Arizona Shootings

I have been thinking about the recent Arizona shootings where Gabrielle Giffords, a federal judge, a 3-year-old, and a half-dozen other people were shot by Jared Lee Loughner. What’s going on here? How can we explain this? How can we prevent this?

I’m a psychiatrist. I’ve been one for 24 years. I worked on a mobile crisis team for four years in New York City. I went to events just like this where a mentally ill individual acted out and became dangerous.

Let’s look at some history in order to understand what happened here. In the early 20th century, we treated mentally ill people by putting them in hospitals where they would stay. Sometimes they’d get better and sometimes they wouldn’t, but they were kept safe, out of society and locked away where they were prevented from hurting others.

By the mid 1900s, new powerful anti-psychotic medications and antidepressants had been discovered. And by the early 1960s, we decided to close those hospitals where we had previously kept the mentally ill and, instead, treat them in community mental health centers with drugs like Thorazine, Trilafon, Haldol, Amitriptyline, Imipramine and Desiprimine.

That was great. For the first time in the history of mankind, we were able to take a lot of these people out of these mental health hospitals.

But, that also created a problem. Because people with mental illnesses, such as schizophrenia and bipolar disorder, were living out in the community, and some people with these illnesses can be a threat to themselves or others.

So what about Loughner? It’s possible he suffers from schizophrenia or bipolar disorder.  Some people have said to me, “Well Dr. Agresti, he’s a sociopath.”

No, he’s not a sociopath. Sociopaths become dangerous if you get in their way. They want what they want and they’ll do whatever it takes to get it. They don’t randomly seek out other people and hurt them unless they’re getting something out of it.

By looking at Loughner’s history as it came out in the news, I speculate that he may suffer from some form of psychosis.

For people suffering from schizophrenia or bipolar disorder, the illness usually begins in their early 20s and there are usually plenty of warning signs.

Often, these individuals are peculiar in their adolescence, but by around 20, they begin exhibiting what we call positive signs: delusions, hallucinations.

A delusion is a false, fixed belief where an individual believes the government is out to get him, or there is some conspiracy, or he’s under some great threat, or he has to solve some geo-political problem by killing people. He’s irrational. He’s disorganized in his speech and in his behavior.

But in Loughner’s case, it doesn’t make sense, you say. He was able to buy a gun. Yes, they can get dressed, obtain a gun, and fire it, but the reasons behind these behaviors are diluted, disorganized and inappropriate.

Loughner exhibited plenty of warning signs: in college, in his writings, with complaints from friends, family, and the school. Everyone knew that he had a problem. So, why wasn’t the system alerted?

The system was not alerted because there is no system. That’s the problem. We did away with the old system and we do not have a system in place where we can pick these people up and treat them.

We should. We do have systems in place that act as safeguards for other problems. For example, if a child is being abused, we can call a hot-line, and that hot-line sends out investigators to find out if this child has been abused or not. If the child has been abused, the system protects the child.

Abused children may be put in an alternate home. The parents may be given help or they may be arrested, but the children are protected, given a new home, and the parents are educated or helped.

What if we had some kind of system in place that would have helped Jared Lee Loughner? What if we could have called a hot-line when we saw him behaving bizarrely?

I’m not talking about a punitive system. But rather, I’m thinking about a hot-line that would alert a mobile crisis team that could have brought him in for an examination.

Mentally ill people usually consent to an examination, but if they refused, then that would begin a process to force them into treatment. These individuals would then be tracked, maintained on their medicines and protected.

In the case of Jared Loughner, he became a danger and a threat. Then he killed people.

Let’s think about the mentally ill people who are not dangerous to others. I’d say 99 percent of the time, when people are psychotic, they become victims. These people usually fall on hard times. Often, they become the victims of violent crime, or the police arrest them and put them in prisons. That’s the current system.  We wait until something occurs where they break the law or they do something dangerous and we lock them up.

There is no mental health system to pick up on warning signs of mental illness and to seek out these people and treat them.

We have very effective treatments for schizophrenia. If that is the illness Loughner has, with relatively safe medications with minimal side effects, we could have helped him be much more appropriate and organized in his thought speech and behaviors. Followed by psychotherapy, his treatment would have been even more effective.

Bipolar disorder, another possibility for Loughner, could also have been treated.

This terrible shooting did not have to happen. We’d have to change some laws and set up some new systems, but we can manage these mental health problems.