Keep the Crazies Out

In Wrocław, Poland, there is a residential building in the city center with a small plaque affixed to its exterior wall. The plaque commemorates the building's former use as a psychiatric facility, noting that its patients were eventually transferred to a dedicated psychiatric hospital on the outskirts of the city—a hospital that remains in operation today. The plaque is not an apology. It is a statement of civic memory: This is what we did, and we continue to do it. Poland understood then and understands now that people who cannot or will not coexist within the boundaries of civilized society must be separated from it—not out of cruelty, but out of a basic obligation to the community that follows the rules. The mentally deranged, the chronically violent, the pathologically destructive—these individuals are housed, treated, and kept apart from the women, children, and law-abiding citizens whose safety and peace of mind are not negotiable. This is not a controversial position in Poland. It is common sense.

It was common sense in America, too, until the nineteen-sixties. The United States once operated a system of state psychiatric hospitals that housed hundreds of thousands of patients who could not function safely in public life. In 1955, state mental institutions held five hundred and fifty-eight thousand patients. Then came the Community Mental Health Act of 1963, signed by President Kennedy, which promised to replace these institutions with a national network of fifteen hundred community mental health centers. The theory was optimistic: new antipsychotic medications would stabilize patients, and local clinics would manage their care. The reality was catastrophic. Only seven hundred of the planned centers were ever built, and the ones that opened focused on patients with mild conditions rather than the severely mentally ill. The hospitals closed. The patients were released. And the system that was supposed to catch them never materialized. What materialized instead was the modern American street—populated by deranged, aggressive, and dangerous individuals who scream at children, assault women, defecate on sidewalks, and terrorize neighborhoods with impunity.