How Not to Treat Psychosis

In the course of a long portrait of the family of Sandy Hook shooter Adam Lanza Andrew Solomon remarks that none of the several psychiatrists who examined him diagnosed him as a dangerous psychotic, a homicidal paranoid schizophrenic.

Apparently, Solomon was arguing against those who believe that dangerous psychotics should be committed and treated involuntarily.

Once this predicate is laid down, one will feel forced to conclude that such massacres can only be stopped by strict gun control.

Obviously, it is extremely difficult to predict which schizophrenic will become a mass murderer. And yet, no harm is done by offering psychiatric treatment to a schizophrenic who will “merely” join the army of the homeless, living in abject squalor on the streets of San Francisco.

For my part, when I read Solomon’s article, I began to question the professional abilities of these psychiatrists. It is hard to imagine that they all missed a diagnosis that would have been obvious to any layman, but stranger things have happened. As with many of other psychotic murderers, people around them are often painfully aware of their illness.

Of course, it has become increasingly difficult to commit a patient involuntarily. Thanks to advocacy groups, state legislatures have been allowing psychotics to exercise what appears to be their freedom. A few months before the Sandy Hook shooting, the Connecticut legislature voted down a bill that would have made it easier to hospitalize Adam Lanza against his will.

Today, the Wall Street Journal explains that the problem is larger than even the ACLU. Much of the fault lies with the bureaucrats who work in a little-known branch of the department of Health and Human Services. Commanding a $3.6 billion budget the Substance Abuse and Mental Health Services Administration, known as Samhsa, had been making it more difficult to treat those who suffer from extreme mental illness.

Psychiatrists understand the nature of mental illness and the best approaches to treating it. The Journal explains:

Health professionals agree on the need to provide medical intervention for serious psychiatric disorders—schizophrenia, bipolar disorder, severe depression. The National Institute of Mental Health does evidence-based research and promotes medically driven models of care, including early intervention, intense psychiatric treatment and drugs. Doctors have promoted reforms such as "need for treatment" standards in civil-commitment laws, or assisted-outpatient laws so courts can require the mentally ill to receive treatment to avoid hospitalization. These reforms help the mentally ill and reduce crime, incarceration and homelessness.

For the sake of argument, let’s call it settled science.

Unfortunately, Samhsa is not part of the solution; it is part of the problem. The reason, the Journal editorializes, lies in the fact that this bureaucracy is a gussied up version of the 1960s anti-psychiatry movement. In general, they do not recognize the reality of mental illness. Some believe that mental illness is a social construct. Others hold that mental illness is a function of societal repression. Thus, it becomes a manifestation of societal injustice.

The Journal reports:

Instead of being part of this solution, Samhsa is in the vanguard of the legal-advocacy and anti-psychiatry movement that sprang to life in the 1980s, and it continues to waste taxpayer dollars on programs that undercut efforts to help the world's Adam Lanzas.

Known generally as the "consumer/survivor" movement (as in having "survived" psychiatric treatment), this movement largely opposes drug treatment, psychiatric care, civil-commitment laws or even the reality of mental illness. Samhsa pushes the "recovery model," an approach that puts the patient in charge of crafting his own recovery plan and stresses "empowerment" and coping rather than medical intervention.

For instance, Samhsa's Guide to Mental Illness Awareness Week suggests schools invite as speakers such radical organizations as MindFreedom, which rejects the existence of mental illness and stages "human rights" campaigns against drug treatment and commitments. Or the National Coalition for Mental Health Recovery, which "holds that psychiatric labeling is a pseudoscientific practice of limited value in helping people recover."

Samhsa underwrites the Alternatives conference, which in 2013 included a session titled "Dance Your Way to Wellness and Recovery" and a presentation from the "Hearing Voices Network," which "believes that hearing voices is a part of human experience."

Any psychiatrist will tell you that people who hear voices are very likely to be severely ill.

Since Shamhsa does not recognize the reality of mental illness, it spends a great deal of money on: community mental-health centers aimed primarily at the "worried well."

And since, the Journal correctly notes, no one knows how to prevent mental illness—much of the most severe kind is probably a brain disease—Samhsa doles out grants designed to prevent it.

The Journal says:

Samhsa's grants prioritize "prevention"—though there is no known way to prevent severe mental illness. Samhsa spends millions on anti-bullying coloring books and online kids games and pamphlets on how to handle emotional distress after floods: "Take care of pets . . . Nature and animals can help us to feel better when we are down."