Tuesday, January 11, 2011

Jared Loughner, Paranoid Schizophrenic

Everyone who came into contact with Jared Loughner knew that he was mentally ill. He was not just demoralized or anxious, not just an unstable loner… he was bat-shit crazy. In psychiatric parlance: he was a paranoid schizophrenic.

Meaning what, exactly?

First, it means that he was suffering from a brain disease. It is somewhat of a misnomer to call paranoid schizophrenia a mental illness. It involves the brain, more than the mind.

Thus, there is no psychological treatment for schizophrenia. The recent great advances in treatment involve better medications, not new forms of psychological counseling or therapy.

Second, while it may be true that schizophrenics lose touch with reality, it is better to say that they live in their own reality, one that is distinct from the reality that everyone else inhabits. For a schizophrenic the delusions are real.

Third, schizophrenics take metaphors literally. A schizophrenic will think that Target stores, for examples, are something to shoot at. Since we cannot ban metaphors-- they are intrinsic to the structure of language-- we need to find other ways to deal with schizophrenia.

If a schizophrenic does not find the metaphors in political discourse or in music videos he will surely find it in Shakespeare, Homer, or the Bible.

Fourth, as Loughner made manifest, when a paranoid schizophrenic experiences a moment of onset-- typically in adolescence-- he feels like he is losing his mind.

He will feel that he is losing his free will, his ability to make autonomous decisions, and is falling prey to what are called command hallucinations, voices that are telling him that he must do this or that. These voices torment; they do not comfort.

Even if he tries to fight them off, the schizophrenic knows that at some point the voices are going to tell him to jump or to kill and he will be powerless to do anything but obey their command.

It should not be surprising that Loughner tried to find ways to regain control of his mind. Or that he read books about propaganda and mind control to try to understand what was happening to him, or, more importantly, to attempt to reverse the process.

The books he read and the bizarre rituals he performed were attempts at self-medication. He did not, I would surmise, want to extricate himself from his delusions, but from the anguish they were causing him.

So, everyone knew that Jared Loughner was insane. And everyone knew that he was dangerous. Yet, there was nothing anyone could do.

As a society we have chosen to ignore the reality of schizophrenia. We can say that these patients are out of touch with reality, but when it comes to dealing with them we are inhabiting our own illusory world.

The more often I read a serious scientific study explaining that schizophrenics are no more dangerous than anyone else, the more I think that they are.

I have, in the past, worked in psychiatric institutions that housed schizophrenics. Not all of them were violent, but many of them were. And, those who were always seemed to get involved in extreme acts.

As a society, we have chosen to respect the independent, autonomous judgment of people who have none. We are so allergic to forced treatment that we refuse to acknowledge and counteract the danger in our midst, until it is too late.

It reminds me of the debate over the treatment of anorexia. While anorexia does not seem to be a brain disease, clearly an extreme dietary restriction seems to effect brain chemistry, to the point where these patients cannot bring themselves to eat of their own free will.

Thus, in a somewhat recent development, psychiatrists at Maudsley Hospital in England have been treating anorexics by forcing them to eat, regardless of whether or not they want to. They have found this to be markedly more effective than mind-based methods.

Let’s be clear: schizophrenia and anorexia are not in any way correlated. I raise the issue to point out that our squeamishness about forcing treatment on people can come with a very high price. If we can force-feed anorexics why can’t we force-medicate schizophrenics?

Of course, we know why. The anti-psychiatry movement of the 1960s pronounced schizophrenia a social disease, a rebellion against social norms. It said that we needed to listen to schizophrenics, respect their wisdom, not medicate them.

This never produced positive results, but the notion was picked up by civil libertarians who stepped forward to defend the inalienable constitutional rights of schizophrenics to refuse treatment and hospitalization.

Now, as we see in the reports coming out of Tucson, it is nearly impossible to commit a schizophrenic to a treatment facility without clear evidence that he is a danger to himself or others. That seems to mean, his having committed an act of violence.

Surely, people knew that Loughner was a menace. His community college and the police made every imaginable effort to persuade him to commit himself.

To no avail.

Loughner refused treatment, and the authorities wrong headedly assumed that they had to respect his decision.

In fact, it was not his decision. It was his disease’s decision. Loughner was not just trying to go it alone, but he must have known that the medication was going to deprive him of his reality. However delusional it was, the reality was his. It was all he had left.

In our internet age we must assume that he knew that anti-psychotic medications had very unpleasant side-effects, and that they are not a temporary fix, but a permanent way of life.

As most people know, one of the greatest difficulty treating schizophrenics is keeping them on their meds.

Left to his own devices Jared Loughner set about devising his own treatment program. Having failed at mind control, and bizarre pagan rituals, he ended up targeting the bodily organ that was truly diseased, the brain.

 Only, it wasn't his own. Feeling that he was tormented by a brain that was out of control, he seemed to conclude that he could treat himself by harming the brain of someone he thought had offended him, even caused his illness.

Thus, Loughner attacked the brain of Rep. Gabrielle Giffords. A few years ago he had asked her a question at an open forum that was similar to the one she held last Saturday. She did not give him the answer that he expected or wanted, and this moment seems to have coincided with the onset of his psychosis.

Thus, he returned to the moment when he had lost control over his brain, and found a horrifying way to try to get it back.

17 comments:

Kentucky Packrat said...

Schizophrenia and the most paranoid of bipolar cases have both bothered me tremendously as a libertarian.

IMHO, a person has the right to refuse medical treatment, because the other path can lead to madness of its own. However, as you say schizophrenics (and some bipolar people, and arguably some sociopaths) don't connect to our reality long enough to make an informed decision. Do you medicate them long enough to let them make an informed decision?

For Loughner, it looks clear that (had he been sane) he committed several felonies that would have resulted in prison time. Instead of starting the process and having him skip out with an insanity defense, the system just dropped him out. However, by dropping him straight out, he didn't lose his gun rights(*), and there was no chance to force treatment.

(*) I won't argue that Loughner couldn't have gotten a gun if he had a block on him; I would just argue that the legal system wouldn't have sold him one.

cbpelto said...

TO: Kentucky Packrat
RE: Gun Rights & the Mentally 'Unstable'

Good points.

Based on what I've seen so far, he definitely qualified to be 'Possession Prohibited' under Arizona's Revised Statutes.

" Under Arizona law, prohibited possessor are defined in ARS 13-3101 which states:

7. “Prohibited possessor” means any person:

(a) Who has been found to constitute a danger to himself or to others or to be persistently or acutely disabled or gravely disabled pursuant to court order under section 36-540, and whose right to possess a firearm has not been restored pursuant to section 13-925.

Had campus security and his parents followed up with proper treatment and reported his actions, he, from what it sounds, would have been an easy PP and unable to buy a weapon. Had the Sheriff’s office acted upon what is suggested as their advanced knowledge of Loughner’s troubled history, they may have obtained a warrant and confiscated his firearm – or apprehended him before he bought it."

And Jared didn't lose his gun-rights because, I suspect, the Sheriff couldn't be 'bothered' with following through on the necessity, after Jared had had those run-ins....whatever they may have been.

I suspect that is why the Sheriff is trying so desperately to foist the blame off on Rush Limbaugh and others of his sort.

Regards,

Chuck(le)
[The Truth will out....]

Dennis said...

Bravo Chuck. That is why the Sheriff is tossing rocks at everyone in order to keep them from noticing his seeming malfeasance in this case.

cbpelto said...

TO: Dennis, et al.
RE: The Whole 'Press'....double entendé fully intended....

....on this is to classify conservatives as 'mentally unstable', e.g., 'ill'.

Students of history have seen this as the 'usual suspects' ploy used time and time again to eliminate political dissidents. The Soviet Union, e.g., Communists, a.k.a., 'progressives', used this very effectively. The Chinese Communists use it as well. Disagree with the 'powers that be' in such a society and consider yourself 'mentally ill' and bound for their 'treatment' facilities in far, far away.

Their credo could be stated as....

Help stamp out mental illness, or I'll kill you!

Regards,

Chuck(le)
[A free society is one where it is safe to be unpopular. -- Adlai Stevenson]

cbpelto said...

TO: Dr. Schneiderman
RE: The Definition of Mental Illness

The big questions are:

[1] How do we identify mental illness?
[2] What are the rules for 'restricting' them? Or 'institutionalizing' them?

Regards,

Chuck(le)
[Mental Floss prevents Moral Decay.]

Stuart Schneiderman said...

As you note, the diagnosis of mental illness has sometimes been used to stifle dissent and to lock up political enemies.

That does not mean that it does not exist, but that we need to be careful about applying the label.

With Loughner, it seemed that everyone knew that he was seriously deranged and dangerous. It was common knowledge.

Personally, I don't think it is extremely difficult to diagnose schizophrenia; it does not exist on a continuum, but seems to be a thing itself.

If you look at the picture that is currently circulating, there seems little doubt that we are dealing with some form of illness.

The problems arise when you have to distinguish between paranoias and the kinds of manias that exist in bipolar illness. Or with the kinds of problems that might be caused by a brain tumor.

Clearly, the best approach would be to have some kind of test to determine the nature of the illness. When dealing with bipolar illness, I have been informed, that the illness is caused by a lithium deficiency in the blood, and that the deficiency can be measured with a blood test.

I do not know if that is definitive, but it points in a good direction. And while I have worked in psychiatric institutions, I am not and never have been a psychiatrist. So, consider mine to be lay opinions.

I have also been informed and have seen on several television programs that PET scans of schizophrenics are radically different from those of normal people. Perhaps this will point the way to a test that can determine whether a patient is or is not schizophrenic.

Loughner seems never to have been hospitalized at all, even for observation. I doubt that very many psychiatrists would have missed the diagnosis, if he had been

Anonymous said...

I like this quote

Every right-thinking person knew [Jared Loughner] was a sleeper agent programmed by George W. to be activated with a code word from Sarah Palin. There was no mystery about who this suspect was, not like the shooter at Fort Hood in 2009 who shouted “Allahu Akbar!” as he killed 13 people.

Cathryn Coone-McCrary said...

I think your article is well written and considered. It makes many cogent points.

However, you suggest that people with schizophrenia are more violent than average, strictly BASED on your experience working in a psychiatric hospital. This kind of argument is NOT a convincing argument for your point. Rather, you should look at the research--not at anecdotal experience. If you google this topic, you will find research that undermines your case.

That having been said, a very few of people with schizophrenia are violent, although other variables seem to enter into the equation (such as substance abuse) that you do not mention.

I take exception to your statements because of my own personal experience. I do not have schizophrenia, but I do have something called Bipolar II. This condition is mainly characterized by extremely severe, even suicidal, depression, and I have been contending with this illness now for 30 years. In my twenties, and especially my thirties, the depression was exacerbated by something called "hypomania." Anyone who googles this term will find its definition; that aside, it took me 17 years to seek any treatment. WHY? Because of misconceptions about people with mental illness--that we're all gun-toting, homicidal maniacs.

Your article, again, certainly made many valid points, but to emphasize the violence angle does more harm than good. It would be better to focus on how to solve this public health crisis, which I agree does center around how to get these people treated, but asserting that individuals with schizophrenia are more violent than the general population will only serve to worsen an already tragic situation.

Stuart Schneiderman said...

Thank you, Cathryn, for your comments. I had merely wanted to express a suspicion about schizophrenics and violence, based on limited experience.

I wanted to say that I was skeptical about the studies, and leave the question open.

This morning I put up another post on schizophrenia and violence, this one referring to the opinions of Oxford psychiatrist Dr. Seena Fazel. He reports on research studies that demonstrate that schizophrenics are indeed more violent, though they cannot discount the role of drugs in the violence.

I have not really commented on the public health crisis, because I am not in the field, but I would mention that Dr. Fazel believes that recognizing the potential for violence in schizophrenics might make it easier to treat them.

I would only wonder whether these illnesses would be easier to treat if the psychiatric profession understood fully that they are medical, not psychological, problems.

Way back when I was working in a psychiatric clinic, people seemed to believe that bipolar illness was a psychological condition, albeit one that no one knew how to treat psychologically. Today I don't think that anyone would agree with that.

Cathryn Coone-McCrary said...

Thanks for your reply. I agree that psychological methods--while they might complement the use of medication--are not first and foremost effective in the treatment of schizophrenia.

Clearly you have a good grasp on this issue, and I see your point about emphasizing the violence angle in order to make it likelier for individuals with paranoid schizophrenia to get treated. I am just concerned about the potential damage that this argument could do to the rest of us--and even for those with schizophrenia, who, as you say, do have some initial reality contact when they first start getting ill but who, partly because of stigma, shirk treatment. Wouldn't it be a wonderful world indeed when people like Jared Loughner no longer have to live with shame but who instead see this illness as no less physiological in its origins than a brain tumor--and then seek help accordingly?

Anonymous said...

Confirmed MPD/DID Delta Model, from ERAD behavioral facility in Tucson, AZ.

bobbi said...

Thank you for this article and the unique perspective it presents. However I take issue with a couple of the points you have made. An anorexic requiring forced feeding is at a far, far greater risk for serious self harm than an untreated schizophrenic. There comes a time when forced feeding is absolutely critical to survival. And one can quantify precisely how and when an anorexic will die should the acute stage of their illness persist untreated. While the risk of self / other harm can certainly be assessed in the schizophrenic, it cannot be assessed with enough precision to justify the forced treatment you describe. What's more, this life long illness would require life long forced treatment. Is that what you're advocating? How could you? Furthermore, there has been an extraordinary result of the "social disease" movement of the 19060s. Schizophrenics now maintain ownership of their frontal lobes; unlike the tens of thousands of sufferers involuntarily subjected to lobotomizes during the first half of the 20th Century. There are few populations more vulnerable than the severly mentally ill. Accessibility is sorely needed, not sanctions.

Stuart Schneiderman said...

Thank you, bobbi, for your clarifications. While I agree that an anorexic is guaranteed to be more dangerous to herself than the schizophrenic, the schizophrenic is potentially far more dangerous to others.

Certainly, I am not proposing a return to lobotomies, which were not used for schizophrenia, anyway. But rather, I am looking for a way to get these patients to take the proper medication.

As it happens, some of them do not like their medication. And most of them have severely impaired judgment... thus, I question how much free judgment they should be accorded.

Obviously, the great challenge in the mental health field is to provide this treatment without incarcerating or sanctioning people.

bobbi said...

Stuart, thank you for the thoughtful reply. As the mother of a teenager with severe mental illness, I've spent many a sleepless night worrying about the very topic of your article.

Susan Barringer Wells (Vaughan) said...

Please read Robert B Whitaker's books and look at Finland's Open Dialogue and the Brain Bio Centre's info on screening for physical causes of conditions labeled schizophrenia before deciding medication is the correct or only treatment for those so labeled.

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Mrs. Patricia said...
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