January 13, 2011
Someone you know well — a family member, a student in your classroom, a close friend or colleague — has been behaving erratically for weeks. In recent days, you’ve heard him fantasize out loud about blowing a certain acquaintance’s brains out, and you’ve decided it would be a mistake simply to ignore his ramblings.
In the days since Saturday’s shootings in Tucson, Ariz., a consensus has developed that the roots of that catastrophe are more pathological than political. Those who favor more stringent gun control and those who oppose it are equally capable of understanding that we’d all be better off if people like Jared Loughner could obtain competent mental health care as easily as they can purchase deadly weapons.
But even this may be naively optimistic. I’ve spent the past week talking to psychiatrists who treat psychotics on an inpatient and outpatient basis, and virtually none is confident that medical intervention would have prevented the Tucson rampage.
Psychiatry and neurology are such youthful medical specialties, and the legal and pharmaceutical options available to doctors and hospitals so limited, that even the minority of dangerous individuals who are evaluated and diagnosed are not guaranteed effective treatment.
It’s not clear that Loughner ever underwent the kind of psychiatric evaluation that so many people he met thought he needed. But Seung-Hui Cho, who killed 32 people before killing himself after a 2007 rampage on the Virginia Polytechnic Institute campus, had been diagnosed and treated repeatedly.
Nidal Malik Hasan, who is accused of killing 13 people and wounding another 30 in a November 2009 shooting spree at Ft. Hood, Texas, was a U.S. Army psychiatrist whose unraveling attracted plenty of attention but little effective intervention by his psychiatric colleagues.
Sadly, there is little to suggest that Loughner would have been easier to derail. Numerous psychiatric experts have pointed out that his behavior bears all the markings of paranoid schizophrenia, a chronic condition that is neither curable nor easy to manage over the long term.
Prescription medications can diminish the delusions and hallucinations that sometimes precipitate a psychotic break in schizophrenics, but their effectiveness generally depends on patient compliance with long-term regimens that are difficult for doctors or loved ones to enforce.
Long-term hospitalization for psychiatric care is a relic of the past; even those whose symptoms are so extreme as to compel involuntary commitment can generally be held for only short periods of time.
The virtue of action
Even so, every medical professional I spoke to encouraged people to be more proactive about alerting employers and even law enforcement authorities to behavior that seems threatening or dissociated from reality. Interrupting such an episode even briefly, they emphasize, can defuse a dangerous scenario.
“What medicine can do is distract people and buy them some time to think it over,” Lester Potempa, a psychiatrist on staff at William Beaumont Hospital in Royal Oak and Providence Hospital, told me. “Unfortunately, the reflexive response most of us have to a person experiencing a psychotic break is simply to avoid them.”
Because the risk that even a seriously disturbed patient will act out violently is so difficult to quantify, doctors and family members may never know when they’ve intervened successfully to forestall the next massacre.
“But,” Potempa noted, “we certainly get ample notice when an intervention fails.”
Contact Brian Dickerson: 313-222-6584 or firstname.lastname@example.org.