The Corner

Re: ‘The Madness Lobby’

An e-mail:

For several years I have worked as a psychiatrist in jails, prisons, and now a forensic state hospital.  I’m a registered Republican whose political views intersect heavily with “classical liberalism,” and whose shelves are adorned with most of P.J. O’Rourke’s books.  I also respect greatly Dr. Torrey’s work and philosophy, and have had the privilege of corresponding with him by email.

The state hospital system collapsed as a result of a weird synergy between legal activists and budgeters. The deinstitutionalization experiment proceeded with the belief that liberating the mentally ill would also reduce the cost of their care.

“the politics of deinstitutionalization was generally facilitated by the fact that fiscally `conservative Republicans sought a way to save money… [and] the liberal Democrats sought a way to expand civil rights. The promise of doing good by saving money was irresistible’ (Isaac and Armat, 1990:15). (as quoted in Powers, Rothman, Smith College. Center for the Study of Social and Political Change, “The Least Dangerous Branch? Consequences of Judicial Activism,” 2002)

In the ‘90s I worked at a civil state hospital in Florida that was later closed (G. Pierce Wood.) Within a few years, lawsuits emerged to move a newly developed list of mentally ill persons accumulating in jails – adjudicated incompetent to proceed to stand trial.

Lo and behold … under lawsuit pressure, new state hospital beds were opened – forensic beds – in an amount nearly equal to the civil beds that had been closed. And so Florida policy shifted to require that the mentally ill commit crimes to receive sustained services. The civil side had failed the sickest.

Ironically, the same advocate culture that fomented for “liberating” deinstitutionalization now fomented for re-opening institutional beds.  Oops.

I watch the same thing now unfold in Texas.  It’s a national problem. The U.S. Congress passed the Mentally Ill Offender Treatment and Crime Reduction Act (2004) as a token recognition of this.

But, can we continue the ongoing “devil’s pact” between liberals and conservatives to deprive those with serious mental illness of the services they must have?

Liberals have said “let them loose!” Free them from “cruel” institutions. If they want to live under bridges, then let them! That’s their choice! And don’t force guardianship, medication or hospitalization! The inhumanity!

Conservatives have said, “great … sounds good to us … we didn’t want to spend the money.”

Meanwhile, the anosognosic mentally ill person is dragged off into hell by the illness, with public awareness only bubbling up briefly after events like Tucson.

Serious, psychotic mental illness has no free will, and existing public policies are naive mockeries of its realities.

How many people know that seriously mentally ill people must now commit felonies to receive sustained, meaningful services?  (Google the phrase “criminalization of the mentally ill.”)

How sad that my patients had to be criminally arrested to get services. Sometimes somebody even had to die.

Rich Lowry — Rich Lowry is the editor of National Review. He can be reached via email: 

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