A Brief History Of Mental Health

Jonathan Kellerman, professor of psychology and best-selling author, provides a short history of mental health in the United States since the 1970s. In a nutshell, excuse the expression, it boils down to one thing: turn 'em loose on the streets. The rest, as they say, is history.

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.

That is not to say that anyone who pens violence-laden poetry or lets slip the occasional hostile remark should be protectively incarcerated. But when the level of threat rises to college freshmen and faculty prophesying accurately, perhaps we should err on the side of public safety rather than protect individual liberty at all costs.

Kellerman explains how much of this came about, why it became all the rage to "liberate" the mentally ill. It is worth taking the time to read. From personal experience in a related topic, I can attest that opening the doors to the state hospitals was a questionable idea at best. I have a brother who has Downs Syndrome. He was at a state hospital in New York for many years after several instances where my mother realized she could not control his violent outbursts. He did quite well at the hospital and regarded it as his home. When they started closing the hospitals, they sent him to a group home. A series of them, in fact. Because he has had repeated problems in those settings through the years and ends up getting transferred. Is he better off? I don't know that he is, really. 

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  By Lars Walker, April 24, 2007 @ 7:09 am

  My mother worked for many years at a state hospital for the retarded (as they were called back then). I remember her deep concern over the rage for “mainstreaming,” which finally culminated in the closing of the hospital. Everything she worried about came true.

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  By Granddaddy Long Legs, April 24, 2007 @ 8:04 am

  I prefer to get my history of mental health from Tom Cruise, thank you very much.

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  By Gayle Miller, April 24, 2007 @ 1:47 pm

  Hey Granddaddy Long Legs – betcha you’d really rather hear from Brooke Shields! Come on, fess up!

  And just as an aside, Kellerman writes one hell of a thriller too!

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  By Gaius, April 24, 2007 @ 2:08 pm

  Yeah, I just started reading his newest one.

Other Links to this Post

1. The Thunder Run — April 24, 2007 @ 7:59 am