In the week before the Newtown shootings, much attention was paid to the case of a man who pushed a subway rider onto the tracks in New York. The victim was killed by an oncoming train, and the whole horrific episode was captured on film by a New York Post photographer. Two days later, a 30-year-old homeless man named Naeem Davis was charged with second-degree murder in the case, having told police (according to news reports) that "voices in his head that he couldn't control" prompted him to push the victim onto the tracks and watch him die.

I was interested to note, at the time, that the only ethical question to emerge from this incident was widespread indignation that the Post photographer had taken pictures instead of rushing to the victim's aid. My own view was that photographers appear to be programmed to take pictures, no matter the circumstances; and that in any case the Post photographer could not have rescued the victim. But no one seemed disturbed by the fact that we have come to accept the presence of violent psychotics in our midst as part of the natural fabric of modern life.

For if you consider the perpetrators of recent incidents of mass murder—the Newtown tragedy, the attempted assassination of Rep. Gabrielle Giffords, the 2007 horror at Virginia Tech—the one common thread is their self-evident insanity. To be sure, not all people with mental illness are violent, and not all violent people are insane. But we seem to tolerate the presence of psychotics in our midst, and regard their occasional explosions as a cost of liberty.

I would not waste too much energy in seeking the "reason" for the Newtown shootings, or discerning their "meaning," or contemplating the killer's portrait as the "face of evil." I am not sure what evil looks like, or even if it has an obvious appearance. But it is difficult to look at the faces of Naeem Davis, Adam Lanza, Jared Loughner, Seung Hui Cho, and others, and not swiftly conclude that they are deeply, obviously, and dangerously psychotic.

And yet, in the midst of our national hand wringing, one pertinent fact is persistently unmentioned. Since the passage of the Community Mental Health Act (1963) during the Kennedy administration, which mandated the closing of state mental institutions in favor of "community health centers" and outpatient care, and the massive and progressive "deinstitutionalization" of the mentally ill during the 1960s and '70s, the residents of those old state hospitals have been transferred, almost totally, from the wards to the streets, and with predictable results.

Few "community health centers" were ever built, of course, and psychotics off their meds aren't good outpatients. But the sudden emergence of mass populations of "homeless" people in cities during the 1970s and '80s seems to have caught Americans off guard. It also afforded a political opportunity: The existence of homeless people—ordinary folks just a paycheck away from disaster—was conveniently blamed on the domestic policies of the Reagan (or any subsequent Republican) administration. No attention was paid, no attention was invited, to the mental health of those who lounge, sleep, urinate, defecate, scream, or beg for food on the nation's sidewalks, stab the occasional passerby, or push bystanders onto subway tracks.

Those old state mental hospitals were, inevitably, unpleasant places, and from The Snake Pit (1948) to Frederick Wiseman's Titicut Follies (1967) to Geraldo Rivera's Willowbrook: The Last Disgrace (1972), were relentlessly depicted in the popular culture in all their unpleasantness. But are contemporary circumstances an improvement? Under current law, in most states, it is extremely difficult to compel psychotic individuals, especially adults, to submit to treatment. More than a few of our mass killers had grown up in households where desperate parents, in vain, had sought to get them institutionalized.

Closer to home, the American Civil Liberties Union has been relentless in its advocacy for the rights of psychotics who terrorize library patrons, or against mayors who seek to prevent the homeless from freezing to death. Instead of a lumbering psychiatric bureaucracy, the insane are now in the care of police departments and courts, and warehoused not in asylums (with access to medication) but in prisons that allow the full expression of their psychosis.

There is no comprehensive cure for violence in human society, in America or elsewhere, and agitated calls for further restrictions on gun ownership have a Pavlovian quality. But mental illness is a real and persistent misfortune, which tortures individuals and can lead to public calamities. Instead of contending with abstractions such as evil, which it cannot do, our political culture might shift to undoing past mistakes, thereby doing some good.

Philip Terzian is literary editor ofThe Weekly Standard.

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