From a psychiatric standpoint, there is not yet enough information available to answer the key question surrounding Jared Lee Loughner: At what point, if any, in the last few years did the mental-health surveillance and treatment systems break down? Were there periods along the way where Loughner could have justifiably been coerced into treatment? We simply don’t know yet.
Typically, people who end up at the center of tragic stories such as these — the 2006 Virginia Tech shooter; Andrea Yates, who drowned her children in 2001; Andrew Goldstein, who pushed Kendra Webdale under a New York City subway train in 1999 — have already come into contact with the mental-health system.
And, just as typically, that system broke down in some way: a clinic or emergency room turned them away, released them prematurely, or failed to follow up after discharge. At other times, a state treatment law was inadequate or inadequately enforced.
But it appears, so far, that Loughner never had any interaction with the mental-health system.
We need more information before we can draw conclusions about what went wrong.
We need to know, for example, whether Loughner’s parents or others ever tried to get him help. Did they ever call the police because they were afraid of him?
Pima Community College was clearly worried about him, but should they have done more? Will it become clear that the school has more information on Loughner’s potential riskiness that might have justified their contact with campus police or mental-health authorities?
In retrospect the answer seems obvious, but we must remember that, according to mental-health law, we cannot restrict another’s freedom without first knowing whether he is poised to harm others or himself due to mental illness. Acting weird or lapsing into psychosis, while frightening for everyone and tragic for the ill person, is not, in itself, a crime. Nor does being psychotic necessarily mean one can be treated involuntarily.
Needless to say, I have not examined Loughner, but the details presented thus far suggest that he was wrestling with serious mental illness.
I will update as more facts emerge.
— Sally Satel is a practicing psychiatrist and a resident fellow at the American Enterprise Institute, from whose Enterprise Blog this post is reprinted with permission.
By the end of this week you will know all there is to know. (Unless our 'Political Masters' decide to blackhole his past)
Reply to this commentLinkReport AbuseI think it clear that Loughner was very disturbed. He came to the attention of the authorities many times. He will now spend the rest of his life in either a prison or hospital.
"....lapsing into psychosis, while frightening for everyone and tragic for the ill person, is not, in itself, a crime. Nor does being psychotic necessarily mean one can be treated involuntarily."
You are speaking directly to the problem now: the laws that have gone too far in erecting a wall of rights to mental illness that neither protects the person afflicted, nor the public from their potentials for violence.
If people want to know why there are so many mentally ill homeless in this country, it is the law you speak of that protects the right for mental illness not to be treated. Families give up and the mentally ill end up on the street fending for themselves through the fog of untreated mental illness.
Or others, like Jared Loughner or Andrea Yates, do horrific things that shock us all. The American public says throw the book at them without mercy, but it is the legislation protecting the rights to be untreated mentally ill that needs to be addressed.
Not going to deal with that - giving the mental health system a pass? Then this will happen again repeatedly and untold numbers of families will be destroyed under the weight of the rights of mental illness, instead of the right of public safety.
Reply to this commentLinkReport AbuseI just spoke to psychologist this morning after he testified in court, and he said there have been attempts in the past to develop predictive models for this type of behavior (torturing animals when young, etc.), but for the most part utterly in vain. And I, too, can't even imagine the civil liberties consequences of preemptively singling out people because they're "odd" or "wear stocking caps in July," etc. There may not be much we can do beyond keeping our eyes open and employing reasonable security measures (or one of my favorite clichés: "beefing up" security).
Reply to this commentLinkReport AbuseDouglas: "And I, too, can't even imagine the civil liberties consequences of preemptively singling out people because they're "odd" or "wear stocking caps in July,"
No one wants frivolous commitments to mental lock up, but when family members can't get help for loved ones slipping into a mental abyss, then something is drastically wrong with the mental health system.
When such a large percentage of the homeless in this country are really just souls lost to mental illness, then something is drastically wrong with the mental health system.
While the ACLU frets over the rights to refuse meds and treatment, family members are somewhere gripped in fear that their loved one is going to walk off one day and never be seen again....or be seen on TV having just murdered a bunch of people for no reason.
Reply to this commentLinkReport Abuse"...the details presented thus far suggest that he was wrestling with serious mental illness."
No, ma'am, the details presented thus far suggest someone who has been pinned to the mat by mental illness, for the count.
"Nor does being psychotic necessarily mean one can be treated involuntarily."
I think that would be *precisely* a reason to treat someone involuntarily.
Reply to this commentLinkReport Abuse(Psychosis: the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patients capacity to meet the ordinary demands of life.)
I agree broadly with Ms Satel.
GWB: we need to be clear on our definitions of "psychosis." the definition you cite does back up your point, but from a clinical standpoint (i am speaking as a mental health professional who has hospitalized countless folks both voluntarily and not in my practice) the "pleasantly psychotic" individual not only does not most (if not all) standards of involuntary hospitalization but poses little danger.
we have to be very careful to indict the mentally ill or psychotic. the mental health system is highly variable, and at best it is cumbersome, but at least in my little neck of the woods, people get very good care that meets the interests of the consumer, their family and society at large. this is no small achievement. could it be done better? sure. would i like to make decent money doing it? you bet. but it could be a lot worse.
Reply to this commentLinkReport AbuseWe had a severely mentally ill person in our family, and I agree that the mental health system is broken. The stress is enormous. You're dealing with things like them sneaking out and driving after pilfering the car keys while in a hallucinatory state, or getting into violent moods that make you wonder what is going to happen next, etc.
Reply to this commentLinkReport AbuseAnd if you want to simply know what you can do to help the situation - you won't be told. Patient privacy rights trumps everything.
That is why many families eventually cut off or limit contact, because the mental health workers cut off the family. To remain in that situation means drowning in a semiotic black hole. It's a frightening experience for everyone and the mental health field only cares about "privacy," not helping a desperate family figure out what to expect, how to understand the mental illness, or how to help their loved one.
@Breaker: I won't disparage your work - I'm sure your patients receive wonderful care.
But, the threshold for involuntary treatment needs to come down several notches. If someone is psychotic, I would say the burden should be on proving why they shouldn't require treatment. Disengagement from reality is serious - even when dealing with the "pleasantly psychotic".
That wonderful care you provide only helps if the appropriate person is actually receiving care.
Reply to this commentLinkReport AbuseI agree with Keko. I think that is the experience of families dealing with a mentally ill loved one.
Everyone else can have an opinion, learned or not, but it is just not right to ignore those of us who know first hand what it means to be "drowning in a semiotic black hole."
I guess this is not a sexy enough talking point to rise and become the focus of what American needs to do in response to the Tucson tragedy. Too bad because it is the only thing that has a chance of making a real difference for the future.
Reply to this commentLinkReport Abuse"Nor does being psychotic necessarily mean one can be treated involuntarily."
Here's the crux of the problem. A psychotic person should be deemed by law to lack the capacity to decline treatment - we don't let children decline treatment, because they lack the capacity to make an informed decision. Why do we allow the psychotic to make a decision when swayed by their psychosis into denying reality? How can they be said to be making an informed decision when they are delusional, and their delusion is part of the "information" they are considering?
Reply to this commentLinkReport AbuseThis is a question I have been waiting to see ever since I read about Andrea Yates.
Our mental health system - whether we are talking about laws or providers or the whole collected system itself - is not held responsible for its failures, and so there is no feedback - no incentive, no improvement.
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