Early drunk drivers were probably inebriated people who jumped on horses, camels or elephants. The reason for the excesses wasn’t because a new bar had appeared on the other side of town. Before bottled water, beer and wine were the only beverages that didn’t cause death and disease. Slaves, who likely consumed one and a half gallons of beer a day, built the Great Pyramid at Giza. While these guys likely walked home from work, it is easy to imagine that the upper-class of Egypt and Rome might have driven their chariots under the influence. Attila the Hun, who died in 445 of an alcohol overdose, was usually pictured on his horse, likely riding inebriated.

Moving ahead historically, there have been plenty of drunken horse-drawn carriage drivers, and when the bicycle was invented in the 1800s, more than a few intoxicated types undoubtedly fell off them. George Smith, a cab driver in London holds the distinction of being the first to be arrested when in 1897 he crashed into a building.

Until 1917 when states began issuing licenses, drivers in the United States swerved and crashed without benefit of regulation, Then the debate over personal responsibility behind the wheel began – for some a confusing mix or laws, personal freedom and public safety. Barron H. Lerner in his 2011 book One For The Road, Drunk Driving Since 1900 walks us through the fluidity of our country’s attitudes about those that cause mayhem.  

The author relates that on June 3, 1984, New York Times op-ed piece by a Philip B. Linker, an associate professor of English at Suffolk County Community College, describing how he had driven home the previous Saturday. Linker continued: “…the Saturday before that, and the one before that, in what probably amounts to a fairly consistent pattern over the last 25 years, ever since I have been licensed to drive.” The piece entitled “Drinking and Driving Can Mix,” concluded that it was possible to drive drunk successfully.

Ironically, the professor admired the efforts of MADD, Mothers Against Drunk Drivers and RID, Remove Intoxicated Drivers, and their publicized efforts to get stronger laws passed, be he was concerned about excessive regulation.

Those who responded negatively to the professor pointed out that 25,000 Americans had died in alcohol related crashes in 1983, ninety-seven in the professor’s own Suffolk county.

When the author was interviewed on NPR (November 17, 2011) Lerner talked about Margaret Mitchell, the author of Gone with the Wind, who was struck and killed by a drunk driver while crossing the street in Atlanta in 1949. The driver had 22 previous arrests, including speeding and drunk driving. Initially her fans were horrified, but over time the attitude changed and outrage was replaced with, 'Well, it was her time to go.' Victims of drunk drivers, the author says were thought to have been ‘at the wrong place at the wrong time.’

Alcohol attitudes and practices were revisited on January 17, 2012 on NPR with Dr. Robert Brewer, of the CDC’s Alcohol Program and Dr. Bankole Johnson, chair of the University of Virginia’s Department of Psychiatry and Neurobehavioral Sciences. Dr. Brewer reported that The Centers for Disease Control and Prevention has found that binge drinking, usually associated with young people, is an issue among adults as well, specifically adults over 65.

He reported that one in six adults 18 and older, about 38,000,000, report binging one or more times within a month. The researchers defined binging as four or more drinks for a woman and five or more for a man within a 2-3 hour period. But the actual amount consumed was well above that in quantity and frequency, typically 8 or more drinks, not one a month, but once a week! Neal Conan, the host, asked what else the researchers found surprising?

Brewer found it interesting that people who binged the most frequently were not necessarily those who consumed the highest quantity in a single episode. And when they looked at income, they found that the prevalence of binge drinking is elevated in people with higher household incomes and higher educational level, but the amount consumed per binge was actually higher among those with lower household incomes.

Why we drink or drink to excess is a complicated mix of cultural influences, advertising, genetics and the initially pleasant euphoria of our favorite legal mind-alterer. In the years when I was teaching drug resistance education in the Public Schools, I learned that in order to have credibility, it was essential to be honest. Most kids understand without being told, that drinking does not always cause throwing up and brain damage. They get that Grandma and Grandpa are having fun. But getting back to professor Linker –we no longer argue that one can be margarita-impaired and capable of maneuvering a one-ton vehicle. Hopping on a well-trained horse is not the only alternative. When Frank Sinatra last recorded One More For The Road it was as a duet with Kenny G. I’m guessing Mr. G was his Designated Driver.

When I heard of the tragedy in Newtown, Connecticut I couldn’t help but be struck by the irony. At one time Newtown was synonymous with a 4000 bed state mental hospital.

Today, Internet searches of Fairfield Hills lead to low-quality videos or slideshows with menacing music narrated by young ghost-hunters who trespass and chatter about paranormal activity, torture, the criminally insane, lunatics and the terrifying tunnels connecting the buildings where all manner of mayhem were thought to have taken place.

Without the audio, the images of stately colonial-style buildings and rolling grounds better resemble a university campus. As a nineteen year old, I don’t recall feeling any fear as I entered the locked ward where the other student nurses and I were assigned for our three-month psychiatric rotation.

It had been decades since anyone but the attendants and a lone psychiatrist had shared time with these men. Each day I was more struck with a sense of disbelief that our charges were destined to spend the rest of their lives in boredom – rolling cigarettes and playing checkers and cards, than I was with any sense of terror or fear for my own safety.

The building housed 500 men. Among the ones I knew was a former architect with a traumatic brain injury he’d sustained from falling off a scaffold. He rocked restlessly in a chair by the exit. “What’s it like on the outside?” he’s ask each day. “Someday, I’m going to escape from here.”

“Does he ever try,” I’d asked. “No,” the attendant told me. “We’ve left the door open, but he just sits there, saying the same thing over and over.”

Another, slight fellow with bilateral indentations in his head and a decidedly flat affect, was said to have been violent before his lobotomy.  He seldom spoke, not even to his mother, a white-haired woman who visited regularly.

Saint Anthony’s problem in society was that he liked to expose himself. Another man with schizophrenia had been a concert pianist. He played discordant music on an out-of-tune piano, two different pieces – one with the left hand and one with the right.

My favorite, Mr. M, was one of many alcoholics with Chronic Brain Syndrome, encephalopathy that is characterized, among other things, by memory problems.  Each morning as I walked toward the building, he would call to me from the second story barred windows, “Murphy, old girl.” Mr. M had a twinkle in his eye. He couldn’t quite remember how he came to be there. He recalled vaguely being picked up when he was wandering the streets. Mr. M, imparted the same wisdom to me each morning before we would sit down to a game of gin rummy. “It’s a great life, Murphy old girl, if you don’t weaken.”

He had, and so had other whom we students accompanied through the tunnels on their way to the dining hall or to an occasional movie. I didn’t find the place menacing, only sad and depressing. From a distance, which was most people’s vantage point, the setting was idyllic and during my three months, the autumn foliage magnificent.

None of my charges suffered outwardly. They ate regularly. They had clean clothing and a roof. They were protected from outside harm, and the world was protected from them. Still, my teenage mind couldn’t reconcile how normal some of them seemed. It was disconcerting to think that a drunken episode on a public street or a change in mood or luck could land you in this asylum for a lifetime. The psychiatrist came only to write prescriptions, not to reevaluate anyone. These men and many of the others who lived here lacked hope of ever returning to society. They were going to spend the rest of their lives confined, and from my perspective, their fate seemed so unfair.

But even as I was horrified by the idea of forced institutionalization, reforms were already underway to integrate the mentally ill into the general public with the aid of The Community Mental Health Act. It was thought that with the advent of new psychotropic medications many individuals with severe mental illness could flourish in a community setting, provided the right supports were in place.

The Joint Commission on Mental Illness’s Action for Mental Health called for the integration of the mentally ill into the general public with the aid of Community Mental Health Centers. In 1963, the Mental Retardation Facilities and Community Mental Health Centers implemented the centers, but because of the financial drain of the Vietnam War and the financial crisis of the 1970s, the proposed program was not fully funded. The result was the release of patients into an environment lacking the facilities to adequately treat them. As hospital beds for the acutely mentally ill disappeared, fewer people got the care they needed. Many ended up in more expensive settings such as jails and prisons. Others relied regularly on hospital emergency rooms. The human cost was and still is exorbitant.

A few years after I graduated, I had long since rethought my youthful idealism. I watched people like those I’d cared for during my time in Newtown sleeping on park benches or hallucinating on city streets. Each time I’d see policemen handcuffing  an inebriated wanderer, I’d think of Mr. M.  The promise of deinstitutionalization and outpatient care that I so strongly believed in had failed.

Fairfield Hills in Newtown, Connecticut closed in the mid-1990s. Mr. M, Saint Anthony, the architect and the pianist likely lived their lives out there. I feel reassured knowing that.

Just as we should not define the lives lost at Sandy Hook School in Newtown by how they were lost, we should not easily define the solution to future tragedies. The issues are complex. Solutions should encompass all aspects of the problem.

For me, one aspect to be considered is the price we as a society pay for inadequate mental health care. At one time our net was too easily filled. Those gathered were put away, perhaps too easily, too permanently.

I don’t want to go back to the days when we effortlessly locked away people, because their behavior was inconvenient, but perhaps we can broaden our definition of who needs acute care. Maybe we can make it easier for the safety net of mental care to open for the families those who are in need. Perhaps we as a society can fulfill the promise of the 1960s, catching those who have weakened keeping them and us safe

My favorite holiday story is The Christmas Carol. As one whose profession involves encouraging positive change, and one who knows that most people would rather not,