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Deinstitutionalization of the Mentally Ill:
The Crisis That No One Talks About
Good evening. I have a brother, Ron, who is 12 years older than me; the story I have to tell you tonight is partly the story of his very bright mind, lost to mental illness -- and partly the story of a loss that probably didn't need to happen. Though Ron was quite introverted, and in retrospect we can see some odd behavior before his mental breakdown, he had always seemed like a normal person, though more studious and shy than average.After my brother's service in the Army, he alternated between working and going to UCLA. In his last term, he took the honors sections of calculus, physics, and chemistry, and earned As in all of them. Ron was a very, very smart guy, and I looked up to him. In 1973, I was in my senior year at Santa Monica High School, expecting to finish college without the draft interruption that Ron had experienced. At that point, a tragedy happened to my older brother that neither my parents nor I understood.
The first sign of trouble was that he would keep changing radio stations every few seconds -- and he gave very evasive answers about why. I now know that paranoid schizophrenics often have auditory hallucinations -- most likely, my brother thought that the radio stations were talking about him.
Ron started to behave rudely to the husbands of my sisters. Why? He considered that my sisters had married "unworthy" guys, and the mental illness broke the facade of civility that had kept him from saying anything previously.
Ron suddenly stopped worked, and stopped going to school. Why? Schizophrenics often have trouble concentrating on complex or lengthy processes, and work and studying were now too hard for him. Because of his financial difficulties, he moved back in with my parents. (I was the last of five children at home.)
Then, over a period of perhaps six weeks, Ron started to talk about patches of color that would change, move, and disappear. His visual senses were now misleading him -- and for a very brief while, my brother knew that
something was wrong, but neither he nor my parents quite knew what to make of it.
My parents were perplexed, confused, and I guess somewhat afraid -- they kept as much of this secret from me as they could. Ron began to use foul language in the presence of my parents and me. (For those of you under 35 -- there was a time when the words that you can't say on broadcast television weren't said in front of either children or or your parents in middle class homes.)
The final sign that something was going wrong in Ron's brain were casual acts of violence against complete strangers. I was with my father and Ron at the market. While my father was in the store, Ron suddenly jumped out of the car, ran over to a old man sitting on a bus bench, grabbed him by the shirt, pulled him up to a standing position, and punched him in the face, while making threats. When I asked Ron why he did that, Ron just laughed.
The violence escalated. He smashed in the windows of his car. Why? He gave evasive answers. One evening, I think on my 16
th birthday, Ron for no apparent reason, packed a couple of suitcases, walked out the door in a huff, then returned a couple of minutes later -- and smashed in the front windows of the house we rented. From where we stood in the living room, we could see him kicking his suitcases across the lawn -- and the force that he was using was terrifying. My parents called the police. My brother stood on the front lawn grinning; about 45 minutes later, the police arrived -- just as my brother left.
During this period of a few weeks, there were repeated incidents of violence against strangers. I was scared, especially because my brother was saying some very weird, very strange things to me. My father put what was effectively a medieval castle bar across my bedroom door, giving me a little more sense of security.
Eventually, Ron reached a point where he went to talk to the community mental health center -- and they promptly decided that he was sufficiently dangerous to himself that they sent him to a mental hospital for observation. And this is where one tragedy -- my brother's descent into paranoid schizophrenia -- was compounded by another tragedy.
My brother was held for observation for 72 hours. Then, he was held for another 14 days for further observation and medication. But the psychiatrist in charge of our local hospital's locked ward told us that there was little chance of him being committed. As it was explained to my father, "By the time someone's been pumped full of Thorazine for 14 days, if they still seem dangerous to a judge, they have to be
really dangerous." On at least one occasion, someone who purported to be an advocate for the rights of mental patients was present in court to make sure that all the i's were dotted and all the t's were crossed -- and that no one was locked up against their will in a mental hospital.
What? My brother attacked complete strangers for no reason whatsoever. He smashed in windows at our house, he was saying things that were clearly crazy, and he wasn't going to be kept in a mental hospital? Sad to say, this has been a recurring pattern of my brother's life ever since. He has been arrested dozens of times for attacks on complete strangers. He has been arrested for all sorts of bizarre behaviors. He attacked my mother with a shovel once. He tried to strangle one of my sisters once. He tried to strangle our mother, a year later. He has lived in urine-soaked hotel rooms -- and sometimes he has been a homeless person.
And from all those incidents, spanning 16 years of severe mental illness, there have been only
two times (to my knowledge) that he has been held for more than observation. In both cases, the long-term care he received dramatically improved his mental health, at least for a few months -- or until he stopped taking his medication. (We are still counting the months of the current improved situation, and hoping that this time, it sticks.) The rest of the time, judges have refused to lock him up for treatment. Let me emphasize that this was not a peculiar situation; Ron is not unique. Indeed, Ron is in better condition than many schizophrenics.
I've read that in 1960, there were about 550,000 people in mental hospitals in the U.S.; today there are about 100,000 -- even though our population has grown by almost 50%. Have we gotten that much better at helping the mentally ill to lead productive lives outside? I would like to think so. When chlorpromazine was introduced several decades ago, I understand it was regarded as a bit of a wonder drug, with the same irrational optimism that Prozac seemed to produce about five years ago.
Sadly, much of that drop in mental hospital patients wasn't because the system is doing so much better of a job. We can see where at least some of those people went -- suffering squalid, filthy, and miserable lives under overpasses, pushing all their worldly possessions around in shopping carts, begging in our streets, catching tuberculosis and pneumonia. They die of exposure, of murder, and quite often, when their delusions or their misery become unbearable, they die by their own hand. I have seen the claim that 15% of schizophrenics commit suicide. I don't know if that is true, but I know some truly tragic stories. My mother has a friend who has two schizophrenic children; her daughter stopped taking her medicine, and was overwhelmed by her illness. She lay down on the railroad tracks near Barstow one night to die -- and she did.
For almost 20 years now, people calling themselves "homeless advocates" -- meaning that they call themselves advocates for the homeless, not they themselves are homeless -- have tried to use this tragedy as variously, an indictment of capitalism, Ronald Reagan, or the heartlessness of various city governments. It is clear, from surveys of the homeless, and from my own experience with my brother, as well as talking to and helping homeless people for more than 20 years, that this tragedy is mostly the result of a well-intentioned effort that started in the 1970s, to make it difficult to lock up mentally ill people against their will.
Look around you in any big city, and you will find enormous numbers of people living on the streets, most of them mentally ill. What sane person would spend a single winter night sleeping on a bus bench if they had any alternative? It will take a psychiatrist to determine exactly what
their mental illness is -- but in most cases, it doesn't take professional training to tell that there is something seriously disordered about their minds. A few minutes of conversation is usually quite sufficient.
What happened? In the bad old days, I am told, and my reading of federal court decisions tends to support this claim, people were locked up in mental hospitals who weren't necessarily mentally ill. They might be eccentric, or perhaps they had joined some weird religious cult, or had lots of money that their kids couldn't wait to inherit.
I recall reading of one tragedy involving two sisters who were sent to a mental hospital long, long ago back East after their parents died because they were incapable of speaking anything but gibberish, and were therefore assumed to be retarded. Seventy years later, it was discovered that the gibberish was -- Serbo-Croatian.
Our state mental hospitals, according to both newspaper accounts of the 1960s, and what my sister told me -- she worked as a cook at a mental hospital for a few weeks before quitting in disgust -- were repulsive institutions. They warehoused children and adults in circumstances that would be unacceptable in a dog pound.
For all these reasons, there was a well-intentioned effort to reform commitment laws, starting with the Lanterman-Petris-Short Act, adopted by the California Legislature in 1967, effective in 1969. It became the model for mental illness commitment laws throughout the United States. At roughly the same time, the federal courts became increasingly insistent on certain standards of procedure and proof for committing people to mental hospitals for indefinite periods of time.
From what we were told, from what we saw with my brother, and from what I have gleaned from reading countless newspaper accounts where the mentally ill
finally got some attention -- usually after committing murder -- our system is refusing to lock up large numbers of people who are clearly unable to care for themselves because of mental illness.
Now here is the troubling part of all this. When I read the Lanterman-Petris-Short Act, the statute is perfectly reasonable as written. If a person engages in an act of serious violence against someone else, or demonstrates a likelihood of suicide, commitment for involuntary long-term treatment is supposed to be pretty easy. The same is true for someone who is "gravely disabled," defined as someone who can't provide for their own food, shelter, or clothing because of mental illness.
[1] The courts and the legislature have agreed that "provide for" doesn't mean "able to beg."
[2] And yet, I can't go to most big cities anymore -- and increasingly, some parts of Rohnert Park, without seeing people that are
clearly in that situation. One guy who sits in front of Target in Rohnert Park can't bear to be indoors -- he camps in the fields at night west of town. He's not destitute; he showed a sizable roll of cash to a friend from church who was trying to help.
Of course, sometimes the courts make decisions that twist the law. But I've spent some time reading the decisions associated with Lanterman-Petris-Short about "gravely disabled," as well as a number of the federal court decisions that might explain why the law isn't being used here in California -- and I'm stumped. While I know of particular decisions in other parts of the country -- I'll tell you about one in New York City a bit later -- there seems to be no legal obstacle here to committing large numbers of mentally ill homeless people to hospitals. At least in a mental hospital, they won't be vermin-infested, coughing up blood, and dying by degrees. At least some of them will be treated sufficiently to end the nightmare that afflicts them, and be able to return to the society of the sane.
I've heard it claimed that there's a shortage of beds in mental hospitals, and that's why so many mentally ill people wander the streets. Perhaps this is so, but let me tell you, when my brother was going through various observation periods, I never heard this complaint from doctors or staff. At about the same time in the late 1970s that mentally ill homeless people were becoming a fixture on the streets of Santa Monica, a friend of mine named Eileen was losing the battle with schizophrenia. Her illness was not as severe as Ron's; she at least knew that she had a problem. After three days of not being able to sleep, because the voices kept shouting, "Kill yourself!" she went to the same community mental health center where my brother had gone; she explained what was going on, and she was on her way to the state mental hospital at Camarillo
that day.
Another sign that the current law is not being used is that there are people released who are
clearly dangerous. About eight years ago, a friend named John worked as a workman's compensation rehabilitation counselor. One of his clients had a serious cocaine problem, and connections to the Vallejo drug gangs. This client was mentally unstable, and ended up in a mental hospital for observation. Part way through the 14 days, she started to make serious death threats directed at John, along the lines of, "I'm going to get an Uzi, and kill John." As required by law, the psychiatrists at the mental hospital reported these threats to John. But what made this even more frightening was -- they expected her to be released at the end of the 14 day observation period -- and she was!
John called the police department where he lived, where she lived, and the sheriff's department. All of them basically said, "Give us a call when she tries to kill you." No one suggested, "Maybe she shouldn't be let out of a mental hospital while she's threatening to murder someone." It was a scary few days for John, between the time she was released, and the end of California's 15 day waiting period to buy a handgun.
Do judges not want to lock up people in mental hospitals? I am beginning to fear that this is the problem. In the 1960s, psychiatrists like R. D. Laing and Thomas Szasz challenged the traditional view of mental illness, especially schizophrenia, one of the psychoses that causes so many of the problems we're seeing. Dr. Laing argued that schizophrenics were, if anything, more sane than the rest of us. Dr. Szasz saw the mentally ill as victims as a plot by the government to oppress people -- rather like the way the Soviet Union regularly declared political dissidents to be mentally ill.
[3]
If these ideas had stayed in dusty journal articles, I don't think we would be facing the problem we have today. This notion that mentally ill people aren't really so different from the rest of us -- perhaps even a bit more sane -- showed up repeatedly in movies of the late 1960s and 1970s.
One Flew Over the Cuckoo's Nest, They Might Be Giants, and
King of Hearts are just a few of the movies that were popular as I was reaching adulthood, and I fear have profoundly shaped the thinking of a great many judges.
Some years ago, when Ed Koch was mayor of New York City, there was a homeless woman living on a steam grate. Her clothes were filthy, covered with excrement; she was clearly insane. Mayor Koch finally became so upset about the continual news coverage of this tragedy that he ordered the police to take her to a mental hospital. They did so. The ACLU, incensed at this high-handed treatment of a homeless person, filed suit. While the lawyers filed briefs, and the judges pondered the question of due process, the mental hospital treated her.
By the time the courts ordered her release, some time later, she was no longer incoherent. The lawyers doing this fine work for the ACLU hired her to work as a receptionist in their office. Eventually, the ACLU won a resounding victory for the Constitution, due process, and, in their eyes, for this homeless woman. The appellate court judges that heard the case decided that forcing her into a mental hospital denied the basic human dignity to make our own decisions.
That's not the end of the story, however. After a few months of not taking her medicine, this woman again became delusional. She started to act strangely enough that the lawyers finally had to let her go. Newspaper reporters were still following the case; and the last act I saw reported in this tragedy was that she was back on the steam grate, defecating in her pants. Isn't human dignity wonderful?
The popular historian Paul Johnson wrote a scathing book some years ago titled
Intellectuals. Perhaps it's too much of a stereotype, but Johnson described an intellectual as "someone who loves ideas more than people." While I have the utmost respect for the Bill of Rights, and I am troubled by what can happen when our rights can be taken away on the whim of a judge or a psychiatrist, I fear that this particular case is one of those examples of lawyers and judges more in love with an idea than with people.
So far, I've mostly focused on the suffering of the mentally ill. But there's another side as well -- the danger to our society when people with a limited grasp on reality wander the streets. Let's face it -- most people in this county wouldn't spend $50 to save a homeless person from freezing to death. If you want to appeal to the masses, you need to point out to them the public safety side of this tragedy.
The places change, the victims change, but the tragedy keeps repeating. A month or two ago, it was at a church in Fort Worth. A month before that, it was Buford Furrow shooting kids in Los Angeles. Last year, Russell Weston Jr. murdered two police officers at the U.S. Capitol. There's a common element to all these tragedies -- all the killers were
clearly mentally ill months to years before they started shooting people. These three recent high-profile cases draw the picture in blood.
Buford Furrow was arrested by Washington State police in 1998 after he tried to gain admission to a mental hospital. He was refused, so he drew a knife on the people who told him he wasn't crazy enough. When he went to court, he told the judge about his fantasies of mass murder of minorities. In spite of this statement, and an extensive history of violence, instead of sending Furrow to a mental hospital, the judge gave him six months in jail, then let him out to carry out his hate crime.
Russell Weston Jr. was obviously mentally ill: a paranoid schizophrenic with delusions about a computer hidden inside the Capitol that would resurrect him after death. He was arrested for making threats against the President, held for a few weeks in a mental hospital in Montana -- and released. A year or so later, he went to his father's house, stole a gun, then drove to Washington DC, where he murdered two police officers.
The latest act in this public policy tragedy involved Larry Gene Ashbrook. His brother described Ashbrook as a paranoid schizophrenic -- and one scary enough that he once had to drive Ashbrook away with a shotgun. According to news accounts in the Fort Worth
Star-Telegram, Ashbrook was regarded by neighbors as dangerous and disturbed -- but they were afraid to call the police for fear of retaliation. And why not be afraid? Fort Worth mental health outreach nurse Barbara Murphy described the situation under Texas law: "The bottom line is the police cannot do anything and we cannot do anything except listen to them and try to get them into help."
Three examples. But they aren't alone. One study completed in 1992 indicates that about 1000 murders a year are committed by mental patients who have refused treatment. Murder rates have fallen by about one-third since 1992, so those numbers may not still be accurate, but my point is that there are a
lot of these murders by untreated mental patients.
I can point you to other examples of people who had come to the attention of the courts and were
clearly insane, but were released. If they later commit a murder with a gun, they get a lot of attention, like Patrick Purdy, who murdered five children in Stockton in 1989. (Purdy's mental disability checks bought the guns he used in that schoolyard massacre.) Or the man with a 20 year history of mental illness-related crimes who murdered our landlord's daughter in Golden Gate Park in 1983, and wounded several others.
If they use a knife, they tend not to get the press coverage -- but the victims are still dead. How many of you saw the news story about Joshua Rudiger, arrested in San Francisco last year? The police charged him with murdering one homeless person, and trying to murder three others by slitting their throats. Rudiger explained to the police that he was a 2000 year old vampire. Oh yes, he had been in and out of mental hospitals for schizophrenia since he was 15, including an incident where he shot someone with a bow & arrow. For that incident he was ordered to receive treatment in a live-in treatment center -- and released! He never showed up, and no one went looking for him. Instead, he started killing people.
A couple of years ago, the pastor of the church that I attended asked me to talk to a man who had started attending our church. He was camping in a field behind our church, living out of a bicycle trailer with his dog. He didn't work; like many of the mentally ill living out of doors, he had a government mental disability check of about $600 a month. Ten minutes of conversation were quite sufficient to reveal his confused and irrational thinking; no surprise that he wasn't working.
He was upset that the courts had taken away his children away from him. Perhaps indicative of how disordered his thinking was, he showed me the paperwork that terminated his rights as a parent. The courts had taken away his children because he was showing them pornographic movies, then molesting them. Their mother was already in a mental institution.
You may ask, why didn't they prosecute this guy for child molestation and send him to prison? The children were five years old and younger. I speculate that it would have been a hard case to prove in a criminal trial; the children would have been further traumatized by preparing for the trial. Instead, they let this guy go. My wife still sees him bicycling around Rohnert Park with his dog. Doesn't that make you feel safe and secure?
We have a crisis going on in this country. It is a crisis that makes us less safe on the streets, and that degrades mentally ill people to a point where many people can no longer feel human compassion for their suffering. And yet nothing is being done about it. It is way past time that we recognize that the pendulum has swung too far from the 1950s. Human compassion, public safety, and the need to salvage human wreckage, demands that judges use the laws already on the books to correct this disaster.
Thank you.
1. Cal. W&I § 5008 (h)(1).
2. Cal. W&I § 5250 (d).
3. James F. Calhoun, Abnormal Psychology: Current Perspectives, 2nd ed. (New York: Random House, Inc., 1977), 313.
