Surely the real issue here is not 'mental health' but the need to change
America's gun laws.


Matt Dioguardi <dio@...> wrote:
Here is an article, published in the popular Opinion Journal, and
available on-line. Although it does not directly say so, it basically
lays the fault of the massacre at Thomas Szasz's feet.

I am going to add further comments on this article in a separate post.

Link follows article:
----------------------------------

A DANGER TO SOCIETY
Bedlam Revisited
Why the Virginia Tech shooter was not committed.

BY JONATHAN KELLERMAN
Monday, April 23, 2007 12:01 a.m.

I was in graduate school, studying clinical psychology when they
began shutting down the asylums. The place was California, the time
was the early 1970s, and "they" were an unprecedented confederation
of progressives, libertarians and fiscal conservatives.

From the left marched battalions of self-styled mental health
"liberation activists" steeped in the writings of Scottish
psychiatrist R.D. Laing. Though he denied being opposed to his own
profession, Laing's notion that madness could be a reasonable
reaction to an unjust society, or even a vehicle for spiritual
transformation, helped fuel the anti-psychiatry movement of the post
Love-In era. The most radical of Laingians carried revisionism one
step further: Not only wasn't psychosis a bad thing, it was evidence
of a superior level of consciousness.

The libertarians were fueled by Thomas Szasz, an iconoclastic
psychiatrist who was, and remains, an outspoken foe of virtually
every aspect of his chosen specialty. Hungarian-born in 1920, and
witness to vicious state exploitation of medical practice by the
Nazis and the communists, Dr. Szasz pushed an absolutist dogma of
individual choice, finding ready converts among members of the Do-
Your-Own-Thing generation. Though his early essays offered much-
needed critiques of the Orwellian nightmares that can result when
autocracy corrupts health care, Dr. Szasz devolved into something of
a psychiatric Flat-Earther, insisting in the face of mounting
contrary evidence that mental illness simply does not exist.
Currently, he serves on a commission, cofounded with the Church of
Scientology, that purports to investigate human rights violations
perpetrated by mental health professionals.

Accepting the arguments of the liberationists and the libertarians at
face value led to the assertion that no matter how bizarre, disabling
or life-threatening a person's hallucinations and delusions,
involuntary treatment was never called for. And to the assertion that
violation of that premise created yet another class of political
prisoners.

While moderate members of the anti-asylum movement were willing to
concede that psychosis might pose difficulties for a few individuals,
they insisted that society had no more right to force psychoactive
drugs upon mental patients than it did to hold down diabetics for
insulin injections. If treatment was to be offered, it needed to be
consensually contracted between caregivers and care-recipients on an
outpatient basis. That fit perfectly with the sensibilities of
conservative scrooges searching for ways to cut the state budget, and
all too happy to dismantle a massive state hospital system denigrated
as inefficient at best and inhumane at worst. The replacement chosen
was an untested, less costly treatment model: the community mental
center.
How nice that everyone agreed.

Everyone, that was, except for many families of hospitalized,
hopelessly-decompensated, often self-destructive and occasionally
violent psychotics. They'd lived with the reality of severe mental
illness and wondered what "freedom" would bring. But there weren't
enough of these families to matter.

Were the state hospitals wretched nightmare-palaces straight out of
"One Flew Over the Cuckoo's Nest"?

A few were. But many were well-run institutions for patients in
wretched circumstances, providing optimal care within the limitations
of what constituted psychiatric treatment at that time: a handful of
poorly understood psychotropic drugs and supportive talk-therapy.
Perhaps more important, they offered clean beds and three squares a
day, which led to them being belittled as warehouses. But the
protective environment of the best state hospitals has yet to be
improved upon, or even matched.

No matter, this was baby-and-bathwater time.

When I entered graduate school in 1972, so pervasive was the push to
deinstitutionalize that a newly minted course was added to the
mandatory curriculum: Community Psychology, a cobbled-together
travesty that stood apart from all my other coursework due to its
emphasis on polemics and aversion to science.

The basic premise of Community Psych--that severely mentally ill
people could be depended on to show up for treatment voluntarily--
never made sense to me. The core of the most common and debilitating
psychosis, schizophrenia, is degradation of thought and reason. So
the idea that people with fractured minds could and would make
rational, often complex decisions about self-care seemed preposterous.

One day, I voiced that opinion in class, questioning if any
mechanisms were being set in place to prevent a flood of
schizophrenics from ending up on the streets, homeless, helpless,
victims of crime and, in some cases, victimizers. The Community Psych
professor--one of the liberationists--responded with a patronizing
smile and a folksy account of the success of a program in rural
Belgium or some such place, where humble working folk created a
therapeutic milieu by volunteering to house psychotics in their
humble homes and everything ended up peachy.
I didn't challenge what amounted to flimsy anecdotal data, but I did
question its relevance to the plight of thousands of severely
mentally disabled individuals set loose in vast urban centers. The
professor's smile tightened and he changed the subject; and I
resolved to get through this joke of a prerequisite and concentrate
on becoming the best psychologist possible.

By the time I received my doctorate in 1974, the doors to many of the
locked wards had been flung open and the much vaunted community
mental health centers were being built--predominately in low-rent
neighborhoods. A few years later, government funding for these
allegedly humane treatment outposts had been cut, as yet more fiscal
belt-tightening was inspired by findings that they didn't work.

Because crazy people rarely showed up for treatment voluntarily, and
when they did, the treatment milieu consisted of queuing up
interminably at Thorazine Kiosks.

And now we had a Homeless Problem.

And everyone was astonished.

Estimates vary but there's no doubt that a significant percentage of
people living on heating vents, pushing their belongings in shopping
carts, squatting in city parks and immersed in the squalor of tent
cities suffer from severe mental disease. And their psychosis is
often exacerbated by drug and alcohol abuse--what is, essentially, a
regimen of self-medication that should make a Szaszian proud.

Many of these unfortunates end up as victims of violent crimes. A few
become victimizers and when they do, watch out. For though it is true
that schizophrenics are responsible for a proportionally lower rate
of violent offenses than the general population (because many forms
of the disease engender passivity and physical inactivity), when
crazy people do act out the results are often horrific: bloody spree
killings ignited by paranoid thinking and the angry urgings of
internal voices.

Which brings us to outrages such as the Virginia Tech massacre.

Diagnosis from afar is the purview of talk-shows hosts and other
charlatans, and I will not attempt to detail the psyche of the
Virginia Tech slaughterer. But I will hazard that much of what has
been reported about his pre-massacre behavior--prolonged periods of
asocial mutism and withdrawal, irrational anger and hatred, bizarre
writing and speech--is not at odds with the picture of a fulminating,
serious mental disease. And his age falls squarely within the most
common period when psychosis blossoms.

No one who knew him seems surprised by what he did. On the contrary,
dorm chatter characterized him explicitly as a future school-shooter.
One of his professors, the poet Nikki Giovanni, saw him as a
disruptive bully and kicked him out of her class. Other teachers
viewed him as disturbed and referred him for the ubiquitous
"counseling"--an outcome that is ambiguous to the point of
meaninglessness and akin to "treatment" for a patient with
metastasized cancer.

But even that minimal care wasn't given. The shooter didn't want it
and no one tried to force him to get it. While it's been reported
that he was involuntarily committed to a "Behavioral Health Center"
in December 2005, those reports also say he was released the very
next morning. Even if the will to segregate an obvious menace had
been in place, the legal mechanisms to provide even temporary
"warehousing" were absent. The rest is terrible history.

That is not to say that anyone who pens violence-laden poetry or lets
slip the occasional hostile remark should be protectively
incarcerated. But when the level of threat rises to college freshmen
and faculty prophesying accurately, perhaps we should err on the side
of public safety rather than protect individual liberty at all costs.

If the Virginia Tech shooter had been locked up for careful
observation in a humane mental hospital, the worst-case scenario
would've been a minor league civil liberties goof: an unpleasant
semester break for an odd and hostile young misanthrope who might've
even have learned to be more polite. Yes, it's possible confinement
would've been futile or even stoked his rage. But a third outcome is
also possible: Simply getting a patient through a crisis point can
prevent disaster, as happens with suicidal people restrained from
self-destruction who lose their enthusiasm for repeat performances.

At the very least, in a better world, time spent on psychiatric watch
could've been used to justify placing the Virginia killer on a no-buy
gun list. I'm not naïve enough to believe that illegal firearms
aren't within reach for anyone who really wants them, but just as
loud dogs deter burglars and crime rates drop during harsh weather,
sometimes making life difficult for a would-be criminal is enough.

But all this remains in the realm of fantasy. Penning up and
carefully scrutinizing the killer was never an option. Not in
Virginia or California or any other state in the union. Because in
our well-intentioned quest to maximize personal liberty, we've moved
conceptual eons away from taking the concept of dangerousness seriously.

The best predictor of future violent behavior is past violent
behavior, yet we regularly grant parole to murderers, serial rapists,
chronically assaultive individuals and habitual pedophiles. Even when
we do attempt to segregate low-impulse multiple offenders with
effective tools such as with three-strikes laws, liberationist clamor
never ceases.

Talk to anyone who's tried to commit a dangerously violent child or
parent for even a few days: A stranger with a law degree will show up
at the hearing and paint you as a fascist. So it's far too much to
expect anything resembling a decisive approach to those whose level
of threat remains at the verbal level.

Given the excesses of the past--husbands committing troublesome
wives, involuntary sterilization of those judged defective--extreme
caution is warranted. But like drunk drivers, we sway from one side
of the legal road to the other and find the sensible center lane
elusive.
Unless we confront the unpleasant fact that the brains of a small
percentage of our citizens incubate dark, disturbed thoughts that can
blossom into vicious behavior, we can look forward to repeats of last
week's outrage.
Dr. Kellerman is clinical professor of pediatrics and psychology at
USC's Keck School of Medicine and the author of 27 crime novels and
three books on psychology, including "Savage Spawn: Reflections on
Violent Children" (Ballantine, 1999). His current novel is
"Obsession"(Ballantine, 2007 ).

Copyright © 2007 Dow Jones & Company, Inc. All Rights Reserved.

http://www.opinionjournal.com/editorial/feature.html?id=110009977





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