Consider these scenarios. A popular college student leaves his fraternity house one day, stark naked. He walks three blocks to a stranger’s house, enters, turns on the TV and falls asleep. Moments later, the owner of the house finds him, takes aim with his Glock and kills the young man before he ever wakes up.
Or: an 18-year-old high school basketball star calls 911 to report child abuse because he can’t find any Chinese food in the house. When the police contact his mother, she rushes home to find her son sobbing on the front porch while a confused sergeant stares, watching his tears flow like rain.
Or: a young woman in Nebraska disappears the night before her parents’ thirtieth anniversary celebration—a surprise party she’d spent months planning. Two days later, she is found in Singapore, where she’s been picked up for shoplifting. Though Singapore has some of the harshest criminal penalties in the world, it also has some of the best mental-health care. So, rather than receiving a caning, the young woman is retrieved from a first-class hospital, diagnosed and medicated, her equilibrium restored.
Mental illness in the United States is misunderstood, criminalized, stigmatized and insufficiently covered even by so-called Cadillac insurance plans. If you think you don’t know anyone coping with psychosis or depression, you’re wrong: 58 million Americans (one in five) have some form of mental illness. If most of us don’t realize its prevalence, it’s surely because we’re afraid to talk about it. We’re a nation of fundamentalists about personal agency, and we’re skeptical of mental disorders as “real.” When a friend’s son wrote his family that he just wanted to lie down and die, one faction sent him Bible passages and told him to pray harder, while another sent him a copy of Ayn Rand’s Introduction to Objectivist Epistemology and told him to “take responsibility” for his life.
The insistence that the mentally ill are rational actors informs public policy, too: Jared Lee Loughner, who shot Representative Gabrielle Giffords in Tucson, Arizona, received treatment only so that a court could declare him competent to stand trial. Since 2009, states have slashed more than $1.6 billion from mental-health programs. There are no savings to be gained from such cuts. They simply transfer the costs elsewhere: nearly half of all state and federal prisoners and approximately one-third of the nation’s homeless are mentally ill. Since much mental disease can be treated, this represents a human rights crisis as well as a spectacular waste of human resources.
Indeed, the comments on websites discussing James Holmes’s massacre in Colorado look right past its very bizarreness. “He just wants attention” is a typical remark. Any recognition that Holmes’s acts were terribly sick is accompanied by the assumption that his state must have been immediately obvious to everyone around him, as well as an underestimation of how hard it is to intervene or hospitalize an adult who does not voluntarily seek help.
The New York Times Magazine recently published a piece by Jeneen Interlandi chronicling her family’s struggle to help her father when he developed bipolar disease. She describes the gut-wrenching vigil for someone slowly transforming into a different person, as well as the near impossibility of procuring treatment if the sufferer “presents well” to psychiatrists or police. To commit her father involuntarily, she states, “he had to be an imminent danger to himself or others…in practice, it seemed to mean that he had to be standing on the ledge of a building, or holding a knife to someone’s throat.” The family ended up “locked in a game of chicken: waiting for my father to do something clearly dangerous; praying like hell that it would not be his suicide or accidental death or the death of someone else.”
Tragedies like the one in Aurora always prompt calls for more regulation: that schools be sued, psychologists lose their licenses, hospitals lock more people up. This implies some recognition that untreated mental illness is a public concern. Yet there’s no willingness to reconfigure our insurance system as a public good, or to fund any services that might alleviate the problem. So we are left with narrow remedies like lawsuits after the fact, inadvertently creating incentives for employers to fire mentally ill workers and for schools to expel those who need help the most—or, even worse, to overreact by “taking no chances.”
Risk assessment is an imperfect science, and our extraordinary level of violence only adds to the problem. We legitimize our trigger- happiness by imagining our polity as a war zone, “standing our ground” and girding our loins for the apocalypse. After Holmes’s slaughter, gun sales in Colorado leaped by 40 percent. There are those who insist that gun ownership rates have no causal relation to the rate of gun deaths. It’s a pitched argument (gun ownership is even mandatory in some US towns), unlikely to be settled by the numbers. But can we at least agree that there’s a kind of madness in peddling guns to every American (the NRA sells baby bibs featuring its logo) while decimating our mental health system?
We are all so vulnerable. We are subject to mental disorder as individuals in a toxically stressed modern world. We are subject to disorder based on biological clocks we do not fully understand (most mental illnesses tend to manifest in early adulthood). And we are subject to disorder as groupthink, ideological puritanism and religious extremism.
As I prepare to file this piece, word comes that yet another “lone gunman” has entered a Sikh temple in Wisconsin and killed six people. The FBI has declared it “terrorism.” The Westboro Baptist Church calls it the “beautiful work of an angry God.” CNN’s Eric Marripodi has declared it an “unfair targeting” of Sikhs mistaken for Muslims (a presumably fairer target?). Wisconsin State Representative Mark Honadel declared it “craziness.”
Perhaps one day we’ll know.
For more information about mental disease–including definitions, current research, and local resources–please consult the following websites: The National Alliance on Mental Illness, www.nami.org; The Brain and Behavior Research Foundation, www.bbrfoundation.org; and The National Institute of Mental Health, www.nimh.nih.gov.