The Cuckoo’s Nest, Revisited

What to do about gun violence given the problems of false positives and false negatives in designing mechanisms to get both guns and mentally ill people off of the streets?

This morning I read a nice piece on Bari Weiss’s Substack platform, a piece composed by Bari herself.  She titled it American Madness.

Some readers may recognize Bari as a refugee from The New York Times who, like Glenn Greenwald, has established quite a presence on Substack.  Both Bari and Glenn might recognize themselves as committed people of the Left, but Bari seems to have gone a long way toward discovering threats to individual rights in the run up to her self-exile, auto-defenestration, or actual defenestration from the Times.  Glenn Greenwald has been advocating vigorously for individual rights since we’ve all first heard of Glenn Greenwald.

In today’s piece, Bari was reacting to the business in a Texas border town of a young fellow shooting up an elementary school.  The toll was high even by the standards of America in 2022.  The killer seems to have felled at least 20 people, 19 of whom were young kids.  Any number of others have been wounded.

Alas, we can still be shocked, but I would yet be willing to venture that we all recognize that “school shootings” occupy an important place in the taxonomy of mass shooting events.  And there is a taxonomy, is there not?: “Drive-by shootings,” “Going Postal,” [fill in the blank:] ____________, …  Even so, we might distinguish the Texas shooting in that the killer imposed his toll not on his own school—he had been a high school student—but on people with whom he seems to have had no relationship.  The magnitude of the shooting and the target of the shooting makes the shooting superficially appear more like the business in Dunblane, Scotland in 1996.  In that matter, the “Dunblane Massacre,” the shooter felled sixteen students and one teacher at the Dunblane Primary School.

I liked Bari Weiss’s piece, because it went some way toward identifying difficult questions.  It did not pose canned answers to superficial, asked-and-answered, canned questions.  In this essay I endeavor to do a similar thing: Identify some questions and impose some structure on them.  I still puzzle over the answers.  Very broadly, those questions involve what to do about guns and what to do about mentally ill people—hardly novel areas of inquiry.  What I do want to do, however, is pose some generic but, I think, underappreciated ideas about the design of screening mechanisms and self-selection.  Screening pertains to questions of how to keep guns out of the hands of likely shooters as well as to the bigger question of what to do about mentally ill people “living on the streets.”  Self-selection illuminates something of the performance of programs designed to “get guns off the streets.”  The streets, metaphorically, are where all the action is.  I take these ideas up in turn.

False Positives False Negatives, and the Strategic Abuse of Screening Mechanisms

Let me start with a discussion of some my own experience living on my current street as well as my experience in my former neighborhood in Washington, DC.

I have a lot of experience living in edgy, transitioning neighborhoods.  The photograph above features a cache of firearms that my local police had confiscated from a big, black SUV that had been parked in a no-parking zone right below by own bedroom window.  This was last summer, August 2021.  I nabbed the photo from a local news report: 

Police say multiple firearms were found in an illegally parked vehicle in [my neighborhood].

On Aug. 21, police responded to a call around 1:26 a.m. about a large disorderly crowd in [my neighborhood] at [X and Y Streets].  After issuing citations and gaining control of the crowd, police towed illegally parked vehicles.

The disorderly business must have been going on just around the corner in the site formerly occupied by an art gallery.  The gallery left some months earlier.  The building management must have been desperately eager to get anyone—anyone—in that space to pay any amount of rent.  They ended up with a group that presented themselves as hair stylists.  More likely these people were just selling a lot of drugs, and those same people seemed to be enthusiastic users of their own inventory.  They put on a lot of parties.  The entire building would stink of marijuana.  Pungent stuff they would smoke.

I slept through the partying around the corner, but I did wake up to witness the extracurricular activities below my window.  The police had cordoned off a black SUV.  A sizable group of party goers were trying to antagonize the police.  They weren’t happy with whatever was going on.  A tow-truck eventually showed up and towed some number of vehicles away.  Everyone subsequently retreated.  The street became quiet.  The entire venture made for a successful police intervention, it seems.

A question in my mind is: What do people do with such an impressive cache of weapons?  Do they just haul them around in their vehicles for the fun of it?  They anticipate circumstances in which they would use them?  What would those circumstances be?

I don’t know, but here is a photo from 2020 from a site right across the street from the then-operating art gallery.  I see this kind of thing in my city: admonitions to not carry firearms into public or private spaces.  But, who needs to go around “packing heat?”

I myself have not perceived a need to acquire firearms.  The principal reason is that the local drug dealers or other such entrepreneurs with whom I’ve ever shared a neighborhood will have understood (correctly) that I am not a competitor.  The fit, bespectacled white guy goes running, goes cycling, drives an old, used car.  He’s no threat, and—this is the key point—it’s not worth threatening him and thereby attracting the attention of the authorities.  And, besides, he’s fit.  Taking him down could entail some risk.  More than that, he might be armed.

I can report to have taken down and apprehended a mugger in my former DC neighborhood.  (He was about to abscond down a dark alley with the purse he had just torn away from a young lady who had been walking home late one evening.  That’s a story for another day.)  The real point, however, is that the only threat I might perceive would be from the drug users—from some crazed knucklehead (as Michael Jordan might call them) who was out to score some cash or some items that could be traded for cash.  I have not often seen such people—not on my street—and no such person has ever accosted me.  That said, these people exist.  And they do accost people, and they inflict much harm.  So, for example, even on my own street in my former DC neighborhood, one such knucklehead did shoot and kill a neighbor who lived a few doors down from me on the opposite side of the street. 

This was July 2012.  I had been out of town.  A hurricane had swept through DC that week, and later that same week an earthquake nearly toppled the spires of the Washington Cathedral.  But the worst news was that someone had felled R. right on the steps of his own house.  The shooter had been looking for R’s sister.  R. came out of the house to run this fellow off.  R. took a bullet.

I did not know R. well, but we had been acquainted.  He was Mr. B.’s son.  Mr. B. had been introduced to me as “the Mayor of the Street.”  He was a very engaging fellow.  He would sponsor an annual block party, going so far as to roast a pig for each event.

A local blogger wrote up the shooting in a blog dedicated to documenting the otherwise-ignored killings of black people.  This all went down just as the Trayvon Martin business was going down in Florida.  Alas, the blogger had a point: certain shootings, strategically racialized in the media, get all the attention.  Other killings get ignored and buried in the equally ignored statistics.

The shooter pressed the matter to trial but was subsequently convicted.  The basis for pressing the matter to trial was, it seems, the report that the police had discovered a kitchen knife at the site.  Presumably, R. had armed himself with the knife when confronting the shooter.

Now, what to do about people like the shooter?  Coming around to harass the sister demonstrated bad judgment.  Carrying a gun to a prospective encounter with the sister demonstrated worse judgment.  Was he really planning on using the gun?  Was he going to shoot the sister?  And, how is it that someone so lacking in judgment—just plain stupid and emotionally unstable, it would seem—could end up with a firearm in the first place?  Is this the kind of person who might have constituted a good candidate for institutionalization? 

Hold that thought.

It may be hard not to imagine that people somewhere have been working on AI algorithms for identifying candidates for institutionalization.  Perhaps the central authorities in China have already operationalized such a thing.  Perhaps there are authorities in the ostensibly liberal West who endeavor to operationalize such things.  One thing we do know is that many societies have experience with committing people to institutions.  The term “Bedlam,” for example, derives from the Bethlehem Hospital in London.  The hospital had its origins in the Priory of St. Mary of Bethlehem in the 13th century.  Long story short: “Bedlam” ended up being relocated to a site in Lambeth, on the south side of the Thames—directly south of what is now Waterloo Station—a site now occupied by the Imperial War Museum.  I lived across the street from it one year, when Lambeth was still a bit of a ratty neighborhood.  Admittance to the museum was free from 5 to 6 in late afternoon. Well worth it.

The hospital came to specialize in the care of the mentally unstable.  Put it that way.  A question in my mind is how people ended up being committed to the hospital.  Were genuinely insane people capable of committing themselves to care?  Had it been up to family or friends to commit the committed?  Had the public authorities maintained a role in picking people up off the streets and getting them committed?

These are questions for further research.  But they are generic questions.  We have all seen people on the street who really need care—somewhere.  At home?  In an institution?

During most of my years in Washington, DC, my commute to my office would take me past the homeless shelter, the Community for Creative Non-violence, tucked between D and E Streets on 2nd Street, NW.  That block of 2nd Street had been renamed “Mitch Snyder Place” some time after Mitch Snyder had committed suicide in 1990.  Mitch Snyder had been “one of the early advocates for the rights of the homeless.”

Over the years I had encountered any number of characters coming out of the Center in the early morning.  (I think everyone was kicked out around 7 am and allowed to return only late in the day.)  There was a long stretch of time during which I’d often see this diminutive, harmless older woman, not old, wandering about the corner of 2nd and E Streets.  She was moderately palsied and carried a cane, suspending it over the ground, never anointing the ground with the tip of it.  She’d be yammering on, loudly, persistently, but not angrily, about whatever.  She always adorned herself in garish clothing.  But her style kind of worked.  There was a studied aesthetic at work there.  

I was amused one early evening to find her on the bus.  I would rarely take the bus, but heavy snow had covered the city like a cold, sodden blanket that late afternoon.  I found myself slipping along the pavement outside my office building.  I decided to take the bus. 

It was packed.  Steamy.  I found myself standing next to my little friend.  She was silent.  That was the amusing part.  I smiled to myself, and I protected her from the pulsing crush of people.  She exited the bus at 2nd and E Streets.  I doubt that anyone had charged her a fare.  But, where had she been coming from?

Was my little friend managing to take care of herself, … sort of?  Were city services sustaining her … kind of?  What kind of formal or informal support (if any) did she have?  And, if no support, would she make a good candidate for “institutionalization” (de facto incarceration)?  Who would decide whether or not to institutionalize a person like that?  What authority would have authority to do such a thing?  Should any public authority maintain such power over the individual?

At some point, my little friend disappeared.  I have no idea where.

Randall McMurphy, the protagonist of Ken Kesey’s One Flew Over the Cuckoo’s Nest (1962), manages to get himself excused from prison labor on a “work farm” and transferred to a mental hospital.  (In all that follows, I might confuse passages in the Milos Forman film [1975] with passages in the book.  I recommend both.)  One of the hospital officials inquires something to the effect of “Why do you think you are here, Mr. McMurphy.”  “Because I like to fight and f*** a lot.”

Not having to work and to just sit around and play cards seemed like a big improvement.  The only real cost, it appeared early on, would be to put up with the group therapy sessions.  And the drugs.  The staff tailored a drug regimen for each inmate.  McMurphy made a point of surreptitiously disposing of this daily allotment of pills.  Thus, so far, he could control enough of his environment to make it worth while to avoid going back to the work farm.

That changes.  McMurphy comes to understand that the staff, led by Nurse Ratched, make a point of bullying the inmates.  And the inmates will not stand up for themselves.  They sheepishly submit to the intentionally spirit-crushing program of therapy and sedation.  But McMurphy, being a spirited fellow, can’t help himself and finds himself encouraging the inmates to resist the bullying.  But this comes at a cost.  Nurse Ratched, he learns, maintains the authority to keep McMurphy incarcerated—indefinitely, were she to determine it.  Here his plan had been to serve out his time lazing about in the hospital, but he finds that Nurse Ratched could keep him locked up with no end in sight.  Moreover, she demonstrates great interest in breaking him.  Her arsenal of tools and treatments include shock therapy and, if need be, she could go nuclear and have him lobotomized.  Alas, the work farm did afford some advantages over incarceration in the mental health facility.

The worst part of McMurphy’s experience is that he learns that some nontrivial number of the other inmates had voluntarily committed themselves to the institution.  They remain there and put up with the abuse of Nurse Ratched and her staff.  They could just pack up and leave. 

It is about here that I’d be tempted to tailor for McMurphy some passages from Henry V.  “I was not angry … until this instant.”  Or Henry’s speech upon revealing his knowledge of the treason of Lords Cambridge and Scroop and Sir Grey, part of which goes:

Hear your sentence:

You have conspired against our royal person,

Joined with an enemy proclaimed, and from his coffers

Received the golden earnest of our death,

Wherein you would have sold your king to slaughter,

His princes and his peers to servitude,

His subjects to oppression and contempt,

And his whole kingdom into desolation…

… Get you therefore hence,

Poor miserable wretches, to your death, …

McMurphy’s problem, of course, is that he is on the wretched, receiving end, rather than the royal, dispensing end, of an oppressive program.  And the program implemented for all of the inmates at the mental health facility is oppressive.  It is also arbitrary.  At least it is in McMurphy’s case, because he has no means of appealing the judgment of the staff.  Nurse Ratched can dictate.

In The Electric Kool-aid Acid Test (1969), Tom Wolfe reports that Ken Kesey got much of his inspiration for Cuckoo’s Nest by working as a night attendant on the psychiatric ward of the Menlo Park Veterans Hospital.  (Menlo Park is just up the road from Stanford University where Kesey was then attending his program on creative writing.  The program was directed by Wallace Stegner and was also attended by Larry McMurtry, author of The Last Picture Show, and Lonesome Dove.)  By then Kesey had already been volunteering his time at $75-an-hour for drug experiments at the VA Hospital.  That was where he enjoyed his first experiences with LSD. 

The night shifts on the psych ward were generally uneventful—by design.  Tom Wolfe wrote of “The whole system, …” It was designed to “Keep them [the inmates] cowed and docile.  Play on the weakness that drove them nuts in the first place.  Stupefy the bastards with tranquilizers and, if they still get out of line, haul them up to the ‘shock shop’ and punish them.  Beautiful—”

Kesey “got absorbed in the life on the psychiatric ward,” and that experience inspired Cuckoo’s Nest.  McMurphy “comes onto the ward … cracking jokes and trying to get some action going among these deadasses in the loony bin.  They can’t resist the guy.  They suddenly want to do things.  The tyrant who runs the place, Big Nurse, hates him for weakening…  Control, and the System.”

Decades before Kesey found himself absorbed in the life on a psychiatric ward, Americans will already have had much exposure to Hollywood dramatizations involving either the consequences of institutionalization or, the real point here, the fact that some people could get other people “committed” to an institution.  Tennessee Williams’ A Streetcar Named Desire made it into film in 1951.  At the very end of the script, Blanche DuBois’ brother-in-law Stanley Kowalski (Marlon Brando) manages to get the authorities to forcibly take her away to an institution. 

With more research, I am sure I could find some number of film noirs or Hitchcock films that each feature a couple involved in a sultry, extra-marital affair who then endeavor to get the inconvenient spouse incarcerated in a mental health institution.  Such stories raise big questions: Who decides who gets institutionalized?  How is it that we get to suspend the rights of the individual and incarcerate the individual with or without his consent?  And then there are big questions about the incentives of the state itself: What happens, say, when the authorities abuse process by institutionalizing politically-inconvenient undesirables?  Is that not what the authorities in the Soviet Union sometimes did to political dissidents, make them disappear by drugging them up and shutting them away in mental health institutions?

I would suggest that the prospect of the state abusing “the System” in order to maintain “Control” of the same “System” is a generic concern.  The Soviets surely were neither the first nor the last to exploit legalistic processes and institutions in order to impose a top-down order.  Indeed, one could read One Flew Over the Cuckoo's Nest as an allegory about an overweening Administrative State.  The State just wants you drugged up and compliant as in say, Brave New World or George Lucas’ first film, THX-1138.  “You have asked, are we happy? … Consultations with leading experts in the field makes it perfectly clear … that we are all programmed for perfect happiness.”  Just take your meds and stay in line. You’ll be entertained with “soma” (the drugs in Brave New World) and pornography.

Note that, by the 1970’s, when people were making films like One Flew Over the Cuckoo’s Nest, THX-1138, or Logan’s Run, sentiment had already been building up to liberate the involuntarily incarcerated from the cuckoo's nest and to send them home with their meds. But then in the 1980's, it became politically-palatable to blame Ronald Reagan and Margaret Thatcher for “throwing” mentally unstable inmates “onto the streets.”  

Forty years later we can still puzzle over the question of re-institutionalizing such people. But, again, who gets to decide who gets committed, against that person's will, to an institution?  The questions get harder when events like that of Dunblane or Uvalde (Texas) inspire demands to lock up people who, from the perspective of some observers, conform to the profiles of prospective shooters.  Indeed, are we really stuck incarcerating people only after they've gunned down some number of people?  Can’t AI help us out here? But, even without AI, we can see who the crazies are.  We walk past them every day.  Perhaps all of them should be swept up and institutionalized.

This business of setting up the public authorities, people who have already been set up in a mature infrastructure of a security state apparatus, to incarcerate people who have yet to commit a crime makes for a business fraught with error.  Can we come up with a reliable screening mechanism?  That is, can we come up with a scheme that is reliable in that it (1) sweeps up people who really do need care within a highly regulated environment (an institution) but (2) does not generate false positives and (3) doesn't enable the authorities to abuse the system? All systems generate false positives (people who should be left alone but end up being institutionalized) and false negatives (people who should be taken off the streets but end up harming others). On top of all that, add the problem of keeping the authorities from abusing the system.

A year ago, I would have been more amenable to suggesting that this business of the authorities abusing The System might not prove to be a big concern going forward.  Yes, yes.  There are historical precedents.  The Soviets abused people.  The Chinese authorities are abusing people right now by the millions in western China.  But, here in the liberal West where the self-anointed best-and-brightest staff and manage “our democracy” …

Some observers might yet suggest that the ostensibly liberal West has been assembling a robust security state over at least the last 30 years.  If one were to read David Halberstam’s The Best and the Brightest (1969), one might argue that the West has been assembling its security state since 1947. Meanwhile, the COVID experience has demonstrated that the liberal west is more than capable of doing violence to the rights of the individual.  The countries of the British Commonwealth, so smugly proud of their ersatz democratic traditions, would most vividly make the case.  In Canada, for example, Justin Trudeau and his party of thugs have demonstrated ample eagerness and willingness to persecute people of modest means merely because they had the audacity to show up and protest in the capital.  The government moved to cut people off from their bank accounts.  Small donors to the protests have lost their jobs.  The government’s hysterical response to the Canadian “trucker protests” of January and February suggest neither strength nor confidence in actually democratic process but rather fear that genuinely liberal process could undermine their authority.

I would suggest that all screening mechanisms will yield false positives and false negatives.  Perhaps clever people can come up with processes that yield fewer of these things, but mistakes will yet proliferate.  I would further suggest, however, that the biggest issue in designing screening mechanisms would be the susceptibility of those same mechanisms to abuse.  This is hardly a novel question: Who guards the guardians?  Who polices the police?  Who governs the self-anointed best-and-brightest in government?  Quis custodiet ipsos custodes?

Self-selection makes a hash of gun buy-back programs

A few days ago, I read a piece about how a municipality somewhere had implemented a cash-for-guns buy-back program.  Municipalities in the United States, including Washington, DC, have done this kind of thing from time to time.  The idea is to “get guns off of the streets.”  All well and good, but two points.  The first is that the people who choose to trade in firearms for cash tend not to the be the kind of people offering the kinds of firearms that the authorities endeavor to get off of the streets.  These people tend to be those who ended up in the possession of firearms through no effort of their own.  An uncle had owned a gun.  Now they have it.  And they don’t know what to do with it.  Or they don’t perceive value to keeping a gun around the house.  They’re happy to trade it in for cash.  So, they get some cash.  The authorities then announce success in getting guns off the street.  Everyone declares victory.  But it is a hollow victory.  Hence, the second point: The people who anticipate using their firearms keep a hold of them.  It is only people who were unlikely to use firearms in the first place who end up self-selecting into a buy-back program.

If we could make the world conform to a Hollywood film script, buy-back programs would induce all people to happily trade in all of their firearms for cash, and we’d be able to identify the bad guys before they do bad stuff.  And, if the bad guys did manage to get away with doing bad stuff, we could at least set the Dirty Harry types off on taking them down.  Further, we’d lock up all of the insane people in institutions and get them drugged up and happy.  We’d also incarcerate all of the genuinely bad people.   But that makes for an insipid script.  Actual implementation should factor in the hazard that screening mechanisms will yield false positives and false negatives.  A system that is genuinely adapted to the problem of preserving individual rights will do something that the proponents of cheap-and-easy slogans will not do: recognize that such hazards exist.  An actually liberal system will then go farther: implement processes—processes that may be unavoidably messy—for mitigating the hazards.

As it is, sloganeering with respect to violence on the streets tends to come in two flavors.  One flavor concentrates attention—indeed, restricts attention—to firearms.  We have to get firearms off the streets.  Somehow, getting rid of firearms will resolve violence.  Not likely.  The other flavor concentrates attention on “mental health.”  “Guns don’t kill people; people kill people.”  There is something to that.  But to anyone who invokes “mental health”: All well and good, but you have an enormous amount of work to do.  Just claiming that we have “a mental health problem” is lazy and irresponsible.  One cannot dodge questions of the design of mechanisms—and, of the demonstrable and recently demonstrated capacity of the central authorities in the self-avowedly liberal West to abuse those same mechanisms.