The Real Social Justice Issue: Taking Care of the Violent Mentally Ill

A memorial wreath for the victims of the Sandy Hook Elementary School shooting tragedy is pictured in Newtown, Conn., Dec. 16. (CNS photo/Michelle McLoughlin, Reuters)

In the aftermath of the heartbreaking school shooting in Newtown, Connecticut on December 14, the editors at the National Catholic Reporter have joined with the leaders of the Soros-supported advocacy organization Catholics United to demand further restrictions on gun ownership. Ignoring the fact that Connecticut has some of the strictest gun control laws in the country, they have declared that a commitment to social justice demands that we “face up to intransigent special interests and engage in a serious discussion of how to end—permanently—the cycle of gun violence in America.” 

Gun control advocates continue to believe that if we just outlaw guns, we will end these acts of senseless violence. Claiming that gun control will “prevent yet another American family from having to go through Christmas without the loved ones they lost to gun violence,” the progressive Catholics at the National Catholic Reporter have joined President Obama in what the president now promises will be “meaningful action” on gun control.

The debate on gun control may be a good one if it reminds us once again exactly who these shooters are. Rather than focusing exclusively on guns themselves, the debate will be fruitful if we begin to pay closer attention to those who are committing these violent acts. A true commitment to social justice demands that we begin to take notice of the real health and safety needs of the mentally ill living among us. While progressives claim the moral high ground in their calls for gun control, they tend to ignore the fact that progressive policies on mental illness may have contributed to this dark day in Newtown.

For more than 40 years, we have been defining down the risks posed by the violent mentally ill. Dismissing the potential for violence within the population of the mentally ill was a noble goal in the beginning—an enlightened society needed to move away from the values and norms surrounding mental illness in the 18th century, when aristocratic elites visited the “mad” in London’s Bedlam Hospital and called it “entertainment.” But the social cost of defining down the risks posed by the violent mentally ill has been high—as the parents of the children of Newtown know.

To understand how mental illness went from a being considered a form of great deviance to an alternative lifestyle, it is helpful to look back at the efforts of the 1960s advocates who began lobbying for the rights of the mentally ill. Inspired by sociologist Erving Goffman’s book Asylums, progressives began to claim in the 1960s that coercive treatment for mental illness actually exacerbated the bizarre behavior of those labeled mentally ill. This outlook was reinforced by Michel Foucault, who asserted in Madness and Civilization that modern conceptions of mental illness were “socially constructed” when bourgeois society prevailed and demanded greater conformity. 

From Foucault’s postmodern perspective, notions of madness and increased institutional warehousing were the result of the elite’s decreased tolerance for “difference.” Psychiatrist Thomas Szasz began writing about the “myth” of mental illness, and R.D. Laing drew upon existentialist philosophy to reject what he called the “absurdity of the normal.” By the time Ken Kesey’s book One Flew Over the Cuckoo’s Nest (later adapted into a film starring Jack Nicholson) was released in 1975, audiences were well prepared for the idea of the mental institution as the ultimate agent of social control, and for the parallel notion that insanity is really a sane response to an insane world.

It was in this climate that the Supreme Court declared in its 1975 O’Connor v. Donaldson decision that mentally ill individuals who pose no obvious danger to anyone cannot be confined against their will. And, for the past four decades, rather than focusing on the well-being of the mentally ill—and their neighbors, family, and friends—efforts have focused instead on reducing the stigma associated with their condition. 

The costs have been high—especially in big cities. Despite a declining crime rate in New York City, there continue to be attacks on innocent people by violent mentally ill persons. Just last month an innocent man was pushed onto the subway tracks to his death by a man described as “disturbed.” Reminiscent of a string of such violent attacks in the 1990s and beyond, this most recent incident reminded New Yorkers of the epidemic of subway-pushers just a decade or so ago. The subway attacks began in 1995 when Ruben Harris, a paranoid schizophrenic with 12 previous admissions to state hospitals, simply walked out of the Manhattan Psychiatric Center on Wards Island, then pushed a 63-year-old woman to her death from a Manhattan subway platform. Witnesses said Harris appeared to wait until the train approached the station before he shoved the unsuspecting woman onto the tracks. Afterward, Harris was described by New York Times reporter James Barron “laughing and babbling gibberish” while he walked away from the subway stop. The Times also reported that Harris had been convicted of slashing a subway panhandler in the face with a razor six years earlier. Nevertheless, a Manhattan jury found him “not guilty” by reason of “mental defect” in the death of the woman on the subway platform.

There were several more such attacks, and by 1999, when Edgar Rivera was pushed to the tracks by a mentally ill homeless man just as a train entered the Lexington Avenue station at 51st Street, any remaining sympathy for those capable of such behavior had evaporated. Julio Perez, the perpetrator, was living in a shelter for the homeless in Washington Heights and being treated for a 20-year history of schizophrenia at a program run by New York Presbyterian Hospital. Rivera, a 37-year-old father of three young children, survived the attack, but sued the hospital in civil court, contending that they failed to take adequate steps to protect others from an obviously unstable mental patient.

This type of civil litigation, designed to hold responsible those who care for the violent mentally ill, is itself is a backdoor way of re-establishing such behavior as deviant and in need of negative sanctions. Patricia Webdale, whose daughter Kendra was killed when she was pushed in front of a train in January 1999, sued seven medical institutions for negligence in releasing Andrew Goldstein, the man who committed the crime. Webdale filed a $70 million lawsuit against psychiatric staff members of the various Manhattan and Long Island area hospitals that had repeatedly sent Goldstein home even though they knew he was dangerous and unlikely to take the medication that stabilized him. Goldstein had been hospitalized 13 times in 1997 and 1998, and had committed more than a dozen assaults, many on hospital staff, during the two-year span. 

The Goldstein case was an important one because it finally led the New York State legislature to allow courts to require the involuntary hospitalization of mentally ill individuals who are found to have stopped taking their prescribed medications. But the law pertains only to those who have been mandated by the court to take medication. It does not apply to people like Paul O’Dwyer, another violent mentally ill man who, in 2000, tried to push three women and a man onto the tracks of the West Fourth Street and Broadway Lafayette stations.

Beyond the subway pushers, New Yorkers have had to deal with random attacks by violent mentally ill individuals throughout the city. On November 16, 1999, a mentally ill man walked to the corner of 42nd Street and Madison Avenue and used a seven-pound paving stone to smash the skull of Nicole Barrett, a 27-year-old woman from Texas. A few months later, in another random attack—perhaps a copycat case—a second mentally ill homeless man smashed a five-pound chunk of concrete on the head of Tiffany Goldberg, a 25-year-old Sarah Lawrence College graduate. Surveillance camera footage showed the homeless man prowling throughout the area prior to the attack, carrying the rock in a plastic bag and apparently looking for a young female victim. 

Despite the prevalence of such violence by mentally ill individuals, advocates from the National Alliance for the Mentally Ill’s “Stigma Alert” and the National Institute of Mental Health’s “Stigma Watch” are more concerned about the perpetrators of such violence. Anti-stigma advocates pay careful attention to the way the mentally ill are presented in the media news reports. When Kendra Webdale’s attacker was identified, the National Alliance for the Mentally Ill rallied to his defense, saying that he too was a victim. Laurie Flynn, the group’s executive director, wrote in a media release that “we grieve for Andrew Goldstein whose promise was stolen by schizophrenia over a decade ago.”

The Newtown shooter has been described in the media as having suffered from a “personality disorder” as well as Asperger’s syndrome. He is described as having a “flat affect” and refusing to make eye contact with others. Although unconfirmed as yet, we can expect to learn much more about the young perpetrator’s history of mental instability. As one might expect, the Autism Self Advocacy Network quickly denounced suggestions made by the media regarding the perpetrator of the Newtown school shooting and autism, posting a statement on their website that reads in part:

Recent media reports have suggested that the perpetrator of this violence, Adam Lanza, may have been diagnosed with Asperger’s Syndrome, a diagnosis on the autism spectrum, or with another psychiatric disability. In either event, it is imperative that as we mourn the victims of this horrific tragedy that commentators and the media avoid drawing inappropriate and unfounded links between autism or other disabilities and violence.

These advocates are indeed correct in their claims that the overwhelming majority of people with diagnosed mental disorders—including personality disorders like the one Lanza has been described as having—are not dangerous. But there is a well-documented connection between severe mental illness, substance abuse, and violence.

For a series on “rampage killers,” in 2000 the New York Times examined 100 multiple-homicide incidents that occurred in the United States over the previous 50 years. Reporters gathered extensive information on all the cases and looked even more closely at a subset of more than 25 of them. The analysis included reviews of court cases, news coverage, and mental health records, as well as interviews with families and friends, psychologists and victims. In some cases, reporters questioned the killers themselves.

Based on this information, the Times investigation revealed a high association between violence and mental illness. Nearly half (47) of the 100 rampage killers had a history of mental health problems before they killed, 20 had been hospitalized for psychiatric problems, and 42 had been seen by mental health professionals. Psychiatric drugs had been prescribed to 24 of the killers at some point before their rampages, but most were not taking their prescribed medication when they committed their crimes. 

Even more revealing, the Times reporters found that the killers were so noticeably unstable that in their own social circles they had been awarded nicknames like “Crazy Pat” or “Crazy John.” Anyone who lives in a major metropolitan area is familiar with frequent reports on the evening news about assaults or murders growing out of “enraged” or “disturbed” behavior. One especially tragic story unfolded during the spring of 2001, when an out-of-control freshman at the University of California at Santa Barbara gunned his similarly out-of-control car down a street filled with partying Santa Barbara students. Four were killed in the ensuing crash. When he finally stopped, the driver of the careening car—who had been known on the Santa Barbara campus as “Crazy Dave” because of his increasingly bizarre behavior—began yelling, “I am the angel of death,” claiming that those he had hit “deserved to die.”

Santa Barbara students recalled that during the weeks before the collision, the clearly disturbed young man had begun telling anyone who would listen that he was a prophet who wanted to spread good through the world. He spoke of the devil and the supernatural, and said he was afraid he was going to die. Despite all of this, not a single student, administrator, dorm advisor, professor, or counselor on campus appears to have done anything to help the troubled student. 

As the story surrounding the Newtown shooter continues to unfold, gun control advocates will spar with the parade of psychological practitioners who will suggest that there are “uncontrollable biochemical causes” that lead teenagers and young men to shoot their parents or their classmates. As a result, we will be encouraged to see violence as the result of biochemical determinism. At the same time that partisans of this viewpoint reassure us that there is no link between violence and mental illness, they admit that we can never predict what these unstable individuals might do. These advocates avoid being caught in a contradiction by asserting that if only the troubled individuals had been properly treated and medicated, none of the mayhem would have occurred.

More than two decades ago, New Yorkers elected Rudolph Giuliani as mayor because he promised to address the conditions that citizens knew were making them unsafe. But it was not an easy election for him. The 1993 mayoral race in New York began with an attempt by then-Mayor David Dinkins to brand Giuliani as someone who would “criminalize” the weak and poor. National politicians and celebrities came to New York to help re-elect Dinkins, including President and Mrs. Clinton. However, in the midst of the contentious campaign, a mentally ill homeless man named Jeffrey Rose diverted attention away from the celebrity visitors when he grabbed a baby from its mother on a busy Manhattan street and began stabbing the child in the face with a pen. Eight years earlier, Rose had been arrested for pushing a man through a glass counter at an East Side deli.

It is hard to know what to do about the violent mentally ill living among us. O’Connor v. Donaldson has made it difficult for us to address such problems through coercive treatment measures. But anyone who thinks that gun control is the answer is not paying attention to the violent mentally ill who use ballpoint pens to stab babies, or push people onto New York’s subway tracks, or use paving stones to smash the skulls of random women on the street, or use their cars to mow their classmates down. Ignoring the possibility that it may have been progressive policies on mental illness that contributed to these incidents, gun control advocates may yet again give the country the easy answers to ending violence. Choosing gun control and refusing to seriously consider the psychological and sociological factors—including family disruption through divorce—that this troubled young man in Newtown faced would be a mistake.