January 18, 2013


While most of the gun violence in America is committed by the clinically sane, the most horrific massacres are often the work of deranged people whose problems had come to the attention of family, neighbors or work associates.

Strangely, America has regressed in its treatment of the mentally ill. In the 19th century, most of the nation’s disturbed were either on the street or in jail. In an effort to provide humane treatment, state institutions popped up across the country, confining most of the nation’s severely deranged. Yet by the 1960s, controversy erupted as stories of mistreatment and poor conditions (One Flew Over the Cuckoos Nest, anyone?) became rampant. Deinstitutionalization followed, in a movement that received strong bipartisan support. Liberals championed the fall of state psychiatric hospitals on the grounds of compassion and freedom; conservatives saw it as a way to save money and as a blow against the intrusive nanny state.

State institutions closed down in droves; of the one public psychiatric bed for every 300 Americans in 1955, only one for 7,000 remained in 2012. Community treatment centers (nursing homes, care homes, etc.) moved in as substitutes, but they received little funding and resources. A series of federal laws were then passed to make it nearly impossible to confine or treat someone against their will. Individuals had to be shown to pose an imminent threat to themselves or others. In America, you have a right to be mad.

Overall, available treatment not only became scarcer, but far more expensive. The mentally ill were either forced to live with their families, who weren’t prepared to deal with their condition, or were abandoned altogether.

Clayton Cramer has a book on this.

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