VA Tech and Mental Illness

The following are two accounts of a mom and a wife dealing with schizophrenia, that I found in the days after the Virginia shooting. They are at:

http://just-a-mom-thats-more-than-enough.blogspot.com/2007/04/violence-scizophrenia-and-my-son.html

I thought your article was right on the money, and I hope it gets widely disseminated and discussed.

Commitment Phobia

E. Fuller Torrey has a great article in the Wall Street Journal today.

The question inevitably follows the carnage at Virginia Tech: Are individuals with severe mental illnesses more dangerous than the general population? Since the 1960s, when the emptying of public mental hospitals went on fast forward, this question has recurred with each publicized psychiatric tragedy. And each time, mental health organizations have replied with an identical mantra: Psychiatric patients are not more dangerous than the general population.

This answer may be politically correct, but it is factually incorrect. To be precise, mentally ill individuals who are taking medication to control the symptoms of their illness are not more dangerous. But on any given day, approximately half of severely mentally ill individuals are not taking medication. The evidence is clear that a portion of these individuals are significantly more dangerous....

All of this is known but assiduously ignored by most mental health organizations. The reason usually given is that to talk publicly about violence increases stigma against all individuals with mental illness. The problem with such reasoning is that the violent episodes themselves are the main source of stigma -- until the issue of violence is addressed the stigma will remain. This was illustrated by a 1996 survey that found that 31% of Americans associated mental illness with violence, an unexpected increase from a similar survey in 1950 that had reported that only 13% did. The general public apparently bases its opinion on actual events, not on mythology fashioned by mental health organizations.

The most remarkable aspect of psychiatrically related tragedies is that most of them can be avoided. Studies suggest that problems of violence are associated with a small percentage -- approximately 10% -- of all individuals with serious mental illnesses. These are often the same individuals who are intermittently homeless, incarcerated and rehospitalized. Because of their brain disease, these individuals have little or no awareness of their illness and will not voluntarily take medication, because they believe there is nothing wrong with them.

Dr. Torrey is the President of the Treatment Advocacy Center. Visit their site here.

More on Mental Illness and the Virginia Tech Massacre

Here is a note from a long-time reader of mine, with his perspective on the problem of the mentally ill in a free society.

Some in your blog might ask: "Why?" the situation regarding support for the mentally ill is so desperate in a country as blessed as America? Linked below is the history of how we got to where we are. It's not a pretty picture. Really, a comedy [that's not at all funny] of unintended consequences and legislative mis-steps that has left the innocent and the afflicted condemned to relive the bitter harvest of well intentioned, but serious mistakes and...

Now, at VT, [AGAIN] the completely innocent suffer this harvest of ultimate bitterness. I do pray for them and for future innocents, but I harbor little hope of real repair for it seems to me, we only poorly understand the real cause of our communal trauma. How does it feel [Dr. J] to be a "voice crying out in the desert?"

The catastrophic dismantling of the "delivery system" was aggravated, strangely enough, by the absolutely incredible effectiveness of "new" medications. See John Kennedy quoted in the attached link. If [and it's a big if] the right meds "cocktail" can be found and the patient can accept lifelong treatment, some hope remains. But, the appearance and "feel" of normalcy during periods of effective med management will beguile all but the most discerning of the afflicted. Few will stay on their meds as others in the blog confirm. In fact, many will conclude they were mis-diagnosed to begin with by overanxious parents and doctors.

The real problem IMO, as you correctly point out in both your books, is the abandonment [by choice] of a shared value system that correctly balances the needs of the weakest among us [children and the mentally ill] and our "rights" as individuals. New discussion, same problem...............how about that?

[The Story of Deinstitutionalization - Pat M. Stubbs - updated 9/1/98]
"The homeless mentally ill problem has given rise to issues ranging from legal to ethical - the answer may lay in a simple, straightforward large-scale values clarification by asking ourselves the question, Can we as an advanced, wealthy nation afford to allow the problem to continue?"
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=368

More Editorial Comments on Mental Illness and the Virginia Tech Massacre

Suzanne Fields starts strong and trails off. Parents are not necessarily "reluctant to commit" their children. In some cases, parents have few opportunities to get meaningful treatment for their children. Contrary to some of the comments over at Town Hall, there are people who really are dangerous to themselves and others. About a third of the "homeless" population have serious mental illnesses. We are doing no one any favor by pretending they are just a little different, or just transgressive non-conformists. Of course, there is the danger of over-treating people, or of commiting people who shouldn't be committed. But at this time in our history, the pendulum has swung so far in the direction of protecting the civil liberties of the insane, rather than protecting the sanity of the mentally ill (which can sometimes be improved with medications) and the safety of the public.
Daniel Henninger, at the Wall Street Journal, refers to the Safe Schools report and its perhaps surprising conclusion that although most of th school shooters gave indications that should have been recognized, not all of the school shooters were certifiablly insane.

One of the Safe School report's most relevant findings, for the purposes of stopping another Virginia Tech, is that the 37 school attacks weren't typically carried out by severely ill, unhinged psychotics like Cho Seung-Hui. This is not to say they were happy campers (the study interviewed 10 perpetrators in depth). Though few of them would get off by reason of insanity, they were all mentally very unhappy campers; and what is more, other people knew that. And in nearly every case, someone knew they were planning the attack: "In nearly two thirds of the incidents, more than one person had information about the attack before it occurred."

Henniger's bottom line is that people need to DO something when they notice strange behavior. Running to get medication or commitment papers is not the "something" that needs to be done in all cases. But we need to stop being so passive:

Among the reasons widely adduced for not doing something about Cho's violent proclivities are HIPAA and FERPA, the confidentiality laws for health records and college students' records. Well, there's no FERPA for high schools. There is merely the weird cultural refusal to turn in bad actors to adult authority. In one school attack, so many students knew it was coming that 24 were waiting on a mezzanine to watch, one with a camera. The enemy is us....

If there is a sliver of silver lining in the Virginia Tech aftermath, it is that there seems to be a willingness to look hard at the status quo -- no matter what assumptions pre-existed about rights, privacy, stigma, coercion, security or whether we can blame it on Karl Rove. On Tuesday, for example, the Chronicle of Higher Education published a piece by a professor titled, "Why It's OK to Rat On Other Students." Here, as with the message screaming off the pages of the Safe School report, the exhortation is to do something, no matter what the intimidations of the law or received wisdom.

What this means is that some college presidents, and their lawyers, rather than rolling over before those confidentiality laws, should tell some aggrieved student who is refusing to take the medication prescribed for his psychosis: So sue! Let a judge decide whether 32 deaths warrant a reconsideration of these restrictions.

Thanks from a Virginia Tech Prof

This came in early yesterday:

I would like to complement you on your article on NRO today. One of too few careful and thoughtful pieces on the situation. It is clear that our handling of Cho was inadequate. The results speak for themselves. But I've gotten pretty tired of reading that we "did nothing." This is just a vile insult to the teachers, police, councilors, and mental health professional who tried (and, yes,
failed) to deal with this man's mental illness. We can face (and in fact probably welcome) serious criticism. I'm just getting sick of the stupid potshot. Thanks for writing with a clear head.

Your welcome.

What to do with a sociopath?

Tragedies like Virginia Tech invariably bring out ideas for what to do differently. Here is one I got from a reader, with my comments interspersed.

1% of all humans born – no matter where, no matter what race, gender, group, etc. are psychopaths (meaning, at heart, they have no conscience). No technique, not psychotherapy, not medicine, not anything except two things work on them. The two things are: 1) scaring them and 2) avoiding them.

Where do you get the 1% figure? That means in my neighborhood of 40 houses, there are 2 or 3 born psychopaths. I'm not convinced. Also, I'm not convinced that all psychopaths, or sociopaths, which is the more accurate term, are born. I can believe that some are born, but it is possible to turn perfectly normal infants into sociopaths, if you neglect them profoundly enough. I have written about this in my books, especially Love and Economics
Also, there is an important distinction between the child without a conscience, who is the real sociopath, and the kind of delusional mentally ill person we saw at Virginia Tech. You are painting with too broad a brush here.

I see this problem at the root of wars, Virginia tech massacres, Enron, you name it. I advocate we monitor these people from children, and to be honest limit their constitutional rights, for our safety. That is preferable to numerous laws that limit behaviors for everyone (like Sarbanes Oxley for example).

There is something to this. A free society needs to be populated by people who can use their freedom without bothering other people too much. Again, that was the whole point of Love and Economics, whose subtitle is "Why the Laissez-Faire Family Doesn't Work." My libertarian friends never forgave me for that subtitle, I guess.

My solution has problems – such as false diagnosis of psychopaths, misdiagnosis (these people can fool others easily), since psychopaths break laws we have now, they will break these as well. Also, amending the constitution is not something you do in a four paragraph email, and we will have to have a different constitution for psychos, what a discussion that will bring. But we ought to think about some way to monitor them, limit the harm they can do, and protect others from them. We do a lot already – it could be worse, but acknowledging this problem might help us improve.

No kidding, your solution has problems. But, in effect, that is what we are now trying to do with sex offenders: monitor them for life, since we are so pessimistic about ever really changing them. And you are absolutely right that we have to acknowledge that we have a problem. That is where we are falling down on the job with the mentally ill. We keep trying to redefine them as a special case of something else, which they are not. We are treating them as if their civil liberties were more important to them and to us, than their sanity. See Carol Hawkins post below about how her mother, now in her right mind, sincerely wishes someone had honored her sanity more than her "freedom."

The only other advice is to follow the example of Jesus – do not be afraid of the devil (psychopaths)! Know what to look for, Face them, pushback from their nonsense when you see them in real life, and yes we all do see them.

Once again, you are painting with too broad a brush. We are dealing with multiple problems here. We can "push back" as you say, in the case of the person without a conscience, because they are extremely manipulative and go in for the juggular at the first display of weakness. But the families who are writing to me are dealing with something quite different.
There is one teaching of Jesus that we really have to be careful about applying correctly: turn the other cheek. We have no right to turn someone else's cheek: if we have any responsibility for protecting the public, we have no right to ask that someone else turn their cheek. And, in many cases, we aren't doing the person any favor by overlooking their behavior. For the truly mentally ill person, we need to confront their illness on its terms and deal with it. For the person without a conscience, we need to confront their behavior, set extremetly tight limits on it, with no excuses.
And you are right about this: we need to not be afraid.

Mental Illness and the Virginia Tech Massacre

My commentary called, "Waiting until it is too late," is up on National Review. Here is the bottom line:

What would be constructive is an honest discussion about how a free society should face the reality of mental illness. It is not a protection of civil liberties to redefine the mentally ill as if they were rational and able to make informed decisions about their care and treatment, even when they are obviously not. As we can see from the Virginia Tech massacre, it is not consistent with public safety to wait until a mentally ill person has committed a crime. It is not “personal responsibility” to expect the families of mentally ill people to take care of them themselves. This means turning their homes into a 24-hours-a-day mental institution, staffed by relatives who never get training, help, or a day off.

Some smart radio talk-show host could do a real public service by inviting the relatives of mentally ill people to call in and describe the challenges they have faced in getting meaningful help. They will give you an earful. They will tell you about the legal institutions that protect the civil liberties of the ill, without providing protection for the well. They will tell you about being sent home from the hospital with medications they can’t make their relative take. They will tell you about the revolving door between the street, the hospital and the jail.

Let these relatives of the seriously mentally ill tell their stories. I promise you a much more interesting hour of talk radio than yet another hour of yammering about gun control.

Facing the reality of mental illness just might prevent another round of school-shooting victims.

I'm getting many reactions to this article, which I will post later today.