De-Institutionalizaton, Update

Observations and graphs of numbers institutionalized are discussed by Bernard Harcourt guestblogging at Volokh. His conclusion:

What is also clear is that Seung-Hui Cho probably would have been institutionalized in the 1940s or 50s and, as a result, the Virginia Tech tragedy may not have happened. According to the New York Times, the director of the campus counseling services at Virginia Tech said of Cho: “The mental health professionals were there to assess his safety, not particularly the safety of others.” It’s unlikely we would have taken that attitude fifty years ago.
But the problem is, we would also be institutionalizing another huge swath of humanity — and it’s simply not clear how many of those other lives we would be irreparably harming in the process.

Volokh introduces Harcourt, Julius Kreeger Professor of Law and Criminology at the University of Chicago. His guest blogging posts will chiefly focus on a new paper “that looks at the massive shift in institutionalization from mental hospitals to prisons during the 20th century, a topic that’s particularly timely in light of the Virginia Tech incident.”

His findings give substance to some of the observations on this blog and agree in part with Kellerman’s editorial, linked to earlier. His interest, however, is less with the links to homelessness than to incarceration. Certainly this is not an area full of easy answers. The chronic nature of these problems make solutions – at least as our understanding of these illnesses now stands – always temporary; the result can be the false hope that a temporary solution is a long-term one.

6 thoughts on “De-Institutionalizaton, Update”

  1. The issue of whether or not crazy people should be locked up in mental hospitals/prisons is red herring. Crazy people, like the poor, will always be with us.

    There can be no doubt that Cho did these deeds in order to get his name in the paper and his face on TV. No one would have been killed if Cho had been certain his deeds would go unreported. Reporting these crimes is the same as shouting “fire” in a crowded theatre.

    So certain was Cho that he would becomne famous that he did not even stay alive to find out if it happened. Indeed, so certain is the reward these people seek that they can enjoy their fame before they do the deed and be positive that if they die doing the deed that fame is gauranteed.

    Just as we can say guns kill people, so can can we say that irresponsible journals is the major cause of terrorism today.
    And just as we need gun free zones, so do we need journalism free zones.

    As things stand the only people dying to protect the 1st amendment are the victims of terrorism and crazies like Cho.
    The journalists are in no danger and only get rich from the suffering of others.

  2. Sol Vason,

    While the form such news takes, especially obsessively in our time of 24-hour news, etc., may be important, your first remark that insanity is going to continue as part of the human condition is probably a more important observation. That it is expressed in a 21st century way – powerful guns, students in classes, 24-hour news cycle – is different, perhaps.

    How we care for the mentally impaired has always been an important question in our society. That cliches (it is the fault of journalists by some and it is the fault of a society unwilling to spend money by others) simply do not face the fact that at this time, with the techniques & knowledge we now have, our society must make trade-offs – less often of money than of liberty. The nature of those trade-offs, of the assumptions about society and human nature that inspire them, seem to me issues with which those of a libertarian belief need to address honestly.

    This is, of course, despite the tragedy that inspired our look at the problem, a matter in which the glass is at least half full. Many people are able to navigate in the general society who couldn’t have a generation ago because diagnostics and pharmaceuticals are remarkably better. And our society is slowly beginning to recognize that it is not always helpful to apply the old assumptions of the noble savage grown mad in rotten society and the blank slate on which a perfect society would never write words of chaos and despair.

  3. I don’t really buy the idea that we are sending the mentally ill to prison instead of treating them. Granted, the same legal environment that makes it difficult to compulsively treat the mentally ill also makes them legally culpable. It’s a two edged sword, if a person is competent to make their own medical decisions then they are also competent to take legal responsibility for their actions.

    However, incarceration rates track strongly by ethnic group.

    At yearend 2005 there were 3,145 black male sentenced prison inmates per 100,000 black males in the United States, compared to 1,244 Hispanic male inmates per 100,000 Hispanic males and 471 white male inmates per 100,000 white males.

    Unless we presume that blacks and hispanics suffer from mental illness at far higher rates than whites then we can presume that changes in prison populations do not reflect changes in the mental health of the prison population.

    The correlation of increases in prison populations with a decrease in mental institutionalization is largely just coincidence. The increases in prison populations since 1980 is largely due to significantly longer sentences. After all, crime rates have dropped fairly steadily during that time so we are not locking people up at higher rates than we used to, we merely keep them their longer. The net effect is a much larger percentage of the population is in prison at any given time.

  4. Here is an axiom. Terrorism cannot exist without journalists. If nobody knows a deed was done, no one can be terrified.

    The notion that psychiatrists should be enlisted as front line troops in the War on Terrorism should be anathema for many reasons.

    First, whatever a patient confides to his doctor must be confidential. Of course, today there is no confidentiality.

    Second, prognoses which would be used to protect society are entirely subjective and can never be 100% accurate. If we believe a person is innocent until proven guilty we cannot accept a test that is less than absolutely accurate. 95% confidence is not good enough by this standard and 90% or 80% are unthinkable.

    Third, psychiatrists will err on the side of Society because no one wants to be responsible for unleashing a terrorist on society. People who are not crazy will be imprisoned / hospitalized.

    Fourth, entire classes of people will be imprisoned because they fit certain profiles. For example all Moslems who have been to Mecca and have owned or learned to use assault weapons.

    Take away the reward and terrorism will cease. Just as gun free zones have made this a safer world so also will journalism free zones make us all safer.

  5. Most of these comments ignore one very important thing: Federal law, ignored by Virginia and many other states because of a loophole in the law that congress has not seen fit to fix, says that those with mental problems (have been judged to have problems by specialists) ought not be granted gun permits. Many states take advantage of a loophole in the Brady bill and grant permits to those judged to have some special problems.Even the NRA suggests that this should not take place.

  6. Sol Vason’s comments indicate a belief that the motivations are external. I’m sure that is true to some extent and certainly the hyperventilating media are of little help either in terms of crazy mass murderers or terrorists. But this is also part of us, reflects what has (and has historically) gone wrong with our brains; given their complexity it isn’t surprising it becomes skewed.


    Shannon points to the crux: It’s a two edged sword, if a person is competent to make their own medical decisions then they are also competent to take legal responsibility for their actions.As so often, we come back to assumptions. And we see here the inadequacy of the blank slate and the noble savage, but we also see the inadequacy of assuming a society has no involvement, is only designed to make sure we are left alone

    The more we want authority over our lives the more we must take responsibility. I prefer a world in which this is maximized, but it is not without its problems. Cho & Andrea Yates would have been institutionalized in communities more invasive and statist. And their problems became other’s problems in a tragic way. But our hearts also go out to the man sitting on his piece of cardboard. Surely, another life would be better than that on the streets. How rational is his choice? Not very, we say, but others would argue that it is his, irrational or not.

    The population groups of prisons & mental hospitals appear to be predominantly different categories. I’m not sure that disproves the correlation as much as pointing to how complex our interactions are and how much more or less of one element can change the dynamics of a person’s choices.

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