Psychiatric Experts and Mass Murder

On the question of mass killings, the conventional wisdom has concluded that the problem is gun control. There is a certain logic to the argument. For those who are especially simple-minded, it is incontestably true that if there were no guns there would be no gun violence. And yet, citizens own over 300 million guns. Taking them away is not just daunting. It would be nearly impossible.

Would it not be easier and more effective to provide treatment for the few dozen psychotics and psychopaths who are prone to these acts of senseless violence. As you recall, the great majority of the shooters in these murders were known to be severely troubled. Yet, as the laws are now written, it is nearly impossible to have them committed to a psychiatric hospital involuntarily. That includes James Holmes in Aurora, Colorado and Adam Lanza in Connecticut.

You can thank the civil liberties lobby for placing the good of an individual suffering from a brain disease ahead of the public good.

Today, looking at the Thousand Oaks, CA massacre, Bruce Bawer has some additional observations, made more poignant by the fact that the son of an old friend was among the victims.

Bawer places considerable blame on the psychiatric profession, on the people who are supposed to know these things. But who fail miserably… because they are afraid to pronounce judgment on someone they ought to know to be a danger to himself or others.

As for the Thousand Oaks killer, his mother knew that he was dangerous. His neighbors called the police. The police sent him to see mental health experts… who said that it was not a problem:

Looking at a couple of newspaper reports, I discovered that the killer was a former member of the U.S. Marines who had served in Afghanistan and who had apparently come back home with PTSD. His mother, with whom he lived, had been “terrified” he might hurt himself or others, and his conduct was so disturbing that neighbors called the cops. The cops, in turn, had him looked at by mental health “experts,” but they determined that he was of no danger to himself or others.

Bawer has had other experiences of the same kind, in New York City, among other places. He explains the case of an individual he knew, and who was being treated by a psychiatrist and a psychologist:

For months before I came to this determination about the person in New York, he had been regularly seeing a psychologist and a fancy Central Park West psychiatrist, neither of whom recognized that he required hospitalization and medication. Instead, they professed that he was, yes, “of no danger to himself or others.” They were busy giving him talk therapy – an activity that, as I could see (but they couldn't), was only making him sicker. While these doctors were insisting he was basically OK, he was, unbeknownst to them, frequenting some of the seediest bars in Manhattan, where, he told a mutual friend, his goal was to get infected with HIV so he could then pass it on to others.

Not a danger, they said???

These so-called experts are, one supposes, intimidated or incompetent or both:

... the simple fact is that in the minds of too many of these practitioners, the hesitation to deprive mentally ill persons of their freedom of movement even for a temporary period, while being treated and getting better, routinely trumps any inclination to keep them locked up, under observation, and safe until they're definitely healthy again.

Often enough psychiatric interviews involve reading off a list of questions, of the kind: Are you planning to commit suicide? Do you want to harm other people? If the patients answer in the negative, the psychiatrist concludes that he is not a danger to himself or others.

So, Bawer sees in the rash of shootings a symptom of professional failure. He rightly questions the value of mental health expertise:

The bottom line here is that all of this so-called mental health expertise is, with a very few exceptions, a scam. The ranks of psychiatrists and psychologists are filled with incompetents who have no business deciding whether or not a mentally ill person should be hospitalized – or, once that person is hospitalized, have no business deciding whether to send him home. Topping off their incompetence is, in all too many instances, an overweening arrogance. You might think that if everyone who is closest to a person thinks he needs help, that fact would carry some weight with the psych professionals. On the contrary, one often gets the impression that these practitioners enjoy, and even pride themselves on, dismissing the pleas of a potential patient's loved ones. Perhaps they resent the idea of family members playing doctor or making diagnoses.

He concludes:

To be sure, dethroning these quacks may not be the only answer to mass murders such as the one in Thousand Oaks, but it's one of the answers. There is an urgent need for a more competent and aggressive approach to examining disturbed individuals such as this ex-Marine, and “experts” must be compelled to err not in the direction of respecting patient freedom but, rather, in the direction of protecting public safety. Depriving someone of freedom of movement for a few days, weeks, or even months while he is being treated for a dangerous illness is better than allowing him to roam free, acquire a gun, and rob others of their lives forever….

And that's all there is to say. We have to do better. And doing better means, in part, ending the reign of these crank doctors, these useless mountebanks, these credentialed incompetents, and putting in a tougher, tighter system of mental-health screening run by tough-minded people with some goddamn sense.

As David Foster occasionally reminds us, we are so enamored of credentials and so ready to assume that credentials bespeak expertise that we bow down meekly to the authority of psychiatrists. If I have been pointing to anything on this blog, for more than a decade, it is this: the mental health profession is in very bad shape. It has made some progress in psychopharmacology, but the world of talk therapy, the kind that Bawer saw being offered to his acquaintance in New York… is a joke.

It reminds me of a story from Marseilles, France. A psychiatrist in a mental hospital wanted to release a man. Her colleagues all declared that the man was dangerous and that, if released, he was very likely to kill someone. The psychiatrist released him anyway. He then went out and killed someone.

For her dereliction and poor judgment the psychiatrist was charged and eventually convicted of manslaughter. When the French are tougher than you are, you have a real problem.