By Jerome C. Wakefield
NEW YORK-Mareeg.com – The shootings of United States Congresswoman Gabrielle Giffords and
others in Arizona last month are but the latest in a series of mass shootings in the
US in which the (alleged) perpetrator suffered from an apparent mental disorder.
Predictably, the Arizona tragedy has elicited calls for policy changes. But what, if
anything, should be done differently?
The vast majority of severely mentally disordered individuals are not violent.
Predicting which few without a prior history of violence will become violent is
almost impossible. At the same time, proposals to protect society from the
dangerously mentally ill pose basic civil-liberties issues.
A Russian reporter, Andrei Sitov, raised this question when he asserted at a White
House press conference that American freedom was complicit in the Arizona shootings:
“As to why – it does not seem all that incomprehensible, at least from the outside.
It’s the reverse side of freedom. Unless you want restrictions, unless you want a
bigger role for the government...This is America, democracy, freedom of speech,
freedom of assembly, the freedom to petition your government. And many people
outside would also say the ‘freedom’ of a deranged mind to react in a violent way is
also American.”
President Barack Obama’s press secretary answered defensively that American values
do not endorse violence. That is true, but irrelevant. The question is whether
American values favoring individual rights somehow facilitated the Arizona tragedy.
After all, rates of severe mental illness are about the same across the developed
world, yet the US seems to have more such shootings than do other countries.
One freedom-related suggestion is that the US needs stricter laws that keep guns out
of the hands of the mentally ill. But the alleged shooter had never been formally
diagnosed as mentally ill, so such targeted laws would not have prevented him from
obtaining a gun. General gun control is essential, but unlikely for now.
The US also needs more accessible mental-health services. Although his college
demanded professional evaluation before he would be allowed to return, the suspect
in the Arizona shootings, it seems, failed to seek help from Tucson’s available
services. Unlike those with physical illnesses, mentally ill individuals often are
unaware – even vehemently deny – that they have a problem, thus forgoing treatment
and losing desperately needed disability benefits.
Many colleges have increased monitoring of students’ odd behavior by
threat-assessment teams. But such mass screening is notoriously ineffective in
predicting violence, often yielding enormous numbers of misidentified threats. For
example, psychiatric screening for suicide risk in one New York high school
identified 44% of the student body as being at risk. Similarly, screening for loose,
eccentric thinking yields mostly individuals who never become psychiatrically
disordered.
In the months before the shootings, the suspect’s behavior displayed marked signs of
serious mental problems, including confusing speech, disruptiveness in class,
bizarre imagery, deterioration in social, academic, and occupational functioning,
and a dramatic personality change. With such blatant signals, why didn’t others
intervene? Arizona law allows any interested party to report an individual’s bizarre
or threatening behavior to the authorities, who can involuntarily commit the
individual for psychiatric evaluation.
Though his community college suspended the suspect for his threatening demeanor, it
took no further action. One reason is that American educational privacy laws
severely restrict the sharing of information, even with parents, let alone with
other authorities. Additional privacy protections for medical records sometimes make
it difficult to notify parents when a child is troubled.
Moreover, the US Constitution prohibits preventive detention: even severely
disturbed individuals cannot be detained involuntarily unless judged an imminent
threat to themselves or others. College counselors apparently did not think that the
suspect met this demanding threshold. Although disruptive, the suspect was able to
function – as shown by the disciplined nature of the attack.
Such protections should not be surrendered easily. The irony of Sitov’s comment is
that during the Soviet era, Russian political dissidents were psychiatrically
diagnosed, institutionalized, and drugged into submission. Soviet Premier Nikita
Khrushchev, paving the way for the political abuse of psychiatric diagnosis, argued
that, “Of those who might start calling for opposition to Communism…, we can say
that clearly their mental state is not normal.”
The line between angry political extremism or eccentric normality and delusional
mental disorder is tricky to draw. If restrictions on involuntary commitment to
prevent crime are eased, zealous prosecutors could circumvent civil liberties. Such
abuses have emerged when preventive institutionalization has passed constitutional
muster, as in the laws some US states have enacted in order to incarcerate “sexually
violent predators.”
So, what can be done? Sitov was correct to the extent that the Arizona shootings
were likely facilitated by a uniquely American interaction between legal protection
of individual privacy and freedom, lack of strong community bonds and resources, and
easy access to handguns. Americans must acknowledge that educational and medical
privacy laws require limited exceptions for notification of family and authorities
when clear signs of severe mental illness surface, so that colleges and other
institutions can take timely action.
Adequate community mental-health services with educational outreach can induce
disturbed youth to get help voluntarily. Perhaps prudent loosening of the
imminent-harm standard for involuntary commitment in clear cases of severe disorder
might be helpful. Screening, if carefully targeted to limit errors, also may have a
role to play. Finally, improved gun control vis-à-vis the severely mentally ill is
imperative.
Such measures might have prevented the Arizona shootings. A stronger community
response, supported by limited exceptions to legal restrictions on
information-sharing, could have allowed involuntary evaluation of the suspect.
If he refused treatment and was released because he posed no imminent threat, his
severe mental disorder would nonetheless have been diagnosed. Placing him
immediately on a “watch list” for weapons – frequently updated under strengthened
laws – could have prevented him from purchasing the gun and ammunition he
subsequently used. Source Project Syndicate
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