"Psychiatric illness does not make a person violent." Okay, what about David Weston? "People with psychiatric illness, and no substance abuse, are no more likely to be violent than others in the community." And then someone gets a Montana-made bomb mailed to him. To observe the different appraisals of the violence-mental illness issue from institutional and forensic mental health compete for the high road is to witness an unending series of contradictions.

In one corner are those whose noble desire to promote the self-respect and hope of the chronic mentally ill translates into a tenacious crusade to rid the media of tabloid headlines. It's a 'spin necessitated not by the falsity of screaming banners, but 'by their grotesque aim at the viscera of a public trained to fear mental illness. Alas, with the sincerity of James Carville, and the effectiveness of the GOP, mental health advocates' disavowal of violence by the mentally ill comes across as tantamount to ignoring the festering pimple on its forehead.

In New York City, a white (yes; it does matter), telegenic (yes, that matters, too) girl next door was allegedly pushed in front of a subway train by someone with chronic mental illness. In a most peculiar gesture, advocacy groups issued statements mourning her death. Why? To put makeup on the pimple? Why should the mentally ill be distinguished as some politicized entity which is behooved to express a collective apology? Maybe that's appropriate for Yasser Arafat, but nobody is jeopardizing subsidies to our patients whenever the ill kill.

Occupying another area of the ideological landscape are advocates for alternatives to incarceration. Powered by their own noble idealism, and with theories borne out by occasional research and some pilot program successes, they argue that the chemical dependency of criminals should be better appreciated, as well as their heretofore untreated psychiatric illness and need for treatment. With varying degrees of zealotry-and all the blindness typical of true believers-their utopia consists of a world where a criminal offense is followed by treatment, recovery, and reintegration. But the credibility of this movement is handicapped by its true agenda-alternatives to punishment.

The most obvious acknowledgement of crime as a function of sickness is the successful insanity defense, the concession that the actor was not appreciative, was not aware, was not well, himself. And that's what separates psychiatric patients from others with chronic diseases. The day we see a multiple murderer advance a diabetes defense is the day the stigma will be associated with that malady as well. The day we open a forensic gynecology hospital for female offenders is the day when vilification will not be the exclusive domain of the mentally ill.

The insanity defense in practice (read: non high-profile cases) now often involves the orchestrated push of patients with some evidence of major illness into hospitals, whether or not they meet criteria for legal insanity. And off to the hospital they go, for "treatment," and to protect society. Is it always so simple or successful?

Of course not. Prosecution goals are overachieved to the point of abuse when the long-since recovered felon is kept psychiatrically incarcerated. And yet, when an evil insanity acquittee with major mental illness is released, no one should be surprised when he re-offends. The psychiatric hospital had no choice but to release him though he is a menace to society, worse, than many of the sex offenders who are now doggie tagged. The deafening silence you hear is from those same alternative to incarceration dreamers who ignore the violent recidivist who stumbles into the mental illness track of the justice system and stumbles back out, recovered from illness. They would do well to learn the lesson of medicine, that not everyone can-or should-be saved.

How sad it is that the current focus of so many mental health and justice advocates is away from our prisons. Every time I consult to a forensic facility for treating insanity acquittees. I am struck by how intact and how well adjusted many of the patients/prisoners are. They are healthier than many of the patients in our outpatient clinics, let alone our non-secure civil facilities. And yet there are thousands of quite sick inmates living in jails and prisons who receive the most cursory of mental health services and most deficient care. The sickest of forensic psychiatric patients, as. a group, reside in our penal facilities, not in our hospitals.

Many of those who have observed this phenomenon talk of the criminalization of the mentally ill. Does this imply their innocence? Why should a hostile, assaultive schizophrenic be entitled to any more mercy than a hostile minority with poor impulse control who does the same? To spend time in the corrections system is to appreciate the pathos of the great majority of inmates, not just the mentally ill. If they weren't so pathetic, they'd gladly find something else to do.

The goals of public safety and compassion toward offenders do not have to be at odds. But first, zealotry and its disingenuous myopia-needs corrective eye surgery. When all is said and done, there are those with mental problems who do get violent and menace others. Get over it. A lot of them belong in prison, not hospitals. Get over that. It's all just so squeaky clean to treat the violent-mentally ill in hospitals, clinics, and other compassionate venues that ignore the merits of punishment. But if we are to have any hope of preparing for the future, our prisons should be where we invest heavily in the psychiatric treatment and reintegration of all offenders. If we don't get our hands dirty, we don't fool the public-only ourselves.