When people learn I am a psychologist, they often ask me about current events. Today on the golf course one of the group asked me about Jared Loughner. “I bet he'd keep you busy,” she said.
The case of Jared Loughner is a fairly easy case. Like several others in recent history, (Seung-Hui Cho, VA Tech; Kip Kinkel, Thurston High School and others), an understanding of the issues surrounding his illness and the murders elevates the dialog about this mass murder to a more important level for our society. The shooting of Congresswoman Giffords and eighteen others is the result of fairly simple but painful equation that our society can't seem to bear to explore.
X x Y + A/B +C = MM
X=Decreased healthcare services
Y=Increased freedoms for the mentally ill
A=Loose gun control laws
B=Availability of military weaponry
M= Mass Murder
Decreased healthcare services +increased freedoms for the mentally ill + loose gun control laws/ availability of military weaponry + thoughtless rhetoric = Mass Murder
Like any good math problem, this one needs to be broken down to be solved.
- Decreased health care services:
When healthcare is seen as a privilege and not a right, the severely mentally ill are left to fend for themselves. If a patient is lucky enough to have someone help them obtain Medicaid, there may be money for treatment. Even if there is coverage though, many doctors do not accept Medicaid. (Here in Southern California most doctors do not.)
If a doctor takes Medicaid, it is usually only for a percentage of the practice. So if the office has openings in the practice for Medicaid, it can take as long as three months to get an appointment. During that time, the symptoms go untreated and get worse. The voices in the patient's head become more commanding or demanding and the person may become more disorganized, erratic and unpredictable. What started out as suicidal thoughts can progress to suicidal plans or homocidal behavior.
At the doctor's visit, the prescribed medications must be procured and then reliably taken on a regular basis. (A big problem with the medications, is that they are unpleasant and make a person feel crappy. Compliance is difficult when the medications make the individual feel sick.) If the patient is an adult, supervision may be necessary to ensure compliance. This requires a paid attendant.
The individual with mental illness has great difficulty navigating the system to get all these different pieces in place while also trying to manage the delusions, suicidal thoughts and hallucinations. If the patient is paranoid, and that is often the case, he is likely challenging and opposing the process at everystep.
- Increased freedoms for the mentally il
In the 1960's, at the beginning of the social justice movement, we thought we were doing the mentally ill a favor by releasing them from institutions and creating homes in the community for a more normalized environment. We relaxed the laws regarding mandatory commitment, and minimized the time for short term involuntary commitment and evaluation.
Over time the few solutions we had have been eliminated with budget cuts. The community housing situations are all but gone. There simply are no homes for the mentally ill. If a paitent is obviously ill, (like some thought Jared Loughner was) they are only hospitalized involuntarily if present a severe danger to themselves or someone else. But by law, only for three days. There are provisions for longer hospitalization, but most patients know what to say and do, to reassure staff long enough to be released. Family members are brought in and expected to handle a patient in crisis, interrupting work and other responsibilities. The family couldn;t handle the patient in the first place, and certainly not do so after 3 days of hospitalization. Only in cases of extreme known risk for suicide or homicide can a patient be held beyond that time.
The hospital 3-day stay is not a fix. During the hospitalization, the individual has the right to refuse medications. I understand the desire to avoid these dangerous and uncomfortable medications, but sometimes when society may be at risk there is little alternative. We don't have the facilities to contain these individuals behaviorally, and so chemical restraint is necessary. But the rights of the mentally ill have taken precedence. In order to administer this medication involuntarily requires a judicial hearing and a court order; often that takes longer than the 3 days. If the individual is mandated to take the medication, that only lasts as long as they are in the hospital.When they are released the order is no longer binding.
Loose gun control laws
Gun control is a hotly contested and volatile issue. But the right to own a gun seems to have taken precedence over good judgment. Many in our society are simply not willing to examine the meaning and original intent of the constitutional right to bear arms. The right to own guns has been loosened and expanded such that an individual with mental illness (or known mental symptoms) can be permitted to purchase a gun. (This is particularly true idf the illness has not been diagnosed or treated, and this is likely if thepatient does not have health insurance.)
Availability of high powered weaponry
Along with the loosening of gun control laws has been an expansion of the weapons available. Semi automatic and automatic weapons are easily available for purchase. There simply is no reasonable argument for the ownership of these weapons.
The prevailing argument against prohibition of such arms is that individuals who want them will "get them anyway, or modify weapons themselves." This is weak. We must trust that our law enforcement professionals can and will track and prosecute these lawbreakers. If the police have the community support to go after individuals modifying guns, the laws prohibiting automatic weapons would have more teeth. An examination of the statistics of gun crime in England is helpful in understanding this concept. England, which has tightly restricted laws regarding permitted gun ownership has an extremely low homicide rate by guns, in comparison to the United States.
Rhetoric is part of the political tradition in the United States and in most any democracy that permits the freedom of speech. Unfortunately though the rhetoric has an impact on the psyche on our society. We are not a citizen that can critcally think about the issues raise. Many of our citizens have only a high school education or less; this is not an education that includes the skills necessary to critically think about an issue. So, when rhetoric is colorful and emotional, the emotions take over and the thinking stops. No real analysis of the issues can occur when the thinking stops, there is only the drama stirred by the emotion of the speech.
So, when a patient has mental illness he is unable to hold a job. He has no insurance, and likely cannot qualify for Medicaid (or simply hasn't been able to navigate the system.) He is constantly confronting what he doesn't have, what he cannot do, and rejection from others. He is afraid of the voices in his mind.These voices are the impetus for action, like theaction taken by Jared Loughner.
"YOU ARE SATAN...
SHE IS SATAN... DON'T LISTEN TO YOUR MOTHER
YOUR DOCTOR THINKS YOU ARE CRAZY...
YOU ARE A COWARD. SHE MUST DIE. YOU WILL BE A HERO IF SHE DIES..."
The patient becomes out of control, and acts on the voices. In someone who is so compromised, the struggle against the voices is harder and harder to engage and the person begins to live more inside his head, than in the world. He starts believing the voices, and the anxiety begins to decrease, because he isn't fighting them anymore. And inside his head the voices don't sound so crazy... so he pulls the trigger.