[Marxism] Dick Osborne on schizophrenia and de-institutionalization

Louis Proyect lnp3 at panix.com
Tue Jul 5 07:38:25 MDT 2011

This was a comment on my Jared Loughner/Henry Cockburn post. Dick 
Osborne is a psychotherapist in the Albany area who was a comrade 
in the Boston SWP in the early 70s.

Interesting piece. It raises a number of important issues about 
the intersection of our mental health and criminal justice 
systems. The irrationality of medicating someone who is psychotic 
and deluded so that they become sane enough to successfully 
prosecute and punish strikes me as the ultimate game of legal 
“gotcha!” In any case, the determination of legal “competence” is 
an extremely low bar to clear and, contrary to public perceptions, 
is not at all the same as establishing sanity or the absence of 
paranoid delusions. Unfortunately, the hostility to the insanity 
defense is now a deeply entrenched attitude.

It is part of a larger shift over the past 30 years towards an 
ever more punitive approach to crime pushed by cynical politicians 
who have come to understand that there is much to gain and very 
little political downside to playing the tough on crime, 
lock-the-bastards-up-and-throw-away-the-key card. Cable TV aids 
and abets this with its ubiquitous crime porn – reality cop shows 
with harsh take downs of various bogey men and low lifes; true 
crime shows with their endless documentaries of serial killers; 
reality prison shows in which viewers can guess the next victim of 
prison rape. And flowing underneath this, aimed at the dim 
irrational regions of the limbic system, a steadily flowing 
undercurrent of racism as viewers witness what they often perceive 
as the revolving door between the inner city (where they’re all 
welfare cheats, of course) and America’s now vast gulag of 

The idea that someone can actually lose their minds and kill 
someone is deeply disturbing to many. They prefer to embrace the 
common attitude that the insanity defense is a scam used by sleazy 
liberal lawyers trying to do an end run around the notion of 
personal responsibility as the bedrock of our justice system.
Cockburn’s writing on deinstitutionalization and the failed 
promise of “community mental health” is interesting. Apparently, 
the UK and and US ran on parallel tracks in this regard. Having 
worked in state mental hospital at the beginning of my career I 
can attest to their Spartan and even grim conditions. But sleeping 
on heating grates and being victimized by street criminals has 
never struck me as preferable — nor as “freedom”.

The story of why the move towards deinstitutionalization came to 
be so persuasive and unstoppable is interesting in itself and has 
not, to my knowledge, been adequately explicated. Money 
undoubtedly played its role. But deeper ideological forces were 
also at work. The state mental hospitals came to be perceived as 
analogous somehow to the concentration camps of the Soviet gulag. 
The history of Left Psychiatry – especially RD Laing and Thomas 
Szasz (and later Foucault) – played an auxiliary role in promoting 
deinstitutionalization with its suggestion that Psychiatric 
illness was “socially constructed” as a form of social control. 
Anyone who has actually worked in a Psychiatric hospital and had 
to deal with someone in the grip of a psychotic episode knows how 
silly some of these ideas actually were. It provides an 
instructive case study in the limits of constructivism.

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