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.
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.
Mr. Beran makes so many mistakes that it is difficult to know where to start. Modern Mental Health care is driven by what the customer will pay for. I, myself, think "Morale" therapy has a place. Certainly it would be nice if American society was more supportive and less competitive. That has nothing to do with what faces psychiatrists. We have to clean up messes, often against the patient's will, in order to protect others. And we do so amidst the kicks and abuse of Berans.
I am not familiar with the studies Mr. Beran notes of "superior" treatment in third world countries; I'm just a psychiatrist with extensive inpatient and outpatient experience with indigeneous peoples in New Zealand and the USA. Drug Abuse, particularly marijuana abuse, contributes greatly to psychosis, and the major problem that we psychiatrists have is in initiating and maintaining involuntary treatment on dangerous individuals, mostly due to attitudes like Mr. Beran's---this despite research showing that involuntary treatment in these circumstances is not only beneficial to the patient, but cost effective. Riese Versus St. Mary's and Thomas Szasz are the two main drivers of the system's inability to deal with people like the Tucson shooter. To the extent that Mr. Beran supports this approach, he supports the atmosphere that makes these catastrophes not only possible, but inevitable.
Quite frankly, it would be nice if he spent some time actually observing a psychiatry unit as opposed to spinning his ivory tower idiocies.
I also do not know where to start with this article.
The citation of Wikipedia (rather than evidence based medical studies) for better prognosis of Schizophrenia outside the US is laughable.
The excerpts from DSMIV criteria of personality disorders are mentioned without stating that these are part of a criteria that includes a general pattern of behavior that is pervasive and stable through time and lead to impairment and dysfunciton (and actual evidence based studies suggest that 1% of the population has Narcissitic Personality Disorder, making it quite possible that many politicians are in that group).
Finally, studies also show that "psychotic violence" as he calls it is no more prevalent than "non-psychotic violence." In other words, a person with Psychosis is no more likely to attack someone than a person in the general population. In reality, they are more likely to hurt themselves.
However, when they do hurt someone else, I strongly believe they should be handled by the law the same way as anyone else would be. What most do not understand is that there are big differences between the medical definition of "mental illness," the legal definition of "insanity," and the lay definition of "psycho." They do not always overlap.
Next time you want to write about Psychiatric disorders, ask Krauthammer to help.
I'll defer to Hoyle (ex-Astronomer Royal) in his brief and concise definition of science: prediction.
Psychiatry has so far proven itself utterly incapable of reliably identifying a person as sane (violent psychotic is released and immediately kills someone) or insane (harmless people are kidnapped and imprisoned for unconventional behavior).
As "science", this learned discipline falls somewhere between phrenology and Mesmerism.
Isaiah, if he ever existed, may well have been psychotic. Discussing literary portrayals of madness mainly serves to show how ignorant even great writers can be about mental illness. In any case, such opinions are no basis for public policy. Once again, psychopaths are not psychotic. It's debatable as to whether they are mentally ill at all. Schizophrenics as a group are not particularly violent but one sub-group - young paranoid schizophrenic men who have refused treatment - certainly is. Such people merit surveillance and compulsory hospitalization if necessary. This disease probably represents an early brain injury. IMHO it has nothing to do with how social or communicative we are as a society.
