Street violence managed to shock us this week, when it was directed toward a member of Congress. Big surprise, the gunman is said to be “unstable”. Rep. Gabrielle Giffords has begun her slow recovery from a gunshot wound to the head, and Tucson has begun to grieve 6 dead bystanders, chance victims of a strange young man with an automatic pistol and, apparently, a plan to do as much harm as possible. They were expecting a quiet Saturday morning, and a chance to meet their much-liked Representative. Making sense of incoherent malice will occupy us now, haunting our dreams and our plans. What if, as many suspect, the shooter suffers from chronic mental illness?
Anecdotal evidence is streaming in, that the young gunman had a history of odd behavior and thinking: writing gibberish on math exams, staring into space, disrupting class, and accusing neighbors of stalking him. As reported on CNN, his behavior triggered anxiety among his peers and suspension from school, pending a mental health assessment. It is not yet clear whether he ever received one, and until he does, we will not know whether his eccentricity and lethal rage meet criteria for a clinical diagnosis, or several. What should have happened, along the way, to prevent this tragedy?
Just so you know: a therapist cannot ethically report somebody for being strange, or even for having Paranoid Schizophrenia, unless he makes a specific threat of violence. Having a mental illness, by itself, doesn’t significantly increase the likelihood of violent behavior. According to Medscape.com (May 2009), it is the combination of substance abuse and Schizophrenia that significantly increases the risk. Unfortunately, access to care for mental health and addiction is not just inadequate at the moment, but compartmentalized. That means that people seeking help for either an emotional problem or an addiction, are unlikely in most settings, to be adequately screened for the other type of problem. Just so you know: a person cannot be required by law to accept treatment, unless they make an explicit, specific threat. Grim poetry doesn’t do it. We rely on the clout of loved ones to guide people into the care they need. What if mom and dad, pastor or supervisor “don’t believe in therapy”?
It is not clear that the Tucson shooter was paranoid in the clinical sense. We’ll see. Most people with Paranoid Schizophrenia have hallucinations as well as odd, unreasonable thoughts: either that they are being singled out for persecution, or for special recognition. I have known kind, caring people who were clinically paranoid, and were tormented with harsh whispered judgments spoken by dead people, or believed they were secretly married to one or more US Presidents. They were no more violent than the rest of us; but true enough, every so often, some American preoccupied with his own anger, lashes out in a violent act. Being paranoid doesn’t necessarily mean you’re crazy, or angry, or unable to think things through, especially when in treatment. Should it turn out that the man with the pistol, who went to the Safeway to kill Rep. Gabby Giffords, gets a diagnosis of Paranoid Schizophrenia, I imagine there will be paranoid people all around America who are ashamed to be categorized with him. Perhaps this tragedy will become a reason to make their medications affordable.