The C Word In The Hallways

The saddest phrase I've read in a long time is this one: psychological autopsy. That's what the doctors call it when a kid kills himself and they go back over the plowed ground of his short life, and discover all the hidden markers that led to the rope, the blade, the gun.

There's a plague on all our houses, and since it doesn't announce itself with lumps or spots or protest marches, it has gone unremarked in the quiet suburbs and busy cities where it has been laying waste. The number of suicides and homicides committed by teenagers, most often young men, has exploded in the last three decades, until it has become commonplace to have black-bordered photographs in yearbooks and murder suspects with acne problems. And everyone searches for reasons, and scapegoats, and solutions, most often punitive. Yet one solution continues to elude us, and that is ending the ignorance about mental health, and moving it from the margins of care and into the mainstream where it belongs. As surely as any vaccine, this would save lives.

So many have already been lost. This month Kip Kinkel was sentenced to life in prison in Oregon for the murders of his parents and a shooting rampage at his high school that killed two students. A psychiatrist who specializes in the care of adolescents testified that Kinkel, now 17, had been hearing voices since he was 12. Sam Manzie is also 17. He is serving a 70-year sentence for luring an 11-year-old boy named Eddie Werner into his New Jersey home and strangling him with the cord of an alarm clock because his Sega Genesis was out of reach. Manzie had his first psychological evaluation in the first grade.

Excuses, excuses. That's what so many think of the underlying pathology in such unimaginable crimes. In the 1956 movie "The Bad Seed," little Patty McCormack played what was then called a homicidal maniac, and the film censors demanded a ludicrous mock curtain call in which the child actress was taken over the knee of her screen father and spanked. There are still some representatives of the "good spanking" school out there, although today the spanking may wind up being life in prison. And there's still plenty of that useless adult "what in the world does a 16-year-old have to be depressed about" mind-set to keep depressed 16-year-olds from getting help.

It's true that both the Kinkel and the Manzie boys had already been introduced to the mental-health system before their crimes. Concerned by her son's fascination with weapons, Faith Kinkel took him for nine sessions with a psychologist in the year before the shootings. Because of his rages and his continuing relationship with a pedophile, Sam's parents had tried to have him admitted to a residential facility just days before their son invited Eddie in.

But they were threading their way through a mental-health system that is marginalized by shame, ignorance, custom, the courts, even by business practice. Kip Kinkel's father made no secret of his disapproval of therapy. During its course he bought his son the Glock that Kip would later use on his killing spree, which speaks sad volumes about our peculiar standards of masculinity. Sam's father, on the other hand, spent days trying to figure out how much of the cost of a home for troubled kids his insurance would cover. In the meantime, a psychiatrist who examined his son for less time than it takes to eat a Happy Meal concluded that he was no danger to himself or others, and a judge lectured Sam from the bench: "you know the difference between what's right and wrong, don't you?"

The federal Center for Mental Health Services estimates that at least 6 million children in this country have some serious emotional disturbance, and for some of them, right and wrong takes second seat to the voices in their heads. Fifty years ago their parents might have surrendered them to life in an institution, or a doctor flying blind with an ice pick might have performed a lobotomy, leaving them to loll away their days. Now lots of them wind up in jail. Warm fuzzies aside, consider this from a utilitarian point of view: psychological intervention is cheaper than incarceration.

The most optimistic estimate is that two thirds of these emotionally disturbed children are not getting any treatment. Imagine how we would respond if two thirds of America's babies were not being immunized. Many health-insurance plans do not provide coverage for necessary treatment, or financially penalize those who need a psychiatrist instead of an oncologist. Teachers are not trained to recognize mental illness, and some dismiss it, "Bad Seed" fashion, as bad behavior. Parents are afraid, and ashamed, creating a home environment, and a national atmosphere, too, that tells teenagers their demons are a disgrace.

And then there are the teenagers themselves, slouching toward adulthood in a world that loves conformity. Add to the horror of creeping depression or delusions that of peer derision, the sound of the C word in the hallways: crazy, man, he's crazy, haven't you seen him, didn't you hear? Boys, especially, still suspect that talk therapy, or even heartfelt talk, is somehow sissified, weak. Sometimes even their own fathers think so, at least until they have to identify the body.

Another sad little phrase is "If only," and there are always plenty of them littering the valleys of tragedy. If only there had been long-term intervention and medication, Kip Kinkel might be out of jail, off the taxpayers' tab and perhaps leading a productive life. If only Sam Manzie had been treated aggressively earlier, new psychotropic drugs might have slowed or stilled his downward slide. And if only those things had happened, Faith Kinkel, William Kinkel, Mikael Nickolauson, Ben Walker and Eddie Werner might all be alive today. Mental-health care is health care, too, and mental illness is an illness, not a character flaw. Insurance providers should act like it. Hospitals and schools should act like it. Above all, we parents should act like it. Then maybe the kids will believe it.