. I think governor Pat Brown actually signed the law that called for the closings, over which Reagan presided. True, Reagan could have bucked the trend, but instead he went along with it, and he was wrong.
This was the beginning of the "de-institutionalization" and "mainstreaming" movements, and they were a huge change in philosophy for the mental health profession. The history of this is tedious, and it is no wonder most people do not fully understand it. Since Reagan was governor of California, and since California was, as she often is, on the leading edge of the trend which later went national, I certainly would expect nothing less of die-hard Democrats to dig up his bones and bash him for this one in perpetuity.
Still, the problem is more serious than politics, and it is not a simple one either.
If I still have anyone's attention, the thinking of the mainstreaming & de-institutionalization movement went something like this: The pharmaceutical companies were in fact developing better drugs to treat lunacy, and the existing system of mental hospitals had serious systemic problems of abuse and corruption. Since drugs like lithium and valium and others were in fact much better than that which had preceeded them, psychiatrists and others in the medical professions were optimistic about applying these meds. In fact they collaborated with others who wanted to close down what they saw as hopelessly corrupt and unjust commitment process and delapidated, abusive institutions. Then as now, politicians did not put much thought, effort or money into the field of mental health. Because certified lunatics do not vote, and because thankfully, the number of them in comparison to the total population is relatively small, few politicians care much about them, their plight, or that of their families.
In any case, while history would later prove that in fact the psychiatrists, the medical doctors, and the social workers were far too optimistic, the de-institutionalization movement was off and running nationally by the early 1970's and continued well into the 1980's. Others whose motives were not as good also crawled on this bandwagon; lawyers suing for money all around, and cheapskates who diverted savings from the closing of the institutions away from the social services departments, and toward other state uses. The basic M.O. was to seriously downsize any and all mental institutions, both for the mentally insane and for retarded folks. Retarded people were to be mainstreamed into society and lunatics whose condition could be chemically managed were sent to half-way homes for job training, with the expectations they would eventually live on their own. Only the most pathetic and hopeless were to be left in the now underfunded and discredited state mental hospitals. Laws were enacted to prevent these folks from being put back into institutions; laws that made it difficult to commit someone to a mental hospital. While their was some federal funding involved, mental health fell and still falls mainly under the purview of the states. This new service-style, or de-centralized mental health "system" was to be overseen by the social services departments of the individual states.
Of course, proper oversight and accountability in a loose organizational stucture like this is very difficult, and in any case has not developed as it should have. By now (almost forty years on), many, many people with mental health problems have fallen through the cracks; they quit taking their medications and lost their jobs, jumped into a bottle of booze and live under a bridge, or something like that.
Many of the homeless you see in the larger cities are the result of de-institutionalization. While God knows how they suffer (from living in the elements, the abuse from criminals, and with the torments of their own demons), few of the rest of us seem to care. We are content with tossing them a few quarters and maybe a cigarette on our way out of the shopping center. Sometimes we tell them to sober up and get a job. As the rest of us casually stroll around the richest nation in the world, we hardly notice these folks begging at our feet. It is nothing short of a national disgrace, and anyone with a conscience - Republican, Democrat or otherwise - ought to be deeply ashamed.
Simply put, we need to spend the money to build at least one mental hospital in each of the fifty states, and we need to take another look at the limits we have put on committing people to mental asylums. We need to enact reasonable commitment laws that protect peoples' civil liberties, and the new institutions need to be run more humanely than the old ones were, but the upshot is we need to be able to lock up lunatics. The lunatic obviously needs help, food, and shelter, and society needs to be protected from him.
We need to re-examine this issue and keep mercy, human kindness, and chairty in mind. For the common good, we need to strike a balance between the rights of the mentally deranged individual and the greatest good for the greatest number.
Societies are (correctly) judged by how they treat their weakest members. On the issue of the mentally ill, the homeless, and the retarded, we have been tested and have been found wanting.
Ken Berg at 11:13AM on May 1st 2007
7.
I agree with everything you said Ken.
We can assign blame all we want, it doesn't change our mental health system one bit.
Peter at 11:27AM on May 1st 2007
8. Great blog... very thought-provoking. But I have to admit.... today I was really hoping for a bit of commentary on Fidel Castro's lack of an appearance on May Day.
Tony Messinger at 12:11PM on May 1st 2007
9. Bergermini tries - "Reagan was governor of California and - mistakenly in my opinion - presided over closing many mental hospitals in California. That was in the late 1960's. I think governor Pat Brown actually signed the law that called for the closings, over which Reagan presided. True, Reagan could have bucked the trend, but instead he went along with it, and he was wrong."
No, Pat Brown didn't sign anything. Raygun becan closing the Mental Hospitals in California as a budget cutting measure, starting with the Budget of 1969.
He continued this effort by defunding Mental Health Initiatives throughout his Presidency in the 80's.
In response to series of horric crimes committed by former inmates at State Mental Institutions that Raygun had kicked out onto the street - the Claifornia Legislature passd a bill in 1974 prohibiting the further closure of State Mental Hospitals by Raygun.
"I hold the state executive and the state legislative officers as responsible for these ten lives as I do the defendant himself.� -- K. Springer, jury foreman Mullin Murder Trial, 1973
"After the trial, the jury foreman wrote that California Governor Ronald Reagan was �as responsible� as Mullin for the deaths of thirteen people. Reagan�s administration had been systematically closing down California�s mental hospitals, with the plan to �deactivate� all of them in a few years."
http://www.crimelibrary.com/serial_killers/weird/mullin/index_1.html
Chapter 12.
Raygun's legacy is the murder and maiming of thousands of Americans - as well as the brutal conditions that many of the mentally ill were forced into - living homelss on the street.
As a person who has had to take care of a seriously mentally ill person for near 20 years...
About the only bad thing I can say about Hinkley...
Is he missed.
BT at 4:43PM on May 1st 2007
10. No BT, I think you are wrong to lay all that on Reagan. I think he was one of the better presidents we have had.
I do think we need to seriously review the condition of our mental health service system, and make the necessary changes, but I do not think this is an issue with which we ought to play politics.
While they suffer greatly, because the mentally ill do not vote and are not great in numbers, they and their families simply are not on the politicians' radar screen.
The only way politicians - Republican or Democrat - will give any thought, effort, or money to the issue of mental health is when a large enough part of the voting public tells them to. In a certain sense this is understandable; we live in a republic, after all.
When enough Americans understand it is our Christian duty to care for these folks, and that is in the best interest of the public to have reasonable commitment laws and humane institutions to provide care for the mentally ill, then we would need to notify politicians and direct them to apply money and effort toward those ends.
Until then, very little progress will be made.
Ken Berg at 5:33PM on May 1st 2007
11. Ken Berg,
Mostly I just liked the idea of a Red-State Pope. You're right that it wasn't primarily Reagan who closed down mental hospitals.
See?! This is how you admit when you're wrong, Berg. You just say it! It barely even hurts. I know it's almost impossible for an (R), but try.
lil_turk at 6:13PM on May 1st 2007
12. Ken - If this was the ONLY mistake we have had to suffer from because of Raygun...
He might make it in the top 10.
Unfortunately we are strapped with the short sighted vision of his administration and may well be recovering from it longer than the 20 years it will take to recover from Dumbya.
And you are right - care for the Mentally Ill in this country shouldn't be a political football. Sadly, the conservative vision of shifting "Big Gub'ment" expenditure away from Social Programs and into financing the Defense Complex isn't in synch with with any logical approach to solving our social ills.
Bushthwak at 7:41PM on May 1st 2007
13. Bushthwak, did you thoughtfully read Berg's remarks? I didn't think so from your everlastingly snippy comments. If Reagan was wrong, it was because he believed the "experts" who were telling us that it was no longer necessary or humane to keep people locked up.
Seeing the mess that the mentally ill make of their lives and the potential threat they are to innocent bystanders, we need to rethink our laws and policies. That's what decent people do rather than to try to score debating points against others.
By the way, many of the homeless are not mentally ill, but prefer to live a work-free lifestyle (yucky, but their choice) -- they are enabled by the soup kitchens and shelters that make this marginal, but responsibility-free lifestyle possible. I have worked at soup kitchens and heard the comments made by the "guests" who have the freebies all mapped out.
Margaret at 9:51AM on May 2nd 2007
14. If you want to blame Reagan - and him alone - for all of the problems we have with the mental health care system in this nation, that is your business. However you can blame him until the cows come home (he is dead by the way), and that will not help one single person.
The fact of the matter is that the program of de-institutionalization and mainstreaming that began in the early 1970's and ran well into the '80's has left society with some real problems.
Now, just because those who implemented de-institutionalization seem to have thrown the baby out with the bathwater does not mean we should do the same thing.
The pendulum having been full tilt toward institionalization up until the mid-late 1960's, was pushed full tilt the other way and remains there. I think we would do well to evaluate the successes and failures of each approach, and try to put the pendulum somewhere in the middle.
In other words, having tried excessive and harsh institutionalization (up until about 1970), and having also tried the more loosely organized de-institutionalization (from about the early 70's until now), It seems like it is time we sit down and take a look at both programs and evealuate the successes and failures of each approach.
I think we are smart enough, and that we now have enough experience with both approaches, that we should be able to sort things out enough to integreate the good parts of both types of systems into a new hybrid-type of mental health care system which hopefully will be better than what we now have.
I agree with Margaret; not all the homeless are insane. I do not have the numbers, but my guess is that about a third are just drunks, drug addicts, or otherwise irresponsible and/or antisocial, and another third are good folks just temporarily down of their luck and finally, about a third are in some way mentally ill and are in need of full time care.
The reformed institutions of the new hybrid sytem would obviously help those in need of full time care, and might even provide some jobs for those homeless folks who are just down of their luck.
I do not have answers for the other third of the homeless population; the drunks and drug addicts. Those who are sane, but just drunk or stoned or otherwise irresponsible, and who really wish to live that way are a difficult bunch for sure.
However, one should not let the good be the enemy of the best, and not being able to solve an entire problem is no excuse for not trying to start the process of solving part of the problem.
Ken Berg at 11:05AM on May 2nd 2007
15. Ken,
There is no doubt that you did my homework on this issue. Thanks for you input!!!
Cdalealden at 1:03PM on May 2nd 2007