I'm Eccentric, You're Weird, He's Crazy—What, If Anything, Can We Do About Crazies?

Another week, another crazy shooting, and much chatter about mental health.  

Last weekend's Radio Derb (here, here, and on iTunes) had a go at the topic in reference to the Connecticut school shootings.  Extract:

The second sidebar issue here, much commented on in the past few days, is the identification and treatment of mad people.

The common narrative goes something like this:

  • Up until the late 1960s we put crazy people in secure institutions. Then two things happened.
  • First, psychopharmacology reached a takeoff point, where we had some psychoactive medications that in at least some cases could make crazy people less crazy. Looking back, we were a bit overconfident there. Not all the drugs performed as advertised; some had side effects worse than the condition they were supposed to help. Still there was genuine relief in many cases, so that institutionalized people could be sent home to live fairly normal lives … so long as they took their meds, of course.
  • Second, there was a change in thinking about mental illness. In part this was an aspect of the overturning of accepted notions and conventions that was going on all over society in the 1960s, and in part it was a genuine concern for the rights of people incarcerated against their will.
  • Some of this rethinking went over the top. The radical British psychiatrist R.D. Laing, for example, often seems to have been saying that crazy people's point of view was just as sound as sane people's, if not better — that society at large is crazy and could be improved by appreciating the perspective of the schizophrenics. These ideas are in direct line of descent from the so-called Frankfurt School of Marxism that flourished in the 1930s, 40s, and 50s. The Frankfurters argued — to boil it down to a thumbnail sketch — that capitalism makes you crazy.
  • It wasn't all over the top, though. There was some genuine libertarian concern that people's natural rights over their own bodies were being taken away. Remember that at that time the U.S.S.R. was locking up political dissidents in mental asylums and forcibly medicating them. This was the Cold War, and Americans of the classical liberal tradition — what we nowadays call "libertarians" — didn't want to be doing anything the Soviets were doing. A key name here is the American psychiatrist Thomas Szasz, who died just a few weeks ago.
  • These changes in our thinking were memorably represented to the public in Milos Forman's 1975 movie One Flew Over the Cuckoo's Nest, which was set in a mental hospital. That's the movie in which Jack Nicholson tells his fellow inmates, quote: "You're no crazier than the average asshole out walkin' around on the streets." The villain of the movie is Nurse Ratched, a bourgeois authority figure, memorably played by Louise Fletcher; so there is a dash of Szasz's libertarian social critique, and a dash of Laing's leftist one.
  • Well, the two things — confidence in new drugs and the change of thinking about mental illness and rights — together led to massive de-institutionalization. This went too far, and whereas before we were too ready to put people in asylums, we are now too reluctant, so that crazy people are at large to harass us in the streets and subways, or to commit atrocities like last Friday's in Connecticut.

That's the common narrative. There's a case to be made for it. Certainly there are people on the streets of New York who ought to be under institutional care. Heck, I'll name one for you: Naeem Davis, the guy who threw a New Yorker to his death under a subway train December 3rd.

Identifying dangerously crazy people before they do outrageouly crazy things is a hit-and-miss business, though. We weren't any better at it in the age of institutionalization than we are now. The worst massacre of elementary-school children in all of U.S. history was not the one in Connecticut last Friday, it was the school bombings in Bath Township, Michigan that killed 38 kids and six adults. That was in 1927. I'm sure that at the time the Michigan bomber was cooking up his murderous plan in freedom, there were thousands of harmless people locked up in that state's asylums.

Or think of Charles Whitman, who went up the tower at the University of Texas Austin campus in 1966 and murdered 14 people. That was in the age of institutionalization, though towards the end of it, and Whitman was in fact taking prescription psychoactive medication at the time.

I return here to my opening remarks about this being a zone of chaos, in which seeking for rhyme or reason in the event is futile. I don't mean that it's inherently futile, or will always be futile: but it's futile right now because we don't yet understand enough about human nature.

The way our minds are constructed, we are always driven to seek rhymes and reasons for things. We weren't very good at this, though, until historically quite recently — until scientific method came up in the 17th century. Seeking rhyme and reason for earthquakes, our pre-scientific ancestors came up with folk explanations involving angry gods, restless dragons, and such. We now know that those folk explanations are false. Earthquakes are caused by convection flows in our planet's molten interior causing cracking and shifting of the solid crust.

Perhaps one day we'll know why crazy people do crazy things, and how to identify those people accurately. Perhaps we'll be able to stop the crazy things, though that doesn't necessarily follow: we understand earthquakes, but we can't stop them. Still, understanding would be nice.

We don't have it yet, though. Our understanding of the mind is not far beyond the angry gods and restless dragons stage.

I don't have much patience with explanatory thinking at the folk level; I want to see hard, reproducible scientific results. Until they come along, I'll hold on tight to my liberties. Without science, we only have pseudoscience: and pseudoscience has always been close friends with tyranny.