In his Tucson speech, President Barack Obama rightly said that “terrible things happen for reasons that defy human understanding.” Why that morning? Why Gabby Giffords? These and other questions can’t be answered, but at a more pedestrian level the Tucson massacre isn’t so mysterious: Someone displaying all the symptoms of untreated schizophrenia killed people.
This is not an extraordinarily rare or inexplicable occurrence. According to the psychiatrist E. Fuller Torrey, 4 million people in the United States have serious mental illnesses, and 1.8 million of them go untreated. Two hundred thousand are homeless, and 300,000 are in jail or prison. Tormented by depression or delusions, about 15 percent kill themselves, and they commit about 1,600 murders a year.
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President Obama was too sweeping when he said we shouldn’t point fingers. Our ire should be directed at the mental-health “advocates,” federal bureaucrats, and crusading civil libertarians who fight to maintain a status quo that makes it hard to treat the mentally ill. They are the madness lobby.
They aren’t responsible for Jared Loughner or his crimes. They do deserve the blame for a system that willfully lets people fall through the cracks and pretends diseased minds can make rational decisions. At its best, this system is cruel in abandoning the ill to their suffering; in exceptional cases, it is reckless in leaving dangerous people to do harm to themselves or others. The madness lobby helps make the literally lunatic act of violence a routine part of the American landscape.
A group of “anti-psychiatrist” thinkers provided the philosophical impetus for emptying our mental institutions. Thomas Szasz, Michel Foucault, and others ably demonstrated the power of idiot ravings to increase the sum total of human misery. Szasz compared psychiatry to slavery, while idealistic lawyers who wanted to vindicate the civil rights of patients launched an assault on commitment laws.
In a combination of foolish budget-cutting and misconceived compassion (some of the institutions were indeed horrors), states began to dump people out of mental hospitals in the 1960s. In his book The Insanity Offense, Dr. Torrey documents how, as the numbers of mentally ill in institutions declined throughout the 1970s and 1980s, the numbers on the streets or in jails increased. For many of the mentally ill, deinstitutionalization was essentially a shuffle — from hospital to prison.
In the 1970s, a Wisconsin court struck down the state’s civil-commitment law in a decision that reverberated nationally. In writing his 2008 book, Dr. Torrey visited Alberta Lessard, the schizophrenic woman whose case prompted the decision. Still untreated, she had spent time homeless and had never held a job, had been charged with ten crimes, and lived with constant delusions of people persecuting her.
In the wake of Lessard and similar decisions, it became the rule in most states to wait until someone is on the very cusp of suicide or murder to commit him. And it nearly became impossible to force the mentally ill to take their medication, in or out of the hospital.
Today, even with the human wreckage of its handiwork all around us, the madness lobby persists. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) funds efforts to liberate the seriously ill from their treatment. Writing in The Weekly Standard, Sally Satel recounted a case in Maine where a SAMHSA-funded outfit got a patient out of the hospital over the objections of his parents; he killed his mother with a hatchet two months later.
Mental illness is the only disease that has an influential lobby devoted to not treating it.
Arizona has a quite sensible legal regime. It allows the imposition of care on someone who is “persistently and acutely disabled” and “likely to benefit from treatment.” But apparently no one brought Jared Loughner to the attention of the mental-health system.
Perhaps we won’t seize on this particular senseless murder by someone who is deeply disturbed to reconsider our neglect of the mentally ill. But don’t worry: It will happen again.
We CAN trust the state to determine when certain people need treatment and to impose it on them.
These are not circumstances where an oppressive dictatorship incarcerates people for political reasons. These are people that just about all of us would agree need help; and in these limited circumstances we can actually trust state institutions, by and large, to make accurate determinations, as long as there are proper checks and balances to correct the inevitable but (we hope) only occasional errors.
I know I framed this in a way to sound sarcastic to many on the Right, but I am not being sarcastic.
What a great idea.
To whom should we complain when this method proves to "make mistakes" in either direction:
1. diagnose people as mentally ill who are simply irritating those in power (Martha Mitchell begins talking out of turn on what's happening in the Nixon White House)?
2. release highly dangerous patients, who kill people within hours of release (Adam Berwid goes home and kills his wife).
The answer: you can't.
Psychiatry admits no error, and no responsibility. Hospital records are confidential "to protect the patient" (meaning: it makes suing them for malpractice nearly impossible).
They do not "review the current policy" when someone merely "acting out" or "having a bad day" (no injury, no victim) is kidnapped and forcibly medicated, or admit contributory negligence when a clever patient detects exactly what lie the doctor has been waiting to hear ("Thank you so much, now I understand what I did wrong - can I go home now?") - especially when their insurance runs out.
Until mental health statutes improve to something better than a witch hunt immune to oversight or criticism, its power should be even more restricted.
Americans of all stripes are united on one thing about Tuscon--it was the act of an insane person. All that consensus, before a single professional examination. However, the evidence coming in now from the actor's own hand suggests strongly that the insanity defense will not fly legally. Why not?
Are all killers insane or just some? Were the 9-11 hijackers insane? Can 19 insane people do what they did?
Charles Krauthammer, a professional psychiatrist who presumably knows something about insanity diagnosed the Tuscon guy as paranoid-schizophrenic on national television--without examining any evidence or medical records. Regular Americans make similar diagnoses early and often. When so many so often wield the insanity charge, the term loses import and becomes just noise. There is hardly an American alive who hasn't been diagnosed as insane by a fellow American.
To paraphrase a great American philosopher, "we have diagnosed the enemy and he is us."
For years, my dad worked at a state mental hospital, and for a time, our family lived on the grounds. There I learned compassion for the mentally ill, and learned that they are people in need of compassion and care. Some of the patients had privileges, and were allowed to walk around the grounds or even go to town. Every once in a while, a patient would get loose and run around town. One attacked my mom in a restaurant once. But she wasn't hurt, and in ten years, I don't remember any serious crimes committed by an escapee.
When bleeding-heart do-gooders began to push for releasing many of these people, my dad predicted a rise in homelessness and crime. Family members aren't capable of providing care or control of the mentally ill.
Even though I am a small-government conservative, I believe that providing mental institutions is as much a part of government as prisons. At least in an institution, the mentally ill are cared for and treated, and the rest of us are protected.
1.) Mental Illness is not a "sexy" hot-button issue - it's not going to get anyone elected, most people prefer to avoid the topic in polite conversation, although it's the 800 lb. gorilla in the ballroom.
I've seen time and again that the issues which take precedence are always those that influence voters, and look good on one's resume. This one is a loser.
2.) Just as important, it's all about the Benjamins, brother. ;)
What politician wants to commit career suicide by proposing, - much less voting - on a bill requiring substantial funding to truly provide any real benefits to the numbers of the afflicted?
One side of the aisle believes it's a non-issue, the other, a huge waste of tax-payer funds in a bad economy.
So instead, we get a pontificating President who states what a shame the current situation is, and something really ought to be done about it - but of course he himself pauses and dodges taking the next logical step and proposing any actual plan to do so.
Politics as usual, and what community will suffer next because of it?
This tragedy shook me to the core. Six months ago my formerly outgoing, academically successful, athletic 23-year-old nephew was diagnosed with paranoid schizophrenia. He'd been acting strange for a few years but was in college and hiding it fairly well. He become more and more withdrawn, neglected his grooming and slept a lot. He finally had a meltdown and his parents took him for help.
It took a year to diagnose the schizophrenia (he finally admitted to hearing voices). Meanwhile despite ongoing therepy and meds, he got steadily worse...he came to my sister one day and said that he was having thoughts about killing them (his parents). He didn't know if he could ignore the voices. They managed to get him committed temporarily to the mental ward of the hospital. After a week, the hospital just let him go, saying they couldn't keep him any longer. This was three months ago, and his parents have been battling the county health system every since to get him into the system and any kind of programs. The system is a complete nightmare. Meanwhile my sister goes to bed every night hoping she wakes up. She finally called them yesterday and said enough is enough, he is spiraling downward again and she is afraid for her life and the life of her family. They are finally getting him into a day program startling next week.
The tragedy is also that this was a NORMAL, fun loving kid, with nary a dark thought before the onset of P.S. His disease is driving the bus. If indeed Loughner is a paranoid schizophrenic, this situation goes much deeper than just "The Right drove him to it!" I guarantee you he wasn't paying attention to Sarah Palin or Rush Limbaugh. He was listening to the voices in his head, which are not influenced by anything but the mental illness he has. There IS no reasoning when it comes to P.S. To use this as a political opportunity is reprehensible.
And PS - I never would have written this, or thought this, six months ago...pre-diagnosis.
I cannot believe that in the 63rd year of my life that mental illness is still a stigma. Why? There are physical illnesses that we are raising money for that patients bring on themselves. We don't talk about it because it would become a stigma. We are trying to cure babies of people who have taken drugs. This is never discussed. We are paying billions for the education and care of these mentally defective children.
My father, 10 years after WWII, suffered from schizophrenia. Fortunately he had the type that was curable but it took a very long time. He lived out the rest of his days working with men who made fun of him because he wasn't the same person as he was before. He died at 58.
Mental illness runs in families. I would suspect that the parents of this young man have issues themselves and may not have recognized anything unusual in his behavior.
Yes, this young man will have to pay for what he did but first, try to cure him. We should be praying for him and his family as well as the victims. He is a victim too.
It's already too easy to commit people for personal or political reasons. The reason crazy people get neglected is that no one cares. People who annoy cops, on the other hand, can be dealt with swiftly.
Rich, I appreciate your passion for this issue which I share because it was my life long experience with my mom. Hell was unleashed on our family, and now I see the fuller picture of why. How many families have been through the decades of hell as mine was?
If there are 1.8 million untreated mentally ill, then multiply that by 3 or 4 family members and you start to see how deeply the bite of the status quo is taking devouring so many lives.
No lobby to treat mental illness? Drug companies, NAMI, psychologists, social workers, behavioral health therapists all lobby to increase state mental health Medicaid spending an virtually every disorder chronicled in the DSM whether it is amenable to "treatment" or not.
I worked for years in a residential mental health program where I provided direct care to people about as crazy as Loughner appears to be. (Which is to say, quite crazy.)
But although many of them had in the past been MHA'd (detained by police in a Mental Health Arrest), and all had spent time in psych hospitals, almost all had been voluntary admissions; only a few had been involuntarily committed.
I'd like to see a discussion of what "diseases" other than mental "illness" should result in involuntary hospitalization and forced medication.
"That's rather a nasty case of shingles you've got there, Mr. Jones. I think you ought to go along with this police officer so we can make sure you get the treatment and medication you need to manage it." I don't think so.
"That's rather a nasty case of Schizo-Affective Disorder you've got there, Mr. Jones. I think you ought to go along with this police officer so we can make sure you get the treatment and medication you need to manage it." Well, sure, he might… you know, DO something.
A parallel discussion might involve other "diseases" that are defined exclusively in terms of their symptoms, not in terms of some malfunction of the body. These are "metaphorical diseases," like ADD and alcoholism; their names describe behaviors that are deemed to be socially or societally unacceptable.
People of all levels of mental stability sometimes just freak out, and the result is mayhem or even murder. Ask any cop how many murders he has seen in which the killer was drunk. Most will shrug and say, "Pretty near all of 'em."
Public intoxication is a petty crime, and DUI is a serious crime. But alcoholism isn't a crime. (And it bears less stigma than mental illness.) But beating or killing someone IS a crime, whether you are drunk or sober, or even crazy; if you kill someone, you will almost certainly be charged with a crime.
If you are crazy, whether or not you are convicted depends on many things, almost none of them "medical" in any other context.
If you want to lock up crazy people, either make mental illness a crime (beyond the current laws governing MHA's), or wait until a crime is committed. Otherwise, you are moving the world toward what Phil Dick described in "Minority Report": a world where people are arrested for crimes we fear they will commit.
The "madness lobby" is a sub-group of the criminal rights lobby, the group that's always moaning about prison overcrowding, and dreaming up useless community corrections schemes.
Their motive is simple. They maintain that "The criminal class [including the criminally insane] are the shock troops of the revolution."
The shock troops' mission is to frighten the bourgeoisie (i.e. you) into accepting, even demanding, a more restrictive police state... aka socialism.
Rich, thank you so much for writing this article. When I started hearing the comments of the fellow students, professors, and friends of Jared Loughner I thought of what I had learned by reading Dr. Torrey's book, and how difficult it is to get help to our mentally ill. I recommend that everyone read this book. It is very well written, and not very long. Perfect for the lay person to understand how we got to where we are. And to make it easy to find the book:
Judges and prosecutors, lawyers and psychiatrists, all protest their passionate desire to know why a person accused of a crime did what he did. But their actions completely belie their words: their efforts are now directed toward letting everyone speak in court but the defendant himself -- especially if he is accused of a political or psychiatric crime. -- Thomas Szasz, The Second Sin.
> Charles Krauthammer, a professional psychiatrist who presumably knows something about insanity diagnosed the Tuscon guy as paranoid-schizophrenic on national television--without examining any evidence or medical records.
Good point. The grossly overrated Krauthammer has in fact done this before, regarding Andrea Yates.
Part of the problem with perception and/or treatment of the criminally mentally ill, is that once their crimes rise to a high-enough level of visibility, they rapidly become enmeshed in identity politics (note: because he is a white male we will probably be spared this is for Jared Loughner.) When Andrea Yates slaughtered her children (yes, it was premeditated), the entire femisphere right and left, rose en mass to either A) blame the husband (recall Kathleen Parker's "bad-marriage day?"), or B) come up with a psychological disorder no one had ever heard of before: "post-partum psychosis" (why that hit her only when she had 5 children was never explained.)
In short, right or left, feminists sought to make political hay of it. And it is not just the feminists, though they have been the most successful at the game. How many times has a person belonging to pet group of the democrat party committed a murder and immediately been exonerated by the media as having "depression?" If you haven't observed this you need to get out more often.
In short, nobody cares about the mentally ill. They exist merely as a political football to be used by whatever group finds it useful to claim them. And then are promptly dropped when no longer needed.
BTW, I observed a spike in the number of cases of women murdering their children, particularly in Texas, following the Yates exoneration. I wrote Dr. Krauthammer regarding that but he didn't reply.
I earlier tried to post a comment but something went wrong and it was erased. I wanted to defend Charles Krauthammer who diagnosed Jared on national TV without having personally examined him. There was enough information available to make such a diagnosis based upon his writings on various internet sites, his pot and alcohol abuse, his escalating run ins with the law for "petty offenses", his increasingly threatening behavior and presence in college classes. His thought disorder was obvious to anyone who has worked with a schizophrenic population and their family. Jared's behavior made his diagnosis by a trained psychiatrist or psychologist obvious.
After working in the mental health system in Denver and Chicago for 30 years I can say that I never saw anyone who was not disturbed confined to treatment. WHile there may have been abuses in the 60's, I never saw them. The abuse I did see was dumping mentally ill people onto the CHicago streets beginning in the late 1960's. Two of my schizophrenic patients committed suicide and many more decompensated after being discharged to the tender mercies of the Chicago streets. That was the crime and abuse - not attempting to lock up people who didn't need it.
Jared Lee Loughner needed treatment. Had the police at Pima Co. College taken him to an ER where he could have been evaulated by a competent psychiatrist or psychologist, he would have been held for treatment for at least 72 hours and the entire disaster may have been prevented. No one took the responsibility to help him -- they just tried to dump him any place in the streets. A recent poll on Fox news was quoted as saying 40% of Americans believe the incident could not have been prevented -- this is sheer ignorance and not supported by facts. It was preventable.
Some blame the mental health system but in this case, it was never even utilized -- if it had and it failed that would have been another matter.
Actually, schizophrenia should be considered a brain disorder, because that is what it is - not a "mental illness." In most schizophrenics', even at their first psychotic episode there is evidence of brain atrophy in the frontal and temporal lobes. This man needed help - not derision. He was to be pitied and I believe the Jr. college officials should have required him to have an evaluation whether he was going to be expelled or not given the amount of information they had about him. There is no excuse for what happened - it was a failure of a number of institutions to take any responsibility for Loughner even though they were evidently afraid of him.
We are not going to get a perfect world, and we are never going to get a system where *no* mistakes are ever made. But we should do our best to do the right thing for both the mentally ill person and the community when the stakes are this high. The problem is that people who have completely lost track of reality can be good, kind, sweet people... and kill you in "self defense" one day because they think you are a demon attempting to steal their soul. Or they can be as creepy as this guy was over many years but never commit a crime.. until they do. The main thing is that if a person has lost all contact with reality, they can't take care of themselves, they can't make a rational decision, and they can turn dangerous at any moment even if they have never been a violent person ever before. There need to be clear proceedures to commit such people, with reasonable checks-and-balances. Does that mean no mistakes will ever be made, and the system will never be abused? Nope. All systems fail and are abused sometimes. That sure knowledge should not paralyze us and keep us from doing what we can to save as many of the severely mentally ill as we can from themselves, and to save others from them should the worst happen as it did in Tuscon.
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