If they stayed on their meds (an enormous "if"), some of them could manage in group homes, but they often discarded their prescriptions because of uncomfortable side effects. For decades, society, driven by a variety of vested interests, began camouflaging the kind of mental disability exhibited by Cho Seung-hui, the shooter at Blacksburg. Parents were embarrassed to seek help. Civil liberties lawyers rigorously defended the rights of the nuts. Authorities were afraid of getting sued. Friends were protective. Hospitalization was expensive. We can't know whether psychiatry could have prevented Cho's murderous rage, but the tragedy should shake us up enough to think again about attitudes toward mental illness and how to treat it.
Parents who refused to commit their children before the massacre may be more willing to get help for them now. Commitment laws have to be examined closely and sometimes changed. Parents and policy makers as well as friends and family -- including sisters, cousins and aunts -- must realize that seriously mentally ill patients must be observed by professionals for a long time to see how they function on drugs and therapy. The complexities of mental illness do not often, or even usually, become apparent in outpatient treatment. Symptoms can mimic a wide range of human behavior that can pass for normal, or merely eccentric. Psychopaths are particularly clever in fooling us.
We still don't know a lot about the different causes and cures for mental illness. While Cho's "creative writing" is supposed to have offered clues to his potential for violence, many of our best writers have depicted, albeit far more stylishly, similarly violent themes. It's comforting to blame the violent messages on movies and music, but young men in other cultures who get different cultural messages -- Islamic messages, for example -- become suicide bombers, and many are as crazy as Cho. Culture can enable a mentally sick person to sublimate his craziness in forms that are either approved, rewarded or go unchallenged by society. It's unlikely to be the root cause of sickness.
Scientific research has uncovered parts of the brain that trigger psychopathology (including tumors) and is beginning to reveal how genetics, brain circuitry and biological predispositions play into mental disorders. But common sense is as important as science in confronting somebody who consistently seems a little "off." We don't have perfect knowledge or absolute cures, but we should at least act sensibly on what we do have. To paraphrase Hamlet: "Madness in ordinary ones, must not unwatched go."