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.