Gun Control, Mental Illness, and Safety: A Letter for Ted Cruz
February 7, 2013
The Honorable Ted Cruz
The United States Senate
Capitol Hill
Washington, D.C.
Dear Senator Cruz:
Thank you for inviting me to share my expertise concerning the problem of gun violence in America. My published books and law review articles examine, among other subjects, black history, the origins of American gun culture, the judicial interpretation of both federal and state right to keep and bear arms provisions, and the history of mental health care in the United States. My work has been cited in D.C. v. Heller (2008), McDonald v. Chicago (2010), and many decisions of the U.S. Courts of Appeal and state supreme courts.
Attached please find an article from the Federalist Society publication Engage published last year: “Madness, Deinstitutionalization & Murder.” The Engage article examines the role that the deinstitutionalization of the mentally ill, starting in the 1960s and reaching full fruition in the 1970s, played in increasing murder rates. Of most relevance to the recent tragedy in Connecticut, deinstitutionalization turned what had been a shockingly rare event — random acts of mass murder — into something that horrifies us but no longer shocks us because such incidents happen several times a year. This article is adapted from a chapter in My Brother Ron: A Personal and Social History of the Deinstitutionalization of the Mentally Ill (2012).
That deinstitutionalization increased murder rates is not an impressionistic or anecdotal claim: as the article points out, multivariate correlation analysis by Prof. Bernard Harcourt of the University of Chicago demonstrates a statistically significant negative correlation between murder rates and total institutionalization rates (the sum of prison and mental hospital occupancy) for the years 1928 to 2000. Using an entirely different technique, Prof. Stephen P. Segal of University of California, Berkeley demonstrated in 2011 that three measures of mental health care systems are statistically significant in relation to state-to-state variations in murder rates. Indeed, one-third of this variation can be explained by one factor alone: the relative ease of involuntary commitment of the mentally ill.
The evidence for this is includes not only the many examples in the Engage article, but also the details of many of the most recent and most horrifying of these mass murders. James Holmes is the man being tried for the murders in Aurora, Colorado. Several weeks before those murders, his psychiatrist was sufficiently concerned about him to contact local police. The exact nature of those contacts, of course, is now tied up in court proceedings,[1] but for a psychiatrist to break doctor/patient confidentiality suggests that she believed she had a Tarasoff obligation to inform the police that her patient was a danger to others.[2] Unfortunately, Colorado’s current emergency commitment statute creates an extraordinarily high standard of what constitutes “imminent danger to others or to himself”[3], and James Holmes apparently was not considered an “imminent risk.”[4]
Similarly, news reports quote a friend of the Lanza family claiming that Mrs. Lanza was attempting to have her son committed at the time he went on the rampage in Newtown, Connecticut. Because court records on such proceedings are not public, the most that local police officials could confirm was that there was some discussion about future mental health care for the son.[5]
Yet while the connection between deinstitutionalization and these random acts of mass murder is abundantly clear, the focus on these relatively rare crimes (totaling less than 1% of all U.S. murders each year) obscures the far more common murders by mentally ill offenders that receive only local news coverage, because they involve only one or two victims.
As the Engage article points out, at least 18% of Indiana inmates convicted of murder are mentally ill: a more detailed examination of the data shows that 11% of Indiana murder convicts are suffering from psychotic conditions that have caused them to lose connection to reality. By my estimate, it is likely that there are 1,300 to 1,400 murders a year in the U.S. by such severely mentally ill offenders.
Of these, about 500 likely involve weapons other than firearms. (One example from last Tuesday: a mentally ill woman in Sebastopol, California, charged with stabbing her mother to death.)[6] Any gun-control measures are guaranteed to be ineffective at reducing non-gun murders by mentally ill offenders. At best, they can only reduce murders with guns — and only the very optimistic believe that gun-control laws will make anything but a marginal improvement in murder rates.
Published on Feb 12, 2013 Ben Swann Full Disclosure conducts a one on one interview with Dr. Jim Garrow who claims the Obama administration is weeding out top military brass who are unwilling to fire upon Americans. Ben talks with Dr. Garrow and asks viewers questions.
http://www.youtube.com/watch?v=Ynwj33XY664
Simply because the officers give orders does not mean the soldiers will carry them out—the Philippine dictator Ferdinand Marcos found this out the hard way. You cannot depend on such mercy, though. The British citizens of Concord and Lexington were fired on by their fellow citizens.
I read a thread on a nuclear industry online forum last night, and a very experienced alumnus of the Navy Nuclear Propulsion Officer Candidate Program (NUPOC) repeatedly emphasized to prospective candidates that the Armed Forces exist to serve the aims of the President. I don’t know what he was getting at, but it seemed that he thought that was not synonymous with the best interests of the country, though he did not come right out and say that.
When a candidate would say “I want to serve my country” he would respond “You will be serving the President.”
It’s a lesson every prospective enlistee should learn. The service can and will call upon you to do things you disagree with and don’t want to do. The orders you can choose to disobey are extremely limited in scope, and your personal definition of “legal” and “illegal” do not matter. You do not get to choose which wars to fight or which enemies to kill. If you can’t handle that, you have no business being in a career in which following orders is essential.
Germans were prosecuted for “following orders” in the trials at Nuremberg (sp) after WW2. So “following orders” could in theory be the commission of a serious crime. The US has violated conventions against the use of torture, although it is unlikely that anyone will ever be charged for it as we are the dominant nation on Earth and are likely to remain so for some time.
Good thing the Enlisted Soldiers are the ones who carry out orders. Or decide not to. And it’s the officers in the system of courts-martial that decide whether orders are lawful or not, not the officers giving those orders.
The oath of enlistment begins with “I…… do solemnly swear to support and defend the Constitution of the United States, and to bear true faith and allegiance to the same;”
It goes on to state that the enlistee will “obey the lawful orders of the President, and the officers appointed over me.”
Serving the Constitution is duty number 1. Anyone that says differently doesn’t belong in the military of the United States.
If there is another revolution in this nation, the majority of the people who have sworn such an oath will side with the Constitution, period. That means they will fire on anyone who wishes to damage or destroy that Constitution, or the laws faithful to it.
I doubt many officers have the guts to say “no” to their superiors. I do believe a lot of ammunition will be wasted firing over the heads of the citizens of this nation.
There is a lot of irony here. Deinstitutionalization was legitimated by those ’50s Hollywood movies about the “snake pits.” In California republicans got on the progressive bandwagon to close down those expensive state institutions by sending the patients and the money back to the local counties and cities for more humane client centered therapy. But somehow the money always went to other priorities and the crazies were left to fend for themselves on the streets with limited police powers to commence 72 hour revolving door civil commitments. As time went on, local jails became the new dumping grounds for the former patients, the “insane” jailed for “criminal” conduct just to get them off the streets for “treatment” in the new snake pits.
We also have Ken Kesey and his ‘One flew over the cukoo’s nest’ to thank for this tragedy. The book and movie with Jack Nicholson were hugely influential.
Violent offenders as well as non-violent disturbed people were also affected by the lack of facilities. Who knows how many thousands of people have suffered because of deinstitutionalization.
As my book discusses, freezing death rates more than doubled 1974-1984. As bad as mental hospitals were, at least they were warm.
In California those community based “reforms” were well underway by the time Nurse Ratchet hit the screen. So you ended up with people with psych issues self medicating on the streets with illegal drugs and dumpster diving when not defecating on someone’s storefront because they went off their psych meds or had a bad LSD trip. Indeed around the time that movie came out Edmund Kemper, after being signed off by his state psychologist, killed his grandmother and then proceeded to become the coed killer (like Jack Ripper) in the Santa Cruz area.
There was indeed legitimate criticism of the state of mental hospitals well into the 1950s (and even later in some states). But many of these problems were well under way to solution by the time action was taken (transinstitutionalization of the senile elderly after Medicare comes into effect, penicillin largely ending syphilitic insanity, improved public funding once the Depression and World War II were no longer starving state governments) — and good intentions were not enough.
There was also the introduction of medications like lithium for schizophrenia. lithium was deemed so effective that the trials were ended early. If someone took the medication, their schizophrenia was under control so there was no justification for institutionalizing them. Unfortunately, many released patients were unwilling or unable to take their medications properly. Their conditions relapsed but they had no place to go.
I am aware of the use of lithium for bipolar disorder; this is the first that I have heard of it being used for schizophrenia.
Uninformed Larry was probably thinking of phenothiazine class drugs such as thorazine, stellazine, and mellaril. Thorazine was synthesized in 1950, is a very powerful antipsychotic, and probably did more to empty mental institutions than any other single factor. Sadly, the bright future hoped for by this pharmaceutical breakthrough was not as bright as anticipated. It is quite common for antipsychotic drugs to return a person to a level of mentation where they determine for themselves that they don’t need the drugs and quit taking them.
Following on the heels of the antipsychotic drug breakthroughs was a series of court cases culminating in the US Supreme Court decision in 1975 which severely restricted “involuntary commitment”. Liberalism never stops paying (negative) dividends.
Cramer
Well done.
I wish you had added verbiage re potential side effects of drugs given to the disturbed. I’m guessing you didn’t due to lack of data.
Actually, more due to lack of confidence in the relationship. Mass murderers often have histories of psychiatric drugs, but it isn’t clear that the drugs cause this, or what we are seeing is failure of the drugs to work. Causality on this by no means clear; often, people with serious mental illness problems are given these drugs because they are mentally ill.
Thank you for saying that. Sometimes the drugs do actually work, which is why I’m against creating a national database of people who have simply been treated for mental illness (as distinguished from those who have been hospitalized). It’ll discourage people from seeking help in the first place, and then there’ll be more crazy people than ever.
Not to mention that many people who are treated for depression or bipolar disorder are not a danger to anyone but themselves.
It could be a mixture of both – but there is definitely a correspondence between these kinds of violent actions and the presence of these kinds of drugs going all the way back to the Texas Towers shooting in 1966.
The question is, are these drugs causing the violence or simply present because the person is already mentally ill and previously prone to such violence?
The website ssristories has lots of examples of both suicides and violent aggression, and from a legal standpoint they also list cases where what they are calling the “SSRI defense” was successfully used as a defense after the fact.
Basically, it is a claim that the medication made them do it.
Of great interest to me, when I first discovered that resource, were the numbers of stories where someone was depressed or suffering from some other mental condition that was only a threat to themselves (or possibly not even that) – but who upon receiving medication eventually became violent.
Lots of stories there where people’s personalities completely changed when they started taking the medications, even though they may have been suffering some mental illness for a while without such violent tendencies – right up until they started taking certain medications.
Now I’m about as conservative on personal accountability as you’ll find – but after reading through story after story I’ve come to the conclusion that drugs, which by intent alter ones mood, can likewise alter that mood in a very negative and dangerous manner.
When prescribed incorrectly, I believe drugs designed to help people can end up driving some patients over the edge into suicidal or homicidal behavior.
Unfortunately, we have a LOT of people in our society on these medications and this is a conversation that requires a certain delicacy.
Sadly, my idea of delicacy resembles a sledge hammer approach….
BRAVO, Mr. Clayton! And thanks for all your work and writings here, in Shotgun News,and your own website.
“Unfortunately, Colorado’s current emergency commitment statute creates an extraordinarily high standard of what constitutes ‘imminent danger to others or to himself’, and James Holmes apparently was not considered an ‘imminent risk.’”
Hey, the White House can provide some assistance here. I understand that they have worked out all these imminence issues with regard to American citizens. They could just port those policies over to the evaluation of the risk of violence related to mental illness. Drones away, baby!
“….only the very optimistic believe that gun-control laws will make anything but a marginal improvement in murder rates.”
The politicians are not really concerned with improving murder rates. their agenda is disarming the American people. Improving murder and crime rates, is the bs they are trying to sell to the American people.
Mr. Cramer,
A well-deserved thank you for your work and research in this area, as well as your participation in the public arena on a much-needed topic of discussion. My wife, a recently retired state Supreme Court Justice, has devoted considerable time and energies addressing many of these issues and concerns, advocating for the wider creation of specifically-designated mental health courts that work in-concert with area support services (e.g. housing, treatment, employment, etc). The purpose of this being to combine and leverage their respective resources so as to more-effectively and humanely treat the mentally ill versus the present day scenario of homelessness, lack of adequate treatment, if at all, and oftentimes, repetitive (and largely ineffective) incarcerations. Thus far, and in the multiple locales in which this has been implemented, crime, recidivism, and formerly problematic, untreated persons have been markedly reduced.
Additionally, and viewed from a purely economic perspective, the data strongly suggest this method is preferable to, and more effective, than the current schema, one that has to date proven ill-equipped to deal with the inundation of ill individuals put upon the public and its resources as a consequence of institutional closures.
I sincerely hope you find a wide number of sympathetic listeners on Capital Hill and who, in turn, will actually act appropriately and affirmatively on your findings.
Good luck in your endeavors, sir!!
Thank you. Unfortunately, many state legislatures are so short-term focused that they don’t realize that they aren’t saving money by refusing to deal with the mental illness problem — they are actually making the situation worse. Here in Idaho (where no one listens to me) the legislature just decided to scrap building a secure mental health facility for both felons and civil commits, in spite of an often desperate shortage of psychiatric beds.
Unfortunately, gun control is progressing rapidly in Colorado. Emotional testimony from relatives and victims of both gang violence and James Holmes seems to have inflamed the debate beyond reason. What they don’t recognize is that there are two separate problems here: lack of incarceration for the mentally ill and gangs.
Since mental health in the gun control debate seemingly trumps the problems of gun ‘access’, it appears that some want to hone in on the ‘apparent’ mentally infirmed rather than the non-apparent and otherwise normal ‘appearing’ person.
Somehow, the issue of high numbers of crimes commited with guns is largely being ignored while the smallest percentage of gun crimes, i.e., mass homicides is taking center stage.
Studies interviewing convicted felons using guns in crime, have shown that they access their guns primarily from theft and secondarily, from street sales that seemingly, would be synonymous.
Statistical data also indicates that about 45% of the several million felonies committed each year with approximately 60% involving guns, are commited by those with no previous felony convictions. Should not this category of gun crimes be significant to the debate?
While mental health issues are certainly a valid issue of discussion in and of itself, I think the statistical data of homicides using guns by the ‘obvious’ mentally infirmed, is a very minute percentage and a diversion away from the most significant problem of gun crimes including homicide, in the gun regulation debate.
General means of access by theft and a better system of identifying mental issues at point of sales I would think, would be the more pertinent issues of the debate.
By George I think you’ve hit the nail on the head!
How’s about this for a plan? I know it’s a long shot, but it just might be crazy enough to work. Now try to hear me out before criticizing my plan, but here goes…
Drum roll please…
How about we make both murder AND stealing guns illegal???
Speaking of mentally ill, Scottch, that’s just crazy talk. Murder illegal, ha.
The mentally ill committing murder is not a minute fraction of murders; it is actually pretty substantial. What is minute are these mass murders; lots of attention for what is actually a pretty trivial fraction of the murders in the U.S. But it gets popular attention — so why would anyone bother to look at the typical murders? That would be logical.
“The mentally ill committing murder is not a minute fraction of murders; it is actually pretty substantial.”
With due respect, I was keeping my comments and data references to crimes and homicides commited with “guns” rather than other instruments and causes of homicides. If I’m misreading your comment and you too are referring to gun homicides, I would be interested in your data source(s). Thanks!
As I mentioned in the article, about 11% of murderers held in Indiana prisoners were severely mentally ill (psychotic disorders). I have not seen a breakdown by weapon type, but clearly, many mentally ill murderers do use guns. The mass murders get all the attention, but they are not the only such incidents involving mentally ill murderers.
“I have not seen a breakdown by weapon type, but clearly, many mentally ill murderers do use guns.”
Thats brings to light an interesting but convoluted point, whether the instrument is a gun or not — “many mentally ill murderers do use guns.”
Homicides, other than justifiable seemingly reflects on a mental defect but, juris prudence seemingly conflicts with both common and clinical definitions of mental defect at least in terms of of a defensible state of mind in our legal system. It becomes rather corrupted in both a sense of the legal system and the professional pathology. For example. If a person were to voluntarily walk into a clinic and disclose that they’ve experienced thoughts of killing someone or otherwise stated they’d have no particular emotional feeling for having killed somebody, that person would be adjudged appropriately by the DSM as having a serious mental defect. That same person having no previous contact with a clinic professional, goes out and commits a homicide and goes through the criminal court system. Now, its a 99.999% probability that, that person will be diagnosed and adjudged at a minimum, of having the capacity too 1) assist in his defense and 2) has the capacity to know right from wrong thus, having no defensible mental defect and off to a prison if convicted.
Seems mental defect has litte to no general relevance and falls into two distinct categories of voluntarily commits or commits a crime, with the latter, being seen and dealt with radically different from the preceding category. There are millions of people walking around with mental defect that their indicators goes largely ignored and or undiagnosed. How many of them are lawful gun owners or have access to guns owned by lawful gun owners?
Well, Zeke, when the department of pre-crime is a reality, maybe you’ll be able to do something. Until then, there’s the pesky little problem of “Constitutional rights” and “innocent until PROVEN guilty of actual crimes”. Keep trying to take those away by end-run and you might just get to find out how fragile an advanced technic culture is.
On a running average over a ten year reporting process there are approximately 500,000 guns stolen each year that would seemingly have nothing to do with the constitution or infringing on the Second Amendment. Why would any rational person who was a ‘responsible’ gun owner and or a constitutionalist have a problem with addressing unlawful gun access by theft? You can do the math over a ten year period to see how many guns end up in the wrong hands and on the streets to be sold too….
Thats a pretty significant problem! Should there not be a matter of ‘responsible’ gun ownership?
Thank you Mr. Cramer for facts and logic, a refreshing alternative to our lousy political demagoguery.
From my limited background, it may be fair to say that the deinstitutionalization benefited many, those treatable on an out patient bases, with home support to facilitate stable medication. But it literally threw on the street, sick people who inevitably wound up in prison. Depending on quality of care, they probably are better off than under a bridge, in February. And further, modern medical advances, e.g. lithium, greatly redistributed these sub populations. I would add that coming technologies, e.g. fMRI, and blood-brain barrier meds will redistribute the cohorts again, in the future.
If this be true, how does society correctly ID one guy in the data base as unfit to handle a weapon? Now, and as he responds to treatment? Apparently, the ex-Navy SEAL sniper, Mr. Chris Kyle, made a heroic, but poor decision to use weapon use as therapy. What should be done upstream of the trigger?
These answers will lower the carnage. Magazine size will not.
Federal law is already pretty narrow who may be denied firearms ownership based on mental illness: those adjudicated mentally defective, and those institutionalized long-term against their will. The Clinton Administration added a lot of PTSD sufferers to the list, unlawfully; HR 2640 passed several years ago was supposed to fix that.
Yes, deinstitutionalization of the mentally ill has obviously resulted in terrible problems not only for those who are a danger to themselves, but for society as a whole. But I noticed in the article that nothing was mentioned of what was probably the most terrible medical procedure ever inflicted on those who had been institutionalized. I suspect this procedure – called prefrontal lobotomy – might have played a significant role in the push to get these patients out from under the care of those butcher-physicians who ran the large mental institutions at that time.
For readers who have never heard of prefrontal lobotomy, here is a short summary of what it was. In 1936 the Portugese physician Antonio Egas Moniz developed a surgical procedure called prefrontal lobotomy to treat some forms of mental illness; and for this procedure – later called the “ice-pick lobotomy” – he was awarded the 1949 Nobel Prize for Medicine.
Lobotomy was widely used until the mid 1950s, and during this time the European and American medical communities showered many honors and international recognition upon Moniz, despite the fact that it invariably left its victims in far worse condition mentally than they had been – commonly turning them into babbling idiots – whereas they may have been just a bit unruly. This ghastly procedure, which was usually performed without the patient’s informed consent, consisted of cutting the neural connections inside the brain to and from the prefrontal cortex.
It was typically performed by inserting an instrument that was essentially an ice-pick under the eyelid and above the eye into the eye socket, and then striking it with a hammer to penetrate the thin layer of bone & drive the pick into the brain. Once inside the skull, the ice pick shaft was waved side to side to sever the nerve fibers connecting the frontal lobes to the thalamus; and in many cases the shaft was pushed much deeper inside the brain to perform a more “radical” lobotomy for patients with more severe “disturbances”. The ice-pick was then pulled out and the procedure repeated thru the other eye. This was commonly done by psychiatrists in state mental asylums without operating rooms, or by real surgeons, and with the patient awake & only under mild sedation, or frequently just strapped down and under no anesthesia at all, so it could be performed cheaply and on an assembly-line basis. If the patient was “lucky” his doctor rendered him unconscious first with electroconvulsive shock therapy – which was itself a ghastly procedure which frequently resulted in brain damage.
For some 30 years lobotomy was used commonly to treat a wide range of mental illnesses – from schizophrenia & clinical depression, to simple anxiety disorders. Most psychiatrists & staff at mental asylums highly approved of lobotomy because it made custodial care of their patients much easier. The first “whistle-blowers” began to condemn this procedure in 1947 as utterly inhumane, but lobotomy will remain legally practiced in the US, the UK, France, India, Finland, Norway, Sweden, Belgium, & Holland well into the 1970s, but on a much less frequent & more “controlled” basis. Over the years some 40,000 people were lobotomized in the US, 17,000 in the UK, at least 4,500 in Sweden, & some 9,300 total throughout the Scandinavian countries.
Not until modern anti-psychotic drugs, such as Thorazine, came on the market did physicians end this ghastly practice, which has since been called “undoubtedly the most barbaric mistake ever perpetrated by mainstream medicine”.
Disturbingly, the same types who lauded lobotomy and electroshock therapy are now the same types most firmly in the bandwagon for psychotropic medications….
What “types” are those? Psychiatrists were overjoyed when Thorazine came along; if there were enthusiasts for lobotomies, they must have been pretty rare.
Lobotomies did not come to be widely accepted by the public in a vacuum, there actually were proponents of the procedure – and they were apparently aided and abetted by the press at the time, though that support did begin to wane over the years.
http://facstaff.unca.edu/ddiefenb/lobotomy.html
Consider the alternatives that were then available. Horrible, but chaining someone down for years on end isn’t good, either.
Scottch,
Your link referred to the notorious Dr. Freeman. Here is some more info on just how bad he was, and how much he popularized lobotomy. So much for the so-called oath by physicians to “first do no harm”.
The most infamous practitioner of prefrontal lobotomy in the United States was Dr. Walter J. Freeman (1895 – 1972), a physician-psychiatrist who had no surgical training, but nevertheless personally performed nearly 3,500 lobotomies using his invention of “ice-pick” lobotomy. To popularize his barbaric technique, Freeman embarked on a national campaign in his van, using it as his “operating room” & calling it his “lobotomobile”, to demonstrate to doctors working at state-run insane asylums that they could also perform this “simple” operation without needing a real operating room. He thus became very popular because these institutions were extremely overcrowded & there was no effective treatment to use on those who had been committed.
What the managers of the insane asylums loved about the procedure was that lobotomy invariably resulted in the victim being turned into a passive imbecile who was no longer “disruptive”, & thus far easier to manage. Freeman was described as performing his lobotomies “with a recklessness bordering on lunacy, touring the country like a traveling evangelist…performing a procedure which was nothing more than a gross & unwarranted mutilation carried out by a self-righteous zealot ”. Freeman’s most notorious operation was the one he personally carried out on Rosemary Kennedy, the 23-yr old sister of the future President John F. Kennedy. Their father, Joseph P. Kennedy, who had gotten rich by bootlegging during Prohibition, ordered the involuntary lobotomy upon her due to her “mood swings”, because Freeman convinced him that it would improve her personality & “make her less of a bother”. However the lobotomy reduced her to an infantile mentality for the rest of her life, capable only of babbling unintelligibly, & having no control over her own body.
@ Clayton Cramer,
While I agree chaining someone down for long term is horrible, the alternative of a lobotomy is, in my opinion, worse.
Chaining them down is physically restraining them – but if a cure can ever be found there is always hope of curing them.
Medications are certainly an option in that case, but societ had to wait for those drugs to be developed.
However, when someone is lobotomized, that option of a future cure is taken away permanently.
Which is the more horrible option?
Personally, being of reasonable judgement at the moment, I’d rather prefer to be chained down until a cure for what ails me can be found than have my brain permanently and physically scrambled like an omelet by a guy with an ice pick stabbing through my eye socket.
Please don’t lump lobotomy and electroshock therapy together. Electroconvulsive therapy, done properly, can be genuinely helpful for otherwise intractable depression.
Yup. ECT is still in use because there are some forms of severe depression that it seems to cure. (Like everything else in medicine, it is by no means a certainty.)
What amazes me is that you take a medical procedure that did not work (nice use of Monday Morning QB’ing by the way) and those that used it and lump those who currently believe that the system is broken into the same field of baled hay.
I am SO very facinated with those who constantly whip out Straw Man arguments. When my children were too young to know better the good old straw man is what they used everytime they wanted to do something that they KNEW their mother and I were not going to allow.
But then they turned ten and became smart enough to debate like an adult.
My book explores the bizarre, often absurd treatments developed in the 1920s through the 1940s attempting to solve the problems of mental illness. Lobotomies were a desperate measure because the alternative for many of these patients was chaining them down. Thorazine pretty well ended the argument for such monstrous procedures, and that is largely why they went away.
Psychotropic drugs have their side effects, and need to be used with great care. There are many schizophrenics for whom these drugs, properly used, enable them to live outside a mental hospital with a reasonably healthy life.
I agree.
Where I will probably disagree is the extent to which such drugs are prescribed.
Administering drugs so you don’t have to chain some poor mental patient to a bed all day long is a good thing provided they react well to the treatment.
Handing the drugs out as casually as the profession now seems to do is a bad thing, and it’s proper that the medical community begin to take a long hard look at how these medications are being utilized.
There is no question in my mind that drugs are being used far too widely for some problems. Antidepressants are a fine thing for dealing with depression, but not if the result is to avoid confronting WHY someone is depressed. Are they in an unhappy marriage? Is there a job situation that has them angry, but they don’t feel that they can express it? Depression as a response to anger that you can’t express is quite common, and using antidepressants on a long-term basis is likely a mistake.
My daughter and son-in-law are social workers. They tell me that they see many kids being treated with various ADHD drugs where the real problem appears to be bad parenting or an unwillingness to admit that little boys are more rambunctious than little girls.
The parents of every little boy in my subdivision have been informed at one time or another by a teacher that their son was ADHD.
Every single one.
The teacher in my son’s 2nd grade class insisted my child “just couldn’t do it”, meaning the school work. She insisted he needed medication because he didn’t act to suit her.
You have no idea the pressure parents are placed under, but fortunately I was more stubborn than she was – and I didn’t care whether the assistant principal was siding with the teacher or not.
Interestingly enough, redistricting landed my son in a different school – and a different teacher – the next year. The experience with her was the complete opposite of the previous teacher.
She had to teach him not only 3rd grade material, but also the 2nd grade material the previous teacher had insisted he couldn’t do.
Did I mention by Middle School he was well adjusted and in Beta club?
I can definitely see how so many parents can buckle under to that kind of pressure, and I have personally seen a kid who spent probably 6 or 7 years on those very medications.
Disturbingly, they determined recently he had been misdiagnosed and was on the incorrect medications. Of course this was after he became increasingly violent and was throwing chairs in the classroom and had been expelled….
My granddaughters first grade class this year is comprised of 26 students and 14 are on presciption drugs for behavior and mood modification while 9 of them are active in a therapeutic environment after school. This is a trend year after year in most of the K5 schools in this rural city/county — a major military installation involving 3 other counties. Violent behavior and assaults are routine beginning in pre-K and K grades injuring students, classroom teachers and unit administrators. There are no alternative educational facilities or tracks for these kinds of students since inclusion laws were enacted.
Most of these students are passed through the system with kid-gloves and on the streets somewhere after high school with virtually NO record trail accessible.
What a horrible procedure,I don’t understand how Joe Kennedy could have his daughter Rosemary undergo this procedure…awful.
I think we all know what a lobotomy is.
Mr. Cramer, I don’t have it in front of me, but in your book I think you refer to federal court cases that hold mentally people have a right to refuse treatment and can’t be committed without proof they’re an imminent danger. Can the changes in state law you propose survive, if challenged in federal court?
Also, I’ve heard it claimed that HIPPA (a federal law) prohibits release of patient information including mental health treatment information. Even if the state standard was lowered for background-check purposes, would the federal law still prevent effective background checks?
You raise an interesting question, but so far, states that have moved back from the ACLU’s zealous due process view have survived the court challenges, such as Wisconsin’s “fifth standard” revision about ten years ago, and New York State’s “Kendra’s Law.”
I’m not sure what the interaction of HIPPA and state mental health records would be. This is an interesting question.
Having seen a great deal of written endorsement for the relaxing of restrictions against involuntary psychiatric holds in recent days, I would be curious as to the author’s opinions as to what level of investigative and due process rigor should be afforded to those under the procedures of involuntary commitment. Inasmuch as they fill a role in forcibly removing people from society deemed a threat to themselves and others, involuntary commitment and imprisonment are effectively identical, but whereas the latter primarily takes the form of a sentence administered after a crime proven in accordance to the customs and procedures of criminal justice, the former routinely occupies a much more gray set of criteria of what the accused might do in the future, potentially creating a hazard of presuming guilt in advance unless thought is put into the matter of how such accusations are investigated, and what rights and discourse the accused have in the matter.
A perhaps more insidious hazard to consider is the threat that, barring such rigors of due process, there is the potential for abuse of involuntary commitment not to apprehend mentally ill perpetrators of violent crimes, but to essentially imprison people who demonstrate socially undesirable behavior without having committed or been in preparation to commit an actual crime. I have several friends living in California, intelligent, productive people, who for various non-violent behavioral or personality disorders have related to me that they live in fear of being 5150′d, as is the slang for the section of that state’s Welfare and Institutions Code which empowers any police officer to confine a person deemed to have a mental disorder which makes them a danger to themselves or others for 72 hours, with the potential of long term commitment at the discretion of psychiatrist, to my knowledge without necessarily needing any evidence on par with a criminal investigation that someone committed this way was preparing to engage in a crime.
The specifics may escape an amateur mind on the matter, but it seems straightforward enough reasoning to me that the decision to involuntary commit a person carries similar weight as any other involuntary imprisonment. Therefore it would not in my opinion suffice to speak of loosening such restrictions on it as a panacea for crime committed by the mentally ill without context. There must also be discussion of the rights of the accused and the criteria for which such confinements are deemed necessary to prevent an imminent criminal threat.
Until the 1960s, there was an imperfect due process requirement just about everywhere. When I say imperfect, I mean that there were a few states where a person could be hospitalized on the say-so of a police officer or a doctor, and that emergency commitment could be extended indefinitely without going to court, such as in Maine. In most states, however, long-term commitment required jury trial, or lunacy commissions that usually involved a lawyer or judge and a couple of doctors. These were not perfect, but much of due process in the criminal area was still pretty weak.
The big difference is that the standard of proof used for such civil commitments was preponderance of evidence, rather than the criminal standard of evidence. The theory was that such civil commitments were primarily for the benefit of the patient, and only secondarily for the protection of society. Addington v. Texas (1979) dramatically increased this requirement, although going to the beyond reasonable doubt requirement of a criminal conviction.
We don’t have to go back to 1960, but we can at least make the process, especially for emergency commitments to determine competency, a bit easier.
By the way, California’s 5150 procedure is actually surprisingly relaxed. It is actually somewhat easier than the pre-LPS requirement on this, which is part of why many psychiatrists supported passage of the Lanterman-Petris-Short Act. The difficulty is that the long-term commitment procedure is extremely difficult — I would argue too difficult.
I am glad you are being called. I read your book and appreciated your perspective as a researcher and care giver to your brother. It seems that having read your book that a national approach to mental illness would be counter productive given that the better success seemed to be in smaller communities where an individual approach was more likely to be accomplished. Could Congress make things worse?
Mostly what I want Congress to do is shine a light on this issue. It’s primarily a state level change that is required.
You seem to be addressing the nuts and bolts problems of involuntary commitment – used by the Soviets and lamented greatly by the late Dr. Thomas Szasz – and the willingness of the totalitarians and statists to adopt this as a tool of repression is a litany of horror. I fear the involuntary commitment statutes that need tightening will somehow find a way to link to ‘hate crimes’ and ‘hate-speech’ should the ‘progressives’ see the opportunities. There are no simple answers here.
The Soviets also had prisons for rapists, murderers, and robbers, but that doesn’t make the concept of prison for these crimes immediately suspect.
I agree that whatever reforms we make must be careful to distinguish between the merely eccentric and the truly dangerous. What surprised me when I first started to research the subject is how few cases I was able to find of persons who are merely eccentric being hospitalized.
Without question there must have been abuses of these statutes, because human beings will abuse power you give them a chance, but I was astonished at how few examples anyone, even the ACLU as late as 1963, could give up such abuses. The reason was simple: state mental hospitals were severely overcrowded. The doctors that ran the state mental hospitals had no economic interest in bringing more patients in. It seems likely that someone who clearly did not belong in a mental hospital would have been bounced out to make room for someone who did.
I think we need to truly appreciate the real basis for deinstitutionalization, reference The Dream and the Nightmare by Myron Magnet.
Thomas Szasz, in his 1961 book “The Myth of Mental Illness” argued that madness is the fault of society, or at least the powerful classes that control it. Mentally ill people are not ill but rather responding to their circumstances with a different kind of way to communicate.
Erving Goffman’s book, “Asylums” also came out in 1961 also and argued that treatment of mental illness is nothing more than oppression of the marginal and powerless.
The Chief of Planning for NIMH said in 1968, “The individual’s mental health is formed by the total society in which he exists” and “The totality of urban life is the only rational focus for concern with mental illness.”
In other words, the mentally ill are not really ill; they are just reacting to hanging around with a bad crowd, i.e., the rest of us.
These ideas formed the basis for deinstitutionalization in the 1960’s and 1970’s and still form the approach employed to this day.
yes, my book mentions the very destructive ideas of Thomas Szasz and R.D. Laing, as well as the influence of Goff’s book, in creating the pressure for deinstitutionalization. These were not the only motivations: the psychodynamic school of psychiatry got a little big for their britches, at one point arguing that most people were mentally ill, pretty much demolishing their claims of omniscience. There were some very serious problems with overcrowding and underfunding of mental hospitals as well, and a genuine desire to replace hopeless institutions with something a little bit more human scale.
Good intentions, however, are not enough. We tried the experiment: it failed. It is time to try something different.
Note that, like global warming, for example, the “solutions” put forth my these “experts” just incidentally confer on them enormous power to shape and control society. Sounds like delusions of grandure to me. All these guys have to do is stick their hand between the buttons of their coat and they’s be pretending to be Napolean. Besides, running the world is no doubt very lucrative.
And purely from the standpoint of their profession, 3600 Community mental health centers no doubt sounds a lot better for full employment than do the 50 or so state mental hospitals. Maybe there would be one in Malibu or Santa Barbara or the Hamptons or Vale or Hilton Head or places like that.
The 2000 community mental health centers that were at the core of the idea of deinstitutionalization in the early 1960s failed to come into existence because except in urban centers, the density of those in need of care was simply too low to make this work. Furthermore, there are economies of scale from large institutions. There were other problems with large institutions, but economies of scale make a big difference.
I read recently that in some communities they have placed dangerous mentally ill people into rest homes populated mainly by the elderly. Lacking mental hospitals desigened for protective incarceration that seemed to be the only option, since they did not want to send them to prison and probably would not be allowed to do so in any case.
And, as you might expect, these dangerous people then prey upon the helpless elderly people in the rest homes. I realy can’t believe this is happening!
Any leaders not confronting the shooting hoaxes must support them, logically, or else they are being extorted in some way. I guess if you have a security clearance then you need to play along?
Shooting hoaxes? Are you one of those conspiracy theorists who think these things are not happening?
“Theory” is a cop-out, and more like a cheap insult when coming from critics. The fact is several shootings were staged as drills and exercises, but reported as real events. These include the Sikh temple, Amish school house, and Alabama bus attack.
Conservative media is either helpless or colluding. I say it’s the latter, generally, with few exceptions.
Yup, the conspiracy is so broad reaching that it includes EVERYONE except you, Alex Jones, and a few other enlightened ones.
No, the conspiracy is with the media and American intelligence agencies. Alex Jones serves both those interests, just as you do apparently.
Isn’t it easier just to take away guns? Putting the mentally ill in institutions may save lives but it doesn’t grow the power of government and diminish individual rights and responsibilities like gun control does. Therefore, liberals will never go along with it.
There is a simpler, less conspiratorial explanation. For many people on the left, the right of due process, even if it leads to mentally ill people freezing to death on steam grates, is sacrosanct. Gun rights? Not so much.
Another part of the problem is that most Americans under 40 do not remember a time when our cities were not filled with homeless people muttering to themselves, dying of exposure, suicide, and murder. They are unable to understand how far our society has degraded the mentally ill and itself because they can imagine nothing else.
“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”
— C. S. Lewis
I hope that you can distinguish between the busybody that wants you to lose weight, stop smoking, and smile more and the one that wants you to stop worrying about the aliens that are following you around, preparing to abduct aboard a spaceship.
I don’t know if he’s talking about those who want to make sure that those who need treated will get it, or if he’s talking about those who were so interested in preserving the rights of the patient, that they would rather see them on the streets or in jails, than in mental institutions…
I, for one, could read it both ways.
Mr. Cramer, Having had a wife involved in social work and the mentally ill going back to the 70′s, I have read your article with interest – even though not my field. Just wanted to commend you and thank you for your very active and grounded participation in the discussion threads. It really enhances the PJM experience.
BTW, I always wondered why there were never any protestations over the way mental health workers were portrayed by Nurse Ratched and her crew in “One Flew Over The Cuckoo’s Nest”. Such character traits, while perhaps found in some small percentage in the field, were (and I assume still are) rare. But not as rare I think as such noble and likable inmates created by the author/script writers.
” … to disarm the people – that was the best and most effectual way to enslave them.”
– George Mason, 3 Elliot, Debates at 380
“Certainly one of the chief guarantees of freedom under any government, no matter how popular and respected, is the right of citizens to keep and bear arms … The right of citizens to bear arms is just one guarantee against arbitrary government, one more safeguard, against the tyranny which now appears remote in America but which historically has proven to be always possible.”
- Hubert H. Humphrey, Senator, Vice President, 22 October 1959
“[The Constitution preserves] the advantage of being armed which Americans possess over the people of almost every other nation…(where) the governments are afraid to trust the people with arms.”–James Madison, The Federalist Papers, No. 46
“That the said Constitution shall never be construed to authorize Congress to infringe the just liberty of the press or the rights of conscience; or to prevent the people of the United States who are peaceable citizens from keeping their own arms … ” – Samuel Adams, Debates and Proceedings in the Convention of the Commonwealth of Massachusetts, at 86-87 (Pierce & Hale, eds., Boston, 1850)
Colorado has always been weak on Mental Health Law. While I was living in Colorado in the sixties and early seventies a woman drowned her two children in a bathtub. She “got off” the charge of murder on an insanity plea and was sent to a state mental hospital. About eight or ten years later I read a short story in the Corpus Christi Caller about the same woman. After having been discharged from the mental hospital she remarried, had two more children, and drowned them in a bathtub. She returned to the hospital and, I bet, was discharged again.
I worked in both mental health systems, the institutional and deinstitutional. It is very clear that the institutional one of the first half of the Twentieth Century was superior to the deinstitutional one of the second. I’m happy to see the research on that supporting my experiential view.
The woman was obviously using her “Right to choose” albeit a few months post birth.
Her body her bathtub. Margaret Sanger Harris and her spawn the modern abortion movement and it’s spawn the Democratic Party would love to use this woman on a Billboard of how open minded they are.
I hope you’re heard. I’ve seen a lot of changes, from the 1960s in Rochester where we were used to seeing only one mentally ill person, “Garbage Can Annie,” to today where school children see hordes of mentally ill on the streets on their way home from school. You’re a voice of common sense.
God Bless Ted Cruz.
I am proud to FINALLY have a Senator from Texas in that Seat who is more concerned with getting our Government working under the parameters of the Constitution which the country was founded, than the prior occupant who was more worried about being fashionably dressed and at all the right parties.
Senator Cruz is the Poster Boy for a Candidate that runs and gets elected on rock solid true Constitutional beliefs over the chosen candidate of the Party Establishment.
If we can get a few more Ted Cruz’s in the Legislative Branch this country MIGHT, just MIGHT still be saved.
But before we defeat the Left we must first conquer the “moldy dishrag” branch of the GOP. A POX on the Karl Rove’s, McConnell’s, Boehner, Dole, & McCain’s of the Party.
I have a son who doesn’t really need to be institutionalized, but does need to be supervised. We have him in a group home now that does that. It would be better if that group home could also provide him with some mental health counselling, but he does have access to that counselling (and prescription medication) through Medicare. It took us eight years to find a spot where he is now, where he can live comfortably, but under supervision. There are many, many reasons why we couldn’t take care of him at home, including the loss of his health insurance.
There need to be more beds in places such as the one my son is in, yet each year the number decreases — mostly due to more regulation. A secure place for people with more severe problems would be great, especially if the people there could also work from such a site without losing their necessary benefits. Our current government really doesn’t understand these people, or their needs.