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Shrink-Think after Tucson
The modern mental-health disciplines have done much good. But they have forgotten much of what used to keep the psychic peace.


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In the aftermath of Tucson, many have pointed to the need for more state intervention in the treatment of those suffering from grave mental illness. Although there may be merit in having government do more to police the mentally ill — to identify those who may pose a threat, to require them to submit to treatment, and in some cases to confine them — such an approach is not the whole answer to the problem of psychotic violence, and it has drawbacks of its own.

It is true that, had Jared Lee Loughner been compelled to undergo treatment for mental illness, the Tucson horror might have been averted. But it is easy to overrate the potential effectiveness of enforcement mechanisms that would rely largely on a mental-health industry plagued by its fair share of pseudo-science.

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Mental-health professionals have yet to develop reliable tests for mental illness; the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a study in over-inclusive definition. Consider the DSM-IV criteria for the “Schizotypal Personality Disorder.” These include “odd thinking and speech . . . vague, circumstantial, metaphorical, overelaborate, or stereotyped” (a criterion that might have caught Proust and Ruskin in its net) and “behavior or appearance that is odd, eccentric, or peculiar” (a standard that puts Lady Gaga outside the pale).

The DSM-IV criteria for “Narcissistic Personality Disorder” include a “pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy,” and a “grandiose sense of self-importance,” infirmities that characterize perhaps half the Senate. The first question in one schizophrenia screening test — “I see and hear things that others cannot see or hear.  Not at all   Just a little   Somewhat   All the time” — would have perplexed G. B. Shaw and the Kennedy brothers, with their predilection for the “vision thing.” Search for an adequate definition of paranoid schizophrenia that would definitely exclude, say, the prophet Isaiah, and you will search in vain.

Pseudo-science is a dangerous thing where the evaluation of mental heath is concerned because it can so easily be abused, as Richard Hofstadter demonstrated when he maintained that the “contemporary right wing” suffered from a paranoid disorder, and as Theodor Adorno and others showed when they argued that conservatives are afflicted by an “authoritarian personality” syndrome.

True, the danger that a mental-health police supervised by state or federal authorities will politicize insanity is at present remote. But slopes are slippery where bureaucrats are busy. Should there ever be a Federal Bureau for Sanity, with the power to administer mental patdowns, one can only hope that there will be safeguards.

It is true that, in spite of ambiguous definitions, there is considerable consensus about what constitutes serious or “certifiable” mental deterioration. Jared Lee Loughner would seem by any reasonable standard to be sick. But although some forms of psychotic violence might be prevented if people like Loughner were brought under the aegis of a reinvigorated enforcement regime, such a solution will do little to impede other forms of violent lunacy. Acts of psychopathic violence will continue to be committed by those who are able to conceal their lunacy, as Ted Bundy did.



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