Esteban Santiago's Psychosis

It has been four decades since I stepped foot in a psychiatric hospital or clinic. And since I am not a psychiatrist I hesitate to offer a diagnosis of someone I read about in the papers.

And yet, I have often hinted that, to my mind, many of our mass killers—from Jared Loughner to James Holmes to Adam Lanza—have been psychotic. That is, have been schizophrenic. The same diagnosis seems clearly to fit Esteban Santiago, the man who opened fire at the Fort Lauderdale airport last week.

Shouldn't these professionals should know the difference between schizophrenia and PTSD?

This morning the New York Times offers the views of some New York experts. Which is not the same as the experts in Anchorage where Santiago was interned for a few days. The New York experts clearly understand that the man was suffering from schizophrenia.

Previous reports suggested that Santiago was released after two weeks in the hospital. The Times tells us that he was released after four days… because was not seen as a threat. Why we are not asking the Anchorage psychiatrists what they were thinking?

The Times explained:

After telling the F.B.I. in November that his mind was being controlled, Mr. Santiago was taken to a civilian psychiatric hospital. The law prevents patients from being held involuntarily if they are not an imminent threat to themselves or others. Mr. Santiago was released after four days.

The Times reported the New York psychiatrists' diagnoses:

Mr. Santiago’s family said he reported hearing voices and had other hallucinations, but said he was never given a diagnosis of PTSD. In November, he walked into an F.B.I. office in Alaska and told agents that his mind was being controlled by a United States intelligence agency.

“The delusions, the hallucinations are far more consistent with psychosis than PTSD,” said Dr. Donald C. Goff, a psychiatrist at New York University and a leading expert on schizophrenia. “So is the timing of the onset.”

Hallucinations and delusions belong to the world of psychosis. They are not characteristic of PTSD.

The Times continues:

PTSD sufferers can struggle with anxiety, sleeplessness, flashbacks and anger. In rare cases, the disorder results in increased violence and aggressiveness. But paranoid delusions are not typical.

“That is a cardinal symptom of psychosis,” Dr. Chemtob said. “But inevitably people’s prejudice toward veterans is going to lead them to emphasize PTSD.”

Apparently, the rush to diagnose war veterans as suffering from PTSD derives from the anti-war movement.

The Times writes:

Veterans have complained that too often they are labeled with the disorder, and that ascribing all violent acts among veterans to the psychological scars of war perpetuates damaging stereotypes. Many have argued that is what happened with Eddie Ray Routh, the 24-year-old former Marine corporal who killed Chris Kyle, a member of the Navy SEALs and the author of “American Sniper,” in 2013.

Mr. Routh’s medical records revealed he had persistent delusions that he was being devoured from the inside by parasites, and that his co-workers were pig people who wanted to eat him, but a doctor at a veterans hospital gave him a diagnosis of PTSD.

Clearly, the media is selling a narrative. In it soldiers come home from war irretrievably broken. Thus, we should never fight any wars any more:

“The public sees veterans as broken, and they often shape the narrative to fit their perceptions,” Mr. Rausch said. When the news of the Fort Lauderdale shooting broke, he said: “My first thought was that I hoped no one was hurt. My second was that I hoped it wasn’t a veteran because I knew if they were, it would spark a simplified explanation that would never happen with a civilian, tying everything back to war."