A Plea for Mental Health Reform
“Vitriolic statements made night and day on radio and TV about [Rep. Gifford’s] support of health care…” are the sparks that inflamed Jared Loughner into committing mass murder. Pima County Sheriff Clarence Dupnik admits he has no evidence for a belief he is nevertheless proselytizing far and wide. Elsewhere on cable news today one finds rote calls for stricter gun control laws, as if sentient and malignant firearms were collectively to blame for our latest national tragedy. But what about the perpetrator himself: What do we know about Jared Loughner's behavior and his community's response?
Loughner gave every sign of suffering from a serious mental illness that evolved over a great many months. Unfortunately, as with Virginia Tech shooter Sheng-Hui Cho, clear behavioral warnings were ignored or ineffectually managed--casualties of political correctness and absurdly hermetic federal privacy regulations.
For example, the Washington Post presents a series of emails sent last summer by a Loughner classmate at Pima Community College
From June 14: "We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news, after he has come into class with an automatic weapon. Everyone interviewed would say, Yeah, he was in my math class and he was really weird. I sit by the door with my purse handy. If you see it on the news one night, know that I got out fast..."
Loughner’s behavior was so bizarre that college instructor Ben McGahee insisted on his removal from class. On Fox News this evening McGahee reported that Loughner spent most lectures red-faced and visibly shaking, and answered one math quiz with a disturbing reference to “mayhemfest.” Despite McGahee’s concerns, political correctness kept Loughner in his seat disrupting class for a full month. Eventually, Pima College administrators suspended Loughner and conditioned return to college on a psychiatric clearance demonstrating that he was not a threat to himself or others. Despite this extraordinary level of concern, nothing further was done to help Loughner or protect the public. As far as we know, Jared Loughner never received any psychiatric attention.
Loughner clearly is suffering from a profound and progressive psychosis. One manifestation of this sort of mental illness is a loss of self-awareness necessitating compulsory diagnosis and treatment. Drug therapy can be surprisingly effective, but somebody first has to step up to do the compelling, and our usually compassionate society has lost its way by failing to implement an appropriate mental health care system.
Consider: Many responsible people worried enough about Jared Loughner's potentially dangerous behavior to suspend him from college and urge a mental health evaluation. Yet no other action was taken--perhaps none could be taken-- and months later Loughner embarked on a lethal rampage that left my beloved aunt and many others dead and a congresswoman and others maimed.
Jared Loughner should have been compelled to undergo a mental health evaluation followed by appropriate treatment. Had this been required by law yesterday’s tragedy would have been avoided. Let's prevent the next mass shooting, not by demonizing political speech we disagree with or further regulating inanimate objects, but by helping those mentally ill people, like Jared Loughner, who cannot help themselves. We need mental health reform and we need it now.
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Jan '11
Re: A Plea for Mental Health Reform
In addition putting some blame on civil libertarians ensuring that psychotics don't have to take medicine against their will, we should also consider how communities as a whole have been breaking down. We don't know our neighbours, and have little idea about what goes on around us. When I was a child a few millennia ago, there was a concept of community discipline and involvement. If older neighbours saw us doing something, word made its way back home pretty quickly. These days, all sorts of behaviour goes unnoticed and unchecked - and while this is an imperfect answer to those who are mentally ill, it is another facet worth contemplating.
May '10
Re: A Plea for Mental Health Reform
Aaron Miller
In other words, what was lacking was room for human judgment. ...we're fools if we think finer-tuned laws and rules can protect us from hard trade-offs and the possibility of grievous error.
A cousin of mine is schizophrenic. .. His best protection, and others best protection from him, is a network of family who love him, watch him closely and intervene when need exists.
I had a post in the works but Aaron has said it all for me. A situation that seems confusing and solution-less in the abstract can be quite clear when dealing with specific individuals. For my family and almost universally for those others I am familiar with, "the right thing to do" was immediately obvious to all but legally beyond our reach.
There are situations "at the margin" where the right course is difficult to see, and there are situations where people of bad intent can exploit a mental health system, but our laws have allowed fear of the occasional error or fraud to prevent a lot of potential good.
Re: A Plea for Mental Health Reform
G.A. and Aaron, maybe I'm wrong here; perhaps the needed reform is an absence of federal law. It seems that we did better in earlier years when there was more judgment expected and less mandated paint-by-numbers. Certainly, greater community cohesion was one factor, but I can't help but wonder at the tendency of our well-meaning privacy laws (e.g., HIPAA) to accentuate the modern tendency toward isolation. There is no way I want to create a therapeutic state intent on chucking people wholesale into the mental health system. However, there must be some way to reverse the active helplessness at play when time after time officials presented with future shooters undergoing cognitive disintegration wring their hands to no effect.
May '10
Re: A Plea for Mental Health Reform
Aaron Miller
In other words, what was lacking was room for human judgment.
I agree wholeheartedly Aaron. The best care for the afflicted person and the best protection for the public would come if family members were free to make decisions case by case, unrestricted by one size fits all laws. But, because mental illness is so stigmatized and the family is so broken in our culture, people are falling through the cracks all the time. Institutionalization is a much better choice than homelessness. For the person and the public.
I really appreciate Dr. Savage seeing this tragedy as extraordinary, especially in light of his loss. I am deeply troubled by those who think suicide or mass murder or the outcomes of schizophrenia. Modern medicine has brought much hope and healing to many families. The last thing we need to do is further demonize mental illness. It needs to be brought out into the light. Cancer was once unmentionable but is now a cause all can rally around to defeat.
Nov '10
Re: A Plea for Mental Health Reform
Good Berean: The type of reform you are referring to is not mental health reform it is legal reform. The mentally ill have their civil rights protected to such an extent that it is very difficult to force the mentally ill into therapy against their will, and nearly impossible to force them to continue therapy once it is instituted. . . . It is disheartening to see the mentally ill suffering while their loved ones and others who want to help them must stand by helplessly while they reject the help they need, and the legal system perpetuates this vicious cycle.
I am very grieved that you and your family have been victimized by this person and this system. You have my condolences. The system needs to be reformed. ·
I agree with Good Berean on every point, and would only add that an additional part of the problem is that we have essentially dismantled our residential mental health system over the last 30 years. The goals of the civil libertarians have coincided with the interests of cost-cutting, and the ones who suffer are the mentally ill, their families, and in the case of the few dangerous people, their victims.
Re: A Plea for Mental Health Reform
And if we can reverse the trend toward government acting in loco parentis for every American--I can provide my own health insurance, thank you very much--perhaps we can once again afford to fund a mental health system adequate to treating those Americans who are objectively unable to care for themselves. Adequate inpatient psychiatric care beats the heck out of living on a sidewalk grate.
Nov '10
Re: A Plea for Mental Health Reform
Aaron Miller
Perhaps some reforms would be good, but I doubt we could ever reach a point at which people were not calling for reform because of various problems. The most important element is demanding that families and neighbors take care of their own. Child or adult, a mentally sick person can be helped by family, even when he or she rejects much of the help offered.
You are very lucky if your mentally ill family member responds to the help of his/her family. Many do not. Many are actually dangerous to their family members. And if those family members try to intervene, the courts almost always come down on the side of the civil liberties of the dangerous person, rather than on the side of the terrorized/terrified relatives.
I was horrified in the wake of the Virginia Tech shooting to see people blame the shooter's family for not intervening more; these people could/may have done everything in their power and still been rebuffed by the system. In my opinion, this is the worst sort of blaming the victim.
Re: A Plea for Mental Health Reform
My own uncle suffers from schizophrenia. It is a terrible illness. Fortunately, modern therapies can help a lot, particularly in patients treated early in the course of the disease. It is the opposite of compassion to condemn these patients to their delusions by perversely invoking American civil libertarian traditions.
Nov '10
Re: A Plea for Mental Health Reform
Absolutely.
I do want to echo Katie O in suggesting that mass murder isn't an inevitable outcome of schizophrenia. There are many sweet schizophrenics, some of whom could do just fine in the community with proper support--but they don't get that support in our current nonsystem, and many do end up sleeping on grates. Even the healthiest of them may occasionally have a period of needing inpatient care--which has all but completely disappeared these days.
On the other hand, when you see a truly horrible mass shooting like this one, the murderer is usually someone with an illness somewhat related to schizophrenia. These people in their own way are also suffering, and a better system would be kinder to them as well as to everyone else.
May '10
Re: A Plea for Mental Health Reform
When I was in high school -- in a psychology class, ironically enough -- there was a mentally unstable guy who sat at the front of the class. He would sweat and fret, mutter to himself, and occasionally make an emotional outburst. It put students around him on edge, but a few made regular efforts to console him. At some point, he stopped coming to class -- he had shot himself in the bathroom of the grocery store where he worked.
Looking back, I'm not sure any of us, including the teacher or principal, would have done anything differently if the laws or other rules were different. We wanted to give the guy a chance.
Basically, I agree, George. There are some legal hurdles to helping these people and there are some cultural hurdles. Ultimately, though, balancing respect for the free will of broken individuals (even where free will is sporadic or weak) and respect for the well being of those who live around them is a moral quandary in which we will never find clear answers and respite.
Schizophrenics, like all people, want to live free. It's seldom clear to themselves or others where the condition ends and responsibility begins.
May '10
Re: A Plea for Mental Health Reform
George, I'm very sorry to hear of your loss.
Edited on January 10, 2011 at 9:24pmMay '10
Re: A Plea for Mental Health Reform
George, I'm very sorry to hear of your loss.
Aug '10
Re: A Plea for Mental Health Reform
Catch-22. If you tried to bring in these sorts of mental health/legal reforms, it would take all of five seconds before big-government administrators started to use the new provisions to target anybody with conservative views as "mentally ill".
May '10
Re: A Plea for Mental Health Reform
Richard VanderHoek: Taken to an extreme, the charge of having a mental illness could be used against those that one either does not like or with whom they disagree. Sure, I know, not likely, but who decides? ...
So I'm very leery of reform efforts. But then, I admit, I'm not sure what the right steps are. · Jan 10 at 7:29am
Edited for space.
When someone is truly psychotic, it is clear. I think having disinterested groups, maybe 3 doctors pulled at random from a pool might work.
Aug '10
Re: A Plea for Mental Health Reform
Correct me if I am wrong, but doesn't schizophrenia have observable effects on the brain, particularly a shutting down of the frontal lobe? Couldn't we then produce an objective test for the disease that would not rely purely on subjective "expert" opinion? When so many sufferers live on the streets in their own filth (too many to count here in San Francisco), anything would be an improvement. Another interesting fact which I recall but no longer have a reference to is that that if you add together the incarceration rate with the rate of the involuntarily committed today and compare it with the same for the 1950's, you get a very similar value. The difference is that now we jail many more. It seems that many mentally I'll people just end up in prison with no hope of proper treatment. Can a mental hospital be any worse?