Violent fantasies

National Review, July 20, 1998 by Sally Satel, D.J. Jaffe

And many states do not allow judges to consider past violence when deciding whether someone should be committed. Even a court order for hospitalization does not guarantee medication, since in some states judges may not mandate that a hospitalized psychotic patient take an antipsychotic drug merely because he is dangerous: he must also be judged incompetent to refuse the medication. While over half the states permit judges to order a patient to continue to take his medication once he is discharged from the hospital (if he has a known habit of stopping the medication and becoming dangerous), such laws are actually applied only infrequently.

Obviously, treatment is of profound importance. It can keep people with serious mental disorders out of jails and shelters. It can prevent suicide and help the afflicted rejoin society. And certainty that the mentally ill will be treated might make communities less resistant to supervised housing and other desperately needed community-based programs. Yet, political correctness--an unwillingness to offend or "stigmatize"--prompts efforts to conceal the risk of violence from people suffering from unmedicated psychosis.

After years of denying the association between untreated mental illness and aggression, the National Alliance for the Mentally Ill, the largest and most influential grass-roots organization of family members of mentally ill people, has come full circle. Carla Jacobs, a NAMI board member from California, became an activist for involuntary commitment after her mother-in-law was fatally stabbed and shot by a mentally ill relative.

"We used to think it was stigmatizing to acknowledge violence," she says. "Now we recognize that violence by the minority tars the majority, and makes communities less likely to welcome the community-based housing that can facilitate treatment and reduce violence." Besides, she adds, "too many of our relatives are hurting others, and winding up in jail. The first step to helping them is admitting there's a problem."

Unfortunately, the MacArthur study will make it harder even to take that first, basic step.

Dr. Satel is a practicing psychiatrist in Washington, D.C., and a lecturer at the Yale University School of Medicine. Mr. Jaffe is cofounder of the NAMI Treatment Advocacy Center in Arlington, Va.