A perennial argument of Second Amendment supporters is that those who attack in mass shootings will merely find another weapon if guns are taken away from law-abiding owners. This time, the argument was timely.

A young medical student was stabbed over 20 times in the Winchester Public Library. The man who killed her had been hospitalized many times for his mental illness, and was well known to his neighbors. Some of them kept a bat near their front door to ward him off. He was out on probation for trying to break into a neighbor’s home to attack them. He had been ordered to seek treatment while awaiting trial. He at least got a knife instead of a gun.

This is not to say all those who attack others do so because of mental illness. They deserve treatment, and their families deserve support. But it is a cold fact that too many people who would have been hospitalized in years past are committing acts of violence driven by their illness and lack of safe confinement to prevent them harming themselves or others.

A recent article in The Atlantic put it this way: “The number of patients living in U.S. psychiatric hospitals peaked in 1955 at 560,000. But in the decades following, mental health care went through what’s known as 'deinstitutionalization,' or the shuttering of mental hospitals. Far from being therapeutic, many of these hospitals were warehouses in which, say, schizophrenics would live alongside epileptics. Patients were often abused and rarely rehabilitated. When drugs that could control the delusions and psychoses of major mental illnesses came along, they were seen as a cheaper and more humane alternative to long-term, inpatient psychiatric care.”

We began the deinstitutionalization process here in 1966, and there was much to reform. Young people, mostly women, judged to be "wayward" could be committed to a state hospital by their parents for failure to obey them. A person "accused" of mental illness had few rights or say about what was done with them. I worked – very briefly – in a state hospital, assigned to what was called a "senile ward." Old women were strapped into rolling wheelchairs, lining the perimeter of a large room with frosted chicken wire windows and tile walls. My job was to take them paper cups of "medication" – usually Thorazine – and stand over them to make sure they swallowed it. But if they spoke, I must not answer, and I should avoid making eye contact as that just got them "riled up." They wanted to talk, or touch my hand, but I was to remain oblivious to them, ignoring them as humans. I could not do it, and I still remember them. So I understand what warehousing was like.

But we went too far in the other direction. By closing institutions, we failed to provide a viable alternative. The expectation was that there would be group homes and community placement, but the patients were discharged before the largely imaginary community-based facilities were created or in place. Not every diagnosis responds to medication, or mentoring, or a talking cure, but those were the only tools offered. Those whose illness makes them too dangerous for communal living were cast adrift, becoming wraiths that we look away from when they approach us, because eye contact will just get them "riled up."

Some do become violent from frustration at being unable to find a place and others from their pathology as it advances. But a patients’ rights movement also established the protocol that a person could not be kept for more than a brief period without their consent. Families might argue that they were ill and they could not make such a decision, but they had the right to refuse treatment and leave the hospital, and many did. The process of committing a person to care has become hedged around rights and safeguards, assuming that a person in a psychotic break can make wise care decisions.

A few decide to strike back. Federal law only prohibits firearm possession by individuals who have been “committed to a mental institution” or “adjudicated as a mental defective.” But with institutions becoming nonexistent, there are fewer legal checks when they decide to exert their right to have a gun, and we see the results in the quickening pace of shootings. We need to acknowledge that wholesale deinstitutionalization has been a 50-year experiment that has failed both the patients and society at large.

It would not be right to equate mental illness and violence like school shootings, but it also cannot be denied that someone who would do such a thing is mentally ill. It is something that we need to look in the eye, even if it does get people "riled up."
