Nice piece on those with mental problems and the history of treatment decay. I was a med student in 1967 in CA when Reagan was Governor. He and the large CA mental health facility system, that was very well run but held lots of "inmates" came under attack by the head of the Norwegian Secretary of mental health as barbaric and unenlightened. Reagan, a master of the media, arranged a visit to the premier facility in the State in which I was at a training session the day before. The place had many patients with the character disorders you described, including so called "hysterics", women who had trouble dealing with men. As a group they were very well kept people and usually very attractive. All of these patients were brought before the(then) well controlled cameras to give the appearance of happy well good looking well fed and cared for inmates. The facility itself was painted the day before and the ground,even where it was not devoid of grass, was sprayed with green paint( I got it on my shoes). Reagan won that round and Norway shut up, but in the end many of the facilities were closed, and Reagan himself was an advocate of the process. High costs and the advent of psychotherapeutic drugs like Thorazine gave credence to emptying institutions. How patients might be forced to take their drugs was not a question to be raised, and is still ignored. There will always be shooters like the Tuscon guy but there would be fewer if more attention was paid to less voluntary organized help. Those who advocated freedom for the mentally ill would prefer less freedom for others to try and control the problems they helped create, and they have not given up on these ideas

I don't think you can imagine the amount of money that is spent on the "care" of the mentally ill in this country. In any given hospital in which I have been a physician, their are about 20 to 40 individuals that are always at the hospital and always at the ER. These people require a considerable amount of work and expend a large amount of the health care dollar and resources. Almost all of these people are nuts, to use the clinical terms. They don't take their medication (if they can afford it) and have extremely unstalbe illnesses that are life threatening. Yet nothing can be done over the long haul to care for them due to our inability to address their mental health issues, these are the real culprit in their repeated hospitalizations. If you wanted to reduce the expenditure of health resouces and reduce the cost of medical care, then re-institute mental health care in the fashion of the 50 and 60's.