Mental Illness And Crime: What The Legacy Of Dorothea Dix Hath Wrought
    By Hank Campbell | June 16th 2014 10:23 AM | 31 comments | Print | E-mail | Track Comments
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    In the 1830s, jails were an all-purpose solution for a lot of issues. Inmates lived in squalor and people truly did not want to be there so there was a lot less crime. The downside was that nobody really cared about the people who did not belong there, like those with 'retardation' who had been abandoned, or people who were mentally ill but not criminals.

    Dorothea Dix was the activist whose efforts led to the first generation of American mental asylums. At the age of 39, she happened to visit a local jail to do a Sunday school sermon for female inmates. She found that criminals, retarded people and the mentally ill all lived together in terrible, unheated conditions. When she asked why, she was told  "the insane do not feel heat or cold"(Viney&Zorich, 1982). Not exactly evidence-based.

    She had no interest in defending criminals but she began a radical campaign to stop treating mental illness as a crime. She went to court to get conditions improved and won. Then she went to the legislature and convinced them that mentally ill people were not criminals and could be fixed with proper treatment. She succeeded, so then she went to more states and then she went to the US Congress to lobby for federal oversight. Then she went to Europe and did the same thing there. Her work resulted in taking mental health patients out of jails and putting them in hospitals, which was obviously a good thing. She did not believe mental illness could not be fixed.

    Today, the cultural scenario is much different. Experts in the 20th century began to say that asylums, a dramatic improvement over jails, were the problem. Horror stories about abuse led to a 90% reduction in mental health facilities, instead the trend became outpatient care and drugs. In 1955, there were almost 560,000 patients in mental hospitals and now there are about 35,000. What also happened after the decline in asylums? Mentally ill people are convicted of crimes and end up in jails, just like when Dorothea Dix first visited a local facility in 1841. 

    Asylums are mostly known about due to horror movie imagery and click-bait stories about "chilling" institutions. As a result, mentally ill people end up in jail, and somewhere in psychology heaven Dorothea Dix is doing a giant facepalm. Danvers State Insane Asylum, Massachusetts. Closed since 1992. Link:

    But the reasons now are different. Mental illness has become such an exculpatory part of the American cultural landscape that it is used to absolve all kinds of things - pleading mental illness is a common defense. Some even now contend that many criminals are not actually criminals but are instead mental health patients - that we have gone back to the time of Dorothea Dix, when mentally ill people were just thrown in jail. A recent report from Treatment Advocacy Center says there are 10 times more people with mental illness in state prisons and county jails (207,000 and 49,000, respectively) than there are in state mental hospitals (35,000). A jail is the largest single “mental institution” in 44 of 50 states while beds in mental hospitals have declined in the last 60 years. 

    That's a provocative claim, it was dutifully rehashed by people who want to feel like they care about the mentally ill, in the spirit of Dorothea Dix. Few stated the painfully obvious sociological aspects of this, they just took those numbers at face value and used it as cultural criticism. The real issue is a bigger problem because it doesn't impact just the 0.1% who may or may not be criminals that would not be criminals if they had proper mental health care. 

    Dorothea Dix. Link:

    What curves match the increase in prisoners with psychological diagnoses, real or not, in the last 50 years? The trend toward everyone having a psychological diagnosis. Psychology has become less scientific and more about creating new diagnoses than solving mental health problems - that has meant it's been easy to find a psychologist willing to testify that a criminal has a mental health disorder, which attorneys have been happy to exploit if it is remotely plausible. Even if they don't get their clients absolved, the diagnosis is still part of the public record and therefore shows up in claims about how most criminals instead belong in a mental health hospital. Medicine stopped using symptom-based diagnosis 50 years ago yet it is still common in psychology and psychiatry.

    Given the willingness to diagnose someone as mentally ill, how do we know the difference between criminals and people who aren't inclined to commit crime with treatment? That is the problem, we don't. There's no way to know how many of the people in jail with mental health issues actually have them - beyond the fact that engaging in rape, murder, assault and robbery is not something mentally healthy engage in - because almost everything can be a mental illness. The loose definition of autism spectrum disorder alone means an overwhelming majority of criminals have it. Parents of most children with autism can't imagine their children being violent criminals - they inherently lack the ability to be mean, in a lot of cases - yet a confirmed criminal is absolved of guilt if they are portrayed as mentally ill.

    Without clear definitions, and not a DSM 5 mishmash of constituency consensus lobbying by people who want more things covered by health insurance, we can't make any progress in helping those with mental illness. Real definitions would tell us things that could actually help, like if young men or minorities are in jail more because of underlying issues that can't be blamed on the president's economic policies or the NRA's gun policies or everything else invoked by partisan groups.

    Dr. Thomas Insel, M.D., head of the National Institute of Mental Health, believes that a return to asylums are not the answer, though he clearly has respect for Dorothea Dix and her efforts to create asylums, but the other institutional solutions, hospitals and jails, require people there to become a 'jack of all trades' and try to solve one of psychology's most vexing puzzles - criminal behavior. Advocates say criminals with a mental illness diagnosis should be released and have managed care, but how can we determine which people are safe for society? Since homelessness correlates strongly with mental illness, aren't people freed from jail likely to fall into that grouping where, without medication, things could get even worse?

    We have so many more mental patients in jails not because we have returned to the America of the 1830s, where the mentally ill are just thrown in jail so we don't have to think about them, but because mental illness has been turned into a scientifically subjective loophole and therefore part of a cultural agenda.  


    Dorothea Dix was a villain, she was no heroine. Her efforts contributed to the asylum (psychiatric prisons really) building boom of the 19th century that we are only just recovering from. This building boom lead to a glut of so-called mental illness, but as mental illness has no factual basis in medicine, well, you get the picture. It is a message that we'd best take to heart as we're in the middle of another man made epidemic of so called mental illness right now. When do you say enough, too much is too much. Apparently hind sight is much less than 20/20 or people would be taking active steps to ward off the coming disaster.

    I'm aware of the revisionist history but that is like blaming Darwin for the eugenics of Oliver Wendell Holmes and HG Wells and Keynes. 

    She was the first crusader for mental health treatment, she traveled all over the world to document their plight and get better conditions. You seem to think it was better 170 years ago to have mentally ill people treated as criminals. What have you done to help?
    Forced mental health treatment in the USA, the thing you got from asylums, goes back to the Pennsylvania Hospital in Philadelphia beginning in the mid 18th century. Before that time, forced psychiatric treatment, psychiatric imprisonment, was limited to non-existent. Dorothea Dix was instrumental in the asylum building boom that took place in the 19th century. Accompanying this proliferation in Lunatic Asylums was a corresponding rise in the numbers of people categorized as "mad", or "mentally ill" in today's parlance. People in these asylums were held prisoner involuntarily and against their will and wishes. Their human rights, and their citizenship rights, were neither acknowledged nor respected. They were, in effect, treated like subhumans. Only recently have we gotten around to closing the huge asylums that permitted this debacle to occur. Dorothea Dix part in the institutionalization that we have only just got around to ending should neither be ignored nor shrugged off. Dorothea Dix was certainly no Darwin. Since you bring up the subject, perhaps a more suitable comparison would with his cousin, Francis Galton, the man who gave us the word eugenics.

    We closed the asylums.

    But now we have no place to put Elliot Rodger, James Holmes or Adam Lanza.

    Ironically, there is a closed mental hospital right there in Newtown, Connecticut that might once have housed Lanza.

    Where do we put James Holmes, and was he "sane" at the time of the commission of the crime? Elliot Rodger and Adam Lanza are dead.

    The insanity defense is invoken in less than 1% of crimes, and it is seldom successful [Perlin, Michael. The Jurisprudence of the Insanity Defense (Carolina Academic Press, 1994), p. 108.]. So I think that your premise that prisons are the new asylums might be somewhat flawed.

    It isn't my premise, obviously, but if there are 2 million people in jail and 350,000 are diagnosed with a mental illness and only 35,000 people outside jails are in mental treatment facilities - compared to all of those people being in mental care facilities 60 years ago, then the numbers certainly look like we are back to 1840.
    There were fewer people all toll back in 1840. It is hardly an apt comparison. People don't go to jail because they are "sick". People go to jail because they break the law. If those that break the law have had psychiatric histories, that doesn't make them innocent of law breaking. I imagine there are criminals in the mental health system as well, but nobody is asking about punishing them. You have to catch them committing a crime first.

    Today we treat people labeled "mentally ill" like criminals anyway. A civil commitment is all it takes to take away a person's second amendment rights, and to put that person's name on a criminal background checklist. That's right, CRIMINAL background database. We call this kind of prejudicial mistreatment psychiatric profiling. Mental hospitals, as long as the wards are locked and the patients not free to come and go, are like prisons more than hospitals. I am a survivor of psychiatric treatment, and as such I am involved with a number of different organizations and groups fighting to change the current paradigm of practice that often harms people more than it helps them.

    There is little humor in most writing about mental illnesses. This article is no exception.

    What do we know about mental illnesses? That we as a culture have decided not to know about them. Hidden behind stark brick walls, we claimed not to see and not to know. All the hundred thousands of comers and goers, employees also did not, when of course we all did.

    We closed the institutions, you called them "asylums." Places of safety they were not. Places of horror they were.

    Now some of these people are on the streets, visible and unseen. It does not take a brick wall. We are bothered. Not enough to care.

    When will our inertia end? When we stop pretending these are issues of the mind and are actual medical issues. That is slowly occurring, but far too slowly. We continue to educate people that these are issues of the mind, until we end that, more generations will relegate people with the most serious illnesses to the streets, to the voids in our own minds..

    Harold A. Maio

    When the mental hospitals were closed in Pittsburgh, Psychiatry literally dumped and forced out of these 'mad houses' or "coo coo's nest' several hundred residents-patients, loaded with psychotropic cocktails and sick care Labels (codes as well) into our Community Health Programs. Nothing has changed, they continue to dump everyone they see either into a community hospital or a CMH Center with no hope for recovery. No health services, follow up, or referral. Psychiatry should be thrown out of the Medical - Sick Care Industry. They continue to harm everyone they see and obviously they have never, ever cured anyone of a DISORDER....they don't even know what they are treating, so no one improves. When will our local communities and state governments stand up and expose these "enemies of humanity."

    It seems that Dorothea Dix was a.Sunday school teacher and therefore this is again a religious problem.She has come from a branch of the Christian church which has a teaching ministry but divorced from other branches of the church which have a spiritual ministry;she obviously thought that her ministry to the mind was the only one that mattered and a lot of problems of criminality could be solved this way.This is the problem with many scientists who refuse to think outside their own area.Until science accepts that "it's not what you do but the way that you do it or say it"{or the way we think}then they will never solve the problem of unreasonable criminal behaviour.The picture I see on t.v.sometimes of people who have committed horrendous crimes,is one of someone sane and in their right mind one could say just like the rest of us.It's almost like something has taken them over at the time and used them for evil and then left them to carry the can.Suicidal people are also taken over at a moment in time by a black way of looking at life and yet just before seem quite normal.Unless psychology sees that,psychologists could well be taken over by these evil spirits or ways of thinking and themselves be conduits for them rather like the spread of the common cold.I am convinced that these evil spirits or dark ways of thinking rely on secrecy and the best way for them to multiply is for people and science to deny they exist and the best way to eradicate them is to bring them into the light of day and get people to see that they exist..Sarcasm and cynicism are prime examples of saying,thinking or doing things apparently kindly yet really meaning malice,showing that the way is even more important than the what.

    You're blaming religion because she...went into prisons and saw the horrid conditions and lobbied for reform all over the world?

    I don't think you are succeeding in your agenda.
    As per usual Hank,you always get hold of the wrong end of the stick.I t is not her good will i am blaming but her narrow mindedness in thinking only her way could solve this problem and not opening her mind to alternatives i.e bigotry.I wish I could get you to open your mind to the possibility that there is a spiritual reality and science should examine it.The way we say ,think and do is just as important as the what.It would appear that you are set for the defence of mindlessness and unreason that often accompanies religion because some scientists seem to embrace it.You have sidestepped my contribution to solving the problem by openly bringing these evil spirits into the light of human understanding and not allowing them to work in secret,unrecognised.

    You are criticizing Dix for not knowing everything by 1850. Instead, she knew that putting the mentally ill in human rights violation conditions was unethical and did something about it.

    It seems you (a) also bounce around the Internet criticizing Henry Ford because he did not build a modern car in 1910 and (b) prefer that mentally ill people be kept in unheated and uncooled cells with hardened criminals.

    Your comment leaves no other choice - pseudo-philosophical mumbo-jumbo has, to-date, saved no one ever.

    The problem was not Dix or her motives, but unintended consequences. This is a universal problem, because there is no way to really see the result of changes. Proper policy involves periodic corrections and the realization that what was a good approach in the past may not mesh well with society's changes.

    It's easy in hindsight to see what happened in some institutions, but it's also true that many were still better off then being abandoned on the street or thrown into filthy jails to be abused by criminals. Similarly the reform movement of the past few decades which endeavored to restore some personal autonomy to former patients worked out well for some but very badly for others. Like Dix, the reform movement was not evil, but some of its byproducts did not work as planned.

    I am not criticizing Dix,but explaining where she went wrong,and you also think she went wrong in your blog.On the contrary Hank you are therefore saying that we shouldn't drive modern ford cars and you are bouncing around the internet advocating that there was nothing wrong with the 1910 fords so we should all think they were great.If this is what you are advocating Hank you are in danger of decending into pseudo-scientific mumbo-jumbo and i am not being sarcastic now but sincere,your last sentence is laced with malice and i don't know why.I am pro reason and love of truth but religion seeks to crush these things or hadn't you noticed,sunni muslim trying to crush shia muslim,jew trying to crush muslim,muslim trying to crush christian and jews,ad infinitum . if people want to take refuge in mental illness then no responsibility should mean no power.Whereas if they take responsibility they should have power of adulthood.I don't believe in prisons Hank,I did not bring my children up to believe that if they did wrong they would be locked away in their rooms for days on end..They were brought up as I was with punishment for wrong doing and praise for well doing.When treating mental illness though psychologists have to show their patients the way they are thinking,doing saying and speaking is evil not the what and being exposed it will disappear .The next time someone is sarcastic to you Hank confront the way they are saying in the same way as you would confront verbal abuse and see what happens to it,;it will vanish away.

    John Hasenkam
    We have so many more mental patients in jails not because we have returned to the America of the 1830s, where the mentally ill are just thrown in jail so we don't have to think about them, but because mental illness has been turned into a scientifically subjective loophole and therefore part of a cultural agenda.  

    That's a bit harsh Hank. We need to consider the possibility that the recent rises in mental illness are real not just the product of the psychiatric community push for more patients. If anything the problem is developed countries is a lack of mental health care so I'm doubtful the psychiatric community is out there trying to drum up business. 

    Mental illness determination will remain subjective for a very long time. The reason for that is we know so little about the relationship between physiology and behavior. At the research level there are promising developments but it will take a very long time to lead to clinical improvements. 

    We also need to be realistic about the current therapeutic limitations. It would be lovely if we could identify all those in prisons with mental illness and find an appropriate treatment but we can't. We do not like the idea of the mentally ill being removed from society but this must be balanced against the need to remove dangerous individuals from society. That they are mentally ill does not give them the right to live in society and be a threat. We need to accept that even in the best of all possible worlds there will be mentally ill people who need to be removed from society. 

    I am not convinced they are real, nor is the National Institute of Mental Health. The rise in the desire to hand someone a label and a pill is why the NIMH gave up on DSM 5 and said they won't use it any more. 

    Obviously I am happy that real diseases are better diagnosed but people are over-diagnosed because there is no legitimate understanding of the problem, that is the problem with symptom-based treatment. If medical doctors were wrong and ineffective as often as their psychiatric counterparts, the entire industry would be gone - but no one can prove psychology is wrong, including other psychologists, because a lot of it is made up.
    In general, you make some points worthy of consideration - especially the major point that we are not in a position to deal as effectively as we would like with brain dysfunctions & maladaptive behavior. However, you overstate the case for nonpsychiatric medicine - many symptom-based diagnoses and, at least partially efficacious, empirical therapeutics remain - and you understate the case for mental health treatments which, in many cases, benefit the patients.

    In the end, however, medicine MUST do something to try to assuage the anguish of brain dysfunction and society MUST do something about the relationship of the mentally disturbed to civil tranquility. Do you suggest the dissolution of psych as an attempt, however 'primitive' it might be? Do you suggest bad actors be allowed to run amok because they can't be helped?

    Is low IQ not a mental deficiency? And, it has a high correlation with violent crime. What to do?

    Is a lack of empathy an emotional illness? And, it has a high correlation with sociopathy. What to do?

    Ted Bundy clearly had one or more brain abnormalities - he was incapable of remorse and derived pleasure from murdering young women. He was also compulsive - he acknowledged that he could not resist his urge to murder. This is not uncommon among serial murderers and pedophiles. Many pedophiles request castration, drugs, or even to be executed on the grounds that they KNOW they cannot resist their compunctions. Are they being treated 'justly' by permanent incarceration or execution? Are they to be punished for their mental disorder while the depressed or schizophrenic are subjects of social concern and sympathy?

    What to do?

    Hank: You write " If medical doctors were wrong and ineffective as often as their psychiatric counterparts, the entire industry would be gone..."

    Well, physicians spent centuries being exactly that wrong and ineffective, and yet survived and ultimately prospered. I don't mean to nit pick; rather, the issue is how an ineffective field such as medicine in the 18th or most of the 19th century managed to flourish and achieve high status (and ultimately convert this status into an extraordinary industry), the driving question of Paul Starr's classic history of medicine in the U.S. Triumphalist histories of psychiatry trace a similar development from exorcising demons to molecular psychiatry, warehousing to treatment, etc. (Ed Shorter's work may be the most shamelessly optimistic in that regard). I'm a cardiologist, so I spend little time worrying about the new DSM, but my impression is that the serious psychoses and affective disorders are being understood and treated better now than in the past, and that the more problematic features of the new DSM have to do with more marginal conditions and the pathologizing of behavior that is merely bad or unwelcome, as in the personality disorders.

    One problem with symptom-based treatment is that the symptom becomes the disease -- in my field we fixate on a handful of measures that we assume are related to cardiac risk, often without good evidence or without a deeper understanding of the complex relationships involved. But historically the treatment of symptoms often, perhaps almost always, has preceded the deeper understanding of disease, and in the meantime I hope that the search for more effective treatments for the symptoms of serious mental illness continues alongside research into the causes, course, and outcomes.

    David Taylor, MD

    Hi David,

    It's not as young as you claim it is by comparison. We both know that prior to the creation of Harvard Medical School, medicine itself was not a legitimate field, it was a lot like psychology, unfortunately. So, yes, medicine technically had a 100 year head start but that is no reason to continue to do things wrong and believe that if we do things wrong enough, something correct will be done.

    Medicine stopped doing things wrong when they saw they were wrong - mental health is still primarily symptom-based when everyone, including psychiatrists who went to medical school, knows that is wrong.  A cardiologist will see a symptom and find the disease - you do not see shortness of breath and treat that. Psychologists and psychiatrists would spend a patient's life giving them breathing medication and talking about what they were thinking of before they got shortness of breath.
    I'm always grateful when people explain to me how I do my job, though it makes me wonder why I spent years in training! I guess Harry Collins is on to something in his new book... Nonetheless, I do think you underestimate the extent to which we still treat symptoms rather than an underlying disease, and especially with the increasing prevalence of chronic disease and an aging population, symptomatic relief is about all we can offer many patients. Keep in mind also that symptom hierarchies can be deep: that shortness of breath you mentioned can be a symptom of COPD, but COPD can be a symptom of emphysema, which is unlikely to get treated except symptomatically. A lot of primary care docs prescribe statins and an anti-hypertensive, but don't treat the underlying disease, which may in fact be rather elusive, an issue for us cardiologists who like to think that we have a more complex and deeper understanding of the disease, and more treatment options. Ask your GP or family physician what specific disease s/he is treating with that script for a statin that so many Americans get.

    Medical history suggests that the most common model of disease is that of acute, infectious disease, and there we have in fact seen a shift historically from regarding the symptoms as the disease to the realization that clusters of symptoms and signs are associated with underlying pathology. Antibiotics treat the bacterial infection rather than the symptoms. But for chronic disease it's not even clear in many cases what is the symptom and what is the 'disease'. Type 2 diabetes? A symptom of metabolic syndrome? A disease in itself? Both? If I can treat Type 2 diabetes with diet alone, is really a "disease"? (My old friend Howard Brody, a prominent family doc, won't prescribe insulin until his patient tries a diet first...)

    To your point: I draw an optimistic conclusion from all of this regarding psychiatry, and the psych literature that I see can be pretty deeply into the search for 'disease' rather than simple symptom treatments. Perhaps this is just a half-full/half-empty issue. In any event, it doesn't hurt to push any specialty to do its job better....

    Cordially, David Taylor, MD

    You have a decidedly simplistic understanding of disease and treatment. Without even getting into all the possible pathologies, you presume that disease diagnosis is a straightforward process. You completely neglect the fact that many tests are inconclusive or provide no evidence of a particular infectious agent. You completely neglect the fact that individuals may test positive for infections but be asymptomatic.

    When sickness occurs, you can't simply wait around to conduct tests in the hopes that you find one that is precise, especially when there may be none available. While tests are a useful tool, they may not answer all the questions present. In addition, many diseases are undetectable during their early stages, so one only has symptoms on which to base treatment and failure to treat may increase the risk of a mild case becoming serious. From this, tests may occur later, or based on the response to treatment, the diagnosis may be inferred if no other evidence is present.

    However, to present "symptom-based" treatment as some pseudo-scientific process, without a great deal more qualification than you provide, is clearly wrong.

    John Hasenkam
    I am not convinced they are real, nor is the National Institute of Mental Health.

    I'm not convinced either but Insel has written an article on childhood medication where he raises this possibility. He writes:

    The possibility that there is a real increase in the number of children suffering with severe emotional problems, just as there is a real increase in the number of children with diabetes and food allergies, is not even considered. Shouldn’t we be asking why so many children, at younger ages, are being seen for emotional and behavioral problems?

    Depression is certainly over diagnosed but by how much. Simply saying X is over diagnosed is too ambiguous. The latest studies on antidepressants are very disappointing because they indicate that the greater majority receive no benefit from the same. There are even well designed studies showing that N A cysteine and curcumin(antioxidants!) are just as effective. Physiologically one has to take very long and dangerous logical leaps to understand those results. Antidepressant medication has risen by GPs not psychiatrists. Nonetheless it is fair criticism that we were conned by both psychiatry and Big Pharma regarding these interventions, though it should be noted many psychiatrists did repudiate the "chemical imbalance" bullshit. 

    Many medical interventions are about treating the consequences rather than the pathology itself. CVD disease(the cholesterol hypothesis is dead, it was stillborn but many tried to give it life), autoimmune diseases, diabetes, cancers ... . So that complaint is silly because it would negate a huge swath of medical interventions. 

    but no one can prove psychology is wrong, including other psychologists, because a lot of it is made up.
    If you think schizophrenia etc is made up then go join the Mad in America crowd. The problem is not that mental illnesses are made up, the problem is one of diagnosis. While in the USA the docs may rely on the DSM that is certainly not true across the globe, there is also the ICD. There is also clinical experience and contrary to popular belief the DSM is not a bible. (Okay, maybe it is because the Bible is also full of contradictions.) Diagnoses can be made up, can be very difficult to determine, but that is completely different from denying the reality that mental illness exists. 

    My personal view is that there is something peculiar about psychiatry in the USA. Psychiatrists there are amongst the largest recipients of Big Pharma money and studies have demonstrated that receiving such money does influence prescribing habits. The big increases in the use of antipsychotics in children is very worrying because these drugs do carry some very real risks with a number of studies pointing to decreased neocortical volume correlating with dosage and duration. 

    Ongoing attempts to establish valid biomarkers are failing. I suspect the reason for that is that there is no clear single pathway linkage from physiology to behavior. That is, the same behavioral outcome can be achieved through a number of different physiological processes. We see the same with cancer and heart disease(eg. 50% of all heart attack victims have no obvious risk markers). 
    A good article. Having seen the horror up front and personal, I could add a few things.

    The fundamental problem is the complexity of the human brain, and the unknown nexus between it and the mind, free will etc. We are not far from witch doctors in our societal response to severe psychosis. D. Dix, with the tools available, distinguished criminals from nuts. For a centuries, we chained them both naked to the dungeon wall, the snake pit, and prayed over them. It was the best we could do. Then we strapped the nuts into wheel chairs for a century. Then we sedated them into zombies so we could cut the ropes. Reagan closed the nut houses so now they live under bridges. The key is to somehow keep getting pills into them. But the fundamental problem remains, psychiatry only sees symptoms, not sources. Some doubt if it a science.

    There is now hope, real hope, and it comes from science. The nascent developments in fMRI permit real time viewing of the brain's activities and is yielding startling discoveries. There is consistent clearly distinguishable behavior between controlled groups of nuts and normals. And there are advances in meds which can penetrate the blood -brain barrier, IMHO poorly termed, nanotechnology. We can now, for the first time in history, use rifle shot techniques, watch the moving complex bull's eye, and adjust aim. That is science.

    How this is factored into budgets and treatments is an unknown. My guess: lots of fMRI confessionals, and out patient treatment. Most mentally ill patients are harmless, a significant minority are a danger to themselves, and a tiny, over publicized population slaughter innocents thinking they are slicing lettuce.

    We still need prisons for bad guys. And prayer for those who suffer horribly.

    "The nascent developments in fMRI permit real time viewing of the brain's activities and is yielding startling discoveries."

    fMRI may provide some insights to inform people who specialize in brain pathologies (psychiatry, neurosurgery, for example), but some nueroscientists are making some outrageous unscientific claims. I recommend reading Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott O Lilienfeld.
    "This page intentionally left blank." --Gödel
    Why is everyone so upset? No one is suggesting we reopen Creedmore as it was in 1970. These people are in jail right now. Isn't a medical facility better? Also, I live in NYC and I reject the idea that sick people are better off on the streets. There are more and more these days. They are filthy and obviously sick. What are the options? And no, leave them on the street is not an option. No one should be living on the street.

    Perhaps we should first address the problem of lunacy in the legislature. The difference between a jail/prison and an insane asylum isn't much.

    Maybe I missed something here but I didn't see a clear statement of how hard a scientific problem mental illness is. It's not laziness or stupidity or profit or any such thing that has prevented (in most cases) cures for these diseases, it is that the problems are extremely difficult.

    A basic understanding of infectious diseases goes back to the 19th century, the microscope has allowed study of disease organisms from even before that ... where's the equivalent for schizophrenia? How many skilled doctors out of 100 would agree AND BE PROVEN CORRECT on whether a particular patient would ever become a mass murderer or suicidal?

    The public would be better served if more professionals could simply acknowledge the truth: mental health isn't really a science yet and policy needs to begin with that fact.