It was at least a decade ever since the "incident", and as of now, Kyle was in the asylum due from the consequences.
What was this supposed "incident", dare to be asked?
Well. It actually started just a few months after the initial visit to Cirque Du Cheville; Kyle, sitting at the lunch table with his friends as usual, was having a chat about his recent findings and knowledge of clowns, courtesy of Cirque Du Cheville. Cartman, what else, says his usual dribble and such, and Kyle decides to jest back, getting quite a bit of laughter from their table.
The back and forth went alone for a while, and Eric grew agitated. As the other students laughed and sneered at the jesting, Eric decided to turn a 180, and deck Kyle square in the nose; Much to everyone's surprise. Chef did break it up before things got worse off thankfully, but that punch seemed to have awoken something in Kyle's psyche like no other..
On that very night when Eric was asleep, Kyle decided to sneak himself into his room, wearing a red clown nose to cover the bruise, an oversized yellow coat, and red makeup around his mouth. In his offhand, he brandished a knife.
He could've stabbed Eric right then and there, but the noise he made with a step seemed to have stirred some footsteps from Ms. Cartman, having her come down the hall to check on her son, Eric. In haste, Kyle hid, and, well.
Lets just say, that's where history started and broiled into something emotionally and psychologically bigger; Hence the incarceration to the asylum a decade later..