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Jewish World Review / July 29, 1998 / 6 Menachem-Av, 5758

Mona Charen

Lock up those who need psychiatric care

ONE DAY BEFORE HE ALLEGEDLY OPENED FIRE on complete strangers, killing two guards and seriously wounding a young female tourist in the United States Capitol building, Russell E. Weston Jr. had taken a shotgun and killed 14 cats, including two of his father's favorite pets, at his rural Illinois home.

Though his family has known for 20 years that "Rusty" was mentally ill, they knew little about what could be done to help him or themselves. He had been twice diagnosed as a paranoid schizophrenic and had been prescribed anti-psychotic medications. But when he declined to take his medicine, his parents threw up their hands.

"What are you going to do with a 41-year-old man?" his mother told the New York Times.

There isn't much the family of a mentally ill person can do to get treatment for someone who refuses it because at least half the states forbid involuntary treatment unless the patient is an immediate danger to himself or others. The Catch-22 is that many mental illnesses, particularly schizophrenia and bipolar disorder, prevent the sufferer from perceiving that he is ill or in need of treatment. The family of convicted Unabomber Theodore Kaczynski had tried to get treatment for him but were stymied by such laws.

Not all, or even most, mentally ill people are dangerous. But a statistically significant percentage are. We have adopted the philosophical stance that everyone -- including the insane -- is a perfectly competent decision-maker. Accordingly, we can only intervene when it is too late -- when the person has committed or attempted to commit a crime. At that point, the criminal justice system takes over and sends the insane person to a mental institution or prison.

It wasn't always this way. There was a time when the family, in consultation with physicians, could have someone committed against his will. But in the middle and late 1960s, there were scandalous stories about conditions in state mental institutions -- like New York's Willowbrook -- which contributed to a reformist movement.

It wasn't just stories about abuses that caused the United States to veer away from involuntary commitment. It was intellectual fashion, too. In 1961 Dr. Thomas Szasz published an influential book called set "The Myth of Mental Illness." It fit with the nihilistic spirit of the decade. Mental illness came to be seen as a romantic form of social protest (as in, "One Flew Over the Cuckoo's Nest"). There followed a great deal of drivel about the mentally ill being the only sane people in America, and so on. The march to empty the insane asylums was underway.

Psychiatrist Dr. Willard Gaylin argues in his book "The Perversion of Autonomy" that left-wing reformers who thought they were protecting the "rights" of mental patients teamed up with right-wing libertarians to discharge even severe cases. The resulting problem of the homeless mentally ill has dogged us ever since, reducing the quality of life for ordinary people and, in Gaylin's words, "freeing the mentally ill to defecate, urinate, sleep, starve, freeze, murder and be murdered in the streets of our larger cities. All in the name of autonomy."

Where is common sense? Freedom is for those with the capacity to take advantage of it. It makes as much sense to grant freedom to the severely mentally ill as it does to a 5-year-old child.

Besides, involuntary commitment, properly administered, is the only humane thing to do for a sick person. Gaylin offers the example of Timothy Waldrop, a deinstitutionalized schizophrenic who gouged out both of his eyes, leaving him totally blind, after he was imprisoned for armed robbery.

Were there abuses under the old rules? Didn't families sometimes "put away" those who were merely annoying rather than truly insane? Perhaps. But that is relatively easy to prevent. Require two doctors and a judge to consider the evidence of insanity. Permit involuntary hospitalization for 30 days at a time. At the end of 30 days, the patient should be discharged unless the doctors, staff and family provide solid evidence of continuing inability to function in society. Failure to take prescribed medicine should be grounds for reinstitutionalization.

But don't indulge in the fantasy that the mentally ill are competent to refuse treatment. The result is very often tragedy.