The Violence Carousel and Mental Illness


On January 25, 2019 a 21-year-old guy started shooting people randomly in a quiet neighborhood restaurant near Penn State University. Four people died including the gunman. We have no idea why.


It’s just one more rotation of the violence carousel.


The violence carousel seems to have become an expected part of the American culture. It just goes around and around, season after season, tragedy after tragedy. According to Wikipedia, there were 323 mass shootings in 2018 alone that took hundreds of lives and injured hundreds more. The carousel moves from state to state, north to south and east to west.


We keep discussing semi-automatic weapons, bump stocks, and scores of dead elementary school children, dead teachers, scores of others. These deaths aren’t Soprano or Corleone Family-style hits, they’re almost all seemingly senseless killings. Sometimes these killings are linked to evil or anger or alcohol. Sometimes they’re linked to mental illness. 


Let’s look at a typical example.


If you remember back in 2013, we all discussed about a dozen people dead at a Navy yard near the nation’s capital. It’s very clear that the killer, a former naval reservist named Aaron Alexis, was severely mentally ill and had been trying to get mental health care. Instead of treatment, he obtained a shotgun, a lot of buckshot, and he used them to kill a group of innocent people who had done him no harm. Why would somebody commit such a senseless act of destruction? 


He was sick. Literally. 


This is a man who had been clearly psychotic i.e. he was not capable of caring for himself because he was out of touch with reality. Reportedly, he believed that ELF (extremely low frequency) radio waves were being used to control his thoughts and keep him from falling asleep. Mr. Alexis apparently experienced this and a variety of other common paranoid delusions. Based on the little we know, the man probably suffered from schizophrenia, which affects the frontal region of the brain, much as Parkinson’s disease impacts the part of the brain responsible for movement. Somehow, in his tortured mind, what Mr. Alexis did made sense to him because he was ill. 


He was sick. Why didn’t he get the treatment he needed? The answer is complex, but part of the explanation is that our society simply has not yet decided to treat mental illness the same way we treat physical illness. Care for psychological disorders is not as readily available as it is for other health problems. When John F. Kennedy was president, part of his New Frontiers program was the 1963 Community Mental Health Act that provided for the building of Mental Health - Mental Retardation (MHMR) centers in local communities all over the country. 


These facilities were designed to be community-based treatment centers and, originally, were extremely well-funded and staffed. Over the next decade, large state mental hospitals were gradually closed, under the assumption that treatment would instead be better provided in the patient’s home community. Over time, politicians gradually defunded the MHMR system and the state hospitals in favor of other spending priorities, leaving the community mental health system a hollow shell, a failing fragment of what it once was.


One of the places politicians elected to put the MHMR money was our prison system. It was decided that our society needed to get “tough on crime,” and that’s why we now have a larger percentage of our citizens behind bars than any other nation in the world. And approximately 7-15% of our prison population is suffering from a severe mental illness. We put a lot of money into prisons that could be going into mental health treatment. 


The Guardian recently reported that, “In America, jails and prisons have become the nation’s de facto mental healthcare providers…” Billions are spent on keeping the mentally ill in prison. A billion dollars is a lot of money, and the treatment available in prisons is, quite frankly, abysmal. Eventually, these psychologically impaired prisoners are released onto the street without support.


You want more? Most health insurance policies don't cover mental health treatment at the same level as other health problems. The policies tend to be far more restrictive and reimbursement levels are so low that many practitioners simply won’t accept insurance cases. Is this any way to run a system?


Can we do anything to stop the violence carousel from coming around again? Sure we can, and let’s stop pretending we can’t. 


For starters, we can pass meaningful gun control laws. We can stop making prisons into mental hospitals. We can reinvigorate our MHMR system. Tell your elected representatives what you’ve learned. 


Ask for more. We can do better.